ABSTRACT
Colorectal cancer (CRC) represents an important health problem, being the third most common type of cancer. In Romania, the CRC incidence has doubled over the years. Both environmental factors and genetic susceptibility are very important for the pathogenesis of CRC. The epidermal growth factor receptor (EGFR) plays an extremely important role in CRC tumorigenesis. Overexpression or dysregulation of EGFR pathway molecules are frequently associated with tumor aggressiveness and patient response to treatment. Based on these considerations, EGFR became one of the first targets of molecular therapies used in CRC. At present, cetuximab and panitumumab are considered to be essential in the treatment of patients with metastatic colorectal cancer expressing the KRAS wild-type gene and EGFR. The main adverse effect for both cetuximab and panitumumab is skin toxicity, present in approximately 80% of patients. The risk of secondary infections, in particular of bacterial infections, is also increased. Cases of staphylococcal infection associated with skin peeling, cellulite, erysipelas, and even Staphylococcus sepsis, were reported. For a long time cutaneous toxicity has been a positive predictor in the efficacy of anti-EGFR treatment, but compliance with treatment and the quality of life of patients with metastatic CRC decreases in the presence of these skin reactions. That is why we emphasize the necessity and importance of using a modern method (molecular analysis of gene polymorphisms possibly supplemented by targeted confocal laser endomicroscopy) to identify a molecular diagnosis, in order to foresee and prevent the appearance of skin reactions and to manage skin toxicity.
ABSTRACT
Melanonychia is the brown or black color of the finger or toe nail due to melanin deposition or melanocytes in the nail plate. The evidence of melanocytic disease is made by the dermatoscope, which allows to highlight the anomalies of the plate. The purpose of our study was to evaluate dermatoscopically the melanonychia, both in the form of stain and longitudinal on finger and/or toe nails in order to establish the type of nail hyperpigmentation. MATERIALS AND METHOD: 33 patients with longitudinal and stain melanonychia were examined with 30x Molemax HD computerized dermatoscope between May 2017-septembre 2018 in this prospective study conducted in the Department of Dermatology of Medical Center Dr. Ianosi (Craiova, Romania). Clinical data included: type of melanonychia, number and name of involved fingers, the presence or absence of fungal infections, nail apparatus tumors or hemorrhage. RESULTS: The most frequent nail diagnosis was fungal infection (onychomycosis) observed in 18 patients (54.54%), malignant melanoma was diagnosed in 1 patient (3.03%) and the junctional nevus in 4 patients (12.12%). In 18 patients which has longitudinal melanonychia, the most frequent involved finger was the big toe, and in 15 patients which has stain melanonychia, all of them (100%) had affected the big toe, 7 (46.66%) patients had affected the thumb and the same percent the forth finger. CONCLUSION: Nail dermatoscopy is an important method in establishing the diagnosis of melanonychia and allowed to avoid unnecessary biopsy for melanonychia.
ABSTRACT
Urinary stress incontinence is a condition that increases with age, influenced by many factors, mainly anatomical pathological ones, determined by changes of muscular pelvic floor, but also by hormonal and local neurological modifications. The aim of the study was an overview of the efficacy of stress urinary incontinencetherapy with transobturatorurethralsling suspension in patients with or without prior hysterectomy. Additionally, we evaluated the effectiveness and the rate of side effects of this method. The study group consisted of 100 patients and, within it, 32 patients (group A)underwent a hysterectomy.We noticed an improvement of symptoms, a reduced discomfort and an increase of quality of life, more prominent in group B (patients without previous hysterectomy) (p=0,0012, p=0,17 respectively, p=0,03). We consider that transobturator approach in treating stress urinary incontinence is a simple, rapid and effective procedure and, not lastly, modern technique that assures a significant improvement of symptomsand quality of life for the patients; positioning the sling along to the insufficient pubourethral ligaments reinforces the structures supporting the urethra; this approach is minimally-invasive with rapid recovery, reduced hospitalization, is cost effective and involves minimal risks of infection, bleeding, etc. moreover, the transobturator tension free sling has some advantages (no pain or tension). The rate of success of the treatment is significantly lower in patients with prior hysterectomy.
