The impact of Sambucus nigra L. extract on inflammation, oxidative stress and tissue remodeling in a rat model of lipopolysaccharide-induced subacute rhinosinusitis.

Rhinosinusitis is a common disorder related to inflammation of paranasal sinuses and nasal cavity mucosa. Herbal medicines could be an option in the treatment of rhinosinusitis due to their anti-inflammatory and anti-oxidative properties. The study aims to investigate the effect of intranasal Sambucus nigra L. subsp. nigra (SN) extract against inflammation, oxidative stress, and tissue remodeling in nasal and sinus mucosa, but also in serum, lungs, and brain, in Wistar rat model of subacute sinonasal inflammation induced by local administration of lipopolysaccharides (LPS), from Escherichia Coli. The cytokines (TNF-α, IL-1ß, IL-6) and oxidative stress (malondialdehyde) in nasal mucosa, blood, lungs, and brain were analyzed. In addition, a histopathological examination was performed, and NF-kB, MMP2, MMP9, TIMP1 expressions were also evaluated in nasal mucosa. Both doses of LPS increased the production of cytokines in all the investigated tissues, especially in the nasal mucosa and blood (p < 0.01 and p < 0.05), and stimulated their secretion in the lungs, and partially in the brain. Malondialdehyde increased in all the investigated tissues (p < 0.01 and p < 0.05). In parallel, upregulation of NF-kB and MMP2 expressions with downregulation of TIMP1, particularly at high dose of LPS, was observed. SN extract reduced the local inflammatory response, maintained low levels of IL-6, TNF-α, and IL-1ß. In lungs, SN reduced all cytokines levels while in the brain, the protective effect was noticed only on IL-6. Additionally, SN diminished lipid peroxidation and downregulated NF-kB in animals exposed to a low dose of LPS, with increased TIMP1 expression, while in animals treated with a high dose of LPS, SN increased NF-kB, MMP2, and MMP9 levels. In conclusion, SN extract diminished the inflammatory response, reduced generation of reactive oxygen species (ROS) and, influenced MMPs expressions, suggesting the benficial effect of SN extract on tissue remodeling in subacute rhinosinusitis and on systemic inflammatory response.

Gold nanoparticles phytoreduced with Cornus mas extract mitigate some of gliadin effects on Caco-2 cells.

Celiac disease (CD) is an autoimmune condition that occurs in genetically predisposed people where the ingestion of gluten produces damage in the small intestine. The treatment accepted until now is a strict gluten free diet. This implies the need for novel or adjuvant treatments, in addition to the standard of care. The present study aimed to assess the effect of gold nanoparticles phytosynthesized with Cornus mas extract (AuCM) compared to Cornus mas extract (CM) and luteolin (LT) on Caco-2 cells, exposed or not to gliadin. Ultraviolet-visible spectroscopy and transmission electron microscopy were used for the characterization of AuCM. Measured cellular outcomes included oxidative stress markers (malondialdehyde level, catalase and superoxide dismutase activities), inflammatory response and cellular signaling and transcription factors involved in apoptosis (NFκB, pNFκB, NOS2, TNF-α, TRAIL, Bax, Bcl-2, p53). The internalization of gold nanoparticles in cells was evidenced by transmission electron microscopy (TEM). The gliadin administration induced oxidative stress, improved the activity of antioxidants enzymes, increased NOS2 and NFκB expressions and reduced pNFκB/NFκB ratio. In addition, gliadin enhanced TRAIL and Bcl-2 levels and reduced p53 expression in Caco-2 cells. The pretreatment with AuCM, CM extract and LT diminished oxidative stress and reduced NOS2 activity. AuCM and CM treatment amplified the expression of p53 and pNFκB/NFκB ratio and diminished Bcl-2, NFκB and pNFκB, especially AuCM. The results obtained confirmed that AuCM mitigate some of gliadin effects on Caco-2 cells through modulation of oxidative stress and inflammation.

Anatomical variations of the obturator veins and their surgical implications.

PURPOSE OF INVESTIGATION: The obturator veins and their network contribute to major bleeding complications during gynaecologic surgery. MATERIALS AND METHODS: The anatomical variations of the obturator veins were studied on 106 patients in which a thorough bilateral pelvic lymphadenectomy was performed. RESULTS: Symmetrical drainage on right and left sides was found in 75 cases: only in internal iliac vein in 32 cases, both in external iliac vein and internal in 41 cases, and only in external in two cases (so called "pubic vein"). In 31 procedures, asymmetric drainage was found between the two sides: one side in internal, the other side both in internal and external in 25 patients; in three patients, in external on one side and in both internal and external on the other; and in external on one side and in internal on the other side in one patient. CONCLUSIONS: Anatomical variations of the obturator veins appear quite often.

Abdominal radical trachelectomy (ART) performed during pregnancy: a case report.

PURPOSE OF INVESTIGATION: Cervical cancer is one of the most frequent malignant diseases diagnosed during pregnancy. Abdominal or vaginal radical trachelectomies are fertility-preserving alternatives to radical hysterectomy for young women with early-stage cervical cancer that can be performed during ongoing pregnancy. MATERIAL AND METHODS: The authors report a pregnancy complicated by cervical cancer treated by abdominal radical trachelectomy (ART) at 16-17 gestational weeks with preservation of the concurrent pregnancy. RESULTS: The pregnancy evolved normally and delivery occurred at 38-39 gestational weeks by elective caesarean section. CONCLUSIONS: Radical trachelectomy could be offered as an option for pregnant patients with early invasive cervical cancer. It may help women to avoid the triple losses of a desired pregnancy, fertility, and motherhood.

Multimodal oncosurgery approach to treat peritoneal carcinomatosis in a patient with occlusive ovarian carcinoma.

UNLABELLED: Summary BACKGROUND: This paper aims to present a "pattern" of oncosurgery solution in a case generally considered unrecoverable: intestinal occlusion in case of ovarian carcinoma and carcinomatosis. CASE REPORT: A 62-year-old female patient with ascites, carcinomatosis, unresectable pelvic tumour, and intestinal obstruction suffered a five-step oncosurgery "model": three surgical interventions overlapping chemotherapy administered via the systemic and intraperitoneal route: Step 1: colostomy and partial omentectomy; Step 2: five courses of systemic chemotherapy supported by granulocyte colony-stimulating factor; Step 3: radical surgery--total hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy, omentectomy, appendectomy, pelvic peritonectomy, and hyperthermic intraperitoneal chemotherapy; Step 4: consolidation systemic chemotherapy consisting of three more similar cycles; Step 5: closure of the colostomy. Nine months after the beginning of treatment, the patient is with no evidence of disease. CONCLUSIONS: The association of surgical and oncologic treatment and the use of hyperthermic intraperitoneal chemotherapy (HIPEC) technology can solve some of these complex cases.

The mandatory role of groin lymphadenectomy in clinical Stages IB and II vulvar cancer.

PURPOSE OF INVESTIGATION: To analyze the prevalence of inguinofemoral lymph nodes metastases in clinical Stages IB-II vulva cancer. MATERIALS AND METHODS: Twenty-two patients with FIGO Stages IB-II FIGO vulva cancer with no clinically and imagistic evidence of nodes metastases were treated in the present clinic. The surgical procedures consisted in radical vulvectomy plus inguinofemoral lym- phadenectomy. RESULTS: The final pathological result was squamous carcinoma in 20 patients, vulva melanoma in one, and carcinosar- coma in one. The prevalence of positive lymph nodes was 45.4%. The median number of harvested lymph nodes was 14.0 per groin (between four and 27). Twelve patients (54.5%) developed some wound complications, but all were resolved. At the present time, 20 patients are alive, but the follow-up period is short for many of them; two patients died of disease. CONCLUSION: The prevalence of groin metastases in Stages IB-II vulvar cancer is high. A thorough inguino-femoral dissection seems necessary, despite the high incidence of wound complications.

Pelvic exenteration--our initial experience in 15 cases.

OBJECTIVE: To analyse the initial experience of pelvic exenteration for gynaecological malignancies in a tertiary referral center. MATERIALS AND METHODS: Between 2011 and 2013, 15 patients underwent a pelvic exenteration for gynaecological malignancies. RESULTS: Out of the 15 exenterations, six were total, four anterior, and five posterior. The indication was cervical (nine patients), advanced vaginal (one patient), and ovarian cancer (in five patients). A Bricker non-continent ileal urinary conduit was performed in all ten anterior and total exenterations. In-hospital complications occurred in six patients (40%) of whom two perioperative deaths (13%). Among the 15 patients, at this moment, eight are alive and six died because of the disease, and one was lost to follow-up. CONCLUSION: Pelvic exenterantion for recurrent or advanced pelvic malignancies can be associated with long-term survival and even cure without high perioperative mortality in properly selected patients. However, postoperative complications are common and can be lethal.

Recurrent left Bockdalek hernia in adult, a rare cause of subocclusive syndrome.

PURPOSE: To present a rare clinical case of a subocclusive syndrome caused by recurrence of a left Bockdalek hernia, with emphasis on the radiological diagnosis and surgical treatment. The current paper presents a 36 year old female with past surgical history of Bockdalek hernia repaired 7 years ago using a diaphragmorrhaphy by thoraco-abdominal approach who presented with a subocclusive syndrome and epigastric pain. Upper endoscopy showed a duodenal ulcer positive for H. pylori. Initial abdominal CT scan was read as negative. On a closer evaluation of the CT images, a small Bockdalek hernia was appreciated, with the elevation of the left colic angle through the diaphragm. Given the occlusive symptoms, the patient underwent surgical treatment with diaphragmorrhaphy and alloplasty with polypropylene mesh, using an open approach. Postoperatively, the patient had a favourable course, being discharged home two days later. To date, there are 173 cases of Bockdalek hernia in the the medical literature, but none with a recurrence. Bockdalek hernia is a rare disease, with non-specific symptoms. It has a broad differential diagnosis that may delay early identification and management. The surgical treatment, either open or laparoscopic, must follow the current recommendations of the surgical societies, including mesh alloplasty to prevent recurrences.

Gastric metastasis of cervix uteri carcinoma, rare cause of lower gastric stenosis.

AIM: the paper presents a rare case of metachronous gastric metastasis of uterine cervix cancer, clinically manifested through severe pyloric stenosis. METHOD: 49-year-old patient, operated on in January 2009, with uterine cervix cancer (Squamous cell carcinoma T2bN1M0), is hospitalized in August 2011 with pyloric stenosis: epigastric pains, abundant, stasis, late postprandial emesis, significant weight loss, stomach form visible upon abdomen inspection. Endoscopy: antral stenosis with intact gastric mucosa, and CT-scan: circumferential intramural gastric tumor, stomach dilated in the upper part, lack of cleavage between the tumor and the liver bed of the gall bladder. CEA increased to 13,78 (below 5), CA 19-9 slightly increased 29.9 (below 27). The case is considered as a second neoplasia and a D2 subtotal gastrectomy was performed, with 1 positive ganglion out of 27 on block with atypical hepatectomy of segments 4-5 for liver invasion, the final mounting being Y Roux. RESULTS: The histopathological examination shows a gastric metastasis of squamous carcinoma, of uterine cervix origin, the invaded perigastric ganglion having the same aspect of uterine cervix carcinoma. The post-surgery evolution was favorable, under chemo radiotherapy the patient being alive without relapse at 9 months post-surgery. CONCLUSION: In the literature there are 2 more cases of gastric metastasis of uterine cervix carcinoma, and 4 of uterine carcinoma without topographic indication, but without the histological documentation of the tumor filiation, without data related to resecability or follow-up, the case at hand being, from this perspective, the first documented resectable metachronous gastric metastasis from a cervix uteri carcinoma.