Airway Ultrasound for Anesthesia and in Intensive Care Patients-A Narrative Review of the Literature.

Ultrasound is an everyday diagnostic tool. In anesthesia and intensive care, it has a role as an adjuvant for many procedures, including the evaluation of the airway. Ultrasound airway evaluation can help predict a difficult airway, visualize the proper positioning of an intubation cannula, or evaluate the airway post-intubation. Protocols need to be established for the better integration of ultrasound in the airway evaluation, however until a consensus is reached in this respect, the ultrasound is a reliable aid in anesthesia and intensive care.

Cardio Protective Effects of Lipid Emulsion against Ropivacaine-Induced Local Anesthetic Systemic Toxicity-An Experimental Study.

Inadvertent intravascular injection of local anesthetics (LA) during regional anesthesia causes Local Anesthetic Systemic Toxicity (LAST). Theories of lipid rescue in the case of LAST proved that the administration of lipids in LAST has beneficial effects. One possible mechanism of action is based on the lipophilic properties of LA which allow plasma-free LA to be bound by the molecules of Lipid Emulsion (LE). The association LA-LE is shuttled towards organs such as liver and the kidneys, and the half-life of LA is shortened. The main objective of this experimental study was to assess the possible cardio-prophylactic effect of LE administration before the induction of LAST by intravenous administration of Ropivacaine. This was an experimental, interventional, prospective, and non-randomized study. The subjects were divided into groups and received, under general anesthesia, LE 20% first 0.3-0.4 mL, followed by 0.1 mL Ropivacaine 2 mg/mL, or Ropivacaine alone. At the end of the experiment, the subjects were sacrificed, and tissue samples of kidney, heart and liver were harvested for histopathological examination. LE, when administered as prophylaxis in Ropivacaine-induced LAST, had protective cardiac effects in rats. The LE known side effects were not produced if the substance was administered in the low doses used for LAST prophylaxis.

Histological and immunohistochemical study on sentinel lymph node in colorectal cancer - values and limitations.

Colorectal cancer is currently one of the most common malignancies in both men and women. Surgical resection remains the essential element in the local control of the disease but the development of novel diagnostic and therapeutic tools can enhance the results of radical surgery. The indication for adjuvant treatment majorly depends on a correct pathological assessment of the surgical specimen - a correct pTNM staging. For patients diagnosed with stage III disease (characterized by the presence of lymph node metastases), adjuvant chemotherapy increases the survival rate, while in stage II disease, in most cases, the chemotherapy is contraindicated, due to increase morbidity without real benefit. This is why an accurate pN stage becomes essential. It is proven that classic pathological exam sometimes fails to identify lymph node micrometastases or isolate tumor cells, which might explain local or distant relapses in stage II patients. In our study, we evaluated a total of 39 surgical specimens of cTNM stage II patients operated for colon or rectal cancer. In the attempt to enhance the accuracy of pTNM staging we used ex vivo lymph node mapping combined with sentinel node analysis on serial sections in both classical histological and immunohistochemical (IHC) staining. We have demonstrated that the IHC staining on sentinel lymph node can improve the accuracy of pTNM staging, when used as a complementary diagnostic test, by identifying micrometastases and isolated tumor cells.

A nonfunctional neuroendocrine tumor of the pancreas - a case report.

Pancreatic neuroendocrine tumors (pNETs) represent about 1-5% of the pancreatic tumors, having an annual incidence of about 1/100 000, with difficult positive and differential diagnostic, especially in nonfunctioning tumors. We present a case of large dimensions (10/8 cm) pancreatic tail NET developed in a 65-year-old woman, incidentally discovered while she was examined for a strangled inguinal hernia. The patient had no specific tumor signs and the imagistic examination did not reveal any metastases. The histopathological and especially the immunohistochemical examinations were decisive for the diagnosis, treatment and prognostic establishment. The tumor showed intense positivity for chromogranin, synaptophysin, CD56, CD117, CK19, MNF-116 and negative for CK5/6 and CK7. The proliferative index established through the Ki-67 assessment was around 3%, while p53 was positive in 25-30% of tumor cells nuclei.