Short histological kaleidoscope - recent findings in histology. Part III.

The paper provides an overview of the current understanding of different cells' biology (e.g., keratinocytes, Paneth cells, myoepithelial cells, myofibroblasts, chondroclasts, monocytes, atrial cardiomyocytes), including their origin, structure, function, and role in disease pathogenesis, and of the latest findings in the medical literature concerning the brown adipose tissue and the juxtaoral organ of Chievitz.

The Beneficial Effect of Swimming Training Associated with Quercetin Administration on the Endothelial Nitric Oxide-Dependent Relaxation in the Aorta of Rats with Experimentally Induced Type 1 Diabetes Mellitus.

Type 1 diabetes mellitus is related to the vascular oxidative and nitrosative stress, the trigger for atherosclerosis and cardiovascular complications. The effects of moderate swimming training associated with quercetin oral administration were evaluated in aorta of rats with experimentally induced type 1 diabetes mellitus (T1DM), by analysing the nitric oxide-endothelial dependent relaxation (NO-EDR). T1DM rats received daily quercetin 30 mg/kg and followed the protocol of 5-weeks swimming exercise (30 min/day; 5 days/week). Aorta relaxation to acetylcholine (Ach) and sodium nitroprusside (SNP) were measured at the end of the experiment. Ach-induced endothelial dependent relaxation was significantly decreased in phenylephrine (PE) pre-contracted aorta of diabetic rats. Swimming exercise with quercetin administration preserved Ach-induced EDR but did not have any impact on SNP-induced endothelium-independent relaxation in the diabetic aorta. These findings suggest that quercetin administration associated with moderate swimming exercise could improve the endothelial NO-dependent relaxation in the aorta of rats with experimentally induced type 1 diabetes mellitus, showing that this therapeutical combination may improve and even prevent the vascular complications that occur in diabetic patients.

The Role of Radio-Frequency and Stereotactic Ablation in the Treatment of Pancreatic Cancer.

Pancreatic adenocarcinoma is a very aggressive tumor with a low overall survival rate. The prognostic and the treatment of this disease are strongly interconnected and highly dependent on the resectability criteria of the tumor, surgical excision being the golden standard. For local advance disease or for unresectable tumors, with or without metastasis we can take into consideration as adjuvant therapy, together with chemotherapy, the radiofrequency ablation or stereotactic ablation radiotherapy of the solid tumor mass. This article is a narrative review that aims to describe these two interventional techniques: radiofrequency ablation and stereotactic ablation radiotherapy. We will discuss the techniques themselves, benefits that they bring and also, about the possible complications that can appear when using them in the management of pancreatic cancer.

Evaluation of prognostic factors for 5 year-survival after surgery for colorectal cancer.

AIM: The aim of this study was to assess and analyze the prognostic factors for survival in patients undergoing curative surgery for colorectal cancer and to identify new prognostic factors. METHODS: The prospective study included 301 patients diagnosed with colorectal cancer, stages I-III, undergoing curative surgery. Demographic data, clinical and anamnestic data, laboratory exams, paraclinical examinations, morphological and pathological examination were recorded. The Petersen index was calculated. Tumor necrosis, desmoplasia and mucinous component were assessed. Local inflammatory response was calculated using Klintrup criteria. Patients were followed for five years after surgery. RESULTS: There were 197 patients (66.4%) who survived and 104 patients (34.6%) who died during the 5-year follow- up period. Multivariate analysis showed that death was mostly associated with patients over 60 years of age (p=0.05). Tumor location within the colon was associated with a better survival than tumor location within the rectum (HR - 0.57; p=0.02). Patients with T>2 had a poor prognosis compared to those with T=<2 (HR - 2.23; p=0.02). Patients with Klintrup score >1 had a better prognosis (HR - 0.20; p <0.001). Patients with venous invasion showed significantly worse prognosis (HR - 2.26; p=0.003). Patients with desmoplasia score 3 had lower death rates than those with score 1 (HR - 0.42; p=0.01). CONCLUSION: Survival was superior in patients with cancer of the colon. The following parameters had a strong independent prognostic factor for survival: age, stage T>2, venous invasion, mucinous component and desmoplasia. KEY WORDS: Colorectal cancer, Prognostic factors, Survival.

The prognostic role of microsatellite instability in colorectal cancer patients.

BACKGROUND: Data from the literature regarding the prognostic role of DNA mismatch repair system (MMR) in colorectal cancer are still controversial. AIM: The aim of the study was to identify the prognostic role of different phenotypic, clinical and pathological characteristics in microsatellite unstable vs. microsatellite stable colorectal cancer in terms of survival and disease free interval. METHODS: We conducted a retrospective study that included a total of 103 patients who underwent curative surgery for colorectal cancer. Immunohistochemistry testing revealed MLH1, MLH2, MLH6, PMS2 genes and mutations of the BRAF gene. We identified three groups of patients: patients with colorectal tumors with MSI produced by hypermethylation, (MLH1/BRAF+) group, patients with microsatellite instable tumours produced by genetic mutations MSI groupb(MLH1, MLH2, MLH6, PMS2) and patients with microsatellite stable tumours (MSS). RESULTS: The study shows that: MSI tumours (MLH1/BRAF+) group occur more frequently in women (p=0.05), on the right side of the colon (p=0.001). The 5-year survival rate was higher in patients with MSI tumours (MLH1/BRAF+) group than in those with microsatellite stable tumours, the differences were not statistically significant ; relapse rate was higher in patients with MSI tumors than in those with MSI tumours (MLH1/BRAF+) group (p=0.03) or with MSS tumors (p=0.004). CONCLUSIONS: The identification of microsatellite unstable colorectal tumours is an important molecular marker with role in recognition subgroups of patients with different phenotypic characteristics, survival and relapse rates. KEY WORDS: Colorectal cancer, Mismatch repair genes, Prognostic role.

Spontaneous cholecystocutaneous fistula as a primary manifestation of gallbladder adenocarcinoma associated with gallbladder lithiasis - case report.

Spontaneous cholecystocutaneous fistula (SCF) is a rare complication of neglected calculous biliary disease and also an extremely rare complication of gallbladder neoplasm. This pathology has become even rarer because of prompt diagnosis and expedient surgical intervention for gallstones. So far, there is one published report of a SCF due to gallbladder adenocarcinoma. We present the case of a woman aged 87 years, admitted to the Vth Department of Surgery, Clinical Municipal Hospital of Cluj-Napoca (Romania) for a tumoral mass located in the epigastrium. In the epigastrium, the patient had three skin orifices of about 1-2 mm each, through which purulent secretion occurred. The abdominal ultrasound highlighted a cholecystocutaneous fistula with the presence of a subcutaneous gallstone. Intraoperatively, we found a cholecystocutaneous fistula, a 1 cm subcutaneous gallstone, gallbladder with thickened walls containing a cylinder-shaped gallstone of 5÷3 cm. Fistulectomy, gallstones extraction and cholecystectomy were performed. The histopathological examination highlighted gallbladder adenocarcinoma. In conclusion, SCF can be the first significant manifestation of gallbladder cancer associated with neglected calculous biliary disease.

The impact of stress and glucocorticoids on memory.

Responses to stress are mediated by a complex network of the nervous and endocrine systems. Glucocorticoids, which are among the most important "players" in stress resilience, may have important implications in the cognitive functions, particularly in the modulation of memory. Declarative memory, the memory for facts, events and word meaning is the most studied type of memory on which glucocorticoids exert an influence, both positively through consolidation and negatively through impairment. These effects depend on the receptor type, dose, time of exposure, memory component and the salience of stimuli, retrieval being generally affected and storage being facilitated, especially for emotionally relevant events. Glucocorticoids also induce hippocampal atrophy, which is a hallmark seen in various diseases accompanied by a chronic high level of cortisol, such as the Cushing syndrome, major depression, post-traumatic stress disorder. Also, chronic stress might be a risk factor for the development of Alzheimer's disease, especially when a genetic background and other environmental influences are present.

Operative outcomes of robot-assisted transaxillary thyroid surgery for benign thyroid disease: early experience in 50 patients.

PURPOSE: The main benefits of robot-assisted transaxillary thyroid surgery are to overcome the technical limitations of other endoscopic procedures for this surgical pathology and to avoid any cervical skin incision. This article describes the first experience of a Romanian team with the endoscopic robot-assisted thyroid surgery. MATERIAL AND METHODS: We used the da Vinci SI intuitive surgical system to carry out 50 thyroid operations: 33 unilateral total lobectomies with isthmectomy (TL), 8 unilateral total lobectomies, with contralateral subtotal lobectomy, and 9 total thyroidectomies. Preoperatively, the patients were diagnosed with nodular goiter in 42 cases, nodular autoimmune thyroiditis in 3 cases, Basedow disease in 2 cases, toxic thyroid adenoma in 2 cases, and diffuse goiter in 1 case. We analyzed the clinical characteristics, size and location of the nodules, surgery duration, postoperative complications, pain medication, histopathological findings and postoperative cosmetic results. RESULTS: All surgical procedures were carried out without major incidents. One case required conversion to open approach. The mean length of surgery was 159 ± 38.2 min and the average console time was 68 ± 39.9 min; postoperatively, we recorded one case of transient brachial plexus neurapraxia, one transient vocal cord paresis, one transient hypocalcemia, and four postoperative wound complications. The final histopathological examination revealed two cases of well-differentiated carcinoma. CONCLUSIONS: This paper reports the largest series to date in Southeast Europe about robot-assisted transaxillary thyroidectomy. On a group of selected Caucasian patients, postoperative results were similar to open cervicotomy in terms of postoperative complications. The major cosmetic advantage is the absence of scar in the anterior cervical region.

The role and prognostic impact of lymph node ratio on stage III colorectal cancer.

AIM: The aim of this study was to evaluate the prognostic significance of the lymph node ratio (LNR) in patients with stage III colorectal cancer. MATERIALS AND METHODS: We included 35 stage III colorectal cancer patients who underwent a curative resection at the County Clinic Hospital, Cluj-Napoca, 5(th) Surgical Clinic between January 2006-July2008. Patients were categorized into LNR groups 1 to 5 according to cut-off points: <0.1; 0.21; 0.36; 0.6; >0.61. The Kaplan-Meier and the Cox proportional hazard models were used to evaluate the prognostic effect according to the LNR. RESULTS: From one hundred forty-eight patients who underwent colorectal cancer resection, 33.1 % were stage III and 35 patients met the study inclusion criteria. The five-year survival rate in N1 group was 64.62% compared to the N2 group, where it was 8.57% (p<0.001) The lymph node ratio (LNR) groups consisted of 5 cases (14.2%) in LNR1 group (<0.1), five-year survival rate 100%, 6 cases (17.14%) in LNR2 group (0.11-0.21), five-year survival rate 83.33%, 8 cases (22.8%) in LNR3 group (0.22-0.36), five-year survival rate 37.5%, 12 cases (34.28%) in LNR4 group (0.37-0.60), survival rate 0%, and LNR5 group (>0.6). The relationship between the five-year survival rates in the five LNR groups results in a statistically significant proportionality (p<0.001). CONCLUSION: Lymph node ratio can be considered a more accurate and potent modality for prognosis in stage III colorectal cancer and may improve stratification in this heterogenous group of patients.