Emergency Hospital of Bucharest

Bucharest, Romania

Emergency Hospital of Bucharest

Bucharest, Romania
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Negoi I.,Emergency Hospital of Bucharest | Hostiuc S.,National Institute of Legal Medicine Mina Minovici | Runcanu A.,Emergency Hospital of Bucharest | Negoi R.I.,Carol Davila University of Medicine and Pharmacy | Beuran M.,Emergency Hospital of Bucharest
Hepatobiliary and Pancreatic Diseases International | Year: 2017

Background The superior mesenteric artery (SMA) first approach was proposed recently as a new modification of the standard pancreaticoduodenectomy. Increasing evidence showed that a periadventiceal dissection of the SMA with early transection of the inflow during pancreaticoduodenectomy associates better early perioperative results, and setup the scene for long-term oncological benefits. The objectives of the current study are to compare the operative results and long-term oncological outcomes of SMA first approach pancreaticoduodenectomy (SMA-PD) with standard pancreaticoduodenectomy (S-PD). Data Sources Electronic search of the PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Library was performed until July 2015. We considered randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) comparing SMA-PD with S-PD to be eligible if they included patients with periampullary cancers. Results A total of one RCT and thirteen NRCSs met the inclusion criteria, involving 640 patients with SMA-PD and 514 patients with S-PD. The SMA-PD was associated with less intraoperative bleeding, less blood transfusions and higher rate of associated venous resections. The pancreatic fistula and delayed gastric emptying had a significantly lower rate in the SMA-PD group. There were no differences between the two approaches regarding overall complications, major complication rates and in-hospital mortality. There was no difference regarding R0 resection rate, and one-, two- or three-year overall survival. The SMA-PD was associated with a lower local, hepatic and extrahepatic metastatic rate. Conclusions The SMA-PD is associated with better perioperative outcomes, such as blood loss, transfusion requirements, pancreatic fistula, and delayed gastric emptying. Although the one-, two- or three-year overall survival rate is not superior, the SMA-PD has a lower local and metastatic recurrence rate. © 2017 The Editorial Board of Hepatobiliary & Pancreatic Diseases International

Negoi I.,Carol Davila University of Medicine and Pharmacy | Negoi I.,Emergency Hospital of Bucharest | Hostiuc S.,Carol Davila University of Medicine and Pharmacy | Hostiuc S.,National Institute of Legal Medicine Mina Minovici | And 4 more authors.
American Journal of Surgery | Year: 2016

Objectives: The aim of this systematic review and meta-analysis is to summarize the current knowledge regarding microRNA-21 and to evaluate its prognostic impact in patients with pancreatic cancer. Methods: We conducted an electronic literature search to identify all published studies in PubMed/MEDLINE, Scopus and Google Scholar databases from 2000 until August 2016. Results: A total of 17 studies involving 1471 patients met the inclusion criteria for the quantitative synthesis. The microRNA-21 upregulation was significantly associated with poorer overall survival, disease-free survival, and progression-free survival. The subgroup analysis revealed that microRNA-21 overexpression has a significant higher prognostic value for patients who receive adjuvant chemotherapy. Increased microRNA-21 was associated with a statistically significant higher rate of metastatic lymph nodes and poorly differentiated tumors. Conclusions: MicroRNA-21 upregulation in pancreatic cancer is associated with a significantly poorer overall survival, disease-free survival, and progression-free survival. MicroRNA-21 may be a useful prognostic biomarker, allowing stratification for chemotherapy administration, and being a component of precision medicine in patients with pancreatic cancer. © 2017 Elsevier Inc.

PubMed | University of Newcastle, Infectologia Institucional SRL, National and Kapodistrian University of Athens, Thammasat University and 149 more.
Type: | Journal: World journal of emergency surgery : WJES | Year: 2016

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the worlds leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.

Beuran M.,Emergency Hospital of Bucharest | Beuran M.,Carol Davila University of Medicine and Pharmacy | Negoi I.,Emergency Hospital of Bucharest | Negoi I.,Carol Davila University of Medicine and Pharmacy | And 7 more authors.
Pancreatology | Year: 2015

Background/Objectives The present article summarizes and analyzes the current knowledge about the role of the epithelial to mesenchymal transition (EMT) in the systemic invasiveness of pancreatic cancer. Method An electronic search of PubMed/MEDLINE, EMBASE, and the Web of Science was used to identify relevant original articles and reviews. Results The EMT represents a key step during normal embryogenesis. However, increasing evidence reveals its essential role in the local progression and metastasis of pancreatic cancer. Areas of interest are the cross-linking between cells undergoing the EMT and pancreatic cancer stem cells, and the correlation between the EMT and chemoresistance to standard therapies. During carcinogenesis, malignant pancreatic cells at the primary site acquire the ability to undergo the EMT, a transformation associated with increased mobility. The reverse process at secondary sites, the mesenchymal to epithelial transition (MET), has devastating consequences, allowing neoplastic epithelial cells to invade surrounding tissues and spread to distant sites. Consequences of the EMT are the loss of E-cadherin expression and the acquisition of mesenchymal markers including fibronectin or vimentin. Detailed knowledge of the molecular processes underlying the EMT has opened possibilities for new therapeutic agents. These include an EMT approach for patients with early cancers, to prevent invasion and dissemination, and anti-MET therapy for patients with established metastasis. Conclusions The current literature shows a strong correlation between the EMT and the systemic aggressiveness of pancreatic tumors. Individualized therapy, targeting the process of EMT and its cross-linking with cancer stem cells, may increase survival of patients with pancreatic cancer. © 2015 IAP and EPC.

Beuran M.,Carol Davila University of Medicine and Pharmacy | Beuran M.,Emergency Hospital of Bucharest | Negoi I.,Carol Davila University of Medicine and Pharmacy | Negoi I.,Emergency Hospital of Bucharest | And 6 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2016

Background: Pancreatic pseudocysts are the most common complication of acute and chronic pancreatitis. They account for 75% of the cystic lesions of the pancreas. Case report: A 37 year-old woman was admitted three months after an episode of severe acute pancreatitis with a large tumor mass located in her left abdomen, abdominal tenderness and asthenia. Abdominal Computed Tomography (CT) revealed a giant pancreatic pseudocyst of 23/15/12 centimeters. We performed an anterior laparoscopic transgastric cystogastrostomy. The postoperative clinical course was uneventful, and she was discharged nine days later. After another month she was re-admitted for general malaise and fever. We performed endoscopic evaluation of the cystogastrostomy patency followed by lavage of the pseudocyst cavity. After five days of broad spectrum antibiotic therapy the clinical course started to improve and the patient was discharged after another eight days. One- and two-year follow-ups revealed no remnant cavity. Conclusions: Laparoscopic transgastric cystogastrostomy is a feasible option for selected patients with pancreatic pseudocysts. Careful patients’ evaluation in a multidisciplinary team, including imaging specialists, dedicated gastroenterologists with experience in advanced interventional techniques and pancreatic surgeons, balancing between watchful waiting and step-up minimally invasive approach offers the best tailored approach for a specific patient. © 2016, Romanian Society of Gastroenterology. All rights reserved.

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