Bucharest, Romania
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Pelvic recurrences after irradiated and surgically treated cervical cancer are frequent situations which require an aggressive surgical approach in order to provide a benefit in terms of survival. Most often in these situations pelvic exenterations are needed to obtain a curative resection with negative resection margins. We present the case of a 68 year old patient who was successfully submitted to anterior pelvic exenteration for a centropelvic recurrence after pre-irradiated, surgically treated cervical cancer. At eighteen months follow up the patient is free of local or distant recurrences. © 2016 Romanian Society of Ultrasonography in Obstetrics and Gynecology.


Bacalbasa N.,Carol Davila University of Medicine and Pharmacy | Balescu I.,Ponderas Hospital
Archives of the Balkan Medical Union | Year: 2015

Lipomas represent the most frequently seen benign tumors of mesenchymal origin which are usually found where ever subcutaneous fatty tissue is well represented. The exact incidence of breast lipoma is not exactly known, paradoxically the lesion being described both as common and very uncommon. Although cases presenting with superficial lesions are rather easy to be diagnosed, in patients in whom the tumor is located more deeply, resection might be needed in order to have an exact and precise diagnosis. We present the case of a 45 year old patient who presented for the apparition of a large tumor located on the right breast, which was enucleated. The histopatological examination confirmed the presence of a breast lipoma. ©2015 CELSIUS.


Iancu M.E.,Ponderas Hospital | Copaescu C.,Ponderas Hospital | Copaescu C.,University of Bucharest | Serban M.,Emergency Institute for Cardiovascular Diseases | And 2 more authors.
Obesity Surgery | Year: 2014

Background Obesity is accompanied by increased arterial stiffness, left ventricular (LV) hypertrophy, and diastolic dysfunction, all associated with a negative prognosis. The evolution of LV mass, function, and arterial elasticity after laparoscopic sleeve gastrectomy (LSG) was unknown, and this is what we have investigated. Methods Thirty-four consecutive obese subjects (mean age, 39±11 years; 35.2 % men), scheduled for LSG, were studied before, at 6 and 12 months after surgery. Results The body mass index (BMI) decreased from43.6±11.9 to 32.1±7.4 and to 28.9±5.8 kg/m2 at 6 and 12 months after surgery (all p <0.05). The baseline LV mass index was correlated with age, BMI, waist circumference, blood glucose level, systemic hypertension stage, and with aortic distensibility, strain, and stiffness index (all p <0.05). Aortic distensibility increased by 110 %, aortic strain by 58 %, and aortic stiffness index decreased by 88 % at 6 months after LSG (all p6 months- baseline <0.05) and all the parameters had similar values at 12 months postoperatively (all p12-6 months=NS). LV hypertrophy prevalence decreased from 61.8 to 47.1 % and to 32.3 % at 6 and 12 months after surgery (all p <0.05). The proportion of patients with LV diastolic dysfunction decreased from 52.9 to 23.5 % at 6 months (p6 months-baseline <0.01) and to 20.6 % at 12 months postoperatively (p12-6 months=0.7). Conclusions Significant improvements of aortic elasticity and of LV diastolic function were recorded at 6 months, and they were maintained at 12 months after LSG. The LV hypertrophy showed also a favorable evolution: it has been slightly improved 6 months after surgery and further ameliorated 1 year postoperatively. © Springer Science+Business Media New York 2013.


Bacalbasa N.,UMF Carol Davila | Balescu I.,Ponderas Hospital | Filipescu A.,UMF Carol Davila | Filipescu A.,Elias Emergency Hospital
Gineco.eu | Year: 2014

Ovarian cancer represents one of the most aggressive gynecologic malignancies, most women still being diagnosed in an advanced stage of the disease. Although primary maximal cytoreduction associated with adjuvant chemotherapy seems to be the most efficient way to achieve a good control of the disease most patients recurre at a certain moment. In these cases secondary and tertiary cytoreduction appear to be associated with a significant survival benefit. Studies regarding the role of cytoreduction beyond tertiary surgery remain scarce but preliminary reports proove that in selected cases this might represent a reasonable option in order to prolong survival.


Bacalbasa N.,Carol Davila University of Medicine and Pharmacy | Balescu I.,Ponderas Hospital
Anticancer Research | Year: 2015

Pelvic exenteration remains one of the most aggressive gynecological surgical procedures performed for patients with locally-invasive cervical cancer, usually performed with curative intent. However, there exist patients who present in a very advanced stage of the disease, in which only a palliative surgical procedure can be performed. Although in these cases the survival benefit is minimal, performing a pelvic exenteration significantly improves the quality of life. We present the case of a 63-year-old female who was submitted to palliative pelvic exenteration for a locally invasive recurrence in the left sciatic foramen after surgically-treated cervical cancer.


Bacalbasa N.,Carol Davila University of Medicine and Pharmacy | Balescu I.,Ponderas Hospital
Gineco.eu | Year: 2015

Endometrial stromal sarcomas (ESS) are rare mesenchymal tumors of the uterus characterized by an indolent behavior and favorable outcomes. However, late recurrence is a common event even in cases diagnosed in an early stage of the disease. The present review presents the largest studies which focused on determining the prognostic factors and outcomes after surgically treated ESS. In this respect, we also presents various answers for the most significant unsolved questions regarding the role of bilateral adnexectomy and the benefits of pelvic and para-aortic lymph node dissection. © 2015 Romanian Society of Ultrasonography in Obstetrics and Gynecology.


Bacalbasa N.,Carol Davila University of Medicine and Pharmacy | Balescu I.,Ponderas Hospital
Anticancer Research | Year: 2015

Endometrial stromal sarcomas are rare uterine malignancies with a high capacity for recurrence, even in cases diagnosed at an early stage of the disease. Recurrence is usually confined to the pelvic space but sometimes accelerated growth and extension into the upper abdomen can be found. In such cases, an aggressive surgical approach might be needed in order to provide complete resection of the recurrent tumor. We present the case of a 51-year-old patient who was diagnosed with an atypical spindle-shaped recurrence stretching from the pelvic floor to the right renal hilum along the inferior vena cava following total interadnexial hysterectomy for a presumed benign uterine tumor. An R0 resection of the recurrent tumor was performed and the histopathological study revealed the presence of a low-grade endometrial stromal sarcoma. © 2015, International Institute of Anticancer Research. All rights reserved.


Bacalbasa N.,Carol Davila University of Medicine and Pharmacy | Tomescu D.,Fundeni Clinical Institute | Balescu I.,Ponderas Hospital
Anticancer Research | Year: 2015

For most patients with bulky pelvic tumors, pelvic exenteration remains the only curative option. Although initially reported as a palliative procedure, nowadays it is rather performed with curative intent. Once the resectional phase is ended, a large defect will remain at the level of the pelvic diaphragm, predisposing to severe complications which are generically included under the name of empty pelvis syndrome. It has been widely demonstrated that this type of complication is associated with severe mortality, even if the patient is free of any pelvic recurrence. We present the case of a 56-year-old patient submitted to total pelvic exenteration for locally invasive previously chemo-irradiated cervical cancer who presented six months after surgery with a severe enteroperineal fistula. We decided to reoperate on the patient; intraoperatively we found recurrence on both pelvic walls and an enteroperineal fistula caused by tumoral invasion. We performed an intestinal resection with enteroenteral anastomosis. In order to isolate the intestinal loops from the unresectable pelvic recurrence, in the pelvis we placed three Foley catheters inflated with 60 ml of saline each, in order to hold the intestinal loops away from the pelvic wall. The postoperative course was uneventful. The urinary cathethers were removed after six weeks.


Bacalbasa N.,Carol Davila University of Medicine and Pharmacy | Balescu I.,Ponderas Hospital | Tomescu D.,Fundeni Clinical Institute
Anticancer Research | Year: 2015

Cervical cancer is an aggressive gynecological malignancy which can develop local invasion of the surrounding organs. In cases presenting locally advanced disease, the association of neoadjuvant chemo-irradiation might reduce the local invasion and might transform the patient into a candidate for a conservative surgical procedure. However, there are also patients who refuse any association of neoadjuvant treatment; we present the case of a 52-year-old patient diagnosed with a locally invasive cervical tumor involving both ureteral ostia who formally refused any neoadjuvant oncological treatment and urostomy. Total radical hysterectomy with bilateral adnexectomy with partial cystectomy and distal bilateral ureterectomy was performed. The two ureters were re-implanted in the remnant urinary bladder.


Bacalbasa N.,Carol Davila University of Medicine and Pharmacy | Balescu I.,Ponderas Hospital
Gineco.eu | Year: 2016

The absence of residual disease remains the strongest predictor for disease free and overall survival in patients with advanced stage or relapsed ovarian cancer. However in most cases this desiderates is achieved after performing multiple visceral resections. Extended pelvic disease usually involves the surrounding pelvic viscera and leads to the necessity of digestive resections such as rectosigmoidectomy. In other cases other digestive resections such as right ileocolectomy might be needed. We present the case of a 64 year old patient in which an R0 resection was feasible after association of rectosigmoidectomy, right ileocolectomy and segmental ileal resection. © 2016 Romanian Society of Ultrasonography in Obstetrics and Gynecology.

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