Volume 13 (2020): Issue 2 (December 2020)

The article presents a detailed survey of recent publications in the literature concerning clinical expertise, existing guidelines, and differing opinions on Fluoropyrimidine chemotherapy-related toxicity and the implication of Dihydropyrimidine dehydrogenase (DPD) screening aiming to prevent severe 5-Fluorouracil-induced adverse drug reactions. The first section provides information on the mechanism of action, clinical application, pharmacokinetics and pharmacodynamics, and toxicity and adverse reactions of 5-Fluorouracil, Capecitabine, Floxuridine, and Flucytosine.

The second section summarizes DPD phenol- and genotype data and provides reasons for determining a DPD life-threatening complete or partial enzyme deficiency. The pros and cons of the methodological approaches for DPD screening are analysed, and recommendations are made to introduce them into clinical practice.

The third section includes a brief economic analysis of expenses for DPD screening of patients scheduled for 5-Fluorouracil chemotherapy. The costs are compared to those related to the treatment of patients suffering from 5-Fluorouracil-induced toxicity and unwanted adverse effects.

Surgical treatment of rectal cancer is still difficult even in big centers. The limited pelvic space, problematic operative exposure, complex surgeries with more common anastomotic complications make the results unsatisfying. After the concept of total mesorectal excision (TME) was introduced by Heald, the results have improved dramatically. Advances in technology added further excitement about awaited promising results. Surgeons tried to apply all new methods to search for the best treatment: – atraumatic, painless, safe, with low recurrence rates, fast recovery, with an acceptable price, and easy to learn or teach. Robotic-assisted laparoscopic surgery (RALS) was introduced to overcome the limitations of conventional laparoscopic and open surgery and improve on their main advantages.

A non-systematic literature review on the articles on RALS in the PubMed and Scopus database was performed. RALS, robotic-assisted laparoscopic surgery, and rectal cancer keywords were used. The search was restricted to articles in English, with main endpoints of interest on short-term and long-term surgical results and oncological outcomes. Fifty-seven articles from Europe, the USA, and Asia were identified. RALS was tried in large series in patients with different pathology and showed its values. However, there are still many controversies on its superiority, cost, and advantages. RALS is safe and efficient in experienced hands. It could be superior to conventional laparoscopic surgery (CLS). Its advantages in oncological outcomes over CLS are to be proven in structured randomized clinical trials (RCTs).

Squamous cell carcinoma is the cause in most cases of cervical cancer. A very unusual subtype of squamous cell carcinoma is lymphoepithelioma-like carcinoma, found in less than 1% of the neoplasm processes in the uterine cervix. Histologically it looks like a large nest of big-sized tumor cells with large vascular nuclei. Immunohistochemical markers used for LELC are p63, p16, human leukocyte antigen-D related (HLA-DR), and B-cell lymphoma 2. Even though it has aggressive morphological features, it has a better prognosis than most carcinoma cases of the uterine cervix. The condition is treatable, with a hysterectomy and bilateral salpingo-oophorectomy as the most common method. There are rare cases of pelvic lymph node dissection reported in the literature.

There is data that lymphoepithelioma-like carcinoma is associated with the Ebstein-Barr virus and human papillomavirus. According to a survey by Tseng et al. and Chao et al., EBV is associated with LELC in Asian women, while HPV is associated with Caucasian women.

Due to the small number of studies found in the literature, no conclusion can be drawn concerning the said viruses’ involvement in Asian and Caucasian patients.

An increased risk of developing Alzheimer’s disease (AD) exists in patients with a history of depression. In the present study, we demonstrated that chronic agomelatine intraperitoneal treatment, at a dose of 40 mg/ kg for 21 days, starting one month after inducing AD by intracerebroventricular injection of amyloid-beta (Aβ) corrected anhedonia, decreased anxiety, and showed a potential to mitigate working memory errors during the last session in a radial arm maze. Altogether, our findings suggest that chronic agomelatine administration treatment could alleviate the burden of AD and may be considered a promising therapeutic approach to some adverse symptoms caused by the disease.

A survey was performed to evaluate patient exposure after a procedure for the CT X-ray tube’s emergency warm-up, with the patient positioned on the table within the CT gantry. Three CT units, situated in three different University hospitals, were included in the survey. The evaluation was performed with AGFA personal monitoring films to visualize the results and discuss them with the radiographers who operate the systems. Additional measurements were performed with the RaySafe X2 system to demonstrate the presence of exposure. The air kerma resulting from implementing the warm-up protocol was evaluated to be higher than 112 μGy, 409 μGy, and 807 μGy for each of the CT units. Those values were underestimated because of the dosimetry equipment used and the methodology. A discussion between medical staff, engineers, and medical physicist was initiated. The practice with unnecessary patient exposure was terminated.

The study presents the outcomes from platelet-rich plasma (PRP) application in treating acute and potentially problematic skin wounds from 2009 to 2016. Fifty-six hospitalized patients with acute skin wounds were divided into two groups: an experimental group of 30 patients treated with platelet-rich plasma and 26 controls with similar wounds, treated by conventional methods. After platelet-rich plasma treatment of 30 acute and potentially problematic wounds in the Experimental Group patients, 29 (96.7%) of the wounds healed for 16 weeks on average. After applying conventional treatment with surgical wound debridement, of the 26 acute, potentially problematic wounds in the controls, only 2 (7.6%) healed. Since acute and potentially problematic wounds are very likely to become chronic and difficult to heal, we recommend PRP application as a preventive treatment in patients at risk.

Preterm birth is the most common cause of perinatal morbidity and mortality worldwide. The routine method for predicting premature birth is the measurement of the cervical length. However, to make a better and more precise prognosis, the cervicovaginal fluid (CVF) was widely inspected through many studies. Its content is used nowadays as a diagnostic method for different conditions. One of the clinical biomarkers used to predict preterm labour in the CVF is the phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1). This study aimed to evaluate the accuracy of pIGFBP-1 as a predictor of preterm labour when used with cervical biometrics.

A prospective, cross-sectional study was conducted on pregnant patients, divided into groups: Group A included participants at risk for premature labour, and Group B -women with an uncomplicated pregnancy. All patients underwent a test for pIGFBP-1, followed by a transvaginal measurement of the cervical length.

A total of 32 patients were recruited for the study. Their pregnancy outcomes were followed up. In the group of symptomatic patients, the results were positive in 8 patients, and despite the intensive tocolytic therapy given, 5 of them gave preterm birth within 14 days. There were two patients with a cervical length of less than 10 mm. They both had positive results for pIGFBP-1 and gave spontaneous preterm birth within a few hours. The predictive value of pIGFBP-1 in cases with negative results was high.

The leading cause for fetal morbidity and mortality in the twenty-first century remains premature delivery. Many investigations are currently carried out, aiming to facilitate preterm labor prediction and quickly estimate a pregnant woman’s ability to carry to time. The patients at highest risk are detected by measuring the cervical length. Newly searched clinical biomarkers such as fetal fibronectin found in the CVF might help predict preterm birth in time.

We present tooth extraction in a patient treated with bisphosphonates (BPs) for cancer and at risk of osteonecrosis of the jaw. The administration of platelet-rich fibrin (PRF) is an innovative method of promoting wound healing that allows hermetic closure at the surgical site after extraction without mucoperiosteal flaps or periosteal release sections. Here, we describe the case of a 60-year-old man who had osteonecrosis of the upper jaw and underwent surgery for prostate cancer in 2012. In 2014, bone metastases were detected, and the patient was treated with Xgeva and Zometa: a two-year therapy with Xgeva, followed by treatment with Zometa. In 2018, after extraction of a tooth in the upper right jaw, a healing wound of extraction and stripping of the maxillary bone occurred. The patient was admitted for hospital treatment and underwent surgery to remove the osteonecrotic lesion, sequester and administer PRF (platelet-rich fibrin), and sew tightly. As a result of the treatment, complete re-epithelialization of the wound without infection occurred. Generally, in more invasive surgical procedures, the use of PRF to close the wells after extraction in patients receiving BP appears to be a promising alternative. Additional clinical trials will be essential t to clarify the effectiveness of PRF in preventing BP-related osteonecrosis after tooth extraction.

Frequent mood changes are found in premenstrual dysphoric disorder (PMDD) as well as in bipolar affective disorder (BAD). The differential diagnosis is difficult because both conditions share some other common symptoms.

We present a case study of a woman with premenstrual dysphoric disorder misdiagnosed as bipolar disorder. As a result, the patient was prescribed lithium and remained symptomatic for a prolonged period. She recovered only after initiation of treatment with a selective serotonin reuptake inhibitor, which is the treatment of choice in the management of PMDD.

In such cases, the importance of affective symptoms evaluation is underscored in the context of the menstrual cycle, as well as in recognizing them for the correct diagnosis and treatment.

Brain abscess in children is a rare and particularly severe complication of acute otitis media/Chronic suppurative otitis media (CSOM). Presenting a child with brain abscess, which was developed as a pre-surgical complication of CSOM with cholesteatoma. Visualization of the abscess on a 3-D Sectra Visualization table was performed.

An 8-year-old child who often suffered from untreated runny ear was admitted in a critical state. The history and clinical and laboratory data suggested severe chronic inflammation of the right middle ear. The examination did not reveal signs of meningeal irritation, increased intracranial pressure, excitation, sensory disorders, or focal symptoms.

Surgical treatment was performed as a radical mastoidectomy with the removal of a cholesteatoma. After a three-day uneventful postoperative period, the patient worsened. A CT scan visualized a brain abscess in the right temporal lobe. A craniotomy was performed by opening the brain abscess, with an aspiration of pus, and lavage of the cavity. After surgical and conservative treatment, the child was discharged clinically healthy on the fourteenth day. Processing the image check-ups on a Sectra 3-D visualization table helped determine the size and localization of the abscess and the choice of surgical access.