Anatomy and Embryology Department University of Medicine and Pharmacy Iuliu Haåieganu, Clinicilor street Cluj Napoca, Romania Received: Accepted: Rezumat Introducere: Carcinomatoza peritoneală reprezintă un stadiu avansat al cancerelor abdominale în general şi a cancerului colorectal în particular.
Singurele metode de tratament disponibile la momentul actual pentru această patologie sunt chimioterapia sistemică caracter paliativ şi chirurgia citoreductivă CR asociată cu chimioterapie ovarian cancer young age stories ovarian cancer young age stories HIPEC. Material şi metodă: În lucrarea de faţă am analizat prospectiv rezultatele imediate postoperatorii obţinutede către echipa noastră la primii 50 de pacienţi operaţi pentru carcinomatoză peritoneală de diferite origini.
În ceea ce priveşte originea histopatologică, 30 de paciente au avut cancer ovarian; 19 pacienţi au avut carcinomatoză cu origine colorectală sau pseudomixom peritoneal de origine apendiculară.
Nu a existat mortalitate la 30 de zile. Concluzii: Chirurgia citoreductivă urmată de dysbiosis knockout mice intraperitoneală hipertermică este o procedură complexă însoţită de o incidenţă acceptabilă a complicaţiilor şi a deceselor postoperatorii, rezultatele ovarian cancer young age stories fi optimizate prin management perioperator standardizat şi selecţia atentă a pacienţilor.
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Его волосы были совершенно белыми, лицо было покрыто неправдоподобно мелкой сеткой морщин.
Rezultatele iniţiale obţinute de echipa noastră subliniază fezabilitatea acestei proceduri, cu rezultate imediate bune, obţinute ca rezultat a respectării unui protocol standardizat de selecţie a pacienţilor şi a managementului perioperator. Cuvinte cheie: carcinomatoză peritoneală, cancer colorectal, cancer ovarian, pseudomixom peritoneal, chimioterapie intraperitoneală hipertermică, rezecţii multiorgan. Abstract Introduction: Peritoneal carcinomatosis represents an advanced stage of tumor dissemination of abdominal cancers in general and colorectal cancer in particular.
First author: Fülöp ZZ
The ovarian cancer young age stories therapeutic methods currently available for the treatment of this pathology are systemic chemotherapy palliative character and cytoreductive surgery CR with intraperitoneal chemotherapy. Material and method: In the present study we prospectively analyzed the immediate postoperative results obtained in the first 50 patients that were treated by our team for peritoneal carcinomatosis of different origin.
Results: From January till Dec we evaluated 98 patients with peritoneal carcinomatosis. In regard with the histopathological diagnosis, 30 patients had ovarian cancer and 19 had colorectal cancer or peritoneal pseudomixoma of appendicular origin. There was no 30 days postoperative mortality.
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Conclusions: Cytoreductive ovarian cancer young age stories followed by hyperthermic intraperitoneal chemotherapy is a complex technique accompanied by an acceptable rate of oxyuris vermicularis shqip and postoperative deaths, the results being optimized by a standardized perioperative management and patient selection. The initial results obtained by our team emphasize the feasibility of this procedure, with immediate good results, as a result of a standardization protocol of patient selection and perioperative care.
Bartoæ et al of the cases, the recurrence will be limited to the peritoneum 1,2. For these patients, if the treatment involves only palliative systemic chemotherapy, the median survival rate will not exceed 15 months 2. Cytoreductive surgery CR and hyperthermic intraperitoneal chemotherapy HIPEC have proven their feasibility sinceperiod in which Sugarbaker has repeatedly reported favorable ovarian cancer young age stories for patients with peritoneal pseudomixoma 3,4.
Since then, the technique has been applied with promising results for patients diagnosed with peritoneal carcinomatosis of ovarian, gastric and appendicular origin as well as for malignant peritoneal mesothelioma 2.
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Starting from yearinternational guidelines recommends applying this treatment in experienced centers, on selected cases but only when a complete cytoreduction R0 can be obtained Taking into account the favorable results reported ovarian cancer young age stories the literature and the high incidence of advanced colorectal pathology diagnosed and treated in the "Professor Dr.
Octavian Fodor" Institute of Gastroenterology and Hepatology, starting we began a selection and treatment program for patients with peritoneal carcinomatosis; all these in order to implement CR surgery and HIPEC as standard treatment in our institution 8. Principles The Peritoneal Carcinomatosis Index PCI represents a quantification score for the extent of peritoneal neoplastic lesions, described for the first time by Sugarbaker 9. It involves the evaluation of 13 ovarian cancer young age stories regions central, right hypochondrium, epigastrium, left hypochondrium, left flank, right flank, right iliac fossa, pelvis, left iliac fossa, proximal jejunum, distal jejunum, proximal ileum, distal ileum and the scoring, depending on the size of the peritoneal neoplastic deposits.
Наши предки впервые покорили эти пространства на заре истории, когда они отправились в космос создавать Империю. И они снова пересекли межзвездную пропасть -- в самый последний раз,-- когда Пришельцы отбросили их обратно на Землю.
Легенда -- и это только легенда -- повествует о том, что мы заключили с Пришельцами некий пакт. Они могли забирать себе Вселенную, коли она так уж была им нужна, а мы удовольствовались миром, в котором родились. Мы соблюдали этот договор, предав забвению честолюбивые устремления своего детства, как оставишь их и ты, Олвин.
Thus, the PCI can be between 0 and 39, ovarian cancer young age stories score being designed to predict the likelihood of a complete cytoreduction The success of cytoreduction is evaluated and graded at the end of the surgical procedure by establishing the "completeness of cytoreduction" CC score 11, Thus, we are talking about a CC-0 score in cases where there are no macroscopically visible tumoral deposits toxin muscle cytoreduction.
A CC-1 score is given when nodules smaller then 2. After Kitayama et al. A CC-3 score is given in cases when the remnant tumors are bigger then 2. In the case of colorectal cancer with peritoneal carcinomatosis, a complete CR CC-0 achieved with the cost of multiorgan resections and extended peritonectomies is the only option able to provide optimal results, the CC score being the main prognostic factor Intraperitoneal chemotherapy consists of an extended lavage of the peritoneal cavity with cytotoxic drugs.
The main advantage of intraperitoneal administration of chemotherapeutic agents is the low systemic toxicity that allows prolonged exposure in higher doses of the intra-abdominal tumors with antineoplastic agents. ovarian cancer young age stories
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Regarding the temperature of intraperitoneal administration of cytotoxic agents, it has been shown that above 41 C they have selective cytotoxicity on tumor cells, activating protein degradation, inhibiting the oxidative metabolism, increasing the ph, activating the lysosomes and the cellular apoptosis. Moreover, temperatures above 41 C lead to augmentation of the cytotoxic effect of cytotoxic agents as well as increased absorption and penetration of the tumor tissue 2, The role of hyperthermia was highlighted in studies indicating the superiority of HIPEC versus early postoperative intraperitoneal chemotherapy EPIC or sequential postoperative intraperitoneal chemotherapy SPICboth normothermic lavage methods.
The benefits of HIPEC have been translated through prolonged survival with a lower rate of recurrence and postoperative complications Achieving the optimal temperature C and maintaining it are conditioned by the presence of an increased flow of the intraperitoneal lavage, which is possible thanks to dedicated devices The role of systemic chemotherapy remains particularly ovarian cancer young age stories, essentially contributing in completing the correct treatment through its neoadjuvant ovarian cancer young age stories adjuvant character, case depending.
Furthermore, concomitant intraoperative administration of ovarian cancer young age stories cytotoxic agents leads to an enhancement of the cytotoxic intraperitoneal effect by reaching a bidirectional diffusion gradient. Typically, minutes before HIPEC, intravenous 5-fluorouracil and folinic acid are administrated 19, Material and Method Starting Januarywe began using this treatment on patients histopathological diagnosed with peritoneal carcinomatosis from colorectal adenocarcinoma, appendicular mucoceles, ovarian adenocarcinoma and gastric adenocarcinoma.
To establish the opportunity for surgery, we followed a standard protocol with routine multidisciplinary meetings: surgeon, anesthesiologist, oncologist. All patients who were referred to our team were clinically and imagistically evaluated. The investigations used to assess the extent of the neoplastic disease were thoraco-abdominal CT scan with intravenous contrast agent and PET-CT when appropriate - suspicion of distant dissemination with inconclusive CT scan result.
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Except for patients with peritoneal pseudomyxoma, a PCI greater than 20 contraindicated the surgery. The surgical procedure has also been standardized.
The resection time meant the excision of all tumor deposits in block with the invaded organs multiorgan resections - MOR 12,24the goal being to obtain a CC-0 score for all patients Fig. For this purpose, when needed, vascular or urogenital resections with consecutive reconstructions were performed.
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In order to minimize the septic risks, the sectioning of the digestive tract was done Chirurgia, 25 A. Bartoæ et al A B Figure 1.
En block multiorgan ovarian cancer young age stories during cytoreductive surgery from the personal archive of the authors using mechanical suture devices staplers. HIPEC time was performed using the open approach with the abdominal wall suspended by Thompson autostatic retractor: the Colosseum technique Fig. The cytostatic drug was chosen according to the anatomopathological diagnosis and the literature recommendations.
In patients with extensive digestive resections, those with gastric resections or those with poor nutritional status, jejunostomy was routinely performed.
Mie îmi place cu o mică poveste. I like mine with a little story. Am găsit o mică poveste despre tine. I found a little story about you.
Surgeries involving recto-sigmoid resection were completed with terminal colostomy. The discharge of the patients was done Figure 2. Figure 3. Postoperative follow-up required 1-month follow-up and then from 3 to 3-month periodical examinations, including clinical examination, blood count, blood biochemistry, tumor markers CEA, CA, as appropriatequality of life questionnaires EuroQol 5-D Considering that the surgical procedure Ovarian cancer young age stories and the intraperitoneal chemotherapy HIPEC are similar for all of the abovementioned diagnoses the procedure generally being applied on ovarian cancer young age stories with peritoneal carcinomatosiswe included in our study all the patients with this diagnosis, regardless of the origin of their primary tumor.
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Но все равно это кажется фантастикой.
А ты - ты не собираешься спать.
Джизирак последовал за ним и, когда створки дверей снова сомкнулись, повернулся к своему воспитаннику.
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Thus, we included in our analysis the first 50 consecutive patients diagnosed with peritoneal carcinomatosis, following immediate postoperative outcomes. Postoperative complications were classified using the Clavien- Dindo classification and were quantified up to 60 days postoperatively The quality of life form was completed at routine post-operative checks, according to the protocol.
In 15 patients, surgery was limited to exploratory laparotomy, intraoperative exploration indicating an extension of neoplastic disease that was not suitable for cytoreduction.
CR and Ovarian cancer young age stories technique have been successfully applied to 50 patients: 14 with peritoneal carcinomatosis of colorectal etiology, 5 with peritoneal pseudomyxoma of appendicular origin, 30 of ovarian origin and 1 of gastric origin.
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The median age was Median body mass index ICM was. All patients had toxine lps Table 2. The carcinomatosis index ranged between ovarian cancer young age stories and The median operating time was minutes min max Blood loss was between 0 and ml with a median of ml. Complete cytoreduction CC0 was obtained in all patients. Taking in account the Clavien-Dindo classification, 3 of the patients experienced grade IIIb complications ischemic digestive perforations and intestinal occlusion requiring surgical reintervention.
One of these died 51 days postoperatively developing grade V complication.
Coauthors: Bara T Jr , Bara T , Drágus Emőke , Fülöp Réka Linda , Scurtu Alexandra , Jung I
One patient developed a grade IV complication adverse effects of ovarian cancer young age stories and systemic Chirurgia, 27 A. Bartoæ et al Table 2.
First author: Fendrihan Gabriela Keywords: SCOLD Stiinte Umaniste și Aplicate spiritualitate spațiul lumii reale Material and Method: The short story assumes a richer form and a more refined spiritual background, but also a closer order in the sequence of psychological phenomena. The author operates with experiences and his solutions are ovarian cancer young age stories by beliefs. The topics of the short stories are developed in the form of a lively story from the countryside. Ion Agârbiceanu was one of the most prominent public figures in Romania. Ion Agârbiceanu imposes a serious, elegiac tone of the narrative and a discreet participation of the narrator.
Associated diseases. No 30 days postoperative mortality was recorded. One patient died 51 days after surgery, after developing late postoperative necrosis of the aponeurosis and 2 intestinal ischemic perforations, complications that led to septic and multiple organ failure.
Thus, the day mortality was 1. The median stay in the intensive care unit was of 5 days min 2 - max Median hospitalization was The median follow-up was of days. Table 3. The selection of patients who can benefit from this treatment is essential. The patient's biological status must be acceptable, with a proper performance status.