Background and Objectives: Parathyroid cancer is a very rare endocrine tumor, especially in patients with secondary hyperparathyroidism due to end stage renal disease failure. This pathology is difficult to diagnose preoperatively because it has nonspecific clinical manifestations and paraclinical aspects. Our study of the literature identified 34 reported cases of parathyroid carcinoma over the last 40 years in patients undergoing dialysis. We present our experience as illustrative of the features of clinical presentation and histopathological findings of parathyroid carcinoma and assess its management considering the recent relevant literature. Materials and Methods: From January 2012 to November 2022, 650 patients with secondary hyperparathyroidism undergoing dialysis were treated at our academic Department of General Surgery and only two cases of parathyroid carcinoma were diagnosed on histopathological examination. Results: All patients presented with symptomatic hypercalcemia, with no clinical or imaging suspicion of malignant disease and were surgically treated by total parathyroidectomy. Histopathological examination revealed morphologic aspects of parathyroid carcinoma in two cases and immunostaining of Ki-67 was performed for diagnostic confirmation. Postoperative follow-up showed no signs of recurrence and no oncological adjuvant treatment or surgical reinterventions were needed. Conclusions: Parathyroid neoplasia is a particularly rare disease, that remains a challenge when it comes to diagnosis and proper management. Surgical approach is the only valid treatment to remove the malignant tissue and thus improve the patient’s prognosis. Medical and oncologic treatment may be beneficial to control hypercalcemia in case of tumor recurrence.
Background and Objectives: In advanced chronic obstructive pulmonary disease (COPD), functional status is significantly impaired mainly as a result of disease related respiratory symptoms such as dyspnea or as a result of fatigue, which is the extra-respiratory symptom the most prevalent in this setting. “Physical” frailty, considered to be an aging phenotype, has defining traits that can also be considered when studying impaired functional status, but little is known about this relationship in advanced COPD. This review discusses the relevance of this type of frailty in advanced COPD and evaluates it utility and its clinical applicability as a potential outcome measure in palliative care for COPD. Materials and Methods: A conceptual review on the functional status as an outcome measure of mortality and morbidity in COPD, and an update on the definition and traits of frailty. Results: Data on the prognostic role of frailty in COPD are rather limited, but individual data on traits of frailty demonstrating their relationship with mortality and morbidity in advanced COPD are available and supportive. Conclusions: Frailty assessment in COPD patients is becoming a relevant issue not only for its potential prognostic value for increased morbidity or for mortality, but also for its potential role as a measure of functional status in palliative care for advanced COPD.
Rezumat Decompresia digestivã în prevenåia fistulelor digestive dupã rezecåia gastricã pentru neoplasmIntroducere: Riscul de fistulã digestivã la pacienåii operaåi pentru neoplasm gastric este crescut datoritã dezechilibrelor biologice generate de evoluåia cancerului, de stadiile avansate la prezentare aei de amploarea intervenåiei. În aceste condiåii utilizarea unor metode tehnice care sã protejeze suturile digestive la aceaeti pacienåi este utilã. Scop: Analiza eficienåei mijloacelor tehnice de protejare a suturilor digestive la pacienåii operaåi în diferite stadii de evoluåie a cancerului gastric. Material aei metodã: Am efectuat un studiu retrospectiv pentru un lot format din 130 pacienåi operaåi pentru cancer gastric în Clinica de Chirurgie Generalã aei Oncologicã I IOB, între 2010-2014. Rezultate: În lotul studiat 38,46% dintre pacienåi au fost în stadiul IV cu complicaåii aei multiple dezechilibre biologice. S-au efectuat 52 de gastrectomii totale, 40 de rezecåii gastrice, iar la 34 pacienåi s-au efectuat "excizii tumorale" paliative sau alte tipuri de intervenåii chirurgicale paliative. La 15 pacienåi dintre cei cu rezecåii gastrice s-a utilizat sondã de decompresie duodenalã, iar la 13 pacienåi dintre cei cu gastrectomie totalã s-a utilizat sonda de aspiraåie esojejunalã alãturi de sonda de alimentaåie jejunalã ca mãsuri tehnice suplimentare de prevenire a fistulei. Incidenåa fistulei de bont duodenal a fost de 7,69%, cea a fistulei de anastomoza esojejunalã de 2,3%, cu o mortalitate generalã de 3,07%, iar la anastomoza gastro-jejunalã a fost de 0,76%. Concluzie: Având în vedere riscul de fistulã la pacienåii cu cancer gastric precum aei creaeterea acestui risc în stadiile avansate de evoluåie, apreciem cã utilizarea mijloacelor tehnice de protecåie a suturilor digestive este beneficã aei oportunã ducând la scãderea incidenåei fistulelor, la scãderea debitului aei a efectelor fiziopatologice ale acestora precum aei la reducerea mortalitãåii.
The CD34 protein was identified almost four decades ago as a biomarker for hematopoietic stem cell progenitors. CD34 expression of these stem cells has been exploited for therapeutic purposes in various hematological disorders. In the last few decades, studies have revealed the presence of CD34 expression on other types of cells with non-hematopoietic origins, such as interstitial cells, endothelial cells, fibrocytes, and muscle satellite cells. Furthermore, CD34 expression may also be found on a variety of cancer stem cells. Nowadays, the molecular functions of this protein have been involved in a variety of cellular functions, such as enhancing proliferation and blocking cell differentiation, enhanced lymphocyte adhesion, and cell morphogenesis. Although a complete understanding of this transmembrane protein, including its developmental origins, its stem cell connections, and other functions, is yet to be achieved. In this paper, we aimed to carry out a systematic analysis of the structure, functions, and relationship with cancer stem cells of CD34 based on the literature overview.
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