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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 94-96页

作者： Sorin T Alexandrescu Andrei C Zlate Razvan T Grigorie Mihnea Ionescu irinel popescu Fundeni Clinical Institute Dan Setlacec Centre of General Surgery and Liver TransplantationSos.Fundeni nr.258sector 2BucharestRomania Carol Davila University of Medicine and Pharmacy BucharestRomania Titu Maiorescu University Faculty of MedicineBucharestRomania

To the Editor:Many patients with tumors of the pancreatic head or of the ampulla of Vater require endoscopic manipulation of the duodenal papilla in order to achieve tumor biopsy or for common bile duct *** interventional endoscopy approaches may lead to acute *** iatrogenic acute pancreatitis will influence the surgical strategy in patients scheduled for pancreaticoduodenectomy(PD).Due to the small number of cases,the surgical strategy in patients who require PD in the context of acute pancreatitis has not been standardized.

关键词： pancreatitis acute Vater

Influence of hepatitis viruses on clinico-pathological profiles and long-term outcome in patients undergoing surgery for hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 162-172页

作者： Anna-Maria Tanase Traian Dumitrascu Simona Dima Razvan Grigorie Agnes Marchio Pascal Pineau irinel popescu Center of General Surgery and Liver Transplant Fundeni Clinical Institute Unité "Organisation nucléaire et oncogenèse" INSERM U993Institut

BACKGROUND: The global risk of hepatocellular carcinoma(HCC) is largely due to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. In recent years, however, an increased prevalence of non-viral HCC has been noted. The clinical impact of the presence/absence of viral infections in HCC remains controversial. The present study aimed to assess the effect of hepatitis viruses on demographics, clinical and pathological features and long-term outcome in a large cohort of Romanian patients who underwent surgery for HCC. METHODS: The study included 404 patients with HCC who had undergone resection, transplantation or radiofrequency ablation at a single institution between 2001 and 2010. The patients were divided into four groups: 85 patients with hepatitis B virus infection (HBV group), 164 patients with hepatitis C virus infection (HCV group), 39 patients with hepatitis B and C virus co-infection (HBCV group), and 116 patients without viral infection (non-BC group). RESULTS: The patients of both HBV (56.0±11.3 years) and HBCV groups (56.0±9.9 years) were significantly younger than those of the HCV (61.0±8.5 years, P=0.001) and non-BC groups(61.0±13.0 years, P=0.002). Interestingly, the prevalence of liver cirrhosis was significantly lower in the non-BC group (47%)than in any other subsets (72%-90%, P<0.002). Furthermore, the non-BC patients were more advanced according to the Barcelona Clinic Liver Cancer stages than the patients of the HCV or HBCV groups (P<0.020); accordingly, they were more frequently assessed beyond the Milan criteria than any other groups (P=0.001). No significant differences in the disease-free or overall survival rates were observed among these groups. CONCLUSIONS: Patients with non-viral HCC are diagnosed at advanced ages and stages, a situation plausibly due to the poor effectiveness of cancer surveillance in community practice. The presence of viral infections does not appear to impair the longterm prognosis after surgical treatm

关键词： hepatitis B virus hepatitis Cvirus hepatocellular carcinoma recurrence prognosis

Aggressive surgical approach in patients with adrenal-only metastases from hepatocellular carcinoma enables higher survival rates than standard systemic therapy

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 28-33页

作者： Sorin T Alexandrescu Adina E Croitoru Razvan T Grigorie Dana R Tomescu Gabriela Droc Mugur C Grasu irinel popescu Dan Setlacec Centre of General Surgery and Liver Transplantation Fundeni Clinical InstituteBucharest 022328Romania Carol Davila University of Medicine and Pharmacy Bucharest 020021Romania Department of Oncology Fundeni Clinical InstituteBucharest 022328Romania Faculty of Medicine Titu Maiorescu UniversityBucharest 031593Romania Dan Tulbure Centre of Anesteziology and Intensive Care Fundeni Clinical InstituteBucharest 022328Romania Department of Radiology Fundeni Clinical InstituteBucharest 022328Romania

Background:Although guidelines recommend systemic therapy even in patients with limited extrahepatic metastases from hepatocellular carcinoma(HCC),a few recent studies suggested a potential benefit for resection of extrahepatic ***,the benefit of adrenal resection(AR)for adrenal-only metastases(AOM)from HCC was not proved *** is the first study to compare long-term outcomes of AR to those of sorafenib in patients with AOM from ***:The patients with adrenal metastases(AM)from HCC were identified from the electronic records of the institution between January 2002 and December *** who presented AM and other sites of extrahepatic disease were ***,the patients with AOM who received other therapies than AR or sorafenib were ***:A total of 34 patients with AM from HCC were *** of these,22 patients had AOM,6 receiving other treatment than AR or ***,8 patients with AOM underwent AR(AR group),while 8 patients were treated with sorafenib(SOR group).The baseline characteristics of the two groups were not significantly different in terms of age,sex,number and size of the primary tumor,timing of AM diagnosis,Child-Pugh and ECOG *** a median follow-up of 15.5 months,in the AR group,the 1-,3-,and 5-year overall survival rates(85.7%,42.9%,and 0%,respectively)were significantly higher than those achieved in the SOR group(62.5%,0%and 0%at 1-,3-and 5-year,respectively)(P=0.009).The median progression-free survival after AR(14 months)was significantly longer than that after sorafenib therapy(6 months,P=0.002).Conclusions:In patients with AOM from HCC,AR was associated with significantly higher overall and progression-free survival rates than systemic therapy with *** results could represent a starting-point for future phase II/III clinical trials.

关键词： Adrenal metastases Hepatocellular carcinoma Adrenal resection Sorafenib Survival

Male gender and increased body mass index independently predicts clinically relevant morbidity after spleen-preserving distal pancreatectomy

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World Journal of Gastrointestinal Surgery 2018年第8期10卷 84-89页

作者： Traian Dumitrascu Mihai Eftimie ANDra Aiordachioae Cezar Stroescu Simona Dima Mihnea Ionescu irinel popescu Department of General Surgery and Liver Transplant Fundeni Clinical Institute

AIM To identify risk factors for clinically relevant complications after spleen-preserving distal pancreatectomy(SPDP). No previous studies explored potential predictors of morbidity after *** The data of 41 patients who underwent a SPDP in a single surgical center between 2000 and 2015 were retrospectively reviewed from a prospectively maintained electronic database established in our Department of Surgery. The database included demographic, clinical, bioumoral, pathological, intraoperative and postoperative parameters. Uni-and multivariate ana-lyses were performed to assess potential predictors of clinically relevant morbidity. Postoperative morbidity was defined as in-hospital complications and mortality was assessed at 90 d. Clinically relevant morbidity was defined as complication ≥ grade 2 *** Overall morbidity rate was 34.1%(14 patients): grade Ⅰ(6 patients, 14.6%), grade Ⅱ(2 patients, 4.8%), grade Ⅲa(1 patient, 2.4%), and grade Ⅲb(5 patients, 12.2%). A number of 5 patients(12.2%) required re-laparotomy for postoperative complications. There was no postoperative mortality. Thus, at least one clinically relevant complication occurred in 8 patients(19.5%). Univariate analysis identified male gender(P = 0.034), increased body mass index(P = 0.002) and neuroendocrine pathology(P = 0.013) as statistically significant risk factors. Multivariate analysis identified male gender [odds ratio(OR): 1.29, 95%CI: 1.07-1.55, P = 0.005] and increased body mass index(OR: 23.18, 95%CI: 1.72-310.96, P = 0.018) as the only independent risk factors of clinically relevant morbidity after *** Male gender and increased body mass index are independently associated with increased risk of clinically relevant morbidity after SPDP. These findings may assist a surgeon in clinical decision-making to better select patients suitable for SPDP.

关键词： Spleen-preserving distal pancreatectomy Morbidity Male gender Body mass index

High plasma levels of COL10A1 are associated with advanced tumor stage in gastric cancer patients

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World Journal of Gastroenterology 2020年第22期26卷 3024-3033页

作者： Laura Necula Lilia Matei Denisa Dragu Ioana Pitica Ana Iulia Neagu Coralia Bleotu Simona Dima irinel popescu Carmen C Diaconu Mihaela Chivu-Economescu Department of Cellular and Molecular Pathology Stefan S.Nicolau Institute of VirologyBucharest 030304Romania Titu Maiorescu University Faculty of MedicineBucharest 040441Romania Fundeni Clinical Institute Bucharest 022328Romania

BACKGROUND Gastric cancer(GC)remains an aggressive malignancy with a high rate of mortality,being the third leading cause of cancer-related *** than one million newly diagnosed cases and 782685 deaths due to GC were reported in *** is characterized by limited effective treatment options and the lack of consistent biomarkers for the diagnosis and prognosis of these *** discovery of new biomarkers useful in the early diagnosis of GC is *** To evaluate the potential of COL10A1 as a circulating biomarker for the diagnosis and prognosis of gastric adenocarcinoma *** Plasma and tissue obtained from 49 patients with gastric adenocarcinoma have been used in exploring the expression of ***-time PCR and western blot techniques were used to evaluate COL10A1 level in gastric tumor tissue compared to normal adjacent *** circulating level of COL10A1 was also evaluated by ELISA in plasma of gastric adenocarcinoma *** analysis was made in order to evaluate the potential of COL10A1 as a biomarker for the diagnosis and prognosis of gastric adenocarcinoma *** Our results showed a significant increase in COL10A1 gene expression and protein levels in gastric tumor tissue compared to adjacent normal tissue(P<0.05).COL10A1 seems to show an elevated expression from the beginning of carcinogenesis,in the early stages,and its increased level remains elevated during cancer progression.A significant increase of COL10A1 plasma level in gastric adenocarcinoma patients was also ***,increased COL10A1 plasma level was associated with poor survival of the *** COL10A1 performed a diagnostic value in GC with area under the receiver operating characteristic curve(AUC)of 0.9171(P=0.0002),sensitivity of 87.76%,and specificity of 100.0%.Furthermore,this study demonstrated the potential role of plasma COL10A1 in the early detection of GC,as in the early stage,we obtained an AUC of 0.8789(P=0.00

关键词： Gastric cancer COL10A1 Circulating biomarkers Early diagnosis Poor prognosis Tumor stage

Severe liver trauma with complex portal and common bile duct avulsion:A case report and review of the literature

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World Journal of Clinical Cases 2023年第16期11卷 3837-3846页

作者： Bianca Mitricof Alin Kraft Florentina Anton Alexandru Barcu Darina Barzan Carmen Haiducu Vladislav Brasoveanu irinel popescu Cosmin Alec Moldovan Florin Botea Medicine Doctoral School Titu Maiorescu University of BucharestBucharest 040441Romania Department of General Surgery Regina Maria Military Emergency HospitalBrasov 500007Romania Faculty of Medicine Carol Davila University of Medicine and PharmacyBucharest 050474Romania Dan Setlacec Center for General Surgery and Liver Transplant Fundeni Clinical InstituteBucharest 022328Romania Department of Medical-Surgical and Prophylactic Disciplines Faculty of MedicineTitu Maiorescu University of BucharestBucharest 031593Romania Department of General Surgery Witting Clinical HospitalBucharest 010243Romania

BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal *** to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of treatment for hemodynamically stable ***,those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical ***,an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability,thereby imposing therapeutic challenges in the tertiary referral hepato-biliopancreatic centers’*** SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion,due to a crush *** patient was referred to the nearest emergency hospital and because of the hemorrhagic shock,damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery,and hemostatic ***,the patient was referred immediately to our tertiary hepato-bilio-pancreatic *** performed depacking,a right hepatectomy and Roux-en-Y *** the 9th postoperative day,the patient developed a high output anastomotic bile leak that required a redo of the *** postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound *** follow-up was optimal,with no complications at 55 *** In conclusion,the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management,conducted in a tertiary referral hepato-bilio-pancreatic center,where a stepwise and complex surgical approach is mandatory.

关键词： Severe Liver Trauma Avulsion Right portal vein Common bile duct Case report

Endoscopic ultrasound-guided fine-needle aspiration pancreatic adenocarcinoma samples yield adequate DNA for next-generation sequencing:A cohort analysis

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World Journal of Gastroenterology 2023年第18期29卷 2864-2874页

作者： Stefania Bunduc Bianca Varzaru Razvan Andrei Iacob Andrei Sorop Ioana Manea Andreea Spiridon Raluca Chelaru Adina Emilia Croitoru Gabriel Becheanu Mona Dumbrava Simona Dima irinel popescu Cristian Gheorghe Faculty of Medicine Carol Davila University of Medicine and PharmacyBucharest 020021Romania Digestive Diseases and Liver Transplantation Center Fundeni Clinical InstituteBucharest 022328Romania Center of Excellence in Translational Medicine Fundeni Clinical InstituteBucharest 022328Romania

BACKGROUND Genetic tests are increasingly performed for the management of unresectable pancreatic *** genotyping aimed samples current guidelines recommend using core specimens,although based on moderate quality ***,in clinical practice among the endoscopic ultrasound(EUS) guided tissue acquisition methods,fine needle aspiration(FNA) is the most widely *** To assess the adequacy for next generation sequencing(NGS) of the DNA yielded from EUS-FNA pancreatic adenocarcinoma(PDAC) *** Between November 2018 and December 2021,105 patients with PDAC confirmed by EUS-FNA were included in the study at our tertiary gastroenterology *** 22 gauge(G) or 19G FNA needles were *** pass was dedicated to DNA *** concentration and purity(A260/280,A260/230) were assessed by *** assessed the differences in DNA parameters according to needle size and tumor characteristics(size,location) and the adequacy of the extracted DNA for NGS(defined as A260/280 ≥ 1.7,and DNA yield:≥ 10 ng for amplicon based NGS,≥ 50 ng for whole exome sequencing [WES],≥ 100 ng for whole genome sequencing [WGS]) by analysis of variance and ttest ***,we compared DNA purity parameters across the different DNA yield *** Our cohort included 49% male patients,aged 67.02 ± 8.38 *** 22G needle was used in 71%of the *** DNA parameters across our samples varied as follows:DNA yield:1289 ng(inter quartile range:534.75-3101),A260/280 = 1.85(1.79-1.86),A260/230 = 2.2(1.72-2.36).DNA yield was > 10 ng in all samples and > 100 ng in 93% of them(one sample < 50 ng).There were no significant differences in the concentration and A260/280 between samples by needle *** size was the only independent predictor of A260/230 which was higher in the 22G samples(P =0.038).NGS adequacy rate was 90% for 19G samples regardless of NGS type,and for 22G samples it reached 89% for WGS adequacy and 91% for WES and

关键词： Pancreatic adenocarcinoma Endoscopic ultrasound guided fine needle aspiration Next generation sequencing DNA yield Needle size Genetic testing