Sinziana Ionescu - Academia.edu (original) (raw)

Papers by Sinziana Ionescu

The Introduction starts with the unusual case of three consecutive cancers (uterine cervix, ovari... more The Introduction starts with the unusual case of three consecutive cancers (uterine cervix, ovarian and rectal) and their relapses in one patient, requiring several surgical procedures, sometimes in emergency settings. Methods We drew a minute analysis of this case, which was operated on in the First Clinic of General Surgery and Surgical Oncology of the Bucharest Oncology Institute, and we looked into the details and examined the clinical context in which a series of surgeries were needed: at first, in the beginning of the disease process, for surgical oncologic reasons - and, further on, in the case of tumour relapse, in order to perform life-saving interventions. Results The surgical personal patient history, in this case, is impressive: the patient was initially histerectomised for a cervical tumour, a few years after she presented with an intraabdominal cystic tumour, which was diagnosed as ovarian cancer relapse, and after that she underwent further chemotherapy and, afterwards, a rectal tumour was diagnosed and treated with preoperative radiotherapy and abdomino-perineal resection.
This year she presented with a bleeding tumour at the level of the vagina which was biopsied and treated with radiofrequency ablation and afterwards the patient addressed the hospital in intestinal obstruction with an enterovaginal fistula. The fistular path was found, it was in strict adherence to the pelvic floor, and the lesional process was shunted by an ileocaecal anastomosis. In the postoperative period, the patient developed an anastomotic leak, and a median ileostomy was performed. Conclusion of this retrospective case analysis would lead towards the fact that, in such unusual cases, in which the surgeon must deal with several complications from cancer and cancer relapse, in the context of multiple primary tumours, it becomes imperative to try to solve the surgical emergency setting and not to try in vain to cure the advanced stage of disease through extensive and dangerous resections in a frail patient.

Cancers, Apr 9, 2024

Background. Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing, inadequately un... more Background. Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing,
inadequately understood neoplasm with a 5-year progression-free survival rate of as low as 48%. It
is characterized by varying degrees of malignancy and the production of mucinous and gelatinous
structures. Typically, the development of pseudomyxoma peritonei is associated with the rupture
of appendiceal mucinous tumors and other gastrointestinal or ovarian mucinous tumors. The goal
of our literature review was to identify various aspects that characterize the ovarian causes of pseu-
domyxoma peritonei. Materials and methods. The authors performed an extensive literature search
between 1 February 2024 and 2 March 2024 on the following databases: Pubmed, Scopus, Oxford
Journals, and Reaxys, and the findings were summarized into seven main clinical and paraclinical
situations. Results. According to our research, the main instances in which pseudomyxoma peritonei
can be triggered by an ovarian cause are the following: (1) mucinous cystadenoma; (2) mucinous
ovarian cancer; (3) colon cancer with ovarian metastasis; (4) malignant transformation of an ovarian
primary mature cystic teratoma; (5) appendiceal mucocele with peritoneal dissemination mimicking
an ovarian tumor with peritoneal carcinomatosis; (6) mucinous borderline tumor developing inside
an ovarian teratoma; and (7) the association between a mucinous bilateral ovarian cancer and a colonic
tumor. Conclusions. In our study, we aimed to provide a comprehensive overview of the ovarian
causes of pseudomyxoma peritonei,

Dr Sofia Ionescu (1920-2008) started performing surgical interventions during her years as a stud... more Dr Sofia Ionescu (1920-2008) started performing surgical interventions during her years as a student in 1944 when she performed a trepanation to save the life of a child. She obtained her PhD thesis in medicine and surgery in 1945, and it is in the next year when she becomes a certified surgeon, and, later on, in 1954, she becomes a consultant in neurosurgery. She worked in the surgical team of Dr Constantin Arseni (1912-1994), the most famous neurosurgeon in Romania at that time. She practised for 47 years, bringing new contributions, innovations and resourceful medical solutions; in neurosurgery, mostly in the fields of the spine, and also of the brain. Furthermore, her papers appeared and were cited in famous international surgery magazines. She was the first female neurosurgeon in Romania and also the first female neurosurgeon in South-Eastern Europe. She had numerous famous patients such as singers, spouses of political leaders, wives of Princes, and also poets. Dr Sofia Ionescu was a professor at the University, a Member of the Romanian Society of The History of Medicine, a Member of the Academy of Medical Sciences and she was declared a HERO DOCTOR by the World Health Organisation, next to other 65 great doctors. Le Dr. Sofia Ionescu (1920-2008) commence à faire des interventions chirurgicales en 1944 pendant ses études médicales, quand elle exécute une trépanation afin de sauver la vie d'un enfant. Elle obtient son diplôme de docteur en médecine et chirurgie (PhD) en 1945. L'année d'après elle devient chirurgien attitré, et peu après, en 1954, elle est promue consultante en neurochirurgie. Elle a travaillé dans l'équipe du Dr. Constantin Arseni (1912- 1994), le neurochirurgien le plus connu de Roumanie à l'époque. Elle a pratiqué pendant 47 ans. Elle a laissé plusieurs contributions, innovations et solutions médicales originales; en neurochirurgie surtout dans les domaines du rachis et du cerveau. De plus, ses articles ont été publiés et Elle a été la première femme neurochirurgien en Europe du Sud-Est. Elle avait plusieurs patients très célèbres, chanteurs, épouses de politiciens et de princes, ou poètes. Dr. Sofia Ionescu était professeure à l'Université, membre de la Société Roumaine d'Histoire de la Médecine, et membre de l'Académie des Sciences Médicales; elle a été déclarée Docteur- Héros par l'Organisation Mondiale de la Santé, avec 65 autres grands médecins. cités dans nombreuses revues de chirurgie internationales.

Hypothesis: The null hypothesis of the study was that none of the markers studied had any statist... more Hypothesis: The null hypothesis of the study was that none of the markers studied had any statistical importance in which concerns their variation with radiotherapy. Methods: We examined immunohistochemical parameters from tissue samples using paraffin blocks from 52 patients. The examinations were done comparatively, both: before radiotherapy (tissues from diagnostic biopsy), as after radiotherapy (tissues from abdomino-perineal resection). The patients had received treatment in the following units: Bucharest Oncology Institute and Coltea, Fundeni and Colentina Hospitals. Results: Out of 12 biomarkers studied, the ones with statistical importance were: EGFR in the tumor (p=0.00045), EGFR in the normal epithelium(p=0.0017), VEGF in the tumor (p=0.0132), VEGF in the tumor stroma (p=0.030) and p53, with a p value of 0.044. Conclusions: Markers of statistical significance were EGFR at the tumor level, EGFR in the tumor stroma, EGFR in the normal epithelium and they all increased. Moreover, EGFR increased in expression in the smooth muscle fibers and nervous fibers demonstrating the involvement of the normal stroma in the response to radiotherapy. Another marker which was modified with radiotherapy was VEGF in the tumor and in the tumor stroma. Also, p53 varied significantly with radiotherapy.

Esso Volume of abstracts

The null hypothesis of the study was that none of the : cell type distribution, desmoplastic reac... more The null hypothesis of the study was that none of the : cell type distribution, desmoplastic reaction, variation of the distribution of atypias, or variation in the distribution of the colloid response had any statistical meaning. Methods: We examined tissue samples using paraffin blocks from 52 patients. The examinations were done comparatively, both: before radiotherapy (tissues from diagnostic biopsy), as after radiotherapy (tissues from abdomino-perineal resection). The patients had received treatment in the following units: Bucharest Oncology Institute and Coltea, Fundeni and Colentina Hospital Results: Cell type distribution varied with a p=0.96, Distribution of the desmoplastic reaction varied with a p=0.218 , Distribution of atypias varied with a p= 0.910 Distribution of the colloid type* varied with a p=0,001 *The only morphological parameter with statistical meaning, when using the χ test with corresponding p value Conclusions: The following morphological factors studied in our batch did not present with statistical significance: cell type, desmoplastic reaction, atypias. On the other hand, the colloid type suffered a marked change with radiotherapy becoming in the majority of the cases from 0-1. Non colloid type Colloid type

Background: The authors considered of interest to study and discuss the methods of surgical treat... more Background: The authors considered of interest to study and discuss the methods of surgical treatment options in patients with colo-rectal cancer and associated factors which usually dramatically impact on the surgical outcome in the postoperative period, and sometimes on survival itself , such as: old age of more than 65 years, chemotherapy and radiotherapy treatments before the surgical moment and low opportunities of good wound healing , such as hypoproteinemia and malnutrition. Material and methods: We performed a retrospective study from 01/01/2010 to 27/12/2017 in which we reviewed 2316 hospital re-admissions in our clinic (First Clinic of General Surgery and Surgical Oncology from the Bucharest Oncology Institute, Bucharest, Romania), out of which we selected 711 patients with colo-rectal cancers. Consequently, we compared the outcomes of two separate groups, patients without any clinical or laboratory proof of immunodepression , (except the diagnosis of colo-rectal cancer) versus patients immune-compromised with one or more elements of the following: old age, chemotherapy , radiotherapy and hypo-proteinemia and malnutrition. The parameters followed in the postoperative period were : fistula formation, paralytic ileus with cardiac and respiratory complications, intra-abdominal abscess formation , peritonitis and postoperative days in the ICU unit or in the hospital. Results: Out of the total, 75% were immunocompromised patients with poor prognosis and bad general estate before the surgical intervention. 15% had more than 80 years of age with associated pathology .We demonstrated that the choice of ileostomy or colostomy, with the inherent decision not to do an anastomosis in cases of great risk of performing postoperative complications was life saving. We found that in our group, fistula formation in immunocompetent patients was between 9-12 % and in immunodepressed patients it was 23-30%(when one or more factors of bad healing prognosis were associated). Conclusions: The surgeon should refrain from choosing an anastomosis even if the technical conditions allow it , because the appearance of complications in cancer patients is much more frequent than it is in the general population and cancer itself decreases the immunity defences. Moreover, associated factors, such as old age , recent chemotherapy or radiotherapy treatments ,hypoproteinemia and malnutrition add odds to the possibility of serious postoperative complications which can be lifethreatening in an immunodepressed patient.

Problem statement: The authors wanted to know the level of prediction of invaded lymph nodes in t... more Problem statement: The authors wanted to know the level of prediction of invaded lymph nodes in the appreciation of recurrence of genital cancers. We performed a study highlighting the loco-regional and lymph node recurrence, after the radical interventions. Methods: We searched for the number of invaded lymph nodes from the area in which lymphadenectomy was performed and we also used the technique of the sentinel lymph node. In the First Clinic of General Surgery and Surgical Oncology , a clinic with 70 hospital beds , of the Bucharest Oncology Institute, in Bucharest, Romania, in a 5 year time interval (1/01/2012-31/12/2017), we studied cancer recurrence after the standardized oncological surgical techniques in pelvic gynecologic cancers ,performed by general surgeons specialized in surgical oncology. The degree of relapse was associated with the number of invaded lymph nodes at the moment of the first surgical procedure .

Esso Volume of Abstracts, 2012

In case of tumours in the ampullar region, in the head of pancreas, in the distal choledocus or i... more In case of tumours in the ampullar region, in the head of pancreas, in the distal choledocus or in the duodenum, radical surgery (cephalic duodenopancreatectomy) is performed, in one or two stages, in order to remove the head of the pancreas, the duodenum and the duodeno-jejunal angle, the terminal choledocus, the gastric antrum and loco-regional lymphatic nodules. Brief history: The first procedure of this type was performed by Kausch in 1909, and in 1940 Whipple perfected the technique and applied it during a one-stage surgery. In 1994, the first laparoscopic CDP procedure was performed. Surgical procedures evaluated: 158 axial draining and prosthesis of the bilioenteric anastomosis 42 Benign lesions Bilioenteric anastomoses-29 Repermeabilization of anastomotic stenoses-The prosthesis of biliary and pancreaticojejunal anastomosis is temporary, as it ensures the safety of sutures. The prosthesis advantages are: avoidance of fistulae, avoidance of stensoses, easier cholangiographic exploration.

ESSO41 Bordeaux , 2022

Background: Friedrich Ernst Krukenberg (1871-1946) first described Krukenberg tumours in 1896, an... more Background: Friedrich Ernst Krukenberg (1871-1946) first described Krukenberg tumours in 1896, and their incidence ranges between 1% and 21%.According to a number of studies, Krukenberg (TK) tumours are: all ovarian malignancies with digestive origins, whereas according to others, they are: the most common ovarian metastasis with ring cells with sealants and mucinous characteristics. Even though they were first described more than a century ago, some aspects of Krukenberg tumours continue to be contested. Several aspects, including the lack of consensus and consistency in using a single definition, the difficulty in admitting the existence of a primitive form of the tumour, the lack of knowledge regarding the precise mechanisms of metastasis, and the absence of distinctive and characteristic clinical symptoms that frequently contrast the typically large dimensions of the tumour, require additional clarification.KT is associated with a poor prognosis due to its aggressive character, the fact that it is difficult to diagnose, and the inefficacy of treatment. Multiple treatments, such as cytoreductive surgery (CRS), adjuvant chemotherapy (CT), and/or hyperthermic intraperitoneal chemotherapy (HIPC), have been utilised (HIPEC). It is not possible to say with certainty whether a particular treatment or combination of therapies is associated with increased survival rates as of the present time.
Material and methods: This section comprises the medical record data describing the patient's presentation, diagnosis, and treatment in the case of a patient addressing our hospital with bowel obstruction and a Krukenberg tumour. In our case study, we gathered information regarding patients' follow-up visits and identified factors influencing frequent and uncommon characteristics of Krukenberg tumours.
Results: Our report describes the case of a 49-year-old woman who was diagnosed clinically and by CT scan with stage IV colon cancer (M1hep) and an enormous ovarian tumour that was causing intestinal obstruction. Prior to this point, a stent was placed at the level of the descending colon to treat a colonic malignancy that had developed with infiltration and invasion in the adjacent structures of the retroperitoneum, up to the level of the left kidney. Following this, chemotherapy was administered.
Both chronic (diffuse gastrointestinal pain) and acute (the newly-installed colon obstruction with emesis and absent transit) symptoms were treated by palliative surgery. Urgent intestinal obstruction surgery (unilateral adnexectomy en bloque with the large ovarian tumour and transverse colostomy) was performed. The patient was able to undertake subsequent oncological treatment for the management of the underlying condition (stage IV colon cancer) because he did not experience postoperative stomach distress and his transit returned to normal.
Conclusions: Conclusions regarding our case and the brief initial literature review conducted to better orient the diagnosis indicated that emergency surgery in cancer patients, even at late stages (IV), may alleviate and even resolve the critical situation, thereby allowing future cancer therapies. Even if the disease has already progressed to stage IV, this statement is accurate. In a subset of cases, cytoreductive surgery for KT has been shown to enhance patients' prospects of surviving the disease.

ESSo Volume of abstracts, 2023

ESSo Volume of Abstracts, 2023

Background: Neuroendocrine tumours (NETs) vary in primary tumour sites, functional status (hormon... more Background: Neuroendocrine tumours (NETs) vary in primary tumour sites, functional status (hormone secreting or non-functional), and aggressiveness (well-differentiated grade 1 to poorly differentiated grade 3). Lung, small bowel, pancreas, and appendix are most prevalent. Clinics can vary between:incidental lesions on cross-sectional imaging, small bowel obstruction, carcinoid syndrome, or other syndromic presentations Biochemical indicators, CT, MRI, and somatostatin-receptor-based functional imaging diagnose the disease. Somatostatin analogues, PRRT, everolimus, sunitinib, liver-directed treatments, and chemotherapy are used for disease stabilisation and curative resection. Local and systemic problems had good 5- and 10-year survival rates.
Material and methods: Our study has started from the details of a case that the authors encountered, which consisted in chronic abdominal pain and subacute bowel obstruction, secondary to four small bowel tumors that were further revealed as neuroendocrine tumors , confirmed during the intraoperative pathology exam. The diagnosis, supported also by immunohistochemistry was : well-differentiated neuroendocrine tumour. The clinical attitude was enterectomy and the patient was subsequently referred to the oncology department, which decided follow-up and watchful waiting as viable treatment options.
Results: Our ER admitted a 68-year-old woman with clinical and radiological evidence of acute abdominal urgency. The patient had three weeks of intermittent vomiting, colicky stomach discomfort, abdominal distension, and no flatus or faeces for 48h. Physical examination revealed: diffuse abdomen pain, guarding, rebound tenderness, abdominal distension, absence of bowel movement on auscultation, flatus, and stool, and considerable nausea and vomiting. WBC count was normal, however CRP was elevated. BUN, creatinine, and potassium also increased. X-ray and ultrasonography showed intestinal blockage and free fluid in the abdomen. Abdominal CT scan confirmed X-ray and ultrasound findings. Abdominal CT showed no liver metastases. Emergency surgery followed NG tube installation, urinary catheter insertion, two IV needles, crystalloid rehydration, and broad-spectrum antibiotics. Ileal stenosing mass caused minor bowel blockage during the surgery. The patient underwent small bowel resection “en bloque “with tumour mass and manual end-to-end anastomosis.
Conclusions: High-resolution imaging and endoscopy have increased early NET diagnosis, which improves prognosis, but a high percentage of small bowel-NETs are still diagnosed during emergency surgery for acute bowel obstruction, perforation, and, rarely, haemorrhage. Small bowel-NETs are still treated surgically, as a first treatment option.

Cancers, Apr 9, 2024

Esso Volume of abstracts

Esso Volume of Abstracts, 2012

ESSO41 Bordeaux , 2022

ESSo Volume of abstracts, 2023

ESSo Volume of Abstracts, 2023

ISHM Abstract Book, 2024

The oldest medical links between Italy and the Romanian territories that we will refer to are tho... more The oldest medical links between Italy and the Romanian territories that we will refer to are those from the Court of the Rulers of the Principalities. Thus, at Alexandru Lapusneanu's court (Ruler of Moldavia between1552 –1561 and 1564 – 1568), there was a doctor of Italian origin. Likewise, at the court of Stephen the Great (Ruler of Moldavia between 1457-1504), historical sources mention the presence of Baldasar de Perusino, and, later on, in 1502, the presence of Matteo Muriano. The latter also arrived to the Court as a "doctor of arts and medicine," apparently sent on a medical mission. Many centuries later, in 1831, we find information about the presence of Pietro Ferrari a decorated doctor from Padua, who could be found in Bucharest. Moreover, in the 1838 Inventory, two other Italian physicians were mentioned: Adolfo Pregli and Francesco Nisate. In 1844, doctor Claudio Agostini mentioned to the Romanian authorities the importance of the implementation of a program to control venereal diseases. Another physician of Italian origin who contributed to the development of Medical Academic teaching in the Romanian territories was Nicola Picolo, who worked for the Ruler Gh. Bibescu (1843–1848) and was an official correspondent of the Centralised Health Administration System from the southern province (Muntenia, also known as Wallachia).

ISHM abstract book Salerno , 2024

On the subject of female doctors being outstanding in surgical specialties- in Romanian territor... more On the subject of female doctors being outstanding in surgical specialties- in Romanian territories, there were some important premieres and achievements that we consider worth remembering.
Martha Trancu Rainer (1875–1950) the first female specialist in general surgery, who was Queen Mary’s of Romania’s Personal Physician. During the First World War, Martha Trancu Rainer was mobilized with the rank of Major and ran three military hospitals - the Colțea hospital, the Surgery Hospital installed at the Royal Palace in Calea Victoriei (at the request of Queen Maria) and the Hospital at the Bridges and Roads School, - where wounded soldiers were operated on.
Another distinguished example is that of Sofia Ionescu (1920-2008), one of the firsts female neurosurgeons worldwide. For a span of 47 years, she served as a neurosurgeon at Hospital Nr. 9, collaborating alongside Ionel Ionescu and Constantin Arseni(1912-1994) as a cohesive team, all under the supervision of Dumitru Bagdasar (1893-1946). They established the first neurological team in Romania, thereafter referred to as "The golden team," which played a pivotal role in advancing the field of neurosurgery in the country.
We continue with yet another remarkable example of excellence and skill: Elena Densusianu Puscariu(1875-1966). She earned her PhD at the age of 24 and became the first female ophthalmology professor. At 90, she published her final work of research, after a distinguished academic and medical career.
The path of Romanian Women Surgeons has a great and outstanding tradition, but it is the responsibility of the present and future generations of female doctors to achieve and conquer territories and surgical specialties that have not been properly represented so far.