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Surgery reach its limits in treating rectal cancers. Old fashion chemotherapy has so many adverse effects and the survival rates became steady for the last decades. Efforts were made in two other directions prevention of rectal cancers by large population screenings, and the other was research of intimate mechanism of rectal cancer progression and identifying new markers for better targeted new anti-cancer drugs. We intend to emphasize the role of angiogenesis markers in actual stage of research in order to settle new goals for our research. We identified three possible paths in evaluation of the rectal cancer angiogenesis suitable for our research: microvessel density quantified by CD34 and CD105, morphometric analysis of the intratumor and peritumor vessel marked with CD34 and CD105 in order to achieve new patterns of progressing for rectal cancer, and a combined analyses of VEGF and podoplanin.The biological behaviour of rectal cancers is tailored by many factors, most of them activating different pathways of vascular growth. Reasearch should focus on the relation between these factors and finding new ways of targeting multiple factors during chemotherapy in order to restrict tumor blood supply by slowing the angiogenesis. [ABSTRACT FROM AUTHOR]

Introduction: Within the last years, there has been a trend in many hospitals to switch their surgical activity from open/laparoscopic procedures to robotic surgery. Some open surgeons have been shifting their activity to robotic surgery. It is still unclear whether there is a transfer of open surgical skills to robotic ones. Aim: To evaluate whether such transfer of skills occurs and to identify which specific skills are more significantly transferred from the operative table to the console. Material and methods: Twenty-five volunteers were included in the study, divided into 2 groups: group A (15 participants) - medical students (without any surgical experience in open, laparoscopic or robotic surgery); and group B (10 participants) - surgeons with exclusively open surgical experience, without any previous laparoscopic or robotic experience. Participants were asked to complete 3 robotic simulator console exercises structured from the easiest one (Peg Board) to the toughest one (Sponge Suture). Overall scores for each exercise as well as specific metrics were compared between the two groups. Results: There were no significant differences between overall scores of the two groups for the easiest task. Overall scores were better for group B as the exercises got more complex. For the intermediate and high-difficulty level exercises, most of the specific metrics were better for group B, with the exception of the working master space item. Conclusions: Our results suggest that the open surgical skills transfer to robotic skills, at least for the very beginning of the training process. [ABSTRACT FROM AUTHOR]

Reducing the number of unneeded thyroid surgeries could impact hospitalization costs, but also surgical complications and iatrogenic hypothyroidism. The purpose of the present study was to assess retrospectively the number thyroidectomies which had a complete presurgical clinical and imaging thyroid evaluation and respectively the overlap between the surgical indication and the final pathology result. We included all the patients admitted in the three Surgical Departments in Timisoara Emergency County Hospital for thyroid surgery between January 1st 2018 and December 31st 2019 (2 years) and compared the pre- and post-surgical diagnosis. 1036 patients were admitted for thyroid surgery in the three surgical departments of Timisoara County Hospital "Pius Brinzeu" in Romania: 180 unilateral lobectomies, 824 total thyroidectomies and also 32 redo operations for completion of thyroidectomy. 90.3% were females and the mean age was of 53.8±13 years. Out of the total 892 cases with NG, only 218 (24.4%) presented a well-defined indication for surgery: compression, US high-risk, malignant cytology result or hyperthyroidism. Cancer was detected in 32.9% (n=338) of the cases. A higher prevalence of thyroid malignancy in the men (55.6% vs 30.5%, p<0.01) and in woman older than 30 (16% vs. 31.8%). An important finding was the relatively high prevalence of malignancy in the lobectomy group: 22.8%, while 65% of the total thyroidectomies proved to be benign. Important discordances were detected between the clinical diagnosis and the pathology report: 46.2% of cases. The group with associated compressive symptoms presented an important malignancy rate of 42.6%. In 110 cases, the pathology report showed that chronic autoimmune thyroiditis (CAT) was misdiagnosed, clinically or on US evaluation, as nodular goiter. Rare findings included one patient with metastasis from pulmonary neoplasia and 3 cases with lymphomas (before surgery one of them was suspected to be anaplastic thyroid cancer). The number of FNAs performed and documented in the studied surgical cases is very low (121 out of 674 cases with only non-toxic nodules -17.9%). We estimated that surgery could have been avoided, with correct presurgical risk stratification algorithms, in up to 46% (473/1027) of the cases. Nevertheless, the important percentage of detected thyroid cancers supports the current radical surgical attitude, given the lack of uniform and precise presurgical diagnosis. [ABSTRACT FROM AUTHOR]

Changing diet and lifestyle has led to an impressive increase in the incidence of obesity in recent decades. Obesity in humans is a serious health issue per se, but also through the association with related disorders, e.g., type II diabetes, hypertension and metabolic disturbances. At the same time it is associated with increased levels of inflammatory cytokines secreted by adipocytes who are responsible for inducing inflammatory status. The aim of our study was to assess the of kinetics of plasma levels of pro-inflammatory cytokines (IL-6 and TNF-α) and some seric markers of the metabolic syndrome (total cholesterol, triglycerides, glycaemia) in patients with malignant obesity, before and after laparoscopic sleeve gastrectomy. The results of our study confirm the benefic role of bariatric surgery. The technique may improve the chronic disease and the state of inflammation associated with obesity. [ABSTRACT FROM AUTHOR]

Medullary thyroid carcinoma (MTC) is a rare form of malignancy, having an intermediate prognosis. Controversies exist regarding the best surgical approach. The aim of the study was to analyze the outcome in a group of patients with MTC, diagnosed and followed up in a single care center. We performed a retrospective analysis of all the patients diagnosed with MTC in the Department of Endocrinology from the County Emergency Hospital Timisoara between 1992 and 2012. The study group included 19 patients, 6 men (31.6 %), mean age 41.2 ± 12.5 years (20-72 years). The preoperative diagnosis was based on the protocol for nodular thyroid disease. Total or near-total thyroidectomy was performed in 10 out of 16 patients who could be operated. Postoperative follow-up included repeated measurements of serum calcitonin and imaging investigations. Nine out of the total of 19 (47.3 %) patients had hereditary forms of MTC. Most of the cases (84.2 %) were submitted to surgery. The median duration of follow-up was 84 months. The pTNM staging indicated that the majority of the patients with hereditary MTC were diagnosed in an earlier stage. Disease remission was achieved in 7 cases (43.8 %). Four patients, all with sporadic forms, died. Survival rates at 1, 5 and 10 years were significantly higher ( p = 0.048) in patients with hereditary MTC. An early diagnosis of MTC allows a better surgical approach and an improved survival rate. We support the general recommendation that modified radical neck dissection is not necessary for all the patients with MTC. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the third most diagnosed cancer in men (after prostate and lung cancers) and in women (after breast and lung cancer). It is the second cause of cancer death in men (after lung cancer) and the third one in women (after breast and lung cancers). It is estimated that, in EU-27 countries in 2020, colorectal cancer accounted for 12.7% of all new cancer diagnoses and 12.4% of all deaths due to cancer. Our study aims to assess the opportunistic colorectal cancer screening by colonoscopy in a private hospital. A secondary objective of this study is to analyse the adenoma detection rate (ADR), polyp detection rate (PDR), and colorectal cancer (CRC) detection rate. We designed a retrospective single-centre study in the Gastroenterology Department of Saint Mary Hospital. The study population includes all individuals who performed colonoscopies in 2 years, January 2019–December 2020, addressed to our department by their family physician or came by themselves for a colonoscopy. One thousand seven hundred seventy-eight asymptomatic subjects underwent a colonoscopy for the first time. The mean age was 59.0 ± 10.9, 59.5% female. Eight hundred seventy-three polyps were found in 525 patients. Five hundred and twenty-five had at least one polyp, 185 patients had two polyps, 87 had three polyps, and 40 patients had more than three polyps. The PDR was 49.1%, ADR 39.0%, advanced adenomas in 7.9%, and carcinomas were found in 5.4% of patients. In a country without any colorectal cancer screening policy, polyps were found in almost half of the 1778 asymptomatic patients evaluated in a single private center, 39% of cases adenomas, and 5.4% colorectal cancer. Our study suggests starting screening colonoscopy at the age of 45. A poor bowel preparation significantly impacted the adenoma detection rate. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is an unpredictable disease affecting the pancreas and it is characterized by a wide range of symptoms and modified lab tests, thus there is a continuing struggle to classify this disease and to find risk factors associated with a worse outcome. The main objective of this study was to identify the risk factors associated with the fatal outcome of the intensive care unit's patients diagnosed and admitted for severe acute pancreatitis, the secondary objective was to investigate the prediction value for the death of different inflammatory markers at the time of their admission to the hospital. This retrospective study included all the patients with a diagnosis of acute pancreatitis admitted to the Intensive Care Unit of the Emergency County Hospital Timisoara between 1 January 2016 and 31 May 2021. The study included 53 patients diagnosed with severe acute pancreatitis, out of which 21 (39.6%) survived and 32 (60.4%) died. For the neutrophils/lymphocytes ratio, a cut-off value of 12.4 was found. When analyzing age, we found out that age above 52 years old can predict mortality, and for the platelets/lymphocytes ratio, a cut-off value of 127 was found. Combining the three factors we get a new model for predicting mortality, with an increased performance, AUROC = 0.95, p < 0.001. Multiple persistent organ failure, age over 50, higher values of C reactive protein, and surgery were risk factors for death in the patients with severe acute pancreatitis admitted to the intensive care unit. The model design from the neutrophils/lymphocytes ratio, platelets/lymphocytes ratio, and age proved to be the best in predicting mortality in severe acute pancreatitis. [ABSTRACT FROM AUTHOR]

The prevalence of obesity has increased in recent decades and has become a public health problem. In obesity patients the metabolism of almost all adipokines is markedly dysregulated. Studies regarding levels of ghrelin, leptin, and adiponectin after bariatric surgery reveal contradictory results. The purpose of the present study was to analyze modification of body weight and plasma levels of fasting glucose, ghrelin, adiponectin and leptin, in obese rats with T2DM after sleeve gastrectomy (SG), gastric plication (GP) and sham-operated (SO). Eighteen specimens where randomized to three weight-matched groups: Group SG underwent sleeve gastrectomy (n=6), group GP underwent gastric plication (n=6) and the control group SO underwent sham surgery (n=6). Upon surgery a normal rat chow diet (Bio-Serv® product no. F4031) was fed to the rats until the end of the experiment. Additional blood samples were harvested after 4 weeks. The results revealed that body mass decreased in the SG (783.17±101.39 vs. 658.33±86.57 g; P<0.0001) and the GP (781.33±103.12 vs. 702.33±84.06 g; P=0.004) rats after surgery. There were significant lower fasting glucose levels at 4 weeks postoperative in the SG group compared to the SO group (83.1±12.81 vs. 104.5±9.81 mg/dl; P=0.016). The same trend was observed in the GP group vs. the SO group (86.7±11.43 vs. 104.5±9.81 mg/dl; P=0.026). There was no difference regarding mean glucose levels between the SG group compared to the GP group (P>0.05). Plasma acylated ghrelin and leptin levels decreased four weeks after surgery compared to preoperative levels, while adiponectin levels increased four weeks after surgery in the SG and GP groups, respectively. The present study revealed that plasma glucose levels, ghrelin and leptin levels decreased after SG and GP, while adiponectin levels improved. This suggests that there may be hormonal contribution in weight loss. [ABSTRACT FROM AUTHOR]