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Mental health can be negatively affected during life to varying degrees, from minor indispositions created by daily debates, to major psycho-social traumas that have a significant and long-term impact. Physical injuries, especially those involving limb amputation, are probably the most traumatic and hard to accept events, as they cause severe biological, psychological and social damage to the individual. Losing a limb or part of a limb leads to significant physical disability, changes in physical appearance and self-esteem, difficulty returning to work and problems with social integration. Consequently, after an amputation operation, the patient's recovery must be approached with great care. Some of the patients adapt relatively easily to the new condition, while others successfully benefit from intensive recovery programs. Unfortunately, a small group of patients fail in post-operative recovery and some even believe that isolation/suicide could be a possible solution for their difficulties. The psychological response/behavior of patients to limb amputations is dependent on many factors, such as: personality, level of education, social status, the environment and culture from which it originates, the support from society in terms of their integration, age, gender, the affected limb and extent of amputation, accessibility to different methods of recovery/prosthetics, etc. This complexity of the factors involved in the post-operative recovery period of the amputee patient causes the rehabilitation programs to be extremely elaborate on the one hand, but also highly personalized according to the individual characteristics, on the other hand. In this review, aspects of the psychological rehabilitation of patients undergoing limb amputation are presented and updated. It seems that such measures should be approached interdisciplinary with the patient and initiated even before surgery, if possible, to achieve the best possible results.

Inflammatory bowel diseases (IBD), namely Crohn’s disease and ulcerative colitis, are relatively rare diseases in our country, known as a low prevalence geographic region. IBD are a multidisciplinary problem, that implies gastroenterologists, as well as surgeons. Surgical management in inflammatory bowel disease is often impaired by a high complication rate and a significant recurrence rate, specific mostly for Crohn’s disease. Indications for surgery include failure of medical therapy (including delayed puberty for young patients and drug intolerance), toxic megacolon, bowel perforation, obstruction, enteric fistula and abdominal or perianal abscess. Advances in medical treatment options for IBD are continuously accumulating. However, a large number of patients still require surgical procedures during lifetime.

Introduction. Chronic limb-threatening ischemia (CLTI) is a debilitating condition characterized by inadequate blood supply to the lower extremities, often leading to tissue damage, ulcers, and limb loss. Amputation-free survival (AFS) serves as a crucial measure in evaluating interventions and managing CLTI, emphasizing limb preservation, functional restoration, and prevention of recurrent ischemic events. Objectives. This study aimed to assess mid to long term AFS in CLTI patients treated with hybrid vascular techniques. Materials and Methods. Conducted over 24 months at the Emergency Hospital of Saint Pantelimon in Bucharest, Romania, the study enrolled 62 adult CLTI patients, tracking them postoperatively. Kaplan Meyer survival curves were used to assess AFS rates. Results. Findings revealed a high prevalence of cardiovascular risk factors among participants, with most undergoing infrainguinal bypass revascularization in association with proximal and/or distal angioplasty with or without stenting. Prior to intervention, the majority of patients exhibited advanced stages of ischemia, with trophic lesions predominantly confined to the toes. Analysis of AFS revealed a decline over time, with the majority of amputations occurring within three months postrevascularization. Notably, 64.5% of patients achieved amputation free complete wound healing within the first year, with 90% of them achieving this within the first six months. Complex wounds were associated with prolonged healing. Conclusions. The study shows a 75.2% AFS rate at 24 months, highlighting the effectiveness of hybrid revascularization techniques and proper wound care in optimizing outcomes for CLTI patients. [ABSTRACT FROM AUTHOR]

Introduction. This study aims to evaluate the impact of stoma formation on the quality of life of patients undergoing colonic surgery, considering both emergency and elective procedures. Several factors (demographic data, Charlson comorbidity score, type of surgical intervention, duration of hospitalization, postoperative outcomes and complications, etc.) were analyzed to understand their influence on patients' well-being. Materials and Methods. A retrospective analysis was performed on patients who underwent colorectal surgery that required stoma formation. A total of 270 patients were included in the study, with 69.25% undergoing emergency surgery and 30.74% undergoing elective procedures. Results. The Charlson comorbidity score was significantly higher in the emergency surgery group compared to the elective group, 8.51 vs 7.67, respectively (p < 0.05). Patients who underwent emergency surgery experienced more postoperative (including stoma-related) complications, leading to a lower quality of life score compared to those undergoing elective procedures. Conclusions. Especially in emergency cases, colostomy involves difficulties related to patient compliance and quality of life, a fact supported by higher scores regarding comorbidities and postoperative complications. Thus, presenting patients at early stages of disease, customized surgical techniques, and appropriate preoperative counseling can help improve both patient outcomes and overall well-being. [ABSTRACT FROM AUTHOR]

Colon cancer is relatively asymptomatic in the early stages, the manifestations appearing and intensifying with the evolution of the disease, especially when associated with local and/or systemic complications. In such cases, surgical interventions are often emergency and involve more extensive operations (on metabolically and immune-stressed organisms), so that an early diagnosis (endoscopy, tumor markers, etc.) remains not only desirable but even a priority, especially in predisposed patients (genetic factors, lifestyle, etc.). As a consequence, the involvement of tumor markers in colon neoplasms has become more and more investigated in recent times. This review investigates the roles of serological and genetic markers in the management of patients with colon cancer, focusing on carcinoembryonic antigen, mismatch repair deficiency (dMMR), as well as KRAS and BRAF mutations. As a preliminary conclusion, tumor biomarkers seem to have a significant contribution to the diagnosis, decisions related to operative management, prognosis and postoperative follow-up of colon cancer, both in the categories of patients from high-risk groups and those without a clear predisposition to this condition. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is one of the most common comorbidities of patients undergoing surgery. Colorectal surgery is frequently associated with postoperative complications, and diabetic patients represent a population that presents a high risk of developing such complications. Understanding the interrelationships between neoplastic disease and diabetes, as well as the pathophysiological mechanisms underlying postoperative complications, are essential for effective therapeutic management. Genetic predispositions, alterations in the gut microbiota, inflammatory response, ischemic, thrombotic and infectious processes contribute significantly to the development of severe surgical complications, such as anastomotic fistulas. Postoperative ileus, characterized by gastrointestinal dysmotility, is common in diabetic patients due to neuropathic dysfunction and altered intestinal metabolism. In addition, diabetic patients are at increased risk of intestinal ischemia, requiring specific perioperative care. The strategies to avoid these complications assume an adequate surgical technique, a personalized anesthesia management, and last but not least, the best possible glycemic control. This article highlights the importance of a better understanding of the interaction between diabetes and postoperative complications, in order to obtain good results with an important impact on the patient's health and well-being. [ABSTRACT FROM AUTHOR]

Introduction. Globally, over 230 million people have peripheral artery disease, often undiagnosed, leading to chronic limb-threatening ischemia. Revascularization is vital for preventing amputation and improving quality of life. While specific questionnaires for severe ischemia are lacking, the SF-36 questionnaire is widely used to assess quality of life, with variations like SF-12 and SF-8 for larger cohorts. Objectives. Our aim was to assess how different lower limb revascularization methods affect the postoperative quality of life in patients with chronic limb-threatening ischemia. Methods. This study was conducted at the St. Pantelimon Emergency Hospital of Bucharest, Romania. It included 166 adult patients with chronic limb-threatening ischemia who were monitored for 12 months. Quality of life was assessed using the SF-36 questionnaire. The patients were categorized into two groups: 112 underwent conventional surgery, and 54 had hybrid procedures. Data analysis involved t-tests, Mann-Whitney U tests and assessment of data reliability. Results. In the Conventional Surgery group, the average age was 70.5 years, predominantly male, with similar risk factors as the second group. The Hybrid Surgery group had an average age of 73 and exhibited more extensive distal arterial lesions, higher rates of ulcer/gangrene, and a higher occurrence of postoperative minor amputations. The SF-36 questionnaire showed low data reliability for the General Health and Social Functioning domains. Additionally, the Hybrid Surgery group had poorer preoperative perception in the Body Pain category. However, significant postoperative improvements in quality of life were observed in all domains for both groups with similar results. Conclusions. Revascularization improves the quality of life for patients with chronic limbthreatening ischemia, including those that also require minor amputations. SF-36 has good assessment for most QoL aspects, but reliability declines in severe ischemia. [ABSTRACT FROM AUTHOR]

Barrett's esophagus (BE) represents a special clinical entity, which may have reduced symptoms, but an increased potential for malignant degeneration. The factors that lead to the appearance of Barrett's esophagus are multiple, the most important being gastro-esophageal reflux, as well as smoking and obesity. BE occurs as a result of damage of the esophageal mucosa, caused by acid/basic gastroesophageal reflux and resulting in the transformation of the epithelium from squamous to intestinal type. The diagnosis of BE is primarily based on endoscopic examination. This method has not only a diagnostic role, but also a therapeutic one through the minimally invasive resection of the mucosa with suspicious dysplastic lesions, thus reducing the risk of esophageal adenocarcinoma. Conservative therapeutic methods by administering chemoprotective agents (proton pump inhibitors, statins, etc.) are also useful. Surgical treatment of Barrett's esophagus aims to both resect areas of high-grade esophageal dysplasia/adenocarcinoma and reduce the degree of gastroesophageal reflux through various surgical procedures. As a conclusion, the potential for malignant degeneration of BE should not be neglected, the form of treatment largely depending on the patient's age and comorbidities. [ABSTRACT FROM AUTHOR]

Gastric cancer is an extremely aggressive form of malignancy that, if left untreated, is life-threatening. Improved survival rates depend on early detection of the disease, as well as on the combination of different forms of treatment (surgery, chemotherapy, radiotherapy, immunotherapy, etc.). Screening methods have brought real benefit in early detection of malignancies, but many cases are still diagnosed at advanced stages. The current study is a review related to actualities and perspectives of early diagnosis and targeted therapy of gastric cancer. After an extensive review of the literature, epidemiological, diagnostic and treatment data are presented. The open surgical approach is used in emergency centers or with a low surgical activity, while the minimally invasive approach (laparoscopic, robotic) is possible in large centers dedicated to the treatment of gastric cancer. In the near future, new diagnostic and therapeutic tools are expected to appear, not only to cure cancer definitively, but also to be able to prevent it, if possible, without radically changing the lifestyle of the population. [ABSTRACT FROM AUTHOR]

Colorectal cancer is an important health problem with a significant impact on the individual and society. Malignancy (including colorectal cancer) is usually slightly symptomatic in its initial stages. This causes cancer to be discovered in some patients accidentally (either through screening tests in predisposed individuals or during routine investigations for other diseases), while in other patients the colorectal cancer is discovered in late stages, when the symptoms are much more intense due to complications. Unfortunately, such advanced cases of the disease have high rates of morbidity and mortality even with treatment. Current treatment methods are usually complex, interdisciplinary, causing significant suffering (physical, mental) to the individual, while the cost of treatment per patient seems to be extremely high. Until finding therapeutic methods that are effective and accessible to most patients with advanced colorectal cancer, several methods of prophylaxis and early diagnosis should be considered, to reduce as much as possible the devastating impact of this disease. The purpose of this review is to present literature data regarding the current methods of diagnosis and treatment of patients presenting to the doctor with colorectal cancer in advanced stages of complications. [ABSTRACT FROM AUTHOR]

Objectives. This study aims to analyze the evolution of chronic wounds treated both surgically and by complementary nursing using Manuka honey. The parameters monitored were: presence/persistence of bacterial infection, the duration of healing, the recovery period and the patients' quality of life. Materials and Methods. The study group and the control group each consisted of 10 patients, aged between 50-60 years, with chronic wounds of various etiologies but without other significant systemic pathologies. Data collection was carried out through anamnesis, physical examination and analysis of medical documents. Results. In the study group, the depth of the wound was reduced rapidly and significantly, with complete epithelialization after about four weeks. In the control group, the wound was completely healed by classical treatment, but in eleven weeks and in the form of an unaesthetic keloid scar. The recovery period of a chronic wound appears to be significantly influenced by the use of Manuka honey. Conclusions. Future studies on large groups of patients need to verify the potential therapeutic properties of this compound (antiinflammatory, antibacterial, antifungal, antioxidant, autolytic debridement, etc.), as well as its adjunctive contribution to wound dressing (maintaining a moist environment and reducing trauma and unpleasant odors). [ABSTRACT FROM AUTHOR]

Objectives. The incidence of acute cholecystitis increases with age, when patients usually associate additional comorbidities. Such comorbidities and the late presentation to the doctor make the treatment more complex, associating higher rates of complications. The present study aims to evaluate the methods of diagnosis and treatment applied to a group of older patients with acute cholecystitis. Materials and Methods. 585 patients were enrolled in the study between 2019 and 2023. The inclusion criteria in the study were represented by the presence of the diagnosis of acute cholecystitis in patients over 65 years of age, while patients who presented complex locoregional pathologies (trauma, cancer, etc.) were excluded. Results. In about 91% of cases, acute cholecystitis was determined by gallstones. 61.19% of cases benefited from laparoscopic cholecystectomy, the rest of the patients requiring additional procedures or open surgery. Morbidity and mortality were not significantly influenced, but some of the patients required complex interventions and longer hospital stay. Conclusions. The clinical manifestations of acute cholecystitis can be diminished in some of the elderly patients (neurological disorders, diabetes, immunosenescence, etc.), being initially appreciated as mild forms. Later it is found (by imaging or intraoperatively) that these are much more severe forms, which often require a customized therapeutic approach. [ABSTRACT FROM AUTHOR]

Despite remarkable advances in medicine, limb amputations remain a therapeutic measure that saves the lives of many patients. Given the varied etiopathogenesis, such operations are performed both as an emergency and as an elective procedure. Such interventions address either only the distal segments of a limb, or even the entire limb, having a great psychological, functional and social impact on the patient. Due to these multiple implications, limb amputations must be performed by specialized teams, in order to achieve the best possible functional and aesthetic results to be compatible with the correction of the remaining deficit with a prosthesis. The main causes leading to amputations and the corresponding preventive measures are presented, as well as the general principles of amputations as a therapeutic solution of last resort. In conclusion, reducing the number of traffic/workplace accidents and effective treatment of chronic diseases affecting the vascular system can contribute to decreasing the need for amputations, a life-saving therapeutic solution, but with a devastating impact on the patient and society. [ABSTRACT FROM AUTHOR]

Acute pancreatitis is an acute inflammatory process of the pancreas, which can remain localized at the level of the gland or can extend to the peripancreatic and retroperitoneal tissues. The use and interpretation of paraclinical examinations at the onset can predict the form of evolution of acute pancreatitis (mild or severe). Depending on the evolution, these data are useful in determining the type of surgical intervention that might be necessary based on severity. We present a retrospective study consisting of 118 patients diagnosed and hospitalized with acute pancreatitis during 2016-2020 in the Surgery I section of the Sibiu County Emergency Clinical Hospital. Several parameters were taken into account at hospitalization such as age, sex, the environment of origin, etiology of pancreatitis, biochemical parameters with their repetition at 24, 72 hours, and at discharge, and clinical signs at hospitalization. surgeries performed depending on the severity of pancreatitis specifying their complications. [ABSTRACT FROM AUTHOR]

SARS-COV 2 recently caused a global pandemic, with the first case being reported in Romania in February 2020. Important restrictive measures were imposed, so that the addressability of patients to medical services decreased. Upper gastrointestinal bleeding had more severe forms of evolution at the time of presentation, which required additional methods of diagnosis and treatment. This is a retrospective study performed on 268 patients, which aims to evaluate the type and effectiveness of different treatment methods for upper gastrointestinal bleeding during the COVID 19 pandemic. Severity assessment was performed by measuring the Rockall score and additional methods of diagnosis. The association of COVID-19 with upper gastrointestinal bleeding can lead to much more severe outcomes for the patient, so treatment must be sustained and fast established. If the initial therapeutic methods fail, the other available therapeutic measures should be introduced progressively and without delay to achieve the best possible outcomes. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease is a group of conditions of unknown etiology, represented by Crohn's disease and ulcerative colitis and characterized by the presence of intestinal wall inflammation. From the first cases described to date, several studies have been performed to elucidate the cause of inflammatory bowel disease. Generally, the genetic factors predispose to their occurrence while epigenetic and environmental factors trigger them. Genetic factors are mutations of the genes involved in the response and recognition of immune cells to different pathogens. The most studied epigenetic and environmental factors are smoking (which predisposes to Crohn's disease and can be protective for ulcerative colitis), lack of vitamin D, a diet rich in sugars and low in flavonoids and fibers. The diagnosis is usually established by endoscopy and biopsy. Recent technologies can perform live biopsies such as endocytoscopy or confocal laser endomicroscopy, with an accuracy of 100% compared to classical methods. Therapy involves several classes of drugs, preferably in association with diet and lifestyle changes. In case of complications or in non-responsive diseases, surgery must be considered, as documented for ulcerative colitis that can be cured by removing the entire colon. The purpose of this review is to present recent findings on pathology, as well as modern diagnosis and treatment methods for IBD. [ABSTRACT FROM AUTHOR]

Giant pancreatic pseudocysts are considered those cysts whose dimensions exceed 10 cm and are sporadically reported in the literature. Although there are multiple treatment modalities, there are currently no treatment guidelines or consensus on the best therapeutic approach for giant pancreatic pseudocysts. We report the case of a 32-year-old male patient with a giant pancreatic pseudocyst after an episode of acute pancreatitis, which was treated by internal surgical drainage through cyst-jejunal anastomosis. This surgical procedure was followed by the formation of a retroperitoneal abscess which was resolved by ultrasoundguided drainage. The subsequent evolution of the patient was favorable, without other complications. Given their complex anatomical relations, the treatment of giant pseudocysts requires strategies adapted to the local conditions. The optimal choice of the operative time and of the therapeutic strategy is based on clinical considerations and the effectiveness of the method used can be assessed by a long-term follow-up. [ABSTRACT FROM AUTHOR]

Congenital epulis is a rare benign tumor of the newborn that could be detected in the prenatal period. Females are more often affected than males and the premaxillary region is usually the predilection site for this oral mass. Excision is the treatment of choice and no recurrences have been reported so far. We present our experience with two cases of congenital epulis, detected in the second trimester of gestation and treated shortly after birth with no further complications. Histopathology should differentiate between congenital epulis and other congenital oral tumors even if its clinical appearance is usually enough to make a tentative diagnosis. A multidisciplinary assessment in the management of this tumor can avoid unwanted complications such as airway obstruction or bleeding. [ABSTRACT FROM AUTHOR]

The gastrointestinal microbiome contains at least 100 trillion microorganisms (bacteria, viruses, fungi), whose distribution varies from the mouth to the rectum spatially and temporally throughout one's lifetime. The microbiome benefits from advancing research due to its major role in human health. Studies indicate that its functions are immunity, metabolic processes and mucosal barrier. The disturbances of these functions, dysbiosis, influence physiology, lead to diabetes, inflammatory bowel disease, obesity and colon tumorigenesis. The third most common form of cancer, colorectal cancer, is the result of many factors and genes, and although the link between dysbiosis and this type of cancer is poorly characterized, it has been shown that some bacterial species and their metabolites have a critical role in developing colorectal cancer. Also, gut microbiota plays a role in the inflammatory response and immune process perturbations during the progression of colorectal cancer. Some new technologies, such as metagenome sequencing, facilitated the progress by analyzing the metabolic and genetic profile of microbiota, revealing details about the bacterial composition, host interactions, and taxonomic alterations. This review summarizes the studies regarding the link between gut microbiota and colorectal cancer, targeting new therapeutic strategies. [ABSTRACT FROM AUTHOR]

Esophageal tumors are uncommon in pediatric population and most of them are benign. Esophageal hamartomas have been reported extremely rare in children. These can present as intramural tumors of the esophageal wall or as polyps. Dysphagia is the main symptom described in their case, but other specific symptoms are also reported. Such symptoms encountered in clinical practice are represented by obstructive apnea episodes and bradycardia, poor weight gain, epigastric or retrosternal pain, hematemesis or melena, dysphonia or tracheal sounds. Diagnosis can be delayed due to the insidious onset and non-specific symptoms, therefore patient's compliance to follow-up and broad, careful evaluation are mandatory. Preoperative imagistic assessment is extremely important for a precise definition of the tumor's anatomical relations, especially when facing large tumors located in the posterior mediastinum. Herein we report a case of a large chondromatous polypoid hamartoma of the esophagus in a 9 years old boy, emphasizing over the diagnosis and surgical challenges we have met, along with comments on illustrative similar cases reported in the literature. [ABSTRACT FROM AUTHOR]

Prostate cancer represents the leading malignant tumor in men over 50 years of age with 400,000 new cases being diagnosed yearly in Europe. Even if the incidence rate is higher than the mortality rate, still there is an increasing trend when speaking of its mortality. The increasing incidence of the metabolic syndrome, the unhealthy lifestyle, the high lipid and Calcium intake, the high spread of infections with Human Papilloma Virus, Human Herpes Virus, the excess of androgen consumption and the longer life expectancy, are few of the main causes of prostate cancer increasing incidence. The new systemic therapies such as immunotherapy with Checkpoint Inhibitors or Poly, ADP-Ribose Polymerase inhibitors and local experimental procedures addressing tumor destruction, such as High- Intensity Focused Ultrasound, the Cryo and Focal Laser Ablation, provide good outcomes and become new promising tools for prostate cancer therapy. Physicians consider these methods worth using; the efficacy of some specific categories of patients being arguments for their use in the current protocols even though solid data regarding the improvement of global mortality rates are not yet published. The current article focuses on the newest systemic and local experimental treatment tools highlighting their benefits, especially for hormone-resistant prostate cancer. [ABSTRACT FROM AUTHOR]

We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a "burnout syndrome" in the last few months. The particularity of the presented case is the severe coronary artery disease in a young patient without discovering the main etiology of the advanced atherosclerotic process. [ABSTRACT FROM AUTHOR]

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without anesthetic cream, using energies between 14-19J / cm. The average recovery time was 5 days. Registered effects included bruises, pustules, burning sensation, transient stinging, and hypopigmentation. For patients with telangiectasia, the optimal number of sessions was two, performed at an average interval of once per month/monthly. [ABSTRACT FROM AUTHOR]

ACUTE INTESTINAL OBSTRUCTION OCCURS WHENEVER THERE IS ANY INTERRUPTION IN THE NORMAL FLOW OF INTESTINAL CONTENTS. MANAGEMENT OF INTESTINAL OBSTRUCTION IS AIMED TO PRIMARILY CORRECT THE PHYSIOPATHOLOGIC CHANGES CAUSED BY THE OBSTRUCTION ITSELF AND THEN, IF POSSIBLE, REMOVING THE SOURCE OF OBSTRUCTION. THE FORMER THERAPEUTIC ACTION IS ACCOMPLISHED BY INTRAVENOUS FLUID RESUSCITATION WITH INTRAVASCULAR ISOTONIC FLUIDS. EARLY FLUID REPLACEMENT PROVED AN IMPORTANT FACTOR TO REDUCE POSTOPERATIVE MORTALITY, ESPECIALLY IN THE ELDERLY. CHRYSTALLOID SOLUTIONS SEEM TO BE THE BEST OPTION FOR VOLEMIC INITIAL RESUSCITATION. [ABSTRACT FROM AUTHOR]

In very few cases stated in the literature, the vermiform appendix might be contained in a hernial sac. This distinctive pathology is described as Amyand's hernia and has the very small occurrence of about 1%. We report the case of a 62-year-old man that presented for a reducible tumoral mass located in the right inguinal region. Amyand’s hernia was the intraoperative diagnostic. We performed hernioplasty (using the Lichtenstein tension-free mesh repair with a composite polypropylene mesh) without appendectomy. This case matches the type 1 Lossanoff and Basson’s classification and has no facile management. Due to the clinical specificities of each case that presents with defining features of an Amyand’s hernia, surgical management depends on the recommendations stated in the literature, as well as the surgeon’s judgment based on experience. [ABSTRACT FROM AUTHOR]

Morphea or localized scleroderma is an uncommon autoimmune and inflammatory disease which affects patients of any age. Even if morphea lesions present systemic symptoms as myalgias or arthritis, it is distinct from systemic sclerosis because it does not associate Raynaud’s phenomena or sclerodactyly, which are encountered in systemic scleroderma. The most common form of morphea in children is `en coup de sabre`, which can alter the local anatomy by deep tissue involvement. In contrast, the most frequent form that affects adults is represented by circumscribed morphea. The initial lesions present an inflammatory phase that manifests in the form of erythematous plaques, sometimes accompanied by edema. In later stages, the inflammation decreases and the lesions become sclerotic to atrophic. Therapy is most beneficial when initiated in the inflammatory stage. Topical application of high potency steroids along with phototherapy demonstrates the best results in the active phase of the disease. Localized superficial morphea can be treated with the excimer laser (using ultraviolet type B light, in range of 308nm) if topical steroid administration shows no significant clinical improvement. Phototherapy with ultraviolet light is capable of decreasing inflammation and may also have immunomodulatory effects. [ABSTRACT FROM AUTHOR]

THE HUMAN MICROBIOME, AS A WHOLE, AND DUE TO THE COMPLEXITY OF THE GENE, IS THE ONE THAT MAKES THE MAJOR DIFFERENCE BETWEEN INDIVIDUALS OF A SPECIES, OUR VARIABILITY, AS REPORTED ONLY ON ITS OWN GENOME, WAS ESTIMATED TO BE 0.1%. THE STUDY OF THE INFANT GROUP OF PROBIOTICS IN THE CONTEXT OF AN EPISODE OF DIARRHEAL DIARRHEA INDIRECTLY DEMONSTRATES THE IMPORTANCE OF HEALTHY MICROFLORA BY: RAPID NUTRITIONAL RECOVERY, REDUCING THE DURATION OF HOSPITALIZATION, REDUCING THE RISK OF SUBSEQUENT RECURRENCE. BUCCOPHARYNGEAL RECOLONIZATION WITH SAPROPHYTIC BACTERIA SALIVARIUS STREET HAD A POSITIVE ASPECT IN RELIEVING SYMPTOMS, RESTORING THE NORMAL PHARYNGEAL MACROSCOPIC APPEARANCE, AVOIDING ANTIBIOTIC THERAPY. [ABSTRACT FROM AUTHOR]

ANAMNESIS, OR PHYSICIAN-PATIENT DISCUSSION, HAS REMAINED AN ESSENTIAL AND PRELIMINARY STEP FOR ESTABLISHING A CORRECT DIAGNOSIS SINCE HIPPOCRATES. THE RISK OF POSSIBLE ERRORS SHOULD BE MINIMIZED BY PROVIDING SOME PARAMETERS: ACCURACY, GOING THROUGH "CHRONOLOGICAL" INTERVIEWING PHASES, EMPATHY TOWARDS THE PATIENT AND CARETAKERS, PROVIDING A CALM ENVIRONMENT WITHOUT DISTURBANCE, WITHOUT DISTURBANCE, ADAPTING MEDICAL LANGUAGE AND USING DISCERNING MEDICAL TERMS ACCORDING TO THE PARTICULARITIES INTELLECTUALS OF THE INTERLOCUTOR. NOT COMMITTING TO ANY STAGE, ACCURATE AND USEFUL INFORMATION COLLECTION HELPS TO QUICKLY APPLY PROPER TREATMENT, SHORTER HOSPITALIZATION, AND EASIER RECOVERY OF THE PATIENT, THE MORE IT IS ABOUT A CHILD. [ABSTRACT FROM AUTHOR]

ENDOMETRIOSIS IS CHARACTERIZED BY THE PRESENCE OF UTERINE MUCOSAL TISSUE OUTSIDE THE UTERUS. ABDOMINAL WALL ENDOMETRIOSIS (AWE) IS A RARE ENTITY, USUALLY DEVELOPED IN THE FERTILE PERIOD OF WOMEN. IT MEANS ENDOMETRIOSIS OUTSIDE THE PERITONEUM. PARIETAL ENDOMETRIOSIS INCLUDE, BESIDE AWE, PERINEAL ENDOMETRIOSIS. IT CAN BE PRIMARY ENDOMETRIOSIS (WHICH IS QUITE RARE, SUCH AS UMBILICAL), OR, MORE OFTEN, SECONDARY, AFTER SURGICAL OR GYNECOLOGICAL PROCEDURES. SCAR ENDOMETRIOSIS IS DUE TO INTRAOPERATIVE DISEMINATION AND IS MORE FREQUENTLY LOCATED TO C-SECTION SCAR. THE SYMPTOMS INCLUDE CATAMENIAL PAIN, PALPABLE MASS WITH OR WITHOUT CYCLIC VARIATIONS, AND EVEN EXTERNAL HAEMORRAGE SYNCRONOUS WITH MENSTRA. CYCLICITY OF PAIN OR OF MASS DIMENSIONS' VARIATION IS NOT PRESENT IN ALL CASES. DIFFERENTIAL DIAGNOSIS SHOULD BE MADE WITH STITCH GRANULOMA, ABSCESS, LIPOMA, HEMATOMA, SEBACEOUS CYST, SEROMA, HERNIA, OR EVEN MALIGNANT TUMORS. IMAGISTIC METHODS, SUCH AS ULTRASOUND, MRI AND CT SCAN ARE USEFULL FOR DIAGNOSIS. SURGICAL EXCISION OF ENDOMETRIAL MASS IS UNANIMOUSLY CONSIDERED TO BE THE ONLY CURATIVE TREATMENT. [ABSTRACT FROM AUTHOR]

Copyright of Paliatia: Journal of Palliative Care is the property of HOSPICE Casa Sperantei Foundation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Oncology patients often have a nutritional status, which is usually weak and therefore have special needs. Factors such as nausea, lack of appetite, postoperative ileus, postoperative pain, difficulty in swallowing, bedridden state, affect the alimentation capacities of oncology patients, leading to malnutrition over time. Neoplastic cachexia becomes a risk factor per se, which adds to the already precarious condition of the patients. They increase the risk for any further medical maneuvers. For patients in intensive care units, intubated, things become even more difficult, requiring parenteral and enteral nutrition. [ABSTRACT FROM AUTHOR]

Copyright of Paliatia: Journal of Palliative Care is the property of HOSPICE Casa Sperantei Foundation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

GALLBLADDER CARCINOMA IS FAR TO BE AN EXTREMELY RARE DIAGNOSTIC. IT REPRESENTS THE FIFTH LOCATION IN FREQUENCY ORDER FOR DIGESTIVE TRACT MALIGNANCY. IT IS MORE FREQUENT THAN CHOLANGIOCARCINOMA. WE NOTICED RECENTLY (LAST YEARS) AN INCREASING NUMBER OF GALLBLADDER CARCINOMAS IN OUR CLINIC. MOST OF THEM ARE NOT DIAGNOSED PRE-OPERATIVELY. SOME CASES ARE INTRAOPERATIVE SURPRISES AND SOME ARE EVEN POST-OPERATIVE SURPRISES FROM HISTOPATHOLOGY LAB. THE ONCOLOGIC CORRECT SURGICAL TREATMENT ASSUMES A PRE-OPERATIVE DIAGNOSTIC, WHICH, UNFORTUNATELY, IS VERY RARE. SOME SPECIFIC CASES WITH AN ULTRASOUND RESULT SUGGESTING A TUMOR OF THE GALLBLADDER UNDERGO AN ABDOMINAL CT SCAN OR MRI THAT COULD CONFIRM THE DIAGNOSIS. THE MOST COMMON MISMATCH IS ACUTE CHOLECISTITIS. IN THE LAST FIVE YEARS (2014-2018), WE TREATED IN OUR SURGICAL CLINIC 11 CASES OF GALLBLADDER CARCINOMA. [ABSTRACT FROM AUTHOR]

INTRODUCTION. THE DIVERTICULAR DISEASE REPRESENTS A COMMON PATHOLOGY IN DEVELOPED OR DEVELOPING COUNTRIES. FOR ABOUT 80% OF PATIENTS THE DISEASE IS ASYMPTOMATIC (DIVERTICULOSIS), 20% DEVELOPING NON-SPECIFIC DIGESTIVE SYMPTOMS (UNCOMPLICATED SYMPTOMATIC DIVERTICULAR DISEASE) OR CMPLICATIONS, SUCH AS ACUTE DIVERTICULITIS. MATERIAL AND METHOD. THE AIM OF THE RESEARCH IS TO PRESENT THE THERAPEUTICAL APPROACH IN COLONIC DIVERTICULOSIS, UNCOMPLICATED SYMPTOMATIC DIVERTICULAR DISEASE AND ACUTE DIVERTICULITIS, A REVIEW OF THE RECENT MEDICAL LITERATURE BEING MADE TO SUPPORT THE INFORMATION PROVIDED. RESULTS. THE DATA AVAILABLE FROM THE LAST 10 YEARS REGARDING THE SUBJECT HAVE BEEN ANALYZED. OVER THE PAST 5 YEARS 6 DIFFERENT THERAPEUTIC GUIDELINES FOR THE COLONIC DIVERTICULAR DISEASE HAVE BEEN REGISTERED. THERE ARE NO CLEAR INDICATIONS REGARDING THE MEDICAL TREATMENT IN ASYMPTOMATIC COLONIC DIVERTICULOSIS, THE INDICATIONS BEING ALSO LIMITED IN THE CASE OF LOWERING THE RISK OF DIVERTICULOSIS BY INCREASING THE FIBER INTAKE. THERE IS NOT YET A THERAPEUTIC STANDARD IN ASYMPTOMATIC DIVERTICULAR DISEASE, VARIOUS THERAPEUTIC STRATEGIES WITH FIBERS, PROBIOTICS, RIFAXIMIN OR MESALAZINE BEING TAKEN INTO CONSIDERATION. AN AGREEMENT HAS BEEN REACHED IN THE TREATMENT OF THE ACUTE DIVERTICULITIS, THE LATEST GUIDELINES DEMONSTRATING THE FACT THAT ANTIBIOTICS CAN BE ADMINISTERED ONLY IN CAREFULLY SELECTED CASES, AVOIDING THEIR ROUTINE USE. THE RESULTS OF THE VARIOUS STUDIES REGARDING THE PRIMARY OR SECONDARY PROPHYLAXIS IN ACUTE DIVERTICULITIS AND THE EFFICACY OF RIFAXIMIN OR MESALAZINE ARE HETEROGENOUS. CONCLUSIONS. THE THERAPEUTIC MANAGEMENT IN COLONIC DIVERTICULOSIS AND IN UNCOMPLICATED SYMPTOMATIC DIVERTICULAR DISEASE, AS WELL AS THE PRIMARY AND SECONDARY PROPHYLAXIS STRATEGIES REPRESENT REAL CHALLENGES OF THE DAILY MEDICAL PRACTICE. [ABSTRACT FROM AUTHOR]

WE PRESENT A CASE OF A 62 YEARS OLD MAN, WHO WAS ADMITTED RECENTLY IN OUR SURGICAL CLINIC. HE WAS OPERATED LAPAROSCOPICALLY, APPROXIMATELY 7 MONTHS BEFORE, FOR AN ACUTE CALCULOUS CHOLECYSTITIS. HE PRESENTED AT EMERGENCY ROOM FOR PERSISTENT RIGHT FLANK ABDOMINAL PAIN AND A PALPABLE MASS AT THE SAME LEVEL. COLONOSCOPY CONFIRMED THE ABDOMINAL ULTRASOUND SUPPOSITION: A BIG TUMOR OF ASCENDING COLON AND, SURPRISINGLY, ALSO A SMALL TUMOR OF SIGMOID COLON. THE PATIENT WAS OPERATED THROUGH AN OPEN PROCEDURE AND THE POSTOPERATIVE OUTCOME WAS VERY GOOD. THE PARTICULARITY OF THIS CASE IS COEXISTENCE OF ASYMPTOMATIC SYNCHRONOUS COLONIC TUMORS AND ACUTE CALCULOUS CHOLECISTITIS AT THE TIME OF THE FIRST INTERVENTION (CHOLECYSTECTOMY). [ABSTRACT FROM AUTHOR]

INTRODUCTION. THE CONTINUALLY CHANGING OF THE MEDICAL FIELD AND ADVANCES IN DIAGNOSIS AND MANAGEMENT OF MULTIPLE TRAUMA PATIENTS HAVE, RECENTLY, DETERMINED A CONSERVATIVE APPROACH FOR MOST CASES OF BLUNT ABDOMINAL TRAUMA. THE PRESENT STUDY AIMS TO DETERMINE THE IMPACT OF BLUNT ABDOMINAL TRAUMA UPON THE PROCESS OF PERITONEAL ADHESION FORMATION. MATERIAL AND METHOD. THE PURPOSE OF THIS RETROSPECTIVE STUDY IS TO EVALUATE THE PREVALENCE AND SEVERITY OF INTRAABDOMINAL ADHESIONS IN EMERGENCY LAPAROTOMY IN PATIENTS WHO HAD NT BEEN OPERATED BEFORE AND HAD A HISTORY OF BLUNT ABDOMINAL TRAUMA. 10 PATIENTS WHO UNDERWENT EMERGENCY LAPAROTOMY IN THE SURGICAL DEPARTMENT OF "SFẬNTUL PANTELIMON" HOSPITAL FROM BUCHAREST, BETWENN JANUARY 2015-DECEMBER 2016 WERE ENROLLED IN THE STUDY. THE SEVERITY OF INTRAABDOMINAL ADHESIONS WERE EVALUATED USING ZŰHLKE CLASSIFICATION. THE OVERALL ADHESION RATIO FOR THIS STUDY GROUP WAS FOUND TO BE 80%. RESULTS AND CONCLUSIONS. THE MAIN CAUSE FOR BOWEL OBSTRUCTIONS SECONDARY TO INTRABDOMINAL PERITONEAL ADHESIONS IS REPRESENTED BY PREVIOUS INTRAABDOMINAL SURGERY. IN PATIENTS WITH NO SURGICAL HISTORY, INTRAABDOMINAL ADHESIONS HAVE RARELY BEEN ATTRIBUTED TO BLUNT ABDOMINAL TRAUMA. [ABSTRACT FROM AUTHOR]

THE PURPOSE OF THE PRESENT STUDY IS TO DEMONSTRATE THE HIGH INCIDENCE OF THE PERITONEAL ADHESIONS AFTER OPEN ABDOMINAL OR PELVIC SURGERY, IN ORDER TO PROVIDE A BASIS FOR THE FUTURE STUDIES REGARDING THE NEW AND EFFICIENT PREVENTION METHODS. MATERIAL. DATA FROM THE MEDICAL RECORD DATABASE OF THE SURGICAL DEPARTMENT OF "SFẬNTUL PANTELIMON" EMERGENCY HOSPITAL FROM BUCHAREST, ROMANIA, WERE USED IN ORDER TO IDENTIFY PATIENTS UNDERGOING OPEN ABDOMINAL OR PELVIC SURGERY IN 2014, WHO HAD NO RECORD OF SUCH SURGICAL INTERVENTIONS IN THE PRECEDING 5 YEARS, BEING FOLLOWED UP FOR 3 YEARS, UNTIL JANUARY 2018, ANALYSING THE SUBSEQUENT READMISSIONS. THE RATE OF ADHESIONRELATED ADMISSIONS AMONG THE TOTAL NUMBER OF ADMISSIONS BETWEEN JANUARY 2014 AND JANUARY 2018 IN THE GENERAL SURGERY DEPARTMENT WAS, ALSO, ASSESSED. RESULTS. 7% OF ALL READMISSIONS WERE RELATED TO POSTOPERATIVE PERITONEAL ADHESIONS, MOST OF THEM BEING MANAGED OPERATIVELY. 35% OF THE PATIENTS WHO UNDERWENT ABDOMINAL OR PELVIC SURGERY IN 2014 WERE READMITTED FOR AT LEAST ONE TIME OVER THE 3 YEARS OF FOLLOW-UP FOR A COMPLICATION OF THE PERITONEAL ADHESION SYNDROME, MOST OF THE RADMISSIONS OCCURING IN THE FIRST YEAR AFTER THE INITIAL INTERVENTION, BUT CONTINUING STEADILY THROUGHOUT THE 3-YEAR PERIOD. BETWEEN JANUARY 2014 AND JANUARY 2018, 15% OF THE ADMISSIONS WERE DIRECTLY RELATED TO POSTOPERATIVE ADHESIONS. CONCLUSIONS. POSTOPERATIVE PERITONEAL ADHESION SYNDROME HAS AN IMPORTANT IMPACT UPON PATIENTS, SURGEONS AND THE HEALTHCARE SYSTEM, HIGHLIGHTING THE NECESSITY OF EFFICIENT PREVENTION METHODS. [ABSTRACT FROM AUTHOR]

The goal of this paper was the design, development, and characterization of some new composites, based on collagen and dextran as natural polymers and zinc oxide as antimicrobial, to be used in wound healing. Collagen hydrogels with various concentrations of dextran and zinc oxide were investigated in terms of rheological analysis. The spongious composites, obtained by freeze-drying of hydrogels, were evaluated by morphology (SEM), water uptake, and biological (enzymatic biodegradation) analysis. All the results were strongly influenced by the nature and concentration of composite components. Based on the performances of the hydrogels, stationary rheometry, porous structure, morphology, and biological behavior, the antimicrobial spongious composite based on collagen and dextran with 50% ZnO were the most promising for future applications in wound dressing and a biomaterial with high potential in skin regeneration. [ABSTRACT FROM AUTHOR]

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