Niculae Iordache - Academia.edu (original) (raw)
Papers by Niculae Iordache
Mædica, Mar 15, 2024
Inguinoscrotal hernia (ISH) is an entity for which treatment is under debate. Open surgery is the... more Inguinoscrotal hernia (ISH) is an entity for which treatment is under debate. Open surgery is the standard approach, but the laparoscopic technique has a great outcome when used by experienced surgeons. Seroma is one of the complications following laparoscopic hernia repair for these scrotal hernias, which is due to the large hernia sac, usually transected, leaving in place a remnant of the sac. Conservative measures can be applied for the treatment of seroma; however, in symptomatic cases, puncture and aspiration of fluid are recommended. Sometimes, these seromas can reach a large size and require surgery to remove the remnant sac. Herein, we report the case of a 49-year-old male with a large seroma that occurred four days after the laparoscopic approach-total extraperitoneal repair (TEP) for inguinoscrotal hernia. Conservative measures failed, and
Journal of surgical case reports, Apr 1, 2024
Mædica, Dec 15, 2023
Introduction: Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Ope... more Introduction: Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Open and minimally invasive techniques for the treatment of bilateral inguinal hernia have been previously described. If resources and surgeon expertise are available, guidelines recommend laparoscopic repair for this entity. Methods: We analyzed data from 83 patients who underwent laparoscopic inguinal hernia repair (total extraperitoneal repair-TEP) of 158 hernias (146 inguinal hernias and 12 other types). Patients had bilateral symptomatic hernias. Results: Male predominance, with a mean age of 56.7 years, was noted. Lateral hernias (according to EHS classification) were prevalent (71.08%). In the majority of cases (77.11%), meshes made up of a custom polypropylene monofilament mesh were used, followed by Bard 3D Max mesh and Ultralight mesh. Regarding postoperative complications, seroma was the most frequently encountered one in our series (7.23%), followed by urinary retention and 'feeling' of mesh (2.41%). Hydrocele, wound hematoma, cord hematoma and chronic
PubMed, Nov 30, 2023
Introduction: Bilateral inguinal hernia can be safely repaired simultaneously, open or minimally ... more Introduction: Bilateral inguinal hernia can be safely repaired simultaneously, open or minimally invasive, in an elective sce-nario. The choice of surgical approach depends on the patient's status, hernia characteristics, surgeons and patient preferences. Whether age criteria should be considered when selecting between the two approaches is still a matter of debate. Considering that there is no consensus regarding the best repair in bilateral inguinal herniorrhaphy, the aim of the study is to perform an analysis regarding elective surgical approach of patients with bilateral inguinal hernias. Material and Methods: To study the relationship between exposure to an open versus laparoscopic approach in patients with bilateral inguinal hernia, we conducted a case-control study. In our retrospective analysis, cases (23 patients) were the open-approach hernia repair, and controls (82 patients) were laparoscopic hernia repair. We analyzed two sets of variables: first, related to patient characteristics (age 65 years, BMI 30 kg/m2, smoking habit, HTA status, COPD status, DM status, use of anticoagulants, presence of neoplastic status) and second, variables related to hernia features (inguinoscrotal hernia, recurrent hernia and complicated hernia). Results: The mean age for cases was 73.26 (Ã+-12.99) years and that of controls, was 56.48 (Ã+-15.15) years. Univariate analysis demonstrated four variables with statistical significance: age 65 years, inguinoscrotal hernia, neo-plastic status, and anticoagulant use. When introduced into the multivariate analysis, we noted that only two variables, age 65 years (OR=4.183, 95% CI [1.289, 13.572], p=0.017) and use of anticoagulants (OR=38.876, 95% CI [1.305, 1158.011], p=0.035) reached statistical significance. Conclusion: This study demonstrates that when we refer to bilateral inguinal hernia repair, patients aged 65 years are at risk of having an open procedure at least fourfold more than patients aged 65 years. In addition, the use of anticoagulants increases the risk of open hernia repair 38 times more than that of minimally invasive repair for the same age group. Interestingly, in our study, hernia characteristics were not found to be associated with open hernia repair and age 65 years. In our study we found that age 65 years is associated with electing open hernia repair over minimally invasive repair, which can be linked to age-related risk factors. Further re-search is needed to investigate the impact of age and age-related risk factors on surgical outcomes of bilateral inguinal hernia repair.
British Journal of Surgery, May 1, 2023
2. The average CT imaging measurement of the transverse defect was 13,7cm. The median of Cedar's ... more 2. The average CT imaging measurement of the transverse defect was 13,7cm. The median of Cedar's calculation was 27%. 7 patients (54%) only needed a Rives Stoppa Wantz (RSW) for midline closure, but 6 patients still needed a CST. The median time of the surgery for the RSW was 233 min and for the CST 330 min. Of the patients submitted to RSW, 1 complicated with a deep incisional infection and 2 CST patients had surgical complications. No recurrences in the RSW group and one hernia persistence after a major complication on the CST group.
British Journal of Surgery, Oct 1, 2022
Background: Large incisional hernias represent a challenge for parietal surgeon. Thanks to the mo... more Background: Large incisional hernias represent a challenge for parietal surgeon. Thanks to the modification of the Rives-Stoppa technique introduced by Novitsky, a new era in solving complex defects begun. Posterior component separation (PCS) with unilateral/bilateral TAR has promising results in many studies. Our experience is presented in a retrospective study. Method: We present a study on 18 patients (sex ratio=1:1), operated between 2019-2022, with large complex incisional hernias. Mean body mass index was 37.17 kg/m2 (range 31-42). Mean age-58 years (range 34-70 years). We used PCS with bilateral TAR in 12 cases (66.66%) and unilateral TAR in 6 cases. One of the hernias was a combined midline-large parastomal hernia operated using Pauli technique. 5 of the hernias (27.78%) were lumbar, of which 2 were operated with hybrid technique (open and laparoscopic), using reverse TAR. Mesh used was polypropylene (61.11%) and ePTFE mesh (38.89%). The prothesis size ranged from 20×25 cm to 34×32 cm. Mean operative time was 3.41 hrs (range 2-4 hrs). Average hospitalization time was 5.44 days (range 2-14 days). Results: Fascial closure anterior to mesh was achieved in 72.22% of patients. No recurrences were reported in the follow-up (3-12 months). Postoperative morbidity: seromas (33.33%), wound infection (11.11%), hematoma (5.55%). Conclusions: Rives-Stoppa technique is the gold standard in VHR. Extending this technique with PCS-TAR in complex incisional hernias seems to be the perfect solution in obese patients with great outcome and low postoperative morbidity. Also the hybrid approach has great results and we hence recommend.
Practica medicală, Jun 30, 2017
Objectives. Evaluation of management of intra-and postoperative analgesia in patients who benefit... more Objectives. Evaluation of management of intra-and postoperative analgesia in patients who benefited from total hip arthroplasty in the surgical treatment of coxarthrosis. The achievement of this goal could reside in the comparison of two distinct methods of anaesthesiology: epidural analgesia and continuous lumbar plexus block. Materials and methods. The current prospective study, conducted between January 2014 and January 2016, targets a total of 48 patients who underwent total hip replacement surgery. There was a split in two groups: 23 patients benefited from epidural analgesia and 25 patients were selected for lumbar plexus block, depending on the procedure chosen by the anaesthetist. Both groups received the same concentration of initial dose of 0.75% Ropivacaine, the first group initially receiving 3 ml (test dose), then another 6 ml, and the second initially 5 ml (test dose), then 15 ml. Through catheters were injected continuously 8 ml / h of 0.2% Ropivacaine for the first group and 10 ml / h of Ropivacaine 0.375%, these doses being adjusted to Pain Visits, performed twice a day. The purpose of these visits was to monitor both the evolution of implanted catheters and the completion of mandatory protocols (these protocols monitor sensitivity and motor activity of limbs, initiation of mobilization, opioid supplementation to ongoing therapy, and patients' satisfaction with therapy, at catheter removal). Results. Patients in the first group had the highest satisfaction rate of 30.4%, compared to patients in the second group, who scored 52% for the 15 (maximum) level of satisfaction. In the first group of patients, 52.2% did not require additional opioids for ongoing therapy (in postoperative units or in the department), while for patients in the second group the percentage was 60%. In terms of complications, the differences are notable and have an important statistical value: the first category of patients, 52.17% (n = 12), the second category, 12% (n = 3). Day zero (surgery day) is not marked by significant differences between the two categories of people in treatment, in terms of pain intensity. At rest, 78.2% of the first category patients and 84% of the second category patients had a NRS of less than or equal to 4, while in the state of mobilization, the percentages were 78.2% and 80% respectively. The initiation of mobilization is an important parameter, which also
PubMed, 1991
The case of a 55-year-old woman with a duodenal ulcer developing since 6 months is reported, in w... more The case of a 55-year-old woman with a duodenal ulcer developing since 6 months is reported, in whom the surgical indication was early established on the basis of increasing of suffering and inefficacy of the medical treatment. Intraoperatively an exophytic pancreatic tumour sited on the upper border of the isthmus, sized 5/6/4 cm, was found. In view of the suspicion of gastrinoma and considering that total gastrectomy or splenopancreatectomy would be excessive taking into account the patient's state, option was made for exeresis of the tumour. The ulcerous suffering disappeared and the histological examination of the specimen (weighting 70 g) confirmed a benign gastrinoma. The peculiarities of the case and data from the literature dealing with gastrinomas are discussed.
Diagnostics, Feb 27, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Annals of Hepato-Biliary-Pancreatic surgery, Jun 30, 2021
EP-209 Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life... more EP-209 Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life of the resident in a young team practicing such surgery in a developing country look like? Methods: Surgical residents interested in acquiring advanced training in HBP surgery should take a fellowship in this kind of surgery, spending at least four years in a specialized center. Results: The pre and postoperative management of patients is a core function of a junior doctor, but they have to be involved in every step of the journey represented by complex HBP surgery: from establishing anesthesia routine to training team and taking part in tumor board meetings. Mentorship is also a key factor in promoting and maintaining fulfillment in surgical practice. Conclusions: In a young HBP team, bidirectional growth-both mentors and residents is crucial to developing this king of surgery. Working hard, studying and training every day are very important steps in order to build a career as a HBP surgeon.
The European Research Journal, May 4, 2022
Objectives: Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptida... more Objectives: Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptidases play an important role in adipogenesis and angiogenesis by modifying tissues and degrading the extracellular matrix (ECM). Matrix glycoproteins, gelatin, collagens, proteoglycans and elastin are all found in the ECM. Current meta-analysis confirmed the lower levels of IL-6 and CRP was found following bariatric surgery. Several studies have shown correlations between E-selectin levels, BMI, and MMP-9 levels. There was also a strong link between the metalloproteinases MMP-2 and MMP-9. MMP-2 and adiponectin levels are related. MMP-9 levels, on the other hand, were modestly linked with E-selectin and HDL cholesterol levels, as previously stated. Also current observations imply that alterations in the ECM caused by MMP-mediated degradation may be crucial for the differentiation of adipocytes. The most crucial component of this is that MMPs are involved in the remodeling of tissue after gastric bypass surgery, as revealed by these markers (especially MMP-2 and MMP-9). Thus, it is tempting to assume that adipocyte derived MMPs may constitute a novel pharmaceutical target for limiting adipose tissue development through the reduction of adipocyte differentiation and angiogenesis. MMP-2 exhibits far more accurate oscillations than MMP-9 during pre-and post-surgical weight fluctuations, and hence may be used as a predictor for gastric bypass success. The purpose of this paper is to conduct a comprehensive review of the literature with an emphasis on the critical functions that MMPs have in the pathophysiology of obesity and the related diseases.
British Journal of Surgery, 2021
Aim Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impa... more Aim Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impalpable testis and CT/MRI. The surgical correction of cryptorchidism is possible in childhood, but in adult orchiectomy is recommended, considering the malignancy risk. The association with hernia is uncommon. Material and Methods We report the case of a 23 years old male with left inguinal hernia and concomitant left cryptorchidism. MRI revealed the intra-abdominal left testicle, with reduced size and short vessels. Lab analysis were normal. We underwent laparoscopic exploration: the left testicle was small and had pelvic localization. A large inguinal hernia was also confirmed. We decided to perform laparoscopic TAPP (transaabdominal preperitoneal repair) and left orchiectomy. The evolution was uneventful and patient discharged 1st day postoperatively. Histology revealed testicular atrophy with no malignancy, also no spermatogenesis was present. No recurrence was found during follow-up....
Hpb, 2019
operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusi... more operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusion: Hepatic artery pseudoaneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.
Public Health and Toxicology
The European Research Journal
Objectives: Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptida... more Objectives: Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptidases play an important role in adipogenesis and angiogenesis by modifying tissues and degrading the extracellular matrix (ECM). Matrix glycoproteins, gelatin, collagens, proteoglycans and elastin are all found in the ECM. Current meta-analysis confirmed the lower levels of IL-6 and CRP was found following bariatric surgery. Several studies have shown correlations between E-selectin levels, BMI, and MMP-9 levels. There was also a strong link between the metalloproteinases MMP-2 and MMP-9. MMP-2 and adiponectin levels are related. MMP-9 levels, on the other hand, were modestly linked with E-selectin and HDL cholesterol levels, as previously stated. Also current observations imply that alterations in the ECM caused by MMP-mediated degradation may be crucial for the differentiation of adipocytes. The most crucial component of this is that MMPs are involved in the remodeling of tissue after gastric bypass surgery, as revealed by these markers (especially MMP-2 and MMP-9). Thus, it is tempting to assume that adipocyte derived MMPs may constitute a novel pharmaceutical target for limiting adipose tissue development through the reduction of adipocyte differentiation and angiogenesis. MMP-2 exhibits far more accurate oscillations than MMP-9 during pre-and post-surgical weight fluctuations, and hence may be used as a predictor for gastric bypass success. The purpose of this paper is to conduct a comprehensive review of the literature with an emphasis on the critical functions that MMPs have in the pathophysiology of obesity and the related diseases.
Annals of Hepato-Biliary-Pancreatic Surgery
Annals of Hepato-Biliary-Pancreatic Surgery, 2021
EP-209 Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life... more EP-209 Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life of the resident in a young team practicing such surgery in a developing country look like? Methods: Surgical residents interested in acquiring advanced training in HBP surgery should take a fellowship in this kind of surgery, spending at least four years in a specialized center. Results: The pre and postoperative management of patients is a core function of a junior doctor, but they have to be involved in every step of the journey represented by complex HBP surgery: from establishing anesthesia routine to training team and taking part in tumor board meetings. Mentorship is also a key factor in promoting and maintaining fulfillment in surgical practice. Conclusions: In a young HBP team, bidirectional growth-both mentors and residents is crucial to developing this king of surgery. Working hard, studying and training every day are very important steps in order to build a career as a HBP surgeon.
Medical Science and Discovery, 2020
Objective: Obesity is an exceedingly current pathology with many clinical, molecular, and psychol... more Objective: Obesity is an exceedingly current pathology with many clinical, molecular, and psychological implications. The number of obese people has doubled in the past ten years, and we can observe an early onset of obesity. Bariatric surgery is an effective treatment for severe obesity and type 2 diabetes mellitus (T2DM); Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most prevalent types of this procedure . Nevertheless, no single mechanism has emerged that thoroughly explains the metabolic benefit and subsequent long-term effects after surgery. Webster's new collegiate dictionary defines the noun model as: 'a descriptive or analogy used to help visualize something that cannot be directly observed.' Sustained by this definition, the animal models in nutritional research are fundamental to improve human conditions. Due to the recent boost in experimental surgery, our aim in this study is to set the main technical characteristics of the gastric ...
Mædica, Mar 15, 2024
Inguinoscrotal hernia (ISH) is an entity for which treatment is under debate. Open surgery is the... more Inguinoscrotal hernia (ISH) is an entity for which treatment is under debate. Open surgery is the standard approach, but the laparoscopic technique has a great outcome when used by experienced surgeons. Seroma is one of the complications following laparoscopic hernia repair for these scrotal hernias, which is due to the large hernia sac, usually transected, leaving in place a remnant of the sac. Conservative measures can be applied for the treatment of seroma; however, in symptomatic cases, puncture and aspiration of fluid are recommended. Sometimes, these seromas can reach a large size and require surgery to remove the remnant sac. Herein, we report the case of a 49-year-old male with a large seroma that occurred four days after the laparoscopic approach-total extraperitoneal repair (TEP) for inguinoscrotal hernia. Conservative measures failed, and
Journal of surgical case reports, Apr 1, 2024
Mædica, Dec 15, 2023
Introduction: Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Ope... more Introduction: Bilateral inguinal hernia is a distinct entity in the inguinal hernia category. Open and minimally invasive techniques for the treatment of bilateral inguinal hernia have been previously described. If resources and surgeon expertise are available, guidelines recommend laparoscopic repair for this entity. Methods: We analyzed data from 83 patients who underwent laparoscopic inguinal hernia repair (total extraperitoneal repair-TEP) of 158 hernias (146 inguinal hernias and 12 other types). Patients had bilateral symptomatic hernias. Results: Male predominance, with a mean age of 56.7 years, was noted. Lateral hernias (according to EHS classification) were prevalent (71.08%). In the majority of cases (77.11%), meshes made up of a custom polypropylene monofilament mesh were used, followed by Bard 3D Max mesh and Ultralight mesh. Regarding postoperative complications, seroma was the most frequently encountered one in our series (7.23%), followed by urinary retention and 'feeling' of mesh (2.41%). Hydrocele, wound hematoma, cord hematoma and chronic
PubMed, Nov 30, 2023
Introduction: Bilateral inguinal hernia can be safely repaired simultaneously, open or minimally ... more Introduction: Bilateral inguinal hernia can be safely repaired simultaneously, open or minimally invasive, in an elective sce-nario. The choice of surgical approach depends on the patient's status, hernia characteristics, surgeons and patient preferences. Whether age criteria should be considered when selecting between the two approaches is still a matter of debate. Considering that there is no consensus regarding the best repair in bilateral inguinal herniorrhaphy, the aim of the study is to perform an analysis regarding elective surgical approach of patients with bilateral inguinal hernias. Material and Methods: To study the relationship between exposure to an open versus laparoscopic approach in patients with bilateral inguinal hernia, we conducted a case-control study. In our retrospective analysis, cases (23 patients) were the open-approach hernia repair, and controls (82 patients) were laparoscopic hernia repair. We analyzed two sets of variables: first, related to patient characteristics (age 65 years, BMI 30 kg/m2, smoking habit, HTA status, COPD status, DM status, use of anticoagulants, presence of neoplastic status) and second, variables related to hernia features (inguinoscrotal hernia, recurrent hernia and complicated hernia). Results: The mean age for cases was 73.26 (Ã+-12.99) years and that of controls, was 56.48 (Ã+-15.15) years. Univariate analysis demonstrated four variables with statistical significance: age 65 years, inguinoscrotal hernia, neo-plastic status, and anticoagulant use. When introduced into the multivariate analysis, we noted that only two variables, age 65 years (OR=4.183, 95% CI [1.289, 13.572], p=0.017) and use of anticoagulants (OR=38.876, 95% CI [1.305, 1158.011], p=0.035) reached statistical significance. Conclusion: This study demonstrates that when we refer to bilateral inguinal hernia repair, patients aged 65 years are at risk of having an open procedure at least fourfold more than patients aged 65 years. In addition, the use of anticoagulants increases the risk of open hernia repair 38 times more than that of minimally invasive repair for the same age group. Interestingly, in our study, hernia characteristics were not found to be associated with open hernia repair and age 65 years. In our study we found that age 65 years is associated with electing open hernia repair over minimally invasive repair, which can be linked to age-related risk factors. Further re-search is needed to investigate the impact of age and age-related risk factors on surgical outcomes of bilateral inguinal hernia repair.
British Journal of Surgery, May 1, 2023
2. The average CT imaging measurement of the transverse defect was 13,7cm. The median of Cedar's ... more 2. The average CT imaging measurement of the transverse defect was 13,7cm. The median of Cedar's calculation was 27%. 7 patients (54%) only needed a Rives Stoppa Wantz (RSW) for midline closure, but 6 patients still needed a CST. The median time of the surgery for the RSW was 233 min and for the CST 330 min. Of the patients submitted to RSW, 1 complicated with a deep incisional infection and 2 CST patients had surgical complications. No recurrences in the RSW group and one hernia persistence after a major complication on the CST group.
British Journal of Surgery, Oct 1, 2022
Background: Large incisional hernias represent a challenge for parietal surgeon. Thanks to the mo... more Background: Large incisional hernias represent a challenge for parietal surgeon. Thanks to the modification of the Rives-Stoppa technique introduced by Novitsky, a new era in solving complex defects begun. Posterior component separation (PCS) with unilateral/bilateral TAR has promising results in many studies. Our experience is presented in a retrospective study. Method: We present a study on 18 patients (sex ratio=1:1), operated between 2019-2022, with large complex incisional hernias. Mean body mass index was 37.17 kg/m2 (range 31-42). Mean age-58 years (range 34-70 years). We used PCS with bilateral TAR in 12 cases (66.66%) and unilateral TAR in 6 cases. One of the hernias was a combined midline-large parastomal hernia operated using Pauli technique. 5 of the hernias (27.78%) were lumbar, of which 2 were operated with hybrid technique (open and laparoscopic), using reverse TAR. Mesh used was polypropylene (61.11%) and ePTFE mesh (38.89%). The prothesis size ranged from 20×25 cm to 34×32 cm. Mean operative time was 3.41 hrs (range 2-4 hrs). Average hospitalization time was 5.44 days (range 2-14 days). Results: Fascial closure anterior to mesh was achieved in 72.22% of patients. No recurrences were reported in the follow-up (3-12 months). Postoperative morbidity: seromas (33.33%), wound infection (11.11%), hematoma (5.55%). Conclusions: Rives-Stoppa technique is the gold standard in VHR. Extending this technique with PCS-TAR in complex incisional hernias seems to be the perfect solution in obese patients with great outcome and low postoperative morbidity. Also the hybrid approach has great results and we hence recommend.
Practica medicală, Jun 30, 2017
Objectives. Evaluation of management of intra-and postoperative analgesia in patients who benefit... more Objectives. Evaluation of management of intra-and postoperative analgesia in patients who benefited from total hip arthroplasty in the surgical treatment of coxarthrosis. The achievement of this goal could reside in the comparison of two distinct methods of anaesthesiology: epidural analgesia and continuous lumbar plexus block. Materials and methods. The current prospective study, conducted between January 2014 and January 2016, targets a total of 48 patients who underwent total hip replacement surgery. There was a split in two groups: 23 patients benefited from epidural analgesia and 25 patients were selected for lumbar plexus block, depending on the procedure chosen by the anaesthetist. Both groups received the same concentration of initial dose of 0.75% Ropivacaine, the first group initially receiving 3 ml (test dose), then another 6 ml, and the second initially 5 ml (test dose), then 15 ml. Through catheters were injected continuously 8 ml / h of 0.2% Ropivacaine for the first group and 10 ml / h of Ropivacaine 0.375%, these doses being adjusted to Pain Visits, performed twice a day. The purpose of these visits was to monitor both the evolution of implanted catheters and the completion of mandatory protocols (these protocols monitor sensitivity and motor activity of limbs, initiation of mobilization, opioid supplementation to ongoing therapy, and patients' satisfaction with therapy, at catheter removal). Results. Patients in the first group had the highest satisfaction rate of 30.4%, compared to patients in the second group, who scored 52% for the 15 (maximum) level of satisfaction. In the first group of patients, 52.2% did not require additional opioids for ongoing therapy (in postoperative units or in the department), while for patients in the second group the percentage was 60%. In terms of complications, the differences are notable and have an important statistical value: the first category of patients, 52.17% (n = 12), the second category, 12% (n = 3). Day zero (surgery day) is not marked by significant differences between the two categories of people in treatment, in terms of pain intensity. At rest, 78.2% of the first category patients and 84% of the second category patients had a NRS of less than or equal to 4, while in the state of mobilization, the percentages were 78.2% and 80% respectively. The initiation of mobilization is an important parameter, which also
PubMed, 1991
The case of a 55-year-old woman with a duodenal ulcer developing since 6 months is reported, in w... more The case of a 55-year-old woman with a duodenal ulcer developing since 6 months is reported, in whom the surgical indication was early established on the basis of increasing of suffering and inefficacy of the medical treatment. Intraoperatively an exophytic pancreatic tumour sited on the upper border of the isthmus, sized 5/6/4 cm, was found. In view of the suspicion of gastrinoma and considering that total gastrectomy or splenopancreatectomy would be excessive taking into account the patient's state, option was made for exeresis of the tumour. The ulcerous suffering disappeared and the histological examination of the specimen (weighting 70 g) confirmed a benign gastrinoma. The peculiarities of the case and data from the literature dealing with gastrinomas are discussed.
Diagnostics, Feb 27, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Annals of Hepato-Biliary-Pancreatic surgery, Jun 30, 2021
EP-209 Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life... more EP-209 Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life of the resident in a young team practicing such surgery in a developing country look like? Methods: Surgical residents interested in acquiring advanced training in HBP surgery should take a fellowship in this kind of surgery, spending at least four years in a specialized center. Results: The pre and postoperative management of patients is a core function of a junior doctor, but they have to be involved in every step of the journey represented by complex HBP surgery: from establishing anesthesia routine to training team and taking part in tumor board meetings. Mentorship is also a key factor in promoting and maintaining fulfillment in surgical practice. Conclusions: In a young HBP team, bidirectional growth-both mentors and residents is crucial to developing this king of surgery. Working hard, studying and training every day are very important steps in order to build a career as a HBP surgeon.
The European Research Journal, May 4, 2022
Objectives: Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptida... more Objectives: Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptidases play an important role in adipogenesis and angiogenesis by modifying tissues and degrading the extracellular matrix (ECM). Matrix glycoproteins, gelatin, collagens, proteoglycans and elastin are all found in the ECM. Current meta-analysis confirmed the lower levels of IL-6 and CRP was found following bariatric surgery. Several studies have shown correlations between E-selectin levels, BMI, and MMP-9 levels. There was also a strong link between the metalloproteinases MMP-2 and MMP-9. MMP-2 and adiponectin levels are related. MMP-9 levels, on the other hand, were modestly linked with E-selectin and HDL cholesterol levels, as previously stated. Also current observations imply that alterations in the ECM caused by MMP-mediated degradation may be crucial for the differentiation of adipocytes. The most crucial component of this is that MMPs are involved in the remodeling of tissue after gastric bypass surgery, as revealed by these markers (especially MMP-2 and MMP-9). Thus, it is tempting to assume that adipocyte derived MMPs may constitute a novel pharmaceutical target for limiting adipose tissue development through the reduction of adipocyte differentiation and angiogenesis. MMP-2 exhibits far more accurate oscillations than MMP-9 during pre-and post-surgical weight fluctuations, and hence may be used as a predictor for gastric bypass success. The purpose of this paper is to conduct a comprehensive review of the literature with an emphasis on the critical functions that MMPs have in the pathophysiology of obesity and the related diseases.
British Journal of Surgery, 2021
Aim Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impa... more Aim Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impalpable testis and CT/MRI. The surgical correction of cryptorchidism is possible in childhood, but in adult orchiectomy is recommended, considering the malignancy risk. The association with hernia is uncommon. Material and Methods We report the case of a 23 years old male with left inguinal hernia and concomitant left cryptorchidism. MRI revealed the intra-abdominal left testicle, with reduced size and short vessels. Lab analysis were normal. We underwent laparoscopic exploration: the left testicle was small and had pelvic localization. A large inguinal hernia was also confirmed. We decided to perform laparoscopic TAPP (transaabdominal preperitoneal repair) and left orchiectomy. The evolution was uneventful and patient discharged 1st day postoperatively. Histology revealed testicular atrophy with no malignancy, also no spermatogenesis was present. No recurrence was found during follow-up....
Hpb, 2019
operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusi... more operative course went uneventfully, and patient was discharged on post-operative day 10. Conclusion: Hepatic artery pseudoaneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.
Public Health and Toxicology
The European Research Journal
Objectives: Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptida... more Objectives: Matrix Metalloproteinases (MMPs), these calcium-dependent zinc-containing endopeptidases play an important role in adipogenesis and angiogenesis by modifying tissues and degrading the extracellular matrix (ECM). Matrix glycoproteins, gelatin, collagens, proteoglycans and elastin are all found in the ECM. Current meta-analysis confirmed the lower levels of IL-6 and CRP was found following bariatric surgery. Several studies have shown correlations between E-selectin levels, BMI, and MMP-9 levels. There was also a strong link between the metalloproteinases MMP-2 and MMP-9. MMP-2 and adiponectin levels are related. MMP-9 levels, on the other hand, were modestly linked with E-selectin and HDL cholesterol levels, as previously stated. Also current observations imply that alterations in the ECM caused by MMP-mediated degradation may be crucial for the differentiation of adipocytes. The most crucial component of this is that MMPs are involved in the remodeling of tissue after gastric bypass surgery, as revealed by these markers (especially MMP-2 and MMP-9). Thus, it is tempting to assume that adipocyte derived MMPs may constitute a novel pharmaceutical target for limiting adipose tissue development through the reduction of adipocyte differentiation and angiogenesis. MMP-2 exhibits far more accurate oscillations than MMP-9 during pre-and post-surgical weight fluctuations, and hence may be used as a predictor for gastric bypass success. The purpose of this paper is to conduct a comprehensive review of the literature with an emphasis on the critical functions that MMPs have in the pathophysiology of obesity and the related diseases.
Annals of Hepato-Biliary-Pancreatic Surgery
Annals of Hepato-Biliary-Pancreatic Surgery, 2021
EP-209 Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life... more EP-209 Introduction: What does hepato-biliary-pancreatic (HBP) surgery mean and how does the life of the resident in a young team practicing such surgery in a developing country look like? Methods: Surgical residents interested in acquiring advanced training in HBP surgery should take a fellowship in this kind of surgery, spending at least four years in a specialized center. Results: The pre and postoperative management of patients is a core function of a junior doctor, but they have to be involved in every step of the journey represented by complex HBP surgery: from establishing anesthesia routine to training team and taking part in tumor board meetings. Mentorship is also a key factor in promoting and maintaining fulfillment in surgical practice. Conclusions: In a young HBP team, bidirectional growth-both mentors and residents is crucial to developing this king of surgery. Working hard, studying and training every day are very important steps in order to build a career as a HBP surgeon.
Medical Science and Discovery, 2020
Objective: Obesity is an exceedingly current pathology with many clinical, molecular, and psychol... more Objective: Obesity is an exceedingly current pathology with many clinical, molecular, and psychological implications. The number of obese people has doubled in the past ten years, and we can observe an early onset of obesity. Bariatric surgery is an effective treatment for severe obesity and type 2 diabetes mellitus (T2DM); Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most prevalent types of this procedure . Nevertheless, no single mechanism has emerged that thoroughly explains the metabolic benefit and subsequent long-term effects after surgery. Webster's new collegiate dictionary defines the noun model as: 'a descriptive or analogy used to help visualize something that cannot be directly observed.' Sustained by this definition, the animal models in nutritional research are fundamental to improve human conditions. Due to the recent boost in experimental surgery, our aim in this study is to set the main technical characteristics of the gastric ...