Nutritional status prior to bariatric surgery for severe obesity: a review.

Obesity pandemic represents a threat to public health of paramount importance. Bariatric surgery represents the most effective and long-lasting treatment for severe obesity so far. The nutritional status of obese patients seeking bariatric surgery is impaired prior to surgery because of prevalent nutritional deficiencies.

Transfemoral Approach in Revision Hip Arthroplasty: A Prospective Analysis of 36 Cases: Radiological and Functional Results at a Minimum 2 Years Follow-up.

: One of the most difficult aspects of hip revision is to remove the stem from the femoral canal with or without cement while maintaining the maximal amount of bone stock to obtain the best possible press-fit of the revision prosthesis. The transfemoral approach ensures direct access to the medullary canal so that the content removal is completed under direct control, while protecting the bone. This type of approach is particularly efficient for special conditions, such as deformation of the proximal femoral region, broken stems, or the presence of cement over a long distance distal to the prosthesis.

Bone Mineral Density Trends During the First Year After Laparoscopic Sleeve Gastrectomy-a Cohort Study on 241 Patients.

Purpose: Laparoscopic sleeve gastrectomy (LSG) is an effective weight loss procedure, but detrimental effects on bone health have been described. We aimed to assess the dynamics of regional and total bone mineral density (BMD) in a cohort of patients undergoing LSG and to capture gender differences in terms of evolution.

Materials And Methods: We conducted a retrospective study on 241 patients who underwent LSG to determine the regional and total BMD changes at 6 and 12 months after the intervention.

Bariatric Surgery in Obesity: Effects on Gut Microbiota and Micronutrient Status.

Obesity is associated with reduced gut microbial diversity and a high rate of micronutrient deficiency. Bariatric surgery, the therapy of choice for severe obesity, produces sustained weight loss and improvements in obesity-related comorbidities. Also, it significantly alters the gut microbiota (GM) composition and function, which might have an important impact on the micronutrient status as GM is able to synthesize certain vitamins, such as riboflavin, folate, B, or vitamin K.

Laparoscopic total hysterectomy still not routinely chosen Operative description and available instruments.

Hysterectomy is the most common gynecological surgical intervention; therefore, there are many technical variations in different healthcare systems around the world. We aimed to review, step by step, the technique of laparoscopic hysterectomy as well as to present the available variety of surgical instruments impartially so that the operative team can decide in an informed manner the model and characteristics of the equipment used. The surgical technique is presented based on the experience of the authors, focusing mainly on intraoperative recommendation and suggestions.

Identification of significant obstructive sleep apnoea in the obese patient: development of the novel DX-OSA score.

Background And Objectives: There is a high prevalence of undiagnosed obstructive sleep apnoea (OSA) in obese surgical patients. We investigated the extent to which anthropometric measurements can be used to identify the presence of significant OSA (Apnoea/Hypopnoea Index (AHI) ≥ 20) in adult patients.

Materials And Methods: We prospectively studied 1357 adult patients scheduled for elective laparoscopic bariatric surgery.

Basic Features and Clinical Applicability of 'Preliminary Universal Surgical Invasiveness Score' (pUSIS): A Multi-Centre Pilot Study.

Objective: There is still a lack of a universally applicable and comprehensive scoring system for documenting the invasiveness of surgical procedures. The proposed preliminary 'Universal Surgical Invasiveness Score' (pUSIS) is intended to fill this gap.

Methods: We used the recently developed pUSIS to obtain values from 8 types of surgery and 80 individual interventions.

Hepatic Resection for Liver Metastases from Cervical Cancer Is Safe and May Have Survival Benefit.

The goal of this study was to evaluate the single-centre experience with hepatectomy for liver metastases from cervical cancer (CCLM). Fifteen patients who underwent such surgery at the Fundeni Clinical Hospital between January 2002 and April 2014 were retrospectively reviewed. Liver lesions diagnosed at more than 6 months from cervical cancer diagnosis were classified as metachronous lesions, while lesions occurring within the first 6 months were considered synchronous lesions.

Endometrial Adenocarcinoma Presenting as Hematometra with Underlying Thickened Endometrial Lining in a Postmenopausal Woman - A Case Report.

Background: Although most postmenopausal women diagnosed with endometrial cancer usually present with vaginal bleeding, when complete cervical stenosis is present, this sign may be missing. In these cases, the patient usually complaints for pelvic or abdominal pain while the transvaginal ultrasonography might reveal the presence of an intrauterine fluid collection in association with a thickened endometrial lining.

Case Report: We present the case of a 65-year-old patient who presented with association of pelvic pain, enlarged uterine cavity with an underlying hematometra and an irregular, thickened endometrium who was submitted to surgery for total histerectomy, bilateral adnexectomy, pelvic and para-aortic lymph node dissection.

Incidental Finding of a Neuroendocrine Tumor Arising from Meckel Diverticulum During Hernia Repair - A Case Report and Literature Review.

Meckel diverticulum is the most common abnormality of the gastrointestinal tract arising from an incomplete obliteration of the vitelline duct during the intrauterine life. Although tumor development in Meckel diverticulum is not a common situation, it can occur due to the persistence of cellular islets with gastric, pancreatic or intestinal origin. The presence of a neuroendocrine tumor arising from Meckel diverticulum is even scarcer.

Atypical Right Hepatectomy for Liver Metastasis from Ovarian Leiomyosarcoma - A Case Report and Literature Review.

Ovarian leiomyosarcomas are extremely rare ovarian malignancies, usually associated with poor prognosis in terms of survival. Most often, ovarian leiomyosarcomas are diagnosed in postmenopausal women at an advanced stage of disease, the main symptoms consisting of abdominal pain. We present the case of a 52-year-old patient who was initially submitted to surgery for a large ruptured ovarian tumor in April 2009; at that time, total hysterectomy with bilateral adnexectomy, omentectomy, pelvic and para-aortic lymph node dissection were performed.

Large cell neuroendocrine cervical tumor treated by radical surgery and adjuvant chemotherapy: A case report and literature review.

Neuroendocrine carcinomas of the uterine cervix are rare, but extremely aggressive, gynecological malignancies that are associated with an overall poor prognosis. The present study reports the case of a 41-year-old patient diagnosed with large cell neuroendocrine cervical tumor. A radical total hysterectomy with bilateral adnexectomy, pelvic and lymph node dissection was performed.

Long-term Survivors After Liver Resection for Ovarian Cancer Liver Metastases.

Unlabelled: Ovarian cancer is one of the most aggressive gynecological malignancies and most patients are diagnosed at an advanced stage of disease. In these cases, the best therapeutic approach in order to provide good control remains an aggressive surgical approach leading to complete R0 resection. The experience provided by performing liver resection for colorectal hepatic metastases in association with the observation that residual disease remains the most important prognostic factor in ovarian cancer encouraged surgeons worldwide to include hepatic resection as part of the therapeutic armamentarium in ovarian cancer liver metastases.

Long-term Survivors After Liver Resection for Breast Cancer Liver Metastases.

Unlabelled: Although breast cancer liver metastases are considered a sign of systemic recurrence and are considered a poor prognostic factor that transforms the patient into a candidate for palliative chemotherapy, surgery might be performed with good results. Success reported after liver resection for colorectal hepatic metastases encouraged the oncological surgeon to apply similar protocols in breast cancer liver metastases.

Patients And Methods: Data of patients submitted to hepatectomies for breast cancer liver metastases in the "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest were retrospectively reviewed.

The Role of Re-resection for Breast Cancer Liver Metastases-a Single Center Experience.

Unlabelled: The aim of the present study was to evaluate the effectiveness and safety of hepatic re-resection for breast cancer liver metastases.

Patients And Methods: Between January 2004 and December 2014 seven patients were submitted to liver re-resection for breast cancer liver metastases at our Center. The main inclusion criteria were presence of isolated liver metastases and absence of systemic recurrent disease Results: The median age at the time of breast surgery was 51 years (range=39-69 years).

Hematogenous Splenic Metastases as an Independent Negative Prognosis Factor at the Moment of Primary Cytoreduction in Advanced Stage Epithelial Ovarian Cancer--A Single Center Experience.

Ovarian cancer represents an aggressive gynecological malignancy with a high capacity for dissemination. Once the tumor cells go beyond the pelvic area, upper abdominal involvement, including hepatic, diaphragmatic or even splenic, is frequently seen. The aim of the present study was to determine the impact on survival of parenchymatous versus peritoneal splenic metastases versus splenic hilum lymph node involvement at the time of primary cytoreduction for advanced-stage epithelial ovarian cancer.

Endometrial Carcinoma Associated with Ovarian Granulosa Cell Tumors--A Case Report.

Ovarian granulosa cell tumors represent uncommon neoplasms with estrogen-secreting capacity. Due to their association with persistently increased levels of estrogen, modifications of the endometrial tissue ranging from hyperplasia to malignant degeneration may be encountered. We present the case of a 65-year-old patient who presented for post-menopausal vaginal bleeding.

Use of Inflated Foley Catheters to Prevent Early Empty Pelvis Complications Following Pelvic Exenteration.

For most patients with bulky pelvic tumors, pelvic exenteration remains the only curative option. Although initially reported as a palliative procedure, nowadays it is rather performed with curative intent. Once the resectional phase is ended, a large defect will remain at the level of the pelvic diaphragm, predisposing to severe complications which are generically included under the name of empty pelvis syndrome.

Partial Cystectomy with Distal Ureteral Resection and Re-implantation for Locally Invasive Cervical Cancer.

Cervical cancer is an aggressive gynecological malignancy which can develop local invasion of the surrounding organs. In cases presenting locally advanced disease, the association of neoadjuvant chemo-irradiation might reduce the local invasion and might transform the patient into a candidate for a conservative surgical procedure. However, there are also patients who refuse any association of neoadjuvant treatment; we present the case of a 52-year-old patient diagnosed with a locally invasive cervical tumor involving both ureteral ostia who formally refused any neoadjuvant oncological treatment and urostomy.

Total pelvic exenteration for pelvic recurrence after advanced epithelial ovarian cancer--A case report and literature review.

Ovarian cancer is an aggressive disease, which, although associated with a high rate of recurrence, seems to benefit most from iterative cytoreduction. Although the main patterns of its spreading are represented by peritoneal, lymphatic or hematogenous route, local recurrences might also be seen. Whenever pelvic recurrence develops, complete resections based on the ultraradical principles applied in resections for pelvic recurrences originating from cervical cancer, are useful.

Abdomino-Perineal Recto- Sigmoidectomy with Pelvic and Para-Aortic Lymph Node Dissection for Synchronous Anal and Rectal Tumor.

Colorectal cancer represents the third most encountered malignancy worldwide and the third cause of death in United States of America. A special subgroup is represented by the patients presenting an association of a colic tumor and intraluminal colo-rectal metastases. In these cases the distal tumor is believed to be rather a distant metastasis originating from the proximal one.

Splenectomy as Part of Cytoreductive Surgery in Recurrent Epithelial Ovarian Cancer.

Aim: To determine the impact of survival of peritoneal versus splenic metastasis in cases submitted to splenectomy as part of cytoreductive surgery in recurrent epithelial ovarian cancer.

Patients And Methods: Between January 2002 and May 2014, 28 patients were submitted to splenectomy as part of secondary, tertiary and beyond tertiary cytoreduction at the Dan Setlacec Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest.

Results: Splenectomy was performed as follows: at secondary cytoreduction in 21 cases, at tertiary cytoreduction in six cases, and beyond tertiary cytoreduction in one case.

Palliative Pelvic Exenteration for Pelvic Recurrence Invading the Sciatic Foramen with Chronic Cutaneous Perineal Fistula after Radical Surgery for Cervical Cancer: A Case Report.

Pelvic exenteration remains one of the most aggressive gynecological surgical procedures performed for patients with locally-invasive cervical cancer, usually performed with curative intent. However, there exist patients who present in a very advanced stage of the disease, in which only a palliative surgical procedure can be performed. Although in these cases the survival benefit is minimal, performing a pelvic exenteration significantly improves the quality of life.

Liver resection for ovarian cancer liver metastases as part of cytoreductive surgery is safe and may bring survival benefit.

Background: The aim of this study was to evaluate whether hepatic resections of ovarian cancer liver metastases provide a benefit in terms of survival as part of primary, secondary, tertiary, and even quaternary cytoreductive surgery.

Methods: Data of patients submitted to surgery for ovarian cancer liver metastases at Fundeni Clinical Institute between January 2002 and April 2014 were retrospectively reviewed. Liver lesions were classified according to their origin in parenchymal and peritoneal lesions.