Chirurgia最新文献

Background: Breast cancer remains the most prevalent malignancy in women worldwide and a leading cause of cancer-related mortality. Invasive micropapillary carcinoma (IMPC), though relatively uncommon, exhibits aggressive biological behavior, characterized by lymphovascular invasion and a marked propensity for nodal metastasis. The HER2-positive subtype of IMPC poses particular therapeutic challenges, necessitating targeted biological therapy but also conferring an increased risk of treatment-related adverse events. Objective: This review aims to synthesize current evidence on the clinicopathological features and treatment of HER2-positive IMPC, with a special emphasis on the emerging complication of typhlitis in the context of taxane-based chemotherapy. Methods: A narrative review of the literature was conducted to summarize data regarding pathogenic mechanisms, clinical presentation, diagnostic considerations, and management strategies related to HER2-positive IMPC and chemotherapy-associated typhlitis. Results: Existing evidence highlights the aggressive course of IMPC, the therapeutic relevance of HER2-directed regimens, and the rare but potentially life-threatening occurrence of neutropenic enterocolitis in patients receiving taxanes. Although data remain limited, reported cases underscore the importance of early recognition and multidisciplinary management. Conclusions: HER2-positive invasive micropapillary carcinoma is a rare but aggressive breast cancer subtype requiring multimodal therapy. While dual HER2 blockade with taxane-based chemotherapy improves survival, it also increases the risk of severe complications such as typhlitis. Early recognition and timely surgical intervention are essential to reduce morbidity and mortality. With appropriate therapeutic adjustments, systemic treatment can be safely continued, emphasizing the need for better risk stratification and preventive strategies.

Purpose: Diagnosing bowel ischaemia (BI) can be challenging with non-specific clinical, biochemical and radiological findings. We aimed to identify biomarkers in peritoneal fluid that could be utilised to enhance the diagnosis of BI. Methods: A prospective single-centre observational study was conducted with adult patients undergoing laparotomy for suspected BI. Samples of preoperative serum and intraoperative peritoneal fluid were analysed. Patients with bowel perforation were excluded. Results: Sixty-nine patients were identified; 5 were excluded for bowel perforation and 6 for incomplete data. Thirty-four patients had BI intraoperatively and were allocated to the ischaemia group; 24 did not have features of BI intraoperatively and were allocated to the control group. The ischaemia group had significantly higher median peritoneal fluid lactate (3.9 vs 1.2 mmol/L; p = 0.002) and pyruvate (190 vs 114 ümol/L; p = 0.003); as well as significantly higher mean serum white cell count (16.23 x 109/L vs 9.77 x 109/L; p = 0.001), neutrophils (13.97 x 109/L vs 7.03 x 109/L; p 0.001) and C-reactive protein (95.56 vs 53.42 mg/L; p = 0.039). The area under the curve (AUC) was the greatest for peritoneal fluid lactate (0.770), followed by pyruvate (0.751); the composite AUC for these peritoneal fluid and serum biomarkers was 0.901.

Conclusion: BI was associated with elevated peritoneal fluid lactate and pyruvate. Introducing a composite analysis of these peritoneal fluid and serum biomarkers could improve the diagnosis of BI in surgical practice.

Introduction: The accuracy of histopathological diagnosis is crucial in the management of prostate cancer. Benign entities such as atypical adenomatous hyperplasia (AAH) and atypical small acinar proliferation (ASAP), referred to as "lesions that mimic prostate cancer", represent a major diagnostic pitfall, placing the surgeon in a therapeutic dilemma. Thus, this study aimed to quantify the incidence of these entities in a tertiary center in Romania. Materials and Methods: Retrospective study on a cohort of 900 patients who underwent ultrasound-guided prostate biopsy/TURP between January 2020 and March 2025. Histopathological diagnoses were established according to the International Society of Urological Pathology (ISUP) criteria. Results: Of the 900 biopsies, the most common primary diagnoses were benign prostatic hyperplasia (BPH) (62%, n = 558) and prostatic adenocarcinoma (ADK) (27.6%, n = 248). The potentially major confounding entities, AAH and ASAP, together accounted for 6.6% (n = 59) of all biopsies. AAH (6%) was three times more common than Gleason 6 ADK (2%). The mean age of patients with AAH (69.2 years) was similar to that of patients with ADK (71.5 years). Multivariate analysis showed that age 70 years was an independent predictor of ADK (OR=1.9, p 0.01), and PSA values showed significant overlap between groups. Conclusions: In total, 6.6% (n=59) of the biopsies analyzed presented entities that can mimic prostate cancer and that require careful interpretation to avoid errors and to establish the most appropriate surgical conduct. Histopathological correlation with imaging and rebiopsy, within a multidisciplinary approach, are essential steps in the management of these cases.

Background: Renal anatomical anomalies are associated with altered urinary drainage and pH, which may influence urinary stone formation and composition. However, limited studies have assessed the stone composition differences in patients with abnormal versus normal renal anatomy. Methods: This observational study included 100 patients treated between September 2023 and August 2024 in a tertiary academic center in southern Romania. Stone composition was assessed using Fourier-transform infrared spectroscopy and categorized into five major types. Comparative and multivariate analyses were performed to assess associations between renal morphology, comorbidities, and stone type. Results: Uric acid (39%) and calcium oxalate (32%) were the most common stone types. Patients with horseshoe kidney and ectopic kidneys showed higher proportions of calcium phosphate stones. Diabetes and hyperuricemia were significant predictors of calcium phosphate and uric acid stones, respectively. No statistically significant association was found between renal anatomy and stone composition, though descriptive differences were observed. Conclusions: While anatomical anomalies did not show statistically significant differences in stone composition, metabolic factors such as diabetes and hyperuricemia strongly influenced stone type. Spectroscopic analysis remains essential in guiding individualized nephrolithiasis management.

Background: Gastric cancer remains a major global health burden. Beyond oncologic outcomes, health-related quality of life (HRQoL) is increasingly recognized as a critical endpoint influenced by the reconstruction method after gastrectomy. Methods: A prospective observational study was conducted between December 2021 and December 2024 at the Emergency County Hospital of Targu Mures, Romania, including 150 patients undergoing curative-intent gastrectomy. Patients were divided into two groups: gastroduodenal anastomosis (Billroth I, n=72) and gastrojejunal anastomosis (Billroth II/Roux-en-Y, n = 78). HRQoL was assessed using the EORTC QLQ-STO22 preoperatively and at 3 and 6 months postoperatively. Scores were linearly transformed to a 0 100 scale. Statistical analysis was performed with EasyMedStat Results: The mean age was 61 years, with similar baseline characteristics. Postoperative complications occurred in 32.0% of patients, mostly grade I II. Both groups showed deterioration in dysphagia, pain, reflux, and anxiety at 3 months, followed by partial recovery at 6 months. Reflux scores were consistently higher in the gastrojejunal group at all timepoints (baseline 26.1 vs. 17.6; 3 months 36.5 vs. 24.5; 6 months 27.2 vs. 14.7; p 0.001). Eating restrictions were also greater at 3 and 6 months. Conclusions: Both reconstruction methods impair short-term HRQoL, with partial recovery by 6 months. Gastrojejunal reconstruction is associated with higher reflux and eating restrictions, whereas gastroduodenal reconstruction shows more favorable functional outcomes.

Background: This article offers a comprehensive exploration of surgical techniques practiced in ancient Greece, tracing their development from prehistoric times through the Classical, Hellenistic, and Byzantine periods. Methods: Drawing on literary, archaeological, and anatomical evidence, this examination explores procedures such as trepanation, fracture management, nasal and facial reconstruction, and early interventions in the abdominal and thoracic regions. Particular attention is given to the contributions of Hippocrates, Galen, and Paul of Aegina, whose systematic approaches to trauma, wound care, and operative techniques laid the foundation for later surgical traditions. The study also highlights the use of specialized instruments, pharmacological treatments, and ethical considerations rooted in mythological and philosophical thought. Results: By highlighting the scientific sophistication and enduring influence of ancient Greek surgical practices, this work underscores their pivotal role in the development of Western medicine. Conclusions: Ancient Greek surgery stands as a complex intersection of empirical skill, ethical reflection, and cultural meaning - a practice shaped as much by philosophical restraint as by technical ingenuity.

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is an emerging minimally invasive technique of performing thyroidectomy with no scarring, less dissection and less laryngeal nerve manipulation. This article presents in detail the TOETVA technique and includes the first Romanian series of 23 patients enrolled in a study between December 2024 and June 2025 who underwent TOETVA. All procedures were carried out by a single surgical team using standard laparoscopic equipment. Surgeon experience in both endocrine surgery and laparoscopy is necessary. For a selected group of patients, this technique proved to be safe, with no laryngeal or mental nerve injury, few cases of transient hypocalcaemia and good aesthetic results, the most common complication being anterior cervical ecchymosis. These preliminary results support TOETVA as an effective alternative to the conventional open thyroidectomy, especially for patients seeking scarless outcomes.

Objectives: To assess the influence of technical parameters (such as phaco time and ultrasound energy) and patient`s characteristics (associated diseases, endothelial cell density (CD), intra-ocular pressure (IOP)) on visual acuity outcomes in individuals undergoing phacoemulsification surgery with intraocular lens implantation.

Methodology: This cross-sectional, retrospective study involved 122 eyes divided into 4 groups using the LOCS III system classification: Grade 1 (25 eyes), Grade 2 (21 eyes), Grade 3 (30 eyes) and Grade 4 (46 eyes). Specular microscopy was performed pre- and postoperatively, while the ultrasound energy consumption and the effective phaco time were observed intraoperatively. Results: A progressive decrease of cell density (CD) was observed in all groups at end of the 1st week postoperatively, with a mean endothelial cell loss of about 700 cell/mm2. The postoperative intraocular pressure (IOP) dropped significantly in Grade 4 cataract group from a mean value of 21.3 +- 10.06 to 17.43 +- 3.81 mmHg, accompanied by higher ultrasound energy consumption. A progressive improvement of visual acuity was observed, from the 1st day postsurgical visit to the 1st week follow-up evaluation in all the groups. Visual acuity improvement was maintained significant after 1st week only when comparing groups 1 and 4. The multiple regression analysis identified cataracts Grade 3 and 4 along with the preoperative visual acuity as strong predictors for the final visual acuity outcomes, while gender, age, IOL type, comorbidities, phaco time (EPT), ultrasound energy (U/S), preoperative intraocular pressure and cell density were not independently associated with visual acuity outcomes.

Conclusion: Our results indicated that 95.9% of the patients evaluated 1 day postoperative had visual acuity better than 6/18, while 4.1% had borderline visual acuity in the range of 6/18-6/60, being in line with the World Health Organization (WHO) standards for cataract surgery outcomes.

Introduction: The objective of this study was to collect and analyze data on patient demographics, lifestyle, abdominal cavity characteristics, and their impact on intra-abdominal pressure before and after minimally invasive treatment of large parietal defects in hernia pathology. Additionally, the study examines the role of the CT scan as a reliable and valid measure of defect and muscle characteristics, which can help establish the indication for performing Transversus Abdominis Release (TAR) and evaluate the outcomes of this procedure along with differences in intra-abdominal pressure (IAP) and plateau pressure (Pplat). Methods: This prospective study involved 20 patients with parietal defects wider than 10 cm, treated over four years at the Central Military Hospital in Bucharest. All procedures were performed using the laparoscopic TAR technique by the same surgical team. Preoperative assessments included CT imaging to measure defect size, volumes, and IAP. Data including defect dimensions, muscle measurements, IAP, and Pplat were systematically recorded in a dedicated database with a follow-up at 6 months with clinical and imaging evaluations. Results: In our cohort of 20 patients, all female, the mean BMI was 26.81Ã+-3.05, and the hernia sac volume (HSV) averaged 159.01+-189.79 cm³. The defect area was 69.53 cm² (+-30.11). IAP decreased from 5 cmH2O (+-1.28) preoperatively to 1.91 cmH2O (+-1.93) postoperatively. The reduction in Pplat was similarly significant. Pressure variations were influenced by the topographic location of the defect, with higher pressures seen in epigastric defects, and by the characteristics of the peritoneo-fascial defects, including number, size, and localization, which affect pressure outcomes. Additionally, dimensions of the anterior-lateral abdominal muscles correlated with pressure changes. These findings highlight the importance of comprehensive preoperative assessment of defect characteristics, muscular anatomy, and defect location for predicting pressure reductions and guiding surgical planning. Conclusions: Higher BMI and large, multiple parietal defects predict increased IAP and Pplat postoperatively. Preoperative volumetric and morphometric parameters, defect localization, and topographic characteristics significantly influence pressure outcomes. The TAR technique effectively manages large defects while minimizing pressure increases, but consideration of morphological factors is crucial for optimal results. Further research is needed to refine patient selection and surgical strategies.

Background: Polytrauma is a major cause of morbidity and mortality, yet formal training in its management is often absent from undergraduate medical curricula. This study aimed to assess the knowledge and perceptions of Romanian medical students regarding polytrauma management and evaluate the need for dedicated curricular courses.

Methods: A cross-sectional survey was conducted among medical students from seven major universities in Romania. The questionnaire included demographic data, knowledge about polytrauma, skills related to first aid, and perceptions on introducing polytrauma courses. The study took place at several prominent medical universities across Romania, including Bucharest, Craiova, Timisoara, Iasi, Cluj-Napoca, Targu Mures, and Sibiu. Overall, 413 students participated in the survey and were recruited through online platforms and direct interaction. All participants completed the survey voluntarily.

Results: Of all the participants, 78.7% had heard about polytrauma primarily through clinical rotations in General Surgery, Emergency Medicine, and Orthopedics. However, only 31% of the participants who heard about polytrauma accurately defined it. No correlation was found between confidence in providing first aid and actual knowledge (p=0.097). Almost 80% believed that polytrauma management should be a mandatory subject in the curriculum.

Conclusion: The study highlights a significant gap in Romanian medical education regarding polytrauma management skills among students. It supports the introduction of mandatory courses on trauma care to enhance practical skills and knowledge retention among future healthcare professionals.