EP-209Introduction: 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.
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Objective: There was a critical inconsistency in making therapeutic choices regarding anticoagulation in patients with COVID-19. This study aims to evaluate and determine the causes that led to the formation of hematomas, spontaneous bleeding or what is involved in this hypothesis and the elements related to this aspect. Patients and methods: The present study is a case series analysis that aims to identify and verify the cause of spontaneous hematomas in COVID positive patients for whom surgery was required. Thus, we analysed patients who presented various spontaneous hematomas during the covid pandemic (March 2020 - May 2021) for which surgery was performed, having as a control group (CG) a homogeneous group in terms of age, covid infection severity, and comorbidities with the study group (SG). Results: Regarding the preoperative and postoperative days, SG had average values of 4.76±5.36 (Mean±SD) for preoperative days and 9.5±9.327 for postoperative days. Given that one of the most suspected causes of hematomas was considered an anticoagulant overdose, we compared the anticoagulant doses and the type of anticoagulant, so the anticoagulant doses did not show statistically significant differences (0.836±0.294ml in SG versus 0.866±0.343ml in CG with p=0.588). As expected, hemoglobin (Hb) was significantly lower for SG with mean values of 7.266±1.431mg/dl compared to CG that had mean values of 12.9±2.092mg/dl (p=0.001). The correlation between the value of Hb (average value was 12.9 mg/dl, a minimum of 8.7 mg/dl and a maximum of 16.6 mg/dl) and the value of procalcitonin (average value was 0.13, a minimum of 0.02 and a maximum of 0.7) is statistically significant having p=0.012. In SG, hemoglobin can be correlated with ESR (erythrocyte sedimentation rate), p=0.008 and with procalcitonin, p=0.05. Both have a negative correlation explained by a proinflammatory status that can aggravate low hemoglobin levels, but without a direct link to high ESR and procalcitonin values. Conclusions: The hypothesis of anticoagulant overdose is not supported or verified by the present study, we consider that additional thromboelastography tests are necessary to be able to completely refute it. Mortality did not increase statistically significantly
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 bypass operation and specific animal care in the metabolic surgery field we have been undertaking in our center. Materials and methods: We chose Wistar rats fed with a high caloric diet (HCD) 82g / 100 g fat, 53/100 g saturated fat, 64/100 g carbohydrates. After 7-15 weeks of this diet, depending on the protocol understudy, a consistent three-fold greater weight gain is achieved than the usual range of the free eating chow. After approximately three months on an HCD, the obese rats manifest biochemical features of the metabolic syndrome. Results: The weight loss for group B (By-pass) was 125 ± 16.16 g, and for group BS (By-pass + Sulodexid), it was 133.10 ± 14.38 g. Although the weight loss was higher in group BS, it is not statistically significantly higher than in group B (p = 0.345), despite administering a pharmacologically active substance in group BS. Although small (approximately 40-50 g), the difference between the control group and groups B and BS is statistically significant with p = 0.016 and 0.026 and Pearson index of 0.674 and 0.628, respectively. Statistical significance also kept the difference between group C and group S (p = 0.028, Pearson Coefficient = 0.621). Conclusions: First of all, Metabolic surgery is the most effective weight-loss method and improvement or even remission of some diseases associated with obesity. Like today's high-calorie diet, the diet administered, mostly of adolescents, generates both obesity and its associated diseases: diabetes, hypertriglyceridemia, hypercholesterolism, thus increasing mortality and overall morbidity. Second, metabolic surgery radically improves the parameters targeting obesity (weight,% EBWL) and its associated conditions: diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, strongly associated with decreasing life expectancy of the general population. Parameters targeted by gastric bypass: glycemia, TGL, CHO, hepatic steatosis, testicular atrophy registering significant improvements.
Introduction: Obesity is currently an endemic problem worldwide largely caused by an environment that promotes excessive food consumption and discourages physical activity. The sources of obesity are directly related to two areas: genetic and environmental factors, which constantly interact in the regulation of body weight. Aim: Through this research, it was aimed to evaluate the typical profile of the individual who uses metabolic surgery and the degree of physical and psychological satisfaction after such an intervention. Materials and methods: The patients introduced in the study are from personal cases, in number of about 1130, operated during 9 years. Of these, 122 represented the basis for the analysis and had to answer 37 questions in a preoperative questionnaire and 34 questions in a postoperative one and we extracted 15 questions from each of the questionnaire. Results: Statistics show that there was an improvement in quality of life as reported by 77.78% of interviewers, libido and sexual quality were improved in 44% of the included patients and a level of stress considered responsible for food hyperapetitis in only about 43% of respondents. Conclusions: Improving the quality of life is directly related to weight loss. In addition, there is a correlation between improving the quality of life and improving sex life or increasing the frequency of exercise. Metabolic surgery must be understood with all the benefits it generates.
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