Post-thyroidectomy Hypocalcemia-Risk Factors and Management Chirurgia, 114 (5), 2019 www.revistachirurgia.ro dezvolta hipocalcemie tranzitorie şi complicaţii acute în comparaţie cu suplimente de calciu singur sau fără suplimente. În cazurile de hipoparatiroidism este preferat calcitriolul.

Background: There are only a few studies involving the use of melatonin for premedication for anaesthesia. The goal of our study was to compare the effects of melatonin and midazolam administered as premedication for laparoscopic cholecystectomy.Methods: This double-blind, placebo-controlled study included 53 patients (ASA I, II) undergoing laparoscopic cholecystectomy under general anaesthesia. The patients were divided into three groups: group 1 (n = 18) included patients receiving 3 mg melatonin the night before and as premedication; group 2 (n = 17) included the patients receiving 3,75 mg midazolam (1/2 of a 7,5 mg tablet) by the same protocol as for melatonin; and group 3 (n = 18) included patients receiving placebo tablets. Preoperatively, the anxiety and sedation scores, as well as the quality of preanaesthetic sleep, were evaluated. Postoperatively, the anxiety and sedation scores and the number of remembered pictures were evaluated at 15 and 60 minutes and 6, 12 and 24 hours respectively. The intra-anaesthetic opioid requirements were also evaluated.Results: Preoperatively the lowest anxiety score was registered in the midazolam group; also the difference between the melatonin and midazolam groups was not significant. In the placebo group the anxiety score was significantly higher as compared with melatonin or midazolam. Postoperatively anxiety scores were lowest in the melatonin group at every time interval. The scores for the remembered pictures were consistently better in the melatonin group. The sedation score was lower in the melatonin group as compared with midazolam, as were the intra-anaesthetic opioid requirements.Conclusions: Melatonin (3 mg) can be successfully used as premedication for laparoscopic cholecystectomy, especially for day case surgery. Advantages over midazolam and placebo include better perioperative anxiolysis, and a better recovery profile as assessed by sedation and memory.

Cancer continues to represent a global health concern, imposing an ongoing need to research for better treatment alternatives. In this context, nanomedicine seems to be the solution to existing problems, bringing unprecedented results in various biomedical applications, including cancer therapy, diagnosing, and imaging. As numerous studies have uncovered the advantageous properties of various nanoscale metals, this review aims to present metal-based nanoparticles that are most frequently employed for cancer applications. This paper follows the description of relevant nanoparticles made of metals, metal derivatives, hybrids, and alloys, further discussing in more detail their potential applications in cancer management, ranging from the delivery of chemotherapeutics, vaccines, and genes to ablative hyperthermia therapies and theranostic platforms.

Background: often the medical personnel from the emergency departments are confronted with patients incumbent forensic aspects. The role of nurses in contact with the forensic patient goes beyond the normal care delivery practices requiring specific skills, knowledge and attitudes that influence the the forensic patient future evolution and case management. Presently no specific systematic training is availableat national level for continuous education of nurses for that specific issue. Aim and methodology: A descriptive study aiming to describe the experiences, knowledge, attitudes, practices and to identify and rank the educational needs of nurses in emergency department was carried out on a lot of 30 nurses from the emergency department of Bucharest Universitary Hospital in order to identify the main areas for future development of a dedicated training module for forensic nursing. Results: The result reveals that more than 90% of respondents are aware that forensicpatients occurs frequently in their practice and all of them are in favour of a dedicated training on forensic nursing aspects is necessary for emergency care nurses. Conclusion: Further development of adequate training module for different level of health care professionals involved in forensic patient diagnostic and treatment form nurses, medical doctors, social workers, paramedics, child care, police officers is necessary as a guarantee of adequate care for that specific category of patient.

Cancer represents one of the leading causes of morbidity and mortality worldwide, imposing an urgent need to develop more efficient treatment alternatives. In this respect, much attention has been drawn from conventional cancer treatments to more modern approaches, such as the use of nanotechnology. Extensive research has been done for designing innovative nanoparticles able to specifically target tumor cells and ensure the controlled release of anticancer agents. To avoid the potential toxicity of synthetic materials, natural nanoparticles started to attract increasing scientific interest. In this context, this paper aims to review the most important natural nanoparticles used as active ingredients (e.g., polyphenols, polysaccharides, proteins, and sterol-like compounds) or as carriers (e.g., proteins, polysaccharides, viral nanoparticles, and exosomes) of various anticancer moieties, focusing on their recent applications in treating diverse malignancies.

Breast cancer is known as one of the most commonly occurring cancer which can be diagnosed in women. The number of new cases of breast cancer in female patients, both in early stages and in advanced stages, has slowly, but continuously increased in the last decades. Immunotherapy has been used in recent years in the treatment of many types of cancer, due to its reduced adverse reactions and a considerable tolerance when administrated compared to currently used therapies such as chemotherapy, radiation and surgery (1). GcMAF is a protein-derived macrophage-activating factor, a new and unapproved medication that has shown promising results in treating breast cancer (2). This review aims to summarize the studies and case reports presenting the GcMAF experience in breast cancer therapy.

Haemobilia is a rare cause of upper gastrointestinal bleeding that consists of haemorrhage within the biliary tree. Most cases of haemobilia are due to iatrogenic cause, laparoscopic or open cholecystectomy, abdominal trauma, gallstones, hepatic tumours, vascular aneurism. We present the case of a male patient admitted in the surgery department for epigastric and right hypochondria pain, nausea and vomiting. Open cholecystectomy was performed with a trans-cystic tube drainage. Postoperative outcome was favourable but with a continuous decrease in haemoglobin level. In the 13th day postoperatively biliary drainage was 800 ml - haemobilia. Patient health status altered and melena and hematemesis occurred. Endoscopy, cholangiography and abdominal computer tomography (CT) were performed. The episode repeated in day 27 after initial surgery. Duodenotomy and exploration of the biliary tree was performed. Angiography was performed next day that revealed biliary-arterial fistula within segment IV of the liver followed by embolization. Haemobilia reoccurred fifteen days later and colonoscopy and angiography were performed. Embolization with metallic coils was performed. Patient outcome was favourable and was discharged 13 days after second embolization. Interventional angiography remains the first treatment option of haemobilia. Selective arterial ligation or hepatectomy remain the options in case of lack of angiography or insufficient results after embolization.

Acest review de literatură îşi propune să sintetizeze factorii de risc care predispun la apariţia hipertensiunii intraabdominale în urma curei chirurgicale a herniilor incizionale. Cercetarea noastră a utilizat platformele de cercetare Web of Science, Scopus şi PubMed şi a utilizat ca formulă de căutare: ("Intraabdominal hypertension" OR "intraabdominal pressure" OR "abdominal compartiment syndrome") AND "risk factors" AND "incisional hernia". Filtrarea rezultatelor s-a realizat după următoarele criterii: limba: engleză, publish year > 2000 şi acces: in extenso. În acest context, am ales să împărţim factorii de risc pentru creşterea PIA în următoarele categorii: cei legaţi de habitusul şi antropometria corpului; cei asociaţi cu prezenţa comorbidităţilor; cei legaţi de caracteristicile defectului (eventraţiei) din peretele abdominal; cei asociaţi actului chirurgical. Printre cei mai importanţi pot fi amintiţi: indicele de masă corporală, BPOC, eventraţiile de dimensiuni mari cu pierderea dreptului la domiciliu, tehnica chirurgicală utilizată, timpul operator prelungit şi tentative repetate de închidere a defectului. Cuvinte cheie: hipertensiune intraabdominală, hernie incizională, complicaţiile reconstrucţiei peretelui abdominal, factori de risc