BackgroundEven though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed. Materials and methodsOver the last 9 years 9542 LCs have been performed at this centre, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged >65 years. ResultsThe main operative incidents encountered were haemorrhage

Background. An active molecule in sulfurous mineral - therapeutic waters and also in sapropelic mud is H2S, a hormetic gaseous molecule that can actively penetrate the skin. While high levels of H2S are extremely toxic, low levels are tolerated and have potential cytoprotective effects, with anti-inflammatory and antioxidant applications. Objective. This systematic review aims to rigorously select related articles and identify within their content the main possible uses of hydrogen sulfide from balneary sources and to explain its physiological mechanisms and therapeutic properties. Methods. To elaborate our systematic review, we have searched for relevant open access articles in 6 international databases: Cochrane , Elsevier , NCBI/PubMed , NCBI/PMC , PEDro , and ISI Web of Knowledge/Science , published from January 2016 until July 2021. The contextually quested keywords combinations/ syntaxes used are specified on this page. The eligible articles were analyzed in detail regarding pathologies addressed by hydrogen sulfide. All articles with any design (reviews, randomized controlled trials, non-randomized controlled trials, case-control studies, cross-sectional studies), if eligible according to the above-mentioned selection methodology, containing in the title the selected combinations, were included in the analysis. Articles were excluded in the second phase if they did not reach the relevance criterion. Results. Our search identified, first, 291 articles. After eliminating the duplicates and non-ISI articles, remained 121 papers. In the second phase, we applied a PEDro selection filter, resulting in 108 articles that passed the relevance criterion and were included in this systematic review. Conclusions. H2S biology and medical relevance are not fully understood and used adequately for sanogenic or medical purposes. More research is needed to fully understand the mechanisms and importance of this therapeutic gase. The link between balneotherapy and medical rehabilitation regarding the usage of hydrogen sulfide emphasises the unity for this medical speciality.

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A 48 years-old man, chronic alcohol consumer, with a history of recurrent mild acute pancreatitis episodes, was diagnosed in 2010 with segmental chronic pancreatitis complicated by a 4cm pseudocyst in the pancreatic head. He stopped drinking, but acute episodes continued to reoccur, while the pseudocyst disappeared. In 2012 the patient was admitted to our department with painful chronic pancreatitis and a new acute episode. EUS diagnosed a cystic dystrophy of the duodenal wall with groove pancreatitis, and endoscopic opening of the cysts into the duodenum was performed. Laparoscopic cholecystectomy was imposed by small gallbladder stones seen at EUS. After 6 months of silence, pain and acute episodes reappeared, imposing pancreatoduodenectomy. Patient is now well, without symptoms during 5 years of follow-up. Cystic dystrophy of heterotopic pancreas can be thought of in case of recurrent idiopathic acute pancreatitis. EUS is the best diagnosis tool, and can provide opening of the cysts into the duodenum. Surgery - pancreatoduodenectomy - offer best results.

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Objective: To evaluate the concordance between intraoperative ultrasound (IOUS) and abdominal ultrasound (US) for the characterization of focal liver lesions in patients with colorectal cancer, and to evaluate the way in which IOUS influences the initially established hepatic surgical protocol based on abdominal US only. Method: In this prospective study 73 patients with colorectal cancer and focal liver lesions found during IOUS were included. Abdominal US and IOUS findings were compared. The initially established hepatic surgical protocol based on abdominal US only was recorded. All patients in whom IOUS influenced this protocol and the way in which this was influenced were recorded. Results: Of the 73 patients, 41 (56.2%) had focal liver lesions classified as malignant by IOUS. In 26 of the 73 patients (35.6%), there were discordances between abdominal US and IOUS. IOUS influenced the operative protocol in 9 of the 73 patients included in the study (12.3%), and in 8 of the 41 patients with malignant lesions (19.5%). IOUS influenced the operative protocol by cancelling the preoperative hepatic surgery decision by evidencing the additional multiple malignant focal liver lesions, following the classification of some lesions as benign or by demonstrating the non-resectable character of other lesions. IOUS also determined unplanned hepatic resections by detecting resectable malignant lesions undiagnosed by abdominal US, and extended or limited the scheduled hepatic surgery based on abdominal US only. Conclusions: There were inconsistencies between IOUS and abdominal US, therefore in patients with colorectal cancer IOUS provided additional information about focal liver lesions. IOUS influenced the operative protocol and consequently, unnecessary liver surgery was avoided. Also, IOUS identified malignant resectable liver lesions which were undetected by abdominal US.

Background Previous genome-wide association studies (GWAS) identified IGF1, IRS1, GCKR, PPARG, GCK1 and KCTD1 as candidate genes for insulin resistance and type 2 diabetes (T2D). We investigated the associations of these previously reported common variants in these genes with insulin resistance in overweight children from Romania and Moldova. Methods Six single nucleotide polymorphisms (SNPs), IGF1 (rs35767), IRS1 (rs2943634), GCKR (rs780094), PPARG (rs1801282), GCK1 (rs1799884) and KCTD15 (rs29941), were genotyped in 100 overweight children along with clinical and metabolic parameters. Homeostatic model assessment of insulin resistance (HOMA-IR) above 3.4 (defining insulin resistance) was used as the outcome. Results Children differed in insulin resistance status despite having similar body mass index (BMI) standard deviation scores (SDS) (World Health Organization, [WHO] reference). The identified predictors for altered insulin metabolism were higher cholesterol levels, higher diastolic blood pressure and higher waist-to-hip-ratio (as a marker for increased abdominal fat). None of the SNPs showed significant association with increase in the risk for insulin resistance in children (p range=0.478–0.724; odds ratio [OR] range=1.924–4.842); however, the risk allele in GCKR (rs780094, p=0.06, OR=6.871) demonstrated near statistical significance. Conclusions The interrogated risk alleles did not show any significant association with insulin resistance in children in our cohort; however, the GCKR (rs780094) might be a viable candidate in larger cohorts. The lack of replication of the proposed association may point to differences in linkage disequilibrium or effect modifiers across studies.

Introduction. Balneology has a long European and Asian tradition and Romania can be the cornerstone of international bridges in this area due to its geographical position, legendary tradition and extraordinary natural resources of all kind. The use of thermal and mineral springs on the territory of the country for health and treatment purposes is a tradition with a history of more than two thousand years. Unique spa resources, such as thermal and mineral springs, mud, mofettes, saline microclimate and bioclimate (sedative or relaxing, exciting of marine seaside or plains, stimulant or tonic), are used successfully in the sphere of health care services, preventive medical actions, rehabilitation and wellness. Legend of Hercule bathing in Cerna's waters is a proof of the use of thermal waters long before the Roman conquest. This tradition exists in almost all civilizations. Today it maintains its usefulness and is spread across all continents, mainly in the Middle East and South and East Europe, Asia (Middle East, Japan, China, Turkey), South America (Argentina, Mexico, Colombia) and North Africa (Morocco, Tunisia) (244-249). Material and method. This article is a sistematic and summarizing review of all published articles by Balneo Research Journal in its ten years of existence, from november 2010 until September 2019. All the ten volumes and more than 250 articles were analized in order to understand the main thematic of the articles, the more usefull scientific concepts, the realistic benefits of the published articles for the development of Balneology. Results and discussions. Analizing an article database of about 250 publised articles in Balneo Research Journal can be of real impact on the development of the field of Balneology but also can drive the future of the jurnal to better understand its implications in the scientific arena. Conclusions. Main scientific concepts with which Balneology is operating, interdisciplinary connections and interests were focused on ideas to have in mind by the authors and readers of this article. Key words: Balneology, Balneotherapy, Balneo Research Journal, Natural therapeutic factors, Balneary Resort,