Introduction Laparoscopic sleeve gastrectomy (LSG) is an established bariatric procedure. Aim We present our long-term results regarding weight loss and comorbidities during 9 years. Material and methods We calculated the percent excess weight loss (%EWL) and changes in body mass index (ΔBMI). We evaluated arterial hypertension (AHT), type 2 diabetes (T2DM) and obstructive sleep apnea syndrome (OSAS). Results One hundred seventy-nine patients were included (136 female/43 male), mean age of 40.47 ±11.08 years, median preoperative body mass index (BMI) of 42.93 kg/m 2 . Median follow-up period was 72 months (36–84 months). The %EWL during follow-up was 41.8 (n = 179 patients, at 3-month follow-up), 64.1 (n = 163), 75.33 (n = 134), 77.1 (n = 103), 76,03 (n = 99), 73.78 (n = 64), 71.58 (n = 37), 63.83 (n = 22) and 64.1 (n = 14) at 6, 12, 18, 24, 36, 48, 60 and 72 months, respectively. We noted a negative correlation between %EWL and both the age and initial weight and BMI of the patient; a negative correlation between gender (male patients) and %EWL was also found. After LSG, 68.2% of patients with AHT presented resolution (no medication) or significant improvement (doses reduced) of the disease. As regards T2DM, 65.8% described resolution or significant improvement after surgery. Furthermore, 31 (70.4%) patients with preoperative OSAS reported resolution/improvement within a year from surgery. Conclusions Laparoscopic sleeve gastrectomy is a safe and effective procedure, with good results in the short and medium term. Long-term follow-up reveals a tendency to weight regain after approximately 2 years from primary surgery, with the need for revisional surgery in some cases.
Introducere: Cancerul colorectal este unul dintre cele mai frecvent întâlnite tumori maligne ale sistemului digestiv, incidenţa acestei boli crude crescând constant. Materiale şi Metode: 236 de pacienţi diagnosticaţi cu cancer de colon drept au fost revizuiţi retrospectiv. Pentru toţi pacienţii incluşi în acest studiu, hemicolectomie dreaptă sau hemicolectomie dreaptă extinsă cu anastomoză ileo-colonică a fost efectuată. Pacienţii au fost împărţiţi în două grupuri: grupul de studiu incluzând pacienţi care au dezvoltat fistulă de anastomoză şi grupul de control, incluzând pacienţi fără fistulă. Date clinice, chirurgicale, postoperatorii şi împrejurările apariţiei fistulelor anastomotice (AL) au fost evaluate. Studiul investighează posibilii factori de risc şi de protecţie pentru dezvoltarea fistulelor anastomotice şi nu în ultimul rând studiează relaţia dintre fistulă de anastomoză şi mortalitatea. Rezultate: factori de risc cum ar fi vârstă înaintată, tumorile 1/3 drepte ale colonului transvers, intervenţiile chirurgicale de urgenţă, sutură mecanică, anastomoza L-T, reluarea tardivă a motilităţii intestinale au fost identificate în timpul cercetării. Anastomoza L-L a fost identificată ca factor protector în dezvoltarea fistulei de anastomoză. Concluzii: Conform rezultatelor cercetării, în cazul tumorilor colonului drept, anastomoza ileo-transversă L-L ar trebui adaptată, având ceea mai scăzută rată în ceea ce priveşte dezvoltarea fistulei de anastomoză.
Context. Permanent hypocalcemia is a rare but significant complication of thyroid surgeryObjective. The aim of this study was to identify predictive factors of hypocalcemia and hypoparathyroidism after thyroidectomy .Design. Study included 134 total patients submitted to thyroidectomy from two endocrine units (January 2015 -August 2016).Methods. We measured total serum calcium (sCa) and intact PTH (iPTH) on postoperative day one and 1 month after surgery.Results. 118 patients were women with F/M ratio of 7.3/1 and a mean age of 51.8 years. 64 patients were included in group A (iPTH <12 pg/mL) and 70 patients in group B (iPTH >12 pg/mL). sCa and hypocalcemia symptoms were correlated with iPTH, measured 24 hours after surgery. The cut-off value was for sCa 8.05 mg/dL with a sensitivity of 85.29% and a specificity of 88.0% and for iPTH 11.2 pg/mL, with a sensitivity of 82.3% and a specificity of 71.0%. SCa (< 8.05 mg/dL) was a predictive factor with a 99 (IC95%:12.86-761.58) and iPTH (<11.2 pg/mL) with a 10.77 higher risk (CI95%: 3.83-30.30) to be associated with symptoms.Conclusion. SCa and iPTH represent good predictive factors of early and safe hospital discharge and can predict the risk of prolonged and permanent hypoparathyroidism.
Introducere: Cancerul colorectal (CRC) se numără printre principalele cauze de deces cauzate de cancer în întreaga lume. Pacienţii vârstnici sunt adesea consideraţi ca fiind o categorie cu risc crescut, predispuşi la complicaţii postoperatorii. Materiale şi metode: 138 pacienţi cu vârsta de peste 75 de ani şi diagnosticaţi cu cancer colorectal au fost revizuiţi retrospectiv. Pacienţii au fost împărţiţi în două grupuri: Grupul de studiupacienţii care au dezvoltat complicaţii postoperatorii, şi Grupul de control-pacienţii fără probleme în perioada postoperatorie. Au fost comparate date clinice, preoperatorii, chirurgicale, postoperatorii şi oncologice. Scopul studiului a fost de a determina posibili factori de risc în apariţia complicaţiilor postoperatorii şi de a analiza influenţa acestora asupra mortalităţii. Rezultate: Factori de risc cum ar fi sexul bărbătesc, obezitate, insuficienţa cardiacă, diabet zaharat tip II, anemie severă, hipoproteinemie, clasificare ASA III-IV, intervenţiile chirurgicale efectuate în urgenţă, timp operator îndelungat, sângerări semnificative intra-operatorie, internare prelungită, localizare distală a formaţiunilor tumorale, stadiile TNM III-IV, antecedente de cancer digestiv operat sau alte operaţii abdominale majore necanceroase efectuate au fost identificaţi. Concluzii: Tratamentul chirurgical al cancerului colorectal în cazul populaţiei cu vârstă înaintată rămâne o provocare, această categorie de pacienţi trebuie să beneficieze de o atenţie deosebită pentru a asigura o şansă de a minimaliza sau evita aceste complicaţii.
Introduction: Romania is one of the European countries with a significant burden of tuberculosis (TB). Although pulmonary TB is still highly prevalent, intestinal TB is very rare and remains a diagnosis of exclusion, especially in children. The authors aimed to raise the awareness on this pathology by discussing the challenges faced in the management of one difficult case. Case presentation: A 3-year-old boy was hospitalized in the Pediatrics Department of Grigore Alexandrescu Emergency Children's Hospital, Bucharest, Romania, for abdominal pain and melena. On clinical examination, he was malnourished, with generalized edema and marked abdominal distension. Laboratory tests revealed iron-deficiency anemia, low plasma proteins, inflammatory syndrome and high fecal calprotectin. The abdominal ultrasound showed bowel wall thickening and diffuse edematous mesentery; the colonoscopy described multiple ulcers with edematous margins. Parenteral nutrition and complex antibiotic treatment were initiated with no effect. During the hospital stay, the medical staff observed how the mother chewed the patient's food. The child's pulmonary X-ray was normal, but the mother's was suggestive for pulmonary TB. The QuantiFERON ® test was positive. Biopsy of the bowel mucosa revealed numerous granulomas; the Auramine O/Rhodamine B staining of the specimen was positive. Specific TB treatment was started with good results: the patient resumed growth, abdominal pain and distention disappeared. Conclusions: Intestinal TB poses a diagnostic challenge, especially in the absence of pulmonary disease. It may mimic many other intestinal pathologies. Since correct treatment depends on making the correct diagnosis, a high index of suspicion must be kept when facing atypical abdominal symptoms.
Introduction Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcaemia associated with hypophosphatemia and hypomagnesaemia, and is exacerbated by suppressed parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. [1] Case report This report concerns a dialysed patient who underwent surgical treatment for secondary refractory hyperparathyroidism. Haemodialysis was carried out pre-operatively, and subsequently, a total parathyroidectomy with auto-transplantation of parathyroid tissue in the sternocleidomastoid muscle (SCM) was performed. Rapid and progressive hypocalcaemia symptoms developed during the second day postoperatively. Acute cardiac symptoms with tachyarrhythmia, haemodynamic instability and finally asystole occurred, which required cardiopulmonary resuscitation (CPR). The ionic calcium level was 2.2 mg/dL being consistent with a diagnosis of HBS. A second cardiac arrest unresponsive to CPR followed an initial period of normal sinus rhythm. Death ensued shortly after. Before death, the ionic calcium was 3.1 mg/dL. Conclusion HBS, after parathyroidectomy in patients with secondary hyperparathyroidism (SHPT), may be severe, prolonged and sometimes fatal. Generally, HBS symptomatology is that of a mild hypocalcaemia. It can, however, include heart rhythm disturbances with haemodynamic alterations requiring intensive care measurements and even cardiopulmonary resuscitation. A close clinical and laboratory post-parathyroidectomy monitoring of dialysed patients is of the utmost importance.
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