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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

The pathology of the adrenal gland and the clinical management of the adrenal clinical entities are particularly complex. The surgical approach to adrenal disorders, both in the classic way and especially in the minimally invasive way, is reserved for highly addressable centers and experienced surgeons. The surgical treatment is dedicated to both functional and nonfunctional adrenal tumors, closely following specific criteria. Regarding adrenal pathology, the surgical treatment is indicated for adrenal tumors that secret mineralocorticoid hormones (Conn syndrome), adrenal tumors secreting glucocorticoids (Cushing syndrome), pheochromocytomas, paragangliomas, neuroblastomas, adrenal carcinomas, and metastases. At the same time, non-secreting tumors should be removed as soon as imaging details are recorded an increasing dimensions of these tumors during a short time interval (up to one year). Although laparoscopic adrenal removal became a gold standard procedure in the late 90s, the classic open surgical adrenalectomy is reserved for bulky adrenal tumors and adrenal cancers, but it is overshadowed by possible multiple complications such as lung damage, wound infections, thrombosis, bleeding, etc. The minimally invasive approach, either laparoscopically or robotically, is dedicated to small tumors, with the advantage of rapid patient recovery, rapid socio-professional reintegration, and reduction of complications. Laparoscopic adrenalectomy is indicated in a wide range of pathologies, ranging from Conn adenoma, Cushing syndrome, and pheochromocytoma, to hormonal inactive tumors or other pathologies. The surgical sparing of the adrenal cortex is advised in cases of hereditary disorders affecting the adrenal gland (such as the MEN2 syndrome) in order to avoid primary adrenal insufficiency after the surgical excision. The postoperative evolution must be closely monitored by the anesthetic-surgical team, and the subsequent follow-up must not be neglected. We will discuss the primary surgical indications and contraindications of adrenal gland pathology in this chapter, as well as the perioperative management of specific tumors, surgical approach types, pluses and minuses of various adrenal surgery procedures, surgical technique and tactics, potential complications, and postoperative management.

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.

Aim Cryptorchidism is a rare condition of adult male. The diagnosis is based on examination: impalpable testis and CT/MRI. The surgical correction of cryptorchidism is possible in childhood, but in adult orchiectomy is recommended, considering the malignancy risk. The association with hernia is uncommon. Material and Methods We report the case of a 23 years old male with left inguinal hernia and concomitant left cryptorchidism. MRI revealed the intra-abdominal left testicle, with reduced size and short vessels. Lab analysis were normal. We underwent laparoscopic exploration: the left testicle was small and had pelvic localization. A large inguinal hernia was also confirmed. We decided to perform laparoscopic TAPP (transaabdominal preperitoneal repair) and left orchiectomy. The evolution was uneventful and patient discharged 1st day postoperatively. Histology revealed testicular atrophy with no malignancy, also no spermatogenesis was present. No recurrence was found during follow-up. Results Cryptorchidism in adult is rare. The association with hernia is even more rare. The open management is not easy, often in pelvic/abdominal localization, the inguinal approach can be cumbersome. There is no standard of care for these cases, but we found the minimally invasive approach to be a good choice. Laparoscopic surgery has the advantage of enhanced exploration and orhidectomy can be easily performed. Associated with the orchidectomy, hernia cure can be facilitated by laparoscopic TAPP procedure. Conclusions In cases of concomitant hernia and cryptorchidism, we emphasize the idea of simultaneously cure hernia via laparoscopic TAPP procedure associated with orchidectomy as feasible and safe.

Pheochromocytomas are tumors composed of chromaffin cells that can produce, secrete and metabolise catecholamines. The surgical excision procedure of these tumors may present the risk of significant variations in blood pressure, as well as the chance of cardiovascular complications in the perioperative period. During surgery, patients may be at risk for cardiovascular events such as major variations in blood pressure, pulmonary edema, stroke, myocardial infraction and a long period of intubation. The surgical approach to pheochromocytomas must always be preceded by accurate imaging evaluation, endocrine screening and identification of associated genetic mutations. In addition, the surgical technique of choice consists in using minimally invasive surgical methods, with a transabdominal or retroperitoneal approach.

Matrix metalloproteinases (MMPs) are enzymes involved in the modulation of extracellular matrix (ECM) and adipocytes and preadipocyte differentiation. The pathophysiology of obesity has characterized by many cellular and molecular processes such as inflammatory processes, macrophage infiltration of adipose tissue, and remodeling of ECM via MMP. The purpose of the study was to determine if we can consider MMPs as a marker of effectiveness in bariatric surgery and if sulodexide administration pre- and postoperative has a benefit in terms of tissue remodeling of weight loss. An experimental study has performed using 40 obese Wistar rats (10 rats in the control group and 30 obese rats in study groups). Those in the study group were divided into three groups and underwent gastric bypass (B group), sulodexide administration (S group), gastric bypass, and sulodexide administration (BS group). Sulodexide was administered because of its antithrombotic effect in the procoagulant status of obese subjects. The pre- and postoperative weight, glucose level, cholesterol, triglycerides, MMP-2, and MMP-9 were analyzed. We compared the results to see if bariatric surgery modifies the MMPs status and if there is a correlation between the weight loss and the other parameters and also if sulodexide has any contribution to the results. The MMP-2 and MMP-9 activities were detectable, but MMP-2 was significantly higher than MMP-9. MMP-2 correlates with body weight parameters before surgery and after surgery, after significant bodyweight reduction as a result of bariatric surgery (r = 0.478, p = 0.017). There is a strong correlation between the weight loss, glucose level, and cholesterol and the values of MMP-2 (r = 0.92, p = 0.022, respectively, r = 0.759, p = 0.033). MMP-9 is correlated with weight loss and triglycerides level. But it was not as sensitive as MMP-2. Sulodexide administration in group S had a positive influence on the MMP-2 and MMP-9 compared with the values of groups B and C but without statistical significance. MMP-2 and MMP-9 are the two most important ECM enzymes involved in adipose tissue remodeling after bariatric surgery. The correlations between cholesterol, triglycerides, glucose, weight loss, excess weight, and body mass index (BMI) parameters and MMPs level demonstrate the direct relationship of these enzymes in obesity. Although we believe that more in-depth studies are required, MMPs may be considered a marker of the effectiveness of bariatric surgery.

Chromogranin A (CgA) is part of the family of granins, which are acidic glycoproteins that represent an important part of secretory dense core granules. They are specific to various neuroendocrine and endocrine tissues, as components of diffuse neuroendocrine system and endocrine glands. CgA is co-secreted and co-released in the circulation along with hormones, bioamines and peptides secreted from the neuroendocrine cells . In the last decade, studies have emphasized the major importance of serum CgA in the diagnosis and follow-up of neuroendocrine tumors such as gastroenteropancreatic tumors, pheochromocytoma, medullary thyroid carcinoma. But its diagnostic value for adrenocortical adenomas or for adrenal malignancy, is still controversial. The current study aims to provide a comprehensive review , for synthesizing current knowledge regarding corelations between plasma CgA concentration and various adrenal tumors. Furthermore, there will be also analyzed and synthesized the clinical applicability and the diagnostic usefulness of dosing CgA in adrenal pathology, both medullary and cortical benign and malignant lesions.

Background: Combined hysteroscopy and laparoscopy is a valuable method for diagnosing and treating infertility and benign uterine pathology. Both procedures are minimally invasive, reliable, and safe, with a low complication rate. Aim: In this review, we expose the efficiency and safety of hysterolaparoscopy in the management of infertility and other benign uterine pathologies. Method: We performed a systematic literature review on several databases: PubMed®/MEDLINE, PMC, Crossref.org, and Web of Science in the last 10 years. Inclusion criteria: Women of reproductive age with primary or secondary infertility and/or benign uterine pathology. Exclusion criteria: pre-puberty, menopause, couple with male infertility. Conclusion: Hysterolaparoscopy is a useful tool to assess infertility and simultaneously diagnose and treat pelvic and uterine lesions.

Obesity involves the growth of adipose tissue cells (adipocytes and preadipocytes), as well as microvascular endothelial cells. Matrix metalloproteinases (MMPs) are relevant ezymes for the modulation of extracellular matrix (ECM) and adipocyte and preadipocytes differentiation. They are elevated in obese patients, generating abnormal ECM metabolism.[1]. This article proposes a thorough study of literature with focus on the important roles of matrix metalloproteinases in the pathophysiology of obesity. The article represents a narrative review based on an English-language PubMed research of the medical literature regardind important aspects of the proposed aim. MMP-2 activity was signi�cantly higher than MMP-9, both activities were detectable. MMP-9 was strongly correlated with body weight parameters before surgery, as well as after significant body weight reduction as a result of bariatric surgery. Concerning MMP-2 and MMP-9 they are also involved in the turnover of basement membranes both those of adipose tissue and endothelial. MMP-9 levels were moderately correlated with HDL cholesterol levels. Taken together, the present data suggest that changes in ECM through MMP-mediated degradation might play a critical role in the adipocyte differentiation process. These findings are detected both in clinical trials and in laboratory animal experiments. It is then tempting to speculate that the adipocyte-derived MMPs might represent a new pharmacological target for the inhibition of adipose tissue growth by inhibiting adipose differentiation as well as angiogenic process.

Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during 1994-2014. We wanted to identify evolution trends in complications of laparoscopic surgery, analyzing the dynamic of errors occurred in all patients with laparoscopic procedures. Results. We recorded 26847 laparoscopic interventions with a total of 427 intra-or postoperative complications that required 160 conversions and 267 reinterventions to resolve inconsistencies. The average frequency of occurrence of complications was 15.9‰ (15.9 of 1,000 cases). In the period under review it was a good momentum of laparoscopic procedures in our department. Number of minimally invasive interventions increased almost 10 times, from 266 cases operated laparoscopically in 1995 to 2638 cases in 2008. Annual growth of the number of laparoscopic procedures has surpassed the number of complications. Conclusions. Laborious work of laparoscopic surgery and a specialized centre with well-trained team of surgeons provide premises for a good performance even in the assimilation of new and difficult procedures.

Melanoma has a significant mortality and its growing incidence is associated with important social and health care costs. Thus, investigation of the complex mechanisms contributing to emergence and development of melanoma are of real interest both in scientific research and clinical practice. Estrogens play an important role in the emergence and development of certain types of cancer, such as breast cancer, endometrial cancer and ovarian cancer, but their role in development of cutaneous melanoma is still a matter of debate. Various data suggest that increased levels of endogenous estrogens during pregnancy or exposure to exogenous estrogens by use of oral contraceptives (OCs) and hormone replacement therapy (HRT) may have a potential role in melanoma development and progression. Moreover, there were revealed several intracellular pathways which can support the connection between estrogens, estrogen receptors (ER) and melanoma. While ER-β plays an antiproliferative role, ER-α promotes cell growth and cellular atypia. Thus, inhibition of ER-β activity in the skin can increase the risk for development of cutaneous melanoma and spread of metastatic cells. However, despite recent advances in this area, the exact role and clinical implications of estrogens and estrogen receptors in melanoma are still not entirely understood and require further investigations.

Anabolic androgenic steroids (AAS), simply called “androgens”, represent the most widespread drugs used to enhance performance and appearance in a sporting environment. High-dosage and/or long-term AAS administration has been associated frequently with significant alterations in the cardiovascular system, some of these with severe endpoints. The induction of a prothrombotic state is probably the most life-threatening consequence, suggested by numerous case reports in AAS-abusing athletes, and by a considerable number of human and animal studies assessing the influence of exogenous androgens on hemostasis. Despite over fifty years of research, data regarding the thrombogenic potential of exogenous androgens are still scarce. The main reason is the limited possibility of conducting human prospective studies. However, human observational studies conducted in athletes or patients, in vitro human studies, and animal experiments have pointed out that androgens in supraphysiological doses induce enhanced platelet activity and thrombopoiesis, leading to increased platelet aggregation. If this tendency overlaps previously existing coagulation and/or fibrinolysis dysfunctions, it may lead to a thrombotic diathesis, which could explain the multitude of thromboembolic events reported in the AAS-abusing population. The influence of androgen excess on the platelet activity and fluid–coagulant balance remains a subject of debate, urging for supplementary studies in order to clarify the effects on hemostasis, and to provide new compelling evidence for their claimed thrombogenic potential.

Multiple endocrine neoplasia type 2 is a group of medical disorders associated with tumours of the endocrine system. The tumours may be benign or malignant. They generally occur in the endocrine organs (e.g. thyroid, parathyroid, and adrenals), but may also occur in the endocrine tissues of organs not classically thought of as endocrine. We present the case of a 28-year-old female, with history of MEN2A syndrome confirmed by genetic screening and manifested by bilateral pheochromocytoma, for which she underwent right adrenalectomy in 2009 and left adrenalectomy in 2011, as well as by medullary carcinoma of the thyroid, for which total thyroidectomy was performed in 2009. At present, the patient is under replacement treatment of the thyroid function with LT4 and glucocorticoid and mineralocorticoid replacement therapy with Prednisone and Astonin. Currently, the patient has been periodically presenting herself for clinical and therapeutic endocrinological re-evaluation, in the context of an ongoing pregnancy. During a presentation, in September 2015, the pregnancy being in its 24th week, at ultrasonography, a possible remnant of thyroid tissue was detected, a superior and mediolateral adenopathy, well defined, with some interior calcifications, discretely vascularized, therefore of a suspicious nature and a left supraclavicular small cluster of microcalcifications was also detected. Calcitonin blood level was measured in order to dynamically correlate its evolution with the new ultrasound findings with a significant increase at the current dosing reaching 587.20 pg / ml.

Medical students have an increased risk of developing psychological and eating disorders due to the academic stress and the degree of physical activity. The stress during the exam session affects eating attitudes, mental health and physical activity. The aim of the study was to analyse the eating behaviors, mental status and grades of physical activity before and during exam session in medical college students. We performed an analytical observational study in a population of 78 undergraduate 1st and 2nd year medical students (66 girls and 12 boys). Eating-related attitudes were studied using the EAT- 26 questionnaire. Anxiety and depression scores were evaluated with GAD7 and PHQ-9 questionnaires. Physical activity was also assessed. All of the questionnaires were given before and during the exam session. The scores of EAT 26 questionnaire reflect a normal reporting of dieting attitudes, regardless of the time of evaluation. Regarding assessment of anxiety (GAD7) and depression (PHQ-9), an increase in the number of cases of severe anxiety and depression during the exams session was shown. In addition, the physical activity index dropped significantly during the exam period. The academic and psychological stress during the exam session affected the mental status of the medical students causing an increase in the anxiety and depressions scores. Also, the physical activity diminished, emphasizing their psychological state. No significant changes in eating behavior were observed.

Anabolic androgenic steroids (AAS) are synthetic derivatives of testosterone with thrombogenic potential in high doses and long-term administration. Taurine, a widely distributed amino-sulfonic acid, is known for its beneficial effects in hypercoagulable states. In order to assess the impact of chronic administration of high doses of AAS and taurine upon haemostasis process in rats, 40 male Wistar rats were divided into four equal groups: control group (group C) - no treatment; androgen group (group A) - received 10 mg/kg per week of nandrolone decanoate (DECA); taurine (group T) - received oral supplementation of 2% taurine in drinking water; androgen and taurine group (group AT) - concomitant administration of DECA and taurine. After 12 weeks, blood samples were collected and haemostasis parameters were assessed with the thrombelastographic (TEG) analysis system: reaction time, clot kinetics (K, α), final clot strength, coagulation index and the clot lysis (Ly30). Nandrolone significantly decreased reaction time in group A compared with control (P0.001), whereas taurine significantly increase reaction time (P=0.01), and this effect was maintained in group AT compared with group A (P=0.009). Similar differences between groups have been recorded for the clot kinetics parameters K, α. The final clot strength and coagulation index were significantly increased in group A versus group C (P=0.04, respectively P0.001), but not in group AT versus group C (P0.05). There were no differences in clot lysis, as shown by Ly30. Nandrolone produces an accelerated clot development and an increased clot firmness in Wistar rats. Taurine association ensures a protective effect against this hypercoagulable state, partially restoring the altered parameters of the coagulation profile.