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Background: medical teams continue to face challenges with infections following hip replacement surgery, whether they occur shortly after the procedure or months or years later. Certain medical conditions like diabetes, rheumatoid arthritis, and obesity are risk factors that make patients more susceptible to infections. Traditional intervention methods such as DAIR, one-step, or two-step procedures are being enhanced and refined to ensure quicker and more effective treatment. Some cases present particularly difficult challenges, featuring persistent fistulas and unpredictable responses to treatment. Methods: in our article, we share two unique cases, detailing their histories, progressions, and treatment decisions. We explore the use of antibiotic-impregnated calcium biocomposite as a local adjuvant therapy and the application of negative pressure therapy to expedite healing. The system of NWPT has seen widespread uptake and is now implemented routinely for open wounds, such as open fractures, fasciotomies, ulcers, and infected wounds. Results: our findings demonstrate that surgical debridement and calcium sulfate bead insertion successfully treat bone and joint infections without causing any side effects or complications. As a particularity, in the first case, we encountered the exteriorization of Stimulan pearls after surgery, without other complications related to the biocomposite. Conclusions: we have found that NPWT is a beneficial tool in managing complex wounds in both acute and chronic stages, after the infection is cured, reducing the need for frequent dressing changes, shortening hospital stays, and enhancing patient comfort. [ABSTRACT FROM AUTHOR]

Background: Given the increasing rate of infections following hip arthroplasty, one of the current options is the application of a biocomposite at the site of the infection. One of the products used is Stimulan, a completely resorbable calcium sulfate, designed to treat acute and chronic infections. This biocomposite has a controlled purity, is easy to mix with liquid, powder, and antibiotics, and can be applied directly to the site of infection, or it can be injected. Methods: We analyzed data from 76 patients, who were admitted to the County Clinical Hospital of Emergency "St. Apostol Andrei" in Galati during January 2017–September 2023, with a diagnosis of infection associated with hip arthroplasty. Results: In 69.73% of cases (52 patients), we decided to keep the implant in place. In this subgroup, Stimulan was applied in 26 cases (57.78%). Of these, 100% were cured—compared to the subgroup in which Stimulan was not applied, where this percentage was lower. All patients underwent chemical and mechanical toileting, and for 24 patients (20.27%), it was necessary to ablate the implant with or without the application of Stimulan, then reimplantation of the prosthesis. Conclusions: The patients with Stimulan had a longer average length of hospitalization, almost half of them required intervention in two periods, and a quarter required the implantation of spacers. However, the cure rate was higher, only in three people could we not control the infection, and there was no death. This study confirms the effectiveness of the treatment when using a biocomposite in addition to the classical treatment for both acute and chronic cases. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common cause of cancer death in women and the second cause in the general population. The incidence has increased over time. Women in developing countries often present at an advanced stage where initial surgery is not feasible. Short disease-free intervals, the number of metastatic organs and liver metastasis were consistently associated with poor overall survival. Surgery is an integral part of the therapeutic plan for locally advanced breast cancer. The integration of surgical care into the management of patients with advanced cancer has changed substantially with the use of neoadjuvant chemotherapy. Also, more recently, neoadjuvant endocrine therapy and targeted therapies offer new opportunities to downsize the tumor burden and transform the role of surgery for this population from palliation to largely curative intent. Innovative surgical approach to the primary tumor in metastatic disease may provide survival benefits and local control in some patients. Similar to systemic therapy, surgical therapy for secondary dissemination should be considered in certain cases for improved individual outcomes. Advances in reconstructive techniques have improved the quality of life of these patients. [ABSTRACT FROM AUTHOR]

Hemophilia patients have a deficiency in or dysfunction of clotting factors, which can lead to a bleeding tendency. However, paradoxically, some hemophilia patients may also be at an increased risk of developing thrombotic events such as deep vein thrombosis or pulmonary embolism. The pathophysiology of thrombosis in hemophilia patients is not fully understood, but it is thought to involve a complex interplay of various factors, including the severity of the hemophilia, the presence of other risk factors such as obesity, smoking, or the use of hormonal therapies, and the presence of certain genetic mutations that increase the risk of thrombosis. In addition, it has been suggested that the use of clotting factor replacement therapy, which is a standard treatment for hemophilia, may also contribute to the development of thrombosis in some cases. [ABSTRACT FROM AUTHOR]

(1) Background: There has been a growing interest in understanding the causes of obesity and developing effective prevention strategies. Lifestyle change programs are often considered the gold standard for weight reduction, and they can help individuals with obesity achieve an annual weight loss of around 8–10%. The aim of this review was to evaluate the effect of food during the winter holidays. This knowledge will serve as a valuable foundation for the development of targeted interventions and prevention programs. (2) Methods: We conducted a systematic search of the literature via one database (PubMed). The search was limited to studies published in English in the last 10 years, with adult participants, but without specifying limits regarding the study design. We excluded articles that addressed intermittent fasting diets or weight loss intervention methods during the holidays through various diets. (3) In separate sections, we analyzed the psychological causes of gaining weight during the winter holidays, behavioral patterns, prevention strategies and the nutritional composition of the different types of food served during the festive period. Results: Using the combination of the terms "holiday and obesity", "holiday and weight gain", "festive season and obesity", and "festive season and weight gain" we obtained 216 results involving the addressed topic. Thus, only ten articles remained after screening, with a total of 4627 participants. Most participants experienced weight fluctuations during the study period, particularly during holidays. One concerning observation was that most of the weight gained during these periods was maintained even after the end of the studies, especially in those with obesity. A supervised exercise program and a controlled diet at work over the Christmas period are effective strategies for avoiding weight gain and its deleterious effects in people with metabolic syndrome or weight problems. (4) In addition, attention must be focused on the psycho-social factors during the holidays because for some people it is a stressful period and can cause a much higher caloric consumption. The simplest method to approach during the holidays is to implement small tips and tricks during this period that will prevent individuals from gaining extra pounds. Conclusions: It is essential to acknowledge that obesity is a multifaceted condition that requires a comprehensive and multidisciplinary approach to address its underlying factors and provide ongoing assistance to individuals in their weight-management endeavors. Even the most effective short-term interventions are likely to produce continued positive outcomes with persistent intervention and support. [ABSTRACT FROM AUTHOR]

Dementia and hip fractures are two crucial problems in the elderly and the associations of these pathologies increase substantial morbidity and mortality. 178 patients with dementia (average age 81.5 years) were operated with an uncemented bipolar prosthesis for a displaced femoral neck fracture. They started rehabilitation sessions in the immediate postoperative period and were divided into two groups: group 1 - partial weight-bearing for 72 cases - and group 2 - total weightbearing for 106 cases. 17 patients were unable to walk and 6 died during hospitalization. 172 patients were discharged to a rehabilitation department (46.6%) or to their home with (31.9%) or without (21.5%) rehabilitation facilities. During follow-up, 103 out of 172 patients accepted a phone interview. After three months 55 patients had regained the pre-fracture level of independence (6 patients from group 1 and 49 patients from group 2; 81% were included in a rehabilitation program). The mortality at one year postoperative period was 26.21%; the majorities of these patients were included in group 1, were more than 80 years old and had more than 4 comorbidities (except dementia). The authors concluded that, for patients undergoing uncemented bipolar HA, immediate total weight-bearing and discharging to a rehabilitation facility showed a better recovery and return to the pre-fracture level, as well as a better one-year survival rate. [ABSTRACT FROM AUTHOR]

Pacients with entero-cutaneos fistula may represent a real challenge for surgeons, requiring close monitoring and also an optimal approach regarding the invasive gestures. We report the use of two classic methods, combined with modern ones, for closure of a high-output duodenal fistula in a patient who had undergone duodenal surgical treatment for obtaining hemostasis in a higher digestive haemorrhage. We present the case of a 46 year-old patient, admitted in our service for an external postoperative digestive fistula arising in the context of mixed decompensated liver cirrhosis with toxic etiology after a surgical intervention for a duodenal bleeding ulcer. The patient developed an early (48h) external postoperative digestive fistula. After the clipping intervention, a compression dressing is applied, so that the flow rate of the fistula becomes minimal. The progressive decrease of drainage during 7 post-operative days imposed approaches like the model of instillation-suction of lactic acid (Tremoliere) and of Monica Roşca meshing for solving the digestive fistula. After the cessation of digestive secretion, a rapid process of scarring and wound retreatment occurs, alongwith the appearance of reepithelial edges, due to patient's status, which did not permit classic surgery for the closure of the abdominal wall, so that treatment with negative pressure to close the wound was decided. [ABSTRACT FROM AUTHOR]

Aim: Negative Pressure Wound Therapy (NPWT) devices demonstrated their importance in wound healing process. Our clinical study evaluates the role of NPWT in skin grafts healing, both in acute and chronic wounds. Method: We used NPWT for acute and chronic soft tissue defects therapy (56 cases), before and after reconstruction with skin grafts. We compared the evolution of two groups of patients, with similar wounds, admitted and treated during a 7-year period (2016-2022). For 25 patients we used NPWT only before reconstruction with skin grafts (15 acute, 10 chronic wounds), and for the other 31 patients we used NPWT before and after skin grafting (14 acute, 17 chronic). Results / Discussion: Before local reconstruction, NPWT stimulated wound debridement (16 patients with burn injuries, 8 patients with deep posttraumatic soft tissue defects) or granular tissue development (9 patients with trophic ulcers on the leg, 13 patients with diabetic foot, 5 patients with pressure sores, 5 patients with defects after tumor excision). Immediately after the reconstruction, NPWT offered the best conditions for wound healing by reducing local edema, maintaining graft adhesion to the wound bed, stimulating new vessels to grow and nourish the skin graft. Conclusion: NPWT provided a better quality of local healing, in a shorter time and with lower costs. [ABSTRACT FROM AUTHOR]

The abdominal vacuum-assisted closure (VAC) system has been introduced, providing a new possibility to treat an open abdomen. Abdominal compartment syndrome has a great relevance in surgical practice and patient care in critical condition, due to the effects of increased pressure in the enclosed space of the abdomen, possibly leading to multiple organ failure. We present a case of a 53 year-old woman with acute severe pancreatitis, admitted to intensive care unit with increasing abdominal pressure and rapid development of the compartment syndrome which overcame non-surgical manoeuvres, so that emergency surgery was imposed. The surgical procedure implied a laparostoma managed through negative pressure therapy. Severe cases of acute pancreatitis are associated with high mortality rate, secondary to early and late complications that develop as a consensus of the progression of the inflammatory and necrotic process. [ABSTRACT FROM AUTHOR]