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The paper focuses on the employer branding creation and HR marketing in selected healthcare service providers. The employer branding creation and HR marketing have become an interesting and creative area both in the field of HR management and marketing. The process of the employer branding creation and the conception of HR marketing coming from within the organizations and corporations could an interesting and effective tool that management not only in healthcare service providers could use to create a relationship with their current and also the potential employees. The aim of the article was to find out, among other things, which factors influence the choice of the employer (concerning the selected healthcare service provider). This study was researched on the gender and biological age of the respondents. For research purposes, a structured questionnaire was used. This questionnaire was distributed among selected healthcare service providers in the Czech Republic. The proposed research hypotheses have been verified through research. The statistical method of the Pearson’s Chi-square test was chosen to verify the research hypotheses. This research study has brought the compelling findings. Firstly, that there is a statistically significant relationship between the factors influencing the choice of the employer (the selected healthcare service provider) and the age of the respondents, and secondly that there is a statistically significant relationship between the factors influencing the choice of the employer and the gender of the respondents in selected healthcare service providers in the Czech Republic.

Introduction. Vesicovaginal fistulas are perhaps the most feared complications of female pelvic surgery. Ideally the majority of VVFs should be amenable by transvaginal repair. The relative advantages of vaginal repair compared to an abdominal approach are quick convalescence and return to normal activities; approach is not compromised by multiple prior abdomino-pelvic surgeries, minimal blood loss and postoperative pain. The main disadvantages of the transvaginal approach include the relative lack of familiarity of the vaginal cuff anatomy to many urologists, the difficulty in exposing high or retracted fistulae located near the vaginal cuff. The situation is even more difficult if there is no apical prolapse or we have to deal with a narrow vagina. The abdominal approach is advantageous in several situation such as fistulas located high at the vaginal cuff, when reimplantation is necessary or when other intraabdominal pathology require repair. In our experience, large, complex or recurrent VVF are best approached abdominally as well. Material and methods. We present a retrospective study based on the personal experience in the field of major urologic surgery on a period of almost 10 years. During Jan 2008 - July 2016 I operated 34 VVFs in two major hospitals in Bucharest - Fundeni Clinical Institute and ”Saint Mary” Clinical Hospital.We used the combined transvesical and transabdominal approach in 8 cases. Surgical technique: The patient is positioned in a low lithotomy position with access to vagina in the sterile operative field. We can use a midline or Pfannenstiel incision. The retropubic space is opened and the bladder is mobilized anteriorly and laterally. Pouch of Douglas, vaginal apex and the entire bladder should be exposed. The bowels are packed away to keep it out the operative field. A midline cystotomy should be carried posteriorly down to the fistula. The fistulous tract is excised by circumscribing the bladder portion, dissecting it down to the vaginal wall and removing it by a circumscribing incision in the vagina. The edges of the vaginal wall are freed up by sharp dissection to permit adequate mobilization for closure in a tension free manner.Well vascularized tissue should remain for closure of bladder and vagina.Vagina is closed with separate absorbable suture. An interpositional flap of greater omentum is highly recommended. The flap is secured 1 to 2 cm distally beyond the excised VVF tract. Urethral catheter and lond ureteral mono-J stents are placed, sometimes a suprapubic tube could be usefull. Bladder is closed in two layers. Retzius space and peritoneal cavity are drained. The wound is closed in layers in a standard manner. Results. The etiology of the fistulas were 5 cases (62.5%) after hysterectomy (3 open - abdominal; 2 laparoscopic); 3 cases (37.5%) after radiotherapy and Wertheim operation (2 open; 1 laparoscopic).In two cases we performed ureteral reimplantation due to the fact that fistula tract was in close proximity of the ureteric orifice. In one case we performed preoperative nephrostomy drainage in order to preserve the renal unit. No fistula reccurence was noted. No renal unit was lost. Mean operative time was aproximately 120 min (range between 80 and 200 min). Mean blood loss was 150 ml (range between 100-600 ml). Mean hospital stay was 14 days (range between 12-22 days). During a median follow-up period of 72 months (3-116 months ) the patients continued to void normally, without fistula recurrence and had sterile urine cultures. Conclusions. We should always remember that the first operation is the one most likely to succeed. You always should select an approach with which you feel confortable. The combined approach transvesical and transperitoneal represents a feasible technique especially for large fistulae located high in a deep narrow vagina, in failures after other approaches and also when we need to perform ureteral reimplantation.The key to the operation is the mobilization [ABSTRACT FROM AUTHOR]

Introduction. Urethral endometriosis is a rare entity and only few cases have been reported. It represents about 2 percent of all urinary tract involvements and is briefly mentioned in the clinical guidlines and literatures. It may arise from suburethral location or within urethral diverticula. Material and methods. A 54 year old woman was admitted in our urology department, at ”Saint Mary” Clinical Hospital, for urinary stress incontinence, urinary tract infections, mild disuria. Pelvic examination revealed a suburethral mass, painless, two centimeters in diameter. No pus was expressed through the urethra with cyst massage. Transvaginal ultrasound revealed a cystic lesion on the anterior aspect of mid urethra. Uterine adenomyosis was noted. Cistoscopy showed that the cystic lesion did not communicate with the urethral lumen. Under spinal anesthesia she underwent an urethrocystoscopy that did not reveal any diverticular ostium. Then we proceded to transvaginal resection of the mass. The lesion was located to the level of the mid urethra. The entire mass was resected. The lesion contained a thick, dark liquid blood count. Intraoperative frozen section histopathology showed endometriosis. Regarding the involuntary leakage of urine, we continued the surgical intervention with the placement of a tension free transobturator tape sling. Results. Postoperative evolution was favorable and the pacient was discharged on the third day postoperatively.` The paraffin histopathology showed endometriosis. After surgery the pacient was guided to the gynecology service for further investigation and medical treatment on the endometriosis. At six months postoperative control the pacient was fully recovered, with disappearence of stress urinary incontinence. No endometriosis recurrence was encountered. Conclusions. Although rare, endometriosis should be considered in the diagnostic evaluation of any periurethral cystic mass, especially if it is associated with a history of pelvic pain, dyspareunia, dysmenhorrea (or menstrual disorders), voiding difficulty or urinary incontinence. Knowledge of the etiology, evaluation and treatment of cystic lesions of the vagina is essential as these lesions are not very often encountered in urological practice. Familiarity with the different types of cystic lesions is important for any clinician involved in gynecological or female urological practice to arrive at the correct diagnosis and treatment plan. [ABSTRACT FROM AUTHOR]

Introduction. Vesicovaginal fistulas are perhaps the most feared complications of female pelvic surgery. More than half of such fistulas occur after hysterectomy for benign diseases. Material and methods. During Jan 2008 - July 2016 I operated 34 VVFs in two major hospitals in Bucharest - Fundeni Clinical Institute and ”Saint Mary” Clinical Hospital. We used transvesical (extraperitoneal) approach in 14 cases. All the cases were after abdominal hysterectomy - 12 open and 2 laparoscopic. Surgical technique: The patient is positioned in a low lithotomy position with access to vagina in the sterile operative field. A vaginal mesh was inserted. We can use a midline or Pfannenstiel incision. The retropubic space is opened and the bladder is mobilized anteriorly and laterally. A midline cystotomy should be carried posteriorly down to the fistula. The fistula tract could be observed and bilateral ureteral catheters are inserted up to the level of renal pelvises. A mucosal circumferential incision was carried out 3-4 mm away from the fistula excising its tract. Minimal dissection of the bladder from the vagina is needed in order to allow a tension free suture of both the bladder and vaginal defects, which were closed separately. A Foley catheter was placed to further drain the bladder. We closed the bladder is closed in two layers, drained the Retzius space and the wound is closed in layers in a standard manner. Results. The etiology of the fistulas were in all cases after hysterectomy (12 open; 2 laparoscopic) for benign conditions. The median age was 41 years (range 33 and 58 years). In 2 cases (14.28%) we noted fistula reccurence in the first 10 days from the previous reconstruction. In both cases we did a second succesfull attempt using a combined transvesical and transabdominal approach with omental flap interposition at 2 and 3.5 months respectively. No renal unit was lost. Total operative time was aproximately 80 minutes. Blood loss was 100-150 ml.Urethral catheter was left in place for 10 days (range 8-18 days). Ureteral catheters were removed after 8 days (range 5-14 days). During a median follow-up period of 68 months (8-110 months) the patients continued to void normally, without fistula recurrence and had sterile urine cultures. The success rate after first attempt was 87.21% (12 cases from 14). The two failures were approached by transabdominal with omental flap interposition and the result was favorable without fistula reccurence. Conclusions. We should always remember that the first operation is the one most likely to succeed. Transvesical approach is feasible and familiar for urologist. Also due to the fact that the surgery is extraperitoneal, the recovery is relative quick. [ABSTRACT FROM AUTHOR]

Introduction. Acquired vesico-vaginal fistulae (VVF) is almost universally unexpected and an undesired postoperative event. The repair of this pathology represents sometimes a real challenge. Generally speaking the goals of urinary fistula repair are: the expedious resolution of urinary leakage, sepsis avoidance and preservation of renal units. While the emotional status of the patient should not be underestimated, it also should not play a role in the decision process of when to repair a VVF. Material and methods. We present a retrospective study based on personal experience in the VVF repair. Between Jan 2008 - July 2016 we operated 34 vesicovaginal fistulae (VVFs) in two major hospitals from Bucharest - Fundeni Clinical Institute and ”Saint Mary” Clinical Hospital. The etiology of the fistulas were: in 21 cases (61.76%) after abdominal hysterectomy; in 1 case (2.94%) after vaginal hysterectomy and in 12 cases (35.29%) after radiotherapy and Wertheim operation.The location of the fistulas were supratrigonal 23 cases (67.64%), trigonal 4 cases (11.76%), involving bladder neck and urethra 7 cases (20.58%). Results. We performed reconstruction by transvaginal approach in 3 cases (8.82%), transvesical (extraperitoneal) in 14 cases (41.17%), combined transvesical and transabdominal in 8 cases (23.52%), Bricker urinary diversion in 6 cases (17.64%) and Bricker urinary diversion and colostomy in 3 cases (8.82%). One case required preoperative nephrostomy drainage in order to preserve the renal unit. In two cases we performed ureteral reimplantation due to the fact that fistula tract was in close proximity or involved the ureteric orifice. We used Martius flap in 2 cases repaired by transvaginal approach and omentum flap in 8 cases repaired by combined transvesical and transabdominal approach. The median age was 43 years - range between 31 and 62. Urethral catheter was used for 14 days (10-21 days ); ureteral stents were removed after 10 days (5-18 days). Suprapubic cystostomy was used in 2 cases. We registered 2 failures that were operated after 2 respectively 3,5 months after previous attempt. In both cases the approach was transabdominal with omental flap interposision. Mean operative time was aproximately 120 min (range between 50 and 380 min). Mean blood loss was 150ml (range between 100-600ml). Mean hospital stay was 14 days (range between 12-22 days). During a median follow-up period of 72 months (3 months- 116 months) the patients in which we reconstructed the urinary tract continued to void normally, without fistula recurrence and had sterile urine cultures. Conclusions. Vesicovaginal fistula after different types of surgery may result in a great deal of inconvenience, discomfort and physical disability for the affected females. Not infrequently the medicolegal aspects of these cases can be very disturbing to the treating physician. Nevertheless, minimizing patient discomfort, maintaining a positive and honest patient - physician relationship while providing constant reassurance and finally pursuing optimal successful treatment of the fistula will most often result in a satisfying long term outcome. There is no preferred approach for all fistulae and the optimal approach is the one that is most successful in the individual surgeon's hands. However, the surgeon should be familiarized with different reconstructive techniques due to the fact that sometime we should be able to change the reconstructive technique intraoperativelly. [ABSTRACT FROM AUTHOR]

Background and Objectives : Secretory carcinoma of the breast is an uncommon histological subtype of breast cancer. There is little research on this entity and only a few larger studies, which lack consensus. We aim to report a particular apocrine differentiation in this subtype and ponder upon the clinical outcome of this case. Case presentation : We report the case of a 72-year-old female patient who presented to our hospital with a suspicious breast tumor. Core biopsy and mastectomy showed a low-grade breast carcinoma, a secretory subtype with apocrine differentiation. Immunohistochemistry confirmed both the secretory nature and the apocrine nature of the tumor cells. Surgical excision was considered curative and the patient is under long-term surveillance for any recurrences. Conclusions : There is very little research on the clinical behavior of secretory carcinomas with apocrine differentiation. The clinical outcome is unknown and, unfortunately, besides surgery, no other adjuvant treatments have shown efficacy. Further studies on long-term clinical progression are required for this rare entity.

Esophageal fistula remains one of the main postoperative complications, with the treatment often requiring the use of stents. This article reviews the updates on the use of endoscopic stents for the treatment of postoperative esophageal leakage in terms of indications, types of stents used, efficiency, specific complications and perspectives., Materials and Methods: We searched the PubMed and MEDLINE databases for the keywords postoperative esophageal anastomotic leak and postoperative esophageal anastomotic leak stent, and retrieved relevant papers published until December 2022., Results: The endoscopic discovery of the fistula is usually followed by the insertion of a fully covered esophageal stent. It has an efficiency of more than 60% in closing the fistula, and the failure is related to the delayed application of the method, a situation more suitable for endo vac therapy. The most common complication is migration, but life-threatening complications have also been described. The combination of the advantages of endoscopic stents and vacuum therapy is probably found in the emerging VACstent procedure., Conclusions: Although the competing approaches give promising results, this method has a well-defined place in the treatment of esophageal fistulas, and it is probably necessary to refine the indications for each individual procedure.

We present the case of a patient with rheumatoid polyarthritis treated in our department, with a long history of chronic calcifying pancreatitis which was incidentaly diagnosed during a renal colic with a pancreatic tumor. Pancreatoduodenectomy with lateral superior mesenteric vein resection was performed, the final pathological examination revealed a malignant solid pseudopapillary neoplasm with a positive lymph node. Clinical, surgical, pathological and a review of the literature are presented., (Celsius.)

Background: Reinforcement of posterior cruroplasty has been proposed to minimize the failure of hiatal hernia repair (HHR). The applications of autologous platelet-rich plasma (PRP) and absorbable mesh are barely reported in this area., Aims: To analyze local macroscopic and microscopic changes induced by mesh vs. PRP as reinforcement of HHR, using a reliable laparoscopic experimental porcine model., Material and Methods: This prospective, comparative pilot study was conducted on 14 female pigs, aged four to six months. An iatrogenic hiatal defect was laparoscopically simulated and repaired, reinforced with Bio-A® mesh (group A) or PRP (group B). Specimen retrieval was performed after seven months for histopathological (HP) examination., Results: No local or general complications were registered, with complete resorption of reinforcements, that determined inflammatory infiltrates with local collagen production and tissue neo-vascularization. Group A had an increased mean chronic inflammation score ( p  = .3061), showing significant sclerotic collagenizing process. PRP enhanced angiogenesis, collagenizing, myofibroblast recruitment and tissue ingrowth., Conclusions: No residual materials or evidence of anatomical distortion were found. Animal model was safe and reliable. This is the first report of complete absorption of Bio-A ® positioned on crural area. HP results suggest the clinical application of PRP in HHR as a promising co-adjuvant to local remodeling and healing. Abbreviations: ASA: American Society of Anesthesiologists; AB: Alcian Blue; PAS: Periodic Acid-Schiff; CP: platelet concentrate; fPC: filtered plasma concentrate; GERD: gastro-esophageal reflux disease; HSA: hiatal surface area; HHR: hiatal hernia repair; HP: histopathological; HH: hiatal hernia; HE: hematoxylin and eosin; HR: hiatus repair alone; HRM: hiatus repair and acellular dermal matrix; NM: Nicolae Manolesccu; LNF: laparoscopic Nissen fundoplication; PC: posterior cruroplasty; PPP: platelet-poor plasma; RP: platelet-rich plasma.

Hepatocellular carcinoma (HCC) is the fifth most common cancer, with an increasing incidence in recent years. The prognosis is unfavorable, representing the third most frequent cause of cancer-related death worldwide. This is because it generally develops in patients with pre-existing liver pathology, thus limiting therapeutic options. The role of ablative therapies is well-established in nodules smaller than 3 cm, but for nodules from 3 to 5 cm, the best therapeutic management is not well defined. Recent studies reported that combining minimally invasive procedures like transarterial chemoembolization (TACE) with microwave ablation (MWA) or radiofrequency ablation is superior to each alone. However, there is no consensus regarding the timing and the order in which each procedure should be performed. We report a case of an 86 years old male with HCV-related compensated hepatic cirrhosis and multiple cardiac comorbidities diagnosed with a 47/50 mm HCC. Pre-surgical evaluation of the associated pathologies determined that the risk for the surgical approach outweighs the benefits, so the committee decided to treat it in a less invasive manner. We performed MWA and TACE in a single session with technical success according to the modified Response Evaluation Criteria in Solid Tumors (m-RECIST). This case illustrates the first case of simultaneous MWA and TACE performed in our center. This new approach of hepatocellular carcinoma appears to be a good alternative to more invasive methods, with good results even in older people that are unfit for surgery., (©2022 JOURNAL of MEDICINE and LIFE.)

Introduction: We present our department experience in pancreatic surgery over the last 6 years. From its inception the number of pancreatic resections has been continuously growing each year. Method: We performed a retrospective analysis of a prospectively maintained database where we included all the patients with pancreatic resections over the last 6 years. We present the main indication and the different types of pancreatic resections, postoperative morbidity, intrahospital and 90-day mortality and an analysis of survival for the patients with pancreatic ductal adenocarcinoma. Results: We analyzed 198 patients, 193 with pancreatic resections and 5 patients with open surgery microwave ablation. There were 145 pancreaticoduodenectomies, 37 distal pancreatectomies, one total pancreatectomy, 3 distal pancreatectomies with celiac axis resection and 7 surgical interventions for chronic pancreatitis. Conclusion: We presented our center's experience in pancreatic surgery with good overall results, however, there is still room for continuous improvement and refinements to achieve better shortterm outcomes, regarding postoperative morbidity and mortality., (Celsius.)

Background: Liver transplantation (LT) has become an established treatment for end-stage liver disease, with more than 20.000 procedures yearly worldwide. The aim of this study was to analyze the results of Romanian National Program of LT. Methods: Between April 2000 and April 2017, 817 pts received 852 LTs in Romania. Male/female ratio was 487/330, while adult/pediatric ratio was 753/64, with a mean age of 46 years (median 50 yrs; range 7 months - 68 yrs). Main LT indications were HBV cirrhosis (230 pts; 28.2%), HCC (173 pts; 21.2%), and HCV cirrhosis (137 pts; 16.8%). Waiting time and indications for LT, patient and donor demographics, graft features, surgical procedures, and short and long-term outcomes were analyzed. Results: DDLT was performed in 682 pts (83.9%): whole LT in 662 pts (81%), split LT in 16 pts (2.3%), reduced LT in 2 pts (0.2%), and domino LT in 1 pts (0.1%). LDLT was performed in 135 pts (16.5%): right hemiliver in 93 pts (11.4%), left lateral section in 28 pts (3.4%), left hemiliver in 8 pts (1%), left hemiliver with segment 1 in 4 pts (0.5%), and dual graft LDLT in 2 pts (0.2%). Overall major morbidity rate was 31.4% (268 pts), while perioperative mortality was 7.9% (65 pts). Retransplantation rate was 4.3% (35 pts): 27 whole LTs, 3 reduced LTs, 3 split LTs, and 2 LDLT. Long-term overall 1-, 3-, and 5-year estimated survival rates for patients were 87.9%, 81.5%, and 79.1%, respectively. One-, 3-, and 5-year overall mortality on waiting list also decreased significantly over time from 31.4%, 54.1% and 63.5%, to 4.4%, 13.9% and 23.6%, respectively. Conclusions: The Romanian National program for liver transplantation addresses all causes of acute and chronic liver failure or liver tumors in adults and children, using all surgical techniques, with good long-term outcome. The program constantly evolved over time, leading to decreased mortality rate on the waiting list., (Celsius.)

Prosthesis use in surgical repair of abdominal wall is becoming nowadays a worldwide method, being imposed by its efficiency in solving the defects. The authors are speaking in the light of their experience gained with 100 patients that underwent the operation of prosthesis implant inside the abdominal wall between 1990 and 1996. There have been correlated the early and late postoperative results with some features of this surgical procedure (see below), to prove its efficacy. The authors discuss some principles of alloplastic treatment, which represent also the conclusions of the study: the moment of when a prosthesis is recommended, the choice of synthetic material, where and how is placed the prosthesis, some additional measures which contribute to therapeutic success.