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The term robot first appeared in 1921 when Karel Capek mentioned it in his play Rossom's Universal Robots, which in free translation means forced labor. Today, robots are still unintelligent machines, but great strides have been made to integrate them as much as possible into people's daily lives. At present, this statement can no longer be supported, robots are used in the field of surgery almost daily in some specialized medical centers, the surgical system is used even to perform a trans-continental cholecystectomy in 2000. However, robotic surgery belongs to the field of minimally invasive surgery that began in 1987 with the first laparoscopic cholecystectomy. Since then, this type of surgery has grown rapidly and has been assigned more and more interventions as the skills and confidence of the surgeons who used it to increase. The degrees of movement of laparoscopic instruments are limited, namely, most of them have only 4 degrees of movement, also the physiological tremor of the surgeon is transmitted to the instrument he works with making delicate interventions such as anastomosis of 2 vessels very difficult. Therefore, the origin of robotic surgery lies in the desire to overcome these shortcomings of laparoscopy and to exploit to the maximum the resources of minimally invasive surgery.

Cancer represents one of the leading causes of morbidity and mortality worldwide, imposing an urgent need to develop more efficient treatment alternatives. In this respect, much attention has been drawn from conventional cancer treatments to more modern approaches, such as the use of nanotechnology. Extensive research has been done for designing innovative nanoparticles able to specifically target tumor cells and ensure the controlled release of anticancer agents. To avoid the potential toxicity of synthetic materials, natural nanoparticles started to attract increasing scientific interest. In this context, this paper aims to review the most important natural nanoparticles used as active ingredients (e.g., polyphenols, polysaccharides, proteins, and sterol-like compounds) or as carriers (e.g., proteins, polysaccharides, viral nanoparticles, and exosomes) of various anticancer moieties, focusing on their recent applications in treating diverse malignancies.

Echinococcosis is an endemic disease in countries from the Mediterranean area, Eastern Europe, the Middle and the Far East, Australia, South America and Eastern Africa. However, it has a worldwide distribution because the dog, a definitive host, is a ubiquitous animal. Another important factor that led to a worldwide spread of the disease is population migration, as the number of cases in non-endemic regions has been increasing. We present the case of a 28-year-old HIV positive patient suffering from a liver hydatid cyst that had ruptured inside the biliary pathways. US and CT were the imaging tools used to establish a preoperatory diagnosis and the main therapeutic approach was neutralizing the parasite using 90 degrees alcohol, Lagot deroofing, contents’ evacuation through open surgery and appropriate drainage afterward. ERCP was very useful in unblocking the main biliary pathways after the surgery as well as installing a stent to ensure its further permeability.

Cytoreductive surgery and HIPEC have become de pillars of treatment in advanced, metastatic colorectal cancer. This state of evolution of the disease was considered terminal just a few years ago. It has been demonstrated that by combining these therapies in selected patients one can increase survival time. Once this has been obtained to some length modern studies have been focused on the quality of life, safety, and how this time interval can be increased. We have reviewed the most important prospective, randomized clinical trials regarding HIPEC and peritoneal carcinomatosis. The technique, complications, principles of action, and evolution through time of HIPEC have been addressed and covered. Special consideration had been given to the correlation between the carcinomatosis index and HIPEC. HIPEC with maximal cytoreduction can be considered a curative procedure only in strictly selected patients diagnosed with colorectal cancer and peritoneal carcinomatosis. Although it has been present in the medical field for almost 30 years, it is not wide-spread due to the high costs of implementation and the requirement of highly specialized surgical and medical teams. As technology evolves, the costs can be decreased and HIPEC should be largely available in oncological centers since the foundation of implementation is solid and the fact that clear benefits although small have been demonstrated. Taking into account all of the above, HIPEC should not be considered a standard treatment at present and should only be performed in experienced centers. The correct selection of patients is critical to the success of this procedure. Maximum cytoreduction should only be performed if the carcinomatosis index allows.

Diagnosis, tratament and follow-up of patients with melanoma during COVID-19 pandemic is quite challenging. These patients are often immunocompromised, but, on the other hand, management of this malignant skin cancer should not be delayed. It is necessary to diagnose and stage the melanoma as soon as possible, in an attempt to provide a better prognosis. There are few data regarding the treatament of melanoma during COVID-19 pandemia. However, the general recommandations suggest testing all cancer patients prior administration of the therapy. The European Society for Medical Oncology (ESMO) provided guidelines regarding therapy of this skin cancer during COVID-19 pandemic. Every patient is different, and it is always important to evaluate the risks and benefits. © 2020 Universidade do Porto - Faculdade de Engenharia. All rights reserved.

Due to its anatomical position, traumatic lesions of the pancreas are rare and difficult to diagnose. Diagnosis time is paramount as an increase in duration translates into an increase in morbidity and mortality. Duct lesions are hard to identify on CT, ERCP being the investigation of choice but it is difficult to obtain as it requires highly specialized staff and equipment. Intraoperative macroscopic and palpatory evaluation of the pancreas in a trauma patient should be elective no matter what other lesions are present. The treatment is mainly dictated by this evaluation and is defined as it follows: stage I and II usually require a conservative approach; stage III, IV, and V usually imply resection of the pancreas although recent advances in conservative management have been made through ERCP and pancreatic duct stenting. In these stages, intraoperative evaluation should ensure the ampulla is intact if the head of the pancreas is not resected. Serum amylase and lipase levels do not offer a concrete direction towards a pancreatic lesion. Currently, there is no standard surgical treatment for these stages thus making intraoperative evaluation mandatory. One must remember that post-traumatic pancreatitis exists, which becomes apparent days after the accident.

Mesenteric lesions in abdominal trauma are encountered in 3% of the cases. Diagnosis of these lesions is difficult, which translates into important delays until surgery that affects patient survival. The short-term consequences of mesenteric lesions translate in bowel ischemia or important blood loss. If a lesion is confirmed after imagistic investigations, one must have complete knowledge of the anatomy and the particular distribution of the main arterial and venous trunks to predict the region of the small bowel that will have to be observed or resected if surgery is required. The aim of our study was to demonstrate this particular distribution of blood vessels through cadaver dissection and to note the resources available to diagnose such lesions.

Psoas muscle abcesses are a pathological entity, with very low incidence, and a lot of diagnosis and management discussions.Our paper aims to assess the presence of this pathology in literature as a short introductive narrative review and to present a series of cases from our experience.The research was retrospective, descriptive and enrolled a total of 14 patients.Specialty literature is poor regarding this pathology, with no agreement on the correct diagnosis and treatment algorithm. Future studies may offer diagnostic scores to facilitate rapid diagnosis.

Alcohol consumption alters one’s consciousness and may lead to accidents and traumatic events with deadly consequences. We aimed to analyze the most recent information available in WHO databases about overall mortality rates and alcohol consumption in European countries. The parameters taken into account were the total number of deaths by trauma, alcohol consumption per capita, prevalence of heavy drinking episodes and national legal blood alcohol concentration while drinking The mortality rate by trauma is influenced by many factors and alcohol intoxication could be one of them. Our analysis shows a moderate correlation between overall alchool consumption and death by trauma in Europe in 2015. There are studies who show a positive effect of alcohol consmption on the overall chance of survival after trauma. Chronic consumption is associated with an increase in mortality. Nonetheless, further research is needed and strongly encouraged.

Laparoscopic sleeve gastrectomy is a relatively simple procedure, but the complications can quickly become life-threating. The aim of this study was to investigate based on our experience when is best to follow a conservative protocol in postoperative bleeding after sleeve gastrectomy. The study is retrospective, we identified a number of 150 cases of sleeve gastrectomy, of which 18 has postoperative bleeding. A conservative approach with close observation (ultrasound, CT, Hb levels) was practiced in 10 cases and no surgical intervention was required. The recommendations are as follows: The first and obvious recommendation is to stop anticoagulants. The perigastric drainage should drain, if Hb levels go down an nothing is coming through the drain consider other sources of bleed or try to reopen the blocked drain. A blood cloth developed around the bleeder may maintain the active bleed due to local fibrinolysis, in these cases, one should take into consideration guided drainage (ultrasound/CT) and monitor Hb levels afterward. The presence of a small perigastric collection without clinical manifestation should be left as such. Take into consideration reintervention if: signs of hypovolemia are present (tachycardia, hypotension, profuse sweating), Hb below 7g/dL. The patient's clinical state should always play an important role in decision making.

Introduction: Functional hypothalamic amenorrhea is a diagnostic challenge, especially in association with structural pituitary changes. We present the case of a patient with functional amenorrhea and pituitary microadenoma, evaluated in multiple medical centres. Case report: A 27-year-old female was referred to our clinic for secondary amenorrhea installed 18 months prior, insomnia, polydipsia (around 4-6 l water intake/day) and polyuria. Clinical examination revealed an underweight patient, with BMI (Body Mass Index) of 17.5 kg/m2, normal secondary sex characteristics, pallor of the skin and mucosa. The hormonal profi le revealed normal FSH (Follicle Stimulating Hormone) levels, low LH - Luteinizing Hormone (of 0.15 U/L, normal: 1.20-12.8 U/L), estradiol (of 11.2 pg/mL, normal: 49-291 pg/mL) and progesterone (of 1.13 ng/mL, normal: 5.16-18.56 ng/mL). No pathological changes were recorded at somatotropic, lactotropic, thyrotropic and corticotropic levels. The Diphereline stimulation test revealed functional integrity of the pituitary gland and ovaries. The progesterone with drawal test was negative. There were no pathological fi ndings on biochemical workup and the water deprivation test excluded diabetes insipidus. Morphological exploration of the hypothalamic-pituitary region by contrast-enhanced MRI (Magnetic Resonance Imaging) scan revealed a left pituitary microadenoma measuring 5 mm in diameter. Adequate diet and oral contraceptive treatment were recommended. Conclusion: Functional hypothalamic amenorrhea (FHA) is the most common cause of neuroendocrine amenorrhea. Identifying the context and causative factors is essential for making an appropriate therapeutic decision.

Introduction: Cushing's disease (CD) is a complex endocrine disorder characterized by an increased risk of recurrence and persistence of hypercortisolism after initial transsphenoidal adenomectomy, a situation requiring alternative therapeutic measures. Case presentation: A 21-year-old female patient was admitted for weight gain with centripetal fat distribution, transient headache, hair thinning and psycho-emotional lability. Clinical examination revealed round facies, acne, purple-red striae, hirsutism with a Ferriman-Gallwey score of 20. The hormonal profile revealed high serum cortisol (of 283.1 ng/mL, normal:70-225 ng/mL) and high ACTH (Adrenocorticotropic Hormone) levels (of 260.6 pg/mL, normal: 7.2-63.3 pg/mL). The pituitary MRI (Magnetic Resonance Imaging) examination found a 4.3/4.4/6.2mm left paramedian microadenoma. The persistence of hypercortisolism after adenomectomy required GKRS (Gamma Knife radiosurgery). Four months after radiosurgery, complete remission of the disease was achieved and it was maintained at the last evaluation. At present, the patient is 20 weeks pregnant. Conclusions: Gamma Knife radiosurgery offers a high control rate of pituitary adenomas and a reasonable rate of remission of residual hypercortisolism after neurosurgical treatment. After surgery or GKRS, periodic monitoring is necessary for patients with CD due to the risk of pituitary insufficiency or relapse.

Introduction: Cushing’s disease (CD) is characterized by multiple complications, particularly due to the condition itself, but also as a result of curative treatment. Nowadays, transsphenoidal surgery is considered the first-line therapy. Persistent hypercortisolism requires the initiation of medical therapy in order to limit the consequences of the disease. A common complication of pasireotide treatment is type 2 diabetes mellitus. We present a case of persistent Cushing’s disease after transsphenoidal adenomectomy and pasireotide therapy, evaluated in several medical centers. Case presentation: A 27-year-old female was referred to our clinic for weight gain, hypertension, transient headache and recurrent depression. Clinical examination revealed plethoric moon face, purple striae, hirsutism with a Ferriman-Gallwey score of 14, acanthosis nigricans. The hormonal profile showed high ACTH (adrenocorticotropic hormone) levels (of 110.6 pg/mL, normal: 7.2-63.3 pg/mL), high urinary free cortisol (UFC) (of 846.5 μg/24h, normal: 50-190 μg/24h) and serum cortisol, accompanied by non-suppression of cortisol after the 1 mg DXM (Dexamethasone) suppression test (of 26.6 μg/dL, normal: 18 μg/dL) and adequate suppression after the overnight 8 mg DXM test. Pituitary MRI (Magnetic Resonance Imaging) revealed a microadenoma measuring 4.3/4.4/6.2 mm. Transsphenoidal adenomectomy was recommended. After surgery, the patient developed multiple pituitary hormone defi ciency, without signifi cant remission of hypercortisolism. Pasireotide therapy was initiated, followed by inadequate control of hypercortisolism and the onset of type 2 diabetes mellitus, requiring oral antidiabetic agents and insulin. Conclusion: In persistent Cushing’s disease, the challenge lies in identifying the optimal therapeutic methods in order to achieve a cure while, at the same time, limiting their side effects. Careful long-term follow-up by a multidisciplinary team is required.

Introduction. Precocious puberty is a common endocrine disorder in pediatric patients, leading to important changes in growth patterns. Case presentation. We present the case of a patient with precocious puberty and accelerated bone maturation, evaluated in several medical centers. A 9-year-and-11-month-old female patient was evaluated for premature thelarche, adrenarche and menarche starting at the age of 7. On clinical examination, height was 143 cm, 0.9 SD above the age and sex median, with 37.91% excess weight. She also presented with acne, cervical posterior acanthosis nigricans, hirsutism and Tanner puberty development stage B3/P4. The endocrine profile showed pubertal values for FSH (Follicle-Stimulating Hormone), LH (Luteinizing Hormone) and estradiol, before and after the Diphereline test, hyperprolactinemia (of 38.6 ng/mL, normal: 2-18.9 ng/mL) and high levels of 17-OH Progesterone (of 2.60 ng/mL, normal: 0.2-0.9 ng/mL). The Synactene® test excluded 21-hydroxylase deficiency. Knee X-rays showed a tendency for premature growth plate fusion and bone age advancement of 3.1 years. Gynecological examination and pelvic ultrasound showed normal ovarian morphology and volume, according to chronological age and a 17-mm endometrium. Hypothalamic-pituitary MRI (Magnetic Resonance Imaging) excluded the presence of a local lesion. Conclusions. In the absence of therapeutic intervention, accelerated skeletal development due to precocious puberty initially leads to high stature compared to the patient’s age group, followed by premature closure of the growth plates and low final height.

Surgical practice worldwide has changed rapidly in response to the coronavirus disease 2019 (COVID-19) pandemic. The study aimed to analyze the impact of the COVID-19 pandemic on mortality, in hospitalized patients, in Romanian surgical services. We have developed our research on a national survey of the consecutive records of hospitalizations, surgical interventions and deaths performed in Romania between March and August 2020. Results show that 47 surgical departments responded to the request. The admissions in the period March–August 2020 represented 52% of that from the similar period of 2019. In the studied period, the share of surgical interventions in patients admitted to non-COVID-19 centres was 98.7%, respectively 78.2% in COVID-19 support hospitals (p < 0.05), and emergency interventions of 43.4% in non-COVID-19 hospitals, respectively 84.8% in COVID-19 support hospitals (p < 0.05). Overall mortality in this period was 5.82%, compared to 3.28% in a similar period in 2019, (p < 0.05). Postoperative mortality in COVID-19-positive patients was 19%. In conclusion, in the hospitals in Romania included in the survey, the overall mortality in the studied period was higher than in a similar period in 2019. In patients with COVID-19 positive, the recorded postoperative mortality was higher than overall mortality.

Acromegaly is a hormonal disorder which occurs as the result of growth hormone (GH) and insulin growth factor 1 (IGF-1) over-secretion; both hormones are related to skin anomalies. The skin acts as a large endocrine organ, hosting GH receptors in every cell while IGF-1 receptors are expressed only in keratinocytes. This review is a literature review of skin anomalies found in acromegaly, either related to the disease itself or associated with related complications such as secondary diabetes mellitus, or involving associated conditions such as genetic syndromes. The following clinical points are mentioned as follows. Excessive skin and enlargement of soft tissue are due to glycosaminoglycan deposits, edema, and hyperhidrosis (mostly facial and acral). Acanthosis nigricans, a body fold dermatosis associated with insulin resistance, involves local or diffuse hyperkeratotic plaques with or without hyperpigmentation, caused by growth factors including GH/IGF-1. Other findings include cherry angiomas (due to the effects of lipid anomalies on small vessels); oily skin features with keratosis, epidermoid cysts, crochordons, pseudo-acanthosis nigricans; a potentially higher prevalence of varicose veins and psoriasis; low level of evidence for basal cell carcinoma, respective hidroadenitis suppurativa has been noted. In addition, complicated uncontrolled secondary diabetes mellitus (DM) may result in necrobiosis lipoidica diabeticorum, diabetic dermopathy, skin bacterial infections, dermatological complications of diabetic neuropathy, and nephropathy. Finally, associated hereditary syndromes may cause collagenomas, fibromas/angiofibromas, lipomas in multiple endocrine neoplasia type 1 (MEN1) syndrome; cafe-au-lait macules, early onset neurofibromas, juvenile xanthogranuloma (involving non-Langerhans cell histiocytes), and intertriginous freckling in neurofibromatosis type 1. Clinical findings are differentiated from pseudo-acromegaly such as pachydermoperiostosis. Iatrogenic rash, lipodystrophy (lipoatrophy with/without lipohypertrophy) are rarely reported after pegvisomant/somatostatin analogues or after insulin use for DM. Experiments using human cell lines have shown that GH/IGF-1 over-secretion are prone to epithelial-to-mesenchymal transition (EMT) in melanoma. In non-acromegalic subjects, the exact role of GH/IGF-1 in skin tumorigenesis is yet to be determined. Skin in acromegaly speaks for itself, either as the first step of disease identification or as a complication or part of a complex syndromic context.

With the prevalence of digitalization in all aspects of modern society, health assessment is becoming digital too. Taking advantage of the most recent technological advances and approaching medicine from an interdisciplinary perspective has allowed for important progress in healthcare services. Digital health technologies and biotelemetry devices have been more extensively employed for preventing, detecting, diagnosing, monitoring, and predicting the evolution of various diseases, without requiring wires, invasive procedures, or face-to-face interaction with medical personnel. This paper aims to review the concepts correlated to digital health, classify and describe biotelemetry devices, and present the potential of digitalization for remote health assessment, the transition to personalized medicine, and the streamlining of clinical trials.

Clostridium difficile (CD) is an anaerobic, gram-positive bacterium that can produce a spectrum of gastrointestinal diseases ranging from pseudomembranous colitis to diarrhea to toxic megacolon. The infection is even more difficult to manage as CD produces high-end spores, suggesting that this may be the cause of the dangerous recurrent disease as well as dissemination among healthy members in the community. Spores can be hosted in the digestive tract of both symptomatic and asymptomatic patients. The most relevant risk factor in the development of Clostridium difficile infection (CDI) seems to be the overuse of antimicrobials. Comorbidities are another risk factor that may predispose towards more serious CDI. Treatment options vary from oral antibiotics to extensive surgical interventions. The present study aimed to analyze the prevalence, severity, and management of CDIs in a general surgery department in an effort to determine the correlative elements between the infection and surgical pathology.

Inguinal hernia is one of the most common surgical pathologies, which appears mainly due to the weakening of the abdominal muscles. Currently, the gold standard in the repair of inguinal hernias by open approach is the Lichtenstein procedure, while the gold standard of laparo-endoscopic procedures are the pre-peritoneal transabdominal technique (TAPP) and the total extraperitoneal technique (TEP). The purpose of this study is to evaluate, for a period of 4 years, the cases of inguinal hernias operated both by laparoscopic and open procedures to analyze their characteristics, under the conditions in which none was imposed as absolute gold standard for groin hernias. The present study was retrospective and descriptive, including a number of 214 cases hospitalized with the diagnosis of inguinal hernia. In the surgery of the groin hernia, both laparoscopic and open procedures have demonstrated their feasibility. Our study shows the preference for open surgery in elderly patients and those with comorbidities, as well as a faster evolution, with earlier discharge in the case of laparoscopic interventions.

Repairing an incisional ventral hernia represents a challenge for the surgeon. The high recurrence rates observed during hernia repair by tissue approximation leads to development of tension-free procedures by using prosthetic materials. Incisional or ventral hernia is a very common multifactorial pathology that requires surgical intervention to prevent complications, such as pain, discomfort, bowel obstruction or strangulation. To perform the wall repair it is of utmost importance to understand the pathogenesis of the hernia, the anatomy and physiology of the abdominal wall, and surgical techniques. Several repair methods are available, including open suture repair, open mesh repair, the component separation technique, and tissue expansion assisted closure. To perform the ventral hernia repair properly, a full understanding and correct selection of mesh and management of probable complications, such as seroma, bowel injury, enteric fi stulae, and recurrence, is essential. There are lots of scientific debates about an ideal material for mesh parietal repair. In latest years, the tendency is that the continuous decreasing territory of polyester mesh to be slowly replaced by the increasing territory of polypropylene mesh in open procedures for abdominal incisional hernia repair. The goals of incisional hernia repair are the prevention of visceral eventration, incorporation of the abdominal wall in the repair, provision of dynamic muscular support, and restoration of abdominal wall continuity in a tension-free manner. We present the case of a 55 years old woman who had a history of multiple surgical interventions. We performed an open surgical approach, tension free technique using an intraperitoneal dual-mesh.

Acute pancreatitis is an important current problem with a growing frequency and a potentially severe or even fatal evolution in some cases. In recent years, an increase in the incidence of acute pancreatitis has been observed in the population, which emphasizes the importance of establishing optimal therapeutic behavior. We performed a descriptive, retrospective clinical study, from January 2015 to November 2018, single-center, on a number of 57 patients with the diagnosis of acute pancreatitis. The presentation characteristics of patients with acute pancreatitis are largely consistent with the literature, with patient sex being the sure parameter that highlights a significant difference, with a greater number of women being diagnosed with acute pancreatitis.

Surgical site infection (SSI) represents a concerning for all surgeons because both the unfavorable impact on health care costs and risk factors that increase the durations of wound healing and SSI rate. A review of PubMed, Scopus and Google Scholar has been made. The keywords used were related to surgical site infection prevetion. SSIs have a raised incidence in abdominal surgery because of the fact that many types of bacterias live in the gastrointestinal tract and during a surgical procedure some may escape and cause an infection. There is a high risk of postoperatory infections in gastric surgery due to intestinal anastomoses which are predisposed to leakage. In hernia repair surgery there is a higher rate of SSIs than expected for a clean procedure, and one risk factor may be represented by the prosthetic device used. On the other hand, in laparoscopic cholecystectomy, there is a very low risk of SSI and antibioprophylaxis is not recommended. But the most contaminated procedure with the highest risk of infectious complications is colorectal surgery, which requieres a combination of antibiotics because of the numerous types of microorganism. Abdominal surgery comprises different techniques and involves most elements of the gastrointestinal tract. Some procedures need antibiotic prophylaxis and in others antibiotic administration is even prohibited. The most effective antibiotics are first and second-generation cephalosporins.

The clinical signs and symptoms of an acute in increase intraabdominal pressure (IAP) are subtle, especially in the conditions of the polytraumatized patient. Thus, abdominal compartment syndrome (ACS) can brutally occur and can have a major impact on the body’s main organs and systems. The purpose of our research was to identify the influence of intraabdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome, in the evolution of polytraumatized patients. Our study analyzed the patients admitted in the IIIrd Department of General Surgery of University Emergency Hospital in Bucharest between 1st of January 2010 and 31st of December 2018. The value of intraabdominal pressure, on admission, correlated with the risk of IAH/ ACS in patients with abdominal trauma - being major causes of morbidity and mortality. IAP monitoring should become a mandatory part of the management plan for patients with abdominal trauma.

Myasthenia gravis(MG)is an antibody mediated, T cell dependent autoimmune disease characterized by a disorderof neuromuscular junction with progressive inability to sustain a maintained or repeated contraction of striated muscle. It is represented by antibodies directed against the nicotinic acetylcholine receptors (nAchR) of the post junctional membranes. We present the case of an 82-year-old patient, who was admitted to the hospital for plasmapheresis due to an aggravation of her auto-immune generalized myasthenia. The clinical examination at admission revealed ptosis, dysphagia, a medium effort dyspnea, difficulties in closing the mouth, dysphonia with a nasal voice and limited walking with a bent head and camptocormia, with Osserman score 46/100 (diplopia and bilateral ptosis). The thoracic scanner describes a tissue lesion in the thymus region with a diameter of 35 mm corresponding to a thymoma. The Magnetic Resonance Imaging confirmed the possible thymoma. A thymectomy using video-assisted thoracoscopic surgery (VATS) technique was performed according to the age and general status of the patient. Post-operative histological examination revealed a B2 type thymoma and the TNM staging system classifies the thymoma as being T1bNx.

The surgical management of breast cancer tumors depends not only on knowing the right histological type of tumor, but also on identifying the grade of axillary node invasion and the presence of metastases. Unfortunately, due to a lack of general understanding of how these tumors actually spread and their path towards axillary lymph nodes, there is a tendency of over or undertreating patients in the surgical environment. Even though we now have the Sentinel Ganglion method to help us, we haven�t decided on a universally accepted algorithm in the management of this disease. Many studies are still needed in order to fully clarify the most appropriate surgical management for each type of tumor and the level of axillary node dissection. Multiple factors should be taken into account when managing the case of a patient suffering from breast cancer and faced with the need of an axillary lymph node dissection (ALND). We have tried to identify some of these factors based on the experience of our clinic and available literature. The factors identified are the positive SLN (Sentinel Lymphatic Node) aspect, the differentiation between micro and macrometastases, the use of the S classification of SLN and microanatomic location of SLN metastases and the microanatomic location (MAL) of the tumor deposit in the sentinel ganglion.

Even in the age of minimally invasive surgery, incisional hernias remain frequent complications where standard resolution is alloplasty in various technical variants. The revolution brought by the introduction of synthetic materials is overshadowed by the unsatisfactory results obtained in some lesional types that seem to go beyond the nosological framework of standard incisional hernias and which can be reunited under the name of difficult incisional hernias. Our work attempts to make a conceptual clarification in a lesional amalgam through the two compulsory targets required for surgical correction: to solidly cover the parieto-abdominal defect and to maintain intra-abdominal postoperative pressure to values that did not trigger the pathophysiological cascade of intraabdominal hypertension.

Dyslipidemia constitutes a well-known factor that can lead to acute pancreatitis. Hypertrigliceridemia and hypercholesterolemia are part of dyslipidemia. In a prospecitve study, we analyzed the role of hypercholesterolemia in triggering episodes of acute pancreatitis and the capacity of cholesterol blood level to predict the severity and the evolution of acute pancreatitis. In our prospective study, a preexistent cholesterol blood level above 240 mg/dl proved to be a trigger for pancreatitis and an increasing cholesterol level in evolution predicts a pancreatitis with organ failure (moderately-severe or severe).

Artificial intelligence has the potential to revolutionize modern society in all its aspects. Encouraged by the variety and vast amount of data that can be gathered from patients (e.g., medical images, text, and electronic health records), researchers have recently increased their interest in developing AI solutions for clinical care. Moreover, a diverse repertoire of methods can be chosen towards creating performant models for use in medical applications, ranging from disease prediction, diagnosis, and prognosis to opting for the most appropriate treatment for an individual patient. In this respect, the present paper aims to review the advancements reported at the convergence of AI and clinical care. Thus, this work presents AI clinical applications in a comprehensive manner, discussing the recent literature studies classified according to medical specialties. In addition, the challenges and limitations hindering AI integration in the clinical setting are further pointed out.