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Introduction: Primary tumor resection can prevent future tumor-related complications in patients with stage IV colorectal cancer. This may influence the quality of life and prevent colostomies associated with the emergency surgery. Laparoscopic approach plays an important role in attempts to reduce perioperative complications in this specific group of patients. Purpose: The aim is to assess early perioperative results in a group of 17 patients with stage IV colorectal cancer—multiple incurable liver metastases and/or pulmonary/peritoneal metastases of the disease. On the other hand, postoperative complications may delay administration of chemotherapy and influence survival. Materials and methods: We analyze retrospectively the perioperative results in a group of 17 patients with laparoscopic palliative colorectal resections for stage IV colorectal cancer. Assessment includes perioperative complications, median hospital stay, perioperative blood loss, need for blood transfusion, operative time, and type of surgical procedure. Results: We performed totally laparoscopic 10 sigmoid resections, five left colectomies, and two right colectomies. Fourteen simultaneous liver biopsies were performed during laparoscopy. No perioperative deaths were registered. Perioperative mortality rate is 0%. Perioperative morbidity rate is 0%. No perioperative complications. The median perioperative stay is 5.3 days. Median blood loss is 47.9 mL. Overall, three units of blood were transfused. The median transfusion rate is 0.17 units per patient. The median operative time is 130.2 minutes. Conclusion: The laparoscopic approach is associated with very good perioperative results in patients with stage IV colorectal cancer and palliative resection of the primary tumor. Early hospital discharge and minimal operative trauma may not influence early administration of chemotherapy.

In this article, we present a clinical case of a 63-year-old patient who was treated in the COVID unit of the Clinic for Internal Diseases of UMBALSM (University General Hospital for Active Care and Emergency Medicine) “N. I. Pirogov” on the occasion of a proven coronavirus infection with a PCR positive test for SARS-CoV2-virus, clinical symptoms of severe coronavirus pneumonia, and with accompanying disease - lymphoma with skin localization, condition after lower right lobectomy, chemotherapy and checkpoint therapy for squamous cell carcinoma of the lung. We also examined the role of the transcription factor NF-kB in the course of the coronavirus infection in a patient with the indicated lymphoproliferative disease and a history of active smoking. We tried to clarify questions such as “Do severe forms of coronavirus infection and the relatively rare disease lymphoma with cutaneous localization have a common pathogenesis?” Is it possible to effectively pharmacotherapeutically influence two, at first glance, so heterogeneous diseases?’’ The conclusions drawn can help us to specify certain nosological units as “more vulnerable” to severe forms of COVID19 infection.

The cytokine storm has been identified as one of the leading causes of the severe course and, in some cases, the fatal outcome of COVID-19 infection. Other factors aggravating the course of the disease are accompanying disorders such as cardiovascular diseases, diabetes mellitus, diseases of the respiratory system, and oncological diseases. In this article, we present the course of the coronavirus infection in patients with an accompanying malignant disease, chronic lymphocytic leukemia (CLL), namely. The study included 8 patients with proven PCR-positive tests for SARS-CoV2 and confirmed chronic lymphocytic leukemia as a comorbidity. The course of the coronavirus infection in the CLL group was compared with that in the control group of 100 patients. In both groups, we compared subjective complaints such as tiredness, fatigue, and joint and muscle pain with objective criteria such as temperature, laboratory markers of inflammation, X-ray imaging, and frequency of necessary intubation. Despite the expected poor prognosis in patients with concomitant oncological disease, in the case of chronic lymphocytic leukemia, our results showed a quite different milder coronavirus infection course. Obviously, patients with CLL cannot develop a pronounced cytokine storm, most probably due to certain immunosuppression related to the pathogenesis and drug treatment options for the comorbidity of CLL.

Background: Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a relatively new method of inguinal hernia surgical repair that, at theory, provides a good view of the inguinal anatomy and sac contents and, as a laparoscopic procedure, is considered less invasive and with fewer complications compared to total extraperitoneal (TEP) inguinal hernia repair. Purpose: This study aims to assess the short-term outcome of laparoscopic transabdominal preperitoneal inguinal hernia (TAPP) repair. Material and methods: The retrospective clinical data for 138 patients with unilateral and bilateral hernia, operated in the Department of General, Visceral, and Emergency Surgery of the University Emergency Medicine Hospital ‘N. Pirogov’ from 01 January 2022, to 01 January 2023, were included. The risk profile of the patients, the intraoperative and postoperative complications, the duration of hospital stay, the frequency, and the type of analgesics used were analyzed. Results: Forty-one women (29.7%) were included; men comprised 97 (70.29%) of the cohort. Of the selected group, 63 (45.7%) patients had indirect inguinal hernias, 34 (24.6%), and 25 (18.1%) were diagnosed with direct inguinal hernia and accreta inguinal hernia, respectively. A history of repeatedly occurring hernias was found in 16 patients (11.6%). The average hospital stay was 32 hours (or 1.3 days) and ranged from 24 hours (1 day) to 48 hours (2 days). Complications occurred in 11 (7.97%) patients. The need for analgesics and anti-inflammatory agents was reliably reduced compared to the patients undergoing conventional surgical treatment of inguinal hernia. The patients were followed for three months post-discharge for the occurrence of surgical morbidity associated with the TAPP hernia repair. None of the patients used an antimicrobial agent, as indicated by a possible complicating bacterial infection. Rehabilitation was started within the first 12 hours after the operation, thus contributing to a significantly shorter hospital stay compared to patients undergoing conventional surgical repair of an inguinal hernia. Conclusion: Our results demonstrate that TAPP inguinal hernia repair is a safe procedure with reduced postoperative pain. It has fewer complications, with no significantly longer operative time and a shorter overall hospital stay.

Introduction: Acute cholecystitis is the second most common non-obstetric surgical disease during pregnancy. There have been several trials comparing operative and non-operative management in the past. Purpose: To present a clinical case from our practice and to compare clinical management with worldwide standards. Materials and methods: A 42-year-old patient in the 20th gestational week presented to our department with complaints of pain in the epigastrium and RUQ, as well as a single incidence of vomiting, during the last two days. Results: We operated 15 h after admission and did a standard laparoscopy. The patient was discharged on the 4th postoperative day. Conclusion: A review of the available literature shows the prevalence of early laparoscopic cholecystectomy, while non-operative management has proven to have higher complication rates. Laparoscopic surgery in pregnancy has proven to be safe for both mother and fetus. In our case, the patient was operated on within the first 24 hours of admission. We did not observe any complications during her stay and follow-up.

The etiological cause of Coronavirus infection, which has captured the attention of almost the whole world at the moment, is SARS-CoV2. The clinical picture of coronavirus infection varies from asymptomatic to severe respiratory infection with manifestations of respiratory failure, the development of respiratory distress syndrome and even death. Already in the first months of the coronavirus pandemic in the United States there was a serious decline in the number of patients seeking medical care in the Emergency Department (49.3%) compared to 2019. There is evidence of increased mortality during the pandemic, which causality cannot be directly or associated with coronavirus infection. Even in the context of a global pandemic, we must not forget all other diagnoses and conditions that exist as comorbidity, and emergency care must be provided without delay and delay.

The new pandemic disease COVID is quick spread worldwide.The primary method used for diagnosing of COVID-19 is detecting viral nucleic acids. The main problem with RT-PCR test is the false negative results. The negative RT-PCR does not exclude a SARS-CoV-2 infection and this method should not be used as the only diagnostic criteria. The RT-PCR result does not change the complex treatment of the disease. The aim of the current study is to compare the four groups clinical cases of the different parameters: RT-PCR test, rapid test, clinical picture, laboratory tests as hematology, inflammatory markers, coagulation status and chemistry and imaging examinations: Chest X-ray at and Chest CT scan. Complex therapeutic approach has been implemented: antibiotic, inflammatory, anticoagulants, oxygen therapy, hepatoprotectors, antimycotics, fibrinolytics, probiotics, essential oils, vitamins. During the follow-up period, a tendency for significant reduction and resorption of the pulmonary changes on the CT scans has been seen.