Late Complications after Laparoscopic Longitudinal Gastrectomy - Case Report

INTRODUCTION

Bariatric surgery is now widely regarded as the most effective treatment for morbid obesity. It aims to enhance patients' health by achieving long-lasting weight loss, reducing associated comorbidities, and improving their quality of life.

CASE REPORT

The case involves a 51-year-old female patient who underwent sleeve gastrectomy eight years ago to address morbid obesity (Body Mass Index (BMI) = 43). Subsequently, the patient developed gastric obstructive syndrome, leading to diagnostic investigations including repeated upper digestive endoscopies and native computed tomography. These examinations revealed the presence of a hiatal hernia. In 2021, the patient underwent fundoplication type Dor with anterior hemivalve. However, post-surgery, the patient's condition did not improve, with persistent symptoms including regurgitation, heartburn, difficulty ingesting food, sensation of gastric fullness, and epigastralgia. Further exploratory procedures, including upper digestive endoscopy, abdominal computed tomography with contrast substance, and barium transit with contrast substance, led to the diagnosis of mediogastric stenosis postgastrectomy longitudinal, necessitating surgical intervention. This finding prompted a surgical approach involving distal gastric resection and restoration of digestive tract continuity through Hoffmeister-Finsterer gastro-jejunal anastomosis. Following the surgery, the patient's postoperative symptoms showed improvement.

DISCUSSION

Several other studies have demonstrated that the incisura angularis is the most common site of obstruction, as was observed in our study. This particular location appears to be more prone to narrowing, likely attributable to its angular shape. The linear staple line in this area can create a locus minoris resistentiae for kinking, as well as increase the risk of true stenosis if stapling is performed too close to the incisura angularis.

CONCLUSIONS

Bariatric surgery should not be considered as the initial treatment option. However, in cases where it becomes necessary, postoperative monitoring is essential to prevent complications or address them promptly.

A Comprehensive Summary of the Current Understanding of the Relationship between Severe Obesity, Metabolic Syndrome, and Inflammatory Status

At present, obesity, as a part of metabolic syndrome, represents the leading factor for disability, and is correlated with higher inflammation status, morbidity, and mortality. The purpose of our study is to add new insights to the present body of knowledge regarding the correlations between chronic systemic inflammation and severe obesity, which cannot be treated without considering other metabolic syndrome conditions. Biomarkers of high-level chronic inflammation are recognized as important predictors of pro-inflammatory disease. Besides the well-known pro-inflammatory cytokines, such as WBCs (white blood cells), IL-1 (interleukin-1), IL-6 (interleukin-6), TNF-alpha (tumor necrosis factor-alpha), and hsCRP (high-sensitivity C-reactive protein), as well as anti-inflammatory markers, such as adiponectin and systemic inflammation, can be determined by a variety of blood tests as a largely available and inexpensive inflammatory biomarker tool. A few parameters, such as the neutrophil-to-lymphocyte ratio; the level of cholesterol 25-hydroxylase, which is part of the macrophage-enriched metabolic network in adipose tissue; or levels of glutamine, an immune-metabolic regulator in white adipose tissue, are markers that link obesity to inflammation. Through this narrative review, we try to emphasize the influence of the weight-loss process in reducing obesity-related pro-inflammatory status and associated comorbidities. All data from the presented studies report positive results following weight-loss procedures while improving overall health, an effect that lasts over time, as far as the existing research data show.

Locally advanced breast cancer in Eastern European developing countries

AIM

Breast cancer is known as the most frequent cancer type among women. In several developing countries advanced stage cases present an increase trend, despite the global provisions of screening for early detection. The aim was to investigate patients with locally advanced breast cancers, in a developing country from eastern Europe.

MATERIAL AND METHODS

A retrospective study was performed, including patients diagnosed with breast cancer who underwent surgical intervention, during 2007-2017. Besides demographic data, surgical techniques were investigated. Within histopathological data tumor size, type and grade were examined. We also investigated lymph node status and patient's hormonal parameters.

RESULTS

We examined 1008 patients diagnosed with benign and malignant mammary gland tumors over 11 years. After excluding benign tumors, inflammatory cancers, biopsies, recurrent breast cancers and initial stages, 125 patients remained eligible. Exulceration and hemorrhage were observed in 64 (51.2%) locally advanced cases. Resection of the pectoralis major muscle was realized in 12.8% due to tumoral infiltration.

DISCUSSION

Locally advanced breast cancer represents approximately 5% in developed countries. Within our results, this rate was 27.9%. This discrepancy is given by the regular national mammary screening programs within several developed countries.

CONCLUSIONS

In the developing countries locally advanced breast cancer presents a continuous increase and hemorrhagic exulcerated types are not uncommon. Due to the poor health education and sometimes inadequate health care in eastern Europe, just a few patients have benefited of neoadjuvant therapy and preoperative mammography was performed in a small number of patients.

KEY WORDS

Brest Cancer, Locally Advanced.

An Up-to-Date Article Regarding Particularities of Drug Treatment in Patients with Chronic Heart Failure

Since the prevalence of heart failure (HF) increases with age, HF is now one of the most common reasons for the hospitalization of elderly people. Although the treatment strategies and overall outcomes of HF patients have improved over time, hospitalization and mortality rates remain elevated, especially in developed countries where populations are aging. Therefore, this paper is intended to be a valuable multidisciplinary source of information for both doctors (cardiologists and general physicians) and pharmacists in order to decrease the morbidity and mortality of heart failure patients. We address several aspects regarding pharmacological treatment (including new approaches in HF treatment strategies [sacubitril/valsartan combination and sodium glucose co-transporter-2 inhibitors]), as well as the particularities of patients (age-induced changes and sex differences) and treatment (pharmacokinetic and pharmacodynamic changes in drugs; cardiorenal syndrome). The article also highlights several drugs and food supplements that may worsen the prognosis of HF patients and discusses some potential drug-drug interactions, their consequences and recommendations for health care providers, as well as the risks of adverse drug reactions and treatment discontinuation, as an interdisciplinary approach to treatment is essential for HF patients.

Vegetal Compounds as Sources of Prophylactic and Therapeutic Agents in Dentistry

Dental pathology remains a global health problem affecting both children and adults. The most important dental diseases are dental caries and periodontal pathologies. The main cause of oral health problems is overpopulation with pathogenic bacteria and for this reason, conventional therapy can often be ineffective due to bacterial resistance or may have unpleasant side effects. For that reason, studies in the field have focused on finding new therapeutic alternatives. Special attention is paid to the plant kingdom, which offers a wide range of plants and active compounds in various pathologies. This review focused on the most used plants in the dental field, especially on active phytocompounds, both in terms of chemical structure and in terms of mechanism of action. It also approached the in vitro study of active compounds and the main types of cell lines used to elucidate the effect and mechanism of action. Thus, medicinal plants and their compounds represent a promising and interesting alternative to conventional therapy.

Antibiotics: Conventional Therapy and Natural Compounds with Antibacterial Activity-A Pharmaco-Toxicological Screening

Antibiotics are considered as a cornerstone of modern medicine and their discovery offers the resolution to the infectious diseases problem. However, the excessive use of antibiotics worldwide has generated a critical public health issue and the bacterial resistance correlated with antibiotics inefficiency is still unsolved. Finding novel therapeutic approaches to overcome bacterial resistance is imperative, and natural compounds with antibacterial effects could be considered a promising option. The role played by antibiotics in tumorigenesis and their interrelation with the microbiota are still debatable and are far from being elucidated. Thus, the present manuscript offers a global perspective on antibiotics in terms of evolution from a historical perspective with an emphasis on the main classes of antibiotics and their adverse effects. It also highlights the connection between antibiotics and microbiota, focusing on the dual role played by antibiotics in tumorigenesis. In addition, using the natural compounds with antibacterial properties as potential alternatives for the classical antibiotic therapy is discussed.

Rotation of a strongly coupled dust cluster in plasma by the torque of an electron beam

A 1-mm-size cluster composed of 10 dust particles immersed in plasma is rotated by the torque of a pulsed electron beam with energy in the range 8-12 keV. The dust particles are electrically charged spheres with radius 5.9 μm and are levitated in the plasma sheath, forming a round, planar, Coulomb-coupled cluster. The electron beam irradiates the dust cluster passing slightly off its center, and sets the particles in motion by the action of the electron drag force. The total torque at 12 keV is 4.9±0.2×10^{-11} Nm at an angular speed 1.41±0.05 rad s^{-1}. The main dynamical features of the cluster such as intershell rotation and itinerancy of the dust particles inside the cluster are simulated by using a molecular dynamics code.

An in vitro Evaluation of Apigenin and Apigenin-7-O-glucoside Against HeLa Human Cervical Cancer Cell Line

pigenin (API) is a phytocompound belonging to the subclass of flavones that can be found in both functional foods as well as medicinal plants. Recent studies have assigned API antioxidant, anti-inflammatory, anti-spasmodic, anti-viral, anti-thrombotic, anti-angiogenic and chemopreventive potential in vitro on various cell lines and/or in experimental animal models. Apigenin-7-O-glucoside (API-7) is one of its main glycosides and can be commonly found in chamomile flowers, parsley, celery. The aim of this study was to evaluate the in vitro anti-proliferative and pro-apoptotic effects of API and its glycoside (apigenin-7-O-glucoside) against HeLa human cervical cancer cells. Results have shown that in the set experimental conditions both the aglycone as well as the heteroside elicit antiproliferative and pro-apoptotic potential against the screened cell line, the aglycone being more active than the heteroside.

Experimental demonstration of Martian soil simulant removal from a surface using a pulsed plasma jet

A plasma jet produced in a small coaxial plasma gun operated at voltages up to 2 kV and working in pure carbon dioxide (CO2) at a few Torr is used to remove Martian soil simulant from a surface. A capacitor with 0.5 mF is charged up from a high voltage source and supplies the power to the coaxial electrodes. The muzzle of the coaxial plasma gun is placed at a few millimeters near the dusty surface and the jet is fired parallel with the surface. Removal of dust is imaged in real time with a high speed camera. Mars regolith simulant JSC-Mars-1A with particle sizes up to 5 mm is used on different types of surfaces made of aluminium, cotton fabric, polyethylene, cardboard, and phenolic.