Surgical Approach in Pheochromocytoma

Pheochromocytomas are tumors composed of chromaffin cells that can produce, secrete and metabolise catecholamines. The surgical excision procedure of these tumors may present the risk of significant variations in blood pressure, as well as the chance of cardiovascular complications in the perioperative period. During surgery, patients may be at risk for cardiovascular events such as major variations in blood pressure, pulmonary edema, stroke, myocardial infraction and a long period of intubation. The surgical approach to pheochromocytomas must always be preceded by accurate imaging evaluation, endocrine screening and identification of associated genetic mutations. In addition, the surgical technique of choice consists in using minimally invasive surgical methods, with a transabdominal or retroperitoneal approach

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Experimental model for the evaluation of metabolic status after gastric bypass in obese rats

Objective: Obesity is an exceedingly current pathology with many clinical, molecular, and psychological implications. The number of obese people has doubled in the past ten years, and we can observe an early onset of obesity. Bariatric surgery is an effective treatment for severe obesity and type 2 diabetes mellitus (T2DM); Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most prevalent types of this procedure . Nevertheless, no single mechanism has emerged that thoroughly explains the metabolic benefit and subsequent long-term effects after surgery. Webster's new collegiate dictionary defines the noun model as: 'a descriptive or analogy used to help visualize something that cannot be directly observed.' Sustained by this definition, the animal models in nutritional research are fundamental to improve human conditions. Due to the recent boost in experimental surgery, our aim in this study is to set the main technical characteristics of the gastric bypass operation and specific animal care in the metabolic surgery field we have been undertaking in our center.&#x0D; Materials and methods: We chose Wistar rats fed with a high caloric diet (HCD) 82g / 100 g fat, 53/100 g saturated fat, 64/100 g carbohydrates. After 7-15 weeks of this diet, depending on the protocol understudy, a consistent three-fold greater weight gain is achieved than the usual range of the free eating chow. After approximately three months on an HCD, the obese rats manifest biochemical features of the metabolic syndrome.&#x0D; Results: The weight loss for group B (By-pass) was 125 ± 16.16 g, and for group BS (By-pass + Sulodexid), it was 133.10 ± 14.38 g. Although the weight loss was higher in group BS, it is not statistically significantly higher than in group B (p = 0.345), despite administering a pharmacologically active substance in group BS. Although small (approximately 40-50 g), the difference between the control group and groups B and BS is statistically significant with p = 0.016 and 0.026 and Pearson index of 0.674 and 0.628, respectively. Statistical significance also kept the difference between group C and group S (p = 0.028, Pearson Coefficient = 0.621).&#x0D; Conclusions: First of all, Metabolic surgery is the most effective weight-loss method and improvement or even remission of some diseases associated with obesity. Like today's high-calorie diet, the diet administered, mostly of adolescents, generates both obesity and its associated diseases: diabetes, hypertriglyceridemia, hypercholesterolism, thus increasing mortality and overall morbidity. Second, metabolic surgery radically improves the parameters targeting obesity (weight,% EBWL) and its associated conditions: diabetes mellitus, hypertriglyceridemia, hypercholesterolemia, strongly associated with decreasing life expectancy of the general population. Parameters targeted by gastric bypass: glycemia, TGL, CHO, hepatic steatosis, testicular atrophy registering significant improvements.</jats:p

The Important Roles of Matrix Metalloproteinases in the Pathophysiology of Obesity

Obesity involves the growth of adipose tissue cells (adipocytes and preadipocytes), as well as microvascular endothelial cells. Matrix metalloproteinases (MMPs) are relevant ezymes for the modulation of extracellular matrix (ECM) and adipocyte and preadipocytes differentiation. They are elevated in obese patients, generating abnormal ECM metabolism.[1]. This article proposes a thorough study of literature with focus on the important roles of matrix metalloproteinases in the pathophysiology of obesity. The article represents a narrative review based on an English-language PubMed research of the medical literature regardind important aspects of the proposed aim. MMP-2 activity was signi�cantly higher than MMP-9, both activities were detectable. MMP-9 was strongly correlated with body weight parameters before surgery, as well as after significant body weight reduction as a result of bariatric surgery. Concerning MMP-2 and MMP-9 they are also involved in the turnover of basement membranes both those of adipose tissue and endothelial. MMP-9 levels were moderately correlated with HDL cholesterol levels. Taken together, the present data suggest that changes in ECM through MMP-mediated degradation might play a critical role in the adipocyte differentiation process. These findings are detected both in clinical trials and in laboratory animal experiments. It is then tempting to speculate that the adipocyte-derived MMPs might represent a new pharmacological target for the inhibition of adipose tissue growth by inhibiting adipose differentiation as well as angiogenic process. </jats:p

Living and Eating Behavior before and after Metabolic Surgery in Romanian Patients

Introduction: Obesity is currently an endemic problem worldwide largely caused by an environment that promotes excessive food consumption and discourages physical activity. The sources of obesity are directly related to two areas: genetic and environmental factors, which constantly interact in the regulation of body weight. Aim: Through this research, it was aimed to evaluate the typical profile of the individual who uses metabolic surgery and the degree of physical and psychological satisfaction after such an intervention. Materials and methods: The patients introduced in the study are from personal cases, in number of about 1130, operated during 9 years. Of these, 122 represented the basis for the analysis and had to answer 37 questions in a preoperative questionnaire and 34 questions in a postoperative one and we extracted 15 questions from each of the questionnaire. Results: Statistics show that there was an improvement in quality of life as reported by 77.78% of interviewers, libido and sexual quality were improved in 44% of the included patients and a level of stress considered responsible for food hyperapetitis in only about 43% of respondents. Conclusions: Improving the quality of life is directly related to weight loss. In addition, there is a correlation between improving the quality of life and improving sex life or increasing the frequency of exercise. Metabolic surgery must be understood with all the benefits it generates.</jats:p

Targeted axillary dissection: worldwide variations in clinical practice

Purpose: Targeted axillary dissection (TAD) for the axillary staging of clinically node-positive (cN +) breast cancer patients converting to clinically node negative post neoadjuvant chemotherapy (NAC), has gained popularity due to its minimal false negative rate and low arm morbidity. The aim of this study is to shed more light on the variation in the clinical practice globally in terms of indications and perceived limitations of TAD. Methods: A panel of expert breast surgeons constructed a structured questionnaire comprising of 18 questions and asked surgeons worldwide for their opinions and routine practice on TAD. The questionnaire was electronically distributed and answers were collected between May 1st and August 1st 2022. Results: Responses included 137 entries from 36 countries. Of them, 73.7% consider TAD for cN + patients planned to receive NAC. Among them, the greatest number of respondents (45%) perform the procedure for tumours up to T3, whereas 27% regardless of T-stage. The majority (42%) perform TAD on patients with 1–3 positive nodes and only 30% consider TAD when matted nodes are present. HER2 positive and Triple Negative subtypes are more likely to undergo TAD than Luminal A and B (86%, 79.1%, 39.5%, and 62.8%, respectively). Maximum acceptable lymph node burden is median 3 nodes for any subtype with a tendency to accept more positive nodes for Triple Negative. Conclusion: This study demonstrates the differences in current practice regarding TAD as well as the fact that the biology of the tumour heavily affects the method of axillary staging. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024