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Breast cancer remains a significant health concern, with predictions indicating a rise in global incidence. While the
primary focus is on oncological radicality, the aesthetic and psychological impacts of surgical interventions, such as radical
mastectomy, cannot be ignored. This study, conducted over 8 years, aimed to identify factors that can prevent unnecessary
lymphadenectomy. The research analyzed various parameters, including age, BMI, tumor size, and immunohistochemistry, to
determine their correlation with axillary lymph node invasion. The results highlighted the importance of tumor size and estrogen
receptor status in predicting axillary lymph node metastasis. The study underscores the value of sentinel lymph node biopsy in
early breast cancer treatment, emphasizing its benefits over complete axillary lymph node dissection.

Vulvovaginal atrophy is a condition frequently encoutered among menopausal women that often is ignored, remains undiscussed with the physician and the patient adapts the life style is such matter that offers a run from the specific symptomathology. According to the specialized published data, only 25% of the patients with vulvovaginal atrophy receive adequate therapy. The therapeutic perspective is quite extensive but the patient should receive recommendations and try different products until they find one that meets their needs and the one they like best. Proper estrogen therapy leads to a restoration of the acidic, normal vaginal pH, of the vaginal microflora, thickens the epithelium, increases vaginal lubrication and decreases vaginal dryness, also, adverse effects of vaginal estrogen therapy are uncommon. Early active detection of this pathological condition and the provision of an appropriately selected therapy can prevent the progression of the symptomatology and can significantly improve the sexuality of women.

The applications of negative-pressure wound therapy (NPWT) have achieved remarkable diversification. Initially used in the therapy of soft tissue wounds related to open fractures, this technique led to the understanding of the complex mechanisms underlying it. This paper aims to analyze the evolutionary scenarios of a group of patients with heterogeneous lesions under negative pressure aspiration treatment. We aimed to identify and analyze various associated pathologies that have the potential to negatively influence the healing process under negative pressure treatment and implicitly analyze the particularities of representative cases for the group whose evolution under treatment proved to be unfavorable. Retrospective, observational study, type series of cases focused on a group of 17 hospitalized patients, who received treatment by negative aspiration, between 2015-2019 in the Surgery Department of the University Emergency Hospital Bucharest. Regarding the obtained results, diabetes mellitus, obliterating arteriopathy, and anemia had a prevalent distribution in the group with unfavorable evolution. The glycemic value can predict 17% of the evolutionary scenario of a patient (favorable/unfavorable) being necessary an integrative therapeutic conduct. Concluding, although an extremely promising therapeutic option, NPWT can prove to be disappointing given its impact in the background of suboptimally managed comorbidities.

Colorectal cancer is the third most common cancer worldwide and represents a significant major public health issue.
Therefore, the interest in detecting the multiple factors implied in the development of cancer has increased recently. One of the
factors could be the Helicobacter pylori infection, but a direct causal connection is missing. This gram-negative bacterium infects
approximately 4 billion individuals globally and various conditions such as gastroduodenal ulcers or gastric adenocarcinomas can
be induced by it. Some of the reported carcinogenic effects of Helicobacter pylori bacterium are hypergastrinemia, chronic
inflammation, dysbiosis, and toxin production. Each of these elements involved in the pathogenesis has various mechanisms of
action. Dysbiosis can occur due to various treatments for the eradication of the Helicobacter pylori infection. This bacterium also
has a proinflammatory effect at the gastric level which can predispose to the development of dysplasia or even neoplasia. The
toxins produced by this bacterium, such as the vacuolating cytotoxin A, promote inflammation. In this review, we discuss the
possible connections between the Helicobacter pylori infection, through its diverse pathogenic mechanisms, and colorectal
neoplasm. Prospective studies are necessary to determine whether there certainly is a direct link between the two conditions.

Background. Primary headaches are comprised of three big categories: migraines (with or without aura), the third most
common and the 6th most disabling disease worldwide, tension-headaches, and trigeminal autonomic cephalalgias, each with
different, complex, and not completely understood pathophysiological, clinical, and neuroimagistic characteristics. Structures like
the brain stem, hippocampus, or hypothalamus have been depicted as being the main triggers of these types of headaches, which
have a significant impact on the quality of life. Methods. We performed a broad literature review on primary headaches from
January 2016 to June 2023, analyzing the latest scientific updates and emphasizing the pathophysiological and neuroimagistic
characteristics. Results. We provide a concise review of the main neuroimaging studies that help in differential diagnosis between
several types of primary headaches. Conclusions. It is difficult to approach the pathophysiology of these three primary headache
categories. Keeping in mind that neuroimagistic methods are rapidly developing (especially in the MRI sphere), the most
important endpoint of future studies will be to establish a reliable distinction system for all these types of cephalalgias, thus
updating the protocols and guidelines. Currently, imaging studies are indicated only in certain circumstances.

"Melanoma outcome seems different between females and males, with a potential protective role of estrogen (E) through estrogen receptors (ER) expression into the tumor. In the study of ERs, both alfa (ERα) and beta (ERβ) is a well-known endocrine elements in non-melanoma tumors, like mammary and endometrial cancer. Immunohistochemistry (IHC) assessment of melanoma concerning ERs represents a path to explore the tumor profile to provide useful information concerning the prognostic and potential adjuvant treatment. Currently, this is not a routine practice, nor a mandatory step for deciding the medical therapy. Typically, IHCs are based on usual kits for mammary tumors regarding ERs configuration. Prior/concomitant use of oral contraceptives and hormonal replacement therapy is not correlated with a better prognostic in melanoma; neither have they represented a contraindication for survivors of melanoma; a subset of tumors might present a higher ER expression which is potentially targeted by the hormone-based treatment as SERMs (Selective Estrogen Receptors Modulator), for instance, tamoxifen. Experimental studies on melanoma cell lines confirmed the anti-tumor activity of ERβ which might function as a prognostic marker. G-protein-coupled estrogen receptors in melanocytes and keratinocytes might be involved, too. Additional crosstalk of TGF-β (Transforming Growth Factor β), respective IGF1 (Insulin-like Growth Factor), and ERα expression are involved in tumorigenic pathways. Recent preclinical studies showed the potential benefits of diarylpropionitrile, a selective agonist of ERβ; pyrazole derivates 21-23 can block ERs. Murine melanoma models showed the interference of anti-estrogenic medication (like molecule fulvestrant) to enhance immune checkpoint blockade, a modern approach to solid cancers. The proliferation of melanoma might be partially explained by ERs; whether this is generally applicable or there is a subgroup of tumors particularly related to E status is still debatable. The subject of E status in melanoma is far from clear at this point and further studies are necessary concerning this particular issue to implement it as a practical approach in the daily management of a disease that still has a very severe prognostic nowadays "

Abstract: Bladder trauma is caused by a direct blow to the distended bladder, severe injury fracturing the pelvis, iatrogenic, or penetrating wounds. Early detection and diagnosis are key to successful management of cases, but omission or late reveal of bladder damage increase mortality and create long-term problems. A bladder injury may not always present with immediate obvious signs and symptoms, especially in a multi-trauma patient, who is also more difficult to investigate. Moreover, during the COVID-19 pandemic, delayed patients' access to tertiary, multidisciplinary hospitals, increases the risk for delayed diagnosis and also increases the need for more specialists from different surgical and non-surgical areas to raise their awareness of less common manifestations of bladder trauma. We present a review of literature and cases of less common bladder damage from the perspective of a multi-disciplinary team in the University Emergency Hospital in Bucharest. Keywords: bladder injury, pelvic fracture, urinary fistula

"Boosted by the COVID-19 pandemic, the adoption of technology has shifted people's lifestyles, impacting social interactions and leading to an increase in the use of telemedicine, including teledermatology (TD). Social media platforms facilitate communication between patients and physicians, between primary care physicians and specialists, and between dermatologists. The study aimed to assess the attitudes, views, and usage of dermatologists regarding TD consultations. A cross-sectional study was performed with the use of an anonymous, web-based questionnaire intended to be completed by dermatologists. A total number of 73 physicians, both resident and board-certified dermatologists completed the survey. Almost everyone (98.6%) used some form of teledermatology, the most frequently used platforms being WhatsApp, followed by classical telephone calls/messages, email, and other forms of TD. TD is considered to be especially useful in communicating with peer colleagues (94.4%), with physicians of other specialties (90.0%), with family doctors (72.9%) and with patients (69.9%). Since TD can facilitate the treatment-related follow-up of adverse effects, while also being useful in the triage of patients, its use will likely increase in the future. The main concerns were related to the accuracy of the diagnosis through TD, a less developed doctor-patient relationship, a less informative consultation, an increased workload as well and a diminished financial reimbursement. Dermatologists currently use TD in addition to the classical consultations of patients, as well as to communicate with family physicians and peer colleagues to better manage complex cases. Furthermore, TD proves to be an important tool in the education of young dermatologists."

The interparietoperitoneal (IPP) space, by a broad definition, is the space between the musculo-fascial walls of the abdomen and the parietal peritoneum. A review of the literature on this subject has been performed through a search in the databases according to the following keywords: Bogros space, Retzius space, preperitoneal approach, and urogenital fascia. We have also analyzed the video recordings of the dissections of the inguinopreperitoneal region during TAPP, conducted by a single team, evaluating the dissection planes in the two compartments (medial and lateral) of the IPPS. Based on the latest data from the literature, as well as on our own experience in laparo-endoscopic herniation surgery, we aim to provide answers to several questions. IPPS from the inguinal region is an area as complex as it is narrow, but of great current surgical interest (approaches of hernias, vessels, prostate). The fascial distribution has its origin in the embryological development of the urogenital apparatus. The basic fascial structure in understanding IPPS compartmentalization is the UGF, along with its extensions.