ACTA ENDOCRINOLOGICA (BUC)

Endemic goiter and primary hyperparathyroidism are two common endocrine disorders, and, consequently, they could coexist in many European countries. The prevalence of nodular goiters is increased in the patients with primary hyperparathyroidism, ranging widely between 22 to 70%, with higher prevalence in endemic goiter areas.\r\nRomania is a country having both endemic goiter and a high prevalence of vitamin D deficiency. Coexisting vitamin D deficiency is associated with more cases of symptomatic primary hyperparathyroidism or may mask a primary hyperparathyroidism, serum calcium being in the normal range.\r\nBecause of the frequent association of parathyroid adenomas with thyroid nodules, the optimal imaging combination is 99mTc-sestamibi and ultrasonography. Thyroid nodules can give false positive results at preoperative scintigraphy because they trap and retain 99mTc-sestamibi similarly as parathyroid adenomas.\r\nBilateral neck exploration (vs minimally invasive parathyroidectomy) is probably necessary in the treatment of primary hyperparathyroidism associated with nodular goiter, because nodular goiters increases the difficulty of preoperative localization of parathyroid lesion(s).

Obesity is a worldwide public health problem (both in developed and developing countries), the most frequent nutritional disease in the world, with considerable morbiditymortality and high costs for the public healthcare systems. Bariatric surgery has been found to be the only method capable of maintaining proper and long-lasting weight loss for morbid obesity. Laparoscopy is the gold standard for bariatric procedures. We studied a group of 341 patients who underwent different types of laparoscopic bariatric surgical procedures: laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic gastric bypass (LGB) and laparoscopic biliopancreatic diversion (LBPD). They were evaluated preoperative (weight, BMI, comorbidities) and followed-up for 1 year: 238 patients LAGB, 46 LSG, 49 LGB and 8 LBPD. Mortality and conversion rate were nil for all groups. A significant reduction in patients’ weight was shown at 12 months postoperatively. BMI decreased from 45.6 kg/m2 to 37.9 for LAGB, from 54.12 to 40.8 kg/m2 for LGB and from 49.1 to 31.2 kg/m2 for LSG. The excess weight loss for LBPD was 63%. A significant improvement of co-morbidities was noticed; all patients with type 2 diabetes have normal serum glucose levels at 1 year after surgery. Bariatric surgery is safe with a low complication rate and the outcome was similar to literature data. Although we do not benefit of a long time follow-up, the favorable results allow us to state that minimally invasive surgical techniques deserve an important place in the efforts of struggling against obesity and its consequences.

The discovery of the cannabinoid receptors CB1 and CB2 in 1990 and 1993, respectively, as well as of the two main endocannabinoids, anandamide in 1992 and 2-arachidonylglycerol in 1995, was an important step in identifying the strongest homeostatic system in the human body, namely the endocannabinoid system. Ever since, research has highlighted the crucial part played by this system in all the reproduction stages: folliculogenesis, spermatogenesis, oogenesis, fecundation, transport of the egg through the fallopian tubes, blastocyte implantation and pregnancy progression, as well as its implications in the physiopathology of the reproductive system: in endometriosis, ectopic pregnancy, miscarriage, preeclampsia, endometrial cancer, polycystic ovary syndrome, ovarian cancer. A special attention must be paid to the phytocannabinoids, natural components originating especially from the Cannabis plant inflorescences, whose medical effects are wellestablished nowadays with also acting on the receptors of the endocannabinoid system. The most recent research mainly focuses on the reproductive dysfunctions and disorders of the reproductive tissues, respectively, through its action upon the endocannabinoid system. Medical cannabis is nowadays legalized in more and more countries all over the world. At the same time, recreational cannabis remains one of the most consumed drugs (in Romania the most consumed one by young adults). Therefore, it is mandatory for specialists in obstetrics and gynecology, endocrinology, public health, hygiene or for general practitioners, to permanently update their information on this subject.

Context. In HIV+ patients, several factors related to patient and antiretroviral therapy (ART) could determine early onset of bone mineral density (BMD) disturbances. Objective. Evaluation of bone quality according to gender in patients from the HIV Romanian cohort. Design. A cross-sectional study in “Prof. Dr. Matei Balș” National Institute for Infectious Diseases, Bucharest between 2016-2018. Subject and Methods. We collected data regarding HIV infection, ART history, viral hepatitis co-infections and we calculated patients body mass index (BMI). CD4 cell count, HIV viral load (VL), vitamin-D levels were determined. Dual-energy X-ray absorptiometry (DXA) scans were used to evaluate BMD. Results. We enrolled 97 patients with the median age of 26 years. According to the DXA T-scores, 10 males and 8 females had osteopenia and 4 males and 4 females had osteoporosis. According to Z-scores 2 males and 1 female had osteoporosis. Hip DXA T-scores revealed osteopenia in 6 males and 9 females, whereas T and Z-scores showed osteoporosis in 2 males and 3 females. Lumbar spine (LS) T-score diagnosed osteopenia in 9 males and 6 females, while T and Z-scores revealed osteoporosis in 3 males and females. In males, low T-scores were associated with decreased BMI; low LS DXA Z-scores with low vitamin-D levels; low T and Z-scores and LS-BMD with high VL. Conclusions. Evaluating bone quality in patients with a long history of HIV infection, multiple factors should be taken into account.

Context. Laparoscopic sleeve gastrectomy (SG) has gained popularity as a metabolic procedure, but its longterm effectiveness for Romanian patients remains unclear. Objectives. To assess the long-term efficacy of SG for Romanian patients and to evaluate the differences between 5 years and 1 year follow-up. Design. A longitudinal, prospective analysis of collected data from 68 patients undergoing SG between 2009 and 2014 was performed. Long-term outcomes at 5 years were analyzed in terms of total weight loss (%TWL), excess weight loss (%EWL), body composition and glucose homeostasis. Subjects and Methods. All patients meeting the standard criteria for SG before inclusion were prospectively enrolled in the study. Of the 68 patients, eight were lost to follow-up, therefore, 60 patients (41.7±12.5 years, baseline body mass index [BMI] 44.6±9.9Kg/m2) were analyzed. Results. The BMI decreased at 12 months with 30.7% from the preoperative BMI (p<0.001) and subsequently stabilized at 5 years. TWL and EWL were 30.6% and 83.1%, respectively at 1 year, with a slightly increase at 5 years. Therapeutic success rate (%EWL≥50) and diabetes remission rate (Buchwald criteria) were 93.3% and respectively 63.6% at 5 years. Insulin sensitivity index and metabolic clearance rate of glucose increased with 92.5% and 60.1% respectively, in the third month from baseline (p<0.001), while estimated second phase of insulin secretion decreased with 7.9% in the first month postoperatively (p=0.04), remaining stable afterwards. Conclusions. SG was effective in terms of %EWL, body composition and glucose homeostasis improvement for Romanian patients, the outcomes stabilizing after 1 year follow-up.