Background and Objectives: Extensive research has demonstrated that various approaches to the quadratus lumborum (QL) block offer superior postoperative analgesia compared to the transversus abdominis plane (TAP) block, particularly in reducing opioid consumption. This study aims to compare postoperative analgesia between the blocks in laparoscopic colorectal surgery. Materials and Methods: A retrospective analysis was performed on patients with elective colorectal surgeries who received bilateral US TAP blocks in the supine position or US anterior QL block in the lateral position at the end of the surgery and before extubating, with Ropivacaine 0.25%. Total opioid consumption and time to first intravenous analgesic were noted. Results: Between January 2020 and December 2024, 410 patients underwent elective laparoscopic colorectal oncology surgery under general anesthesia, with peripheral nerve blocks. Of these, we analyzed 116 patients with localized diseases who underwent elective surgeries and who did not require conversion to classical surgery and received either QL or TAP blocks. A total of 62 patients underwent QL block and 54 received TAP block. For the primary outcome, in the QL group, significantly fewer opioids were used than in the TAP group (p < 0.001), and time to first rescue analgesic was prolonged in the QL group at 16 h (IQR 14–18) compared to the TAP group, where the requirement occurred earlier at 8 h (IQR 8–8) postoperatively (p < 0.001). Conclusions: Postoperative bilateral US anterior QL block reduced morphine consumption and improved time to rescue analgesia and LOS compared with midaxillary line bilateral US TAP block.

Background/Objectives: Penile squamous cell carcinoma (PSCC) is a rare malignancy with a potential major impact on survival. Prognostic assessment remains challenging, particularly in underrepresented eastern European populations, where region-specific evidence is lacking. This paper aimed to identify independent predictors of overall survival in surgically treated patients with PSCC from a Romanian high-volume tertiary center. Methods: This retrospective cohort study analyzed 60 patients who were surgically treated for PSCC between October 2020 and December 2024. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent prognostic factors. Results: The mean patient age was 62 ± 12 years. T-stage distribution showed 30% pT1, 35% pT2, 31.67% pT3, and 3.33% pT4, with 55% of patients presenting with nodal metastases. Univariate analyses demonstrated significant associations between lymphovascular invasion (p < 0.001), perineural invasion (p = 0.022), and positive surgical margins (p = 0.030) and risk of death. Multivariate analysis identified three independent prognostic factors: absence of histologically documented urethral invasion (HR 0.32; p = 0.027), T3–T4 disease (HR 8.26; p = 0.005 vs. T1), and N3 stage (HR 3.53; p = 0.030 vs. N0–N1). Patients without urethral invasion demonstrated significantly longer median overall survival (63 months vs. 11 months). The final three-variable prognostic model demonstrated good discrimination (C-index 0.78), providing a potential practical risk stratification tool. Conclusions: Urethral invasion, advanced T-stage, and N3 disease independently predict poor survival in surgically treated PSCC. The identification of urethral invasion as an independent prognostic factor warrants consideration in clinical practice. This is the first study of a Romanian cohort to provide critical data for risk-adapted treatment strategies in underrepresented eastern European populations.

Background and Objectives: Preoperative anaemia represents a key modifiable risk factor in obstetrics. Within the framework of Patient Blood Management (PBM), establishing precise hemoglobin (Hb) thresholds is essential for optimal clinical decision-making. This study aimed to assess the predictive value of preoperative hemoglobin levels and to determine the optimal cutoff associated with transfusion risk. Materials and Methods: A retrospective analysis was performed on 932 pregnant women. The association between preoperative hemoglobin, anticoagulant therapy, mode of delivery and maternal age with the need for red blood cell transfusion was evaluated using binary logistic regression and Receiver Operating Characteristic (ROC) curve analysis with the Youden index. Results: Red blood cell transfusion was required in 5.2% (n = 48) of the study population. Logistic regression identified preoperative hemoglobin as the strongest independent predictor (p < 0.001, OR = 0.216, 95% CI: 0.153–0.306), indicating that each 1 g/dL increase in Hb reduced the likelihood of transfusion by 78.4%. Anticoagulant therapy and age were not significant independent predictors (p > 0.05). ROC analysis demonstrated excellent predictive performance, with an Area Under the Curve (AUC) of 0.875 (95% CI: 0.823–0.927, p < 0.001). The optimal threshold for predicting transfusion risk was 10.9 g/dL (sensitivity: 89.6%, specificity: 60.5%). Conclusions: Preoperative hemoglobin concentration is the primary determinant of transfusion risk, outweighing the influence of clinical comorbidities. The integration of PBM protocols designed to sustain hemoglobin levels above 10.9 g/dL is essential to reduce perioperative transfusion requirements and to promote improved maternal safety and clinical outcomes.

Effective postoperative pain control is pivotal in enhancing recovery following laparoscopic colorectal surgery. Regional anesthesia techniques such as the transversus abdominis plane (TAP) block and the quadratus lumborum (QL) block have gained prominence as components of multimodal analgesia. However, their comparative efficacy remains underexplored. This retrospective observational cohort study analyzed data from 289 patients undergoing laparoscopic colon surgery. Patients were stratified into three groups: TAP block (Group A, n = 54), QL block (Group B, n = 62), and no regional block (Group C, n = 173). Primary endpoints included time to first analgesic administration and total analgesic consumption (opioids and non-opioids). Statistical analyses were conducted using R (v4.4.2) and Jamovi (v2.3), with significance set at P < 0.05. Group B (QL block) demonstrated significantly reduced opioid consumption (mean 13.16 ± 2.69 mg) compared to both Group A (16.80 ± 5.51 mg) and Group C (18.03 ± 4.29 mg), P < 0.001. Time to first analgesic request was longer in Group B (16.06 ± 2.53 h), indicating more durable analgesia. Non-opioid usage (paracetamol, tramadol, nefopam) was similarly lower in Group B across all comparisons (P < 0.001). Group B also exhibited a significantly shorter hospital stay (4.87 ± 1.14 days) relative to Groups A and C. The QL block was associated with superior postoperative analgesia, reduced opioid and adjunct analgesic requirements, prolonged pain-free intervals, and accelerated postoperative recovery in laparoscopic colorectal surgery. These findings underscore QL block as a potent element of opioid-sparing, multimodal analgesic strategies and support its broader adoption in enhanced recovery protocols.

Liver transplantation remains the definitive therapy for end-stage liver disease, yet Early Allograft Dysfunction (EAD) continues to challenge post-transpl

Background and Objectives: Paraneoplastic hypercalcemia represents a rare but clinically significant complication of penile squamous cell carcinoma (PSCC), with limited evidence available. This systematic review aimed to comprehensively evaluate the pathophysiological mechanisms, clinical presentation, therapeutic strategies and prognostic outcomes of tumor-induced hypercalcemia in PSCC. Methods: A comprehensive literature search was conducted across PubMed/MEDLINE and Scopus databases from inception to December 2024. Cases were included if they documented histopathologically confirmed PSCC with biochemically verified hypercalcemia and objective evidence of paraneoplastic etiology. Data extraction encompassed tumor characteristics, hypercalcemia severity, mechanistic classification, therapeutic interventions and survival outcomes. Analysis followed PRISMA 2020 guidelines adapted for descriptive synthesis. Results: Twelve published cases spanning six decades (1965-2024) met inclusion criteria. The median age at presentation was 56 years, with 91.6% of patients presenting with advanced disease. Severe hypercalcemia (≥14 mg/dL) occurred in 66.7% of cases, with a median calcium level of 15.45 mg/dL. Three distinct pathophysiological mechanisms were identified: PTHrP-mediated humoral hypercalcemia, bone metastasis-associated hypercalcemia and tumor burden-mediated hypercalcemia. Despite biochemical correction, median overall survival was 9 weeks following hypercalcemia diagnosis. Conclusions: Paraneoplastic hypercalcemia in PSCC represents a rare metabolic emergency. While aggressive management can achieve biochemical correction, the occurrence of hypercalcemia uniformly indicates advanced tumor biology with limited survival benefit. Early recognition and prompt multidisciplinary intervention remain essential for symptomatic relief and quality of life preservation. Future prospective studies are needed to better characterize optimal management strategies and refine prognostic models.