Hysterectomy is the most common gynecologic procedure performed all over the world and various complications may appear depending on the surgical route. Delayed postoperative hemorrhage is a rare, life threatening complication. It requires timely management and recently the surgical reinterventions tend to be replaced by minimally invasive techniques. Transcatheter arterial embolization shows good results as a treatment strategy for massive vaginal bleeding post hysterectomy, when vaginal vault suturing fails to achieve hemostasis. We report a case of right uterine artery bleeding occurring 30 days after vaginal hysterectomy that was successfully treated by transcatheter arterial embolization.

Uterine rupture is a significant maternal and fetal morbidity and mortality factor. It is defined as the complete cleaving of the three uterine layers. The pregnancy distention leads to alteration of the uterine wall fibers, especially in the low resistance points like surgical scars. World Health Organization realized an extensive systematic review to determine the prevalence of uterine rupture. A lower prevalence was seen in developed countries and higher rates for least developed countries. The incidence of uterine rupture in women with caesarean section is estimated to be 1% and without caesarean section is as low as 0.006%. Although the uterine scar is the main feature of uterine rupture, other contributing influences on untoward outcomes must be promptly recognized. The aim of this paper was to assess the frequency of uterine ruptures in a tertiary referral center, to identify risk factors and symptoms for complete and partial uterine rupture before labor, common symptoms of uterine rupture, multidisciplinary approach, and emergency surgical management.

In Bucharest University Emergency Hospital every day we deal with difficult cases either presented per primam in our setting or, even more difficult situations, cases that were intended to be treated in other hospitals but due to lack of infrastructure are sent towards our multidisciplinary hospital, as a final stop. Conditions that our teams have to deal in a very restricted amount of time in the Emergency Room are: submucous myoma with heavy bleeding acquired uterine arteriovenous fistulae, ovarian ruptured cyst , ovarian hyperstimulation syndrome, adnexal torsion, tuboovarian abscess, classical tubal ectopic pregnancy, Cesarean scar ectopic pregnancy, molar pregnancy, incomplete abortion, ruptured uterus post minimally invasive procedures performed before pregnancy, placental abruption, placenta praevia with heavy bleeding, and the PAS – Placenta Accreta Spectrum. All these conditions recquire a rapid differential diagnosis where ultrasonography is useful in adopting a tailored management either conservative or radical, in avoidance of haemorhagic accidents or even death and, when needed, in fertility sparing.

Metaplastic breast cancer (MBC) is a rare, aggressive form of breast cancer first described by pathologists in 2000. It is usually discovered in advanced stages and has a low survival rate. It is divided into various subtypes: lowgrade adenosquamous, fibromatosis-like metaplastic, squamous cell, spindle cell, metaplastic with mesenchymal differentiation (including chondroid, osseous, or other types), mixed metaplastic, and myoepithelial carcinomas. Surgery is the treatment of choice, followed by adjuvant chemotherapy and/or radiotherapy. We present the case of a 44-year-old woman with metaplastic breast cancer, reviewing the characteristics of this condition, the particularities of the case, and the treatment chosen in this particular situation.

Shockwaves can be defi ned as transient pressure oscillations which propagate in three dimensions and offer an increased pressure in a very short period of time. Biological effects of shockwave therapy have been proven to stimulate the release of angiogenic growth factors, and contribute to the improvement of blood supply which leads to the repair of bone and soft tissue. The role of ESWT in the treatment of chronic calcifying tendinitis of the rotator cuff has been evaluated in many studies. ESWT has been gaining attention as an alternative option to surgical excision of calcifi cation or when other conservative options have not proven effi cient. The main purpose for using ESWT in heel spur is to increase the local blood supply by inducing neovascularisation. This action influences the inflammatory process and furthermore stimulates the local metabolism. Also, shockwaves have been proposed as a possible treatment in early phases of femoral head necrosis in adults. In case of patellar tendinopathy in vitro studies have shown biological effects, while clinical effects remain unclear. Data suggests that ESWT associated with other physical modalities achieve realiable clinical importance of pain reduction in lateral epycondylitis. However there is still a lack of standardisation and a consensus is needed regarding frequency and intensity.

Anterior cruciate ligament lessions represent one of the most frequently met injuries of the knee, with an increasing incidence depending on the statistics, most of them occuring in athletes or young adults[1-5]. The re-construction of the anterior cruciate ligament can be obtained by using different surgical procedures and varies according to the graft material that is used. The outcomes after ACL reconstruction is depended on both surgical and rehabilitation factors[6,7]. [...]

Metabolic syndrome (MetS) is defined as a cluster of elements represented by increased levels of fasting plasma glucose, raised tryglicerides, high blood pressure and modified values of HDL cholesterol associated with the presence of abnormal abdominal waist[1,2]. Due to this elements it represents a predicting factor regarding the development of type II diabetes and cardiovascular disease. Although insulin resistance[3] and central obesity[4] represent the main causative factors, there are still many unknown variables of its components that require further research. [...]

Metabolic Syndrome (MetS) represents a group of clinical and biological criteria that when combined can become a potential threat for the development of severe pathologies -diabetes mellitus, cardiovascular disease, obesity. The International Diabetes Federation(IDF) defines the presence of MetS when 3 or more of the following criteria are detected: 1.raised triglycerides ?150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality
2.reduced HDL cholesterol <40 mg/dL (1.03 mmol/L) in males <50 mg/dL (1.29 mmol/L) in females or specific treatment for this lipid abnormality
3.raised blood pressure systolic BP ?130 or diastolic BP ?85 mm Hg or treatment of previously diagnosed hypertension
4.raised fasting plasma glucose, (FPG) ?100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes
5.central obesity (defined as waist circumference* with ethnicity specific values) (IDF guidelines)[1-3].