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Povzetek: Introduction: Functional hypogonadism, a manifestation of testosterone deficiency in simultaneously present comorbidities, profoundly impairs quality of life in men with overweight and obesity - yet remains persistently under-recognized in clinical practice. Findings: Lifestyle modification constitutes first-line therapy, while pharmacological and surgical interventions increasingly complement it. Both promote substantial weight loss and may reverse obesity-related hypogonadism; bariatric surgery, in particular, elicits marked rises in circulating testosterone but entails risks of bone demineralization and uncertain long-term reproductive sequelae. Notwithstanding, testosterone deficiency itself represents a key driver of secondary osteoporosis, insulin resistance, anemia, fatigue, and depression as well as sexual symptoms. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have redefined obesity therapy through profound weight reduction and cardiometabolic benefit, yet concomitant losses of lean mass raise concern over sarcopenia and skeletal fragility. Conclusion: This focused review article aims to present a comprehensive update on the latest data concerning combining testosterone therapy with contemporary anti-obesity pharmacotherapy as a new standard of care for obese men with functional hypogonadism, uniting metabolic, vascular, sexual, cognitive, and skeletal benefits within a comprehensive strategy to fortify corporeal resilience and enhance quality of life.
Ključne besede: male hypogonadism, testosterone, GLP-1RAs, obesity, bones, osteoporosis
Objavljeno v DiRROS: 23.12.2025; Ogledov: 4; Prenosov: 4
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Povzetek: Background and Objectives: Robot-assisted procedures represent a significant advancement in minimally invasive liver resection techniques. Nonetheless, the introduction of a novel surgical technique in a new environment necessitates meticulous planning and a gradual, stepwise approach. This study describes the adoption of a robotic surgical platform for liver resection at a high-volume tertiary care center. Materials and Methods: We retrospectively analyzed data that had been prospectively collected from fifty robot-assisted liver resections. Descriptive statistics, including frequencies, percentages, means/medians, and standard deviations, were employed for description and summary. Results: The median operative duration was 166 min (range: 85–400 min), with an average intraoperative blood loss of 200 mL (range: 50–1000 milliliters). Intraoperative or postoperative blood transfusion was required in 8% of patients. Conversion to open resection was necessary in one patient (2%). The mean duration of hospitalization was 5 days (range: 3–20 days), with a 30-day readmission rate of 6% and no mortality within 90 days. Postoperative complications classified as Clavien-Dindo grade 3 or higher were observed in five patients (10%). The mean tumor size varied according to pathology: 58.5 mm (range: 30–120 mm) in the hepatocellular carcinoma group; 27.4 mm (range: 10–32 mm) in the secondary malignancy group; and 42.6 mm (range: 24–60 mm) in the intrahepatic cholangiocarcinoma group. The median number of lymph nodes harvested during lymphadenectomy (IHHCA/GBCA) was 5.4, ranging from 1 to 11. The R0 resection rate for malignant tumors was 88.2% (of 30/34). Conclusions: This study validates the safe integration of robot-assisted surgery into liver disease treatment, supported by our initial experience. Despite its technical advantages, robotic-assisted liver surgery remains complex and demanding. Structured robotic training within established programs, meticulous patient selection, and a stepwise implementation approach are critical during the early phases to optimize the outcomes.
Ključne besede: robot-assisted surgery, liver surgery, implementation, minimal invasive liver surgery, structured program
Objavljeno v DiRROS: 23.12.2025; Ogledov: 7; Prenosov: 5
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Ključne besede: absorbed energy, Charpy impact test, V-notch test pieces, casting parameters, modeling, linear regression, genetic programming
Objavljeno v DiRROS: 22.12.2025; Ogledov: 33; Prenosov: 19
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Povzetek: Objectives: The goal of this study is to document outcomes of ablation for high-risk accessory pathways in paediatrics using 3D mapping systems with minimal to zero fluoroscopy. Methods: It is a cross-sectional, multicentre study, conducted between 2013 and 2023, and involving four different centres in Hungary, Croatia, Kuwait, and Slovenia. Results: A total of 128 procedures were performed on 111 patients. The cohort included 57.8% anteroseptal (AS) pathways and 42.2% midseptal (MS) pathways. The mean follow-up time was 2.0 ± 2.1 years. Cryoablation was used in 72.7% of the cases, and radiofrequency ablation was used in 27.3%. The EnSite Precision™ Cardiac Mapping System was the predominant system used. The overall acute success rate was 89.1%, with recurrence rates at 17.2% with similar results regardless of the type of energy used. The success rate was not significantly different between AS and MS substrates. The age and weight of the patient had no bearing on the outcomes (median age and weight were 13 years and 52 kg, respectively). The complications rate was at 4.69% and included transient AV block (three patients), hematoma (one patient), right bundle branch block (one patient), and possible permanent complete AV block (one patient). Fluoroscopy was utilized in 18 cases, with a fluoroscopy time mean of 3 min and 45 s. Conclusions: MS and AS AP in paediatric patients can be treated effectively with either RF or cryoablation and with a low dose of radiation using 3D mapping systems, with excellent acute success rates and low complication rates.
Ključne besede: accessory pathway, electrophysiology, radiation dose, cryoablation, heart block
Objavljeno v DiRROS: 22.12.2025; Ogledov: 33; Prenosov: 19
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Povzetek: Background: Intermittent ventricular pre‐excitation has long been considered a low‐risk marker for sudden death. Accessory pathways (APs) with high‐risk intermittent antegrade conductive properties may exist, but this still represents a gray area in current guidelines. We evaluated differences in risk characteristics between symptomatic and asymptomatic patients with intermittent pre‐excitation (IPX) and those with persistent pre‐excitation (PPX) in a multicenter international registry. Methods: 392 consecutive patients [IPX: 79 (20.15%); PPX: 313 (79.85%)] underwent electrophysiological (EP) study. Data on arrhythmia inducibility (AVRT/AF), AP antegrade conduction properties (ERP/SPERRI), site, and number were collected. Results: No significant differences were found in demographic characteristics and EP features between PPX and IPX patients, including antegrade conductive properties, prevalence of multiple APs, and AP locations, except for AVRT inducibility which was more frequent in IPX group. Similarly, no differences were detected between symptomatic and asymptomatic IPX patients. Conclusions: Except for AVRT inducibility, our study shows no significant differences in demographic and other electrophysiological features between PPX and IPX patients. Likewise, no differences in demographic and EP features were detected between symptomatic and asymptomatic IPX patients. Therefore, intermittent pre‐excitation is an unreliable noninvasive marker of arrhythmic risk and it warrants an invasive risk assessment via EP study.
Ključne besede: electrophysiological study, intermittent ventricular pre‐excitation, risk stratification, sudden cardiac death, Wolff - Parkinson - White syndrome
Objavljeno v DiRROS: 22.12.2025; Ogledov: 38; Prenosov: 20
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