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Squamous cell carcinoma of the hypopharyngeal region is a rare, aggressive disease with a poor prognosis and a high mortality rate, and represents up to 95% of all hypopharyngeal tumors. Patients with upper aerodigestive tract tumors can develop airway compromise before or during chemoradiotherapy. The present study aims to investigate the complication differences between elective tracheostomy and emergency-setting tracheostomy for patients with advanced hypopharyngeal squamous cell. The study group included 36 patients and analyzed the number and type of complications, functional outcomes and comparation of the laboratory testing in all the patients at 3 specific points (before tracheotomy, during the radiation therapy and at least 3 months after completion of radiation therapy). In addition, univariate analysis was performed in order to evaluate the prognosis of local control rates. The type and number of complications between elective and emergency-setting tracheostomy varied, but all the complications were resolved, and no hypoxic complications secondary to displacement of the tracheostomy tube or death cases related to the tracheostomy occurred. A total of 20/36 patients presented with complications, with 73% (16 patients) from the emergency tracheostomy cohort and 36% (4 patients) from the elective tracheostomy group. More than half of the elective tracheostomy (6/11 patients) responded favorably to the treatment, with a higher frequency than the patients with emergency tracheostomy (5/22 patients). The present study did not encounter significant statistical differences (P>0.05) of the treatment end-result regarding the type of tracheostomy performed, but the prediction analysis found for the patients aged under 60 years old, elective tracheostomy was associated with a higher chance of favorable treatment end result., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Vulcu Cordunianu et al.)

Introduction: Sepsis and septic shock represent severe pathological states, characterized by the systemic response to infection, which can lead to organ dysfunction and high mortality. Early diagnosis and rapid intervention are crucial for improving survival chances. However, the diagnosis of sepsis is complex due to its nonspecific symptoms and the variability of patient responses to infections., Methods: The objective of this research was to analyze the implications of using artificial intelligence (AI) in the diagnosis of sepsis and septic shock. The research method applied in the analysis of the implications of using artificial intelligence (AI) in the diagnosis of sepsis and septic shock is the literature review., Results: Among the benefits of using AI in the diagnosis of sepsis, it is noted that artificial intelligence can rapidly analyze large volumes of clinical data to identify early signs of sepsis, sometimes even before symptoms become evident to medical staff. AI models can use predictive algorithms to assess the risk of sepsis in patients, allowing for early interventions that can save lives. AI can contribute to the development of personalized treatment plans, adapting to the specific needs of each patient based on their medical history and response to treatment. The use of patient data to train AI models raises concerns regarding data privacy and security., Conclusions: Artificial intelligence has the potential to revolutionize the diagnosis and treatment of sepsis, offering powerful tools for early identification and management of this critical condition. However, to realize this potential, close collaboration between researchers, clinicians, and technology developers is necessary, as well as addressing ethical and implementation challenges., Competing Interests: Conflicts of interest: All authors – none to declare., (GERMS.)

Colorectal polyps, frequently adenomas, are common in older adults, with villous adenomas being a notable subset due to their potential for significant malignancy risk. This case report highlights a rare instance of a giant villous adenoma in a 79-year-old female patient, challenging in both diagnosis and treatment. The patient, with a history of untreated essential arterial hypertension, was hospitalized for severe anemia following a massive rectal hemorrhage. An irreducible, prolapsed rectal mass was evident upon examination, and further investigations, including rectoscopy and abdominopelvic computed tomography scan, confirmed a villous adenoma with severe dysplasia. Given the tumor's substantial size, circumferential nature, and proximity to the dentate line, an abdominoperineal resection using the Miles technique was performed. The histopathological examination post-surgery confirmed the presence of a villous adenoma with high-grade epithelial neoplasia and localized areas of well-differentiated tubular adenocarcinoma. This case underscores the diagnostic and management complexities of large villous adenomas, emphasizing the need for meticulous surgical decision-making to ensure oncological safety and patient welfare, particularly when conservative resection may be inadequate., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Munteanu et al.)

Background: Hypopharyngeal cancer has the bleakest prognosis among head and neck cancers due to its extensive submucosal involvement, advanced tumor stage, and limited surgical reconstruction options. Its primary causes include alcohol consumption, tobacco use, genetic predisposition, 1` diet, and socioeconomic conditions. While squamous cell carcinoma (SCC) accounts for 95% of hypopharyngeal tumors, it remains a rare form, comprising only 3%-5% of all SCC cases in the head and neck region. Globally, Central and Eastern Europe have the highest incidence rates for males (3.9 per 100000) and the third highest for females (2.26 per 100000), underscoring the significance of this seemingly uncommon condition. In Romania, hypopharyngeal cancer ranked 24 th in incidence rate, with 634 new cases in 2020., Aim: To study the incidence, treatment and survival rates of hypopharyngeal tumor cases in a major ear, nose, throat (ENT) surgical center., Methods: A retrospective epidemiological clinical study was conducted on patients diagnosed and treated for hypopharyngeal cancer at the ENT department of "Carol Davila Central University Emergency Military Hospital" in Bucharest between January 2018 and August 2022. The study included 53 patients and was authorized by the Ethics Committee of Titu Maiorescu Doctoral School (Bucharest, Romania) and the Ethics Committee of Carol Davila Central University Emergency Military Hospital (Bucharest, Romania). Inclusion criteria required a positive histopathological diagnosis of hypopharyngeal cancer, tumor localization in the hypopharyngeal region, and informed consent for data usage. Exclusion criteria involved major psychiatric pathologies and disagreement for data usage. Diagnosis was based on ENT assessment, imaging reports, and laboratory data. Treatment methods were determined based on various factors. Additional tools, such as Adult Comorbidity Evaluation-27 and Karnofski Performance Status Scale, were used for risk assessment and functional capacity evaluation. Quality of life aspects were measured using the European Organisation for Reasearch and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35 questionnaire., Results: Our retrospective study examined 53 patients with hypopharyngeal cancer between January 2018 and August 2022. The majority of patients were male (94.3%), with an average age at diagnosis of 62.5 years. Among the patients, 20.75% were employed, 66.03% were retired, and 9.43% were unemployed. Smoking was prevalent among 69.81% of patients, while alcohol consumption was frequent in 32.07% of cases. The tumors were mostly diagnosed at an advanced stage (stage IV) and were predominantly SCC. Comorbidities were present in 83.01% of patients, with cardiovascular diseases being the most common. Dysphagia and neck mass were the most common symptoms reported. Treatment methods included surgery, radiation therapy, and chemotherapy. A favorable treatment response was observed in 22.64% of cases, while relapse occurred in 6 cases. Follow-up data was unavailable for some patients., Conclusion: In summary, our findings align with existing literature; however, we observed a higher severity., Competing Interests: Conflict-of-interest statement: The authors declare no conflict-of-interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise., Aim: To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities., Methods: We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons., Results: Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chron`s disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients., Conclusion: Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities., Competing Interests: Conflict-of-interest statement: All authors declare no conflict-of-interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Squamous cell carcinoma (SCC) of the hypopharynx is associated with the worst prognosis of all squamous cell cancer types of the head and neck, with a rich submucosal lymphatic network and a significant inferior extent. Generally, cancers of the head and neck have a big impact on the quality of life (QoL) in patients, both before and after treatment, due to the fact that most cases are diagnosed in advanced stages, with lymph node metastases and have an aggressive pattern associated with low survival rates. The present case report aimed to see the evolution of a patient successfully treated for hypopharyngeal cancer with conservation therapies from the QoL perspective and the influence made by the presence of tracheostomy. Variables, including clinical parameters (sex, age, TNM classification, performance status, histological type and tumor subsite), local control, QoL, Adult Comorbidity Evaluation-27 score and overall survival were assessed, according to the American Joint Committee on Cancer 8th edition, for a 58-year-old patient treated with conservation therapies and tracheostomy in a tertiary center. Subjective features measured through the QoL questionnaire had scores with lowering tendencies during the treatment period. The patient was provided with early training for tracheostomy care and early discharge education. The following objective features of treatment response were exhibited: Hemoglobin levels, leukocyte count, tumor size, imagistic evaluations and local control to confirm treatment response. It is essential when planning the treatment of aggressive and rare pathologies, such as hypopharyngeal cancer, to consider the QoL and patient choice for better adherence. Overall, the results demonstrated that the initial requirement for emergency tracheostomy was not associated with any ulterior complications and did not influence the end result of the treatment., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Cordunianu et al.)

The present study was a multicenter, analytical, nonrandomized research on 108 cases of intraoperative vascular and bile duct lesions during laparoscopic cholecystectomies. We selected these cases from 16,559 cholecystectomies performed entirely laparoscopically or debuted laparoscopically and converted to an open approach. The study included two surgical centers labeled as primary, with extensive experience in hepato-biliary reconstructive surgery, and four other centers labeled as secondary that referred cases to the previous two. Our study analyzed several key parameters such as the percentage of iatrogenic lesions recorded, the variability of the main biliary pathway and conformation as well as its relationship to the adjacent critical anatomical landmarks, the anatomical and physiopathological characteristics of pathology requiring surgical intervention, factors related to laparoscopic surgical technique, the surgical technique used to repair the recorded lesions, the duration of survivability and the rate of the occurring complications. Based on the analysis of these parameters, we developed a descriptive algorithm with visual representation relying on several decisional points to guide the surgeons in choosing the optimal treatment method so that patients will benefit from a favorable clinical path., Competing Interests: The authors declare they have no competing interests., (Copyright: © Moldovan et al.)

Sepsis is a clinical syndrome defined by the presence of infection and systemic inflammatory response to infection and results from a complex interaction between the host and infectious agents. It is characterized by the activation of multiple inflammatory pathways, with an increased risk of mortality. The incidence of sepsis has been on an ever-increasing pathway in recent years. Sepsis can be induced by several clinical situations that predispose to its occurrence: malignant tumors, organ transplantation, AIDS, radiation therapy, burns, sores, polytrauma, diabetes mellitus, hepatic failure, renal failure, malnutrition, catheters or different invasive devices, and urinary catheters. The microorganisms involved in the pathogenesis of sepsis are Gram-positive cocci ( Staphylococci , Streptococci ) and Gram-negative bacilli ( Klebsiella, Pseudomonas aeruginosa , E. coli ), fungi ( Candida ), parasites, and viruses. Among mechanisms involved in septic shock production, two pathological phenomena appear: the profound decompensation of circulation and metabolic disturbances that evolve towards an irreversible state. The intimate mechanism of shock involves the activation of monocytes, macrophages and neutrophils by lipopolysaccharides of Gram-negative bacteria. The microvascular bed is directly involved in the etiopathogenesis of disorders of acute inflammatory states associated with or without sepsis. A better comprehension of sepsis pathophysiology, especially the molecular mechanisms of septic shock, allows for new therapeutic perspectives., Competing Interests: The authors declare no competing interests in drafting this manuscript., (Copyright: © Gorecki et al.)

Considered by Dieulafoy as the "great abdominal drama", acute pancreatitis has always been, and still remains, a real diagnostic and therapeutic challenge because of its etiological, clinical and biological variability, the unpredictable evolution and the difficulty of establishing appropriate treatment for each patient. In this context, various, sometimes diametrically opposed, conceptions about the interpretation of the cases and the adopted therapeutic algorithm have been encountered over time, as evidenced by the great number of papers dedicated to this subject. A more thorough understanding of acute pancreatitis pathophysiology, with increasing interest in severity classification based on determinant factors (local and general) are decisive factors in predicting severity and adopting the modern therapeutic strategy of this complex and heterogeneous disease., (Celsius.)

Cardiovascular diseases (CVD) are the main object of morbidity and death in the world. There are different triggers of CVD, but atherosclerosis and/or hypertension are the most usual. CVD risk factors are used as prognosticators of disease process, while the biomarkers that envisage cardiovascular risk have an important biological basis. The integration of CVD risk factors and new biomarkers can improve CVD risk stratification and disease management. The identification of microparticles (MPs) in body fluids has opened new perspectives in diagnosis, prognosis and therapy of CVD pathogenesis. MPs are submicron vesicles released from a diversity of cell types with pleiotropic biological effects on signaling among cells. They are correlated with disease state and play a major role in atherosclerosis associated with inflammation, thrombosis as well as in CVD development and progression. This review reveals many sides of MPs as risk factors, biomarkers, novel forms of intercellular communication, non-invasive potential diagnostic tools and discusses their positive and negative impact on CVD., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background Information: Atherosclerosis is an inflammatory disease, in which risk factors such as hyperlipidemia and hypertension affect the arterial endothelium, resulting in dysfunction, cell damage or both. The number of circulating endothelial progenitor cells and microparticles provides invaluable outcome prediction for atherosclerosis disease. However, evidence for the therapeutic potential of endothelial progenitor cells and microparticles in atherosclerosis development is limited. Our study was designed to investigate the possible protective role of a cell therapy-based approach, using endothelial progenitor cells and the dual behaviour of circulating platelet microparticles, on atherosclerosis development in hypertensive-hypercholesterolemic hamster model. Consequently, control hamsters received four intravenous inoculations of: (1) 1×10(5) endothelial progenitor cells of healthy origins in one dose per month, during four months of diet-induced atherosclerosis, and after hypertensive-hypercholesterolemic diet for further four months; (2) in a second set of experiments, 1×10(5) endothelial progenitor cells of healthy origins or/and 1×10(5) platelet microparticles of atherosclerotic origins were inoculated every other month during hypertensive-hypercholesterolemic diet., Results: Endothelial progenitor cell treatment had the following effects: (1) re-established plasmatic parameters: cholesterol and triglyceride concentrations, blood pressure, heart rate, cytokine and chemokine profiles, platelet microparticle pro-thrombotic activity and endothelial progenitor cell paracrine activity reflected by cytokine/chemokine detection; (2) reduced lipid, macrophage and microparticle accumulation in liver; (3) reduced atherosclerosis development, revealed by decreased lipid, macrophage and microparticle content of arterial wall; (4) induced the recruitment and incorporation of endothelial progenitor cells into liver and arterial wall; (5) improved arterial dysfunction by increasing contraction and relaxation; (6) reduced the protein expression of specific pro-inflammatory molecules in liver and arterial wall. Platelet microparticle transplantation aggravated the above-mentioned biomarkers and atherosclerosis process, which were partially reverted with co-inoculation of platelet microparticles and endothelial progenitor cells., Conclusions: With this study, we demonstrate in a hypertensive-hypercholesterolemic hamster model, that the endothelial progenitor cell-based therapy suppresses the development of atherosclerosis and reduces hepatic lipid and macrophage accumulation with the consequent alleviation of dyslipidaemia and hypertension., Significance: Our results support the notion that increasing the number of circulating endothelial progenitor cells by different ways could be a promising therapeutic tool for atherosclerosis., (© 2016 Société Française des Microscopies and Société de Biologie Cellulaire de France. Published by John Wiley & Sons Ltd.)

The recognition of the importance of diabetes in vascular disease has greatly increased lately. Common risk factors for diabetes-related vascular disease include hyperglycemia, insulin resistance, dyslipidemia, inflammation, hypercoagulability, hypertension, and atherosclerosis. All of these factors contribute to the endothelial dysfunction which generates the diabetic complications, both macro and microvascular. Knowledge of diabetes-related vascular complications and of associated mechanisms it is becoming increasingly important for therapists. The discovery of microparticles (MPs) and their associated microRNAs (miRNAs) have opened new perspectives capturing the attention of basic and clinical scientists for their potential to become new therapeutic targets and clinical biomarkers. MPs known as submicron vesicles generated from membranes of apoptotic or activated cells into circulation have the ability to act as autocrine and paracrine effectors in cell-to-cell communication. They operate as biological vectors modulating the endothelial dysfunction, inflammation, coagulation, angiogenesis, thrombosis, subsequently contributing to the progression of macro and microvascular complications in diabetes. More recently, miRNAs have started to be actively investigated, leading to first exciting reports, which suggest their significant role in vascular physiology and disease. The contribution of MPs and also of their associated miRNAs to the development of vascular complications in diabetes was largely unexplored and undiscussed. In essence, with this review we bring light upon the understanding of impact diabetes has on vascular biology, and the significant role of MPs and MPs associated miRNAs as novel mediators, potential biomarkers and therapeutic targets in vascular complications in diabetes., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Just like simulators are a standard in aviation and aerospace sciences, we expect for surgical simulators to soon become a standard in medical applications. These will correctly instruct future doctors in surgical techniques without there being a need for hands on patient instruction. Using virtual reality by digitally transposing surgical procedures changes surgery in are volutionary manner by offering possibilities for implementing new, much more efficient, learning methods, by allowing the practice of new surgical techniques and by improving surgeon abilities and skills. Perfecting haptic devices has opened the door to a series of opportunities in the fields of research,industry, nuclear science and medicine. Concepts purely theoretical at first, such as telerobotics, telepresence or telerepresentation,have become a practical reality as calculus techniques, telecommunications and haptic devices evolved,virtual reality taking a new leap. In the field of surgery barrier sand controversies still remain, regarding implementation and generalization of surgical virtual simulators. These obstacles remain connected to the high costs of this yet fully sufficiently developed technology, especially in the domain of haptic devices., (Celsius.)

Purpose: This classification should eliminate the confusion in terminology occurring over the last 20 years with direct implications in clinical practice., Method: The study was based on the web-based consultation of experts worldwide. 528 invitations were sent and 240 responses received from 49 countries from all continents., Results: In an attempt to eliminate many confusions of the old classification, definitions that have built-in modern concepts of the disease have been issued, clinical evaluation of these severity has been improved and a standardized reporting data to objectively evaluate new treatments and to facilitate the communication of data between centers has been created., Discussions: An ideal classification should reflect the whole area of clinical and paraclinical changes for one patient, at a given time. In the chosen classification, the main variable that characterizes the degree of severity is only the transitory or persistent organ dysfunction(s) failure(s)., Conclusions: The most significant contribution to this update is redefining local complications based on their content,existence or non-existence of the wall, the place of their appearance and their evolution over time (local determinants).Systemic determinants take into account the presence of organ failures (transient or persistent). The presence of determinant factors has a cumulative effect., (Celsius.)

The aim of the present study was to examine the effects of obesity alone and obesity associated with Type 2 diabetes on the structure, vascular reactivity and response to insulin of isolated human subcutaneous fat arterioles; these effects were correlated with the expression of insulin signalling proteins. Periumbilical subcutaneous adipose tissue was explanted during surgery, small arterioles (internal diameter 220 ± 40 μm) were dissected out and investigated by electron microscopy, myography and immunoblotting. Compared with the subcutaneous arterioles of lean subjects, obesity activated the endothelium, enhanced the accumulation of collagen within vascular wall and increased the sensitivity of adrenergic response; obesity also diminished eNOS (endothelial NO synthase) protein expression, NO production, and endothelium-dependent and insulin-induced vasodilatation, as well as the protein expression of both IRS (insulin receptor substrates)-1 and IRS-2 and of the downstream molecules in the insulin signalling pathway, such as PI3K (phosphoinositide 3-kinase), phospho-Akt and Akt. When obesity was associated with Type 2 diabetes, these changes were significantly augmented. In conclusion, obesity alone or obesity associated with Type 2 diabetes alters human periumbilical adipose tissue arterioles in terms of structure, function and biochemsitry, including diminished eNOS expression and reduced levels of IRS-1, IRS-2, PI3K and Akt in the insulin signalling pathway.

Pathophysiological and molecular research have marked the understanding of the primary events taking place in triggering acute pancreatitis, although the early diagnosis of pancreas diseases in general, continues to be a source of frustration in modem medicine. This presents the news about pathogenesis (co-localization theory, auto-activation theory of the tripsynogen), location of early events (acinar pancreatic cells which are the "key" involved: muscarinic receptors, acinar membrane, role of ionized calcium, the phenomenon of apoptosis), extracellular events in initiation of acute pancreatitis with the granting of a central place to enzyme activation and systemic inflammatory response. Aspects of early microvascular changes, disturbances of ischemia-reperfusion and systemic microvascular abnormalities are so important that justifies therapeutic concept of microcirculatory protection. Participation of monocyte/macrophage system, excessive activation of leukocytes that involving activation and release of lysosomal enzymes and oxygen free radicals associated with ischemia-reperfusion mechanism are defining for pathogenesis of acute pancreatitis.

The management in severe acute pancreatitis evolved in the last two decades. Consulting the literature and the accumulated clinical experience manage to the release of this study based on the comparison of the treatment in PAS between two distinct periods: 1994-1999 (retrospective) and 2000-2007 (prospective). Among the 285 patients whit PAS admitted and treated in the two departments, 224 (78.6%) was submitted to the surgical intervention with various surgical indications. There is an obvious difference between the retrospective and prospective studies concerning the indication of surgery and mostly the timing for surgery. The lots were analyzed concerning the etiology, management of treatments and specific treatments, and the timing of the surgical intervention was analyzed based on the specific etiologic treatment and the period of time between the admission and the first surgical intervention, the mark being the 21 day according with the recommendations of the International Association of Pancreatology. There were analyzed: the period of time between the onset of the disease and the surgical intervention, the status of the patients at the surgical moment, the global mortality based on the timing of surgery, the evolution of the management of PAS along the period of the research, comparisons whit the literature. The registered data were statistically processed using the SPSS test version 17 for Windows.

The surgical technique we applied was the classical one with several improvements. Firstly, the timing of intervention is delayed until the occurrence of the clearly defined infected necrosis. Secondly, we limited the propagation of infection in submesocolic peritoneal cavity by creating this omental laparostomy with suturing the cutting edges of the gastrocolic ligament to the supra-umbilical anterior parietal peritoneum, near to the laparotomy, achieving the "marsupialisation" of the lesser sac. With this maneuver we protect submesocolic region by creating an "omental wall". Another major advantage of our approach was the subsequent necrosectomy, daily during the first week, which was accompanied by the change of dressings. Simultaneously we carefully perform haemostasis in the areas of necrosectomy, even with the harmonic scalpel if the situation required it. "Targeted" antibiotherapy and antifungal medication was initiated according to the microbiological results. Considering the fact that the intensive care techniques are approximately the same in the last 10-15 years, we thought that this improvement in the survival rate may be due to the application of OPLS in cases with indication and optimal timing for surgery.

Anderson Fabry disease (alpha galactosidase A deficiency) is an X-linked recessive lysosomal storage disorder; alpha galactosidase A deficiency results in accumulation of neutral glycosphingolipids, especially globotriaosylceramide (Gb3), in various cell types promoting development of disease with renal, cardiovascular, and cerebrovascular involvement. Clinical aspects which usually begin in childhood or adolescence include intermittent pain in the extremities (acroparesthesias), episodic "Fabry crisis" of acute pain lasting hours to days, characteristic skin lesions (angiokeratomas), hypohidrosis, heat and cold intolerance. Classic phenotype conception of the disease has changed within the past decade, recognizing that disease is not limited to the classical full-blown manifestation in affected males, but may also occur in carrier females. The expanding clinical spectrum of Anderson Fabry disease (AFD) is a real challenge to diagnosis, especially in some patients whose exclusive single organ manifestation belongs to the heart or kidney. This paper reviews natural history of three unrecognized cases recently diagnosed by markedly deficient alpha galactosidase A (alpha Gal A) activity in peripheral leucocytes. Case A: A male patient, aged 24 years, experienced recurrent acroparesthesia when he was 9 years-old. His 26 years-old sister has angiokeratomas as the only sign of disease (case B). Case C: the uncle of these two cases (A, B) has a long history of disease including chronic renal failure, bilateral deafness, stroke, aseptic osteonecrosis. The purpose of the presentation is to sharpen physicians' perception of this disease. Early and accurate diagnosis is mandatory considering that this disorder is now, after introduction of the novel enzyme replacement therapy, a treatable disease.

The increase of the peripheral blood flow resistance level is the major hemodynamic parameter in pathophysiology of essential hypertension (HT). The functional and morphological abnormalities of the microcirculation in the early stage, sometimes before the increase of the blood pressure, are intensely explored. Their identification is a proof for the genetical component of the hypertensive disease theory (studies on young male patients). Our purpose is to examine the capillary peripheral bed at the terminal phalanx level using in vivo capillary microscopy on a group of patients that have the risk of developing HT or that already have HT stage I (according to the JNC 7 Report). The nailfold area and the dorsal surface of the phalanx of fingers 3 and 4 were observed, having as a first objective the search for the areas with rare capillaries. Contrary to the data of the existing studies we have not found any case of significant capillary density decrease or of diffuse capillary rarefaction. Seven patients out of the total number of fifteen with HT stage I were identified to have a low vasomotility score. Considering the association of these cases with glucose intolerance (3 cases) and dyslipidemia (4 cases) the capillary functional anomaly could be related to precapillary arteriole modifications (endothelial dysfunction? metabolic status?).

A patient aged 42, diagnosed with polycondritis for approximately 14 years is presented; she has undergone urgent surgery for a splenic abscess in imminent fistulization in the left pleural cavity. Her susceptibility to infections is marked in time by surgical interventions for pultaceous amygdalitis, an abscess of the right submandibular salivary gland, a splenic abscess. To be noted the peculiar connection between the illness and the pregnancy, which differs from the data to be found in reference literature that is the association with a tendency to spontaneous abortion and the sudden installation of an evolutionary acute episode during pregnancy, which was followed by deafness. Based on these facts, immunopathogenic observations on recurrent polycondritis are getting into shape.

Pseudomyxoma peritonei (PMP) is an uncommon clinical entity, lacking a precisely defined etiopathogenesis. Its clinical features are not specific and diagnosis is difficult. We analysed 10 patients, all of them women, whom we had treated surgically in combination with intraperitoneal chemotherapy. Postoperative complications had been minimal and no death had occurred. 5 patients were followed up in time, 4 of them presenting a favourable evolution (2 required reintervention), and 1 patient decreased. We analysed up-to-date therapeutic approaches and the benefit of their combinations in order to identify the optimal therapeutic strategy. We consider that the combinations surgery + intraperitoneal chemotherapy or surgery + intracavitary radiotherapy are the most effective up to date.

Primary repair of the abdominal wall and the cure of incisional hernias using the relon mono-filamentous fibres (N.I. 2402/76) Confronted with long lasting parietal suppurations which are entertained by the classic nylon poly-filamentous fibres, suppurations that cannot be avoided unless the above fibres are removed on one hand assuming the risk of a possible subsequent incisional hernias and on the other hand because of the relative elevated price of the mono-filamentous fibres brought from abroad, within the last years (from 1982) we have utilised the relon mono-filamentous fibre (N.I. 2402/76) in abdominal wall reconstruction (initially for the surgical cure of the incisional hernias and there after in primary abdominal wall reconstruction when there were factors predisposing to a possible subsequent parietal for septic contamination, in overweight patients, immune-compromised patients, in patients following steroid therapy, chemotherapy, etc. Our present experience extends over more than 1000 patients who have undertook a surgical procedure.