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Malignant peripheral nerve sheath tumors are rare aggressive tumors that account for 5-10% of soft tissue sarcoma. The treatment is complex, involving surgical excision of the primary tumor and oncologic therapy. The natural evolution of MPNST is towards relapse and pulmonary metastasis. Careful postoperatory follow-up is essential for long term survival. Materials and Method: The patient, a 41-year old man, was admitted to our clinic for an operated, relapsed soft tissue mass in his left thigh. At admission he had a nodule in his inferior right pulmonary lobe. After undergoing imagistic investigations, the patient is operated, the mass is removed, with negative microscopic margins. The patient is referred to the oncologist for chemotherapy and radiotherapy. After 6 months, the MRI investigation detects a soft tissue mass in the inguinal region, without any suspicion of malignancy. Fortunately, a full body PET-CT showed a "hot" nodule in the inguinal region. The mass was surgically removed. The pathologic examination confirms the clinical suspicion: relapse of MPNST. Conclusion: Tumor relapse, due to the subsequent diversity in their histology may vary in clinical and imagistic appearance. Pet-Ct offers valuable information on the metabolic activity of a suspicious mass, allowing rapid detection of neoplastic cells. [ABSTRACT FROM AUTHOR]

This anatomical study of micro-dissection of the fascicles at the intranervous level of the proximal components of plexus brachialis is made in the idea to demonstrate that it is possible to identify these microscopic structures inside of every constituents of the plexus brachialis (roots, trunks, cords, terminal branches) and to separate them on a proper lenght (distance of dissection) in order to use them for micro-surgery methods of direct nerve repair, nerve grafting or techniques of nerve transfer. [ABSTRACT FROM AUTHOR]

In medical practice, plastic surgeons confront with patients with sarcomas of the extremities that require a radical surgical approach. Knowing when to attempt limb-sparing surgery and when to give in to limb amputation is one of the most difficult decisions a surgeon can take. The correct approach and management of such cases ensure surgical success and the patient survival. In this paper, the case of a 56-year-old man, admitted in our clinic with a crush injury of the right calf and subsequent haematoma is presented. During haematoma drainage, the surgeon noticed abnormal tissue and performed an incisional biopsy. The patient was diagnosed with myxoid liposarcoma of the external compartment of the right calf. Limb amputation was proposed, but the patient refused. After the clinical examination, blood tests and diagnostic imaging, which allowed the correct evaluation of the case-tumor sizes and neighboring tissue reports, and preoperatory radiotherapy, limb sparing surgery, respectively primary tumor excision was decided to be performed. Negative margins could not be obtained by 3 successive resections or by adjuvant chemotherapy. The presented case supports the idea that limb-sparing surgery is only applicable to carefully selected patients with soft tissue sarcoma. In some cases, radical excision involving even mutilating amputations may provide a better oncologic and functional result. [ABSTRACT FROM AUTHOR]

Malignant peripheral nerve sheath tumors are rare aggressive tumors that account for 5-10% of soft tissue sarcoma. The treatment is complex, involving surgical excision of the primary tumor and oncologic therapy. The natural evolution of MPNST is towards relapse and pulmonary metastasis. Careful postoperatory follow-up is essential for long term survival. Materials and Method: The patient, a 41-year old man, was admitted to our clinic for an operated, relapsed soft tissue mass in his left thigh. At admission he had a nodule in his inferior right pulmonary lobe. After undergoing imagistic investigations, the patient is operated, the mass is removed, with negative microscopic margins. The patient is referred to the oncologist for chemotherapy and radiotherapy. After 6 months, the MRI investigation detects a soft tissue mass in the inguinal region, without any suspicion of malignancy. Fortunately, a full body PET-CT showed a "hot" nodule in the inguinal region. The mass was surgically removed. The pathologic examination confirms the clinical suspicion: relapse of MPNST. Conclusion: Tumor relapse, due to the subsequent diversity in their histology may vary in clinical and imagistic appearance. Pet-Ct offers valuable information on the metabolic activity of a suspicious mass, allowing rapid detection of neoplastic cells. [ABSTRACT FROM AUTHOR]

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive version of squamous cell carcinoma (SCC) that preferentially occurs in the upper aerodigestive tract. Since the first description by Wain SL et al., in 1986, only 21 cases with BSCC in the nasal cavity or in the paranasal cavity have been reported in the English literature. We present a case of BSCC arising in a paranasal sinus, a 51-year-old male patient with four months history of right cheek swelling and unilateral nasal obstruction, who underwent an operation and postoperative radiotherapy. Clinical, pathological and surgical findings in this case are presented along with a brief discussion of literature. [ABSTRACT FROM AUTHOR]

Background. Successful tongue reconstruction after total glossectomy for advanced tongue or base of tongue cancer should restore swallowing, speech function, and cosmesis. Methods. The anterior lateral thigh flap sensitive myocutaneous (ALTF) with vastus lateralis muscle was used to reconstruct the oral defect in a patient undergoing total glossectomy with laryngeal preservation for T4 tongue cancer. Results. Good functional outcomes, measured by independent feeding, speech and swallowing, were achieved. Conclusions. The anterolateral thigh myocutaneous flap for total tongue reconstruction creates a free neotongue tip with an adequate volume, producing acceptable swallowing function and cosmesis. The reconstruction with free flaps is a feasible method of restoring the functional outcomes in speech and deglutition among patients who undergo total glossectomy with laryngeal preservation. [ABSTRACT FROM AUTHOR]

Amputations in the upper extremity due to trauma are, by definition, devastating injuries that involve multiple critical structures of the fingers, hand, arm, or any combination of the three and nearly always lead to significant disabilities, both directly and through their psychosocial impact. Replantation is defined as the reattachment of a part that has been completely cut off and the reconnection of the damaged vascular structures. Chances of viability depend on the degree of vascular, bone, muscle and nerve lesions, the level of amputation, the trauma mechanism, the pacient's age and comorbidities, the ischemia time while the functional recovery is assessed according to the following criteria: the active range of motion, the two-point discrimination sensibility ratings, the grip and pinch strength, the cold intolerance, and the return to previous employment. We report a case of a man D.V., aged 51, with a non-pathological personal history, admitted in April 2014 in the Emergency Hospital of Bucharest with the diagnostic "Severe injury by circular right upper limb. Hand amputation from radiocarpal joint, 3 hours old". The pacient was urgently transported in the operating room, where the right hand replantation was performed. He was first hospitalized in the Intensive Care Unit, then he was transferred in the Plastic Surgery and Reconstructive Microsurgery Clinic. Post-operatively, the results were favorable, our patient achieved at 6 months evaluation S3+ and M4 on British Medical Research Council's scale . [ABSTRACT FROM AUTHOR]

Background -- hypothesis and objective: In the past decades, extensive burn care has improved to the extent that burn victims can now frequently survive. Current treatment of a severe burned patient extends beyond the preservation of life and function; the ultimate goal is the return of survivors, as full participants, back to their families, work field and communities. Methods: This paper is based on our experience in treating patients with extensive burns. We had two panels as follows: 148 subjects with extensive burns in one original retrospective study (2002-2009) and other 47 new patients with extensive burns enrolled in other original prospective study (2010-2011). We selected the subjects with extensive burns who received allotransplant (n = 59). Our study aimed to identify and quantify the main psychosocial difficulties in patients with extensive burns who received allotransplant, also taking into account the surgical procedures applied in each case. Results: One of the major problems a surgeon faces is the nature of the decision he has to make regarding a treatment (conservative versus operative), based on the exact determination of burn wound depth. In case of early excision, deep lesions and suitable grafting represent the chosen surgical treatment in our center. The benefits of skin allografts are well known due to their contribution to burn management. Conclusions & discussion: This paper is designed as a guideline and instruction manual to help those with less experience through particular situations in surgical burn care. Early excision and immediate coverage of the burn wounds represent nowadays the standard care for extensive burned patients. For patients with massive thermal injury, temporary coverage with allografts is essential. The use of allograft has multiple benefits because it plays both as physiologic and mechanical barriers. [ABSTRACT FROM AUTHOR]

Breast cancer is a major health problem that requires multiple forms of treatment, including surgery, adjuvant chemotherapy and radiotherapy and more recently, reconstructive surgery. The aim of this study is to determine the factors that can predict the chances of a patient having postoperative complications after breast reconstruction. [ABSTRACT FROM AUTHOR]

The objectives of the study: Basal cell carcinoma is the most common skin cancer, 90% occurring on the head and neck. The eyelid is involved in 10 % of the cases, being the most common type of eyelid cancer. The bleedpurpose of this paper is to present the therapeutic management of bilateral basal cell carcinomas on the lower eyelids in case of a 64-year old woman, with multiple comorbidities. Used methodology: We describe the case of a 64-year old woman admitted in the Plastic Surgery Department with bilateral lesions on the inferior eyelids. The treatment consisted in the excision of the tumors in two different surgeries, with reconstruction of the eyelids using a cartilage graft and genian flaps. The result of the histhopatological examination was bilateral basal cell carcinomas completely resected, with safe margins. The conclusions of the study: Despite the size and the invasion of the tumors on the lower eyelids, complete resection was possible with an adequate reconstruction, the postoperative scars being functionally and cosmetically acceptable with no evidence of recurrence after 6 months. Bilateral basal cell carcinoma of the eyelids is a rarely seen situation, early diagnosis and excision being important in treating it adequately and in preventing complications. [ABSTRACT FROM AUTHOR]

Native arteriovenous fistulae (AVF) are the best options for chronic hemodialysis (HD) access. In elderly, diabetics or patients with late initiation of HD we need to adapt surgical procedures, taking advantage of any opportunity to overcame shortcomings and create a native dialysis access. The case that we present has the particularity of a deep cephalic vein that required superficialization of the acquired brachiocephalic AVF in a normal weight patient (body mass index = 18.6 kg/m2). At the intervention for fistula formation, the poor nutritional status (moderate malnutrition - albuminemia = 2.9 g/dL) and the thin walls of the vein obliged us to perform the two-step procedure: first the creation, then the transposition of the fistula. The presence of two collateral veins imposed a classical intervention that allowed the ligature of these tributary vessels for a better fistula maturation. There were no injuries of the vessels or inflammatory / infectious complications, no impediment for cannulation due to overlapping scar after superficialization. In the dialysis vascular access planning algorithm we must consider all the conditions of the patient, anatomical particularities and the best way to ensure the longevity of the AVF. All the techniques available must be considered as options. [ABSTRACT FROM AUTHOR]

Background: While the incidence of lip cancers incidence in the central Europe is low 0.7% of all malignant tumors compared to the 1-2% generally considered, they are extremely important from a clinical and surgical point of view because of the morphological and functional changes involved. Materials and methods: We reviewed the possibilities of surgical reconstruction for the total lower lip defects and after assessment of the advantages and disadvantages we have chosen the Camille-Bernard modified technique to treat a series of 11 patients with lower lip tumors. Results:We had for complications a fistula above the chin for 3 patients and the need of a secondary revision of the red aspect of the lip in 4 patients. Discussions: While Karapandzic restores the functionality of the orbicularis muscle it also has a series of drawbacks: the appearance of microstomia, but mainly the aesthetic result is unsatisfying due to the visible scar. The Camille-Bernard technique for lower lip allows restoring of the comissure, does not cause microstomia and allows to easily rebuild vermilion with mucosa. The disadvantages are represented by possible hypoesthesia and hypotonia of the lower lip with salivary incontinence. Conclusions: For the lower lip reconstruction the most appropriate surgical approach to adopt should always be aimed at maintaining, the functionality and appearance of the lip. The Camille Bernard modified technique offers a good oral aperture, does not alter the oral contention and phonation and offers a satisfactory or good aesthetic result. [ABSTRACT FROM AUTHOR]

The objectives of the study: Basal cell carcinoma is the most common skin cancer, 90% occurring on the head and neck. The eyelid is involved in 10% of the cases, being the most common type of eyelid cancer. The purpose of this paper is to present the therapeutic management of bilateral basal cell carcinomas on the lower eyelids in case of a 64-year old woman, with multiple comorbidities. Used methodology: We describe the case of a 64-year old woman admitted in the Plastic Surgery Department with bilateral lesions on the inferior eyelids. The treatment consisted in the excision of the tumors in two different surgeries, with reconstruction of the eyelids using a cartilage graft and genian flaps. The result of the histhopatological examination was bilateral basal cell carcinomas completely resected, with safe margins. The conclusions of the study: Despite the size and the invasion of the tumors on the lower eyelids, complete resection was possible with an adequate reconstruction, the postoperative scars being functionally and cosmetically acceptable with no evidence of recurrence after 6 months. Bilateral basal cell carcinoma of the eyelids is a rarely seen situation, early diagnosis and excision being important in treating it adequately and in preventing complications. [ABSTRACT FROM AUTHOR]

Background: While the incidence of lip cancers incidence in the central Europe is low 0.7% of all malignant tumors compared to the 1-2% generally considered, they are extremely important from a clinical and surgical point of view because of the morphological and functional changes involved. Materials and methods: We reviewed the possibilities of surgical reconstruction for the total lower lip defects and after assessment of the advantages and disadvantages we have chosen the Camille-Bernard modified technique to treat a series of 11 patients with lower lip tumors. Results:We had for complications a fistula above the chin for 3 patients and the need of a secondary revision of the red aspect of the lip in 4 patients. Discussions: While Karapandzic restores the functionality of the orbicularis muscle it also has a series of drawbacks: the appearance of microstomia, but mainly the aesthetic result is unsatisfying due to the visible scar. The Camille-Bernard technique for lower lip allows restoring of the comissure, does not cause microstomia and allows to easily rebuild vermilion with mucosa. The disadvantages are represented by possible hypoesthesia and hypotonia of the lower lip with salivary incontinence. Conclusions: For the lower lip reconstruction the most appropriate surgical approach to adopt should always be aimed at maintaining, the functionality and appearance of the lip. The Camille Bernard modified technique offers a good oral aperture, does not alter the oral contention and phonation and offers a satisfactory or good aesthetic result. [ABSTRACT FROM AUTHOR]

The field of transplantation, including the specialized area of vascularized composite allotransplantation (VCA), has been transformed since the first hand transplant in 1998. The major challenge in VCA comes from the need for life-long immunosuppressive therapy due to its non-vital nature and a high rate of systemic complications. Ongoing research is focused on immunosuppressive therapeutic strategies to avoid toxicity and promote donor-specific tolerance. This includes studying the balance between tolerance and effector mechanisms in immune modulation, particularly the role of costimulatory signals in T lymphocyte activation. Costimulatory signals during T cell activation can have either stimulatory or inhibitory effects. Interfering with T cell activation through costimulation blockade strategies shows potential in avoiding rejection and prolonging the survival of transplanted organs. This review paper aims to summarize current data on the immunologic role of costimulatory blockade in the field of transplantation. It focuses on strategies that can be applied in vascularized composite allotransplantation, offering insights into novel methods for enhancing the success and safety of these procedures.

Benign and malignant cartilaginous bone tumors of the hand are rare findings, however representing a particular pathology due to the capacity to induce significant functional impairment. Even though a large proportion of tumors of the hand and wrist are benign, these may present destructive characteristics, deforming adjacent structures until compromising function. The most appropriate surgical approach for most benign tumors is intralesional lesion resection. Malignant tumors often require wide excision, up to segment amputation to obtain tumor control. A five-year retrospective study was performed on patients admitted in our Clinic with benign cartilaginous tumors of the hand, in which 15 patients were admitted within this period, 10 presenting with enchondroma, four presenting with osteochondroma, and lastly one with chondromatosis. After clinical and imaging evaluation, all the aforementioned tumors were surgically removed. Definitive diagnosis for all bone tumors, either benign or malignant, was established by tissue biopsy and histopathological examination, dictating therapeutic strategy.

Intranodal schwannoma is a rare benign tumor, which originates from the peripheral nerve sheath (Schwann cells), fewer cases being reported with lymphatic involvement. We present the case of a middle-aged female patient, with one-year growing mass in the lateral-cervical area, in intimate relation with the vascular package of the neck. Preoperative cervical computed tomography examination showed the tumor features. There was no intraoperative complication, with the piece being completely removed. The morphological examination revealed the structure of a lymph node, and after Hematoxylin-Eosin staining, there were eosinophilic cytoplasm, euchromatic nuclei, with round, elongated or slightly wavy form and reduced pleomorphism, rare degenerative nuclear atypia, and no mitotic activity nor necrosis. The expression of S100 protein on immunohistochemistry, along with negative results for smooth muscle actin and desmin sustained the diagnosis of intranodal schwannoma of the neck. With a low index of cellular proliferation (Ki67), this case is in line with the reported features of schwannoma having extremely rare malignant transformation.

Benign peripheral nerve tumors and malignant peripheral nerve tumors are rarely found in patients with upper limb tumors. A four-year retrospective study was conducted on patients with tumors in the upper limb area admitted to the Emergency Clinical Hospital, Bucharest, Romania. Seventeen patients were admitted within this time range, 15 of which were benign and two malignant. All patients required surgical intervention after thorough clinical and imaging evaluation. Benign masses were removed, follow-up examination revealing no local recurrent, as well as good function recovery. On the other hand, malignant tumors due to their highly aggressive features, both determined local recurrence, one requiring upper limb amputation, the other presenting metastases.

Iron deficiency is a major problem in worldwide populations, being more alarming in surgical patients. In the presence of absolute iron deficiency (depletion of body iron), functional iron deficiency (during intense bone marrow stimulation by endogenous or exogenous factors), or iron sequestration (acute or chronic inflammatory conditions), iron-restricted erythropoiesis can develop. This systemic review was conducted to draw attention to the delicate problem of perioperative anemia, and to provide solutions to optimize the management of anemic surgical patients. Systemic reviews and meta-analyses, clinical studies and trials, case reports and international guidelines were studied, from a database of 50 articles. Bone marrow biopsy, serum ferritin levels, transferrin saturation, the mean corpuscular volume, and mean corpuscular hemoglobin concentration were used in the diagnosis of iron deficiency. There are various intravenous iron formulations, with different pharmacological profiles used for restoring iron. In surgical patients, anemia is an independent risk factor for morbidity and mortality. Therefore, anemia correction should be rapid, with parenteral iron formulations-the oral ones-being inefficient. Various studies showed the safety and efficacy of parenteral iron formulations in correcting hemoglobin levels and decreasing the blood transfusion rate, the overall mortality, the postoperative infections incidence, hospitalization days, and the general costs.

Organophosphate (OP) use remains largely available worldwide despite more strict regulatory measures, in agriculture, parks or households, leading to a daily low-dose exposure. The systemic dysfunction appears partly due to acetylcholinesterase inhibition, exhibiting a primary toxic effect on the endocrine system but also on the liver and kidneys, which are responsible for products metabolization and elimination. Prolonged OP exposure can be responsible for histopathological (HP) changes that can either evolve or worsen pre-existing conditions. We conducted an experimental study including six male Wistar rats divided into two groups (four rats in the study group and two in the control group). The subjects in the first group were administered 100 mg∕kg Chlorpyrifos half median lethal dose (LD50) at baseline and at 48 hours, under general anesthesia. Organ harvesting was achieved after one week. HP modifications were discovered in all kidney samples, with dystrophic changes and vacuolization of mesangial cells, dilation of renal tubules and epithelial atrophy. Congestion of vascular structures also occurred. The liver samples showed severe alteration in both vessels and hepatocytes. Adrenal gland impairment was confirmed through an increase in vacuole number in all areas, while a decrease in colloid content was noted in the thyroid gland simultaneously with a modified foamy aspect. This study is the first to certify the extent of organ injury induced by OP exposure, describing both glomerular and tubular involvement in the kidneys, liver necrosis and endocrine disturbances.

Background and objectives: Breast cancer is the most common cancer in women. The immunohistochemical profile, but also the stage of the tumor determines the therapeutic management, which varies from conservative surgery to mastectomy associated with chemotherapy, hormonal and biological therapy and/or radiotherapy. Mastectomy remains one of the most radical surgical intervention for women, having great consequences on quality of life, which can be improved by realizing immediate or delayed breast reconstruction. The objective of the study was to evaluate the period of time between the mastectomy and the breast reconstruction. Material and methods: We performed a retrospective study on 57 female patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania. All the patients underwent immediate or delayed breast reconstruction after mastectomy for confirmed breast cancer. Descriptive data analysis was realized with evaluation of type of breast reconstruction considering the staging of the tumor, the invaded lymph nodes, and the necessity of adjuvant chemoradiotherapy. Moreover, the median period between mastectomy and reconstruction was evaluated. Results: The immediate breast reconstruction was performed in patients with stage I, in patients with stage II, delayed reconstruction was performed after minimum six months, and the patients with stage III had the breast reconstructed with free flap (50%), 8-43 months post-mastectomy. Radiotherapy determines the type of breast reconstruction, in most of the cases the latissimus dorsi flap was used with implant (22.6%). Conclusions: Breast reconstruction is an important step in increasing the quality of life for women who underwent mastectomy after breast cancer. The proper timing for breast reconstruction must be settled by a team formed by the patient, the plastic surgeon, and the oncologist.

Pathological wound healing states, such as hypertrophic scarring and keloids, represent a huge clinical and financial burden on healthcare system. The complex biological mechanisms occurring in hypertrophic scarring are still barely understood. To date, there is no satisfactory description of hypertrophic fibroblasts. Therefore, in the present study we focused on the comparatively characterization of the fibroblasts residing in different regions of hypertrophic scars. To achieve this aim, fibroblasts were isolated from normal skin samples (n=4) and hypertrophic scars (n=4). These cell populations were further were used for the evaluation of proliferation and migration capacity, for the gene and protein expression of extracellular matrix protein type I collagen and fibronectin and for the presence of myofibroblasts. Our results demonstrated that perilesional and intralesional fibroblasts isolated from hypertrophic scars could be considered as distinct populations, having different properties. Thus, the intralesional fibroblasts had an increased proliferation capacity and increased gene and protein expression of collagen I and fibronectin. However, the perilesional fibroblasts had augmented mobility as revealed by in vitro scratch test and contained a higher percentage of myofibroblasts [alpha-smooth muscle actin (α-SMA)high cells], in comparison to the intralesional population. In conclusion, our data could provide an explanation regarding the inconsistent efficacy of topic therapies for hypertrophic scars.

The aim of the study was to observe similarities and differences regarding surgical safety and prognosis between en bloc bipolar resection and monopolar transurethral resection of bladder tumors (TURBTs) in medium size papillary non-muscle invasive bladder tumors (NMIBTs). A total of 90 patients with papillary bladder tumors presenting a diameter between 1 and 3 cm were equally divided and alternatively assigned for en bloc bipolar ablation (the study group) and conventional TURBT (the control group). During one year, every three months, the follow-up was performed and the protocol included urinary cytology and cystoscopy. Similar mean patients' age and tumor diameter were determined in both groups. In the study group, it was noticed an important reduced rate of obturator nerve reflex adverse event that caused bladder wall perforation. In addition, comparing the results between the two groups, the following aspects were observed in the study arm: decreased mean operation time (13.4 versus 19.7 minutes), hemoglobin level drop (0.28 versus 0.76 g∕dL), catheterization period (1.9 versus 2.8 days) and hospital stay (2.3 versus 3.1 days). A total of 41 and respectively 40 patients completed the 12 months follow-up protocol. After one year, the en bloc group presented a significantly lower recurrence rate, superior surgical safety, decreased perioperative morbidity and faster recovery. Therefore, the en bloc surgery approach presented a better oncological prognosis due to the reduced heterotopic NMIBT recurrences up to one year.