EVALUATION OF PATIENTS WITH PATHOLOGY AT RISK FOR FOREARM AND HAND AMPUTATION

Forearm and hand pathologies, such as trauma, infections, tumors or extensive burns, represent a genuine challenge for the orthopedic surgeon, considering the fact that they have a major impact on the patient quality of life. Amputations at this level, though rare, are often a lifesaving procedure, which helps minimize the severe complications that may occur. We present a retrospective study made on a number of 3203 patients which were admitted to an Orthopedic clinic, from 2012 to 2014. We analyzed which is the most frequent cause for upper limb procedures, the distribution in both genders, the average hospitalization period of time and we determined which is the higher occurrence between lower and upper limb pathologies, aiming to determine the prevalence of forearm and hand amputations in the studied group.

THYROID ULTRASOUND PERFORMED FIRST HAND BY THE ENT SURGEON

The next level in thyroid disease management is the use of first hand surgeon performed sonography. Given the fact that many of the cases with thyroid carcinoma are referred to Ear Nose and Throat (ENT) departments, this diagnostic imaging modality should be available on site. We present a case series with thyroid pathology that benefited from sonography performed first hand by the ENT surgeon in a tertiary teaching hospital. Thyroid pathology is varied from benign cysts to papillary and medullar carcinomas. Further data are necessary for establishing the learning curve for this exam used by ENT surgeons. The foreseeable advantages are faster protocol in oncology cases, cost efficiency and wide scale availability of thyroid ultrasonography.

THE ROLE OF LAPAROSCOPY IN GYNECOLOGIC EMERGENCIES

We performed an analytical, cohort, retrospective study, starting from our own experience, to explore the role of laparoscopy in acute gynecological abdominal emergencies. The present work was obtained at the “Prof. Dr. Agrippa Ionescu” Hospital, Bucharest and includes a consecutive series of 37 patients, admitted in emergency settings, during the past 5 years. In order to complete the diagnosis, all of the patients included in the study were investigated using an abdominal ultrasound. The following aspects were investigated: the correlation between the preoperative diagnosis and the lesions identified by laparoscopy, the rate of postoperative complications, reintervention rate, length of hospital stay, conversion rate. Our results show that the laparoscopic approach has a decreased length of hospital stay, and can offer both a diagnosis opportunity and a therapeutic opportunity with results comparable with that of an open approach. Also, laparoscopy allows simultaneous treatment of other abdominal pathologies using the same access path. Our experience shows that the need for a correct and rapid diagnosis when an acute surgical abdomen is suspected is of paramount importance and laparoscopy can offer this opportunity.

VULVAR MELANOMA – THERAPEUTIC CONSIDERATIONS

Melanoma can develop both on the skin and in the mucosa at different levels: respiratory, gastrointestinal or genital, due to the melanocyte content of these tissues. In most cases, the prognosis of melanoma at the mucosal level has a much worse prognosis compared to that for melanoma at the tegument level. Symptoms described by patients with vulvar melanoma include bleeding, itching, vaginal discharge, dyspareunia or a palpable / visible tumor formation. We present the case of a 56-year-old, presented to our service with macula about 3.5 cm in diameter, dark brown color, and irregular edges, located at the level of the upper pole of the vulva.

PREGNANCY AND LACTATION IN PATIENTS WITH PSORIASIS

Psoriasis is an inflammatory chronic, common skin disease that represents a great burden affecting people of all ages. It has no clear cause and although there are treatments none of them can guaranty remission. This pathology has a significant negative impact on people in all countries, affecting between 0.09% and 11.43%, which means at least 100 million people worldwide. A particular category is represented by pregnant women. Although it is reported that 55% of the patients have improved symptomatology during pregnancy, 21% reported no change and 23% suffered worsening of the illness. Psoriasis can be difficult to manage due to fluctuations in hormone levels. Even if patients can experience improvements during pregnancy, most of the women report worsening in the post-partum period (4-6 weeks). Pregnancy and lactation can also interfere with specific treatment for psoriasis. Psoriasis can increase the risk of gestational, diabetes, pre-eclampsia and hypertension in pregnancy, increased risk of preterm birth, low birth weight and emergency caesarean section. In order to have a positive outcome for the mother and the baby, careful multidisciplinary management is needed. The aim of this review is to summarize the notions in the literature regarding pregnancy with psoriasis and the current treatment trend in this group of patients.

REVIEW OF THE SPINAL TUBERCULOSIS SURGICAL TREATMENT AND OUTCOMES

Spinal tuberculosis (TB), caused by mycobacterium tuberculosis, is one of the oldest diseases in the world. Spinal TB represents 50% of bone and joint TB. If spinal TB is not diagnosed and treated in time, it could cause spinal cord infection, nerve compression and paralysis. Spinal TB often causes abscesses formation, spinal dysfunction, spinal instability, and kyphosis onset disorder. Most spinal TB can be cured by non-surgical treatment. Surgery is the ultimate method of treatment of spinal tuberculosis and it is used for eliminating lesions, relieving spinal cord and nerve compression, correcting kyphosis and building spine stability. At present, spinal TB surgical approaches are mainly posterior approach, combined anterior-posterior approach and minimally invasive techniques. The present review summarizes the advantages, disadvantages and indications for each surgical method.

LINEAR IG A BULLOUS DERMATOSIS – CASE REPORT

Linear IgA bullous dermatosis (LABD) is a rare, immune-mediated cutaneous pathology, characterized by IgA deposits along the basal membrane. Clinically, it manifests as an eruption, consisting of vesicles and bullae, with herpetiform distribution, on erythematous and/or normal skin. The lesions are located symmetrically, at the level of the trunk and extremities. Clinically, diagnosis can be difficult because it can be easily mistaken with dermatitis herpetiformis or bullous pemphigoid. We present the case of a 79-years-old woman, without significant comorbidities, who developed a vasculo-bullous eruption, intensely itchy, located symmetrically on trunk and extremities, evolving for 4 years. We performed a skin biopsy, with histopathological examination and direct immunofluorescence, which revealed: sub epidermal vesicular-bullous lesion and dermal infiltrate with numerous neutrophils and eosinophils; IgA - continuous linear positivity at the dermal-epidermal junction. Thus, the diagnosis of LABD was established. The treatment consisted of systemic corticosteroids, colchicine, and antihistamines, with favorable evolution. The management of these patients can be challenging, as LABD can be induced by certain drugs, and may also be associated with lymphoid malignancies.

NOSE RECONSTRUCTION AFTER TRAUMATIC AMPUTATION

Nasal amputation is a disabling aesthetical and functional deformity, which raised the need for nasal reconstruction. It is very important to use a well-established plastic reconstruction technique because of its importance in the aesthetic of the face. Every structure is important and all the missing layers of the nose must be reconstructed. In our case a three-stage procedure was done. First stage: Reconstruction of the cover using a paramedian forehead flap, harvesting a strut graft to recreate a columella to support the height of the nasal tip. Second stage: Re-elevation of the flap, thinning of the layers, and reconstruction of the framework. Third stage: Division of the pedicle. This type of nasal reconstruction had both good and stable results aesthetically and functionally.

FOLLICULAR MUCINOSIS IN A PATIENT WITH PARAPSORIASIS

We present the case of a young patient, without comorbidities, who developed an erythematous-squamous, disseminated, discrete itchy rash, associated with scarring alopecia at the level of the scalp and the external third of the eyebrows, in 3-year evolution, in which two skin biopsies showed: subacute spongiotic dermatitis and psoriasiform dermatitis. As new lesions continued to appear despite treatment with phototherapy, systemic, local corticosteroids, it was decided to perform another skin biopsy: loose areas, granular appearance that color blue with Alcian Blue staining, thus supporting the diagnosis of follicular mucinosis. The treatment consisted of Acitretin 30 mg / day, with favorable evolution. Follicular mucinosis is a rare inflammatory disease, characterized by mucin deposits located in the follicular epithelium and sebaceous glands. There are two clinical forms: a primary, benign, limited to the skin, and a secondary form, commonly associated with cutaneous T-cell lymphoma. The evolution of both forms of follicular mucinosis is a chronic one, and the correct therapeutic attitude consists primarily in the periodic surveillance of the patient, with possible repeat biopsy, to exclude the form associated with a mycosis fungoides. The management of such patients is extremely difficult, as a number of conditions must be evaluated, such as: screening for collagenosis, diabetes, inflammatory bowel disease, evaluation of thyroid function, tumor markers.

ANALYSIS OF E-CADHERIN EXPRESSION IN A GROUP OF PRIMARY CUTANEOUS SQUAMOUS CELL CARCINOMAS

E-cadherin is an adhesion molecule essential in maintaining cellular integrity and preserving normal epithelial tissue architecture in adult organisms. Loss of E-cadherin expression and epithelial characteristics has been described in the late stages of carcinogenesis in various human cancers. By loosing cell-cell adhesion mediated by E-cadherin and acquiring mesenchymal properties, a process reffered to as epithelial to mesenchymal transition (EMT), carcinoma cells become more motile and invasive, thus being able to penetrate the surrounding stroma. Our aim is to investigate E-cadherin expression, part of the EMT phenomenom, in cutaneous squamous cell carcinomas (cSCCs), knowing that it represents a valuable model for understanding cancer progression. We conducted a retrospective study, performing immunohistochemical staining of E-cadherin and analyzing its expression in 32 cases of primary cSCCs. E-cadherin membrane positivity was assessed in cells from the main tumor and cells from the invasion front and described in terms of percentage of positive tumoral cells and in terms of intensity. Statistycal analysis showed the proportion of E-Cadherin positive cells in the tumor central and superficial areas is lower in higher degrees of anaplasia (marginally significant p=0.07), confirming the higher potential of poor outcome in these tumors. Median intensity and proportion values of E-Cadherin positive cells were significantly higher in the tumor central and superficial areas than in the invasion front (p<0.0001), suggesting that loss of epithelial features portends higher potential of invasion and metastasis in the setting of EMT. Further studies are required in order to establish clear correlations.