The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

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The Use of Ultrasonic Aspirator in the Surgery of the Fibrous Dysplasia Involving the Skull Base

2014-03

V. Zainea, M. Hainăroșie, O. Ceachir, Irina G Ioniță, Andreea Sorică, Cătălina Pietroșanu, R. Hainăroșie

Craniofacial fibrous dysplasia is a non-malignant disease. It appears due to the mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. Sometimes it is isolated to a single or multiple skeletal sites and / or endocrine organ (1, 2, 3, 4).

The disease commonly progress as a slow developing mass. Distortion of optic nerve, eye ball, nasal airway, facial nerve, teeth and middle year ossicles can occur. In young patients, at prepubertal age, the growth is rapid and can cause aneurismal bone cysts or mucoceles (1, 3, 5). The malignant change to osteosarcoma or other form of sarcoma can appear in less than 1% of cases (1, 2).

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The Inferior Gluteal Flap - Breast Reconstruction - Anatomic Dissection on a Cadaver

2014-03

S. Cortan, I. Lascar, I.P. Florescu, M. Valcu, Ioana Teona Sebe

The breast has been the expression of beauty and fertility since ancient times. The aesthetic reconstruction of the breast is and has been a challenge for plastic surgeons. Microsurgical techniques of dissection and free transfer are commonly used.

During the dissection of one fresh, female cadaver, age 67, a free inferior gluteal flap was taken from gluteal region, using loupe magnification. The dissection preparations were photographed with a high definition camera.

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POSTERIOR PELVIC EXENTERATION FOR ADVANCED, UNRESPONSIVE TO RADIATION THERAPY CERVICAL CANCER - A CASE REPORT

2014-03

N. Bacalbașa, Irina Bălescu

Although pelvic exenterations represent aggressive surgical procedures which might associate physical and psychological problems and a worsened body image, they are the only potential solution with curative intent in centro-pelvic tumors originating from both digestive and gynecologic tract. (1,2,3) In selected cases preoperative oncologic treatment can offer a tumor down-staging or can diminish the tumoral invasion in adjacent organs providing this way the possibility of less aggressive surgical procedures. In other cases this desiderate cannot be obtained; the tumor proves to be unresponsive to neo-adjuvant treatment and multivisceral resections being needed in order to obtain a good control of the disease. Studies have shown that clinical features of the tumor and both molecular and non-molecular biomarkers can be responsible for the poor tumoral response at irradiation. (4) In these cases surgery remains the only treatment with curative intent. We present the case of a 62 year old patient diagnosed with a large cervical tumor in which neo-adjuvant treatment failed to obtain an acceptable control of the disease. She was addressed to our service after augmentation of the tumor under neo-adjuvant treatment; we performed a total hysterectomy en bloc with bilateral adnexectomy, total colpectomy, abdomino-perineal rectal resection and pelvic lymph node dissection with good results.

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The Use of Coblation in the Surgery of the Juvenile Angiofibroma

2014-03

R. Hainăroșie, M. Hainăroșie, O. Ceachir, Irina G Ioniță, Cătălina Pietroșanu, V. Zainea

Coblation is a surgical technology which consists in delivering radiofrequency energy to soft tissue. This technology uses radiofrequency in a bipolar mode with a conductive solution, such as saline (1). It energizes the ions in the saline to form localized plasma near the tissue placed in the area of surgical interest. Plasma’s energy dissociates water molecules from saline solution thus providing the optimal chemical conditions for breaking the tissue’s molecular bonds (2).

The application of this technology has three effects: tissue ablation, localized removal and tissue volumetric reduction (2). The dissipated heat by using this type of radiosurgery is significantly lower than common radiofrequency techniques. This is due to intrinsic of the chemical process and the continuous cooling of the tissue from the surrounding saline solution at the level of the instrument’s tip (3). In this way the temperature rises to 45-85°C (1, 2). The decreased thermal effect of coblation, better than classic radiosurgery, induces a gentle but efficient surgical effect in the target area. Thus the surgeon can gently remove tumors, small organs (tonsils) and can melt some anatomical structures (turbinate, palate, base of tongue). There is a large field of surgical applications in the pathology of the upper aero digestive tract.

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Narrow Band Imaging - From Technological Progress to Superior Urothelial Cancer Diagnostic

2014-03

M. Jecu, P. Geavlete, I.A. Checheriță, C. Ene, B. Geavlete

Bladder cancer represents the most common malignancy of the urinary tract and the 7th most frequent cancer in men and 17th in women. The prevalence of this malignancy varies between regions and countries. In Europe for example, the highest age-standardized incidence rate has been reported in Spain and the lowest in Finland (1). In the United States, the incidence and mortality due to bladder cancer is also high (more than 60,000 new cases and up to 13,000 deaths annually) (2). Therefore, in the last decades, it has been noticed an increased prevalence of bladder cancer, probably caused by tobacco abuse, industrial carcinogens risk factors and overall aging process of the population (3).

75-85% of all newly diagnosed bladder tumors is represented by non-muscle-invasive bladder cancer (NMIBC), a multifocal disease, that includes stages pTa, pT1 and carcinoma in situ (CIS) (4). Furthermore, this pathology has a high recurrence rate within the first 5 years after the initial diagnosis (5), despite the recent technological advances (6).

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