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

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The Use of the Composite Muco-perichondrial-cartilaginous Vascularised Septal Flap in the Reconstructive Surgery of the Skull..

2014-02

The Use of the Composite Muco-perichondrial-cartilaginous Vascularised Septal Flap in the Reconstructive Surgery of the Skull Base Defects

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

The original vascularised nasoseptal mucoperichondrial flap was described and used, in the endoscopic reconstructive surgery of the skull base tumors, for the first time in 2006, by two surgeons, Hadad and Bassagasteguy [1]. This kind of vascularised flap provides the surgeons the ability to close large skull base deffects after removing sinonasal tumors. The vascularisation is provided by the posterior septal branch of the spheno-palatine artery [1]. The flap is well vascularised and the surgeon is able to harvest a large surface flap using almost all septal mucosa from one nostril. Sometimes, if the defect that had to be reconstructed was very large, some authors reported that they harvested the nasal mucosa from the nasal floor too. Some modifications were reported on patients where the flap was created by using bilateral nasal mucosa, but no advantage was gained by sub-maximal, bilateral septal flap harvesting as compared to a single, large, long, unilateral flap, taken to the vestibular skin anteriorly and to the inferior meatus laterally including the palatal floor [2,3]. Bilateral mucosal elevation leaves denuded septal cartilage and bone on both sides of the septum which prolongs the return of nasal mucosal function unless a formal posterior septectomy is also performed. The large surface area of the nasoseptal flap allows great versatility of movement [4]. It is capable of reaching any single segment of the ventral skull base, including the sella turcica, planum sphenoidale, clivus or the cribriform plate [4,5]. At its largest dimension, the nasoseptal flap is able to cover an entire anterior craniofacial defect from the frontal sinus to the planum sphenoidale and from orbit to orbit. The good vascularisation of the flap and the origin of the vascular source provide the surgeon with the ability to rotate the flap almost all directions [5].

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Para-Aortic Lymphadenectomy Associated with Excision of Liver Lesions in Advanced-Stage Cervical Cancer - A Case Report

2014-02

N. Bacalbașa, Irina Balescu

Cervical cancer represents a major health problem, ranking worldwide as the second most frequent malignancy in women (1,2). Although screening tests for cervical cancer are widely utilized, there is still a large number of patients who are diagnosed in an advanced stage of the disease (3). The main patterns of tumoral spread involve mainly parametria, upper vagina, uterus and pelvic lymph nodes (4,5). The incidence of positive lymph nodes increases proportionally with FIGO stage: pelvic lymph node metastases range between 12% in stage Ib up to 43% in stage IIb (4). Metastases to the aortic lymph nodes are secondary to the pelvic ones, the risk of positive para-aortic lymph nodes rising up to 30 %; on the other hand, skip metastases to aortic nodes represents a very rare condition (6-10). Extended para-aortic lymph node dissection provides an appropriate debulking surgery, allows an adequate histological evaluation and disease staging and offers important information in order to plan the extension of postoperative radiation field (7-15).

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Nonsurgical Treatment of Hepatic Hydatid Cyst

2014-02

I. Brezean, M. Vilcu, E. Catrina, I. Pantea, D. Ferechide

Hopes for a medical treatment of the hydatid cyst are old. However, the noninvasive treatments (vaccinotherapy, immunotherapy, chemotherapy) used so far did not lead to a cure. The latest drugs introduced as treatment are albendazole and mebendazole with a parasiticidal effect and praziquantel with a parasitostatic effect. Chemotherapy indications, established by WHO in 1996, are the adjuvant treatment administered preoperatively and postoperatively in the plurivisceral hydatid disease

when surgical treatment is contraindicated. The contraindications for chemotherapy are given by the occurrence of cysts complications or by the death of the parasite (1). The results of chemotherapy as a single treatment are 10-13% cure, 40-60% partial remission, 10-30% failure (1,2). Albendazole is a benzimidazole anthelmintic derivative for roundworms, flatworms and the larval forms of E. Granulosus. It acts at the level of the parasites’ cells, respectively of the proligerous membrane of E. Granulosus by inhibiting the poly-merization of β-tubulin from which the intracyto-plasmic tubules are formed and through which glucose is absorbed. Blocking glucose absorption causes parasite’s death through a process of vesicula-tion and fibrosis of the proligerous membrane which becomes infertile. Albendazole dosage is 10-15/mg/kgc/day, in two daily doses, over a 30-day course of treatment, which is to be repeated after a two-week pause.

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The Ethical Implications of Complementary and Alternative Medicine in Systemic Lupus Erythematosus

2014-02

Monica Costescu, Simona Roxana Georgescu, F. Draghia, M. Tampa, L. Coman, Oana Andreia Coman

Lupus erythematosus is an autoimmune disease with multiple symptoms and each patient presents a particular clinical and immunological-biological profile. The cause of the disease remains unknown. Lupus erythematosus embraces three clinical forms: chronic, subacute and systemic. Events in the three clinical forms range from skin involvement (chronic form) to serious systemic implications, affecting patient's health and life (as a systemic disease).

The systemic form - systemic lupus erythematosus - has a wide range of immunological abnormalities that cause inflammation in various organs and systems. The inflammation occurs as a result of excessive production of autoantibodies, that are directed against self structures that are no longer recognized. In systemic lupus, cutaneous manifestations are often accompanied by renal, cardiac, osteoarticular, neuropsychiatric disorders.

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Vascular Calcifications, Major Risk Factor for Cardiovascular Events in Chronic Kidney Disease: An Update on the Pathophy...

2014-02

Vascular Calcifications, Major Risk Factor for Cardiovascular Events in Chronic Kidney Disease: An Update on the Pathophysiological Process

Alice Bălăceanu, Camelia Diaconu, Cristiana David, A. Niculae, Ileana Peride, Gheorghița Aron

Hypertension, diabetes mellitus, dyslipidaemia are frequently encountered in patients with chronic kidney disease (CKD) (1). They are the major risk factors for the development and progression of the endothelial dysfunction and atherosclerosis and contribute to the progression of renal failure (1). Microalbuminuria increases to two- to four-fold the cardiovascular risk (1). It is also a quantitative association between glomerular filtration rate (GFR) and cardiovascular risk (1). The risk increase to two to four-fold in stage 3 of CKD (GFR 30-59 mL/min/1.73 m˛), four- to 10-fold in stage 4 (GFR 15-29 mL/min/1.73 m˛) and 10- to 50-fold in stage 5 renal failure (GFR <15 mL/min/1.73 m˛ OR dialysis) in comparison with persons free of CKD (1). Atherosclerosis with intimal involvement and Moenckeberg’s media sclerosis are the main cardiovascular determinations in CKD. Coronary artery calcifications attain the highest levels in young adults patients with renal failure and dialysis, as has been shown in angiographic studies (2). These patients have many coronary risk factors leading to intimal calcifications and these are coexisting with medial calcification founded only in CKD (2). The degree of coronary artery calcifications seems to be related to the estimated GFR in a multivariate analysis (2).</p>

KDIGO guidelines recommend that patients with CKD stages 3-5D with known vascular/valvular calcification be considered at highest cardiovascular risk (class 2A recommendations) (3).

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