Conserving surgery - balance between good cosmetic aspect and local disease control in incipient breast cancer.

New acquisitions in the study of breast cancer, based on several retrospective and prospective studies, have led over the past decades to the possibility of applying conserving methods of treatment for breast cancer (breast conserving therapy -BCT) in incipient stages. Starting with 1996, a single surgical team, among others at the Bucharest Oncology Institute,performed BCT in 497 patients out of the total 2,256 cases of breast cancer treated. Work protocol consisted of tumour excision with safety margins, intraoperative histology exam,samples from all the walls of the remaining cavity, with intraoperative histology exam, axillary lymphadenectomy, followed by mandatory irradiation of the entire breast, associated or not with systemic or hormonal adjuvant treatment. 38 patients developed local disease recurrences, 14 of which in the first 5 years. In this paper we present the results obtained through BCT, as a means of supporting this type of treatment adequate for patients with initial stage breast cancer, with cosmetic results visibly superior to those of mastectomy.

Involvement of reactive oxygen species in the mechanisms associated with cervical cancer specific treatment.

Cervical cancer represents a genuine health issue in Romania.The courses of treatment applied are complex, and the accompanying biochemical mechanisms are yet to be fully understood. Thus, radiotherapy, which induces reactive oxygen species, can lead to failure of treatment in hypoxic tissues,tissues which are difficult to identify due to the small quantity in which these cytotoxic species are produced. As a result, the aim of this paper is to identify the production and role of reactive oxygen species, as well as the manner of activation of endogenous antioxidant defense mechanisms in cervical cancer patients admitted to the Oncologic Institute of Bucharest. To this purpose the biochemical parameters of oxidative stress were identified in 30 patients with cervical tumour localization, prior to surgery. The results obtained have showed that a production of reactive oxygen species is identifiable in these patients, having lipids as a primary target and leading to their peroxidation. The extension of protein oxidative degradation takes place at a much lower value, as well as the activation of endogenous antioxidant defence systems, comparing to our expectations. To conclude,we consider that when the production of active oxygen metabolites takes place in small concentrations, associated with hypoxia, the signals transmitted are towards modifying the phenotype under anaerobic conditions into one activating neo vascularization, angiogenesis initiation, new cell growth and proliferation. The moment that this phase is overcome anew oxidative stress is installed, one potentially destructive for biomolecules essential to life, but also useful for further treatment, such as radiotherapy.

Free tissue transfer in hand surgery--essential step in hand transplantation.

INTRODUCTION: The development of microsurgery allowed huge advancements in the reconstructive surgery of the upper limb. The use of free digital transfer started a true revolution for the reconstruction of the mutilated, functionally compromised hand, with multiple amputations. Slowly, surgeons started using free tissue transfers in other reconstructive procedures of the hand, forearm and arm. This way they avoided amputating a limb and they realized quality reconstructions in a single surgical step in cases in which classical methods did not apply. We shouldn't neglect to mention that free tissue transfers, along with hand replantation, represent an important step for microsurgery centers in preparing the hand transplant. MATERIAL AND METHODS: There have been 48 cases of free tissue transfers of the upper limb in the Plastic Surgery Department of the "Bagdasar-Arseni" Emergency Hospital between 2000 and 2010, of which 18 free digital transfers, 11 free tissue transfers of the hand, 15 transfers of the forearm and 4 of the arm. RESULTS AND DISCUSSION: Of the total 48 cases we studied, 4 have been total failures and 6 cases presented partial necrosis of the transferred tissue, all of which have been managed with ulterior corrective procedures. We used free tissue transfer in cases where there was no other surgical option and also in cases where other methods applied, but free tissue transfer provided a superior quality solution.

Tissue transplantation in face reconstruction.

INTRODUCTION: At face level, tissue transplantation is one of the main methods in reconstructive surgery, generally used when local and locoregional reserves are outworked. To reconstruct different face units after trauma or oncologic resection we use different methods, according to dimensions, nature and site of the defect. In cases with extensive defects or mutilating sequelas, face transplantation can be a reconstructive option that should be taken in account, despite its desavantages. MATERIAL AND METHOD: In this paper we present a retrospective study of the cases we operated during 2004-2010, in our Plastic and Reconstructive Surgery Clinic of Clinical Emergency Hospital "Bagdasar-Arseni" which needed reconstructions with different tissue transplantation methods. RESULTS: Case evaluation showed that postoperative results were good and very good. For this evaluation, we took in account both case gravity and operative risks, for each reconstructive method. CONCLUSIONS: Tissue transplantation for face reconstruction represents the latest milestone in face reconstruction, as well as a preliminary stage for face transplantation, when there is right indication.

[Surgical methods of covering head soft tissues defects]. / Modalitati chirurgicale de acoperire a defectelor de parti moi la nivelul capului.

Posttraumatic and post-excisional head soft tissue defects represent a challenge for the plastic surgeon due to the functional and esthetic impact of this body area. Choosing the simplest way of covering a defect is many times the most efficient way, but it must deliver a good tissue cover and their aspect and function must simulate the characteristics of that area. This article is proposing to be a brief description of all these procedures, informing and being necessary for every general surgeon. The methods of covering head soft tissues defects specific to plastic surgery will be presented in a ladder way from simple to complex, that means from the simple skin graft to island flaps and the tissues transfers. Choosing a right procedure refers to the etiopathogeny, and the length and width of the defect. We shall present advantages and disadvantages of each procedure, indications and their limits, giving specific clinical cases. We shall present the results for each type of procedure also, giving specific arguments for our option. We'll insist on the functional reconstruction of the lids, nose and cheek, as single defects and on the surgical limits which come upon very large soft tissue defects. Due to the complexity of the head structures, either single or complex, and to the functional and esthetic impact of these soft tissue defects, we consider this paper to be a real benefit. It is very important to choose the right procedure, considering all the factors who are implicated (sex, age, general condition, etiopathogeny, the length and width of the defect, previous treatments, patient wish, etc).

[Nosocomial infections in the Clinica Chirurgie CFR, Craiova]. / Infectii nosocomiale în Clinica Chirurgie CFR Craiova.

The authors present Craiova CFR General Surgery Clinic experience on hospital infections from 1991 through 1996. This study shows that the frequency of hospital infections in our clinic is greater than all the other postoperative complications. Over the investigated period of time we witnessed an increase in the incidence of the postoperative septic complications in addition to those directly linked to the operated interventions (e.g. wound infections, postoperative peritonitis) such as: pulmonary infections: urinary tract infections, catheter sepsis etc. Finally, the authors pointed to the consequences of the hospital infections such as: mortality and late morbidity rates, economic implications. Thus, it is worth mentioning that 30 deaths (75%) out of our clinic total of 40 over the studied period of time were due to a postoperative infections and treatments.

[Post-operative temporary enteral nutrition methods]. / Cai temporare de nutritie enterala postoperatorie.

THE AIM: Of the present work is to promote duodenostomy as the postoperative enteral nutrition way, when surgery ends in an anastomosis in which one of the partners is the esophagus (esophagectomies, esogastrectomies and total gastrectomies). MATERIAL AND METHOD: Consisted of 45 cases 815 total gastrectomy, 14 esogastrectomy, 6 esophageal resections and 10-esophageal plasty) in which we used: nasofaringoesogastric or nasofaringoesojejunal probes (14 cases); Witzel jejunostomy (11 cases); gastrostomy (10 cases); duodenostomy (10 cases). THE CONCLUSIONS: Show the many advantages of duodenostomy as compared to other enternal nutrition methods: technical simplicity, patient's comfort, avoidance of complications involved by the use of nasopharingoesodigestive probe or by jejunostomy, etc.

[Thoracic esophageal neoplasm-therapeutical problems and post-surgery evolution]. / Neoplasmul de esofag toracic--probleme terapeutice si evolutie postoperatorie.

The authors are presenting a few considerations on Thoracic Esophageal Neoplasm, as resulted from an 18-cases study performed on patients that were operated between 1994-1999. The esophageal resection rate was of 50%, as follows: 7 Esophageal Resections and 2 Superior Polar Esogastric Resections. The digestive transit was reestablished by means of intrathoracic transposition of the stomach (6 cases) or of the right ileo-colon (2 cases). In one of the cases an Esogastric Anastomosis was performed at the neck level (cervical-right). Immediate post-op mortality after Esophageal Resection (1 case) was due to an acute respiratory distress syndrome (ARDS). The post-op complications were as follow: one anastomotic fistula associated with a purulent pleurisy, 4 non-infectious pulmonary complications and 2 cardiac complications (paroxysmal supraventricular tachycardia). The Discussions and Conclusions of the present work are presenting samples of surgical techniques, post-op complications and prognosis.

Transplantation of composite tissue allograft: scientific bases and clinical applications.

Plastic surgery is by excellence a surgery in permanent search for new reconstructive options. In the last 50 years researches in the field of allotransplantation led to obtaining promising results for solving difficult cases when autologous tissues are not available for reconstruction, despite all the bioethical issues of this subject. This field of composite tissue transplantation evolved constantly, the top of it being total face transplantation, successfully accomplished while being based on the knowledge accumulated. There are many clinical applications of CTA, hand transplantation or only flexor tendon apparatus, lower limb, partial or complete face transplantations represent the most important part for us, plastic surgeons for obtaining the best reconstruction possible.

Correlations between morphological appearance and psychosocial difficulties in patients with extensive burns who received allotransplant.

Extensive burns are devastating traumatic events, with significant potential for development of complex psychosocial problems. The aim of the study was to identify and quantify these difficulties among extensive burns patients. This study was conducted at Clinical Emergency Hospital for Plastic, Reconstructive and Burns Surgery and "Bagdasar-Arseni" Emergency Hospital, in Bucharest, on 43 extensive burn patients. For each patient we developed a statistic sheet with demographic data and medical information. For data collection, subjects completed the following instruments: Hamilton Depression Scale (HAMD) and Satisfaction With Appearance Scale (SWAP). The impact variables evaluated in this study were demographic characteristic of patients, burn injury characteristics, abnormal scarring and visible scars, body image dissatisfaction and depression symptoms. Although performed on a small sample, the results of this pilot study could be a valuable starting point for future larger studies, to achieve more generalizable results on extensive burns survivor's quality of life.

Psychological impact of burn scars on quality of life in patients with extensive burns who received allotransplant.

With the remarkable progress in the field of burns treatment, the outcome of extensive burns improved significantly. The increased likelihood of survival of a burn victim heightens concerns for potential psychological morbidity for the survivors. Hypertrophic scarring is devastating and can result in disfigurement that affects quality of life. To assess the impact of burn scars on the quality of life of the survivors, we used two scales: the WHOQOL-BREF questionnaire to evaluate the quality of life and the POSAS scale for the subjective evaluation of the post-burn scars in 26 patients who suffered extensive burns and received allotransplant. A significant correlation was observed between the WHOQOL-BREF score and POSAS scale (r=-0.93, p<0.001). In conclusion, burn scar visibility and severity did have a strong relationship with the quality of life in the survivors of a major burn who received allotransplant. Therefore, more effort must be placed into developing psychosocial interventions that help survivors to accept scars, reduce depression and build a strong supportive system.

[Risks and difficulties in the treatment of malignant tumors of the lower face]. / Riscuri si dificultati în tratamentul neoplasmelor de etaj facial inferior.

The extensive malignant tumors of the face impose numerous problems regarding the surgical treatment due to, on one hand to their extension and on the other hand, to the aggressivity of the histological entity. The histopathology and the grading of these tumors are very helpful in orientating the specialist to choose the best therapeutic protocol in each case.

[Therapeutic solutions in post-excision defects for plantar verrucous carcinoma]. / Modalitati de acoperire într-un caz de carcinom verucos plantar (Epithelioma cuniculatum).

Carcinoma verrucous--anatomoclinical entity histological high rate of differentiation of the spinocellular epithelioma, clinically associated with 3 types of lesion. We present the therapeutical solution of a plantar carcinoma verrucous case, a large post-excisional defect-free flap transfer of latissimus dorsi muscle using microsurgical techniques.