Proposal for future diagnosis and management of vascular tumors by using automatic software for image processing and statistic prediction.

RATIONALE: Infantile Hemangiomas (IH) are the most frequent tumors of vascular origin, and the differential diagnosis from vascular malformations is difficult to establish. Specific types of IH due to the location, dimensions and fast evolution, can determine important functional and esthetic sequels. To avoid these unfortunate consequences it is necessary to establish the exact appropriate moment to begin the treatment and decide which the most adequate therapeutic procedure is. OBJECTIVE: Based on clinical data collected by a serial clinical observations correlated with imaging data, and processed by a computer-aided diagnosis system (CAD), the study intended to develop a treatment algorithm to accurately predict the best final results, from the esthetical and functional point of view, for a certain type of lesion. METHODS AND RESULTS: The preliminary database was composed of 75 patients divided into 4 groups according to the treatment management they received: medical therapy, sclerotherapy, surgical excision and no treatment. The serial clinical observation was performed each month and all the data was processed by using CAD. DISCUSSIONS: The project goal was to create a software that incorporated advanced methods to accurately measure the specific IH lesions, integrated medical information, statistical methods and computational methods to correlate this information with that obtained from the processing of images. Based on these correlations, a prediction mechanism of the evolution of hemangioma, which helped determine the best method of therapeutic intervention to minimize further complications, was established.

Proteus Syndrome: a difficult diagnosis and management plan.

RATIONALE: Proteus Syndrome (PS) is an extremely rare congenital pathology that causes overgrowth of multiple tissues, in particular bone and fat, following a mosaic pattern. The estimated incidence is of less than 1 per 1,000.000 live births and represents a significant challenge to the pediatric and orthopedic surgeons in order to establish a diagnosis and to elaborate a management plan. OBJECTIVES: We had the opportunity of treating many children who were afflicted by overgrowth syndromes and have been previously misdiagnosed as Proteus Syndrome in our department of pediatric and orthopedic surgery of "Maria Sklodowska Curie" Clinical Emergency Hospital for Children. This study helped us develop a diagnostic for these patients and report the first case of a confirmed PS in Romania. METHODS AND RESULTS: We report the case of a 5-year-old white male who is in the attention of the clinic since birth. He presented with multiple overgrowth bone segments, fatty subcutaneous or intraabdominal tumors and other connective tissues abnormalities. All the tests performed confirmed the diagnosis of PS at the age of 4 and the management is still to be decided. DISCUSSIONS: We followed the latest diagnostic indications and the patient fulfilled the general and specific criteria. The treatment is still in progress and it represents a challenge for the multidisciplinary medical team.

Herbert capsuloplasty and Burnei tenomyoplasty for the correction of genu flexum in cerebral palsy, arthrogryposis and posttraumatic.

INTRODUCTION: Studies of gait dynamics revealed the complex motions that the knee must undergo in sync with the hip and ankle, in both the swing and support phase of walking. If these motions are restricted, usually as a consequence of cerebral palsy or arthrogryposis, normal gait is hindered; the patient may be able to walk for very short distances or, eventually, not at all. Children with knee extension limited by 10 - 30 degrees,especially those with cerebral palsy, exhibit a stance compatible with walking. Walking is difficult and the gait pattern, "crouch gait", is considered typical for this degree of limitation. AIM: This paper is meant as an update regarding the usefulness of Herbert knee capsuloplasty, conceived in 1938 and introduced in Romania in 1956 by Clement Baciu, and Burneidistal medial hamstring tenomyoplasty, invented in 1993. MATERIALS AND METHODS: Herbert knee capsuloplasty, although initially intended for ailments other than spasticity or arthrogryposis,became known, in time, as a useful operation for spastic genu flexum with a 15 to 30 degree limitation of extension. Severing the posterior cruciate ligament (PCL) in children less than 10 years old often results in genu recurva tumor joint instability. In order to avoid these complications, PCL transection has been phased out and our clinic started to use, preferentially for spastic genu flexum rather than arthrogryposis,the Burnei tenomyoplasty. When applied in the same operative session, the two techniques complement each other and act in synergy. RESULTS: Herbert capsuloplasty can achieve only partial correction of genu flexum ranging between 30 and 60 degrees of extension deficit. Full extension is opposed by the PCL,contracture of the hamstrings and vascular retraction. Burnei tenomyoplasty used by itself is useful for genu flexum with less than 30 degrees of extension deficit. For children with 30 to 60 degrees of knee extension deficit, combining the Herbertand Burnei procedures achieves the best results. CONCLUSIONS: The simultaneous application of Herbert capsuloplasty and Burnei tenomyoplasty allows for the correction of stiff genu flexum and enables the patient to resume walking,with or without support. This course of treatment also avoids the progression of genu flexum beyond 60 degrees, which would require an osteotomy. This combined procedure avoids the cartilage lesions which may develop when patients with 30- 60 degree genu flexum undergo Herbert capsuloplasty alone.Not in the least, the risk of postoperative knee dislocation is significantly reduced.

Burnei's "double X" internal fixation technique for supracondylar humerus fractures in children: indications, technique, advantages and alternative interventions : Study and Research Group in Pediatric Orthopaedics-2012.

BACKGROUND: The Study and Research Group in Pediatric Orthopedics-2012 initated this retrospective study due to the fact that in Romania and in other countries, the numerous procedures do not ensure the physicians a definite point of view related to the therapeutic criteria in the treatment of supracondylar fractures. That is why the number of complications and their severity brought into notice these existent deficiencies. In order to correct some of these complications, cubitus varus or valgus, Prof. Al. Pesamosca communicated a paper called "Personal procedure in the treatment of posttraumatic cubitus varus" at the County Conference from Bacau, in June 24, 1978. This procedure has next been made popular by Prof. Gh. Burnei and his coworkers by operating patients with cubitus varus or valgus due to supracondylar humeral fractures and by presenting papers related to the subject at the national and international congresses. The latest paper regarding this problem has been presented at the 29th Annual Meeting of the European Pediatric Orthopedic Society in Zagreb, Croatia, April 7-10, 2010, being titled "Distal humeral Z-osteotomy for posttraumatic cubitus varus or valgus", having as authors Gh. Burnei, Ileana Georgescu, Stefan Gavriliu, Costel Vlad and Daniela Dan. As members of this group, based on the performed studies, we wish to make popular this type of osteosynthesis, which ensures a tight fixation, avoids complications and allows a rapid postoperative activity. INTRODUCTION: The acknowledged treatment for these types of fractures is the orthopedic one and it must be accomplished as soon as possible, in the first 6 hours, by reduction and cast immobilization or by closed or open reduction and fixation, using one of the several methods (Judet, Boehler, Kapandji, San Antonio, San Diego, Burnei's double X technique). The exposed treatment is indicated in irreducible supracondylar humeral fractures, in reducible, but unstable type, in polytraumatized patients with supracondylar fractures, in supracondylar fractures with vascular injury, in late presenting fractures, in case of loss of reduction under cast immobilization or in case of surgery with other types of fixation that is deteriorated. We have been using Burnei's osteosynthesis for about 10 years. AIM: This paper aims to present the operative technique, its results and advantages. MATERIALS AND METHODS: 56 cases were treated with Burnei's "double X" osteosynthesis in "Alexandru Pesamosca" Surgery Clinics, from 2001 to 2011. We used the Kocher approach and the aim of surgery was to obtain a fixation that does not require cast immobilization and that allows motion 24 hours after the surgery. The wires placed in "double X" must not occupy the olecranon fossa. The reduction must be anatomical and the olecranon fossa free. Flexion and extension of the elbow must be in normal range after surgery without crackles or limitations. This surgery was performed on patients with: Loss of reduction after 10 days with cast immobilization; Surgery with other types of fixation, deteriorated; Polytraumatized patients with supracondylar fracture; After neglected or late presenting fractures, without the orthopedic reduction made in emergency; Fractures with edema and blistering. RESULTS AND COMPLICATIONS: The patients' ages ranged 3 to12 years old, the mean age for girls was 7,3 years and 6,8 for boys. The hospitalization ranged 3 to 7 days, the average period being of 5 days. The wires had been pulled out after 21 days. The total recovery of the flexion and extension motion of the elbow was, depending on the age, between 21 and 40 days with an average period of 30 days. There were 5 cases of minor complications: in 3 cases the wires migrated outwards up to the 10th day and in 2 cases the wires were found in the olecranon fossa. The CT exam highlighted the impingement effect and the wire that passed through the olecranon fossa had to be removed between the 7th and the 9th day. No reported cases of cubitus varus or valgus were reported. CONCLUSION: The Burnei's "double X" osteosynthesis does not require cast immobilization. In oblique fractures, the stability is more difficult to obtain and by using other methods, elbow stiffness or ulnar nerve palsy may appear. The Burnei's "double X" osteosynthesis ensures stability of these types of fractures and avoids complications. This technique allows early motion after surgery and, in case of polytrauma, ensures comfort both to the patient and the physician, allowing repetitive examinations, preferential positions or the nursing of the extensive skin lesions.

The assessment of primitive or metastatic malignant pulmonary tumors in children.

BACKGROUND: The purpose of our study is to assess primitive and secondary malignant pulmonary tumors in children. The presence of lung tumors in newborns and infants is a point of interest to specialists in pediatric surgery, thoracic surgery and genetics due to the high death rate. The 5-years survival rate communicated by EUROCARE-study is less than 10% for primitive tumors and less than 15% in lung metastases. MATERIALS AND METHOD: We performed a retrospective study which analysed 11 children with pulmonary primary ormetastatic tumors admitted in the Pediatric Surgery Department "Prof. Dr. Al. Pesamosca" of the Emergency Clinical Hospital for Children "Maria Sklodowska Curie",Bucharest. The analysed and operated patients underwent surgery by Prof. Dr. Al. Pesamosca and the authors during the period of 1985-2011. In our series there where 4 primitive lung tumors and 7 secondary ones: 8 underwent surgery and 2 died before being operated on. The incidence of primitive pulmonary lung malignancies is higher for females, 3 to1, and secondary ones are more frequent in males, 6 to 1. RESULTS: Patients with primitive pulmonary malignancies were late diagnosed. Their age ranged between 1 to 6 years;3 were operated on, out of which 2 died, and 1 operated still survives. The 7 patients with secondary pulmonary malignancies were late diagnosed, too, probably as a consequence of a late diagnosis of the origin tumor. CONCLUSIONS: Even if all malignancies require an early diagnosis and treatment, this aim regarding malignant lung tumors is still a desideratum animating all practitioners. Primitive tumors are diagnosed presenting the main clinical manifestation abroncho pulmonary infection. Secondary lung malignancies are usually asymptomatic and are diagnosed when monitoring a patient for a malignancy with another origin. Chemotherapy,radiotherapy and surgery of malignant primitive tumors or metastatic ones in children remain unsatisfactory because of the late diagnosis and the limited methods of treatment. Nowadays genetics identified the responsible oncogenes for pulmonary blastic explosion and better results could be obtained by genetic surgery.

Laparoscopic surgery complications: postoperative peritonitis.

INTRODUCTION: Complications within laparoscopic surgery, similar to classic surgery are inevitable and require immediate actions both to diminish intraoperative risks and to choose the appropriate therapeutic attitude. Peritonitis and hemorrhagic incidents are both part of the complications aspect of laparoscopic surgery. Fortunately, the incidence is limited, thus excluding the rejection of celioscopic methods. Patient's risks and benefits are to be analyzed carefully prior recommending laparoscopic surgery. MATERIALS AND METHODS: This study presents a statistical analysis of peritonitis consecutive to laparoscopic surgery, experience of "Sf. Ioan" Emergency Hospital, Bucharest, and Department of Surgery (2000-2010). RESULTS: There were 180 (0,96%) complicated situations requiring reinterventions, from a total of 18676 laparoscopic procedures. 106 cases (0,56%) represented different grades of postoperative peritonitis. Most frequently, there were consecutive laparoscopic appendicectomia and colecistectomia. During the last decade, few severe cases of peritonitis followed laparoscopic bariatric surgical procedures. CONCLUSIONS: This study reflects the possibility of unfavorable evolution of postoperative peritonitis comparing with hemorrhagic incidents within laparoscopic surgery.

The electromagnetic bio-field: clinical experiments and interferences.

INTRODUCTION: One of the most important factors is the technical and scientifically rapid development that is continually modifying the world we live in and polluting it with electromagnetic radiations. A functional and structural influence of magnetic and electromagnetic field on living organisms is presented in the literature by many performed experiments. MATERIAL AND METHODS: The notion of bio-field represents the electromagnetic field generated by the bio-structures, not only in their normal physiological activities but also in their pathological states. There is a tight interdependency between the bio-field and the bio-structure, which respects the primary notion of an electromagnetic field given by the Maxwell-Faraday laws, in which, the electromagnetic phenomena are simplified to the field variations. These variations can be expressed in a coherent differential equation system that bounds the field vectors to different space points at different time moments. RESULTS: The living organisms cannot contain electrostatic and magneto-static fields due to the intense activity of the bio-structures. The biochemical reactions that have high rhythms and speeds always impose the electrodynamics character of the biologic field that also corresponds to the stability of the protein molecule that can be explained only through a dynamic way. The existent energy is not considered an exciting agent, and it does not lead to any effects. CONCLUSIONS: The parameters of these elementary bio-fields cannot yet be fully known due to technical reasons. The biological structures are very complex ones and undergo continuous dynamical activity. That is why the calculus model should be related to the constant dynamics, nowadays being very difficult to express.

[Laparoscopic training--the guarantee of a future in pediatric surgery]. / Trainingul laparoscopic--certitudinea unui viitor în chirurgia pediatrica.

Laparoscopy is considered today the highlight of modern surgery, the forerunner of the fascinating world of video and robotic surgery, both of them derived from the sophisticated areas of aeronautic industry. Remarkably, Romanian specialists keep up with the pace of worldwide technological developments, assimilating one by one each and every video endoscopic procedure. In the early 90s, the Romanian laparos-copic school was founded with the contribution of many important personalities; their activities and achievements have been an inspiration for the following generation of laparoscopic surgeons. In this last decade, the newest branch of laparoscopic surgery in our country, pediatric laparoscopy, managed to evolve from its "shy" beginnings to become an important method of improving the quality of surgical procedures, to the benefit of our "small patients". The purpose of this article is to encourage and promote minimally invasive video endoscopic surgery training, emphasizing its crucial role in the education and professional development of the next generation of pediatric surgeons, and not only. The modem concept of laparoscopic training includes experimental scientific practices, as well as the newest technical acquisitions such as virtual reality video-electronic simulation.

Study of the prognosis factors in liver cirrhosis.

In a prospective study carried out on a group of 1210 patients with liver cirrhosis (LC), the diagnosis was based on clinical, biological and histological criteria, as well as on the prognostic significance of 20 clinical, biochemical and histological parameters. The group, including 830 males (68.59%) and 380 females (31.41%), with an average age of 49.27 +/- 13.18 years, was studied during periods of 6 to 16 months, the initial investigations being periodically repeated. The statistical significance of the prognosis factors was studied by uni- and multivariative methods, according to the model of Cox, with the help of an IMB computer. The survival rate for the group studied ranged from 6 to 204 months, with an average period of survival of 38.29 months. The multivariative analysis demonstrated that the prognosis factor with a best correlation with the death power is ascites, which has additional predictive significance in association with encephalopathy and/or jaundice. The multivariative analysis selects as clinical factors of unfavourable prognosis the cholestasis, the hepatocytolytic syndrome, the syndrome of liver deficiency and the age over 50. The limits of the biochemical parameters with unfavourable significance were: bilirubinemia level greater than 3 mg%, ASAT/ALAT = 50.24/70.33 u.i., prothrombinemic index less than 50% and albuminemia greater than 3 g%. The multivariative method proved also superior in appreciating the interrelations of the prognostic factors, emphasizing the significance of the clinical parameters (ascites, encephalopathy, jaundice), while the multivariative analysis differentiated the biochemical prognosis factors (bilirubinemia, ASAT/ALAT, prothrombinemic index, albuminemia) and their level of significance.