Upper Limb Compartment Syndrome-An Extremely Rare Life-Threatening Complication of Cutaneous Anthrax.

(1) Background: Cutaneous anthrax is a disease caused by a Gram-positive bacillus, spore-forming Bacillus anthracis (BA). Cutaneous anthrax accounts for 95% of all anthrax cases, with mortality between 10-40% in untreated forms. The most feared complication, which can be life-threatening and is rarely encountered and described in the literature, is compartment syndrome. (2) Methods: We report a series of six cases of cutaneous anthrax from the same endemic area. In two of the cases, the disease was complicated by compartment syndrome. The systematic review was conducted according to systematic review guidelines, and the PubMed, Google Scholar, and Web of Science databases were searched for publications from 1 January 2008 to 31 December 2023. The keywords used were: "cutaneous anthrax" and "compartment syndrome by cutaneous anthrax". (3) Results: For compartment syndrome, emergency surgical intervention for decompression was required, along with another three surgeries, with hospitalization between 21 and 23 days. In the systematic review, among the 37 articles, 29 did not contain cases focusing on compartment syndrome of the thoracic limb in cutaneous anthrax. The results were included in a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram. (4) Conclusions: Early recognition of the characteristic cutaneous lesions and compartment syndrome with early initiation of antibiotics and urgent surgical treatment is the lifesaving solution.

Severe Acute Pancreatitis Treated with Negative Pressure Wound Therapy System: Influence of Laboratory Markers.

(1) Background: An open abdomen is a serious medical condition that requires prompt and effective treatment to prevent complications and improve patient outcomes. Negative pressure therapy (NPT) has emerged as a viable therapeutic option for temporary closure of the abdomen, offering several benefits over traditional methods. (2) Methods: We included 15 patients with pancreatitis who were hospitalized in the I-II Surgery Clinic of the Emergency County Hospital "St. Spiridon" from Iasi, Romania, between 2011-2018 and received NPT. (3) Results: Preoperatively, the mean IAP level was 28.62 mmHg, decreasing significantly postoperatively to 21.31 mmHg. The mean level of the highest IAP value recorded in pancreatitis patients treated with VAC did not differ significantly by lethality (30.31 vs. 28.50; p = 0.810). In vacuum-treated pancreatitis patients with a IAP level > 12, the probability of survival dropped below 50% during the first 7 days of stay in the ICU, so that after 20 days the probability of survival was approximately 20%. IAP enters the determinism of surgery with a sensitivity of 92.3% and a specificity of 99%, the cut-off value of IAP being 15 mmHg. (4) Conclusions: The timing of surgical decompression in abdominal compartment syndrome is very important. Consequently, it is vital to identify a parameter, easy to measure, within the reach of any clinician, so that the indication for surgical intervention can be made judiciously and without delay.

Clostridium difficile Infections in an Emergency Surgical Unit from North-East Romania.

Background and Objectives: Colitis with Clostridium difficile is an important health problem that occurs with an intensity that varies between mild and severe. Surgical interventions are required only in fulminant forms. There is little evidence regarding the best surgical intervention in these cases. Materials and Methods: Patients with C. difficile infection were identified from the two surgery clinics from the 'Saint Spiridon' Emergency Hospital Iași, Romania. Data regarding the presentation, indication for surgery, antibiotic therapy, type of toxins, and post-operative outcomes were collected over a 3-year period. Results: From a total of 12,432 patients admitted for emergency or elective surgery, 140 (1.12%) were diagnosed with C. difficile infection. The mortality rate was 14% (20 cases). Non-survivors had higher rates of lower-limb amputations, bowel resections, hepatectomy, and splenectomy. Additional surgery was necessary in 2.8% of cases because of the complications of C. difficile colitis. In three cases, terminal colostomy was performed and as well as one case with subtotal colectomy with ileostomy. All patients who required the second surgery died within the 30-day mortality period. Conclusions: In our prospective study, the incidence was increased both in cases of patients with interventions on the colon and in those requiring limb amputations. Surgical interventions are rarely required in patients with C. difficile colitis.

The Usefulness of Nanotechnology in Improving the Prognosis of Lung Cancer.

Lung cancer remains a major public health problem both in terms of incidence and specific mortality despite recent developments in terms of prevention, such as smoking reduction policies and clinical management advances. Better lung cancer prognosis could be achieved by early and accurate diagnosis and improved therapeutic interventions. Nanotechnology is a dynamic and fast-developing field; various medical applications have been developed and deployed, and more exist as proofs of concepts or experimental models. We aim to summarize current knowledge relevant to the use of nanotechnology in lung cancer management. Starting from the chemical structure-based classification of nanoparticles, we identify and review various practical implementations roughly organized as diagnostic or therapeutic in scope, ranging from innovative contrast agents to targeted drug carriers. Available data are presented starting with standards of practice and moving to highly experimental methods and proofs of concept; particularities, advantages, limits and future directions are explored, focusing on the potential impact on lung cancer clinical prognosis.

Rare Benign Tumors and Tumor-like Lesions of the Hand without Skin Damage-Clinical, Imagistic and Histopathological Diagnosis, Retrospective Study.

BACKGROUND: The broad spectrum of diagnoses and clinical features of hand tumors and the absence of pathognomonic signs often lead to an inaccurate or delayed diagnosis. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study intends to highlight the clinical, imaging and histological characteristics of uncommon hand tumors or tumor-like lesions. METHODS: In this retrospective study, we report a series of 80 patients diagnosed with rare hand tumors and tumor-like lesions without skin damage. Age, gender, tumor location, imaging examinations and clinical and laboratory findings were analyzed. The histopathological exam established the final diagnosis. Surgery was indicated and performed in all cases. RESULTS: This study included: neurofibroma, glomus tumor, lipoma, schwannoma, epidermal inclusion cyst and idiopathic tenosynovitis with "rice bodies." We have described the clinical, imagistic and histopathological particularities of these tumors. Surgical management included the complete removal of tumors, with no recurrence recorded within two years and overall high patient satisfaction. The most common findings were lipomas and the rarest neurofibromas. CONCLUSIONS: To optimize the care of hand tumors and reduce diagnostic and treatment errors, knowledge of hand tumor types and their clinical and laboratory characteristics is necessary for every surgeon.

Floating-dislocated elbow in adults: Case reports and literature review.

RATIONALE: Floating-dislocated elbow is a severe and extremely rare injury in adults. Reviewing the literature, we found around 6 case reports regarding floating-dislocated elbow in adults. PATIENT CONCERNS AND DIAGNOSES: We report 2 cases of this unusual injury association. Both patients suffered a high energy trauma - fall from a height. Initial X-rays (radiography) revealed in both cases the fractures above and below the elbow (floating elbow) and associated elbow dislocation (floating-dislocated elbow). One case was a type IIIB Gustilo-Anderson open fracture-dislocation with an intra-articular component (olecranon fracture). INTERVENTIONS AND OUTCOMES: Each case had his own management problem regarding what to treat first: the dislocation or the associated fractures? Fractures were treated surgically by reduction and internal fixation, and after elbow dislocation reduction, the upper limb was immobilized in a long, well-padded plaster, with the elbow in 90° of flexion, for 3 weeks. Bone union was observed radiographically at 2 months after surgery in both cases. At the 2-year follow-up we recorded full upper limb recovery in terms of muscular trophism and elbow full range of motion. LESSONS: In addition to adding 2 new cases to a lower number of such lesion associations in adults, we also added a new variant of floating-dislocated elbow which has not been reported until now in the literature. Prompt management of these injuries, with stable fixation of the fractures allowed for early rehabilitation with excellent 2-years functional outcome.

Atypical Sites of the Lipoma on the Hand and Fingers: Clinical and Imaging Features and Surgical Outcomes.

BACKGROUND: Lipomas are the most frequent benign soft tissue tumor that are rarely found in the hand and are exceptionally rare on the fingers. The aim of this study was to investigate lipomas of atypical locations, so that they can be taken into account when making a differential diagnosis of a tumor of the hand or fingers. METHODS: We studied a group of 27 patients diagnosed with lipoma of the wrist, palm, and fingers. The diagnosis was made by clinical and imaging examinations. Surgical treatment was established based on symptoms of pain, paresthesias, functional impairment, or aesthetic concerns. Treatment outcomes were assessed clinically at 1.5 years post-intervention. RESULTS: Sizes over 5 cm were recorded in five cases, with the largest lipoma being 8 by 5 by 3.5 cm in size and weighing 125 g, located in the palm. There was one case of spontaneous tendon rupture and one case of carpal tunnel syndrome. There was no recurrence recorded at 1.5-year follow-up. CONCLUSIONS: Lipomas in the palm and fingers are rare entities (with more men affected), and surgical treatment consists of complete removal of the tumor and providing definitive healing. Despite their rarity, clinicians should consider lipomas when making differential diagnoses of soft tissue tumors of the hand.

Schwannoma of the Upper Limb: Retrospective Study of a Rare Tumor with Uncommon Locations.

BACKGROUND: Although schwannoma (neurilemmoma) is the most common tumor of the peripheral nerve, its low incidence, slow growth and vague symptoms often lead to misdiagnosis or delayed diagnosis. The aim of the study is to present a series with a large number of schwannomas in the upper limbs, some with very rare occurrence. METHODS: We report 17 patients with a mean age of 58.5 years and upper limb schwannomas, located on the median, ulnar and radial nerves, but also on the posterior interosseous nerve and digital collateral nerves. The diagnosis was made by clinical examination and imaging tests, and in no case was a preoperative biopsy performed. Surgical treatment was established based on symptoms or aesthetic concerns. In all cases, a diagnosis of schwannoma was confirmed through histopathological and immunohistochemical examinations. RESULTS: For all patients, a complete tumor enucleation was performed under a surgical microscope. No recurrence was recorded at 2 years after surgery. Patient satisfaction was good, with complete socio-professional integration in all cases. CONCLUSIONS: Although more frequently present on the main nerve trunks, schwannoma may be present on the collateral digital nerves in rare cases. A correct technique with complete tumor excision offers excellent postoperative outcomes and avoids recurrences.

Connections between Orthopedic Conditions and Oxidative Stress: Current Perspective and the Possible Relevance of Other Factors, Such as Metabolic Implications, Antibiotic Resistance, and COVID-19.

The general opinion in the literature is that these topics remain clearly understudied and underrated, with many unknown aspects and with controversial results in the respective areas of research. Based on the previous experience of our groups regarding such matters investigated separately, here we attempt a short overview upon their links. Thus, we summarize here the current state of knowledge regarding the connections between oxidative stress and: (a) orthopedic conditions; (b) COVID-19. We also present the reciprocal interferences among them. Oxidative stress is, of course, an interesting and continuously growing area, but what exactly is the impact of COVID-19 in orthopedic patients? In the current paper we also approached some theories on how oxidative stress, metabolism involvement, and even antibiotic resistance might be influenced by either orthopedic conditions or COVID-19. These manifestations could be relevant and of great interest in the context of this current global health threat; therefore, we summarize the current knowledge and/or the lack of sufficient evidence to support the interactions between these conditions.

Clinical, histopathological and immunohistochemical features of glomus tumor of the nail bed.

PURPOSE: Glomus tumors account for 1-4% of benign hand tumors. In 65% of cases, it is located in the nail bed. Its rarity makes misdiagnosis problems relatively common. Symptomatology is characterized by the hallmark symptomatic triad. Imaging investigations may guide the diagnosis, but the diagnosis is made by pathological examination doubled by immunohistochemical (IHC) markers. PATIENTS, MATERIALS AND METHODS: We studied a group of seven female patients, aged 28 to 56 years. Clinical examination revealed the presence of the characteristic symptomatic triad. Ultrasound imaging tests were performed. RESULTS: Anatomopathological examination made a diagnosis of glomus tumor in all seven cases. IHC staining showed that tumor cells were positive for alpha-smooth muscle actin (α-SMA) and h-caldesmon in all seven cases and negative for cluster of differentiation 34 (CD34) in 72.14%. IHC stainings for p63, S100, cytokeratin (CK) AE1∕AE3 were negative in all cases. The clinical diagnosis completed by ultrasonography was histopathologically confirmed in all cases. CONCLUSIONS: Although the glomus tumor is a rare lesion, we need to be familiar with it because a diagnostic delay also implies a treatment delay which will lead to amplified suffering and even real disability due to the high-intensity pain in these cases.

Idiopathic tenosynovitis with rice bodies.

PURPOSE: Idiopathic tenosynovitis with rice bodies is a rare disease and its non-association with rheumatic diseases, tuberculosis infection or trauma is reported only in few cases in literature. PATIENTS, MATERIALS AND METHODS: Our study presents a series of five patients diagnosed with tenosynovitis with rice bodies at the flexor tendons of the upper limb. Medical history revealed no associated disease or trauma. Disease duration ranged between two months and four years, two patients presenting symptoms of acute carpal tunnel and three patients tumor mass. In one case, the tumor measured 210 mm in length and a tendon rupture was suspected. Laboratory and imaging investigations could not establish a specific associated pathology and a preoperative diagnosis. Surgical treatment consisting of synovectomy was performed in all patients. RESULTS: In all five cases, intraoperative appearance could easily determine the presence of rice bodies. Histopathological examination revealed typical aspect for rice bodies and make the diagnosis possible without the need for other more laborious processing (immunohistochemistry). The amount of rice bodies was directly proportional to disease duration. In all cases, the recovery was complete. After a median 30.4-month follow-up, no recurrence was detected. Subsequently performed laboratory investigations and specific tests did not reveal tuberculosis infection, rheumatic disease, or other diseases. CONCLUSIONS: This is the largest series of patients with idiopathic tenosynovitis with rice bodies and the bigger tumor mass reported to date. Synovectomy with removal of all rice bodies represents the optimal treatment. A longer disease course may be associated with a larger number of rice bodies, which may be associated with tendon rupture. The etiopathogenesis remains unclear, further studies being necessary to establish it.