The Immune Response of Cutaneous Basosquamous- and Squamous-Cell Carcinoma Associated with Sun Exposure.

In recent years, there has been an observed increase in the frequency of cutaneous carcinoma, which correlates with sun exposure. This study aims to explore the variances of tumor characteristics and immune response markers among patients diagnosed with cutaneous squamous-cell carcinoma (SCC) and basosquamous-cell carcinoma (BSC) with varying levels of sun exposure. The objective is to elucidate the potential influence of sun exposure on tumor progression and immune response in these types of carcinomas. We conducted a retrospective observational study that included 132 patients diagnosed with SCC and BSC. Participants were separated into high- and low-sun exposure groups. Tumor characteristics and immune response markers, including lymphocyte percentage (LY%), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR), were assessed using the Mann-Whitney U test. Our findings revealed the interplay between sun exposure, inflammation, aging, and immune response. In 80% of cases, it was found that individuals had high sun exposure throughout their lifetime. Patients in the high sun exposure category had a significantly higher LY% than those with low sun exposure (24.22 ± 7.64 vs. 20.71 ± 8.10, p = 0.041). Also, the NLR was lower in patients with high sun exposure (3.08 ± 1.47 vs. 3.94 ± 2.43, p = 0.023). Regarding inflammatory markers, the erythrocyte sedimentation rate (ESR), LY%, NLR, and LMR showed significant differences between the two groups. Patients who were diagnosed with SCC had higher ESR values (p = 0.041), higher LY% (p = 0.037), higher NLR (p = 0.041), and lower LMR (p = 0.025). This study provides evidence supporting distinct tumor characteristics and immune response patterns in patients diagnosed with SCC and BSC with a high sun exposure history. These findings imply that sun exposure may contribute to tumor progression and influence the immune response in individuals with SCC and BSC.

Thermographic camera in traumatology, diabetic foot and reconstructive procedures.

Traumatic lacerations, burns and ulcerations are a common cause of admission in the plastic surgery wards. Clinical evaluation alone sometimes provides insufficient or even inaccurate information. Thermographic camera is a new tool that could provide additional information regarding skin vascularization, presence of inflammation or involvement of deep tissue. A prospective study was realized for assessing pre and postoperative status of patients with lacerations, trauma, burn and diabetic foot. Preoperative evaluation helped in assessing bone involvement, inflammation and infection in order to decide the necessity of surgery. Postoperative evaluation was useful in preventing and lowering the rate of complications. Thermographic camera could be a new helpful and non-invasive tool especially in emergency hospitals in order to assess rapidly and objectively wound status and to start if necessary, a surgical treatment.

Cutaneous melanoma arising on pre-existing nevi - case reports.

Skin cancer is a common healthcare issue that affects millions of people worldwide. Only a small part of that population is suffering from melanoma and an even smaller proportion has melanoma developed on a pre-existing nevus. This paper illustrates five such cases, diagnosed over an 18-month period, with their histological particular aspects. Among the total number of patients diagnosed and treated in the Department of Plastic and Reconstructive Surgery, University Emergency Hospital, Bucharest, Romania, over approximately one year, of which half for melanoma in general or for benign nevi, only a small fraction had developed melanoma on a common or dysplastic nevus. These patients, as well as those with de novo developed melanoma, are a reason for concern since most of the lesions were diagnosed in a locally advanced stage of the disease. Though efforts are being made to screen and diagnose early, there are still a lot to be done in order to lower the mortality and morbidity rates for this pathology.

The curious case of a forehead metatypical basal cell carcinoma.

The risk of developing basal cell carcinoma (BCC) during lifetime varies between 29-55%, while for squamous cell carcinoma (SCC) varies between 7-11%. Between them, considered to be a BCC, there is a particular histological type, named metatypical basal cell carcinoma (MTC) or basosquamous cell carcinoma (BSCC). In this paper, we presented a rare case of metatypical carcinoma of the forehead with an interesting history of unexpected recurrences, underlining the clinical, therapeutic and histological essential aspects that may come in use to other clinicians in managing this type of cancer. In this case, the last recurrent tumor invaded the external layer of the frontal bone and needed a temporo-parietal flap to cover the large defect, which was previously covered in 2014 using skin grafts. Using Hematoxylin-Eosin (HE) staining, the histological assessment revealed a basosquamous carcinoma (IDO-O 8094/3, according to World Health Organization). In addition to the histological aspects revealed using HE staining, in this case, diffused tumor cells were p63 nuclear positive, which according to Bircan et al. (2006), it is strongly and diffuse reactive in 82.1% differentiated, in 77.8% of superficial and in 72.3% of solid undifferentiated BCCs. The aggressive behavior was revealed by tumor's dimension, local invasion of the frontal bone with high mitotic rate as seen in the van Gieson and HE staining, also by the number of recurrences. The prognosis of this case is reserved due to the number of recurrent tumors, immunohistochemistry anomalies, involvement of the external layer of the frontal bone, tumor site, gender, poor remaining reconstructive procedures in case of a relapse, thus, close follow-up is to be recommended for a period of minimum five years. Recurrent tumors raise treatment difficulties regarding the reconstruction procedure of the defect after wide surgical excision. Therefore, the aggressive behavior of the MTC should be taken into consideration in clinical practice.

Immediate Versus Delayed Breast Reconstruction for Postmastectomy Patients. Controversies and Solutions.

When considering breast reconstruction, two main decisions have to be made: optimal timing and appropriate reconstruction technique,that would best suit each patient, while also taking into consideration the complications and risks that these decisions might lead to. By careful patient selection and individualized breast reconstruction approach, the risks and complications of the procedure can be minimized, while attaining successful aesthetic outcomes and high patient satisfaction. Breast reconstruction can be performed in three different settings: immediate reconstruction - at the time of mastectomy; delayed reconstruction " after the completion of the adjuvant treatment and in a delayed-immediate setting that uses both previous methods" includes tissue expansion at the time of mastectomy and definitive reconstruction performed after completion of the adjuvant treatment. The strategies perfected for decades in breast reconstructive surgery have now made breast reconstruction more possible than ever, thus offering patients the chance to recover after a mastectomy procedure with a new reconstructed breast. Although, the choice of breast reconstruction is not adressed by all breast cancer patients, rates are gradually expanding while new and improved techniques are rapidly developing.

A case of a generalized symptomatic calcinosis in systemic sclerosis.

Calcinosis consists of abnormal calcium deposition in soft tissues, which appears often in patients with limited systemic sclerosis, being one of the criteria of CREST (calcinosis cutis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. With a long evolution, the aim of the treatment is to control the symptoms and prevent complications. In this article, we present the challenging management of a profuse lesion of calcinosis in a patient with systemic sclerosis. We describe the case of a 52-year-old woman with systemic sclerosis and CREST syndrome who was admitted in our Department with multiple painful and disabling tumoral masses, situated in nearly all joints. The interscapular vertebral tumoral mass was excised and the defect was closed. Histopathological examination revealed cutaneous calcinosis, probably associated with CREST syndrome, a type of scleroderma. Postoperative results were favorable and no local complications were encountered. Six months follow-up revealed no evidence of recurrence. Despite the size and the invasion of the tumor in the muscle, complete resection was possible with an adequate reconstruction; the postoperative result being acceptable. With a lower response to medication, surgical treatment is considered the only option for treating symptomatic lesions of calcinosis in order to improve quality of life.

Experimental study regarding the biocompatibility test of the Prolene (polypropylene abdominal mesh) product.

The polypropylene mesh, although is one of the most used prosthetic biomaterials for abdominal wall defects, proved not to be completely inert, generating from precocious foreign body inflammatory reactions (varying by individual reactivity, the amount of used material and its structure), to late complications such as chronic infections, stercoral fistulae or mesh migration. The present paper was aimed at studying the behavior of implants of this material in three different areas of the body of experimental animals, as follows: intramuscular, intraperitoneal and extraperitoneal. The observation time was 21 days and 90 days. We observed foreign body reactions induced locally by the mesh that remains temporary, generating a moderate number of macrophages and foreign body giant cells. The material did not systemically affect the healing and the scaring of the surgical wounds, but in all three implant areas, the polypropylene mesh generated locally a fibrous proliferation reaction of neoformation tissue, which wrapped and secured the implanted product on all surfaces.

Histological differences between laser-assisted and suction-assisted lipoplasty aspirates - a comparative study.

INTRODUCTION: The authors aimed to assess the histological differences between the traditional suction-assisted lipoplasty (SAL) and the more recently developed laser-assisted lipoplasty (LAL) aspirates, in a 20-case comparative study. PATIENTS AND METHODS: Between March of 2011 and March of 2012, we operated on 20 healthy female patients seeking body contouring procedures of the abdomen, flanks and outer thighs, all having good to moderate skin tone and moderate to heavy adipose deposits and no previous treatment of the interested areas. After initial aspiration of a 100 mL sample of fat tissue through the SAL technique, we applied the LAL protocol, using a Lipolite device with a 1064 nm Nd:YAG laser, again sampling the aspirate for histological study. RESULTS: The analyzed samples revealed significant histological difference between the two aspirates: the adipose tissue architecture, after conducting the LAL procedure, appeared to be disrupted, consisting of deformed and ruptured fat cells surrounded by coagulation-modified collagen, small lymphocytic inflammatory infiltrate, coagulated small blood vessel and intact nerves. In contrast, the cytological patterns of the adipose tissue after using the SAL technique resembled normal fat tissue structure. CONCLUSIONS: Our study succeeded in demonstrating significant histological differences between SAL and LAL aspirates, many of which could explain certain disparities between the clinical outcomes of the two procedures.

Anatomopathological findings in scars: comparative study between different specimens.

In spite of the remarkable progress science and medicine have experienced, many facts concerning healing processes and pathological scars are still unknown or incompletely explained. This paper is part of a larger study (research for a PhD thesis) concerning new approaches in the prevention and treatment of pathological post-burn scars. We present and analyze the cases of some patients who developed abnormal scars in order to understand and point out the characteristics, that different types of pathological scars have in common and how we can differentiate them. Knowing what issue to address is the key to any successful therapy. Thus, the information we obtained will help us in applying more appropriate and efficient methods of treatment and in our further research: comparing the efficiency of newer therapies to that of older ones.

BReast Ecology Assessment in the STudy of local MicroFlora - Study Protocol.

INTRODUCTION: Recent articles have described an endogenous breast flora, particularly in the nipple ducts, with potential implications in the outcome of aesthetic breast surgery. To characterize the ecology of the breast, we designed a study to assess the microbial species identified on the breast skin and parenchyma in patients undergoing breast surgical interventions. METHODS: AFTER OBTAINING INFORMED CONSENT AND BACKGROUND DATA ON CONCURRENT DISEASES, PREVIOUS CONTACT WITH THE HOSPITAL SYSTEM AND PRIOR USE OF ANTIBIOTICS, SAMPLES ARE COLLECTED PREOPERATIVELY FROM THREE AREAS OF THE BREAST SKIN, BILATERALLY: the inframammary fold, the areola and the axilla, prior to decontamination. These samples will serve as positive controls and will aid in characterizing the normal breast skin flora. After preoperative decontamination, samples are again collected, to check for any residual bacterial flora and the nipple is sealed with Tegaderm (3M, USA) and betadine ointment, to reduce any putative bacterial load. Intraoperatively, samples are collected from: a) the incision line (dermal level): 1. superficially, 2. medium depth in the breast parenchyma, 3. deep parenchyma, and b) axillary parenchyma (where possible), together with a bioptic fragment. Postoperatively, a second nipple sample is collected. For secondary breast augmentation surgeries, capsular biopsy is also performed (where relevant), and the implants undergo sonication, to allow biofilm identification. In the laboratory, all samples are cultured on blood agar incubated with CO2, cystine lactose electrolyte deficient medium and Sabouraud gentamicin-chloramphenicol agar. For positive culture samples, the number of colonies and their morphologic characteristics are reported. Identification will be carried out with MALDI-TOF and VITEK (bioMérieux, France), yielding automated antibiotic sensitivity profiles. For all germs with sensitivity profiles differing from the wild-type strain, E-tests will be performed. Follow-up information on the postoperative evolution will be collected and analyzed for potential factors predictive of good evolution. DISCUSSION: This study will provide important information about the microflora of the breast skin, its sensitivity profile, and the degree of contamination of the nipple ducts and parenchyma, if any, addressing a scientific hypothesis insufficiently explored so far.

Overview about the keloid scars and the elaboration of a non-invasive, unconventional treatment.

Although the healing means 2 types of biological mechanisms that seem to be "pathologic", the swell and the granulations are a normal process in the biology of the human being, representing two systemic functions: the adaptation and the morphogenesis. There is a pathological healing in which the fundamental healing phenomenon is deviated from the normal. There are three variable parameters responsible for the pathological evolution of a scar: the cellular population, the fundamental matrix and the fibers. The healing evolution can be deviated to an intense maturation with an "old", atrophic scar, or to an incomplete maturation and the result is a hypertrophic or a keloid scar. For the hypertrophic scars, the excision and the skin graft lead to good results and the relapses are rare; the keloid relapse is always at the border between the graft and the wound edge, or between the two skin grafts. These are the considerations for which the treatments are mixed, combined (surgical, drugs, physiotherapy) both in our country and abroad, but the results are still frustrating. That is why new, modern methods of treatment are used today: criotherapy, laser, ultrasounds. However, even those treatments are not very successful: tissue expander, external press therapy, corticosteroids injections, other pharmacological agents (retinoic acid, colchicines, antineoplasics). We propose a regenerative, alternative, non-invasive treatment starting from the results we obtained in a research work 4 years ago, when we irradiated the fibroblasts in an electromagnetic high frequency millimeter waves field, and we obtained the fibroblasts apoptosis and the reorganization of the collagen fibers by changing the piezoelectric emission.

Pressure sores--a constant problem for plegic patients and a permanent challenge for plastic surgery.

Pressure sores can be defined as lesions caused by unrelieved pressure resulting in damage of the underlying tissue. They represent a common problem in the pathology of plegic patients and, plastic surgery has a significant role in their treatment. Pressure sores occur over bony prominences and so, they are most commonly seen at the sacrum and trochanters in paralyzed patients and at ischium for the patients who sit in a wheelchair for a long time. For these patients, surgical treatment is very important because on one hand, it stops the loss of nutrients and proteins at the site of the pressure sore, and on the other hand, it permits the initiation of neuromuscular recuperation treatment much faster.

Forequarter amputation (upper limb and shoulder girdle) in a synovial sarcoma case--case report.

We are often confronted with severe cases - patients with very aggressive tumours that suppose a complex and in the same time radical approach--in our medical practice. The correct approach and management of such cases ensure both the surgical success and the patient survival. In this paper, we present the case of a young woman, who has been admitted in our clinic with a giant, irradiated tumour involving left axilla, shoulder and scapula. Due to the vast size of the tumour and to the fact that surgical biopsy revealed a poorly differentiated sarcoma; other clinics considered that the case above belongs to surgical therapy. After the clinical examination, blood tests and diagnostic imaging, which allowed the correct evaluation of the case--tumour sizes and neighbouring tissue reports--we decided to perform tumour radical excision, respectively forequarter amputation, when the patient presented a satisfactory metabolic status. The presented case supports the idea that radical excision which might involve even mutilating amputations for extensive cancers can give patients a chance, even in desperate cases.