Non-operative Management - The First Option in the Treatment of Blunt Liver and Spleen Trauma in Pediatric Patients.

AIM: The aim of the present study is to assess some characteristics of blunt hepatic and splenic injuries in children, the non-operative management (NOM) procedures and efficiency, over a 5-year period in a tertiary hospital for children. Materials and Methods: We conducted a retrospective study on 32 patients with blunt liver and/or spleen injuries. Age, gender, mechanism of injury, hemoglobin and hematocrit levels, lenght of stay and bedrest, imaging diagnosis, hemostatics and transfusions, treatment, and discharge status were evaluated. Results: 58% of patients were males. Mean age was 10.7 years. The main mechanism of injury was motor vehicle accident. Ultrasound (US) and Computed Tomography (CT) found 56.2% patients with spleen injury and 43.8% with liver injuries. On US the most frequent injuries were lacerations, and on CT were splenic-grade III and hepatic-grade II. 84.4% of patients were hospitalized in Intensive Care Unit and 15.6% in the surgical unit. The mean hemoglobin and hematocrit were 10.91g/l and 33%, respectively.The treatment was non-operative for 84.4%, and operative for 15.6%. When discharged, 56.2% of patients were cured and 43.8% were improved. CONCLUSION: With a performing multidisciplinary team of surgeons, intensive care therapists and radiologists, NOM in pediatric patients with blunt liver and spleen injuries is safe and effective, may be conducted depending on the hemodynamic stability rather than the lesions' extension, and reduces the ICU lenght of stay, as well as the need for hemostatics and transfusion.

Leonardo Gigli and the Gigli Saw-Gigli Redivivus.

Just like Raymond M. Peardon Donaghy and Gazi Yasargil changed modern neurosurgery by introducing the surgical microscope into the operating room, so did Leonardo Gigli by developing and using for the first time a tool that allowed faster, easier, and safer opening of the skull. The invention of the simple but brilliant Gigli saw represented a game changer for practitioners of neurosurgery worldwide. Gigli (1863-1908) was an Italian surgeon and obstetrician remembered among others for describing his operation-the lateralized version of Severin Pineau's pubiotomy for safe delivery in cases of maternal pelvic deformity-and for designing the Gigli saw, a simple yet brilliant wire saw, versatile enough to be used as both a tool of war and a surgical instrument in the fields of gynecology, orthopedics, surgery, and neurosurgery. The authors pay tribute to Gigli and his contribution at 125 years since the first written mention of his innovative instrument.

Dr. Lenke Horvath (1917-1991): Creator of Pediatric Neurosurgery in Romania.

The development of neurosurgery as an independent specialty took place with great difficulty in Romania. In this respect, the most revered personalities are those of Professor Alexandru Moruzzi (1900-1957) (in Iasi) and Professor Dimitrie Bagdasar (1893-1946) (in Bucharest), who are the fathers of modern neurosurgery in Romania. Professor Bagdasar was schooled in Professor Harvey Cushing's clinic in Boston and is credited with creating the first completely independent neurosurgical unit in Romania. His legacy was carried on with honor by Professor Constantin Arseni (1912-1994), who, in 1975, tasked Dr. Lenke Horvath (1917-1991) with creating the first autonomous pediatric neurosurgery unit in Bucharest. This article is a small tribute to the founder of pediatric neurosurgery in Romania and one of the female pioneer neurosurgeons, who, by personal example of dedication and hard work, radically changed medical thinking and neurosurgery in Romania.

Interference of apoptosis in the pathophysiology of subarachnoid hemorrhage.

Programmed cell death is crucial for the correct development of the organism and the clearance of harmful cells like tumor cells or autoreactive immune cells. Apoptosis is initiated by the activation of cell death receptors and in most cases it is associated with the activation of the cysteine proteases, which lead to apoptotic cell death. Cells shrink, chromatin clumps and forms a large, sharply demarcated, crescent-shaped or round mass; the nucleus condenses, apoptotic bodies are formed and eventually dead cells are engulfed by a neighboring cell or cleared by phagocytosis. The authors have summarized the most important data concerning apoptosis in subarachnoid hemorrhage that have been issued in the medical literature in the last 20 years.

Sofia Ionescu, the first woman neurosurgeon in the world.

The authors present the activity of Mrs. Sofia Ionescu, the one female surgeon who was nominated as the first woman neurosurgeon in the world. Sofia Ionescu worked in the field of neurosurgery for 47 years, performing all the known neurosurgical procedures of the time. She made herself known through her incredible surgical skill and her enormous work power. Due to her incredible modesty and workload, she never participated at international congresses or manifestations. The nomination as first woman neurosurgery took place in Marrakech, Morocco, during the 2005 WFNS Congress. Although some claim that Diana Beck was the first woman neurosurgeon in the world, our theory suggests otherwise. The first documented surgical intervention performed by Diana Beck dates to 1952. Sofia Ionescu operated for the first time on a human brain as early as 1944. Furthermore, Diana Beck's actions surfaced in the year 1947, long after the war had ended and Sofia Ionescu had become a neurosurgeon.