[Laparoscopic sleeve gastrectomy: the initial experience of the First Surgical Clinic Tg-Mures. Early and late (after 5-10 month follow-up) results]. / Gastrectomia longitudinala laparoscopica--experienta initiala a Clinicii Chirurgie I Tg-Mures. Rezultate precoce si tardive (follow-up între 5-10 luni).

AIM: This paper aims to present the initial experience of the I-st Surgery Clinic Târgu Mures in laparoscopic sleeve gastrectomy, stressing the technical aspects of surgery and postoperative immediate and late results. METHOD: Started in 2008, I Surgery Clinic's experience includes 11 cases of laparoscopic sleeve gastrectomy, pursued between 5 and 10 months postsurgery.The group is structured as follows: 80% female, aged between 13 and 55 years, average BMI 46, with limits between 35 and 72. Surgical technique was unitary, 10 of 11 cases beeing performed by the same team. RESULTS: Surgergical results were excellent: 0 conversions, 0 bleeding, 0 fistulas, 0 missfire. Average hospitalisation was of 48 hours postsurgery. EWL overall 68%, with limits between 50%, in 2 cases (initial BMI 70) and 100%--1 case (initial BMI 35). Life threatening morbidity--0.0 mortality, average BAROS score 6.7. CONCLUSION: GLL is a well standardized, secure, efficient, applicable with good results in all categories of patients with morbid obesity.

[The importance of the I-colic time in colorectal cancer with synchronous hepatic metastases. Specifics of surgical strategy]. / Importanta timpului I-colic în cancerul colo-rectal cu metastaze hepatice sincrone. Particularitati de tactica chirurgicala.

AIM: This paper proposes the presentation of a decision-making algorithm in colorectal cancer with synchronous hepatic metastases, as stressing the importance of I-colic time in obtaining the R0 desideratum. MATERIAL AND METHOD: There is no worldwide consensus regarding the surgical attitude in metastatic colorectal cancer. There are some predominantly conservative attitudes which use stenting and neoadjuvant chemotherapy followed by periodical re-evaluation or more aggressive surgical treatment. In the pertinent literature, emphasis is on surgery in two stages, on the separation of the colic stage from the hepatic one, the majority proposing stage one cholic and stage two hepatic, thus there are also situations in which the liver may be dealt with from the first intention. RESULTS: We propose to present, taking the examples from clinical cases, the main techniques of dealing with the cases of metastatic colorectal cancer, stressing personal attitude: aggressive surgery in a short step, which is either radical or creates the conditions for a step II radical one. CONCLUSION: In our vision the liver is the key to the surgical treatment in metastatic colorectal cancer and we must take into account from the first step through interventions with radical intent any time it is possible or through other operations: ligature of portal branch, partial hepatectomies, unilateral local destruction, preparing the way to radical step II.

[Vascular exclusion of the liver: surgical technique and initial clinical experience]. / Excluzia vasculara a ficatului (EVF): tehnica chirurgicala si experienta clinica initiala.

The intraoperative hemorrhage is the most life threatening complication during a liver resection, reason why the intraoperative vascular control represents one of the key points in the liver resection. This work presents the liver vascular exclusion without caval occlusion technique and also studies the first cases operated in University Surgery Clinic Nr. 1, Targu Mures, Romania. LVE consists of an association between hilum occlusion by Pringle manoeuvre and selective clampage of the three hepatic veins. Once achieved, the technique allows resection without blood lose and no special cautions, a continue clampage of 60-90 minutes being useful for the reconstruction of the possibly harmed or resected structures during the hepatectomy. The indications of the technique are voluminous center located liver tumors, multiple liver tumors, tumors in contact with hepatic veins or with hilum bifurcation. University Surgery Clinic Nr. 1 Targu Mures's experience in this technique began in 2005 consists in 8 cases. Preoperative diagnosis were: 2 right liver voluminous benign tumors (hemangiomas), 5 cases of colo-rectal metastasis and one resection for metastases of gastro-intestinal stromal tumor. Postsurgery evolution was very good with an average hospitalisation of 6 days. Mortality rate and morbidity were zero. We strongly recommend the use of LVE technique for selected cases of difficult liver resection, LVE being one of the most advanced techniques of liver resection.

[Management of craniofacial fractures with titanium mini-plate osteosynthesis and primary bone transplantation]. / Craniofacialis törések ellátása titán minilemezes osteosynthesissel és primer csonttranszplantációval.

The frontobasal traumatic lesions are often combined with several type of midface fractures therefore the authors adopted the craniofacial injury definition. In the years 1995-1997, 534 patients with head trauma were operated on by maxillofacial surgeon and neurosurgeon of which 35 (6.5%) cases showed concomitant combined frontonaso-orbital-skull base involvement. In the complex management of the severe craniofacial lesions the cooperative team-work of maxillofacial surgeon, neurosurgeon, otolaryngologist and ophthalmologist is required. Stabilized midface and the "watertight" dura closure or plasty are basically important conditions for the ceasing of cerebrospinal fluid leak. In the instance of optic nerve lesion the exploration and decompression within the eight hours is mandatory by transcranial-subcranial approach. At their cases authors preferred the early, definitive one-stage management with step-by step titanium miniplate reconstructive osteosynthesis and primary bone grafting correct bony restoration could be achieved. According their experiences of new treatment method with definitive one-stage management of complex craniofacial injuries they decreased the incidence of postoperative complications, the time of hospitalisations obtained optimal functional and cosmetic results.

[The mental foramen syndrome]. / A foramen mentale syndroma.

The authors outline an extraordinary rare case of metastatic mandible carcinoma. The examined patient who earlier had a mastectomy due to breast carcinoma showed signs of the foramen mentale syndrome (numbness, pain, swelling) also on the right side after 5 years. The process of the generalized malignant tumour was first indicated by the mandibula metastatic tumour of the foramen mentale syndrome.

[Fee flap from the fibula: microsurgical method for the substitution of mandibular loss]. / Fibula free flap: az állkapocshiány pótlásának mikrosebészeti mütéti módszere.

The authors report on the microsurgery method of the vascularized free fibula flap transplantation for the reconstruction of large segmental mandibular defect. They have established from the literatury data and by their own experience of two cases, that the use of free fibula flap seems to be the best replacement method, when the bone defect is bigger then twelve centimeters.

Physico-chemical modeling of the role of free radicals in photodynamic therapy. III. Interactions of stable free radicals with excited photosensitizers studied by kinetic ESR spectroscopy.

The loss of paramagnetism of the stable free radical 4,4'-di-tert.-butyl- diphenyl-1-nitroxy during illumination of the photosensitizer meso-tetrahydroxyphenyl chlorine by light above 620 nm in the absence of oxygen has been followed by kinetic ESR spectroscopy. Addition of the spin trap alpha-(4-pyridyl-1-oxide)- N-tert.-butyl-nitrone reduces the initial rate of the disappearance of the free radical enabling to separate triplet-doublet interactions from processes between radicals stemming from the triplet sensitizer and the stable free radical. Kinetic treatment of the mechanism suggested yielded the rate constant of the triplet-doublet interaction proceeding via electron transfer being about 6% of the rate constant of the overall interaction including both energy transfer and electron transfer.