[Marjolin's ulcer on burn scar, a curable but neglected disease]. / Ulcerul Marjolin dezvoltat pe cicatrici postcombustionale--afectiune vindecabila, dar neglijata.

We discuss 9 consecutive carcinomas developed on postburn scars. Our interest was focused on surgery, recurrence, metastasis and long-term survival. The delay between burn trauma and the first clinical manifestation was 25-63 years. The most common localisation was in the limbs (10). Two cases presented with visceral metastasis. We performed either wide excision and grafting (5) or amputation (5). From the anatomo-pathological stand point we encountered 8 SCC and 1 BCC. In 6 cases we had no local recidive or metastasis. One presented a local recidive. There were two deaths--lung metastasis and "spontaneous" rupture of invaded axillary artery. The Marjolin's ulcer has a low incidence because of the patient's poor education. The prophylactic attitude is optimal. We favour early excision--grafting of the deep burns, long-term follow-up, excision and grafting of unstable areas (joint area, depigmented regions, chronic ulcers). The optimal surgical technique is excision followed by skin grafting since it allows early detection of the recurrence.

[The skin substitute center--a need in the treatment of patients with severe burns]. / Centrul de substituienti cutanati--o necesitate pentru tratamentul pacientilor cu arsuri severe.

The treatment of the severe burned patient has two main dimensions acting in an interdependent manner. First it is the life keeping and the second is skin resurfacing in a fair period of time. The failure of one of these two components leads to the patient's death. In the absence of the autografts the skin resurfacing has to be made by permanent skin substitutes--cultured epithelium, dermal equivalents or reconstructed skin, developed by a special unit, a Skin Substitute Center. The paper is setting the utility of such a center in our area, and the possible developing directions. It is our firm opinion that in case of failure to develop such a center, despite all the financial efforts directed toward the infrastructure of a modern Burn Unit affiliated to an University Accident Hospital, all the surgical experience cumulated during the past 13 years by a very motivated team, good quality results are still to be expected. Any patient with a deep second degree burn on more than 50% TBSA will be a potentially victim as in early 60s.

[A microsurgical patient, a procedural dilemma]. / Un pacient microchirurgical, o dilema tactica.

We are presenting a case which had five operations with the central point being the microsurgery. The patient is admitted in our unit 48 ours after sustaining a complex trauma of the left forearm with cvasicomplete destruction of the volar muscles, defects on cubital and radial vasculo-nervous axes and the median nerve. Upon arrival we performed the staged surgical debridement, ligature of the radial and ulnar vessels, anchoring of the ends of the nerves, forearm volar and dorsal fasciotomies, followed by skin grafting. After five months, the grafted skin is replaced by an ipsilateral parascapular free flap. After other three months we repaired the nerves by the mean of sural nerve grafts. The particularity of the case consists in fact that the ulnar nerve, with a longer defect, was reconstructed in a two stage approach. Long-time follow up (one year) shows a very good functional clinical result, confirmed by electromyography. Apart from the clinical challenge, this case confronted us with tactical dilemma. In a case of the facial nerve for the best results the cross-face is performed in two stages. Why shouldn't we do the same thing for all the nerve grafts when we are faced to semnificative defects?

[The treatment of superficial burns of the hands under controlled microclimate conditions]. / Tratamentul arsurilor superficiale ale mâinii în conditii de microclimat controlat.

In the treatment of the superficial burns of the hands, since October 1996, we have used exclusively the method of the controlled microclimate, verified in different variants starting early sixties. At the end of the usual primary wound treatment, the hand covered with the chosen topic is an ordinary new polyethylene bag. The bags are not pre-sterilized but the test showed no pathogen germs. The patient uses the hands for the daily activities--eating, reading. He/she is encouraged to perform active exercises (light gymnastics). We change the bags daily or whenever necessary, after a careful of the wound. We evaluated the healing time, the epithelial quality, secretions, mobility, patient's and medical personnel's acceptability, and the economic aspect. Though we couldn't notice a shorter period of healing, the epithelium showed a better quality in the early period of regeneration. The range of mobility was faster restored but long term results were the same as with usual dressings. We consider the method is appropriate for standardization in superficial hand burns in inpatients or outpatients for at least 4 reasons: comfort for the patient, his active and conscious participation in the process of healing, high acceptability among medical personnel, the semnificative economic advantage.

[Tumors and cysts of the mesentery. Clinical and therapeutic study]. / Tumorile si chisturile mezenterului. Studiu clinic si terapeutic.

This study is based on a group of 34 primary tumours of the mesenterium which were treated in the first surgical Clinic between 1960 and 1981. In this series were 19 women and 15 men, and the age of the patients varied between 16 and 68 years, being in the average of 44 years. Ten cystic tumours were recorded, and 24 solid tumours. Nine of the tumours were benign and the remaining 25 were malignant. The cystic tumours, for the most of the benign type, were almost exclusively cystic lymphangiomas. One serous cyst was also recorded, as well as one hematic cyst, and one dermoid cyst that had underwent malignization. The solid tumours were all malignant, of the sarcomatous type,, and their starting point was the mesenteral connective-vascular structures. The clinical picture of the mesenteral tumours is polymorphous and non-characteristic. In the frame of paraclinical examinations the radiologic investigation holds an important place and this is especially true for selective arteriography of the upper mesenteric artery, which provides useful informations concerning the topography of the tumour in relation to the mesenteral vascular trunk. Therapeutic possibilities are discussed, and the fact is stressed that, for improving the prognosis an early diagnosis is essential.

[Cervicomediastinal and thoracic goiters]. / Gusile cervicomediastinale si toracice.

Between 1950 and 1979 approximately 2400 patients with thyropathies have been operated in the I-st Surgical Clinic of Jassy. Of these 100 had cervico-mediastinal goiters, of which 79 were of the plunging cervico-mediastinal type, 18 were of the mediastino-cervical type and 3 were mediastinal goiters. The surgical treatment was applied in 98 patients, cervicotomy being sufficient to relieve the symptoms in 92 of the cases. The mixed approach (cervicosternotomy, or cervico-thoracic approach) were necessary in 5 cases, and the thoracic approach was selected in one case with an independent posterior mediastinal goiter. The immediate postoperative evolution, as well as the late evolution was good in most of the cases. Postoperative mortality was of 2 percent.

[Peculiarities of the surgical treatment of thyrotoxicosis in the aged]. / Particularitati ale tratamentului chirurgical al hipertiroidiilor la vîrstnici.

With an increasing frequency, recorded by most of the statistics, the thyrotoxicosis of the aged present themselves, most often, under uncharacteristic clinical aspects, often delusive. Out of a series of 37 thyrotoxic patients (representing 9.2% of all cases of thyrotoxicosis admitted to the Ist Surgical Clinic between 1970 and 1980) in 27 cases we performed a the surgical treatmeat with good immediate and late results. As a preliminary, execepting the endocrine balancing the improvement of the respiratory exchanges, the compensation of the possible heart disturbances and the ensurance of a good hydration and restoring of the nutritional state were followed.

[Tumors of the small intestine]. / Tumorile intestinului subtire.

On the basis of 20 observations of tumours of the small bowel a series of diagnostic, therapeutic and prognosis of these lesions are discussed. Malignant tumours of the small bowel (10 adenocarcinomas and 2 sarcomas in the present statistics) represent 1,9 per cent of the total number of malignant tumours of the small bowel. The patients were hospitalized following an acute complication occlusion, haemorrhage, perforation). Four of the patients benefited from a curative treatment, in 5 only a derivation was possible, and in 9 only exploratory laparotomy and bioptic sampling. Eight of the tumours were benign and consisted in : 3 fibromas; 2 neurogenic tumours; 2 adenomatous polyps, and one lipoma. All were discovered in the course of emergency surgery for occluding syndrome or haemorrhage, and benefited from a radical treatment. Two deaths were recorded in the entire series (one following embolism in the 10-th day after surgery and another in the 3-rd day with occluding shock). Both patients were in a condition of severe hydroelectrolytic imbalance.