C-reactive Protein: An Inflammatory Biomarker and a Predictor of Neurodegenerative Disease in Patients With Inflammatory Bowel Disease?

Inflammatory bowel disease (IBD) refers to two chronic conditions of the digestive tract: ulcerative colitis (UC) and Crohn's disease (CD), representing a progressive inflammatory process that mainly occurs in the gut, with frequent extra-intestinal manifestations. Even if remission is periodically obtained for some patients, the histological activity and digestive symptoms may continue, maintaining a persistent systemic inflammation that could induce further extra-intestinal complications and contribute to the development of neurodegenerative disease. C-reactive protein (CRP) is an acute-phase reactant that is widely accepted as a dominant serum biomarker in IBD. CRP consequently activates the complement cascade, supports the release of pro-inflammatory cytokines, and the clearance of microbial pathogens. All these processes facilitate further processes, including atherosclerosis and hypercoagulability, alteration of the intestinal microbiota, and the increased permeability of the intestinal barrier for neurotoxic substances produced by gut microorganisms, due to the presence of a high level of lipopolysaccharides. For IBD, the connection between intestinal inflammation and central nervous system inflammation could be explained through the activity of the vagus nerve, a carrier of cytokines, CRP, and toxic materials to the brain, potentially inducing vascular lesions and damage of the glial vascular unit, with further risk for degeneration within the central nervous system. CRP is a key marker for IBD pathogenesis and is able to dissociate into its monomeric form, mCRP, on contact with activated cell and tissue components via the systemic circulation. We hypothesize that the chronic inflammatory process within IBD could initiate neuroinflammation and neurodegeneration, and therefore, further investigation of the significance of chronically raised plasma of CRP and mCRP in patients with IBD is warranted, as it may represent a critical predictive factor associated with a later neurodegenerative risk. Any future initiative aimed at pharmacologic modulation of CRP (e.g., blocking CRP-mCRP dissociation), could represent a new therapeutic approach protecting against intestinal inflammation and concomitantly reducing the risk of neuroinflammation, neurodegeneration, and cognitive decline.

A single-center prospective study on the efficiency of negative pressure wound therapy versus conventional wound therapy in the postoperative management of devitalized and infected wounds.

INTRODUCTION: In this study, we aim to present the benefits of using negative pressure wound therapy, particularly with respect to the speed up of recovery time of devitalized and infected post-operative wounds, cost-effectiveness of local healing, pain relief during treatment, and returning to work and resuming normal daily activities at an earlier time. MATERIALS AND METHODS: This was a prospective study performed in General Surgery Clinic, between 2016-2018. The study comprised 67 patients divided into two groups: A (29 patients who underwent negative pressure wound therapy) and B (38 patients who underwent conventional wound therapy). RESULTS: The average age of patients included in group A was 64.2 ± 12.3 years and in group B, 63.2 ± 9.7 years (p=0.440). The wounds were located on the foot, thigh, abdomen, and other areas, and the average length of stay in hospital was 33 ± 18 days for group A versus 17 ± 14 days for group B (p=0.042) but with an average local healing time of 12 ± 5 days in group A versus 44 ± 17 days in group B (p<0.001). The average cost of hospitalization was higher in group A: 17,868 ± 9,560 RON (3,834 ± 2,051 euros) compared to group B: 6,025 ± 4,137 RON (1,292 ± 887 euros) (p=0.443) but the average cost of local healing was lower in group A: 5,437 ± 2,238 RON (1,166 ± 480 euro) compared to group B: 6,840 ± 3,520 RON (1,467 ± 755 euro) (p=0.005). CONCLUSIONS: The treatment of devitalized and infected post-operative wounds by using negative pressure wound therapy reduces local and complete healing time by approximately 30%, local healing costs by 26%, and allows better pain management during treatment with minimal complications. KEY WORDS: Negative pressure wound Therapy, Conventional wound therapy, Local healing, average cost.

Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder.

Introduction: Generalized Anxiety Disorder (GAD) is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual's quality of life. Besides medication, Cognitive-Behavioral Therapy (CBT) represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented with Virtual Reality (VR). Materials and methods: This study included 66 participants (M age = 22.53 years; SD = 2.21) with moderate GAD symptoms that were randomized to the standard CBT group (CBTs; N = 32) and the Integrative and Multimodal CBT augmented with VR (IM-VRCBT; N = 34) group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale (HARS) and Penn-State Worry Questionnaire (PSWQ) to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Unconditional Self-Acceptance Questionnaire (USAQ). Results: Both interventions determined statistically significant effects on both primary and secondary outcomes (ps < 0.001) in the expected direction. However, CBTs was associated with higher effect sizes for anxiety (Cohen's d = 2.76) and worries (Cohen's d = 1.85), in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes. Conclusion: This research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment.

Thought Suppression in Primary Psychotic Disorders and Substance/Medication Induced Psychotic Disorder.

INTRODUCTION: First episode-psychosis (FEP) represents a stressful/traumatic event for patients. To our knowledge, no study to date has investigated thought suppression involved in FEP in a Romanian population. Our objective was to investigate thought suppression occurring during FEP within primary psychotic disorders (PPD) and substance/medication induced psychotic disorders (SMIPD). Further, we examined the relationship between thought suppression and negative automatic thoughts within PPD and SMIPD. METHODS: The study included 30 participants (17 females) with PPD and 25 participants (10 females) with SMIPD. Psychological scales were administered to assess psychotic symptoms and negative automatic thoughts, along a psychiatric clinical interview and a biochemical drug test. RESULTS: Participants in the PPD group reported higher thought suppression compared to SMIPD group. For the PPD group, results showed a positive correlation between thought suppression and automatic thoughts. For the SMIPD group, results also showed a positive correlation between thought suppression and automatic thoughts. CONCLUSIONS: Patients with PPD rely more on thought suppression, as opposed to SMIPD patients. Thought suppression may be viewed as an unhealthy reaction to FEP, which is associated with the experience of negative automatic thoughts and might be especially problematic in patients with PPD. Cognitive behavioral therapy is recommended to decrease thought suppression and improve patients' functioning.

Innovative Use of Sheep Wool for Obtaining Materials with Improved Sound-Absorbing Properties.

In recent years, natural materials are becoming a valid alternative to traditional sound absorbers due to reduced production costs and environmental protection. This study explores alternative usage of sheep wool as a construction material with improved sound absorbing properties beyond its traditional application as a sound absorber in textile industry or using of waste wool in the textile industry as a raw material. The aim of this study was to obtain materials with improved sound-absorbing properties using sheep wool as a raw material. Seven materials were obtained by hot pressing (60 ÷ 80 °C and 0.05 ÷ 6 MPa) of wool fibers and one by cold pressing. Results showed that by simply hot pressing the wool, a different product was obtained, which could be processed and easily manipulated. The obtained materials had very good sound absorption properties, with acoustic absorption coefficient values of over 0.7 for the frequency range of 800 ÷ 3150 Hz. The results prove that sheep wool has a comparable sound absorption performance to mineral wool or recycled polyurethane foam.

Long-term outcomes of laparoscopic sleeve gastrectomy - a single-center prospective observational study.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is an established bariatric procedure. AIM: We present our long-term results regarding weight loss and comorbidities during 9 years. MATERIAL AND METHODS: We calculated the percent excess weight loss (%EWL) and changes in body mass index (ΔBMI). We evaluated arterial hypertension (AHT), type 2 diabetes (T2DM) and obstructive sleep apnea syndrome (OSAS). RESULTS: One hundred seventy-nine patients were included (136 female/43 male), mean age of 40.47 ±11.08 years, median preoperative body mass index (BMI) of 42.93 kg/m2. Median follow-up period was 72 months (36-84 months). The %EWL during follow-up was 41.8 (n = 179 patients, at 3-month follow-up), 64.1 (n = 163), 75.33 (n = 134), 77.1 (n = 103), 76,03 (n = 99), 73.78 (n = 64), 71.58 (n = 37), 63.83 (n = 22) and 64.1 (n = 14) at 6, 12, 18, 24, 36, 48, 60 and 72 months, respectively. We noted a negative correlation between %EWL and both the age and initial weight and BMI of the patient; a negative correlation between gender (male patients) and %EWL was also found. After LSG, 68.2% of patients with AHT presented resolution (no medication) or significant improvement (doses reduced) of the disease. As regards T2DM, 65.8% described resolution or significant improvement after surgery. Furthermore, 31 (70.4%) patients with preoperative OSAS reported resolution/improvement within a year from surgery. CONCLUSIONS: Laparoscopic sleeve gastrectomy is a safe and effective procedure, with good results in the short and medium term. Long-term follow-up reveals a tendency to weight regain after approximately 2 years from primary surgery, with the need for revisional surgery in some cases.

A prospective follow-up study on completion thyroidectomy for well-differentiated thyroid cancer. A single-center report.

BACKGROUND: Completion thyroidectomy (cT) becomes a choice after any type of less than total thyroid surgery, when a "total" would have been indicated on primary intervention if malignancy diagnosis had been available. The study main aim is to define predictive factors of malignancy in the thyroid remnant and to assess the morbidity risk after cT according to the type of initial intervention. MATERIAL AND METHOD: Sixty-three patients on whom cT was performed were finally included with 61 surgeries performed in our department. RESULTS: Or cohort included 55 (87.3%) women and 8 men (12.7%), with a mean age of 48.3 on whom were primary performed 34 lobectomies with isthumusectomies (LwI=53.96%) and 29 subtotal thyroidectomies or hemithyroidectomies (STT=46.03%). Histopathological examination after reintervention detected malignancy in 30.15% of excised thyroid remnants (19 patients), in the majority of these cases microcarcinoma. We found statistically significant correlations between the risk of malignancy in the thyroid remnant and both the primary thyroid tumor multicentricity (p=0,001) and its extracapsular and/or vascular invasion (p=0,006) respectively. The time span between the two interventions ranged from 3 days to 12 months (mean 63 days). No 30-day mortality occurred in our group of patients. We noted 3 cases of RLN palsy (4.76%) of which one permanent (1.58%) and 12 cases (19.04%) of postoperative hypoparathyroidism, of which two (3.17%) permanent. CONCLUSIONS: Multicentricity and capsular and/ or vascular invasion of the initial tumor are factors predictive of malignancy in the remnant thyroid. The rate of postoperative hypoparathyroidism is higher after initial subtotal thyroidectomy. KEY WORDS: Completion thyroidectomy, Incidental parathyroidectomy, Multifocality, Thyroid cancer.

Hypercalcaemic Crisis Due to Primary Hyperparathyroidism: Report of Two Cases.

INTRODUCTION: A hypercalcaemic crisis, also called para thyrotoxicosis, hyper parathyroid crisis or parathyroid storm, is a complication of primary hyperparathyroidism (PHPT) and an endocrinology emergency that can have dramatic or even fatal consequences if it is not recognised and treated in time. CASE PRESENTATION: Two cases presented in the emergency department with critical hypercalcaemic symptoms and severe elevation of serum calcium and parathyroid hormone levels, consistent with a hypercalcaemic crisis. The first case, a 16-year-old female patient, had imaging data that highlighted a single right inferior parathyroid adenoma and a targeted surgical approach was used. The second case, a 35-year-old man was admitted for abdominal pain, poor appetite, nausea and vomiting. Laboratory tests revealed severe hypercalcaemia, hypophosphatemia and an increased serum iPth level. There was no correlation between scintigraphy and ultrasonography, and a bilateral exploration of the neck was preferred, resulting in the exposure of two parathyroid adenomas. The patients were referred for surgery and recovery in both cases was uneventful. CONCLUSION: These cases support the evidence that surgery remains the best approach for patients with a hypercalcaemic crisis of hyperparathyroidism origin, ensuring the rapid improvement of both the symptomatology and biochemical alterations of this critical disease.

Musculoskeletal ultrasound: a useful tool for diagnosis of hip developmental dysplasia: One single-center experience.

Developmental dysplasia of the hip (DDH) is one of the most common congenital abnormalities of the musculoskeletal apparatus in newborns. The aim of this study was to analyze the contribution of ultrasonography in the detection of DDH in newborns and infants, identifying the regional incidence of this pathology in the central area of Romania, emphasizing the risk factors that underlie DDH etiopathogenicity.This article represents a retrospective study of 847 newborns and infants examined in the Imagistic Department of a medical center from the central area of Romania, between January 1 and December 31, 2016. The ultrasound examinations were performed for the bilateral coxofemoral joints, using the method and technique described by Graf. For subjects born in the same medical center, data regarding mother's age, birth weights, and type of delivery (natural vs. caesarian section) were statistically analyzed.In our study group, the frequency of ultrasound diagnosis obtained from the examinations of right and left hips showed that the most frequent stage was type IA, and the rarest stage was III. The IA stage of right coxofemoral joints (87.3%) was higher than in the left coxofemoral joints (87.2%). The incidence of hip dysplasia (type III) diagnosed with ultrasound examinations in subjects from the central area of Romania was 0.2% (0.1% in both hips and 0.1% for the left coxofemoral joint).The musculoskeletal ultrasound examination is effective in early detection of hip dysplasia. The implementation of national and regional programs that promote indications, risk factors, and the screening age for DDH in both rural and urban areas could be a step forward in the early diagnosis of hip dysplasia for newborns and infants. The low incidence of DDH from our study group is not able to identify the role of advanced age of the mother, high birth weight of the newborn, or caesarean section as risk factors involved in the etiology of hip dysplasia. The implementation of national and regional programs that promote the musculoskeletal ultrasound as a screening imagistic investigation for DDH, in both rural and urban areas, could be a step forward in the early diagnosis of hip dysplasia for newborns and infants.

Modified enteromesenteric bridging operation for primary lymphedema.

BACKGROUND: Primary lymphedema represents a condition which affects the lymph vessels and their cells without any pathologic patient history leading to soft tissue swelling. They are described in the literature three types: congenital primary lymphedema, or Milroy disease, lymphedema praecox, which occurs in puberty, and lymphedema tarda, when, the same symptoms, develop over 35 years old patients. The aim of this paper is to present a modified Kimmoth's original procedure for a praecox lymphedema by introducing an omental flap in the resorptive area. CASE REPORT: We present a case of 18 year-old patient with a significant lymphedema of the lower limbs and genitalia associated with high-symptomatic under-knee and scrotal ulcerative, necrotic and inflammatory lesions. The ultrasound and computed-tomography scans showed bilateral hypertrophic lymph-nodes in the inguinal and external iliac areas. Considering this diagnosis we decided to perform a physiologic lymph drainage by combining the enteromesenteric bridge with the omental transposition. The postoperative course was favorable without wound complications. Three months after, it was resected the remnant scrotal sclero-lymphatic tissue. 3 years after surgery, the clinical follow-up showed a significant reduced lymphedema with 10 cm shank / 15 cm thigh circumference lost. CONCLUSIONS: The enteromesenteric bridge combined with the omental flap proved to be efficient in ensuring the lymphatic drainage in a case with proximal lymphatic occlusion. KEY WORDS: Enteromesenteric bridging operation, Omental flap transposition, Primary lymphedema.

Durability of an Advanced Skin Protectant Compared With Other Commercially Available Products in Healthy Human Volunteers.

BACKGROUND: A new skin protectant with improved adhesion to denuded skin and resistance to wash off has been developed to protect skin from incontinence-associated dermatitis (IAD) or general loss of skin integrity. OBJECTIVE: This controlled, randomized, prospective, open-label study determines the durability of the new protectant when applied to intact skin in 21 healthy human volunteers and compares it to 3 other products used for similar clinical indications. MATERIALS AND METHODS: Eight 0.75-in circles of black carbon pigment were applied to the bilateral forearms (4 per arm to allow for duplicates) of the participants and covered with the various products. Participants conducted normal routine activities over 7 days. Photographs were taken and a test site assessment was completed before and after application of the products on day 0 and at days 1, 2, 3, 4, and 7 to evaluate pigment loss over time. Carbon integrated optical density (CIOD) was measured under the assumption that a loss of pigment correlated with a loss of the protective product. These data were used to calculate the percent barrier remaining over time. RESULTS: The percent of intact film was significantly greater (P < .05) from day 3 onwards for the new skin protectant compared with the other 3 products. The new product showed no significant change in CIOD (P = .46) from day 1 through day 7, indicating no meaningful wear over time. The other 3 products showed significant changes in CIOD (P < .01) beginning at either day 2 or day 3. CONCLUSIONS: The new skin protectant was more durable than the other products tested. It remained in place for up to 7 days for all participants, whereas the other products had < 50% remaining on the skin by that time point.

Negative Pressure Wound Therapy of Open Abdomen and Definitive Closure Techniques After Decompressive Laparotomy: A Single-center Observational Prospective Study.

INTRODUCTION: Open abdomen is a concept that was developed especially in relation to abdominal compartment syndrome (ACS). OBJECTIVE: This study presents the evolution and complications related to the management of the open abdomen after decompressive laparotomy, using a standardized method based on negative pressure wound therapy (NPWT). MATERIALS AND METHODS: This observational prospective study conducted over a 9-month period included 19 patients who underwent decompressive laparotomies for ACS. The triggering conditions were peritonitis, infected and noninfected acute pancreatitis, ileus, and trauma. Temporary abdominal closure was performed using NPWT and the final closure by primary suture or dual mesh. Intra-abdominal pressure was permanently and indirectly monitored transvesically. RESULTS: After decompressive laparotomy, the intra-abdominal pressure decreased significantly (P < .001) compared with the value preoperatively (41.4 mm Hg to 15.3 mm Hg). Mortality was 21.2%, with higher rates for acute pancreatitis (odds ratio [OR] = 3.75) and trauma (OR = 1.25) due to the severity of the primary illness. The final closure was performed after 11.7 days, and primary closure was possible in 4 cases. CONCLUSIONS: Decompressive laparotomy significantly reduced intra-abdominal pressure for ACS, improving the prognosis.

Laparoscopic gastric plication for the treatment of morbid obesity by using real-time imaging of the stomach pouch.

BACKGROUND: Bariatric surgery is a continuously evolving field. Laparoscopic greater curvature plication is a new investigational procedure used to treat patients with morbid obesity. The demand for this operation from the obese patients is also rising. The problem is that during gastric plication the exact dimensions and volume of the pouch are not known so frequently it is too large or too tight thus compromising the results. The aim of the study was to identify the parameters that can improve the outcomes after this procedure. METHODS: We performed laparoscopic greater curvature plication in 75 obese patients during 2013-2015. The last 25 patients underwent surgery with a modified surgical technique using real-time imaging of the stomach pouch. The inclusion criteria for the 25 patients enrolled in this case series were the usual, body mass index higher than 40 or higher than 35 but with comorbidities along with the option of the patients for laparoscopic gastric plication. The operative technique was enhanced by using a computerized device and special intragastric catheters during the procedure that permitted real-time imaging of the gastric geometry. With this new operative approach we obtained the desired volume of the gastric remnant and we avoided strictures, obstruction or irregular shape of the pouch, problems that otherwise could have compromised the outcomes. RESULTS: We found an increased excess weight loss of 55% at six month and 65% over a 12-month follow-up period with alleviation of comorbidities. There were no major complications (gastric outlet obstructions or leaks) and less minor complications (nausea and vomiting) than in the patients operated with classic gastric plication procedure. CONCLUSIONS: This study shows that in case of laparoscopic gastric plication the use of our modified operative technique has better outcomes than in the classical setting. This is a new operative approach in the bariatric literature which can lead to greater acceptance of gastric plication among bariatric surgeons. The target population is represented by the obese patients who want to obtain similar results to those after gastric bypass and sleeve gastrectomy but are concerned about removing a part of their stomach and the postoperative complications that may occur, especially leaks and nutritional complications. KEY WORDS: Gastric geometry, Laparoscopic gastric plication, Morbid obesity, Real-time imaging.

Communication skills in pediatrics - the relationship between pediatrician and child.

Interpersonal and communication skills are 2 essential qualities of every physician. These are separate and distinct parts of the professional character of every physician. In pediatrics these abilities present even a higher impact.We performed a survey-type prospective study based on questionnaires on 100 subjects, equally divided into 4 groups: 25 children, 25 pediatricians, 25 care-givers (parents, tutors, and relatives), and 25 health care staff, in a Tertiary Pediatric Clinic from Romania, between January 2017 and April 2017.We included 100 participants in our study, equally divided into 4 groups: pediatric patients, pediatricians, care-givers, and health care staff. The 1st group comprised 25 children diagnosed with different chronic conditions, presenting the age between 5 and 14 years. The male gender predominated among the children (57%). The lowest general average score for "Communication" section was encountered among pediatricians group, 3.8, while the other 3 groups presented the same average score for this section, that is, 4.6. The children and the health care staff offered the same average score for "Transparency," that is, 4.6, while the pediatricians offered a score of 4.5, and the care-givers of 4.7. The lowest average score for the item "Hospital environment" was given by the doctors, that is, 3.3, followed by care-givers with a score of 3.6, health care staff 3.7, and children with an average score of 3.8. All the 4 groups included in the study offered a general average of 4.9 out of 5 for the "Intercultural issues" section. The lowest average score for "Time management" section was offered by both children and pediatricians, that is, 4.1, while care-givers and health care staff had a slightly better perception regarding this item, offering 4.2 and 4.3, respectively.The opinion among the 4 groups included in the study was generally similar regarding the 5 items assessed by our questionnaires. Therefore, the main aspects that need to be improved in the health care system in downward order are the following: hospital environment, time management, communication, transparency, and intercultural issues.

Crossover iliofemoral bypass graft through tension-free abdominal wall-repair mesh.

INTRODUCTION: In vascular surgery the crossover iliofemoral bypass grafting is a well-known surgical technique. In general surgery the repair of an abdominal defect using a Polypropylene mesh is also a standard procedure. A particular technique is defined by the performance of these 2 separate procedures inside a single operation in which the crossover arterial graft is directed from the retroperitoneal space toward the contra-lateral femoral bifurcation through a Polypropylene mesh which closes the musculoaponeurotic layers of the abdominal wall. We present our experience with the use of this particular surgical technique in patients with critical limb ischemia and with indication for extra-anatomic crossover bypass (high-risk patients with contra-indication for the transperitoneal approach, extensive calcified aortic or iliac wall which contraindicated the direct arterial reconstruction or secondary arterial reconstruction after the occlusion of an aorto- femoral graft). METHODS: In principle, the hernioplasty was performed by using the Lichtenstein tension-free hernia repair technique, followed by the crossover iliofemoral bypass. The main feature of this technique is to pass the vascular graft from the retroperitoneal space above the mesh through a calibrated hole in the mesh RESULTS: The 7 patients with inguinal hernia and l limb-threatening ischemia had favorable evolution, without hernia recurrence, limb-threatening ischemia or any graft complication at 3 years. DISCUSSION: Using this particular surgical technique we treated 2 surgical diseases using a single intervention for highrisk patients who had both inguinal hernia and contra-lateral critical limb ischemia. Being encouraged by the initial satisfactory results, we extended this technique even for the patients with indication of crossover iliofemoral bypass but without inguinal hernia. CONCLUSIONS: The particular surgical technique of the crossover bypass in which the vascular graft crosses a tension-free Polypropylene mesh from the retroperitoneal space toward the Retzius space represents an efficient and short procedure which treats simultaneously 2 different surgical diseases (inguinal hernia and contra-lateral critical limb ischemia) in high-risk patients. The results were satisfactory: we had no hernia recurrence and the limb-threatening ischemia was successfully treated. The preferred vascular graft for this particular technique is the reversed autogenous vein because its resistance to infections and the vein long-term patency is better than of a vascular prosthesis. When a prosthetic graft is required, we prefer to use the classic technique in which the crossover graft is placed in an under-aponeurosis site, in order to diminish the prosthesis infection risk. KEY WORDS: Abdominal wall, Iliofemoral bypass, Vascular surgery.

How much does decompressive laparotomy reduce the mortality rate in primary abdominal compartment syndrome?: A single-center prospective study on 66 patients.

Contribution of decompressive laparotomy within the framework of the complex therapeutic algorithm of abdominal compartment syndrome (ACS) is cited with an extremely heterogeneous percentage in terms of survival. The purpose of this study was to present new data regarding contribution of each therapeutic step toward decreasing the mortality of this syndrome.This is a longitudinal prospective study including 134 patients with risk factors for ACS. The intra-abdominal pressure was measured every hour indirectly based on transvesical approach and the appearance of organ dysfunction. Specific therapy for ACS was based on the 2013 World Society of Abdominal Compartment Syndrome guidelines, which include laparotomy decompression. Management of the temporarily open abdomen included an assisted vacuum wound therapy.Of 134 patients, 66 developed ACS. The average intra-abdominal pressure significantly decreased after therapy and decompression surgery. The overall rate of mortality was 27.3% with statistical significance in necrotizing infected pancreatitis. Surgical decompression performed within the first 24 hours after the onset of ACS had a protective role against mortality (odds ratio <1). The average time after which laparotomy decompression was performed was 16.23 hours. The complications occurred during TAC were 2 wound suppurations and 1 intestinal obstruction. Wound suppurations evolved favorably by using vacuum wound-assisted therapy associated with the general treatment, whereas for occlusion, resurgery was performed after which adhesions dissolved. The final closure of the abdomen was performed at a mean of 11.7 days (min. = 9, max. = 14). The closure type was primary suture of the musculoaponeurotic edges in 4 cases, and the use of dual mesh in the other 11 cases.The highest mortality rate in the study group was registered in patients with necrotizing pancreatitis and the lowest in trauma group. Surgical decompression within the framework of the complex algorithm treatment of ACS contributed to the reduction of mortality by 8.7%. It is extremely important that the elapsed time since the initiation of the ACS until the surgical decompression is minimal (under 24 hours).

The accuracy of musculoskeletal ultrasound examination for the exploration of meniscus injuries in athletes.

BACKGROUND: Meniscus injuries represent a frequently occurring pathology in athletes and require an optimum diagnosis protocol. This study aimed to evaluate the accuracy of ultrasound examination for the identification of meniscus injuries, in comparison with magnetic resonance imaging (MRI), using the arthroscopy as reference. METHODS: This prospective longitudinal comparative study included 45 athletes who were clinically examined by MRI and further, by arthroscopy, in a medical center dedicated to sport traumatology. RESULTS: The conventional ultrasound exploration of the knee allowed the identification of a diverse pathology, presenting a sensitivity of 88.8% for the diagnosis of medial meniscus injuries and 70.0% for the lateral meniscus. The specificity was 77.7% for the medial meniscus and 96.0% for the identification of lateral meniscus injuries. Using MRI, a sensitivity of 69.4% was obtained for the medial meniscus and 75.0% for the lateral meniscus, with a specificity of 76.6% for the pathology of medial meniscus and 80.0% for the lateral meniscus. Statistical analysis, based on the comparison of ROC curves, did not show any significant difference between the two applied diagnostic techniques (P=0.061 for the medial meniscus and P=0.534 for the lateral meniscus). CONCLUSIONS: The musculoskeletal ultrasound exploration of the knee joint, performed in a medical center with high addressability, by an experienced examiner, was able to identify the medial and lateral meniscus injuries with an accuracy comparable to that of MRI examination.

Multilevel brown tumors of the spine in a patient with severe secondary hyperparathyroidism A case report and review of the literature.

BACKGROUND: The brown tumour is an extreme form of osteitis fibrosa cystica, representing a serious complication of the advanced primary or secondary hyperparathyroidism. It occurs in settings of high levels parathyroid hormone, like in primary or secondary hyperparathyroidism, with a frequency of 3-4% and 1.5-13% respectively, usually affecting young people. CASE REPORT: The authors report a case of a 45 years old woman on long-term hemodialysis, with severe secondary hyperparathyroidism. The main clinical complaints were neck pain, lower thoraco-lumbar back pain, persistent left groin pain, and bilateral lower extremities weakness. The computed tomography scan revealed multiple spine brown tumors affecting the cervical, thoracic and lumbar level. After an initial partial response to the treatment of two years with Cinacalcet, a deterioration of the secondary hyperparathyroidism occurred (hypercalcemia, hyperphosphatemia) and the patient was referred for parathyroidectomy. The patient underwent total parathyroidectomy with auto-transplantation, with a positive postoperative result. CONCLUSIONS: Secondary hyperparathyroidism can lead, during its course, to osteolytic bone lesions called brown tumors. If the medical treatment fails, the surgical removal of the parathyroid glands with autotransplant remains the only treatment of the bone lesions progression. Reviewing the relevant literature in English (until March 2015), we found 24 cases of symptomatic vertebral brown tumors. To the authors' knowledge, this is the first case which describes a multilevel spine involvement (more than two), and the fifth describing a cervical localization. KEY WORDS: Hypocalcaemia, Secondary hyperparathyroidism, Spine brown tumors.

[Hernia recurrence long term follow-up after open procedures of abdominal wall plasty-prospective study including 142 patients]. / Seguimiento remoto de la recaída de hernia después de procesos abiertos de plastia de la pared abdominal- estudio prospectivo que incluye 142 pacientes.

BACKGROUND: The incisional hernia continues to be a frequent complication of laparotomies. The purpose of study is the analysis of hernia disease relapse after one year after different open plasties methods of the abdominal wall. MATERIAL AND METHODS: A prospective longitudinal study was performed that included 142 patients. An analysis was performed on the individual data, the level of obesity, intra-surgical variations in intra-abdominal pressure, the intensity of post-surgical pain, the post-surgical complications, and the types of plasties of abdominal wall, simple and with polypropylene mesh. RESULTS: The analysis of studied group showed a general rate of relapse of 16.9%, and within the 4 procedures, 40.74% in the case of simple plasties, of 16.07% after the only plasties, 6.97% after the retro-muscular plasties, and 6.25% after the full substitution of parietal defect. On analysing the collected, hernia relapse was statistically significantly related to the level of obesity, variations in intra-abdominal pressure, post-surgical pain, and the type of procedure performed. CONCLUSIONS: Hernia is a frequent complication of laparotomies. Hernia relapse was more frequent in the case of simple plasties. Among the mesh procedures, the onlay plasty showed a higher rate of relapse and post-surgical complications. Hernia relapse was more frequent in the case of variations of intra-abdominal pressure, and with increased post-surgical pain. The use of an echography examination may increase the accuracy of the presence of hernia disease.

The intraabdominal pressure A real indicator of the tension free principle during anterior wall repair procedure after incisional hernias.

AIM: Incisional hernias represent a late onset complication of any type of laparotomy, with a relatively high incidence, and reported in 2% to 11% of all laparotomies. MATERIAL AND METHODS: We performed a prospective longitudinal study that included a total number of 102 patients. The following parameters were monitored: patient history clinical findings, time of hospitalization, laboratory test results, types of surgery. Intra-abdominal pressure variations were measured using a specialized kit. RESULTS: Obesity was present in 69 of the patients (67.64%). Mesh plasty was most frequently used (80.39%). The inset of the mesh was performed in onlay position (40.19%), retromuscular (29.98%) or complete defect substitution (11.76%). The correlation between the type of abdominal wall plasty, variations on the Borg dyspnea scal and likewise the correlation between the VAS (visual analogue scale) pain scale and the abdominal wall plasty procedures proved to be highly statistically significant: p< 0.001. Furthermore, the intra-abdominal pressure varied with the type of abdominoplasty carried out, reviewing the tension free principle. The most important parameter was the intra-abdominal pressure recorded at the end of the abdominoplasty, which showed significant correlations with the tension free plasties (retromuscular mesh and substitution mesh). CONCLUSIONS: The tension free methods, reflected by the intra-abdominal pressure variation, were associated with a lower degree of dyspnea, low postoperative pain and less hospitalization time. KEY WORDS: Borg scale, Incisional hernia, Intra-abdominal pressure, Onlay, Visual analogue scale.