[Options for flap coverage in pressure sores]. / Optiuni de acoperire cu lambouri in escarele de decubit.

Despite improvements in reconstructive techniques for pressure sores, recurrences are still seen frequently, and success rate remains variable. During 2003 - 2007, at the Emergency Hospital for Plastic Surgery and Burns in Bucharest, 27 patients underwent surgical repair of 45 pressure sores located at sacral (22 ulcers), ischial (12 ulcers) and trochanteric (11 ulcers) regions. The mean patient age was 57, 1 years (range 26 to 82 years). Mean postoperative follow-up was 6 months (range 2 months - 2 years). There were 18 complications for the 45 sores (40%). At 6 months postoperatively, recurrence was noted in 12 ulcers (27%). Details regarding indications, contraindications, advantages and disadvantages for different coverage options are outlined. The authors advocate the importance of surgical coverage in reducing morbidity, mortality and treatment costs.

[Reconstructive option in the surgical treatment of recurrent pilonidal cyst]. / O optiune reconstructiva în cura chirurgicala a sinusului pilonidal recidivat.

This paper presents a newly introduced technique in our practice based upon the experience published by Garrido in British Journal of Plastic Surgery in 2002 regarding the coverage of the natal cleft by a superior gluteal perforator fasciocutaneous flap. This flap was used in the coverage of the recurrent pilonidal disease. As advocated by the original authors, the technique proved to be safe, easy reproductible and provided a stable coverage. We used this flap as a first option because it fits all the requirements of the defect and even in the case of partial or total failure, the other reconstructive sources available in the gluteal region are kept intact.

Rapid identification of oral anaerobic bacteria cultivated from subgingival biofilm by MALDI-TOF-MS.

INTRODUCTION: To facilitate the identification of anaerobes cultivated from periodontal disease, whole cell bacterial identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was evaluated. METHODS: A total of 84 strains (nine reference strains and 75 recent clinical isolates from 33 patients with aggressive periodontitis) previously identified with phenotypic methods were used. All the references and 10 clinical isolates belonging to the same species as the reference strains were genotypically identified by sequence analysis of the 16S ribosomal RNA gene. All the strains were then analyzed using MALDI-TOF-MS. RESULTS: The reference strains of anaerobic bacteria used showed characteristic MALDI-TOF-MS spectra with peaks between m/z 2000 and up to about m/z 13,000. On visual inspection, the similarity of spectra produced by strains of a single genus could be recognized. Obvious differences between spectra produced by strains of different species were also easily noticed. The reproducibility of the method was proved by the similarity of spectra belonging to the same species. The spectra of the Prevotella intermedia strains identified with MALDI clustered together and clustered separately from the spectra of Prevotella nigrescens, proving that MALDI-TOF-MS is an accurate method that is capable of separating these two species. The quality of clustering was characterized by calculating an inconsistency coefficient (Mathworks:/Matlab Reference Manual v2007a/, Statistical toolbox). CONCLUSION: Our results suggest that MALDI-TOF-MS might become a useful method for the identification of anaerobic bacteria, especially for those that cannot be readily identified by biochemical analysis. It may become an attractive system even for the routine identification of clinical isolates.

[Acute urinary retention in primary vaginal carcinoma: therapeutic approach]. / Retentie acuta de urina prin cancer de vagin: atitudine terapeutica.

Carcinoma of the vagina is a very rare disease. Primary vaginal carcinoma tends to spread by local invasion of the adjacent pelvic organs (without any kind of metastases) and secondarily through lymphatic channels. The aim of this report is to add observations concerning the surgical treatment of this rare occurrence of carcinoma. The 33-year old patient's history began with an acute urinary retention which imposed bladder catheterization. Local examination revealed a hard 3/3 cm large mass on the middle third of the anterior vaginal wall, invasive in the urinary bladder. Cystoscopic examination confirmed the tumor invasion in the trigone. Biopsy specimens of the tumor and histological examination showed carcinoma. Anterior pelvic exenteration with pelvic lymph nodes dissection and total colpectomy was performed and the patient received a continent urinary diversion to the skin (modified Indiana pouch), ovary transposition, vaginal reconstruction with gracilis myocutaneous flaps. Postoperative evolution was uneventful. Organ reconstruction surgery including continent urinary diversion, vaginal reconstruction will significantly improve the quality of life and don't change the body image of the patients after pelvic major surgical procedures such pelvic exenteration.

[Soft tissue reconstruction after total pelvic exenteration]. / Reconstructia defectelor tisulare dupa exenteratia pelvina totala.

Total pelvic exenteration leaves a major defect in pelvic-perineal region. Delayed healing, bowel fistulae, occlusion or protrusion and infection are frequent complications of this procedure. During 2000-2006, in General Surgery and Liver Transplantation Fundeni, 73 patients with advanced pelvic cancer and invasive recurrences were operated. For 42 patients, various procedures for pelvic and vaginal reconstruction (omental flap, muscular and musculo-cutaneous flaps--rectus abdominis and gracilis) were performed in order to fill the pelvi-perineal defects and restore form and function. Technical principles, indications, contraindications, advantages and disadvantages of these procedures are outlined. We found that complications related to total pelvic exenteration dramatically decreased and primary healing of the perineal wound was superior, facts that correlate with the literature data.

[Total pelvic exenteration in the treatment of advanced pelvic cancer]. / Exenteratia pelvina totala in tratamentul cancerului pelvin avansat.

Total pelvic exenteration (TPE) is a radical and aggressive procedure performed in the local advanced pelvic cancer started from any pelvic organ. The experience of 73 TPE performed for local invasive cancer and centro-pelvic recurrences with initial malignancy at the cervix (45 cases), rectum (19 cases), vagina (5 cases), endometrial (3 cases) and urinary bladder (1 case), in 61 females and 12 males with age range 27-78 years, are analysed. The procedures were performed for advanced pelvic cancer in 24 cases and also for invasive centro-pelvic recurrences in 49 cases (67.5%). In 5 cases, TPE was extended laterally. In 42 patients reconstructive procedures were added. All patients survived to surgery but 5 postoperative deaths (6.8%) were recorded. Complications occurred in 52% of cases, 38 from 73 patients had one or more than one complication with an average of 1.5 per patient. 22 among these patients (30%) requiring operative treatment. The average survival was 49.07 months, the median survival of 55 months and the estimated survival at 11 and 78 months was 66%, respectively 50%. The procedure is indicated in the absence of pelvic wall invasion and secondary distant dissemination and lengthens significantly the life span and increase the quality of life.

[Orthoptic treatment efficiency in convergence insufficiency treatment]. / Eficienta tratamentului ortoptic în terapia insuficientei de convergenta.

We studied a group of 162 patients(89 females, 73 males), with ages between 15-30 years, who complained of blurred vision at near work. 98 patients(60.4%) were diagnosed with convergence insufficiency (C.I.), the rest of 64 patients(39.6%) had: low refractive errors, heterophoria and intermittent heterotropia. Patients with convergence insufficiency were divided in 3 groups: group 1(34 patients--34.6%) were treated with orthoptic exercises and near point exercises at home, group 2 (34 patients--34.6%) were treated with only near point exercises at home and control group 3 (30 patients--30.8%) without treatment. The result of the treatment of C.I. was good at 25 patients(73.5%) of group 1, at 8 patients(23.5%) of group 2 while in group 3 at only one patient the symptoms disappeared.

[Iopidine in the control of intraocular pressure after glaucoma laser treatment]. / Iopidina în controlul cresterilor presionale dupa proceduri antiglaucomatoase laser.

Iopidine is an a 2 agonist with a few indications in glaucoma treatment. 48 patients with medically uncontrolled POAG and PACG were treated with ALT and Nd-Yag iridotomy. In lot A Iopidine was instilled 30' before and immediately after laser treatment and in lot B Iopidine was delivered only postlaser. The mean and percent change in intraocular pressure were similar in both groups one and two hours after laser treatment.

[Retinoschisis--the clinical associations and therapeutic possibilities]. / Retinoschizis--asocieri clinice si posibilitati terapeutice.

Retinoschisis is a vitreo retinal dystrophy characterized by splitting of the neuroretinal layers. The paper presents two cases of retinoschisis associated with retinal detachment. As a particularity, one patient was diagnosed with von Willebrand disease and the other one, with otomandibular dysostosis (Francois-Haustrade). There are presented therapeutical methods used in this two cases: Laser, Argon photocoagulation, transscleral cryopexia, scleral buckling and also the functional and anatomical results.

Activity of the investigational fluoroquinolone finafloxacin and seven other antimicrobial agents against 114 obligately anaerobic bacteria.

The activity of finafloxacin against 73 strains of the Bacteroides fragilis group, 10 other Gram-negative anaerobic rods and 31 Clostridium difficile strains was determined by the broth microdilution technique. The activity was compared with that of moxifloxacin, levofloxacin, ciprofloxacin, clindamycin, imipenem, piperacillin/tazobactam and metronidazole. MIC(50/90) values (minimum inhibitory concentration, in µg/mL, at which 50% and 90% of the isolates tested are inhibited, respectively) for finafloxacin for the different species were determined: B. fragilis group, 0.5/2; other Gram-negative rods, 0.06/0.25; and C. difficile, 4/16. Furthermore, the MICs against 11 selected B. fragilis strains were determined under acidic conditions and resulted in MIC(50/90) values for finafloxacin of 0.25/4 µg/mL. Thus, finafloxacin shows promising activity against several pathogenic species of anaerobes. Furthermore, finafloxacin has increased activity against selected B. fragilis strains under acidic conditions compared with activity at neutral pH.