Fracture sonography-review of literature and current recommendations.

Over a span of more than two years, a collaborative expert group consisting of 9 professional societies has meticulously crafted the S2e guideline on fracture sonography. This publication encapsulates the essential insights pertaining to specific indications. A thorough and systematic literature search, covering the period from 2000 to March 2021, was conducted across PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, complemented by an evaluation of bibliographies. Inclusion criteria encompassed randomized controlled clinical trials, observational clinical trials, meta-analyses, and systematic reviews, while guidelines, conferences, reviews, case reports, and expert opinions were excluded. The SIGN grading system (1999-2012) was applied to assess evidence, and resultant SIGN tables were presented to the expert group. Specific recommendations for the application of fracture sonography were then derived through unanimous consensus after detailed discussions. Out of the initial pool of 520 literature sources, a meticulous screening and content assessment process yielded 182 sources (146 clinical studies and 36 meta-analyses and systematic reviews) for evaluation. The comprehensive analysis identified twenty-one indications that substantiate the judicious use of fracture sonography. Ultrasound emerges as a pragmatic and user-friendly diagnostic method, showcasing feasibility across a diverse range of indications.

Dopaminergic neurons establish a distinctive axonal arbor with a majority of non-synaptic terminals.

Chemical neurotransmission typically occurs through synapses. Previous ultrastructural examinations of monoamine neuron axon terminals often failed to identify a pre- and postsynaptic coupling, leading to the concept of "volume" transmission. Whether this results from intrinsic properties of these neurons remains undefined. We find that dopaminergic neurons in vitro establish a distinctive axonal arbor compared to glutamatergic or GABAergic neurons in both size and propensity of terminals to avoid direct contact with target neurons. While most dopaminergic varicosities are active and contain exocytosis proteins like synaptotagmin 1, only ~20% of these are synaptic. The active zone protein bassoon was found to be enriched in dopaminergic terminals that are in proximity to a target cell. Finally, we found that the proteins neurexin-1αSS4- and neuroligin-1A+B play a critical role in the formation of synapses by dopamine (DA) neurons. Our findings suggest that DA neurons are endowed with a distinctive developmental connectivity program.

Stimulatory Effect of Lactobacillus Metabolites on Colonic Contractions in Newborn Rats.

Microbiota are known to play an important role in gastrointestinal physiology and pathophysiology. Microbiota and their metabolites can affect gut motility, neural regulation and the enteric endocrine systems and immune systems of the gut. The use of fermented/hydrolyzed products may be a promising new avenue for stimulating gastrointestinal motility. The purpose of this study was to investigate the effect of lactobacillus metabolites (PP), produced using a U.S.-patented fermentation method, on rat colon motility in vitro. The distal colon was incised from newborn male Wistar rats. A sensitive tensometric method for the study of colon contractions was used. The [Ca2+]i in colon tissue was registered using a computerized ratiometric system for an intracellular ion content assay (Intracellular Imaging and Photometry System, Intracellular imaging, Inc. Cincinnati, OH, USA). The cumulative addition of PP induced contraction with sigmoid dose responses with ED50 = 0.13 ± 0.02% (n = 4), where 10% PP was accepted as a maximal dose. This contraction was accompanied by an increase in the concentration of [Ca2+]i. It was shown that introducing Lactobacillus metabolites produced using a U.S.-patented fermentation method quickly stimulates dose-dependent colon contractions and an increase in intracellular calcium. The direct application of PP via enema to the colon could stimulate colon motility and suppress pathogenic microbiota, owing to the antagonistic property of PP on pathogens.

Accurate Diagnosis of Sigmoid Colon Endometriosis by Immunohistochemistry and Transmission Electron Microscopy - A Case Report.

Endometriosis is described as the presence of functioning endometrial tissue at sites outside the uterus. Up to 15% ofwomen in their reproductive period are affected by this condition. Endometriosis is mostly foundon the uterosacral ligaments, inside the rectovaginalseptum or vagina, in the rectosigmoid area, ovarianfossa, pelvic peritoneum, ureters, and bladder, causinga distortion of the pelvic anatomy. Colonic involvement is rare but is usually found at the level of the rectum or the sigmoid colon. Acute presentation with intestinal obstruction or perforation is rare. While malignant transformation of endometrial lesions is rare, findings of dysplasia on pathology sections can give rise to questions of management. Immunohistochemistry and electron microscopy can help decision making. We present the case of a 38 year old woman with intestinal obstruction caused by sigmoid colon endometriosis with moderate dysplasia in which transmission electron microscopy was used for postoperative diagnosis. Detailed analysis of these cases, while logistically difficult, can prove useful in understanding the etiology and pathophysiology of the disease.

Stump appendicitis - an overlooked clinical entity.

Stump appendicitis is a rare disease, often overlooked. Thepossibility of stump appendicitis is not clear to all clinicians.It can represent a diagnostic dilemma if the treating physicianis not aware of this uncommon disease. Presenting symptomsare indistinguishable from those of primary appendicitis. Wepresent two cases of stump appendicitis operated in ourdepartment and their treatment. A heightened awareness ofthe possibility of this disease can lead to good initial surgical technique and prevention, and to early diagnosis in the eventof stump appendicitis.

Spontaneous rupture of a splenic hydatid cyst with anaphylaxis in a patient with multi-organ hydatid disease.

Hidatid cysts of the spleen are a rare occurrence, the spleen being the third most common organ for the development of Echinococcus Granulosus. Splenic hydatid cysts are commonly part of multi-organ hydatid disease. Diagnosis is often established when investigating a splenomegaly or by chance during an unrelated consult. It can also be diagnosed after rupture, be it following trauma (the most common occurrence)or spontaneous. Splenic hydatid cyst rupture requires immediate action and is a life-threatening condition. It results, most often, in splenectomy. We present the case of a patient with multi-organ hydatid disease that presented with a ruptured splenic cyst and developed anaphylaxis. The case was resolved by splenectomy and recovered well.

The value of serum bilirubin level and of white blood cell count as severity markers for acute appendicitis.

Discussions regarding the correlations between elevated white blood cell levels and clinical and pathological stages of acute appendicitis are well known. Recent studies show that a high level of serum bilirubin could emerge as a prognostic marker for gangrenous or perforated stages of acute appendicitis. We studied the correlations between anatomical and pathological stages of acute appendicitis and white blood cell count, serum total bilirubin, and indirect serum bilirubin on a large series of cases, in the course of one year, in our department. Although there being a correlation between severe forms of acute appendicitis (gangrenous, perforated), elevated white blood cell count, elevated serum bilirubin (mostly the indirect fraction), none of the indicators proved to have a definitive diagnostic value. Cases with perforation and localized generalized peritonitis are more frequently associated with elevated bilirubin levels.

Conditional deletion of neurexins dysregulates neurotransmission from dopamine neurons.

Midbrain dopamine (DA) neurons are key regulators of basal ganglia functions. The axonal domain of these neurons is highly complex, with a large subset of non-synaptic release sites and a smaller subset of synaptic terminals from which in addition to DA, glutamate or GABA are also released. The molecular mechanisms regulating the connectivity of DA neurons and their neurochemical identity are unknown. An emerging literature suggests that neuroligins, trans-synaptic cell adhesion molecules, regulate both DA neuron connectivity and neurotransmission. However, the contribution of their major interaction partners, neurexins (Nrxns), is unexplored. Here, we tested the hypothesis that Nrxns regulate DA neuron neurotransmission. Mice with conditional deletion of all Nrxns in DA neurons (DAT::NrxnsKO) exhibited normal basic motor functions. However, they showed an impaired locomotor response to the psychostimulant amphetamine. In line with an alteration in DA neurotransmission, decreased levels of the membrane DA transporter (DAT) and increased levels of the vesicular monoamine transporter (VMAT2) were detected in the striatum of DAT::NrxnsKO mice, along with reduced activity-dependent DA release. Strikingly, electrophysiological recordings revealed an increase of GABA co-release from DA neuron axons in the striatum of these mice. Together, these findings suggest that Nrxns act as regulators of the functional connectivity of DA neurons.

The human brain contains billions of nerve cells, known as neurons, which receive input from the outside world and process this information in the brain. Neurons communicate with each other by releasing chemical messengers from specialized structures, called axon terminals, some of which form junctions known as synapses. These messengers then generate signals in the target neurons. Based on the type of chemical they release, neurons can be classified into different types. For example, neurons releasing dopamine are considered to act as key regulators of learning, movements and motivation. Such neurons establish very large numbers of axon terminals, but very few of them form synapses. Specific sets of proteins, including neurexins and neuroligins, are thought to help regulate the activity of the connexions between these neurons. Previous research has shown that when neuroligins were removed from the neurons of worms or mice, it affected the ability of the animals to move. So far, the role of neurexins in managing the connectivity of regulatory neurons, such as those releasing dopamine, has received much less attention. To bridge this knowledge gap, Ducrot et al. explored how removing neurexins from dopamine neurons in mice affected their behaviour. The experiments revealed that eliminating neurexins did not affect their motor skills on a rotating rod, but it did reduce their movements in response to the psychostimulant amphetamine, a molecule known to enhance dopamine-associated behaviours. The cellular structure of dopamine neurons lacking neurexins was the same as in neurons containing this protein. But dopamine neurons without neurexins were slower to recycle dopamine, and they released a higher amount of the inhibitory messenger GABA. This suggests that neurexin acts as an important suppressor of GABA secretion to help regulate the signals released by dopamine neurons. These findings set the stage for further research into the role of neurexins in regulating dopamine and other populations of neurons in conditions such as Parkinson's disease, where movement and coordination are affected.

Rare urogenital malformation associated with complex vascular malformation -- case report.

BACKGROUND: Class 3 urogenital malformations are a rarely encountered in the clinical setting. The association with complex vascular malformations represent a challenge in diagnosis and intraoperative management with an enhanced degree of the complexity. CASE PRESENTATION: Young female presented to the emergency department with pain in the left lower quadrant and unspecific abdominal symptoms that appear regularly one week prior and during her menstruation. Diagnostic studies and intraoperative findings lead to the diagnosis of a rare urogenital malformation associated with complex vascular malformations. In conclusion the most helpful diagnostic study was the abdominal MRI. Regarding the functional status of the postoperative urogenital tract no clear assessment can be made yet.

[Lower limb revascularization--a continuous challenge]. / Revascularizarea membrului inferior--între deziderat si posibilitati.

Revascularization of the lower extremity in patients with diabetes or chronic obstructive arterial disease is a challenging, still unsolved problem. Modern day technique (stem cell therapy, hyperbaric therapy) has yet to deliver satisfactory results. Homogenous (safenous vein) or heterogeneous (terom, dacron, PTFE-teflon) by-pass surgery is limited because of technical difficulty and positive outcomes have a short duration. All these lead to, in most patients, to amputations as first line therapy or as an alternative to failed approaches. By-pass surgery is limited by graft obstruction. One of the current approaches is the use of omental flap autotransplantation.

[Enteral non-Hodgkin lymphoma in young age--difficult diagnosis]. / Limfom non-Hodgkinian forma enterala la tânar, caz subdiagnosticat.

Lately, we have been confronted with an increased number of malignant tumors of the large bowel, appearing at younger patients. Among all histopathologic forms of malignant colonic tumors treated in our Clinic, lymphoma is the fifth as frequency of apparition, respectively the fourth at patients less than 40 years old. We present the case of a 22-years-old patient, having colonic polyposis and multicentric non-Hodgkin lymphoma of the terminal ileum and ascending colon. This pathologic association represented for us an uncommon situation. The rest of malignant colonic tumors developed on patients with rectocolonic polyposis were adenocarcinoma.

[Complications in morbid obesity treatment--pylorus obstruction caused by a deflated intragastric balloon]. / Complicatii în tratamentul obezitatii--obstructie pilorica prin balon intragastric.

An aggressive array of new treatments and improvements of existing approaches for addressing morbid obesity were developed during the last two decades in response to the recognition that a new pandemic affects humanity, i.e. obesity. Initially used as a temporizing solution for other specific interventions used for obesity treatment, the endoscopic placement of an intragastric balloons has currently became in certain cases a complete therapeutic solution. Multiple studies emphasize the efficiency of this new therapeutic method, in some cases resulting in a 45 kg weight loss at the end of the monitoring period. The intragastric balloon, after endoscopic placement can be kept into position for an average period of 4-6 months. After this period, balloon extraction is recommended because of the complications that can occur with prolonged intragastric placement. This paper presents a case of pyloric obstruction by an intragastric balloon kept for 14 months. In this case, the initial approach was endoscopic, but the surgical approach offered the definitive therapeutic solution.

[Origin and evolution of human immunodeficiency viruses]. / Originea si evolutia virusurilor imunodeficientei umane.

After the diagnosis of the AIDS symptoms, in 1981, and after the discovery of the virus that causes AIDS, in 1983, the virologists have formulated different theories about its origin. Some of them involved natural causes, e.g., HIV origin from SIV strains. Other theories go further to the possibility of a deadly man-made virus escaped from laboratories or voluntary spread by some conspirative organisations. At this moment, the scientists limits themselves to search proofs to sustain the zoonotic origin of HIV from SIV and its accomodation to human body conditions.

[Diversification of influenza viruses]. / Cai de diversificare a virusurilor gripale.

The presence of flu in humankind history was cited by numerous sources (the oldest known source was written by Hyppocrates, in 412 BC), but the epidemic impact could be measured only starting with the XVIII-th century, after the pandemics from 1729 - 1733 (with estimates of about two million deaths). Nowadays, health scientists dispenses vaccines, containing the antigenes of the viruses responsible with the flu in the last winter mixed with other two major flu-types. The effect of the current flu vaccines extends over about six months from the moment of innoculation. The reason of that short effectiveness of the vaccines is given by ability of viruses to change themselves very quickly. There are two ways through which the virus can astonish the victim antibodies (humans or animals): the mutation (named antigenic drift) and the genetic recombination of the genomic segments from different strains (named antigenic shift).

Biocompatible crosslinked ß-cyclodextrin nanoparticles as multifunctional carriers for cellular delivery.

Nanoparticle-based biomedicine has received enormous attention for theranostic applications, as these systems are expected to overcome several drawbacks of conventional therapy. Herein, effective and controlled drug delivery systems with on-demand release abilities and biocompatible properties are used as a versatile and powerful class of nanocarriers. We report the synthesis of a novel biocompatible and multifunctional material, entirely consisting of covalently crosslinked organic molecules. Specifically, ß-cyclodextrin (CD) precursors were crosslinked with rigid organic linker molecules to obtain small (∼150 nm), thermally stable and highly water-dispersible nanoparticles with an accessible pore system containing ß-CD rings. The nanoparticles can be covalently labeled with dye molecules to allow effective tracking in in vitro cell experiments. Rapid sugar-mediated cell-uptake kinetics were observed with HeLa cells, revealing exceptional particle uptake within only 30 minutes. Additionally, the particles could be loaded with different cargo molecules showing pH-responsive release behavior. Successful nuclei staining with Hoechst 33342 dye and effective cell killing with doxorubicin cargo molecules were demonstrated in live-cell experiments, respectively. This novel nanocarrier concept provides a promising platform for the development of controllable and highly biocompatible theranostic systems.

[Viral small bowel intussusception: a rare cause of intestinal obstruction]. / Invaginatia intestinala de etiologie virala: cauza rara de ocluzie la adult.

Representing a rare cause of bowel obstruction, the ileal intussusception is commonly met in the pediatric surgery. Even if in children's cases the symptoms can mimick a multitude of abdominal syndromes, usually in adult cases the symptoms fit the pattern of the intestinal obstruction. This paper presents 2 clinical cases of small bowel intussusception in adult, the particularity of cases being that the pathogenesis couldn't be established first hand; the pathology exam revealed only minor inflammatory responses,including modest reactive lymph nodes in the vicinity of lesions, without further alterations. The etiology of bowel intussusception was finally attributed to viral infection with gastroenteritis, based on clinical and pathological criteria.

Efficient decellularization for tissue engineering of the tendon-bone interface with preservation of biomechanics.

Interfaces between tendon/ligament and bone ("entheses") are highly specialized tissues that allow for stress transfer between mechanically dissimilar materials. Entheses show very low regenerative capacity resulting in high incidences of failure after surgical repair. Tissue engineering is a promising approach to recover functionality of entheses. Here, we established a protocol to decellularize porcine entheses as scaffolds for enthesis tissue engineering. Chemical detergents as well as physical treatments were investigated with regard to their efficiency to decellularize 2 mm thick porcine Achilles tendon entheses. A two-phase approach was employed: study 1 investigated the effect of various concentrations of sodium dodecyl sulfate (SDS) and t-octylphenoxypolyethoxy-ethanol (Triton X-100) as decellularization agents. The most efficient combination of SDS and Triton was then carried forward into study 2, where different physical methods, including freeze-thaw cycles, ultrasound, perfusion, and hydrostatic washing were used to enhance the decellularization effect. Cell counts, DNA quantification, and histology showed that washing with 0.5% SDS + 1% Triton X-100 for 72 h at room temperature could remove ~ 98% cells from the interface. Further investigation of physical methods proved that washing under 200 mmHg hydrostatic pressure shortened the detergent exposing time from 72 h to 48 h. Biomechanical tensile testing showed that the biomechanical features of treated samples were preserved. Washing under 200 mmHg hydrostatic pressure with 0.5% SDS + 1% Triton X-100 for 48 h efficiently decellularized entheses with preservation of matrix structure and biomechanical features. This protocol can be used to efficiently decellularize entheses as scaffolds for tissue engineering.

[The clinico-evolutionary and therapeutic aspects in diastatic perforation of the cecum]. / Aspecte clinico-evolutive si terapeutiuce în perforatia diastazica de cec.

We describe five cases of diastatic perforation of cecum due to colonic cancer obstruction with secondary diffuse peritonitis, all in elderly patients with many organics dysfunctions and, most important a late arrival for hospitalisation (over 48 h). The surgical treatment aimed for the perforation and the obstruction has permitted the realization--in emergency--of: cecostomy on site of perforation, with multiple peritoneal drainage; subtotal colectomy with ileosigmoid anastomosis; cecum perforation sutures, with left colostomy, opened per primam; cecostomy on site of perforation with left colostomy, drainage. We underline the severe postoperative evolution, with only one survival be cause of the fast pace evolution of toxico-septic shock by pyostercoral peritonitis due to perforation.

Predictive value of POSSUM score in surgery of acute abdomen in cirrhotic patients.

INTRODUCTION: As liver cirrhosis has an increasing incidence in the general population and the life expectancy for these patients has increased, surgery procedures practiced for acute abdomen in such category of patients are more frequent. AIM: To evaluate the predictive value of POSSUM score in cirrhotic patients undergoing abdominal surgery in emergency cases. MATERIAL AND METHOD: A prospective study based on 115 consecutive patients with liver cirrhosis hospitalized and operated in the first 24 hours from admission for acute abdomen. The patients' stratification was done by using Child Pugh score for liver cirrhosis. POSSUM score was calculated for each patient and postoperative outcomes were compared with prediction based on this score. Statistical data analysis was made by using the chi-square test and a p value of less than 0,05 was considered to be statistically significant. RESULTS: There were 33 patients in stage Child A of cirrhosis, 54 in stage Child B and 28 in stage Child C. For Child A group, the POSSUM score had a satisfactory prediction in terms of morbidity and mortality. In advanced stages of liver cirrhosis, Child B and C, mortality had high rate and the observed outcomes were outside the area of POSSUM score prediction. CONCLUSIONS: POSSUM score offers a satisfactory prediction for morbidity and mortality in emergency abdominal surgery for patients in compensated stages of liver cirrhosis. In advanced stages of cirrhosis high levels of mortality cannot be predicted by using POSSUM score.

Prognosis elements in surgical treatment of complicated umbilical hernia in patients with liver cirrhosis.

INTRODUCTION: The surgical treatment of umbilical hernia in cirrhosis patients raises special management challenges. The attitude upon the repair of these hernias varies from expectancy or elective treatment in early stages of the disease to the surgical treatment only if complications occur. MATERIAL AND METHOD: We have assessed 22 consecutive cases of cirrhosis patients treated for complicated umbilical hernia in the Surgical Department of "Sf. Pantelimon" Emergency Hospital in Bucharest between January 2008 and December 2012. The patients' stratification was done in stages of liver disease based upon Child-Pugh classification. Complications that required emergency repair were the following: strangulation, incarceration and hernia rupture. The postoperative complications were ordered in five grades of severity based upon Clavien classification. RESULTS: The severity of the complications was higher in advanced stages of liver cirrhosis, Child B and C. There were 5 deaths representing 22,7%, four of them in patients with Child C disease stage. CONCLUSION: The incidence of morbidity and mortality after umbilical hernia repair in emergencies increases in advanced stages of liver cirrhosis. It is advisable to prevent complications occurrence and perform surgical repair of umbilical hernia in elective condition.