The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

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Hypopharyngeal defect reconstruction, following extended total laryngectomy, using a myocutaneous sternocleidomastoid flap

2014-01

O. Ceachir, R. Hainăroșie, V. Zainea

Hypopharyngeal cancer represents approximately 7% of all head and neck malignancies, occurring more frequently in men (male / female ratio 3:1) with a maximum incidence in the 6th and 7th decades (1, 2).

The lack of specific symptoms causes late presentation with advanced T-stage disease (T3-T4) which restricts surgical options to total laryngectomy with partial pharyngectomy or total laryngectomy with circular pharyngectomy, associated, in most cases, with bilateral neck dissection (1, 3). Submucosal extension of the tumor is what compels the surgeon to practice an extended resection in order to meet the criteria of oncological resection (4, 5). In order to achieve a primary suture of the pharynx is imperative that the width of the remaining mucosa is at least 2.5-3 cm (2, 6). If this goal is not achieved then the resectional stage is mandatory followed by a reconstructive one, in order to prevent pharyngocutaneous fistula occurrence, pharyngeal stenosis or poor vocal rehabilitation. For lateral pharyngeal wall defects, reconstruction can be performed using regional flaps (myocutaneous pectoralis major flap, lateral island trapezius, deltopectoral flap, latissimus myocutaneous flap, submental island flap) or free flaps (radial forearm fasciocutaneous free flap, lateral arm free flap) (1,2,3,5,6). If a circumferential resection has been performed the optimal reconstruction is the one that re-creates a lumen that can allow normal deglutition so, jejunal free flaps, ileocolic free flaps, radial arm free flaps, anterolateral tigh flap, peroneal flap, gastro-omental free flap, gastric transposition and many other methods were successfully used (3, 5, 6, 7, 8, 9). The reconstructive procedure performed by us used a pediculated, myocutaneous sternocleidomastoid flap harvested from the same side as the lesion and it was addressed to a lateral hypopharyngeal wall defect.

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Revascularization - A Key Element for Obtaining Granulation Tissue in a Patient with Diabetes and Arteriopathy

2014-01

Mihaela Vīlcu, Z. Filipovski, I. Brezean, T. Pătrașcu

The morbidity of the patients with diabetes is generated - besides the renal, occular, cerebral, cardiac impairment - to a great extent by the diabetic foot infections. The infection develops due to the ulcerations whose etiology (neuropathy or arteriopathy) is particularly important for the approach of the therapeutic algorhythm, which often involves an interdisciplinary collaboration. Diabetes mellitus is the risk factor associated with the highest rate of critical ischemia of the lower limbs. [1]

The association of peripheral arterial disease with infection represents the determining binomial of major amputations in the patient with diabetes and, in 80% of the cases, the gateway is an ulceration of the foot. [1].

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A Retrospective Clinical Study of 640 Scoliosis Treated by Posterior Segmental Rachisynthesis

2014-01

M. Jianu, A. Thiery, Beatrice Frumușeanu, Raluca Damean, Violeta Oriță

Although the scoliosis has in Romania relatively the same incidence as in most of the European countries, it is usually late diagnosed, when the Cobb angle has significant values.

Since 2010, Romania has a program of screening and early treatment of spine deformities funded by The Ministry of Health.

In a 14 years period in Pediatric Orthopedic Department of Central Emergengy Hospital for Children "Grigore Alexandrescu" Bucharest and also in the private hospitals "Regina Maria" and "Sanador" were examined and diagnosed 14.853 patients with scoliosis.

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Reactive Thrombocytosis in Pediatric Pathology

2014-01

Alina Deaconu, Cătălina Bica, D. Bulucea

Thrombocytosis (over 500.000/mmc) is classified as primary (clonal) or secondary (reactive). Increasing the number of platelets as response to various stimuli (inflammatory diseases, acute and recurrent bleeding, systemic infections or various types of malignancies) are considered to be reactive thrombocytosis [1,2,3].

Clonal or primary thrombocytosis (PT) is an abnormality of platelets production caused by clonal expansion of hematopoietic progenitor cells. In primary thrombocytosis autonomous platelets production is not regulated by physiological feedback mechanisms to maintain platelets count normal.

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The Dietotherapy of Malignant Degeneration of Small Intestine and Colon, Correlated with the Anticancerous Therapy

2014-01

T. Mogoș, Andra Evelin Iacobini

The presence of primary or metastatic cancer in small intestine has as a first line treatment the segmental resection. We reach the same therapeutic conduct in case of cancerous patients exposed to abdominal radiation therapy, sometimes severily affecting the small intestine (perforations, strictures, hemorrhages, fistulae). The nutritional implications of intestinal resection are significant, given the role of small intestine in digestion and absorbtion of nutricious principles, and the maintainance of enterohepatic circulation of biliary salts [1].

When we resort to ileal resection, if it does not exceed 100 cm, then a considerable part of biliary salts can not enter the reversed hepatic circuit (the surface for intestinal absorbtion diminishes) and they enter the colon, where they induce a watery diarrhea. It can be avoided if the patient is administered cholestyramine (it binds biliary salts, making them unable to induce diarrhea). Dietary measures alone are not sufficient. We start with 4 grams of cholestyramine per day, dosage after which the diarrhea stops abruptly. Afterwards, the dosage is decreased to half or less. In the mentioned conditions, though a part of the biliary salts loose their capacity to emulsify fats, the absorbtion of fats is not considerably disturbed [2].

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