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

Crenguta Coman

Crenguta Coman

Imaging Diagnosis in Colorectal Endometriosis

Colorectal deep infiltrative endometriosis (DIE) can have a major impact on patient’s health and quality of life. Surgical treatment of colorectal DIE varies depending on the location and characteristics of the lesions, which is why the preoperative non-invasive diagnosis needs to be correct and complete. Multiple imaging methods are currently available, but their usefulness is still being studied, as none of them has proven itself perfect. In the present study we wanted to find out to what extent the combined use of magnetic resonance imaging (MRI), endorectal ultrasound (ERUS) and computed tomography-based virtual colonoscopy (CTC) helps perform the preoperative mapping of lesions. We conducted a retrospective study of prospectively collected data that included 49 patients operated for colorectal DIE. In identifying rectal nodules, MRI as a single diagnostic method was the most useful. When ERUS or CTC was added, the concordance between intraoperative and imaging results was very strong. CTC was the most useful in identifying sigmoid nodules. ERUS evaluates the depth of rectal nodules best. CTC assesses best the stenosis for both rectal and sigmoid nodules. Each method contributed to the completion of the diagnosis, so performing ERUS and CTC in addition to MRI seems to be preferable in patients with colorectal DIE.

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The Benefit of Breast Reconstruction after Mastectomy

Being diagnosed with breast cancer means that the involved patients are dealing with a new phase in their lives. We can say that their priorities change radically. A study from 2011 shows that the leading cause of cancer deaths, in women, in developing countries, is breast cancer, compared to the past decade where the main cause was the cervical cancer. (1)
Up to accepting the diagnosis and regaining the strength to move forward, women go through frustration, denial, guilt, feelings exacerbated by physical mutilation (mastectomy) which they have to deal with this disease. Breast cancer is the most commonly diagnosed cancer and the main cause of cancer death among females, representing 23% of total cancer cases and 14% of cancer deaths. (1)

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PERFORATORS OF THE CALF ARTERIES - ANATOMICAL STUDY

In reconstructive surgery, perforator flaps have a short history. Not more than 27 years ago, Nakajima et al. described the six types of perforator vessels known at present: direct cutaneous, direct septocutaneous, direct cutaneous branch of muscular vessel, perforating cutaneous branch of muscular vessel, septocutaneous perforator and musculo-cutaneous perforator [1]. (Fig. 1)
The knowledge about these perforator vessels continuously grew, by identifying the vascular networks of the entire body, formed by the perforator vessels. Therefore, it became possible to create a lot of perforator flaps based on these perforator vessels [2]. Thus, perforator flaps can be considered the latest milestone in the evolution of reconstructive flap surgery. Many methods are used for investigating the exact location of the perforators, such as imaging methods: computed tomography, magnetic resonance angiography and lately thermal imaging that became also reliable [3]. The exact knowledge of the location and caliber of perforators became a real help for plastic surgeons, especially in the calf area, where the reconstructive method has to accomplish the functional and aesthetic needs for both reconstructed and donor areas.

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