Razvan Hainarosie

Razvan Hainarosie

Alcohol Withdrawal Syndrome: a Review

Alcoholism is a common condition and frequently clinicians are forced to confront its complications in general hospital settings. Within each country, there is an excellent correlation between the level of alcohol consumption and the prevalence of alcohol-related harm. In fact, the consumption in Europe is 10.9 liters of pure alcohol per person per year[1]. There are an estimated 3 million alcohol-dependent people in Romania alone, with episodes of withdrawal severe enough to require pharmacologic treatment[1]. [...]

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Important Aspects to Take Into Consideration When Administering Cytotoxic Chemotherapy. A Review

In the last decade, huge efforts have been made to optimize and personalize oncological treatment. Many novel therapies and better combinations of older ones have been implemented. Even if novelty is always exciting, one has take into consideration that the way a drug is administered is as important as the drug itself. The present review focuses on how the administration of several cancer drugs can minimize the toxicity they induce. It stresses that if enough importance is given to this aspect, patients can tolerate effective doses of treatment with better outcomes and have better quality of life. [...]

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Intraoperative Monitoring of the Recurrent Laryngeal Nerve During Thyroidectomy

Following thyroidectomy, the preservation of the recurrent laryngeal nerve is the gold standard. Visual identification of the recurrent laryngeal nerve is mandatory during thyroidectomy. That technique has decreased the rate of permanent palsy during thyroid or parathyroid surgery (1). However, the palsy can occur when using only the visualization of the nerve, even in experienced hands (2).
Intraoperative nerve monitoring is a common technique in ear surgery, used to permanently monitor the facial nerve. This technique can be used in the thyroid surgery as well. Intraoperative neuromonitoring of the recurrent laryngeal nerve represents an adjuvant technique, until the visual identification and functional confirmation of the nerve.

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Transoral Approach of the Parapharyngeal Tumors

Parapharyngeal space has the shape of a reversed pyramid with the base at the cranial surface delimited by temporal and sphenoid bone and and the top pointing to the large horn of the hyoid bone.[1] Styloid diaphragm divides the parapharyngeal space into two regions with different anatomy and constituents: prestyloid space, anterior, conta-ining the deep lobe of the parotid gland, internal maxillary artery, inferior alveolar nerve, lingual, auriculo-temporal, and retrostyloid space, posterior, neurovascular, that contains the internal carotid artery, internal jugular vein, cranial nerves glossopharyngeal, vagus, accessory, hypoglossal and cervical sympathetic chain. [2]
Tumors arising in parapharyngeal space are rare, representing less than 1% of all head and neck malignancies. Any of the structures contained in this space can be a starting point for developing a tumor masses at this level. Most of these tumors are benign, approximately 20% are malignant. [1] The most common tumors of the salivary gland tissue derived from space and are epithelial in nature. Others are likely neurogenic, vascular, lymphatic, etc. [3]

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The Use of NBI in Early Detection and Follow up of the Laryngeal Malignancies

Laryngeal tumors are often discovered in advanced stages because the patients do not pay attention to early symptoms. Sometimes small tumors are difficult to see even if the surgeon performs a fiber optic exam that uses conventional white light. In the last years some technologies started to be used in order to help the surgeon to perform an early detection or to follow up de patient with laryngeal malignancies (1). Early detection of laryngeal neoplasm is one of the most important factors for the success of the treatment. Visualizing abnormal modification at the follow up exam for patient with laryngeal cancer will help the surgeon to initiate the treatment for the recurrence. Some of technologies such as autofluorescence or video contact endoscopy started to be used for early detection of laryngeal malignancies (2,3).

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The Use of Ultrasonic Aspirator in the Surgery of the Fibrous Dysplasia Involving the Skull Base

Craniofacial fibrous dysplasia is a non-malignant disease. It appears due to the mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. Sometimes it is isolated to a single or multiple skeletal sites and / or endocrine organ (1, 2, 3, 4). The disease commonly progress as a slow developing mass. Distortion of optic nerve, eye ball, nasal airway, facial nerve, teeth and middle year ossicles can occur. In young patients, at prepubertal age, the growth is rapid and can cause aneurismal bone cysts or mucoceles (1, 3, 5). The malignant change to osteosarcoma or other form of sarcoma can appear in less than 1% of cases (1, 2).

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The Use of Coblation in the Surgery of the Juvenile Angiofibroma

Coblation is a surgical technology which consists in delivering radiofrequency energy to soft tissue. This technology uses radiofrequency in a bipolar mode with a conductive solution, such as saline (1). It energizes the ions in the saline to form localized plasma near the tissue placed in the area of surgical interest. Plasma’s energy dissociates water molecules from saline solution thus providing the optimal chemical conditions for breaking the tissue’s molecular bonds (2). The application of this technology has three effects: tissue ablation, localized removal and tissue volumetric reduction (2). The dissipated heat by using this type of radiosurgery is significantly lower than common radiofrequency techniques. This is due to intrinsic of the chemical process and the continuous cooling of the tissue from the surrounding saline solution at the level of the instrument’s tip (3). In this way the temperature rises to 45-85°C (1, 2). The decreased thermal effect of coblation, better than classic radiosurgery, induces a gentle but efficient surgical effect in the target area. Thus the surgeon can gently remove tumors, small organs (tonsils) and can melt some anatomical structures (turbinate, palate, base of tongue). There is a large field of surgical applications in the pathology of the upper aero digestive tract.

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The Use of the Composite Muco-perichondrial-cartilaginous Vascularised Septal Flap in the Reconstructive Surgery of the Skull..

The original vascularised nasoseptal mucoperichondrial flap was described and used, in the endoscopic reconstructive surgery of the skull base tumors, for the first time in 2006, by two surgeons, Hadad and Bassagasteguy [1]. This kind of vascularised flap provides the surgeons the ability to close large skull base deffects after removing sinonasal tumors. The vascularisation is provided by the posterior septal branch of the spheno-palatine artery [1]. The flap is well vascularised and the surgeon is able to harvest a large surface flap using almost all septal mucosa from one nostril. Sometimes, if the defect that had to be reconstructed was very large, some authors reported that they harvested the nasal mucosa from the nasal floor too. Some modifications were reported on patients where the flap was created by using bilateral nasal mucosa, but no advantage was gained by sub-maximal, bilateral septal flap harvesting as compared to a single, large, long, unilateral flap, taken to the vestibular skin anteriorly and to the inferior meatus laterally including the palatal floor [2,3]. Bilateral mucosal elevation leaves denuded septal cartilage and bone on both sides of the septum which prolongs the return of nasal mucosal function unless a formal posterior septectomy is also performed. The large surface area of the nasoseptal flap allows great versatility of movement [4]. It is capable of reaching any single segment of the ventral skull base, including the sella turcica, planum sphenoidale, clivus or the cribriform plate [4,5]. At its largest dimension, the nasoseptal flap is able to cover an entire anterior craniofacial defect from the frontal sinus to the planum sphenoidale and from orbit to orbit. The good vascularisation of the flap and the origin of the vascular source provide the surgeon with the ability to rotate the flap almost all directions [5].

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The Management of Facial Fibrous Dysplasia

Fibrous dysplasia is a benign condition consisting in replacement of normal bone with fibrous tissue and unorganized bone woven (1). The malignant change to osteosarcoma can appear in less than 1% of cases (2). Osteosarcoma is found most often, but other lesions as fibrosarcoma, chondrosarcoma, and malignant fibrohistiocytoma are reported (3,4). Fibrous dysplasia appears due to somatic activation of mutation in the G protein encoded by the gene GNAS. GNAS gene mutations cause McCune-Albright syndrome defined by the triad of PFD, café-au-lait skin macules and endocrinopathies, including amongothers, precocious puberty (5). It is caused by a random mutation in the GNAS gene that occurs very early in development.

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

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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