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Multiple sclerosis (MS) is the leading cause of non-traumatic disability in young adults. New avenues are needed to help predict individuals at risk for developing MS and aid in diagnosis, prognosis, and outcome of therapeutic treatments. Previously, we showed that skin fibroblasts derived from patients with MS have altered signatures of cell stress and bioenergetics, which likely reflects changes in their protein, lipid, and biochemical profiles. Here, we used Fourier transform infrared (FTIR) spectroscopy to determine if the biochemical landscape of MS skin fibroblasts were altered when compared to age- and sex-matched controls (CTRL). More so, we sought to determine if FTIR spectroscopic signatures detected in MS skin fibroblasts are disease specific by comparing them to amyotrophic lateral sclerosis (ALS) skin fibroblasts. Spectral profiling of skin fibroblasts from MS individuals suggests significant alterations in lipid and protein organization and homeostasis, which may be affecting metabolic processes, cellular organization, and oxidation status. Sparse partial least squares-discriminant analysis of spectral profiles show that CTRL skin fibroblasts segregate well from diseased cells and that changes in MS and ALS may be unique. Differential changes in the spectral profile of CTRL, MS, and ALS cells support the development of FTIR spectroscopy to detect biomolecular modifications in patient-derived skin fibroblasts, which may eventually help establish novel peripheral biomarkers.

Hypodiploid acute lymphoblastic leukemia (ALL) is an aggressive blood cancer with a poor prognosis despite intensive chemotherapy or stem cell transplant. Children and adolescents with positive end-of-induction minimal residual disease have an overall survival lower than 30%. However, data regarding therapeutic alternatives for this disease is nearly nonexistent, emphasizing the critical need for new or adjunctive therapies that can improve outcomes. We previously reported on the therapeutic efficacy of venetoclax (ABT-199) in hypodiploid B-lineage ALL but with limitations as monotherapy. In this study, we set out to identify drugs enhancing the anti-leukemic effect of venetoclax in hypodiploid ALL. Using a highthroughput drug screen, we identified dinaciclib, a cyclin-dependent kinase inhibitor that worked synergistically with venetoclax to induce cell death in hypodiploid cell lines. This combination eradicated leukemic blasts within hypodiploid ALL patient-derived xenografts mice with low off-target toxicity. Our findings suggest that dual inhibition of BCL-2 (venetoclax) and CDK9/MCL-1 (dinaciclib) is a promising therapeutic approach in hypodiploid ALL, warranting further investigation to inform clinical trials in this high-risk patient population.

Since the outbreak of the COVID-19 pandemic in December 2019 there has been an array have studies regarding otolaryngologist and head and neck surgeons considering the exceptionally high risk of exposure. The purpose of this article is to evaluate the current practice in an oncology ENT Department, which ensures health care services for upper aero digestive tract cancer patients. It is of outmost importance that all the health care providers are aware of good clinical practice recommendations and training, according to the current guidelines that needs to be performed as often as possible, so that the implementation of the institution specific guidelines to be optimal. Performing a tracheostomy for an ENT emergency in a patient with suspected or confirmed COVID-19 disease requires preparation from the health care provider so, after reviewing the international literature, we have elaborated a protocol and guidelines in Colțea Clinical Hospital to ensure the possibility of performing emergency surgical interventions for oncology patients. Testing for SARS-CoV-2 is mandatory prior to surgery since opening the trachea and operating on the upper respiratory tract leads to aerosol particles that can infect the surrounding environment and health care providers. Limitations are predictable as long as health care systems are being under tremendous pressure from the general condition and by patients with life threatening disease.

Solid tumors represent chronic disease that can be rarely detected, diagnosed and treated without the use of a multidisciplinary team. When a neoplastic disease is initially evaluated, involvement of a single physician does not seem to be sufficient to establish diagnosis and staging. Assessment of each individual case of malignancy is the main purpose of the entire medical staff engaged in treating cancer patients. In Romania, the use of oncology committee with a multidisciplinary form of organization has been set to work in Bucharest and Cluj-Napoca, since the beginning of 1978 under direct supervision of professors Alexandru Trestioreanu and Ion Chiricuță. The joint session of the tumor board resides into establishing the optimal oncology therapy for each patient. The task of informing the patient about the decision is performed by the physician that is overseeing the patients’ evolution. There is no mandatory oncology therapy action from behalf of the physician after the decision of the tumor board was made. However, it is more likely for head and neck cancer patients to receive better, more accurate staging, as well as optimal oncology therapy in a local or academic hospital tumor board setup.

Introduction. The quality of life of patients after total laryngectomy is influenced by both the disease and the radical therapeutic interventions. After surgical treatment, vocal rehabilitation, along with pulmonary and deglutition rehabilitation, are necessary. The objective of the study was to assess the quality of life in patients with total laryngectomy. Materials and methods. A questionnaire with 14 questions was randomly addressed to 100 patients with total laryngectomy who presented to Coltea Clinical Hospital, Bucharest, Romania, over a period of three months. Results. Fifty patients answered that they had no pain. Regarding everyday activities, 34 patients answered that they were as active as before surgery. Regarding their appearance, 50 patients answered that there is no change, or the change is minor, while 39 answered that their appearance bothers them, but they remain active, and 5 answered that they feel disfigured and limit their activity, while 6 patients answered that they cannot be with other people because of their aspect. 34 patients answered that they could swallow as well as prior to surgery, other 34 patients answered that they cannot swallow certain foods, while 21 answered that they only swallow liquid food or are dependent on a feeding tube. Regarding everyday activity, 67 patients answered there are times when they cannot keep up with their old pace, but they get out of the house and enjoy life. About their mood, 38 patients answered that they were not in a good mood, nor depressed, while 36 said their mood is generally good and only occasionally affected by cancer. Six patients answered that their mood is excellent, while 15 patients were somewhat depressed and 5 were extremely depressed. Conclusions. The quality of life is influenced by the patients’ appearance after total laryngectomy, and their ability to maintain everyday activities. Swallowing, taste and saliva quality have a great impact on the quality of life of patients with total laryngectomy and also influence their nutritional status.

Introduction. Squamous cell carcinoma of the tongue is a very rare disease among children, with only a few cases reported in the literature. The tongue is the most common site for oral malignancy. The main contributing factors to pelvilingual cancer are constant irritants of the oral mucosa, such as tobacco, alcohol, and dentures. In children, however, the risk factors are immunosuppression induced by a hemopathy such as Fanconi anemia or by chemotherapy, Xeroderma Pigmentosum Syndrome or KID (keratitis, ichthyosis, deafness), Plummer-Vinson syndrome. Cases presentations. The authors present two cases of children, 12 and 15 years old, diagnosed with pelvilingual malignant neoplasia, for which review of the clinical manifestations, the methods of diagnosis and treatment used, but also the evolution will be described. Conclusions. Clinical symptoms of tongue cancer are similar to other types of neoplastic diseases developed in the oral cavity (for example oral floor neoplasm). Confirmation of the diagnosis is made by histopathological examination of the tissue specimen obtained from the tumor site. Therapy has a complex multimodal approach and includes, depending on staging, general condition, and the patient’s option, primary and adjuvant methods. Surgery followed by radio-, chemo-, immunotherapy are the preferred methods. Another possibility is tumor stage conversion by radio-, chemo- and immunotherapeutic treatment, followed by surgery. In some cases, surgery is an ultimate method of therapy, a salvage therapy.

Advanced analytical methods play an important role in quantifying serum disease biomarkers. The problem of separating thousands of proteins can be reduced by analyzing for a ‘sub-proteome’, such as the ‘metalloproteome’, defined as all proteins that contain bound metals. We employed size exclusion chromatography (SEC) coupled to an inductively coupled plasma atomic emission spectrometer (ICP-AES) to analyze plasma from multiple sclerosis (MS) participants (n = 21), acute ischemic stroke (AIS) participants (n = 17) and healthy controls (n = 21) for Fe, Cu and Zn-metalloproteins. Using ANOVA analysis to compare the mean peak areas among the groups revealed no statistically significant differences for ceruloplasmin (p = 0.31), α2macroglobulin (p = 0.51) and transferrin (p = 0.31). However, a statistically significant difference was observed for the haptoglobin-hemoglobin (Hp-Hb) complex (p = 0.04), being driven by the difference between the control group and AIS (p = 0.012), but not with the MS group (p = 0.13), based on Dunnes test. A linear regression model for Hp-Hb complex with the groups now adjusted for age found no statistically significant differences between the groups (p = 0.95), but was suggestive for age (p = 0.057). To measure the strength of association between the Hp-Hb complex and age without possible modifications due to disease, we calculated the Spearman rank correlation in the healthy controls. The latter revealed a positive association (r = 0.39, 95% Confidence Interval = (-0.05, 0.83), which suggests that either the removal of Hp-Hb complexes from the blood circulation slows with age or that the release of Hb from red blood cells increases with age. We also observed that the Fe-peak corresponding to the Hp-Hb complex eluted ~100 s later in ~14% of all study samples, which was not correlated with age or disease diagnosis, but is consistent with the presence of the smaller Hp (1–1) isoform in 15% of the population.

In our work, the kinetics of martensitic transformations and the influence of thermal treatments on martensitic transformations, as well as the related magnetic properties of the Ni49Mn32Ga19 ferromagnetic shape memory melt-spun ribbons, have been investigated. Thermal treatments at 673 K for 1, 4 and 8 h can be considered an instrument for fine-tuning the performance parameters of alloys. One-hour thermal treatments promote an improvement in the crystallinity of these otherwise highly textured ribbons, reducing internal defects and stress induced by the melt-spinning technique. Longer thermal treatments induce an important magnetization rise concomitantly with a slight and continuous increase in martensitic temperatures and transformation enthalpy. The activation energy, evaluated from differential scanning calorimeter experimental data with a Friedman model, significantly increases after thermal treatments as a result of the multi-phase coexistence and stabilization of the non-modulated martensitic phase, which increases the reverse martensitic transformation hindrance.

The influence of processing on the martensitic transformation and related magnetic properties of the Ni55Fe18Nd2Ga25 ferromagnetic shape memory alloy, as bulk and ribbons prepared by the melt spinning method and subjected to different thermal treatments, is investigated. Structural, calorimetric, and magnetic characterizations are performed. Thermal treatment at 1173 K induces a decrease in both the Curie and the martensitic transformation temperatures, while a treatment at 673 K produces the structural ordering of the ribbons, hence an increase in TC. A maximum value of the magnetic entropy variation of −5.41 J/kgK was recorded at 310 K for the as quenched ribbons. The evaluation of the magnetoresistive effect shows a remarkable value of −13.5% at 275 K on the bulk sample, which is much higher than in the ribbons.

Oral and pharyngeal cancer are currently on an ascending slope in terms of incidence, mainly due to alcohol and tobacco consumption. In terms of risk factors, certain subtypes of HPV have been associated with an increased incidence of oral cancer. Despite the knowledge of the methods of oral cancer prevention, screening is less efficient in some areas where medical services are unavailable or patients are not educated on the topic. This trans-oral robotic derived approach was introduced by M.M. Fernandez in 2014 as an alternative to the classical approach of the malignant tumors of the oral cavity, oropharynx and hypopharynx. In some selected cases, partial laryngectomy is an indication for using this technique. The aim of this paper is to present some early considerations on this technique with indications, complications, advantages and disadvantages.

The ENT practitioner has a principal role for diagnosis, treatment and clinical recovery of vestibular schwannoma patients. These tumors require a special attention, concerning the treatment and the follow-up, because of their location in a deep anatomical region, very rich in vascular and neurological elements. If surgery is chosen as the best treatment modality, the vascular related complications, during surgery or immediately after surgery, can be disastrous for the patient. The surgeon must have the anatomical knowledge and appropriate skills. The anatomy of the venous system has an individual variability, with an impact to the procedure’s surgical risks. The objective of this publication is to synthetize the local venous anatomy and surgical practices in case of venous bleeding at the level of the pontocerebellar angle.

A patient with pontocerebellar pathology has complaints in the ENT field, like hearing loss, tinnitus, vertigo or facial pain The vestibular and non-vestibular schwannoma are the most frequent pathologies of this anatomical region, and because of their “mild” clinical manifestations, the diagnosis can be delayed during a regular follow-up. Improvement of differential diagnosis between vestibular schwannoma and non-vestibular schwannoma requires a detailed anamnesis as well as radiological and electrophysiological exams. Nevertheless, the non-vestibular tumors are often misdiagnosed as vestibular tumors. The surgeon must have all the knowledge and skills in order to provide, case by case, the right diagnosis and the best care for his patient. The aim of this publication is to overview the most recent data related to pontocerebellar non-vestibular schwannoma.

Laryngeal cancer continues to raise challenges for specialists all over the world even if there has been improvement in its diagnosis, therapeutic options and comprehensive view of the malignant tumor process. The decision of the oncological committee is not subject to the preferences of the patient, since in terms of therapy, this is the role of the specialist treating the patient. It is very important that the patient should know the implications of total surgery and that the patient has a poorer quality of life after total laryngectomy. The quality of life of these patients has been assessed by means of European quality of life questionnaires in terms of physical status and symptoms, social integration and psychoemotional status. The absence of voice, the impairment in swallowing, the esthetic impairment, the family and social reintegration need to be addressed by the oncological team so that the quality of life of these patients be at optimal levels. The specific questionnaires for the quality of life evaluation need to be used for any patient with laryngeal cancer and key points need to be addressed individually to meet each patient's expectations.

Objective Acute hematogenous osteomyelitis (AHO) has declining incidence in developed countries. AHO can cause rapid destruction of bone that can lead to functional impairment or even death if misdiagnosed and not treated urgently. In this study, we aimed to identify the main factors that may lead to a poor outcome and to establish a profile of patients with AHO who might have a negative outcome. Methods We conducted a retrospective single-center study including 94 patients with AHO, over a 10-year interval. Complete medical history including age at diagnosis, sex, socioeconomic status, symptoms, entry portal, pathogenic agent, location of infection, radiological features, treatment, and outcome were recorded. Results Male predominance was observed, with boys from rural areas more prone to a poor outcome. This is likely because they are more exposed to trauma and do not have proper access to emergency medical care. Staphylococcus aureus was the most common etiologic agent, with 84 patients testing positive. Disease evolution was toward chronicity in patients diagnosed late. The most frequent complications were sepsis and pathological fractures. Conclusions In our study, patients with negative outcomes were characterized by young age, repeated negative cultures, delayed surgery, rural residence, and male sex.

Locally advanced larynx cancer benefits from curative surgery therapy. Clinical trials have been proposed for assessing the quality of life for patients with larynx malignant neoplasia who underwent radical surgery. The removal of the “voice box” is known to have great impact on the social reintegration of these patients as well as psychological distress. The presence of tracheostomy and voice impairment are two of the major issues that need to be thought of by patients that will have a total laryngectomy. The quality of life is a multi-dimensional subjective and personal concept which includes normal physical activity, looks, psychological status, somatic symptoms and, non the less, sexual activity. Cancer free survival intervals for patients with larynx cancer must be evaluated physical and psychological modifications with particular considerations to stress, anxiety and depression related symptoms and to functional rehabilitation adaptation regarding swallowing and speech. Oncology surgeons must consider that QoL is impaired in all patients with larynx cancer that benefit from total laryngectomy. However, there is evidence presented below that the difference in QoL parameters is small when comparing radical surgery, total laryngectomy, and larynx conservation by radio and chemotherapy.

Laryngo-tracheal stenosis is a complex pathology which requires multiple surgical interventions and diligence from the surgeon and patience from the patient so that normal physiology may be restored. The aim of this paper is to evaluate the factors that can influence the evolution of this pathology. It is presented a retrospective study in which 20 cases of larynx stenosis from 2008 until 2018 were evaluated. The study revealed a predominance of the pathology in men, especially from rural environment. The etiology of larynx stenosis was both iatrogenic and traumatic. Multiple surgical interventions classical and endoscopic were necessary, along with tracheostomy. In 7 cases there was the need for larynx stent to be mounted. There was no significant correlation between age, etiology and the site of stenosis and the removal of the tracheostomy. Larynx stenosis benefit in present by modern surgical techniques. Current therapeutic options include conservative therapy, endoscopic approach and external approach depending on the site, severity, morbidities of the stenosis. Even if technology is of great help in LS management of many patients, unfortunately there are still cases where therapy is very complex and with poor functional results.

Therapy for those with relapsed or refractory acute myeloid leukemia is suboptimal. Studies have suggested that timed sequential salvage combination cytotoxic chemotherapy may be particularly useful for that indication. We report here a series of ten such adult patients treated sequentially at a single center with EMA (cytarabine 500 mg/m2/day as continuous infusion on days 1–3 and days 8–10, mitoxantrone 12 mg/m2/day on days 1–3, and etoposide 200 mg/m2/day as continuous infusion on days 8–10). The overall complete remission rate was 40% (including 3 of 4 of those with relapsed disease), but use of this regimen was associated with prolonged cytopenia and a high rate of infectious adverse events. Even with the availability of modern infectious prophylaxis and therapies, the EMA regimen is likely best reserved for those with relapsed disease treated with curative intent prior to an allogeneic hematopoietic cell transplant.

Infections of the deep neck spaces often present a clinical challenge for the ENT surgeon. Management of these complex suppurations of the neck requires in fact a multidisciplinary approach due to possible complications like mediastinitis, septic shock and MSOF, life threatening bleeding and ICU management. The spread of infection from the primary site to other regions is possible through the lymphatic, arterial and venous vessels, or directly along the fasciae. There are several classifications for the etiology, pathogenic mechanism and site of evolution, the most frequently encountered clinical forms being peritonsillar abscess, retropharyngeal abscess, lateropharyngeal abscess, and the deep cervical abscess. All of these abscesses are suppurative complications of primary neck infections. Extensive inflammation and suppuration of the neck requires in most cases multiple incisions for drainage such that patients experience significant scarring of the neck. Along with the presence of the tracheostomy and nazo-gastric feeding tube, the aesthetic aspect of the neck surgery involves a high degree of psychological stress for the patients. As a conclusion and in line with literature data, patients must be fully informed about the technique and the outcome of the surgery so that they can provide informed consent since the pathology can be both life- threatening and mutilating.

Dysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare nonhereditary skeletal disorder affecting one side of the epiphyses or the epiphyses-equivalents. It is often misdiagnosed for traumatic injuries, infections, or other tumors because of the nonspecific clinical features. The diagnosis is mostly based on radiographic involvement of one half of the epiphysis displaying an overgrowth; it is hard to distinguish between DEH and osteochondroma on the gross hystopathological exam. There are few immunohistochemical markers, as well as genetic tests, for EXT1 and EXT2 gene expression that can reveal a more accurate diagnosis. No evidence of malignant changes has been reported and no hereditary transmission or environmental factor has been incriminated as an etiological factor. The natural history of the disease is continuous growth of the lesions until skeletal maturity. Without treatment, the joint might suffer degenerative modification, and the patient can develop early onset osteoarthritis. In the present paper, we report two new cases of DEH of the ankle. The aim of this paper is to consider Trevor’s disease when encountering tumoral masses in the epiphyses of pediatric patients and to present our treatment approach and results.

The influence of the rapid solidification technique and heat treatment on the martensitic transformation, magnetic properties, thermo- and magnetic induced strain and electrical resistivity is investigated for the Cu doped NiMnGa Heusler-based ferromagnetic shape memory ribbons. The martensitic transformation temperatures are unexpectedly low (below 90 K—which can be attributed to the disordered texture as well as to the uncertainty in the elements substituted by the Cu), preceded by a premartensitic transformation (starting at around 190 K). A thermal treatment slightly increases the transformation as well as the Curie temperatures. Additionally, the thermal treatment promotes a higher magnetization value of the austenite phase and a lower one in the martensite. The shift of the martensitic transformation temperatures induced by the applied magnetic field, quantified from thermo-magnetic and thermo-magnetic induced strain measurements, is measured to have a positive value of about 1 K/T, and is then used to calculate the transformation entropy of the ribbons. The magnetostriction measurements suggest a rotational mechanism in low fields for the thermal treated samples and a saturation tendency at higher magnetic fields, except for the temperatures close to the phase transition temperatures (saturation is not reached at 5 T), where a linear volume magnetostriction cannot be ruled out. Resistivity and magnetoresistance properties have also been measured for all the samples.

This work focuses on the temperature evolution of the martensitic phase ε (hexagonal close packed) induced by the severe plastic deformation via High Speed High Pressure Torsion method in Fe57Mn27Si11Cr5 (at %) alloy. The iron rich alloy crystalline structure, magnetic and transport properties were investigated on samples subjected to room temperature High Speed High Pressure Torsion incorporating 1.86 degree of deformation and also hot-compression. Thermo-resistivity as well as thermomagnetic measurements indicate an antiferromagnetic behavior with the Néel temperature (TN) around 244 K, directly related to the austenitic γ-phase. The sudden increase of the resistivity on cooling below the Néel temperature can be explained by an increased phonon-electron interaction. In-situ magnetic and electric transport measurements up to 900 K are equivalent to thermal treatments and lead to the appearance of the bcc-ferrite-like type phase, to the detriment of the ε(hcp) martensite and the γ (fcc) austenite phases.

Ultrasound exerts an important role in breast cancer diagnosis protocol, but the use of eco-senometry can also improve therapeutic options, surgical planning and technique. We describe various measurement formulas and techniques that are applied in order to acquire important information regarding the breast and its lesions. Senometry and ultrasonography have been proven to be very effective, reaching up to reliability levels as high as 0.997 and accuracy levels as high as 99.6%. Senometry and ultrasonography have clearly demonstrated their value in breast cancer diagnosis and treatment. These methods are reliable, inexpensive and can be easily performed by the surgeon. More advances in the domain are expected in the future.

Coping mechanisms are patients’ means of adapting to stressful situations and involve psychological and physical changes in behavior. Patients adapt to head and neck cancer in a variety of ways. Head and neck cancers are extremely debilitating, especially in advanced stages of the disease or in end-of-life situations. While an oncology team needs to address the needs of all oncology patients, the advanced terminal patients require special attention. Most of these patients do not cope well with their situation and have a tendency to cease social interactions. Pain is the most frequentlyexperienced medical disability in patients having an end-stage illness experience, and thus an important medical endeavor is to afford dignity to the dying patient facingan incurable disease. In such cases, the medical community should never refuse therapy or to assist a dying patient.In some instances, the patient and family may derive benefit from their religious beliefs.

The therapeutic management decision-making process for breast cancer is complex, and is influenced by multiple factors including patient age, comorbidities, ethnicity, education, and availability of immediate or delayed reconstruction options. Our study analysed 276 patients diagnosed with breast cancer in the “Colțea” Clinical Hospital between 2014 and 2015. Mean patients age was 61.24, median 62, with a range of 31 to 89 years. Younger age was associated with a less advanced local disease and younger patients were more likely to choose and benefit from conservative surgery. Most patients (61.76%) came from rural areas. Place of origin had a significant influence on the tumor size at the time of diagnosis (3.9 cm vs. 1.8cm) as well as on the choice of surgical procedure. Personalized treatment management plans that include aesthetic satisfaction coupled with oncological safety should be the objectives of contemporary breast surgery. Patient age is so important to the decision making process that it has been proposed as a determinant of educational and counselling strategies. From our experience, young patients from urban areas were more proactive patients. They were diagnosed earlier and more involved in treatment decisions compared with patients from rural areas, who generally did not question the surgeon’s opinion. Factors that influence the decision-making process likely include age, socioeconomic status, availability of radiotherapy, the necessity of periodic follow-up and the concern about recurrence.

Necrotizing fasciitis represents a severe and rare infectious disease, which is accompanied by extended necrosis of subcutaneous tissues and fascia layers, having as a result gangrene of the teguments. To reduce mortality associated with this disease, a rapid diagnosis is necessary as well as aggressive surgical treatment, accompanied by adequate, aggressive antibiotic therapy. As a rule, etiology is teeth related, with the condition more common in immunology-depressed patients. This article presents the experience of the authors regarding a case presentation of necrotizing fasciitis with typical clinical expression and management of the disease in an immunological-depressed patient. Further data on diagnosis, microbiology, clinical manifestations, therapy principles, and prognosis are yet needed for atypical cases.

Pharynx fistula is a pathological state that can pose serious problems for both physician and patient and can lead up to the death of the patient in complicated cases. The authors describe a series of guidelines for the management of the pharynx fistula regarding the complications of the instrumentation of the upper digestive tract. Most of the cases that are addressed to our clinic can be treated with a conservative approach and a nutrition therapy plan tailored to each case. In selected cases surgery is the method of choice for therapy. The management of the pharynx fistula can be well managed in a multidisciplinary approach using resources from the E.N.T. and H.N.S. department and more important from the ICU department.

Introduction. Pre and postoperative psychological status is an important aspect in patients diagnosed with breast cancer, having a great impact on their quality of life. Considering the high incidence, mortality rate, and the added effect on self-image, breast cancer is considered a major stressor for women worldwide, almost 50% of these experiencing psychological distress. Methods. Our study retrospectively analysed the relationship between preoperative diagnosed depression and the number of medical care days, on patients diagnosed with breast cancer and admitted for surgical treatment in Colțea Clinical Hospital between 2017 and 2018. Results. We had 62 patients scheduled for breast cancer surgery, who had been preoperatively evaluated using psychological tests. Of those patients, 18 had scores indicating significant symptoms of depression (moderate or severe symptoms, HDSR >17). Patients with high HDSR scores needed an 18.4% longer hospitalization than patients without symptoms of depression. They also had 35.4% more ambulatory visits in the month following discharge, and a higher incidence of postoperative complications. Conclusions. There seem to be both physiological and somatic determinants responsible for the need of prolonged medical care, but the mechanisms responsible for these effects remain unclear. Identifying high-risk patients could not only lower the postoperative morbidity, but also increase the therapeutic outcomes.

This study aims to establish whether the use of biomaterials, particularly polydimethylsiloxane (PDMS), for surgical reconstruction of the esophagus with templates, Montgomery salivary tube, after radical oncology surgery for malignant neoplasia is an optimal choice for patients’ safety and for optimal function preservation and organ rehabilitation. Structural analysis by Raman spectrometry and biomechanical properties with dynamic mechanical analysis are performed for fatigue strength and toughness, essential factors in durability of a prosthesis in the reconstruction practice of the esophagus. Nanocomposites with silicone elastomers and nanoparticles used in implantable devices and in reconstruction surgery present risks of infection and fatigue strength when required to perform a mechanical effort for long periods of time. This report takes into account the effect of silver (Ag) nanoparticles on the fatigue strength using polydimethylsiloxane (PDMS) matrix, representative for silicon elastomers used in implantable devices. PDMS with 5% (wt) Ag nanoparticles of 100–150 nm during mechanical fatigue testing at shear strength loses elasticity properties after 400 loading-unloading cycles and up to 15% shear strain. The fatigue strength, toughness, maximum shear strength, as well as clinical properties are key issues in designing Montgomery salivary tube and derivates with appropriate biomechanical behavior for each patient. Prosthesis design needs to indulge both clinical outcomes as well as design methods and research in the field of biomaterials.

The equimolar oxide mixture β-Ga2O3—α-Fe2O3 was subjected to high-energy ball milling (HEBM) with the aim to obtain the nanoscaled GaFeO3 ortho-ferrite. X-ray diffraction, 57Fe Mössbauer spectroscopy, and transmission electron microscopy were used to evidence the phase structure and evolution of the equimolar nano-system β-Ga2O3—α-Fe2O3 under mechanochemical activation, either as-prepared or followed by subsequent calcination. The mechanical activation was performed for 2 h to 12 h in normal atmosphere. After 12 h of HEBM, only nanoscaled (~20 nm) gallium-doped α-Fe2O3 was obtained. The GaFeO3 structure was obtained as single phase, merely after calcination at 950 °C for a couple of hours, of the sample being subjected to HEBM for 12 h. This temperature is 450 °C lower than used in the conventional solid phase reaction to obtain gallium orthoferrite. The optical and magnetic properties of representative nanoscaled samples, revealing their multifunctional character, were presented.

Background. Breast sarcomas are a heterogeneous group of breast neoplasms with a low incidence and a reserved prognosis. No treatment protocol has been yet established, a guideline similar to soft tissue sarcomas is used. Materials and Methods. Our study analyzed all the patients admitted with the diagnosis of malignant breast disease in two specialized centers on a five-year time frame. We compared long term results for the patients who underwent conservative treatment and mastectomy. Results. A total of 76 cases received surgical treatment with curative intent, 24 conservative procedures and 52 mastectomies. Incidence of local recurrence does not appear to be closely related to the type of surgical procedure. There were a number of five local recurrences for patients who received conservative treatment and 7 local recurrences where we used mastectomy. Kaplan-Meier analysis conducted shows no differences statistically significant (sig = 0.459) between the results of conservative treatment and mastectomy. Basically conservative surgery seems to get similar results, provided that R0 resection objective can be met. Conclusions. Treatment options are more limited for breast sarcomas than carcinomas, the role of surgery being more important to therapeutic success. The biological characteristic of the tumor including histological type and sub-type, play an important role in determining the results and the treatment should be tailored and adapted for each case.

Laryngocele is a rare pathology, but because of their clinical evolution and the symptoms they generate, they should always be considered as a differential diagnosis when investigating neck masses. A laryngocele is basically a herniation of the mucosa of the laryngeal ventricle (Morgagni's ventricle) arising usually from the saccular region. This herniation may remain confined to the larynx - in which case the laryngocele is internal- or expand through the thyro-hyoid membrane into the structures of the neck - thus being called an external laryngocele. Usually the laryngocele has both an internal and external component thus being a mixed laryngocele. Diagnosis of laryngoceles still relies heavily on clinical signs such as tympanism, easily depressible neck mass, indirect laryngoscopy, but is now simplified by imagistic investigations (ultrasound, CT and MRI). However, the treatment of this condition is exclusively surgical and consists of total excision of the laryngocele, as well as proper identification of the point of origin from the saccule and also the final suture of the breach in order to prevent recurrence. Investigation of possible causes of obstruction of the laryngeal ventricle should always be performed (because of the possibility of an underlying malignancy) as well as a follow-up protocol of the patient, given the risk of relapse. We present a recently diagnosed case of a 32 year old man with mixed laryngocele, which we have operated in our clinic.

Larynx cancer is one of the most susceptible form of cancer susceptible to induce alteration of the patient’s psychological profile due to the social role that the larynx has in communication. Oral communication is severely impaired even after voice rehabilitation of the laryngectomized patients, so that the social rehabilitation is somewhat not only a medical but also a social problem. The psychological profile of these patients is altered in a way that dealing with the disease is sometimes neglected and the interaction with the outside world in terms of oral communication is totally abandoned. The starting point for depression in these cases is the acknowledgement of the disease and is, in some cases, the entire medical environment. Facial scarring, the inability to verbally interact with other human, as well as the presence of the tracheostoma, are all deciding factors in the presence of a low self-esteem for these particular patients. Psychological counseling is a mandatory approach for laryngectomized patients, in order to improve their ability to cope with cancer and providing better recovery chances.

Breast surgery was one of the most dynamic fields of medicine which benefited from significant progress during the last decades. The transition from aggressive and mutilating amputations to conservative, oncoplastic and reconstructive techniques has been constant, offering improved and rewarding results, viewed from both, oncological and aesthetical perspectives. Conservative techniques, especially those which preserve the nipple areola complex, are followed by improved patient’s perception of their body image, confidence and sexuality, with the only drawback of increased anxiety linked to recurrence risk.

The psychological impact on patients suffering radical cystectomy is twofold - (both that of the underlying neoplastic disease and that measured by the quality of life subsequent to surgery) and increases as the urinary derivation technique is less physiological and affects more the local anatomy. Although there are numerous questionnaires that assess the quality of life of patients with cancer (HRQoL - health related QoL), not many probe bladder cancer morbidity or correlate the different types of urinary diversions’ impact on QoL (quality of life). We analyzed 39 cases in our clinic who underwent radical cystectomy between August 2013 and August 2014. Different diversions were performed, as follows: for 24 patients a cutaneous ureterostomy was performed, in 10 cases a Mainz II pouch, in 3 cases a Bricker derivation and in 2 patients a Studer neobladder was performed. In these patients, QoL - Cancer Version and FACT-BL questionnaires were administered and were followed for an initial period of 2 years. According to our survey, the Bricker derivation is best tolerated, followed by neobladder and the Mainz II pouch.

The larynx is one of the organs that is usually involved in the tumor growth in the head and neck region and it is the second site of malignant neoplasia of the respiratory tract after the lungs. It is a wellknown fact that larynx cancer is more often present in male population, with a ratio of 3:1 male/female because of the higher rate of tobacco and alcohol use. The issues related to total laryngectomy are the loss of voice, swallowing rehabilitation, reeducation of breathing through the tracheostomy, psychological alterations and social pressure. Women tend to be more affected by the presence of the tracheostomy, since general physical aspect is a major concern for modern women. Also, the emotional status of women is a plays a major role for the adherence to the therapy plan. The response to total laryngectomy by men and women is similar with slight differences in physical aspect and social reinsertion.

Quantitative sensory testing (QST) is a potentially useful tool for measuring sensory impairment for clinical and research studies but there is still no consensus regarding the place of this evaluation in every day clinical practice. Our study included 15 patients previously diagnosed with neuropathic pain due to small fiber sensory polyneuropathy based on clinical and electrodiagnostic criteria.Variables were compared with an age matched control group of 7 healthy persons. We looked to pain severity rated on Visual Analog Scale and Pain Detect Questionnaire and we searched for correlations with sensory nerve conduction studies and parameters of quantitative sensory testing – thermotest, limits method. QST was a sensitive technique for evaluation of patients with small fiber sensory polyneuropathy. Score on Pain Detect Questionnaire has statistically significant correlation with values recorded for cooling detection threshold on QST, documenting sensory loss and A delta fibers dysfunction in the study group.

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Introduction: Complicated rhinosinusitis is a rare but life-threatening pathology that requires both medical and surgical treatment as soon as possible. The spread of the infection from the paranasal sinuses affects, most often, the orbit, patients presenting diplopia, preseptal cellulitis, orbital cellulitis, or even blindness alongside exteriorization of puss from the middle meatus and nasal obstruction. Materials and methods: We carried out a retrospective review of 32 patients that were diagnosed in our clinic with complicated rhinosinusitis from 2015 to 2022. All the patients received at least one intravenous antibiotic, and some also received antifungal drugs. All patients underwent surgery, either endoscopically or combined approach. Nasal washout or nasal swabs during surgery were sent for laboratory examination in all patients, and we studied the microbial etiology in these extensive infections. A database with all the information regarding demographic and medical data was established. Results: 78% of the patients were male, with a mean age of 50.55. A wide range of antibiotics were used, while some patients, diagnosed with mucormycosis also received antifungal drugs. The mean hospitalization period was 12 days. We correlated the type of antibiotic with the hospitalization period and the outcome but also the degree of involvement of the orbit and the microbial strains identified. Discussion: The management of patients with complicated rhinosinusitis is complex and dynamic and it must be tailored to every patient, after an interdisciplinary meeting with the infectious disease specialist, ophthalmologist, and rhinologist. The microbial strains that produce such important infections are sometimes multi-resistant or combined, patients usually already had followed a course of antibiotics at home, and choosing the right treatment is sometimes challenging. [ABSTRACT FROM AUTHOR]