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Background: Abdominoperineal resection (APR)—the standard surgical procedure for low-lying rectal cancer (LRC)—leads to significant perineal defects, posing considerable reconstruction challenges that, in selected cases, necessitate the use of plastic surgery techniques (flaps). Purpose: To develop valuable decision algorithms for choosing the appropriate surgical plan for the reconstruction of perineal defects. Methods: Our study included 245 LRC cases treated using APR. Guided by the few available publications in the field, we have designed several personalized decisional algorithms for managing perineal defects considering the following factors: preoperative radiotherapy, intraoperative position, surgical technique, perineal defect volume, and quality of tissues and perforators. The algorithms have been improved continuously during the entire period of our study based on the immediate and remote outcomes. Results: In 239 patients following APR, the direct closing procedure was performed versus 6 cases in which we used various types of flaps for perineal reconstruction. Perineal incisional hernia occurred in 12 patients (5.02%) with direct perineal wound closure versus in none of those reconstructed using flaps. Conclusion: The reduced rate of postoperative complications suggests the efficiency of the proposed decisional algorithms; however, more extended studies are required to categorize them as evidence-based management guide tools.

Aim of the study The aim of this study is to emphasize the principles of face burn management based on our personal experience correlated with published literature data. We aim to illustrate different possible approaches of treatment in order to obtain good functional and aesthetic outcomes. Material and methods The study group included 342 patients (144 females and 198 males), with ages ranging between 18 and 92 years old, hospitalized and treated in the Burn Unit from the “Sf. Spiridon” Emergency County Hospital from Iași, Romania, during december 2020 – october 2023. The inclusion criteria for the study were: patients over 18 years old, isolated burn lesions only of the face or in association with burn lesions distributed on various anatomical regions, burns of all degrees. Results The group included 144 females (42,1%) and 198 males (57,89%). The etiologies of the burns were represented by flame (123 cases) – 35,96%, scald (103 cases) – 30,11%, contact (52) – 15,20%, electrocutions (31) – 9,06% or ultraviolet exposure (33) – 9,64%. 134 patients (39,18%) had isolated lesions of the face and 208 patients (60,81%) associated other localisations as well. Out of the total number of cases, the majority (276 cases) – 69% were treated conservatory, while 31% required different forms of surgical interventions. Conclusions The management of facial burns must be multidisciplinary and early in the face of serious complications that may endanger the vital, functional and aesthetic prognosis. Periodic evaluations must be constant and involve the physical and mental status of the patient. Social, family and professional integration takes a significant place in the overall management of facial burns to limit the difficulty of reintegration of a person affected by burns.

Aim of the study This study aims to investigate the efficacy of Negative Pressure Wound Therapy (NPWT) in optimizing wound care across a diverse range of etiologies and localizations. Material and methods A study of 97 patients with various wound etiologies and localizations was conducted. NPWT was meticulously applied according to established protocols, with treatment parameters being methodically documented. Results NPWT exhibited substantial efficacy in promoting wound healing across varied etiologies and localizations. Acute wounds demonstrated reduced dimensions alongside enhanced granulation tissue formation. In parallel, chronic wounds exhibited improved wound bed preparation and diminished bacterial colonization. Conclusions NPWT proves to be a versatile and effective treatment modality for optimizing wound care across different etiologies and localizations. Its ability to improve wound healing outcomes, by enhancing tissue perfusion, reducing edema, and modulating inflammation, positions NPWT as a valuable tool in comprehensive wound management strategies. Its ability to enhance tissue perfusion, mitigate edema, and modulate inflammation underscores its value as a pivotal tool within comprehensive wound management strategies.

Background: In recent years, social media and AI have indirectly taken control of our daily lives. We bring attention to the impact that social networks, photo-editing applications, and artificial intelligence have on potential patients when they are looking for a surgeon for a possible cosmetic surgery, as well as the criteria they consider in relation to the interest in the use of the internet by surgeons. Methods: A systematic review of the past 10 years (2014–2024) was conducted following the PRISMA structure. PubMed and Google Scholar were searched for articles containing the following terms: plastic/esthetic surgery, social media, AI, filters, dysmorphia. All articles were saved using Zotero software version 6.0.37. We reported a prospective study including a 141 patients applying for esthetic surgical interventions in the time interval between February and October 2021. It also involved 44 esthetic surgeons from Tunisian clinics. The influence of social media was evaluated using questionnaires made based on the literature. Results: Using the keyword search, 71 articles were found. A total of 19 articles were selected for data extraction. It was observed that in the last 3 years, the literature has focused on photo-editing and AI in the cosmetic surgery field. A total of 107 patients chose their surgeon based on a surgeon’s social medias rather than their reputation and their website. Conclusions: The increased advancements of the internet have clearly influenced decision making in the field of cosmetic surgery.

(1) Background: Cutaneous anthrax is a disease caused by a Gram-positive bacillus, spore-forming Bacillus anthracis (BA). Cutaneous anthrax accounts for 95% of all anthrax cases, with mortality between 10–40% in untreated forms. The most feared complication, which can be life-threatening and is rarely encountered and described in the literature, is compartment syndrome. (2) Methods: We report a series of six cases of cutaneous anthrax from the same endemic area. In two of the cases, the disease was complicated by compartment syndrome. The systematic review was conducted according to systematic review guidelines, and the PubMed, Google Scholar, and Web of Science databases were searched for publications from 1 January 2008 to 31 December 2023. The keywords used were: “cutaneous anthrax” and “compartment syndrome by cutaneous anthrax”. (3) Results: For compartment syndrome, emergency surgical intervention for decompression was required, along with another three surgeries, with hospitalization between 21 and 23 days. In the systematic review, among the 37 articles, 29 did not contain cases focusing on compartment syndrome of the thoracic limb in cutaneous anthrax. The results were included in a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram. (4) Conclusions: Early recognition of the characteristic cutaneous lesions and compartment syndrome with early initiation of antibiotics and urgent surgical treatment is the lifesaving solution.

The paper proposes a textile device for patients with large area burn wounds consisting of an assembly made up of a knitted backing layer, a hydrogel, with an antibiotic content, as a second layer and a membrane with controlled porosity located directly at the interface with the wound. The knit is the material support with a supporting clothing role, but also as a solution tank. The hydrogel has a keratin structure obtained from human hair with advanced swelling capacity and porosity. The study proposes the use of silver sulfadiazine (SSD), an antibiotic used in the topical therapy of burn wounds. The work optimizes the degree of swelling, evaluates the porosity of the hydrogel and designs the support garment for wound therapy. The optimal parameters to obtain the maximal swelling degree are: duration of hydrolytic reaction 180 min, volume of hydrogen peroxide 3.7 mL and duration of oxidation 90–125 min. Based on these optimal parameters one can obtain swelling degrees higher than 1000%. The device proposed is reusable and supports the SSD diffusion to wound.

Aim of the study The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, as well as its necessity and importance during the COVID-19 pandemics. Material and methods A retrospective study was performed between March 2020 and September 2021 to evaluate advantages of WALANT, taking into consideration the rules imposed by the pandemic context. This study included 360 patients, treated for acute and chronic hand diseases. A statistical investigation was performed using SPSS 20.0 version software and applying the ANOVA regression, evaluating demographic, anatomical and surgical variables. Results: 234 males and 126 females, treated for acute hand trauma (metacarpal and phalanx fractures, tendon and nerves lesions) and chronic hand diseases such as carpal tunnel syndrome (CTS) dupuytren’s disease (DD), trigger finger (TF), soft tissue and bone tumors. The average patient waiting time from admission in the operating room was 13.95 minutes, while the mean time of onset of local anesthesia was 12.15 minutes. No complications such as distal digital bleeding, hematoma, the necessity of using the antidote, or necrosis occurred, the outcomes were very good and the patient satisfaction high. Conclusions: The WALANT technique can be considered the “gold standard” in hand surgery anesthesia during the COVID-19 pandemic, ensuring a correct and safe surgical treatment in the restrictive conditions imposed by the epidemiological context.

Basal cell carcinoma (BCC) has a slow evolution and possible massive tissue destruction when neglected and reaches large dimensions. BCC involves various histological subtypes, the nodular form being the most common. Frequent localization on the face confirms that ultraviolet radiation is an important risk factor for this type of skin cancer. Basal cell carcinoma is most frequently on the cutaneous lips. It is reported that BCC is more frequent in the upper lip in women, while squamous cell carcinoma (SCC) seems to be more frequent in men, in the lower lip. Smoking and alcohol are reported as predisposing factors. The study purpose was to evidence the high incidence of BCC of the perioral and lips regions. 2) Methods: Retrospective descriptive study on a group of 55 patients diagnosed with BCCof the face, in whom surgical excision (in oncologic limits) treatment was performed, and postoperative follow-up was applied. 3) Results: The predominance of the ulcerated-infiltrative form was highlighted, predominantly in the age group between 60 and 80 years. 4) Conclusions: The increased number of BCC as well as the growing number of large and neglected tumors, evidenced the need of including BCC in a cancer registry and the implementation of a screening program, as well as a better information of the population regarding this type of skin cancer.

Background: Capsular contracture remains a common complication in silicone breast implantation. The etiology, formation mechanisms, predisposing and favoring factors are still subjects of research. This study aims to demonstrate the effectiveness of using autologous fat introduced periprosthetically in preventing capsular contracture compared to other known methods: antibiotics and corticosteroids. Methods: A cohort of 80 Wistar rats was included in the study, divided into four subgroups. All subjects received a silicone implant, implanted in a pocket created along the abdominal midline. The first subgroup served as the control group, with subjects having the implant placed without any treatment. For the second and third subgroups, the implants were treated with an antibiotic solution and intramuscular injections of dexamethasone, respectively. The subjects in the last subgroup received centrifuged autologous fat introduced periprosthetically. Results: The subgroup with autologous fat exhibited a significantly smaller capsule thickness, which was poorly represented, with a smooth surface. The use of autologous fat for treating silicone prosthesis was linked with the lack of acute inflammation around the prosthetic site. Conclusions: Autologous fat helps to minimize the “non-self” reaction, which results in the development of a periprosthetic capsule consisting of mature collagen fibers interspersed with adipocytes.

The overweight status or obesity can be confirmed through classical methods such as the body mass index (BMI) and the waist-to-hip ratio (WHR). Apart from metabolic issues such as atherosclerosis, liver steatosis, or diabetes mellitus, long-term obesity or overweight status can pose a risk for cardiovascular and neurovascular complications. While some acute adverse events like coronary syndromes of strokes are well-documented to be linked to an increased body mass, there are also chronic processes that, due to their silent onset and evolution, are underdiagnosed and not as thoroughly studied. Through this review, we aimed to collect all relevant data with regard to the long-term impact of obesity on cognitive function in all ages and its correlation with an earlier onset of dementia such as Alzheimer’s disease (AD). The exact mechanisms through which a decline in cognitive functions occurs in overweight or obese persons are still being discussed. A combination of factors has been acknowledged as potential triggers, such as a sedentary lifestyle and stress, as well as a genetic predisposition, for example, the apolipoprotein E (ApoE) alleles in AD. Most research highlights the impact of vascular dysfunction and systemic inflammation on the nervous system in patients with obesity and the subsequent neurological changes. Obesity during the early to mid-ages leads to an earlier onset of cognitive dysfunction in various forms. Also, lifestyle intervention can reverse cognitive dysfunction, especially dieting, to encourage weight loss.

Background: The broad spectrum of diagnoses and clinical features of hand tumors and the absence of pathognomonic signs often lead to an inaccurate or delayed diagnosis. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study intends to highlight the clinical, imaging and histological characteristics of uncommon hand tumors or tumor-like lesions. Methods: In this retrospective study, we report a series of 80 patients diagnosed with rare hand tumors and tumor-like lesions without skin damage. Age, gender, tumor location, imaging examinations and clinical and laboratory findings were analyzed. The histopathological exam established the final diagnosis. Surgery was indicated and performed in all cases. Results: This study included: neurofibroma, glomus tumor, lipoma, schwannoma, epidermal inclusion cyst and idiopathic tenosynovitis with “rice bodies.” We have described the clinical, imagistic and histopathological particularities of these tumors. Surgical management included the complete removal of tumors, with no recurrence recorded within two years and overall high patient satisfaction. The most common findings were lipomas and the rarest neurofibromas. Conclusions: To optimize the care of hand tumors and reduce diagnostic and treatment errors, knowledge of hand tumor types and their clinical and laboratory characteristics is necessary for every surgeon.

Background: Although schwannoma (neurilemmoma) is the most common tumor of the peripheral nerve, its low incidence, slow growth and vague symptoms often lead to misdiagnosis or delayed diagnosis. The aim of the study is to present a series with a large number of schwannomas in the upper limbs, some with very rare occurrence. Methods: We report 17 patients with a mean age of 58.5 years and upper limb schwannomas, located on the median, ulnar and radial nerves, but also on the posterior interosseous nerve and digital collateral nerves. The diagnosis was made by clinical examination and imaging tests, and in no case was a preoperative biopsy performed. Surgical treatment was established based on symptoms or aesthetic concerns. In all cases, a diagnosis of schwannoma was confirmed through histopathological and immunohistochemical examinations. Results: For all patients, a complete tumor enucleation was performed under a surgical microscope. No recurrence was recorded at 2 years after surgery. Patient satisfaction was good, with complete socio-professional integration in all cases. Conclusions: Although more frequently present on the main nerve trunks, schwannoma may be present on the collateral digital nerves in rare cases. A correct technique with complete tumor excision offers excellent postoperative outcomes and avoids recurrences.

Introduction. Hepatitis E is an acute liver disease caused by E hepatitis virus (HEV), representing a global public health problem comparable with other transmissible infections. Aim. The purpose of this paper is to present the epidemiological, clinical, biological and evolutive aspects of HEV infection. Material and method. An estimated 20 million infections are annually reported worldwide with higher prevalence rates recorded in South-East Asia (over 60% of infections and over 65% of HEV related deaths). In Romania the incidence of HEV in 2009 was 12%, the frequency of infection being limited to the anti-HEV specific IgG antibodies seroprevalence. Results. HEV transmission is predominantly by digestive tract (especially contaminated water) but also by blood, plasma, organ transplant. The incubation period ranges from 21 to 45 days, onset of gastrointestinal simptoms, fever, influenza-like syndrome, asthenia, skin rush, weight loss, abdominal pain, dehydration. The state period is characterized by sclero-tegumentary jaundice (75% cases), skin pruritus, steathoresis, dark urine and pale stools. HEV can cause extrahepatic manifestations (neurological, renal lesions, pancreatitis and haematological disturbencies). Farmacological treatment of HEV infection includes Peg-Inf, Ribavirin and also newest DAAs agents. Discussions. In most patients hepatitis E causes a self-limited disease that lasts for several weeks. Acute infection is generally asymptomatic and is caused by genotype 1 in young people, while genotypes 3 and 4 generally affect immunosuppressed patients. Chronic infection is caused by genotypes 3 and 4 in immunosuppressed pacients (transplanted, HIV-positive and haematological patients) and has a lower incidence and mortality. Evolution of viral hepatitis E may be severe and fulminant due to acute liver failure. A recombinant vaccine approved in China in 2011 opens up prospects for the specific prevention measures in areas identified as being at risk to limit the consequences of hepatitis E virus infection in the general population and exposed groups. Conclusions. Hepatitis E management involves the therapy of chronic infection in immunosuppressed patients, the extrahepatic manifestations and also acute severe HEV infections.

Background: The use of bromelain for the removal of eschar in deep burns is considered to be effective because it does not affect the unaffected skin and leaves a clean dermis after use. The main objective of this study is to find out whether bromelain is a good alternative to surgical debridement. In order to achieve that, we aim to evaluate its indications, limitations, and safety measures. Methods: The current study was conducted on a group of 30 patients with deep burn lesions, aged 20 to 56 years, from which 15 underwent enzymatic debridement and 15 patients acted as a control group in which primary surgical debridement was used. The mixture of enzymes enriched in bromelain, meant to dissolve burn eschar, was provided by NexoBrid™. The inclusion criteria were in agreement with the manufacturer’s protocols, but the application protocol was slightly modified in order to implement a better intern protocol and to assess its efficiency. Results: Complete eschar debridement was obtained in 13 of the 15 cases, from which 10 patients went through spontaneous healing and 3 needed to be covered with a skin graft. In the other 2 cases, partial eschar debridement was associated with surgical debridement and coverage with split-thickness skin graft in the same operation. The results obtained in the two groups were assessed with the Vancouver Scar Scale. Conclusions: Even though early excision followed by coverage with split-thickness skin graft remains the gold standard for the treatment of deep burns, enzymatic debridement can provide a series of advantages when the inclusion and exclusion criteria are respected. Bromelain is an alternative to surgical debridement that provides speed, tissue selectivity, safety, and less blood loss.

Hospital-acquired pneumonia (HAP) and its subtype, ventilator-associated pneumonia (VAP), remain two significant causes of morbidity and mortality worldwide, despite the better understanding of pathophysiological mechanisms, etiology, risk factors, preventive methods (bundle of care principles) and supportive care. Prior detection of the risk factors combined with a clear clinical judgement based on clinical scores and dosage of different inflammatory biomarkers (procalcitonin, soluble triggering receptor expressed on myelloid cells type 1, C-reactive protein, mid-regional pro-adrenomedullin, mid-regional pro-atrial natriuretic peptide) represent the cornerstones of a well-established management plan by improving patient’s outcome. This review article provides an overview of the newly approved terminology considering nosocomial pneumonia, as well as the risk factors, biomarkers, diagnostic methods and new treatment options that can guide the management of this spectrum of infections.

Background and Objectives. The intensive care unit (ICU), especially in an infectious disease hospital, is both an area with a high consumption of antibiotics (atb) and a “reservoir” of multidrug-resistant bacteria. We proposed the analysis of antibiotic therapy practices in such a department that treated, in conditions of a pandemic wave, patients with COVID-19 and its complications. Materials and Methods. This was a retrospective transversal study of 184 COVID-19 patients treated in the ICU of a regional infectious disease hospital of Iaşi, Romania, in a 3-month interval of 2020 and 2021. Results. All the included patients (Caucasians, 53% males, with a median age of 68 years, and a Charlton comorbidity index of 3) received at least one antibiotic during their stay in the ICU (43% also had antibiotics prior to hospital admission and 68% in the Infectious Diseases ward). Only 22.3% of the ICU patients had only one antibiotic. A total of 77.7% of them started with an association of two antibiotics, and 19.6% of them received more than three antibiotics. The most-used ones were linezolid (77.2%), imipenem (75.5%), and ceftriaxone (33.7%). The median atb duration was 9 days. No change in the number or type of atb prescription was seen in 2021 (compared to 2020). Only 9.8% of the patients had a microbiological confirmation of bacterial infection. A total of 38.3% of the tested patients had elevated procalcitonin levels at ICU admission. The overall fatality rate was 68.5%, with no significant differences between the two analyzed periods or the number of administered antibiotics. More than half (51.1%) of the patients developed oral candidiasis during their stay in the ICU, but only 5.4% had C. difficile colitis. Conclusion. Antibiotics were widely used in our ICU patients in the presence of a reduced microbiological confirmation of a bacterial co-infection, and were justified by other clinical or biological criteria.

Introducere. Hepatita E este o infecţie acută a ficatului determinată de VHE şi reprezintă o problemă de sănătate publică la nivel internaţional comparabilă cu cea cauzată de alte boli transmisibile. Scop. Scopul acestei lucrări este de a prezenta aspectele epidemiologice, clinico-biologice şi evolutive a infecţie determinată de VHC. Material şi metodă. Anual, în întreaga lume, se înregistrează aproximativ 20 de milioane de infecţii cu VHE. Această boală are o răspândire universală, dar cu prevalenţe mai ridicate în Asia de Sud şi Est, unde se concentrează peste 60% dintre cazuri şi peste 65% dinrte decesele prin HVE. În România, incidenţa HVE în 2009 a fost de 12%, datele privind frecvenţa infecţiilor fiind limitate la studiile de seroprevalenţă ale Ac IgG specifici anti-hepatită E. Rezultate. Transmiterea se realizează preponderent pe cale digestivă (în special prin apă contaminată), dar şi prin sânge, plasmă, transplant de organe. Perioada de incubaţie este cuprinsă între 21 şi 45 de zile. Boala debutează prin tulburări gastro-intestinale (sindrom dispeptic, greţuri, vărsături, inapetenţă), febră, sindrom pseudo-gripal, astenie, erupţie urticariană, scădere în greutate (între 2 şi 4 kg), durere sau disconfort abdominal la nivelul HD, deshidratare. În perioada de stare, bolnavul poate prezenta icter sclero-tegumentar, prurit tegumentar, steatoree, urini hipercrome. În plus faţă de manifestările clasice hepatice, VHE este responsabil pentru tulburări extrahepatice. Acestea includ o serie de sindroame neurologice, leziuni renale, pancreatită şi probleme hematologice. Tratamentul farmacologic al infecţiei cu HVE include Peg-Inf, Ribavirin şi, de asemenea, cei mai noi agenţi DAA. Discuţii. La majoritatea pacienţilor, hepatita E provoacă o boală autolimitată care durează câteva săptămâni. Infecţia acută – în general asimptomatică – este determinată de genotipul 1, care afectează persoanele tinere, genotipurile 3 şi 4 afectând în general imunodeprimaţii. Infecţia cronică este determinată de genotipurile 3 şi 4 la imunodeprimaţi (transplantaţi, pacienţi HIV+, pacienţi hematologici), având incidenţă şi mortalitate inferioare. Evoluţia hepatitei virale E poate fi severă şi fulminantă din cauza insuficienţei hepatice acute. Un vaccin recombinat aprobat şi efectuat în China în 2011 deschide perspective pentru măsurile de prevenire specifice în zonele identificate ca fiind expuse riscului, pentru a limita consecinţele infecţiei cu virusul hepatitei E în populaţia generală şi grupurile expuse. Concluzii. Managementul hepatitei E implică atât terapia pacienţilor cronici sau imunodeprimaţi, cât şi terapia infecţiilor severe acute cu VHE şi a manifestărilor extrahepatice