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The combination of posterior femoral head dislocation with ipsilateral intertrochanteric fracture is an extremely rare occurrence, therefore, few reports exist. In this paper, we describe a particular case of a middle-aged patient who sustained a high energy trauma which led amongst other to this lesion. We performed the reduction and fixation of the fracture-dislocation on a traction table with a Dynamic Hip Screw-plate (DHS-plate). Primary objectives of the treatment were to obtain a stable limb, to reduce blood loss in a polytraumatized patient and allow early mobilization. Follow-up after three months was good. [ABSTRACT FROM AUTHOR]

The thumb is responsible for 40% of the hand function. Therefore, when resurfacing of the thumb is required, cross-finger flap may prove very useful. In this paper, we reported three cases where cross-finger flaps were used successfully in order to cover soft tissue defects of the thumb's distal phalanx. No major complications were encountered. All patients were satisfied with the cosmetic aspect of the reconstruction procedure (9 on VAS). All the fingers were fully functional, with a mean TAM score of 266° for the donor fingers and a mean DASH score of 2.16 after 1 year from injury. Using this technique, we obtain good quality soft and bulky tissue to restore the original form of the thumb in order to prevent function loss by reducing length and primary suture of the finger. Therefore, we consider this method very effective in covering vital structures with almost no morbidity related to the donor site. Alongside other previous papers describing this technique, we concluded that the cross-finger flap is a versatile reconstruction procedure. [ABSTRACT FROM AUTHOR]

Rhinophyma is a benign tumor characterized by a progressive hypertrophy of the nasal soft tissue and it is believed to be the end stage of severe acne rosacea. It is more common in Caucasian men. The main differential diagnosis is the basal cell carcinoma. Non-surgical treatment proved insufficient in reversing this disease, while surgery remains the golden standard, even if a spontaneous regression may be observed in extremely rare cases. We presented a case of a severe rhinophyma associated with a giant nodule successfully treated with surgical removal of the suspicious tissues with safety margin and grafting of the excised area. The postoperative outcome was satisfactory for the patient. [ABSTRACT FROM AUTHOR]

The Lisfranc fracture-dislocation of the foot is uncommon and many cases are misdiagnosed. A neglected or untreated injury of the Lisfranc joint can lead to secondary arthritis and significant morbidity with disability. In this paper we described pacient's recent medical history that led to Lisfranc lesion and our means of diagnosis and treatment. The chosen implant was a limited contact plate 3.5 mm (LCP) with screws and screw fixation, and temporary Kirschner (K) wire fixation (6 weeks). The main objectives of the treatment consists in anatomical reduction associated with an early mobilization in order to avoid mineral bone loss and to keep the patient as close as possible to the fullest of its function prior to the event that has led to his static and kinematic disorder. After three months the follow-up was excellent. [ABSTRACT FROM AUTHOR]

The nose represents one of the most common sites for skin cancer, therefore, treatment usually leads to defects of this aesthetic unit that needs reconstruction procedures. Even if there are many surgical methods described in the literature, repairing this complex structure is a challenge for every surgeon. In this paper we described our method in order to cover a medium defect of the distal third of the dorsum nasi after tumor removal. A long and narrow nasolabial flap was used in a single-stage reconstruction procedure. Some minor complications were encountered due to the pushing of the flap measurement limits and the defatted choice of flap, therefore with a thin blood supply. This method lead to good outcomes with tumor recurrence-free after a 2 years follow-up and to a very good cosmetic result according to the patient's appreciation. [ABSTRACT FROM AUTHOR]

The hand is both a motor and sensory organ, and in terms of society, it is an organ of defense, of creation and an organ of expression. This is why hand surgery is very important and studies regarding the functional results of different treatments in order to treat injuries are necessary. In this paper, we presented the results of a retrospective clinical study in order to compare osteosynthesis using plates and screws (n=36) versus fixation using Kirschner wires (n=32) in order to treat metacarpal fractures of 68 patients. The functional outcomes where assessed using the DASH and the TAM score measured at two and twelve months from surgery.The DASH scores were lower (showing better results) in the PS group compared to the KW group, with a mean difference of 20.53 after two months and 6.41 after twelve months, while the TAM scores were higher (235° at two and 261° at twelve months in the PS group compared with 218° at two and 257° at twelve months in the KW group). Therefore, we concluded that osteosynthesis using plates and screws leads to better functional recovery than osteoynthesis using Kirschner wire. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is a commonly encountered pathology in medical practice, and its prevalence has shown a continuous rise over the past years. Atrial fibrillation has a significant impact on patients' quality of life, not only due to the standard anticoagulant treatment with vitamin K antagonists that require close monitoring and dose adjustment, but also due to the fragile equilibrium between hemorrhagic and thrombotic risks. The introduction of new oral anticoagulants (NOACs) in the treatment guidelines for atrial fibrillation has improved the quality of life, as NOACs do not require close monitoring or dose adjustments. However, even if the safety profile of the NOACs regarding the hemorrhagic risk is superior to vitamin K antagonists, the problem raised by an unexpected hemorrhage (e.g. severe hemorrhage after an accident) and the need for efficient hemostasis in a chronic anticoagulated patient has remained unsolved. To find a solution for this problem, reversal agents for NOACs have been developed and tested, and two of them, idarucizumab and andexanet-alpha, have already been approved by the FDA, thus making NOACs increasingly appealing as a choice of anticoagulation treatment. [ABSTRACT FROM AUTHOR]

Malignant ureteral obstruction (MUO) caused by a primarily urological tumor or secondary to a late-stage malignancy can be difficult for the urologist to manage. Due to a lack of clinical data on the management of MUO, every case is particular and should be aborted individually. Lack of specific treatment, either palliative or definitive, can severely damage renal function and lifetime expectancy in patients, causing even more damage that could otherwise be avoided. Prompt management directed at the recovery of renal function is the main goal in such cases. Even after urinary flow is restored, life threatening post-obstructive diuresis needs to be managed. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a systemic inflammatory disorder that manifests predominantly in the synovial joint, where it causes a chronic inflammatory process, leading to early osteoarticular destructions. These destructions are progressive and irreversible, generating a significant functional deficiency. During the last years, the diagnostic approach of RA has focused on early arthritis. Early arthritis can develop into established RA or another established arthropathy, like systemic lupus erythematosus or psoriatic arthritis. It can have a spontaneous resolution or may remain undifferentiated for indefinite periods of time. The management of early arthritis has changed considerably in the past few years, under the influence of new concepts of diagnosis and new effective therapies. The treatment goal of early arthritis should now be the clinical remission and prevention of joint destruction. Methotrexate is the first line of therapy, used to treat early arthralgia and to reverse or limit impending exacerbation to RA. Biological treatment is used as a second line therapy in patients with severe disease who do not respond or have a contraindication to disease-modifying antirheumatic drugs (DMARDs). Patients with early arthritis should usually be identified and directed to rheumatologists to confirm the presence of arthritis, and to establish the correct diagnosis plus to initiate the proper treatment strategies. [ABSTRACT FROM AUTHOR]

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The thumb is responsible for 40% of the hand function. Therefore, when resurfacing of the thumb is required, cross-fi nger flap may prove very useful. In this paper, we reported three cases where cross-fi nger flaps were used successfully in order to cover soft tissue defects of the thumb`s distal phalanx. No major complications were encountered. All patients were satisfi ed with the cosmetic aspect of the reconstruction procedure (9 on VAS). All the fi ngers were fully functional, with a mean TAM score of 266° for the donor fi ngers and a mean DASH score of 2.16 after 1 year from injury. Using this technique, we obtain good quality soft and bulky tissue to restore the original form of the thumb in order to prevent function loss by reducing length and primary suture of the fi nger. Therefore, we consider this method very effective in covering vital structures with almost no morbidity related to the donor site. Alongside other previous papers describing this technique, we concluded that the cross-fi nger flap is a versatile reconstruction procedure. [ABSTRACT FROM AUTHOR]

The nose represents one of the most common sites for skin cancer, therefore, treatment usually leads to defects of this aesthetic unit that needs reconstruction procedures. Even if there are many surgical methods described in the literature, repairing this complex structure is a challenge for every surgeon. In this paper we described our method in order to cover a medium defect of the distal third of the dorsum nasi after tumor removal. A long and narrow nasolabial flap was used in a single-stage reconstruction procedure. Some minor complications were encountered due to the pushing of the flap measurement limits and the defatted choice of flap, therefore with a thin blood supply. This method lead to good outcomes with tumor recurrence-free after a 2 years follow-up and to a very good cosmetic result according to the patient's appreciation. [ABSTRACT FROM AUTHOR]

The hand is both a motor and sensory organ, and in terms of society, it is an organ of defense, of creation and an organ of expression. This is why hand surgery is very important and studies regarding the functional results of different treatments in order to treat injuries are necessary. In this paper, we presented the results of a retrospective clinical study in order to compare osteosynthesis using plates and screws (n=36) versus fi xation using Kirschner wires (n=32) in order to treat metacarpal fractures of 68 patients. The functional outcomes where assessed using the DASH and the TAM score measured at two and twelve months from surgery.The DASH scores were lower (showing better results) in the PS group compared to the KW group, with a mean difference of 20.53 after two months and 6.41 after twelve months, while the TAM scores were higher (235° at two and 261° at twelve months in the PS group compared with 218° at two and 257° at twelve months in the KW group). Therefore, we concluded that osteosynthesis using plates and screws leads to better functional recovery than osteoynthesis using Kirschner wire. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE), essentially deep venous thrombosis and pulmonary embolism, urinary tract infection, and renal failure are the main unplanned hospital events with negative long-term impact on burn patients’ rehabilitation. Due to the hypercoagulable state induced by severe critical burns, either in the acute or recovery phase and the intimal vascular damage, the risk of VTE is increased, with an incidence varying from 0.4% to almost 60%. Other risk factors for VTE in burn patients are prolonged immobilization, long and multiple surgical interventions, central venous catheterization, wound infection and sepsis, extensive burns, and red blood cell transfusion. To avoid underdiagnosing VTE, in face of increased incidence of asymptomatic venous thromboembolism, high risk-patients should be routinely screened using Doppler ultrasound. Patients’ weight and burn size, as well as the high incidence of heparin resistance in the first weeks after injury, should be considered when establishing the optimal dose for venous thromboembolism prophylaxis, targeting an anti-Xa level of 0.2-0.5 IU/mL. [ABSTRACT FROM AUTHOR]

Surgical intervention can lead to blood loss either through perioperative complications, or through disease severity until surgery. For this reason, mastering the main strategies to improve surgical patients’ haematological status, to reduce transfusion rate, and to correct haemoglobin level represent the state of art in surgical patient management. In the last period, due to COVID-19 pandemic and the blood shortage crisis across hospitals, applying principles meant to reduce blood loss, and therefore the rate of blood transfusion, have become even more important. [ABSTRACT FROM AUTHOR]

Alcohol abuse is one of the leading health problems, with subsequent alcohol withdrawal syndrome (AWS) affecting around 50% of hospitalized patients, varying from mild to severe forms. Rapid recognition of AWS symptoms, along with prompt therapeutic management in the first 24 hours, can lead to better outcome. Improper treatment is correlated with seizure or delirium tremens, requiring specific intensive care management, and being the cause of with various complications, high mortality, and increased costs. Some studies reported possible predictive factors that may help clinicians identify patients at risk of developing severe or resistant forms. [ABSTRACT FROM AUTHOR]

Hospitalized COVID-19 patients often develop acute kidney injury (AKI), leading to increased mortality. In order to improve patients’ survival rate, it is important to understand the pathophysiology mechanism of AKI. In this brief review, we highlight the most important elements of the etiology and pathophysiology of COVID-19 associated AKI. Acute tubular injury seems to be more frequent than prerenal azotemia in COVID-19 patients and collapsing glomerulopathy is the most encountered form of glomerular disease. Another important role in acute kidney injury seems to play immune cell infiltration, inflammation, endothelial injury and microvascular thrombi. Renin-angiotensin-aldosterone system is also important in the pathophysiology of COVID-19 associated AKI. [ABSTRACT FROM AUTHOR]

As COVID-19 pandemic continues to test the medical world, due to rapid viral transmission and subsequent mutations, the old burning health crisis continues to surface, one of them being the blood shortage. The current situation has disrupted the fragile balance between blood donors and the real need of blood in hospitals, especially due to repetitive lock-downs, isolation, social-restrictions, and ongoing anxiety promoted by social media, threatening the quality of medical cares. [ABSTRACT FROM AUTHOR]

Purpose of review: The aim of this paper is to provide the clinician an overview about the link between iron homeostasis and erythropoiesis and how we can promote this relationship in order to improve surgical patients’ outcome. Key elements: Iron is essential for various cellular processes, like cell signalling, oxygen transport, erythrocyte and heme synthesis, mitochondrial respiration, host defence, nucleic acid replication. Erythropoietin and iron are the main erythropoiesis regulators. Under iron-restricted conditions, the erythrocytes production is impaired, leading to microcytic hypochromic anemia appearance. Iron-restricted condition enables patient capacity to recover from post-surgery anemia. Long-term consequences of chronic anemia affect patient’s quality of life. Therefore, parenteral iron supplementation, in patients with anemia secondary to blood loss, can lead to a fivefold increase in erythropoietic response, therefore enhancing recovery. Summary: Under normal circumstances, the link between iron and erythropoiesis is maintained especially through regulatory feedback mechanisms, with minimal external support. In face of important blood loss, with secondary acquired iron-restricted anemia, parenteral iron supplementation improves the bone marrow erythroid response and helps correcting haemoglobin levels. [ABSTRACT FROM AUTHOR]

Background: Severe burns pose significant therapeutic challenges due to their complex pathophysiology, the potential for life-threatening complications, long-term sequelae and the need for a multidisciplinary approach. In this retrospective study, we aimed to comprehensively analyze burns involving over 50% of the total body surface area (TBSA) treated in our institution over six years. Materials and methods: We performed a retrospective study including 91 patients. The following epidemiological and clinical characteristics were documented: age, sex, comorbidities, admission modality, mechanism of injury, TBSA burned, burn depth, presence of inhalation injury, outcome, length of stay and associated costs. Results: In the study group, subjects had a mean age of 54.4 years (24-93), with a male-to-female ratio of 2.5:1. The median percentage of TBSA burned was 70% (50-99%) and 93.4% of patients had third-degree burns. Inhalation injury was present in 71.4% of patients. Flame burns occurred in 90.1% of patients. Prediction scores were assessed, with 60.4% of patients having an ABSI score above 12. Mortality in our study group was 84.61% and 39.5% of patients died in the first week after burn injury. The most frequent systemic complications were respiratory complications (95.6%), followed by cardiocirculatory (93.4%), metabolic (84.6%), hematological (74.7%), renal (64.8%), hepatic (59.3%) and infectious complications (38.4%). Conclusions: Managing major burns is a highly complex process, which requires specialized care and infrastructure to improve outcomes. Extensive burns, especially over 50% TBSA, have high morbidity and mortality, with factors like age, severity and inhalation injury affecting prognosis. A multidisciplinary approach is essential for treatment, addressing not only the burns but also systemic complications to prevent multiple organ dysfunction syndrome and death. [ABSTRACT FROM AUTHOR]

Hydrotherapy represents the use of water for medical purpose, being involved in burn wound care since the 17th century. Burn wound cleansing, performed daily, twice a day, or as needed, as part of standard care, should be scheduled by a burn surgeon and supervised by proper specialists. It can be performed by various methods, like shower, immersion, bedside irrigation or wiping. Due to the high risk of cross-contamination, immersion is no longer recommended. Tap water seems to be superior to saline solution in burn wound care, and adjuvants can be added, especially chlorhexidine, povidone-iodine, or special detergents. Disposable plastic sheets use during showering and the following of cleaning protocols for washing areas have decreased the risk of infection. Apart from the wound-cleansing role, hydrotherapy reduces itching and pain, improves wound healing, favours early mobilization and increases patients’ comfort. Controversy persists around the optimal method and appropriate solutions for cleaning burn injuries and clinical studies are further required to solve this matter. In the absence of standardized recommendations, most burn centers are guided by experience. [ABSTRACT FROM AUTHOR]

Introduction. The „major burns“ are critically ill patients with extended burn injuries, on over 20% of the total body surface, IInd or IIIrd degree or with certain locations as face, neck, upper respiratory airways, or lesions that are associated with other traumatic injuries (1). One of the early systemic changes after the burn injury is the coagulation disorder, which influences the outcome. The posttraumatic coagulopathy is influenced primarily by the surface extension and degree of the burn lesion (2), but there are also systemic factors that are induced by the traumatic lesions and amplify the coagulopathy: the systemic inflammatory response, the tissue hypoperfusion, the acidosis (4). Other important factors, which may change the evolution of the major burnt, are: the initial excessive fluid resuscitation, the age, the gender, the comorbidities of the patient (5). Materials and methods. The authors conducted an analysis of the coagulation disorders in a case series of burned patients hospitalized in 2015, in the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest. The prospective observational study included 11 patients hospitalized simultaneously. The study was approved by the internal ethical committee and the consent was obtained for the processing of clinical and laboratory anonymous data. We analysed the demographic data, the severity of the burn lesions, injury severity score (ISS), the haemostatic pattern through the assessment of the complete blood count, classical coagulation tests, rotational thromboelastometry (ROTEM). Results. Patients̒ median age was of 36.00±7.89 years, with variation between 21 and 45 years old. Men to women ratio was of 7:4. The estimated body surface was between 20-70%, with a mean value of 42.5%±12.03% (we counted only the burns with degree 2 and 3). At the admission, the ISS score was between 17-61 points [of 75 points maximum (10)], with a mean value of 45 ±15.18 points. The lot was devided into two groups, with or without the presence of the posttraumatic coagulopathy criteria, on lab tests or ROTEM, despite blood replacement therapy. There were analysed the parameters which define the posttraumatic coagulopathy and their impact on the blood replacement therapy and mortality. Conclusions. The etiology of the coagulation disorder at the „major burnt“ is multifactorial, but regardless of the predominant cause, it worsens the patients' outcome, increases the need for transfusions and mortality. The optimization of the diagnostic methods for the coagulopathy can offer important data regarding the incidence and the severity, with the possibility for faster and targeted therapeutic intervention to the patient's need. [ABSTRACT FROM AUTHOR]

The latest treatment guidelines for patients with arterial hypertension continues to indicate as the first line therapy a minimal association between renin-angiotensin system (RAS) blockers and a thiazide-type or a thiazide-like diuretic. In addition, according to 2018 ESC/ESH (European Society of Cardiology/European Society of Hypertension) guidelines for the management of arterial hypertension, a mineralocorticoid receptor antagonist may be added in resistant hypertension cases (uncontrolled hypertension under at least 3 classes of antihypertensive drugs including a RAS blocker, thiazide diuretic and a calcium channel blocker) for general population. For chronic kidney disease (CKD) patients, achieving the optimal blood pressure (BP) level can be difficult because high complication rates can be encountered in any antihypertensive class mentioned, especially for RAS blockers and mineralocorticoid receptor inhibitors. This brief review aims to highlight the importance of diuretics use in CKD patients and the boundaries of their usage. [ABSTRACT FROM AUTHOR]

Acute disseminated encephalomyelitis is an inflammatory, immune-mediated disease of the central nervous system (CNS) that usually appears in the first nine years of life, commonly following an infection or vaccination. We report the case of a middle-aged female, with history of recent perpetual infections, with neurologic symptoms masked by a severe septic shock and subsequent multiple organ failure. Although in adults the prognosis is more severe, and there are various reported cases with unfavorable evolution, following corticosteroid and physical therapy, our patient was able to recover an important part of her neurological deficits. [ABSTRACT FROM AUTHOR]

The negative impact of an elevated serum uric acid on the onset and/or progression of different diseases is well known. During the last decade, new forms of therapies were developed, with beneficial results on correcting hyperuricemia, but also with potential side effects that should not be overlooked as most of the hyperuricemic patients are presenting concomitant comorbidities that could influence the decision in prescribing a specific lowering serum uric acid drug. The review will describe recent treatment options, part of them available also in our country. [ABSTRACT FROM AUTHOR]

Immunoglobulin A (IgA) nephropathy is one of the most common glomerulonephritis. Its clinical manifestations vary from asymptomatic forms to cases with nephritic syndrome or nephrotic-range proteinuria. The prognosis depends on the level of proteinuria, decline of glomerular filtration rate and control of blood pressure. The pathognomonic histological changes are represented by the granular IgA deposits in the mesangium. The treatment consists of comprehensive support care and immunosuppressive therapy. We discuss the case of a 50-year-old man who presented microscopic hematuria, nephrotic-range proteinuria and decreased renal function, exacerbated in the last 6 months prior the admission. We performed a renal biopsy and granular deposits were present in the glomerular mesangium that were highly suggestive for IgA nephropathy. Immunosuppressive therapy was instituted immediately, but the decline of the renal function continued and renal replacement therapy was needed. Patients with poor prognosis have an unsatisfactory response to the immunosuppressants, especially those with a delayed diagnosis. [ABSTRACT FROM AUTHOR]

Severe burn injuries represent a major challenge to the entire healthcare system in developing countries and even for states with a high standard of care. A clear understanding of the physiopathology of burn injuries is essential for providing an adequate prompt treatment to ensure an optimal patient outcome. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. Specific treatment must be conducted according to the characteristics of the patients in order to reduce morbidity and mortality and avoid the development of antimicrobial resistance. A diagnostic and therapeutic algorithm is presented, centered on infectious source prevention and control with early surgical excision and skin grafting together with culture-guided antimicrobial therapy. It is a known fact that, indifferent of the involved germ, the best intervention for both prophylaxis and treatment of infections in the burn patient is the early excision of the devitalized tissue and subsequent closure of burn wounds with skin grafts, measures that diminish local and systemic mediator releasing effects in burnt tissue, attenuating the progressive inflammatory chain. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of hypokalemia in psychiatric population is very high with eating disorders and laxative abuse being the main incriminated factors. Case presentation: We report a case of a 34-year-old woman with history of sleeve gastrectomy and breast implant, who presented for fatigue, severe myalgia, generalized hypotonia and palpitations. Laboratory exams revealed severe hypokalemia and rhabdomyolysis. The electrocardiography showed prolonged QT interval and ST segment depression with second-degree atrioventricular block. She received intravenous potassium supplementation with consecutive hydration. When potassium level was within safety limits, the patients received loop diuretics in order to decrease rhabdomyolysis and avoid kidney injury. The underlying cause was a pathological behavior, with frequent self-provoked episodes of nausea and vomiting after eating and chronic consumption of laxatives. She started psychotherapy. Conclusion: Psychiatric behaviour can lead to life-threatening conditions, therefore it should be discovered and managed promptly. [ABSTRACT FROM AUTHOR]

Introduction: Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment. [ABSTRACT FROM AUTHOR]

Over the past six decades, abdominal compartment syndrome (ACS) remained a very controversial subject, both in surgical and non-surgical specialties. Doctors failed to understand why critically ill patients died in the ICU with distended abdomens without fi nding any cause or why postoperative patients with wound defects such as dehiscence died after suturing the wound again „very tightly”. After the concept of intra-abdominal pressure (IAP) was established and methods for measuring it and diagnosing intra-abdominal hypertension (IAH) were available for clinicians to use it, it became clearer that ACS was a very serious and life threating pathology and the need for a correct treatment is essential. In this article we will try to make a literature review of the past decade and see when and how to diagnose correctly a patient with ACS and also how the diagnostic and treatments methods changed over the years. [ABSTRACT FROM AUTHOR]

Introduction: Severe burn injuries still are a major challenge for the entire healthcare system. Multiple predictive factors may influence the prognosis of burn patients and a careful management of those parameters will decrease the morbidity and mortality and will determine an improvement in patient's final functional outcome. Material and Methods: We present a two years study on the burn patients hospitalized in our institution. A total of 355 burned patients were hospitalized during this period, 210 (59%) of them being addmited in Critical Care Burn Unit. A detailed analysis was performed on those 210 critical patients in order to determine the parameters that aggravate the prognosis of burn injuries. A large data panel was taken into consideration regarding burn severity, mechanism of injury, patient characteristics, associated illnesses, promptitude in hospitalizing the patient in our burn center; ABSI score was used to evaluate the mortality risk, burn injury-associated complications were noted and analyzed. Results and discussion: We highlighted a series of parameters regarding therapeutic management that influence the outcome of the patient after severe burn injury: an adequate hydro-electrolytic resuscitation in the acute phase, further support of vital functions, early excision and grafting of deep burn injuries, comorbidities treatment and adherence to rehabilitation and follow-up program. ABSI Score is an important tool in the assessment of mortality in burn patients. Multiple complications were encountered in our patients: infections, pulmonary, cardiac, renal, thrombo-embolic, hematologic, digestive and neurologic disorders. Conclusion: A detailed analysis of the physiopathology of burn injuries and their complications is essential for providing an adequate prompt treatment for decreasing morbidity and mortality. Mortality still represents the primary outcome evaluation for burn care, therefore scoring systems aim to use the most predictive patient and injury-related parameters to appreciate an expected mortality for a given patient. Early excision of the devitalized tissue and subsequent grafting reduce the local and systemic effects of the mediators released from the burned tissue with cessation of the progressive inflammatory chain. Early recognition and treatment of burns complications, especially severe infections represent an important prevention strategy, improving survival after these severe injuries. [ABSTRACT FROM AUTHOR]

Introduction: The more and more frequent use of radiotherapy has hindered the approach manner of breast reconstruction. Applied before, during or after breast reconstruction, the radiotherapy compromises the esthetical results. Material and Method: The team's study included a number of 68 patients admitted to the Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu" Plastic and Reconstructive Surgery, within the period May 2013 - June 2017 for breast reconstruction after radical modified mastectomy with adjuvant treatment, chemotherapy / radiotherapy, or for subcutaneous mastectomy and immediate reconstruction with oncological indication. Among the followed objectives, we can list: the comparative assessment of the various reconstructive techniques with the premises of the presence of an adjuvant treatment of the curative mastectomy; the influence exercised by the medical history of the patient on the final result of the reconstruction and the susceptibility to complications or the need for a surgical re-intervention based on the used reconstructive procedure. Results: A careful and detailed pre-operatory assessment of the expectations of the patient and the selection of the adequate reconstructive procedure represent a necessity for a satisfying result. The breast reconstruction with implant during the associated therapy leads to the possibility of development of capsular contracture. Also, the additional use of a flap does not always offer protection against this complication. Conclusion: The radiotherapy improves the survival rate in the case of the patients with breast cancer in advanced stages, but makes difficult the selection of a reconstructive procedure. [ABSTRACT FROM AUTHOR]

Adenocarcinoma of the pancreatic tail remains a malignancy with a generally dismal outcome owing to the delayed presentation of the disease. Surgery remains the goldstandard of treatment for pancreatic ductal adenocarcinoma and complete removal of the cancer confers a definite survival advantage. We report the case of a 48 year old male patient with imagistic findings (CT scan, MRI) that reveal a pancreatic tail tumor with advanced loco-regional invasion and liver metastasis. Multivisceral resection with liver metastasectomy was performed, with postoperative outcome complicated by Clostridium difficile infection (CDI). No signs of local recurrence or distant metastasis were present at three months follow-up. Chemotherapy was delayed due to pulmonary thromboembolism 5 weeks after surgery and a severe recurrence of the CDI was diagnosed 9 weeks postoperatively. We consider that a multidisciplinary meeting is mandatory to optimize the outcome in these type of patients. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing postmastectomy breast reconstruction, with a history of prior radiation therapy, present a particular clinical scenario. This is because of their well-documented higher complication rates, secondary to deleterious effects of irradiation on the soft tissue envelope of the remaining breast. Case presentation: This article presents the case of a breast reconstruction in a 53-year old woman with two subsequent breast reconstruction procedures after being treated with chemotherapy and radiotherapy. The first procedure was placing an expander under the mastectomy skin flaps, but it was followed by complications requiring the removal of the expander. One year later the second procedure was performed with latissimus dorsi flap and implant with satisfactory results. But after two years from the latest procedure, the patient turned to our clinic for improvement of the cosmetic outcome. Taking into account the medical and surgical history of the patient and after a complete clinical evaluation, the decision was to perform the right breast reconstruction with contralateral unipedicle musculocutaneous TRAM flap. Conclusions: The aesthetic results of standard delayed breast reconstruction after radiation therapy in patients with locally advanced breast cancer are satisfactory at best, even in the hands of experienced surgeons. The result quality that can be obtained in a patient with previous radiotherapy is therefore less optimal than the one achieved in a nonirradiated patient. [ABSTRACT FROM AUTHOR]

Background: The reconstruction of the breast with latissimus dorsi muscle-cutaneous flap and implant continues to be a reliable and easy to perform method, both by the experienced surgeons and also for the beginners. Case presentation: This article describes the case of a 38-year old woman who underwent breast reconstruction after 5 months from the mastectomy. After the clinical and paraclinical evaluation, all reconstruction options were presented to her, with advantages and disadvantages. Following the detailed pre-operatory evaluation and observing, as much as possible, the desires of the patient - to have a bigger breast compared to the amputated one and, at the same time, with an as natural as possible aspect, observing the integrity of the abdominal wall and the possibility to hide the scar of the donor area at the back - the surgical team together with the patient decided the reconstruction of the right breast with latissimus dorsi muscle - cutaneous flap and silicone implant (295cc). Even if the specialty literature presents this technique with some disadvantages in the final results and functionality of the ipsilateral shoulder, in this case the latissimus dorsi muscle-cutaneous flap offered a good coverage with satisfactory cosmetic outcome and proper functionality of the shoulder. Conclusions: Through the approach of a standardized protocol and adjusted to the requirements and anatomic possibilities of the patient, the breast reconstruction with LD and implant remains one of the most versatile techniques of reconstruction and which local complications are comparable to the ones in the esthetic mammary augmentation. [ABSTRACT FROM AUTHOR]