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A tracheoesophageal fistula (TEF) is a communication between the trachea and esophagus that is acquired or congenital. Congenital TEF, without other conditions like esophageal atresia, is usually diagnosed after birth or during infancy, as the baby will develop respiratory symptomatology, mostly severe, due to fluid/food aspiration in the trachea. In adults, TEFs can be caused by malignant conditions, blunt trauma, iatrogenic injury, prolonged mechanical ventilation and excessive inflation pressure of the endotracheal tube. We report a male patient of 86 years of age who presented at the "St. Spiridon" Emergency County Hospital in January 2022, accusing breathing difficulty, productive cough and occasional stabbing pain in the posterior thorax, within the previous week. Clinical exam was typical for pneumonia, but since the patient mentioned coughing episodes during eating/drinking since December 2021, together with a history of general anesthesia for abdominal surgery in mid-November 2021, a CT scan was performed. It confirmed a TEF of 7/16 mm (transverse/cranio-caudal) in size, located at the level of T2 vertebral body. The particularity of the case resides in the uncertain etiology of the fistula. If this patient had a clear iatrogenic injury, aspiration pneumonia should have occurred within days after the intubation event. However, after the surgery the patient was fine and discharged home without any symptomatology relevant for TEF. Only after one month, he started experiencing coughing during eating, that leads us to the assumption that he might have been born with a very small and asymptomatic tracheoesophageal defect, and the intubation for general anesthesia, even if done in a correct manner, represented a trigger event which led to development of a TEF. There are very few cases reported in literature with adult patients presenting a minor structural defect that remained unnoticed for a very long time. [ABSTRACT FROM AUTHOR]

Background: The celiac trunk represents an unpaired visceral branch of the abdominal aorta, which detaches at the level of the 12th cervical vertebra. It has a trajectory of 1-2 cm and a caliber of 5-8 mm, having relations with the parietal peritoneum, the vestibule of the omental bursa, the diaphragmatic lymph nodes and the diaphragmatic pillar muscles, the caudate lobe of the liver, the vertical portion of the small gastric curvature and the median arcuate ligament. The celiac trunk trifurcates into three terminal branches: the left gastric artery, the common hepatic artery and the splenic artery. Each of these branches has a specific trajectory and relations, vascularizing the corresponding organs. Given its importance as a source of vascularization, any anatomical variation is eloquent and necessary to be known for the diagnosis and treatment of conditions at this level. Methods: The selection of articles that were included in this paper was made using the PubMed database, where the following keywords were used: variation of celiac trunk, celiac trunk and laparoscopic surgery, clinical implications of celiac trunk, celiac trunk and oncologic extensive surgery. Entering the mentioned keywords generated an initial number of 5428 references. They were subjected to a filtering process: duplicates were removed, only free full-text articles were selected, and inclusion and exclusion criteria were applied. Subsequently, the most appropriate articles for the topic of the paper were chosen, according to the Web of Science Impact Factor and suitability criteria, resulting in a final number of 28 articles. Literature review: These 28 articles were reviewed based on the criteria: anatomical variants in the branching of the celiac trunk, implications of anatomical variations of the celiac trunk in: laparoscopic surgery - treatment of median arcuate ligament syndrome, abdominal oncological surgery, liver transplant and interventional radiology. Conclusions: The anatomical variations of the celiac trunk have a significant impact on abdominal surgery, whether oncological or not, liver transplant, as well as minimally invasive radiological procedures. A correct knowledge of the up-mentioned variations significantly decreases the rate of intra- and post-interventional complications, accompanied by a smaller recovery time in the possible event of a complication, and also the general healing time following surgery. [ABSTRACT FROM AUTHOR]

Forensic identification is the means to highlight the unique characteristics of an entity and differentiate it from any other. The term identity derives from the Latin word "idem" meaning "same" or "identical". The identification of persons (living or deceased) is a process that is ideally achieved through the interdisciplinary collaboration of forensic medicine with the anthropologist, criminologist and judicial police. Gender estimation is a topic of great interest in forensic medicine, and numerous studies in the field have given rise to a database of diagnostic traits. The purpose of this paper is to demonstrate the reality of sexual dysmorphism based on anthropometric measurements of the orbit and to reinforce the importance of radiology in forensic practice. The study consists in 27 computed-tomography images on which we made some measurements of orbits cavities, after which a statistical analysis was performed. Following the measurements, a comparison was made between the values obtained for males and those obtained for females, confirming the hypothesis supported by many authors that these values are generally higher in men, thus helping identify unknown persons. The development of newer and better methodologies for gender estimation, as well as the reevaluation of existing ones, will continue to emerge, and the efforts of forensic researchers will lead to much more accurate results from indirect analyses of human bone structures through digital imaging. [ABSTRACT FROM AUTHOR]

The knee joint (Articulatio genus) is the largest joint of the body. The tibial plateaus represent the proximal, articular surface of the tibial condyles that articulate with the femoral condyles. The traumatic damage of these surfaces invariably leads to the change in the distribution of the forces of mechanical pressure, which results in uneven wear and the appearance of arthrosis. We conducted a review of the literature using the PubMed database in order to identify the optimal treatment of the tibial plateaus fractures, the evolution and the prognosis. Out of 3047 identified references, 26 articles were selected for analysis after the application of the exclusion criteria. There is a consensus among the majority of authors regarding recommended surgical treatment for displacement fractures and increased attention to frequently associated ligament and meniscal injuries. The most common surgical method chosen is open reduction and internal osteosynthesis. The complexity of these fractures sometimes makes it difficult to fit them into a classification system and the prognosis may be reserved, given the large number of immediate and late complications. [ABSTRACT FROM AUTHOR]

Background: The vertebral column represents the axial skeleton and has an indispensable role in the protection of the spinal cord. Early identification of its pathologies and an adequate treatment are essential for a favorable outcome. Methods: For the selection of the articles included in this review work, the PubMed database was searched, using the following queries: "acute lumbar back pain, chronic lumbar disc pain, intervertebral disc disease, lumbar intervertebral disc injury, lumbar spine intervertebral disc x -ray imaging, lumbar spine intervertebral disc magnetic resonance imaging, intervertebral lumbar disc treatment options". A total of 2756 articles resulted from the search with the previously mentioned keywords, and after identifying and removing duplicates, 2063 references remained. After applying the free full-text criterion, 532 articles resulted, and the subsequent application of the novelty criterion (articles from the last 5 years, 2018-2023) led to the selection of 241 references. The inclusion and exclusion criteria defined in the present paper were applied to these 241 references, resulting in 178 articles, of which 36 articles were finally included in the paper, following an impact-factor-based quality assessment. Literature review: These 36 articles were reviewed based on the criteria: etiology and etiopathogenesis of lower back pain, classification and description of lumbar disc diseases, as well as their diagnosis and treatment. Conclusions: Lumbar disc diseases are a real burden in the lives of patients from a psychological, social and professional point of view. They limit the ability to perform the previously-carried-out activities, thus reducing the quality of life of patients. An early diagnosis, followed by the initiation of treatment, are essential in the management of these pathologies that are increasingly common nowadays. [ABSTRACT FROM AUTHOR]

Purpose: reviewing data on the anatomical variations of mandible and imaging data. Material and method: 10 studies were selected over a period of eighteen years (2013-2021), which have as object of study anatomical variations of mandible. A total of 482 patients were analyzed in imaging studies of anatomical variations of mandible, of which were 170 male and 312 were female. Results: The mandibular foramen was situated in the inferior 1/3 of mandibular ramus in 30 cases.(3-6). In 20 cases (40%) the mandibular foramen was situated in the middle of the ramus. Mental foramen was located on the anterior surface of the corpus of the mandible, posterior to the mental tubercle and had a round shape in 30 cases (60%). Mental foramen had an oval shape in 20 cases (40%). [ABSTRACT FROM AUTHOR]

The absence of the pectoralis major muscle is considered a feature of the Poland Syndrome, described as a complex disease, affecting not only muscular tissue, but also bones and various organs, both in the proximity and at distance from the muscular defect. Having no clear evidence-based etiology, partial agenesis of the pectoralis major muscle is a silent anomaly, discovered exclusively when symptomatic and during an early age. The method used in this particular case was computed tomography (CT), in the circumstances of a respiratory tract complaint. However, similarities between our case and literature databases have been outlined only regarding the prevalence in gender, type of impairment and right side localization. No anatomical, genetic or hereditary links or associations have been observed in our patient's current condition or throughout his past medical history, nor other medically proven related syndromes or diseases were noted. Consequently, our aim is to draw attention to the fact that unilateral partial agenesis of pectoralis muscle alone has been scarcely reported in recent or former research papers, alongside with stating that this discovery may be as well portrayed in the near future as an individuality itself, included or not amongst the widespread accepted and standard characteristics of a possible Poland syndrome. [ABSTRACT FROM AUTHOR]

The human heart beats around 2.5 billion times during a normal lifetime. Responsible for this function is the cardiac conduction system (CCS). This unique system is formed by specialized cardiomyocites, in which generate the cardiac impulse and conduct it from the atrial to the ventricular chambers. The functional components of the CCS are: sinoatrial node (SAN), atrioventricular node(AVN), atrioventricular bundle (AVB or bundle of His), the right and the left bundle branches (RBB and LBB) and the Purkinje network fibers. The CCS examination is a difficult task for most practicing pathologists, because it is macroscopically identical to the surrounding cardiac structures. For this reason,detailed anatomical knowledge is required to identify it. [ABSTRACT FROM AUTHOR]

COMPLETE SACRAL SPINA BIFIDA OCCULTA fortuitously DISCOVERED IN A TRAUMA PATIENT (Abstract): Sacral spina bifida occulta (SSBO) is a defect occurring during embryonic life when the neural tube develops. It consists of o complete lack of the posterior wall of the sacral canal, which anatomically is represented by the median sacral crest. This condition belongs to a larger group of pathologies named spina bifida, the latter comprising also the meningocele and the myelomeningocele. In this paper we present a totally asymptomatic complete SSBO in a 47- year old patient with multiple traumas that arrived at "Sf Spiridon" Emergency County Hospital in Iasi, Romania. He experienced an accidental fall from approximately 1.5 - 2.0 metres and we managed to discover his sacral defect during the CT scans he underwent in the Radiology Department. We present the axial and the reconstructed CT images and discuss the anatomy of the sacrum in both complete and incomplete SSBO, pointing towards possible complications that might arise in case of injury at this level. We have reviewed the related literature on PubMed discovering the controversies amongst classification and the methodological approach of this condition. Several data is presented comparatively and an emphasis is done on the prevalence of this rare finding in several anthropological studies, based on archaeological sites from abroad and even located in our city, Iasi. [ABSTRACT FROM AUTHOR]

Introduction: In the last years, throughout the world, the cardio-vascular pathology has a massive and continuous growth, with an increased gravity due to the lowering of the age of patients affected by this type of illness. Objectives: The main objective is reviewing the medico-legal cases with cardio-vascular pathology encountered by the authors in the 2015-2018 interval, with confirmation and positive appreciation of the growing incidence of this pathology, decreasing the age threshold and other medicolegal aspects, macroscopical and histopathological. Material and method: The following paper evaluates the cases of deaths due to myocardial fibrosis, encountered in the activity of the authors, on a 4-years period (2015-2018), at the Institute of Legal Medicine Iasi, Romania. Results: Out of a total of 374 medico-legal autopsies performed by the authors in the 2015-2018 period at the Institute of Legal Medicine Iasi, 80 deaths were attributed to myocardial fibrosis. Conclusions: Although the medical world is trying, on a global scale, to prevent cardio-vascular diseases by means of educational programs, encouraging periodic medical check-ups and innovative therapies, the incidence of this pathology is continuously growing, affecting increasingly younger patients. This review of the medico-legal cases encountered by the authors aims to confirm the ascending trend of cardio-vascular disease incidence and to raise attention to this issue. [ABSTRACT FROM AUTHOR]

The commissural pathways of the brain have represented a point of interest for anatomists beginning with the 19th century. However, only by mid 1950s Theodor W. Blackstad achieved the experimental analysis of their functional organisation. The canal of the anterior commissure and its lateral segment were mentioned beginning with the 18th century by Vicq D'Azyr, so that in 1983 Malcolm D. Carpenter would achieve the first anatomical description of the rostral commissure. The purpose of this study is to achieve a morphometrical analysis of the mediosagittal segment of the anterior cerebral commissure, constituting an important landmark in surgical interventions at the level of the anterior wall of the third cerebral ventricle. The anatomical material is represented by 20 adult brains in the collection of "Ion Iancu" Anatomy Institute of "Gr. T. Popa" University of Medicine and Pharmacy Iaşi. The anatomical pieces were preserved through immersion into a formaldehyde solution 10% for 6 months. The images were taken with the help of a Fujifilm FinePix S3200 camera, with a resolution of 10 megapixels and processed with the ArchiCAD software. Through the measurements taken regarding the maximum and the minimum diameter, as well as through the determination of the area of the mediosagittal section, our study represents a first basis in the carrying out of an anatomical norm regarding the anterior white commissure. [ABSTRACT FROM AUTHOR]

Ankylosing spondylarthritis is an immune-mediated inflammatory disease, which includes axial and peripheral arthritis, inflammation of the site where tendons and joint capsules attaches to the bone and degeneration of the sacroiliac joint and the spinal cord joints, leading to progressive spinal fusions. Introduction of new immunomodulatory molecules into therapy aiming at interleukins, such as the tumor necrosis factor alpha, was considered a major breakthrough in the treatment of severe ankylosing spondylarthritis. This case illustrates the particular evolution of the clinical manifestations in correlation with joint trauma, gastrointestinal infection and the devastating consequences of active HLA-B27 positive ankylosing spondylarthritis with juvenile onset. [ABSTRACT FROM AUTHOR]

Spondilartrita anchilozantă este o boală inflamatorie mediată imun, care include artrita axială şi periferică, inflamaţia locului unde tendoanele şi capsulele articulare se inseră pe os, precum şi degenerarea articulaţiilor sacro-iliace şi ale coloanei vertebrale, care conduce la fuziuni progresive ale vertebrelor. Introducerea în terapie a moleculelor imunomodulatoare, cu ţintă pe interleukine, cum ar fi pe factorul de necroză tumorală alfa, a fost considerată ca un progres major în tratamentul formelor severe de spondiliartrite ankilozante. Acest caz ilustrează evoluţia particulară a manifestărilor clinice în corelaţie cu traumatismul articular, infecţia digestivă şi consecinţele devastatoare ale spondilitei ankilozante active HLA-B27 pozitivă cu debut juvenil. [ABSTRACT FROM AUTHOR]