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Abnormal pneumatization of the middle nasal turbinate, also named concha bullosa, is one of the most frequent anomalies of the ethmoid-osteomeatal complex. Clinical studies have demonstrated a prevalence between 14% and 53% in the general population. Apart from the high frequency, the importance of this anomaly resides in the loco-regional changes it produces. First, it modifies the airflow at the level of the nasal passages both through the mass effect and through the irritating action on the adjacent nasal mucosa. Therefore, congestion of the nasal mucosa occurs. Secondly, it is a predisposing factor for the installation of rhinosinus infections, especially with chronic rhinosinusitis and fungal sinus infections. Thirdly, concha bullosa can cause rhinogenic pain through the same irritating phenomenon at the level of the mucosa. Our paper aims to address the anatomic-clinical, diagnostic and therapeutic aspects of the pneumatization of the middle nasal turbinate, paying special attention to the concepts of development and etiological factors. Finally, yet importantly, we propose an original anatomical-morphological classification that includes semiological computer tomographic aspects highlighted both in the sagittal plane and in the axial plane.

IntroductionThe triangular recess (TR), also called triangular fossa or vulva cerebri, represents the anterior extension of the diencephalic ventricle, located between the anterior columns of the fornix and the anterior white commissure. Over time, this structure of the third cerebral ventricle generated many disputes. While some anatomists support its presence, others have opposite opinions, considering that it only becomes visible under certain conditions. The aim of the study is to demonstrate the tangible structure of the triangular recess. Secondly, the quantitative analysis allowed us to establish an anatomical morphometric standard, as well as the deviations from the standard.Materials and methodsOur study is both a quantitative and a qualitative evaluation of the triangular fossa. We dissected 100 non-neurological adult brains, which were fixed in 10% formaldehyde solution for 10 weeks. The samples are part of the collection of the Institute of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi. We highlighted the triangular fossa by performing dissections in two stages at the level of the roof of the III ventricle.ResultsThe qualitative analysis is a re-evaluation of the classical data concerning the anatomy of the fossa triangularis. We proposed an original 3D model of the triangular recess in which we described a superficial part called vestibule and a deep part called pars profunda. We measured the sides of the communication between the two proposed segments, as well as the communication with the III ventricle. By applying the Heron’s formula, we calculated the area of the two communications. Statistical evaluations have shown that these communications are higher than they are wide. In addition, there is a statistical difference between the surfaces of the two communications: 34.07 mm2 ± 7.01 vs. 271.43 mm2 ± 46.36 (p = 0.001).ConclusionThe outcome of our study is both qualitative and quantitative. Firstly, we demonstrated the existence of the triangular fossa and we conceived a spatial division of this structure. Secondly, the measurements carried out establish an anatomo-morphometric norm of the triangular recess, which is useful in assessing the degree of hydrocephalus during the third endoscopic ventriculoscopy.

Background and Objectives: Haller Cells (HCs) represent the abnormal migration of ethmoid cells that are located below the ethmoid bulla at the level of the upper wall of the maxillary sinus. Through their placement, the cells can exert a mass effect on the infundibulum of the maxillary sinus. The aim of our study is to investigate the prevalence of Haller cells in the Romanian population and to evaluate the relationship between this anatomical variation and chronic rhinosinusitis. Secondly, we want to morphometrically evaluate the impact of Haller cells’ presence in the drainage paths of the maxillary sinuses. Materials and Methods: We conducted a randomised retrospective study that included 255 consecutive multi-detector computed tomography (MDCT) scans of the head. To carry out a comparative evaluation of the association of Haller cells with chronic rhinosinusitis, we divided the patients into two subgroups, a seasonal-based sample, between November 2022 and January 2023, and June 2023 and August 2023, respectively. We report the mean ± standard deviation for the continuous variables. To compare the results, we used the following statistical tests: a chi-squared test and a paired Student’s t-test (one-tail). Results: Our study identified a high prevalence of Haller cells, namely in 128 out of 255 patients (50.2%). There were no statistically significant associations between the presence of HCs and the age and the gender of the sample, respectively. The unilocular morphotype predominates in unilateral shapes and in bilateral shapes as well (p = 0.002). Our study identified the correlation between the Haller cells and the chronic rhinosinusitis in both research samples: “Winter group” and “Summer group” (p = 0.0002 and p = 0.0001, respectively). Conclusions: It was determined that for 40 out of 42 patients, the presence of HCs changes the morphometric pattern of the infundibular maxillary sinus.

Background and Objectives: The ponticulus posticus (PP) is a bony bridge that emerges from the posterior aspect of the superior articular process, to connect the posterior arch of the atlas. It is often associated with neurological symptoms. The aim of this study was to obtain an insight into this malformation, and prevalence in the North East region of the Romanian population. Materials and methods: This anatomical variant was analyzed through an observational and retrospective study which was carried out in St. Spiridon Hospital Iasi. The duration of the study was 10 months and, a number of 487 patients who presented neurological symptoms without cranio-cerebral traumatisms were enrolled and a computed tomography (CT) scan was performed. We proposed a new classification of PP in five types. The prevalence of PP was calculated and Skewness test, ANOVA test with Bonferroni correction, and Student’s t-test were used for statistical analysis. Results: Among the sample of 487 patients, PP was found in 170 cases (34.90%) in an age group of 8–90 years (mean age = 59.52 years, SD ± 19.94 years). Type I was found in 11.29%, followed by Type II—8.21%, Type III—5.13%, Type IV—5.54%, and Type V—4.72% (p = 0.347). It was 19.5%, mirroring the incomplete type, whereas the complete type was reported in 15.40% of cases (p = 0.347), the highest prevalence, namely 41.17% was found in the “41 to 60 years” age group, followed by 36.95% in the “21 to 40 years” group (p = 0.00148). The mean age was higher in patients with PP Type III (61.16 years, SD ± 19.98), while patients with PP Type V recorded the lowest mean age (56.48 years, SD ± 22.13). The differences between the comparative average ages on types were not statistically significant (p = 0.411). The gender and age were not good predictors of PP Type V (AUC < 0.600). Conclusion: according to our study, incomplete types of PP were found to be more prevalent as compared to complete types. No difference between males and females was detected. PP is more frequent in adults and young adults than in the elderly population. It is confirmed that gender and age were not good predictors of the bilateral complete type of PP.

Background and Aim: Melanoma is the most serious form of skin cancer causing most of the skin cancer-related deaths. The incidence of melanoma has risen so dramatically over past few years that no other solid or blood malignancy comes close to it in terms of increased incidence. The main issue is low treatment response in conventional therapies. The aim is a low total body impact with high melanoma cells targeted treatment. Materials and Methods: nanotechnology has become instrumental with its far-reaching ramifications both in diagnosis and treatment of melanoma. Nanomaterials tailored as delivery vehicles can be nanocapsules, nanorods, nanotubes, nanoshells, and nanocages. All these structures protect the intended drug against degradation and enhance its stability. The development and characterization of polymeric nanoparticles, polymeric micelles, liposomes, nanohydrogel, dendrimers, inorganic nanoparticles, and hybrid nanocarriers are among the delivery vehicles that transport different anticancer agents. Functionalization of nanocarriers with specific molecules, such as antibodies, can generate different smart nanodrugs for application in cancer therapy and/or diagnosis. Nanotherapeutic strategies deal with several shortcomings that comprise of tumor characteristics, biological barriers, biocompatibility, and so on. We studied the available technologies on the European medical market which are appliable on specific cases of nodular melanoma during 2019-2021 in our Plastic Surgery unit on 18 cases of nodular melanoma stage I to IIIrd. Results: Development of upgraded therapeutic modalities for melanoma facilitating early diagnosis with subsequent excision before metastasis is, therefore, an urgent need. The basic results is that all patients had a proper treatment, some of them experimental one with nanotechnology and the main result is that side effects were significantly smaller in time and manifestation, the disease stopped the progress and overall satisfaction was bigger in comparison with conventional chemotherapy. Conclusion: Nanotechnology could be the future in targetted treatments in nodular melanoma.

the treatment with antibiotics represents one of the main components of the medical treatment of neglected peritonitises. Material and method: in principle, the antibiotics therapy must take place based on the bacteriological examination and with the results of the antibiogram in mind. However, in practice, because of the emergency situation and the polymorphism of bacteria we could also apply certain theoretical criteria in order to properly select the antibiotics treatment, but: the antibiotic must be active for the peritonitis germs; it must have a good penetration and it must concentrate in the peritoneal cavity; it must not any have toxic effects and must not be conducive to kidney failure. In our trial we have used a systematic antibiotics treatment in emergency situations, and we have often chosen combination of antibiotics following the analysis of the peritoneal pus and the antibiogram outcome. Results: The antibiotics used the most were Penicillin, Gentamicin, Metronidazole and Ampicillin. The combination of three antibiotics was used in 67.35% of all the cases when antibiotics were used. The antibiotics mostly used in an association of two were: Penicillin, Gentamicin, Ceftriaxone, Cefazolin. This association was used in 26.53% of the cases when antibiotics were used in the treatment. The most frequent antibiotics used in a combination of two for the treatment of acute appendicitis were: Ampicillin and Gentamicin, respectively Ampicillin and Metronidazole. The percentage of this association of the whole antibiotherapy for acute appendicitis represents 23.81%. In our trial we have compared the therapeutic proficiency of one antibiotic vs the combination of antibiotics in cases of neglected peritonitises. From our results we have found that there was an increased sensibility and a high rate of response (92%) in the patients treated with Imipenem and Netilmicin, in comparison with the rate of positive response of 83%, which we achieved when Imipenem was administrated in monotherapy. Conclusions: We have applied an algorithm of antibiotics therapy in a growing scale: Tienam (Imipenem) usually, in the 3 days until we have obtained the result of the antibiogram and we have become aware of the sensibility of the bacteria and had the possibility to choose a combination of antibiotics.