Publications by authors named "Cristian-Radu Jecan"

20 Publications

  • Page 1 of 1

The importance of adrenal venous sampling in ACTH-independent Cushing syndrome: A case report and literature review.

Exp Ther Med 2021 Jul 18;22(1):772. Epub 2021 May 18.

Discipline of Pediatric Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Independent Cushing's adrenocorticotropic hormone (ACTH) syndrome can have several causes, including adrenal carcinoma or simple adrenal hyperplasia. Although the distinction between malignant and benign can be effectively made through imaging investigations, in the situation where there are bilateral formations, their hormonal activity is impossible to appreciate via non-invasive techniques. The present study includes the presentation of a clinical case on the basis of which a literature review was made. The clinical case pertains to a 32-year-old patient with ACTH-independent Cushing's syndrome and bilateral adrenal tumor formations leading to the utility of adrenal venous sampling to avoid bilateral adrenalectomy. A literature review was subsequently conducted focusing on articles pertaining to the PICO criteria in order to describe: The diagnosis of adrenal tumor masses, the decision on the type of surgery and most importantly, the impact of adrenal venous sampling in avoiding surgical resection. These interventions severely limit the patients' quality of life.
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http://dx.doi.org/10.3892/etm.2021.10204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145433PMC
July 2021

6 Years of Breast Reconstruction in One Center - An Objective Analysis.

Chirurgia (Bucur) 2021 Mar-Apr;116(2 Suppl):98-104

Breast cancer represents the most common type of neoplasm in women around the world. Breast reconstruction following mastectomy has become a demanding procedure in the treatment of patients suffering from breast cancer. Their major role is to improve the quality of life of women, leading to better aesthetic outcomes. Based on each type of reconstruction, the complications following surgery and the duration of hospital stay, the financial implications slightly vary. Our study included 168 female patients who underwent immediate or delayed breast reconstruction after mastectomy. We assessed the clinical management of each of these cases and we evaluated the average final cost of the treatment after the reconstruction, focusing on the reconstructive method used, the complications that occurred and the number of days of hospitalization. The total cost of care in breast reconstruction surgery depends on the type of reconstructive procedure used, which consequently affects the duration of hospitalization of the patients. The expenses also depend on the materials that are used: the type of implant/expander or the use of ADM. Costs were higher in patients who underwent breast reconstruction using a latissimus dorsi flap associated with an implant, in comparison to reconstruction using a free flap. Breast reconstruction represents a crucial process in the management of women who underwent mastectomies following cancer and presumes variable financial resources, depending on the chosen reconstructive method.
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http://dx.doi.org/10.21614/chirurgia.116.2 Suppl.S98DOI Listing
May 2021

Patient-Reported Quality of Life 3 Months after Breast Reconstruction.

Chirurgia (Bucur) 2021 Mar-Apr;116(2):232-237

Breast cancer is considered to be the second major cause of cancer death in women after lung cancer. Due to a remarkable progress, the treatments against breast cancer became more efficient and less toxic. In addition, the reconstructive procedures after mastectomy have improved significantly the quality of life especially in younger women. The aim of the study was to evaluate the quality of life of patients 3 months after breast reconstruction. We performed a prospective study on 25 female patients who underwent immediate or delayed reconstruction of the breast after mastectomy. A health-related quality of life questionnaire was distributed and the answers were evaluated. The patients from the rural area reported that their health in general was much worse than one year ago. The patients with ductal carcinoma reported a serious limitation for vigorous activities, such as running, lifting heavy objects, participating in strenuous sports. 15 patients declared that their general health is good, 8 very good and just two women considered it excellent. Breast reconstruction following mastectomy have an effect on the patient's quality of life. Therefore, there is an increased need to recognize and evaluate the quality of life after post reconstruction.
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http://dx.doi.org/10.21614/chirurgia.116.2.232DOI Listing
May 2021

Primary thyroid angiosarcoma in a non-endemic region - a rare case.

Rom J Morphol Embryol 2020 ;61(1):267-271

Department of Plastic and Reconstructive Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, Romania; Discipline of Internal Medicine I and Nephrology, Department of Medical Semiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Department of Nephrology, Emergency University Hospital, Bucharest, Romania;

Thyroid angiosarcoma (AS) is a specific type of vascular tumor that arises from the endothelial cells, being highly aggressive, with increased recurrence rates and metastasis. It is characterized by positive endothelial markers and co-positive markers for cytokeratins and epithelial membrane antigen. We are describing the case of a 76-year-old patient who presented to the hospital for dyspnea and asthenia. The clinical and paraclinical investigations confirmed the presence of a right large thyroid nodule, which turned out positive at immunostaining for AS. Even if thyroid AS is a rare type of tumor, mainly described in the Alps, one has to take into account that it can evolve in any other regions and should be considered as a differential diagnosis.
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http://dx.doi.org/10.47162/RJME.61.1.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728125PMC
June 2021

Vaginal Reconstruction in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome-One Centre Experience.

Medicina (Kaunas) 2020 Jul 1;56(7). Epub 2020 Jul 1.

Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Clinical Emergency Hospital, 011356 Bucharest, Romania.

The Mayer-Rokitansky-Küster-Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009-December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer-Rokitansky-Küster-Hauser syndrome. The Abbe'-McIndoe technique with an autologous skin graft was performed in all cases. The average age of our patients was 20.16 (16-28) years. All patients were 46 XX. The average surgical timing was 3.05 h (range 2.85-4h). Postoperative rectovaginal fistula was encountered in 1 patient. Postoperative average vaginal length was 10.4 cm (range 9.8-12.1 cm). Regular sexual life was achieved in 10 patients. Nowadays, there is no established standard method of vaginal reconstruction. In Romania, the McIndoe technique is the most applied. Unfortunately, even if the MRKH syndrome is not uncommon, less and less surgeons are willing to perform the procedure to create a neovagina.
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http://dx.doi.org/10.3390/medicina56070327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404697PMC
July 2020

Characteristics of patients at initiation of renal replacement therapy - experience of a hemodialysis center.

Exp Ther Med 2020 Jul 17;20(1):103-108. Epub 2020 Mar 17.

Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

The monitoring and care of patients with chronic kidney disease (CKD) before the dialysis initiation contribute to a better survival rate and an improvement in quality of life. The patients who do not benefit from a good predialysis management have a worse short and long-term prognosis. A retrospective, unicentric study was performed to evaluate the status of patients with stage 5 CKD at the time of initiation of renal replacement treatment. A total of 109 patients were included in the study. The evaluation of the patients included the clinical manifestations leading to hemodialysis initiation, the clinical and laboratory data of the patients when the hemodialysis was started. Based on the obtained data, a statistical analysis was performed using the Chi-square test, Fisher's exact test, ANOVA, and Kruskal-Wallis H test. The mean age of the patients was 64.61±13.59 years. Of the patients 51.38% were women. Vascular nephropathies and diabetes mellitus dominated the etiology of CKD. The comorbidities were high blood pressure, ischemic heart disease, history of myocardial infarction, heart failure, history of stroke, peripheral artery disease or atrial fibrillation. Only 43 (39.45%) of our patients were monitored before the hemodialysis initiation. Hemodialysis was initiated on central venous catheter (in most cases non-tunneled) in 78.90% of the patients. Most of the patients had an altered general status, fatigue/tiredness with poor exercise capacity when hemodialysis was initiated. Most of the patients (98.17%) had anemia, the average level of hemoglobin being 8.69±1.85 g/dl. In conclusion, careful monitoring of patients in the early stages of CKD would result in lower morbidity and mortality. These objectives can be achieved by implementing screening programs and early interventions.
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http://dx.doi.org/10.3892/etm.2020.8608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271700PMC
July 2020

Thermographic camera in traumatology, diabetic foot and reconstructive procedures.

Injury 2020 Dec 9;51 Suppl 4:S117-S120. Epub 2020 Mar 9.

Carol Davila University of Medicine and Pharmacy, Department of Plastic and Reconstructive Surgery, Bucharest; Agrippa Ionescu Emergency Clinical Hospital, Department of Plastic and Reconstructive Surgery, Bucharest.

Traumatic lacerations, burns and ulcerations are a common cause of admission in the plastic surgery wards. Clinical evaluation alone sometimes provides insufficient or even inaccurate information. Thermographic camera is a new tool that could provide additional information regarding skin vascularization, presence of inflammation or involvement of deep tissue. A prospective study was realized for assessing pre and postoperative status of patients with lacerations, trauma, burn and diabetic foot. Preoperative evaluation helped in assessing bone involvement, inflammation and infection in order to decide the necessity of surgery. Postoperative evaluation was useful in preventing and lowering the rate of complications. Thermographic camera could be a new helpful and non-invasive tool especially in emergency hospitals in order to assess rapidly and objectively wound status and to start if necessary, a surgical treatment.
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http://dx.doi.org/10.1016/j.injury.2020.03.020DOI Listing
December 2020

Timing between Breast Reconstruction and Oncologic Mastectomy-One Center Experience.

Medicina (Kaunas) 2020 Feb 20;56(2). Epub 2020 Feb 20.

Department of Plastic and Reconstructive Surgery, Faculty of Medicine "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Breast cancer is the most common cancer in women. The immunohistochemical profile, but also the stage of the tumor determines the therapeutic management, which varies from conservative surgery to mastectomy associated with chemotherapy, hormonal and biological therapy and/or radiotherapy. Mastectomy remains one of the most radical surgical intervention for women, having great consequences on quality of life, which can be improved by realizing immediate or delayed breast reconstruction. The objective of the study was to evaluate the period of time between the mastectomy and the breast reconstruction. We performed a retrospective study on 57 female patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania. All the patients underwent immediate or delayed breast reconstruction after mastectomy for confirmed breast cancer. Descriptive data analysis was realized with evaluation of type of breast reconstruction considering the staging of the tumor, the invaded lymph nodes, and the necessity of adjuvant chemoradiotherapy. Moreover, the median period between mastectomy and reconstruction was evaluated. The immediate breast reconstruction was performed in patients with stage I, in patients with stage II, delayed reconstruction was performed after minimum six months, and the patients with stage III had the breast reconstructed with free flap (50%), 8-43 months post-mastectomy. Radiotherapy determines the type of breast reconstruction, in most of the cases the latissimus dorsi flap was used with implant (22.6%). Breast reconstruction is an important step in increasing the quality of life for women who underwent mastectomy after breast cancer. The proper timing for breast reconstruction must be settled by a team formed by the patient, the plastic surgeon, and the oncologist.
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http://dx.doi.org/10.3390/medicina56020086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073902PMC
February 2020

Quality of Life in Patients with Surgically Removed Skin Tumors.

Medicina (Kaunas) 2020 Feb 9;56(2). Epub 2020 Feb 9.

Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, 011356, Romania.

: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients' mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Surgery is one of the main steps in treating skin cancer. It has a great impact on patients' quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically.
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http://dx.doi.org/10.3390/medicina56020066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074335PMC
February 2020

Cutaneous melanoma arising on pre-existing nevi - case reports.

Rom J Morphol Embryol 2019 ;60(3):1025-1030

Department of Plastic and Reconstructive Surgery, University Emergency Hospital, Bucharest, Romania;

Skin cancer is a common healthcare issue that affects millions of people worldwide. Only a small part of that population is suffering from melanoma and an even smaller proportion has melanoma developed on a pre-existing nevus. This paper illustrates five such cases, diagnosed over an 18-month period, with their histological particular aspects. Among the total number of patients diagnosed and treated in the Department of Plastic and Reconstructive Surgery, University Emergency Hospital, Bucharest, Romania, over approximately one year, of which half for melanoma in general or for benign nevi, only a small fraction had developed melanoma on a common or dysplastic nevus. These patients, as well as those with de novo developed melanoma, are a reason for concern since most of the lesions were diagnosed in a locally advanced stage of the disease. Though efforts are being made to screen and diagnose early, there are still a lot to be done in order to lower the mortality and morbidity rates for this pathology.
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June 2020

A recurrent solitary glomus tumor of the forearm.

Rom J Morphol Embryol 2019 ;60(3):1019-1023

Department of Pharmacology, Faculty of Medicine and Pharmacy, "Lower Danube" University of Galaţi, Romania;

Glomus tumors account for 1.6% of all soft tissue tumors and the majority are localized at the level of the fingertips and do not exceed the size of 5 mm. They are usually solitary tumors, characterized by the following clinical triad - severe pain, pinpoint tenderness, and cold intolerance. We present the case of a 63-year-old patient with a fixed tumor located in the lower third of the right forearm with a long-axis diameter of 4 cm, with irregular borders and tenderness to palpation. The tumor had been surgically removed 15 years ago, but it redeveloped two months after surgery, and grew in size until the fourth month after the surgery when it stopped growing. The preoperative ultrasound showed an expansive mass suggestive of swelling/inflammation in the adjacent soft tissue and having a mass effect on the deep muscle structures. Intraoperatively, a 3/4/3 cm (antero-posterior∕transversal∕cranio-caudal) pink tumor was found subcutaneously, with well-defined borders, which was mobile on the deep planes, apparently encapsulated. The tumor was removed with safety margins of about 1 cm and hemostasis was performed. Postoperatively, immunohistochemistry confirmed the diagnosis of glomus tumor: alpha-smooth muscle actin (α-SMA) positive in the cytoplasm of malignant cells, type IV collagen positive in the basement membrane, cluster of differentiation 34 (CD34) negative in the malignant cells, CD34 positive in endothelial cells, Ki67 positive in the 1-2% of the cancer cells nuclei. The postoperative evolution was favorable, without complications and no recurrence at six months.
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June 2020

The curious case of a forehead metatypical basal cell carcinoma.

Rom J Morphol Embryol 2018 ;59(1):345-352

Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, Romania;

The risk of developing basal cell carcinoma (BCC) during lifetime varies between 29-55%, while for squamous cell carcinoma (SCC) varies between 7-11%. Between them, considered to be a BCC, there is a particular histological type, named metatypical basal cell carcinoma (MTC) or basosquamous cell carcinoma (BSCC). In this paper, we presented a rare case of metatypical carcinoma of the forehead with an interesting history of unexpected recurrences, underlining the clinical, therapeutic and histological essential aspects that may come in use to other clinicians in managing this type of cancer. In this case, the last recurrent tumor invaded the external layer of the frontal bone and needed a temporo-parietal flap to cover the large defect, which was previously covered in 2014 using skin grafts. Using Hematoxylin-Eosin (HE) staining, the histological assessment revealed a basosquamous carcinoma (IDO-O 8094/3, according to World Health Organization). In addition to the histological aspects revealed using HE staining, in this case, diffused tumor cells were p63 nuclear positive, which according to Bircan et al. (2006), it is strongly and diffuse reactive in 82.1% differentiated, in 77.8% of superficial and in 72.3% of solid undifferentiated BCCs. The aggressive behavior was revealed by tumor's dimension, local invasion of the frontal bone with high mitotic rate as seen in the van Gieson and HE staining, also by the number of recurrences. The prognosis of this case is reserved due to the number of recurrent tumors, immunohistochemistry anomalies, involvement of the external layer of the frontal bone, tumor site, gender, poor remaining reconstructive procedures in case of a relapse, thus, close follow-up is to be recommended for a period of minimum five years. Recurrent tumors raise treatment difficulties regarding the reconstruction procedure of the defect after wide surgical excision. Therefore, the aggressive behavior of the MTC should be taken into consideration in clinical practice.
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October 2018

Femtosecond-LASIK outcomes using the VisuMax®-MEL® 80 platform for mixed astigmatism refractive surgery.

Rom J Morphol Embryol 2018 ;59(1):277-283

Department of Neurology, "Victor Babes" University of Medicine and Pharmacy, "Pius Brinzeu" Emergency County Hospital, Timisoara, Romania;

Aim: To evaluate the predictability, efficacy and safety of Femtosecond-laser-assisted in situ keratomileusis (LASIK) procedure for mixed astigmatism.

Patients, Materials And Methods: We prospectively evaluated for 12 months 74 eyes (52 patients) with mixed astigmatism that underwent Femtosecond-LASIK treatment. The preoperative mean refractive sphere value was +1.879±1.313 diopters (D) and the mean refractive cylinder value was -4.169±1.091 D. The anterior corneal flap was cut using the VisuMax® femtosecond laser and then the stromal ablation was done using the MEL® 80 excimer laser.

Results: Mean age was 30.22±6.421 years with 61.53% female patients. Postoperative spherical equivalent at 12 months was within ±0.5D of emmetropia in 75.8% of eyes and within ±1D in 97.3% of eyes. Postoperative uncorrected distance visual acuity was equivalent to or better than the preoperative corrected distance visual acuity in 91.9% of eyes. Compared to the preoperative corrected distance visual acuity (CDVA), 8.1% of eyes gained one line, 2.7% gained two lines and 2.7% gained three lines of visual acuity.

Conclusions: Femtosecond-LASIK using the VisuMax®-MEL® 80 platform appears to have safe, effective and predictable results in mixed astigmatic eyes. The results are impressive for high refractive error treatment and for improvement of both uncorrected and corrected distance visual acuity.
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October 2018

Immediate Versus Delayed Breast Reconstruction for Postmastectomy Patients. Controversies and Solutions.

Chirurgia (Bucur) 2017 Jul-Aug;112(4):378-386

When considering breast reconstruction, two main decisions have to be made: optimal timing and appropriate reconstruction technique,that would best suit each patient, while also taking into consideration the complications and risks that these decisions might lead to. By careful patient selection and individualized breast reconstruction approach, the risks and complications of the procedure can be minimized, while attaining successful aesthetic outcomes and high patient satisfaction. Breast reconstruction can be performed in three different settings: immediate reconstruction - at the time of mastectomy; delayed reconstruction " after the completion of the adjuvant treatment and in a delayed-immediate setting that uses both previous methods" includes tissue expansion at the time of mastectomy and definitive reconstruction performed after completion of the adjuvant treatment. The strategies perfected for decades in breast reconstructive surgery have now made breast reconstruction more possible than ever, thus offering patients the chance to recover after a mastectomy procedure with a new reconstructed breast. Although, the choice of breast reconstruction is not adressed by all breast cancer patients, rates are gradually expanding while new and improved techniques are rapidly developing.
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http://dx.doi.org/10.21614/chirurgia.112.4.378DOI Listing
March 2018

The relationship between periosteum and fracture healing.

Rom J Morphol Embryol 2016 ;57(4):1215-1220

Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, Romania;

Fracture healing is a complex process that involves presence of osteoprogenitor cells and growth factors. Therefore, the integrity of the fracture site surrounding tissues including periosteum is necessary in order to provide the resources for bone regeneration. The purpose of this review is to organize and synthesize the relevant information regarding periosteum and fracture repair. Periosteum cells are involved in endochondral or intramembranous ossification according to the presence of a new formed cartilage. The periosteal osteoprogenitor mesenchymal cells differentiation is guided by a multitude of signaling molecules, especially bone morphogenetic protein 2 (BMP2), but also as a response to mechanical stimuli. If the periosteum is traumatized or removed, there are other osteoprogenitor cell sources as the ones located in the medullar cavity of the bones, the pericytes from the blood vessel walls as well as the undifferentiated cells from the adjacent soft tissue, muscles and fascia. However, total absence of the periosteum and lesions of the intramedullary vascular network is associated with fracture non-union. In these cases, muscular tissue surrounding the site could take over some of the cambium functions. In conclusion, there are other factors that can influence significantly fracture healing, besides periosteum.
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May 2017

Histological assessment of fracture healing after reduction of the rat femur using two different osteosynthesis methods.

Rom J Morphol Embryol 2016 ;57(3):1051-1056

Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, Romania;

Osteosynthesis using Kirschner (K) wires and plates with screws were compared on the same subject in a previous experimental protocol, but none of them led to fracture healing. We designed a new murine study in order to compare this two methods on different subjects in order to obtain histological proofs of which one is better and to see how limited periosteum removal influence fracture healing. Divided in two equal groups, femoral osteotomies were performed on 30 Brown Norway rats, then reduced using plates and screws in the OPS (osteosynthesis using plates and screws) group and using K-wires in the OIKW (osteosynthesis using Kirschner wire) group. The animals underwent clinical, radiological and histological assessment for eight weeks. The quality of the fracture healing was associated with a higher number of osteocytes/microscopic field at eight weeks. The difference between the groups regarding the number of osteocytes inside lacuna was statistically significant (t-test for equal variances not assumed, p=0.001), which confirms a mean difference of 32 cells÷microscopic field (mf) with a 95% confidence interval of 15-50 cells÷mf. In conclusion, limited periosteum removal did not influence negatively fracture healing. Therefore, we considered that osteosynthesis using plates and screws led to better results compared to fracture fixation using K-wires.
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May 2017

A case of a generalized symptomatic calcinosis in systemic sclerosis.

Rom J Morphol Embryol 2016 ;57(2 Suppl):865-869

Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, Bucharest, Romania;

Calcinosis consists of abnormal calcium deposition in soft tissues, which appears often in patients with limited systemic sclerosis, being one of the criteria of CREST (calcinosis cutis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. With a long evolution, the aim of the treatment is to control the symptoms and prevent complications. In this article, we present the challenging management of a profuse lesion of calcinosis in a patient with systemic sclerosis. We describe the case of a 52-year-old woman with systemic sclerosis and CREST syndrome who was admitted in our Department with multiple painful and disabling tumoral masses, situated in nearly all joints. The interscapular vertebral tumoral mass was excised and the defect was closed. Histopathological examination revealed cutaneous calcinosis, probably associated with CREST syndrome, a type of scleroderma. Postoperative results were favorable and no local complications were encountered. Six months follow-up revealed no evidence of recurrence. Despite the size and the invasion of the tumor in the muscle, complete resection was possible with an adequate reconstruction; the postoperative result being acceptable. With a lower response to medication, surgical treatment is considered the only option for treating symptomatic lesions of calcinosis in order to improve quality of life.
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April 2017

Renal artery bilateral arteriosclerosis cause of resistant hypertension in hemodialysed patients.

Rom J Morphol Embryol 2016 ;57(2):591-4

Department of Nephrology and Dialysis, "St. John" Emergency Clinical Hospital, Clinical Department No. 3, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;

We present the case of a 57-year-old hemodialysed male patient known with severe hypertension resistant to six classes of hypotensive medication, in maximal doses, correlated with increased ultrafiltration during the hemodialysis session. In this case, bilateral nephrectomy was performed as final treatment option for malignant hypertension, and histopathological examination of both kidneys emphasized arteriosclerosis lesions. The results consisted in better hypertension management, with a reduction in both the number and doses of antihypertensive drugs.
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April 2017

A case of extrapleural solitary fibrous tumor of the thigh with eight years follow-up.

Rom J Morphol Embryol 2016 ;57(1):303-6

Department of Plastic and Reconstructive Surgery, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;

Solitary fibrous tumor (SFT) is a rare neoplasia. Now classified as SFT, it was first described in 1942 as "hemangiopericytoma" (HPC), and its origin was supposed to be the pericytes. The location outside the pleura is considered uncommon and the tumor situation on the thigh is much more unusual. In this article, we present a case of a SFT located in the hip. Even if the limb situation of the SFT is considered rare, some tumors in lower limb were reported in the past few years. Our initial clinical diagnosis, in this case, was a variant of lipoma (fibrolipoma), so no further investigations were performed before surgery at that time, and the surgery was planned as a simple procedure. The mimics of SFT with a large variety of benign tumors, especially in long-term evolution cases, make the preoperative diagnosis much more difficult. After the excision of the tumor and histological and immunohistochemical (IHC) tests, the diagnosis was finally stated. Even the findings in the exam conducted us to a most likely benign evolution, the eight years follow-up allowed us to strongly correlate the evolution with laboratory findings in this case. Further follow-up in this case can and will be performed.
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March 2017

Histological differences between laser-assisted and suction-assisted lipoplasty aspirates - a comparative study.

Rom J Morphol Embryol 2015 ;56(2 Suppl):797-801

Department of Plastic, Aesthetic and Reconstructive Microsurgery, "Prof. Dr. Agrippa Ionescu" Clinical Emergency Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;

Introduction: The authors aimed to assess the histological differences between the traditional suction-assisted lipoplasty (SAL) and the more recently developed laser-assisted lipoplasty (LAL) aspirates, in a 20-case comparative study.

Patients And Methods: Between March of 2011 and March of 2012, we operated on 20 healthy female patients seeking body contouring procedures of the abdomen, flanks and outer thighs, all having good to moderate skin tone and moderate to heavy adipose deposits and no previous treatment of the interested areas. After initial aspiration of a 100 mL sample of fat tissue through the SAL technique, we applied the LAL protocol, using a Lipolite device with a 1064 nm Nd:YAG laser, again sampling the aspirate for histological study.

Results: The analyzed samples revealed significant histological difference between the two aspirates: the adipose tissue architecture, after conducting the LAL procedure, appeared to be disrupted, consisting of deformed and ruptured fat cells surrounded by coagulation-modified collagen, small lymphocytic inflammatory infiltrate, coagulated small blood vessel and intact nerves. In contrast, the cytological patterns of the adipose tissue after using the SAL technique resembled normal fat tissue structure.

Conclusions: Our study succeeded in demonstrating significant histological differences between SAL and LAL aspirates, many of which could explain certain disparities between the clinical outcomes of the two procedures.
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May 2016
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