Breast reconstruction on actinic affected territory by using of the latissimus dorsi flap plasty and dermotension (Case report)

Clinica de Chirurgie Plastică și Microchirurgie Reconstructivă, USMF “Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Caz clinic: Lucrarea reflectă cazul clinic al unei femei de 33 ani supusă amputației totale de sîn pe motiv oncologic. Postoperator a urmat 3 cure de radioterapie. La 6 luni de la intervenția chirurgicală primară a susținut un examen complex după care a primit acordul medical la refacerea plastică a sânului. La momentul examinării în Clinica de chirurgie plastică prezenta dureri în regiunea cicatricei rămase după amputația sânului. La prima etapă de tratament s-a decis înlăturarea cicatricelor aderate agresiv de hemitorace și plastia defectului rămas cu un lambou insular din latissimus dorsi. Etapa a doua a urmat după obținerea regenerării primei etape – implantarea unui expander tisular cu un volum maximal de 500 ml. Etapa a treia a avut loc după umplerea balonului expandat. Sub surplusul tegumentar în schimbul expanderului am plasat o proteză mamară. Cunoscând că un component al tratamentului a fost iradierea actinică, temerea pentru înlaturarea cicatricei și plastia defectului cu țesuturi locale era argumentată. Astfel motivați am decis să folosim lamboul insular latissimus dorsi din regiunea sănătoasă. Dimensiunile lui maxime au permis expandarea, care a rezultat cu refacerea sânului prin punerea unui implant mamar. Concluzii: Utilizarea metodelor de chirurgie plastică-reconstructivă și estetică într-o consecutivitate corectă permit refacerea sânului după amputații oncologice, chiar dacă regiunea marcată este tratată actinic.Clinical case: We present a clinical case of 33 years old female, which was subjected to total breast amputation. After surgery she followed 3 cycles of radiation therapy. At 6 months after primary surgery she underwent a comprehensive examination after which has received medical agreement for plastic restoring of the breast. At the moment of the examination she has been complaining on pain in the region of the scar. In the first stage of the treatment it was decided to remove the aggressive adhered on hemithorax scars and to do the plasty of the defect with a free latissimus dorsi flap. The second stage was constituted of implanting a tissue expander. The third stage: under the tissue’s excess instead of expander we have placed a mammary prosthesis. Knowing that one of the treatment factors was actinic radiation, the fear for the removal of the scar and the plasty of the defect with local tissues was substantiated. Thus, we decided to use latissimus dorsi flap from the healthy region. Its maximal dimensions have allowed expanding resulting with restoration of the breast by placing a mammary implant. Conclusion: Using the methods of plastic-reconstructive and aesthetic surgery in a correct order allows the rebuilding of the breast after oncological amputations, even if the region was exposed to actinic treatment

The first rays joint fractures and treatment modalities

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Incidenţa crescută a traumatismelor mâinii ocupa primul loc in traumatismele corpului uman. Aceasta stimulează în permanenţă ingeniozitatea chirurgilor în a găsi noi metode reconstructive tot mai performante. Deși, ei se confruntă pe de o parte, cu anatomia complexă a mâinii, iar pe de altă parte cu obligativitatea de a păstra integritatea sistemului nervos, vascular şi tendinos totuși, este reala posibilitatea unei reconstrucţii complexe cu ţesuturi similare fără a crea defecte secundare importante.Scopul. Eșalonarea incidenței lezionale a policelui în complexul de traumatisme ale mâinii si separarea itimilor depistați în funcție de suprafață și pe nivele razei digitale. Material si metode. În lucrare am inclus un lot de 460 de pacienți pe perioada anului 2015. Limitele de vârsta au fost între 19-70 ani, divizați pe categorii a câte 10 ani. Repartizarea pe sexe dintre cei 79 de pacienți cu traumatisme a policelui a constituit: 69 (87.34%) bărbați si 10 (12.66%) femei. Frecvența traumatismelor înregistrate la membrul stâng 40 (50.34%) a fost mai mare decât la membrul drept 39 (49.67%). 79 (17.17%) pacienți din lotul total au suferit traumatisme ale policelui, dintre care: separat al policelui 46 (58.22%) și în complex cu alte degete 33 (41.78%). În traumatismele policelui pe segmente au fost incluși pacienții tratați in staționar. Falanga proximală s-a dovedit a fi cel mai des traumată 39 (49.36%) de cazuri, apoi urmează falanga distală 37 (46.83%) de cazuri și doar în 3 (3.79%) cazuri au avut de suferit ambele falange. Rezultate. Incidența traumatismului policelui separat se întâlnesc la 46(58.22%) de pacienți și in complex cu alte degete la 33 (41.78%) de pacienți. Ceia ce constituie din ansamblu de traumatisme ale mâinii 17.17%. Prelucrarea materialului obținut denota prevalenta incidentei pentru falanga distală a policelui dar nu si ca gravitate care se manifesta mai accentuat pe măsura avansării spre baza lui. Aceasta a dictat managementul tratamentului si complexitatea intervențiilor chirurgicale efectuate. Concluzie. Leziunile policelui in complexul traumatismelor mâinii se întâlnesc mai des ca fiind un traumatism separat decât in asociere cu celelalte degete ale mâinii, prevalând la bărbați, iar membrul superior stâng fiind afectat intr-o incidenta ușor mai sporită.Introduction. The increased incidence of hand trauma injuries ranks first in the human body. This continually stimulates surgeons ingenuity to find new performant ways in reconstructive methods. Although, they are facing, on the one hand, with complex hand’s anatomy complex and, on the other hand, with the obligation to preserve the integrity of the nervous, vascular and tendon system, however, it is real the possibility of a complex reconstruction with similar tissues without creating significant defects. Purpose. Distribution of thumb’s lesional incidence in hand’s trauma complex and items separation detected depending on the surface and levels of digital beam. Material and methods. In this paper we included a group of 460 patients treated during the 2015 year. The age limits were between 19-70 years, divided into categories of 10 years. The sex ratio of the 79 patients with thumb injury was: 69 (87.34%) men and 10 (12.66%) women. Frequency of trauma registered in left member - 40 (50.34%), was higher than in the right one - 39 (49.67%). 79 (17.17%) patients from total group have suffered thumb’s trauma, including: separate thumb - 46 (58.22%) and in complex with other fingers - 33 (41.78%). In thumb’s trauma, according to segments, were included patients treated in hospital. Proximal phalanx was found to be most traumatized - 39 (49.36%) cases, followed by the distal phalanx - 37 (46.83%) cases and only in 3 (3.79%) cases have suffered both phalanges. Results. Incidents of separate thumb’s trauma are met at 46 (58.22%) patients and in complex with other fingers in 33 (41.78%) patients, which constitutes in the ensemble of hand’s trauma 17.17%. Processing of obtained material denotes prevalence of incidence of thumb’s distal phalanx, but not the severity that manifests more pronounced as it progresses toward its base. This dictated the treatment’s management and complexity of performed surgery. Conclusion. Thumb’s injuries in complex of hand’s trauma are more often met as a separate trauma than in association with other fingers of the hand, with prevalence in men, and left upper limb is affected with a slightly increased incidence

Importance of thermometry in monitoring of the flaps

Department of Orthopaedics and Traumatology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Complications highlighted in the postoperative period remains to be one of the current problems of reconstructive surgery, which has a relatively increased incidence (5-17%). Aim: evaluation of diagnostic value of local thermometry of flaps for early detection of complications. Material and methods: The study group was 36 patients treated in the period 2014-2015 within the IEM, women - 10 (27.8%), men - 26 (72.2%). The limits of age were 16-70 years, with mean age 44.7 years. The thermometry was performed with an electronic thermometer with an accuracy of 0.1 0C and the data were recorded in the form of thermal curves. The temperature of the receiving areas were considered baseline values that were compared to the thermometric values of the flaps. Duration of monitoring was from 1 postoperative day to 1 year, at 2-3 months range. Data were statistically analyzed using the "step by step regression" with truthful coefficients. Results: In the study group were 30(83.3%) island flaps, free – 6 (16.7%) cases. Thermometric differences in the postoperative period ZR/ZD >20C were found in 6 (16.7%) cases: island flaps – 4 (13.3%) cases, free – 2 (33.3%) cases. If the island complications occurred in 8( 26.7%) cases, free – two (33.3%) cases. Free flap complications: venous insufficiency due to anastomosis’s thrombosis (n=1), marginal necrosis (n=1) and insufficiency of anastomosis due to adjacent tissue’s edema (n=1). Complications of island flaps were: marginal necrosis (n=4), vascular insufficiency due to edema (n=3) and loss of the flap (n=1). Conclusions: In the early postoperative period thermometric difference >20C indicates a flap’s vascular suffering that requires urgent actions. In the case of island flaps the thermometry has a sensitivity of approximately 85%, while in the case of free - 95%, the specificity is 98% in both

Thermometry need in monitoring flaps

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Complicațiile evidențiate în perioada post-operatorie rămân a fi una din problemele actuale ale chirurgiei reconstructive, acestea având o incidență relativ mărită (5-17%). Scopul. Evaluarea valorii diagnostice a termometriei locale a lambourilor în depistarea precoce a complicațiilor. Material și metode. Lotul de studiu a constituit 36 de pacienți, tratați în perioada 2014-2115 în cadrul IMU,repartizarea fiind: femei - 10 (27,8%), bărbați - 26 (72,2%). Limitele de vârstă - 16-70 ani, vârsta medie fiind de 44,7 ani. Termometria s-a efectuat cu un termometru electronic cu precizie de 0,1 0C, datele fiind înregistrate sub forma de curbe termice. Valorile termice ale zonelor receptoare au fost considerate valori de referință cu care s-au comparat valorile termice ale lambourilor. Durata de monitorizare: din 1 zi postoperator până la 1 an, cu interval de 2-3 luni. Datele obținute au fost prelucrate statistic prin metoda “regresiei pas cu pas” cu coeficienți veridici. Rezultate. În lotul de studiu au fost lambouri insulare 30 (83,3%) cazuri, libere – 6 (16,7%) cazuri. În perioada postoperatorie diferențele termometrice ZR/ZD > 2 0C au fost evidențiate în 6 (16,7%) cazuri: lambouri insulare – 4 (13,3%) cazuri, libere – 2 (33,3%) cazuri). În cazul celor insulare complicații au survenit în 8 (26,7%) cazuri, în libere - 2 (33,3%) cazuri. Concluzii. În perioada postoperatorie precoce diferența termometrică >20C indică asupra unei suferințe vasculare a lamboului necesitând măsuri urgente de resuscitare. În cazul lambourilor insulare termometria posedă o sensibilitate de aproximativ 85%, iar în cazul celor libere - 95 %, specificitatea fiind de 98% în ambele tipuri.Introduction. Complications highlighted in the postoperative period remains to be one of the current problems of reconstructive surgery, which has a relatively increased incidence (5-17%). Purpose. Evaluation of diagnostic value of local thermometry of flaps for early detection of complications. Material and methods. The study group was 36 patients treated in the period 2014-2115 within the IEM, women - 10 (27.8%), men - 26 (72.2%). The limits of age were 16-70 years, with mean age 44.7 years. The thermometry was performed with an electronic thermometer with an accuracy of 0.1 0C and the data were recorded in the form of thermal curves. The temperature of the receiving areas was considered baseline values that were compared to the thermometric values of the flaps. Duration of monitoring was from 1 postoperative day to 1 year, at 2-3 months range. Data were statistically analyzed using the "step by step regression" with truthful coefficients. Results. In the study group were 30(83.3%) island flaps, free - 6(16.7%) cases. Thermometric differences in the postoperative period ZR / ZD> 20C were found in 6(16.7%) cases: island flaps - 4(13.3%) cases, free - 2(33.3%) cases). If the island complications occurred in 8(26.7%) cases, free - two(33.3%) cases. Conclusions. In the early postoperative period thermometric difference > 20C indicates a flap’s vascular suffering that requires urgent actions. In the case of island flaps the thermometry has a sensitivity of approximately 85%, while in the case of free - 95%, the specificity is 98% in both

TgDrpC, an atypical dynamin‐related protein in Toxoplasma gondii, is associated with vesicular transport factors and parasite division

Dynamin‐related proteins (Drps) are involved in diverse processes such as organelle division and vesicle trafficking. The intracellular parasite Toxoplasma gondii possesses three distinct Drps. TgDrpC, whose function remains unresolved, is unusual in that it lacks a conserved GTPase Effector Domain, which is typically required for function. Here, we show that TgDrpC localizes to cytoplasmic puncta; however, in dividing parasites, TgDrpC redistributes to the growing edge of the daughter cells. By conditional knockdown, we determined that loss of TgDrpC stalls division and leads to rapid deterioration of multiple organelles and the IMC. We also show that TgDrpC interacts with proteins that exhibit homology to those involved in vesicle transport, including members of the adaptor complex 2. Two of these proteins, a homolog of the adaptor protein 2 (AP‐2) complex subunit alpha‐1 and a homolog of the ezrin–radixin–moesin (ERM) family proteins, localize to puncta and associate with the daughter cells. Consistent with the association with vesicle transport proteins, re‐distribution of TgDrpC to the IMC during division is dependent on post‐Golgi trafficking. Together, these results support that TgDrpC contributes to vesicle trafficking and is critical for stability of parasite organelles and division

The ring avulsion injury – management aspects of specialized treatment

Clinica Chirurgie Plastică şi Microchirurgie Reconstructivă, USMF “Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Creșterea numărului traumatismelor prin verighetă şi spectrul larg de leziuni ne impune prezenţa unei soluţii urgente şi eficiente. Scopul lucrării: Evidenţierea metodelor paliative, de păstrare şi reconstrucţie în caz de traumatism prin verighetă în dependenţă de severitatea leziunii. Material şi metode: Lotul de studiu a fost format din 96 pacienţi (42 bărbaţi și 54 femei) trataţi în perioada anilor 1990-2011. Distribuţia pacienţilor în dependenţă de severitatea leziunii, în baza clasificării Urbaniak, modificată de Adani (1996): Gradul I – 31 (32,29%), gradul II – 27 (28,13%), gradul III – 18 (18,75%), gradul IVd/IVp – 20 (20,83%), gradul IVi – nici un caz. Cazurile cu gradul I au fost tratate medicamentos şi fizioterapeutic, gradul II –19 revascularizări venoase şi 8 arteriale, gradul III – 2 revascularizări venoase şi 6 arteriale, gradul IV – 5 replantări, 3 reconstrucţii la nivel de mînă, 4 – la nivel de deget şi 8 amputaţii. Osteosinteză s-a realizat cu broşe. Rezultate: În grupul I am restabilit funcţia în totalitate. În grupul II au fost salvate 22 de degete, 5 – au fost amputate. În grupul III au fost salvate 10 degete, 8 au progresat spre necroză totală. În grupul IV am efectuat 5 replantări cu succes, în 15 cazuri nu erau prezente porţiunile amputate de deget, efectuîndu-se 7 plastii urgente primare microchirurgicale, în 3 cazuri am excizat raza digitală, lăsînd 4 degete şi în 5 cazuri – amputaţie la nivelul falangei proximale. Concluzii: Traumatismul prin verighetă este foarte problematic din punct de vedere estetic şi funcţional, necesitînd o soluţie urgentă.Introduction: The growing number of ring avulsion injury and its wide spectrum of damage demand an urgent and efficient solution. The aim of study: Highlighting saving, reparative and palliative procedures used in ring avulsion injury depending on injury’s severity. Material and methods: The study included 96 patients (42 men/54 women), treated with ring avulsion injuries during the years 1990-2011. The patients’ distribution depending on injury’s severity was based on Urbaniak classification, modified by Adani (1996). The patients with grade I injury numbered 31 (32.29%), grade II – 27 (28.13%), grade III – 18 (18.75%), grade IVd/IVp – 20 (20.83%), grade IVi – none. The patients with grade I injury followed conservative treatment and physiotherapy. In grade II group we performed 19 venous and 8 arterial revascularizations, in grade III – 12 venous revascularizations and 6 arterial, in grade IV injuries – 5 replantations, 3 reconstructive operations at the hand’s level, 4 reconstructive plastic operations at the fingers’ level and 8 amputations. The skeleton was stabilized with pins. Results: In group I function was fully restored. In group II we saved 22 fingers, 5 fingers were amputated. In group III – 10 fingers were saved, 8 cases progressed to full necrosis. In group IV – 5 successful replantation, 15 patients were brought without amputated portion of the finger, performing 7 emergency primary microsurgical plasties, 3 digital ray’s removal, leaving hand with 4 fingers, and 5 common amputations at proximal phalanx. Conclusion: The ring avulsion injury is very problematic in functional and aesthetic aspect, but also requires an urgent solution

Planning flaps in the calf according to availability physiology

Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Acest studiu a fost efectuat pentru a determina lățimea optima disponibila a zonei donatoare de lambou care nu va prejudicia închiderea primara a plăgii donore, fiind suturata primar plan cu plan.Scop. Evaluarea disponibilității tegumentare fiziologice a fiecărei regiuni donatoare de la nivelul gambei. Material și metode. Studiul a fost efectuat pe un lot de 30 de voluntari, pe membrele sănătoase. Limitele de vârsta in lot au fost de 20 - 60 de ani, divizate pe categorii a câte 10 ani, fiecare subcategorie incluzând minim 5 voluntari. Disponibilitatea fiziologica s-a calculat pentru lambourile: safen, sural, peronier superficial, suprameleolar, fibular, tibial posterior si tibial anterior. Tegumentul s-a plicaturat in centrul teritoriului donator (cetripet), pana când părtile plicaturate contactau formând duplicatura (Ld). Grosimea duplicaturii s-a măsurat, fiind trecuta pe linia milimetrica. Ulterior, plica cutanata era desfăcuta la parametrii normali ai tegumentului cu extensia acelorași puncte in exterior (centrifug), fixându-se lungimea in milimetri (Le). Disponibilitatea tegumentara fiziologica (Dt) s-a calculat după formula: Dt =Le – Ld. Rezultate. Cea mai mare disponibilitate fiziologica la nivelul gambei s-a determinat in regiunea lamboului safen (5.05±0.29 cm; n=30; p=0.033), urmata de regiunea lamboului sural (4.83±0.25 cm; n=30; p=0.028) si regiunea lamboului tibial anterior (4.28±0.20 cm; n=30; p=0.03). Cea mai mica disponibilitate fiziologica s-a determinat în regiunea lamboului supramaleolar (3.04±0.21 cm; n=30; p=0.018). Concluzii. În urma studiului efectuat am constatat ca ridicarea unui lambou cu lățimea disponibila fiziologica a regiunilor donatoare la gamba nu va produce probleme de închidere a plăgii donore, fiind suturata primar plan cu plan.Introduction. This study was conducted to determine the optimal, available width of the flap’s donor site that will not harm the primary closure of donor wound. Purpose. To assess the skin physiological availability of each donor region of the calf. Material and methods. The study was conducted on a group of 30 volunteers, assessing healthy limbs. Age limits in group were 20-60 years, divided into categories of 10 years, including at least 5 volunteers each category. Physiological availability was calculated for flaps: saphenous, sural, superficial peroneal, suprameleolar, fibular, posterior and anterior tibial. The skin was fold in the center of donor territory (centripetal) until the folded parts was contacting, forming a folding (Ld). Folding’s thickness was measured, being passed on millimeter line. Subsequently, skin fold was unfolded to normal skin with the extension of the same points outside (centrifugal), attaching the length in millimeters (Le). Skin physiological availability (Dt) was calculated using the formula: Dt = Le - Ld. Results. Highest physiological availability was determined in region of saphenous flap (5.05±0.29 cm; n = 30; p = 0.033), followed by the sural flap (4.83±0.25 cm; n=30; p= 0.028) and region of anterior tibial flap (4.28±0.20 cm, n=30; p=0.03). The smallest physiological availability was determined in the region of supramalleolar flap (3.04±0.21 cm, n = 30; p = 0.018). Conclusions. From this study we found that raising a flap with physiological available width of donor regions of calf will not cause problems in donor wound’s closure, this being sutured primary

The Natural Course of Adolescent Depression Treatment in the Primary Care Setting

Introduction: Little is known about how adolescents receive depression follow-up in primary care. The purpose of this study was to describe the rates of symptom assessment and depression treatment over time in a group of adolescents screening positive for moderate or severe depression in the primary care setting. Methods: Retrospective chart reviews were conducted to gather information related to symptom reassessments, antidepressant prescriptions, psychotherapy referrals, and treatment discontinuation. Descriptive statistics were calculated, and a qualitative content analysis was conducted to determine the reasons for treatment discontinuation. Results: Eighty records were reviewed (mean age = 15.3, 73% female, 59% Black). Treatment was initiated for 83% (n = 66) of patients, and 45% (n = 30) of patients discontinued treatment during the review period for a variety of reasons. Discussion: To improve adolescents' adherence to depression treatment, providers should address factors that contribute to treatment discontinuation and use tools to manage depression follow-up care

Therapeutic effect of exogenous Hsp70 in mouse models of Alzheimer's disease

Brain deterioration resulting from "protein folding" diseases, such as the Alzheimer's disease (AD), is one of the leading causes of morbidity and mortality in the aging human population. Heat shock proteins (Hsps) constitute the major cellular quality control system for proteins that mitigates the pathological burden of neurotoxic protein fibrils and aggregates. However, the therapeutic effect of Hsps has not been tested in a relevant setting. Here we report the dramatic neuroprotective effect of recombinant human Hsp70 in the bilateral olfactory bulbectomy model (OBX mice) and 5XFAD mouse models of neurodegeneration. We show that intranasally-administered Hsp70 rapidly enters the afflicted brain regions and mitigates multiple AD-like morphological and cognitive abnormalities observed in model animals. In particular, in both cases it normalizes the density of neurons in the hippocampus and cortex which correlates with the diminished accumulation of amyloid-β (Aβ) peptide and, in the case of 5XFAD mice, reduces Aβ plaque formation. Consistently, Hsp70 treatment also protects spatial memory in OBX and 5XFAD mice. These studies demonstrate that exogenous Hsp70 may be a practical therapeutic agent for treatment of neurodegenerative diseases associated with abnormal protein biogenesis and cognitive disturbances, such as AD, for which neuroprotective therapy is urgently needed