Prosthetic Reconstruction of the Upper Digestive Tract

In cases of locally advanced cancers involving the junction between the hypopharynx and cervical oesophagus, the curative surgical treatment is total circular laryngo-pharyngectomy with resection of the upper cervical oesophagus, coupled with modified radical neck dissection. Techniques used to re-establish the continuity of the digestive tract have been pectoral transposition flap, gastric pull-up, jejunum or colon transposition and free pedicled fascial-cutaneous flap reconstruction. Prosthetic reconstruction was thought of and used only as a temporary solution. In our clinic, we adapted the Montgomery oesophageal prosthesis as more than just a temporary solution and used it in 63 patients operated from 2004 to 2014 with advanced (stages III and IV) cancer involving most of the hypopharynx or extending towards the upper cervical oesophagus. Following total circular laryngo-pharyngectomy with bilateral modified radical neck dissection, prosthetic reconstruction was performed using the Montgomery oesophageal tube. Patients were followed up on, and their status was monitored. Favourable results encouraged the authors to further develop a new active prosthesis, with advanced design and materials that better mimic the anatomy and physiology of the replaced segment. Prosthetic reconstruction of the upper digestive tract following radical oncologic surgery is a viable option, with advantages compared to other laborious plastic techniques. The new active model is under development, hopefully offering soon a safe and more cost-effective alternative to the other techniques

Radial artery harvesting technique for use in coronary bypass surgery

Universitatea de Medicină și Farmacie ”Gr. T. Popa” Iași, România Institutul de Boli Cardiovasculare „Prof. Gr. George I.M. Georgescu”, Iași, RomâniaThe radial artery (RA) was introduced in coronary artery bypass grafting (CABG) as an alternative to the use of the great saphenous vein at the beginning of the 1970s (Carpentier, 1973). The authors describe the anatomical characteristisc of the radial artery, the main procedures used in harvesting the vessel, underlying the most risky anatomical area that should be avoided during the surgical procedures. Compared with the internal mammary artery (IMA), the radial artery is characterized by an increased prevalence of intimal alterations of fibrointimal hyperplasia or atherosclerosis type. Rigurous knowledge of brachi-antebrahial anatomical structures and gentle manipulation of the RA prevents CABG complications such as arterial spasm, injury to the endothelium, dysesthesia, ischemia, and compartment syndrome. The strategy of the graft procedure (graft type, method of harvesting) depends on the clinico-anamnestic specificities of the case, on the surgeon's choice and his surgical expertise.Artera radială (AR) a fost introdusă în chirurgia cardiacă la începutul anilor 1970 ca alternativă a utilizării venelor în chirurgia de bypass aorto-coronarian (BAC) (Carpentier, 1973). Autorii descriu caracteristicile anatomice ale AR și metoda de recoltare chirurgicală insistând asupra zonelor anatomice riscante care trebuie abordate cu atenție pe parcursul intervenției. Datorită introducerii în practica medicală a blocanţilor de calciu, a perfecţionării tehnicilor de recoltare şi preparare a AR, a crescut durata patenţei graftului arterial, AR redevenind graft de elecţie în chirurgia arterelor coronare. Comparativ cu artera mamară internă (AMI), AR este caracterizată de o prevalență crescută a leziunilor intimale de tip hiperplazie fibrointimală sau ateroscleroză. Cunoaşterea morfologiei și anatomiei topografice a structurilor brahiantibrahiale precum și manevrarea delicată a AR previne apariţia complicațiilor secundare bypass-ului de tipul spasmului arterial, lezarea endarterei, disesteziilor, ischemiei, sindromului de compartiment. Tehnica BAC (alegerea tipului de graft, metoda de recoltare) depinde de particularitățile clinoc-anamnestice ale cazului, opțiunea și experiența chirurgului

HPV-Positive Oral Squamous Cell Carcinoma

Head and neck malignancies represent the sixth most frequent type of cancer currently in worldwide statistics. Of these, oral and pharyngeal cancers have steadily increased, being linked with the increase in HPV infection pandemic. This rise is not due to one cause, but rather multiple factors such as lifestyle and sexual behavior pattern changes and globalization. Because of the anatomy of the oral cavity and oropharynx, the proper diagnosis is easily delayed, and patients present with advanced stage disease, which requires aggressive and extensive surgery along with neck dissection and chemoradiotherapy. Patients with advanced stage disease have a high recurrence risk with a low 5-year survival rate. Preventing the HPV infection is of course desirable, but right now, for adults which already are infected and have a higher risk of developing HPV-related neoplasias, as well as for our head and neck cancer patients, alternative treatment algorithms are necessary

Takayasu Arteritis: new trends in surgical approach – case presentation

Takayasu arteritis (TA) is defined as a rare chronic granulomatous panarteritis that classically involves segments of large arteries such as the aortic arch. The aim of this report is to present our recent experience in diagnosis and treatment of TA and to provide aspects of surgical strategy for inflammatory aneurysms caused by TA. We present the case of a 36-year-old Caucasian female admitted to our clinic with low effort dyspnea, fatigability, palpitations, sweats, malaise and light-headedness. The medical history revealed a history of treated tuberculosis, anemia, arterial hypertension, chronic inflammatory syndrome, aortic insufficiency, and anterior mitral valve prolapse. Echocardiography revealed grade III-IV aortic regurgitation, grade I-II mitral regurgitation, a dilated ascending aorta and mild systolic dysfunction. CT angiography revealed an aneurysmal dilatation of the ascending aorta. Surgical treatment was mandatory, and intraoperative, the surgeon noted a diffuse thickening of the aortic wall and suspected TA, further confirmed by histopathological examination. The tricuspid aortic valve was excised and a composite graft with a biological valve and an aortic conduit were implanted on patient’s request. Postoperative course was uneventful and the patient was discharged from the hospital on the 10th postoperative day, and directed towards Rheumatology Clinic for medical treatment. A multidisciplinary approach to the diagnosis and management of TA patients is essential to a satisfactory outcome

Design and Development of a Remote-Control Test Bench for Remote Piloted Aircraft\u27s Brushless Motors

The present paper is focused on designing and manufacturing a remote-control test bench for RPA\u27s brushless motors. The main components of the testing bench (structural, mechanical and electric components) are presented, how they are coupled, and the operating principle. The test bench is characterized by five emergency systems, one manual and four automated emergency systems that can stop the test under different conditions to avoid damaging the motor. To validate the testing bench, a SK3-5045 660 kV electric motor was selected along with a carbon fibre reinforced composite propeller. It was experimentally demonstrated that the test bench was fully automated, there were measured the propulsion force, current intensity, voltage, but also the consumed power of a motor intended for an RPA. The test results were used to determine the motorization performance and power consumption of an RPA designed with four electric motors (quadcopter type)

Hypopharyngeal Cancer

Hypopharyngeal cancer is one of the most challenging pathologies regarding location, evolution, prognosis and functional implications. Since the hypopharynx is a crossroad in the digestive and respiratory pathways malignant pathology located at this site can cause dysphagia, odynophagia, respiratory distress and dysphonia. Complex anatomy and physiology of the hypopharynx make for pathology with a poor prognosis in late stages. Diagnosis and therapy are mandatory for ensuring high survival rates and as little functional impairment as possible. Therapy of hypopharyngeal cancer is a difficult test for both physician and patient. It requires a good collaboration between the ENT surgeon, pathologist, radiotherapist, chemotherapist, nutrition therapist and psychologist. Our approach to the subject is due to that data concerning this pathology is limited and the results of the overall oncology therapy are discouraging. Nonetheless, the technical steps of surgery make it difficult for ENT cancer surgeons to approach it, therefore the surgeons’ experience plays a very important role in decision making and establishing a good doctor-patient relationship, both during initial therapy and follow-up. We will also present an original technique developed in our clinic for restoring the continuity of the pharynx after total circular resection using the synthetic prosthesis

Orbital complications of acute rhinosinusitis

Introduction. Rhinosinusitis is the infection and inflammation of at least one of the 4 paranasal sinuses (frontal, maxillary, ethmoid and sphenoid). Their correct diagnosis is generally determined by examining the patient clinically and by rhinosinusal endoscopic examination. There are also cases that show complications or continued evolution despite the correct treatment, and then we will use some imaging investigations to find out more about affection(radiography of anterior sinuses of the face, sinus computerized tomography, sinus magnetic resonance imaging). In particular, acute rhinosinusitis should be carefully managed to avoid complications such as the local ones: orbital cellulitis, orbital abscess, osteomyelitis, cavernous sinus thrombosis; and intracranial complications: meningitis, epidural abscess, subdural abscess, cerebral abscess.Materials and methods. There will be presented all orbital complications according to the cases treated in the ENT Clinic of the Coltea Clinical Hospital.Conclusions. Diagnosis of rhinosinusitis is largely clinical and endoscopic.When complications of the condition arise, these should be investigated imagistically to determine their exact extent and to institute the correct treatment as soon as possible. The complications of rhinosinusitis are medical and surgical life-threatening emergencies, which is why in order to diagnose and correct and quickly institute therapy requires a multidisciplinary approach

The immune response in canine and human leishmaniasis and how this influences the diagnosis- a review and assessment of recent research

Leishmaniasis is a widespread but still underdiagnosed parasitic disease that affects both humans and animals. There are at least 20 pathogenic species of Leishmania, most of them being zoonotic. The diagnosis of leishmaniasis remains a major challenge, with an important role being played by the species of parasites involved, the genetic background, the immunocompetence of the host. This paper brings to the fore the sensitivity of the balance in canine and human leishmaniasis and addresses the importance of the host’s immune response in establishing a correct diagnosis, especially in certain cases of asymptomatic leishmaniasis, or in the situation the host is immunosuppressed or acquired leishmaniasis through vertical transmission. The methods considered as a reference in the diagnosis of leishmaniasis no longer present certainty, the diagnosis being influenced mostly by the immune response of the host, which differs according to the presence of other associated diseases or even according to the breed in dogs. Consequently, the diagnosis and surveillance of leishmaniasis cases remains an open topic, requiring new diagnostic methods adapted to the immunological state of the host