Microsurgery in the treatment of local advanced laryngeal cancer

IMSP Institutul Oncologic, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Anual în Republica Moldova sunt depistați circa 150 pacienți cu cancer localizat în zon larinofaringiană. În majoritatea cazurilor clinice procesului este local avansat, ce necesită un tratament combinat, complex şi o reabilitare chirurgicală amplă. Pe lîngă metodele tradiționale de reabilitare chirurgicală, în secția tumorilor capului şi gâtului din luna mai 1989 a fost implimentată metoda microchirurgicală de reabilitare a pacienților. În perioada 1989 până în prezent după această metodă au fost tratați circa 150 pacienți, 66 din ei au fost tratați pentru cancer local avansat al zonei laringofaringiene. Toți pacienții au fost supuşi tratamentului radioterapic pre- sau/şi postoperator, în volum 40 – 66 Gr. În toate cazurile au fost efectuate laringectomii cu formare de faringoesofagostomie planică. Toți pacienții au fost supuşi intervenției chirurgicale la căile limfatice cervicale.Primul grup – lambourile utilizate pentru formarea tunicii interne a traiectului faringoesofagian. Lambouri libere: 1. cutanofasciale: radial 10 cazuri; scapular 10 cazuri; 2. viscerale: jejunal 7 cazuri; stomac- epiplon 4 cazuri. Al doilea grup: lambourile utilizate pentru formarea tunicii externe a traiectului faringoesofagian. Lambouri libere: 1. cutanomusculare: TDL 22 cazuri; TFL 1 caz; TDL + SL 2 cazuri. Complicațiile postoperatorii au fost cauzate de dereglări în microcirculația lamboului şi anastomozei vasculare. În 40% cazuri dereglările de microcirculație s-au manifestat prin declanşarea necrozei parțiale a lamboului şi apariția fistulei faringo-esofagiene. Într-un caz a fost constatată necroza totală a lamboului. Durata perioadei de reabilitare a pacienților cu restabilirea totală a traiectului faringo-esofagian a constituit în mediu 25 zile.Each year, in Moldova, about 150 pacients are being traced, having laryngopharyngeal cancer. In most cases, the process is in advanced stage, needing a combined and complex treatment, with a large surgical rehabilitation. Besides the traditional methods, the Departement of Head and Neck Tumors, since May 1989, has implemented the microsurgical method of rehabilitation. Beginning with 1989 until present, with the help of this method, about 150 patients have been treated, 66 of them having local advanced laryngopharyngeal cancer.All patients have passed radiotherapy, either before the surgical intervention, after it or both, in terms of 40-66 Gr. Laryngectomy with planned pharyngoesophagostomy has been performed in every case. All patients have passed surgical intervention on lymphatic cervical canals. First group – the flaps used for forming the internal tunic of pharyngoesophageal path.Free flaps:1)cutanofascial: radial – 10 cases, scapular – 10 cases;2)visceral: jejunal – 7 cases; stomach-omentum – 4 cases;Second group – the flaps used for forming the external tunic of pharyngoesophageal path.Free flaps:1)cutanomuscular: TDL – 22 cases, TFL – 1 case, TDL+SL – 2 cases.The after-surgical complications have been caused by disorders, appeared in the microcirculation of the flap and the vascular anastomosis. In 40% of all cases, the microcirculation disorders have been displayed by triggering the partial necrosis of the flap and by the appearance of pharyngoesophageal fistula. In one case, there has been observed a total necrosis of the flap.The period of rehabilitation, with total recovery of the pharyngoesophageal path, has lasted an average of 25 days

Microsurgical Approach in a Thoracic Meningioma in Elderly: Case Report

Improved results in the treatment of intraspinal tumors have followed greater sophistication of diagnostic modalities and surgical techniques. Whereas originally tumors could be diagnosed radiologically only by bone erosion seen on radiographic films, now mielography, computed tomography (CT) and magnetic resonance imaging (MRI) provide precise localization. Indeed, MRI is a stand-alone diagnostic preoperative study for virtually all intradural tumors. With the advent of the operating microscope, microsurgical instruments, bipolar cautery and intraoperative ultrasonography, combined with ultrasoniccavitation devices and other techniques, surgeons can approach these tumors with greater ease

Intracranian arahnoid cysts in children (ACs)

Intracranial arachnoid cysts (ACs) represent an extremely common condition in pediatric pathology. With the development of CT Scan and especially MRI these cysts could be find more constantly. ACs are congenital lesions with maximum frequency in middle cranial fossa, followed by supraselar aria , ponto-cerebelar angle and cranial posterior fossa. These cysts are often incidentally uncovered during a routine neuroimaging investigations for cranio-cerebral trauma or other diseases. The authors present a series of 317 cases in children with ACs over a period of 10 years. The authors avocate over the MRI evaluation of Acs and refering to therapeutic approach it is recomanded only in compresive forms with focal neurologica sings or seizures. Are rewiewed therapeutical procedures as: microsurgical fenestration with cystwall excision, endoscopic approach, stereotaxic suction, cyst shunting by cysto-peritoneal procedures. A number of cases remain under observation the surgical treatment beeing unnecesary. The surgical treatment must be carfuly chosen, there is non therapeutical priority. It remains that improved neuroendoscopic methods to improve operator prognosis in Acs

Menthol Inhibits 5-HT 3

The effects of alcohol monoterpene menthol, a major active in-gredient of the peppermint plant, were tested on the function of human 5-hydroxytryptamine type 3 (5-HT3) receptors expressed in Xenopus laevis oocytes. 5-HT (1 mM)-evoked currents recorded by two-electrode voltage-clamp technique were reversibly inhibited bymenthol in a concentration-dependent (IC505 163mM)manner. The effects of menthol developed gradually, reaching a steady-state level within 10–15 minutes and did not involve G-proteins, since GTPgS activity remained unaltered and the effect of menthol was not sensitive to pertussis toxin pretreatment. The actions of menthol were not stereoselective as (2), (1), and racemic menthol inhibited 5-HT3 receptor–mediated currents to the same extent. Menthol inhibition was not altered by intracellular 1,2-bis(o-aminophenoxy)ethane-N,N,N9,N9-tetraacetic acid injections an