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

Partial vertebrectomy with vertebral shortening for thoraco-lumbar fracture-dislocation: Case report and technical note

Thoraco-lumbar fracture-dislocations represent one of the most instable lesions and are frequently associated with neurological deficit. We present a patient with a T11 – T12 fracture-dislocation with complete neurological deficit – ASIA - A, who underwent partial vertebrectomy, shortening of the spine and posterior instrumentation 21 days after a motor vehicle accident

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

Diabetic patients and postoperative complications in colorectal surgery

Diabetes mellitus is one of the most common comorbidities of patients undergoing surgery. Colorectal surgery is frequently associated with postoperative complications, and diabetic patients represent a population that presents a high risk of developing such complications. Understanding the interrelationships between neoplastic disease and diabetes, as well as the pathophysiological mechanisms underlying postoperative complications, are essential for effective therapeutic management. Genetic predispositions, alterations in the gut microbiota, inflammatory response, ischemic, thrombotic and infectious processes contribute significantly to the development of severe surgical complications, such as anastomotic fistulas. Postoperative ileus, characterized by gastrointestinal dysmotility, is common in diabetic patients due to neuropathic dysfunction and altered intestinal metabolism. In addition, diabetic patients are at increased risk of intestinal ischemia, requiring specific perioperative care. The strategies to avoid these complications assume an adequate surgical technique, a personalized anesthesia management, and last but not least, the best possible glycemic control. This article highlights the importance of a better understanding of the interaction between diabetes and postoperative complications, in order to obtain good results with an important impact on the patient\u27s health and well-being. This article highlights the importance of a better understanding of the interplay between diabetes and postoperative complications informs targeted interventions aimed at reducing morbidity and improving patient well-being