Pheochromocytoma – clinical manifestations, diagnosis and current perioperative management

Pheochromocytoma is a neuroendocrine tumor characterized by the excessive production of catecholamines (epinephrine, norepinephrine, and dopamine). The diagnosis is suspected due to hypertensive paroxysms, associated with vegetative phenomena, due to the catecholaminergic hypersecretion. Diagnosis involves biochemical tests that reveal elevated levels of catecholamine metabolites (metanephrine and normetanephrine). Functional imaging, such as 123I-metaiodobenzylguanidine scintigraphy (123I-MIBG), has increased specificity in identifying the catecholamine-producing tumor and its metastases. The gold-standard treatment for patients with pheochromocytoma is represented by the surgical removal of the tumor. Before surgical resection, it is important to optimize blood pressure and intravascular volume in order to avoid negative hemodynamic events

Treatment of the posttraumatic damage of the pelvic limb in patients with diabetes

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. Riscul de fractura a piciorului la persoanele cu diabet zaharat este legat de existenta neuropatiei diabetice periferice, ce reprezintă un factor important in dezvoltarea defectelor piciorului, infecțiilor si amputațiilor de membre inferioare Scop. Analiza defectelor posttraumatice in asociere cu polineuropatia diabetica a membrului pelvin si posibilități de acoperire a acestora. Material și metodă. Cei 15 pacienți au fost împărțiți in 4 categorii: lambouri de vecinătate, lambouri la distanta, plastie cu piele libera despicata, amputație. Parametrii urmăriți sunt: vârsta, sex, tipul diabetului zaharat, localizarea. Rezultate. 4 femei si 11 bărbați au fost repartizați in 4 categorii după tipul intervențiilor chirurgicale: plastii cu lambouri de vecinătate 4, lambouri la distanta 2, plastie cu piele libera despicata 7, amputație 2. Din lotul total de pacienți cu diabet zaharat tip II au fost 12 pacienți, iar 3 pacienți cu diabet zaharat insulin-dependent. Cei 15 pacienți, care au beneficiat de reconstrucții prin lambouri, au avut defecte la gamba distala si picior, iar pacienții care au suferit amputație per primam, au avut leziuni la nivelul gambei proximale, care au constat in necroze tegumentare si de părți moi, cu afectare osoasa si osteita, semn al gradului avansat al afectării vasculare. La pacienții care au beneficiat de plastie cu piele libera despicata, majoritatea defectelor au fost la nivelul gambei si erau prezente leziuni tegumentare. Concluzii. Defectele posttraumatice la pacienții cu polineuropatii diabetice a membrului pelvin pot fi rezolvate prin plastie cu piele libera despicata, reconstrucții prin lambouri, astfel rata amputațiilor scade.Introduction. Leg fracture risk at people with diabetes is related to the existence of diabetic peripheral neuropathy, which is an important factor in the development of foot defects, infections and amputations of lower limb. Purpose. Analysis of the posttraumatic damage coupled with diabetic polyneuropathy of the pelvic limb and possibilities of healing the defects. Material and methods. The 15 patients were divided in 4 subgroups according to the type of surgical procedure performed: split skin grafts, the neighboring flaps, distant flaps, amputation at different levels. The descriptive parameters included: age, gender, the presence of type I or type II diabetes, the location. Results. 15 patients included in this study, out of which 4 women and 11 men were divided into four subgroups based on type of performed surgeries: the neighboring flaps - 4, distant flaps - 2, split skin grafts - 7, amputation in 2 cases. 12 patients had diabetes of type II, and the remaining 3 patients were insulin dependent. The 6 patients who had reconstruction through flaps, had distal defects (foot or ankle), whereas the patients who suffered per primam amputation had lesions at the ankle which were skin and soft tissue necrosis, with bone disease and osteitis, with signs of severe vascular disease. The majority of patients who had benefited from split skin grafts, suffered from skin lesion at the ankle level. Conclusions. Posttraumatic defects in patients with diabetic polyneuropathy of the pelvic limb can be treated through flaps or split skin grafts, so the amputation rate decreases significantly

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

Excitation and relaxation dynamics in ultrafast laser irradiated optical glasses

We discuss the dynamics of ultrashort pulsed laser excitation in bulk optical silica-based glasses (fused silica and borosilicate BK7) well-above the permanent modification threshold. We indicate subsequent structural and thermomechanical energy relaxation paths that translate into positive and negative refractive index changes, compression and rarefaction zones. If fast electronic decay occurs at low excitation levels in fused silica via self-trapping of excitons, for carrier densities in the vicinity of the critical value at the incident wavelength, persistent long-living absorptive states indicate the achievement of low viscosity matter states manifesting pressure relaxation, rarefaction, void opening and compaction in the neighboring domains. An intermediate ps-long excited carrier dynamics is observed for BK7 in the range corresponding to structural expansion and rarefaction. The amount of excitation and the strength of the subsequent hydrodynamic evolution is critically dependent on the pulse time envelope, indicative of potential optimization schemes

High shock release in ultrafast laser irradiated metals: Scenario for material ejection

We present one-dimensional numerical simulations describing the behavior of solid matter exposed to subpicosecond near infrared pulsed laser radiation. We point out to the role of strong isochoric heating as a mechanism for producing highly non-equilibrium thermodynamic states. In the case of metals, the conditions of material ejection from the surface are discussed in a hydrodynamic context, allowing correlation of the thermodynamic features with ablation mechanisms. A convenient synthetic representation of the thermodynamic processes is presented, emphasizing different competitive pathways of material ejection. Based on the study of the relaxation and cooling processes which constrain the system to follow original thermodynamic paths, we establish that the metal surface can exhibit several kinds of phase evolution which can result in phase explosion or fragmentation. An estimation of the amount of material exceeding the specific energy required for melting is reported for copper and aluminum and a theoretical value of the limit-size of the recast material after ultrashort laser irradiation is determined. Ablation by mechanical fragmentation is also analysed and compared to experimental data for aluminum subjected to high tensile pressures and ultrafast loading rates. Spallation is expected to occur at the rear surface of the aluminum foils and a comparison with simulation results can determine a spall strength value related to high strain rates

Dynamics of ripple formation on silicon surfaces by ultrashort laser pulses in sub-ablation conditions

An investigation of ultrashort pulsed laser induced surface modification due to conditions that result in a superheated melted liquid layer and material evaporation are considered. To describe the surface modification occurring after cooling and resolidification of the melted layer and understand the underlying physical fundamental mechanisms, a unified model is presented to account for crater and subwavelength ripple formation based on a synergy of electron excitation and capillary waves solidification. The proposed theoretical framework aims to address the laser-material interaction in sub-ablation conditions and thus minimal mass removal in combination with a hydrodynamics-based scenario of the crater creation and ripple formation following surface irradiation with single and multiple pulses, respectively. The development of the periodic structures is attributed to the interference of the incident wave with a surface plasmon wave. Details of the surface morphology attained are elaborated as a function of the imposed conditions and results are tested against experimental data

On the feasibility of N2 fixation via a single-site FeI/FeIV cycle: Spectroscopic studies of FeI(N2)FeI, FeIV=N, and related species

The electronic properties of an unusually redox-rich iron system, [PhBPR 3]FeNx (where [PhBPR 3] is [PhB(CH2PR2)3]−), are explored by Mössbauer, EPR, magnetization, and density-functional methods to gain a detailed picture regarding their oxidation states and electronic structures. The complexes of primary interest in this article are the two terminal iron(IV) nitride species, [PhBPiPr 3]FeN (3a) and [PhBPCH2Cy 3]FeN (3b), and the formally diiron(I) bridged-Fe(μ-N2)Fe species, {[PhBPiPr 3]Fe}2(μ-N2) (4). Complex 4 is chemically related to 3a via a spontaneous nitride coupling reaction. The diamagnetic iron(IV) nitrides 3a and 3b exhibit unique electronic environments that are reflected in their unusual Mössbauer parameters, including quadrupole-splitting values of 6.01(1) mm/s and isomer shift values of −0.34(1) mm/s. The data for 4 suggest that this complex can be described by a weak ferromagnetic interaction (J/D < 1) between two iron(I) centers. For comparison, four other relevant complexes also are characterized: a diamagnetic iron(IV) trihydride [PhBPiPr 3]Fe(H)3(PMe3) (5), an S = 3/2 iron(I) phosphine adduct [PhBPiPr 3]FePMe3 (6), and the S = 2 iron(II) precursors to 3a, [PhBPiPr 3]FeCl and [PhBPiPr 3]Fe-2,3:5,6-dibenzo-7-aza bicyclo[2.2.1]hepta-2,5-diene (dbabh). The electronic properties of these respective complexes also have been explored by density-functional methods to help corroborate our spectral assignments and to probe their electronic structures further

Novel therapeutical approaches to managing atherosclerotic risk

Atherosclerosis is a multifactorial vascular disease that leads to inflammation and stiff-ening of the arteries and decreases their elasticity due to the accumulation of calcium, small dense Low Density Lipoproteins (sdLDL), inflammatory cells, and fibrotic material. A review of studies pertaining to cardiometabolic risk factors, lipids alterations, hypolipidemic agents, nutraceuticals, hypoglycaemic drugs, atherosclerosis, endothelial dysfunction, and inflammation was performed. There are several therapeutic strategies including Proprotein Convertase Subtilisin/Kexin 9 (PCSK9) inhibitors, inclisiran, bempedoic acid, Glucagon-Like Peptide-1 Receptor agonists (GLP-1 RAs), and nutraceuticals that promise improvement in the atheromatous plaque from a molecular point of view, because have actions on the exposure of the LDL-Receptor (LDL-R), on endothelial dysfunction, activation of macrophages, on lipid oxidation, formations on foam cells, and deposition extracellular lipids. Atheroma plaque reduction both as a result of LDL-Cholesterol (LDL-C) intensive lowering and reducing inflammation and other residual risk factors is an integral part of the management of atherosclerotic disease, and the use of valid therapeutic alternatives appear to be appealing avenues to solving the problem

Plasty of ankle and foot defects caused by the skin squamous cancer

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 2016Scopul. Tratamentul defectelor gleznei și piciorului generate de cancerul pavimentos al pielii cu lambouri locoregionale. Material și metode. Materialul prelucrat în lucrare a fost reprezentat de 8 pacienți care au suferit intervenții chirurgicale pentru ablația formațiuni tumorale din regiunea gleznei și piciorului. Pentru acoperirea defectelor rezultate sau utilizat următoarele tipuri de lambouri: tibial posterior perforant (2), perforant fibular (1), supramaleolar (2), safen perforant (1), perforant peronier (1), prin avansare (1). Criteriile după care au fost monitorizați pacienții include: procesul de integrare a lamboului în patul receptor, prezența/absența recidivelor și funcția la distanță a zonei interesate. Rezultate. Din lotul total de 8 pacienți incluși în studiu și urmăriți la distanțe diferite de timp s-au înregistrat următoarele rezultate: un caz de cicatrizare secundară, un caz de recidivă a cancerului (în zona adiacentă lamboului) și un caz a necesitat o intervenție chirurgicală repetată, pentru ajustare estetică (la insistența pacientei). În celelalte cazuri, rezultate bune. Concluzii. Defectele generate de cancerul pavimentos al pielii de la nivelul gleznei și piciorului pot fi acoperite cu țesuturi durabile, bine vascularizate al lambourilor loco-regionale, fiind o soluție satisfăcătoare.Purpose. Treatment of ankle and foot defects caused by squamous skin cancer of loco-regional flaps. Materials and methods. In the material we discuss about 8 patients that had ablation of tumor at the ankle and foot. For covering the defects, we use the following types of flaps: perforator posterior tibial (2), perforator fibular (1), supramalleolar (2), perforator saphenous (1), by submission (1), peroneal perforator (1). The criteria through which we monitored patients were: integration of the flap, presence or absence of relapses, function at the distance of the concerned area. Results. In total group of 8 patients that were in the study followed-up at different time period, were recorded the following results: a case of secondary scarring, one case of cancer recurrence (in the adjacent flap) and one case has required repeated surgery, for aesthetic adjustment. In other cases - good results. Conclusion. Defects caused by the skin squamous cancer of the ankle and foot tissues can be coated with vascularized skin of the loco-regional flaps