Surgical treatment of distal tibia fractures with intra-medullary nail

IInd Clinic of Orthopaedics and Traumatology, University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Introduction. Fractures of the distal tibia in the adult result from a combination of axial compression and rotational forces. Surgical treatment of extra-articular fractures of distal tibia is a controversial topic throughout the entire literature. The recent development of more distal locking options with IM nails and anatomically-contoured angle-stable plates have improved our ability to stabilise these fractures. Material and methods. This study included 27 patients admitted and treated for distal extra-articular tibial fractures (AO 43 A1-3) between Jan 2012 and May 2015 in the IInd Clinic of Orthopaedics and Traumatology. Ten patients sustained open fractures (two type I GA, four type II GA and four type IIIA GA). Nine patients also had distal peroneal or peroneal malleolus associated fractures and 18 had associated supra-malleolar fractures of the peroneus. IM nailing was the treatment choice for all cases (with reaming in 14 cases) and for the associated peroneal fractures ORIF with plates and screws was performed. Results. From a total of 27 cases, 4 (14,8%) cases healed with a varum>5o deformity, 3 (11,1%) cases developed pseudarthrosis that necessitated further surgical treatment (angular stable plates and bone graft), 1 (3,7%) case had intraarticular nail migration and infection, 19 (70,4%) cases had a favourable evolution with good outcome. All fracture healing complications appeared within the cases treated without medullary canal reaming and without associated distal peroneal fractures. Conclusions. Cases treated with ORIF for distal peroneal fractures had better results that those treated by conservative means. IM nailing can be extremely important in open fractures where it can provide excellent fixation of the fracture fragments and allows, if necessary, extensive debridement and reconstructive treatment for soft tissues without direct implant exposure. It was also noted that reamed nailing was biomechanically superior in terms of stability to the unreamed nails

Synovial Sarcoma of the Extremities: A Literature Review

Synovial sarcoma (SS) is a rare and highly malignant tumor and a type of soft tissue sarcoma (STS), for which survival has not improved significantly in recent years. Synovial sarcomas occur mostly in adolescents and young adults (15–35 years old), usually affecting the deep soft tissues near the large joints of the extremities, with males being at a slightly higher risk. Despite its name, synovial sarcoma is neither related to the synovial tissues that are a part of the joints, i.e., the synovium, nor does it express synovial markers; however, the periarticular synovial sarcomas can spread as a secondary tumor to the joint capsule. SS was initially described as a biphasic neoplasm comprising of both epithelial and uniform spindle cell components. Synovial sarcoma is characterized by the presence of the pathognomonic t (X; 18) (p11.2; q11.2) translocation, involving a fusion of the SS18 (formerly SYT) gene on chromosome 18 to one of the synovial sarcoma X (SSX) genes on chromosome X (usually SSX1 or SSX2), which is seen in more than 90% of SSs and results in the formation of SS18-SSX fusion oncogenes

Cross-Cultural Adaptation and Validation of the Romanian Marx Activity Rating Scale for Anterior Cruciate Ligament Reconstruction

Aim: We aimed to translate, cross-cultural adapt and validate the Marx activity rating scale (MARS) of the knee for Romanian patients with anterior cruciate ligament (ACL) injury. Method: The original English form was translated according to guidelines. We included patients with ACL injury undergoing reconstruction in two centers over 3 years. Subjects completed the translated MARS, International Knee Documentation Committee (IKDC) subjective knee form and EuroQol EQ5D. The examining physician completed the Tegner Lysholm scale as an objective evaluation. Re-testing was obtained after one month. We used Spearman`s correlation to evaluate construct validity and reproducibility, Cronbach’s alpha for internal consistency and intraclass correlation for test-retest reliability. Results: We collected valid forms from 99 patients (32.1 ± 8.8 years, 64.6% males) during the preoperative evaluation and 45 were re-tested. Significant, very good correlations were found between the MARS and Tegner Lysholm (Spearman’s r = 0.712, p < 0.0001) and IKDC (Spearman’s r = 0.801, p < 0.0001). Cronbach’s alpha was 0.893 at the initial completion and 0.799 at re-test. The intraclass correlation coefficient was 0.895. Conclusions: The Romanian-translated MARS is a valid, consistent and reliable physical activity outcome measure in patients with anterior cruciate ligament reconstruction

The Prevalence and Treatment Costs of Non-Melanoma Skin Cancer in Cluj-Napoca Maxillofacial Center

Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients’ features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options

The Prevalence and Treatment Costs of Non-Melanoma Skin Cancer in Cluj-Napoca Maxillofacial Center

Background and Objectives: An increasing incidence of non-melanoma skin cancer (NMSC) is noted, as well as an increasing cost of the treatment, with NMSC becoming a public health problem. We aimed to investigate the prevalence and treatment costs of surgically treated NMSC from the Oral and Maxillofacial Surgery Department of Cluj-Napoca County Hospital. Materials and Methods: We retrospectively analyzed the clinical data and the charge data of hospitalization from the informatic system of Cluj-Napoca County Hospital. All patients benefited from standard surgical excision with the reconstruction of the post-excisional defect. A statistical analysis of the costs related to the patients’ features, period and conditions of hospitalization, materials, medication, and paraclinical investigations was performed. Results: Between 2015 and 2019, 133 patients with NMSC were addressed to our department, with basal cell carcinoma (BCC) being four-fold higher than squamous cell carcinoma (SCC). Most NMSC cases were diagnosed in stage I or II, and they benefited from local reconstruction. The treatment costs progressively increased in the last five years, reaching a total cost of EUR ~13.000 in 2019. The treatment cost per episode was higher for SCC compared to BCC, while the total cost of treatment in 5 years was higher for BCC. Low income, immunosuppression, comorbidities, flap reconstruction option, long-lasting surgery, and prolonged hospitalization were associated with an increased cost of the treatment. Conclusion: The prevalence and treatment cost of surgically treated NMSC of the head and neck region increased in the last five years, with high-cost drivers being related to patients and treatment options

Unexpected Repercussions of the COVID-19 Pandemic on Total Hip Arthroplasty with Cemented Hip Prosthesis versus Cementless Implants

(1) Background: Total hip arthroplasty (THA) is one of the most common procedures used for adult hip reconstruction, employing mainly two types of prostheses: cemented (CHP) and cementless (CLHP). This study aims to analyze the impact of the COVID-19 pandemic on THA with CHP and CLHP, in terms of the benefit/cost ratio. (2) Methods: This article represents a retrospective analysis of the differences concerning the benefit/cost ratio between THA with the two types of prostheses in 2950 patients admitted for THA in the two orthopedic clinics of our hospital between 1 January 2015–1 March 2020 in comparison with 1005 THA subjects seen between 1 April 2020–31 December 2022. (3) Results: In the first period, THA with CHP was performed in 45.83% of cases, while CLHP was used in 54.16% of patients. During the COVID-19 period, CHP was inserted in 52% of THA patients, while the other 48% had CLHP inserted, with a hospitalization duration reduced by over 50% for both types of implants (p ˂ 0.001). (4) Conclusions: CHP offered good outcomes, with quicker mobilization, and shorter hospitalization duration, compared to CLHP, but optimization of the patients’ management can be achieved mainly by reducing the length of hospitalization through an appropriate preoperative patient evaluation through a multidisciplinary approach, an aspect that was proven during the COVID-19 pandemic

Salivary Exosomal MicroRNA-486-5p and MicroRNA-10b-5p in Oral and Oropharyngeal Squamous Cell Carcinoma

Background and Objectives: The research aimed at evaluating the capacity of salivary exosomal miR-10b-5p and miR-486-5p for oral and oropharyngeal cancer detection. Materials and Methods: The saliva samples were harvested from histopathological diagnosed oral and oropharyngeal squamous cell carcinoma patients and healthy volunteer subjects. The exosomes were isolated by differential ultracentrifugation and quantified by Nano Track Analysis. The microRNAs were extracted and quantified from salivary exosomes by quantitative Real-Time Polymerase Chain Reaction. Results: This research comprised fifty participants. When compared to healthy controls, salivary exosomal miR-486-5p was elevated and miR-10b-5p was reduced in oral and oropharyngeal squamous cell carcinoma. Moreover, miR-486-5p had a high expression level in stage II of cancer in comparison to the other cancer stages. The cancer samples presented an increased exosome dimension compared to the control samples. Conclusions: Salivary exosomal miR-10b-5p and miR-486-5p have an altered expression in oral and oropharyngeal cancer

Phyto-Inhibitory and Antimicrobial Activity of Brown Propolis from Romania

The objective of this paper was to study the phyto-inhibitory and antimicrobial activity of brown propolis collected from the counties of four regions in Romania. The main physico-chemical and functional properties of 16 samples of propolis from different landforms of geographical regions were determined. Their antimicrobial activities were established against 5 bacterial strains (Pseudomonas fluorescens, Bacillus subtilis, Bacillus cereus, Escherichia coli, and Proteus mirabilis) and 5 fungal strains (Alternaria alternata, Cladosporium cladosporioides, Fusarium oxysporum, Mucor racemosus, and Aspergillus niger). Simultaneously, the phyto-inhibitory effect of propolis samples on different cereals was highlighted: hexaploid bread wheat (Triticum aestivum), maize (Zea mays L.), oats (Avena sativa L.), and barley (Hordeum vulgare L.). Correlations between the antioxidant activity and total flavonoid and phenol content of the propolis samples were identified, respectively, and the statistical analysis highlighted that the diameter of the inhibition zone was influenced by the strain type (bacterial and fungal) and the geographical regions of propolis. Principal component analysis (PCA) indicated that out of seven principal components, only two exhibited > 0.5. Pearson’s correlation coefficient showed a low and moderate positive linear relationship between the diameter of the inhibition zone and the flavonoid and phenol concentration of the propolis samples

A Rare Case of Polysplenia Syndrome Associated with Severe Cardiac Malformations and Congenital Alveolar Dysplasia in a One-Month-Old Infant: A Complete Macroscopic and Histopathologic Study

Polysplenia syndrome represents a type of left atrial isomerism characterized by multiple small spleens, often associated with cardiac malformations and with situs ambiguus of the abdominal organs. The case presented is of a one-month-old male infant, weighing approximately 3000 g, born at the County Clinical Emergency Hospital of Sibiu, who was hospitalized from birth until death. The patient suffered cardio-respiratory arrest due to severe hypoxia and septicemia on the background of a series of complex cardiac malformations associated with congenital abdominal organ anomalies. Examination of the body revealed a common atrium with complete atrioventricular canal defect, left ventricular hypertrophy, right ventricle hypoplasia, truncus arteriosus, superior vena cava duplication, bilobation of the lungs, situs ambiguous of the abdominal organs with right-sided stomach, a midline liver, gall bladder agenesis, multiple right-sided spleens and complete inversion of the intestines and pancreas. Histopathology concluded that the patient suffered cardiac lesions consistent with infantile lactic acidosis, as well as pulmonary modifications suggesting congenital alveolar dysplasia and altered hepatic architecture compatible with fibrosis