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Răducu L, Moraru OE, Gheoca-Mutu DE, Peligrad T, Țigăran AE, Abu-Baker A, Ion DE, Ursuț BM, Jecan CR, Avino A. Confronting a New Challenge in Plastic Surgery: MDR Infections in Patients with Chronic Wounds. Life (Basel) 2024; 14:444. [PMID: 38672715 DOI: 10.3390/life14040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The presence of a wound can be anywhere from non-problematic to life-threatening on a severity spectrum, with bacterial infection and resistance playing a major role in the development of chronicity, delaying wound healing. Wound colonization with multiple organisms and the limited number of effective antibiotics place a heavy burden on the healthcare system, with patients going through multiple surgeries during a prolonged hospitalization time. By analyzing the resistance patterns of pluri-bacterial populations and the approach used in managing complex cases, we aim to improve the protocols applied in caring for chronic wounds in our practice and share our experiences and observations. METHODS We designed a retrospective study on 212 diabetic and non-diabetic patients, aiming to evaluate the course of chronic wound treatment in our practice. We focused on the impact that MDR bacteria and diabetes have on surgical outcomes and their role in the healing process. RESULTS Patients who received empiric antibiotic therapy before being admitted eventually presented with multiple MDR bacteria compared to those who did not receive antibiotics (p = 0.014). The presence of at least one MDR bacteria in the wound bed was associated with ulcers reaching bone (p = 0.02) and was positively correlated with the number of surgeries performed (p < 0.001). Diabetes played a significant role in surgery-related complications (p = 0.02) and hospitalization time (p < 0.001). CONCLUSIONS Proper management of chronic wounds requires a comprehensive, multidisciplinary approach and a thorough understanding of antibiotic usage. To address this need, we have developed and implemented a chronic wound treatment protocol in our clinic, with the goal of discharging patients once their ulcers have been treated and closed. A key summary of the protocol presented is to reduce the incidence of MDR bacteria and improve the patient's quality of life.
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Affiliation(s)
- Laura Răducu
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Oriana Elena Moraru
- Discipline of Cardiovascular Surgery, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Vascular Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Discipline of Anatomy, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Teodora Peligrad
- Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Andrada-Elena Țigăran
- Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Abdalah Abu-Baker
- Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela-Elena Ion
- Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Bogdan Mihai Ursuț
- Discipline of Anatomy, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of General Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Cristian-Radu Jecan
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Adelaida Avino
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Avino A, Ion DE, Gheoca-Mutu DE, Abu-Baker A, Țigăran AE, Peligrad T, Hariga CS, Balcangiu-Stroescu AE, Jecan CR, Tudor A, Răducu L. Diagnostic and Therapeutic Particularities of Symptomatic Melanoma Brain Metastases from Case Report to Literature Review. Diagnostics (Basel) 2024; 14:688. [PMID: 38611601 PMCID: PMC11011469 DOI: 10.3390/diagnostics14070688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
The recent introduction of immunotherapy and targeted therapy has substantially enriched the therapeutic landscape of metastatic melanoma. However, cerebral metastases remain unrelenting entities with atypical metabolic and genetic profiles compared to extracranial metastases, requiring combined approaches with local ablative treatment to alleviate symptoms, prevent recurrence and restore patients' biological and psychological resources for fighting malignancy. This paper aims to provide the latest scientific evidence about the rationale and timing of treatment, emphasizing the complementary roles of surgery, radiotherapy, and systemic therapy in eradicating brain metastases, with a special focus on the distinct response of intracranial and extracranial disease, which are regarded as separate molecular entities. To illustrate the complexity of designing individualized therapeutic schemes, we report a case of delayed BRAF-mutant diagnosis, an aggressive forearm melanoma, in a presumed psychiatric patient whose symptoms were caused by cerebral melanoma metastases. The decision to administer molecularly targeted therapy was dictated by the urgency of diminishing the tumor burden for symptom control, due to potentially life-threatening complications caused by the flourishing of extracranial disease in locations rarely reported in living patients, further proving the necessity of multidisciplinary management.
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Affiliation(s)
- Adelaida Avino
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Daniela-Elena Ion
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
- Discipline of Anatomy, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Abdalah Abu-Baker
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Andrada-Elena Țigăran
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Teodora Peligrad
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Cristian-Sorin Hariga
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- Discipline of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristian-Radu Jecan
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Adrian Tudor
- Discipline of Anatomy and Embriology, University of Medicine, Sciences and Technology “George Emil Palade”, 540139 Targu Mures, Romania;
- Department of General Surgery I, Targu Mures Emergency Clinical Hospital, 540136 Targu Mures, Romania
| | - Laura Răducu
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
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Abu-Baker A, Țigăran AE, Peligrad T, Ion DE, Gheoca-Mutu DE, Avino A, Hariga CS, Moraru OE, Răducu L, Jecan RC. Exploring an Innovative Approach: Integrating Negative-Pressure Wound Therapy with Silver Nanoparticle Dressings in Skin Graft Procedures. J Pers Med 2024; 14:206. [PMID: 38392639 PMCID: PMC10890209 DOI: 10.3390/jpm14020206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Skin grafting is a helpful instrument in a plastic surgeon's arsenal. Several types of dressings were designed to facilitate the process of graft integration. Negative-pressure wound therapy is a proven dressing method, enhancing graft survival through several mechanisms: aspiration of secretions, stimulation of neoangiogenesis, and promotion of an anti-inflammatory environment. Silver nanoparticle dressings also bring multiple benefits by bearing an antimicrobial effect and providing a humid medium, which are favorable for epithelialization. The combination of NPWT (negative-pressure wound therapy) with AgNPs (silver nanoparticles) has not been widely studied. MATERIALS AND METHODS This study aimed to compare the outcomes of silver nanoparticle sheets with the combination of negative-pressure wound therapy and silver nanoparticle dressings. We conducted a comparative prospective study on 80 patients admitted to the Plastic Surgery Department of "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital between 1st of January 2020 and 31st of December 2022. The study population was randomized to receive either silver nanoparticle dressings or negative-pressure wound therapy (NPWT) combined with silver nanoparticle dressings. Various parameters were monitored, including patient comorbidities and graft-related data such as defect etiology, graft integration, and graft size. Dressings were changed, and graft status was evaluated at 7, 10, and 14 days postoperatively. Additionally, baseline C-reactive protein (CRP) levels were measured before surgery and 7, 10, and 14 days postoperatively. RESULTS The study demonstrated an enhanced integration of skin grafts at all evaluation stages when employing NPWT combined with AgNPs, particularly evident 10 days post operation. Significant variations in graft integration were also observed based on factors such as diabetes, cardiovascular disease, graft size, or the origin of the grafted defect. Moreover, dynamic C-reactive protein monitoring showed a statistically significant decrease in CRP levels 10 days post operation among patients treated with NPWT in conjunction with silver dressing, consistent with the nearly complete integration of skin grafts at this evaluation threshold. CONCLUSION Several factors influence the postoperative evolution of split-skin grafts. Postoperative dressings target local factors to enhance graft integration further. Our research demonstrated that the innovative combination of NPWT-assisted dressings, complemented by a silver nanoparticle sheet, resulted in improved benefits for graft integration and the alleviation of systemic inflammation.
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Affiliation(s)
- Abdalah Abu-Baker
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Andrada-Elena Țigăran
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Teodora Peligrad
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Daniela-Elena Ion
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Discipline of Anatomy, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Adelaida Avino
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Cristian-Sorin Hariga
- Department of Plastic Surgery, Emergency Clinical Hospital, 014461 Bucharest, Romania
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Oriana Elena Moraru
- Discipline of Cardiovascular Surgery, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
- Department of Vascular Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
| | - Laura Răducu
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Radu-Cristian Jecan
- Department of Plastic Surgery, "Prof. Dr. Agrippa Ionescu" Emergency Clinical Hospital, 011356 Bucharest, Romania
- Discipline of Plastic Surgery, "Carol Davila" University of Medicine and Pharmacy, 010221 Bucharest, Romania
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Țigăran AE, Abu-Baker A, Ion DE, Peligrad T, Gheoca-Mutu DE, Avino A, Anghel AW, Balcangiu-Stroescu AE, Toma A, Răducu L. Extremely Rare Type of Breast Cancer-Dedifferentiated Breast Liposarcoma-Diagnosis and Treatment. J Pers Med 2023; 13:1451. [PMID: 37888062 PMCID: PMC10608349 DOI: 10.3390/jpm13101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Primary liposarcoma of the breast is an uncommon soft tissue malignant tumor, comprising only 0.003% of all malignant breast tumors. The main differential diagnosis of this mass consists of malignant phyllodes tumor and metaplastic breast carcinoma. The objective of this paper is to report a case of dedifferentiated breast liposarcoma, therapeutic approach and outcome. We present a case of a 79-year-old woman complaining of a large mass in her left breast which had increased in size over the last 6 months. Physical examination revealed an enlarged left breast, and a total body CT scan showed a large tumor in contact with the musculature of the anterior thoracic wall, with no metastatic lesions. The histopathology report of a fine needle biopsy described a high-grade sarcoma. The Oncological Tumor Board recommended neoadjuvant radiotherapy sessions and reevaluation by MRI and CT scans. The patient underwent radical mastectomy with latissimus dorsi myo-cutaneous flap reconstruction. The final histopathology diagnosis was a grade 3 dedifferentiated liposarcoma (FNCLCC), with certain response to radiotherapy and positive MDM2, CDK4 markers. The postoperative period was uneventful; 12 months after surgery, the follow-up CT scan showed multiple pulmonary lesions with metastatic characteristics. Liposarcoma is a very rare type of breast cancer, and the most important treatment for breast sarcoma is surgery, the role of axillary lymph node removal, chemotherapy and radiotherapy still being controversial. Considering such cases are scarce and the development of surgical guidelines is difficult, reporting any new case is crucial.
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Affiliation(s)
- Andrada-Elena Țigăran
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
| | - Abdalah Abu-Baker
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela-Elena Ion
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
| | - Teodora Peligrad
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
- Discipline of Anatomy, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adelaida Avino
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Discipline of Plastic Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Andrei-Wilhelm Anghel
- Department of Radiotherapy, Elias University Emergency Hospital, 011461 Bucharest, Romania;
- Department of Radiotherapy, MedEuropa, 022343 Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- Discipline of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Anca Toma
- Department of Anatomic Pathology, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania;
| | - Laura Răducu
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (A.-E.Ț.); (A.A.-B.); (D.-E.I.); (T.P.); (D.-E.G.-M.); (L.R.)
- Discipline of Plastic Surgery, ‘Prof. Dr Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania
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Mareş T, Răducu L, Avino A, Gheoca-Mutu DE, Teodoreanu RN, Jecan CR. Dermatofibrosarcoma Protuberans: One Centre Experience. Chirurgia (Bucur) 2022; 117:601-607. [PMID: 36318691 DOI: 10.21614/chirurgia.2778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Background: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor that is classified as a non-melanoma skin cancer. Surgical excision with wide safety margins is the cornerstone treatment and frequently requires advanced reconstruction methods for wound closure. This study aimed to report our experience with the management of seven consecutive patients with dermatofibrosarcoma protuberans. Materials and Methods: We performed a retrospective study of seven consecutive patients with dermatofibrosarcoma protuberans admitted to our Plastic and Reconstructive Surgery Department of Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu" Bucharest, Romania, between July 12, 2018, and July 4, 2022. Results: The mean age of the patients was 38.2 years. In 4 patients, the primary treatment consisted of wide local excision, while 3 presented to our clinic for re-resection. All cases required complex reconstruction methods 3 patients with a split-thickness skin graft (STSG), 3 patients with local flaps, and in one patient, because of the superior size of the post-excisional defect, we used local advancement flaps and STSG. In two cases, the histopathological diagnosis revealed fibrosarcomatous differentiation (the largest primary tumor dimension), one of which showed fascial invasion, and both of them received adjuvant radiotherapy. Conclusion: A soft tissue tumor with a clinical appearance suggestive of DFSP, especially in cases of increased tumor sizes, incisional biopsy and subsequent multidisciplinary approach will lead to a wide surgical excision with negative histopathological margins, as a standard treatment, for a lowgrade sarcoma, which rarely metastasizes.
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Enciu O, Avino A, Calu V, Toma E, Tulin A, Tulin R, Slavu I, Răducu L, Balcangiu‑Stroescu AE, Gheoca Mutu DE, Tomescu L, Miron A. Laparoscopic vs. open resection for colon cancer‑quality of oncologic resection evaluation in a medium volume center. Exp Ther Med 2022; 24:455. [PMID: 35747155 PMCID: PMC9204561 DOI: 10.3892/etm.2022.11382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Despite concerns regarding oncologic safety, laparoscopic surgery for colon cancer has been proven in several trials in the lasts decades to be superior to open surgery. In addition, the benefits of laparoscopic surgery can be offered to other patients with malignant disease. The aim of the present study was to compare the quality of oncologic resection for non-metastatic, resectable colon cancer between laparoscopic and open surgery in terms of specimen margins and retrieved lymph nodes in a medium volume center in Romania. A total of 219 patients underwent surgery for non-metastatic colon cancer between January 2017 and December 2020. Of these, 52 underwent laparoscopic resection, while 167 had open surgery. None of the patients in the laparoscopic group had positive circumferential margins (P=0.035) while 12 (7.19%) patients in the open group (OG) had positive margins. A total of three patients in the laparoscopic group (5.77%) and seven patients (4.19%) in the OG had invaded axial margins. While the number of retrieved lymph nodes was not correlated with the type of procedure [laparoscopic group 16.12 (14±6.56), OG 17.31 (15±8.42), P=0.448], the lymph node ratio was significantly higher in the OG (P=0.003). Given the results of the present study, it is safe to conclude that laparoscopic surgery is not inferior to open surgery for non-metastatic colon cancer in a medium volume center.
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Affiliation(s)
- Octavian Enciu
- Discipline of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Adelaida Avino
- Discipline of Plastic and Reconstructive Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Valentin Calu
- Discipline of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Elena Toma
- Discipline of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Adrian Tulin
- Discipline of Anatomy, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Raluca Tulin
- Discipline of Anatomy, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Iulian Slavu
- Discipline of Anatomy, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Laura Răducu
- Discipline of Plastic and Reconstructive Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Andra-Elena Balcangiu‑Stroescu
- Discipline of Physiology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Daniela-Elena Gheoca Mutu
- Department of Plastic and Reconstructive Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Luminiţa Tomescu
- Department of Interventional Radiology, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Adrian Miron
- Discipline of General Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
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Mutu DE, Avino A, Balcangiu‑Stroescu AE, Mehedințu M, Bălan D, Brîndușe L, Popescu AM, Ionescu D, Cristea BM, Tomescu L, Jecan CR, Răducu L. Histopathological evaluation of cutaneous malignant melanoma: A retrospective study. Exp Ther Med 2022; 23:402. [PMID: 35601077 PMCID: PMC9115627 DOI: 10.3892/etm.2022.11329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
Malignant melanoma is a melanocytic neoplasm with a steadily increasing incidence worldwide. In order to define a proper diagnostic protocol and to establish an accurate prognostic method for the disease, specific biomarkers are of notable importance. Their contribution is also significant in the treatment of melanoma for the improvement of newer and more targeted therapeutic approaches. To emphasize the importance of specific immune markers in the diagnosis of melanoma, immunohistochemical analysis was performed on 56 formalin-fixed paraffin-embedded cutaneous melanomas. Besides the traditional prognostic factors, depth of invasion and mitotic rate, the markers tested in the present study were S100 protein family, Melan A, Ki67 and HMB-45. The present results indicated that immunocytochemistry represents a valuable test in the diagnosis and treatment of malignant melanoma and each biomarker had different associations with the progression and prognosis of the disease. Patients with S100 expression were 4.83 times (95% CI=1.2-20.8) more likely to suffer a relapse, whereas patients with a Ki67 expression of >30% had a 5.41-fold higher risk (95% CI=1.3-22.0). The correlation between S100 and the Breslow depth was statistically significant (r-value: 0.43; P=0.027). In addition, the importance of a multidisciplinary team including a plastic surgeon, anatomopathologist and oncologist was highlighted.
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Affiliation(s)
- Daniela-Elena Mutu
- Discipline of Anatomy, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romani
| | - Adelaida Avino
- Department of Plastic and Reconstructive Surgery, ‘Professor Dr Agrippa Ionescu’ Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Andra-Elena Balcangiu‑Stroescu
- Discipline of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Mihai Mehedințu
- Department of Plastic and Reconstructive Surgery, ‘Professor Dr Agrippa Ionescu’ Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Daniela Bălan
- Discipline of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Lăcrămioara Brîndușe
- Discipline of Public Health and Management, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Ana-Maria Popescu
- Department of Financial and Economic Analysis and Valuation, Faculty of Accounting and Management Information Systems, Bucharest University of Economic Studies, Bucharest 010731, Romania
| | - Dorin Ionescu
- Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Bogdan-Mihai Cristea
- Discipline of Anatomy, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Luminiţa Tomescu
- Department of Interventional Radiology, ‘Professor Dr Agrippa Ionescu’ Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Cristian-Radu Jecan
- Department of Plastic and Reconstructive Surgery, ‘Professor Dr Agrippa Ionescu’ Clinical Emergency Hospital, Bucharest 011356, Romania
| | - Laura Răducu
- Department of Plastic and Reconstructive Surgery, ‘Professor Dr Agrippa Ionescu’ Clinical Emergency Hospital, Bucharest 011356, Romania
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Tulin AD, Avino A, Răducu L, Tulin FR, Ştiru O, Balcangiu-Stroescu AE, Timofte D, Tănăsescu MD, Bălan DG, Jecan CR, Ionescu D. Primary thyroid angiosarcoma in a non-endemic region - a rare case. Rom J Morphol Embryol 2021; 61:267-271. [PMID: 32747921 PMCID: PMC7728125 DOI: 10.47162/rjme.61.1.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thyroid angiosarcoma (AS) is a specific type of vascular tumor that arises from the endothelial cells, being highly aggressive, with increased recurrence rates and metastasis. It is characterized by positive endothelial markers and co-positive markers for cytokeratins and epithelial membrane antigen. We are describing the case of a 76-year-old patient who presented to the hospital for dyspnea and asthenia. The clinical and paraclinical investigations confirmed the presence of a right large thyroid nodule, which turned out positive at immunostaining for AS. Even if thyroid AS is a rare type of tumor, mainly described in the Alps, one has to take into account that it can evolve in any other regions and should be considered as a differential diagnosis.
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Affiliation(s)
- Adrian Daniel Tulin
- Department of Plastic and Reconstructive Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, Romania; ; Discipline of Internal Medicine I and Nephrology, Department of Medical Semiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Department of Nephrology, Emergency University Hospital, Bucharest, Romania;
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9
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Tulin R, Tulin A, Tomescu LF, Mihaly E, Avino A, Socea B, Jecan CR, Stiru O, Spataru RI. The importance of adrenal venous sampling in ACTH-independent Cushing syndrome: A case report and literature review. Exp Ther Med 2021; 22:772. [PMID: 34055071 PMCID: PMC8145433 DOI: 10.3892/etm.2021.10204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
Independent Cushing's adrenocorticotropic hormone (ACTH) syndrome can have several causes, including adrenal carcinoma or simple adrenal hyperplasia. Although the distinction between malignant and benign can be effectively made through imaging investigations, in the situation where there are bilateral formations, their hormonal activity is impossible to appreciate via non-invasive techniques. The present study includes the presentation of a clinical case on the basis of which a literature review was made. The clinical case pertains to a 32-year-old patient with ACTH-independent Cushing's syndrome and bilateral adrenal tumor formations leading to the utility of adrenal venous sampling to avoid bilateral adrenalectomy. A literature review was subsequently conducted focusing on articles pertaining to the PICO criteria in order to describe: The diagnosis of adrenal tumor masses, the decision on the type of surgery and most importantly, the impact of adrenal venous sampling in avoiding surgical resection. These interventions severely limit the patients' quality of life.
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Affiliation(s)
- Raluca Tulin
- Department of Embryology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Endocrinology, 'Prof. Dr. Agrippa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Adrian Tulin
- Department of Anatomy, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of General Surgery, 'Prof. Dr. Agrippa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Luminita Florentina Tomescu
- Department of Cardiovascular Surgery, 'Prof. Dr. Agrippa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Enyedi Mihaly
- Department of Anatomy, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adelaida Avino
- Department of Plastic and Reconstructive Surgery, 'Prof. Dr. Agrippa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania.,Department of Plastic and Reconstructive Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Cristian-Radu Jecan
- Department of Plastic and Reconstructive Surgery, 'Prof. Dr. Agrippa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania.,Department of Plastic and Reconstructive Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Cardiovascular Surgery 'Prof. Dr. C. C. Iliescu' Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania
| | - Radu-Iulian Spataru
- Discipline of Pediatric Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Pediatric Surgery, Emergency Clinical Hospital for Children 'Marie S. Curie', 41451 Bucharest, Romania
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Gheoca DE, Avino A, Raducu L, Marina CN, Stefan MC, Tomescu LF, Tulin AD, Jecan CR. 6 Years of Breast Reconstruction in One Center - An Objective Analysis. Chirurgia (Bucur) 2021; 116:98-104. [PMID: 33963699 DOI: 10.21614/chirurgia.116.2 suppl.s98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Breast cancer represents the most common type of neoplasm in women around the world. Breast reconstruction following mastectomy has become a demanding procedure in the treatment of patients suffering from breast cancer. Their major role is to improve the quality of life of women, leading to better aesthetic outcomes. Based on each type of reconstruction, the complications following surgery and the duration of hospital stay, the financial implications slightly vary. Methods: Our study included 168 female patients who underwent immediate or delayed breast reconstruction after mastectomy. We assessed the clinical management of each of these cases and we evaluated the average final cost of the treatment after the reconstruction, focusing on the reconstructive method used, the complications that occurred and the number of days of hospitalization. Results: The total cost of care in breast reconstruction surgery depends on the type of reconstructive procedure used, which consequently affects the duration of hospitalization of the patients. The expenses also depend on the materials that are used: the type of implant/expander or the use of ADM. Costs were higher in patients who underwent breast reconstruction using a latissimus dorsi flap associated with an implant, in comparison to reconstruction using a free flap. Conclusions: Breast reconstruction represents a crucial process in the management of women who underwent mastectomies following cancer and presumes variable financial resources, depending on the chosen reconstructive method.
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Avino A, Gheoca-Mutu DE, Raducu L, Nedelea SA, Jecan CR, Lascar I. Patient-Reported Quality of Life 3 Months after Breast Reconstruction. Chirurgia (Bucur) 2021; 116:232-237. [PMID: 33950820 DOI: 10.21614/chirurgia.116.2.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Breast cancer is considered to be the second major cause of cancer death in women after lung cancer. Due to a remarkable progress, the treatments against breast cancer became more efficient and less toxic. In addition, the reconstructive procedures after mastectomy have improved significantly the quality of life especially in younger women. The aim of the study was to evaluate the quality of life of patients 3 months after breast reconstruction. Methods: We performed a prospective study on 25 female patients who underwent immediate or delayed reconstruction of the breast after mastectomy. A health-related quality of life questionnaire was distributed and the answers were evaluated. Results: The patients from the rural area reported that their health in general was much worse than one year ago. The patients with ductal carcinoma reported a serious limitation for vigorous activities, such as running, lifting heavy objects, participating in strenuous sports. 15 patients declared that their general health is good, 8 very good and just two women considered it excellent. Conclusions: Breast reconstruction following mastectomy have an effect on the patient's quality of life. Therefore, there is an increased need to recognize and evaluate the quality of life after post reconstruction.
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Gheoca Mutu DE, Avino A, Raducu L, Marina CN, Stefan MC, Tomescu LF, Tulin AD, Jecan CR. 6 Years of Breast Reconstruction in One Center - An Objective Analysis. Chirurgia (Bucur) 2021. [DOI: 10.21614/chirurgia.116.2suppl.s98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Timofte D, Dragos D, Balcangiu-Stroescu AE, Tanasescu MD, Gabriela Balan D, Avino A, Tulin A, Stiru O, Ionescu D. Infection with hepatitis C virus in hemodialysis patients: An overview of the diagnosis and prevention rules within a hemodialysis center (Review). Exp Ther Med 2020; 20:109-116. [PMID: 32509002 PMCID: PMC7271692 DOI: 10.3892/etm.2020.8606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/03/2020] [Indexed: 12/20/2022] Open
Abstract
Increase in the number of patients with chronic kidney disease (CKD) calls for improved management of these patients. In stage 5 CKD, when the initiation of renal replacement therapy (RRT) becomes necessary, there is an increase in the infection risk of the patients and immunological tests for hepatitis C virus (HCV) detection turn positive at an alarmingly higher rate compared to general population. With the introduction into clinical practice of diagnostic tests, the increased prevalence of HCV among CKD patients has been known since the 1990s. Also, the negative impacts of HCV infection on CKD evolution as well as the unfavorable evolution of grafts received by HCV infected patients are known. Chronic hemodialysis patients are a category of patients whose risk of HCV infection is substantial. Currently, in the hemodialysis centers, at the base of the transmission of HCV infection there are a multitude of factors. Infection with HCV has a different impact on patient with end-stage renal disease (ESRD). Comorbidities in this case have significant sources of mortality and morbidity. It was proven that the post transplantations problems were prevented and mortality was reduced for patients who were diagnosed with HCV and in whom the infection was treated before the kidney transplant (KT). Consequently, early detection of the infection and the application of specific treatment has a considerable impact on the outcome of the patients. Another important component of the management of HCV infection in the chronic hemodialysis patients is the prevention of the infection transmission by applying specific methods.
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Affiliation(s)
- Delia Timofte
- Department of Dialysis, Emergency University Hospital, 050098 Bucharest, Romania
| | - Dorin Dragos
- Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- Department of Dialysis, Emergency University Hospital, 050098 Bucharest, Romania.,Discipline of Physiology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maria-Daniela Tanasescu
- Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Daniela Gabriela Balan
- Discipline of Physiology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adelaida Avino
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital 'Prof. Dr. Agrippa Ionescu', 011356 Bucharest, Romania
| | - Adrian Tulin
- Department of General Surgery, Clinical Emergency Hospital 'Prof. Dr. Agrippa Ionescu', 011356 Bucharest, Romania.,Anatomy and Cardiovascular Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Prof. Dr. C.C. Iliescu' Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Dorin Ionescu
- Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Nephrology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
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Răducu L, Avino A, Purnichescu Purtan R, Balcangiu-Stroescu AE, Bălan DG, Timofte D, Ionescu D, Jecan CR. Quality of Life in Patients with Surgically Removed Skin Tumors. Medicina (Kaunas) 2020; 56:E66. [PMID: 32050413 PMCID: PMC7074335 DOI: 10.3390/medicina56020066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
Abstract
Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention. Material and methods: We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients' mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. Results: In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Conclusions: Surgery is one of the main steps in treating skin cancer. It has a great impact on patients' quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically.
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Affiliation(s)
- Laura Răducu
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, 011356 Bucharest, Romania; (L.R.); (C.-R.J.)
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adelaida Avino
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, 011356 Bucharest, Romania; (L.R.); (C.-R.J.)
| | - Raluca Purnichescu Purtan
- Department of Mathematical Methods and Models, Faculty of Applied Sciences, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Andra-Elena Balcangiu-Stroescu
- Department of Dialysis, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (A.-E.B.-S.); (D.T.)
- Discipline of Physiology, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, 020021 Bucharest, Romania;
| | - Daniela Gabriela Bălan
- Discipline of Physiology, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, 020021 Bucharest, Romania;
| | - Delia Timofte
- Department of Dialysis, Emergency University Hospital Bucharest, 050098 Bucharest, Romania; (A.-E.B.-S.); (D.T.)
| | - Dorin Ionescu
- Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Nephrology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Cristian-Radu Jecan
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, 011356 Bucharest, Romania; (L.R.); (C.-R.J.)
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Raducu L, Avino A, Cozma CN, Balcangiu-Stroescu AE, Timofte D, Tanasescu MD, Balan DG, Jecan CR, Ionescu D. Open Carpal Tunnel Release:Performed Axillary Brachial Plexus Block vs. Wide Awake. Rev Chim 2019. [DOI: 10.37358/rc.19.5.7183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ropivacaine and lidocaine are used in surgical anaesthesia for the upper extremety. The first one is indicated for the axillary brachial plexus block and the second one as an local anaesthetic. A retrospective study was realized to evaluate the differences between the two anaesthetic methods used for the carpal tunnel release.
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Raducu L, Avino A, Cozma CN, Nedelea S, Balcangiu-Stroescu AE, Tanasescu MD, Balan DG, Timofte D, Jecan CR, Ionescu D. Multidisciplinary Approach of a Very Rare Infected Verrucous Carcinoma of the Scrotum. Rev Chim 2019. [DOI: 10.37358/rc.19.4.7153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Verrucous carcinoma of the scrotum is an extremely rare disease and most cases are thought to result from poor hygiene and chronic inflammation. Currently, it has not been well characterized, the etiology, diagnosis and treatment remaining poorly understood. We present the case of a 50-year-old male patient diagnosed with verrucous carcinoma of the right hemiscrotum. Wide surgical excision was performed. Favorable outcomes can be achieved by surgery, even without any adjuvant therapy, but patients should be carefully followed up.
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Avino A, Cozma CN, Balcangiu-Stroescu AE, Tanasescu MD, Balan DG, Timofte D, Stoicescu SM, Hariga CS, Ionescu D. Our Experience in Skin Grafting and Silver Dressing for Venous Leg Ulcers. Rev Chim 2019. [DOI: 10.37358/rc.19.2.6997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Silver is used nowadays in numerous domains, from the manufacture of jewelery to the medical field. It has also healing properties being used as a wound dressing that creates an aseptic environment. The management of wound healing using a skin grafts often requires hospital admission, a period of immobility, attentive donor site wound care and pain control. A prospective study was realized to evaluate the silver dressing efficacy in treating lesions after skin grafting of chronic ulcers. Our evaluation showed good results with an accelerated re-epithelialization.
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Cozma CN, Raducu L, Avino A, Scaunasu RV, Bratu O, Marcu DR, Jecan CR. A rare case of vulvar squamous cell carcinoma; case presentation. J Clin Invest Surg 2018. [DOI: 10.25083/2559.5555/31.3236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives. Vulvar cancer is a rare gynecological malignancy, with an incidence of 1.5 per 100 000 women/year. The most common vulvar cancer is developed in squamous cells, the most encountered type of skin cells. Case report. We report a case of a 72-year-old female admitted in the Department of Plastic Surgery of Emergency Clinical Hospital “Prof. Dr. Agrippa Ionescu” with a 5/4.2 cm painful ulcerated tumoral mass located in the vulvar area. The lesion slowly increased in size over the past 12 months. The tumour was surgically removed with oncological safety margins and sent for histopathological evaluation. The histopathological examination revealed an ulcerated squamous carcinoma with lymphovascular and perineural invasion, but with negative margins. Postoperative results were favorable, and no local or general complications were observed. Conclusion. We highlight this case due to its unusual presentation in the clitoral area. Moreover, considering the potential for recurrence we point out the importance of the radical vulvectomy with regional lymphadenectomy and histopathological examination, in order to put a precise diagnosis and ensure the best possible treatment for the patient.
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Raducu L, Cozma CN, Balcangiu Stroescu AE, Avino A, Tanasescu MD, Balan DG, Jeca CR. Our Experience in Chronic Wounds Care with Polyurethane Foam. Rev Chim 2018. [DOI: 10.37358/rc.18.3.6154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Polyurethane foam has numerous applications, from furniture to medical field. As a wound dressing creates a moisture environment that promotes epithelialization and diminishes pain. A prospective study was realized to evaluate polyurethane foam efficacy in treating chronic wounds due to venous, arterial or diabetic causes. Our evaluation showed good results with an accelerated epithelialization.
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Raducu L, Cozma CN, Balcangiu Stroescu AE, Panduru M, Avino A, Tanasescu MD, Badita DG, Jecan CR. A Rare Case of a Lower Lip Merkel Cell Carcinoma Diagnosis and treatment. Rev Chim 2018. [DOI: 10.37358/rc.18.2.6106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Merkel cell carcinoma is (MCC) a rare type of skin malignancy that appears as a result of a disorganized multiplication of the Merkel cells and has a high rate of recurrence and metastases even from early stages. We describe the case of an 84-year old women diagnosed with Merkel cell carcinoma of the lower lip. Surgical treatment was realised with tumor excision and reconstruction using advancement flaps. Postoperative cosmetic and functional results were excellent, but invasion of the lateral margins, the patient�s decision of refusing re-excision and delayed radiotherapy lead to a rapid recurrence within 3 weeks. Responsiveness to subsequent radiotherapy was very good with regression of the recurrent tumor and decreasing of the local discomfort. Surgical treatment Merkel cell carcinoma of the lip is sometimes very challenging for a surgeon due to the necessity of wide resection and of the patient�s cosmetic concern. Radiotherapy remained an efficient therapy of Merkel cell carcinoma and should be used as a single or adjuvant therapy in situations where surgery cannot be applied, cisplatin chemotherapy being used for metastasis.
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Avino A, Johnson B, Bandyk D, Back M, Roth S, Kudryk B, Cantor A. Does prosthetic covering of nitinol stents alter healing characteristics or hemodynamics? J Endovasc Ther 2000; 7:469-78. [PMID: 11194818 DOI: 10.1177/152660280000700607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate placement of polyester (Dacron) coverings on nitinol stents implanted in the canine aorta to determine the effect on cross-sectional lumen area, development of intimal hyperplasia, device endothelialization, and flow hemodynamics. METHODS Ten polyester-covered and 10 uncovered nitinol stents (60-mm length, 10- or 12-mm diameter) were deployed percutaneously in the normal infrarenal aorta of 20 adult mongrel dogs using random assignment. Angiography, intravascular ultrasound (IVUS), and duplex ultrasound performed at device deployment and before explantation at 6 weeks were used to measure aorta/device diameter and cross-sectional area. Pressure-perfusion-fixed aortic segments were compared for surface endothelialization (CD31 staining) and for thickness of neointimal formation. RESULTS All 20 endoluminal devices were accurately positioned in the infrarenal aorta without early or delayed evidence of device thrombosis, significant lumen narrowing, or device deformity. IVUS and duplex scanning identified no anatomical stenosis in either the covered or the bare devices by duplex ultrasound; peak systolic velocity measurements were similar (106+/-25 cm/s in the covered stent versus 96+/-25 cm/s for bare stents, p > 0.05). Mean neointimal thickness was significantly greater (p < 0.005) in the covered (326+/-145 microm) compared with the bare (219+/-62 microm) stents. Intima-to-media height ratios were greater in the covered stents (3.0+/-1.1 compared with 1.1+/-0.2, p < 0.003). Mean surface area endothelialization in the proximal, middle, and distal sections of each device was similar (p > 0.05) in covered (59%, 56%, and 69%) and bare (59%, 65%, and 53%) stents. CONCLUSIONS Deployment and balloon dilation of a covered nitinol stent in a nondiseased canine aorta increased neointimal development compared with an uncovered stent, but overall lumen cross-sectional area was preserved. No differences in device patency, intradevice thrombus formation, flow hemodynamics, or luminal endothelialization were demonstrated, despite a thicker intradevice neointima induced by the polyester covering.
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Affiliation(s)
- A Avino
- Department of Surgery, University of South Florida College of Medicine, Tampa, USA
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