SURGERY

POSTER

Decompressive craniectomy, a successful procedure case report

Author: Madalina Hanea
Scientific coordinator: Vicentiu Saceleanu , MD, PhD
Introduction: Decompressive craniectomy is a neurosurgical procedure used in cases
of intracranial hypertension as a consequence of several causes. The procedure
consists of removing a part of the skull to allow the edematous brain to distend and
thus reduce the intracranial pressure.
Materials and Methods: Patient aged 29 years was admitted after a road accident in a
comatose state with GCS score = 7 points. Native cranial MDCT examination reveals
a left parietal frontotemporoparietal subdural hematoma with a thickness of 1.2 cm
and removed cortical brain sulcus to the left hemisphere. Evolving 3 hours late, the
neurological state depreciates, GCS score dropping 2 points. Repeated native cranial
MDCT examination shows a moderate increase in the hematomas dimension. This
occur involves a neurosurgical approach indicating a decompressive craniectomy
realized by necessity. A hematoma centered incision is practiced. The skull bone is cut
into a circular shape. Thus the traumatic bone is removed allowing the evacuation of
the left subdural hematoma and the herniation of the brain due to a massive brain
edema. When the procedure is completed, the skin and connective tissue overlying the
brain are closed with sutures.
Results: Postoperatively the patient shows good status with GCS score = 10 points
and performed well without any complications. Postoperator native cranial MDCT
examination highlights a left frontotemporoparietal craniectomy with diffuse edemas,
midline structures in normal position and normotensive and symmetrical ventricular
system. While the bone is removed, the patient is provided with a custom fit to wear
helmet that prevent brain injury for further time.
Conclusions: Decompressive craniectomy by necessity is a procedure that is
performed in cases of intracranial hypertension, where a marked edema is present in
order to allow the evacuation of the hematoma and allow cerebral distension.
Keywords: decompressive, craniectomy, necessity

Anterior cruciate ligament (ACL) reconstruction with autograft

after 18 months of trauma a case report
Author: Mihaela Georgiana Dimache
Co-authors: Daniela Cristina Haiura, Kinga Blaa
Scientific coordinator: Professor Tiberiu Bag, MD, PhD

Introduction: The anterior cruciate ligament is one of the most frequent affected
ligaments of the knee during sport activities or traumatic events. An ACL injury
usually appears when suddenly stopping, changing direction, sidestepping or
inconvenient landing. The early symptoms that the patient is experiencing are pain,
swelling, unstable knee or a popping sensation in the knee.
Materials and methods: A 46-year-old woman who fell on ice two years ago,
asymptomatic until 8 months ago seeks medical advice for sudden pain, unstable knee,
popping sensation in the knee. A MRI was performed in July when an ACL tear in
the distal 1/3, hydrarthrosis, a 3rd grade lesion of the posterior horn of the medial and
lateral meniscus, a Baker cyst, and degenerative changes were found. In January the
clinical examination revealed a positive anterior drawer test, pain at knee extension,
loss of function.
Results: An arthroscopic intervention was performed with debridement, articular
lavage, and synovectomy. Six weeks after the surgery the patient complains that the
symptoms reappeared. On 8th March 2016 an ACL Reconstruction with Hamstrings
autograft made with the semitendinosus and gracilis tendons was performed.
Conclusions: The particularity of the case consists in the fact that a patient with an
ACL tear was asymptomatic for one year and a half despite the fact she was able to
continue her daily activities that involve a high level of physical activity.
Keywords: Anterior cruciate ligament (ACL), Autograft Reconstruction

Young patient with a neglected meniscus lesion a case report

Author: Daniela Cristina Haiura
Co-authors: Mihaela Georgiana Dimache, Kinga Blaa
Scientific coordinator: Professor Tiberiu Bag, MD, PhD

Introduction: About a half of the people above 65 years old have a meniscus lesion.
Besides degenerative lesions, traumatic injuries are a common cause for a torn
meniscus. The mechanisms of the lesion usually involve suddenly stopping, and
torsion. The early symptoms are knee pain, swelling, tenderness, popping or clicking
sensation, limited motion.
Materials and methods: A 37-year-old carpenter during a football match sprained his
right knee. Despite the fact that he experienced pain, limited flexion and giving way
sensation he neglected his lesion more than three months. When his daily life was
affected a MRI exam was performed and the results revealed hydrarthrosis, a partially
torn ACL and a posterior horn of the external meniscus lesion. In March the clinical
exam showed positive McMurray test.
Results: The arthroscopic intervention revealed posterior horn lesion of the lateral
meniscus, ICRS II grade chondropathy, reactive synovitis, Hoffa adipose pad
hypertrophy and debridement, articular lavage and synovectomy was performed.
Conclusions: The particularity of the case consists in the fact that a young patient
with a high level of physical activity neglected a torn meniscus and an ACL tear more
than three months which affected his cartilage.
Keywords: meniscus lesion, arthroscopic intervention

Epidemiology of uterine fibroids in Odessa region

Author: Kossei Tetiana, MD
Scientific coordinator: Rozhkovska Natalia, MD

Introduction: Uterine fibroids (UF) are benign monoclonal tumors of the

myometrium. There is considerable evidence that the UF growth depends on the
expression of the hormonal receptors for estrogens, progestogen and prolactin.
However the etiology of UF is still unidentified. These tumors rarely appear before
menarche and regress after menopause. Nevertheless the prevalence of UF in female
population remains the highest amongst all gynecological diseases and could be
considered as the leading clinical indication for hysterectomies. By the WHO data the
prevalence of UF varies from 5% to 22%. The Medscape experts urge that available
epidemiological data on UF prevalence and incidence are limited and reliable
population-based research is lacking. Available data are difficult to compare due to
differences in the study population and screening methods.
This study was aimed to assess the epidemiological patterns of the UF in Odessa
region.
Materials and methods: The epidemiological retrospective analysis of medical
records was fulfilled for the time-frame of 2014-2016 years.
Results: There was stated that 123000 cases of UF were recorded in 2015. Further
analysis showed that there were 203 females suffering UF who were operated in the
gynecological department of ONMedU University clinic. So every fifth patient
undergoing surgery in this clinic had UFs. The majority of treated patients undergoes
hysterectomy (40.4%) whereas conservative myomectomy took only 21.2% and
LAVH was used in 12.8% cases.
Conclusions: We consider that the development of the clinical tools for prognosis of
the UF course could improve the outcomes and diminish the quantity of
hysterectomies
Keywords: UF, hysterectomy, LAVH

Renal Tumor with Extension into Inferior Vena Cava and Vertebral
Metastases Case presentation
Author: Alexandru-Dan Costache
Co-authors: Nicoleta Dumitrescu; Bogdan-Marian Tarcu
Scientific Coordinators: Assistant professor Cristian-Radu Costache MD, PhD; Assistant
professor Cornel Moroanu MD, PhD
Introduction: We are presenting the case of a 43 year old patient who was admitted in the
Urological Department of the Dr. C. I. Parhon Hospital, Iai for a right renal tumor with
vascular extension (renal vein and inferior vena cava).
Material and method: The initial MRI investigation, performed at the N. Oblu Emergency
Hospital Iai demonstrated vertebral metastases of unknown origin. Further examination in the
Neurosurgical Department in Trgu Mure revealed a T9 spinal tumor, which required
laminectomy and paramedian epidural tumour excision. The histopathological examination
indicated an adenocarcinoma metastasis and a further CT examination suggested the presence of
a right renal tumor. An abdominal MRI evaluation revealed a right inferior pole renal tumor
with extension into the renal vein and the inferior vena cava and secondary lesions in the T9T11 vertebral bodies, extending into the spinal canal. In the Urological Department, a right
radical nephrectomy with the removal of the caval thrombus was performed, with an uneventful
postoperative evolution.
Results: Following surgery, the histopathological examination diagnosed a renal cell
carcinoma. The sudden onset of paraparesis led to an emergency admission in the Neurosurgical
Department in Iai, where the patient underwent a thoracic spinal tumor ablation with
subsequent spine fixation. Afterwards, the complex treatment of the case included the initiation
of the biological therapy with angiogenesis inhibitors (Sunitib). The subsequent follow-up MRIs
indicated a stationary vertebral mass without medular canal or spine invasion, one year after the
surgical procedure.
Conclusions: The evolution of this complex oncological case outlines the effort made to
accurately stage the disease and the major significance of the multimodal treatment employed. It
also provides a solid argument in favor of the importance of early diagnosis in urological and
non-urological cancers.
Key words: Renal tumor, renal vein thrombosis, spinal metastases.

SURGERY
PRESENTATION

The surgical approach of a patient with Paraganglioma of the Carotid

Body whose medical history includes breast cancer and non-Hodgkins
spleen Lymphoma
Author: tefan Iacob
Scientific coordinator: Lecturer Baroi Livia-Genoveva, MD, PhD
Introduction: Carotid Body tumors (CBTs) or Paragangliomas (PGLs) are extra-adrenal
tumors that have an incidence of only 0,03% of all tumors, making them some of the rarest
neoplastic entities, with only a few vascular surgeons having encountered such a pathology
during their career. Originating from the neuroectodermal tissue, these kinds of tumors are
usually benign, but in up to 6% of the cases they can be malignant, invading the lymphatic
nodes and the non-neuroendocrine tissue.
Material and methods: We present the case of a 63 years old female patient with multiple
neoplastic diseases such as right-sided breast cancer and non-Hodgkins spleen Lymphoma, in
addition to stage III essential hypertension mentioned in her medical history, which was
admitted in the Vascular Surgery Unit for an asymptomatic right-sided neck mass. For the
diagnosis of the patients illness, contrast-enhanced Computer Tomography has been used, as
well as Doppler ultrasonography. The first technique has revealed a 3 cm tumor, its location in
the right carotid area and a partially calcified segment, while the second technique has exposed
the PGLs vascularization level and its compressive effect on the surrounding cervical blood
vessels. The patient underwent complete surgical removal of the Shamblins group II tumor and
also of an adjacent lymphatic node, the histopathological examination diagnosting the CBT as
benign and describing the lymphatic node as having a normal architecture and sinus
histocytosis.
Results: The patients postoperative evolution was favorable, without any neurological,
hemorragical or infectious complications. She will be ecographically rechecked every twelve
months.
Conclusions: The surgical excision of the Paraganglioma is the only treatment option, but the
conservative treatment can also be approached due to the tumors reduced growth speed.

Keywords: Carotid Body Tumor, Paraganglioma, Treatment

Case report of bilateral giant inguinal hernia of a pacient with

multiple comorbidities
Author: Matei Theodor
Scientific coordinator: Velicescu Cristian, MD
Introduction: The inguinal hernia represents a frequent pathology in males having as
redoubtable complications strangulation followed by occlusion of the intestine.
Material and methods:
Subject: C M, 50 years old man diagnosed with giant bilateral inguinal hernia (with
loss of residency right)
Main pathological antecedents:

Ascitogen hepatic cirrhosis (CHILD C)

Chronic kidney disease stage 5 (needs hemodialysis)

Splenomegaly with thrombocytemia

In this case the surgical treatment was extremely difficult. The patient needed
preoperative hemodialysis and important hemodynamic equilibration because of the
risks of general anesthesia.
The surgery tactic for this patient was the preoperative maintenance of ascitic fluid in
order to keep the abdominal pressure high. The main risk in this situation was the
occurrence of postoperative abdominal compartment syndrome.
The intervention consisted of surgical cure of the bilateral inguinal hernia with
evacuation of a big quantity of ascites and introduction of the enteric mass back into
the abdomen balancing the abdominal pressure.
Results: The patient had a good postoperative evolution. He resumed hemodialysis
right after the surgery. The digestive tolerance was good.
Conclusion: The bilateral inguinal hernias with loss of residency right are rare and
very hard to treat and present risk of abdominal compartment syndrome.

Keywords: giant bilateral inguinal hernia, ascitogen hepatic cirrhosis, chronic

kidney disease stage 5

Cardiac arrest in a patient with myxedema. Underlying causes and

outcomes
Author: Maria-Alina Dobos
Co-author: Ioana-Alexandra Paduret
Scientific coordinator: Mihaela Blaj, MD
Introduction: Myxedema coma, a rare entity in 21st century in developed nations, is
associated with high mortality rates. We aim at bringing awareness about the fatal and
uncommon manifestations of this clinical entity.
Material and methods: We report the case of a 43 years old female patient, who was
admitted to the ICU at Saint Spiridon Emergency Hospital after undergoing
resuscitation for pulseless electrical activity. The patient had a personal history of total
thyroidectomy and a subsequent hypothyroidism therapeutically neglected. On
physical examination, she was noted to have morbid obesity, extreme generalized
edema with elephantiasis, hypothermia and a modified neurological status.
Results: Low QRS voltage on the EKG and significant pericardial effusion detected
echocardiographically, suggested pericarditis as the underlying cause of the cardiac
arrest. Emergency pericardiocentesis was performed and a catheter was left in place
for seven more days to prevent fluid buildup inside the pericardium. A drainage tube
was inserted into the left pleural cavity to evacuate the pleural fluid. The patient also
required mechanical ventilation, vasopressor support and corticotherapy. Thyroid
hormone replacement therapy was administered through the nasogastric tube, because
in Romania there are no intravenous hormone replacement agents available. Weaning
the patient from mechanical ventilation was difficult and requested non-invasive
intermittent ventilation. At the end of 39 days of admission to the ICU, the patient was
transferred to the Pneumophtisiology Hospital for further treatment and assessment of
the possibility of home mechanical ventilation.
Conclusion: Myxedema coma can be suspected in patients with hypothyroidism,
altered neurological status, unresponsive hypothermia and unexplained
cardiopulmonary failure. Prompt management of the precipitating cause, supportive
care, glucocorticoid and thyroid hormone replacement therapy can save lives and
reverse the cardiopulmonary symptoms.
Keywords: myxedema coma, Pericarditis, cardiac arrest

New recommendations in septic shock. Diagnostic and therapeutic

implications
Author: Ioana-Alexandra Paduret
Scientific coordinator: Roxana Livadariu, MD

Introduction: Sepsis and septic shock definitions and diagnostic criteria have been
recently revised and new recommendations were released in February 2016. Sepsis
status is evaluated by means of qsofa score. Septic shock is now defined as a subset of
sepsis and it can be identified using the clinical criteria of hypotension requiring
vasopressor agents to maintain mean BP 65 mm Hg in spite of adequate fluid
resuscitation and a serum lactate level greater than 2 mmol/L.
Material and methods: The case of a 44-year-old male patient is presented as an
example of the use of the latest advances in sepsis and septic shock diagnosis criteria
and their importance. The patient was admitted to the ICU at Saint Spiridon
Emergency Hospital, with hepatic abscess and clinical manifestations of septic shock.
Results: Despite surgical abscess drainage and broad spectrum antibiotic therapy, the
patient exhibited high fever and MOSF: circulatory failure, ARDS, renal failure,
coagulopathy, pancytopenia. High levels of presepsin and procalcitonin were also
found. Blood and abscess cultures were positive for Klebsiella pneumoniae. In spite of
multiple paraclinical investigations being performed, no extrahepatic or intrahepatic
infection sources have been found, other than the initial abscess. Mechanical
ventilation, vasopressor support, intravenous immunoglobulin therapy and continuous
veno-venosus hemodialysis with Cytosorb filter were initiated. The patient exhibited
slow recovery thereafter. At the end of 26 days of hospitalization in the ICU, the
patient was discharged.
Conclusions: Prompt diagnosis of sepsis or septic shock can significantly reduce the
mortality rate and the costs associated with the treatment of these clinical entities and
allows physicians to successfully use the latest advances in medical therapy. The new
clinical criteria for sepsis and septic shock enhances medical diagnosis, allowing quick
and efficient bedside evaluation of the patient status.
Keywords: Septic shock, qsofa, CVVHD

Malignant fibrous histiocytoma - Case report

Author: Biliuta Silvia Alina
Co-authors: Silvia Cristina Strat, Cristina Maga
Scientific coordinator: Teaching Assistant Ana Maria Trofin MD, PhD; Professor
Cristian Lupascu, MD, PhD;
Introduction: Malignant fibrous histiocytoma is a sarcoma originating from the
mesenchymal tissue, affecting the soft tissues of the body, especially the extremities
and retroperitoneum. We report a surgical case of a malignant fibrous histiocytoma
that originated from the mesosigmoid and affecting the colon and the abdominal wall.
Material and methods: Male, 59, no significant personal or familial disease history,
upon hospitalization accuses following symptoms: anorexia, fatigue and abnormal
growth of the abdomen.
Results: Ultrasonography examination revealed a large hypoechoic and
inhomogeneous medioabdominal mass of 235/199 mm intense vascularized.
Surgical treatment: En bloc resection of the tumor with the sigmoid resection and
the left iliac colostomy was undertaken. One month follow up revealed local
recurrence
Conclusion: MFH is an aggressive tumor, with a high local recurrence rate and a high
potential of metastasis. Other therapeutic choices were radiotherapy, chemotherapy,
immunotherapy. The prognosis in this patient was very poor, due to the size and depth
of invasion of the tumor and the biological aggressiveness.

Keywords: histiocytoma, sarcoma, malignant

A Rare Cyst-like Congenital Duplication of the Rectum

Author: Iolanda Plimaru
Co-authors: Maria-Larisa Hohan, Bogdan-Emanuel Psroiu
Scientific coordinator: Lecturer of Surgery Florin Grecu, MD, PhD
Introduction: Enteric duplication cyst is a rare congenital malformation which
appears during the embryonic period of the development of human digestive system.
Rectal duplication cyst represents 5% of the alimentary tract duplications. Only about
20 cases of tailgate cysts have been documented in the pediatric patients, accounting
for its rare appearance.
Material and methods: We are presenting the case of a female patient, aged 20, with
recent onset of lower abdominal pain, fever and constipation. We noted a standing
history of surgery for a pelvic abscess at the age of 10, when the patient benefited of a
pelvic drainage. At the admission, although the standard blood test showed normal
values, a slightly elevated level of Ca 19-9 was noted. The ultrasound examination,
and pelvic MRI scans showed a cystic mass lying inferior to the left postero-lateral
side of the rectum, with a dense mucinous content. The cyst had a mass effect over the
surrounding structures, mainly to the middle and inferior rectum, the uterus and vagina
as well.
Results: Low anterior resection of the rectum was performed with the total removal of
the cystic mass which was intimately adherent to the rectum, and total mesorectal
excision, followed by mechanical colorectal anastomosis, at 5 cm from the anal
margin. The postoperative followings were favorable.
Conclusions: Both the microscopic and the macroscopic pathology examination
confirmed a cystic mass resulting from a rectal duplication. Particular about this case
is that the rectal malformation was initially misdiagnosed as a pelvic abscess, with
evolution extended up to the age of 20.
Keywords: rectal duplication cyst, Adult, surgical excision

Glucose biofuel cell

Author: Maiassi Nadir
Co-authors: Houidi Ahmed
Scientific coordinator: Chantal Gondran, MD, PhD
Introduction: Pacemakers are powered by sealed batteries changed every 8-10 years,
this replacement is expensive and not without risk. A team of French researchers:
Philippe Cinquin, Serge Cosnier et al, has succeeded in inventing a micro device that
generates electricity from glucose present in the blood providing an inexhaustible
source of energy for pacemakers in the human body.
Material and Methods: The Glucose biofuel cell (GBFC) has two electrodes,
obtained by the compression of enzymes and conductive material. Electrons are
stripped from the glucose by the enzymes of the anode, and then they flow through a
conductive wire and pass through the device to be powered, before reducing oxygen to
water in contact with the other electrode.
The GBFC are encapsulated in two semi-permeable membranes. The first prevents
leakage of enzymes and lets glucose molecules, the second (Dacron synthetic fabric
used for vascular prostheses) is to prevent inflammation reactions.
Results: The glucose biofuel cell was surgically implanted in the abdominal cavity of
a rat, the performance of the biofuel cell yielded a maximum power of 24.4 w ml1.
The researchers have repeated the experiment and monitored during 3 months the
production of gluconate a byproducts of glucose oxidation in the daily urines of the
animal. The sacrifice autopsies performed show no sign of inflammatory reaction
against the implant, these experiments confirmed the biocompatibility and the capacity
of the GBFC to work in the living organism for months.
Conclusion: We have contacted the team of French inventors for the latest progress
on GBFC, the authors said that they would next like to test the device for longer
periods of time in larger animals, and it would take at least three to five years of tests
for the regulatory evidence before considering to implement it on humans.
Keywords: GBFC, glucose biofuel cell, rat

Gastric volvulus-possible complication of a large paraesophageal

hiatal hernia
Author: Elena-Alina Odin
Co-autori: Andra Maria Stancu, Diana Istetia, Alexandra Maria Poenaru
Scientific coordinator: Theodor Dumitrescu MD, PhD
Introduction: Hiatal hernias are a special variety of diaphragmatic hernia in which
transdiaphragmatic migration of the stomach occurs in the chest through the
esophageal hiatus. By far, the majority of hiatal hernias are asymptomatic and are
discovered by chance (during an esogastric barium transit or upper gastrointestinal
endoscopy). Rarely, paraesophageal hiatal hernia may lead to a life-threatening
complication: gastric volvulus and strangulation.
Materials and methods: From January 2013 to March 2014 in the Surgery Clinic II
of the County Emergency Hospital Craiova were treated surgically 8 hiatal hernias (1
male and 7 female), mean age of 61.5 years (49-78 years). Two of these were
paraesophageal hiatal hernias and 6 were sliding hiatal hernias. Positive diagnosis was
established based on the results of the eso-gastro-duodenal barium radiography and
upper digestive endoscopy.
Results: R.C. patient aged 49 years is hospitalized in the Surgery Clinic II of SCJU
Craiova in February 2013 presenting gastric intolerance, severe epigastric pain and
signs of dehydration, the symptoms started suddenly with 24 hours before admission,
after a dietary abuse. By a complete anamnesis we found out that the patient accuses
epigastric pain, postprandial fullness, dyspnea and postprandial belch.
Conclusions: Clinical signs of paraesophageal hiatal hernia associated to gastric
volvulus are: epigastric pain, gastric intolerance. Gastric volvulus may complicate
with gastric necrosis in sliding paraesophageal hiatal hernias with small vent.
Characteristic radiological sign consists of two overlapping gastric pouches, located
above and below the diaphragm. ("cascade" stomach).
Keywords: gastric volvulus, epigastric pain, high digestive occlusion

Rare complications in multimodal treatment of a rectal neuroendocrine

tumor
Author: Constantin-Vlad Carasevici
Co-authors: Rzvan Alexandru Murgu, Florin Mihai Florea, Patricia Richter
Scientific coordinators: Teaching Assistant Vlad Porumb, MD, PhD; Professor Mihail Gabriel
Dimofte, MD, PhD

Introduction: Neuroendocrine tumors (NETS) of the gastrointestinal tract are rare neoplasms
that arise from cells of the endocrine and nervous systems.
Materials and Methods: We present herein the case of a 46-year old woman known with
operated Morb Pott who was admitted for rectal bleeding.
After the colonoscopy, biopsy and MRI the patient was diagnosed with neuroendocrine rectal
neoplasm.
Results: The therapeutic decision consisted of anterior rectal resection with colorectal
anastomosis and protective ileostomy. The patient returned after a month for ileostomy removal
and followed aggressive chemotherapy treatment for neuroendocrine tumors.
Following chemotherapy in the oncology clinic, the patient showed intense diffuse abdominal
pain for the entire abdominal area, being transferred to surgery with acute peritonitis by ileal
anastomosis fistula. The patient underwent exploratory laparotomy, segmental enterectomy and
ileostomy. Because of the presence of pleural effusion in high volume a pleural drainage was
performed.
Two months after the beginning of the chemotherapy, the patient presented intense and diffuse
abdominal pain on the entire abdominal area and the abdominal radiography revealed multiple
hydro-aerial levels.
Exploratory laparotomy, lavage and drainage is performed establishing the diagnosis of
primitive fungal peritonitis.
The postoperative evolution was favorable and after 3 months the ileostomy was closed. One
year after surgery except periodically dysphagia from inflammatory chest lymph nodes and the
increased stool frequency, the patient presents good general condition.
Conclusions: This case is unique by unexpected high number of postoperative complications,
but also by managing them effectively.
This case also shows that treatment like chemotherapy after surgery can cause significant
complications, surveillance and rapid intervention being crucial to the evolution of the patient.
Keywords: complications, rectal neuroendocrine tumor, fungal peritonitis

Squamous cell carcinoma of the lower lip case report

Author: Bologa Ramona-Andreea
Co-author: Brbuceanu Anca-Lorena, Brdu Andra-Cristina, Aprodu LaviniaGabriela
Scientific coordinator: Popa Dragos-George,MD
Introduction: We present the case of a squamous cell carcinoma of the lower lip,
diagnosed in a male patient, aged 83 with no previous history. SCC is the second most
common type of skin cancer; described as red patches or elevated growths with central
depressed area. SCC is twice more frequent in men and it mostly affects Caucasian
individuals over 50 years old. Most frequent cause of SCC is considered to be the
extensive sun exposure.
Materials and methods: Male patient aged 83 presented to the plastic surgery
specialist in January 2016, with a mass situated on the lower lip. Diagnosed several
months before, the tumor first appeared as a white patch with irregular borders, which
rapidly developed in the last 6 months, becoming immobile. When examined, the
patient accused pain at direct pressure contact. It developed as an ulcerative-vegetant
form, with small hemorrhagic areas which extended to the oral vestibule. During the
surgical treatment, excision and reconstruction, the nervos branches and arteries were
preserved using the Karapandzic flap technique.
Karapandzic flap technique: one-step surgical procedure, curvilinear incision to alar
base, musculocutaneous flaps with width equal to height of the defect, formed on both
sides of the defect, after excision of the tumor
Results: SCC is less frequent in dark skin individuals because of the melanin, but with
higher incidence in other patients. Detected at an early stage and removed, the tumor
is curable, whereas left untreated it can penetrate the underlying tissues and become
disfiguring. It can disseminate to local lymph nodes, distant tissues. Metastasis usually
occurs in 1-3 years after the primary lesion and mostly in the case of large tumors,
preceded by local recurrence.
Conclusions: The patient fully recovered, preserving the mobility and the sensibility
of the lower lip and oral competency.
Keywords: squamous carcinoma, lower lip, karapandzic flap technique

A rare multicolonization following severe physical trauma

Author: Marc-Andre Heller
Co-authors: Olympia-Evangelia Chatzigianni, Stavroula Papaeleftheriou, Andrei Bancu
Scientific coordinator: Bulat Oana-Madalina, MD, PhD
Introduction: Saccharomyces cerevisiae is a yeast used in bread-making and fermentation for
alcoholic beverages. Its role as a pathogen in humans is very uncommon.
Shewanela putrefasciens is a global, gram-negative bacillus which has been isolated in marine
environments. It is also a rather rare pathogen in humans.
Materials and methods: We present the case of a 28 year-old male patient that was brought to
UPU by ambulance 4 days after being in a physical alteration. On presentation, the patient
showed multiple skin lacerations, as well as generalized bruising.
In addition to that he showed signs of systemic infection and mentioned strong and persistent
abdominal pain. A rigid and tender abdomen was noted.
After being transferred to Chirurgie III-la where he was diagnosed with hemoperitoneum, he
was taken into emergency surgery where generalized peritonitis caused by ileal and jejunal
perforations were observed.
A segmental enterectomy, general peritoneal lavage and an ileostomy were performed.
Intra-operatively the patient developed acute renal insufficiency and diselectrolytemia,
necessitating a transfer to the ICU. He remained there for 8 days.
During his ICU stay (alternating between intubated state and spontaneous breathing) he entered
septic shock and his peritoneal cultures were found positive for E.Coli, S. Hominis, A.
Baumanni, K. Pneumoniae, Candida spp. As well as Shewanela putrefasciens and
Saccharomyces cerevisiae.
Results: The patient underwent numerous surgical lavages and vacuum dressing changes until
he was hemodynamically stable and then transferred to the regular surgical ward.
Subsequent surgeries where performed to repair incisional hernias.
Following the initial hospitalization he was rehospitalized for various surgical procedures.
Results:
The patient had a total of 11 surgical interventions stretching over 1 year, 3 months and 29 days
and is now healthy.
Conclusion: Remarkably, the patient survived despite having peritonitis for such a long period
and developing so diverse and numerous colonizations
Keywords: Saccharomyces cerevisiae, Shewanella putrefaciens, traumatic peritonitis

Saphenectomy under local anesthesia: an alternative methodology

Author: Martha Gismondi
Co-authors: Toia Diana Ionela, Ilie Ilona Alina, Ioannis Prasinos
Scientific coordinator: Alessandro Martinazzoli, MD
Introduction: In the last ten years, saphenectomy, the surgical treatment of varicose
veins, has been conducted under general anesthesia. Although there are many
advantages of the treatment under general anesthesia many patients preferred this
surgical intervention under local anesthesia, either to avoid cardiac problems or
because they might refuse the general anesthesia.
This alternative methodology uses the transillumination through optic fiber under a
local anesthesia.
Material and method: an optic fiber has been used with a blunt tip of 150cm
connected to a light source. The optic fiber has been introduced in the saphenous vein
in cranial direction, in this way the precise course into the vein was marked over the
skin of the patient. This methodology allows to find the vein in a fairly simple way,
and thanks to the light is visible and the surgeon can proceed with the infiltration. The
fiber has been retracted in the caudal direction. By using the optic fiber, it is also
possible to make micro and targeted incisions. In this pilot study 12 patients with
varicose veins were included (8 females and 4 males with an age between 31 and 57
years old).
Results: All the patients recovered very well from the surgical operation, which lasted
1 hour, and the patients were able to leave the praxis 1-2 hours after the operation. The
only complication which occurred was a local hematoma in one patient.
Conclusions: this methodology has proven to be simple, safe and economically
friendly. All the materials and the drugs used are very inexpensive and easy
accessible. The mobilization of the patient has been immediate and the patients fully
recovered.
Keywords: saphenectomy, local anesthesia, optic fiber

An unusual cause of a laterocervical mass in an adult patient

Author: Andra Madalina Chiriac
Co-authors: Gabriela Andriescu
Scientific coordinator: Associate Professor Costel Bradea, MD, PhD; Elena Cotea, MD
Introduction: Cystic lymphangioma is a benign vascular growth, characterized by localized
abnormal development of the lymphatic vessels. Most commonly, it is a congenital lesion, with
clinical manifestations occurring before the age of two, but rare cases have been reported in
adults. Frequent tumor sites include the posterior triangle of the neck, the axilla and the
mediastinum.
Materials and methods: We present the case of a 65-year-old female, admitted for the
evaluation of a slowly growing neck mass, developed over the last 15 months. The patients
medical history reveals multiple cardiovascular and metabolic comorbidities, including grade III
arterial hypertension and related hypertensive cardiomyopathy, myocardial ischemia and
insulin-dependent type 2 diabetes mellitus. She was also obese and dyslipidemic, and presented
with iron deficiency anemia.
Imagistic assessment of the laterocervical mass included an ultrasonography followed by a
computed tomography. The former revealed a moderately heterogenous, hemorrhagic lesion
with cystic and nodular areas. Furthermore, a CT scan offered details on its density, location
and relations with the nearby organs. The report described a fluid-filled expansile mass, with
well-defined margins, and no contrast enhancement, localized in the right laterocervical region.
These findings are predictors of a benign lesion, presumably a branchial cleft cyst. The
treatment of choice implied surgical removal, with particular attention to the preoperative
evaluation. Cardiac risk stratification was essential, considering the patients previously
diagnosed conditions, and also an adrenal incidentaloma discovered on the CT scan.
Results: Histopathological examination of the surgical specimen gave the final diagnosis:
cervical cystic hygroma. The postoperative evolution was satisfactory, lacking any
complications or subjective complaints.
Conclusion: This case is a fine example to suggest that cystic lymphangioma should not be
omitted in the differential diagnosis of a neck mass in adult patients, when imaging techniques
and clinical presentation are both consistent with it.
Keywords: lymphangioma, laterocervical mass, benign tumor

Surgical treatment of strabismus in adults

Author: Surguci Alina
Scientific coordinator : Paduca Ala, , M.D., Ph.D., Associate Professor in
Ophtalmology, State Medical and Pharmaceutical University Nicolae Testemianu,
Chiinu, Republic of Moldova.
Introduction: Strabismus is a condition in which the eyes are not properly aligned with each
other. According to specialized literature the estimated prevalence of strabismus in the general
population is 4%. Normal binocular vision is required for many occupational tasks and other
activities in daily life. Prompt diagnosis and treatment of strabismus are critical for minimizing
the adverse effects of strabismus and enhance the patients quality of life.
Materials and methods: The base of this research is a retrospective study of 56 patients with
convergent squint who were treated in the Ophthalmology Section of Clinical Republican
Hospital, Chisinau in the period 2013 2015. Examination of patients was performed by
collecting the following dates: probable time of onset of strabismus, nature of onset, frequency
of deviation, previous treatment (if any, type and results). In addition, all patients were exposed
to an ocular examination that included appreciation of: visual acuity, ocular motor deviation,
monocular fixation, accommodation, sensorimotor fusion and refraction.
Results: The average diagnostic age of patients was 28 years, with limits between 18 and 62
years, the biggest incidence of strabismus was in the age group between 20-29 years. 34 (60%)
from patients were female and 23 (40%) were male. There were 42 cases of convergent
strabismus neglected from childhood, 8 cases of sensory esotropia and 6 cases of consecutive
esotropia. According to visual acuity 19 patients (38%) presented isoacuity, 17 patients (34%)
presented amblyopia, the incidence of amblyopia of 64,8% in esotropia and 35,2% in exotropia.
The preoperative mean degree of deviation was -38,2PD. Postoperative success rate was 79,7%
(degree of deviation up to 10 PD) with binocular vision amelioration (Bagollini positive) in
21% of cases.
Conclusions: Strabismus surgery in adults is not only cosmetic. It is reconstructive, and it has
marked functional benefits, including the restoration of normal alignment and binocularity.
Keywords : strabismus, surgical treatment, adults

Malignant tumors in the oral and maxillofacial surgery field

Author: Andronic Raluca Gabriela
Co-authors: Patru Adrian, Radulescu Cicerone, Nica Laura Elena
Scientific coordinator: Mircea Gheorghita MD, PhD
Introduction: The pathology in the oral and maxillofacial surgery field often reaches
a significant degree of evolutivity because patients rarely present at the consultation in
the early stages.
Materials and methods: During 2015, several patients with distinct pathologies
presented to the oral and maxillofacial surgery clinic, some of which outline the vast
extension of the lesions. We retain a parotid tumoral formation situated on the
superficial lobe which imposed a parotidectomy, a tumor extended to the internal
angle of the eye, pyramid and nasal wing and left gentian region removed surgically ,
the defect was subsequently covered with a frontal flap, a laterocervical
lymphadenopathy secondary to neoplastic pericarditis which was excised; the
remaining defect was reduced by a tunneled deltopectoral flap ,a metastatic
lymphadenopathy with capsule rupture secondary to a primary pretragian tumor, and
ultimately an ulcered and destructive tumor that was extirpated with neck dissection.
There were some patients who declined the surgical intervention, although the extent
of the tumoral process required immediate removal.
Results: After surgery, most patients have enjoyed higher life quality, but in some
cases, due to the extent of the lesions, the procedures had only a palliative purpose.
Conclusions: The low level of education and the lack of information are the main
factors that maintain a proper environment for the development of an impressive
pathology with little chance of healing .The recovery possibilities are even higher as
the formations are diagnosed early; most of them impose as operator step the
ganglionic neck dissection, in absence of which relapses occur frequently.
Keywords: the oral and maxillofacial surgery, tumoral, palliative purpose

Retroperitoneal Ancient Schwannoma

Author: Raluca Gabriela Andronic
Co-authors: Ana Maria Corina Bivolan, Andra Maria Stancu, Oana Catalina
Dragusin
Scientific coordinator: Cristian Mesina, Md, PhD
Introduction: Retroperitoneal ancient schwannomas are rare tumors, more usually
found in the head, neck and flexor surfaces of the extremities. Ancient schwannomas
are a subtype of classic schwannomas with a predominance of degenerative changes,
calcifications, hemosiderin deposition, interstitial fibrosis and vascular hyaline
degeneration. A 33-year-old male was referred on our hospital with a painful mass in
left iliac fossa.
Materials and methods: The patient underwent surgery and intra-operatively the
cystic encapsulated mass was found to be retroperitoneal, between the left psoas major
muscle and left iliac muscle. On microscopic examination found the presence of
Schwann cells in regions with high and low cellularity (Antoni A and B areas) and
S100 protein immune-histochemical examination was intensely positive, being
consistent with the diagnosis of schwannoma.
Results: Complete excision is the only method of the surgical treatment;
schwannomas are not sensitive to radiotherapy and chemotherapy. Some authors
consider that a complete excision of the tumor, while others believe that enucleated or
partial excision of the tumor is sufficient.
Conclusions: The prognosis is good, and the most common complication is
recurrence, possibly by incomplete excision of it being reported in 5-10% of cases. In
conclusion, retroperitoneal schwannomas is usually identified incidentally on
tomographic images. Diagnosis is based on histopathological examination after
surgery and immune-histochemical examination.
Keywords: retroperitoneal schwannomas, Schwann cells

What lies behind a post traumatic chest pain?

Author: Flavia Valinciuc
Co-authors: Alexandru Carp
Scientific coordinator : Teaching Assistant Carmen Elena Pleoianu, MD, PhD; Mircea
Balasanian, MD, PhD, Eugen Bitere, MD, PhD, Professor Ctlina Arsenescu Georgescu, MD,
PhD Grigore T. Popa University of Medicine and Pharmacy, Iai, Romania
Introduction: Aortic rupture is known to be the second cause of mortality in car crashes, after
head trauma. It is usually accompanied by a dramatic clinical picture with rapid onset of
hypovolemic shock symptoms requiring immediate surgical intervention. However, there are
cases where the symptomatology is poor and the imaging techniques play an important role in
the management of the patient.
Material and methods: We present the case of a 24-year old male, involved in a car crash who
complained of chest pain after the trauma. The computed tomography performed in emergency
in a territorial hospital raised the suspicion of aortic dissection and the patient was referred to
the Institute of Cardiovascular Diseases Iai for further investigations and specialized treatment.
On admission the patient was hemodynamically stable with chest pain and blood pressure of
130/67 mmhg, in sinus tachycardia. Biochemical parameters revealed leukocytosis (leukocytes
= 11000/mm3), high transaminases (TGP = 155 u/l, TGO = 156 u/l), the absence of renal
dysfunction (creatinine = 1.08 mg%) and a hemoglobin of 12.3 g/dl. The transthoracic
echocardiography objectified normal left ventricular structure and function and aortic intimal
flap. Incomplete transection of the descending thoracic aorta at the isthmic level, left kidney
embolism, left hemothorax and dilaceration of the arch of azygos vein were objectified on
contrast computed tomography.
Results: A Dacron graft was used to replace the aortic isthmus and the descending aorta,
requiring extracorporeal circulation. The postprocedural evolution was favorable with discharge
at 13 days after the intervention.
Conclusions: Aortic rupture is a life threatening condition requiring prompt diagnosis and
surgical intervention. All patients with important trauma must be investigated to exclude this
high mortality pathology. A multidisciplinary approach and the team work of the cardiologist,
radiologist and surgeon ensured the successful management of the patient.
Keywords: chest pain, aortic rupture

Cryodestruction of cervical intraepithelial lesions associated with

HPV infection
Author: Natalia Kashtalian
Co-authors: Maryna Kashtalian
Scientific coordinator: Professor Igor Gladchuk
Introduction: Pathology of cervix holds one of the main places in the structure of
gynecological pathology in Ukraine. Human papillomavirus (HPV) infection is the
primary cause factor for cervical intraepithelial lesions. Currently in Ukraine different
methods are used for treatment of precancerous pathology of cervix, although in
young with reproductive plans women the privilege is given to cryodestruction as
favorable and non-invasive method.
Aim of the study was determining of influence of cryodestruction on viral load of
HPV type 16 in women with cervical intraepithelial neoplasia (CIN).
Materials and methods: We observed 90 women age 19 to 42, mean age 31,69+6,53
years, with HPV type 16 infection and CIN I-II. 34 (37,78%) patients had high viral
load (>5 Lg /105 cells), 56 (62,22%) patients low clinically significant viral
load (3-5 Lg /103 cells). 55 (61,11%) women were diagnosed with CIN , 35
(38,89%) with CIN . All patients underwent cryodestruction treatment.
Results: 6 months after treatment viral load lessening within clinically significant
margins was noted in 69 (76,67%) women, in 21 (23,33%) women viral load did not
lessen. Also 16 (17,78%) women had recurrent colposcopic changes. Patients with
initially low viral load had 4,9 more odds (95% C 1,54-15,98) of viral load lessening
after treatment then those with initially high viral load.
Conclusions: According to our data there is no evidence that cryodestruction causes
HPV type 16 elimination. Chances of HPV type 16 viral load lessening after
cryodestruction in women with CIN are higher in patients with initially low viral load.
Keywords: cervical intraepithelial neoplasia, human papillomavirus, viral load

Paraesofagian hiatal hernia particular anatomoclinical form

Author: Diana Istetia
Co-authors: Elena Alina Odina, Andra Maria Stancu, Alexandra Maria Poenaru
Scientific coordinator: Theodor Dumitrescu, MD, PhD
Introduction: Hiatal hernias are a special variety of diaphragmatic hernia in which
transdiaphragmatic migration of the stomach occurs in the chest through the
esophageal hiatus. By far, the majority of hiatal hernias are asymptomatic and are
discovered by chance (during an eso gastric barium transit or upper gastrointestinal
endoscopy). Rarely, paraesophageal hiatal hernia may lead to a life-threatening
complication: gastric volvulus and strangulation.
Materials and methods: From January 2013 to March 2014 in the Surgery Clinic II
of the County Emergency Hospital Craiova were treated surgically 8 hiatal hernias (1
male and 7 female), mean age of 61.5 years (49-78 years). Two of these were
paraesophageal hiatal hernias and 6 were sliding hiatal hernias. Positive diagnosis was
established based on the results of the eso-gastro-duodenal barium radiography and
upper digestive endoscopy.
Results: R.C. patient aged 49 years is hospitalized in the Surgery Clinic II of SCJU
Craiova in February 2013 presenting gastric intolerance, severe epigastric pain and
signs of dehydration, the symptoms started suddenly with 24 hours before admission,
after a dietary abuse. By a complete anamnesis we found out that the patient accuses
epigastric pain, postprandial fullness, dyspnea and postprandial belch.
Conclusions: Clinical signs of paraesophageal hiatal hernia associated to gastric
volvulus are: epigastric pain, gastric intolerance. Gastric volvulus may complicate
with gastric necrosis in sliding paraesophageal hiatal hernias with small vent.
Characteristic radiological sign consists of two overlapping gastric pouches, located
above and below the diaphragm (cascade" stomach) .
Keywords: gastric volvulus, paraesophageal hiatal hernia,epigastric pain,high
digestive occlusion.

Single incision Roux-en-Y gastric bypass

Author: Soury Arselen
Co-authors: Souabni Seif-eddine, Houidi Ahmed, Ben Hassine Marouen
Scientific coordinator: Hmida Charaf, MD, PhD
Introduction: In this study, we present single incision Roux-en-Y gastric bypass in 14
patients, focusing on describing the surgical technique. The aim of this study is to
describe the SILS technique and to evaluate its short term outcomes.
Material And Methods: The study group was comprised of 14 patients who
underwent single incision laparoscopic gastric bypass at the Cleveland Clinic Bariatric
and Metabolic Institute between March 2012 and February 2013 using a single vertical
2.53 cm intra-umbilical incision,3-ports placed trans-fascially, and a liver suspension
technique. Short-term outcomes were evaluated.
Results: Weight loss was approximately 20.6 Kg ( 7 ) after 4 months with no needed
re-operation or readmission during the 90 days after surgery.
Conclusions: SILS is a safe technique with promising post-operative results.
Keywords: Single incision laparoscopic surgery, Single incision gastric bypass,
Bariatric surgery

Slope Score: A Gate To Guidelines In Non-Descent Vaginal Hysterectomy

(Ndvh) For Fibroid Uterus
Author: Kaisser Gallaby
Co-authors: Farai Nhambasora, Samuel Daniel Thomas, Vergis Anand Cheriya
Scientific coordinators: Assistant Professor Nora Miron, MD, PhD, Professor Sarita
Kakatkar, MD, PhD
Introduction: Non-descent vaginal hysterectomy (NDVH) is one of the surgical methods used
to remove uterine fibroids. There are many factors which influence intra-operative difficulties in
NDVH such as uterine volume, sub-pubic angle, vaginal capacity, high placed immobile cervix
etc. Anticipating these factors and a proper pre-operative study can improve surgical planning
and a better outcome.
Our aim here is to prove through a scientific basis on which technique to choose between
NDVH and Laparoscopic hysterectomy (LH) by a quantification of intra-operative difficulties
in NDVH. Thus developing guidelines for NDVH for fibroid Uterus.
Material and methods: 400patients with fibroid uterus undergoing hysterectomy was used in
the study. An internal examination in dorsal position without anesthesia after bladder emptying
was done. Location and fibroid size, obliteration of fornices, parity and cervical evaluation were
noted together with obstetric history and ultrasound findings and individually scored 0 to 3
points and totaled. Scores were classified into 3 groups of ascending difficulty and subjected to
the following surgery. Group 1- 0 to 4: low risk, NDVH standard protocol Group 2- 5 to 10:
moderate risk, NDVH may need morcellation and myomectomy Group 3 11+: high risk,
NDVH trial or direct Abdominal Hysterectomy (AH) or Laparoscopic Hysterectomy (LH)
Duration of surgery and blood loss were noted in all cases.
Results: The 400 patients that where considered to be part of the SLOPE study, 389 underwent
a successful NDVH, the remaining patients 9 had failed trial of NDVH followed by abdominal
conversion, and 2 directly posted for abdominal hysterectomy. With a blood loss between 50 to
200 ml and a surgical duration between 30 to 120 minutes.
Conclusions: SLOPE score can be an important tool in training programs, and in improving the
surgical procedure and outcome, by being an essential pre-operative measure to evaluate the
risk and decide the route.
Keywords: SLOPE, Non-descent vaginal hysterectomy (NDVH), Laparoscopic hysterectomy
(LH)

Myolipoma and tethered cord in a complex sacral malformation in

a 26-year-old patient
Author: Adina Mihaela Popa
Co-authors: Teclici Alexandra, Daniela Luca, Diana Andrei
Scientific coordinator: Bogdan Florin Iliescu MD
Introduction: Myolipoma with intradural location is a very rare occurrence in
neurosurgical pathology.
Although the reported number of cases is scarce and all are in patients younger than
18 year old, we diagnosed this congenital tumor in a symptomatic tethered spinal cord
of a 26-year-old male in the context of a more complex sacral malformation. We
analyze the imagistic, operatory, and decision making issues of this very particular
case.
Materials and methods: A 26 year old male came to our department describing
paresthesia in both forearms and hands and a history of micturition urgency. The
physical exam revealed a significant atrophy of the gastrocnemius muscle in the left
lower limb. He also presented, at coccygeal level, a 5 centimeter long pseudotail. The
MRI showed no pathological changes at the level of the brain nor in the cervical and
dorsal spine. At the lumbar-sacral level it revealed a 7 by 2 cm sacral mass at S3-S5
level, with a low-lying conus and evidence of a tethered spinal cord. The intervention
consisted of microsurgical removal of the tumor using ultrasonic aspiration and
intraoperative electrophysiological monitoring.
Results: The post-operative evolution was favorable. Paresthesias in the lower limbs
remitted completely. The micturition urgency resolved and the motor function
returned to normal almost completely with a small degree of paresis left on the left
side.
Conclusion: Intradural myolipoma represents an extremely rare finding in spine
pathology. It consists of fat
Tissue mingled with fully differentiated striate muscle fibers. Only five cases have
been previously reported in the literature.
Keywords: myolipoma, sacral malformation, tethered cord

Multiple association of congenital malformations on a female newborn

Author: Octavia Maftei
Co-author: Teodora Patraucean
Scientific coordinators: Teaching Assistant Mihaela Ciornei, MD, PhD; Teaching Assistant
Elena Hanganu, MD, PhD
Introduction: Cloacal malformation is one of the most complex anomalies, resulting from a
combination of different aspects of urogenital sinus and anorectal malformations when the
urethra, vagina and rectum fuse together forming a common channel opening as a single
perineal orifice. Esophageal atresia is the congenital discontinuity of the esophagus that may
associate a fistulous communication between the trachea and one of the esophageal segments.
The possibility of multiple embryogenesis abnormalities in weeks 4-6 of fetal life, represents
the basis of these defects and may explain their association in the same patient.
Materials and methods: We present the case of a female newborn, AGA, from a
polyhydramnios pregnancy, delivered by Caesarean section with a cephalic presentation,
APGAR score 9. Examination in the delivery room: the passage attempt of a nasogastric tube
showed continuity interruption of the proximal digestive tract, and the perineal inspection
revealed an imperforate anus. Due to suggestive clinical signs, esophageal atresia and cloacal
malformation were suspected, and the patient was transferred to the pediatric surgery clinic.
The patients cardiorespiratory stability has allowed clinical and paraclinical reassessment
(abdominal x-ray, echocardiography, transfontanelar and abdominal ultrasound).
Results: Imaging and biological exploration revealed the following diagnosis: type III Ladd
esophageal atresia, cloaca, right renal and sacral agenesis, ureterohydronephrosis of the left
kidney, absence of right kidney, persistent ductus arteriosus, bicuspid aortic valve. Due to
multiple malformations, the patient can be diagnosed with VACTERL syndrome.
The patients treatment is in multiple stages, requiring immediate postnatal surgical
management: tracheoesophageal fistula repair, restoring esophageal continuity, decompression
of digestive tract by colostomy until the definitive intervention.
Conclusions: The case is particular due to complexity of the associated malformations, with an
uncertain immediate and long-term vital prognosis, with an impact not only on survival, but also
on quality of life, whose management requires multidisciplinary resources.
Keywords: Esophageal atresia, Cloaca, VACTERL Syndrome

Rectosigmoid Cancer
Author: Furdui Ramona
Co-author: Ciubotaru Diana Teodora, Curca Roxana-Ioana
Scientific coordinators: Rector Professor Scripcariu Viorel, MD, PhD, Teaching Assistant
Anitei Maria-Gabriela, MD, PhD
Introduction: Rectosigmoid cancer represent the most frequent site for gastro-intestinal cancer.
Furthermore, the rectosigmoid portion of the digestive tract is especially particular from the
anatomical and surgical point of view due to its large percentage of tumors found there and its
local recidives.
A 63 year old male patient come to the E.R. with: discontinuous abdominal pain, macroscopic
hematuria, rectal bleeding. The clinical exam discovered a right pararectal mass, with
ulceration, local infection, of approximately 15/20cm, with anterior abdominal wall invasion.
Personal medical history
In July 2010 he was diagnosed with locally advanced rectosigmoid cancer TNM stage 4 ( 4 mm
in thickness, ulcerated, well differentiated , no lymphatic system invasion)- high blood pressure,
gallstones .
Materials and Methods: In july 2010, after being diagnosed, a lateral colostomy was
performed and simultaneously a biopsy was taken. The histopathological examination
concluded: well differentiated adenocarcinoma. The pacient undergone cytostatic treatment
(neoadjuvant chemotherapy) and in December 2010 a Hartmann procedure (2/3 cystectomy,
segmental enterectomy) was performed in association with Xeloda.
In 2012 the patient develops a peritoneal recidive which was neglected. The paraclinical exams
discovers that the tumor invaded the sigmoid colon, the urethra , the prostate, the right seminal
vesicle, the mesorect, a portion of the peritoneum , enclosing on the left common iliac artery .
After the diagnosis was made, a pelvic exenteration was performed with segmental enterecomy
associated with an ileal conduit urinary diversion Bricker procedure- and a colostomy
revision.
Results: The patient recovered well, began oral digestive tolerance, resuming intestinal transit
using the colostomy and urinary continence due to the urinary diversion. A 3 months follow up
showed that the patient had normal biological parameters.
Conclusion: the state of the patient was an indication for a large scale procedure. A pelvic
exenteration was preferred because it was a advanced local recidive and it lacked a metastatic
lesion.
Keywords: Pelvic exenteration, Bricker procedure, High blood pressure

Can science cure infertility? Uterus transplant

Author: Maamer Farah
Co-authors: Lakhdhar ghassen, Fizah muratib
Scientific coordinators: Marcus Jee Poh Hock MD
Introduction: In 2010, an estimation of 48.5 million couples worldwide were
reported infertile. Some clinical trials are working on the reduction of infertility rate
that are commonly caused by congenital factors, STDs and cancer, to name a few.
Uterus transplantation has been a consideration of eradicating these conditions. Due to
the encouraging results, the number of volunteers has been steadily rising.
Objectives: The aim is to present the technique of complete uterus transplantation
performed by surgeons and the benefits and risks of this procedure.
Materials and methods: The clinical trials concern women in their reproductive age,
who possess a uterine malformation, which is due to either the absence of the uterus
(uterine agenesis/previous hysterectomy) or the presence of an uterus that is not able
to deliver a pregnancy (intrauterine adhesions/congenital malformation/myoma). The
studies consisted of women undergoing this procedure in the UK and Sweden. The
search for a suitable donor, a thorough description of the surgical techniques, and
several important criteria (such as a psychological evaluation and normal hormone
secretion) are important factors to be considered when choosing an appropriate
candidate for transplant.
Results: From the 9 women who were operated in the UK, 7 were reported to have
regular menstruation for 2 to 3 months. The remaining two had to undergo
hysterectomy due to complications of rejection. In another case in Sweden, a child
was successfully born in 2014 following the transplant.
Conclusion: The inability to bear children has negatively affected many women and
men across the globe for many centuries. It has been proven that infertility can lead to
depression, as well as discrimination, ostracism, physical abuse and even suicide.
Although this is still an experimentally risky procedure, this technique can surely be
the first step to solve the problem of female infertility.
Keywords: cancer, infertility, science

Transcatheter mitral valve implantation (TMVI)

Author: Jihed Daghsni
Co-authors: Seif-Eddine Souabni
Scientific coordinator: Professor Hassine Jamila, MD , "Ibn El Jazzar" university of Medicine
, Sousse ,Tunisia
Introduction: Mitral valve regurgitation (MR) is one of the most common valvular heart
diseases in an ageing population and in patients with heart failure. The transcatheter aortic valve
implantation (TAVI) has demonstrated the feasibility of treating valvular heart disease with
transcatheter therapy. On the back of this success, various transcatheter concepts are being
evaluated to treat other valvular disease, especially mitral regurgitation (MR).
Materials and Methods: The procedure is performed via the transseptal approach under
echocardiography guidance destined for patients with significant symptomatic degenerative MR
who are at prohibitive risk for mitral valve surgery .One of the drawbacks of this approach is
failure to eliminate MR completely. When compared to the aortic valve, the mitral valve has a
larger and non-circular saddle-shaped annulus, a complex subvalvular apparatus and potential
for left ventricular outflow tract (LVOT) obstruction. These attributes, along with the absence of
calcification in MR and high mitral transvalvular gradients, have made development of a
transcatheter mitral valve (TMV) device challenging
Results: A large number of patients are not considered suitable for surgery due to the presence
of comorbidities. Two-year results showed that percutaneous mitral valve edge-to-edge repair
was less effective in reducing MR than surgery but was associated with superior safety and
similar improvements in clinical outcomes. Therefore this new approach is offering potential
treatment for mitral valve regurgitation with a reduced chest trauma which means less postoperative pain, faster recovery time and a potential for improving quality of life of heart
patients.
Conclusion: The surgical resectional and non-resectional techniques for patients with severely
calcified, hors-shoe like mitral annulus are the gold standard. However, the transcatheter valve
implantation (TMVI) into the native mitral valve may be an option in otherwise unmanageable
situations due to the presence of comorbidities but further clinical experience and technical
development are necessary to shorten operation times and to assess further the potential
postoperative benefits of TMVI
Keywords: mitral valve regurgitation, valve replacement, transseptal approach

Clinical experience of the determination of dendritic cells in

infertile females suffering from endometriosis
Author: O.N. Stepanovichus
Co-authors: T.N. Adamovskaya
Scientific coordinators: Professor Valerie Marrichereda, Doctor of medicine,MD
Introduction : The theses is devoted to the pertinent problem of improvement of the
results of treatment of infertile females with external genital endometriosis by
optimizing diagnosis and combined correction of the additional factors of the
infertility. There were determined the factors of infertility among the females with
external genital endometriosis.
Materials and methods: The evaluation of the functional state of the immunity of
the females of risk group was conducted. There was determined that the females
suffering with external genital endometriosis have increased by 95% amount of the
macrophages in the peritoneal liquid due to the relative decrease of the total number of
the cells in the peritoneal liquid up to 18-20 mln./ml. The decrease of the activity of
the matured dendritic cells (to 5,20,5 D23 per mm2 in the functional layer to
6,00,5 CD 23 per mm2 in the basal layer), and the increase of the activity of
imatured dendritic cells (to 34,21,2 cells per mm2) is characteristic for the patients
with external genital endometriosis.
Results: The complex of intraoperative antiadhesive prevention with the
administration of sodium aminodihydrophtalasindion in the complex post-surgery
treatment allows to decrease the relative risk of pain syndrome occurrence and
relapses (RRR=0,22 with CI 95% (0,18; 0,25)).
Conclusions : The developed diagnostic-treating algorithm for the clinical
management of the patients with external genital endometriosis consider to use the
treating-diagnostic laparoscope with the administration of low-dose monophasic
combined estrogen-gestagen medication containing dienogest and sodium
aminodihydrophtalasindion in the post-surgery period with active expectant
management with controlled ovarian stimulation leads to improving reproductive
results.

Keywords: endometriosis, infertility, diagnosis, treatment, immunity.

A rare case of gigantic meningioma

Author: Carmen Maria Brsan
Co-authors: Farai Nhambasorra, Ionela Larisa Irimia, Radu tefan Miftode
Scientific coordinator: Professor Ion Poeata, MD, phd, Cosmin Apetrei, MD, PhD
Introduction: This represents 13-20% of intracranial tumors, women predominate and peak
incidence which occurs between 45-70 years.
Although the Majority of meningiomas is benign, malignant presentations do appear.
Materials and methods: The patient, aged 60 years with no significant medical history was
hospitalized at the Emergency Hospital "Prof. Dr. Nicholas Oblu "for right hemiparesis,
confuso-aphasic syndrome and intracranial hypertension syndrome, all slowly progressed. MRI
reveals a giant craniocerebral meningioma of the left cavernous sinus with invasion on the
internal third of the sphenoid wing, the cranial Base and Temporo-polar.
Histopathology examination revealed a diagnosis of atypical meningioma and immunehistochemical tests have revealed a high proliferative activity of the tumor and the presence of
10% of the marker Ki 67.
Treatment in this case was surgery, practicing total macroscopic resection of meningiomas
through the subtemporal transsylvian window, microsurgical resection and coagulation of dural
inserts. Postoperative evolution was favorable both clinical and on imaging (CT).
Results: The frequency of this type of tumor is 2 times higher in women and in most cases
meningiomas are discovered accidentally in the context of imaging tests for other pathology.
Classification of meningiomas is based on the WHO classification system.
Benign (Grade I) - (90%) - meningothelial, fibrous, transitional, psammomatous, angioblasts;
Atypical (Grade II) - (7%) - chordoid, clear cell, atypical (includes brain invasion) Anaplastic/
malignant (Grade III) - (2%) - papillary, rhabdoid, anaplastic (most aggressive).
Conclusions: Meningioma was found in giant stage, the tumor was slowly progressive and well
compensated within certain limits. Treatment depends on the tumor size, the speed of growth
and the symptoms caused.
Keywords: meningioma, neurosurgery

Ileal atresia possibilities of surgical management and the impact

for postoperative evolution
Author: Alexandru-Eduard Murrau
Co-authors: Carmen-Maria Brsan, Ionela-Larisa Irimia, Mihail-Ionu Paniru
Scientific coordinators: Assistant Professor Elena Hanganu, MD, PhD; Assistant
Professor Simona Lacramioara Gavrilescu, MD, PhD
Introduction: Jejunoilealatresia is major causes of neonatal intestinal obstruction and
can occur anywhere between 1000-4000 newborns with clinical symptoms of
abdominal distension, vomiting, delay to pass stools and food intolerance during late
day 1 or 2 of postpartum. They are associated with other congenital anomalies and in
peers with a high level of consanguinity.
Materials and Methods: We proceeded to assemble a few comparison between two
cases of patients in Pediatric Surgery Clinic of "Sf. Maria" Children Hospital and
formulate conclusions based on these reports and thoroughly examinations and
exploratory investigations.
Results: After the interpretation of the paraclinical exploratory results and a devise
differential diagnosis, it was established the one for jejunoileal atresia. The best course
of action of the treatment was a surgical intervention.
We are presenting the essential particularities of the diagnosis and treatment to this
rare pathology, in parallel with specific data, from published and review materials
accredited in medical journals and studies.
The correct formula for the right diagnosis is primarily essential in proceeding with
the appropriate treatment and observing the evolution of other associated pathology
and complications such as: regarding the nursery of the ileostomy, sepsis, dehydration
through high output of the stoma etc.
Conclusion: Jejunoileal atresia and stenosis are a condition with risky potential of
immediate complications that is why is an urgent matter to prematurely discovered
and behavior toward to increasing life expectancy of the newborns suffering from this
affection.
Keywords: Ileal, Atresia, Postoperatorium

Maggot debridement therapy in the treatment of leg and foot ulcers

- A literature review
Author: Shaheer Aslam Joiya
Co-authors: Sumayyah Khan
Scientific coordinator: Muhammad Aslam, MD
Introduction: Maggot debridement therapy (MDT) has been used for decades for the
debridement of wounds. Existing evidence suggests that MDT is an effective
treatment option on a variety of wounds. The maggots act by secreting digestive
proteolytic enzymes which result in dissolution of necrotic tissue, followed by wound
disinfection and stimulation of wound healing.
Objective: Evaluating the efficacy of MDT compared with standard treatment for leg
and foot ulcers through the critical analysis of open literature.
Materials and Methods: A review was undertaken of existing academic literature for
MDT as a treatment method for leg and foot ulcers. From the 226 studies found, only
6 studies consisting a total of 450 subjects met the inclusion criteria.
Results: Of the six studies reviewed, five demonstrated that MDT is more efficacious
compared to conventional management. Wayman et al found a significant difference
in wound debridement as one application of larval dressing resulted in debridement in
100% of the patients, whereas only 66.7% of the patients in the hydrogel dressing
group showed debridement and 33.3% still needed dressing at one month. Another
study demonstrated that for the patients in the MDT group, healing time was
significantly shorter in comparison with the control group (18.5 4.8 compared to
22.4 4.4 weeks). However, Paul et al found conventional treatment to be more
effective than MDT as only 48% of wounds healed in the MDT group compared to
60% in the control group, which has a strong grounding to dispute the efficacy of
MDT.
Conclusion: MDT is a more efficacious treatment for leg and foot ulcers compared to
conventional therapy. However, it does not have a high confidence level to be
recommended as a routine treatment as the existing evidence is limited. Further
studies with larger sample sizes are required to assess the efficacy of MDT.
Keywords: 'maggot therapy', 'biodebridement', 'leg and foot ulcers'

Metastatic Renal Cell Carcinoma presenting as papilledema and central

Scotoma
Author: Shaheer Aslam Joiya
Scientific coordinator: Professor Lorraine Cassid, MD, PhD
Introduction: Renal cell carcinoma (RCC) is the most prevalent form of kidney cancer in
adults as it constitutes 3% of adult malignancies and approximately 90 95% of neoplasms
emerging from the kidney. Brain metastases (BM) are usually found in patients suffering from
RCC with an observed incidence of 2 17%. Brain metastases in RCC patients are associated
with peritumoral edema, which is susceptible to spontaneous intracranial haemorrhage which
could lead to a bilateral papilledema. It could also give rise to bilateral central scotoma. Several
symptoms including headaches and seizures are frequently observed in approximately 95% of
the patients with RCC brain metastases.
Objective: To investigate the correlation between metastatic RCC and bilateral papilledema and
bilateral central scotoma.
Material and methods: We present a case of a 60-year-old male with advanced RCC who
developed bilateral papilledema and bilateral central scotoma. Background history included
corneal ulcer and moderate systemic hypertension. He had associated history of burning
sensation when urinating, hematuria and significant weight loss. His visual acuity was 6/60 in
the right eye and 6/38 in the left eye with loss of color vision. Enlarged scotomas and an
enlarged blind spot were revealed through visual field analysis.
Results: His vision improved after starting steroids (right eye 6/18 and left eye 6/24).
Radiotherapy and targeted therapy were also used as a management method and his vision
improved significantly after radiotherapy.
Conclusion: Renal cell carcinoma brain metastases are associated with spontaneous
intratumoral hemorrhage and extensive peritumoral edema which can lead to raised intra cranial
pressure. Treatment modalities for BM include conventional surgical resection, whole brain
radiation therapy and stereotactic radiosurgery. To our knowledge, this is the first report of
isolated bilateral papilledema presentation associated with advanced RCC metastasis
Keywords: RCC, metastasis, tumor

Angioplasty and Stent Placement for Carotid Artery Thrombosis

Author: Ayari Mohamed Wejdi
Scientific coordinator:
Introduction: The endovascular techniques on this floor have been proposed:1) because of the less invasive
nature , their lower cost potential ;2) for carotid artery stenosis tell surgical risk ( contralateral occlusion,
restenosis, lesions or difficult to access) .These different proposals are disputed , finally clinical experiments
were hitherto unfavorable to endovascular maneuvers.
Materials and methods: 53 patient with signs of cerebral ischemia ipsilateral carotid stenosis in an internal
were retained
The endovascular procedure was performed with the following protocol:
1) First femoral ;2) heparin (ACT > 300);3) pre-dilation of the stricture ;4) Wall stent 10 x 20 mm ;5)
expansion of the stent ;6) absence of cerebral protection ;7) platelet antagregant end of the procedure ;8)
introducer into femoral vein for transitional Pacemaker .Monitoring procedures included :1)
Doppler to 24 hours , 1 month, 3 months, 6 months, 12 months, 24 months ;2) regular neurological
examinations ;3 ) Nuclear magnetic resonance 6 months, 12 months
Results: Symptoms and risk factors were distributed identically in both groups. The permeability of the
internal carotid artery was always satisfactory Doppler 24 months. Morbidity: The surgery group had fewer
complications, limited to a cervical hematoma with re-exploration, five peripheral nerve disorders .The stent
group focused most of morbidity: an episode of confusion with sensory disturbances lateralized, regressive
with hemodynamic instability, which underlines the importance of these disorders especially in coronary;
hemodynamic disturbances which insist on recent publications were bradycardia 7/53 12/53 patients
hypertension patients. Troubles initially treated with temporary SEA, then drug treatment: complications
due to femoral access were three retroperitoneal hematoma after combined use Heparin/reopro a popliteal
thrombosis with acute ischemia leading to leg amputation. Despite the absence of mortality and neurological
complications, morbidity of the endovascular procedure should not be underestimated. The impact of these
two groups in the duration of hospitalization, the recovery of activity and the economic cost is not
significantly different, and these elements are not the dominant elements of the study. Attractions in the
study highlights of this single-center randomized trial are: the right methodology; a neurological control;
regular monitoring of the permeability; control of the brain parenchyma.
Conclusions: The teaching of this essay is to show that a group of carotid stenosis well selected in a given
area with the same operators, surgery and carotid stent can be effective and low risk. Translating these
results to common practice seems dangerous
Keywords: carotid artery thrombosis, stent carotid, angioplasty

Breast cancer: a new surgical technique "robot - assisted"

Author: Chaima Inoubli
Co-authors: Ben Brahim Yosra, Shaheer Aslam
Scientific coordinator: Meddeb Nasser, MD
Introduction: A new surgical technique "robot - assisted" allows a breast removal and
reconstruction simultaneously without scar on the chest.
Material and methods: Gustave Roussy announces the completion of a robot - assisted surgery
for total removal of the breast with simultaneous breast reconstruction by prosthesis. This is
made possible using the Da Vinci surgical robot Xi that will place the incisions in the armpit,
leaving no visible scar on the breast. Gustave Roussy is the only center in the world to have
official permission to use the Da Vinci robot in this indication Xi, currently part of biomedical
research.
Results: A smaller scar. It has two main advantages. First, the removal of the breast and breast
reconstruction are made during the same intervention, while reconstruction usually requires
even more additional passages on the operating table. Then, the usual scar from 15 to 20 cm
under the breast is replaced by a scar under the arm of about 5 cm. An aesthetic advantage
which is not insignificant, while two in five women with breast cancer undergo ablation.
A camera used by the robot. Benjamin Serfati hope that the location of the scar, which is then
no longer in contact with the breast prosthesis, will reduce the number of postoperative
complications, although "we cannot move forward " to this subject. This type of operation
involves two types of women: those who want to make a preventive removal because they carry
a genetic mutation that predisposes to breast cancer and patients already suffering from cancer,
at a stage n ' is too advanced and where the tumor is not too close to the nipple. This is
mastectomies in which we can keep the nipple and areola.
Conclusion: Besides the better cosmetic result and its positive impact on the psychological
level, the robot - assisted surgery may also help to reduce the risk of complications (risk of
infection, skin necrosis, reopening the wound, removal of the prosthesis).
Keywords: breast cancer, skin, scar