Moebius syndrome, also called congenital facial paralysis is a rare neurological disease, whose etiology is not fully elucidated. It affects especially facial and oculomotor cranial nerves and its clinical feature is peripheral facial paralysis. The objective of the study is to highlight the anatomical and functional changes in the Moebius syndrome and establish certain criteria that should be the basis for reparative surgery in this disease. For this purpose, we used a group of six patients diagnosed with this pathology, in whom we pursued functional anatomical and histological changes of the superficial layers of the face that we have grouped in terms of their clinical impact. All the data obtained were centralized in order to assess anatomical functional changes occurring after evolution in time of lesions caused by Moebius syndrome. The results of the study led us to conclude that the face is made up of three main regions - median, medial and lateral -, which behave differently both in atresia of the facial nerve and in healthy individuals. This has an important echo on the way we emphasized the functional anatomy of superficial layers of the face and in surgery.

Parotid superficial and profound fascias are considered to originate from a bifurcation of the profound fascia. Its relations with the facial nerve, the continuity with platysma, temporal and zygomatic fascias suggest it is related to a superficial fascial complex rather with a profound one. The aim of this study is to add clues which sustain the theory of parotid fascia origin from superficial fascia of the face. The study was conducted on 12 cephalic extremities, which were meticulously dissected in the "Ion Iancu" Anatomy Institute of "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania, and on a group of 10 patients admitted to the Clinic of Maxillofacial Surgery, "St. Spiridon" Emergency Clinical Hospital, Iasi, patients which were clinically and imagistically diagnosed [computed tomography (CT), magnetic resonance imaging (MRI)] with parotid tumors and underwent surgical interventions for total or partial parotidectomy. On each stage of dissection mesoscopic images were acquired, examined and further processed to remark the regional stratigraphic differences. Surgical interventions have allowed us segmental anatomical studies, providing in vivo visualization of the fascial and muscular structures, evaluating the possibilities of dissociating the plans and appreciating their vasculature. The collected specimens were processed by paraffin technique and stained with H special techniques for muscular and connective tissue. The results are clearly showing the belonging of parotid fascia to the superficial fascia of face.

The anatomical variations of the fronto-orbital artery are uncommon and rarely described in literature. During the dissection of a 64-year-old female formalized brain, we discovered a particular congenital abnormality regarding the arterial supply of the right fronto-orbital gyrus. We identified three arterial sources: a low caliber ipsilateral fronto-orbital artery that arises from the A2 segment of the right anterior cerebral artery and ends in the posterior part of the fronto-orbital gyrus, a large aberrant contralateral fronto-orbital artery that arises from the A2 segment of the left anterior cerebral artery, supplying most of the right fronto-orbital gyrus and a small accessory branch of the left anterior cerebral artery passing towards the contralateral fronto-orbital gyrus. These abnormalities are associated with a partially duplicated anterior communicating artery. This case shows a unique pattern of congenital brain vascular abnormalities that may have clinical and surgical implications.

Morphological alterations of peritoneum in chronically dialyzed patients involve fibrosis and angiogenesis as pathogenic mechanisms. The aim of this retrospective study was to evaluate morphological changes of peritoneum in chronic peritoneal dialysis (PD) at 4, 8, 12, and 14 years. Peritoneal changes were investigated in 110 patients with end stage renal failure, which were included in a PD program. Intraoperative biopsies were grouped in four study Groups (A: 1-48 months, B: 49-96 months, C: 97-144 months, and D: 145-168 months), and were processed histologically and stereologically. Mesothelial denudation was found in percentage volumes of 5.49% - Group A, 16.10% - Group B, 16.68% - Group C and 19.88% - Group D. Reduplication of the basement membrane was observed in patients with over five years of PD. Interstitial stromal fibrosis recorded percentage volumes of 25.49% (Group A), 26.10% (Group B), 35.85% (Group C) and 56.63% for the patient with 14 years of PD. Subendothelial hyalinizing vasculopathy was recorded in percentage volumes of 2.22%, 6.63%, 9.16% up to 9.20%. Vascular permeability reduction was recorded as decreasing percentage volumes from 22.59% to 12.81%, 7.77% and 7.37%. Perivascular inflammation was marked in the serosa of the patients in Group A (4.55%). Calcifications recorded percentage volumes of 1.63% at eight years, 3.74% at 12 years and 4.03% at 14 years of PD. Peritoneal morphological changes appear at 3-4 years of PD and progressively aggravate with long-term PD.

BACKGROUND Malignant melanoma is an aggressive neoplasm, known for its propensity to early metastatic spread, via lymphatic as well as blood vessels. Tumor progression to an aggressive phenotype is associated with angiogenesis. Tumor lymphangiogenesis may represent a marker for assessing the risk of metastasis in the regional lymph nodes. MATERIALS AND METHODS We studied the lymphatic vessel density in peritumoral and intratumoral areas compared to overall microvessel density in 12 cases of malignant melanoma of the face. All cases were primary invasive melanomas, with a Clark level of invasion III and IV. Lymphatic vessels were marked with D2-40 murine monoclonal antibody and their density evaluated through hot-spot method by examination on optic microscopy (200×). Overall microvessel density was assessed using the same method, vascular endothelial cells being visualized using CD31 monoclonal antibody. Statistical analysis was made using SPSS 17.0 software package (Pearson correlation test and Student's t-test). RESULTS The disposition and aspect of the lymphatic vessels were different in peritumoral and intratumoral areas. Thus, in peritumoral areas lymphatics were generally regular, large, dilated vessels whereas intratumoral lymphatic vessels were smaller, with an irregular lumen. Lymphatic vessel density was generally higher in peritumoral areas. Intratumoral lymphatic vessel density was lower, but significantly correlated to overall microvessel density in these areas. Overall microvessels density was increased in thick cutaneous melanoma. Vessels in the peritumoral areas were larger and more numerous compared to those found in normal tissue. In cases with a dense peritumoral inflammatory infiltrate, we found the highest vascular density. Intratumoral angiogenesis was moderate in most cases, with irregular, smaller or collapsed vessels. CONCLUSIONS Evaluation of the lymphatic vessel density may prove to be useful for the prognostic assessment in malignant melanoma, as it may predict the patients with a risk of developing lymph node metastasis.

Background: The abnormal presence of the pancreatic tissue in other digestive organs is rare but sometimes is the cause of some surgical diseases.Material and Method: This retrospective study is focussed on heterotopic pancreas cases diagnosed in 2nd Surgical Clinic of "Sf. Spiridon" Emergency Hospital from Iasi between jan. 1986 and dec. 2008.Results: 22 patients (15 males/68,2% and 7 females/31,8%) aged between 23 and 76 years were grouped in A group - clinical symptomatic cases (3 patients/13,6%), group B- coincidental cases (17 patients/77,3%) and group C - incidental cases (2 patients/9%). Group A patients presented with obstructing prepyloric polypoid tumors and recquired antrectomy and gastroduodenal anastomosis. 13 patients of group B (76,4%) recquired surgery for pyloroduodenal stenosis and in 4 cases of this group with severe upper-GI bleeding, a subtotal gastric resection (3 patients) or antrectomy (1 case) was performed. In group C patients jejunal HP was histopathologically diagnosed during extensive intestinal resection for colonic malignancies (ascendant colonic and transverse colonic cancers) with jejunal invasion. HP cases were categorized as type I in 40,9% cases (ducts, acini and pancreatic islets), type II in 45,4% cases (ducts and acini) and type III (exclusively with ducts) in 13,6% cases. In 76% patients HP was localized in mucosal and submucosal layers, in 16% intramucosal and in 8% in subserous layer.Conclusion: HP is most often an unexpected symptomless coincidental diagnosis during gastrointestinal surgical diseases.

Établir les corrélations entre le péritoine septique et les altérations morphologiques chez les malades soumis à la dialyse péritonéale chronique. D’un groupe de 328 malades avec dialyse péritonéale chronique (193 hommes et 168 femmes âgés de 19 à 81 années) on a choisi un échantillon de 62 patients (29 hommes et 33 femmes) qui présentaient des changements péritonéaux et splanchniques frappants sur les biopsies prélevées à l’occasion de la suppression des cathéters mis en place pour des péritonites septiques (entre 1995 et 2004 dans le Centre de Dialyse et Transplantation Rénale de l’Hôpital « Dr. C. I. Parhon » de Iassy). 16 femmes et 19 hommes « péritonéodialysés » ont développé 85 épisodes de péritonites aiguës bactériennes, 2 femmes/0,60 % une péritonite fécale et aussi 7 malades/2,13 % (3 hommes/0,91 %, 4 femmes/1,21 %) une péritonite fungique. La pathologie d’urgence chirurgicale associée aux péritonites aiguës qui a obligé à une laparotomie et à la suppression des cathéters a été l’occlusion : fonctionnelle 13 cas/3,96 % (8 cas/2,43 % paraseptiques - 4 cas/1,21 % par cellulites rétropéritonéales, 4 cas/1,21 % par sepsis pariétoabdominal et 5 cas/1,52 % par pancréatites et appendicites aiguës) ; aussi 3 malades/0,91 % ont eu une occlusion de cause herniaire et 2/0,60 % par éventrations cicatricielles étranglées. Les principales altérations morphologiques au niveau de la séreuse péritonéale étaient : la disparition des microvillosités, l’épaississement du réticulum endoplasmique et de la membrane basale des vaisseaux interstitiels du grand épiploon, la fibrose péritonéale avec des dépôts de collagène et infiltration des macrophages activés. La croissance de l’épaisseur de la séreuse est liée à l’incidence et à la sévérité des épisodes de péritonite associés aux changements dus aux sepsis splanchniques. Le résultat de ces changements morphologiques est l’altération fonctionnelle irréversible de la séreuse péritonéale pour la dialyse péritonéale. Les modifications structurelles du péritoine septique (chez les malades avec DP et une péritonite aiguë bactérienne, fungique ou fécale) résident dans la perte de sa fonction de barrière contre la diffusion du glucose dans l’interstitium et l’altération de la dialyse péritonéale. Elles s’installent surtout chez les patients avec une occlusion fonctionnelle ou par obstruction intrinsèque, brides inflammatoires ou volvulus.

AIMS:To describe CAPD technique survival and causes for catheter removal. The study included 320 end stage renal disease (ESRD) patients, initiated on CAPD between 1995-2003. Definitive catheter removal was required in 44 cases (15.1%), 11 of these (3.79%) receiving renal transplant. Causes for catheter removal were: mechanical obstruction by fibrin (8 cases/2.75%), obstruction by tub bower (1 case/0.34%), by omental muff (6 cases/2%); abdominal wall sepsis (30 cases/ 10.3%); non-responsive bacterial peritonitis (13 cases/4.05%), fungal peritonitis (7 cases/ 2.4%), fecal peritonitis (2 cases/0.68%); transfer to hemodialysis program (31 cases/10.6%); renal transplant (11 cases/3.79%); emergency surgical pathology for: necrotic-hemorrhagic pancreatitis (two cases), intestinal occlusions (six cases), locked hernias (three cases) and locked eventrations(three cases), appendicular peritonitis (two cases). Mortality associated with these procedures and underlying pathology was 1.73%.

Continuous ambulatory peritoneal dialysis catheter could be placed also by open laparotomy as well as by laparoscopic techniques. We did a retrospective study on cases to compare the results of laparoscopies. There were included 42 patients which we divided in two groups of 21. Group A underwent 21 cases in which catheters was inserted by open laparotomy. Continuous ambulatory peritoneal dialysis was started in 24 to 48 hours later. Group B incharged 21 patients underwent laparoscopic placement of the catheter between 2000 and 2001. Continuous peritoneal dialysis was started early (after 6 hours). The mean operative time was 28 minutes in group A and 30 minutes in group B. Fluid leakage was noticed in 4 patients in group A and in 3 patients in group B. Peritoneal reactions occurred in 5 patients in group A and in 2 patients in group B. Tip migration occurred in 5 patients in group A (one of which was mobilized accidentaly early after intervention) in which was necessary 4 open reinterventions, and no patients in group B. In group B one patient underwent a simultaneous liver biopsy for cirosis and another female patient underwent ovariectomy for a giant ovary cyst. Laparoscopic placement of dialysis catheter leads to better function than does open procedure, it allows immediate start of dialysis and permits simultaneous performance of other laparoscopic procedures.

With the aim of the evaluation of cystography as a diagnostic method, this study has retrospectively analysed 22 cases of bladder rupture (19) or perforation (3). When performed, the retrograde cystography has made the accurate diagnosis immediately in all the 15 cases (100%). The adequate filling and the x-rays made after the bladder evacuation are the main conditions, that allow the visualisation of the contrast material extravasation. Out of the remaining 7 cases, the urographic cystography has made the correct diagnosis in 6 of them (86%) and the method should be indicated in cases with concomitant rupture of the membranous urethra.

The subject of this case report is a 65 years old female hospitalized for firm, raised, pseudoinflammatory and pseudoangiomatous painless nodular lesions, confluent in large plaques that were localized on the anterior, posterior and left sides of the neck, the anterior and postero-superior areas of the left thorax. These lesions developed in a 3 months period. Histopathological examination of the skin bioptical specimen revealed morphological aspects of an ovarian serous cystadeno-carcinoma metastasis.

Hepatic artera takes part to the greater omentum vascularization by the right gastroomental artera (most frequently as a branch of the gastroduodenal artera). The investigations on 100 anatomical specimens from adult subjects revealed a mean value of the artera length of 19.30 cm and a diameter of 1.5-3 mm. The lienal artera participates to the greater omentum vascularization by the left gastroomental artera (with a mean length of 10-18 cm and a diameter of 1.5-2.0 +/- 0.3 mm. The arterial arch of the large gastric curvature has a length of 45 +/- 5 cm; the functional anastomotic point is localized at 10-15 cm left size reported to the median line of the large curvature.

Peritoneal dialysis was first introduced in Romania in 1995. We are reporting data on patient and technique outcomes, based on the 5-year experience of one of the first two Romanian continuous ambulatory peritoneal dialysis (CAPD) centres. During this period, Romania had the highest rate of increase in renal replacement therapy (RRT) and CAPD (28 times over baseline) in Europe: CAPD increase in Romania vs Eastern Europe was 6.7 compared to a similarly defined ratio of 5.6 for haemodialysis (HD).Between 1995 and 2000, at the C. I. Parhon Hospital in Iasi, 259 patients were started on HD and 102 on CAPD. The 90 CAPD patients we followed were treated for a total of 1896 months. 86.7%, of the patients were alive on 31 July 2000-67.8%, continuing on CAPD. 15.6% on HD and 3.3%, transplanted. The 61 patients still on PD on that date, represented 11.1% of the actual Romanian CAPD population and 31%,, of our RRT Population (compared to 13.7% nationwide).The gross mortality rate was comparable to the mean calculated for he HD population nationwide. Mean survival of the CAPD patients was 45.4 +/-2.6 months (95% CI=40.4-50.4 months). One-year and 5-year patient survival rates were 97.5% and 52.7% respectively, superior and similar to mean figures nationwide. Mean technique survival was 36.6 +/- 0.6 months (95%,, CI = 31.5-41.6 months). One- and 5-year technique survival rates were 83.1% and 34.3% respectively. Technique failure was mainly due to dialysis inefficiency: 50% of cases. Mean weekly Kt V for the 5-year period was 1.92 +/- 0.21 while mean weekly creatinine clearance was 61.2 +/- 12.4 ml. 1.73 m(2) week.Eighty-four episodes of peritonitis were recorded in 46 patients (0.25 episodes patient:year), mean duration to peritonitis was 23 months (95%, CI = 18.2-27.5). Malnutrition was noted (SGA score) in 25.5% of the cases. Blood pressure (assessed by 24-h ABPM) was adequately controlled in 83.3%, of the patients. Left ventricular hypertrophy was ubiquitous (77.7%), but left ventricular dilatation and systolic dysfunction (fractioning shortening index < 25%) were rare-4.4% and 3.3% respectively (similar in prevalence to the Iasi HD population). No statistically significant changes in echocardiographic parameters were recorded between the first and subsequent years on CAPD treatment.Peritoneal dialysis had a rapid increase in the last 5 years in Romania and particularly in the region of Moldova. Outcomes and complication rates are equal or superior to nationwide HD data and comparable to distinguished centres of CAPD in economically developed countries. We conclude that. provided that optimal medical practice is available. CAPD should be the RRT of choice in Romania. and that it represents the only solution to the country's limited dialysis resources.

Actinic keratosis or senile keratosis is the most frequent premalign epithelial lesion that occurs in the elderly with a history of prolonged and intense exposure to the UV radiation and with an inborn susceptibility. Although the genetics and risk factors are clear nowadays, the histogenesis of this lesion is still under study. The histoenzymologic tests (such as those that demonstrate the ATP-ase and SDH-ase activity) are very useful for early detection of the structural and biochemical changes within the actinic keratosis lesion.