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Faur IF, Clim A, Dobrescu A, Prodan C, Hajjar R, Pasca P, Capitanio M, Tarta C, Isaic A, Noditi G, Nati I, Totolici B, Duta C, Lazar G. VRAM Flap for Pelvic Floor Reconstruction after Pelvic Exenteration and Abdominoperineal Excision. J Pers Med 2023; 13:1711. [PMID: 38138938 PMCID: PMC10744748 DOI: 10.3390/jpm13121711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Due to the still large number of patients diagnosed with pelvic neoplasms (colorectal, gynecological, and urological) in advanced stages right from the initial diagnosis, surgery represents the mainstay of treatment, often implying wide, eventually multi-organ resections in order to achieve negative surgical margins. Perineal wound morbidity, particularly in extralevator abominoperineal excision, leads to complications and local infection rates of up to 40%. Strategies to reduce postoperative wound complications are being pursued to address this issue. The VRAM flap remains the gold standard for autologous reconstruction after pelvic oncological resection; it was initially designed for abdominal wall defects and later expanded for large pelvic tissue defects. The flap's application is based on its physical characteristics, including abundant tissue and a generous skin paddle, which effectively obliterates dead space after exenterations. The generous skin paddle offers good cosmetic and functional outcomes at the recipient site. This article describes the case of a patient histopathologically diagnosed with stage IIIA squamous cell carcinoma of the uterine cervix who received multimodal onco-surgical treatment. The surgical mainstay of this treatment is pelvic exenteration. Pelvic reconstruction after this major surgery was performed using a vertical flap with the rectus abdominis.
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Affiliation(s)
- Ionut Flaviu Faur
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
- X Department of General Surgery, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adelina Clim
- IInd Obstetric and Gynecology Clinic “Dominic Stanca”, 400124 Cluj-Napoca, Romania;
| | - Amadeus Dobrescu
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
- X Department of General Surgery, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Catalin Prodan
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
| | - Rami Hajjar
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
| | - Paul Pasca
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
| | - Marco Capitanio
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
| | - Cristi Tarta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
- X Department of General Surgery, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Isaic
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
- X Department of General Surgery, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - George Noditi
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
- X Department of General Surgery, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ionel Nati
- 2nd Department of Obstetric & Ginecology, ”Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babeș Street Number 8, 400347 Cluj-Napoca, Romania; (I.N.); (G.L.)
- Ist Clinic of Oncological Surgery, Oncological Institute “Prof. Dr. I. Chiricuta”, 400015 Cluj-Napoca, Romania
| | - Bogdan Totolici
- Ist Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania;
- Department of General Surgery, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
| | - Ciprian Duta
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania; (I.F.F.); (C.P.); (R.H.); (P.P.); (M.C.); (C.T.); (A.I.); (G.N.); (C.D.)
- X Department of General Surgery, ”Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Gabriel Lazar
- 2nd Department of Obstetric & Ginecology, ”Iuliu Hatieganu” University of Medicine and Pharmacy, Victor Babeș Street Number 8, 400347 Cluj-Napoca, Romania; (I.N.); (G.L.)
- Ist Clinic of Oncological Surgery, Oncological Institute “Prof. Dr. I. Chiricuta”, 400015 Cluj-Napoca, Romania
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Rada MP, Ciortea R, Măluţan AM, Doumouchtsis SK, Bucuri CE, Clim A, Roman A, Mihu D. The profile of urinary biomarkers in overactive bladder. Neurourol Urodyn 2020; 39:2305-2313. [PMID: 32813897 DOI: 10.1002/nau.24487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 12/20/2022]
Abstract
AIMS In overactive bladder (OAB) research, different biomarkers have been proposed as diagnostic tools and may be used to create individual patient profiles. Assessing the diagnostic performance of biomarkers would better outline their utility. Therefore, our aim was to investigate the diagnostic value of four urinary biomarkers: human brain derived neurotrophic factor (hBDNF), malondialdehyde (MDA), h nerve growth factor (hNGF) and h 8-hydroxydeoxyguanosine in women with OAB. These are neurotrophins/oxidative stress markers that have been linked to lower urinary tract symptoms. METHODS A total of 105 women were included in the study and distributed in two groups: a group with OAB (n = 53) and a control group (n = 50). The levels of the biomarkers were determined using enzyme-linked immunosorbent assay technique and they were compared between the groups. If the Mann-Whitney test demonstrated a statistically significant difference, receiver operating curves (ROC) analysis was undertaken. RESULTS When normalized to urinary creatinine, hBDNF, MDA, and hNGF showed significantly increased values in women with OAB as compared to controls, whereas 8-OHdG showed no significant difference. The diagnostic performance of these biomarkers was analyzed based on the area under the ROC curve (AUC). MDA had the highest AUC (0.75), followed by hNGF (0.69) and hBDNF (0.67). CONCLUSIONS Our findings suggest that MDA, a relatively novel biomarker in OAB research, has a fair performance as a diagnostic tool for OAB. Moreover, urinary neurotrophins (NGF and BDNF) as biomarkers may have a role in the diagnostic pathways of women with OAB symptoms.
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Affiliation(s)
- Maria Patricia Rada
- 2nd Department of Obstetrics-Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Răzvan Ciortea
- 2nd Department of Obstetrics-Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Mihai Măluţan
- 2nd Department of Obstetrics-Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, UK
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece
- American University of the Caribbean School of Medicine, Florida
| | - Carmen Elena Bucuri
- 2nd Department of Obstetrics-Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adelina Clim
- 2nd Department of Obstetrics-Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Roman
- Department of Radiology, "Prof. Dr. Ion Chiricuţă" Oncology Institute Cluj-Napoca, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Mihu
- 2nd Department of Obstetrics-Gynaecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Rada MP, Ciortea R, Malutan AM, Fetica B, Bucuri CE, Clim A, Roman A, Mihu D. Microscopic distribution of nerve fibers and ganglia within the bladder trigone in women – a cadaveric studycadaveric study. Med Pharm Rep 2020. [DOI: 10.15386/mpr-1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and aims. The microscopic description of the nerve fibers responsible for micturition is useful when planning minimally invasive interventions for refractory overactive bladder such as intravesical botulinum toxin injections. The purpose of this study was to investigate the density of nerves and ganglia within the bladder trigone, with a focus on identifying areas with a higher density.
Methods. Urinary bladders were harvested from 3 female cadavers. Following tissue processing, a total of 100 slides stained with hematoxylin and eosin (HE) and immunostained for S100 and CD56 were analyzed. The density of nerve fibers (NFD) and ganglia (GD) in 3 different bladder trigone compartments was analyzed.
Results. The NFD in the central compartment (16.2±3.9) was significantly higher than in both the peripheral (p=0.0005) and the intermediary (p=0.01) compartments. The GD was the highest in the peripheral compartment, but it was not significantly different from the other compartments.
Conclusions. This microscopic study showed a pattern of distribution with a dominance of nerve fibers in the central compartment and a rather homogenous distribution of the ganglia within the female bladder trigone.
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