Introducere: Potrivit Organizaţiei Mondiale a Sănătăţii, cazurile de diabet zaharat au crescut de la 108.000.000 în 1980 la 422.000.000 în 2014, cu o creştere mai rapidă în ţările cu venituri mici şi mijlocii. Diabetul cauzează anual aproximativ 1.600.000 decese şi este o cauza majoră de infarct miocardic, accident vascular cerebral, insuficienţă renală, orbire şi amputarea membrelor inferioare. Acest articol oferă informaţii cu privire la tratamentul unei complicaţii frecvente legate de diabet zaharat, şi anume amputaţia piciorului. Defectele mari şi profunde ale piciorului diabetic reprezintă o provocare reconstructivă. Scopul studiului este de a analiza eficienţa metodelor de vindecare folosind grefă de piele coroborat cu terapia cu presiune negativă pentru plăgile rezultate după o intervenţie chirurgicală a piciorului diabetic. În al doilea rând, studiul intenţionează să sublinieze rolul unei secvenţe a abordării multidisciplinare, în acest caz chirurg generalistchirurg plastician, în asigurarea funcţionalităţii membrelor pelvine. Material şi Metodă: Au fost analizati retrospectiv 63 de pacienţi cu diabet zaharat, pacienţi care au fost internaţi în spitalele clinice Dr. I. Cantacuzino şi Bagdasar-Arseni, cu diferite tipuri de plagi rezultate după intervenţiile chirurgicale ale piciorului diabetic, între ianuarie 2016 şi decembrie 2017. Rezultate: Reconstrucţiile au avut succes pentru 56 de pacienţi, iar în timpul perioadei de urmărire nu au existat complicaţii. Din cei 7 pacienţi cu complicaţii (necroză de grefă cutanată, infecţie a grefei),

Glomus tumors are frequently associated with pain, tenderness and cold sensitivity. We report the diagnosis and successful surgical management of a case of a classic glomus tumor in a young woman. The clinical diagnosis was made on the basis of medical history and MRI findings. The lesion was excised via a dorsolateral subungual approach, leading to the complete resolution of symptoms. Histology confirmed the lesion to be a glomus tumor. Glomus tumors are painful subungual lesions. They produce a throbbing or lancinating local discomfort, cold-sensitivity, and severe pain following minor trauma. The diagnosis is confirmed by histology, but the clinical diagnosis is highly suggestive. Complete excision will usually relieve pain. Recurrence is common following incomplete resection.

A 48-year-old woman with antiphospholipid syndrome (APS) had multiple skin necrosis caused by massive bleeding and hematoma collection at the right lower leg, left thigh, and abdomen. During the first month, we did surgical debridement every 2 to 3 days with meticulous coagulation and applied negative pressure wound therapy (NPWT). Then as the base showed initial granulation, we changed the NPWT every 4 days. NPWT was used with lower pressure and cyclic mode (-40 to -75 mm Hg) to minimize trauma and to reduce the possibility of bleeding from the wounds. After 2 months of NPWT treatment, all the wounds eventually healed with secondary intension despite the patient's condition with diabetes, hemodialysis, anticoagulant use, and corticosteroid therapy. This report supports the idea that if accompanied by conservative debridement with meticulous bleeding control, application of NPWT in low pressures and close monitoring of the patient, NPWT is possible to use even in wounds of patients with risk for bleeding.

This manuscript provides a brief review and analysis of the healthcare system in Romania. This study aims to comprehensively analyse the healthcare system in Romania, evaluating its strengths, weaknesses, and impact on the population’s access to quality healthcare services. Within the framework of the Romanian healthcare system, a multitude of pressing challenges endure. These encompass insufficient funding, shortages of medical personnel, and ineffectiveness in the provisioning of services. These impediments substantially hinder the accessibility of healthcare services, particularly in outlying and pastoral regions, thereby rendering the system susceptible and underserving certain demographics. Our investigation presents three hypotheses. The opening conjecture proposes that inadequate funding has a negative impact on the availability and standard of healthcare facilities in Romania. In addition, another hypothesis assumes that insufficient medical staff plays a considerable role in inequalities in access to and delivery of healthcare. Moreover, the existence of inadequacies in service provision serves as a significant barrier, obstructing the timely and efficient delivery of healthcare to those who need it. Our research encompasses a comprehensive analysis of key aspects of the Romanian healthcare system, ranging from healthcare infrastructure and financing mechanisms to service delivery and healthcare outcomes. Through a blend of qualitative and quantitative data sources, including government reports, academic studies, and statistical data, we have endeavoured to provide an in-depth evaluation. The analysis encompasses various aspects, including healthcare infrastructure, financing mechanisms, service delivery, and healthcare outcomes. Romania has a mixed healthcare system with both public and private providers. The primary level of care is delivered by family doctors, while hospitals and specialised medical centres provide secondary and tertiary care services. This research underlines the criticality of significant alterations being implemented in the healthcare system of Romania to address the issues arising from insufficient funding, a shortage of medical personnel, and shortcomings in service delivery. It is vital to tackle the obstacles presented by insufficient funding, the dearth of healthcare staff, and inadequacies in service delivery to attain impartial and reachable healthcare. By implementing these essential transformations, Romania can pave the way towards a healthcare system that efficaciously caters to the diverse requirements of its populace and guarantees the provision of prompt and superior healthcare services.

Rationale: In the last decade, the incidence of skin cancers has been increasing. Early diagnosis, treatment and prevention are crucial in helping to diminish the incidence, mortality and morbidity associated with skin cancers.Objective: This article presents arguments for and against local anesthesia in the treatment of skin cancers, including the clinical cases, a summary of treatment, and prognosis.Methods and results: Under local anesthesia, local and loco-regional flaps offer an optimal shape and volume for face reconstruction, minimizing the operative time and therefore the hospitalization. Facial skin cancer surgery under local anesthesia also contributes significantly to decreasing health care costs compared to general anesthesia.Discussions: Although in our practice, excision of skin tumors in the facial area under local anesthesia is a frequent and harmless surgical method, it can cause increased stress in some patients. However, the benefits are significantly greater than the disadvantages.

Background: Caesarean section rates have continued to trend upward in most countries, including Romania, creating a number of economic challenges. In the public health system, there is no regulation for performing Caesarean sections on demand; it is often done unlawfully, and in private hospitals, it is a real business. Thus, this study aims to investigate the budgetary impact at a hospital level and the profit per procedure by introducing on-demand caesarean sections for a fee. Methods: This study was conducted in one of the largest maternity units in Western Romania—the “Bega” Maternity Clinic of the Timisoara County Emergency Hospital. For the analysis, the difference between a proposed occupancy rate (between 50 and 85%, increasing every 5 percent) and the actual occupancy rate was calculated. Considering that this difference can be used to admit patients to receive Caesarean sections on demand for a fee, the profit that could be obtained during the study period was calculated. Results: It is reported that between 238 (proposed occupancy rate of 50%) and 4683 patients (a proposed occupancy rate of 85%) could have benefited from on-demand caesarean section surgery in 2017–2019. Between RON 419,999 and RON 8,551,636 could be obtained in the 3 years of study by implementing caesarean section against payment. Conclusion: The implementation of a system of on-demand payment for caesarean sections in Romania would bring significant profits to the hospital budget.

Introducere: Piciorul diabetic este o entitate patologică complexă caracterizată prin totalitatea modificărilor care apar la nivelul piciorului în timpul evoluţiei bolii diabetice. Acest studiu vizează elaborarea unui algoritm de tratament pentru pacienţii cu leziuni predominant arteriopate ale piciorului diabetic, cu scopul de a reduce numărul de intervenţii debilitante şi de a îmbunătăţi calitatea vieţii. Material şi Metodă: Au fost analizati un număr de 188 de pacienţi internati la Clinica de Chirurgie I a Spitalului Clinic Dr. I. Cantacuzino, în anul 2017, cu leziuni ale piciorului diabetic predominant arteriopat, pe baza mai multor criterii de includere / excludere. Rezultate: În funcţie de tipul de leziune a piciorului, majoritatea pacienţilor au avut diagnosticul de gangrenă umedă a degetului / degetelor (51,06%), urmată de gangrena ischemică a degetului / degetelor (40,4%), intervenţiile chirurgicale efectuate asupra acestor tipuri de leziuni 73,9% dintre cazuri au constat din amputaţii minore (amputaţia transmetatarsiană a piciorului/a degetelor). Concluzii: Algoritmul de tratament dezvoltat ca rezultat al acestui studiu reprezintă o soluţie fezabilă de tratament pentru patologia

Hand soft tissue defects after trauma injuries or tumor excision are challenging for the plastic surgeon, regardless of the patient’s age, gender, or ethnicity. Current surgical protocols suggest protecting the main arteries by using local or free perforator flaps. This article describes the use of local perforator flaps to resurface soft tissue defects with exposed tendons, nerves, arteries and/or bones to obtain the best mobility of the flexion creases without sacrificing the main artery. We present the use of the dorsal metacarpal artery perforator (Quaba) flap in two cases, showing different types of pathology that could benefit from this method. The first case is a 43-year-old male patient, known with psoriasis, who suffered a home accident with a chainsaw. The second case is a 35-year-old woman with a round, mobile skin tumor located on the volar surface of the metacarpophalangeal joint. The patients were discharged from the hospital the next day postoperative. Both patients reported a slight bulkiness of the flap without affecting the functional outcome, preserving full mobility of the fingers. The Quaba flap is a distally based perforator axial flap suitable for soft tissue defects reconstructions, safe and easy to use, with minimal donor site morbidity. Slight bulkiness could affect the aesthetics of the hand.