No abstract

Background: Although schwannoma (neurilemmoma) is the most common tumor of the peripheral nerve, its low incidence, slow growth and vague symptoms often lead to misdiagnosis or delayed diagnosis. The aim of the study is to present a series with a large number of schwannomas in the upper limbs, some with very rare occurrence. Methods: We report 17 patients with a mean age of 58.5 years and upper limb schwannomas, located on the median, ulnar and radial nerves, but also on the posterior interosseous nerve and digital collateral nerves. The diagnosis was made by clinical examination and imaging tests, and in no case was a preoperative biopsy performed. Surgical treatment was established based on symptoms or aesthetic concerns. In all cases, a diagnosis of schwannoma was confirmed through histopathological and immunohistochemical examinations. Results: For all patients, a complete tumor enucleation was performed under a surgical microscope. No recurrence was recorded at 2 years after surgery. Patient satisfaction was good, with complete socio-professional integration in all cases. Conclusions: Although more frequently present on the main nerve trunks, schwannoma may be present on the collateral digital nerves in rare cases. A correct technique with complete tumor excision offers excellent postoperative outcomes and avoids recurrences.

Rationale:Nail bed solitary neurofibroma is an extremely rare tumor, with only 9 cases recorded in the literature so far.Patient concern:We present the case of a 42-year-old female patient, with a history of a slowly growing tumor in the nail bed of the left index and no clinical features of type I neurofibromatosis.Diagnosis:Nail bed solitary neurofibroma.Intervention:The tumor was surgically removed and the pathology examination established the diagnosis of neurofibroma.Outcomes:The postoperative outcome was good, with no recurrence 12 months after surgery.Lessons:We present the rarity of this type of tumor localized in the nail bed, taking into consideration the only 9 cases recorded in the literature. Nail bed solitary neurofibroma should be also included in the differential diagnosis of a nail bed tumor.

Background. Our article presents the results of an empirical study having as objective the identification of the preoccupations for the management of ethics, the formal or informal ethics programme existing in the practice of the Romanian hospitals. Methods. Our exploratory qualitative research is based on semi-structured interviews, conducted in 2016 in the hospitals in Romania. A number of 19 respondents from nine hospital units in several towns in the country have participated. Results. Our research reveals that the ethics management system in Romanian hospitals is strongly limited to the applying methods and tools to comply to the legal requirements for the healthcare sector activity and mostly focused to the activity of the Council of ethics (organism founded by law, that functions in the hospitals), but a holistic and integrated approach is still missing. Conclusions. As a general conclusion, we notice the managers" awareness of the importance and need to implement an ethics management system, but this is a field that requires more attention and clearly improvement in the Romanian hospital units in terms of vision and systemic approach, ethical culture and leadership, ethics system, policies and programs. The study could be useful first to all hospital managers in improving the global performance and ethical reputation of their unit, but also to public authorities that adopt policies in healthcare system, to accreditation bodies and academics interested in this research area.