Anatomical evidence regarding the existence of sustentaculum facies.

The face, seen as a unitary region is subject to the gravitational force. Since it is the main relational and socialization region of each individual, it presents unique ways of suspension. The elevation system of the face is complex, and it includes four different elements: the continuity with the epicranial fascia, the adhesion of superficial structures to the peri- and inter-orbital mimic muscles, ligaments adhesions and fixing ligaments of the superficial layers to the zygomatic process, and also to the facial fat pad. Each of these four elements were evaluated on 12 cephalic extremities, dissected in detail, layer by layer, and the images were captured with an informatics system connected to an operating microscope. The purchased mesoscopic images revealed the presence of a superficial musculo-aponeurotic system (SMAS) through which the anti-gravity suspension of the superficial facial structures become possible. This system acts against face aging and all four elevation structures form what the so-called sustentaculum facies. The participation of each of the four anatomic components and their approach in the facial rejuvenation surgeries are here in discussion.

Microanatomic aspects of arterial blood supply in rectal carcinomas--predictive models.

Rectum is divided into three distinctive regions (pelvic peritoneal, pelvic subperitoneal and perineal) regarding the regions where it is crossing through. Those three parts are individually not only due to their relation but due to their blood supply, also. The differences occur among them when one of them is involved into a neoplastic process. Both types of pelvic rectal tumors behave quite in the same way but those involving perineal rectum are much different. This is because they purchase a smaller number of anastomosis; when a tumor monopolizes a wide vessel the possibility to grow and become a metastasis is much more likely. These two processes (growth and metastasis) are directly related to the size of its supplying artery. On the other hand, a pelvic rectal tumor is more likely to metastasis by blood flow then a perineal rectal one. The last one will rather send clone cells by lymphatic drainage or will disseminate into the soft tissues around it. In this study, we want to propose an anatomical mathematical model for each of the rectal tumors, depending on their stages also. We used specimens from 24 patients and analyzed them using arteriography; we connected the results of mathematical counting of micro vessels density in a specific area with already known medical aspects regarding their diagnosis, treatment and evolution. The goal of the study concerns the prognosis of the patients (with or without surgical treatment) and the example is useful in rectal tumors staging.

[Quantitative microscopic modifications of the diaphragm and the paraesophageal structures in hiatal hernia. Clinical aspects]. / Modificarile microscopice cantitative ale diafragmei si structurilor anatomice periesofagiene în herniile hiatale. Corelatii clinice.

In the last decade has seen an increase in hiatal hernia diagnosis. These issues led us to study and deepen the anatomic substrate of the changes that occur in the diaphragm muscle and periesophageal structures for optimum management of the disorder. The studied material was represented by fragments of the thoraco-abdominal diaphragm and tissues around the esophagus, biopsy sampling by classic open approach or celioscopic in patients with hiatal hernia, compared with a control group. Histological processing was carried out by current or special methods. After qualitative examining of the selected structures, quantification was performed using an interactive digital program. In the adult diaphragm with hiatal hernia was found in percentage volume reduction pillar of the diaphragm muscle fibers, increased the percentage of vascular lumina in the muscle portion of the crura, while the percentage volume of interstitial spaces increase. The changes of the percentage volume of connective tissue are significant, both crura suffering a fibrous transformation of muscle portions. Microanatomic changes are their quantitative objectivity suggest loss of elasticity and reduced functional capacity of diaphragm muscle in hiatal hernias.

The modifications suffered by the peri-esophageal anatomical structures in the hiatal hernia disease: a qualitative and quantitative microanatomic study.

This paper presents the results of a surgical and histopathological study regarding the microanatomical modifications of the thoraco-abdominal diaphragm and of the peri-esophageal structures in the hiatal hernias, establishing a cause-effect relationship between these structural modifications and the hiatal hernia. The study was represented by two groups of patients: a control group and a group with hiatal hernia. The study method consisted in intraoperatory biopsy of fragments from the diaphragm as well as from the tissue around the esophagus, which were studied from the histopathological viewpoint, using histological methods and quantitative microanatomy. In the end, the results obtained from the two groups were compared. The microscopic examination revealed the presence of an inflammatory infiltrate located between muscle fibers, especially near blood vessels, at the level of the diaphragm crura and the phreno-esophageal membrane. Also, they found red blood cell at this level, most likely due to pressure from the hernia at this level. From the quantitative micro-anatomical viewpoint, there has been noticed an increase in the percent of the vascular lumen (accentuated vasodilatation) as well as the interstices occupied with the edema and hemorrhage, to the detriment of the muscle fibers, the most significant modifications being met at the level of the crura.

[Quantitative histopathological criteria in predicting the giant bone cell tumors's grading]. / Criterii histopatologice cantitative de apreciere a încadrarii tumorilor osoase cu celule gigante.

The giant bone cell tumour is a benign osteolitical tumour of spongious tissue. The evolving characters claimed the identification of the high-risk tumours for improving the prognostics. There were used samples of primitive tumours from 69 patients, paraffin included and coloured H&E and then examined with interactive digital video software. The quantitative standard measurements of giant cells (aria, perimeter and diameter), stereology (percentual volumes of cells, blood vessels and stroma) and proliferative activity assessment were made on the representative sections. The dimensions of the giant cells are higher in the Grade I and are lower in Grade II and III, with a dimensional variability. Bone giant cell tumours with mitotic rate less 1/mm2 were exclusively nonaggressive. Quantitative studies reveal the morphopathological changing specific for the grading and evolving forms of giant bone cell tumours. The stereology and mitotic activity index are essential predictive indicators and may be used in early detection of agressiveness and malignancy.

The patients with cariogenic high-risk after the cervico-facial radiotherapy and their management.

Studying through clinical and laboratory means the bucco-dental status of the 28 patients who followed radiotherapeutical cures in the cervico-facial territory, the authors establish the apparition, at different periods of time, of the rampant caries. The rampant caries have been found in 46.42 percent of the cases, especially in patients exposed to prolonged or repeated cures of cervico-facial radiotherapy (88.88 percent) and concern the cervical zones, incisal edges and cusps, zones that are usually resistant at caries. The appearance and the severity of these types of caries are correlated with: a) the degree of reduction of the repose and stimulated salivary flow; b) the maintaining time of the low salivary flow that is dependent on the received X-ray dose and the number of cures; c) the association with sweet-drinks intake; d) the manner of effectuation of the bucco-dental hygiene; e) the setting-up or not of the some prevention measures. There are presented some preventive measures that must be set-up in this category of patients and treatment-protocols, that can be applied in the clinical situations of appearance of rampant caries after the irradiant treatment of the head and neck. The authors recommend the compulsory use of the prophylactic treatment and suggest a suitable plan of treatment that includes the reduction of microbial flora, the change of the alimentary diet, and salivary stimulates and substitutes. These measures can avoid the apparition of rampant caries, which will require ample restoration. The conclusions emphasize the fact that exists real possibilities of protection and treatment for these types of caries, depending on the clinical status of patient and the disease prognosis, when exists a tight collaboration between the radiotherapist, patients, and dentist.

Clinical and therapeutical aspects of rampant caries in cervico-facial irradiated patients.

The irradiant cervico-facial therapy produces numerous complications in maxillo-facial territory, among which the most frequent are: xerostomia, osteonecrosis, mucosal degeneration and severe rampant caries. This is the reason why a written report must exist between the dentist and the radiologist, with all data of the radiological treatment, which implies the patient follow-up from a stomatologic point of view before, during and after the application of the irradiate treatment. We studied a group of patients that followed an X-ray treatment, determining the salivary flow, the physical and chemical feature of the saliva and bacterial flora before, during the X-ray treatment with different doses and at the end of the treatment and at certain periods of time. The rampant caries were found in 46% of cases and interested the cervical zones, the incisal edges and the cusps, zones that are usually resisting at caries. The irradiation produced an important decrease of the repose and activated salivary flow (under 0.1 mL/min), of the buffering capacity of saliva. Also, the saliva became more viscous and the total quantity of proteins increased. The microbial flora is modified with the increasing level of Streptococcus mutans and Lactobacillus. In 23% of patients the secretion returned to normal at 3 weeks from the irradiation, at the other it was irreversible, as a result of a radiation-induced damage to the salivary glands (the atrophy through the increasing of radiant dose). The treatment was different, depending on the clinical condition of the patient and the disease prognosis. It is recommended the compulsory use of the prophylactic treatment. The authors suggest their treatment planning that includes the reduction of the microbial flora, the change of alimentary diet and salivary stimulates or substitutes. These prevent the appearing of rampant caries that will require ample restorations.