Thymus Surgery Prospectives and Perspectives in Myasthenia Gravis.

The thymus is a lymphoid organ involved in the differentiation of T cells, and has a central role in the physiopathogenesis of Myasthenia Gravis (MG). This connection is proved by a series of changes in the level of neuromuscular junctions, which leads to a decrease in the amplitude of the action potential in the post-synaptic membrane. Because of this, the presence of anti-cholinergic receptor antibodies (AChR), characteristic of MG, is found, which causes the progressive regression of the effect of acetylcholine at the level of neuromuscular junctions, with the appearance of muscle weakness. The thymectomy is a surgical variant of drug therapy administered to patients with MG. In the case of patients with nonthymomatous MG, thymectomy has become a therapeutic standard, despite the fact that there is no solid scientific evidence to explain its positive effect. Videothoracoscopic surgery or robotic surgery led to a decrease in the length of hospital stay for these patients. This paper aims to synthesize the information presented in the literature in order to create a background for the perspectives of thymectomy.

Assessment of Basal Cell Carcinoma Using Dermoscopy and High Frequency Ultrasound Examination.

Basal cell carcinoma (BCC) is the most common form of cutaneous neoplasia in humans, and dermoscopy may provide valuable information for histopathological classification of BCC, which allows for the choice of non-invasive topical or surgical therapy. Similarly, dermoscopy may allow for the identification of incipient forms of BCC that cannot be detected in clinical examination. The importance of early diagnosis using the dermoscopy of superficial BCC forms is proven by the fact that despite their indolent clinical appearance, they can be included in high-risk BCC forms due to the rate of postoperative recurrence. Nodular pigmentary forms of BCCs present ovoid gray-blue nests or multiple gray-blue dots/globules associated with arborized vessels, sometimes undetectable on clinical examination. The management of BCC depends on this, as pigmentary forms have been shown to have a poor response to photodynamic therapy. High frequency ultrasound examination (HFUS) aids in the diagnosis of BCC with hypoechoic tumour masses, as well as in estimating tumour size (thickness and diameter), presurgical margin delineation, and surgical planning. The examination is also useful for determining the invasion of adjacent structures and for studying local recurrences. The use of dermoscopy in combination with HFUS allows for optimisation of the management of the oncological patient.

Surgical and Anatomical Particularities and Difficulties in Histopathological Sampling for Superior Vena Cava Syndrome.

The superior vena cava syndrome is due to the increased venous pressure in the upper torso, neck and head, caused by the obstruction of the superior vena cava. Both external and internal factors cause obstruction (95% are malign causes), and the most severe manifestation is represented by cerebral edema that can even lead to coma. The diagnostic algorithm for the superior vena cava syndrome is widely known. There are many controversies and discussions about the safety of histopathological sampling. The purpose of this paper is to assess such risks, the complication rate and the diagnostic yield of surgical sampling, by analyzing the 26 interventions performed in our clinic. Although the complication rate was higher than that observed in the absence of the superior vena cava syndrome, surgery remains mandatory for a rapid histopathological diagnosis, therefore demanding a protocol that must include a mandatory extemporaneous exam of the biopsy.