Sodium fluorescein is commonly used in clinical ophthalmology to detect the presence and degree of corneal alterations of various etiologies. Postmortem processes also alters the integrity of the corneal epithelium, and based on these etiopatholoigcal analogies we used sodium fluorescein staining to assess postmortem characteristics of corneal damages (with clinical and medico-legal implications) and also to evaluate the correlation between the intensity and extent of these damages with the postmortem interval.

Pharyngo-laryngo-oesophageal en bloc resection and radical cervical lymphadenectomy were followed by reconstruction via free jejunal transfer or colic pedicle grafting. Between 2000 and 2018 we have performed cervical exenteration in 25 patients with tumours originating in the pharynx, larynx or cervical oesophagus. In the cases of 5 patients in whom we did not obtain the oncological safety margin for oesophageal cancer we performed transhiatal pharyngo-laryngo-oesophagectomy. In these patients, we performed reconstruction of the oesophagus with colonic graft. In 20 cases we performed jejunal autotransplant. We recorded 4 perioperative deaths, due to major arterial vessel haemorrhage (1 case), after jejunal necrosis (2 cases), and mediastinitis after oesophageal striping and colonic graft necrosis (1 case). One patient presented tumour recurrence at the level of the tracheal stump. Survival rate varied between 6 months and 4 years for the group of patients who presented for postoperative follow-ups. Cervical exenteration remains an option for tumour recurrence after radiochemotherapy or for obstructive airway or digestive tract tumours. It can be burdened by complications difficult to treat. The surgical team has to adapt its initial surgical strategy to the reality of the surgical field, both in terms of exeresis and in terms of types of pharyngo-oesophageal reconstruction.

Introduction. In the past, Streptococcus agalactiae was known to be associated with invasive infections in pregnant women and newborns. More recently, given a more appropriate antibiotic prophylaxis and treatment, the incidence among pregnant women and infants diminished. However, an increasing number of cases with infective endocarditis with Streptococcus agalactiae has been reported in the recent years in older patients with underlying comorbidities. Case report. An 80-year-old female patient presented with dyspnea, weight loss, fever, fatigue, chills, dry cough and bilateral lower limb edema. The work-up revealed complicated infective endocarditis with Streptococcus agalactiae on the native aortic valve with severe aortic regurgitation as a result of the valvular destruction and a metastatic spleen abscess. Antibiotic treatment was started with resolution of the fever and chills. The patient however developed congestive heart failure due to the valvular regurgitation. A decision was made to proceed urgently with aortic valve replacement and splenectomy, which were performed at the same time, followed by a good recovery. Results and discussion. An increasing number of cases with IE with GBS in elderly patients has been reported in the recent years, with high rate of complications and mortality. The underlying comorbidities are important risk factors for S. agalactiae IE. Considering our case, a patient in her eighties with significant abdominal surgical history and multiple medical conditions could be a typical host. Recovery after cardiac surgery is one of the most important indications of physical training. This includes patients post-coronary artery bypass grafting, after valve prosthetic replacement, after surgery for congenital diseases and after heart transplantation. Early mobilization is particularly important in avoiding immobility and cardiac deconditioning. Conclusions. Despite the fact that mortality in Group B Streptococcus endocarditis is 40%, a combined medical and surgical strategy individualized to the specific situation of each patient have led to a positive outcome in a number of cases. We present such a combined treatment approach in a case of complicated infective endocarditis with metastatic spleen abscess in an elderly patient. The aortic valve replacement and splenectomy were performed at the same time. Keywords: endocarditis, septic emboli, valve replacement, splenectomy

Distal tibial fractures usually result from high-energy trauma, affecting young, active people, producing long-term disability and numerous complications. Their treatment is difficult, especially in type C fractures, which affect both the articular surface and the metaphysis, are quite frequent comminuted fractures, and are accompanied by soft tissue injuries. In these situations, External Fixation (EF) is used as a temporary bridging method, either for treating concomitant soft tissue injuries (in open fractures) or for achieving and maintaining reduction in order to prevent blisters or compartment syndrome, possibly resulting from severe displacement, bleeding or oedema. It must be however underlined that EF is rarely a definitive method for these fractures, especially when the ankle is splinted, and it must be followed by definitive Internal Fixation (IF) - the so-called “sequential method”, otherwise restoration of a normal ankle anatomy and function is improbable, resulting in ankle stiffness or even osteoarthritis. This paper presents a case in which this principle was only partially applied, thus requiring corrective surgery followed by a long-term recovery period.