A male from rural area, S.M., aged 77 years, was admitted in our department for discontinuous headache. His medical history was irrelevant. He has been experiencing intermittent right parietal-occipital headaches during the last 3 months. Neurologic exam revealed a slight right limb ataxia. Initial laboratory findings revealed a white blood cell count of 6500/mm3 with 75% polymorphonuclear leukocytes, 15% lymphocytes and 8% monocytes. His serum glucose was 90 mg/dL. Non Gadolinium CT scan shows rounded, inhomogenous spontaneous hyperdense area (40-45 UH) between 5-12 mm diameter, localized frontal, temporal, occipital and cerebellar bilaterally. The question was whether the lesions were metastasis or parasitic infection? Cerebral MRI showed unenhanced,well lesions defined,multiple lesions between3-17 mm, with iso- • Active parenchymal stage: the scolex within acyst hyperintensityT1, T2, and FLAIR, spreadout may appear as a hyperdense dot periventriculary, subcortically, infrontal, temporal, • Calcified stage: when the parasite dies, parietal lobes andsubtentorially, right and left nodularparenchymal calcifications are seen. cerebellum(figure 2). After serological testsfrom blood and CSF the diagnosticof neurocysticercosis was certified(an enzyme-linked immunosorbentassay of the CSF was positivefor immunoglobulin G cysticercosisantibody, with 1.32 optical densityunits (OD) (positive result > 0.50OD); his serum IgG cysticercosis antibodywas positive with 5.12 OD). CT findings are depending on the stageof evolution: • Vesicular stage (viable larva): hypodense, nonenhancinglesions • Colloidal stage (larval degeneration): hypodense/isodense lesions with peripheral enhancementand edema • Nodular-granular stage: nodular-enhancinglesions • Cysticercotic encephalitis: diffuse edema,collapsed ventricles, and multiple enhancingparenchymal Our patient has multiple lesions in differentphases of evolution (active and calcified). DISCUSSIONS Neurocysticercosis is a parasitic brain infection,caused by larval cysts of the tapeworm Taenia soliumby accidental ingestion of eggs. It is the most common parasitic disease of the nervous system and it is themain cause of acquired epilepsy mainly in developingcountries. Once in the human intestine, Taenia eggsevolve to oncospheres 1 Carol Davila Central Emergency Military Hospital, Bucharest 2 Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest 40

Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of fat in the liver (hepatic steatosis) either on imaging or on liver histology only after the exclusion of secondary causes of fat accumulation in the liver (e.g. high alcohol drinking, drugs and other medical ailments). Considering the fact that there are many causes of hepatic steatosis, the term NAFLD is reserved for the liver disease that is predominantly associated with obesity and metabolic syndrome. The presence of inflammation and cell injury defines steatohepatitis (NASH) which has the potential to evolve into cirrhosis and hepatocarcinoma, being, therefore, the stage of NAFLD most amenable to treatment. Among the treatments available, the most important are: weight loss, vitamin E and, last but not least, probiotics.

Several methods have been exercised during the past years, thus offering the surgeon the possibility to choose when planning reconstructive surgery. Among these methods, we recall: the dislocation of a large surface of skin and fasciocutaneous flaps, the transposition of the muscle and its covering with a simple cutaneous flap or a cutaneo-adipose flap, musculocutaneous pediculate flaps, neurovascular flaps. The study was conducted on 292 patients with 3rd and 4th degree decubitus lesions admitted into and operated at the Plastic Surgery and Reconstructive Microsurgery ward during 10 years. Pediculated flaps on septofasciocutaneous perforating arteries or on musculocutaneous perforating arteries are more difficult to harvest (they require a precise knowledge about the localization of the perforating artery) but provide a better post-op result.

We present a report of a unique surgical entity: acute cholecystitis caused by the gallbladder strangulation within a recurrent right upper quadrant incisional hernia. A previously healthy 39 year-old male patient presented to our Emergency Department with abdominal pain, nausea, vomiting, and a tender mass in the right upper quadrant of the abdomen, where an incisional hernia was palpable. He had a history of a gunshot wound to the right upper quadrant and multiple operations to include repairing mesh of the incisional hernia in that area. Abdominal computed tomography demonstrated an acutely inflamed gallbladder within the recurrent hernia. Open cholecystectomy and primary hernia repair were performed. Intraoperatively, the gallbladder appeared being strangled within the hernia. The patient recovered uneventfully and no cholelithiasis was observed on gross examination of the gallbladder. Though there have been a few reports of gallbladder strangulation within primary incisional hernia, ours is the first to describe this phenomenon in a recurrent hernia.