Background: Cervical dystonia (CD) is a chronic neurological disorder characterized by involuntary neck muscle contractions, leading to abnormal head postures, pain, and functional impairment. Botulinum toxin type A (BoNT-A) remains the treatment of choice, but its efficacy is highly dependent on injection accuracy. Various techniques, including palpation-guided, ultrasound-guided, and electromyography-guided (EMG), have been developed to optimize delivery, each with distinct advantages and limitations. Methods: A systematic search of PubMed and Scopus was conducted up until 30 December 2024, using defined keywords related to BoNT-A, CD, and injection techniques. Studies were included if they reported clinical outcomes of BoNT-A injection methods in adult CD patients. Data on efficacy, safety, accuracy, and muscle targeting were extracted and synthesized. Results: Seven studies comprising 239 patients were included: two randomized controlled trials, one retrospective study, one cohort study, one systematic review, one literature review, and one cadaveric study. The most common CD subtype was torticollis/torticaput (49.79%). Frequently targeted muscles included the trapezius (56.9%), levator scapulae (51.7%), and splenius capitis (48.3%). Ultrasound guidance consistently demonstrated superior injection accuracy and reduced adverse effects due to real-time anatomical visualization. EMG-guided techniques showed advantages in identifying dystonic muscles, especially when anatomy was unclear. In contrast, palpation-guided injections were less accurate and suitable only for superficial muscles. Dosing varied by product, with mean doses of 117–118 units for onabotulinumtoxinA and incobotulinumtoxinA, and 405 units for abobotulinumtoxinA. Adverse events were generally mild, including local discomfort, dysphagia, and transient muscle weakness. Conclusions: Ultrasound- and EMG-guided injections enhance the precision, safety, and efficacy of BoNT-A therapy for CD compared to anatomy-guided techniques. While ultrasound guidance improves anatomical accuracy, EMG remains valuable for functionally identifying dystonic muscles. Integration of both may offer optimal outcomes. However, further high-quality, standardized trials are needed to definitively establish best practices.

Seronegative sicca syndrome encompasses patients who present with xerostomia and/or keratoconjunctivitis sicca but lack anti-SSA/SSB antibodies and do not fulfill current classification criteria for primary Sjögren’s syndrome (pSS). Despite symptom overlap with pSS, these individuals remain diagnostically and therapeutically unclassified. This review studies the clinical, immunological, and pathological spectrum of seronegative sicca, highlighting its heterogeneity and the limitations of antibody-centric diagnostic frameworks. Histopathologic findings in some seronegative patients—including focal lymphocytic sialadenitis—mirror those seen in pSS, suggesting underlying immune-mediated glandular damage. In others, nonspecific or normal biopsy findings suggest non-immune mechanisms. New evidence of immune activity, such as elevated cytokines (BAFF, IFN-α), and novel autoantibodies (SP-1, CA-VI), further supports the concept of subclinical autoimmunity in a subset of these patients. Clinically, they often face significant burden, including dryness, fatigue, and pain, yet remain excluded from most research cohorts, therapeutic trials, and clinical guidelines. Their management is often individualized, relying on symptomatic therapies rather than immunomodulatory agents. The lack of validated diagnostic criteria and prognostic markers compounds the uncertainty surrounding disease evolution, as some patients may later seroconvert or develop systemic features. To address these gaps, a paradigm shift is needed—one that embraces the spectrum of sicca syndromes, incorporates advanced immunophenotyping, and allows inclusion of seronegative patients in research and care algorithms.

 Introduction : Fournier’s gangrene (FG) is a rare and potentially life-threatening infection that leads to necrosis of soft tissue. This condition constitutes a medical emergency, necessitating prompt surgical intervention to mitigate the potential consequences. Aim : To analyze the demographic and clinical characteristics of a small cohort of patients with FG. Patients and methods : The present retrospective study included 31 patients with Fournier’s gangrene who were hospitalized in the Department of General Surgery from January 2020 to December 2023. A comprehensive examination of the patients’ demographic characteristics, comorbidities, presence of diabetes mellitus, microbial agents involved, and methods used for wound management was conducted. Results : The study found that men, particularly those over the age of 55, were more commonly affected than women. Escherichia coli was identified as the predominant microbial agent. The prevalence of diabetes mellitus was found to be higher among female patients. All patients received prompt surgery according to established protocols. Enzyme proteolysis was our method of choice for wound management. Ten patients underwent adjunctive surgery while seven patients had reconstructive procedures. The mortality rate registered was 25.8%. The mean length of hospital stay was 12.8 days. Conclusion : Fournier’s gangrene has a high mortality and complication rate despite the current treatment options. Wound management with enzyme proteolysis yielded promising results.

The combined muscle-skeletal traumas (MST) are very frequent over the last few years. The emergency care try to save the life of the patient and to receive resuscitation treatment. The role of Trauma surgeon is to choose the right moment for surgery. Aim: To present the management of patient with combined height injury, fracture stabilization, partial foot amputation, local flaps, skin grafting and HIFU – thermotherapy as scar treatment. Materials and methods: 40 years old mail patient, injured after a fall from 8 meters in an elevator shaft. After resuscitation treatment to control the shock the Imaging results are: burst fracture of L3 with spinal canal stenosis, fracture of the sacral bone Denis I, fracture of the right humerus in the proximal third, Monteggia fracture of the left arm, fracture of the proximal third of the right tibia as well as comminuted fractures of both calves and of both heel bones. Results: After a few operations his final result was well healed bone fractures and a good quality soft tissue coverage allowing the patient a satisfactory quality of life. Conclusions: Combined traumas of the muscle- skeletal system are severe, serious and difficult to manage. The good outcome in their treatment requires a team approach between the different medical specialists.

Combined musculoskeletal traumas (MST) are complex injuries that can lead to life-threatening conditions and high mortality rates, particularly in men under 45 and women under 35. Recent increases in multiple trauma incidence highlight the need for timely intervention and effective management strategies. The concept of damage control orthopedics emphasizes the importance of stabilizing life-threatening injuries first, followed by staged surgical interventions once the patient’s condition is stabilized. We report a case of a 40-year-old man who sustained multiple MSTs following an 8-meter fall in an elevator shaft. The injuries included a burst L3 vertebral fracture with spinal canal stenosis, multiple limb fractures, and severe foot trauma requiring partial amputation. Initial management involved laminectomy and spinal stabilization, followed by staged fracture fixation and plastic reconstruction of soft tissue defects using adjacent tissue transfer, free skin grafting and high-intensity focused ultrasound (HIFU) therapy. Postoperatively, the patient developed marginal necrosis of the amputation stump, managed with serial necrectomies and nanosilver dressings. Six months postoperatively, the patient achieved good fracture consolidation, preserved vital tissue flaps, and restored mobility with a walking frame. Despite severe soft tissue damage, the final outcome was considered successful, enabling independent mobility. This case underscores the critical role of a multidisciplinary approach in managing MSTs and highlights the use of advanced techniques, such as HIFU and nanosilver therapy, in optimizing functional and aesthetic outcome.

Purpose: the aim of the present study is to evaluate the intra- and postoperative complications following unicondylar knee arthroplasty and subsequent outcome. Material and methods: For the period from 2008 to 2018, we operated on 450 patients with isolated osteoarthritis of the knee joint. In the majority of cases, patients had arthrosis of the medial compartment of the joint due to antero-medial osteoarthritis or osteonecrosis and, in smaller percentage, osteoarthritis in the lateral part of the joint. Results: Various complications were registered which we divided into intraoperative and postoperative, monitoring during the follow-up of patients. Intraoperative include fracture of the tibial plateau during implantation of the component, partial resection of the intercondylar eminence during the preparation of the tibial plateau, incorrect hole placement in the femoral condyle, which led to malalignment positioning of the femoral component in varus or valgus, resection of more bone substance from the tibia leading to subsidence of the implanted component. The postoperative complications include: aseptic loosening, polyethylene wear, impingement, progression of osteoarthritis in the opposite part of the knee joint, periprosthetic infection and arthrofibrosis. Conclusion: Unicompartmental knee arthroplasty is a minimally invasive procedure for the treatment of isolated osteoarthritis of the knee joint and is associated with excellent and good long-term results. Complications could be reduced by using a meticulous surgical technique, selection of suitable implants and last but not least proper indications for surgery.