Patient positioning is a crucial step in neurosurgical interventions This is the responsibility of both the neurosurgeon and the anesthesiologist.
Patient safety, surgeon’s comfort, choosing an optimal trajectory to the lesion, reducing brain tension by facilitating venous drainage, using gravitation to maintain the lesion exposed and dynamic retraction represent general rules for correct positioning. All bony prominences must be protected by silicone padding. The head can be positioned using a horseshoe headrest or three pin skull clamp, following the general principles: avoiding elevating the head above heart more than 30 degrees, avoiding turning the head to one side more than 30 degrees and maintaining 2 to 3 finger breaths between chin and sternum. Serious complications can occur if the patient is not properly positioned so this is why great care must be paid during this step of the surgical act.
Background: Laparoscopic appendectomy (LA) is a common procedure, considered to be a safe alternative to conventional open appendectomy (OA). LA is known to reduce parietal scarring, offers a shortened hospital stay and an earlier return to normal activities. Acute gangrenous and perforated appendicitis may be associated with an increased risk for postoperative complications following laparoscopic appendectomy.
Objective: To determine the complication rate following LA.
Material and methods: Between January 2000 and November 2003, 323 consecutive emergency appendectomies were performed (311 LA, 5 OA and 7 conversions). A retrospective analysis of LA was performed with evaluation of complication rate (fever, pain, intra-abdominal infection or abscess and abdominal wall infection), duration of preceding symptoms, interval between admission and operation, length of the operation, whether the performing surgeon was a resident or a senior surgeon, and the length of hospital stay (LOS).
Results: Two hundred patients (64.3%) were males and mean age was 35 years. Mean waiting time for surgery was 9.4 hours, mean operating time 48 minutes and conversion rate was 2.2%; mean LOS was 3.05 days. Histology showed acute inflammation in 81% (acute appendicitis in 54.34%, phlegomonous appendicitis – 17.36%, perforated or gangrenous appendicitis – 9.00%). There was a 10.6% overall incidence of infectious complications, 9.64% of readmissions and mortality was 0.
Conclusions: It appears that in the current study, the overall complication rate following LA is higher than expected, and tends to be even higher for complicated appendicitis. This needs further evaluation.
Introduction: This paper presents a special case of an acute myeloblastic leukemia accidentally diagnosed on a 57 years old asymptomatic person without occupational exposure, without a medical history, with normal blood count, without thrombocytopenia, as a result of routine hematological tests that reveal the presence of more than 10% blasts on peripheral blood smear.
Material and method: Bone marrow aspirate revealed 80% blasts and flow cytometry confirmed the diagnosis of acute myeloblastic leukemia LAM0. Cytogenetic examination showed normal karyotype 46, XX. The treatment aims to induce, maintain and consolidate remission. Since the classical therapeutical approach with Idarubicine and Cytarabine 3+7 was not tolerated, adjustments were necessary to 2+5, four courses being administered. During the remission period Methotrexate and Purinetol maintenance treatment was administered, it was obtained a tolerable quality of life, the patient resumed his work. The first relapse occurred after approximately one year. Later medical courses were established after chemotherapy protocol with Clofarabine and Cytarabine, but after intolerance, neutropenia, sepsis and death occured.
Results: Because of the severe prognosis and infectious complications the treatment was difficult and dose ajustments were necessary according to patient’s tolerance. Bone marrow transplant was not possible due to the lack of a compatible family donor.
Conclusions: This case of acute myelogenous leukemia treatment reflects the difficulties and complications occurred during the disease evolution. However remission periods with a tolerable quality of life were obtained, duration of treatment was approximately three years until death.