Category Archives: AMM 2012, Volume 58, Number 2

The Use of Heterologous Bovine Pericardium in the Closure of Bronchial Stump After Lung Resections, Experimental Study

Bud V1, Suciu B1, Copotoiu Ruxandra2, Sin Anca3, Cotoi O3, Butiurcă V4, Cordos B5, Brânzaniuc Klara6, Copotoiu C1

1 1st Surgical Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 ICU, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Department of Anatomopathology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
4 Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Veterinarian, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
6 Department of Anatomy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: There are many authors who have devoted their time and expertise to find creative ways for an ideal suture of bronchial stump. Despite their efforts, the bronchial fistula rate reported in the specialty literature remains high, between 2–16%, depending on the author. There are two methods for closing bronchial stumps: manual and mechanical suture. The aim of this study was to experiment a new technique for closing bronchial stumps after lung resections.
Material and method: In order to carry out this study we used 15 common rabbits. We performed left inferior lobectomy in these rabbits. These rabbits were divided into three groups according to the methods used to close the bronchial stump. We used three methods for closing the bronchial stump: simple running suture, suture of the bronchial stump using two vicryl mesh patches and suture of the bronchial stump using two heterologous bovine pericardial patches.
Results: We did not notice any cases of bronchial stump fistula. The most important changes that appear during the bronchial stump healing are: inflammatory response, angiogenesis, hyperplasia of the smooth muscle fibres, migration of fibroblasts and fibrogenesis.
Conclusions: Healing signs appeared on all examined samples, but they were more intensive in the group where we used the heterologous bovine pericardium for closing the bronchial stump. Some further studies are necessary to examine the effectiveness of the use of heterologous bovine pericardium to protect the bronho-anastomosis.

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Wound Healing Problems in Revision Hip Arthroplasty

Bod P1, Kurtus I1, Incze-Bartha S1, Băţagă T2

1 Orthopedics and Traumatology Clinic, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Orthopedics and Traumatology Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Per primam healing of surgical wound is obligatory for good results after arthroplasty. Surgical wound complications can lead to deep periprosthetic infection, therefore a devastating complication. Surgical wound healing is affected by multiple factors related to underlying disease, patient comorbidities, lifestyle, nutrition and associated medications. If these are combined, the risk of periprosthetic infection is greater.
Material and methods: We studied wound healing problems on 57 cases of revision hip arthroplasties performed between 2008–2010. The wounds were monitored daily, and the changes were noted and scored.
Results: All the 57 patients presented various predisposing factors for wound healing complications, 12 patients (21.05%) had a two-stage revision and 11 patients (11.29%) presented wound healing problems.
Conclusion: Per primam wound healing is a basic requirement in hip arthroplasty. Any change noted during wound healing should be treated seriously.

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The AKIN and the RIFLE Limping Criteria to Predict Renal Injury and Mortality Following Cardiac Surgery

Copotoiu Sanda-Maria

Editor-in-chief

When published in 2006, the RIFLE criteria filled the gap for the failing definition of acute kidney injury [1]. The criteria were scheduled to be evaluated. According to the authors who used these criteria in assessing renal impairment, acute kidney injury (AKI) occurred in 67% of ICU (intensive care unit) admissions, with maximum RIFLE class R and F in 12% and 28% respectively. They warned as to the risk of in hospital mortality compared to those who did not pass class R. Events happened in a general ICU. Later, Bagshaw et al retrospectively studied the fate of the patients admitted in 57 New Zealand adult ICUs including over 120,000 critically ill patients, of which 27.8% had a primary diagnosis of sepsis. They concluded that compared to the RIFLE criteria, the AKIN criteria were unable ”to improve the sensitivity, robustness and predictive ability of the definition and classification of AKI in the first 24 hours after admission to ICU” [2].[More]

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The Prognostic Value of AKIN and RIFLE Classifications in Acute Renal Failure Developing After Cardiac Surgery

Baloş S1, Baloş Monica2, Suciu H3, Deac R3, Kovács Judit4

1 Cardiovascular Surgery, County Emergency Clinical Hospital, Târgu Mureş, Romania
2 Department of Prosthetic Dentistry and Oral Rehabilitation, Faculty of Dental Medicine, University of Medicine and Pharmacy, Târgu Mureş, Romania
3 Department of Cardiovascular Surgery, University of Medicine and Pharmacy, Târgu Mureş, Romania
4 Department of Anesthesia, Intensive Care and Emergency Medicine, University of Medicine and Pharmacy, Târgu Mureş, Romania

Background: Renal dysfunction is common after cardiac surgery, ranging from minor changes in serum creatinine without clinical manifestations to frank anuria and severe metabolic dysfunction. In recent years two scores were developed to diagnose renal dysfunction. The aim of our study was to compare the prognostic value of these scores in acute renal failure associated with cardiac surgery.
Materials and methods: In our prospective clinical observational study we calculated and compared the AKIN (Acute Kidney Injury Network) and RIFLE (Risk, Injury, Failure, Loss, Endstage kidney disease) scores in 178 patients undergoing open heart surgery at the Clinic of Cardiovascular Surgery in Târgu Mureș, Romania, between October 1, 2010 and March 31, 2011, and studied the morbidity and mortality in patients with renal dysfunction in terms of these scores.
Results: According to AKI criteria, we identified 39 patients having high risk for developing renal injury (stage I) (with 16 cases more than with RIFLE criteria, class R), but we observed no differences in the number of renal dysfunction (28 patients) or renal failure (18 patients). The patients enrolled in high risk group according to AKI score, but not with RIFLE criteria, had a good outcome with diuretics and avoidance of nephrotoxic agents. Two patients needed renal replacement therapy, both of them were classified in the renal failure group. Mortality was higher in renal failure according to both RIFLE and AKI criteria.
Conclusions: AKI criteria are more sensitive in identifying patients at risk for renal injury, but the RIFLE criteria are more accurate in the estimation of postoperative morbidity and mortality.

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