Category Archives: Number

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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Magnetic Resonance Mammography: Actual Trends and Perspectives

Nechifor-Boila IA1, Buruian M1, Borda Angela2

1 Department of Radiology and Medical Imaging, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Magnetic Resonance Mammography (MRM) is a new radiologic examination with wide perspectives in breast cancer diagnosis. We performed a systematic review of the literature, in order to obtain a clear view on the actual role of MRM, together with an accurate evaluation of its performance in clinical settings.
Material and methods: We conducted a thorough PubMed search, both directly and through MeSH (Medical Subject Headings), using specific keywords. We then applied the following filters: articles published only between 1999 and 2011 and written in English or French. Priority was given to reviews and clinic trials according to previously set criteria.
Results: We evaluated the clinical efficiency of MRM using sensitivity, specificity and predictive values (positive and negative). Sensitivity varied between 81 and 98%, while specificity had a much wider dispersion (65–93%), thus supporting the statement that MRM is a sensitive but not a specific examination. Diffusion MRM was comparable to standard MRM, while spectroscopy showed a low sensitivity and a high specificity.
Conclusions: MRM is a complex investigation, with well documented recommendations and good sensitivity. Diagnostic specificity remains an important issue, but with improvement perspectives from new techniques like diffusion and spectroscopy.

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Multifocal Sarcomatoid Carcinoma of the Small Intestine

Fülöp Emőke1, Marcu Simona Tünde1, Loghin Andrada1, Fülöp EF2, Mocan Simona3

1 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Internal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Pathology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Sarcomatoid carcinomas (SCs) or carcinosarcomas are rare, biphasic tumors, with poor prognosis, only rarely located in the small and large intestine. The first treatment option of these tumors is surgical approach, adjuvant therapy showing no important role in the treatment protocol. We present the case of a 63 years old male patient, hospitalized in the Surgical Department II of the County Emergency Clinical Hospital Tîrgu Mureş with the diagnosis of small intestine tumor with jejunal localization. Microscopically, in hematoxylin-eosin (HE) staining, the tumor was consisting of two components, an epithelial and a mesenchymal one. From immunohistochemical point of view, tumor cells were strongly positive for cytokeratin AE1/AE3 as well as for vimentin. They were negative for epithelial membrane antigen (EMA), CD117, CD34, S100, chromogranin-A and synaptophisin. Based on the macroscopic and microscopic appearance, respectively the immunohistochemical feature of the tumor, the patient was diagnosed with multifocal sarcomatoid carcinoma of the small intestine.

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Particular Clinical-Therapeutic Aspects of Rhinophyma — Atypical Case Report

Andrei Liliana1, Bordeianu I2, Iordache IV2, Bratu I3

1 Hypocrate Medical Center, Tulcea, Romania
2 Faculty of Medicine, Ovidius University, Constanța, Romania
3 Faculty of Pharmacy, Ovidius University, Constanța, Romania

The authors present a case of pseudotumoral rhinophyma with some specific and rare clinical, evolutional and therapeutic aspects. Therapeutic indication was put on functional rather than cosmetic reasons, and surgery led to good functional and cosmetic results, accompanied by a fast spontaneous-directed epithelialization.

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The Predictive Value of Mannheim Score in Patients with Colon Related Peritonitis

Teleanu G¹, Iordache F², Beuran M2

1 General Surgery Clinic I, Clinical Emergency Hospital Floreasca, Bucharest, Romania
2 Faculty of Medicine, University of Medicine and Pharmacy, Bucharest, Romania

Introduction: The aim of this study, is to confirm the predictive value of the Mannheim peritonitis index at the patients with colonic peritonitis.
Material and method: From January 2003 to October 2007 in Surgical Department of Emergency Hospital Bucharest, 98 cases were studied and the patients were divided into two groups according to the Mannheim Peritonitis Index value 24.
Results: A life table was constructed to compare patients survival rate. Patients with Mannheim Peritonitis Index less than or equal to 24 had a mortality not reach 6% and patients with Mannheim Peritonitis Index greater than 24 had a mortality rate of 45%.
Conclusions: The Mannheim Peritonitis Index is a useful method to determine study group in patients with colonic peritonitis. He has a predictive value of outcome at the patients with colonic peritonitis.

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The Usefulness of Magnifying Chromoendoscopy with Methylene Blue in the Detection of Specialized Intestinal Metaplasia and Dysplasia in Barrett’s Esophagus — a Preliminary Report

Pascarenco Ofelia¹, Dobru Daniela¹, Boeriu Alina¹, Brusnic Olga¹, Galeanu Iuliana², Onisor Danusia³, Stoian M4

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Gastroenterology, Municipal Hospital, Câmpulung Moldovenesc, Romania
3 Department of Gastroenterology, Municipal Hospital, Luduș, Romania
4 Department of Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Barrett’s esophagus appears in relation with gastroesophageal reflux disease, which damages the normal squamous mucosa; the injury heals through a metaplastic process in which columnar cells replace squamous ones. The specialized intestinal metaplasia has a malignant potential, but the diagnosis is often difficult in conventional endoscopy.
Aim: Our purpose was to evaluate the results of magnifying chromoendoscopy using methylene blue in the diagnosis of specialized intestinal metaplasia and dysplasia in Barrett’s esophagus.
Methods: Nine patients with proven or suspected Barrett’s esophagus in conventional endoscopy underwent magnified chromoendoscopy with methylene blue for confirming and/or monitoring the intestinal metaplasia or for detecting dysplasia. Biopsies were taken from sites coloured with methylene blue and from regions with particular patterns according to Endo’s classification.
Results: Specialized intestinal metaplasia was reported in 16 out of 29 biopsies; one biopsy proved low grade dysplasia and two samples showed indefinite for dysplasia. The sensitivity and specificity of methylene blue staining in detection of specialized intestinal metaplasia were 87% and 66% respectively (p=0.005). Taking into consideration Endo’s classification, tubular and villous patterns had a significant correlation with SIM detection (p=0.0004) with a sensitivity and a specificity of 66% and 100%.
Conclusions: Magnifying chromoendoscopy with methylene blue allows targeted biopsies for SIM and dysplasia detection; it also allows the selection of the site of the biopsy according to pitpattern.

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Correlation Between Postoperative Cervical Haematoma in Carotid Surgery and Antiplatelet Treatment

Jerzicska Ernő, Fărcaș Felix, Győrbíró László

Clinic of Cardiovascular Surgery, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: Cervical haematoma is one of the local complications of carotid endarterectomy. Cervical haematoma may determine oesophageal compresion or tracheal deviation. We evaluated the correlation between cervical haematoma and preoperative antiplatelet treatment.
Material and methods: We evaluated retrospectively 100 consecutive patients operated with carotid endarterectomy between 2009 and 2011. Group A of 48 patients had monoantiaggregant preoperative treatment, group B of 52 patients had dual preoperative antiaggregant treatment.
Results: We observed cervical haematomas in 16 patients from the total of 100, 13 of them being in group B. Evaluation of age, sex, surgical technique and local drainage showed no differences between the two groups. The group with monoantiaggregant preoperative treatment had a smaller chance to develop cervical haematoma (p=0.022).
Conclusions: Preoperative antiplatelet treatment is crucial for a succesful carotid endarterectomy procedure. We sustain the use of monoantiaggregant preoperative treatment, which is associated with less cervical haematomas as a local haemorrhagic complication, instead of dual antiaggregant preoperative therapy.

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Laparoscopic Transperitoneal Adrenalectomy for Patients with Previous Abdominal Surgery

Ganescu Roxana1, Paun S1, Beuran M1, Vartic Mihaela1, Paun Diana2, Dumitrache C2

1 Emergency Hospital, Bucharest, Romania
2 ”C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania

Background: Adrenal surgery has been radically changed by laparoscopic approach and we wonder whether the increase in the number of adrenalectomies is entirely justified by better understanding of the pathology and a developed diagnosis method. The type of approach (transabdominal/retroperitoneal) remains still a mater of surgeon’s experience.
Method: In past 6 years we performed 152 laparoscopic adrenalectomies by transperitoneal approach, 24 of them having previous significant abdominal surgery (cholecistectomy, gastric surgery, colectomy, bowel obstruction, exploratory laparoscopy, adrenalectomy). The patients had a variety of adrenal pathologies like Cushing’s disease, Cushing’s syndrome, Conn’s syndrome, incidentaloma, pheochromocytoma and even carcinoma.
Results: Three cases were converted to open approach, only one because of the adhesions. Reasons for conversion were also: spleen infarction and a difficulty in mobilizing the tumor. Operating time was not significantly prolonged because of the adhesions (40–360 min, median time 127 min). Postoperative evolution was simple, with no morbidity or mortality and a fast recovery.
Conclusions: Choosing the type of approach is related to surgeon experience, although 79–94% of surgeons prefer the transabdominal lateral approach. We believe that with an experienced surgical team there is no difficulty in performing adrenalectomy by transabdominal approach, with no significantly prolonged operating time, even when the patient had previous abdominal surgery.

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