Tag Archives: surgery

Asymptomatic Myxomatous Degeneration of the Mitral Valve, in a Young Male

DOI: 10.2478/amma-2020-0018

Background: In young patients, the most common cause of mitral valve regurgitation is prolapse or flail of the valve, which is morphologically reflected by myxomatous degeneration. In rare cases, such this presented in this paper, this lesion might be incidentally identified, in young people.
Case presentation: A 43-year-old male, with familial history of hypertension, presented in our Department of Cardiology for a routine check-up. Despite of lack of symptoms, an intense murmur was detected at mitral auscultation area. The echocardiography revealed a severe mitral regurgitation caused by flail of posterior mitral valve. The patient was transferred to the Cardiac Surgery Department for surgical intervention consisting in mitral valve repair. The histopathological examination revealed severe myxomatous degeneration of the spongiosa and fibrosa layers. The recovery after surgery was very good with no postoperative complications. The patient was discharged seven days after surgery, with no significant mitral regurgitation at the three-month follow-up.
Conclusions: In young, asymptomatic patients, the proper time for mitral valve repair should be decided by an interdisciplinary team. For a better understanding of myxomatous degeneration particularities, histopathological assessment should be done in any replaced valve. Certification of such lesions, under microscope, might be an indicator for familial cardiovascular screening, in first degree relatives.

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Left Ventricular Function and Morphology after Cardiac Surgery for Severe Mitral Insufficiency – A Single Center Experience

DOI: 10.2478/amma-2020-0015

Introduction: Mitral insufficiency is a common valvular disease affecting 10% of the general population. The main treatment of the severe mitral regurgitation is surgical. We have analyzed the impact of cardiac surgery on the left ventricular performance and morphology, in patients treated for severe mitral insufficiency accordingly to the type of intervention, ischemic time and type of cardioplegia.
Methods: Ninety patients diagnosed with isolated severe mitral insufficiency that benefited from mitral valvular replacement or mitral valvuloplasty were retrospectively enrolled. The left ventricle, the left atrium, the right ventricle diameters and the left ventricle ejection fraction were measured by two-dimensional (2D) echocardiography before and after surgery. The influence of the myocardial ischemia time and the type of cardioplegia administered on the ventricular systolic function were also analyzed.
Results: Regardless the surgical technique chosen, after surgery we noticed a decreased size of the left ventricle (preoperative mean 54.91mm ±8.18 vs postoperative mean 51.94mm±8.15, p=0.035), right ventricle (preoperative mean 33.49mm±5,87 vs postoperative mean 32.41mm±6.03, p=0.0001), as well as the ejection fraction (preoperative mean 51.29%±8.51 vs postoperative mean 46.57%±8.71, p=0.0001).
Conclusions: Immediately after surgery, a decrease in the size of cardiac cavities as well as a decrease of the left ventricle ejection fraction is noticed.

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The Superiority of Laparoscopic Appendectomy: Myth or Reality?

Background: Laparoscopic appendectomy is a laparoscopic intervention that could be achieved with the improvement of laparoscopic instruments and technology. It presented an upward trend in recent years despite the many controversies surrounding this type of intervention. In our clinic was a “bridge route” to acquire advanced laparoscopic surgical techniques.
Methods: Comparative analysis of laparoscopic appendectomy and classic appendectomy; establishing the superiority of laparoscopic approach. We have studied the casuistry of the Surgery Clinic I of the County Emergency Clinical Hospital Tîrgu Mureș for the 2008–2011 period (3 and half years). Several parameters were analyzed.
Results: In the analyzed period 209 appendectomies were performed: 98 (53%) by laparoscopic approach and 111 (47%) by open approach. 49.13% of all women operated received laparoscopic surgery, while only 44.08% of men have had this approach. The time of laparoscopic surgery was on average 13.10 minutes longer than the classic. Conversions were 10% of total laparoscopic interventions. Complications that required reintervention were recorded in 1 case (20%) after the laparoscopic approach, as opposed to 4 cases (80%) for the classic approach.
Conclusions: Laparoscopic appendectomy weight increased progressively from year to year. The average duration of laparoscopic appendectomy learning curve was part of any specific type of laparoscopic intervention. The benefits of this type of intervention are clear, as represented by the possibility of exploring the peritoneal cavity and differential diagnosis of “painful right iliac fossa syndrome” in women, can guide classic approach in case of conversion, rapid mobilization and early resumption of transit, decreased parietal pain, a lower rate of parietal infection, short-term hospitalization and faster reintegration in activity.

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Multi-trauma Patients Management: a Cross-sectional Study

Introduction: The aim of this study was to evaluate the multi-trauma critical patient management in the Clinical Emergency County Hospital of Tîrgu Mureş, Romania.
Material and method: We conducted a cross-sectional study, data collection was achieved by extracting records from hospital patients database. We collected the data from January 2007 until June 2011. The initial search revealed a number of 784 patients diagnosed with multi-trauma. From this sample we included in the study only a number of 312 patients diagnosed with critical multi-trauma from whom 194 underwent emergency surgery. We evaluated clinical consults distribution, the frequency of mechanisms of injury, therapeutical and diagnostic procedures, clinical transfers, lesions associations, traumatic lesions that required emergency surgery, injured organs and thoracic injuries that required emergency surgery.
Results: From the total number of patients, 214 (68.58%) were men and 98 (31.42%) were women. The incidence of multi-trauma regarding age, showed a peak in the 1st and 2nd decade. Regarding the mechanism of injury, the main cause is represented by car accidents, followed by assault and fall. It was observed that the most frequent clinical consults were the surgical ones, followed by orthopaedic and neurosurgical consults. In the Surgical Department, in the studied period of time, there was admitted a number of 272 patients diagnosed with critical multi-trauma.
Conclusions: In recent years, the incidence of critical multi-trauma patients increased especially in the first and second life decades. Critical multi-trauma patients with emergency surgery presented a low vital prognosis, with a mortality of 4.77%. Survival of this category of patients could increase due to the establishment of a complete chain of care (patient management): accidents site, transport, emergency service, hospital operating room, intensive care postoperative therapy.

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Clinical and Statistical Study on Canine Impaction

DOI: 10.2478/amma-2013-0044

Aim: The aim of this study was to perform a clinical and statistical research on permanent impacted canine patients among those with dental impaction referred to and treated at the Oral and Maxillo-Facial Surgery Clinic of Tîrgu Mureș, over a four years period (2009–2012).
Materials and methods: The study included 858 patients having dental impaction, and upon clinical records, different parameters, like frequency, gender, age, quadrant involvement, patient residence, associated complications, referring specialist and type of treatment, related to canine impaction, were assessed.
Results: The study revealed: about 10% frequency of canine impaction among dental impactions; more frequent in women, in the first quadrant (tooth 13); most cases diagnosed between the age of 10–19 years; patients under 20 were referred by an orthodontist, those over 20 by a dentist; surgical exposure was more often performed than odontectomy.
Conclusions: Canine impaction is the second-most frequent dental impaction in dental arch after third molars; it occurs especially in women. Due to its important role, canine recovery within dental arch is a goal to be achieved, whenever possible. Therefore, diagnose and treatment of canine impaction requires an interdisciplinary approach (surgical and orthodontic).

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Bisphosphonate-Related Osteonecrosis of the Jaws: a real Challenge for Dentists

DOI: 10.1515/amma-2015-0034

Background: Osteonecrosis of the jaw is a serious complication associated with oral and intravenous bisphosphonate therapy. Its pathogenesis is not well understood and its management is difficult.The aim of ourstudy was to evaluate the awareness of dentists in Târgu Mureș on the possibilities of treating patients who are treated with bisphosphonate in dental offices.
Material and method: We carried out a questionnaire-based study among dentists in Târgu Mureș reaching important issues such as: if the patient is asked if medical history follows / followed treatment with bisphosphonates, if they made surgical treatment in these patients, if they know under what conditions can they perform this treatment, if they deem it is necessary to contact the prescriber before surgical treatment.
Results: Seventy questionnaires were returned. During the medical history most clinicians (60%) asked the patients whether they follow/followed treatment with bisphosphonates and most of them (42.85%) did not perform treatments in these patients. While 85.71% of respondents declared that they do contact the prescriber before performing surgical treatment, 48,57% were not aware under what conditions they could undergone the treatment.
Conclusions: The dentists did not seem to be well informed about this pathological entity, known only since 2003. In the absence of appropriate protocols they could not provide a high quality treatment and in these circumstances they might do more harm than good.

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