Traumatic lesions of the rectum, perineum and anus are rare but difficult to treat, requiring exp... more Traumatic lesions of the rectum, perineum and anus are rare but difficult to treat, requiring experience in terms of trauma and colorectal surgery. Case report and electronic search of the
Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more inc... more Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more increased severity, secondary to urban violence and traffic related accidents. We aim to better define the prognostic value of post-traumatic hemoperitoneum (PTH) in the nowadays era of nonoperative management of abdominal lesions, and to correlate it with the current pattern of traumatic injuries. Retrospective study of patients admitted during 24 months. Selections criteria: (1) Traumatic injury; (2) Free peritoneal fluid on preoperative imaging; (3) Surgical exploration of the abdomen. Setting: A level I trauma center. Results: There were 64 patients, with two peak frequencies between 18-35 and 50-70 years old. Abdominal wall ecchymoses were found in 36 (55%) of cases. Out of 64 cases 37 (58.7%) were transportation related, 12 (19%) caused by human aggression and 10 (16.9%) by falls. According to the Trauma Score (TS) there were 50 (78.2%) cases with TS between 14-16, 9 (17.2%) between 1...
Although rarely, due to the high variability of the possible tissues encountered in it’s wall, th... more Although rarely, due to the high variability of the possible tissues encountered in it’s wall, the Meckel’s diverticula can represent a site for tumor development in 0,5-3,2% cases. Data in the literature shows that the most common malignancy at this level is represented by neuroendocrine tumors (NET) the observed incidence of neurendocrine tumors and other primary neoplasia, varies between 12-55%. Moreover, the gastro-intestinal tract was the second primary tumor bearer encountered.
Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we a... more Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we are facing little evidence regarding the elderly patients. The purpose of this study is to define the benefits in terms of early outcome for laparoscopic cholecystectomy in patients over 70 years old and to compare them with the open cholecystectomy through a retrospective study of patients that underwent a cholecystectomy during 12 months in the Emergency Hospital of Bucharest, Romania. Out of 49 patients, 20 had a laparoscopic cholecystectomy (LC) and 29 an open approach (OC). The mean age was 74,6 ± 4,2 (LC) vs. 77,2 ± 5,4 (OC) (P>0.05). There were 7 (33,3%) (LC) vs. 2 (7,1%) (OC) catarrhal cholecystitis, 13 (62%) (LC) vs. 9 (32,1%) (OC) phlegmonous cholecystitis, and 1 (4,8%) (LC) vs. 17 (60,7%) (OC) gangrenous cholecystitis (P=0.001, Cramer’s V=0,590). The median operative time was 90 (LC) vs. 60 (OC) minutes (P=0.001). There were no differences regarding the ASA risk scale (P=0,2...
Recent progress in medical imaging allowed higher accuracy in diagnosis of acute diverticulitis. ... more Recent progress in medical imaging allowed higher accuracy in diagnosis of acute diverticulitis. Contrast enhanced Computed Tomography (CT) has a high sensitivity and specificity, reaching a diagnostic accuracy over 95%. Although abdominal X-ray and ultrasonography are still used, their utility is limited in this pathology. Retrospective study including patients admitted for acute diverticulitis in the Surgery Clinic of Bucharest Clinical Emergency Hospital between January 2012 and July 2014. From the total number of 29508 admissions, 156 patients were diagnosed with acute diverticulitis staged Hinchey I to IV. The imagistic investigations on admission were plain abdominal X-ray (128 cases), which identified 6 cases of pneumoperitoneum; abdominal ultrasound (112 cases) which identified colonic wall thickening and/or free peritoneal fluid in 29.4% cases. Contrast enhanced CT was performed in 97 cases, successfully establishing the diagnostic in 80% of cases. The mean waiting time int...
INTRODUCTION Despite the high frequency of thoracic injuries secondary to traffic related acciden... more INTRODUCTION Despite the high frequency of thoracic injuries secondary to traffic related accidents, the blunt cardiac valve rupture is extremely rare. METHOD Case report and review of the literature using PubMed/MEDLINE and EMBASE databases. RESULT A 38 year old female patient, victim of car accident was admitted. On primary survey the patient was conscious, cooperative and hemodynamic and respiratory stable. On secondary survey was found a bilateral open leg fracture and a seat belt sign. Whole body Computed Tomography revealed minimal haemorrhagic contusion of the cortex, left hemopneumothorax and right pneumothorax, bilateral rib fractures, liver contusion, left femoral neck fracture and fracture to the lumbar spinal column. After bilateral pleurostomy, the patient becomes hemodynamically unstable, but with no signs of external bleeding. The transthoracic echocardiography revealed an acute severe tricuspid regurgitation with hepatic veins reflux. After orthopaedic surgeries, the...
INTRODUCTION The pancreatic injuries have fortunately a low frequency, but when present associate... more INTRODUCTION The pancreatic injuries have fortunately a low frequency, but when present associate multiple intraabdominal lesions, and carry a significant morbidity and mortality. The aim of this study is to underline the significant morbidity associated with high grade pancreatic injuries. CASE REPORT Female patient, 36 years old, with penetrating abdominal trauma due to domestic violence was referred to our center from a regional county hospital, after multiple laparotomies, hemodynamically unstable, with multiple organ failure. Abdominal clinical exam revealed evisceration, with massive pancreatic leakage at the level of the median laparotomy and through the stabbing wounds from the right flank. Emergency Computed Tomography showed multiple intraabdominal collections, with laceration of the liver, right kidney and pancreatic head. Abdominal exploration was decided. After a thorough abdominal debridement was revealed a deep laceration of the pancreatic head, with active extravasat...
Introduction. Acute pancreatitis in pregnancy is a rare condition with an approximate incidence o... more Introduction. Acute pancreatitis in pregnancy is a rare condition with an approximate incidence of 1 over 1,000-12,000 pregnant women, but it is associated with increased incidence of maternal and fetal mortality. Can occur during any trimester but over half (52%) occur during the third trimester and rarely during post-partum period. Difficulty in diagnosis and treatment put significantly in danger the maternal and fetal health. The treatment of pancreatitis in pregnancy should be conservative as far as possible with delaying the definitive treatment until after delivery. Case report. We report a case of a 20-year-old woman, at 32 week of gestation who presented with severe pain confined to the upper abdomen and radiating to the back to the upper abdomen. Investigation undertaken led to the diagnosis of acute pancreatitis which was managed conservatively. She recovered within several days and then delivered a healthy baby. Conclusions. Acute pancreatitis is rare in pregnancy, occurring most commonly in the third trimester. Pancreatitis in pregnancy remains a challenging clinical problem to manage, but if treated early, preterm labor can be avoided.
A mixed score to predict the probability of survival has a key role in the modern trauma systems.... more A mixed score to predict the probability of survival has a key role in the modern trauma systems. The aim of the current studies is to summarize the current knowledge about estimation of survival in major trauma patients, in different trauma registries. Systematic review of the literature using electronic search in the PubMed/Medline, Web of Science Core Collection and EBSCO databases. We have used as a MeSH or truncated words a combination of trauma "probability of survival" and "mixed scores". The search strategy in PubMed was: "((((trauma(MeSH Major Topic)) OR injury(Title/Abstract)) AND score (Title/Abstract)) AND survival) AND registry (Title/Abstract))))". We used as a language selection only English language literature. There is no consensus between the major trauma registries, regarding probability of survival estimation in major trauma patients. The German (RISC II), United Kingdom (PS Model 14) trauma registries scores are based of the largest...
The hemorrhage is the cause of deaths in multiple trauma, through coagulopathy or surgical bleedi... more The hemorrhage is the cause of deaths in multiple trauma, through coagulopathy or surgical bleeding. Rapid diagnosis of posttraumatic coagulopathy can be obtained by ROTEM ® Sigma. Trauma pts with similar injury severity score (ISS) may have different association of lesions with distinct coagulation profiles, therefore different therapeutic approach. The aim of this study is to prove the efficacy of thrombelastrometry in diagnosis and treatment of coagulation disorder. A prospective, observational, unicentric study, including 112 critically care patients with multiple trauma, during 2 years. The study was approved by the ethics committees and written informed consent was obtained. The coagulation was monitored at 7/12/24 h through classical lab tests and point-of-care parameters. 112 patients included, mean age 45.5 ± 5.1 y, mean ISS of 36.4 ± 4.4 p. 69 patients (61.60%) had hemorrhage shock. 55.07% of these were diagnosed with posttraumatic coagulopathy in the first 12 h and 15.94% developed hyperfibrinolysis in the first 7 h. There were evidence of a hypocoagulation trend in patients with ISS > 35 in the first 12 h. 50% of polytrauma with associated burn lesions had hypercoagulation state in the first 24 h, even at an ISS > 35. ROTEM ® Sigma is a reliable method of differential diagnosis in the posttraumatic coagulopathy, identifying also hyperfibrinolysis. Trauma patients, especially with burned lesions can have hyperor hypocoagulation trend and a rapid diagnosis is necessary for treatment.
Magnetic Resonance (MR) is an important imaging instrument for intracranial tumor treatment becau... more Magnetic Resonance (MR) is an important imaging instrument for intracranial tumor treatment because it provides ability to visualize brain tumors. It ensures to detect the location of a tumor and quantify its volume, thus aids the planning of a treatment. Tumor detection is often performed by a radiologist and tumor volume calculation is often done manually and may not be precise enough for surgical operations. It should be noted that because of varying signal intensities on different type of MR images, tumor detection by naked eye might be challenging. This study presents an automatic method for brain tumor segmentation on MR images using morphological operations on MATLAB platform. We developed a script that is capable of automatically detecting and segmenting tumor masses and calculating their areas using morphological operations and enables visualization of tumor volume by coloring it. In this study, T2-weighted MR images of two patients diagnosed with intracranial lesions were examined. The developed script was able to successfully detect the tumors and estimate their areas. The process and results will be discussed in poster presentation.
Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European ... more Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of ...
Particularitãåi tehnice în disecåia laparoscopicã a colecistului la pacienåii cu ficat colestatic... more Particularitãåi tehnice în disecåia laparoscopicã a colecistului la pacienåii cu ficat colestatic Obiectiv: Scopul acestui studiu este de a rezuma cunoaetinåele actuale privind colecistectomia laparoscopicã la pacientii cu colestazã Metodã: Analizã sistematicã a literaturii de specialitate pânã în luna martie 2015, cautarea electronicã în bazele de date PubMed/Medline, Web of Science, aei Science direct, a termenilor: "cholecistectomy", "laparoscopy", "common bile duct stones". Rezultate: Tratamentul litazei cãii biliare principale (CBP) include colangiopancreatografia endoscopicã retrogradã pre sau postoperatorie (ERCP), explorarea chirurgicalã a CBP (în manierã clasicã sau laparoscopicã) sau colangiografia intraoperatorie (CIO). În prezent, tratamentul pacienåilor cu colecistitã aei litiazã CBP este încã un subiect controversat. Colestaza este un factor predispozant pentru sângerare intraoperatorie aei disecåie dificilã. Concluzie: Colecistectomia laparoscopicã la pacienåii cu boalã colestaticã este fezabilã numai în mâinile unui chirurg experimentat în chirurgia laparoscopicã. Disecåia veziculei biliare trebuie fãcutã aproape de perete colecistic iar litiaza CBP trebuie îndepãrtatã chirurgical sau prin abord endoscopic. De cele mai multe ori, sângerarea intraoperatorie reprezintã elementul de dificultate al acestor intervenåii chirurgicale.
Sângerare masivã intraoperatorie dupã rezecåie abdominoperinealã asistatã laparoscopic: prezentar... more Sângerare masivã intraoperatorie dupã rezecåie abdominoperinealã asistatã laparoscopic: prezentare de caz aei revizia sistematicã a literaturii Introducere: Rezecåia abdominoperinealã asistatã laparoscopic s-a dovedit a fi asociatã cu o perioadã mai scurtã a recuperãrii postoperatorii, cu rezultate oncologice echivalente aei o supravieåuire similarã chirurgiei deschise, pentru pacienåii cu neoplasm de rect inferior. Metodã: Prezentare de caz, a unei hemoragii masive intraoperatorii în timpul unei rezecåii abdominoperineale asistatã laparoscopic, aei review-ul sistematic al literaturii de specialitate, utilizând bazele de date PubMed/MedLine, ISI Thomson, OVID aei EMBASE. Rezultate: Pacient în vârstã de 58 de ani, internat în condiåii de urgenåã pentru rectoragii. Tactul rectal a evidenåiat o formaåiune tumoralã protruzivã, friabilã, localizatã la 2 cm de linia anocuanatã. Colonoscopia a relevat o formaåiune tumoralã protruzivã, infiltrativã, la 2 cm de orificiul anal, cu extensie cranialã de 5 cm, fãrã alte leziuni asociate intraluminale colonice. Computer Tomagrafia a evidenåiat o îngroaeare a peretelui rectal de 4,5 cm, fãrã invazia mezorectului sau metastaze ganglionare. Pacientul este transportat în sala de operaåie, unde se efectueazã rezecåia abdominoperinealã asistatã laparoscopic. În timpul hemostazei realizatã la finalul intervenåiei chirurgicale, se produce o sângerare masivã de la nivelul plexului venos presacrat, cu impact hemodinamic major. Aceastã sângerare nu a putut fi controlatã laparoscopic, fiind necesarã conversia la laparotomie, cu meaeaj pelvin. Dupã 48 de ore se realizeazã demeaearea pelvinã, fãrã a se vizualiza semne de reluarea a sângerãrii. S-au aplicat agenåi hemostatici locali aei s-a suturat plaga perinealã. Evoluåia postoperatorie a fost favorabilã. Concluzii: Pentru a preveni mortalitatea aei morbiditatea semnificativã secundarã unei sângerãri de la nivelul plexului venos presacrat este necesar controlul rapid aei eficient al acesteia. Packing-ul pelvin rãmâne o metodã salvatoare de viaåã, la care trebuie apelat în cazurile severe.
Major abdominal trauma, both blunt and penetrating, is commonly seen nowadays, being particularly... more Major abdominal trauma, both blunt and penetrating, is commonly seen nowadays, being particularly difficult to manage due to the frequent altered mental status of the patients and severity of associated injuries. The review article aims to make an uptodate study of the current strategies for therapeutic approach of abdominal injuries in polytrauma setting. Review of the medical literature is up to 2015, by using the PubMed/Medline, Science Direct, Cochrane Library and Web of Science databases. We have used different combinations of the keywords of "abdominal trauma", "liver", "spleen", "renal", to review the reference list of retrieved articles for further relevant studies. Nowadays, we are facing a major change in abdominal trauma therapeutic approach, due to the continuous extending indications and very high successful rate of selective nonoperative management, completed or not with minimally invasive techniques like angiography and angiographic embolization. New imaging methods offer a high-quality characterization of solid organ injuries, being a secure support for decision algorithm in polytrauma patients. After a continuous decrease in number of laparotomies for trauma, new techniques should be developed for maintaining and developing the trauma surgeons' skills. According to the current standards, for a low morbidity and mortality, the trauma patients may be approached by a multidisciplinary and experienced trauma team. Even if nonoperative management is continuously expanding, this may be applied only by a trained and skillful trauma surgeon, who is able to perform difficult surgical techniques at any moments.
PERITONEAL ADHESIONS DOES NOT REPRESENT A CONTRAINDICATION FOR MINIMALLY INVASIVE APPROACH IN GYN... more PERITONEAL ADHESIONS DOES NOT REPRESENT A CONTRAINDICATION FOR MINIMALLY INVASIVE APPROACH IN GYNECOLOGICAL EMERGENCIES (Abstract): The laparoscopic approach offers many diagnostic and terapheutic advantages in emergency setting for gynecological pathologies. In patients with previous abdominal surgeries laparoscopic approach can be very challenging. To define of peritoneal adhesions due to previous abdominal surgeries increase the morbidity and mortality of minimally invasive approach in gynecologic emergencies. Retrospective study of patients admitted in Emergency Hospital of Bucharest between during 24 months. Selection criteria were: (1) acute abdominal pain of suspected gynecologic origin, (2) laparoscopic approach. For statistical analysis the patients were divided into two groups: PAS – patients with previous abdominal surgery and WPAS – without previous abdominal surgery. There were 29 patients with mean age of 27.7±6 years. 12 (41.4%) have had previous abdominal surgeries (...
Traumatic lesions of the rectum, perineum and anus are rare but difficult to treat, requiring exp... more Traumatic lesions of the rectum, perineum and anus are rare but difficult to treat, requiring experience in terms of trauma and colorectal surgery. Case report and electronic search of the
Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more inc... more Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more increased severity, secondary to urban violence and traffic related accidents. We aim to better define the prognostic value of post-traumatic hemoperitoneum (PTH) in the nowadays era of nonoperative management of abdominal lesions, and to correlate it with the current pattern of traumatic injuries. Retrospective study of patients admitted during 24 months. Selections criteria: (1) Traumatic injury; (2) Free peritoneal fluid on preoperative imaging; (3) Surgical exploration of the abdomen. Setting: A level I trauma center. Results: There were 64 patients, with two peak frequencies between 18-35 and 50-70 years old. Abdominal wall ecchymoses were found in 36 (55%) of cases. Out of 64 cases 37 (58.7%) were transportation related, 12 (19%) caused by human aggression and 10 (16.9%) by falls. According to the Trauma Score (TS) there were 50 (78.2%) cases with TS between 14-16, 9 (17.2%) between 1...
Although rarely, due to the high variability of the possible tissues encountered in it’s wall, th... more Although rarely, due to the high variability of the possible tissues encountered in it’s wall, the Meckel’s diverticula can represent a site for tumor development in 0,5-3,2% cases. Data in the literature shows that the most common malignancy at this level is represented by neuroendocrine tumors (NET) the observed incidence of neurendocrine tumors and other primary neoplasia, varies between 12-55%. Moreover, the gastro-intestinal tract was the second primary tumor bearer encountered.
Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we a... more Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we are facing little evidence regarding the elderly patients. The purpose of this study is to define the benefits in terms of early outcome for laparoscopic cholecystectomy in patients over 70 years old and to compare them with the open cholecystectomy through a retrospective study of patients that underwent a cholecystectomy during 12 months in the Emergency Hospital of Bucharest, Romania. Out of 49 patients, 20 had a laparoscopic cholecystectomy (LC) and 29 an open approach (OC). The mean age was 74,6 ± 4,2 (LC) vs. 77,2 ± 5,4 (OC) (P>0.05). There were 7 (33,3%) (LC) vs. 2 (7,1%) (OC) catarrhal cholecystitis, 13 (62%) (LC) vs. 9 (32,1%) (OC) phlegmonous cholecystitis, and 1 (4,8%) (LC) vs. 17 (60,7%) (OC) gangrenous cholecystitis (P=0.001, Cramer’s V=0,590). The median operative time was 90 (LC) vs. 60 (OC) minutes (P=0.001). There were no differences regarding the ASA risk scale (P=0,2...
Recent progress in medical imaging allowed higher accuracy in diagnosis of acute diverticulitis. ... more Recent progress in medical imaging allowed higher accuracy in diagnosis of acute diverticulitis. Contrast enhanced Computed Tomography (CT) has a high sensitivity and specificity, reaching a diagnostic accuracy over 95%. Although abdominal X-ray and ultrasonography are still used, their utility is limited in this pathology. Retrospective study including patients admitted for acute diverticulitis in the Surgery Clinic of Bucharest Clinical Emergency Hospital between January 2012 and July 2014. From the total number of 29508 admissions, 156 patients were diagnosed with acute diverticulitis staged Hinchey I to IV. The imagistic investigations on admission were plain abdominal X-ray (128 cases), which identified 6 cases of pneumoperitoneum; abdominal ultrasound (112 cases) which identified colonic wall thickening and/or free peritoneal fluid in 29.4% cases. Contrast enhanced CT was performed in 97 cases, successfully establishing the diagnostic in 80% of cases. The mean waiting time int...
INTRODUCTION Despite the high frequency of thoracic injuries secondary to traffic related acciden... more INTRODUCTION Despite the high frequency of thoracic injuries secondary to traffic related accidents, the blunt cardiac valve rupture is extremely rare. METHOD Case report and review of the literature using PubMed/MEDLINE and EMBASE databases. RESULT A 38 year old female patient, victim of car accident was admitted. On primary survey the patient was conscious, cooperative and hemodynamic and respiratory stable. On secondary survey was found a bilateral open leg fracture and a seat belt sign. Whole body Computed Tomography revealed minimal haemorrhagic contusion of the cortex, left hemopneumothorax and right pneumothorax, bilateral rib fractures, liver contusion, left femoral neck fracture and fracture to the lumbar spinal column. After bilateral pleurostomy, the patient becomes hemodynamically unstable, but with no signs of external bleeding. The transthoracic echocardiography revealed an acute severe tricuspid regurgitation with hepatic veins reflux. After orthopaedic surgeries, the...
INTRODUCTION The pancreatic injuries have fortunately a low frequency, but when present associate... more INTRODUCTION The pancreatic injuries have fortunately a low frequency, but when present associate multiple intraabdominal lesions, and carry a significant morbidity and mortality. The aim of this study is to underline the significant morbidity associated with high grade pancreatic injuries. CASE REPORT Female patient, 36 years old, with penetrating abdominal trauma due to domestic violence was referred to our center from a regional county hospital, after multiple laparotomies, hemodynamically unstable, with multiple organ failure. Abdominal clinical exam revealed evisceration, with massive pancreatic leakage at the level of the median laparotomy and through the stabbing wounds from the right flank. Emergency Computed Tomography showed multiple intraabdominal collections, with laceration of the liver, right kidney and pancreatic head. Abdominal exploration was decided. After a thorough abdominal debridement was revealed a deep laceration of the pancreatic head, with active extravasat...
Introduction. Acute pancreatitis in pregnancy is a rare condition with an approximate incidence o... more Introduction. Acute pancreatitis in pregnancy is a rare condition with an approximate incidence of 1 over 1,000-12,000 pregnant women, but it is associated with increased incidence of maternal and fetal mortality. Can occur during any trimester but over half (52%) occur during the third trimester and rarely during post-partum period. Difficulty in diagnosis and treatment put significantly in danger the maternal and fetal health. The treatment of pancreatitis in pregnancy should be conservative as far as possible with delaying the definitive treatment until after delivery. Case report. We report a case of a 20-year-old woman, at 32 week of gestation who presented with severe pain confined to the upper abdomen and radiating to the back to the upper abdomen. Investigation undertaken led to the diagnosis of acute pancreatitis which was managed conservatively. She recovered within several days and then delivered a healthy baby. Conclusions. Acute pancreatitis is rare in pregnancy, occurring most commonly in the third trimester. Pancreatitis in pregnancy remains a challenging clinical problem to manage, but if treated early, preterm labor can be avoided.
A mixed score to predict the probability of survival has a key role in the modern trauma systems.... more A mixed score to predict the probability of survival has a key role in the modern trauma systems. The aim of the current studies is to summarize the current knowledge about estimation of survival in major trauma patients, in different trauma registries. Systematic review of the literature using electronic search in the PubMed/Medline, Web of Science Core Collection and EBSCO databases. We have used as a MeSH or truncated words a combination of trauma "probability of survival" and "mixed scores". The search strategy in PubMed was: "((((trauma(MeSH Major Topic)) OR injury(Title/Abstract)) AND score (Title/Abstract)) AND survival) AND registry (Title/Abstract))))". We used as a language selection only English language literature. There is no consensus between the major trauma registries, regarding probability of survival estimation in major trauma patients. The German (RISC II), United Kingdom (PS Model 14) trauma registries scores are based of the largest...
The hemorrhage is the cause of deaths in multiple trauma, through coagulopathy or surgical bleedi... more The hemorrhage is the cause of deaths in multiple trauma, through coagulopathy or surgical bleeding. Rapid diagnosis of posttraumatic coagulopathy can be obtained by ROTEM ® Sigma. Trauma pts with similar injury severity score (ISS) may have different association of lesions with distinct coagulation profiles, therefore different therapeutic approach. The aim of this study is to prove the efficacy of thrombelastrometry in diagnosis and treatment of coagulation disorder. A prospective, observational, unicentric study, including 112 critically care patients with multiple trauma, during 2 years. The study was approved by the ethics committees and written informed consent was obtained. The coagulation was monitored at 7/12/24 h through classical lab tests and point-of-care parameters. 112 patients included, mean age 45.5 ± 5.1 y, mean ISS of 36.4 ± 4.4 p. 69 patients (61.60%) had hemorrhage shock. 55.07% of these were diagnosed with posttraumatic coagulopathy in the first 12 h and 15.94% developed hyperfibrinolysis in the first 7 h. There were evidence of a hypocoagulation trend in patients with ISS > 35 in the first 12 h. 50% of polytrauma with associated burn lesions had hypercoagulation state in the first 24 h, even at an ISS > 35. ROTEM ® Sigma is a reliable method of differential diagnosis in the posttraumatic coagulopathy, identifying also hyperfibrinolysis. Trauma patients, especially with burned lesions can have hyperor hypocoagulation trend and a rapid diagnosis is necessary for treatment.
Magnetic Resonance (MR) is an important imaging instrument for intracranial tumor treatment becau... more Magnetic Resonance (MR) is an important imaging instrument for intracranial tumor treatment because it provides ability to visualize brain tumors. It ensures to detect the location of a tumor and quantify its volume, thus aids the planning of a treatment. Tumor detection is often performed by a radiologist and tumor volume calculation is often done manually and may not be precise enough for surgical operations. It should be noted that because of varying signal intensities on different type of MR images, tumor detection by naked eye might be challenging. This study presents an automatic method for brain tumor segmentation on MR images using morphological operations on MATLAB platform. We developed a script that is capable of automatically detecting and segmenting tumor masses and calculating their areas using morphological operations and enables visualization of tumor volume by coloring it. In this study, T2-weighted MR images of two patients diagnosed with intracranial lesions were examined. The developed script was able to successfully detect the tumors and estimate their areas. The process and results will be discussed in poster presentation.
Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European ... more Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of ...
Particularitãåi tehnice în disecåia laparoscopicã a colecistului la pacienåii cu ficat colestatic... more Particularitãåi tehnice în disecåia laparoscopicã a colecistului la pacienåii cu ficat colestatic Obiectiv: Scopul acestui studiu este de a rezuma cunoaetinåele actuale privind colecistectomia laparoscopicã la pacientii cu colestazã Metodã: Analizã sistematicã a literaturii de specialitate pânã în luna martie 2015, cautarea electronicã în bazele de date PubMed/Medline, Web of Science, aei Science direct, a termenilor: "cholecistectomy", "laparoscopy", "common bile duct stones". Rezultate: Tratamentul litazei cãii biliare principale (CBP) include colangiopancreatografia endoscopicã retrogradã pre sau postoperatorie (ERCP), explorarea chirurgicalã a CBP (în manierã clasicã sau laparoscopicã) sau colangiografia intraoperatorie (CIO). În prezent, tratamentul pacienåilor cu colecistitã aei litiazã CBP este încã un subiect controversat. Colestaza este un factor predispozant pentru sângerare intraoperatorie aei disecåie dificilã. Concluzie: Colecistectomia laparoscopicã la pacienåii cu boalã colestaticã este fezabilã numai în mâinile unui chirurg experimentat în chirurgia laparoscopicã. Disecåia veziculei biliare trebuie fãcutã aproape de perete colecistic iar litiaza CBP trebuie îndepãrtatã chirurgical sau prin abord endoscopic. De cele mai multe ori, sângerarea intraoperatorie reprezintã elementul de dificultate al acestor intervenåii chirurgicale.
Sângerare masivã intraoperatorie dupã rezecåie abdominoperinealã asistatã laparoscopic: prezentar... more Sângerare masivã intraoperatorie dupã rezecåie abdominoperinealã asistatã laparoscopic: prezentare de caz aei revizia sistematicã a literaturii Introducere: Rezecåia abdominoperinealã asistatã laparoscopic s-a dovedit a fi asociatã cu o perioadã mai scurtã a recuperãrii postoperatorii, cu rezultate oncologice echivalente aei o supravieåuire similarã chirurgiei deschise, pentru pacienåii cu neoplasm de rect inferior. Metodã: Prezentare de caz, a unei hemoragii masive intraoperatorii în timpul unei rezecåii abdominoperineale asistatã laparoscopic, aei review-ul sistematic al literaturii de specialitate, utilizând bazele de date PubMed/MedLine, ISI Thomson, OVID aei EMBASE. Rezultate: Pacient în vârstã de 58 de ani, internat în condiåii de urgenåã pentru rectoragii. Tactul rectal a evidenåiat o formaåiune tumoralã protruzivã, friabilã, localizatã la 2 cm de linia anocuanatã. Colonoscopia a relevat o formaåiune tumoralã protruzivã, infiltrativã, la 2 cm de orificiul anal, cu extensie cranialã de 5 cm, fãrã alte leziuni asociate intraluminale colonice. Computer Tomagrafia a evidenåiat o îngroaeare a peretelui rectal de 4,5 cm, fãrã invazia mezorectului sau metastaze ganglionare. Pacientul este transportat în sala de operaåie, unde se efectueazã rezecåia abdominoperinealã asistatã laparoscopic. În timpul hemostazei realizatã la finalul intervenåiei chirurgicale, se produce o sângerare masivã de la nivelul plexului venos presacrat, cu impact hemodinamic major. Aceastã sângerare nu a putut fi controlatã laparoscopic, fiind necesarã conversia la laparotomie, cu meaeaj pelvin. Dupã 48 de ore se realizeazã demeaearea pelvinã, fãrã a se vizualiza semne de reluarea a sângerãrii. S-au aplicat agenåi hemostatici locali aei s-a suturat plaga perinealã. Evoluåia postoperatorie a fost favorabilã. Concluzii: Pentru a preveni mortalitatea aei morbiditatea semnificativã secundarã unei sângerãri de la nivelul plexului venos presacrat este necesar controlul rapid aei eficient al acesteia. Packing-ul pelvin rãmâne o metodã salvatoare de viaåã, la care trebuie apelat în cazurile severe.
Major abdominal trauma, both blunt and penetrating, is commonly seen nowadays, being particularly... more Major abdominal trauma, both blunt and penetrating, is commonly seen nowadays, being particularly difficult to manage due to the frequent altered mental status of the patients and severity of associated injuries. The review article aims to make an uptodate study of the current strategies for therapeutic approach of abdominal injuries in polytrauma setting. Review of the medical literature is up to 2015, by using the PubMed/Medline, Science Direct, Cochrane Library and Web of Science databases. We have used different combinations of the keywords of "abdominal trauma", "liver", "spleen", "renal", to review the reference list of retrieved articles for further relevant studies. Nowadays, we are facing a major change in abdominal trauma therapeutic approach, due to the continuous extending indications and very high successful rate of selective nonoperative management, completed or not with minimally invasive techniques like angiography and angiographic embolization. New imaging methods offer a high-quality characterization of solid organ injuries, being a secure support for decision algorithm in polytrauma patients. After a continuous decrease in number of laparotomies for trauma, new techniques should be developed for maintaining and developing the trauma surgeons' skills. According to the current standards, for a low morbidity and mortality, the trauma patients may be approached by a multidisciplinary and experienced trauma team. Even if nonoperative management is continuously expanding, this may be applied only by a trained and skillful trauma surgeon, who is able to perform difficult surgical techniques at any moments.
PERITONEAL ADHESIONS DOES NOT REPRESENT A CONTRAINDICATION FOR MINIMALLY INVASIVE APPROACH IN GYN... more PERITONEAL ADHESIONS DOES NOT REPRESENT A CONTRAINDICATION FOR MINIMALLY INVASIVE APPROACH IN GYNECOLOGICAL EMERGENCIES (Abstract): The laparoscopic approach offers many diagnostic and terapheutic advantages in emergency setting for gynecological pathologies. In patients with previous abdominal surgeries laparoscopic approach can be very challenging. To define of peritoneal adhesions due to previous abdominal surgeries increase the morbidity and mortality of minimally invasive approach in gynecologic emergencies. Retrospective study of patients admitted in Emergency Hospital of Bucharest between during 24 months. Selection criteria were: (1) acute abdominal pain of suspected gynecologic origin, (2) laparoscopic approach. For statistical analysis the patients were divided into two groups: PAS – patients with previous abdominal surgery and WPAS – without previous abdominal surgery. There were 29 patients with mean age of 27.7±6 years. 12 (41.4%) have had previous abdominal surgeries (...
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