Criteria for the definition and classification of complex post-incision hernias Dr. Roxana-Florina Ristea 1 , dr. nicoleta-aurelia sanda 2 , Conf. Dr. Daniel Ion 1,3 , prof. dr. radu şerban palade 3
Introduction. Complex incisional hernias are a surgical challenge and a current socio-economic problem. In the emergency surgery of this pathology, the surgeon faces the need to obtain a "tension-free" hernia repair being limited in the use of parietal prosthesis due to the frequent needs of opening the gastrointestinal tract and thus contamination of the operating field. Purpose. The aim of this study is to evaluate and adapt emergency surgical treatment in order to reduce the risk of postoperative complications. Material and methods. The present study has a retrospective character and evaluates a group of 390 patients with complex incisional hernias admitted and operated in the General and Emergency Surgery III section of the Bucharest University Emergency Hospital during 2008-2018. Results. We identified 390 patients diagnosed with complex incisional hernias, of whom 95 were presented to the hospital as an emergency.The prosthetic hernioraphy was used in 51 of these patients, and complications were found in 18 patients in the total study group, ranging from wound infection to death. Discussions. The occurrence of postoperative complications was not statistically significantly associated with emergency surgical treatment. Instead, vital complications were much more common in this group. Conclusions. Increasing the degree of information and education of the patient, increasing addressability and avoiding emergency operations for this pathology are long-term objectives in the treatment of complex incisional hernia pathology.
Bifidobacterium spp. are non-sporulating Gram-positive anaerobic bacilli that can grow also in microaerophilic conditions and are constituting part of normal enteral flora, playing a complex role in the maintenance of the health state of the human organism. However, in recent times, the literature has reported that in certain conditions (advanced age, immunodeficiency status, co-morbidities etc), commensal Bifidobacterium strains can turn into pathogens, being implicated in different infectious processes (pancreatitis, peritonitis, neonatal meningitis, aspiration pneumonia), sometimes with severe, life-threatening evolution. In the present study, there are reported five severe clinical cases of abdominal surgical emergencies, in which the Bifidobacterium strains were isolated as the unique etiological infectious agents, exhibiting at the same time, a large profile of virulence factors and high resistance to second generation cephalosporins, meropenem and ertapenem. All five strains exhibited susceptibility to imipenem, amoxicillin plus clavulanic acid, piperacillin plus tazobactam and ticarcillin plus clavulanic acid.
We present a case of severe hypertriglyceridemia-induced acute pancreatitis associated withdiabetic ketoacidosis, managed in the intensive care unit. The patient was a 39-year-old woman, with amedical history of Graves-Basedow disease, essential arterial hypertension and morbid obesity(body mass index=31). Firstly, we aggressively corrected hypovolemia and hemodynamicimbalances (administrating fluids and systemic anticoagulant) and then we focused on the infectionprevention and control of intra-abodminal pressure, for the latter outcome. We decided to start the firstsession of plasma exchange. The patient responded well to the treatment applied. Plasma-exchangewas very efficient, reducing TG levels by 60% after the first treatment and achieving a decrease of77.6% at the third plasmapheresis session. This case was safely and effectively managed withplasmapheresis (three sessions), antibiotics, multimodal analgesia (intravenous and thoracicepidural catheter), early jejunal nutrition and forced mobilization. The patient's evolution wassignificantly favorable, with a reduction of the peripancreatic necrosis on computer scan, at day 28and she was discharged with a normal value of TG and without pain or any clinical signs.
Colorectal cancer is one of the most commonly incriminated neoplastic pathologies and it has afairly high mortality rate. Although the therapeutic arsenal of rectal cancer has steadily improvedthrough the acquisition of biology, technology and pharmacology, the central role of surgicaltechnique is widely recognized in obtaining local control, on the one hand and a good quality of lifeof operated patient on the other hand. This article is a retrospective analysis of surgical proceduresfor rectal neoplasia conducted in order to determine to what extent technological development andcontinuous improvement of surgical techniques have influenced the evolution of patientmanagement with this pathology. This study was retrospective, observational, descriptive, single-center and it was held in the Department of General Surgery and Emergency III of the UniversityEmergency Hospital Bucharest during 1 January 2007 - March 31, 2016 and included a total of127 patients.
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