Traumás asphyxia maradandó látásvesztéssel | Traumatic asphyxia with permanent visual loss. Case report

Absztrakt: A traumás asphyxia egy olyan ritka állapot, amely kompressziós mellkasi-hasi trauma után következik be. Cervicofacialis cyanosissal, oedemával, petechiákkal és kötőhártya-bevérzéssel jelentkezik. Súlyos, életveszélyes mellkasi és hasi sérülésekkel is társulhat. Az esetek többségében konzervatív kezelést követően a felépülés teljes, de ritkán maradandó idegrendszeri elváltozások léphetnek fel. Egy 39 éves férfi beteg esetét mutatjuk be, aki kompressziós mellkasi-hasi sérülést szenvedett. A traumát követően a jellegzetes „ecchymosisos maszk” alakult ki. A hasi sérülések sebészi ellátása és az intenzív terápia után a beteg maradandó látásvesztéssel hagyta el a kórházat. A fej-nyak szintjén kialakuló retrográd vénás nyomás növekedése idegsejt-ischaemiával társulhat, amely maradandó látóideg-sorvadást idézhet elő. Ezért fontos, a szupportív terápia mellett, a rutinszerű, korai és teljes szemészeti vizsgálat, különösen az intubált, illetve nehezen kooperáló betegeknél. Orv Hetil. 2017; 158(22): 864–868. | Abstract: Traumatic asphyxia is a rare condition that occurs after compressive thoracoabdominal trauma, which is characterized by subconjunctival hemorrhage, cervicofacial cyanosis, edema and petechiae. Serious life-threatening thoracic and abdominal injuries may coexist. After conservatory treatment in most cases complete recovery is achieved, but in isolated cases permanent neurological lesions may occur. We present the case of the 39-year-old male patient who suffered a compressive thoracoabdominal trauma. The physical examination showed the characteristic “ecchymotic mask”. After surgical treatment of the abdominal injuries and intensive therapy the patient was discharged with permanent vision loss. The high retrograde venous pressure in the head and neck may be associated with neuronal ischemia, which can lead to irreversible optic nerve atrophy. It is therefore important to carry out an early, routine and complete ophtalmologic examination, especially in the intubated and poorly cooperative patients. Orv Hetil. 2017; 158(22): 864–868

Epehólyag-agenesia. Epekövességet utánzó ritka rendellenesség egy felnőtt nőben = Gallbladder agenesis – A rare congenital anomaly mimicking cholelithiasis in an adult woman

Absztrakt: Az epehólyag-agenesia ritka, a biliaris rendszer embriológiai hibája miatt kialakult veleszületett elváltozás. Az esetek többségében tünetmentes, más esetekben az epekólika tüneteit utánozza. Betegünk 72 éves kaukázusi nő. Anamnézisében magasvérnyomás-betegség, illetve magas koleszterinszint szerepelt, melyekre vérnyomáscsökkentő, illetve koleszterinszint-csökkentő kezelést kapott. Felvételére az epekólika tüneteinek megjelenése miatt került sor. Laparoszkópos műtéten esett át, mely alátámasztotta a végleges diagnózist. E ritka eset kapcsán bemutatjuk megközelítésünket, valamint az orvosi szakirodalom rövid áttekintését. A sebésznek intraoperatívan el kell döntenie, hogy egy lehetséges ectopiás epehólyagot keres, vagy tovább vizsgálja az esetet képalkotó eljárások segítségével. Az epehólyag-agenesia ritka állapot, mellyel a sebésznek számolnia kell. Azokban az esetekben, amikor az epekövesség tünetei nem meggyőzőek, a műtét elkerülése végett a legjobb kiegészítő képalkotó eljárás a mágnesesrezonancia-kolangiopankreatográfia. Orv Hetil. 2019; 160(38): 1510–1513. | Abstract: Gallbladder agenesis is a rare congenital malformation due to an embryological defect of the biliary system. In most cases it is asymptomatic, but it can also mimic biliary colic. We report the case of a 72-year-old Caucasian woman with a medical history of cardiovascular disease and hypercholesterolemia, under cholesterol-lowering and hypotensive treatment, who presented symptoms suggesting biliary colic. She underwent laparoscopic surgery that confirmed the final diagnosis. We present our approach in this rare case as well as a brief review of medical literature. The surgeon should decide intraoperatively whether to continue and search for a possible ectopic gallbladder or investigate further with imaging studies. Gallbladder agenesis is a rare condition that the surgeon must be aware of. In the cases of inconclusive or indirect signs of cholelithiasis, the best approach is complementary imaging investigations such as magnetic resonance cholangiopancreatography in order to avoid surgery. Orv Hetil. 2019; 160(38): 1510–1513

Controlled hydrodynamic conditions on the formation of iron oxide nanostructures synthesized by electrochemical anodization: Effect of the electrode rotation speed

Iron oxide nanostructures are of particular interest because they can be used as photocatalysts in water splitting due to their advantageous properties. Electrochemical anodization is one of the best techniques to synthesize nanostructures directly on the metal substrate (direct back contact). In the present study, a novel methodology consisting of the anodization of iron under hydrodynamic conditions is carried out in order to obtain mainly hematite (α-Fe2O3) nanostructures to be used as photocatalysts for photoelectrochemical water splitting applications. Different rotation speeds were studied with the aim of evaluating the obtained nanostructures and determining the most attractive operational conditions. The synthesized nanostructures were characterized by means of Raman spectroscopy, Field Emission Scanning Electron Microscopy, photoelectrochemical water splitting, stability against photocorrosion tests, Mott-Schottky analysis, Electrochemical Impedance Spectroscopy (EIS) and band gap measurements. The results showed that the highest photocurrent densities for photoelectrochemical water splitting were achieved for the nanostructure synthesized at 1000 rpm which corresponds to a nanotubular structure reaching ∼0.130 mA cm−2 at 0.54 V (vs. Ag/AgCl). This is in agreement with the EIS measurements and Mott-Schottky analysis which showed the lowest resistances and the corresponding donor density values, respectively, for the nanostructure anodized at 1000 rpm

Perioperative Risk Stratification: A Need for an Improved Assessment in Surgery and Anesthesia—A Pilot Study

Background and Objectives: Numerous scoring systems have been introduced into modern medicine. None of the scoring systems assessed both anesthetic and surgical risk of the patient, predict the morbidity, mortality, or the need for postoperative intensive care unit admission. The aim of this study was to compare the anesthetic and surgical scores currently used, for a better evaluation of perioperative risks, morbidity, and mortality. Material and Methods: This is a pilot, prospective, observational study. We enrolled 50 patients scheduled for elective surgery. Anesthetic and surgery risk was assessed using American Society of Anesthesiologists (ASA) scale, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Acute Physiology and Chronic Health Evaluation (APACHE II), and Surgical APGAR Score (SAS) scores. The real and the estimated length of stay (LOS) were registered. Results: We obtained several statistically significant positive correlations: ASA score–P-POSSUM (p < 0.01, r = 0.465); ASA score–SAS, (p < 0.01, r = −0.446); ASA score–APACHE II, (p < 0.01 r = 0.519); predicted LOS and ASA score (p < 0.01, r = 0.676); predicted LOS and p-POSSUM (p < 0.01, r = 0.433); and predicted LOS and APACHE II (p < 0.01, r = 0.454). A significant negative correlation between predicted LOS, real LOS, ASA class, and SAS (p < 0.05) was observed. We found a statistically significant difference between the predicted and actual LOS (p < 001). Conclusions: Anesthetic, surgical, and severity scores, used together, provide clearer information about mortality, morbidity, and LOS. ASA scale, associated with surgical scores and severity scores, presents a better image of the patient’s progress in the perioperative period. In our study, APACHE II is the best predictor of mortality, followed by P-POSSUM and SAS. P-POSSUM score and ASA scale may be complementary in terms of preoperative physiological factors, providing valuable information for postoperative outcomes

MANAGEMENTUL PROTEZELOR VASCULARE INFECTATE

Introduction: Despite routine antibiotic prophylaxis and refinements in implantation technique, microbial infection of the vascular prostehesis can occur. Infection involving a vascular graft is difficult to eradicate. If not recognized or treated promptly, implant failure will occur by producing sepsis, hemorrhage or thrombosis. Management involves graft excision alone, graft preservation within the implant wound, in/situ graft replacement, or graft  excision in conjunction with extra-anatomic bypass grafting. Matherial and method: We retrospectively analysed the operative registers of our clinic as well as the regular archives, from 2000 until 2008, searching for reported graft infections which needed excisions and extraanatomical bypasses or for conservative therapy. There were  50 patients in this interval admitted and treated in Surgical Clinic No.1, out of a total of  950 vascular interventions. 10 of them were early graft infections(4 months).Using Szilagyi’s classification, 10 were grade I, 17 were grade II and 23 grade III.We followed antibiotic prophylaxis protocols in all of the cases, prior to first vascular intervention. Staphylococcus aureus was the most prevalent pathogen ( 95% ) found affecting our grafts. Results: We performed 20 graft excisions for infrainguinal graft infections, with the removal of the entire graft, radical debridement of infected perigraft tissues, closure of the arteriotomies with monofilament suture and the administration of systemic and topical antibiotics. We attempted graft preservation in 5 cases of infrainguinal prosthetic bypass graft infection( with serial surgical wound debridement, coupled with antibiotic therapy, early muscle flap coverage and repeated wound cultures to identify any development of bacterial resistance or change in the microbial flora). We used the staged approach in 20 cases, beginning with drainage of the perigraft abscess, followed in 2 or 3 days by graft excision and autogenous vein grafting. We performed none in-situ replacements with Rifampin-bonded prosthesis, partly because they were not  available until a few years. For the patients with  infection localized to only a portion of an aortofemoral graft, we preferred, for the decreased morbidity, the excision of the infected portion of the graft(partial graft excision) and after solving the inguinal infection, a staged extra-anatomical bypass- in     cases.As for the gold standard regarding the aortic graft- total graft excision and ex-situ bypass, we only performed 5 of them. 3 patients died and 2 required major amputation. Conclusions: Dissatisfaction with the morbidity and the mortality of treating vascular graft infections, regardless of location, by total graft excision and remote bypass has been the impulse for the expanded application of lately performed in-situ bypasses or even for the prophylactic use of antibiotic-bonded grafts, in carefully selected cases.Introducere: In ciuda antibioprofilaxiei de rutina si a rafinarii tehnicilor de implantare, infectiile protezelor vasculare pot totusi surveni si constitui o patologie extrem de complexa si periculoasa, fiind greu de eradicat si producand esecul grafturilor prin sepsis, hemoragie sau tromboza. Tratamentul necesita justa evaluare a unor criterii specifice si individualizarea asocierii mijloacelor din arsenalul terapeutic, reprezentate de: simpla excizie a graftului, excizia in conjunctie cu revascularizatie extra-anatomica, prezervarea graftului sau excizie cu revascularizatie in-situ. Material si metoda: S-a analizat retrospectiv registrele operatorii si celelalte registre ale Clinicii Chirurgie I din cadrul Spitalului Clinic Judetean de urgenta Titgu Mures, din 2000 pana in 2008. Am inclus un numar de 50 de pacienti cu infectii depistate de graft arterial, din totalul de 950 de interventii vasculare. Conform clasificarii Syilagyi, 10  au fost infectii de grad I,17 de grad II si 23 de grad III. Alte 10 au fost infectii precoce si 40 tardive. La revascularizatia primara am folosit la toate cazurile protocoale de antibioprofilaxie. Majoritatea infectiilor (95%) au fost cu Stafilococ auriu, dar a crescut in ultimul timp proportia cazurilor infectate cu germeni gram-negativi si multirezistentí (MRSA). Rezultate: Au fost efectuate 20 de excizii de graft pentru infectii infrainghinale, cu indepartarea intregului graft, debridari radicale ale tesuturilor perigraft, inchiderea arteriotomiilor si asocierea de antibioterapie sistemica si topica. A fost realizata prezervarea graftului la 5 cazuri (cuplata cu antibioterapie si acoperire cu pedicul muscular). A fost  folosita tactica seriata la 20 de cazuri, cu drenarea initiala a abcesului perigraft, urmata dupa 2-3 zile de excizie si graftare autologa. Nu a fost facuta nici o inlocuire in-situ cu proteza impregnata cu Rifampicina. Pentru pacientii cu infectie a unui by-pass aorto-femural localizata doar la nivelul triunghiului Scarpa, s-a preferat excizia partiala, iar dupa vindecarea procesului la acest nivel, o revascularizatie extra-anatomica. A fost  extrasa total proteza aortica doar la 5 pacienti, dintre care 3 au murit, iar ceilalti 2 au necesitat o amputatie majora. Concluzii: Insatisfactia morbiditatii si mortalitatii mari prin aplicarea  metodelor de excizie totala a fost impulsul necesar pentru cautarea unor noi solutii terapeutice pentru problema infectiei protezelor vasculare. Viitorul este reprezentat de materialele revolutionare impregnate cu antibiotice, folosite chiar profilactic, la prima revascularizatie, in cazuri selectate

Previously undiagnosed serotonin toxicity: from pre-anaesthetic assessment to postoperative management – a case report

Serotonin syndrome (SS), also known as serotonin toxicity, is a life-threatening condition induced by certain drugs that affect serotonin metabolism. We report a case of SS, induced by a combination of three drugs encountered in a patient with a previously suspected allergy to metoclopramide and pitofenone discovered as an "anaesthetic incident”. In the immediate postoperative period, following the administration of antiemetic and analgesic treatment, the patient presented generalized myoclonus and intense abdominal pain. The diagnosis of SS was established using the Hunter Criteria. After the discontinuation of potentially triggering medication and anticonvulsant therapy, the patient was discharged from the ICU with complete resolution within six days. Given the increased use in clinical practice of drugs that may interfere with serotonin metabolism, the rising prevalence of mental health and the increasing use of illicit drugs, it is essential for anaesthetists to be aware of the potential for SS occurrence. Continue..

Urban Development and the (Re)use of the Communist-Built Industrial and Agricultural Sites after 1990. The Showcase of Bucharest–Ilfov Development Region

Urban development and changing the patterns of industry and agriculture had caused the foremost spatial and functional transformations of the post-communist period in Romania. These changes have resulted in increased land consumption, often including the reuse of abandoned or non-residential built-up areas (e.g., industrial, agricultural). By integrating spatial and statistical data, the current analysis has revealed as key features: spatial shrinkage, fragmentation, functional diversification, tertiarization and change of patterns. Using a functional change matrix, five main (re)use types have been identified and quantified: maintenance, conversion, replacement, abandonment, and demolition. Overall, between 1990 and 2018, over 50% functional losses have been recorded