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

Aorto-mesenteric Bypass for the Treatment of Chronic Mesenteric Ischemia

Chronic mesenteric artery disease has a much lower incidence than the acute one, but it raises the same problems in terms of patient survival. The long-term outcomes for open surgery are crucial for the right choice of a particular technique. We present the case of a 39-year-old female patient with a history of total nephrectomy, chronic kidney failure, and hypertension, who presented in the Emergency Department with abdominal pain with high intensity, for which she was admitted to the General Surgery Department. Abdominal computed tomography angiography was performed, which indicated the diagnosis of partial upper mesenteric artery stenosis. The patient underwent surgery, during which a retrograde aorto-mesenteric bypass with a Gore-Tex 5 mm diameter prosthesis was performed. In situations where the endovascular approach fails or has no indication (multiple incidence lesions from the origin of the superior mesenteric artery), open surgery is the indication in chronic mesenteric ischemia

The First Record of Marenzelleria neglecta and the Spread of Laonome xeprovala in the Danube Delta–Black Sea Ecosystem

Biological invasions can have major impacts on freshwater and marine ecosystems. Therefore, it is vital that non-indigenous species are accurately identified and reported when potential or confirmed invasions occur. The present study reports the first occurrence of Marenzelleria neglecta (Annelida, Spionidae) and the spread of Laonome xeprovala (Annelida, Sabellidae) in the Danube Delta–Black Sea ecosystem. Spionidae is one of the most diverse families of annelid worms and is a dominant group in terms of the number of species that have been introduced to non-native areas, while the members of Sabellidae are among the most visible polychaetes commonly found in fouling communities and are colonizing new geographic areas. Based on 20 samples collected in 2021, we provide an overview of the distribution of the investigated species and possible arrival pathways for Marenzelleria neglecta. Specimens were identified based on morphological descriptions. Both species have invasive behaviour, colonizing large areas in relatively short time periods and reaching relatively high densities (M. neglecta—1400 ind.m−2; L. xeprovala—40 ind.m−2). Due to their distribution and high abundances, the biology and ecology of these species in the Danube River–Danube Delta–Black Sea system need to be investigated further in order to assess their impact on ecosystem structure and functioning

A New Species of Free-Living Nematodes (Desmodorida, Desmodoridae) in the Romanian Black Sea Waters

The paper reports the record of Pseudochromadora gomoi sp.n. in circalittoral habitats (at depths of 47–59 m) of the Romanian Black Sea waters. The species is characterized by a unispiral amphidial fovea, the presence of lateral alae stretching from the posterior end of the cardia to the level of the cloacal opening, but also shows unique features found in other Desmodorida genera (i.e., the presence of a precloacal ventral ala in males similar to several Desmodora or Echinodesmodora species and eight subcephalic setae on the head capsule). The presence of a constrictor cuticle ring and orange elongated ducts in the anterior body part as in Pseudodesmodora lacrima, Leduc and Wharton, 2010, were also noted. The morphometric measurements of our species differ from most of the Pseudochromadora species reported in specialty literature. We extracted and counted all desmodorid individuals from 9 meiobenthic samples collected in June 2020, and performed a detailed morphological analysis of 12 individuals (5 females and 7 males) belonging to our species, also highlighting the dissimilarities with the related desmodorid species

A New Species of Free-Living Nematodes (Desmodorida, Desmodoridae) in the Romanian Black Sea Waters

The paper reports the record of Pseudochromadora gomoi sp.n. in circalittoral habitats (at depths of 47–59 m) of the Romanian Black Sea waters. The species is characterized by a unispiral amphidial fovea, the presence of lateral alae stretching from the posterior end of the cardia to the level of the cloacal opening, but also shows unique features found in other Desmodorida genera (i.e., the presence of a precloacal ventral ala in males similar to several Desmodora or Echinodesmodora species and eight subcephalic setae on the head capsule). The presence of a constrictor cuticle ring and orange elongated ducts in the anterior body part as in Pseudodesmodora lacrima, Leduc and Wharton, 2010, were also noted. The morphometric measurements of our species differ from most of the Pseudochromadora species reported in specialty literature. We extracted and counted all desmodorid individuals from 9 meiobenthic samples collected in June 2020, and performed a detailed morphological analysis of 12 individuals (5 females and 7 males) belonging to our species, also highlighting the dissimilarities with the related desmodorid species

Anatomical Changes in a Case with Asymmetrical Bilateral Maxillary Sinus Hypoplasia

Background and Objectives: The maxillary sinus hypoplasia (MSH) is an occasional variation of the maxilla, occurring either unilaterally or bilaterally. Previous studies dealing with MSH have not detailed the consequent anatomical changes of the maxilla and adjacent fossae. Materials and Methods: A 58-year-old female case was scanned in Cone Beam Computed Tomography and found to have asymmetrical bilateral MSH, who was then further evaluated anatomically. Results: The maxillary sinuses were hypoplastic and had mild mucosal thickenings. The orbital floors were curved. The uncinate process and the ethmoidal infundibulum were laterally displaced beneath the orbit floor. On each side, the lateral nasal wall protruded within the respective maxillary bone to reach above the vestibular cortical plate of the alveolar process. This expansion of the lateral nasal walls was limited to the premolar and first molar regions. The inferior turbinates were laterally curved. The perpendicular palatine plate was building a postero-lateral nasal wall in front of the pterygopalatine fossa. Conclusions: The classification systems of MSH should be detailed to indicate whether the normal uncinate process is medial or inferior to the orbit. The lateral expansion of the lateral nasal wall in MSH is limited to the anterior part of that wall. The laterally expanded nasal fossa could reach anterior to the pterygopalatine fossa in MSH. Seemingly, CBCT is a better tool than CT to evaluate the detailed anatomy of the modified anatomical structures in MSH; as such, it could be of help in a surgical approach

The Energy Transition between Desideratum and Challenge: Are Cogeneration and Trigeneration the Best Solution?

Climate change has brought to the attention of politicians, researchers, and other stakeholders the need to protect the environment. The concerns at the international level are more and more intense, and the solutions found are multiple. One of the directions to follow is a new energy transition, which involves the use of renewable energy, but also techniques of cogeneration and trigeneration. This study presents the main research on increasing energy efficiency in the use of a primary energy source and the impact on the environment. Compared to the classical methods of obtaining heat and electricity from burning fossil fuels through separate technologies, the study brings to the fore two methods (cogeneration and trigeneration) that have much higher yields by obtaining two or even three forms of energy from the use of a single source of combustion. The impact on the environment is also significantly reduced by eliminating additional sources of pollution (reducing greenhouse gas emissions). Taking into account the evolutions of the energy market during this period, this article aims to analyze, from the point of view of the two most important influencing factors, the economic efficiency of processes and the reduction of greenhouse gas emissions by overlapping their effect, in case of the use of modern technologies (cogeneration and trigeneration), for the combined production of various forms of energy

Study of health and safety in the manufacturing industry using Pareto analysis

The present paper carries out a study on health and safety in the manufacturing industry. The health and safety is analyzed for industrial workers in Brasov county for the years 2017 and 2018. The analysis is based on data for work related accidents and the processing was made using the Pareto Analysis. By complying with the 80/20 rule, it can be focused on the analysis of the 20% of the causes of work accidents that account for 80% of the total work accidents analyzed. Finally, it is presented which actions that can be taken to reduce accidents based on the analysis of the specific stages. After applying the Pareto Analysis in the year 2018 are obtained satisfactory results compared to the year 2017, thus optimizing the performance of the industrial activity in terms of health and safety and improve Quality Assurance in Industrial Manufacturing