The surgical management of pancreatic pseudocysts – outcomes on a group of seven patients

The pancreatic pseudocyst represents the main complication that occurred 3 to 6 weeks after an outbreak of acute or chronic pancreatitis represented by a collection containing pancreatic enzymes without their own epithelial wall. In the present paper, we present a study performed on 7 patients admitted to the Surgical Department of Sibiu County Emergency Clinical Hospital who were diagnosed with pancreatic pseudocyst between 2016 and 2020, and the drainage of the mini-invasive pancreatic pseudocyst by an incision in the right lumbar area, in the case of a 53-year-old patient known to have a history of multiple cardiac defects, the pancreatic pseudocyst being discovered approximately 6 months before, for which the patient underwent conservative treatment, and who had 5 resuscitated cardio-respiratory arrests throughout the evolution

Miniinvazivitate în chirurgia abdominală

Sfârșitul secolului XX, consfințește un nou concept medical, și anume, miniinvazivitatea, demolând blocajele conceptuale, “chirurg mare-incizie mare”, miniinvazivitatea iși face loc și în chirurgie, sprijinită de un “boom” tehnologic într-o specialitate veche dar nou denumită imagistică medicală: ECHO, CT, RMN, Colangio-RMN, PET-CT, Angiografie. De fapt, acest secol XX lărgește considerabil și explicit orizontul chirurgical. Alături de chirurgia tradițională și desprinsă din ea apar două noi orientări: miniinvazititatea și chirugia de transplant, ambele făcand parte din palmaresul românesc, de pe ambele maluri ale Prutului, datorită unor poli de influență și promovare. Chirurgia de transplant, complexă, dificilă, de excepție, ce presupune echipe multiple, spitale multiple, orașe multiple, țări multiple, costisitoare, energofagă, este posibilă prin „chivernisirea” banului public și în conțiile chirurgiei de zi cu zi. Compensator, această reducere a costurilor este generată de apariția miniinvazivitătii chirurgicale. Mininvazivitatea chirurgicală este un nou concept, departe de a fi unul centimetric, eventual milimetric, și este un concept larg, anatomic, anatomo-patologic, fiziologic, fizio-patologic, topografic, cosmetic, psiho-sociologic, tactic, tehnico-tehnologic, dimensional, financiar, umanist și în primul rând de protecție a pacientului. Obiectul miniinvazivității poate fi definit drept “evitarea sacrificiilor inutile, mai ales a celor parietale, consumatoare plastic, imunitar, temporal, în final energetic având drept consecință diminuarea până aproape la dispariție a complicațiilor căilor de abord și o vindecare mult accelerata”. Efectele pozitive tardive sau imediate sunt: - Vindecare spitalicească rapidă (până la “one day surgery” ) sau alte variante cu costuri directe mici și recuperarea post-spitalicească (convalescență) mult redusă (costuri indirecte mici); - Dispariția cicatricilor mari și a patologiei lor (etalare,cheloid, granuloma de fir); - Dispariția patologiei de plagă extinsă ( serom, hematom, supurație, eviscerație, eventrație); - Dispariția patologiei de secțiune musculară, nervoasă și vasculară extinsă; - Cicatrici inaparente (incizii subcicatriceale - liniile de tensiune tegumantară ale lui Langer); - Consumuri energetice și plastice minime, cee ce presupune accelerarea procesului de vindec-re și aplicarea mai rapidă a terapiei oncologice (dacă e necesar); - Consumuri terapeutice minimale (pierderi sangvine minime/nule, antialgice și antibiotice mult reduse cantitativ și calitativ); - Menajarea psihicului bolnavului prin reluarea mobilițății precoce, absența plăgilor largi, dureroase, cicatrici inaparente, absența firelor extractibile de sutură, părăsirea rapidă a spitalu-lui, elemente ce transferă bolnavul din zona omului suferind în zona omului sanatos

The effects of optimizing blood inflow in the pedicle on perforator flap survival: A pilot study in a rat model.

BACKGROUND Perforator flaps have led to a revolution in reconstructive surgery by reducing donor site morbidity. However, many surgeons have witnessed partial flap necrosis. Experimental methods to increase inflow have relied on adding a separate pedicle to the flap. The aim of our study was to experimentally determine whether increasing blood flow in the perforator pedicle itself could benefit flap survival. METHODS In 30 male Lewis rats, an extended posterior thigh perforator flap was elevated and the pedicle was dissected to its origin from the femoral vessels. The rats were assigned to three groups: control (group I), acute inflow (group II) and arterial preconditioning (group III) depending on the timing of ligation of the femoral artery distal to the site of pedicle emergence. Digital planimetry was performed on postoperative day (POD) 7 and all flaps were monitored using laser Doppler flowmetry perioperatively and postoperatively in three regions (P1-proximal flap, P2-middle of the flap, P3-distal flap). RESULTS Digital planimetry showed the highest area of survival in group II (78.12%±8.38%), followed by groups III and I. The laser Doppler results showed statistically significant higher values in group II on POD 7 for P2 and P3. At P3, only group II recorded an increase in the flow on POD 7 in comparison to POD 1. CONCLUSIONS Optimization of arterial inflow, regardless if performed acutely or as preconditioning, led to increased flap survival in a rat perforator flap model

The Propeller Flap for Traumatic Distal Lower-Limb Reconstruction: Risk Factors, Pitfalls, and Recommendations.

BACKGROUND Defects in the distal third of the leg are difficult to cover and often require free tissue transfer, even for defects of limited sizes. Propeller flaps have been designed specifically as an alternative to free tissue transfer but at times have been associated with unacceptably high complication rates. We therefore aimed to prospectively assess our own institutional experience with this technique and to define its role in lower-limb reconstruction. METHODS All patients who had been managed with reconstruction of the distal part of the leg with a propeller flap between 2014 and 2017 were included in the study. Demographic, clinical, and follow-up data on the patients and surgical procedures were recorded with special focus on the complication profile. RESULTS Twenty-six patients underwent propeller flap reconstruction of the distal part of the leg: 12 flaps were based on the posterior tibial artery, and 14 were based on the peroneal artery. Postoperative complications developed in association with 1 of the 12 flaps based on the posterior tibial artery, compared with 8 of the 14 flaps based on the peroneal artery (p = 0.015). Moreover, the presence of a higher Charlson comorbidity index (≥2) was strongly associated with the development of postoperative complications (p < 0.001). CONCLUSIONS Propeller flaps are a reliable option for traumatic reconstruction in carefully selected patients with lower-limb defects. In our experience, the rate of complications was higher for propeller flaps based on the peroneal artery and for patients with a Charlson comorbidity index of ≥2, whereas posterior tibial artery-based propeller flap reconstruction was a reliable surgical option for patients with a small defect in the distal third of the lower limb. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

SEISMIC ENGINEERING RESEARCH INFRASTRUCTURES FOR EUROPEAN SYNERGIES. Full-scale experimental validation of a dual eccentrically braced frame with removable links (DUAREM)

Conventional seismic design philosophy is based on dissipative structural response, which implicitly accepts structural damage under the design earthquake load thus leading to significant economic losses. Different strategies can be employed in order to reduce damage to structures under moderate to strong earthquakes such as base isolation and various implementations of active and semi-active structural control. Other strategies rely on supplemental damping conferred to the structure through various devices. These solutions require specialized knowledge at the design stage and during erection, careful maintenance and high initial cost. Another option constitutes a conventional design with replaceable dissipative members, easy to substitute even after strong earthquake, and thus reducing the repair costs. A system with removable dissipative elements has to fulfil two requirements to be efficient. Firstly, inelastic deformations should occur in removable elements only. Secondly, the damaged dissipative elements must be replaceable. Replacing the elements is more efficient if the structure does not have large permanent deformations. These two concepts were implemented in a dual structure, obtained by combining steel eccentrically braced frames (with removable bolted links) and moment resisting frames. The bolted links provide the energy dissipation capacity, while the moment resisting frames provide the necessary re-centering capabilityJRC.G.4-European laboratory for structural assessmen

Outcomes of Diabetic Retinopathy Post-Bariatric Surgery in Patients with Type 2 Diabetes Mellitus

Bariatric surgery is an emerging therapeutic approach for obese type 2 diabetes mellitus (T2DM) patients, with proven benefits for achieving target glucose control and even remission of diabetes. However, the effect of bariatric surgery upon diabetic retinopathy is still a subject of debate as some studies show a positive effect while others raise concerns about potential early worsening effects. We performed a systematic review, on PubMed, Science Direct, and Web of Science databases regarding the onset and progression of diabetic retinopathy in obese T2DM patients who underwent weight-loss surgical procedures. A total of 6375 T2DM patients were analyzed. Most cases remained stable after bariatric surgery (89.6%). New onset of diabetic retinopathy (DR) was documented in 290 out of 5972 patients (4.8%). In cases with DR at baseline, progression was documented in 50 out of 403 (12.4%) and regression in 90 (22.3%). Preoperative careful preparation of hemoglobin A1c (HbA1c), blood pressure, and lipidemia should be provided to minimize the expectation of DR worsening. Ophthalmologic follow-up should be continued regularly in the postoperative period even in the case of diabetic remission. Further randomized trials are needed to better understand the organ-specific risk factors for progression and provide personalized counseling for T2DM patients planned for bariatric surgery