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

THE EVOLUTION OF FISCAL INDICATORS IN THE LAST YEARSIN ROMANIA

Tax revenues are an important part of budget revenues, and their structure represent the mirror of government\'s fiscal policy. Also their level and structure reflects the evolution of the economy in general. The evolution of tax revenues has been influenced by the financial crisis of this period. The tax revenue structure in Romania is characterized by relatively high share of indirect taxes revenues in comparison with another European Union states, where the share of revenues from direct, indirect taxes and social contribution is relatively close. Government expenditure is vital for the economy especially if they are focused on productive areas. They are the engine of economic developments and plays an important role in raising the standard of living of population in a state. In the last years, the growth rate of public expenditure was higher than the trend of tax revenues increase. Sizing revenue and public expenditure is essential for achieving the budget balance target and to meet the criterion stipulated in the Stability and Growth Pact. According to the Pact, the budget deficit may not exceed 3% of GDP. This development asymmetric led to increased deficits in the last years. The high level of structural deficit has canceled an initiative to tax relaxation in this recession period. The need for fiscal consolidation has been paramount in the context of chronic deficit and difficulties faced in financing it. The opportune solution to finance the high public deficit and to achieve the objective of financial stability of the economy was contracting of public debt from International Monetary Fund. Other measures to reduce the deficit were the reduction of public expenditure and increasing tax revenues. We propose in this paper to analyze the evolution of fiscal indicators in comparison with the evolution of macroeconomic indicators to capture the reaction of taxpayers and economic environment at measures adopted.fiscal, tax, fiscal revenues, budget, financial crisis

A rare complication in a Covid-19 positive patient with sigmoid colon cancer-hemoperitoneum due to gallbladder necrosis following micro-thrombosis

Covid-19, also known as acute respiratory syndrome 2019-nCoV, severe acute respiratory syndrome (SARS) 2, and Wuhan pneumonia, is a viral respiratory disease caused by a SARS-associated coronavirus (SARS-CoV-2). The most serious complications of Covid-19 are due to the development of micro-thrombosis in various organs and systems as a result of the high levels of pro-inflammatory cytokines (tumor necrosis factor alpha, interleukin 1 and 6) which initiate the activation of coagulation and the generation of thrombin. Several studies demonstrated the poor outcome of Covid-19-infected patients who underwent surgery, suggesting that surgery may accelerate and exacerbate Covid-19 progression. We report the case of an 81-year-old patient admitted as an emergency with Covid-19 pneumonia, hemoperitoneum, ischemic acute cholecystitis and obstructive sigmoid cancer. Cholecystectomy, pneumoperitoneal lavage, and Hartmann operation were performed under combined epidural-spinal anesthesia. This technique has some advantages compared to spinal and epidural techniques, such as: rapid onset of analgesia and the possibility of obtaining the desired sensory level, control of the anesthetic block, and ensuring postoperative analgesia. The unfavorable outcome of this case is due to the occurrence of the cytokine storm and coagulation disorders, with the change in the related biological constants, both from a biochemical and systemic point of view

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 evolution of fiscal indicators in the last years in Romania

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Comparative carbon emission assessments of recycled and natural aggregate concrete: Environmental influence of cement content

This work examines the environmental and geochemical impact of recycled aggregate concrete production with properties representative for structural applications. The environmental influence of cement content, aggregate production, transportation, and waste landfilling is analysed by undertaking a life cycle assessment and considering a life cycle inventory largely specific for the region. To obtain a detailed insight into the optimum life cycle parameters, a sensitivity study is carried out in which supplementary cementitious materials, different values of natural-to-recycled aggregate content ratio and case-specific transportation distances were considered. The results show that carbon emissions were between 323 and 332 kgCO2e per cubic metre of cement only natural aggregate concrete. These values can be reduced by up to 17% by replacing 25% of the cement with fly ash. By contrast, carbon emissions can increase when natural coarse aggregates are replaced by recycled aggregates in proportions of 50% and 100%, and transportation is not included in analysis. However, the concrete with 50% recycled aggregate presented lower increase, only 0.3% and 3.4% for normal and high strength concrete, respectively. In some cases, the relative contribution of transportation to the total carbon emissions increased when cement was replaced by fly ash in proportions of 25%, and case-specific transportation distances were considered. In absolute values, the concrete mixes with 100% recycled aggregates and 25% fly ash had lower carbon emissions than concrete with cement and natural aggregates only. Higher environmental benefits can be obtained when the transportation distances of fly ash are relatively short (15–25 km) and the cement replacement by fly ash is equal or higher than 25%, considering that the mechanical properties are adequate for practical application. The observations from this paper show that recycled aggregate concrete with strength characteristics representative for structural members can have lower carbon emissions than conventional concrete, recommending them as an alternative to achieving global sustainability standards in construction

Clinical and biological factors with prognostic value in acute pancreatitis

Acute pancreatitis is an acute inflammatory process of the pancreas, which can remain localized at the level of the gland or can extend to the peripancreatic and retroperitoneal tissues. The use and interpretation of paraclinical examinations at the onset can predict the form of evolution of acute pancreatitis (mild or severe). Depending on the evolution, these data are useful in determining the type of surgical intervention that might be necessary based on severity. We present a retrospective study consisting of 118 patients diagnosed and hospitalized with acute pancreatitis during 2016-2020 in the Surgery I section of the Sibiu County Emergency Clinical Hospital. Several parameters were taken into account at hospitalization such as age, sex, the environment of origin, etiology of pancreatitis, biochemical parameters with their repetition at 24, 72 hours, and at discharge, and clinical signs at hospitalization. surgeries performed depending on the severity of pancreatitis specifying their complications

The importance of therapeutic window in minimally invasive treatment of acute pancreatitis

Clinica Chirurgie II, Departamentul de Imagistică Medicală, Clinica Gastroenterologie, Clinica ATI I, Spitalul Clinic de Urgență, Sibiu, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: Pancreatita acută este o afecțiune gravă cu o mortalitate ridicată în formele necrotico-hemoragice, în ciuda progreselor terapeutice actuale. Dorim să subliniem importanța instituirii terapiei corespunzătoare în intervalul „ferestrei terapeutice”, interval în care lanțul patogenic poate fi întrerupt (manevre miniinvazive). Material şi metodă: În 2006, în Clinica Chirurgie 2 a fost instituit un protocol terapeutic cu viza patogenică, ce asociază terapia medicală cu cea chirurgicală laparoscopică de decompresie precoce a arborelui biliopancreatic şi/sau necrectomie laparoscopică, în funcție de tipul pancreatitei acute. Alegerea momentului operator trebuie să fie precoce (fereastra terapeutică), bine documentată şi adaptată fiecărui caz în parte. Rezultate: Eficiența acestui protocol este obiectivată de reducerea la jumătate a incidenței formelor de pancreatită acută gravă precum şi de reducerea drastică a mortalității. Concluzii: Evoluția favorabilă a cazurilor tratate conform acestui protocol mixt, precum şi perioada de spitalizare relativ redusă, variind între un minim de 7 zile şi un maxim de 25 de zile, pledează pentru acest concept terapeutic patogenic, miniinvaziv.Introduction: Acute pancreatitis is a very serious disease with a high mortality in necrotic forms, despite the progresses made in therapeutic management. Our purpose is to underline the importance of establishing the suitable therapy within the interval of „therapeutic window”, when the pathogenic chain can be cutted down (minimally invasive maneuvers). Matherial and method: In 2006, in Clinic Surgery 2 it had beed established a protocol with pathogenic target which associates medical treatment and laparoscopic decompression of billiary tract and/or laparoscopic necrectomy adapted to the type of the pancreatitis. Chosing the operation moment must be precocious (within therapeutic window) well documented and adapted to each case separately. Results: The efficiency of this protocol is objectifiing through the reduction to half of the incidence of the severe forms of acute pancreatitis and also drastically redu ction of the mortality. Conclusions: The favourable evolution of the cases treated according to this mixt protocol and the relative short period of spitalization between 7 and 25 days, pleads for this pathogenic and minilally invasive concept of treatment. Key words: acute pancreatitis, therapeutic window, laparoscopic necrectomy

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348