The value of the exploratory laparotomy in patients with blunt abdominal trauma

Secția IV Chirurgie, Secția Anestezie și Terapie intensivă, Secția Gastoenterologie, Spital ”Sf. Spiridon”, Secția I Chirurgie Oncologică, Institutul Regional de Oncologie, U.M.F. “Grigore T. Popa”, Iași, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Managementul traumatismelor abdominale închise includ atât măsuri de tip conservator, cât și chirurgical, funcție de leziunile posttraumatice evaluate radiologic și de starea clinică a pacientului. Material și metode: Literatura a fost studiată de către autori după următoarele criterii: 1. ghiduri publicate între anii 1995 și 2019, pagini web și bibliografie; 2. reviews, meta-analize, trialuri clinice, Pubmed, cu detalii de tipul “laparotomie exploratorie”, “traumatisme abdominale închise”, “hemoperitoneu”, “leziuni ale organelor parenchimatoase”. Rezultate: Indicațiile laparotomiei exploratorii sunt: 1.Instabilitate hemodinamică, cu sângerare evidentă abdominală. 2.Semne de peritonită. 3.Sângerare activă decelată computer tomografic 4.Pacient cu evoluție gravă în cursul tratamentului non-chirurgical. Concluzii: Evaluarea promptă și în dinamică a pacientului cu traumatism abdominal închis poate evita laparotomii albe și implicit scădea morbiditatea și mortalitatea, dar poate și impune o laparotomie salvatoare.Introduction: The management of blunt abdominal trauma includes both conservative and surgical measures, depending of the posttraumatic injuries evaluated radiological and clinical status of the patient. Material and methods: The literature was searched by the authors using the following criteria: 1. guidelines published between 1995 and 2019, web pages and references; 2. reviews, meta-analyses, clinical trials, Pubmed with searched details type “exploratory laparotomy”, “blunt abdominal trauma”, “hemoperitoneum”, “parenchymal injuries”. Results: The indications of the exploratory laparotomy are: 1. Hemodinamical instability with evidence of intraabdominal bleeding. 2. Signs of peritonitis. 3. Active bleeding at the computer tomography. 4. Patient with serious evolution during conservative treatment. Conclusions: Prompt evaluation and in dynamic of the patient with blunt abdominal trauma may avoid unnecessary laparotomies and decrease the morbidity and mortality, but may require a saving laparotomy

Pathways of metastatic spread in meningiomas

Meningioma is a common intracranial neoplasm derived from meningothelial cells, and it is generally associated with a benign clinical course. In spite of this, the malignant behaviour of these tumours as the occurrence of extracranial meningioma metastases in different organs is described in the literature: lung and pleura, spine and other bones, abdominal organs, lymph nodes or even skin. The aim of this review is to analyse the pathways of metastatic spread of the intracranial meningioma tumour cells towards different organs

A Rare Colonization in Peritoneum After Blunt Abdominal Trauma: S. putrefaciens and S. cerevisiae

Background: Shewanella spp. are gram-negative bacteria, saprophytes, and rarely pathogenic. Saccharomyces cerevisiae is the well-known yeast used for fermentation in industry and molecular biology for research. In humans, it is a very rare pathogen which colonizes the digestive tract, and its utility has been linked to the treatment and prevention of diarrhea associated with Clostridium difficile. Case Report: A 27-year-old male, victim of aggressive, blunt trauma with a 4-day history of symptoms was admitted to our surgery unit. Abdominal sonography revealed peritoneal fluid in all spaces with fibrin. We performed laparotomy and observed perforations on the ileum and general peritonitis with pus. Following surgery, patient was admitted to the intensive care unit with septic shock. The antibiogram from the peritoneal liquid revealed S. putrefaciens and S. cerevisiae. Conclusion: Although very rare, S. putrefaciens and S. cerevisiae may colonize in the peritoneum after blunt abdominal trauma

Cyclodextrin-Oligocaprolactone Derivatives—Synthesis and Advanced Structural Characterization by MALDI Mass Spectrometry

Cyclodextrins have previously been proven to be active in the catalysis of cyclic ester ring-opening reactions, hypothetically in a similar way to lipase-catalyzed reactions. However, the way they act remains unclear. Here, we focus on β-cyclodextrin’s involvement in the synthesis and characterization of β-cyclodextrin-oligocaprolactone (CDCL) products obtained via the organo-catalyzed ring-opening of ε-caprolactone. Previously, bulk or supercritical carbon dioxide polymerizations has led to inhomogeneous products. Our approach consists of solution polymerization (dimethyl sulfoxide and dimethylformamide) to obtain homogeneous CDCL derivatives with four monomer units on average. Oligomerization kinetics, performed by a matrix-assisted laser desorption ionization mass spectrometry (MALDI MS) optimized method in tandem with 1H NMR, revealed that monomer conversion occurs in two stages: first, the monomer is rapidly attached to the secondary OH groups of β-cyclodextrin and, secondly, the monomer conversion is slower with attachment to the primary OH groups. MALDI MS was further employed for the measurement of the ring-opening kinetics to establish the influence of the solvents as well as the effect of organocatalysts (4-dimethylaminopyridine and (–)-sparteine). Additionally, the mass spectrometry structural evaluation was further enhanced by fragmentation studies which confirmed the attachment of oligoesters to the cyclodextrin and the cleavage of dimethylformamide amide bonds during the ring-opening process

Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease

Abdominopelvic actinomycosis is a rare chronic or subacute bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium that normally colonizes the digestive and genital tracts, clinically presented as an inflammatory mass or abscess formation. Methods: We reviewed the medical records of the patients from our clinic with abdominopelvic actinomycosis who underwent surgery between 2002 and 2022. In this period, 28 cases (9 men and 19 women) were treated. The mean age was 43.36 years and they were hospitalized for abdominopelvic tumors or inflammatory tumors in 15 cases and inflammatory disease in 13 cases. Results: Causes of actinomycosis in the studied group were an intra-uterine contraceptive device in 17 cases, foreign bodies in 2 cases, diabetes in 4 cases, stenting of the bile duct in 1 case, and immunodepression. For 6 patients, we performed surgery by open approach and for 21 patients by a laparoscopic approach. For nine patients, abdominopelvic actinomycosis had been mimicking a colon malignancy (cecum and ascending colon, four cases; transverse colon, two cases; and on the greater omentum, three cases) and for six patients, a pelvic tumor (advanced ovarian cancer). After surgery the patients underwent specific treatment with antibiotics, with good results. In two cases we discovered and treated hepatic actinomycosis, one case by a laparoscopic approach and one case by a percutaneous approach. In our lot we noticed three recurrences that required reintervention in patients who had had short-term antibiotics due to non-compliance with treatment out of four such cases. Conclusions: For abdominopelvic malignancies, actinomycosis should be included in the differential diagnosis, as well as for inflammatory bowel diseases and bowel obstructions. We have a wide range of patients considering the rarity of this condition. Long-term antibiotics are necessary to prevent recurrence

SEROPREVALENȚA MARKERILOR HEPATITELOR VIRALE A, B, C ȘI E LA BOLNAVII UROLOGICI

Obiective. Sublinierea importanței testării periodice la markerii hepatitelor virale pentru pacienții  urologici, ca măsură crucială pentru gestionarea adecvată a infecțiilor. Metode. A fost efectuat un studiu epidemiologic descriptiv transversal (cross-secțional). De la bolnavii secției de urologie a Spitalului Clinic Republican ”Timofei Moșneaga” au fost prelevate probe de sânge pentru examinarea acestora prin metoda imuno-enzimatică (ELISA) la markerii hepatitelor virale: anti-HAV, anti-HAV IgM, AgHBs, anti-HBcor, anti-HBs, anti-HCV, anti-HEV IgG și anti-HEV IgM. În total au fost examinați 234 bolnavi, fiind efectuate 1638 investigații de laborator. Rezultate. La bolnavii din secția de urologie a Spitalului Clinic Republican ”Timofei Moșneaga” au fost identificate următoarele nivele de seroprevalență a markerilor hepatitelor virale: AgHBs – 9,0±1,9%; anti-HBcor – 47,9±3,3%; anti-HBs – 41,0±3,2%; anti-HCV – 7,7±1,7%; anti-HAV – 95,3±1,4%; anti-HAV IgM – 0%; anti-HEV IgG – 17,5±2,5%; anti-HEV IgM – 27,4±2,9%. Cele mai afectate grupuri pentru hepatitele B și C au fost persoanele de gen feminin din zona de Centru a țării, iar pentru hepatita E – persoanele de gen masculin provenite din zona de Nord. Concluzii. Rezultatele obținute denotă faptul, că pacienții urologici pot fi considerați ca un grup la risc sporit de infectare cu virusurile hepatitelor B, C și E

SEROPREVALENȚA MARKERILOR HEPATITELOR VIRALE A, B, C ȘI E LA LUCRĂTORII MEDICALI DIN DOMENIUL UROLOGIEI

Obiective. Stabilirea nivelului seroprevalenței markerilor hepatitelor virale A, B, C și E la lucrătorii medicali din secția de urologie a Spitalului Clinic Republican în vederea ajustării măsurilor de profilaxie a acestor infecții la ei. Metode. A fost realizat un studiu epidemiologic descriptiv transversal în baza probelor de sânge prelevate de la lucrătorii medicali, care au fost testate prin metoda imuno-enzimatică la markerii hepatitelor virale: anti-HAV, anti-HAV IgM, AgHBs, anti-HBcor, anti-HBs, anti-HCV, anti-HEV IgG și anti-HEV IgM. În total, au fost examinați 49 lucrători medicali, efectuându-se 392 de investigații de laborator. Rezultate. În cadrul lucrătorilor din secția de urologie, s-au identificat următoarele seroprevalențe pentru markerii virali: AgHBs - 2,0±2,0%; anti-HBcor - 38,8±7,0%; anti-HBs - 51,0±7,1%; anti-HCV - 4,1±2,8%; anti-HAV - 100%; anti-HAV IgM - 0%; anti-HEV IgG - 12,2±4,7%; anti-HEV IgM - 12,2±4,7%. Grupurile cele mai afectate au fost persoanele de gen feminin, asistentele medicale sau personalul auxiliar și cei cu o experiență de muncă de ≥30 ani. Concluzii. Rezultatele obținute indică faptul că lucrătorii medicali din secția de urologie pot fi considerați un grup cu risc crescut de infectare cu virusurile hepatitelor B, C și E

NEGATIVE PRESSURE THERAPY IN ABDOMINAL COMPARTMENT SYNDROME – A CASE REPORT

The abdominal vacuum-assisted closure (VAC) system has been introduced, providing a new possibility to treat an open abdomen. Abdominal compartment syndrome has a great relevance in surgical practice and patient care in critical condition, due to the effects of increased pressure in the enclosed space of the abdomen, possibly leading to multiple organ failure. We present a case of a 53 year-old woman with acute severe pancreatitis, admitted to intensive care unit with increasing abdominal pressure and rapid development of the compartment syndrome which overcame non-surgical manoeuvres, so that emergency surgery was imposed. The surgical procedure implied a laparostoma managed through negative pressure therapy. Severe cases of acute pancreatitis are associated with high mortality rate, secondary to early and late complications that develop as a consensus of the progression of the inflammatory and necrotic process

Lung Ultrasound-Guided Fluid Management versus Standard Care in Surgical ICU Patients: A Randomised Controlled Trial

The value of lung ultrasound (LU) in assessing extravascular lung water (EVLW) was demonstrated by comparing LU with gold-standard methods for EVLW assessment. However, few studies have analysed the value of B-Line score (BLS) in guiding fluid management during critical illness. The purpose of this trial was to evaluate if a BLS-guided fluid management strategy could improve fluid balance and short-term mortality in surgical intensive care unit (ICU) patients. We conducted a randomised, controlled trial within the ICUs of two university hospitals. Critically ill patients were randomised upon ICU admission in a 1:1 ratio to BLS-guided fluid management (active group) or standard care (control group). In the active group, BLS was monitored daily until ICU discharge or day 28 (whichever came first). On the basis of BLS, different targets for daily fluid balance were set with the aim of avoiding or correcting moderate/severe EVLW increase. The primary outcome was 28-day mortality. Over 24 months, 166 ICU patients were enrolled in the trial and included in the final analysis. Trial results showed that daily BLS monitoring did not lead to a different cumulative fluid balance in surgical ICU patients as compared to standard care. Consecutively, no difference in 28-day mortality between groups was found (10.5% vs. 15.6%, p = 0.34). However, at least 400 patients would have been necessary for conclusive results