Chirurgia Bucharest
-
Chirurgia Bucharest · May 2009
MELD exceptions and new predictive score of death on long waiting lists for liver transplantation.
Cirrhosis related complications, considered MELD exceptions, proved to add prognostic value to the MELD score in predicting waiting list mortality. ⋯ Liver transplantation (LT), Model for End-Stage Liver Disease (MELD), waiting list (WL), United Network for Organ Sharing (UNOS), standard deviation (SD), receiver operating characteristic (ROC), hepatitis B virus (HBV), hepatocellular carcinoma (HCC), positive predictive value (PPV), negative predictive value (NPV), Child-Turcotte-Pugh (CTP), hepatic venous pressure gradient (HVPG).
-
Intracardiac masses are detected more frequently due to the availability of echocardiography. Right atrial thrombosis is rare comparatively with that of the left atrium. The clinical presentation of the patient with right atrial thrombosis is linked with a misleading association between cardiovascular signs and digestive signs (acute abdominal pain, vomiting and marmorated skin of flanks). ⋯ The massive thrombus located in the right atrium, prolapsing during diastole through the tricuspid valve, was associated with the increase in plasmatic D-dimers and new ECG modifications type right bundle block (hemodynamic straining of the right ventricle). The evolution was favorable, after heparin-therapy by infusing pump, with relief of cardiovascular and digestive symptoms after the first 6 hours; after 36 h from the beginning of the treatment the thrombus was lysed. Sudden death likelihood through complete obstruction of the tricuspid ostium was prevented due to the early diagnosis offered by imagistic methods.
-
Chirurgia Bucharest · May 2009
[Clinical and therapeutical considerations regarding odontogenic acute mediastinitis].
Odontogenic acute mediastinitis is an polymicrobial infections caused in most cases by gram negative and anaerobic germs. The odontogenic origin of the cases in this study was based on anamnestic inquiry of the patients, which reveales a dental treatment 7-15 days before the diagnosis of acute mediastinitis was established. Clinical features are often nonspecific at the debut of this affection; septic shock could appear suddenly associated with multiple systems and organs failure. ⋯ Positive diagnosis is based on clinical features associated with labs and imaging studies. Surgery plays an important role in therapy of acute mediastinitis: debridement and drainage of mediastinum with subsequently lavage of it, using antiseptic solutions. Broad spectrum antibiotherapy should be administrated immediately, before antibiogram is ready.
-
New surgical techniques cannot be safely and widely performed in human subjects unless they are first applied to large animal models. Experimental model using swine as surgical practice subject is one of the most reliable and widely practiced, taking into consideration the similarity between human and swine anatomy. Based on our large experience (around 100 pigs) we hereby present important aspects of handling and anesthesia procedures for pigs. Our goal is to share our experience with young surgical and anesthesia investigators who are planning investigations using pig as an experimental animal.