Chirurgia Bucharest
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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.
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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.
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Chirurgia Bucharest · Mar 2009
Case ReportsTraumatic bilateral rupture of the patellar tendon in an apparently healthy patient.
We present a case of a 37 year old male who suffered a fall from approximately 2.5 meters; at the moment of impact he performed a bilateral knee hyperflexion. The presumptive clinical diagnosis was bilateral rupture of patellar tendon. In order to confirm the diagnosis, we performed bilateral anteroposterior and lateral radiographies and bilateral echography of the knee. ⋯ Bilateral rupture of the patellar tendon is rather uncommon and is usually associated with systemic diseases. The case presentation is important because the bilateral patellar tendon rupture due to minimum trauma has no explanation--the patient was young, with no genetic disorders and no systemic diseases. Literature mentions a little over 20 cases of bilateral patellar tendon rupture in individuals with no diseases previous to the injury.
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Chirurgia Bucharest · Mar 2009
Randomized Controlled Trial Comparative Study[TIVA-TCI (Total IntraVenous Anesthesia-Target Controlled Infusion) versus isoflurane anesthesia for laparoscopic cholecystectomy. Postoperative nausea and vomiting, and patient satisfaction].
Numerous studies have shown that TIVA is followed by a significant reduction in the incidence of PONV in day-case surgery, including laparoscopic cholecystectomy, where the incidence of PONV can reach 70% according to some studies. TCI is the TIVA technique that maintain a constant plasma concentration due to pharmacokynetic models incorporated in TCI device that inject the anesthetic agent. Besides implementing TIVA-TCI in clinical practice in Romania, our study was designed to evaluate the impact of TIVA-TCI on postoperative outcome and our patient satisfaction after laparoscopic cholecystectomy. ⋯ Compared with Isoflurane, TIVA-TCI was followed by significantly lower incidence of PONV and significantly greater patients satisfaction.
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Chirurgia Bucharest · Mar 2009
First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results.
Robotic surgery was developed in response to the limitations and drawbacks of laparoscopic surgery. Since 1997 when the first robotic procedure was performed various papers pointed the advantages of robotic-assisted laparoscopic surgery, this technique is now a reality and it will probably become the surgery of the future. The aim of this paper is to present our preliminary experience with the three-arms "da Vinci S surgical system", to assess the feasibility of this technique in various abdominal and thoracic procedures and to point out the advantages of the robotic approach for each type of procedure. ⋯ Our preliminary experience suggests that robotic surgery is feasible and worth of clinical application. The best indications for robotic surgery are the procedures that require a small operating field, a fine a precise dissection (suitable for pelvic and gastric lymphadenectomy, nerve sparing in total mesorectal excision) and safe intracorporeal sutures.