Treatment of complete genital prolapse by sacrospinous fixation, anterior mesh repair and conservation of the uterus.

UNLABELLED: The surgical treatment of complete genital prolapse must aim the restoration of the vaginal support structures. All 3 levels of the vaginal support system must be recreated. Ablation of the uterus is not useful for pelvic floor support. Sparing of the uterus offers the advantage of a reduced surgical trauma, and better pelvic floor restoration. We present the case of a 60-year old woman with complete genital prolapse where the uterus was spared, and sacrospinous fixation, anterior mesh repair,perineal body repair and suburethral sling insertion were performed. The results were very good, by means of pelvic floor statics and physiology of micturition. CONCLUSION: genital prolapse must be cured by reconstruction of the vaginal support system, not by hysterectomy.

Meningococcal septic shock after IUD insertion, a case presentation.

Neisseria meningitidis is a normal commensal of human mucous membranes that is no longer considered to be restricted to the nasopharynx. Due to the practice of oral sex, the mucous membranes of the cervix, urethra or anus have become a potential infection site for this bacterium. Inserting an intrauterine device (IUD), can alter the protective barrier of the endocervical mucosa, allowing for bacterial infection and systemic spread. We present a case report of a 40-year-old woman who presented with abdominal pain, spotting and fever after inserting an IUD and developed a fulminant septic shock. Blood cultures and cultures from ascites showed the presence of Neisseria meningitidis group Y. From our knowledge, there are a few cases presented in the literature of toxic shock syndrome after IUD insertion, caused by Staphylococcus aureus or Streptococcus group A, but this is the first case of meningococcal sepsis after IUD insertion described. So, even though IUDs rarely cause significant infection, physicians should consider this device as a possible source in reproductive-age women with the clinical features of sepsis.

Tie2 expression in human embryonic tissues.

Tie2 is a member of receptor tyrosine kinases family, involved in vasculogenesis and angiogenesis. Its main role is to stabilize, maintain, and facilitate the structural adaptation of the vasculature, during embryo development, and adult wound healing, or tumor development. Tissues from human embryos found in different stages of development (5 and 7-week-old), were investigated for Tie2 expression. The reaction was positive, with maximum intensity in the vascular cords, found in the mesenchymal tissue, and in the connective tissue around the primitive spinal cord. In the 7-week-old embryo, the reaction was negative in large blood vessels, and it was heterogeneous in those showing bridging phenomenon. In conclusion, during the first two months of human embryo development, we have concurrent vasculogenesis, angiogenesis, and blood vessel maturation and stabilization.

[Postoperative complete abdominal dehiscence: risk factors and clinical correlations]. / Evisceratiile postoperatorii: factori de rise ssi corelattii clinice.

UNLABELLED: The purpose of this study is to review our clinical experience with abdominal wound dehiscence in the Surgical Department of City Hospital Timisoara. PATIENTS AND METHODS: 19.116 abdominal procedures were performed between January 1992 - March 2009 in our Department and 29 complete dehiscences were identified (0,15%). Significant risk factors in our analysis were intraabdominal infection, wound infection, emergency surgery, malignancies, digestive fistulae, hiperabdominal pressure, sex and age over 65 years. Less significant factors were the abdominal type of incision, the method of wound closure and heart or respiratory diseases. CONCLUSIONS: postoperative complete dehiscence is a constant presence in a surgical department; despite its low frequency, wound dehiscence is associate with a hight mortality and morbidity rate, and increase the costs and hospitalisation periode. Risk factors evaluation and their associations represente an important role in the therapeutic management of the surgical patient.

[Deep liver wound treated by internal compression with Blakemore catheter]. / Plaga hepatica transfixianta rezolvata prin compresiune intrinseca cu sonda Blakemore.

High incidence of polytraumas of different etiology determines special problems of treatment, the emergency surgeon frequently facing serious and complex injuries the most frequently in unstable patients and therefore difficult to be treated. This paper presents the case of a 19 years old patient, victim of a heteroaggression; clinical examination reveals an unique abdominal wound, surgical procedure showed a liver lesion with massive hemoperitoneum. Authors expose a series of emergency procedures principles for unstable patients and also an unusual method in the treatment of a liver wound. Actually, this method means catheterization of the liver wound with a Blakemore catheter. The esophageal balloon is full fill to make a positive pressure on this wound. Good evolution of the case justifies this method to be used as an alternative procedure to other haemostatic methods (liver resections, hepatic artery ligature etc.).

[Incidence and sensitivity to antibiotics of germs isolated from surgical wound infections]. / Studiu privind incidenta si sensibilitatea la antibiotice a germenilor izolati din infectii postoperatorii de plaga chirurgicala.

We studied 119 bacterial strains isolated from postoperative infected wounds. All these strains were considered to be strains that derived from the same number of nosocomial infections, all the postoperative infections of the wounds being nosocomial infections. Regarding their frequency, we isolated the following strains: E. coli--68 strains (57%), S. aureus--37 strains (31%), Pseudomonas spp.--9 strains (8%) and Proteus spp.--5 strains (4%). We performed the bacteriological study of these strains and some correlations between them and the surgical diagnosis. In order to help the surgical therapy of the overinfected wounds, we tested the drug sensitivity of all these strains. The results regarding the drug sensitivity show that these strains have different types of resistance to antibiotics, the Pseudomonas strains being the most resistant. We noticed a continuous decrease of the sensitivity of the isolated strains to certain antimicrobial drugs, and this focuses the attention on the necessity of monitoring the antibiotic prescriptions in hospitals. Taking into account the results obtained after this study, we should reconsider the concept of nosocomial infections control through prevention activities, in order to reduce the incidence and to identify the potential causes that can lead to nosocomial infections.

Unusual localisation of an ectopic pregnancy.

We present a case of ectopic pregnancy with a peculiar localisation: beneath the peritoneal serosa covering the anterior wall of the uterus, at the level of the uterovesical pouch. The case raised some diagnostic and management problems for the medical team. Considerations are made concerning the etiopathology of this unusual form of ectopic pregnancy.