Large piece of wood board removal and long term survival in a patient with stabbed thoracic wound - case report.

Stabbed thoracic trauma is quite common in military practice,but they very rarely occur in civilian life, where they are predominantly accidental injuries. Thoracic stabbed wounds are more commonly observed in men than in women and in younger rather than older people. The management and prognosis depend on the composition, size and location of the foreign body. A 28-year-old Caucasian woman presented to the emergency room with hemorrhagic shock, a large stabbed wound and retention of a large piece of wood board.Less than 10 minutes after arriving to the emergency room she underwent open surgical thoracotomies and resection of the spleen rupture without any significant postoperative complications. At the end of the procedure the left breast was reconstructed. The original aspects of this case are the singularity of the foreign body and its relative harmlessness in spite of its large size.

New ways of bronchial stump closure after lung resection: experimental study.

INTRODUCTION: Lung surgery has long been associated with a high rate of mortality and morbidity. Bronchial stump fistula is one of the leading causes of high morbidity and high mortality rate. The objectives of our study are to asses the effect of new ways of closure the bronchial stump after lung resections. MATERIALS AND METHODS: For our study, we used eighteen adult rabbits. We performed left trans-thoracic inferior lobectomy to each animal because left lung functional capacities are smaller than right lung functional capacities. The bronchial stump was closed in three different ways: simple running suture of 5.0 monofilament polypropylene (Sweet procedure), running suture of 5.0 monofilament polypropylene (horizontal "U" shape model) and Vycril patch, running suture of 5.0 monofilament polypropylene (horizontal "U" shape model) and bovine pericardium patch. All surviving rabbits were sacrificed in 30 day postoperatively. RESULTS: In our study, we did not notice any deaths among our experimental animals and we did not observe any bronchial stump fistula. In the group of rabbits in which the bronchial stump was closed using a patch of heterologous bovine pericardium, the histological exams revealed a cvasinormal bronchial wall with a normal bronchial epithelium and basal membrane integrity and no inflammatory lympho-plasmocytary infiltrate cell, absence of macrophages at this level. CONCLUSIONS: Using the heterologous bovine pericardium patch to reinforce the bronchial stump could be beneficial because of the faster healing and scarring process. To our knowledge, no studies have previously evaluated this procedure of bronchial stump closure. Our findings could therefore, serve as an impetus for further research in this area.

Factors affecting early morbidity and mortality in non-small cell lung cancer surgery, the experience of Surgical Clinic No. 1, Tg. Mures.

INTRODUCTION: The incidence of lung cancer has increased alarmingly. Lung cancer represents the first cause of death in men. Thoracic surgery is engraved with increased morbidity and mortality. Therefore, a rigorous selection of patients undergoing such surgery is imposed. In order to establish the correct therapeutic attitude,paraclinical explorations are of the ulmost importance. MATERIAL AND METHODS: We conducted a retrospective observational study over a period of six years. We used the casuistry of Surgical Clinic no. 1, Mures County Emergency Hospital. We studied the observation sheets of all the patients admitted in the Surgical Clinic no. 1 over a period of six years (1th of January 2005 to the 31th of December 2010). We studied 197 patients admitted to surgery in our clinic for lung cancer. RESULTS: In the group studied, the majority of patients were in the 5th and 6th decade of life. The average age was 59.48 years. In our study group, most patients were in an advanced stage of the disease, probably due to the late stage diagnosis of lung cancer in general. The majority of the patients were in the stage IIB and IIIA of disease. The overall postoperative morbidity rate was 21.82% (43 cases), In the study group we registered 8 deaths (4.06%)--it should be noted that we considered in-hospital mortality within the first 30 days postoperatively. CONCLUSIONS: The main risk factors for postoperative complications are: late age, male gender, pneumonectomy, low FEV1 value. Certain risk factors are predictive of postoperative mortality. The most important of them are: late age, male gender, type of surgery, FEV value, associated diseases (especially cardiovascular and diabetes).

[Laparoscopic sleeve gastrectomy: the initial experience of the First Surgical Clinic Tg-Mures. Early and late (after 5-10 month follow-up) results]. / Gastrectomia longitudinala laparoscopica--experienta initiala a Clinicii Chirurgie I Tg-Mures. Rezultate precoce si tardive (follow-up între 5-10 luni).

AIM: This paper aims to present the initial experience of the I-st Surgery Clinic Târgu Mures in laparoscopic sleeve gastrectomy, stressing the technical aspects of surgery and postoperative immediate and late results. METHOD: Started in 2008, I Surgery Clinic's experience includes 11 cases of laparoscopic sleeve gastrectomy, pursued between 5 and 10 months postsurgery.The group is structured as follows: 80% female, aged between 13 and 55 years, average BMI 46, with limits between 35 and 72. Surgical technique was unitary, 10 of 11 cases beeing performed by the same team. RESULTS: Surgergical results were excellent: 0 conversions, 0 bleeding, 0 fistulas, 0 missfire. Average hospitalisation was of 48 hours postsurgery. EWL overall 68%, with limits between 50%, in 2 cases (initial BMI 70) and 100%--1 case (initial BMI 35). Life threatening morbidity--0.0 mortality, average BAROS score 6.7. CONCLUSION: GLL is a well standardized, secure, efficient, applicable with good results in all categories of patients with morbid obesity.

[The importance of the I-colic time in colorectal cancer with synchronous hepatic metastases. Specifics of surgical strategy]. / Importanta timpului I-colic în cancerul colo-rectal cu metastaze hepatice sincrone. Particularitati de tactica chirurgicala.

AIM: This paper proposes the presentation of a decision-making algorithm in colorectal cancer with synchronous hepatic metastases, as stressing the importance of I-colic time in obtaining the R0 desideratum. MATERIAL AND METHOD: There is no worldwide consensus regarding the surgical attitude in metastatic colorectal cancer. There are some predominantly conservative attitudes which use stenting and neoadjuvant chemotherapy followed by periodical re-evaluation or more aggressive surgical treatment. In the pertinent literature, emphasis is on surgery in two stages, on the separation of the colic stage from the hepatic one, the majority proposing stage one cholic and stage two hepatic, thus there are also situations in which the liver may be dealt with from the first intention. RESULTS: We propose to present, taking the examples from clinical cases, the main techniques of dealing with the cases of metastatic colorectal cancer, stressing personal attitude: aggressive surgery in a short step, which is either radical or creates the conditions for a step II radical one. CONCLUSION: In our vision the liver is the key to the surgical treatment in metastatic colorectal cancer and we must take into account from the first step through interventions with radical intent any time it is possible or through other operations: ligature of portal branch, partial hepatectomies, unilateral local destruction, preparing the way to radical step II.

Looking for the best management of myasthenia gravis at the Tg.Mures Clinic of Anesthesia and Intensive Care.

Thymectomy is one of the current management strategies for myasthenia gravis. This is observational study focused on the evolution of the surgical and anesthesiological strategies applied to the patients submitted to thymectomy initially by maximal sternotomy (in the years 1994-1998), followed by unconditioned reorientation towards thymectomy by VATS. A number of 103 patients are included, 51 thymectomy by left VATS. All the thoracoscopic thymectomy were performed in general anesthesia, the lungs were separated by left selective intubation, and the left lung was deflated during the surgical procedure. The surgical complications appeared mainly in the VATS group: one pericardial and one myocardial lesion leading to sternotomy (minimal blood loss, uneventful recovery), contralateral pleural lesion with pneumothorax. The classical approach accounted for one hemothorax. The postoperative mortality was zero in the VATS group vs. 6 out of 52 pts in the sternotomy group. The postoperative evolution confronted the anesthesiologist with the classical crises of myasthenia. Death occurred within the first three weeks following surgery. The demise in 3 cases was due to cardiac complications (preexisting cardiomyopathy complicated by ventricular arrhythmia) and respiratory failure plus sepsis (for the remaining cases that we lost). The treatment options in the ICU are discussed: plasmapheresis, immunosuppression, ventilatory support. VATS is appropriate for almost all thymectomy, but the outcome is heavily based on a team approach: neurologist, surgeon and anesthetist.

[Vascular exclusion of the liver: surgical technique and initial clinical experience]. / Excluzia vasculara a ficatului (EVF): tehnica chirurgicala si experienta clinica initiala.

The intraoperative hemorrhage is the most life threatening complication during a liver resection, reason why the intraoperative vascular control represents one of the key points in the liver resection. This work presents the liver vascular exclusion without caval occlusion technique and also studies the first cases operated in University Surgery Clinic Nr. 1, Targu Mures, Romania. LVE consists of an association between hilum occlusion by Pringle manoeuvre and selective clampage of the three hepatic veins. Once achieved, the technique allows resection without blood lose and no special cautions, a continue clampage of 60-90 minutes being useful for the reconstruction of the possibly harmed or resected structures during the hepatectomy. The indications of the technique are voluminous center located liver tumors, multiple liver tumors, tumors in contact with hepatic veins or with hilum bifurcation. University Surgery Clinic Nr. 1 Targu Mures's experience in this technique began in 2005 consists in 8 cases. Preoperative diagnosis were: 2 right liver voluminous benign tumors (hemangiomas), 5 cases of colo-rectal metastasis and one resection for metastases of gastro-intestinal stromal tumor. Postsurgery evolution was very good with an average hospitalisation of 6 days. Mortality rate and morbidity were zero. We strongly recommend the use of LVE technique for selected cases of difficult liver resection, LVE being one of the most advanced techniques of liver resection.

[Two steps liver resection with right portal vein ligation for two giant hemangiomas of the left and right lobes]. / Rezectie hepatica în doi timpi cu ligatura de ram port drept pentru doua hemangioame gigante de lob drept si stâng hepatic.

The liver failure is one of the most life threatening complication after extensive liver resections. In resections that exceed 70% of liver parenchyma, a two steps approach with portal branch ligation is the best alternative. The aim of the paper is to present the management of a 65-year-old female admitted into hospital for two giant symptomatic liver hemangiomas in the left lobe: segment III-20 cm. and in the right lobe: segments V-VIII-19 cm, which were non-resectable in the same intervention because the small amount of liver parenchyma left, and for these we decided a two steps surgery: left atypical resection with right portal vein ligation in the first step, attending 4 month for atrophy-hypertrophy process, and then right typical hepatectomy for second hemangioma who practically occupied all right liver. The postoperative course, was favorable after both interventions, with 7 days postsurgery hospitalisation, despite some hepatic failure symptoms: coagulation disturbance, increasing of bilirubin and ALAT, ASAT levels, ascites.

[Late histopathological changes at the level of the residual pancreatic stump after cephalic duodenopancreatectomy]. / Modificari histopatologice tardive la nivelul bontului pancreatic restant dupa duodenopancreatectomia cefalica.

In this paper the authors present a histopathological study concerning the restant pancreas after cephalic duodenopancreatectomy for 3 cases that had a lethal outcome. In this 3 cases was performed hte cephalic duodenopancreatectomy with Child montage. This study showed that at the level of the restant pancreas it develops a progressive atrophy of the exocrine pancreatic tissue.

[Pancreatic fistula after cephalic duodenopancreatectomy. Its incidence, significance and therapeutic characteristics]. / Fistula pancreatica dupa duodenopancreatectomia cefalica. Incidenta, importanta, si particularitati terapeutice.

In this paper the authors present a study of pancreatic fistula after cephalic duodenopancreatectomy concerning the incidence, importance and the therapeutic features in a number of 37 patients operated between 1.Jan.1990-1.Jan. 1997 at the 1st Department of Surgery of Clinical County Hospital of Târgu-Mures. A number of 8 patients (22%) had pancreatic fistula; a half of them were treated by surgical reintervention, and the second half by conservative procedures.

[Colon cancer in the experience of Surgical Clinic No. 1, Tîrgu-Mures. Late postoperative results]. / Cancerul colic în experienta Clinicii Chirurgicale nr. 1 Tg.- Mures. Rezultate tardive postoperatorii.

We analyzed the informations concerning the late postoperative evolution for 405 (60%) of 760 patients with colon cancer operated between 1968-1996 in the Surgical Clinic from Tg.-Mures and we found a global 5-year survival rate of 35.57%. The conclusion after this study was that the most important worsening prognostic factors were the advanced stage evolution of the tumor and the occlusion. The females had a better prognosis than the males. The rural patients had a better prognosis than the urban. In our study the younger age isn't a worsening factor for survival. The patients with a longer history of the symptoms had an unexpected better survival rate than the others. Localization of the tumors at the site of the descending colon and flexures is an important negative prognostic factor. The penetrating feature of the tumor is more important than the lymphatic invasion for prognosis. Subtotal colectomy performed for stenotic tumors of the left colon, even in emergency for occlusions gave us one of the best 5-year survival rate (75%). The histopathologic type of undifferentiated carcinoma and the mucinous adenocarcinoma are associated with the poorest survival rate. The lymphoma has a better survival rate than the carcinoma. The perioperative blood transfusion, even though is associated with a low survival rate it is not an important prognostic factor.

[Indications for right-sided and total pancreatectomy]. / Unele indicatii ale pancreatectomiei drepte si totale.

The files were studied of 362 patients hospitalized in the Surgical Clinic from Tg. Mures in the last 20 years with various primary or secondary pancreatic affections, and for whom curative, palliative or exploratory surgery was indicated. Of the total 307 had pancreatic cancers, 16 had Vater ampulomas, 23 had gastric cancers, and 5 had primary duodenal tumours. In six patients pseudotumoral chronic pancreatitis was found, 2 had retroperitoneal tumours, and 3 had pancreatic cysts, lymphoma of the spleen, and mesenteric tumour. A total of 212 palliative surgical interventions were performed, 75 radical interventions (pancreatic reactions), and in another 75 patients simple laparotomies were done. In 45 of the pancreatic resections the duodenum was also removed. The other 30 cases included 6 total resections, 6 subtotal pancreatic resections and 18 resections of the left part of the pancreas.