The effect of red blood cell transfusion on peripheral tissue oxygen delivery and consumption in septic patients.

OBJECTIVES: The impact of blood transfusion on tissue oxygen delivery (DO2) and tissue oxygen consumption (VO2) is a subject of current clinical studies. The primary objective of this observational study is to evaluate and measure the parameters involved in determining DO2 and VO2, in early phase of septic patients. A secondary objective of this study is to assess the potential benefit of blood transfusion on tissue metabolism by serial measurements of lactic acid (Ac. Lac.). MATERIAL AND METHODS: A group of 29 patients were studied, each patient received between one to three units of fresh packed red blood cells (pRBC). Clinical and paraclinical criteria for sepsis as well as the plasma value of haemoglobin (Hb) below 10g/dL represented the inclusion criteria in this study. We evaluated Hb, haematocrit (HCT), arterial blood oxigen saturation (SAO2), central venous oxygen saturation (SCVO2), parameters which are involved in determination of DO2 and VO2, before and after the transfusion of one unit of pRBC. Values of Ac. Lac. were also assessed in order to determine the type of metabolism (aerobic or anaerobic). SCVO2, SAO2, Hb, HCT and Ac. Lac. were determined using Epoc blood analyser. The cardiac output (CO) and systemic vascular resistance (SVR) were monitored during blood transfusion, using Vigileo monitor (Edward's Life Science, PreSep catheter kit). SAO2 was also monitored by pulse-oximetry. RESULTS: Changes in Hb, HCT and SCVO2 before and after pRBC transfusion (which further determine VO2) were statistically significant (P<0.001). A statistically significant increase (P<0.001) was obtained in Ac. Lac. values, before and after pRBC transfusion. SAO2 and CO directly involved in producing DO2, were clinically monitored during blood transfusion and the results remained constant. CONCLUSION: Results obtained in this clinical study show an increase in DO2 in critically ill septic patients and also an increase in oxygen tissue uptake which is similar to VO2, clearly pointing out the benefit of pRBC transfusion. The benefits of pRBC transfusion on tissue metabolism in critically ill septic patients remain elusive because of lactic acid values increase during and after transfusion. Based on our findings we recommend that Hb values used as a single trigger for pRBC transfusion should be further studied and that additional parameters such as SCVO2 and lactic acid should be considered as possible triggers for transfusion. Values of Hb and HCT should never be neglected.

Association between varicose veins anatomical pattern and procedural complications following endovascular laser photothermolysis for chronic venous insufficiency.

We sought to assess clinical characteristics and pattern of collateral network involvement associated with development of truncal (systematized) versus diffuse/non-truncal (non-systematized) varicose veins (VVs) in patients undergoing endovascular laser photothermolysis for chronic venous insufficiency (CVI). Secondly, we aimed to assess whether the type of VVs influenced the procedural complications of endovascular laser therapy. A total of 508 patients with hydrostatic VVs of the lower limbs who underwent endovenous laser treatment were included, out of which 84.1% (n=427) had truncal VVs (group 1) and 15.9% (n=81) had diffuse (non-systematized) VVs (group 2). Patients with truncal varices were significantly older (47.50±12.80 vs 43.15±11.75 years, P=0.004) and those with associated connective tissue disorders were more prone to present diffuse VVs (P=0.004). Patients in group 1 presented a significantly higher number of Cockett 1 (P=0.0017), Cockett 2 (P=0.0137), Sherman (P<0.0001), and Hunter (P=0.0011) perforator veins compared to group 2, who presented a higher incidence of Kosinski perforators (P<0.0001). There were no significant differences regarding postoperative complications: thrombophlebitis (P=0.773), local inflammation (P=0.471), pain (P=0.243), paresthesia (P=1.000), or burning sensation (P=0.632). Patients with more advanced CEAP (clinical, etiologic, anatomic, pathophysiologic) classes were older (P<0.0001), more were males (39.05 vs 27.77%, P=0.0084), more were prone to present ulcers (P<0.0001) and local hyperthermia (P=0.019), and presented for endovenous phlebectomy after a longer time from symptom onset. In patients with CVI, systematized VVs were associated with a more severe clinical status and a distinct anatomical pattern of perforators network compared to non-systematized VVs, which is more common in advanced stages.

Association between varicose veins anatomical pattern and procedural complications following endovascular laser photothermolysis for chronic venous insufficiency

We sought to assess clinical characteristics and pattern of collateral network involvement associated with development of truncal (systematized) versus diffuse/non-truncal (non-systematized) varicose veins (VVs) in patients undergoing endovascular laser photothermolysis for chronic venous insufficiency (CVI). Secondly, we aimed to assess whether the type of VVs influenced the procedural complications of endovascular laser therapy. A total of 508 patients with hydrostatic VVs of the lower limbs who underwent endovenous laser treatment were included, out of which 84.1% (n=427) had truncal VVs (group 1) and 15.9% (n=81) had diffuse (non-systematized) VVs (group 2). Patients with truncal varices were significantly older (47.50±12.80 vs 43.15±11.75 years, P=0.004) and those with associated connective tissue disorders were more prone to present diffuse VVs (P=0.004). Patients in group 1 presented a significantly higher number of Cockett 1 (P=0.0017), Cockett 2 (P=0.0137), Sherman (P<0.0001), and Hunter (P=0.0011) perforator veins compared to group 2, who presented a higher incidence of Kosinski perforators (P<0.0001). There were no significant differences regarding postoperative complications: thrombophlebitis (P=0.773), local inflammation (P=0.471), pain (P=0.243), paresthesia (P=1.000), or burning sensation (P=0.632). Patients with more advanced CEAP (clinical, etiologic, anatomic, pathophysiologic) classes were older (P<0.0001), more were males (39.05 vs 27.77%, P=0.0084), more were prone to present ulcers (P<0.0001) and local hyperthermia (P=0.019), and presented for endovenous phlebectomy after a longer time from symptom onset. In patients with CVI, systematized VVs were associated with a more severe clinical status and a distinct anatomical pattern of perforators network compared to non-systematized VVs, which is more common in advanced stages.

Ileo-ceco-descendento-colic intussusception in adult - a case report.

INTRODUCTION: Intestinal intussusception in adult represents a rare cause of intestinal obstruction, therefore the diagnostic and therapeutic methods must be adapted to each case. MATERIALS AND METHODS: We present the case of a 30 year old female admitted in our service suffering from a subocclusive symptomatology. After preoperative tests were completed in another medical unit, we presumed the possibility of intestinal intussusception. The intraoperative exploration revealed the presence of a terminal ileum tumor (4x5x5 cm) with the invaginated segment progressed on ileo-ceco-transversodescendento-colic trajectory. After partial desinvagination, we performed right hemicolectomy with ileo-transverse end-to-endanastomosis. RESULTS: The patient was discharged healthy on the 7th postoperative day. The histopathological findings revealed submucosal ileal lipoma. CONCLUSIONS: Tumors of the terminal ileum, cecum or right colon could have an important role in the etiology of mechanical intestinal obstructions. These tumors can be a starting point for intestinal intussusception, which can advance to the left colon.

[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.