Chirurgia Bucharest
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Chirurgia Bucharest · Nov 2009
Case Reports[Postoperative hypoparathyroidism, an assumed risk in total thyroidectomy for Graves disease].
Hypocalcemia is a common clinical occurrence and has many potential causes, one of which can be congenital or acquired hypoparathyroidism. Acquired hypoparathyroidism is most commonly the result of damage to the glands, usually to their blood supply, during thyroidectomy, parathyroidectomy, or radical neck dissection. We present the case of a 40-year-old female known with Waldenström macroglobulinemia, cronic hepatitis C, who has been diagnosed with Graves disease and associated ophtalmopathy in 2004 and treated with antithyroid drugs for 1.5 years; a decision of total thyroidectomy was made considering the complexity of comorbidities and the fact that the patient already had a relapse under methymazol treatment. The postsurgical evolution was impeared by a sever hypocalcemia, necessitating repeted parenteral calcium administration associated with p.o. calcium and vitamin D, with rapid recovery, seric calcium beeing kept in normal limits and without symptoms.
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Chirurgia Bucharest · Sep 2009
Comparative StudyChanges in vasopressin use and outcomes in surgical intensive care unit patients with septic shock.
This study compares recent vasopressin use and outcomes to our early practice when vasopressin was introduced for septic shock. ⋯ Vasopressin is recently used at lower doses and in less severe septic shock. Patients recently treated with vasopressin have a higher SICU survival rate than the survival rate when vasopressin was first introduced for septic shock.
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Chirurgia Bucharest · Jul 2009
[Intrabiliary rupture of hepatic hydatid cysts: results of 17 years' experience].
Between 1990 and 2006 in the III-rd Surgical Clinic Cluj-Napoca, 366 pacients with hepatic hydatid cyst were admitted and underwent surgery; 81 (22.13%) of them, who had a cyst-biliary comunication, were retrospectively reviewed: 52 (64.2%) had an occult communications and 29 (35.8%) had a frank intrabiliary rupture. The sex ratio was M/F=46/35 with a mean age of 44.5 years and with ages between 17 and 73 years. Choledochotomy, evacuation of parasitic material and lavage of the CBP were performed in all patients with frank intrabiliary rupture. In 25 patients, partial pericystectomy and choledochoduodenostomy/T-tube drainage of CBP was performed. Internal drainage by a Roux-en-Y pericystectojejunostomy and biliodigestive anastomosis was carried out in 2 patients, while other two patients underwent external drainage of cystic cavity and T-tube drainage of CBP. 15 patients (51.7%) had postoperative external bile leaks (fistulas). Occult communications were managed by partial pericystectomy +/- narrowing of the residual cavity (capitonage with an omentum flap or invagination of the fibrosis capsule margins into the cavity) in 35 patients (67.3%) while in 10 patients (19.2%) internal drainage by a Roux-en-Y pericystectojejunostomy was carried out. Regional resection of the liver was performed in 4 cases (7.7%) and external drainage of residual cavity in 3 patients (5.7%). 13 patients (25%) had postoperative external bile leaks (fistulas). The mean postoperative hospitalisation was 20 days with the range 5-85 days. The mortality rate was 2.4% (2 patients): one died due to septicemia and MOFS and the other due to pulmonary thromboembolism. ⋯ Postoperative bile leaks (fistulas) fallowing conservative surgery of ruptured hydatid hepatic cyst into the biliary tract are not rare regardless of the type of rupture (frank or occult). Although the opening of the biliary duct is sutured, the risk of biliary fistulas is not clearly corelated with this approach; in such cases internal drainage provides a good alternative with low morbidity.
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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).
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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.