Search

Burns represent one of the worldwide leading causes of injury. Burn wounds are associated with increased mortality and morbidity, especially the impaired quality of life due to hypertrophic scarring, scar pain and itching, paresthesia, and contractures. To properly influence the burn wound healing, it is important to establish a correct classification of the acute injury and to understand the main phase of burn wound healing process. There are various local and systemic factors that can be influenced to obtain proper healing. The most important factors include local necrosis and infection, increased local pressure and edema, anemia, hypoxia, hypotension, the presence of important chronic disease and medication, immunosuppression, nutritional status, age, and body constitution. After adequate fluid resuscitation and patient stabilization, the main step is represented by the detachment of the devitalized tissues and rapid coverage of the lesion. There are various methods to be used, like autologous or allogenic skin grafting, the use of skin substitutes, or tissue bioengineering. Knowing all these aspects, allows clinicians to properly define a therapeutic management for patients presenting severe burns. [ABSTRACT FROM AUTHOR]

Pain control is crucial in surgical patients, being an essential part of enhanced recovery after surgery protocols. Lidocaine, an amide local anesthetic, was primarily used as an antiarrhythmic. It has analgesic, antihyperalgesic and anti-inflammatory effects, with various actions on cardiovascular, respiratory, and digestive systems. Lidocaine has been shown to also have antithrombotic, antimicrobial, and antitumoral effects. Numerous studies have reported its safe profile and role in managing perioperative pain after breast cancer, abdominal, genitourinary, gynecologic, obstetric, orthopedic, cardiothoracic, spine, thyroid, and upper airway surgery. Lidocaine, as part of multimodal analgesia, also shows promising results in ambulatory surgery. Therefore, the use of intravenous lidocaine in the perioperative period is mainly associated with better pain control, reduced opioid use, diminished incidence of postoperative nausea, vomiting, and ileus, and exhibits antithrombotic effects. [ABSTRACT FROM AUTHOR]

Thumb carpometacarpal (CMC) joint dislocation is rare, and the treatment options may vary from conservatives’ strategies to open reduction and fixation. In face of pain and joint instability persistence, surgical intervention is required. We present the case of a 67-year-old male that was referred to our hospital with pain and edema of the left hand, after the failure of a conservative treatment. After initial refusal of open surgery, due to the persistent joint instability, open reduction of the CMC joint dislocation was performed, and stabilized using two percutaneous Kirschner wires after repairing the joint capsule and dorsoradial ligament. Immobilization was required for 4 weeks. After that, the Kirschner wires were removed. Along with physiotherapy, the follow-up showed no pain persistence nor CMC joint luxation reoccurrence while the joint recovered its mobility. Further studies are required in order to determine the optimal therapy for such cases and to provide standardized recommendations, taking into account that the restoration of thumb CMC joint mobility is one of the most important goals in hand surgery. [ABSTRACT FROM AUTHOR]

Non-syndromic toe syndactyly is a regular cause of foot malformation in children, bilateral form being less common. Syndactyly release procedures had few contraindications, as uncomplicated malformation or important patient comorbidities. Reported data show that corrective surgery using skin grafts is associated with an increased risk of infection, contractures, and web creep. Reconstruction surgical techniques, using flaps reduce morbidity, revision surgery, complication, may be associated with skin grafts and have superior aesthetic and functional results. We present a case of simple bilateral incomplete asymmetric toe syndactyly, released using a modified personalized local flaps reconstruction technique. The normal function and aesthetic of the feet was obtained, with no complications at one-year follow-up. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE), essentially deep venous thrombosis and pulmonary embolism, urinary tract infection, and renal failure are the main unplanned hospital events with negative long-term impact on burn patients’ rehabilitation. Due to the hypercoagulable state induced by severe critical burns, either in the acute or recovery phase and the intimal vascular damage, the risk of VTE is increased, with an incidence varying from 0.4% to almost 60%. Other risk factors for VTE in burn patients are prolonged immobilization, long and multiple surgical interventions, central venous catheterization, wound infection and sepsis, extensive burns, and red blood cell transfusion. To avoid underdiagnosing VTE, in face of increased incidence of asymptomatic venous thromboembolism, high risk-patients should be routinely screened using Doppler ultrasound. Patients’ weight and burn size, as well as the high incidence of heparin resistance in the first weeks after injury, should be considered when establishing the optimal dose for venous thromboembolism prophylaxis, targeting an anti-Xa level of 0.2-0.5 IU/mL. [ABSTRACT FROM AUTHOR]

Surgical intervention can lead to blood loss either through perioperative complications, or through disease severity until surgery. For this reason, mastering the main strategies to improve surgical patients’ haematological status, to reduce transfusion rate, and to correct haemoglobin level represent the state of art in surgical patient management. In the last period, due to COVID-19 pandemic and the blood shortage crisis across hospitals, applying principles meant to reduce blood loss, and therefore the rate of blood transfusion, have become even more important. [ABSTRACT FROM AUTHOR]

Introduction. The „major burns“ are critically ill patients with extended burn injuries, on over 20% of the total body surface, IInd or IIIrd degree or with certain locations as face, neck, upper respiratory airways, or lesions that are associated with other traumatic injuries (1). One of the early systemic changes after the burn injury is the coagulation disorder, which influences the outcome. The posttraumatic coagulopathy is influenced primarily by the surface extension and degree of the burn lesion (2), but there are also systemic factors that are induced by the traumatic lesions and amplify the coagulopathy: the systemic inflammatory response, the tissue hypoperfusion, the acidosis (4). Other important factors, which may change the evolution of the major burnt, are: the initial excessive fluid resuscitation, the age, the gender, the comorbidities of the patient (5). Materials and methods. The authors conducted an analysis of the coagulation disorders in a case series of burned patients hospitalized in 2015, in the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest. The prospective observational study included 11 patients hospitalized simultaneously. The study was approved by the internal ethical committee and the consent was obtained for the processing of clinical and laboratory anonymous data. We analysed the demographic data, the severity of the burn lesions, injury severity score (ISS), the haemostatic pattern through the assessment of the complete blood count, classical coagulation tests, rotational thromboelastometry (ROTEM). Results. Patients̒ median age was of 36.00±7.89 years, with variation between 21 and 45 years old. Men to women ratio was of 7:4. The estimated body surface was between 20-70%, with a mean value of 42.5%±12.03% (we counted only the burns with degree 2 and 3). At the admission, the ISS score was between 17-61 points [of 75 points maximum (10)], with a mean value of 45 ±15.18 points. The lot was devided into two groups, with or without the presence of the posttraumatic coagulopathy criteria, on lab tests or ROTEM, despite blood replacement therapy. There were analysed the parameters which define the posttraumatic coagulopathy and their impact on the blood replacement therapy and mortality. Conclusions. The etiology of the coagulation disorder at the „major burnt“ is multifactorial, but regardless of the predominant cause, it worsens the patients' outcome, increases the need for transfusions and mortality. The optimization of the diagnostic methods for the coagulopathy can offer important data regarding the incidence and the severity, with the possibility for faster and targeted therapeutic intervention to the patient's need. [ABSTRACT FROM AUTHOR]

The latest treatment guidelines for patients with arterial hypertension continues to indicate as the first line therapy a minimal association between renin-angiotensin system (RAS) blockers and a thiazide-type or a thiazide-like diuretic. In addition, according to 2018 ESC/ESH (European Society of Cardiology/European Society of Hypertension) guidelines for the management of arterial hypertension, a mineralocorticoid receptor antagonist may be added in resistant hypertension cases (uncontrolled hypertension under at least 3 classes of antihypertensive drugs including a RAS blocker, thiazide diuretic and a calcium channel blocker) for general population. For chronic kidney disease (CKD) patients, achieving the optimal blood pressure (BP) level can be difficult because high complication rates can be encountered in any antihypertensive class mentioned, especially for RAS blockers and mineralocorticoid receptor inhibitors. This brief review aims to highlight the importance of diuretics use in CKD patients and the boundaries of their usage. [ABSTRACT FROM AUTHOR]

Acute disseminated encephalomyelitis is an inflammatory, immune-mediated disease of the central nervous system (CNS) that usually appears in the first nine years of life, commonly following an infection or vaccination. We report the case of a middle-aged female, with history of recent perpetual infections, with neurologic symptoms masked by a severe septic shock and subsequent multiple organ failure. Although in adults the prognosis is more severe, and there are various reported cases with unfavorable evolution, following corticosteroid and physical therapy, our patient was able to recover an important part of her neurological deficits. [ABSTRACT FROM AUTHOR]

The negative impact of an elevated serum uric acid on the onset and/or progression of different diseases is well known. During the last decade, new forms of therapies were developed, with beneficial results on correcting hyperuricemia, but also with potential side effects that should not be overlooked as most of the hyperuricemic patients are presenting concomitant comorbidities that could influence the decision in prescribing a specific lowering serum uric acid drug. The review will describe recent treatment options, part of them available also in our country. [ABSTRACT FROM AUTHOR]

We present the case of a 82 years old women, who was admitted in our surgical clinic with two giant breast tumors, located on the left breast, with skin ulceration and suprainfection, accompanied by a big axillary mass in the left axilla. The patient was known with a previous rectal tumor, recently operated in another surgical service, for which it was an anterior rectal resection and definitive left colostomy done. The case is an atypical form of presentation of a Lynch II syndrome. The indication for total mastectomy and axillary lymphadenectomy was sustained by tumors' dimensions and suprainfection, although the case was oncologically overcome. [ABSTRACT FROM AUTHOR]

We present the case of a 64 years old man, who was admitted in our surgical clinic with a giant median incisional hernia after a previously colonic resection and anastomosis for a colonic tumor. We had to deal with a loss of domain giant ventral hernia. The patient was known with chronic obstructive pulmonary disease (COPD) and chronic coughing, that was an aggravating condition. We did an alloplasty in Rives-Stoppa manner, accompanied by an anterior component separation. The clinical postoperative outcome was very good and we present the results. [ABSTRACT FROM AUTHOR]