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WE PRESENT A CASE OF A 62 YEARS OLD MAN, WHO WAS ADMITTED RECENTLY IN OUR SURGICAL CLINIC. HE WAS OPERATED LAPAROSCOPICALLY, APPROXIMATELY 7 MONTHS BEFORE, FOR AN ACUTE CALCULOUS CHOLECYSTITIS. HE PRESENTED AT EMERGENCY ROOM FOR PERSISTENT RIGHT FLANK ABDOMINAL PAIN AND A PALPABLE MASS AT THE SAME LEVEL. COLONOSCOPY CONFIRMED THE ABDOMINAL ULTRASOUND SUPPOSITION: A BIG TUMOR OF ASCENDING COLON AND, SURPRISINGLY, ALSO A SMALL TUMOR OF SIGMOID COLON. THE PATIENT WAS OPERATED THROUGH AN OPEN PROCEDURE AND THE POSTOPERATIVE OUTCOME WAS VERY GOOD. THE PARTICULARITY OF THIS CASE IS COEXISTENCE OF ASYMPTOMATIC SYNCHRONOUS COLONIC TUMORS AND ACUTE CALCULOUS CHOLECISTITIS AT THE TIME OF THE FIRST INTERVENTION (CHOLECYSTECTOMY). [ABSTRACT FROM AUTHOR]

INTRODUCTION. THE CONTINUALLY CHANGING OF THE MEDICAL FIELD AND ADVANCES IN DIAGNOSIS AND MANAGEMENT OF MULTIPLE TRAUMA PATIENTS HAVE, RECENTLY, DETERMINED A CONSERVATIVE APPROACH FOR MOST CASES OF BLUNT ABDOMINAL TRAUMA. THE PRESENT STUDY AIMS TO DETERMINE THE IMPACT OF BLUNT ABDOMINAL TRAUMA UPON THE PROCESS OF PERITONEAL ADHESION FORMATION. MATERIAL AND METHOD. THE PURPOSE OF THIS RETROSPECTIVE STUDY IS TO EVALUATE THE PREVALENCE AND SEVERITY OF INTRAABDOMINAL ADHESIONS IN EMERGENCY LAPAROTOMY IN PATIENTS WHO HAD NT BEEN OPERATED BEFORE AND HAD A HISTORY OF BLUNT ABDOMINAL TRAUMA. 10 PATIENTS WHO UNDERWENT EMERGENCY LAPAROTOMY IN THE SURGICAL DEPARTMENT OF "SFẬNTUL PANTELIMON" HOSPITAL FROM BUCHAREST, BETWENN JANUARY 2015-DECEMBER 2016 WERE ENROLLED IN THE STUDY. THE SEVERITY OF INTRAABDOMINAL ADHESIONS WERE EVALUATED USING ZŰHLKE CLASSIFICATION. THE OVERALL ADHESION RATIO FOR THIS STUDY GROUP WAS FOUND TO BE 80%. RESULTS AND CONCLUSIONS. THE MAIN CAUSE FOR BOWEL OBSTRUCTIONS SECONDARY TO INTRABDOMINAL PERITONEAL ADHESIONS IS REPRESENTED BY PREVIOUS INTRAABDOMINAL SURGERY. IN PATIENTS WITH NO SURGICAL HISTORY, INTRAABDOMINAL ADHESIONS HAVE RARELY BEEN ATTRIBUTED TO BLUNT ABDOMINAL TRAUMA. [ABSTRACT FROM AUTHOR]

THE PURPOSE OF THE PRESENT STUDY IS TO DEMONSTRATE THE HIGH INCIDENCE OF THE PERITONEAL ADHESIONS AFTER OPEN ABDOMINAL OR PELVIC SURGERY, IN ORDER TO PROVIDE A BASIS FOR THE FUTURE STUDIES REGARDING THE NEW AND EFFICIENT PREVENTION METHODS. MATERIAL. DATA FROM THE MEDICAL RECORD DATABASE OF THE SURGICAL DEPARTMENT OF "SFẬNTUL PANTELIMON" EMERGENCY HOSPITAL FROM BUCHAREST, ROMANIA, WERE USED IN ORDER TO IDENTIFY PATIENTS UNDERGOING OPEN ABDOMINAL OR PELVIC SURGERY IN 2014, WHO HAD NO RECORD OF SUCH SURGICAL INTERVENTIONS IN THE PRECEDING 5 YEARS, BEING FOLLOWED UP FOR 3 YEARS, UNTIL JANUARY 2018, ANALYSING THE SUBSEQUENT READMISSIONS. THE RATE OF ADHESIONRELATED ADMISSIONS AMONG THE TOTAL NUMBER OF ADMISSIONS BETWEEN JANUARY 2014 AND JANUARY 2018 IN THE GENERAL SURGERY DEPARTMENT WAS, ALSO, ASSESSED. RESULTS. 7% OF ALL READMISSIONS WERE RELATED TO POSTOPERATIVE PERITONEAL ADHESIONS, MOST OF THEM BEING MANAGED OPERATIVELY. 35% OF THE PATIENTS WHO UNDERWENT ABDOMINAL OR PELVIC SURGERY IN 2014 WERE READMITTED FOR AT LEAST ONE TIME OVER THE 3 YEARS OF FOLLOW-UP FOR A COMPLICATION OF THE PERITONEAL ADHESION SYNDROME, MOST OF THE RADMISSIONS OCCURING IN THE FIRST YEAR AFTER THE INITIAL INTERVENTION, BUT CONTINUING STEADILY THROUGHOUT THE 3-YEAR PERIOD. BETWEEN JANUARY 2014 AND JANUARY 2018, 15% OF THE ADMISSIONS WERE DIRECTLY RELATED TO POSTOPERATIVE ADHESIONS. CONCLUSIONS. POSTOPERATIVE PERITONEAL ADHESION SYNDROME HAS AN IMPORTANT IMPACT UPON PATIENTS, SURGEONS AND THE HEALTHCARE SYSTEM, HIGHLIGHTING THE NECESSITY OF EFFICIENT PREVENTION METHODS. [ABSTRACT FROM AUTHOR]

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Copyright of Industria Textila is the property of Institutul National de Cercetare-Dezvoltare pentru Textile si Pielarie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the present paper, I focus on the main determinants of health workforce conduct, the challenges encountered in honing human resources for health, and the grave shortage of human resources for health. The objective of this paper is to emphasize the setting up, production and supervision of human resources forhealth, the health workforce requirements of the population, and the drivers of health employee performance. The literature on the provision of health employees to underserved territories, the impact of the health employees on health outcomes and expenditures, and relevant matters influencing the functioning of health systems is relevant to this discussion. [ABSTRACT FROM AUTHOR]

Background: The 1999 ASHP (American Society of Health-System Pharmacists) recommendation regarding the prevention of stress-related mucosal disease and bleeding in critical care patients by using PPI and H2RA still holds. We tried to compare the results obtained by our group with the international data available and determine the benefits of this prophylactic therapy. Methods: The present paper presents a retrospective single center report of 36 patients with upper gastrointestinal (GI) bleeding caused by stress gastritis. Despite prophylaxis, the patients included in this study who were admitted in the ICU during a five year period (2003-2008) with various underlying conditions, had clinical and endoscopic diagnoses of bleeding from stress-related gastric mucosal disease. The initial treatment focused on patient stabilization first by medical intervention aimed at maintaining an elevated intragastric pH, in association with haemostatic drugs and blood transfusions; complementary endoscopic or surgical haemostatic therapy was employed for patients unresponsive to the initial management. Results: Despite prophylactic acid suppressive therapy, upper Gl bleeding findings were consistently present in high risk patients, 69.4% presenting hematemesis and 55.6% presenting coffee-ground gastric content. Conclusions: Each institution needs to have guidelines in place to establish the patients that actually have sufficient risk factors to justify stress gastritis prophylaxis. [ABSTRACT FROM AUTHOR]

The epidemiological aspects and risk factors in the outcome of upper gastrointestinal bleeding were analyzed in a prospective study of 268 patients with liver cirrhosis. The hemorrhagic episode has a negative prognostic in the immediate outcome, with 96 deaths (35.82%), p<0,01. In the acute phase of bleeding appeared 36 deaths (13.40 %); others were registered after recurrent hemorrhage (48 cases, 17.23%), or after sclerotherapy or surgical treatment of varices (12 cases, 4.47%). Patients in advanced stage of cirrhosis - Child C stage - (n=124), registered the highest death toll (n=76, 61.29%, p<0.01). High potential risk factors responsible for death included: altered general status (p<0.01), jaundice (p<0.01), increased seric level of total bilirubin (over 3 mg%, p<0.01), encephalopathy (p<0.05). Among these risk factors, the highest sensitivity belongs to jaundice (83.33%), and total highest positive predictive value belongs to seric and total bilirubin (over 3mg %), with 64.28% value. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal lesions of the gastrointestinal tract. They originate from the interstitial cells of Cajal and are characterized by overexpression of the tyrosine kinase receptor, protein product of c-KIT gene (KIT). In this retrospective study, conducted over a period of 10 years, we retrieved from our database, a total number of 57 patients, admitted and operated in the surgical department of 'Sf. Pantelimon' Emergency Clinical Hospital, Bucharest, for digestive tumors, histopathologically confirmed as GISTs. More than half of the cases presented as surgical emergencies and the tumors found during the surgical procedures, which proved to be GISTs, were sometimes difficult to differentiate from other mesenchymal tumors, both for the clinician and the pathologist. The diagnosis of GIST relies mostly on pathology and immunohistochemistry, but also on clinical and imagistic data. The most common emergencies were digestive hemorrhage (associated with gastric location), followed by intestinal obstruction (especially for the ileal localization). The largest dimensions corresponded to gastric location. For selected indications (upper digestive sites), upper digestive endoscopy approaches 100% sensitivity. This study focuses on diagnosis of GISTs sustained by both clinical and imagistic methods, along with histopathology and immunohistochemistry techniques, according to the World Health Organization 2019 criteria. Even though the differential diagnosis of these tumors is challenging, an interdisciplinary cooperation with a multiple approach increases the odds of a correct positive diagnosis. [ABSTRACT FROM AUTHOR]

Repairing an incisional ventral hernia represents a challenge for the surgeon. The high recurrence rates observed during hernia repair by tissue approximation leads to development of tension-free procedures by using prosthetic materials. Incisional or ventral hernia is a very common multifactorial pathology that requires surgical intervention to prevent complications, such as pain, discomfort, bowel obstruction or strangulation. To perform the wall repair it is of utmost importance to understand the pathogenesis of the hernia, the anatomy and physiology of the abdominal wall, and surgical techniques. Several repair methods are available, including open suture repair, open mesh repair, the component separation technique, and tissue expansion assisted closure. To perform the ventral hernia repair properly, a full understanding and correct selection of mesh and management of probable complications, such as seroma, bowel injury, enteric fi stulae, and recurrence, is essential. There are lots of scientifi c debates about an ideal material for mesh parietal repair. In latest years, the tendency is that the continuous decreasing territory of polyester mesh to be slowly replaced by the increasing territory of polypropylene mesh in open procedures for abdominal incisional hernia repair. The goals of incisional hernia repair are the prevention of visceral eventration, incorporation of the abdominal wall in the repair, provision of dynamic muscular support, and restoration of abdominal wall continuity in a tension-free manner. We present the case of a 55 years old woman who had a history of multiple surgical interventions. We performed an open surgical approach, tension free technique using an intraperitoneal dual-mesh. [ABSTRACT FROM AUTHOR]

The article is a review of the surgical therapies for iatrogenic bile duct lesions (IBDL). The history of the bile duct surgical procedures starts in 1882, when the first cholecystectomy is performed. There are several classifications of the IBDLs such as Bismuth, Wood et al., McMahon et al., Strasberg et al., Bergman et al., Bismuth and Majno, Stewart-Way, Hannover and Mattox. The choice of the proper surgical treatment of IBDLs depends of their type and the review describes the end-to-end repair, hepaticojejunostomy, hepaticojejunostomy without sutures, mucosal graft (Rodney Smith technique), hepaticoduodenostomy, Heineke-Mikulicz plastic repair of stricture, right and left duct hepaticojejunostomy, construction of hepatic duct bifurcation when bifurcation has been destroyed, intrahepatic cholangiojejunostomy, ligamentum teres (round ligament) approach to the left hepatic duct and Longmire procedure. Even the surgical treatment of IBDLs is in continuous development and research, their best prevention is the proper training of the biliary surgeons in the performance of safe cholecystectomies or any other abdominal surgeries, complex gastrotomies, pancreatic operations, endoscopic biliary tract investigations etc. [ABSTRACT FROM AUTHOR]

Clostridium difficile infection (CDI) has become a global health challenge, due to the dramatic worldwide increase in incidence and severity in the past three decades. Furthermore, the incidence of CDI has increased in surgical patients. The surgery itself is a known risk factor, that, together with the postoperative care (hospitalization, antibiotic treatment, intensive care unit admission), facilitate the development of CDI. Therefore, a matter of paramount importance is the optimization of the management of surgical patients and prevention of Clostridium difficile infection. [ABSTRACT FROM AUTHOR]

Over the past six decades, abdominal compartment syndrome (ACS) remained a very controversial subject, both in surgical and non-surgical specialties. Doctors failed to understand why critically ill patients died in the ICU with distended abdomens without fi nding any cause or why postoperative patients with wound defects such as dehiscence died after suturing the wound again „very tightly”. After the concept of intra-abdominal pressure (IAP) was established and methods for measuring it and diagnosing intra-abdominal hypertension (IAH) were available for clinicians to use it, it became clearer that ACS was a very serious and life threating pathology and the need for a correct treatment is essential. In this article we will try to make a literature review of the past decade and see when and how to diagnose correctly a patient with ACS and also how the diagnostic and treatments methods changed over the years. [ABSTRACT FROM AUTHOR]

Dyslipidemia constitutes a well-known factor that can lead to acute pancreatitis. Hypertrigliceridemia and hypercholesterolemia are part of dyslipidemia. In a prospecitve study, we analyzed the role of hypercholesterolemia in triggering episodes of acute pancreatitis and the capacity of cholesterol blood level to predict the severity and the evolution of acute pancreatitis. In our prospective study, a preexistent cholesterol blood level above 240 mg/dl proved to be a trigger for pancreatitis and an increasing cholesterol level in evolution predicts a pancreatitis with organ failure (moderately-severe or severe). [ABSTRACT FROM AUTHOR]

In recent years, the number of medical litigations is increasing and defensive medicine becomes a widespread approach among physicians all over the world. Defensive behavior of physicians is more common in scheduled, elective, compared to emergency medical services. The immediate direct consequences of this defensive behavior are found in the increase of costs (additional investigations) and the increase of waiting time for certain procedures and interventions (repeated postponements). Diffi cult and uncomfortable to admit that it exists, but defensive behavior is a reality. It raises numerous and complex ethical issues, and the goal of health policies should be to reduce this phenomenon. [ABSTRACT FROM AUTHOR]

When a surgical team is dealing with an after-hours colorectal surgery, they are actually confronting with a chain of elements and events, some linked to the patient and severity of the surgical case, others related to the medical team ability to cooperate, from nurses to surgeon and anesthetist. There is a series of differences between elective and emergency performed surgeries, two of them and most important elements are the patient (disease type, age, preoperative condition) and the operating team (experience, technical performance after-hours, especially at night). [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]

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]

The purpose of this article is to gain a deeper understanding of the management of social media at the local government level, the availability of opportunities for citizen dialogue on government websites, and the impact that social networking applications have on e-government. The results of the current study converge with prior research on the growing awareness amongst government practitioners regarding the relevance of social media, the use of social media for feedback on service quality, and privacy and security commitments in e-government. The literature on the use of information technology to transform government, the potential for online government information to contribute to citizen engagement, and the rapid growth in local government use of social media is relevant to this discussion. [ABSTRACT FROM AUTHOR]