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Peritonitis remains, despite the diagnostic and therapeutic developments, a serious condition, the main cause of septic shock with lethal potential in abdominal surgery Identifying and characterizing the dynamics of early biomarkers of the inflammatory response in abdominal sepsis is important to better follow-up evolution and postoperative infectious complications. The paper aims to study the dynamics of serum concentration of biomarkers LBP, IL6 and bilirubin in patients with acute peritonitis of appendicular cause, in the pre and postoperative stage and the correlation with the clinical evolution of inflammatory syndrome. A prospective 6-month study was performed, including patients for appendicular peritonitis. LBP, IL6, bilirubin, leukocytes were sampled preoperatively, then postoperatively at 72 h, and repeated at 72 h until values returned to normal. Clinical evolution and leukocytes were correlated with biochemical parameters. The mean preoperative values for the studied biochemical parameters were for Il6 of 14.81 +/- 4,047 pg / mL, for LBP of 33,826 +/- 5.5.02 microgram / mL and for bilirubin of 1.77 +/- 0.55mg / mL. The postoperative values decreased in all cases, but remained above normal limits in cases with septic complications. LBP, Il 6 and bilirubin are biomarkers useful in the pre- and postoperative evaluation of sepsis in appendicular peritonitis, correlating more accurately with the evolution of the inflammatory response than leukocytosis. Bilirubin is useful in monitoring intraperitoneal infection, but is not influenced by the existence of extraperitoneal infection. The dynamics of LBP is the most accurate description of bacterial infectious factor exposure.

Romania is located in an area with high seismicity, the role of emergency hospitals being a major one in providing medical aid in the case of earthquakes with mass casualties. The article aims to characterize the particular issues related to specific pathology in case of a seismic disaster, whose proactive awareness and anticipation are important for a good management of the medical-surgical activity. An extensive review of literature was conducted, including scientific studies, recommendations, and practice guides on emergency response planning, published between 2000 and 2018. Emergency hospitals must provide for a surge of 20% in total beds number, allocating the necessary human and material resources. The medical assistance in case of disaster with mass victims presents clinico-surgical particularities related to the dynamics of aflux in the ER, triage, casuistic, gravity and specific risks, with a direct impact on the medical-surgical care protocols. Conclusions. Pre-disaster preparation is the key to an effective management in crisis. Simulation, repeat, and periodic renewal of planning are required. Besides, for an orderly and efficient medical activity, regular education and training of health personnel is of major importance.

The paper is a retrospective study on a group of 97 patients admitted to the emergency room between 2012 to 2015 for suspicion of penetrating abdominal trauma. We have analyzed clinical data, paraclinical tests and how they correlate with therapeutic management. Out of the 97 patients, 78 presented penetrating stab wound. In 62 cases, immediate surgery was decided and 15 cases underwent seriated clinical and imaging follow-up. Of these, 3 patients underwent delayed laparotomy, for developing signs of peritonitis. The rate of non-therapeutic laparotomies was 9.72% (6 cases). Shock, peritonitis and evisceration were indications for immediate laparotomy. When the depth of the wound was uncertain, imaging tests (ultrasound, especially CT) provide valuable information for therapeutic management. Conservative treatment is an option for patients with no signs of hemodynamic instability and peritonitis, under careful clinical and paraclinical surveillance.

During 1985-2014 in our Clinic nearly 4,925 gastrostomes were performed, for a large variety of pathologies: benign and malign esophageal stenosis, esophageal fistulas, posttraumatic ruptures, iatrogenic pathology, strokes. Among those, some were definitives and the others were temporary. We used Gavriliu technique with peritoneal collar in 96% of the cases. During those 30 years we managed to establish an immediate and long-term care protocol of the feeding gastrostomes. This protocol contains specific measures for the monitoring of the vital parameters, biological and metabolical ones, but also the close analysis of the gastric stasis, the imposing of the digestive repose during the first 48-72 hours, the continue follow-up of the quality and the rhythm of alimentation and the mechanical protection of the Pezzer tube. The efficiency of this type of nursing consists in the introduction of food after 48-72 hours, with the second stage of efficiency of the gastrostomy in the same time with the long-term care of the associated oncological and metabolical complications. Due to the importance of the moment of the surgical indication, the technique and nursing that has been used, the survival of the patient with definitive gastrostomy has significantly improved. The elimination of the temporary ones didn’t involve in most of the cases surgical closing.

The study aims that, starting from preoperative clinical and laboratory variables, to identify the most effective predictive multidimensional models for anatomopathological result in acute appendicitis. A prospective study was performed on 147 patients operated for acute appendicitis. The set of potential predictors considered for the selection is as follows: IL6, LBP, Alvarado score, total bilirubin, neutrophils count and WBC, all determined preoperatively. For data analysis we used a variant of a classic sequential analysis discrimination based on linear functions of Discrimination method of Fisher (SPSS). The most effective statistical models with an accuracy of classification of 100% were obtained from the variables: IL6 preop, LBP preop and WBC on admission Model 1) and IL6 preop, LBP preop and score Alvarado (Model 2). These observations lead us to believe that developing a procedure for preoperative diagnosis of appendicitis type is achievable. Defining, validating and assessing the reliability of such a procedure however require further research on a larger volume samples and are representative of both the pathology of appendicitis and population with acute appendicitis.