Laparoscopic pediatric surgery (LA) is becoming a good alternative in many centres of the entire world, being associated with low risk of surgical complications and it offers a better alternative for the management of the appendectomy than open surgery. The goal of the study was to evaluate a comparative LA versus open appendectomy (OA) through the prism of the clinical results as they were reflected in specialty literature in the last two decades. In general, pediatric laparoscopic surgery has become acceptable in centres of the whole world. Many studies and meta-analyses have proven that laparoscopic surgery is a feasible and secure procedure, with many clinical benefits. Because laparoscopic appendectomy (LA) was associated with low risk of surgical complications, it may be a better alternative for appendectomy than OA.
Peripheral artery disease of the lower limbs is, in fact, an arterial pathology, by which the blood flow is reduced, due to the obstruction caused by the deposit of atheroma plaques.(1) This deposition occurs slowly, which leads to a slow progression of the disease, and thus, at the onset of symptomatology. The objective of the study was to make a comparison between the invasive and noninvasive paraclinical investigations performed in patients with peripheral arterial disease of the lower limbs in the E.C.C.H. Sibiu. In conclusion, between the two investigations (computed tomography angiography and digital subtraction angiography) there are no noticeable differences in the terminal aorta and iliac arteries, but in reducing the arteries calibre, the use of digital subtraction angiography is preferred, according to our study, although it is more invasive and exposed to complications.
Worldwide, trauma is the sixth leading cause of death and represents 10% of all-time mortality, being a serious public health problem with significant social and economic costs. This study aims at analysing the costs regarding the maxillofacial trauma of the patients admitted to the Sibiu County Clinical Emergency Hospital, during the period 2014-2017 as well as comparisons regarding the costs of the different treatment methods.
Mechanical stress due to flexion-extension in the femoropopliteal space may cause stent failure via stent fracture and thrombosis. Wire-Interwoven self-expanding Nitinol Stents design partially mimics the reticular structure of native vessels, emphasizing radial strength, flexibility and kink resistance; these stent features can offer more chances for short and long term patency. We have evaluated 5 patients with peripheral artery disease with significant superficial femoral artery or proximal popliteal artery lesions. All patients underwent endovascular therapy with Wire-Interwoven self-expanding Nitinol Stents, with primary focus on stent patency at follow-up visits (1, 6, 12 months). The endovascular initial success was achieved in all 5 patients. Stent patency at 1-year follow-up was achieved in 3 patients (60%). 2 patients (40%) had stent thrombosis within 30 days after procedure secondary to arterial dissection at distal stent extremity and self-withdrawal dual antiplatelet therapy; subsequently target lesion revascularization with endovascular therapy and ilio-femoral bypass was performed.
Iodine deficiency in childhood can influence the mental and somatic growth and development of children by decreasing the thyroid hormone production. Iodine deficiency can be quantified by testing ioduria concentration. Our study has analyzed ioduria concentration of children detected with stature delay, coming from two distinct regions of Sibiu County, namely Gura Rîului, a known endemic area, and Şeica Mare, a lowland region. Approximately 60% of these children with iodine deficiency were detected in both regions, but a much lower average of ioduria was identified in the endemic area, where 23% of children presented severe iodine deficiency. The results are related to those published in other articles and call for their extension to larger group of children throughout the country, because iodine deficiency is still an issue of public health with multiple effects on the mental and somatic growth and development of children.
At this moment, geriatric dentistry represents a very well-defined discipline, which deals with the dental treatments in the elderly patients, more precisely the patients over 60 years old. Unfortunately, in Romania, geriatric dentistry is currently very superficiality treated, this being rather an optional study discipline in the curricula of Dental Medicine Faculties. Therefore, in this material we have tried to explain through solid arguments the importance of geriatric dentistry in the basic training of dentists, dental and dental prophylaxis nurses, as well as dental technicians.
Stress hyperglycemia is commonly identified in children with severe illness and previously normal glucose homeostasis. In the pediatric population febrile seizures are reported among stress-related conditions associated with stress hyperglycemia. The objective of this prospective study was to evaluate the possible association between blood glucose level and febrile seizure severity defined by fever degree, seizure type, seizure duration and hospitalization length. Among 167 febrile seizures the prevalence of stress hyperglycemia (blood glucose concentration over 150mg/dl) was 13.22%. There was a highly significant statistical association between seizure duration (exceeding 15 minutes) and increased blood glucose concentration (p= 0.001). Prolonged febrile seizures combined with high fever were significant risk factors for stress hyperglycemia. Further analysis on acute fluctuation of glycemia, persistence of hyperglycemia should be taken in consideration as possible prebdictive factor for stress hyperglycemia, by comparison to the peak blood glucose concentration .
In acute pancreatitis some prognostic scores have been suggested, based on clinical, laboratory and radiological criteria. The most popular are: Ranson score, APACHE II score and CT severity index (CTSI). The trend is to find a prognostic marker that is easy to use, cheap, and reproductible. Recently, the increase of the intra-abdominal pressure (IAP) has drawn attention. Material and Methods: From January 2012 to April 2014, a group of 64 patients, admitted to the Clinical Department of Anaesthesia and Intensive Care and the Surgical Departments of the SCJU Sibiu, with the diagnosis of acute pancreatitis, were included in this observational prospective study. The cut-off values, the specificity and sensitivity of the prognostic scores were calculated using the receiver operating characteristics (ROC) analysis curves. Results: At a cut-off value of 12 mm Hg IAP max has a sensitivity of 0,75, similar to Ranson score at 48 h (0.72 at a cut-off value 3) and CTSI (0,73 at a cut-off value 4). Better results are just for APACHE II score at 24 h (0,88 at a cut-off value 8). IAP max has a specificity of 0,88, simillary to CTSI (0,83) and APACHE II score (0,82). Conclusions: In our study maximum IAP could be correlated with prognostic markers for severe evolution in acute pancreatitis.
Cardiorenal syndrome (CRS) is a serious condition in which cardiac dysfunction leads to renal impairment and viceversa, with a high risk of mortality. This paper is a review of the most recent studies that investigated the role of Levosimendan on kidney function in case of patients with CRS. Compared with standard therapy (diuretics, other inotropes), Levosimendan has renoprotective effects associated with a lower mortality rate, it leads to an important improvement in NYHA class, a decrease in markers of congestion (BNP) and shortage of hospitalization stay. A study from 2018, in which Levosimendan was compared with Dobutamine, indicated that although both agents increase renal perfusion, only Levosimendan can improve GFR. In conclusion, Levosimendan – through its protective profile for both heart and kidneys, provides higher survival expectancy and seems to be the ideal alternative to the standard therapy in the management of hemodynamic CRS at present.
Lichen planus is an autoimmune, itching disorder that involves T lymphocytes, which may interest the skin, mucous membranes and exoskeletons. The presence of lichen manifestations both at the skin, mucous membranes and at the level of the skin attachments (hair and nails) is rarely mentioned in the literature. Although lichen planus may have a self-limiting evolution, early treatment is important in shortening the evolution of the disease and in controlling the symptoms. The therapeutic effects of retinoids (immunomodulatory, anti-inflammatory, anti-proliferative effects) make them an appropriate choice in the treatment of lichen with (cutaneous-mucosal, nail and planopilaris lesions. We will present the cases of 2 patients with muco-cutaneous, nails and scalp disorder due to lichen planus, and the time of presentation to the doctor made the difference between the complete remission of the disease and the evolution towards severe, extended, definitive alopecia in the scalp and genital lichen sclerosus.