Ario Santini, Leonard Azamfirei and Cosmin Moldovan
Zoltán Ruszkai, Erika Kiss and Zsolt Molnár
Lung protective mechanical ventilation (LPV) even in patients with healthy lungs is associated with a lower incidence of postoperative pulmonary complications (PPC). The pathophysiology of ventilator-induced lung injury and the risk factors of PPCs have been widely identified, and a perioperative lung protective concept has been elaborated. Despite the well-known advantages, results of recent studies indicated that intraoperative LPV is still not widely implemented in current anaesthesia practice.
No nationwide surveys regarding perioperative pulmonary protective management have been carried out previously in Hungary. This study aimed to evaluate the routine anaesthetic care and adherence to the LPV concept of Hungarian anaesthesiologists during major abdominal surgery.
A questionnaire of 36 questions was prepared, and anaesthesiologists were invited by an e-mail and a newsletter to participate in an online survey between January 1st to March 31st, 2018.
A total of one hundred and eleven anaesthesiologists participated in the survey; 61 (54.9%), applied low tidal volumes, 30 (27%) applied the entire LPV concept, and only 6 (5.4%) regularly applied alveolar recruitment manoeuvres (ARM). Application of low plateau and driving pressures were 40.5%. Authoritatively written protocols were not available resulting in markedly different perioperative pulmonary management. According to respondents, the most critical risk factors of PPCs are chronic obstructive pulmonary diseases (103; 92.8%); in contrast malnutrition, anaemia or prolonged use of nasogastric tube were considered negligible risk factors. Positive end-expiratory pressure (PEEP) and regular ARM are usually ignored. Based on the survey, more attention should be given to the use of LPV.
Bhavna P Singh, Gurucharan S Shetty, Padmakumar Arayamparambil Vijayan, Ullas Gopalakrishna, Garud Chandan, Ario Santini and Vivek Padegal
H1N1 is seen in tropical countries like India, occurring irrespective of the season. Complications of the disease are frequently encountered and there is little in the way or guidelines as to the how these should be managed. The treatment of one such complication, a recurrent pneumiomediastinum is the subject of the current paper. The management followed guidance for the treatment of a similar condition known as primary spontaneous pneumomediastinum, an uncommon condition resulting from alveolar rupture-otherwise known as the Macklin phenomenon.
Tatiana Daniela Sala, Simona Mureşan, Ramona Roman, Alexandra Lazăr, Răzvan Ion and Ionela Paşcanu
A hypercalcaemic crisis, also called para thyrotoxicosis, hyper parathyroid crisis or parathyroid storm, is a complication of primary hyperparathyroidism (PHPT) and an endocrinology emergency that can have dramatic or even fatal consequences if it is not recognised and treated in time.
Two cases presented in the emergency department with critical hypercalcaemic symptoms and severe elevation of serum calcium and parathyroid hormone levels, consistent with a hypercalcaemic crisis. The first case, a 16-year-old female patient, had imaging data that highlighted a single right inferior parathyroid adenoma and a targeted surgical approach was used. The second case, a 35-year-old man was admitted for abdominal pain, poor appetite, nausea and vomiting. Laboratory tests revealed severe hypercalcaemia, hypophosphatemia and an increased serum iPth level. There was no correlation between scintigraphy and ultrasonography, and a bilateral exploration of the neck was preferred, resulting in the exposure of two parathyroid adenomas. The patients were referred for surgery and recovery in both cases was uneventful
These cases support the evidence that surgery remains the best approach for patients with a hypercalcaemic crisis of hyperparathyroidism origin, ensuring the rapid improvement of both the symptomatology and biochemical alterations of this critical disease.
Piero Portincasa, Emilio Molina-Molina, Gabriella Garruti and David Q.-H. Wang
Approximately twenty per cent of adults have gallstones making it one of the most prevalent gastrointestinal diseases in Western countries. About twenty per cent of gallstone patients requires medical, endoscopic, or surgical therapies such as cholecystectomy due to the onset of gallstone-related symptoms or gallstone-related complications. Thus, patients with symptomatic, uncomplicated or complicated gallstones, regardless of the type of stones, represent one of the largest patient categories admitted to European hospitals.
This review deals with the important critical care aspects associated with a gallstone-related disease.
Anca Chiriac, Piotr Brzezinski, Meda Bradeanu, Adrian Năznean, Cristian Podoleanu and Simona Stolnicu
Newborns are more likely to develop bruises due to mechanical trauma during birth. Establishing the correct diagnosis in newborns presenting with different skin lesions is not an easy task, and besides the well-known pathology, one must not forget simple posttraumatic injuries. We present three cases that raised questions before establishing that the lesions had been induced by simple mechanical trauma during birth. Trauma-induced skin lesions in newborns may represent an overlooked problem. The three cases presented here are meant to draw attention to the possibility of trauma-induced lesions in newborns, which require only close follow-up and surveillance instead of exhaustive clinical and laboratory investigations, which are inevitably accompanied by anxiety.
Balázs Oltean-Péter, István Kovács, Monica Chițu and Imre Benedek
Atherosclerosis is a systemic disease that most often affects the carotid arteries. Being usually asymptomatic in its early stages, it is diagnosed only in advanced stages, when treatment is more difficult and prognosis is poor. Carotid ultrasound (US) is the most commonly used method for diagnosing carotid artery disease and represents a proper method for screening in patients with cardiovascular (CV) risk factors. This paper shows the methodology and necessity of carotid imaging methods in patients at high risk of developing atherosclerotic lesions. We also review the findings that underline the need of carotid screening in patients with ischemic heart disease or with ischemic arteriopathy, showing that the carotid arteries are like ‘mirrors’ of the arterial system, which need to be assessed in every patient with CV risk factors, regardless of the presence or absence of symptoms.
Bernadette Kerekes-Máthé, Csaba Dudás, Nóra Csergő and Krisztina Mártha
Background: Measurement-based studies are prone to measurement errors, which occur at the same operator or between different operators during repeated measurements of the same sample.
Aim of the study: To assess the inter-operator reliability of morphometric measurements using a bidimensional image analysis method.
Material and methods: Eight study models have been selected, images of teeth and models were taken from vestibular and occlusal view. The following parameters were measured individually by three, previously trained operators: mesio-distal, occluso-gingival, and vestibulo-oral dimensions, vestibular and occlusal area, depth of palatal arch, arch breadth, arch circumference, and arch length. Intraclass correlation coefficients were calculated for each measurement.
Results: The reliability of the measurements showed high degrees, all values being higher than 0.8.
Conclusions: Dental morphometric measurements done by 2D image analysis can be performed by multiple operators with an excellent reliability.
Flavius Mocian, Ruxandra Oancea and Marius Coroș
We present the case of a 48-year-old patient with a recurrent rectovaginal fistula, who we treated surgically by transposing the gracilis muscle. The patient with a history of ulcerative colitis underwent colorectal resection with mechanical anastomosis and diverting ileostomy for rectal cancer. She was subsequently treated by radiation and chemotherapy. Six weeks later, the ileostomy was removed, but afterwards the patient developed a recto-vaginal fistula. A new diverting ileostomy was performed. After eight months, a transvaginal surgical procedure was performed, and the diverting ileostomy was closed after four months. Two years after the last surgery, the patient performed an MRI scan, which revealed the relapse of the rectovaginal fistula. This time the patient was reoperated using a flap of the gracilis muscle interposed between the rectum and the vagina, but the patient refused any diverting stoma. The rectovaginal fistula relapsed again after thirteen days. Fortunately, after six months of intensive systemic and local treatment with aminosalicilic-5-acid, the fistula closed by itself. Our conclusion is that with a well-managed medical treatment, the gracilis flap, because of its good vascular supply, could be successfully used to treat rectovaginal fistulas even in patients with ulcerative colitis who underwent rectal surgery and radiation therapy for cancer.