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Atypical Femoral Fractures due to long-term bisphosphonates therapy

do we stand?. Curr Osteoporos Rep. 2004; 2:24–30. 5. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005; 90:1294-301. 6. Higgins M, Morgan-John S, Badhe S. Simultaneous, bilateral, complete atypical femoral fractures after longterm alendronate use. Journal of Orthopaedics. 2016; 13:401-403. 7. Shane E, Burr D, Ebeling PR et al. Atypical subtrohanteric and diaphyseal femoral fractures: report of a task force of the

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Pupillary dilation reflex and pupillary pain index evaluation during general anaesthesia: a pilot study

: 234-241 13. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth 2014; 112: 991-1004. doi: 10.1093/bja/aeu137 14. Lusk B, Lash AA. The stress response, psychoneuroimmunology, and stress among ICU patients. Dimens Crit Care Nurs 2005; 24: 25-31. doi: 10.1097/00003465-200501000-00004 15. Bernardini R, Tinè A, Mauceri G, Mazzarino MC, Malaponte G, Nicosia A, et al. Plasma beta-endorphin levels and natural-killer cells in two cases of

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International survey of neuromuscular monitoring in two European countries: a questionnaire study among Hungarian and Romanian anaesthesiologists

. Effects of neostigmine reversal of nondepolarizing neuromuscular blocking agents on postoperative respiratory outcomes: a prospective study. Anesthesiology 2014; 121: 959-968. doi: 10.1097/ALN.0000000000000440 12. Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br J Anaesth 2007; 98: 302-316. doi: 10.1093/bja/ael386 13. Cammu GV, Smet V, De Jongh K, Vandeput D. A prospective, observational study comparing postoperative residual curarisation and early adverse respiratory events in patients

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The epidemiology and influence of osteoarthritis on clinical, laboratory and ultrasound parameters of patients with early rheumatoid arthritis

, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino M-A et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005; 32:2485-7. 12. Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis. 2004; 63:988-94. 13. Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum. 2003; 48:955-62. 14. Naredo E, Gamero F

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Defect Reconstruction After Hip Tumor Resection - Our Clinical Experience

Abstract

Aim. Short and mid-term analysis of postoperative results after hip vicinity tumor resection and reconstruction with salvage of the lower limb. Material and method. Retrospective study on a number of 13 cases: 6 pelvis tumors, 3 femur tumors and 4 femur and pelvis tumors. 3 out of the total pelvis tumors were treated using custom pelvis reconstruction prosthesis, the other ones using bone graft and standard implants. The femoral tumors were treated using modular prosthesis and bone graft and osteosynthesis implants. Results. Short-term outcome was favorable. Conclusion. Bone defect reconstruction after hip vicinity tumor resection is a technically difficult procedure, which requires significant material resources. In terms of quality of life, the results are clearly superior compared to tumor resection with the sacrifice of the affected member.

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Surgical Options in Periprosthetic Fractures

Abstract

Purpose. The periprosthetic fractures are a more and more often encountered type of pathology, in which the main problem is the indication for surgery. The most important thing is the choice of the best therapeutic option in order to get a solid fixation of the fracture and, in the end, to allow an early patient’s mobilization. Materials and method. 38 cases of periprosthetic fractures have been treated in the Orthopedics and Traumatology Department of University Emergency Hospital in Bucharest, between 2010 and 2016. International Vancouver classification was used for all cases. The osteosynthesis saving the femoral stem was preferred in 22 cases, as its stability was not affected. Stem revision was performed in 16 cases, as this was unstable due to the fracture. Acetabular component was also revised in 4 cases, as the PE insert presented severe wear. The patients were aged 52 to 84 years old and sex ratio M/ F = 13/ 25. Osteosynthesis was performed using Dall-Miles plates and molded plates, with braided cables or wire cerclage. Long stems, uncemented with or without distal locking, were used in 16 cases. Results. Postoperatively, the bone repair was efficient regarding the stability in most of the cases. The patients’ mobilization was early in most of the cases, except for the very old patients with associated comorbidities and limited biological resources. Conclusions. An appropriate surgical indication, adapted on each type of peri-implant fracture, leads to a good result, with early mobilization and the best consolidation of the fracture.

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Prognosis and Survivability in Surgically Treated Metastasis of the Long Bones

Abstract

Aim: To assess the clinical results after osteosynthesis with locked intramedullary nail in metastasis of the long bones. Material and methods. We designed a prospective study in which we included all the patients with metastasis of the long bones admitted and surgically treated in our department between 2013 and 2015. Data for 64 were available at the final check-up. Our cohort totalized a number of 69 fractures (2 long bones required surgical treatment in 5 patients). The mean follow-up for survivors was 37 months (limits: 18-49 months). The primary tumor was known in 51 patients (79,69%). For the remaining 13 cases (20,31%), the primary tumor was not known and the pathological fracture was the first sign of the malignant disease. In the last group, the tumor could be identified by imagistic methods in 6 cases, while in other 3 cases, a biopsy and histological examination (which were performed in all the remaining 7 cases) determined the source organ. Clinical and radiological check-ups were performed at every 3 months in the first year and at every 6 months after that. Results. Pain amelioration and mobilization of the involved limb were achieved in all the cases. In 3 patients, the osteosynthesis could not compensate the progressive bone loss and the permanent use of an external orthosis was mandatory. The survival rate was 82,81% at 6 months and 67,19% at 12 months. Conclusions. All patients could be mobilized. Two thirds of the patients will survive more than a year. The goals of osteosynthesis are the same, regardless the location of the fracture and implant used: pain amelioration, stability for immediate full weight bearing, durability for patient’s life expectancy.

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Surgical Treatment for Pulmonary Metastases of Osteosar-Coma

Abstract

Introduction. Osteosarcomas represent 40% of bone sarcomas and occur mainly in children and young adults. They are tumors with a high degree of pulmonary metastasis. Pulmonary metastases occur in about 80% of the relapsed patients after primary tumor therapy, whether or not they have received chemotherapy. As therapeutic solutions, both first intention resection of the metastasis and the post-chemotherapy resection or repeated resections in each relapse, represent satisfactory results with prolongation of survival. Material and method. The present study describes a group of 17 patients who were surgically treated for osteosarcoma with different localizations and who presented themselves in the thoracic surgery department during 2011-2016 with suspicion of pulmonary metastases. Three of them were at their second intervention for metastasis resection. Following investigations, 4 of them (23.5%) could not benefit from surgical resection of pulmonary metastases (lesional extension with postoperative vital risk or technical impossibility of metastatic excision). Surgical interventions were curative; lobectomies were performed in 4 cases (30.7%), atypical resections in 8 cases (61.6%) and one pneumonectomy (7.7%). Postoperative progression was favorable in all 13 patients. Discussions and conclusions. Surgical excision of osteosarcoma pulmonary metastases can prolong survival and sometimes even cure disease. In order to benefit from the intervention, the patient should be served by a thoracic surgery clinic in the shortest possible time after the discovery of the pulmonary nodules. Thus, the need for thoracic imaging is required in patients treated for osteosarcoma. Late presentation makes the intervention impossible, particularly because of the lesional extension in the lung parenchyma or the invasion of the adjacent structures, extension given by the number of metastases or their size.

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Bilateral postoperative ultrasound-guided erector spinae plane block in open abdominal hysterectomy: a case series and cadaveric investigation

, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med 2016; 41: 621-627. doi: 10.1097/AAP.0000000000000451 10. Chin KJ, Adhikary S, Sarwani N, Forero M. The analgesic efficacy of pre-operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia 2017; 72: 452-460. doi: 10.1111/anae.13814 11. Younger J, McCue R, Mackey S. Pain outcomes: a brief review of instruments and techniques. Curr Pain Headache Rep 2009; 13: 39-43. doi: 10.1007/s11916

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Management of exposed pacemaker caused by burns

References 1. Bonawitz SC. Management of exposure of cardiac pacemaker systems. Ann Plast Surg 2012; 69: 292-295. doi: 10.1097/SAP.0b013e31822350cc 2. Zhan C, Baine WB, Sedrakyan A, Steiner C. Cardiac device implantation in the United States from 1997 to 2004: a population-based analysis. J Gen Intern Med 2008; 23 Suppl 1: 13-19. doi: 10.1007/s11606-007-0392-0 3. Greenspon AJ, Patel JD, Lau E, Ochoa JA, Frisch DR, Ho RT, et al. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients

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