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Journal of Surgical Sciences
Number of Followers: 0  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2360-3038 - ISSN (Online) 2457-5364
Published by Universitara Carol Davila Homepage  [1 journal]
  • Micro-textured silicone implants in secondary breast reconstruction after
           radiotherapy with latissimus dorsi flap

    • Authors: Andrei Ludovic Poroșnicu, Marius Cotofana, Alina Ionela Mitcan, Ina Petrescu
      Pages: 3 - 8
      Abstract: Delayed breast reconstruction after irradiated mastectomy cases includes a large series of reconstructive procedures like silicone implant/expander, numerous flaps or combined methods. Bad status of irradiated tissues needs to find a way to ensure a stable breast feature. Latissimus dorsi myocutaneous flap with implant represents one of classical methods of breast reconstruction providing a new breast with superior appearance. The aim of this paper is to present the advantages of breast reconstruction with latissimus dorsi flap and silicone-filled implant. New breast is created by combining the silicone implant placed under pectoralis major muscle and latissimus dorsi myocutaneous flap. Markings of flap is performed with the patients in standing position; first the new inframammary fold and midline and on back the skin paddle is design after a pinch test to check the amount available and the future donor site closure. It is recommended to place the incisions in transverse position so that the scar to be hidden in bra line. The study includes 84 patients who underwent breast reconstruction from April 2014 to April 2016. 57 were latissimus dorsi flap with implant and 5 from which were for salvage another breast reconstruction. The patient’s age was average between 32 and 69 years. The implants used were round shape implants, silicone filled with micro-textured shell. Combination between autologous tissue and implant offer superior appearance of new breast with shape, volume, natural ptosis and consistency similar with normal breast. Also, fast recovering and socio-professional reintegration are the benefits of this method. Analyzing different surgical option, breast reconstruction with latissimusdorsi flap and silicone implant seems to offer very good results with minimum complications in such difficult cases. This method can be suitable for almost all irradiated postmastectomy cases.
      PubDate: 2019-05-29
      Issue No: Vol. 6, No. 1 (2019)
       
  • SURGICAL TREATMENT OPTIONS IN COMPLICATED COLO-RECTAL CANCERS OPERATED IN
           EMERGENCY

    • Authors: Georgiana Bianca Constantin, D. Firescu, R. Bîrlă, S. Constantinoiu
      Pages: 9 - 13
      Abstract: Globally, the colo-rectal cancer is the 4th in frequency of all neoplasia and in Romania is the 2nd, with a yearly tendency of increasing the number of new cases. The poor symptomatology in the inchoate stages and also the deficiency of effective screening programs lead to frequently late presentation of patients, with tumors in complicated stages, when the surgical operations, very often can no longer have a curative intention. We will present the results of a retrospective study during 10 years (2007-2016) that included 431 patients with complicated colo-rectal cancers, admitted and operated in the 2nd Surgery Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galati, Romania. In 133 cases (30,9%), most of them occlusive, it was practiced in emergency a left iliac anus, leaving the tumor in its place. The Hartmann operation was practiced in 97 cases (22,5%). Anytime it was possible, we practiced operations with radical intentions, like: right hemicolectomy, in 46 cases (10,7%), left hemicolectomy, in 13 cases (3%), segmentary colectomy with anastomosis, in 30 cases (6,9%). Regarding the surgical operations in emergency, many of them don’t have a radical intention, taking into account the local invasion of the tumors and the metastasis. In these situations, a first surgical gesture is required, as an intervention that is meant to save the patient’s life, solving only the complication.
      PubDate: 2019-05-29
      Issue No: Vol. 6, No. 1 (2019)
       
  • Small intestine neuroendocrine adenocarcinoma with multiple liver
           metastases and ectopic benign pancreatic tumor in a 24-year-old woman –
           case report

    • Authors: Iulian Slavu, A. Tulin, V. Braga, D. Mihăilă, C. Niţipir, L. Alecu
      Pages: 14 - 19
      Abstract: Abstract : Neuroendocrine tumors represent a varied group of neoplasms which have the potential to produce and secrete a wide range of hormones along with other vasoactive substances.The care of these patients involves several specialties including:surgery, oncology, radiotherapy, interventional radiology and nuclear oncology. Despite this large number of options there is currently no consensus on the optimal sequence of these treatment resources for metastatic patients.We present the case of a 24 year women who was diagnosed with a gastric tumor (could not be biopsied) by imagistics and liver metastatsis. A Pean resection with metastasectomy was done. The histopathology study revealed that the gastric tumor was benign ectopic pancreas tissue and the metastases were actualle of neuroendocrine origin. A somatostatin receptor scintigraphy (OctreoScan) was done which revealed the primary tumor in the ileal mesentery which was resected in a secondary intervention. The patient was started on long acting sandostatin with no recurence.
      PubDate: 2019-05-29
      Issue No: Vol. 6, No. 1 (2019)
       
  • SURGICAL APPROACH IN A CASE OF GENERALIZED MYASTHENIA GRAVIS

    • Authors: Anca Anghelache, V. Bîrleanu, D. Ion, D. N. Păduraru, O. Andronic, F. Hubben
      Pages: 20 - 23
      Abstract: Myasthenia gravis(MG)is an antibody mediated, T cell dependent autoimmune disease characterized by a disorderof neuromuscular junction with progressive inability to sustain a maintained or repeated contraction of striated muscle. It is represented by antibodies directed against the nicotinic acetylcholine receptors (nAchR) of the post junctional membranes. We present the case of an 82-year-old patient, who was admitted to the hospital for plasmapheresis due to an aggravation of her auto-immune generalized myasthenia. The clinical examination at admission revealed ptosis, dysphagia, a medium effort dyspnea, difficulties in closing the mouth, dysphonia with a nasal voice and limited walking with a bent head and camptocormia, with Osserman score 46/100 (diplopia and bilateral ptosis). The thoracic scanner describes a tissue lesion in the thymus region with a diameter of 35 mm corresponding to a thymoma. The Magnetic Resonance Imaging confirmed the possible thymoma. A thymectomy using video-assisted thoracoscopic surgery (VATS) technique was performed according to the age and general status of the patient. Post-operative histological examination revealed a B2 type thymoma and the TNM staging system classifies the thymoma as being T1bNx.    
      PubDate: 2019-05-29
      Issue No: Vol. 6, No. 1 (2019)
       
  • GASTRO-ESOPHAGEAL REFLUX DISEASE AND ITS IMPACT ON TRACHEO-ESOPHAGEAL
           SPEAKING VALVE REHABILITATION AFTER TOTAL LARYNGECTOMY

    • Authors: A. Nicolaescu, Ș. Berteșteanu, R. Grigore, B. Popescu, R. Hainăroșie, V. Zainea
      Pages: 24 - 29
      Abstract: Gastro-esophageal reflux disease (GERD) is a pathological entity in which the mixture of gastric contents (with low pH because of the high content of HCl acid) and biliary juice (rich in proteolytic enzymes like pepsin and trypsin) causes lesions on the mucosa lining the esophagus. A higher prevalence of GERD was discovered in patients who had a total laryngectomy. Concerning laryngectomies with tracheo-esophageal speaking valves, it has been demonstrated that GERD is an independent risk factor for failure of this method of speech rehabilitation. The authors performed an analysis of English language articles found following a search of the major medical scientific databases (NCBI®, EMBASE®, Cochrane®) containing the following keyword string: vocal prosthesis, total laryngectomy, GERD, acid reflux, tracheo-esophageal fistula, failure. Studies showed that exposure to the protelolytic enzymes from the reflux juice increases the diameter of the tracheo-esophageal fistula and permits local granulation tissue to form. Progressively, the increasing fistula diameter leads to complications ranging from microaspiration of liquids and saliva to speaking valve expulsion or ingestion and temporary incapacity of oral feeding. Medical therapy in the postoperative period as well as long-term (6 months or more) correction of GERD (PPI therapy, H2 blockers, prokinetics) is also demonstrated to reduce the complication rate in this category of patients. GERD has a high prevalence in the total laryngectomy population of patients and it has multiple etiologic factors. In patients with tracheoesophageal vocal prostheses, GERD causes an increase in the fistula diameter – with important consequences that affect the patient's quality of life - his ability to phonate and his ability to swallow. These complications come with added costs because of the need to more frequently change the vocal prostheses with ones increasing in diameter, as well as multiple hospitalizations (even surgery to recalibrate or close the tracheo-esophageal fistula). Recognizing and treating this condition therefore decreases the risk of complications following vocal prosthesis speech rehabilitation.
      PubDate: 2019-05-29
      Issue No: Vol. 6, No. 1 (2019)
       
  • Antibiotics in acute appendicitis. When and how' A general review

    • Authors: L. Alecu, C. Niţipir, Iulian Slavu, V. Braga, D. Mihăilă, A. Tulin
      Pages: 30 - 33
      Abstract: Introduction: An increasing interest exits towards the use of antibiotics in the treatment of uncomplicated acute appendicitis.Discussion: For a long period of time, surgery was the only treatment for acute appendicitis. Due to recent research in the etiology of acute appendicitis which seems to be driven by intraluminal bacterial proliferation, new data suggests that for non-perforated appendicitis confirmed with the help of CT, antibiotics may play a central role in the treatment. As relapse rates amount in some cases to only 5% after antibiotic treament, a discussion is required regarding the risks of interval appendectomy and its use. The debate regarding the optimal antibiotic course is on-going as some surgeons advocate for amoxicillin/clavulanic while others, due to acquired resistance recommend Ertapenem.Conclusion:  Selective antibiotic treatment for selected forms of acute appendicitis, uncomplicated without perforation is safe and has a relatively low complication rate. However, certain mentions must be made:  surgery must not be delayed if failure of antibiotics exists as it can lead to higher rates of peritonitis. Close clinical surveillance is of utmost importance
      PubDate: 2019-05-29
      Issue No: Vol. 6, No. 1 (2019)
       
  • TAKING THE RISK IN SURGERY

    • Authors: Eugen Brătucu
      Pages: 187 - 188
      Abstract: One of the most difficult to accept treatment options by the patient remains surgical intervention. The patient resorts to a wide range of therapies, more or less appropriate, with the hope that he will solve his health problems by non-surgical ways. Only the idea of a surgical treatment triggers a reaction of fear, sometimes going to panic. The patient resorts to the most unusual solutions: natural medication, bioenergy, homeopathy, magnetism, polarized light, acupuncture, and more others just to avoid the operating room. The patient's reaction is natural and is the expression of a preservation instinct in front of aggression. Surgery remains, however, the most radical therapeutic remedy. Whether it is done in a classical way or minimally invasive, the surgical solution brings almost instantaneous resolution of the disease to which it is addressed. The therapeutic outcome, often spectacular, is accompanied by a number of risks that must be accepted by the patient. Hence retention and fear for surgery. The idea of being "cut" accepting aggression on your own anatomy is a difficult obstacle to overcome.
      There have been many changes in surgery. Advances have been made rapidly, in line with technological changes: endoscopy, laparoscopy and thoracoscopy, robotics, mechanical sutures, surgical lasers, ultrasonic disks, and so on. But the risks are almost unchanged: anesthetics complications, intraoperative hemorrhages, visceral lesions, eviscerations, postoperative bleeding or peritonitis and so on. How can the patient accept “this list of nightmares”' How can he accept the percentage of 0.1-10% of post-operative deaths, a number which varies according to the extent of the surgery and the patient's biological status' The informed consent cannot cover all possible surgical and non-surgical complications. However, the therapeutic act is inseparably linked and conditioned by obtaining this consent. During a few hours, the surgeon is responsible for the life and the future of his patient. A great surgeon, Robert Soupault, once said that the operator has "plein pouvoir sur la vie". These powers should be used with utmost discernment, with the sense of measure, consistent with the illness being treated and with the condition of the patient. Any exaggeration will, unfortunately, be reflected in the postoperative outcome. Overestimating or underestimating the disease are equally risky. "Better is the enemy of good" is an old saying well known in the surgical world.
      Rightly, paraphrasing Iuliu Hațieganu, "surgery is science and consciousness, both heated by respect and love for people.". And then, if things are so, in surgery it's good to think you can, but realize on time when you cannot.
      PubDate: 2019-05-29
      Issue No: Vol. 6, No. 1 (2019)
       
 
 
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