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Chirurgia (Bucur) ; 116(6): 725-736, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1650583


Introduction: The study is presenting a personal experience of a Trauma Centre Level I and is try to conclude on optimal medical attitude for patients with retroperitoneal hematoma, still a controversial topic for traumatologists. Material and Method: A retrospective analysis of 22 cases of post-traumatic retroperitoneal hematoma admitted on Bucharest Emergency Hospital between September 2018 August 2021 (including time of Covid-19 pandemic), is presented Results: The patients (males predominance, mean age 43, mean ISS of 23), benefited of nonoperative management on admission for 10 cases (45%) with a failure rate of 4/10 due to recurrent bleeding from spleen injuries and continuous bleeding from mesenteric vessels lesions. CT scan (73% - 16 cases) within 1 hour from the admission and emergency surgery were necessary for 12 cases (55%). 2 patients benefited of angioembolization on admission. Conservative attitude for retroperitoneal hematoma was adopted for 72% cases. Over-all mortality: 18% (4 patients, mean ISS of 36), among 82% polytrauma cases. Conclusions: Algorithm of treatment is adapted to every case of retroperitoneal hematoma but the following sequences are mandatory: rapid transportation to Trauma Centre Level I with medical help, correct resuscitation, immediate relevant imagistic (CT scan), emergency surgery prior to angioembolization (for hemodynamic instable patients) or after it, ICU stabilization of the patient and then definitive repair of the injuries. Despite all, mortality remains high.

Abdominal Injuries , COVID-19 , Wounds, Nonpenetrating , Abdominal Injuries/complications , Abdominal Injuries/therapy , Adult , Gastrointestinal Hemorrhage , Hematoma/diagnostic imaging , Hematoma/etiology , Hematoma/surgery , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , Treatment Outcome , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/therapy
BMC Neurol ; 21(1): 83, 2021 Feb 19.
Article in English | MEDLINE | ID: covidwho-1090685


BACKGROUND: The respiratory system involvement is the most common presentation of Coronavirus disease 2019 (COVID-19). However, other organs including the central nervous system (CNS) could be affected by the virus. Strokes, seizures, change in mental status, and encephalitis have been reported as the neurological manifestation of the disease. We hypothesized that COVID-19 could predispose younger patients to spontaneous intracerebral hemorrhage (ICH). The present study aimed to investigate whether COVID-19 has any relationship with the occurrence of spontaneous ICH in young or not. METHODS: We retrospectively evaluated all the patients with spontaneous ICH who were referred to our center between 20 Feb and 1 Sep 2020. The demographic, clinical, radiological, and laboratory test data were evaluated. Patients were divided into two groups. The COVID-19 positive patients and COVID-19 negative ones. All the variables including age, sex, history of hypertension, diabetes mellitus, smoking, Glasgow Coma Scale (GCS), hematoma volume and location, the presence of intraventricular hemorrhage and hydrocephalus on admission, the length of hospital stay, the lab test results and the clinical outcome at last visit or discharge as Glasgow Outcome Scale (GOS) were compared between the two groups. RESULTS: There were 22 COVID-19 positive patients (20.8%) and 84 COVID-19 negative ones (79.2%). The mean age of the patients in the case group (54.27 ± 4.67) was significantly lower than that in the control group (69.88 ± 4.47) (p < 0.05). Meanwhile, our results showed a significant difference between the two groups based on the presence of chronic arterial hypertension (p < 0.05). There were no significant differences between the two groups based on gender, diabetes mellitus, smoking, Glasgow Coma Scale (GCS), hematoma volume, need for surgery, the presence of intraventricular hemorrhage and hydrocephalus on admission, White Blood Cell (WBC) count, platelet count, Prothrombin Time (PT), and Partial Thromboplastin Time (PTT) (p > 0.05). CONCLUSIONS: Our results show that COVID positive patients with ICH are younger and with less predisposing factors than COVID negative subjects with ICH.

COVID-19/complications , Cerebral Hemorrhage/epidemiology , Hematoma/epidemiology , Aged , Case-Control Studies , Female , Glasgow Coma Scale , Glasgow Outcome Scale , Hematoma/surgery , Hospitalization , Humans , Hydrocephalus/epidemiology , Length of Stay , Leukocyte Count , Male , Middle Aged , Retrospective Studies
World Neurosurg ; 138: e955-e960, 2020 06.
Article in English | MEDLINE | ID: covidwho-274866


OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.

Aneurysm, Ruptured/surgery , Coronavirus Infections/diagnosis , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intracranial Aneurysm/surgery , Neurosurgical Procedures/methods , Pneumonia, Viral/diagnosis , Subarachnoid Hemorrhage/surgery , Air Filters , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Betacoronavirus , COVID-19 , COVID-19 Testing , China , Clinical Laboratory Techniques , Computed Tomography Angiography , Coronavirus Infections/complications , Craniotomy/methods , Drainage , Emergencies , Hematoma/complications , Hematoma/diagnostic imaging , Hematoma/surgery , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Intracranial Pressure , Intraoperative Care , Lung/diagnostic imaging , Monitoring, Physiologic , Operating Rooms , Pandemics , Perioperative Care , Personal Protective Equipment , Pneumonia, Viral/complications , Practice Guidelines as Topic , SARS-CoV-2 , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed , United States