Angiocatheter Decompression on a Covid-19 Patient with severe Pneumonia, Pneumothorax, and Subcutaneous Emphysema.

BACKGROUND: A novel coronavirus, currently known as Severe Acute Respiratory Syndrome Coronavirus 2, causes Coronavirus disease 2019 (Covid-19). Its most significant complication is a kind of pneumonia known as of 2019 New Coronavirus-Infected Pneumonia (NCIP). Covid-19 pneumonia can have unusual complications that affect both lungs in a widespread manner. Acute lung damage and Acute Respiratory Distress Syndrome (ARDS) are typical in severe Covid-19 cases. Several potential risk factors cause the pneumonia associated with this disease, such as age over 65, diabetes, hypertension, chronic obstructive pulmonary disease, immunosuppression, and pregnancy. Furthermore, various laboratory markers like high levels of C-reactive protein (CRP), D-dimers, ferritin, interleukin-6 (IL-6), and LDH, as well as a low lymphocyte and thrombocyte count, have been linked to increased disease severity and a poor prognosis. METHODS: In this study, we present a case of a 45-year-old patient with a rare evolution of the disease, who made a full recovery against all odds. We highlight the atypical presentation of Covid-19 in this patient, who developed some unusual complications, such as pneumonia, pneumothorax, pneumomediastinum, and subcutaneous emphysema. RESULTS: There is a scarcity of information on patient-related variables linked to pneumothorax in severely sick Covid-19 patients. This study adds to the existing research, reinforcing that spontaneous pneumothorax can be caused by the infection itself, in addition to ventilator-induced trauma in mechanically ventilated patients. CONCLUSIONS: We conclude that patients with Covid-19 pneumonia may develop a more robust and systemic illness characterized by acute lung injury, acute respiratory distress syndrome (ARDS), shock, coagulopathy, and nu¬merous organ dysfunctions, all of which are linked with a high risk of death.

Full factorial design and dynamic modelling of silent and ultrasound-assisted lead and cadmium removal by porous biosorbent.

Present work aimed to analyse single and competitive lead and cadmium batch adsorption, using experimental studies and mathematical modelling. The experiments were conducted in silent and ultrasound-assisted systems, in aqueous environment, using grinded hazelnut shells as porous biosorbent. The influence of process factors (pH, adsorbent concentration, adsorbent particle size, and initial species concentration in liquid phase) on species removal efficiency was evaluated when process equilibrium was attained. The statistical study, following a 24 factorial experimental design, allowed the development of a model to predict variables influence. Based on the obtained results a deeper analysis of the separation efficiency, depending on process factors, was conducted. The dynamic study was performed based on experimentally obtained removal rates, modelled considering species diffusion, with reversible kinetics of sorption inside solid particles. Hence, the dynamics of removal efficiency was determined for several representative experiments. The equilibrium isotherms data, best fitted by an appropriate Langmuir model, were used in the dynamic model to reduce the number of model parameters which normally require experimental identification.

Synthesis and electronic properties of polycyclic aromatic hydrocarbons doped with phosphorus and sulfur.

In this work, we report on the synthesis of polyaromatic hydrocarbons containing phosphole and thiophene rings at the edge. The ring-closure reactions have been investigated by theoretical calculations. The optical and electrochemical properties and density functional theory calculations showed that the properties depend on the relative position of these five membered rings in the PAH structure.

Current endoscopic methods of radical therapy in early esophageal cancer.

During the last three decades, there has been an increasing incidence of the esophageal cancer at the global level, approx. 400,000 new esophageal cancers being currently diagnosed annually. This is the eighth leading cause of cancer incidence and the sixth leading cause of cancer death overall. If we refer to the countries of Western Europe and North America, we could see an increase in the esophageal adenocarcinoma in detriment of squamous cancer. As for the Asian region, referring in particular to China and Japan, 9 out of 10 esophageal cancers are squamous cell carcinomas. Considering that the incidence of gastric cancer in Japan is very high, the endoscopic screenings performed inevitably led to an increased rate of early detection of esophageal cancer, reaching approximately 20% of all esophageal cancers detected. This has led to the possibility of developing therapeutic endoscopic techniques with radical visa that we will describe while presenting comparative data from literature. Currently, however, there are not enough data on the effectiveness of these types of therapies, compared to surgery, in order to be transformed into standard therapeutic endoscopic treatment for early esophageal cancer. However, the combined therapy, resection/ endoscopic ablation + chemoradiotherapy, appears as an alternative to be taken into account. Abbreviations EEC = esophageal early cancer, BE = Barrett's esophagus, HGD = High-grade dysphagia, EUS = Ultra sound endoscopy, CT = Computer tomograph, UGE = Upper gastro endoscopy, PET-CT = Positron Emission Tomography, FNAB = Fine needle aspiration biopsy, EMR = Esophageal mucosal resection, ESD = Esophageal submucosal dissection, SCC = Squamous cellular cancer, PCT = Poli-chemotherapy, RT- Radio-therapy.

Endoscopic palliation of advanced esophageal cancer.

Esophageal cancer represents one of the most aggressive digestive tumors, with a survival rate at 5 years of only 10%. Globally, during the last three decades, there has been an increasing incidence of the esophageal cancer, approx. 400,000 new esophageal cancers being currently diagnosed annually. This represents the eighth leading cause of cancer incidence and the sixth leading cause of cancer death overall. Taking into account the population's global aging and thus, the increase in the number of patients who will not bear surgery, PCT and radiation, or the fact that they do not want it especially because of deficiencies and associated pathology, the endoscopic ablative techniques with palliation purposes represent the alternative. If we refer to the Western Europe countries and North America, we notice an increase of esophageal adenocarcinoma rate versus squamous cancer. As for the Asian region, referring in particular to China and Japan, 9 out of 10 esophageal cancers are squamous cell carcinomas. For at least half of the patients with EC (esophageal cancer) there is no hope of healing because of the advanced regional malignant invasion (T3-4, N+, M+) with no chemo and radiotherapy response, poor preoperative patients' conditions or systemic metastasis. The low life expectancy does not justify the risky medical procedures, the goal of the therapy consisting in the improvement of the quality of life by eliminating dysphagia (reestablishing oral feeding) which represents the most common complication of EC, the respiratory tract complication caused by eso-tracheal fistulas or by eliminating chest pain. To treat dysphagia, which is the main target of palliation, combined methods like endoscopic, chemo and radio-therapy, can be used, each one with indications, benefits and risks.

Protective effect of grape seed extract in experimental menopausal syndrome.

UNLABELLED: Grape seed extract (GSE) is a natural product obtained from Vitis vinifera seeds; it has been used as adjuvant therapy in wide range of pathological conditions. AIM: In the present study, we investigated the ability of GSE to improve the mental status on ovariectomized rats. MATERIAL AND METHODS: GSE (10 mg/kg/day, 60 days long) was administrated orally on ovariectomized adult female rats; then the animals were investigated in open field. Additionally, were measured the hematological parameters, the plasma biochemistry, and the oxidative stress markers. RESULTS AND DISCUSSION: Treatment of GSE improved the loco motor activity in the open field, the number of crossings were almost twice in GSE treated rats (22.25 +/- 8.75) compared to placebo group (13.00 +/- 2.62) (p < 0.05). Lipid peroxides were reduced up to 51.57% (p < 0.05), while hematology and plasma biochemistry remained almost unchanged. CONCLUSION: GSE improve the mental status and reduced the level of oxidative stress in rats subject to experimental ovariectomy.

[Surgical treatment of esophageal diverticula]. / Tratamentul chirurgical al diverticulilor esofagieni.

The aim of this paper is to evaluate the methods and therapeutic principles of esophageal diverticula pathology. We analyze the main pathological mechanisms which establish the therapeutic attitude linked with a complex pretherapeutic evaluation. In our study we enrolled 12 patients operated between 2001-2009 for esophageal diverticula with different topography. In this period of time there were much more patients diagnosed with this pathology, but the need for surgery was establish very tight regarding the actual practical guide which impose the identification and interception of physiological mechanisms by the surgical procedure. We highlight the particular technical details, as well as the important differences of postoperatory complications according to the topography of the diverticula pouch.

[Principles of treatment in locally advanced esophageal squamous cancer]. / Principii de tratament in cancerul esofagian scuamos avansat local.

The diagnosis established in the symptomatic phase of this disease, most often occurs at advanced stage neoplasia. The purpose of this article is to establish the place and method of surgical and radio-chemo therapy in advanced loco-regional squamous esophageal neoplasm (stage IIB-III). Surgical treatment establishes the best results over long periods of time, however, this is done keeping in mind acceptable morbidity and mortality conditions. Multimodal treatment is encompassed in general efforts to achieve optimal results along with increasing the quantity and quality of life. Neoadjuvant radiochemotherapy (CRT) increases practitioners' possibility of resecting tumors, decreasing their size, and establishing proper means of local (radiotherapy) and systemic (chemotherapy) control. Great efforts are made in finding markers which lead to correct diagnosis and treatment options that will further permit nonresponsive radio and chemo therapy treated patients from experiencing unwanted toxicity. The role of adjuvant therapy is that of decreasing recurrence in patients with residual mediastinal disease after palliative surgical resection. Palliative treatment consists of improving dysphagia, and the quality of life using surgical, endoscopic, photodynamic, laser, radio and chemotherapy as alternatives.

[Long-term survival after eso-gastrectomy for esophagogastric junction adenocarcinoma--prospective study]. / Supravietuirea la distanta dupa esogastrectomie pentru adenocarcinom de jonctiune esogastrica--studiu prospectiv.

Detection of the esophagogastric junction adenocarcinoma in symptomatic stage determine a low survival. The aim of the study was to identify the prognostic factors after eso-gastrectomy for esophagogastric junction adenocarcinoma. There was done a prospective study of a 43 patients with esophago-gastric resections and abdomino-mediastinal lymph nodes dissection between 2001 and 2006 at the General and Esophageal Surgery "St. Mary" Clinical Hospital: 25 patients with transhiatal total gastrectomy, 6 patients with total gastrectomy and distal esophagectomy by separated incisions, abdominal and thoracic, 3 patients with total gastrectomy and subtotal esophagectomy by abdomino-cervical approach, 9 patients with subtotal esophagectomy by abdomino-cervical approach with cu small gastric curvature resection, radical resections in 22 patients. The patients were followed by clinic, endoscopic, TC exam and tumoral markers. There were done complex statistic analysis using SPSS 16.0. The mean interval of the surveillance was 24 months (6 - 60 months). 1 year survival was 77,74%. Long-term survival was influenced by age (p_value = 0.0129), tumoral grading (p_value = 0.0297), the number of lymph nodes metastasis (p_value = 0.0029) and pT stage (p_value = 0.0139), and was not dependent on Siewert type, ASA class, surgical approach, resection type, the number of the dissected lymph nodes, abdominal or mediastinal. In locally advanced esophagogastric junction adenocarcinoma, the frequency of lymph nodes metastasis (81%) especially in patients with tumoral type III and unfavorable results of surgical treatment as unique therapeutically method show the necessity of a multimodal approach pre and post-operatory by using selection methods with a good prediction of neoadjuvant treatment.

[Long-term evolution of a T-tube in the common bile duct]. / Evolutia pe termen lung a tubului Kehr în calea biliara principala.

We present the case of an elderly and frail woman, admitted for obstructive jaundice 9 years after cholecystectomy, lithotomy and T-tube drainage. The presence of a T-tube remnant in the common bile duct was suggested by imaging techniques, along with a megacholedocus. Because of the risks associated with advanced biliary cirrhosis, the endoscopic retrieval and lithotripsy was the first therapeutical attempt but failed. Lithotomy and cholangio-jejunostomy by open surgery were followed by a surprising favourable course.

[Total duodenal diversion in hiatal hernia with pathological duodenoesophageal reflux (preliminary results)]. / Diversie duodenala totala în hernia hiatala cu reflux duodenoesofagian patologic (rezultate preliminare).

For some patients, reflux disease means also duodenogastric, as well as gastroesophageal reflux; they may suffer because of duodenoesophageal reflux. For these patients, a simple surgical restoration of the cardial competence may prove to be insufficient; on the contrary, an indirect approach, using vagotomy and duodenal diversion may be a good therapeutical option in selected cases. In our hands, total duodenal diversion has already proven to be a good technical solution for the surgical treatment of the postoperative reflux disease, so we decided to expand its first choice indications to hiatal hernia cases, in the presence of duodenoesophageal reflux. Therefore, our study presents the results of the first 7 cases, operated on since 1995. No case had been gastric operated before, but 4/7 had already suffered a cholecystectomy. Duodenoesophageal reflux is discussed: etiopathogenesis related to surgical approach, using standard antireflux surgery (failures of the hiatal techniques and their causes) or total duodenal diversion (technical aspects, antireflux efficiency, secondary functional effects, pros and cons, therapeutical indications).

[Primary abdominal parietorrhaphy and the cure of eventrations with the relon monofilament suture (N.I. 2402/76)]. / Parietorafia abdominala primara si în cura eventratiilor cu fir de relon monofilament (N.I. 2402/76).

Primary repair of the abdominal wall and the cure of incisional hernias using the relon mono-filamentous fibres (N.I. 2402/76) Confronted with long lasting parietal suppurations which are entertained by the classic nylon poly-filamentous fibres, suppurations that cannot be avoided unless the above fibres are removed on one hand assuming the risk of a possible subsequent incisional hernias and on the other hand because of the relative elevated price of the mono-filamentous fibres brought from abroad, within the last years (from 1982) we have utilised the relon mono-filamentous fibre (N.I. 2402/76) in abdominal wall reconstruction (initially for the surgical cure of the incisional hernias and there after in primary abdominal wall reconstruction when there were factors predisposing to a possible subsequent parietal for septic contamination, in overweight patients, immune-compromised patients, in patients following steroid therapy, chemotherapy, etc. Our present experience extends over more than 1000 patients who have undertook a surgical procedure.

[Madelung's cervicodorsal adipose hypertrophy (the Launois-Bensaude syndrome)]. / Hipertrofie adipoasa cervico-dorsala Madelung (sindromul Launois-Bensaude).

Based on an experience (that we believe may be very low in any Clinic) of three cases of cervicodorsal fatty hypertrophy (Launois-Bensaude syndrome) in one case with relapse of the disease, we performed complex anterior dissection of the region, with access of both vascular bundles of the neck and with subsequent surgical removal of the left hypertrophic maxillary salivary gland, followed in a second step (3 months after the primary operation) by the dissection of the dorsal fatty tumours. The aesthetic and functional results were excellent. In the postoperative step, the patient follows a radiation therapy at a dose for anti-inflammatory purpose and steroid therapy.

[Familial abdominal fibromatosis]. / Fibromatoza abdominala familiala.

Two cases of abdominal fibromatosis are followed-up in two brothers patients development, each of them having a peculiar development. First of them underwent operation for a huge abdominal tumor with a retroperitoneal origin and intraperitoneal development which needed a complex partial resection with first jejunal loop enterectomy. The other patient had first surgery for fibrosarcoma of nuchal area and after that he underwent an operation for superior digestive haemorrhagia as a result of antral gastric fibroid tumor with transverse colic and mezocolic extension, which needed gastro-colectomy. The patients father was followed up for tangible abdominal tumors, but he rejected the proposed coeliotomia. The two brothers patients had a good postoperative development. The examination of the charriotype showed anomalies of the short branch of the 21st and 22nd chromosome (which are still normal).

Monolayer properties of archaeol and caldarchaeol polar lipids of a methanogenic archaebacterium, Methanospirillum hungatei, at the air/water interface.

Monolayer studies at the air/water interface were carried out on the major tetraether (caldarchaeol-) derived phosphoglycolipid, Glcp-alpha(1-2)-Galf-beta(1-1)-caldarchaeol-phosphoglycerol (PGC-I), the major diether (archaeol-) derived glycolipid, Glcp-alpha(1-2)-Galf-beta(1-1)-archaeol (DGA-I), the major archaeol-derived phospholipids, phosphatidyl-N,N dimethylaminopentanetetrol (PPDAA) and phosphatidyl-N,N,N-trimethylaminopentanetetrol (PPTAA) and the minor caldarchaeol-derived glycolipid, Glcp-alpha(1-2)-Galf-beta(1-1)-caldarchaeol (DGC-I) isolated from the methanogenic archaebacterium, Methanospirillum hungatei. The compression isotherms obtained showed that the two tetraether lipids had molecular surface areas about twice those of the diether lipids at all surface pressures, suggesting that both polar headgroups of the tetraether lipids are anchored into the aqueous subphase, even at the collapse pressure pi c. A U-shaped hydrocarbon chain conformation thus appears to be preferred for the tetraether lipids at the air/water interface, rather than an extended chain arrangement. The compression isotherms of the two tetraether lipids PGC-I and DGC-I were very similar at pH 0, both molecules being uncharged, but at pH 5.6 or 8, PGC-I films were much more expanded than the neutral DGC-I, due to ionization of the phosphate group in PGC-I and the resulting charge-charge repulsion. Monolayers of the zwitterionic diether phospholipids PPDAA and PPTAA were much less compressible than the glycosylated lipids, PGC-I, DGC-I and DGA-I, because the latter lipids contain the more compressible diglycosyl headgroup, oriented in horizontal conformation at low surface pressures, compared to the lower compressibility of the zwitterionic headgroup in the vertical conformation, particularly at pH 0 and 5.6.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of stearic acid monolayers upon the procaine adsorption from underlying alkaline aqueous solutions.

Adsorption of procaine at the air/water interface and its penetration into stearic acid monolayers from aqueous subphase of pH 8 are studied by measuring surface tension of aqueous procaine solutions and by recording surface pressure vs. mean molecular area curves for stearic acid monolayers spread onto procaine solutions of different concentrations. The amount of procaine in the interface is derived by means of Gibbs' equation. Results are compared to those obtained earlier at pH 2 and on unbuffered subphases. With increasing pH an increasing procaine adsorption and procaine penetration is observed. This phenomenon is interpreted in terms of protolytic equilibria in which participate both surfactants procaine and stearic acid.