Intra-osseous cerebrospinal fluid shunts-Overview of past and present clinical and experimental evidence.

In the history of hydrocephalus treatment, a variety of diversion sites have been explored to ensure an adequate alternative when the peritoneum was not a feasible option. An interesting choice was the elimination of excessive cerebrospinal fluid (CSF) in the skeletal system. The purpose of this review was to evaluate all shunting systems that have been implemented in bone structures and to determine their therapeutic potential. All articles pertaining to bone derivations were selected from PubMed, Medline, EBSCO and Scopus, using relevant search terms. The search revealed 6 types of osseous shunts that have been used throughout history: vertebral, diploic, ventriculomastoid, ventriculoiliac, ventriculosternal and ventriculohumeral. Some of them are purely of historical significance, but data from more recent clinical and experimental studies have rendered this type of receptacle a potential site for diverting CSF. Having knowledge of all the alternatives used in cases of refractory hydrocephalus is vital for choosing the appropriate surgical intervention.

POSTOPERATIVE ARTERIAL RELAXATION AND INTRAOPERATIVE VENOUS DILATION AS INTERCONNECTED PROGNOSTIC FACTORS FOR THE MATURATION OF ARTERIOVENOUS FISTULAS.

AIM: To investigate if immediate arterial distention can be used as a predictive factor for the development of a good fistula. MATERIAL AND METHODS: Over a 5-months period (January- May 2015) all the patients who underwent an arteriovenous fistula between the radial artery and the cephalic vein of the forearm at the Second Surgical Clinic of the Iasi Regional Cancer Institute and were willing to participate were enrolled in the study. The diameters of the vessels were measured 1 hour and 8 weeks after surgery. RESULTS: We found statistically significant differences for all measured diameter variations between the calcified artery and normal artery groups (p < 0.001 for the arterial distention at 1 hour and 8 weeks after surgery and p = 0.002 for the venous distention 8 weeks after surgery). A linear regression also showed that the degree of arterial distention immediately after surgery and the venous distention 8 weeks after surgery were statistically correlated. CONCLUSIONS: Arterial distention immediately after surgery and therefore the lack of it due to the presence of arterial calcifications can be used to predict whether or not a good fistula can be achieved at a 1% statistical significance level.

Biomineralization capability of adherent bio-glass films prepared by magnetron sputtering.

Radiofrequency magnetron sputtering deposition at low temperature (150 degrees C) was used to deposit bioactive glass coatings onto titanium substrates. Three different working atmospheres were used: Ar 100%, Ar + 7%O(2), and Ar + 20%O(2). The preliminary adhesion tests (pull-out) produced excellent adhesion values (approximately 75 MPa) for the as-deposited bio-glass films. Bioactivity tests in simulated body fluid were carried out for 30 days. SEM-EDS, XRD and FTIR measurements were performed. The tests clearly showed strong bioactive features for all the prepared films. The best biomineralization capability, expressed by the thickest chemically grown carbonated hydroxyapatite layer, was obtained for the bio-glass coating sputtered in a reactive atmosphere with 7% O(2).

[Splenic infarction in endocarditis: case report]. / Infarctul splenic in endocardita. Prezentare de caz.

Splenic infarction is a very rare event though it can occur in a multitude of conditions with general or local manifestations. Splenic involvement in infectious endocarditis can be either infarction or abscess formation. The clinical picture is usually nonspecific and the diagnosis is often not initially suspected. We present a case of a 67 year-old male patient with infectious endocarditis who has been diagnosed with a splenic infarction by abdominal CT scan. The infarction was a result of septic embolization from the infected endocardium. The patient was initially managed conservatively with triple antibiotic therapy and regular follow-up ultrasound scan. The persistence of abdominal symptoms and the suspicion of splenic abscess formation led to the decision of performing splenectomy. Although imaging can characterize the nature of a splenic lesion, it is sometimes impossible to differentiate between infarction and abscess without histopathological confirmation. Splenic infarction should be suspected in all patients with a past history of thromboembolic disease who complain of left upper quadrant pain and present with localized or systemic inflammatory signs. Unfavorable clinical course and suspicion of abscess formation are indications for surgery. The characteristic features of splenic infarction are discussed together with a review of the recent literature.

[True posttraumatic femoral artery aneurysm: a rare clinical entity]. / Anevrism adevarat posttraumatic de artera femurala. Entitate clinica rara.

Traumatic etiology in aneurysms is very rare. After arterial trauma we usually find pseudo aneurysms. True aneurysms are due to deterioration of the arterial wall in small and long-term repetitive trauma. Pseudo aneurysms are usually described on radial and cubital artery in patients who work with vibrating tools ("hypothenar and thenar hammer syndrome") and on axilar artery in those who use axilar crutches. We present a case of a woman with a true aneurysm of the femoral artery developed due to repetitive trauma of the femoral region at the work place. The patient presented as an emergency, with ruptured aneurysm and she underwent an emergency operation. The diagnosis was established late by histopathological examination. This is the first case of posttraumatic true aneurysm with this location. True aneurysms should be considered in repetitive trauma regardless of anatomical region.

[Axillary wound with complete vasculo-nervous section. Functional outcomes]. / Plaga axilara cu sectiune completa nervoasa si vasculara. Rezultate functionale. Caz clinic.

Axillary wound with complete vasculonervous section are rare in adults, males between 20 and 30 years being more affected. In children these lesions are even more rarely encountered. Immediate surgical repair of vascular and nervous sections is recommended. Neurological impalement may be severe when all nervous trunks in the axilla are affected. Recovery of the motor and sensitive deficit is a long process and is often partial, good functional outcome being rare. Recovery in children is supposed to be better due to a more rapid regenerative capacity of the nerves. We present the case of a 9-year-old boy with axillary wound and complete section of axillary artery, median, ulnar, radial and musculocutaneous nerves and medial cutaneous nerve of arm. Vascular reconstruction with venous graft and epiperineural nerve reconstruction was done. Kinetotherapy and physiotherapy was part of recovery treatment. Follow up at 15 months confirmed very good functional outcomes with almost complete motor and sensitive function of the limb.

[Traumatic rupture of the diaphragm: diagnostic considerations, prognostic factors, outcomes]. / Traumatismele diafragmului: consideratii diagnostice, factori prognostici, rezultate.

UNLABELLED: Diaphragmatic rupture remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. AIM: To analyze our experience with the management of these injuries, diagnosis problems, and to identify predictors of outcomes. MATERIAL AND METHOD: Sixty-one patients were treated for diaphragmatic rupture in our hospital, between January 1992 and August 2003. RESULTS: Blunt trauma accounted for 15 injuries (24.6%) and penetrating trauma for the rest of 46 injuries (75.4%). The preoperative diagnostic was established for 17 patients (27.8%), 7 blunt and 10 penetrating. Twenty-nine patients (47.5%) presented with hemorrhagic shock upon admission and 48 patients (78.6%) had associated injury with an average Injury Severity Score of 24 (range 6-75). All cases but 4 were operated on the first 12 hours upon admission. Two right penetrating lesions were treated conservatively and two cases presented after 11 and 23 years respectively from the trauma episode. Intraoperatively, 15 right lesions (24.6%), 45 left (73.7%) and one bilateral (1.6%) were identified. There were 9 deaths (14.7%) and 14 patients (22.9%) developed complications. CONCLUSIONS: Hemorrhagic shock upon admission, Injury Severity Score, mechanism of the injury and age strongly influenced the outcome (p < 0.05). In emergency trauma settings the diagnostic for diaphragmatic lesions is mainly established by laparotomy. A high index of suspicion and a thorough examination of both diaphragms during laparotomy is mandatory in order to avoid missing traumatic diaphragmatic injuries.

[Traumatic injuries to the spleen in adults]. / Traumatismele splinei la adult.

The management of splenic injuries is still controversial, with an increasing trend toward non-operative treatment. The aim of this study was to assess for patients with splenic traumatic injuries, the treatment methods, the factors contributing in selecting appropriate management and the patients outcomes. Between 1994 and 2003, 77 patients were admitted and treated in our hospital for splenic traumatic injuries. There were 69 blunt (89.61%) and 8 penetrating injuries (10.38%). Nineteen patients were initially proposed for non-operative treatment, eventually only 5 patients (16.49%) were successfully treated (success rate 26.31%). Splenic conservation was used in 6 patients (7.79%; success rate 100%) and splenectomy on 66 patients (85.71%). Indications for laparotomy were: hemodynamic instability (35 patients), peritonitis (9 patients) and the presence of hemoperitoneum and splenic injury (22 patients). Overall mortality was 7.79%, with 4 deaths in splenectomy group and 2 deaths in proposed non-operative group. In conclusion, conservative treatment of splenic injuries can be performed with good results and an increasing number of patients can be treated in this way. For this purpose are necessary a perfect selection of the patients, a surgeon skilled in conservative splenic techniques and good techniques facilities.

[Bleeding control in stab wounds to the great vessels at the neck base]. / Controlul hemoragiei în leziunile vaselor mari de la baza gâtului produse prin arme albe.

Stab wounds of the neck are a great challenge for every surgeon. Approximately 25% of penetrating neck injuries results in a vascular lesion. Wounds being situated below the cricoid cartilage are associated with the great mortality and morbidity, having a global mortality between 12-20%. 2/3 of the vascular wounds at this level have a tragic end. We are going to present 3 cases of cervical stab wounds in zone 1 of the neck, with vascular lesions, in which we succeeded to control the hemorrhages throw a midline sternotomy combined with different extensions. After this small experience we think that in patients with wounds situated in zone 1 of the neck, who reach the hospital hemodynamically unstable or with active bleeding, urgent midline sternotomy combined with cervicotomy, or section of the clavicle, is the best way to control the hemorrhages. Using blunt digital dissection we can avoid unpleasant situations that can appear using instrumental dissection into the mediastinal hematoma.

[Diagnostic problems in a case of chronic expanding hematoma]. / Probleme de diagnostic într-un caz rar de hematom cronic expansiv.

We present a case of chronic expanding hematoma occurring in the right medial thigh. The patient was an 86 year-old woman who had this mass with slowly growth 3 years before. Ultrasonography showed a multilocular cyst and computed tomography an image of heterogeneous mass with capsule formation. A diagnose was unable to perform through both methods, which was confirmed by histopathological exam after successful surgical treatment. Microscopically, a fibrous pseudocapsule and in the central cavities blood clot, fibrin and necrotic debris were described.

[Diaphragmatic blunt injuries: analysis of cases]. / Rupturile diafragmului: analiza cazuisticii.

Blunt injuries of diaphragm are frequently encountered in polytrauma and thoraco-abdominal injuries. Between 1992/2001, 12 cases were analyzed, representing 19.64% of of a total of 52 cases with diaphragmatic injuries (12 blunt and 40 penetrating). 11 were victims of traffic accidents (91.66%) and one of precipitation (8.3%). There were six men and five women. When they were admitted all patients presented with signs of trauma and hemorrhagic shock. 11 cases were operated. On the first 3 hours and in 3 cases, the patients were directly transported in operator theatre. Death rate was quite high--27.27%. Hospital stay was 15.54 days in average (13-38 days). Complication rate was 27.3%. Diaphragmatic injury are life threatening injuries, always challenging, associated with a high rate of mortality.