[The effect of preoperative preparation of the patient with rectal cancer on postoperative course]. / Influenta pregatirii preoperatorii a colonului asupra evolutiei postoperatorii la pacientii cu cancer de rect.

UNLABELLED: Preoperative preparation of patients with rectal cancer prior to surgery consisted of a constant concern for both the surgeon and the doctor of anesthesia and intensive care. The purpose of the study is to compare postoperative results in terms of evolution (postoperative morbidity, severity, days of hospitalization) in patients who have undergone surgery for rectal cancer, some with classical preparation, others, according to the ERAS protocol. MATERIAL AND METHOD: During three years period (2005-2008) 88 patients with rectal cancer were operated at the Emergency Surgical Clinic of the "St. John" Hospital Iasi. RESULTS: 41 patients were excluded from the study and operated in emergency without preoperative preparation. The rest 47 followed classical preparation (n=24) or the ERAS protocol (n=23). There were following data: age, gender, presence of associated comorbidities, need for blood transfusion, type of operation, complications, number of hospitalization days after surgery. CONCLUSIONS: Postoperative complications occur more widely and are more severe in patients with rectal cancer who had preoperative classical preparation versus those who have received training in accordance with the ERAS protocol. Duration of hospitalization both in absolute and averaging appears to be influenced by the type of preoperative training records without having significant statistically differences.

[The profile of the autolytic critical patient compared to proper suicider]. / Profilul pacientului critic autolitic in comparatie cu al suicidarului vero.

UNLABELLED: Out of all the patients with nonlethal self-injuries, only a low percentage inflict on themselves lesions that are severe enough to endanger their lives. The purpose of the paper is to analyze whether this smaller category of patients comes close to the profile of the genuine suicide or it remains within the pattern of the patients with non-lethal self-injurious behaviour. MATERIAL AND METHOD: Between January 1, 2005 and December 31, 2006, 656 patients with non-lethal autolytic acts came to the Emergency Hospital (UPU). Only 39 (5.94%) of them had lesions that were so severe as to require their hospitalization in the reanimation unit. During the same period of time, 188 suicial attempts were recorded in Iasi County. The parameters studied were: sex, age, living background and the autolytic method used, since these were the only data to be wholly collected from all the subjects. The information was introduced in the SPSS 8.0 software for Windows. RESULTS: The proportion women: men was higher in the case of sucide attempts (58.8% vs. 38.4%) in comparison to proper suicides (52.7% vs. 46.8%). The division according to age groups shows an almost Gaussian distribution of the suicides, with a peak at the 45-54 years old group whereas, in the case of suicidal attempts, there is a more uniform representation with a peak at the 25-34 years old group. As far as the background and living conditions are concerned, the suicides came mainly from the rural areas in comparison to the others belonging to the urban areas, and, in the case of the methods employed, the former preferred physical methods (87%), while the latter appealed mostly to intoxications (92.3%). CONCLUSIONS: The profile of critical patients hospitalized in the reanimation unit from autolytic lesions partially coincides with that of the subjects who committed suicide. There are similarities concerning their sex or age distribution. There is also a congruence between our data and the specialized literature regarding their distribution according to living areas, but not betweent:he two lots under study. There are major differences in the methods used by the subjects of the two groups we studied.

[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.

[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.

[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.