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BACKGROUND: Olfactory dysfunction is a cardinal symptom of COVID-19 infection, however, studies assessing long-term olfactory dysfunction are limited and no randomised-controlled trials (RCTs) of early olfactory training have been conducted. METHODOLOGY: We conducted a prospective, multi-centre study consisting of baseline psychophysical measurements of smell and taste function. Eligible participants were further recruited into a 12-week RCT of olfactory training versus control (safety information). Patient-reported outcomes were measured using an electronic survey and BSIT at baseline and 12 weeks. An additional 1-year follow-up was open to all participants. RESULTS: 218 individuals with a sudden loss of sense of smell of at least 4-weeks were recruited. Psychophysical smell loss was observed in only 32.1%; 63 participants were recruited into the RCT. The absolute difference in BSIT improvement after 12 weeks was 0.45 higher in the intervention arm. 76 participants completed 1-year follow-up; 10/19 (52.6%) of participants with an abnormal baseline BSIT test scored below the normal threshold at 1-year, and 24/29 (82.8%) had persistent parosmia. CONCLUSIONS: Early olfactory training may be helpful, although our findings are inconclusive. Notably, a number of individuals who completed the 1-year assessment had persistent smell loss and parosmia at 1-year. As such, both should be considered important entities of long-Covid and further studies to improve management are highly warranted.
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COVID-19 , Trastornos del Olfato , Humanos , Olfato , COVID-19/complicaciones , Anosmia/etiología , Entrenamiento Olfativo , Trastornos del Olfato/etiología , Trastornos del Olfato/diagnósticoRESUMEN
Background: Non-functional neuroendocrine tumors of the pancreas (NF-pNETs) are a varied group of extremely rare malignancies. The majority of patients already have liver metastases at the diagnosis moment, thus, treatment options are restricted, and the survival rate is reserved. Case report: We presented the case of 59-year-old patient, diagnosed with non-functional well-differentiated pancreatic neuroendocrine tumor grade II (NET G2) with the presence of chromogranin A, synaptophysin and somatostatin receptor 2, together with liver and bone metastases. Patient underwent a surgical excision of the pancreatic tumor, started long-acting somatostatin analogues (octreotide), interferon therapy for liver metastases and local radiotherapy for bone metastases. After one year, the patient developed diabetes, needing insulin therapy. At approximately three years after the diagnosis, the patient was still living, had a good quality of life, and was free of local recurrence of the tumor or other metastases. Conclusion: Our case report presented a rare case of metastatic non-functional well-differentiated pancreatic neuroendocrine tumor, involving a multidisciplinary therapeutic approach in order to obtain a good long-term survival.
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Neoplasias Pancreáticas/secundario , Femenino , Humanos , Inmunohistoquímica , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Persona de Mediana Edad , Octreótido/uso terapéutico , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/terapia , Calidad de Vida , Proteínas Recombinantes/uso terapéutico , Análisis de Supervivencia , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: The pancreatic injuries have fortunately a low frequency, but when present associate multiple intraabdominal lesions, and carry a significant morbidity and mortality. The aim of this study is to underline the significant morbidity associated with high grade pancreatic injuries. CASE REPORT: Female patient, 36 years old, with penetrating abdominal trauma due to domestic violence was referred to our center from a regional county hospital, after multiple laparotomies, hemodynamically unstable, with multiple organ failure. Abdominal clinical exam revealed evisceration, with massive pancreatic leakage at the level of the median laparotomy and through the stabbing wounds from the right flank. Emergency Computed Tomography showed multiple intraabdominal collections, with laceration of the liver, right kidney and pancreatic head. Abdominal exploration was decided. After a thorough abdominal debridement was revealed a deep laceration of the pancreatic head, with active extravasation of pancreatic secretion, correlating with a grade IV injury. Peritoneal lavage and large drainage of the lesser and greater peritoneal cavity was performed. The postoperative recovery was uneventful, with progressive decrease in pancreatic fistula output and discharge after 35 days. CONCLUSIONS: High grade pancreatic traumas associate a significant morbidity. Efficient drainage of the pancreatic head injuries and patients management in high volume centers for pancreatic surgery maximize the survival rate.
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Traumatismos Abdominales/cirugía , Riñón/cirugía , Hígado/cirugía , Traumatismo Múltiple/cirugía , Páncreas/cirugía , Pancreatectomía , Fístula Pancreática/cirugía , Heridas Punzantes/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Adulto , Desbridamiento , Drenaje , Femenino , Humanos , Riñón/lesiones , Hígado/lesiones , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico , Páncreas/lesiones , Pancreatectomía/métodos , Fístula Pancreática/diagnóstico , Fístula Pancreática/etiología , Transferencia de Pacientes , Lavado Peritoneal , Reoperación , Índice de Severidad de la Enfermedad , Maltrato Conyugal , Resultado del Tratamiento , Heridas Punzantes/complicaciones , Heridas Punzantes/diagnósticoRESUMEN
INTRODUCTION: Despite the high frequency of thoracic injuries secondary to traffic related accidents, the blunt cardiac valve rupture is extremely rare. METHOD: Case report and review of the literature using PubMed/MEDLINE and EMBASE databases. RESULT: A 38 year old female patient, victim of car accident was admitted. On primary survey the patient was conscious, cooperative and hemodynamic and respiratory stable. On secondary survey was found a bilateral open leg fracture and a seat belt sign. Whole body Computed Tomography revealed minimal haemorrhagic contusion of the cortex, left hemopneumothorax and right pneumothorax, bilateral rib fractures, liver contusion, left femoral neck fracture and fracture to the lumbar spinal column. After bilateral pleurostomy, the patient becomes hemodynamically unstable, but with no signs of external bleeding. The transthoracic echocardiography revealed an acute severe tricuspid regurgitation with hepatic veins reflux. After orthopaedic surgeries, the tricuspid valve rupture was managed by replacing the valve with a bioprostheses. The hospital stay was 122 days. CONCLUSION: Only a high index of suspicion may reveal blunt cardiac lesions as a cause for hemodynamic instability in acute setting.
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Accidentes de Tránsito , Fracturas Múltiples/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Traumatismos Torácicos/cirugía , Insuficiencia de la Válvula Tricúspide/cirugía , Válvula Tricúspide/cirugía , Heridas no Penetrantes/cirugía , Adulto , Femenino , Fracturas Múltiples/etiología , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Traumatismo Múltiple/cirugía , Rotura , Traumatismos Torácicos/etiología , Resultado del Tratamiento , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/lesiones , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Ultrasonografía , Heridas no Penetrantes/etiologíaRESUMEN
INTRODUCTION: The laparoscopic-assisted abdominoperineal resection (LAPR) has been proved to be associated with a shorter postoperative recovery, with equivalent oncological results and similar survival when compared with conventional open surgery, for patients with low rectal cancer. METHOD: Case report of a massive intraoperative bleeding during LAPR and systematic review of the English language literature, using PubMed Medline, ISI Thopmson, OVID and EMBASE databases. RESULTS: 58 years old patient admitted in emergency setting or rectal bleeding. Rectal examination revealed a protruding,frail tumor, located 2 cm from the anal verge. Total colono scopy revealed an infiltrative, protruding tumor, situated at 2 cm from the anal verge, with a 5 cm cranial extension,without any additional colonic lesions. Computed Tomography showed a 4,5 cm circumferential rectal wall thickening, without any enlarged mesorectal or abdominal lymph nodes. The patient was transported to operating room for a LAPR. During final hemostasis, at the level of perineal surgical wound, an acute massive bleeding occurred from the presacral vessels with severe blood loss. This bleeding couldnot be managed laparo scopicaly and conversion to laparotomywas decided, with pelvic packing. At 48 hours after the initial surgical approach, the tamponing packs were removed, without signs of active bleeding. There were applied haemostatic agents and the perineal wound was sutured, without further rbleeding during in-hospital stay. CONCLUSIONS: A rapid and effective control of the presacral bleeding is mandatory to prevent a fatal outcome. Pelvic packing remains a life-saving procedure and the treatment of choice in severe cases.
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Pérdida de Sangre Quirúrgica , Colectomía/efectos adversos , Conversión a Cirugía Abierta , Laparoscopía/efectos adversos , Perineo/cirugía , Neoplasias del Recto/cirugía , Biomarcadores de Tumor/sangre , Antígeno Carcinoembrionario/sangre , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Neoplasias del Recto/diagnóstico , Resultado del TratamientoRESUMEN
INTRODUCTION: Associated with the Western diet and life style,diverticular disease is affecting more and more developing countries worldwide. Recent studies show an increase in incidence of the disease at young age, that raises the risk of complications, along with major consequences for the patient but also for the healthcare system. METHOD: Systematic review of the literature with US National Library of Medicine and National Institutes of Health International PubMed Medline, using abstracts and articles available in PubMed Medline, Cochrane databases searching for ("Diverticulosis, Colonic epidemiology" [MeSH] OR"Diverticulosis, Colonic etiology" [MeSH] OR "Diverticulosis,Colonic genetics" [MeSH] OR "Diverticulosis, Colonic history" [MeSH]). RESULTS: Even from the rise of diverticular disease as a public healthcare problem, at the end of the previous century, it was associated with a diet rich in refined sugars, lacking vegetable fibres. The higher incidence in countries like U.S.A., Canada, United Kingdom and the northern states compared with its rare occurrence in the sub-Saharan African continent, strengthen the anterior assumptions. In regions like Asia, the disease pattern is characterized by are latively low incidence of colonic diverticular disease, with distribution of diverticula mainly on the right colon. The different incidence by sex and age show the possible existence of hormonal protective factors. Studies from countries with a rich ethnic diversity, bring into question the probable genetic predisposition to diverticular disease, fact backed-up by the few studies on twins and 1st degree relatives available in the literature. DISCUSSION: The rising incidence of colonic diverticular disease in Romania makes our country adhere the epidemiologic model existing in countries with a close socio-economic status.Although with a lower incidence than countries that have adopted a Western diet, Romania is likely to encounter a public health problem, if certain measures to identify and minimise the population exposure to risk factors are not taken.
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Diverticulosis del Colon/epidemiología , Divertículo/epidemiología , Distribución por Edad , Países Desarrollados , Países en Desarrollo , Dieta/efectos adversos , Diverticulitis del Colon/epidemiología , Diverticulosis del Colon/etiología , Medicina Basada en la Evidencia , Salud Global , Humanos , Incidencia , Factores de Riesgo , Rumanía/epidemiología , Distribución por SexoRESUMEN
INTRODUCTION: Traumas represent the cause of 10 % of deaths in the entire world. The successful development of trauma systems, including the use of trauma registries, played a significant part in lowering the mortality and the disabilities due to injuries resulted from trauma. METHOD: Review of the literature using computerized database of National Library of Medicine and the International Institutes of Health MEDLINE using PubMed interface. There were selected the articles that address the issue of trauma registry from the different world trauma systems. RESULTS: Trauma registries have developed once they were introduced in centers and trauma systems in the United States of America in 1970. First trauma database processed on computers was created in 1969 in Cook County Hospital in Chicago. This database became the prototype of trauma registry in Illinois which started gathering information from 50 designated hospitals across the entire state in 1971.Countries with limited resources were able to start useful trauma registers. Continuous financing and dedicated personnel inside the team are two essential factors in the success of a trauma registry. NISS (New Injury Severity Score) higher than 15 is a widely used inclusion criteria in the trauma register. Exclusion is represented by patients admitted at over 24 hours after the accident, those declared dead before hospital arrival or with no signs of life on arrival in hospital. In addition, it is recommended that asphyxia,drowning and burns to be excluded. CONCLUSION: The improvements regarding the treatment of multi-traumatized people in developing countries depend on establishing and performance of trauma systems, where trauma registry represents a part of these systems infrastructure.
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Sistema de Registros , Centros Traumatológicos/estadística & datos numéricos , Traumatología , Heridas y Lesiones/epidemiología , Países Desarrollados , Países en Desarrollo , Salud Global , Humanos , Rumanía/epidemiología , Estados Unidos/epidemiología , Heridas y Lesiones/mortalidad , Heridas y Lesiones/prevención & controlRESUMEN
Trauma is a global health issue, being the 4th death cause after cardio-vascular disease, malignancies and chronic pulmonary diseases and the main death cause among young people, under 45 years (1). The frequency of abdominal trauma is 10-12% of all polytrauma, and from all abdominal organs, the spleen and liver are the most often involved in polytraumatized patients case (2). The first purpose of a successful operational management is the control of active bleeding, and the second is preserving as much as possible of the destroyed organs. Over the last decades, the treatment of spleen traumas had been diversified,from nonsurgical treatment to surgical, also complex and diversified: from conservative treatment to splenectomy.Currently, from a therapeutic standpoint, the trends in spleen trauma are orientated towards conservative methods as the clinical and experimental data have shown that it is better with the entire spleen than part of it, and better with a part of it than with none at all (Raymond Hinshaw) (3).
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Bazo/trasplante , Esplenectomía , Rotura del Bazo/cirugía , Traumatismos Abdominales/cirugía , Medicina Basada en la Evidencia , Humanos , Medición de Riesgo , Factores de Riesgo , Esplenectomía/métodos , Rotura del Bazo/diagnóstico , Rotura del Bazo/etiología , Resultado del Tratamiento , Heridas no Penetrantes/cirugíaRESUMEN
INTRODUCTION: Ampulla of Vater tumors, neoplastic diseases located at the confluence of the common bile duct with the main pancreatic duct; represent 0.2% of all gastrointestinal cancers. METHOD: Retrospective study of all patients admitted in the Emergency Hospital of Bucharest Romania between January 2008 and January 2013, the only selection criterion used being a pathology report which describes an ampulla of Vater carcinoma. We have also performed a review of the medical literature up to 2013, using the PubMed/Medline, Proquest Hospital Collection, Science Direct, Cochrane Library and Web of Science databases. We have used different combinations of the following keywords: "ampulla of Vater", "carcinoma", "resection", reviewing the reference list of retrieved articles for further relevant studies. RESULTS: Forty eight patients with ampulla of Vater carcinoma were identified, of whom 59.6% men, 71% from urban areas, and a mean age of 66 ± 13.3 years. Most patients were admitted for obstructive jaundice (49%), right upper quadrant abdominal pain (19%), nausea and loss of appetite in 13%, loss of weight (13%) and upper digestive obstruction in 6% of cases. All patients were evaluated with abdominal transparietal ultrasonography and double contrast, pancreatic protocol, Mutidetector Row Computed Tomography. The abdominal Magnetic Resonance Imaging was performed in 10 cases, upper gastrointestinal endoscopy in 9 cases, and Endoscopic Retrograde Cholangiopancreatography in 39 cases. According to the AJCC Cancer Staging 9% were into stage I, 47% into stage II, 40% into stage III and 4% into stage IV of the disease. The therapeutic approach was surgical for 44 patients and an endoscopic palliation with stent insertion in 4 cases. The surgical procedure was represented by Whipple pancreatoduodenectomy in 27 cases, pylorus preserving pancreatoduodenectomy in 15 cases and exploratory laparotomy in 2 cases. Early morbidity was represented by pancreatic leakage in 4 cases. CONCLUSIONS: There are clinical scenarios in which it is quite challenging to distinguish a primary ampullary adenocarcinoma based on a preoperative workup. Nevertheless, an aggressive approach should be performed, knowing the higher resectability rates and a five-year survival for these patients. Complete surgical resection should be performed in all medically fit patients, candidates for pancreatoduodenectomy, by a high volume, trained surgeon, able to offer a low morbidity and mortality.
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Adenocarcinoma/cirugía , Ampolla Hepatopancreática/patología , Ampolla Hepatopancreática/cirugía , Neoplasias del Conducto Colédoco/cirugía , Adenocarcinoma/sangre , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidad , Distribución por Edad , Anciano , Neoplasias del Conducto Colédoco/sangre , Neoplasias del Conducto Colédoco/diagnóstico , Neoplasias del Conducto Colédoco/mortalidad , Femenino , Humanos , Masculino , Estadificación de Neoplasias , Análisis de SupervivenciaRESUMEN
INTRODUCTION: There are many controversies related to the trauma patient care during the pre-hospital period nowadays. Due to the heterogeneity of the rescue personnel and variability of protocols used in various countries, the benefit of the prehospital advanced life support on morbidity and mortality has been not established. METHOD: Systematic review of the literature using computer search of the Library of Medicine and the National Institutes of Health International PubMed Medline database using Entre interface.We reviewed the literature in what concerns the basic and advanced life support given to the trauma patients during the prehospital period. RESULTS: Although the organization of the medical emergency system varies from a country to another, the level of patient'scare can be classified into two main categories: Basic Life Support (BLS) and Advanced Life Support (ALS).There are many studies addressing what to be done at the scene.The prehospital care can be divided into two extremes: stay and play/treat then transfer or scoop and run/load and go. CONCLUSIONS: A balance between "scoop and run" and "stay and play" is probably the best approach for trauma patients. The chosen approach should be made according to the mechanism of injury (blunt versus penetrating trauma), distance to the trauma center (urban versus rural) and the available resources.
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Atención de Apoyo Vital Avanzado en Trauma/organización & administración , Servicios Médicos de Urgencia , Heridas y Lesiones/terapia , Ambulancias/organización & administración , Servicios Médicos de Urgencia/organización & administración , Humanos , Puntaje de Gravedad del Traumatismo , Rumanía , Factores de Tiempo , Centros Traumatológicos/organización & administración , Resultado del Tratamiento , Heridas y Lesiones/diagnósticoRESUMEN
BACKGROUND: A quantitative method for measuring trauma severity has many potential applications: patient triage, a common terminology about injuries severity, prognosis assessment, trauma care audit and epidemiological. METHOD: Systematic review of the literature using computer searching of Library of Medicine and the National Institutes of Health International MEDLINE database using PubMed Entre interface. We have selected articles about the main scoring systems used in today's trauma care. RESULTS: Trauma scores were introduced more than 30 years ago, for assigning numerical values to anatomical lesions and physiological changes after an injury. Physiologic Scores describe changes due to a trauma and translated by changes in vital signs and consciousness. Anatomical Scores describe all the injuries recorded by clinical examination, imaging, surgery or autopsy. If physiological scores are used at first contact with the patient (for triage) and then repeated to monitor patient progress, anatomic scores are used after the diagnosis is complete, generally after patient discharge or postmortem. They are used to stratify trauma patients and to measure lesion severity. Scores that include both anatomical and physiological criteria (mixed scores) are useful for patient prognosis. CONCLUSIONS: Despite their imperfections, trauma scores are very important tools in trauma patients management and research. Using large national databases allow a better research, validation and development of scoring systems.
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Índices de Gravedad del Trauma , Heridas y Lesiones/diagnóstico , Humanos , Puntaje de Gravedad del Traumatismo , Pronóstico , Triaje , Heridas y Lesiones/clasificaciónRESUMEN
The robotic surgery has come through the development of telemedicine and minimally invasive surgery concepts, being developed in the military medicine by NASA during the years 1970-1980. The purpose of this paper is to briefly present our experience in the new field of the robotic surgery, by analyzing the results obtained over a lot of 20 patients operated with the "da Vinci" robot within the last 5 years in the Clinical Emergency Hospital Bucharest for various abdominal defects.
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Abdomen/anomalías , Abdomen/cirugía , Robótica , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Suturas , Adulto JovenRESUMEN
Type 1 neurofibromatosis associates various abdominal tumors as gastrointestinal stromal tumors, duodenal or pancreatic carcinoid, and adrenal tumors like pheochromocytoma. We present the immunohistochemistry report in two cases with different profile regarding the evolution. One case is a 7th decade women diagnosed with unilateral pheochromocytoma and GISTs, with a good prognosis after surgery. The other case is a 41-year-old male diagnosed with duodenal metastatic somatostatinoma after an intestinal occlusive syndrome and later the hormonal profile leaded to the diagnosis of pheochromocytoma. The patient had a fulminate evolution within six months from diagnosis.
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Neoplasias Abdominales/metabolismo , Neoplasias Abdominales/patología , Neoplasias de las Glándulas Suprarrenales/patología , Neurofibromatosis 1/metabolismo , Neurofibromatosis 1/patología , Feocromocitoma/patología , Somatostatinoma/patología , Neoplasias Abdominales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/metabolismo , Adulto , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Neurofibromatosis 1/diagnóstico , Feocromocitoma/diagnóstico , Feocromocitoma/metabolismo , Somatostatinoma/diagnóstico , Somatostatinoma/metabolismoRESUMEN
INTRODUCTION: Understanding the mechanism of injuries represents a key element in blunt and penetrating trauma management. METHOD: Systematic review of the main types of the modem trauma mechanisms, using Medline, Cochrane Library and Embase databases. RESULTS: To properly understand the road car accident injuries, trauma surgeon should know as many details from the scene: the speed of cars, impact direction, if the car rolled over, if occupants were restrained, if airbags exploded, vehicle telemetry, extrication time. Motorcyclists are 20 to 30 times more at risk for severe injuries or death than the four-wheel vehicle occupants. Current evidence shows a significant decrease in injuries severity by increasing use of seat-belts, motorcycle helmets, childrestrains and speed limit. Despite this, few countries around the world have road safety laws relating to key factors that can be considered sufficiently comprehensive in scope. Many modern trauma systems use for prehospital triage mechanism of injury criteria. CONCLUSIONS: The trauma surgeon should know the mechanism of injury. This allows a high suspicion for potential injuries, their early diagnosis and increased quality in the care of trauma patients.
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Accidentes de Tránsito , Heridas y Lesiones/fisiopatología , Accidentes de Tránsito/estadística & datos numéricos , Airbags , Automóviles , Medicina Basada en la Evidencia , Dispositivos de Protección de la Cabeza , Humanos , Puntaje de Gravedad del Traumatismo , Vehículos a Motor , Motocicletas , Rumanía/epidemiología , Seguridad , Cinturones de Seguridad , Triaje , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiologíaRESUMEN
PURPOSE: Demonstrating the potential, in spite of the current trend, of closing an open emergency surgical procedure and to convert it to a minimally invasive approach. METHODS: Case report of an open converted to a laparoscopic approach in an emergency setting for hemoperitoneum of unknown origin. RESULTS: A 28-year-old-female patient was transported to the operating room for suspected acute appendicitis. Through McBurney's incision, hemoperitoneum was found. She was hemodynamically stable. The open incision was closed and a laparoscopic approach established. The diagnosis was a ruptured right ectopic pregnancy with mild hemoperitoneum. After a laparoscopic salpingectomy, her recovery was uneventful. CONCLUSIONS: For selected cases, the conversion of an open procedure to a laparoscopic approach offers a real benefit for the patient, avoiding a large laparotomy and its associated morbidity.
RESUMEN
Adrenal surgery has been radically changed by laparoscopic approach and we wonder whether the increase in the number of adrenalectomies is entirely justified by better understanding of the pathology and a developed diagnosis methods. The type of approach (transabdominal/retroperitoneal) remains a matter of the surgeon's experience. Method: In the past 8 years, we have performed more than 200 laparoscopic adrenalectomies by transperitoneal approach, 24 of them having previously significant abdominal surgery (cholecistectomy, gastric surgery, colectomy, bowel obstruction, exploratory laparoscopy, and adrenalectomy). The patients had a variety of adrenal pathologies such as Cushing disease, Cushing syndrome, Conn syndrome, incidentaloma, pheochromocytoma and even carcinoma. Results: 3 cases were converted to open approach, only one because of the adhesions. Reasons for conversion were also: spleen intarctisation and a difficulty in mobilizing the tumor. Operating time was not significantly prolonged because of the adhesions (40-360 min, median time 127 min). Postoperative evolution was simple with no morbidity or mortality and a fast recovery was recorded. Conclusions: Choosing the type of approach is related to surgeon experience, although 79-94% of the surgeons prefer the transabdominal lateral approach. We believe that with an experienced surgical team, there is no difficulty in performing adrenalectomy by transabdominal approach, with no significantly prolonged operating time, even though the patient has previously had abdominal surgery.
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Zinc (Zn) is an important element in human body and in the last period of time there were a lot of studies regarding its importance. It is significant for the good working of many organs. A special attention was given to the importance of the serum Zn in patients with renal failure. Among the micronutrients, zinc may rank with iron with regard to its importance for public health. This article reviews some epidemiological, clinical, diagnostic and therapeutic aspects of these conditions.
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BACKGROUND: Since its inception, the man suffered injuries through falls, fire, drowning and interpersonal conflict. While the mechanism and frequency of different specific injuries has changed passing of millennia, trauma remains an important cause of mortality and morbidity in modern society. Although the war is presented as one of the four knights of the Apocalypse, we must emphasize the important developments of surgical experience during war. The purpose of this study is to highlight the lessons learned during the history and how they changed the modern trauma care. METHOD: Systematic review of English language literature using computer searching of Library of Medicine and the National Institutes of Health International MEDLINE database using PubMed Entre interface. RESULTS: The first historical record of a trauma medical care is 3605 years ago. Over the past decades, one of the most important changes in trauma patient care is the selective nonoperative management (SNOM) of significant abdominal visceral injuries. SNOM was first described in 1968, for splenic trauma, by Upadhyay and Simpson. It was accepted much later for liver injuries. Beginning from 1960 - 1970, SNOM was introduced for abdominal stab wounds. Exploratory laparotomy remains the standard approach for abdominal gunshot wounds until 1990, when centers from United States and South Africa first reported cases successfully managed nonoperatively. CONCLUSIONS: The trauma surgery has evolved continuously over the centuries, according to more and more severe modem injuries.
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Traumatismos Abdominales/historia , Centros Traumatológicos/historia , Heridas y Lesiones/historia , Traumatismos Abdominales/terapia , Servicios Médicos de Urgencia/historia , Europa (Continente) , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Historia Antigua , Historia Medieval , Humanos , Laparotomía/historia , Sudáfrica , Estados Unidos , Guerra , Heridas y Lesiones/cirugía , Heridas y Lesiones/terapia , Heridas por Arma de Fuego/historia , Heridas por Arma de Fuego/terapia , Heridas no Penetrantes/historia , Heridas no Penetrantes/terapia , Heridas Punzantes/historia , Heridas Punzantes/terapiaRESUMEN
INTRODUCTION: Understanding the epidemiological data on injuries is the cornerstone of modern interventions targeting prevention and treatment to decrease their mortality and morbidity. METHOD: Systematic review of English literature using computer searching and selecting articles that describe the epidemiological data for the main causes of nowadays trauma. RESULTS: Trauma meets the conditions of a pandemy, 5.8 million people dying evey year and 8.4 million being expected in 2020. Trauma is one of the main five causes of mortality and morbidity for all age groups below 60 years. Most deaths caused by road car accidents occur in young adults aged 15-44 years. Over half of deaths by drowning occur between 0-14 years. Over 40% of mortality by falls occurs in people over 70 years. 60% of deaths by poisoning occurs in people 15-59 years. Over 60% of human aggression mortality occurs in young adults aged 15-44 years. Suicide occurs most often in people between 15-44 years. Alcohol consumption is closely correlated with mortality and morbidity due to trauma. CONCLUSIONS: Modem trauma system management should always consider that trauma mortality is the number most easily to measure and to reporte, but it represent only the tip of the iceberg.