[Perforation of hollow organs in the abdominal contusion: diagnostic features and prognostic factors of death]

Blunt hollow viscus perforations (HVP) due to abdominal contusions (AC), although rare, are difficult to diagnose early and are associated with a high mortality.

MATERIALS AND METHODS

Our paper analyses retrospectively data from patients operated for HVP between January 2005 and January 2009, the efficiency of different diagnostic tools, mortality and prognostic factors for death.

RESULTS

There were 62 patients operated for HVP, 14 of which had isolated abdominal contusion and 48 were poly trauma patients. There were 9 women and 53 men, the mean age was 41.5 years (SD: +17,9), the mean ISS was 32.94 (SD: +15,94), 23 patients had associated solid viscus injuries (SVI). Clinical examination was irelevant for 16 of the 62 patients, abdominal Xray was false negative for 30 out of 35 patients and abdominal ultrasound was false negative for 16 out of 60 patients. Abdominal CT was initially false negative for 7 out of 38 patients: for 4 of them the abdominal CT was repeated and was positive for HVP, for 3 patients a diagnostic laparoscopy was performed. Direct signs for HVP on abdominal CT were present for 3 out of 38 patients. Diagnostic laparoscopy was performed for 7 patients with suspicion for HVP, and was positive for 6 of them and false negative for a patient with a duodenal perforation. Single organ perforations were present in 55 cases, multi organ perforations were present in 7 cases. There were 15 deaths (15.2%), most of them caused by haemodynamic instability (3 out of 6 patients) and associated lesions: SOL for 9 out of 23 cases, pelvic fracture (PF) for 6 out of 14 patients, craniocerebral trauma (CCT) for 12 out of 33 patients.Multivariate analysis showed that the prognostic factors for death were ISS value (p = 0,023) and associated CCT (odds ratio = 4,95; p = 0,017). The following factors were not confirmed as prognostic factors for death: age, haemodynamic instability, associated SVI, thoracic trauma (TT), pelvic fractures (PF), limbs fractures (LF) and admission-operation interval under 6 hours.

CONCLUSIONS

Hollow viscus perforations due to abdominal contusions have a high mortality, early diagnosis is difficult, repeated abdominal CT and the selective use of diagnostic laparoscopy for haemodynamic stable patients with ambiguous clinical examination and diagnostic imaging are salutary. Prognostic factors for death were the ISS value and associated craniocerebral trauma.

Laparoscopic repair of post-traumatic diaphragmatic hernia: a case report

In a large number of cases, post-traumatic diaphragmatic hernias (PTDH) are a consequence of occult diaphragmatic injuries associated with penetrating abdominal trauma. We present a case of a 26-year-old male patient who, 2 months prior to the current admission, sustained a non-penetrating stab wound to the left anterior chest below the nipple. Upon presentation the patient complained of epigastric pain radiated to the left shoulder, and nausea and vomiting. The chest X-ray, and abdominal and thoracic CT scan were inconclusive. The patient was sutured and discharged. The laparoscopic approach was selected as a diagnostic and minimally invasive therapeutic method. The suspected diagnosis of PTDH was confirmed. The herniated organs (transverse colon, small bowel loops, and greater omentum) were reduced, and the diaphragmatic defect was sutured by placing 3 non-resorbable 2.0 knots. The suture was reinforced with a composite mesh affixed with resorbable clips. Postoperative period was uneventful, and the patient was discharged 4 days later.

Radio frequency expanding plasmas at low, intermediate, and atmospheric pressure and their applications

We report on the operation and characteristics of radio frequency (RF) plasma beam sources based on the expansion of the discharge outside of limited spaces with small interelectrode gaps. The appropriate electrode configuration, combined with high mass flow values and appropriate power levels, leads to small- or large-size plasma jets, working stably at low, intermediate, and atmospheric pressures. The sources are promising tools for a wide range of applications in thin film deposition, surface modification, and cleaning, including the case of temperature-sensitive substrates.

[Bi-layer hernioplasty in day surgery]

Nowadays the modern surgical techniques of hernia repair highly consider not only the decrease of the recurrence rate, but also a fast recovery, minimal postoperative pain and low costs of this type of surgery. This paper presents the preliminary results of a study performed on 41 patients diagnosed with inguinal hernia and operated under local anesthesia, as day surgery cases, during 2004-2006. The selection of the patients was performed under the "Guidelines and Standards for Day Surgery in Australia". We used local "step by step" anesthesia with a solution of 20 ml of lydocaine 1%, 20 ml of marcaine 0.5% and and 20 ml of NaCl 0.9%. The surgical procedure based on the sutureless technique "Gilbert", implied the placement of two polypropylene meshes: one of them introduced through the deep inguinal ring, and the other one in the inguinal channel, minimally fixed. We studied: intraoperative comfort and postoperative pain of the patients, problems related to the surgical technique, the operative time, complications and the recurrence rate. The follow-up period was 14 months. 85.36% of the patients had a very good intraoperative comfort, and only 14.64 % of them needed supplementary intravenous analgesia; none of the patients needed conversion to general anesthesia. The mean operative time was 65 minutes. The complications were: seroma (3 patients) and hematoma (1 patient), all of them treated conservatively. No recurrence was noticed. From this preliminary study it seems that the surgical treatment of the inguinal hernia with double polypropylene mesh, under local anesthesia and as day surgery is feasible and secure. The minimal postoperative complications and the patients' satisfaction show that the new concept of day surgery must be promoted in our surgery clinics. However, we must emphasize that, in order to obtain good results on a larger scale, certain measures are mandatory, such as: organizing a special area and circuits for day surgery, nursing at home, precise inform of the patients (video samples), the use of modern communication (internet) with patients.

[Retrograde pancreato-cholangiography by the endoscopic method]

Endoscopic retrograde pancreato-cholangiography is a modern technique introduced as a result of the development of digestive fiber optics and which is used for the diagnosis and the treatment of biliary, and pancreatic affections, as well as for affections involving the Vater ampulla. Besides the advantages, the indications and the technique the authors also describe the normal aspect of the pancreas according to established indicators as defined by experienced specialists. The results are also commented in the paper, as well as the importance of this procedure as compared with other techniques.

Epidemiological investigations on viral hepatitis in preschool and school communities. Note II. Evaluation of the prophylactic efficiency of standard gammaglobulin administration

At the beginning of the 1977--1978 schoolyear 10% standard gammaglobulin (0.03 ml/kg body weight) was administered to 974 preschool children and 530 schoolchildren. Representative groups of children were tested serologically and virologically before gammaglobulin administration and 3 months afterwards. No statistically significant reductions of viral hepatitis morbidity were recorded in the protected groups as against controls.