Tiberiu Paul Neagu

Tiberiu Paul Neagu

Defensive Surgery - a New Under-Recognized Reality among Surgeons

In recent years, the number of medical litigations is increasing and defensive medicine becomes a widespread approach among physicians all over the world. Defensive behavior of physicians is more common in scheduled, elective, compared to emergency medical services. The immediate direct consequences of this defensive behavior are found in the increase of costs (additional investigations) and the increase of waiting time for certain procedures and interventions (repeated postponements). Difficult and uncomfortable to admit that it exists, but defensive behavior is a reality. It raises numerous and complex ethical issues, and the goal of health policies should be to reduce this phenomenon.

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Is There an Increased Complications Rate in After-Hours Colorectal Surgery?

When a surgical team is dealing with an after-hours colorectal surgery, they are actually confronting with a chain of elements and events, some linked to the patient and severity of the surgical case, others related to the medical team ability to cooperate, from nurses to surgeon and anesthetist. There is a series of differences between elective and emergency performed surgeries, two of them and most important elements are the patient (disease type, age, preoperative condition) and the operating team (experience, technical performance after-hours, especially at night).

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Life-threatening Consequence of a Psychiatric Behavior

Introduction: The prevalence of hypokalemia in psychiatric population is very high with eating disorders and laxative abuse being the main incriminated factors. Case presentation: We report a case of a 34-year-old woman with history of sleeve gastrectomy and breast implant, who presented for fatigue, severe myalgia, generalized hypotonia and palpitations. Laboratory exams revealed severe hypokalemia and rhabdomyolysis. The electrocardiography showed prolonged QT interval and ST segment depression with second-degree atrioventricular block. She received intravenous potassium supplementation with consecutive hydration. When potassium level was within safety limits, the patients received loop diuretics in order to decrease rhabdomyolysis and avoid kidney injury. The underlying cause was a pathological behavior, with frequent self-provoked episodes of nausea and vomiting after eating and chronic consumption of laxatives. She started psychotherapy. Conclusion: Psychiatric behaviour can lead to life-threatening conditions, therefore it should be discovered and managed promptly.

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The importance of high flow nasal cannula (HFNC) oxygen therapy

High flow nasal cannula (HFNC) oxygen therapy devices are used on a daily-basis in many intensive care units and postoperative wards. Such a device deliver a mixture of air and oxygen, warmed, humidifi ed, with gas flow between 20-60 L/min, and inspired oxygen fraction between 0.21-1. Therefore, it improves oxygenation, decreases dead space, washes out the carbon dioxide (CO2) from patients’ airways, improves thoraco-abdominal synchrony and decreases the work of breathing. Studies have shown effi cacy of HFNC oxygen therapy use for acute hypoxemic respiratory failure, for patients with exacerbations of chronic pulmonary diseases, after extubation in order reduce the need for mechanical ventilation, in perioperative period to prevent atelectasis and in palliative care, in order to reduce breathlessness. It isn`t feasible for patients with severe altered neurological status, facial trauma, basal skull fracture, complete airway obstruction or epistaxis. There are no standardized recommendation for the use or contraindication of HFCN oxygen therapy. The weaning is realised according with patients’ tolerance, oxygen saturation, respiratory and heart rates.

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Abdominal Compartment Syndrome - a Surgical Emergency

Over the past six decades, abdominal compartment syndrome (ACS) remained a very controversial subject, both in surgical and non-surgical specialties. Doctors failed to understand why critically ill patients died in the ICU with distended abdomens without fi nding any cause or why postoperative patients with wound defects such as dehiscence died after suturing the wound again „very tightly”. After the concept of intra-abdominal pressure (IAP) was established and methods for measuring it and diagnosing intra-abdominal hypertension (IAH) were available for clinicians to use it, it became clearer that ACS was a very serious and life threating pathology and the need for a correct treatment is essential. In this article we will try to make a literature review of the past decade and see when and how to diagnose correctly a patient with ACS and also how the diagnostic and treatments methods changed over the years.

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The Labyrinth Behind an Acute Respiratory Failure

Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment.

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Unusual Combination of Posterior Femoral Head Dislocation and Ipsilateral Intertrochanteric Open Fracture: Case Report

The combination of posterior femoral head dislocation with ipsilateral intertrochanteric fracture is an extremely rare occurrence, therefore, few reports exist. The posterior femoral head dislocation is an injury most common encountered in road traffic accident (dash-board) and may associate various types of acetabular, femoral head or femoral neck fractures[1-3] but almost never an intertrochanteric fracture. [...]

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Results in Breast Reconstruction - Retrospective Study

In the last century, the breast reconstruction after mastectomy has become an important element of the multicentric treatment of the patients suffering from breast cancer. Breast reconstruction was initially developed to reduce the complications of mastectomy and the deformations of the thoracic wall. Currently, it is known the fact that reconstruction can improve the psychosocial state and the quality of life of the patients with breast cancer[1]. [...]

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Negative Prognostic Factors in Severe Burns - Implication for Clinical Outcome

Burn injuries are a major public health problem all over the world and despite significant improvements in critical care and surgical treatment, major burns are associated with high morbidity and mortality and poor recovery outcome. Patients with severe burns need immediate intervention and rapid initiation of speci-alized treatment in a dedicated critical care burn unit in order to minimize morbidity and mortality. The complex nature of burn injuries requires an integrative approach, by a multidisciplinary team in order to obta-in an optimal care. [...]

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Posttraumatic Renal Artery Thrombosis

Posttraumatic renal artery thrombosis is a very rare complication of abdominal trauma which occurs especially in young people, after car accidents, with an increasing incidence in the last few years. There are about 400 reported cases in the literature[1], meaning less than 0.08% of all reported abdominal traumas and being found in 1-4% of patients with renal damage[2]. [...]

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The Versatility, Plasticity and Esthetic Aspect of Latissimus Dorsi Muscle-Cutaneous Flap in Breast Reconstruction - Case Report

In the last decades, the approach manner of the defects of the soft parts post-mastectomy developed significantly together with the innovative surgical techniques of oncoplastic surgery.
Among these techniques, the reconstruction of the breast with LD flap and implant continues to be a reliable and easy to perform method, both by the experi-enced surgeons and also for the beginners[1]. [...]

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Versatility of the Cross-Finger Flap for Reconstruction of the Thumb

It is well known that the thumb is responsible for 40% of the hand function. Th erefore, preserving its length and mobility represents the main objective of the plastic surgeon while choosing the most appropriate reconstruction technique[1]. When resurfacing of the fingers is needed after hand injuries, cross-finger flaps have proved themselves very useful[2]. Since its premier many years ago[3], this type of flap remains an elegant method in order to cover exposed bones or tendons of the fi n-ger, in order to ensure length preservation and function recovery. [...]

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How Complicated a Complicated Case Can Become?

The incidence of work related injuries is high worldwide. More than 300 million accidents happen during work and are responsible for almost 2 millions of deaths. The incidence of crush syndrome is 2-15% in all trauma patients and frequently can determine trauma-related amputations, especially if the lower limb is involved and the main mechanism is crushing. Crush syndrome is the systemic manifestation of rhabdomyolysis due to muscles reperfusion injury that happened when the compressive forces on the tissues are released, being of-ten related with occupational accidents[1]. [...]

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A Curious Case of Rhinophyma in a 73-Year-Old Patient

Rhinophyma is a benign tumor characterized by a pro-gressive hypertrophy of the nose soft tissues, with a re-ddish and bulky appearance, affecting most frequently elderly Caucasian males[1], which may also cause functional airway obstruction. It is believed to be the end stage of severe acne rosacea, but the real cause and the exact etiology remain unknown[1]. The male to female ratio of rhinophyma patient varies between 5 to 1 and 30 to 1 [2,3]. The diagnosis is based on the clinical features of this rare and disfiguring disease using Rhinophyma Severity Index Score (RHISI)[4]. The main differential diagnosis is the basal cell carcinoma (BCC), with an occult incidence of 3% to 10% in patients with rhinophyma[1]. [...]

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Charcot Foot Diagnosis - Still an Issue?

The Lisfranc fracture-dislocation of the foot is uncommon and many cases are misdiagnosed. The Lisfranc lesion involves the medial cuneiform and base of the second metatarsal which are considered to be the keystone of the structural integrity of the midfoot. This joint has a stabilization effect on longitudinal and transverse arches of the foot. A neglected or untreated injury to the Lisfranc joint can lead to secondary arthritis and significant morbidity with disability. Furthermore, it is well known the correlation between pacients with periferic neuropathy and this type of lesion, also known as Charcot Foot[1]. It has been documented to occur as a consequence of various peripheral neuropathies, but diabetic neuropathy has become the most common etiology[2]. [...]

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Single-Stage Reconstruction of Distal Third of the Dorsum Nasi Using a Nasolabial Flap after Removal of Basal Cell Carcinoma

The nose represents a common site for skin cancer, especially for Basal Cell Carcinoma (BCC) which is the most common malignant tumor in humans[1-3]. The removal of the tumor will lead to a defect that can involve skin, cartilage and even nasal mucosa. Therefore, reconstruction of this tridimensional structure can be a challenge even for the most experienced surgeons[4]. There are many techniques described in the literature for restoring the lining and skeletal framework[1-8], but all of these techniques should be adapted to the patient’s needs. In this paper we described our preferred surgical method to cover a medium defect of the distal third of the dorsum nasi after tumor excision using a nasolabial flap. In order to perform a single-stage reconstruction, we pushed the limits of the flap measurements and did some tricks so as the pedicle to be well fitted, leading to good aesthetic results. [...]

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Breast Reconstruction Particularities after Radiotherapy - Case Report

Postmastectomy radiation therapy decreases the incidence of locoregional disease recurrence in patients with invasive breast cancer and has been proven to reflect a survival advantage for patients with node positive disease[1,2]. The optimal timing and technique of breast reconstruction procedures in patients requiring post-mastectomy radiation therapy are controversial[1] . Patients undergoing postmastectomy breast reconstruction, with a history of prior radiation therapy, present a particular clinical scenario. This is because of their well-documented higher complication rates, secondary to deleterious effects of irradiation on the soft tissue envelope of the remaining breast. [...]

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Multivisceral Resection for Pancreatic Adenocarcinoma. Case Report and Literature Review

Pancreatic cancer (PC) remains a deadly disease with a dismal prognosis in which the mortality rate nearly equals its incidence [1,4]. Despite advances in modern chemoradiotherapy, the best and only chance of cure for patients with PC is an oncological surgical resection aimed at complete removal of all gross and microscopic disease[5]. Early disease and curative-intent surgery are the best predictors of outcome. Locally advanced cancer of the pancreatic tail involving adjacent organs is often considered unresectable. Radical distal pancreatectomy with en bloc resection of the invaded viscera with or without vascular reconstruction was introduced to treat these tumors[2,3]. Tumors of the body and tail have evidence of involvement of surrounding structures either by tumor infiltration or inflammatory adhesions. In such circumstances, it is advisable to perform en bloc resections to obtain negative surgical margins[6]. According to Shoup, multivisceral resections are technically feasible and, based on the limited data available, these resections are associated with improved survival (5-year survival rates of 16-22%) [7,8]. Given the high morbidity and mortality associated with these procedures, they should be performed only when the possibility of achieving R0 seems distinctly feasible[3,6,8]. [...]

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Comparison of Osteosynthesis Using Plates and Screws Versus Kirschner Wire Fixation for Unstable Metacarpal Fractures: a...

Hand surgery is considered to be the biggest challenge for every plastic surgeon. The social value of the hand is appreciated by any individual, butmostly by plastic surgeons which are, par excellence, hand-working persons. When a hand injury is treated you must consider the Hippocratic concept which states that "healing is a matter of time but it is sometimes also a matter of opportunity". The hand forms a functional unit with the forearm which is a high-precision machine, with multiples levers, who has tactile intelligence that ensure its auto-mechanism, being able to grab and maintain, in any spatial position, large and small tools invented by human genius. The hand is both a motor and sensory organ, and in terms of society,it is an organ of defense, an organ of creation and expression. This is why hand surgery is very important, both in medical and social terms, and any research in this domain has one purpose: improving the treatment of hand injuriesin order to obtain functional results closer to the genetic scale of the divine creation. The purpose of this study was to assess different osteosynthesis techniques in order to establish which one is better in matters of functional results. [...]

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Advances in Peripheral Nerve Regeneration: Materials, Methods, Techniques

Peripheral nerve injuries have a high incidence in limb trauma and have a devastating impact on the quality of life of the patient. Results after surgical treatment are unsatisfactory especially in cases with complete tran-section of the nerve (neurotmesis) associated with late repair. Thus, the necessity to implement into current practice new techniques, materials and methods for nerve repair. [...]

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