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Mircea BEURAN

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Outcome of Laparoscopic Adrenalectomy in Obese Patients

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MÆDICA - a Journal of Clinical Medicine | Vol. 10, nr. 3, 2015 CNCSIS - CMR - B+ OBBCSSR

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Outcome of Laparoscopic Adrenalectomy in Obese Patients

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ABSTRACT

Objectives: To compare early morbidity of obese and nonobese patients with minimally invasive adrenalectomies.

Method: Retrospective study of a prospectively maintained database, between June 2003 – December 2012, in a universitary affiliated tertiary hospital. Selection criteria: Minimally invasive adrenalectomy. Obese patients were defined as BMI over 30 kg/m2.

Results: From 205 patient with laparoscopic adrenalectomies we counted 30 obese patients (OG), 25 of them female and only 5 men with a median age of 54,20 years versus 47,94 years for nonobese group (NOG) (p=0.008). In OG were 15 right sided tumor, 11 on the left side and 4 bilateral all treated with transperitoneal antero-lateral approach. Median operating time was 92.20 minutes for OG versus 91.13 minutes for NOG (p=0.924). In OG, 5 patients had previous abdominal surgeries and we counted 4 conversion to open surgery, 2 postoperative complications (6.6%) and no mortality. All OG patients have diverse comorbidities, 50% of them more then 3. Median specimen size was 5.92 cm for OG versus 4.85 cm for NOG (p=0.057). The histology of OG was: adenoma 11 cases, hiperplasia 13 cases and pheochromocytoma 6. In NOG we had: postoperative hospital stay was 6.57 days in OG versus 4.11 days in NOG (p=0.009).

Conclusions: Although obese patients had a higher rate for early morbidities, the minimally invasive approach has particular benefits for them. Although postoperative hospital stay was significantly longer, we believe that advantages of minimal invasive surgery for obese patients remains valid even in a BMI over 30.

Keywords: laparoscopy, adrenalectomy, obesity, early morbidity

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Clostridium Difficile Colitis in Trauma Patients – a Global Step by Step Review

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MÆDICA - a Journal of Clinical Medicine | Vol. 10, nr. 2, 2015

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Clostridium Difficile Colitis in Trauma Patients – a Global Step by Step Review

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ABSTRACT

Clostridium difficile associated disease is a well recognized nosocomial infection evolving as a severe diarrheal illness, associated with significantly higher rates of morbidity and mortality in critically ill patients. The incidence of Clostridium difficile infection is higher and its impact is more severe in trauma patients when compared with general inpatient population.
There are several potential diagnosis tools for Clostridium difficile colitis, however choosing the right diagnostic approach is a difficult task, especially in trauma patients in whom a rapid and certain diagnosis is of paramount importance. Moreover, managing these patients may prove to be a very challenging task, considering the emergence of novel aggressive Clostridium difficile strains resulting in increased disease severity.

Keywords: Clostridium difficile, trauma, infection, diagnosis, therapy

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Selective Nonoperative Management of Abdominal Injuries in Polytrauma Patients: a Protocol only for Experienced Trauma Centers

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MÆDICA - a Journal of Clinical Medicine | Vol. 9, nr. 2, 2014

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Selective Nonoperative Management of Abdominal Injuries in Polytrauma Patients: a Protocol only for Experienced Trauma Centers

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ABSTRACT

Introduction: Nowadays we are facing a steep increase in non-operative management throughout the injured body areas, with a continuous increase in the injuries’ grade.

Objective: To evaluate the safety and applicability of non-operative management in major trauma patients.

Methods: Prospective observational study, in a level I trauma center, during 30 months. Inclusion criteria: major trauma patients with abdominal visceral lesions.

Results: There were 207 major trauma patients whose average age was 35.8 ± 17.2 years, male being 69.6%. The most severe abdominal injuries were in the spleen (32.9%), the liver (19.2%) and the small bowel (11.6%). For the spleen lesions, the non-operative management was successful in 57.9% cases , with a failure rate of 11.6%. Non operative management was successful in 50% of liver injuries, its rate of success being independent of the hepatic injury grade.

Conclusions: Selective non operative management of abdominal visceral injuries is safe and effective in major trauma patients. Nevertheless, we should stress that this type of protocol should be applied only by highly trained surgeons, able to early convert this management to difficult surgical strategies.

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