Zeitschrift für Chirurgie

Posttraumatic osteolysis is a rare complication of fractures. We present a case of massive, rapidly progressive osteolysis of the femoral head following a fracture of the acetabulum. A 45 years old male patient suffered a transverse acetabular fracture that involved the posterior wall. Through a Kocher-Langenbeck approach we performed open reduction and internal fixation of the fracture with two reconstruction plates. Postoperative radiologic control showed acceptable fracture reduction. At 45 days after surgery, a routine X-ray control was performed and a massive osteolysis involving about 50% of the femoral head was noticed. Three months after the surgery, quasi-total disappearance of the femoral head with superior dislocation of the remaining blunt was observed. Massive osteolysis of the femoral head is a new entity of post-traumatic osteoarthritis described in a small number of patients which should not be confused with aseptic necrosis or rapidly progressive osteoarthritis.

Additive Manufacturing (AM) is one of the latest manufacturing processes. AM technology provides patient specific customized physical model, which is almost not achievable by any other technique. AM medical models are best suitable for pre-planning of complex medical surgeries such as reconstruction of the orbital floor which has fractured due to severe craniofacial trauma. Orbital floor is formed by a very thin bone which is often fractured during trauma. Among all the injuries of the craniofacial region, orbital fractures account for about 40 percent. The restoration of the orbit to its pre-traumatic volume and anatomy is one of the most delicate and difficult procedure. However this method which involves multiple try-ins, poses a risk of injury to the important structures within the orbit. AM provides the flexibility to bend, adapt/modify the plate prior to the surgery, which saves the intra-operative surgery time. This also avoids the revision of surgery in some cases. For the current study a patient specific preplanning medical model was made at a low cost using Fused Deposition Modeling (FDM). Placing a reconstruction plate/mesh which was pre-adapted on a model reduces operating time, risk of soft tissue trauma, and allows precise plate positioning and restoration of orbital volume. Using the FDM medical model overall surgery time is reduced by 40 minutes.

Background: Dentoalveolar ankyloses of the deciduous tooth may lead to collapse of the dental arch complicating eruption and development of the succedaneous permanent dentition. The early interceptive orthodontic treatment is recommended to avoid complications on the eruptive process of the successor tooth.

Objective: The aim of this article is to report the orthodontic treatment of a patient with dentoalveolar ankylosis of the deciduous upper molar and impaction of the succeeding permanent teeth.

Materials and methods: A 15 year-old female patient presented with a complaint about severely intruded maxillary left second deciduous molar and inclination of the adjacent tooth. Computed tomography scam (CT) showed that the premolars were found to be ankylosed and were extracted. The extraction spaces were closed by moving the posterior teeth mesially through NiTi closed springs with miniscrew anchorage.

Results: In the maxillary arch, the first molars were positioned in the place of the second premolars. The occlusal posttreatment evaluation revealed a Class II molar and Class I canine relationship on the sides, normal overjet and overbite, and good intercuspation. Ideal functional occlusion was obtained. Panoramic radiography revealed good positioning and good periodontal health of the teeth, and the parallax of the roots of the teeth. The patient’s skeletal pattern was not altered by the mechanics and the facial esthetics was not compromised.

Conclusion: It is important to diagnose the dental ankyloses or impaction problems as early as possible in order to treatment planning achieve better results with a great long-term stability.

Background: Clostridium difficile infection (CDI) is one of the most common infectious complications affecting vulnerable patients, i.e., after surgery or immunosuppressive therapies, posing a significant risk in an oncological unit.

Materials and methods: We analyzed data recovered from 164 cases of CDI during the period of 2014-2016 in the Regional Oncologic Institute Iasi, majority admitted in the surgical and hematological units. In all cases diagnostic was confirmed if stool samples tested positive for GDH and at least one of the toxins A or B.

Results: The study shows a large population of elder patients (median age 64 years) with female dominance (54%). Out of 117 surgical cases 64% had surgical procedures on the gastro-intestinal tract. Although 20% of patients had equivocal symptoms from admission, the average interval (from admission) until first symptoms developed was 7 days. The confirmation of the diagnosis came in the next day/24h in 68% of cases, leading to initiation of efficient therapy. Although CDI is regarded as an antibiotic associated disease, our data revealed that only one third of patients received antibiotic treatment in the last 3 months. Among the risk factors that may have an influence over development of CDI, antisecretory therapy was delivered to 37% of cases. Epidemiology reports showed that less than 8% of patients had previous contact with other CDI confirmed case. Overall mortality was 4.87% and CDI related mortality was 0.85%.

Conclusions: Even though CDI still poses a great threat during prolonged hospitalization and is especially dangerous in oncologic patients, the early recognition of disease onset and the easy access to diagnostic tests triggers an immediate course of treatment and decreases complication and the risk of spreading.

Pancreatic cancer is one of the most lethal malignancies worldwide and in some of the latest statistics ranks fourth in the total number of deaths related to cancer in patients of both genders. Currently, curative treatment is only possible in cases of resectable disease and during the initial stages. Still, although complete surgical resection is the only potential curative approach of this disease, it can only be performed in 10 to 20% of patients, since most individuals present with advanced disease upon diagnosis. Moreover, in the recent decades the development and improvement of surgical techniques have only improved postoperative mortality, without having any significant impact on the survival, with specialized pancreatic surgery centres reporting mortality below 5%. In this way, in the present study conducted on 188 patients from the “St. Spiridon” Clinical Emergency Hospital Iasi, we were interested in determining the survival rates in pancreatic cancer, as well as looking at the staging criteria for adenocarcinoma of the pancreas that follows the tumor/node/metastasis (TNM) system and the correlations between any of these stages and the overall survival. Weibull distribution was used to estimate the overall survival. Reduced survival in pancreatic cancer was found to be within the limits found in the published literature: 41.7% at 1 year, 8.7% at 3 years and 1.9% at 5 years. Still, no significant correlation was found between any of the disease stages and the overall survival.

Aim: Although retained foreign bodies are a rare and preventable problem, it is one of the medical errors in surgery can have heavy medico-legal consequences. Retained sponges can cause significant morbidity, prolonged hospital stay, postoperative complications, pain and disabilities. Also the costs associated with treatment of retained surgical items can be considerable. The study was undertaken to determine the current implementations related to instruments and sponges counts in the operating rooms in Turkey.

Method: This descriptive study was carried out with 261 operating room nurses. The data collection tool was a questionnaire which was designed on the Google Drive application using the internet. Thereafter its internet link was distributed throughout Turkey using nursing, surgical nursing and operating room nursing social media websites; the answers were gathered in the same way.

Results: Ninety-five percent of participants stated that instruments and sponges were usually counted by the scrub nurses (88.5%). Sponges (97.7%), pads (95.4%), tampons (89.2%), surgical instruments (88.1%) and needles (70.4%) were the items which were usually counted. According to 81.6% of the nurses, a written count protocol exists for their hospitals, however, they noted there was a significant difference in implementation among the various institutions (p=0.026). While 49.8% of participants stated that the count before surgery was done by nurses, 23.7% reported that the count was performed by operating room employees. Furthermore, 81.2% of the nurses noted that if the scrub nurses were replaced during surgery, the surgical count would be repeated. Nurses stated that last count was usually done just before applying skin sutures (72.7%), and if there were a problem with the count, radiological imaging would be done (73.5%) and the count irregularity would be signed by staff (31.0%).

Conclusion: Our results demonstrated that because surgical counts were generally done by the scrub nurses, changing of scrub nurse have high risk for surgical count error. In addition, although most of the hospitals have a count protocol, a serious issue concerns the use of unprofessional hospital employees who carry out this task, thus jeopardizing patient safety to be operating room employess join the count are other problems related to surgical count. There is not any comprehensive research related to surgical instrument and material count in Turkey. The current study enables us to obtain information concerning surgical count protocol in the operating rooms in Turkey.

Introduction: Facial dog bites injuries are high risk of contamination, complex and cosmetic outcome is at its great importance.

Methods: 81 consecutive patients (46 adults and 35 children) treated for facial dog bite injuries at Plastic and Reconstructive Surgery Centre of Vilnius University Hospital, Lithuania between 1993 and 2012 were retrospectively reviewed. The following information recorded: age, number of facial aesthetic units involved, tissue loss, the duration between injury and surgical repair, type of repair, and complications. We divided patients in to two groups for analysis of the results. Patients with one facial aesthetic unit involved and patients with more than one aesthetic unit involved.

Results: First group of the 54 patients (38 adults and 16 children) with one facial aesthetic unit involved. 47 out of 54 wounds were with tissue loss, 7 out of 54 bite wounds without tissue loss. All 7 wounds without tissue loss were directly repaired. Out of 47 wounds with tissue loss 2 were directly repaired, 2 left to heal by secondary intention and 43 required reconstruction surgery with composite graft, skin graft, local or regional flaps. 76% of repairs were performed within 24hours from the injury. 7 complications (13%) were recorded. 1 wound infection after direct closure and 6 out of 7 (86%) complications were composite graft loss. Second group of 27 patients (8 adults and 19 children) with more than one facial aesthetic unit involved. All 14 cases without tissue loss underwent primary closure. Out of 13 wounds with tissue loss 1 repaired directly, 12 required reconstructive surgeries. In this patient group were 5 complications (19%).

Conclusions: Children are more likely to sustain injury to multiple facial aesthetic units following dog bite. Direct repair of facial dog bite injuries is safe.