Journal of Surgery

Introduction: Blood transfusions have been reported to cause post-operative complications. Despite the protocols being conducted to minimize the utilization of blood transfusion and improve the standard of care in blood transfusion strategy, there is no consensus on transfusion indication threshold.
Objectives: This study assessed the effect and complication using a new restrictive blood transfusion strategy threshold in patients undergoing total knee replacement.
Materials and methods: This study performed observational evaluation on the proportion of patients to be transfused with the new restrictive blood transfusion strategy (Hb level below 8 g/dL and/or presence of symptoms of anemia) and compared post-operative symptoms of transfused patients to un-transfused patients, who underwent total knee surgery at Police General Hospital. A total of 120 patients were studied. Patients’ demographics, peri-operative parameter, and post-operative symptoms in conjunction with length of hospitalization were compared between groups. Statistics was determined for each parameter and analyzed using Student’s t-test, Pearson’s chi-square test, Fisher’s exact test, and odd ratio at 95% confidence level.
Results: Of 120 patients, 12 patients (10%) were transfused. The post-operative complications including cardiovascular, respiratory, gastrointestinal, infection, and other symptoms did not differ significantly between transfused and un-transfused patients (p>0.05), except that there was more neuropsychiatric symptom in the un-transfused group than the transfused group (in 16.3% vs. 1.6% of patients; 95% CI 1.43-101.97), whereas the length of hospital stay was not different between groups (p>0.05). Blood utilization reduction with the new transfusion strategy was 74 units.
Conclusion: Among patients undergoing total knee replacement, most patients with hemoglobin level 8-10 g/dL were tolerant to the new transfusion strategy (90.24%). Further, post-operative symptoms were not significantly higher between transfused and un-transfused patients. Also, as in the aforementioned study, the new transfusion strategy is considered relatively safe and can be effective as a blood conservative algorithm.

Introduction: Caustic gastric stenosis is relatively rare complications after voluntary or accidental ingestion of caustic substances.
Methods: They analyzed all the medical recordings of the patients operated in First Surgical Clinic, “St Spiridon” Emergency Hospital Iasi during 2004-2017 (6 cases - lot A) for caustic gastric stenosis presented comparatively with a lot of 46 patients with caustic gastric stenosis (lot B) operated in the same clinic between 1990 and 2003.
Results: The most frequently used substance was the caustic soda in group B and detartrant (surface cleaning product – a descaling agent) in group A. The most common site of stenosis was antral, prepyloric; this is explained by the prolonged contact of the caustic with this declivity area and by the spasm of the ankle muscles secondary to caustic action. In the period of establishment of esophageal and/or gastric stenosis, in all cases of group A, esophageal dilation with endoscopic pneumatic balloon probe was started early for both esophageal and gastric stenosis and in group B only in 19 cases. Surgical treatment depended on the extent of the corrosive lesions. In most cases, with limited antral stenosis, we performed distal gastrectomy with gastroduodenal anastomosis. In the combined lesions (esophageal and gastric stenosis) we preferred surgical interventions in two or three steps.
Conclusion: Associated gastric and esophageal lesions form a distinct subgroup that often requires complex surgical resolution through laborious procedures. It is advisable to perform endoscopic dilation procedures, both esophageal and pyloric lesions, before attempting surgical treatment. Postoperative morbidity and mortality decreased over the time, through a personalized, differentiated approach to each case, into a multidisciplinary team.

Creatine-kinase (CK) is the most widely used enzyme to diagnose and follow muscle disease. This study confirms the validity of postoperative Creatine-kinase (CK) values as an indicator of muscle lesion, assess the relationship of CK with variables indicating surgical invasiveness and investigate an association between CK values and excessive postoperative pain. CK values were higher in men and in younger patients. Significant correlations were found between CK and the number of fused levels and duration of degenerative lumbar spine surgery.

Villous tumors of gastrointestinal area are infrequent and villous adenoma is a type of polyp that grows in the colon and other spaces in the gastrointestinal tract and sometimes in other parts of the body. These adenomas may turn into malignant. Their detection is, typically, fortuitous during an endoscopic investigation. For their degenerative potential and recurrence the complete excision of villous tumors is highly recommended. Voluminous villous tumors are the main cause of limitation for endoscopic resection and require a surgical management. Great morbi-mortality rate and functional conditions of surgery have directed to a growing attention in many further procedures which can expose to recurrence risk particularly in the rectum. We present our experience in dealing a case of huge villous tumors of the rectum in elderly patient.

The first Surgical Unit of Cluj was built between 1897-1899 as a unit of the newly founded “Carolina” National Hungarian University Hospital, which had been designed as a pavilion-type hospital. The surgical building rose on three levels and included the orthopedic outpatient unit, the surgical outpatient unit, a small operating unit, wards with 8 to 24 beds, laboratories, quarters for a part of the staff, teaching rooms, administrative rooms. The main space of the teaching activity was the lecture theater. The clinic capacity (100 beds) was exceeded immediately after its opening, which documents the importance of the Cluj medical center as early as the beginning of the 20th century. The clinic had very well-defined functional routings, aimed at preserving the spaces in aseptic condition. This article depicts a piece of the medical history of Cluj, showing the place and the way our forerunner surgeons worked.