One-year audit of admissions to the Intensive Care Unit of the Queen Elizabeth Central Hospital,Blantyre

The intensive care unit at Queen Elizabeth Central Hospital (QECH) has 4 beds and offers level 2 care. A retrospective audit of all admissions to the unit during 2002 was carried out. There were a total of 339 admissions giving a bed occupancy rate of 82 %. Surgical patients made up 81 % of admissions. 45% of all admissions were ventilated. Overall mortality was 38%. Ventilated patients had a mortality of 71% compared with 10% for non-ventilated. Data are also presented for mortality within the surgical and paediatric surgical admissions.     

Gastroduodenal artery aneurysm broken in duodenum. A rare cause of upper digestive tract hemorrhage

The authors present a case of recidivated upper digestive tract hemorrhage, in which the bleeding initially stopped under conservative treatment. Imagery showed a piloro-duodenal stenosis. During the preoperative care the hemorrhage is resumed abruptly imposing emergency operation. The lesion was an intraoperative surprise imposing the hemostasis at first, and then the surgical management of lesions of the digestive tract.     

Postoperative intestinal fistulae

58 (6.25%) intestinal fistulae raised after 928 operations performed for varied surgical small bowel diseases were studied. The primary operation was performed for bowel obstruction, acute peritonitis, small bowel tumours, postoperative eviscerations and for entro-mesenteric infarction. We also noticed that the surgery was performed for the small bowel diseases in 47 (81%) acses and for the diseases belonging to other abdominal viscera in the rest, having an emergency character in 81% of cases. The small bowel fistulae were single (51 cases) or multiple having the following topographic distribution: jejunal fistulae in 25 (43.4%) cases and ileal fistulae in 33 cases (56.6). The coming out of the fistulae was directly in 41 (70%) cases and trough an intermediate route in 17 (30%) cases. The onset of the fistulae was certainly pointed by the coming out moment, early only in 39.6% of cases. This underlining the importance of an active exploration of the operative wound, imposed by the general and/or local premonitory symptoms. The treatment was complex, using conservative and/or surgical procedures; 23 (39.6%) patients were operated on. The mortality rate was of 29.4%. The parenteral nutrition and the therapeutical option for the conservative methods were the main therapeutical acquisitions, which improved the results and the prognosis of the intestinal fistulae.     

Video-assisted thoracoscopic thymectomy--preliminary results

Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy. From April 1999 to December 1999, we performed a total of 10 video-assisted thoracoscopic thymectomies for myasthenia gravis (MG). There were one male and nine female patients with ages ranging from 8 to 59 years. Thymoma was present in one of the ten patients. We considered that complete thymectomy was accomplished in all cases by examination of the thymic bed and of the resected specimen. There was no mortality or intraoperative complications. The median postoperative hospital stay was 4 days. Clinical improvement was observed in all patients after this short follow-up. Compared with a similar historical group of patients with MG who underwent transsternal thymectomy, the VATS group was associated with significantly less analgesic requirement and shortened hospital stay. We conclude that VAT thymectomy is technically feasible and is associated with a favorable postoperative course compared with the transsternal approach. We believe that complete thymectomy can be achieved by this approach. Further investigation with long-term follow-up is needed to further clarify the role of VAT thymectomy in thoracic surgery.     

Topical immunotherapy with BCG in the adjuvant treatment of superficial bladder tumors--15-year-experience

Between September 1984 and June 1999 we applied a long-term (3 years) protocol treatment (Pasteur strain produced by Cantacuzino Institute) in superficial bladder tumors (SBT) recurrence prophylaxis. In 1014 cases (pTa--11 cases, pT1G1--607 cases, pT1G2--149 cases, pT1G3--247 cases) our retrospective analysis used a personal protocol: 8 weekly intravesical instillations, then monthly instillations until 1 year, then 3 monthly instillations during the following 2 years. Pathologic bladder mucosa (simple, moderate and severe dysplasia, carcinoma in situ) was associated in over 80% of cases. Mean follow-up period was 118 months (range 174 to 6 months). Our results demonstrated the efficiency of this protocol (29.5% recurrences on 840 cases who had complete therapy). The importance of tumoral grading was clearly found: 13% recurrence rate for pT1G1, 39.5% for pT1G2 and 49% for pT1G3. Side-effects (local--78%, systemic--4%) and complications (3%) were treated by symptomatic or antituberculous drugs. Our significative study revealed that intravesical immunotherapy (with BCG vaccine) can be considered the first choice in the complementary treatment of SBT.     

Cardiac amyloidosis. A case report

The paper presents the morphoclinical picture in cardiac amyloidosis to a 50 years old man admitted at Iasi Cardiology Center with progressive chronic cardiac failure, the patient having recent history of restrictive cardiomyopathy. It was made a complete cardiovascular evaluation including the right cardiac catheterization for endomyocardial biopsy. The biopsy specimens were fixed in buffered 10 % formalin, followed by routine paraffin embedding, and were stained with haematoxylin-eosin, elastic Van Gieson and sulphated blue Alcian for amyloid evaluation. The amyloid deposits were evidentiated in the interstitium and into vascular walls of the biopsy, pointing the importance of the morphological exam for amyloidosis diagnosis.     

The role of laparoscopy in the management of the right iliac fossa syndrome

Many cases of nonspecific right-sided lower abdominal pain syndromes are still difficult to diagnose regarding the accuracy of identifying which organ is suffering, in spite of the continuous development of various investigations. The aim of our study is to establish the limits of noninvasive explorations and to evaluate the benefits of laparoscopy approach of such cases. 45 patients, admitted and treated for right lower quadrant abdominal pain along 5 years in the Surgical Department of University Hospital "Caritas" Bucharest, were followed up. For all those patients, diagnostic uncertainty indicated laparoscopic exploration. Analyzing the cases, we noticed that the diagnosis was correctly established on the basis of non-invasive preoperative explorations in 13,33% of cases. In 11,11% of cases the diagnosis was completed by laparoscopy approach and in most cases (75,55%) was established by this procedure. The laparoscopic approach allowed diminishing the number of unnecessary appendectomies, detecting and resolving concomitant lesions with minimal parietal trauma and, essentially, avoiding "exploratory laparotomy".     

Metabolic abnormalities with hematologic manifestation

These are unusual diseases in pediatric pathology. We present the morphologic aspects of peripheral blood smear and bone marrow smear of nine storage disease cases.     

Mediastinal and hilar fibrosis

A case is described of mediastinal and hilar fibrosis in a woman aged 22 years. The fibrotic mass compressed the lobar arteries as well as the veins of various lobes of both lungs. These large vessels as well as numerous smaller arteries and veins were to a large extent obstructed by organized thrombi. It seems likely that 3 years after the beginning of symptoms the fibrosing process was still active. The case provides some support for an immunopathological aetiology of this condition.