Laparoscopic appendectomy--considerations in about 1000 cases

Laparoscopic appendectomy (LA) is a well spread method today, but not as largely accepted as cholecystectomy, the cure of gastro-esophageal reflux and some other procedures (relatively small in number) for which the laparoscopic approach is the golden standard. Otherwise it is improbable that LA will gain such a status, at least in the near future. On the other hand it is obvious that LA offers important advantages for some special situations: the right iliac area syndrome, obesity, professional sportsmen, abnormal localization of the appendix, as well for the cases when localized and especially diffuse peritonitis is associated. Our paper analyses the experience of General Surgery Department at the "St.John" Emergency Hospital Bucharest on laparoscopic appendectomy. The retrospective study includes 996 cases that were treated laparoscopic between 1996-2004. Of these 745 cases were catarrhal, 166 cases were phlegmonous and 76 gangrenous appendicitis. In 93 cases localized or diffuse peritonitis was associated. There were recorded also 3 cases of each of the following: chronic appendicitis, appendicular mass and mucocele. The number of conversions was 28 (2.81%). There were also 10 reinterventions (1.004%), 7 because of intraperitoneal abscess and we also recorded one death.     

Treatment outcome using prednisone in corticosteroid-responsive primary nephrotic syndrome in children

In children, the nephrotic syndrome is usually corticoid-responsive; approximately 70% of patients experience relapses, frequently triggered by infections. Our paper presents the results obtained using a 4 month prednisone regimen. This retrospective study included 83 children afflicted with nephrotic syndrome over a 10 year span. We analyzed: age at diagnosis, boys/girls ratio, response to corticoid treatment - after one month of prednisone and at the completion of the treatment course, number of relapses and their frequency, complications of prednisone treatment. The median age at diagnosis was 4.8 years, males predominating M:F = 1.5:1. Complete response after 4 weeks of prednisone therapy was noted in 98.79% of cases. We had 116 episodes of relapses during the first year of follow-up, occurring in 67.4% of children (27.9% were frequent relapsers, 11.62% subsequently became corticoid-dependent). Late relapses, after the first year, occurred in 32.55% of cases. We noted mostly mild adverse effects of the prednisone treatment: occurrence of infections during therapy (16.27%), cushingoid facies (37.2%), hirsutism (4.6%), high blood pressure (4.65%), stretch marks (2.32%). In conclusion, the 4 month prednisone treatment regimen is efficient in inducing and maintaining a remission. The incidence of relapses is 32.55%, comparable to the figure cited in larger studies. Serious adverse effects are significantly lower with this regimen compared to other corticoid treatment schemes. Key wo     

Indications for esophageal replacement in children

Esophageal substitution in children is required in several types of esophageal atresia, as well as following strictures caused by caustic ingestion or peptic esophagitis. Nowadays, two main types of procedures are used for esophageal replacement: colon segment esophagoplasty (that seems to be preferred by most pediatric surgeons) and gastric tube esophagoplasty. The paper presents the personal experience in the management of a series of 56 children with esophageal replacement, during the last 10 years. In 46 patients, the stricture cause was caustic ingestion, while peptic esophagitis accounted for 3 cases. The remaining 7 cases were long-gap esophageal atresias that could not be managed by primary neonatal anastomosis. The results are rated as good in 42 cases. Complications occurred in 13 cases, while fatal outcome occurred in 5 patients. The most remarkable feature of the series is the high number of procedures required after caustic ingestion.     

Persistent hyperplastic primary vitreous associated with retinal folds

The paper presents the case of a 18 years old male suffering from persistent hyperplastic primary vitreous (PHPV) associated with congenital retinal folds. The clinical features and the pathogenic correlations of the two affections are discussed. Comparing to the PHPV, consequence of a embryogenesis flow appeared in the development of the primary hyaloid-vitreous complex, the congenital retinal folds are considered to be the expression of secondary changes, generated by the background of a varied vitreo-retinal pathology.     

Current aspects of hemolytic uremic syndrome in children

The authors are approaching the problem of hemolytic uremic syndrome, a common cause of acute renal failure in children. This review present an update about the pathophysiology of typical hemolytic uremic syndrome, useful for understanding the clinical picture and the base for some modern therapeutical models. Concerning the evolution, the authors underline the importance of identifying the risk factors for acute phase, the extrarenal manifestations being considered of vital risk. The atypical hemolytic uremic syndrome still has some uncertainties; the article try to make a synthesis of ethiopathogeneity, clinical manifestations, evolution and therapeutical modern approaches.     

Myelinated nerve fibers associated with juxtapapillary haemorrhages

The myelinated nerve fibers (MNF) are o congenital anomaly characterized by the extension of the myelinisation process anterior from the lamina cribosa. The incidence of myelinated nerve fibers is 0.3-0.6% in patients and 0.54% in eyes from autopsies. Although these represent benign lesion, rarely are associated with retinal abnormalities: vascular abnormality (retinal telangiectasis, cranial-facial lesions, coloboma of the iris, keratoconus, myopia/strabismus, amblyopia). Myelinated nerve fibers asSociated with juxtapapillary haemorrhages was not reported in the available literature. We describe the clinical findings and diagnostic particularities of myelinated retinal nerve fibers associated with juxtapapillary haemorrhages in a personal case. An 40-year-old woman was referred for unilateral papillary abnormalities. The diagnosis was myelinated retinal nerve fibers as white striated patches with feathery edges, associated with two juxtapapillary haemorrhages. The clinical and pathogenic features are discussed. Based on the association between the myelinated nerve fibers, the juxtapapillary haemorrhages there is a possible pathogenic correlation between these elements. The action of the myelinated nerve fibers can be explained by a mechanical compression, with the disruption of the retinal artery, a structural vulnerable artery.     

Associations of smoking with cardiometabolic profile and renal function in a Romanian population-based sample from the PREDATORR cross-sectional study

Background: The impact of smoking on morbidity is well known, but in Romania, limited data are available regarding the smoking prevalence and relationship with cardiometabolic profile and kidney function.

Objectives: To assess the association of smoking with cardiometabolic traits and kidney function, in a Romanian population-based sample from the PREDATORR study.

Methods: PREDATORR was an epidemiological cross-sectional study. Between 2012 and 2014, participants were randomly selected from the lists of general practitioners and enrolled if they were aged 20 to 79 years, born and living in the past 10 years in Romania. Sociodemographic and lifestyle characteristics were collected through interviewer-administered questionnaires.

Results: Overall, 2704 participants were included in the analysis, 18% of them being current smokers and 30.8% former smokers. Current smokers compared to non-smokers had higher total cholesterol (220.6?±?50.4 versus 213.9?±?86.8?mg/dl, P?=?0.017), LDL-cholesterol (137.8?±?45.2 versus 130.7?±?83.7?mg/dl, P?=?0.004) and glomerular filtration rate (96.9?±?16.8 versus 90.7?±?19.1?ml/min/1.73?m², P?<0.001) in women and higher triglycerides (170.7?±?129.8 versus 144.3?±?94.2?mg/dl, P?=?0.007), glomerular filtration rate (97.6?±?17 versus 90.3?±?18?ml/min/1.73?m², P?P?=?0.002) in men. Active smoking was associated with hypercholesterolaemia [OR: 1.40 (95% CI: 1.01–1.96), P?=?0.04] and low HDL-cholesterolaemia [OR: 1.39 (95% CI: 1.01–1.91), P?=?0.04] and negatively associated with overweight/obesity [OR: 0.67 (95% CI: 0.48–0.94), P?=?0.02]. Male former smokers had higher prevalence of abdominal obesity (82.4% versus 76.4%, P?=?0.02), hypertriglyceridaemia (43.6% versus 35.6%, P?=?0.01), hypertension (64% versus 56.4%, P?=?0.01) and ischaemic vascular disease (40.5% versus 30.9%, P?=?0.003) than male non-smokers.

Conclusion: The PREDATORR study showed a high prevalence of smoking in the adult Romanian population providing data on the association of smoking with cardiometabolic traits.