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PubMed1993

Antibodies to Haemophilus influenzae type b outer membrane proteins in children with epiglottitis or meningitis and in healthy controls.

The two most common manifestations of Haemophilus influenzae type b (Hib) infection in Western communities are meningitis and epiglottitis. The role of antibodies against outer membrane proteins (OMP) in the pathogenesis of these diseases was investigated by Western blotting (immunoblotting) with an OMP antigen prepared from a local Hib strain. Acute- and convalescent-phase serum samples from 25 children with epiglottitis and 20 with meningitis and single serum samples from 19 control children in the same age group were tested. Western blots were evaluated quantitatively by use of graphs generated from a densitometer. OMP antibody was detected in all sera from patients and controls. There was no significant difference between the mean antibody level in acute-phase sera from children with meningitis (336 +/- 143 arbitrary units) and those from children with epiglottitis (286 +/- 134 arbitrary units). However, the mean OMP antibody level in sera from healthy controls, with no known history of Hib disease, was significantly higher than that in sera from patients with Hib disease within 2 days of admission to the hospital (patients [n = 35], 282 +/- 144; controls [n = 19], 425 +/- 236; P = 0.007). The difference was due mainly to higher levels, in control sera, of antibody against four proteins, one of which is either P1 or a comigrating protein of 49 kDa. The finding of higher levels of OMP antibody in healthy controls suggests a protective role for antibodies directed against one or more OMP. This information could be exploited in future vaccine development.

Acute Disease↗
PubMed1976

Toxigenic bacterial diarrhea: nursery outbreak involving multiple bacterial strains.

An outbreak of watery diarrhea occurred in 14 of 15 infants in a special care unit over a four-day period. Using the CHO cell assay for enterotoxin, we found that 11 of these patients had toxigenic bacteria in their stools. These bacteria comprised nine different serotypes of three species of organisms: Escherichia coli, Klebsiella, and Citrobacter. None of the three serotypes of E. coli were classic enteropathogenic serotypes. Rectal swab specimens from all 15 infants were examined for the presence of viruses by electron microscopic and cell culture techniques as well as by studies in suckling mice. None had parvovirus- or reovirus-like agents and two had adenoviruses. No other viral agents were detected. Of 38 bacterial strains isolated from ten control infants without diarrhea, three Klebsiella strains from two individuals were found to be toxigenic. Analysis of a total of 136 enteric isolates showed that toxigenicity as measured by the CHO assay was strongly associated with strains isolated during acute diarrheal illness when compared with strains isolated in convalescence (p less than 10(-5)) or with strains from control infants without diarrhea (p less than 10(-5)). This study raises the possibility of an outbreak of disease caused by a transmissible plasmid responsible for a cholera-like enterotoxin production in several enteric bacterial strains.

Adenoviruses, Human↗
PubMed2004

[Establishing "fast-track"-colonic surgery in the clinical routine].

OBJECTIVE: A multimodal perioperative concept ("fast-track"-surgery) may decrease the incidence of general complications following elective colonic resections, accelerate rehabilitation and shorten postoperative hospital stay. During the introduction of this new "clinical pathway" several obstacles have to be overcome. This manuscript describes a practical way to establish "fast-track"-colonic surgery in the clinical routine. MATERIAL AND METHODS: After discussion of the many aspects of perioperative pathophysiology following abdominal surgery a "fast-track"-concept for colonic surgery was defined. Since 11.10.2001 the "fast-track" concept was applied to all patients treated by one attending surgeon. Experience with establishing this concept in the clinical routine was analysed. RESULTS: "Fast-track"-colonic surgery was established in close cooperation between surgeons, anesthesiologists and nurses. A written-down concept, the use of checklists and letters of information for patients, their relatives and general practicioners will simplify the introduction of the new perioperative treatment. Traditional practice (i. e. types of incisions, use of drainage, postoperative oral feeding) have to be modified. In 74 "fast-track"-colonic resections postoperative hospital stay was reduced to a median of 4 days, regardless of the way of access to the abominal cavity (laparoscopic or conventional). Postoperative morbidity was acceptable (local complications: 7 %; general complications: 7 %, but only 1 % without local complication). CONCLUSION: Establishing "fast-track"-colonic surgery requires close cooperation between surgery, anestehsiology and nursing personal. Most important is a surgeon prepared to overcome traditional concepts of perioperative care.

Colon↗
PubMed1985

Percutaneous ultrasonic versus surgical removal of kidney stones.

Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized. A long hollow metal probe is advanced through the nephroscope and placed in contact with the stone. This probe conducts the ultrasonic energy. The stone absorbs the energy and breaks into fine granules which are evacuated by suction. Percutaneous lithotomy was performed upon 300 of 302 consecutive patients bearing stones which required removal. Targeted calculi were successfully removed from 97 per cent of these patients. Eighty-one per cent had complete stone removal at the primary procedure; 57 patients required additional percutaneous manipulations under local or general anesthesia. The previous 100 patients with kidney stones underwent surgical removal of the calculi. Complications associated with percutaneous stone removal included postoperative fever, delayed urinary bleeding, ureteral edema, symptomatic urinary extravasation and water intoxication. Only 16 patients with complications required prolonged hospitalization or readmission. No complications required surgical management; no deaths occurred. Anesthetic times were similar for both groups, averaging 152 +/- 4 (S. E. M.) minutes for PL and 193 +/- 8 minutes for SL. Hospital recovery days averaged 5.7 +/- 0.3 for PL and 8.4 +/- 0.5 for SL (p less than 0.01). Associated costs averaged $7,203 +/- 255 for PL and $8,849 +/- 660 for SL (p less than 0.01). The number of narcotic administrations per patient (days one to five postoperatively) averaged 9.9 +/- 0.7 for the PL group and 16.8 +/- 0.8 for the SL group (p less than 0.01). The average patient in the PL group felt capable of full activity 2.0 +/- 0.2 weeks after stone removal, whereas no patient who experienced previous SL recalls a recovery period of less than three weeks (p less than 0.01). Most upper urinary tract calculi may be removed cost-effectively using a percutaneous approach. Patients may expect a rapid convalescence with diminished pain.

Humans↗
PubMed2005

Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease.

OBJECTIVE: To evaluate the outcome of each of the three methods used to treat pilonidal sinus disease. STUDY DESIGN: A prospective blind randomised study. MATERIALS AND METHODS: Between April 2000 and February 2003, 83 patients (68 male and 15 female), aged between 19 and 31 years (mean 26.6), scheduled for elective operations for pilonidal sinus disease. Patients were randomly assigned to receive one of three excisional surgical procedures. Group A consisted of 28 patients (22 males and six females) and underwent wide resection of the skin and subcutaneous tissue of the natal cleft, followed by primary closure of the wound in two layers after insertion of suction drain. Group B consisted of 26 patients (22 males and four females) and underwent wide resection of the skin and subcutaneous tissue and their wounds left opened for secondary intention healing. Group C consisted of 29 patients (24 males and five females) and underwent limited excision of the fistulous tract and their wounds were left opened for secondary intention healing. Patients were followed-up for 15 to 48 months post-operatively. Demographic data, operative time, hospital stay, operative blood loss, post-operative pain, wound healing time and patient's satisfaction were recorded. RESULTS: The limited excision group of patients had a highly significant shorter operative time than the closed wound group of patients (p<0.001). They also had the shortest hospital stay, operative blood loss and post-operative pain (p<0.001). The closed wound group of patients showed significantly shortest wound healing time, followed by the limited excision group of patients; the wide excision group of patients showed the longest healing time. Apart from the minimal non-significant elevation of the rate of recurrence in the closed wound group of patients, there was no difference between the three groups. All recurrent cases were obese patients and presented within the first six months after operations. CONCLUSION: Limited excision of a pilonidal sinus represents one of the best therapeutic options. The result of this method is comparable with the more aggressive frequently used excisional method, and it has the advantage of having a shorter convalescence and better patient satisfaction.

Adult↗
PubMed2006

Laparoscopic adrenalectomy.

Laparoscopic adrenalectomy (LA) was first described in the literature in 1992, and has become the preferred method for the removal of benign functioning and non-functioning tumors of the adrenal gland <12 cm. The objectives of the present study are to review the experience of LA gained since it was first done in 1992 and to critically evaluate its effectiveness for the surgical management of endocrine hypertension; specifically pheochromocytoma, aldosteronoma and Cushing's syndrome and disease, as opposed to open adrenalectomy. The benefits of minimally invasive techniques for the removal of the adrenal gland include decreased requirements for analgesics, improved patient satisfaction, shorter hospital stay and recovery time when compared to open surgery. LA can be performed safely for bilateral disease and may become the standard of care for malignant tumors. Current limitations are operator-dependent and not a factor of limitations of minimally invasive techniques. A thorough pre-operative work-up is key for differentiating the various cases of hypertension and adequate pre-operative treatment is paramount when indicated.

Adenoma↗
PubMed2004

The course of inhalation profiles during an exacerbation of obstructive lung disease.

BACKGROUND: Acute exacerbations of asthma and chronic obstructive pulmonary disease (COPD) are associated with increased airflow Limitation, hyperinflation and respiratory muscle fatigue. It is unclear, whether patients are able to perform adequate inhalations through various inhalation devices with different orfices during an exacerbation. The aim of this study was to examine the evolution of inhalation profiles of patients inhaling through Diskus, Turbuhaler, pressurized metered dose inhaler (pMDI) and Volumatic and consequently the appropriateness of using the various devices during an exacerbation. MEASUREMENTS: 15 hospitalized patients participated in this randomized comparison of inhalation profiles through the four placebo-devices. For each device, triplicate inhalation profiles were recorded during day 1-9 of admission and in stable phase (day 50). RESULTS: The mean percentage of patients performing optimum inhalation profiles was 100% for Diskus, 60% for Turbuhaler, 14% for pMDI and 87% for Volumatic over the interval of day 1-9 and day 50. Patients with an inspiratory muscle strength (MIP) of less than 6kPa were generally unable to generate the optimum flow through the Turbuhaler (>60 l/min). CONCLUSION: The Diskus and Volumatic can be used effectively in the acute phase of an exacerbation of asthma or COPD. The Turbuhaler could be optimally used after the fifth day of convalescence. The pMDI is rather unsuitable during an exacerbation.

Acute Disease↗
PubMed1993

Staging pelvic lymphadenectomy for prostate cancer: a comparison of laparoscopic and open techniques.

The operative morbidity and convalescence of our initial 30 patients who underwent laparoscopic pelvic lymph node dissections were compared to those of 16 patients who underwent open surgical pelvic lymph node dissections performed at our institution for staging purposes between 1990 and 1992. The average time for laparoscopic pelvic lymph node dissection (199.4 minutes) was nearly twice that of surgical pelvic lymph node dissection (102.4 minutes). However, the blood loss in the former group was significantly less. Oral intake occurred after a mean of 0.63 days in the laparoscopic pelvic lymph node dissection group compared to 2.87 days in the surgical group. Also, laparoscopic pelvic lymph node dissection was superior to surgical pelvic lymph node dissection in terms of average postoperative analgesic use (1.55 versus 47 mg. morphine sulfate), average hospital stay (1.7 versus 5.37 days), average return to normal daily activities (4.94 versus 42.9 days) and interval to full recovery (10.8 versus 65.5 days). However, the incidence of significant complications in the laparoscopic pelvic lymph node dissection group was 13%, with no complications seen in the surgical group. Interestingly, all significant problems in the bilateral laparoscopic pelvic lymph node dissection patients were confined to our initial 12 patients, indicating the steepness of the laparoscopic learning curve.

Aged↗
PubMed1996

[Advances in genetic diagnostics for respiratory tract infections].

The past decade has seen the rapid advancement of molecular biology and its application in the field of infectious diseases. The polymerase chain reaction (PCR) is a technique which brings about the in vitro amplification of DNA, and is clinically useful in the sensitive, specific and rapid diagnosis of various infectious diseases. The fast diagnosis of viral infections using PCR is a prime example, since viral culture may take weeks to grow and since serologic conversion seldom occurs until the convalescent phase of the clinical illness. Similarly, PCR is applicable to the diagnosis of pulmonary infections caused by mycobacteria, Legionella, methicillin-resistant Staphylococcus aureus, anaerobes, Mycoplasma, Chlamydia, Pneumocystis carinii and so on. On the other hand, the drug-resistant phenotype of a microorganism is predictable by the detection of gene alterations related to the drug resistance. For example, the deletion of the catalase-peroxidase gene relating to isoniazid resistance of mycobacteria, and point mutations in the RNA polymerase beta subunit (rpoB) gene relating to rifampicin resistance have been elucidated. As these applied techniques become more widely available and less costly, they should contribute not only to the rapid diagnosis of infectious diseases, but also to the adequate selection of antibiotics and the shortening of hospitalization.

Bacterial Infections↗
PubMedDate not supplied

Nurse-initiated telephone follow-up after acute myocardial infarction: a pilot study.

OBJECTIVES: To determine the receptivity of patients with acute myocardial infarction and their spouses to postdischarge follow-up telephone calls from a nurse, and to describe the content of nurse-patient/spouse telephone conversation during early convalescence at home. DESIGN: Descriptive pilot study using qualitative methods. SETTING: University medical center and home. SAMPLE: Twenty-one male patients with acute myocardial infarction and their wives who agreed to participate in the study. RESULTS: All subjects were receptive to telephone follow-up by cardiac nurse clinicians. From data analysis of telephone calls, five content themes emerged. These included (1) difficulty accepting changed health status, (2) reports of attempts at risk factor reduction, (3) concern for financial difficulties, (4) dealing with uncertainty, and (5) expression of appreciation for the nurse-initiated telephone call. Nurse investigators provided information and emotional support and made referrals. CONCLUSIONS: Further research should be done to test the feasibility and effectiveness of nurse-initiated telephone follow-up after hospital discharge for acute myocardial infarction in reducing patient and spouse stress and increasing patient/spouse information about self-care regimens. The clinical trial should also determine whether telephone follow-up by nurse increases patient satisfaction with the health care delivery system.

Adult↗
PubMed1988

Molecular epidemiology of rotavirus infection in a room for convalescing newborns.

In a prospective study, all patients admitted to a unit for convalescing newborns on an infant-toddler ward between January and April 1985 were tested every other day for rotavirus (RV) excretion by using an enzyme-linked immunosorbent assay. RNA electrophoresis of the RV strains identified in this population were analyzed to determine whether specific strains of virus were associated with infections in newborns. RV strains infecting older, symptomatic children from the infant-toddler ward were used for comparison. Among the 39 patients enrolled in the study, RV was detected in the stools of 13 (33%), 11 (86%) of whom were asymptomatic. Three different electropherotypes were seen among the newborns who were RV positive; these electropherotypes were identical to those identified in older children with community-acquired diarrhea and nosocomial-acquired diarrhea who were hospitalized on the infant-toddler ward during the same study period. Each of the three strains was first identified in the general ward and subsequently detected in the room with newborns within three to six days. We failed to identify a particular strain that exclusively infected newborns.

Cross Infection↗
PubMed1996

Advances in the diagnosis of respiratory virus infections.

BACKGROUND: Advances have been made in selecting sensitive cell lines for isolation, in early detection of respiratory virus growth in cells by rapid culture assays, in production of monoclonal antibodies to improve many tests such as immunofluorescence detection of virus antigens in nasopharyngeal aspirates, in highly sensitive antigen detections by time-resolved fluoroimmunoassays (TR-FIAs) and biotin-enzyme immunoassays (BIOTH-E), and, finally, in the polymerase chain reaction (PCR) detection of respiratory virus DNA or RNA in clinical specimens. All of these advances have contributed to new or improved possibilities for the diagnosis of respiratory virus infections. OBJECTIVES AND STUDY DESIGN: This review summarizes our experiences during the last 15 years in the development of diagnostic tests for respiratory virus infections, and in use of these tests in daily diagnostic work and in epidemiological studies. RESULTS: Immunofluorescence tests based on monoclonal antibodies, all-monoclonal TR-FIAs, and biotin-enzyme immunoassays (EIAs) have about the same sensitivities and specificities. They compare well with the sensitivity of virus culture. PCR followed by liquid-phase hybridization is a sensitive method for detecting adenovirus DNA and enterovirus and rhinovirus RNA in clinical specimens. IgG EIA on paired acute and convalescent phase sera is the most sensitive serological test for respiratory virus infections and is a valuable reference method when evaluating the sensitivity of new diagnostic tests. The IgG avidity test can distinguish primary infections from re-infections at least in respiratory syncytial virus (RSV) infections. IgM antibody assays, on the other hand, had low sensitivities in our studies. CONCLUSIONS: The choice of diagnostic methods for respiratory virus infections depends on the type and location of the laboratory, the number of specimens tested, and the previous experience of the laboratory. Virus culture, whenever possible, should be the basic diagnostic method; the results, including identification of the virus, should be available no more than 24 h later than the results of rapid diagnostic tests. In small laboratories, especially in hospitals where specimen transportation is well organized, immunofluorescence may be the best choice for antigen detection with the provision that an experienced microscopist and a good UV microscope are available. If the laboratory receives a large number of specimens and has previous experience with EIAs, then biotin-EIAs or TR-FIAs may be the most practical techniques. Their advantages include the stability of the antigens in clinical samples since intact, exfoliated epithelial cells are not required, treatment of specimens is practical, testing of large numbers of specimens is possible, and reading the printed test result is less subjective than reading fluorescence microscopy. The larger role of PCR in the diagnosis of respiratory virus infections depends on future developments such as practical methods to extract DNA or RNA and to purify the extracts from nonspecific inhibitors, plus further improvements to minimize cross-contamination. Group-specific detection of enteroviruses and rhinoviruses is an example of the potential for PCR technology. In experienced laboratories. EIA IgG antibody tests should be available. Recombinant antigens may be a useful part of such assays.

Journal Article↗
PubMed1998

Extended excretion of rotavirus after severe diarrhoea in young children.

BACKGROUND: Rotaviruses are the major cause of severe childhood diarrhoea. Knowledge of the natural history of infection, including duration of intestinal virus shedding, is important in the understanding of transmission, sources of infection, and immune responses. METHODS: We carried out a study of rotavirus excretion in 37 children admitted to hospital with severe rotavirus diarrhoea. Sequential faecal specimens were collected from each child during 100 days of surveillance, and screened for rotavirus by EIA and by amplification of genome double-stranded RNA by reverse-transcription PCR. IgA coproantibody was estimated by EIA. FINDINGS: Duration of rotavirus excretion ranged from 4 to 57 days after onset of diarrhoea. Excretion ceased within 10 days in 16 (43%) children, and within 20 days in 26 (70%) children. Extended excretion was detected for 25-57 days in the remaining 11 (30%) children owing mainly to continued excretion of the primary infecting strain. Extended excretion was significantly associated with antirotavirus IgA coproantibody boosts during 100 days of surveillance (p=0.001, log-rank test), and with recurrence of mild diarrhoea symptoms during convalescence (p=0.006, Fisher's exact test). INTERPRETATION: Severe rotavirus disease in young children may be followed by extended excretion of rotavirus. The risk of transmission to others may be greater than previously believed. Extended excretion could also explain some cases of the postgastroenteritis syndrome.

Antibodies, Viral↗
PubMed1987

Acute febrile mucocutaneous lymph node (Kawasaki) syndrome. An analysis of 24 cases.

Twenty-five cases of Kawasaki syndrome were seen over a 6-year period at Children's Hospital in Louisville, Kentucky. The diagnosis of Kawasaki syndrome was established in all cases by use of the criteria developed at the Center for Disease Control (CDC). The medical files of these cases were systematically reviewed for epidemiologic, clinical, laboratory, and therapeutic features. The results of this study were comparable to findings from previously reported series. In contrast to previous data, we found several cases in which the febrile illness was associated with a viral infection. Two children developed coronary aneurysms, but there were no deaths, and resolution of the aneurysm occurred in one of the patients. There were no clustering of cases and no unusual epidemiologic findings; none of the patients had a recurrence. Patients with Kawasaki syndrome should be followed closely during both the acute febrile and the convalescent phases. Similar conditions in a child with a fever and a rash need to be excluded.

Age Factors↗
PubMed2000

[Clinical study of an outbreak of aseptic meningitis due to echovirus type 30 in Munakata City in 1997-1998].

From October, 1997 through July, 1998, an outbreak of aseptic meningitis due to echovirus type 30 occurred in the northern part of Kyushu area in Japan. In this outbreak, clinical and virologic observations were carried out on 157 in-patients with aseptic meningitis at our hospital. The age of the patients ranged from 1 year and 9 months to 57-year old. One hundred and twenty out of 157 cases were the children under 15 years of age, and in this age group, male/female ratio was 2:1. The largest proportion of cases occurred in the 5- to 9-year age group. The number of cases reached a peak in December, 1997, but the epidemic extended to the next summer. In 12 families, more than one person became ill (total 22 cases). Virus isolation from cerebrospinal fluid (CSF) was tried on 130 out of 157 cases. Echovirus 30 was isolated in 74 cases (58 children, 16 adults), and echovirus 18 in 9 cases from June, 1998 until the end of the study. Paired acute and convalescent sera were available from the 25 patients with negative virus isolation, and 7 out of 25 patients had a fourfold or greater rise in neutralizing antibodies. Headache, fever, vomiting, nuchal rigidity were detectable in most cases, but in this outbreak, continued severe headache was characteristic. Eye pain was experienced by 2% of the total cases. In children, gastrointestinal symptoms were noted in 12% of the cases, but were not in adult patients. The CSF cell counts ranged from 2 to 3,478 cells per cubic millimeter. Fifty-eight percent were predominantly lymphocytic, while 42% were polymorphonuclear predominant. Virus was highly isolated from the CSF when the specimens were obtained within three days after the onset of the acute illness, but in one case, virus was isolated on day 7. In a few cases, virus was isolated without pleocytosis in CSF.

Adolescent↗
PubMed1997

Acute myocardial infarction due to vasospasm in a 13-year-old-boy.

We describe an unusual case of acute myocardial infarction due to vasospasm in a 13-year-old boy. He was admitted to our hospital with severe congestive heart failure and shock. He had experienced a feeling of chest oppression with dyspnea while running, which grew worse. He then lost consciousness and was brought by ambulance to our intensive care unit. He had had similar but milder episodes of chest oppression months earlier. The family history revealed that his father had died suddenly from hypertrophic cardiomyopathy and that his grandmother also had hypertrophic cardiomyopathy. On admission, the patient was bathed in a cold sweat, his pulse was weak, and his blood pressure was too low to measure. Coarse crackling and wheezing were audible in both lung fields. Administration of catecholamine and intra-aortic balloon pumping failed to stabilize the hemodynamic variables, but percutaneous cardiopulmonary support proved to be lifesaving. Coronary arteriography performed during his convalescence showed on evidence of atherosclerosis. The acetylcholine provocation test ultimately revealed a diagnosis of acute myocardial infarction due to vasospasm.

Acetylcholine↗
PubMed1990

Corticosteroids do not affect the clinical or physiological status of infants with bronchiolitis.

The treatment of infants aged 1.5-11.0 months suffering from acute bronchiolitis with a combination of inhaled albuterol and systemic corticosteroids or inhaled albuterol and placebo was compared in 50 infants in a double blind study. The mean initial clinical score and the rate of improvement was similar in the two groups. The mean +/- SD hospital stay was 5.0 +/- 1.2 days for the steroid group and 5.2 +/- 1.7 days for the placebo group. Lung function was measured in 14 infants (7 from each group) and showed evidence of increased lung volumes and severe airway obstruction in the acute stage (the mean values for the steroid group were: TGV, 31 mL/kg; SGaw, 0.104 L/s.cmH2O; VmaxFRC, 12.9 mL/s/kg; for the placebo group: TGV, 35 mL/kg; SGaw, 0.104 L/s.cmH2O; VmaxFRC, 8.5 mL/s/kg) which had improved 2-4 weeks later (steroid group: TGV, 25 mL/kg; SGaw, 0.168 L/s.cmH2O; VmaxFRC, 21.6 mL/s/kg; -placebo group: TGV, 24 mL/kg, SGaw, 0.198 L/s.cmH2O, VmaxFRC, 17.5 mL/s/kg). There were no significant differences of thoracic gas volume, specific airway conductance, and forced expiratory flow at resting lung volume between the two groups, either in the acute or convalescent stages. We conclude that corticosteroids do not change the rate of clinical improvement in acute bronchiolitis, nor do they effect lung function 2-4 weeks later.

Administration, Inhalation↗
PubMed1990

[Anesthesia at the "Coltzea" Clinical Hospital, a first line hospital during the revolution of the Romanian people].

Anaesthesia and postoperative course of the wounded victims of the romanian revolution in December 1989 at Bucarest are described. The author, a romanian anaesthetist, was an eyewitness of these events. During this four day period, between 21st and 25th December, 97 live wounded were admitted, 75 of them with very serious wounds, and hypovolaemic shock. The remaining 22 had superficial limb wounds. Twenty-one dead wounded were also admitted to hospital. The wounds involved: the head (3), the neck (4), the chest with an opened pleura (3), with closed pleura (8), the abdomen, including the intra-abdominal and retroperitoneal organs, and the pelvis (14), the upper (16) and lower (39) limbs, and minor skin and soft tissue lesions (10). Seventy-five patients were given a general anaesthetic with endotracheal intubation, 12 an intravenous general anaesthetic without intubation; for the remaining 10, a local anaesthetic technique was used. Four patients died during surgery because of extremely serious wounds, incompatible with life, and overwhelming haemorrhage for which surgical haemostasis was impossible. Two other patients died, one 72 h and the other 5 days later, because of severe infection and gangrene. Twenty days after these events, 91 patients still either recovered or were convalescing.

Anesthesia↗