Sebastian Valcea - Academia.edu (original) (raw)
Papers by Sebastian Valcea
Chirurgia, 2017
Introducere: Hemoragia postoperatorie reprezintă una dintre cele mai semnificative complicaţii du... more Introducere: Hemoragia postoperatorie reprezintă una dintre cele mai semnificative complicaţii după duodenopancreatectomia cefalică. Scop: Studiul prezentat în acest articol analizează cazurile de hemoragie intralumenală de la nivelul anastomozei gastrojejunale mecanice secundară duodenopancreatectomiei cefalice. Material şi metodă: În perioada ianuarie 2012-ianuarie 2017, 84 de rezecţii cefalo-pancreatice consecutive au fost efectuate de aceeaşi echipă chirurgicală. Procedeul preferat de reconstrucţie a fost Whipple (76 pacienţi). Anastomoza gastrojejunală a fost efectuată mecanic la toţi pacienţii, folosindu-se staplerul Panther liniar tip GIA. Clasificarea propusă de ISGPS a fost folosită pentru evaluarea severităţii hemoragiei. Rezultate: Din cei 84 de pacienţi, un număr de 7 cazuri de hemoragie intralumenală (8,33 %) a fost observat, în medie în ziua 4 postoperator. Relaparotomia a fost inevitabila în două cazuri. Trei pacienţi din subgrupul cu hemoragie intralumenală postpancreatectomie au decedat. În lotul studiat nu au fost înregistrate cazuri de hemoragie de la nivelul anastomozelor pancreatico-jejunală sau hepatico-jejunală. Concluzii: Anastomoza mecanică poate ridica controverse, sângerarea severă necesitând relaparotomie de urgenţă şi fiind corelată cu rate mari de mortalitate. Hemoragia intralumenală postduodenopancreatectomie rămâne o complicaţie importantă, al cărei management depinde de multipli factori şi care poate avea potenţial devastator.
JOURNAL OF CLINICAL SEXOLOGY
The nose represents one of the most common sites for skin cancer, therefore, treatment usually le... more The nose represents one of the most common sites for skin cancer, therefore, treatment usually leads to defects of this aesthetic unit that needs reconstruction procedures. Even if there are many surgical methods described in the literature, repairing this complex structure is a challenge for every surgeon. In this paper we described our method in order to cover a medium defect of the distal third of the dorsum nasi after tumor removal. A long and narrow nasolabial flap was used in a single-stage reconstruction procedure. Some minor complications were encountered due to the pushing of the flap measurement limits and the defatted choice of flap, therefore with a thin blood supply. This method lead to good outcomes with tumor recurrence-free after a 2 years follow-up and to a very good cosmetic result according to the patient's appreciation. Rezumat Una dintre cele mai des întâlnite localizări ale cancerului de piele o reprezintă nasul, așadar, tratamentul acestor leziuni poate co...
Chirurgia (Bucharest, Romania : 1990)
We present the case of a 93-year-old patient with intestinal occlusion due to a descending colon ... more We present the case of a 93-year-old patient with intestinal occlusion due to a descending colon tumor, with carcinomatous ascites and secondary liver and lung determinations. Considering the risks associated with a surgical act in such a patient and the impossibility of performing a curative intervention, a self-expanding metallic colonic stent was mounted. The post-intervention evolution was favorable, the patient being discharged 48 hours later. Left colon cancer is diagnosed in the occlusive phase in 8 to 26% of cases (1). It often requires an immediate surgical resolution due to the potential risk of death. Emergency surgery involves increased rates of morbidity and mortality (2). Thus, other ways of resolving these surgical emergencies have been developed. Colonic stents were first reported in the literature by Dohmoto (3). Initially, the use of stents was as the final method of palletising (4). Later, they were used as a bridge to minimally invasive programmed surgery (5).
1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of General ... more 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of General Surgery, Emergency Clinical Hospital, Bucharest, Romania 3 Department of Plastic Surgery and Reconstruction Microsurgery, Emergency Clinical Hospital, Bucharest, Romania 4 Department of Anaesthesiology and Intensive Care, Emergency Clinical Hospital, Bucharest, Romania 5 Department of Morphological Sciences, Discipline of Anatomy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Corresponding author: Tiberiu Paul Neagu Department of General Surgery, Emergency Clinical Hospital Bucharest, 8th Floreasca Avenue, Bucharest, Romania. E-mail: dr.neagupaul@gmail.com Abstract
Pancreatic cancer is the fifth leading cause of cancer-related death in men and women in Europe, ... more Pancreatic cancer is the fifth leading cause of cancer-related death in men and women in Europe, being resistant to nonsurgical forms of oncological treatment such as radio-, chemo-, and immunotherapy. Surgery remains the only curative treatment for pancreatic tumors. These patients typically present in a malnourished and advanced state of the disease. Most of the improved survival achieved over the past three decades has been related to improved perioperative management, and earlier recognition and treatment of post-operative morbidity. Malnutrition leads to a vicious cycle, as complications are detrimental to the nutritional state of the patient, with postoperative morbidity rates being still substantial. Whilst the majority of perioperative complications are not life-threatening, they can, however, amount to increased lengths of stay, costs and delays in adjuvant therapy. This article reviews the current literature, the prevention and treatment of most common four postoperative c...
Pancreatic cancer is the fifth leading cause of cancer-related death in men and women in Europe, ... more Pancreatic cancer is the fifth leading cause of cancer-related death in men and women in Europe, being resistant to nonsurgical forms of oncological treatment such as radio-, chemo-, and immunotherapy. Surgery remains the only curative treatment for pancreatic tumors. These patients typically present in a malnourished and advanced state of the disease. Most of the improved survival achieved over the past three decades has been related to improved perioperative management, and earlier recognition and treatment of post-operative morbidity. Malnutrition leads to a vicious cycle, as complications are detrimental to the nutritional state of the patient, with postoperative morbidity rates being still substantial. Whilst the majority of perioperative complications are not life-threatening, they can, however, amount to increased lengths of stay, costs and delays in adjuvant therapy. This article reviews the current literature, the prevention and treatment of most common four postoperative c...
The transversus abdominis plane (TAP) is a peripheral nerve block and it is a relative recently d... more The transversus abdominis plane (TAP) is a peripheral nerve block and it is a relative recently described approach to providing analgesia to the anterior abdominal wall. This kind of anesthetic procedure is performed either before or after the surgical act, before or after general anesthesia. The technique itself blocks the abdominal wall neural afferents by introducing local anesthetic into the neurofascial plane between the internal oblique and transversus abdominis muscles. The main goal of this technique is to reduce the amount of opioid medication used in postoperative analgesia, and, maybe more important, to reduce the side effects of this medication, which includes sedation, nausea and vomiting. This article reviews the current literature regarding the patient selection, medication and dosage used for this procedure, side effects, the surgical pathology that can be used for and, last but not least, how can this procedure can increase the immediate postsurgical quality of life.
1 “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Plastic S... more 1 “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Plastic Surgery and Reconstruction Microsurgery, Emergency Clinical Hospital, Bucharest, Romania 3 Department of Anaesthesiology and Intensive Care, Emergency Clinical Hospital, Bucharest, Romania 4 Department of General Surgery, Emergency Clinical Hospital, Bucharest, Romania Corresponding author: Tiberiu Paul Neagu Department of Plastic Surgery and Reconstruction Microsurgery, Emergency Clinical Hospital, 8th Floreasca Avenue, 1st District, Bucharest, Romania. E-mail: dr.neagupaul@gmail.com Abstract
Chirurgia
Riscul permanent al pacienţilor splenectomizaţi la complicaţii infecţioase, cea mai severă fiind ... more Riscul permanent al pacienţilor splenectomizaţi la complicaţii infecţioase, cea mai severă fiind (OPSI) a determinat căutarea unor soluţii care să diminueze aceste posibilităţi evolutive. Astfel, autotranspantul splenic intraomental pare să fie o opţiune viabilă care, în viziunea unor autori, ar avea efecte benefice prin restabilirea (cel puţin parţială) a funcţiilor splinei. Articolul prezintă experienţa actuală legată de această procedură (principii de tehnică chirurgicală, sediul implantelor, complicaţii, evaluare postprocedurală) în încercarea de a-l aduce/readuce în atenţia chirurgilor de traumă /chirurgie generală. Procedura este simplă, rapidă şi cu complicaţii minime/absente şi trebuie aplicată după orice splenectomie posttraumatică.
Journal of Mind and Medical Sciences
Gastric cancer remains a leading cause of mortality worldwide. The treatment for gastric cancer i... more Gastric cancer remains a leading cause of mortality worldwide. The treatment for gastric cancer is multimodal, in which gastrectomy remains the only curative approach. However, gastric resection is often associated with increased morbidity and mortality rates, depending on several factors. These factors can be attributed to the patient as comorbidities or effects of the disease upon him and, on the other hand, there are risk factors independent of the patient, such as aspects of the tumor (type, staging, location), experience of the surgical and anesthetic team, logistics of the hospital, yield of adjuvant therapies etc. We recognize the fact that patient-related risk factors are often overlooked and not taken into consideration prior to surgery, thus becoming a source of morbidity and mortality. These factors are more susceptible to modulating in order to better select candidates for gastric resection and thus create a better outcome. Therefore, identifying and modulating patient-r...
Journal of Clinical and Investigative Surgery
Introduction. Gastric cancer remains among the top three digestive diseases with the highest mort... more Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious co...
Chirurgia, 2017
Introducere: Hemoragia postoperatorie reprezintă una dintre cele mai semnificative complicaţii du... more Introducere: Hemoragia postoperatorie reprezintă una dintre cele mai semnificative complicaţii după duodenopancreatectomia cefalică. Scop: Studiul prezentat în acest articol analizează cazurile de hemoragie intralumenală de la nivelul anastomozei gastrojejunale mecanice secundară duodenopancreatectomiei cefalice. Material şi metodă: În perioada ianuarie 2012-ianuarie 2017, 84 de rezecţii cefalo-pancreatice consecutive au fost efectuate de aceeaşi echipă chirurgicală. Procedeul preferat de reconstrucţie a fost Whipple (76 pacienţi). Anastomoza gastrojejunală a fost efectuată mecanic la toţi pacienţii, folosindu-se staplerul Panther liniar tip GIA. Clasificarea propusă de ISGPS a fost folosită pentru evaluarea severităţii hemoragiei. Rezultate: Din cei 84 de pacienţi, un număr de 7 cazuri de hemoragie intralumenală (8,33 %) a fost observat, în medie în ziua 4 postoperator. Relaparotomia a fost inevitabila în două cazuri. Trei pacienţi din subgrupul cu hemoragie intralumenală postpancreatectomie au decedat. În lotul studiat nu au fost înregistrate cazuri de hemoragie de la nivelul anastomozelor pancreatico-jejunală sau hepatico-jejunală. Concluzii: Anastomoza mecanică poate ridica controverse, sângerarea severă necesitând relaparotomie de urgenţă şi fiind corelată cu rate mari de mortalitate. Hemoragia intralumenală postduodenopancreatectomie rămâne o complicaţie importantă, al cărei management depinde de multipli factori şi care poate avea potenţial devastator.
JOURNAL OF CLINICAL SEXOLOGY
The nose represents one of the most common sites for skin cancer, therefore, treatment usually le... more The nose represents one of the most common sites for skin cancer, therefore, treatment usually leads to defects of this aesthetic unit that needs reconstruction procedures. Even if there are many surgical methods described in the literature, repairing this complex structure is a challenge for every surgeon. In this paper we described our method in order to cover a medium defect of the distal third of the dorsum nasi after tumor removal. A long and narrow nasolabial flap was used in a single-stage reconstruction procedure. Some minor complications were encountered due to the pushing of the flap measurement limits and the defatted choice of flap, therefore with a thin blood supply. This method lead to good outcomes with tumor recurrence-free after a 2 years follow-up and to a very good cosmetic result according to the patient's appreciation. Rezumat Una dintre cele mai des întâlnite localizări ale cancerului de piele o reprezintă nasul, așadar, tratamentul acestor leziuni poate co...
Chirurgia (Bucharest, Romania : 1990)
We present the case of a 93-year-old patient with intestinal occlusion due to a descending colon ... more We present the case of a 93-year-old patient with intestinal occlusion due to a descending colon tumor, with carcinomatous ascites and secondary liver and lung determinations. Considering the risks associated with a surgical act in such a patient and the impossibility of performing a curative intervention, a self-expanding metallic colonic stent was mounted. The post-intervention evolution was favorable, the patient being discharged 48 hours later. Left colon cancer is diagnosed in the occlusive phase in 8 to 26% of cases (1). It often requires an immediate surgical resolution due to the potential risk of death. Emergency surgery involves increased rates of morbidity and mortality (2). Thus, other ways of resolving these surgical emergencies have been developed. Colonic stents were first reported in the literature by Dohmoto (3). Initially, the use of stents was as the final method of palletising (4). Later, they were used as a bridge to minimally invasive programmed surgery (5).
1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of General ... more 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of General Surgery, Emergency Clinical Hospital, Bucharest, Romania 3 Department of Plastic Surgery and Reconstruction Microsurgery, Emergency Clinical Hospital, Bucharest, Romania 4 Department of Anaesthesiology and Intensive Care, Emergency Clinical Hospital, Bucharest, Romania 5 Department of Morphological Sciences, Discipline of Anatomy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania Corresponding author: Tiberiu Paul Neagu Department of General Surgery, Emergency Clinical Hospital Bucharest, 8th Floreasca Avenue, Bucharest, Romania. E-mail: dr.neagupaul@gmail.com Abstract
Pancreatic cancer is the fifth leading cause of cancer-related death in men and women in Europe, ... more Pancreatic cancer is the fifth leading cause of cancer-related death in men and women in Europe, being resistant to nonsurgical forms of oncological treatment such as radio-, chemo-, and immunotherapy. Surgery remains the only curative treatment for pancreatic tumors. These patients typically present in a malnourished and advanced state of the disease. Most of the improved survival achieved over the past three decades has been related to improved perioperative management, and earlier recognition and treatment of post-operative morbidity. Malnutrition leads to a vicious cycle, as complications are detrimental to the nutritional state of the patient, with postoperative morbidity rates being still substantial. Whilst the majority of perioperative complications are not life-threatening, they can, however, amount to increased lengths of stay, costs and delays in adjuvant therapy. This article reviews the current literature, the prevention and treatment of most common four postoperative c...
Pancreatic cancer is the fifth leading cause of cancer-related death in men and women in Europe, ... more Pancreatic cancer is the fifth leading cause of cancer-related death in men and women in Europe, being resistant to nonsurgical forms of oncological treatment such as radio-, chemo-, and immunotherapy. Surgery remains the only curative treatment for pancreatic tumors. These patients typically present in a malnourished and advanced state of the disease. Most of the improved survival achieved over the past three decades has been related to improved perioperative management, and earlier recognition and treatment of post-operative morbidity. Malnutrition leads to a vicious cycle, as complications are detrimental to the nutritional state of the patient, with postoperative morbidity rates being still substantial. Whilst the majority of perioperative complications are not life-threatening, they can, however, amount to increased lengths of stay, costs and delays in adjuvant therapy. This article reviews the current literature, the prevention and treatment of most common four postoperative c...
The transversus abdominis plane (TAP) is a peripheral nerve block and it is a relative recently d... more The transversus abdominis plane (TAP) is a peripheral nerve block and it is a relative recently described approach to providing analgesia to the anterior abdominal wall. This kind of anesthetic procedure is performed either before or after the surgical act, before or after general anesthesia. The technique itself blocks the abdominal wall neural afferents by introducing local anesthetic into the neurofascial plane between the internal oblique and transversus abdominis muscles. The main goal of this technique is to reduce the amount of opioid medication used in postoperative analgesia, and, maybe more important, to reduce the side effects of this medication, which includes sedation, nausea and vomiting. This article reviews the current literature regarding the patient selection, medication and dosage used for this procedure, side effects, the surgical pathology that can be used for and, last but not least, how can this procedure can increase the immediate postsurgical quality of life.
1 “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Plastic S... more 1 “Carol Davila”University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Plastic Surgery and Reconstruction Microsurgery, Emergency Clinical Hospital, Bucharest, Romania 3 Department of Anaesthesiology and Intensive Care, Emergency Clinical Hospital, Bucharest, Romania 4 Department of General Surgery, Emergency Clinical Hospital, Bucharest, Romania Corresponding author: Tiberiu Paul Neagu Department of Plastic Surgery and Reconstruction Microsurgery, Emergency Clinical Hospital, 8th Floreasca Avenue, 1st District, Bucharest, Romania. E-mail: dr.neagupaul@gmail.com Abstract
Chirurgia
Riscul permanent al pacienţilor splenectomizaţi la complicaţii infecţioase, cea mai severă fiind ... more Riscul permanent al pacienţilor splenectomizaţi la complicaţii infecţioase, cea mai severă fiind (OPSI) a determinat căutarea unor soluţii care să diminueze aceste posibilităţi evolutive. Astfel, autotranspantul splenic intraomental pare să fie o opţiune viabilă care, în viziunea unor autori, ar avea efecte benefice prin restabilirea (cel puţin parţială) a funcţiilor splinei. Articolul prezintă experienţa actuală legată de această procedură (principii de tehnică chirurgicală, sediul implantelor, complicaţii, evaluare postprocedurală) în încercarea de a-l aduce/readuce în atenţia chirurgilor de traumă /chirurgie generală. Procedura este simplă, rapidă şi cu complicaţii minime/absente şi trebuie aplicată după orice splenectomie posttraumatică.
Journal of Mind and Medical Sciences
Gastric cancer remains a leading cause of mortality worldwide. The treatment for gastric cancer i... more Gastric cancer remains a leading cause of mortality worldwide. The treatment for gastric cancer is multimodal, in which gastrectomy remains the only curative approach. However, gastric resection is often associated with increased morbidity and mortality rates, depending on several factors. These factors can be attributed to the patient as comorbidities or effects of the disease upon him and, on the other hand, there are risk factors independent of the patient, such as aspects of the tumor (type, staging, location), experience of the surgical and anesthetic team, logistics of the hospital, yield of adjuvant therapies etc. We recognize the fact that patient-related risk factors are often overlooked and not taken into consideration prior to surgery, thus becoming a source of morbidity and mortality. These factors are more susceptible to modulating in order to better select candidates for gastric resection and thus create a better outcome. Therefore, identifying and modulating patient-r...
Journal of Clinical and Investigative Surgery
Introduction. Gastric cancer remains among the top three digestive diseases with the highest mort... more Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious co...