Tratamentul obezitatii

www.gastric-band.ro are in jur de 6 luni de la lansare si se bucura de un succes constant la un nivel de vizitare in crestere.

El abordeaza tratamentul obezitatii si al diabetului prin metode chirurgicale si anume montarea de inel gastric. acest procedeu este unul din cele 3 mari operatii care se practica in toata lumea cu succes.

citeste si fii la curent cu chirurgia moderna metabolica!

Ruptura de perineu, incontinenta urinara

De curand am lansat un nou site de informare referitor la o problema actuala si foarte des intalnita, dar despre care pacientele refuza sa vorbeasca si evita la nesfarsit tratamentul: ruptura de perineu si incontinenta urinara.

Scopul site-ului este sa lamureasca dubiile si indoielile in legutura cu acesta patologie care se trateaza cu succes! Site-ul propune solutii si indeamna la cresterea gradului de informare medicala.

www.incontinenta-urinara.com

Recomandari hernia inghinala

SSAT Patient Care Guidelines
Surgical Repair of Groin Hernias

Introduction
Groin hernias include inguinal and femoral hernias. Repair of groin hernias is one of the most commonly performed outpatient surgical procedures and it is estimated that 750,000 inguinal hernia repairs are performed yearly in the United States. Inguinal hernias occur most commonly in men. While these hernias afflict persons of all ages, this guideline will address only the adult patient.
A groin hernia is not a "rupture" per se, but rather a groin bulge or mass that develops due to weakened layers of the abdominal wall and protrusion of intra-abdominal contents through the defect. Numerous classification systems for groin hernias have been described, but none have gained universal acceptance. The traditional classification system includes direct, indirect, and femoral hernias. Direct inguinal hernias develop when the posterior portion of the inguinal canal attenuates, allowing the underlying contents of the abdominal cavity to protrude. An indirect inguinal hernia occurs along the spermatic cord or round ligament in the inguinal canal. A femoral hernia passes behind the inguinal canal and herniates alongside of the femoral vessels.

Symptoms and Diagnosis
Inguinal hernias may be asymptomatic (discovered incidentally during physical examination) or present as a bulge discovered by the patient. They may be associated with vague groin pain, commonly made worse by straining or physical activity. Patients may also present with complications of groin hernias such as incarceration (not reducible) or strangulation of bowel which causes an obstruction in that segment. Since most hernias should be repaired, the patient should be referred to a surgeon for evaluation and operative treatment. Ultrasound or other radiologic studies are not required because the diagnosis can usually be made by physical examination. This is best performed with the patient standing and straining against a held breath (Valsalva maneuver).
More difficult to diagnose is the occasional patient with groin pain, or inguinodynia, but no history of groin bulge and no physical findings. Such a patient may not have a hernia, but rather a groin muscle strain. In contrast, if a hernia is not found on physical examination, but the patient describes a groin bulge, a hernia is still possible. Femoral hernias can present as pain in the upper thigh rather than a bulge, and are particularly difficult to diagnose in the elderly or obese patient. Ultrasound or axial imaging may be useful in delineating the abnormality. Although these rarer hernias occur mostly in elderly women, the most common type of groin hernia seen in this patient population is still the indirect inguinal hernia.
Most groin hernias are readily reducible, have minimal or no tenderness, and can be electively referred to a surgeon within a period of weeks. However, if the hernia is tender and not reducible, the patient should be referred immediately due to the risk of strangulated bowel or other viscera. Aggressive attempts to reduce a groin hernia with sedation, ice packs, or sustained weight or pressure should not be pursued. Symptoms such as nausea and vomiting suggest bowel obstruction, which also mandate immediate referral to a surgeon.

Treatment
Most groin hernias can be electively repaired. Urgent repair is required for an acutely non-reducible hernia or for a chronically incarcerated hernia that suddenly becomes painful, as this indicates impending strangulation. While significant morbidity and mortality can be avoided by prompt diagnosis, this clinical emergency causes the death of more than 2,000 patients per year in North America.
Inguinal hernias should be repaired surgically. Hernia belts or trusses should be discouraged, and should be limited to patients who are not candidates for an elective operation. Chronic scarring from their use can lead to a more difficult repair and higher risks of complications. Femoral hernias should always be repaired because of the high incidence of associated bowel herniation. Elderly patients with minor co-morbid conditions will easily tolerate an outpatient elective hernia repair, which can be accomplished with intravenous sedation and local anesthesia. All attempts should be made to avoid emergent repairs of chronically incarcerated hernias, which occur primarily in the elderly. The timing of repair is determined by the symptoms.
The objective of any inguinal or femoral hernia operation is to repair the defect in the abdominal wall. The three basic approaches are: (1) open repair(the traditional repair, utilizing the patient's own tissue); (2) open tension-free repair (in which mesh is used to bridge or cover the defect); and (3)laparoscopic repair, a tension-free repair also utilizing mesh. In general, the traditional, tissue-based repairs have been replaced by tension-free or mesh-based repairs. These include the Lichtenstein, Plug and Patch, laparoscopic, and “hybrid” techniques. No particular technique has been found to be superior, and all of them can be expected to result in excellent outcomes when performed by adequately trained surgeons with sufficient experience in their performance. Open techniques of hernia repair may be safely performed under local, regional, or general anesthesia with equivalent outcomes, while laparoscopic hernia repair requires general anesthesia.
Some selected hernias can be treated nonoperatively with careful observation. Suitable hernias for nonoperative management are direct hernias with a wide neck that easily reduce particularly in elderly asymptomatic patients or patients at a heightened risk for operative intervention.

Risks
The risk of infection or significant hematoma is approximately 1%. With contemporary tension free techniques hernia recurrence occurs in 2%-5% of patients and requires another repair. Chronic groin pain (inguinodynia) may be seen after groin hernia repair (approximately 5%) and is a difficult problem to treat and may require multimodality pain management or further surgery.

Expected Outcomes
Short-term outcome studies suggest that a quick return to normal activities can be achieved following both open and laparoscopic hernia repair. Usual daily activities can be resumed within a few days after surgery, depending on the patient's comfort level. Oral pain medications are needed for only a few days. Heavy lifting and exercise are commonly discouraged for four to six weeks following inguinal hernia repair, although patients can typically resume any physical activity that is comfortable to them and progress at their own pace.

Qualifications for performing inguinal and femoral hernia repairs
Surgeons who are certified or eligible for certification by the American Board of Surgery, the Royal College of Physicians and Surgeons of Canada, or their equivalent should perform both elective and emergent inguinal hernia repair. These surgeons have successfully completed at least five years of surgical training after medical school graduation and are qualified to perform open inguinal hernia repair, with and without tension-free techniques. Advanced laparoscopic training is required for laparoscopic groin hernia repair. The qualifications of the surgeon should be based on training (education), experience, and outcomes.

Soarele cel mai rosu...

La 2 mai soarele apune tandru. E roşu, mîndru si bland. Santierul naval il adaposteste pană ce ruşinea nuditatii diurne paleste. El se imbraca cu pamanatul, marea si cerul pentru ca noaptea sa nu-i tina de frig. Apoi, dimineata il gaseste foarte arogant, frumos ca focul si hotarat sa reziste peste zi. Nu intampina nici o greutate, caci marea il naste repede, mai repede decat apuca oricare din turistii dornici sa caute aparatul foto prin corturile umede. Il lasi jumate in apa si il gasesti trei sferturi gol si uscat de apa sarata. Iţi promiti ca in dimineata urmatoare vei fi mai punctual. Vei dormi mai mult pentru ca vei bea mai putin, vei rade cu prietenii pana la ore mai decente si vei pregăti aparatul de cu seara. Uiti repede promisiunea si seara te prinde ud, dezbrăcat de peste zi, sărat si aspru ca nisipul. Iti cauti haine de seara prin cort si saruti primul pahar cu vin. Apoi tentezi ultima baie in mare. Ai incercat sa faci pluta pe spate in mare noaptea, privind stelele...? Trebuie sa incerci. Te vei apropia de pamant, vei sorbi marea si poate il vei zari si pe Dumnezeu. Sstfel vei incerca sentimente divine bucurandu-te insa de avantajele oamenilor.
Zambesti? De ce o faci...? Nu glumesc deloc caci te tin strans de mana...

Michael Jackson died.

Jackson died at UCLA Medical Center after being stricken at his rented home in the posh Los Angeles neighborhood of Holmby Hills. Paramedics tried to resuscitate him at his home for nearly three-quarters of an hour, then rushed him to the hospital, where doctors continued to work on him.

“It is believed he suffered cardiac arrest in his home. However, the cause of his death is unknown until results of the autopsy are known,” his brother Jermaine said.

Cardiac arrest is an abnormal heart rhythm that stops the heart from pumping blood to the body. It can occur after a heart attack or be caused by other heart problems.

Finally with Sadness

CANCELLED SHOWS
Unfortunately, Depeche Mode are not able to reschedule 8 of the cancelled shows due to scheduling conflicts. Despite efforts to find a window in which to reschedule these dates, it has proven unfeasible to do so.

The eight cancelled shows are:

May 12th - Athens Terra Vibe
May 14th - Istanbul Santral Istanbul
May 16th - Bucharest Parc Izvor
May 18th - Sofia Vasil Levski Stadium
May 20th - Belgrade USCE Park
May 23rd - Warsaw Gwardia Stadium
May 25th - Riga Skonto Stadium
May 27th - Vilnius Zalgirio Stadionas
Ticket holders should return their tickets to the point of purchase for a refund.

RESCHEDULED SHOWS
Depeche Mode have been able to reschedule the 4 shows listed below, which are indoor venues, for later in the year.

These rescheduled shows are:

May 21st - Zagreb Arena
May 30th - London O2 Arena
June 4th - Dusseldorf LTU Arena
June 5th - Dusseldorf LTU Arena
Information regarding the new, rescheduled dates will be announced shortly. More time is required to resolve venue availability and routing issues, before new dates can be announced. Ticket holders are advised to hold onto to their original tickets, which will be valid for the rescheduled shows.

THE BAND WOULD LIKE TO REASSURE FANS THAT THEY ARE 100% COMMITTED TO REPLAYING THESE 4 SHOWS AND ASK FANS TO BEAR WITH THEM A LITTLE LONGER UNTIL THE NEW DATES CAN BE RESOLVED.

Depeche Mode would like to apologise to their fans for any inconvenience this has caused and thank them for their support and patience during this time.

Also, as previously advised in a statement issued on May 28th: -

The shows below have already been rescheduled.

June 2nd - Hamburg HSH Nordbank Arena
This show has been rescheduled to July 1st, 2009. All original tickets remain valid for this new rescheduled date.

July 2nd - Bergen Koengen
The show has been rescheduled to January 28th, 2010 at the Bergen Vestlandshallen. All original tickets remain valid for this new rescheduled date.

Un scop atins.

Putine cuvinte dar bine alese i-au trebuit lui Andrei Vochin(de la GSP) sa atinga un scop deosebit. Inaintea meciului de miercuri aparea in GSP un articol ce mi-a trezit trairi intense si rarisime. Cititi mai jos randurile despre care vorbesc si convingeti-va:

" Hai, aminteşte-ţi tot! Cum ai venit în Ghencea şi din două curse pe dreapta ai dat 3 goluri lui ASA. Cum te-ai dus la naţională şi ai dat două boabe în Portugalia. Şi apoi cum ai venit acasă şi ai început să ucizi portarii. De la Vekeman la Dasaev şi de la Van Breukelen la Urruticoechea. Hai, aminteşte-ţi cum plecai tu pe culoar înainte ca mingile să vină din gheata lui Fane Petcu sau Loţi Boloni. Cum, altruist fiind, pasai în faţa porţii şi apoi, cu umorul tău hîtru, îl întrebai pe marcator: “Ţi-a fost greu, mă?”.

Hai, aminteşte-ţi cum începea Steaua cu tine în Ghencea, cum era 1-0 de la vestiare şi cu Anderlecht, şi cu Vejle, şi cu Goteborg, şi cu Honved. Cum îi încărcai încă de pe tunel pe coechipieri, înspăimîntîndu-i, în acelaşi timp, pe adversari.



Hai, aminteşte-ţi ce ai însemnat ca jucător pentru Steaua. Ai luat Cupa Campionilor şi Supercupa Europei. Te uiţi în urmă şi mai vezi vreo 15 înşi. Aminteşte-ţi cum ai marcat la Mondialul italian. Te uiţi în spate şi mai vezi vreo doi-trei. Cum ai bifat 10 titluri pentru aceeaşi echipă, Steaua. Te uiţi în spate şi vezi că nu mai e nimeni.

Astăzi, te-ai întors în timp. Eşti, ca antrenor, înaintea meciului ăla cu ASA. În faţa celui mai important hop din noua meserie. Hai, Marius, aminteşte-ţi tot, spune-le bărbaţilor din vestiar povestea ta şi porneşte la alt drum! Pe marginea căruia vei avea aceeaşi iubire nebună a fanilor, iar la capătul lui chipul altei legende. Legenda antrenorului. Hai, Marius!

Ultimii 3 ani.

In 6 ianuarie am scris ultimele randuri in acest blog. a fost poate ceva premonitie in ele. din 7 ianuarie mi-am schimbat seful, medicul primar. nimic din ce am facut in primii 3 ani de rezi nu seamana cu ce voi face in urmatorii si ultimii 3 ani de rezidentiat.
un lucru sigur. muncesc 10-12 ore pe zi...zilnic.
muncesc mult dar si bine. am schimbat chirurgia clasica, usor retrograda cu cea moderna, de avangarda in multe din aspecte. nu e atat de simplu dar in principiu pentru moment am spus suficient.
am schimbat in esenta 2 oameni. 2 medici primari. si inca ceva ...aportul meu la propria formare.
mai multe detalii in viitor, caci acum sunt dupa 11 ore de spital. nu stiu cand. sper curand.
cu bine prieteni, si cu ganduri dintre cele mai bune!

O garda cam lunga.

Bine ati venit in tara lui "nu-mi pasa"! Azi dimineata imi incepeam prima garda de chirurgie in UPU(unit. De primiri urgente). In viitor va exista un colectiv unit de dif spec ce va actiona unitar. Azi incepe reforma in spit nostru.  Ca atare nimic nu functioneaza. Sistemul scartaie strasnic dand semne ca va ceda. Evident n-o va face. Cu fiecare mort din spitalele noastrse se mai naste o lege, se mai schimba ceva. de obicei in bine. deci moartea e bună. ajuta la progres. Am intrebat azi dimineata daca sunt prins in schema de masă si daca peste am un pat unde sa mă intind. Masa am da' cică de pat n-am nevoie...sunt de garda, n-am voie sa dorm. Genial, am n-am cazuri stau in picioare in camera de garda. si io care credseam ca e chestie de civilizarie sa asiguri un pat liniei de garda de 24 ore. Vin si zic: pe cine trebuie sa omor ca sa nasc si legea bunului simt in raport cu angajatii din mediul sanitar?! Poate sunt eu obosit...poate a fost garda prea lungă.

2 MINUTE

Întotdeauna m-a incantat nivelul de mare amanunt la care s-a ajuns in civilizatie(a se citi restul lumii civilizate) in raport cu diferite probleme de maxima importanta pentru umanitate. Citeam azi-dimineata un articol din care m-am gandit ca n-ar face rau sa va arat cateva randuri. Nu ca sa ma dau destept ca citesc articole medicale in lb. engleza(cum ar putea zice unii) ci ca sa fiu extrem de explicit in afirmatia mea de mai devreme despre nivelul de amanunt. Iata ca in timp ce la noi in tara exista spitale intregi fara un defibrilator(nu glumesc deloc) si in cele in care exista, probabil ca un procent de 10% de personal care sa stie cum sa-l foloseasca, ar fi generos, unii, adica americanii(sunt dati dracului americanii astia) se gandesc deja sa monteze defibrilatoare la fel de des ca telefoanele publice, tin cursuri de resuscitare pentru publicul larg si se gandesc intens la cele 2 minute in care procentul de supravietuire ramane semnificativ.

Please enjoy it!

HEART DEFIBRILLATION - The American Heart Association recommends that the stopped hearts be shocked within two minutes

"BOSTON, Jan 2 (Reuters) - Nearly 1/3 of patients with misfiring or quivering hearts in U.S. hospitals do not get the life-saving defibrillator shocks they need within the critical first two minutes of cardiac arrest, a study published on Wednesday said. The study confirming the importance of the two-minute period for survival was published in the New England Journal of Medicine, which also ran an accompanying editorial indicating a person might be better off suffering cardiac arrest in a casino than a hospital.
Researchers from 369 hospitals in the National Registry of Cardiopulmonary Resuscitation found that being black or having a cardiac arrest outside of regular weekday working hours also significantly delayed the time it took for hospital workers to shock the heart. 34% of those studied lived to be discharged from the hospital.
Survival rate is disappointingly less than the 50 percent rate among people who collapse in an airport, casino or some other location where automated external defibrillators (AEDs) are readily available for emergency use.
"It is probably fair to say that most patients assume -- unfortunately, incorrectly -- that a hospital would be the best place to survive a cardiac arrest," Saxon said. "Surely we can do better to fulfill this expectation by better using existing technology and the lessons learned from public-access defibrillation."
There are about 750,000 cardiac arrest cases in the United States a year and 2/3 of those occur in hospitals. The study of 6,789 hospital patients found that defibrillation took more than two minutes in 30 percent of patients. The Chan team found the odds of survival dropped off steadily after a delay of more than two minutes.
Saxon said that because "delays in defibrillation have been successfully overcome with AEDs, these devices could be placed in every patient's room to enable the first responder to deliver timely defibrillation."
The researchers found several reasons for the delays. Some delays, Saxon said, were predictable, such as a patient being in the hospital for a reason unrelated to a heart problem, being in a unit where hearts are not monitored or having a cardiac arrest on the weekend or between 5 p.m. and 8 a.m.
For blacks, the Chan team found, the risk of having a delay increased by 23 percent. They said further studies are needed "to determine whether such variations are due to geographical differences in access to hospitals with more resources (such as monitored beds) or whether they reflect actual differences in patterns according to race."
The American Heart Association recommends that the stopped hearts be shocked within two minutes. Their chance of surviving to leave the hospital was 22 percent, compared to a rate of 39 percent for those who received shocks quickly. "