Editorial <strong>Jurnalul</strong> <strong>de</strong> <strong>Chirurgie</strong>, Iasi, 2007, Vol. 3, Nr. 2 [ISSN 1584 – 9341]achieved by active warming of the patient using intraoperative hot air warming blanketswhich cover the nonoperated parts of the body and administration of warm intravenousfluids.- Postoperative nausea and vomiting are frequent after general anesthesia and/or abdominalsurgery. Often the patient forgets the postoperative pain, but remembers well and long themisery of nausea and vomiting. The presence of these symptoms impairs the ability toresume oral hydration. The treatment of PONV begins intraoperativelyavoiding/<strong>de</strong>creasing the dose of drugs which result in PONV and administering antiemeticmedication at the end of surgery.The postoperative strategies inclu<strong>de</strong> effective pain relief, early ambulation and earlyoral hydration and nutrition.- Mistreated pain results in physiologic and psychological consequences, <strong>de</strong>layed andimpaired ambulation and <strong>de</strong>creased comfort and satisfaction. A<strong>de</strong>quate pain relief reliesupon use of written protocols, use of epidural analgesia and frequent pain evaluation anddocumentation (pain evaluation results should be written in patient’s file).- Early ambulation has a lot of well known favorable consequences. It means bed rest in theday of major surgery, but at least 6 hours out of bed during day 1 after surgery. It ispossible in the presence of a<strong>de</strong>quate pain relief without opioids. This strategy proved to beappropriate in case of colonic surgery and with adaptations is explored in other types ofsurgery.- Early oral hydration is recommen<strong>de</strong>d in different types of surgery. The ERAS protocol forcolonic surgery recommends no naso-gastric tube, oral fluid intake in the day of surgerymore than 300ml fluids and stop of iv fluids on day 1. If necessary colloid administrationis encouraged.- Early oral nutrition means early resumption of oral intake. In ERAS protocol for colonicsurgery in the day of surgery oral nutritional supplements are indicated and solid foodduring day 1 after surgery combined with oral supplements (sip drinks).It is always difficult to change routine. The term is not used meaning comfort, butmeaning time-proven ways of doing things. Jose Maessen from the University Hospital inMaastrichit (Netherland) presented at the ESPEN Congress in Lisbon 2004 the lecture„Compliance with a newly introduced treatment protocol – hurdles in changing practice”. Heshowed that the compliance with the newly implemented ERAS protocol was mo<strong>de</strong>st (onlyabout 54% of protocol parameters being fully accomplished). He disclosed with humor thetraditional thinking of surgeons („as long as we do not have an anastomotic leakage”), ofanesthetists („postoperative pain is a solved issue”), of nurses („the patient was dizzy, so Ileft him in bed”) and of patients („I don’t mind staying a little longer in bed”).In conclusion it is not a simple task to implement a new protocol for the surgicalpatient. It needs a lot of <strong>de</strong>termination, wi<strong>de</strong>-spread acceptance, objectives compatible withcommon practice, concrete <strong>de</strong>finitions of <strong>de</strong>sired parameters and an easy accessible and userfriendly format. But in the era of evi<strong>de</strong>nce-based medicine and of economical concerns weshould try.REFERENCES1. Basse L, Thorbol JE, Lossl K, Kehlet H. Colonic Surgery With Accelerated Rehabilitation orConventional Care. Dis Colon Rectum. 2004; 47(3): 271-278.2. Wichmann MW, Roth M, Jauch KW, Bruns CJ. A prospective clinical study for multimodal „fasttrack”rehabilitation in elective pancreatic cancer surgery. Rozhl. Chir. 2006; 85(4): 169-175.91
Articole <strong>de</strong> sinteza <strong>Jurnalul</strong> <strong>de</strong> <strong>Chirurgie</strong>, Iasi, 2007, Vol. 3, Nr. 2 [ISSN 1584 – 9341]PET ŞI PET-CT: PRINCIPIU FIZIC ŞI APLICAŢII MEDICALEV.Rusu, Cipriana ŞtefănescuDepartamentul <strong>de</strong> Biofizică, Fizică medicală - Medicină NuclearăUniversitatea <strong>de</strong> Medicină şi Farmacie „Gr.T.Popa” Iaşi, Facultatea <strong>de</strong> MedicinăPET AND PET-CT: PHYSICAL PRINCIPLE AND MEDICAL APLICATIONS (Abstract): Positron emissiontomography (PET) is a noninvasive imaging method that can “see” the metabolisms insi<strong>de</strong> the living cells. Itinvolves the acquisition of functional images based on the <strong>de</strong>tection of radiation coming from the positronemission of a radiotracer administered to the patient. This radiotracer can be a metabolic analog, like is the caseof glucose analog 2-[fluorine-18]-fluoro-2-<strong>de</strong>oxy-D-glucose ( 18 FDG), the most commonly used PET radiotracer.PET images of the human body are used to evaluate a variety of diseases, most often to <strong>de</strong>tect cancer and toexamine the effects of cancer therapy by characterizing cell viability and biochemical changes in the cell. It ispotentially useful in cancer imaging because the increased metabolism of tumor cells leads to increased uptakeof glucose, and, therefore, uptake of 18 FDG, also. PET-CT is the fusion of functional and anatomic informationacquired almost simultaneously, that lets us see both the structural anatomy and the functional data on the sameimage. They complete each other: if PET scan is powerful in evaluating the functional characteristics of thetissues, CT is a powerful structural resolution imaging method. The highly sensitive PET scan <strong>de</strong>tects themetabolic signal of actively growing cancer cells in the body and the CT scan provi<strong>de</strong>s a <strong>de</strong>tailed picture of theinternal anatomy that reveals sites, size and shape of cancer tissue. Alone, each imaging test has particularbenefits and limitations but when the results of PET and CT scans are "fused" together, the combined imageprovi<strong>de</strong>s complete information on cancer location and metabolism. *KEY WORDS: PET, PET-CT, ONCOLOGYINTRODUCEREDescoperirea unei meto<strong>de</strong> imagistice in vivo care să permită „vizualizarea”metabolismelor din organism a reprezentat o revoluţie atât în medicina nucleară cât şi înimagistica moleculară. Aceasta în condiţiile în care cele patru elemente fundamentale alemateriei vii (C, H, O, N) nu posedă izotopi radioactivi ale căror proprietăţi fizice să fieadaptate <strong>de</strong>tecţiei scintigrafice convenţionale. În cazul a trei dintre aceste elemente există,însă, radioizotopi care emit pozitroni ( 11 C, 15 O şi 13 N) [1]. Radioelementele menţionate au untimp <strong>de</strong> înjumătăţire foarte scurt (20 minute, 123 secun<strong>de</strong> şi, respectiv, 10 minute) şi se obţincu ajutorul ciclotronului. Un alt element emiţător <strong>de</strong> pozitroni, 18 F (timp <strong>de</strong> înjumătăţire 120minute), <strong>de</strong>şi nu există în organism, poate marca molecula <strong>de</strong> glucoză, al cărei metabolism îlpoate face, astfel, „vizibil”, <strong>de</strong>tectabil cu ajutorul gamma camerei [2]. Acestea sunt, <strong>de</strong> altfel,şi principalele elemente radioactive utilizate <strong>de</strong> tomografia prin emisie <strong>de</strong> pozitroni (Positronemission tomography - PET).PET – PRINCIPIU FIZICPET permite <strong>de</strong>tecţia distribuţiei în organism a unor radiofarmaceutice care includradioizotopi emiţători <strong>de</strong> pozitroni.Cei patru radioizotopi menţionaţi anterior sunt folosiţi la marcarea unei varietăţi <strong>de</strong>molecule obţinându-se, astfel, radiotrasori utilizabili în investigarea atât a diferitelor tipuri <strong>de</strong>metabolism cât şi a altor procese biologice.Pozitronul, anti-particulă a electronului <strong>de</strong> aceeaşi masă şi cu sarcină electrică egalădar pozitivă, are un parcurs scurt (circa 1 mm) şi o durată <strong>de</strong> viaţă limitată în ţesuturileorganismului, <strong>de</strong>oarece interacţionează cu electronii existenţi în ţesuturi, ceea ce conduce la* received date: 1.02.2007accepted date: 15.03.200792
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