The Neurologic Complications Associated with Anesthesia in Pediatrics Treated with Radiotherapy Under Anesthesia

Background: Children with brain tumors experience potential neurologic complications when are treated with radiotherapy, especially if done frequently under anesthesia. Objectives: This study aimed to evaluate the neurologic complications associated with anesthesia in pediatrics treated with radiotherapy under anesthesia. Methods: This cross-sectional study consisted of 133 pediatric patients with a brain tumor who needed anesthesia for performing radiotherapy and were referred to Omid Charity Hospital and Imam Khomeini University Hospital from 2014 to 2020 by the census. Statistical values less than 0.05 were considered significant (P < 0.05). Results: The patients were in range of 1 - 8 years, and the number of 3,208 anesthesia inductions were conducted for daily radiotherapy. Major complications such as stroke, arrhythmia, tachyphylaxis, and aspiration were not observed. There was a significant relationship between the tumor side, anesthesia, and neurologic complications (P < 0.05). No significant differences were found between demographic data (age, sex, and weight) (P > 0.05). Conclusions: Anesthesia complications in this study were slight and insignificant. Some were either due to the tumor effect on other vital organs or prior exposure to radiotherapy and chemotherapy. Thus, for providing safe anesthesia, considering the tumor effect on body organs and neurologic complications caused by it can be a great help to reduce anesthesia complications in pediatrics under radiotherapy.

The history of orthopedics and traumatology in Iasi

In Iasi, Orthopedics-Traumatology later appeared as a distinct specialty. In a first stage, orthopedics developed in surgical clinics - the period of surgical clinics (1879-1970). In each surgical clinic there were surgeons who dedicated themselves to orthopedic pathology: Radu Dimitrie, Theodor Căpățînă (Surgery I), Filimon Cicerone, Eusebiu Neagoe, Iulian Grădinaru (Surgery II), Paul Trosc (Surgery III). In 1967, at the Charity Hospital, two surgical services were carried out: The Surgery and Children's Orthopedic Clinic (Th. Economu) and the Osteoarticular Tuberculosis Clinic (A. Berneaga). Also, this year, 1970, in Iasi, the construction of a new medical unit will be completed - the Children's Hospital where the Clinic of Pediatric Surgery and Orthopedics will be moved. The Charity Hospital is disbanded and the Emergency Clinical Hospital will be established on the site of the former establishment. A second period begins - the transition period (1970-1983) - characterized by the search for optimal solutions, which involved changes and temporary until the establishment of orthopedic clinics. The newly established unit, the Emergency Clinical Hospital, was designed to include three departments: General Surgery IV (I. Jitaru), Medical Clinic (G. Popa) and an Orthopedics and Traumatology Clinic (conf. Gh. Floareș). This clinic treated all surgical pathology of orthopedics, traumatology and had didactic activity with fourth year students. The Orthopedics-Traumatology Department had 40 beds. There is also an Orthopedics-Traumatology department, with 40 beds, located in the Dr. C. I. Parhon Hospital run first by A. Berneaga and then by P. Trosc. Dimitrie Radu, Iulian Grădinaru and G. Herescu worked in this department. A new Recovery Hospital appears in Iasi. The new hospital also has an Orthopedics-Traumatology department (with 111 beds) where the orthopedics department will be transferred from Parhon Hospital. In 1983, Professor Gh. Floareș opted to move the clinic from the Emergency Hospital to the new Rehabilitation Hospital. At the Emergency Hospital there remains an Orthopedics-Traumatology Department staffed by a single doctor - Nicolae Georgescu who will develop a new team, which also have teaching activity: T. Cozma, L. Stratan, P. Sîrbu, Ovidiu Alexa, Paul Corlaci, Cezar Popescu. There are eight resident doctors (Elena Glod, Luminița Lăbușcă, Victor Pencu, G. Ghinoiu, C. Nanu, T. Bunescu, R. Malancea, L. Pacu). During this period (1992-1996) a basic A.O. course was organized in Iași. internationally, on which occasion many orthopedists are persuaded to routinely use modern means of osteosynthesis. Two more doctors come in this clinic: B. Puha, R. Asaftei, D. Cionca and A. Ciubara. After 1989, the ATOM was born: The Association of Traumatologists and Orthopedists of Moldova, congresses and postgraduate courses are organized. In 2012 the Orthopedic Clinic moved to the St. Spiridon Emergency Clinical Hospital (Prof. Ovidiu Alexa). The orthopedic clinic at the Recovery Hospital treats chronic osteoarticular pathology (prof Paul Sirbu).

Art and mental health in the women's psychiatric intensive care unit

It is widely acknowledged in hospitals that the quality of design and environment can influence the quality of patient care, the sense of therapeutic security and the experience of staff. This women's PICU collaborated with the charity Hospital Rooms to realise the valuable role of art within the clinical environment. Experienced artists were commissioned to work in genuine partnership with patients and staff to re-envision the physical environment with the installation of eight imaginative, inventive and PICU compliant art works.<br/> The implementation, and both patient and staff perspectives were evaluated. There was no disruption to clinical care and engagement and participation was enthusiastic. There were 35 patient encounters and 32 staff encounters, including creative workshops and an exhibition.<br/> Patient Experience Data Intelligence Centre (PEDIC) reports showed an improvement following artwork installation. Patients were more likely to recommend the ward, felt more involved in their care and that the ward was comfortable. The art transformed clinical spaces creating opportunity for patients to have exceptional experiences: 'being here feels like sitting in the park'.<br/> Staff evaluation through a 'visual matrix' method that explores shared experience, revealed that the art has introduced further possibility of 'respite and escape' for both patients and staff. There is a sense that 'you feel like it is leading you to somewhere, you feel like there is something more'. It has also engendered 'ownership and pride': it 'feels like pushing boundaries, things you thought could never be considered at all, are now being considered'.

Houston: 1948–1951

DeBakey decides to move from New Orleans and take up the reins of the new Department of Surgery at Baylor School of Medicine in 1948. The medical school is understaffed, and the local surgeons are unqualified. There is no University Hospital. After soul-searching, DeBakey opts to remain in Houston. Fortune turns, and with his connections in Washington, D.C., DeBakey obtains the VA Hospital for Baylor as a teaching institution. He befriends local philanthropist Ben Taub, who delivers the Charity Hospital to DeBakey’s teaching service. Grants from the federal government and other local philanthropists help to fund the Surgery Department’s research.

The Ochsner Legacy

One of the iconic families in American surgery is the Ochsners. The youngest son of Swiss immigrants, Henry Ochsner (1877–1902) was the first to enter the medical profession. His promising internship at the Johns Hopkins Hospital ended when he died of cholera, a tragedy deeply felt by his mentor William Osler. On another branch of the family tree, Albert Ochsner (1858–1925) wrote authoritative textbooks on surgery and became president of the ACS and the American Surgical Association. His most significant achievement may have been his mentorship of his cousin's son Alton (1896–1981), guiding his medical education and training in surgery. The younger Ochsner succeeded Rudolph Matas as chair of surgery at Tulane University at the age of only 31 years. Under his leadership, Charity Hospital in New Orleans became a leading program for surgical training and Tulane earned a reputation for clinical excellence. Ochsner and four partners from the Tulane faculty created a multidisciplinary clinic to attract patients from a wider area, a facility that would become today's Ochsner Clinic. His son John (1927–2018) followed him in the profession and received specialty training in cardiovascular surgery under Michael DeBakey in Houston, a Tulane graduate and an Ochsner trainee. John Ochsner returned to the Ochsner Clinic to establish a major cardiothoracic and vascular surgery program. Further generations of the Ochsner family continued the family legacy in surgery and medicine, exemplified by M. Gage Ochsner (1954–2013), Alton's grandson and John's nephew, who became a leading traumatologist and surgical educator in Savannah.

NOBILES PAUPERES: VILNIAUS MISIONIERIŲ ŠPITOLĖS GLOBOTINIAI XVIII A.

In 1695, Jan Teofil Plater and his wife Aleksandra founded a hospital for six impoverished nobles in Vilnius. Situated near the newly built church of the Ascension and the convent of the Congregation of Mission in the Subocz suburb beyond the city walls, this hospital was the first and, until the end of the eighteenth century, the only charitable institution providing care for individuals of particular social status. The article, based on the hospital’s registry book and other sources, examines the quantitative, as well as qualitative characteristics of the institution’s clientele, such as its fluctuations in size, its social composition, and the causes of its inmates’ impoverishment. The research revealed that, despite the demand for care, the overseers managed to maintain a stable number of inmates, rarely admitting more than one or two persons every year, and thus ensuring a steady operation of the hospital (see table 1). However, in contrast with other charitable institutions in Vilnius, the clientele of the Congregation of Mission hospital changed frequently because of expulsions (39.6 percent of all cases) and inmates leaving the hospital on their own initiative (20.1 percent) already in the first year of their stay. The mortality of inmates (27.8 percent) affected the size and turnover of the clientele to a much lesser extent than observed in other hospitals. Although there are no reliable data on the inmates’ age and health, such statistics show that they probably were younger and healthier than the clients of other charitable institutions in Vilnius. Moreover, the Congregation of Mission hospital’s inmates differed from the clients of other institutions in respect of social composition. Impoverished petty nobles, originating mainly from the districts of Lida and Oszmiana, constituted the majority (56.25 percent) of the hospital’s inmates whose social status is noted in the registry book (62.5 percent). The nobles became clients of the Congregation of Mission hospital either because of old age, disability, as well as other accidental causes, or because of increased social vulnerability outside mutual aid networks, comprised of family members, kin or neighbours. The article argues that the foundation of a hospital designated to provide care primarily for impoverished nobles shows that the poverty of nobles was recognized by contemporaries as a social problem that should be tackled. Keywords: poverty, charity, hospital, the Congregation of Mission, Vilnius, nobles, eighteenth century.