Biomedical subjects

A Bordea

Publications and source records attributed to A Bordea.

11 recordsLinked to original sources

PubMed2003

Management of recurrent inguinal hernias: a prospective study of 163 cases.

There remains debate as to how recurrent inguinal hernias should be managed. This study aimed to establish a management plan for recurrent hernias. From 1991-2000, 163 patients were operated on for recurrent inguinal hernias. The average interval from the initial surgery to recurrence was 46 months (range 10 days-13 years). The initial surgery prior to recurrence was Shouldice and other techniques without mesh in 142 cases, a Stoppa or a Lichtenstein procedure in ten and three cases, respectively, and laparoscopic repair in eight cases. The recurrent hernias were treated with a Shouldice repair in 52 cases (31.9%), the Lichtenstein technique in 48 cases (29.4%), a totally extraperitoneal laparoscopic repair in 40 cases (24.5%), and a Stoppa procedure in 23 (14.1%). The approaches to management evolved with time: the use of prostheses for recurrent hernia repair increased from 10% in 1991 (2/10) to 100% in 2000 (22/22). In contrast, the Shouldice repair decreased from 90% (18/20) in 1991 to 0% (0/22) in 2000. The Lichtenstein technique was first employed in 1993, in patients with a history of a conventional, laparoscopic, or Stoppa repair and has increased to represent 77% of cases (17/22) in 2000. The Stoppa technique has not been used since 1998. The use of a totally extraperitoneal laparoscopic approach went from 11% (2/18) in 1992 (introduction of the technique) to 23% (5/22) in 2000 and is reserved for recurrence after a Lichtenstein procedure or after conventional repair in working and/or physically active patients without any contraindications to general anesthesia. Prosthetic reinforcement has become the norm in the treatment of recurrent hernias. Given a previous conventional repair, the prosthesis can be placed by either an anterior or posterior approach. The approach is dependent on the level of activity and operability of the patient. If the recurrence follows a totally extraperitoneal or a Stoppa procedure, then the Lichtenstein intervention is recommended. A recurrence after a Lichtenstein procedure should be treated by a totally extraperitoneal approach.

Adult↗

PubMed1995

[Therapeutic options in locally advanced breast cancers].

The authors are showing their experience on 394 locally advanced breast cancer in the last 10 years. In this trial were included the tumours larger than 5 cm, multiple tumours, tumours invading the skin or the thoracic wall with invaded or fixed axillary or supraclavicular nodes and acute carcinomatous mastitis. The optional therapeutic schedule was modified upon the stage. It consisted in pre- or postoperative radiotherapy, polychemotherapy or polychemo- or radiotherapy alone, associated with nonspecific immunotherapy and hormonotherapy. In patients with complex treatment the survival rate was 45.4% at 5 years and 12.3% at 10 years. The authors highlight the importance of the surgical treatment which offer a big potential in the context of the complex treatment.

Adult↗

PubMedDate not supplied

[The surgical possibilities in locally advanced gastric cancer (LAGC)].

Most frequently the diagnostic of gastric cancer is established in advanced stages. Practically, was noticed that local evolution advances the appearance of metastases. The authors are presenting 159 cases of locally advanced gastric cancer (LAGC) out of 211 gastric cancers submitted to surgery between 1984-1995. The surgical possibilities in such situation specifically adapted to each case, are discussed. The operation has an important role in appreciating local and regional extension, solving complications and even performing radical resections.

Adult↗

PubMedDate not supplied

[Is laparoscopic treatment of adhesions a valid approach for postoperative abdominal pain?].

The role of post-operative adhesions in chronic abdominal pain remains controversial. The aim of this study was to assess the value of laparoscopic treatment of adhesions for chronic post-operative abdominal pain in 32 patients. Over a period of 8 years, 32 patients (25 women and 7 men) with a mean age of 41.5 years (18-69) were hospitalized for chronic abdominal pain of more than 6 months duration, without an obvious underlying neoplasm or psychiatric disorder. They had all undergone at least one previous abdominal operation (mean, 1.9; range, 1-5), with a mean follow-up of 28 months (6-82). The mean duration of the pain was 18 months (6-65) and in 24 of the 32 cases it was mainly hypogastric. Other than the presence of a scar, the clinical examination was completely normal. Prior to hospitalization, 163 different laboratory tests, 162 radiological investigations, including 13 CT scans and 3 MRIs, and 25 endoscopies had been performed. A pneumoperitoneum was made by "open laparoscopy" in 23 cases and with Verres needle in 9 cases. Eight patients (25%) did not have any adhesions, but 6 of them were found to have a gynecological problem (endometriosis). In this group, the laparoscopy lasted 34 minutes (15-45) and the mean hospital stay was 48 hours. In 24 cases, adhesions were found and selected. This was thought to be complete in 22 cases (91.6%). There was a strict correlation between the adhesions and the scar in 85% of cases. In 5 cases, the adhesions were associated with another intervention. There were no conversions. The mean duration of surgery and hospitalization was respectively 56 minutes (32-120) and 3.2 days. There was no mortality and the morbidity rate was 4.1% (1 monopolar injury). The average follow-up was 26.7 months: 22 of the 24 patients who had freeing of adhesions were evaluated after at least 6 months of follow-up. In 10 cases, the pain had completely resolved (45%), in 6 it had decreased (27%) and in 6 cases it was unchanged or had even worsened (1 case of endometriosis). Laparoscopic exploration for chronic post-operative abdominal pain, after an extensive work-up performed after a suitably long delay post-surgery, can be used to detect and treat adhesions in 3/4 cases. In the absence of another lesion, the pain is lessened in 72% cases. However, if there is another lesion, laparoscopic treatment of adhesions is less effective with respect to the pain, but it nevertheless can identify an.

Abdominal Pain↗

PubMedDate not supplied

[Pseudomyxoma peritonei (gelatinous peritonitis )].

UNLABELLED: Pseudomyxoma peritonei (P.P.) is characterised by the presence in the peritoneal cavity of 3 elements--mucinous neoplasic cells, mucinous ascites and diffuses mucinous implants. We analysed the patients treated in our service and we made a literature review. The study is a retrospective analysis on the 1984-2000 period. 6 patients were diagnosed with P.P., 2 females and 4 men, with medial age 63 years (53-75). Clinical findings and biologic analysis were not specific and the imagistic explorers didn't permit the preoperative diagnosis. The patients were submitted to variate surgical procedures, based on the benign (4 cases) or malignant (2 cases) character of the disease and on the origin of the lesions: cystadenoma of the appendix with secondary tumours of the ovary (the 2 females) and, respectively, cystadenoma and cytsadenocarcinoma of the appendix, mucinous paraenteric cyst with pseudomyxoma retroperitonei, mucinous recto-sigmoidian neoplasm (the 4 men). We practiced intraperitoneal chemotherapy with Thio-Tepa in 5 cases (intraoperative in 4 cases) and systemic, with 5-FU and mytomicine, in one case. The operative morbidity and mortality were null. All the patients were follow-up (average 4.2 years). The global 5-year survival rate was 60% (100% in the benign disease and 0% in the malignant form). CONCLUSION: P.P. is a rare disease, still poorly understood. The origin of the disease is the appendix (70-80%) and less frequently the ovary. It was divided in two distinct forms: disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. The treatment associates radical surgery and intraperitoneal chemohyperthermia, in specialised centres, but the prognosis still remains poor (50-70% 5-year global survival rate).

Aged↗

PubMedDate not supplied

[The laparoscopic procedures on abdomen with adhesions].

The scar abdomen is more and more seldom a contraindication of the laparoscopic approach. According to Rohr it is classified in scar abdomen after Mac Burney, suprapubic or supraumbilical approach and of the polyoperated patients. Our trial consists in 452 patients with laparoscopic operations consecutive open abdominal surgery (out of the 3900 patients undergoing celioscopic procedures between 1995-2001). The laparoscopic procedure was performed distant to the previous operation in 95.1%, on a neighboring organ to that initially conventionally operated in 4.1% or on the same organ in 3 patients (0.8%). We lead no preoperative fatalities, but the conversational rate was 12% (54 patients), due to the high-risk dissection or to the unsolvable bleedings by laparoscopic means (2 cases). The operative accidents consisted in visceral injuries soloed by laparotomy. Postoperatively we registered 5 port site seronas, 1 deep vein thrombosis and 1 pneumonia. The evolution and the mean hospitalization was the same for the scar abdomen patients with the operative procedure accomplished laparoscopically as for non previously operated patients. The data support the feasibility of the laparoscopic procedures on scar abdomen, using the "open laparoscopy" with a reasonably increased conversational rate.

Abdominal Muscles↗

PubMedDate not supplied

[Conversion in laparoscopic surgery].

AIM: The conversion causes evaluation in dynamics. METHODOLOGY: The study is a retrospective analysis of the conversion to open surgery in 1993-2001 period, indifferently of the moment and the determinant cause. The yearly dynamics of the conversions was divided by operation types and surgeons. There were also analysed the moment and the cause of the conversion. RESULTS: There were realised 3961 laparoscopic operations (by 7 experienced surgeons and a lot of young surgeons), with 244 conversions (6.2%), percentage variable depending of the operation (3.3% in hernioraphies, 5.3% in cholecystectomies, 8.2% in gynecologic procedures, 12.1% in appendectomies, 33% in abdominal esophagus procedures, 33% in splenectomies) and on surgeon (until 0% and 8%); the differences until the surgeons don't depend on their experience and for the same surgeon, the experience accumulation doesn't reduce the conversion rate. The most conversions happen after a simple inspection or a minimal dissection (73.1% in cholecystectomy) caused by the existence of plastron, the discovery of a difficult anatomic situation or of another pathology; more rarely, the conversion happens in the principal time (23.4% in cholecystectomy), doing to hemorrhage, impossible dissection, visceral injury or even at the end of the operation (3.5% in cholecystectomy), doing to hemorrhage, loss piece or calculs. CONCLUSIONS: The conversion rate depends especially on the correctness of the indication of laparoscopic approach and not on the surgeon experience, what proves that it is a moment of surgical maturity. Decide from the beginning, in the moment of the recognition of a difficult situation and not after the occurrence of a complication, modifies neither the morbidity, nor the much discussed hospital stay.

Cholecystectomy, Laparoscopic↗

PubMedDate not supplied

[Analysis of 3100 laparoscopic cholecystectomies].

AIM: To evaluate the results of laparoscopic cholecystectomy (LC) in the 8 years period. PATIENTS AND METHODS: First LC in Coltea Hospital was performed in September 1993 and introduced for treatment of patients with gallbladder disease. From September 1993 to February 2001 LC was performed in 3100 patients. Mean age 51.2 years (ranged from 8 to 87 years) among 2512 women and 588 men. 232 (7.48%) of the cases were patients with acute cholecystitis. Intraoperative cholangiography was performed in 112 cases (3.6%). RESULTS: Conversion to open cholecystectomy (OC) was necessary in 111 patients (3.58%). Operative complications occurred in 16 (0.5%) patients: CBD lesions in 4 (0.12%) patients, bleeding from cystic artery--12 (0.38%) patients. In one patient CBD injuries was recognized at the time of operation and after conversion to OC primary ductal repair was performed. Postoperative complications occurred in 44 (1.41%) patients: a) local infection--in 15 (0.48%) patients (subhepatic abcess-3, wound infection-9. b) bile leakage--in 21 (0.67%) patients. c) haemoperitoneum because of the bleeding: from the abdominal wall at the trocar insertion site--in 2 patients, from a. cystica-one patient. d) obstructive jaundice due to stone in CBD--in 5 patients (endoscopic papillosphincterotomy and stone extraction was performed). There 21 reoperations due to complications: 13 laparatomies and 8 relaparascopies. Two patients (52 and 64 years old) died after LC-mortality 0.06 per cent. Mean hospitalisation day was 3.8. CONCLUSIONS: To prevent iatrogenic CBD injuries correct preparation with a clear identification of the anatomic structures is essential. Relaparascopy and endoscopic retrograde cholangyopancreatography can be successfully used in the treatment of complications after LC.

Adolescent↗

PubMedDate not supplied

[The therapeutical strategy for locally advanced breast cancer].

As for the other cancers, the strategy of therapy of breast cancers is going to a unitary standardization. In our department between 1984-1999 we are operated 1040 patients with breast cancers, which means 25.3% of all cancers treated. 688 (64.3%) were CMLA, 646 (96.7%) of them were in patients women and 22 (3.3%) men. The mean age was 52.4 years (3-84 years). All patients were divided into two trials and analyzed: retrospectively (A) 312 (46.7%) and prospectively (B) 356 (53.3%) patients, 51.2% of patients was in III and IV TNM stage. The patients from trial B were treated concerning with specific therapeutically protocol, adapted by age, anatomopathological form, volume of tumor, skin or thoracic wall invasion, inflammatory lesions, lymph node invasion and physiological period. The results were: the increase of number of radical surgical interventions, the decrease of the morbidity, the increase of survival and a better quality of life.

Adenocarcinoma↗

PubMedDate not supplied

[High obstruction in strangulated diaphragmatic hernia].

Case report of a 57-year-old man, admitted in emergency, because of high occlusion and severe dyspnea. The physical examination and the imagistics explorations established the diagnostic of strangulated left diaphragmatic hernia. After a short re-equilibration, the surgical approach was made by left thoracophrenolaparotomy and on realize the visceral reduction, the treatment of visceral injuries and the plasty of the pretty high diaphragmatic defect with a nylon mesh. The postoperative evolution was difficult, with hemorrhagic gastropathy, blocked evisceration, pneumonia and left pleural empyema. The control at 10 months show a patient appearing very well, with a voluminous eventration (who need surgical treatment) with normal image on the chest radiography, left hemidiaphragm in normal position and immobile, the gastrointestinal tract sitting intraabdominal, without parietal injuries.

Emergencies↗

PubMedDate not supplied

[Hydatid cyst of the head of the pancreas--a clinical case].

Case report of a 41-year-old man, admitted because of intense sclero-tegumentar jaundice, epigastric pain and brings. The altered general state, because of obstructive jaundice (the total bilirubyne 9.6 mg%, with D 5.8 mg% and I 3.8 mg%, the alkaline phosphatase 650 u.i./l) determined the effectuation in emergency of an endoscopic retrograde cholangiopancreatography, which included also a minipapilosfincterothomy. On obtained the spectacular improvement of the jaundice (the total bilirubyne 1.3 mg%) which permitted the extension of the imagistics explorations, establishing the diagnostic of cystic tumour of the head of the pancreas, but on could't specify the etiology. On made the surgical approach, founding a hydatic cyst of the head of the pancreas; on practised the parasite inactivation, the cyst evacuation, pericysto-jejuno-anastomosis on a loop in Y "à la Roux" and cholecysto-gastro-anastomosis. The postoperative evolution was favourable.

Adult↗