Biomedical subjects

A Miron

Publications and source records attributed to A Miron.

22 records · Page 2Linked to original sources

PubMed1991

[Complicated postbulbar duodenal ulcers: the characteristics of the diagnosis and of the surgical procedure and management].

The paper reports on the authors' experience used on 164 patients with complicated postbulbar ulcers (12% of the duodenal ulcers) with hemorrhage (52 cases), perforation (9 cases), duodenal stenosis (13 cases), stenosis and penetration (36 cases) and pancreatic-biliary penetrations (36 cases). The frequency of hemorrhagic complication was of 31%. As the hemorrhage due to postbulbar ulcer is favoured by vascular fistula, the severe character of the hemorrhage and the frequency of the recurrence, mainly the cataclysmic one, impose the radical surgery as early as possible. The following were used: large Reichel-Polya's gastrectomy (26 cases with 7 deaths) Péan's gastro-duodenectomy (12 cases), Péan's hemigastrectomy+vagotomy (4 cases), gastrectomy for exclusion with hemostasis in situ and ligature of gastroduodenal artery (8 cases, of which 1 with vagotomy and 2 deaths) and pyloroplasty with vagotomy and hemostasis (2 cases). The postsurgical mortality was of 17%. In 9 cases with perforation: Reichel-Polya's gastrectomy in 5 patients (1 death), Péan's gastrectomy in 2 cases, excision pyloroplasty and suture of the perforation in one case, respectively, were used. In the postbulbar ulcers penetrating into the pancreas or into the hepatic pedicle associated with stenosis (36 cases) the following were performed: Reichel-Polya's gastrectomy (7 cases), Péan's gastrectomy (7 cases of which 2 with vagotomy) gastrectomy for exclusion of ulcer in 19 cases, of which 5 with vagotomy, Péan's hemigastrectomy+vagotomy (3 cases). The 36 cases of ulcers penetrating into pancreas were solved as follows: gastrectomy for exclusion (16 cases of which 5 with vagotomy), Reichel-Polya's gastrectomy (10 cases of which 1 with vagotomy), Péan's gastrectomy (10 cases of which 2 with vagotomy). In 13 patients with stenosed ulcers, Reichel's-Polya's gastric resection (10 cases), Péan's gastrectomy, gastrectomy for exclusion and gastrojejunostomy (in one case each) were performed. The conclusions may be drawn that the postbulbar ulcers are complicated ulcers that require differentiated surgical treatment, as early as possible, for diminishing the postsurgical morbidity and mortality (7.5% mortality).

Duodenal Ulcer↗

PubMedDate not supplied

[Pancreatico-jejunal vs pancreatico-gastric anastomosis after cephalic duodenopancreatectomy].

Pancreatoduodenectomy has been for a long time a procedure with high postoperative morbidity and mortality. Several complications after pancreatic resections are known, but one of the most severe is the fistula of the pancreatic anastomosis. Avoiding the pancreatic fistula caused many surgical innovations regarding the procedure of reestablishing the continuity after pancreatoduodenectomy. The aim of this retrospective study was to compare pancreatico-jejunostomy vs pancreatico-gastrostomy with regard to safety of pancreatic anastomosis after pancreatoduodenectomy. No technique was proved to be superior so far, the benefits of these 2 types of pancreatic anastomosis being the subject for intense debates. From 2000 to 2004, 17 patients underwent pancreatoduodenectomy, for pancreas, ampulla, distal bile duct or duodenum cancers. Pancreatic anastomosis was accomplished by pancreatico-gastrostomy in 11 cases and by pancreatico-jejunostomy in 6 cases. There was no significant difference between the two groups (age, gender and primary disease). Comparison between the two groups was made mainly analysing postoperative mortality and morbidity. Postoperative morbidity was 9,1% after pancreatico-gastrostomy and 33,3% after pancreatico-jejunostomy. Postoperative mortality was none after pancreatico-gastrostomy and 16,7% after pancreatico-jejunostomy. This study seems to demonstrate the superiority of the pancreatico-gastric anastomosis, but in most cases the surgeon will choose based on his experience. These results have to be confirmed or invalidated by a prospective multicentric randomised study.

Adult↗

PubMedDate not supplied

[Palliative total gastrectomy].

Gastric cancer, because of lymphonodulary and local extension, often allows only palliative surgery. This study tries to present the total gastrectomy as an alternative meant to improve the life of the patients who cannot hope to radical cure. Thirty-one patients were submitted to this operation during the last five years. The main indication for surgery was cancer extended to the gastric corpus, mainly on the posterior aspects and almost reaching the cardia. Because of lymphonodulary invasion over N2, hepatic and pancreatic and colonic invasion over N2, hepatic and pancreatic and colonic invasion and because of the metastases, the resections were palliative. The operations consisted of total gastrectomy and omentectomy, without trying to reach lymphatic stations over NI. All cases presented evidence of restant cancerous tissue involving the pancreas, the liver or the other lymphatic stations, but the main purpose was the ablation of the gastric tumor. Postoperatively we recorded 3 deaths, 9 anastomotic fistulae and an average survival of 9 months (6-13 months).

Aged↗

PubMedDate not supplied

[The therapeutic options in biliary ileus].

UNLABELLED: Gallstone ileus is a rare, serious condition, requiring emergency surgery. Although most data in the literature confirm the need for a conservative surgical approach, several authors report the one-stage repair of the cholecystoduodenal fistula. The present study deals with seven cases of gallstone ileus operated upon in a 20-year period. The patients were in their seventh decade; three men and four women. All the cases had clinical evidence of intestinal obstruction which was confirmed by radiologic examination, and emergency operations were performed. In three cases the one-stage strategy was used, consisting of enterolithotomy and correction of the bilio-digestive fistula by cholecystectomy and duodenal closure with good results in two cases and one death. In four cases a more conservative strategy was used, treating the intestinal obstruction only and no surgery was performed on the gallbladder or the fistula, having excluded further gallstones. Three patients had no further problems, but one required reoperation because of recurrent cholangitis. The bilio-digestive fistula may close by natural scarring or become a harmless alternative route for biliary drainage. CONCLUSION: Enterolithotomy alone usually is advisable in this serious form of intestinal obstruction, confining more major surgery to those cases in which recurrent biliary symptoms develop. However, if there are residual gallstones in the gallbladder, a 'one-stage' procedure is required to prevent recurrent ileus.

Aged↗