Search PubMed⌕ Search

Biomedical subjects

A Popovici

Publications and source records attributed to A Popovici.

51 records · Page 3Linked to original sources
PubMedDate not supplied

[Radical colectomy in cancer of the transverse colon].

The authors discuss the optimal surgical attitude in the cases of 44 patients with cancers of the transverse colon (excluding the angular localizations), representing 5.4% of the total number of colic cancers operated in the Clinic over the last 20 years. All the patients were in stages C and D (according to the Turnbull and Dukes classification), and the general index of resectibility of 79%. Segmental transverse colectomy should be reserved for patients of advanced age, as well as for those with organic disturbances, altered general condition, of when there is extensive loco-regional involvement, or metastases at distance. Fifteen patients were included in these categories. Extended transverse colectomy, with radical intent from the oncological standpoint, appears to be the optimal attitude in the cases of patients which do not have any of the contraindications mentioned above. Twenty patients were in this group. The postoperative death rate was 11.4% for the entire group of patients in whom resections were performed. Five patients (25%) have survived according to our data between 5 and 11 years after extensive radical colectomy.

Adenocarcinoma↗
PubMedDate not supplied

[Recurrent postoperative ulcer].

A total of 96 patients have been hospitalized over a period of 20 years, of which 89 had been operated for recidivating post-operative ulcer (RPOU). Particular clinical and etiopathogenic aspects are stressed, such as RPOU manifested exclusively by digestive haemorrhage, pseudo-tumoral RPOU, ulcers recidivating after exclusion resection, and multi-recidivating ulcers. Prophylaxis of RPOU is best achieved by a correct primary intervention for ulcers, and the prophylaxis of the recidives should be achieved by a correct re-intervention. This presumes that a correct resection, or a correct iterative resection should be performed, as well as a correct sub-diaphragmatic vagotomy. In recidivating post-operative ulcers on the duodenal stump an important element is the insufficiency of the resection on theright, and the value is stressed of an extended resection of the stump, associated to vagotomy. In multi-recidivating ulcers after repeated interventions that have been correctly performed, gastrectomy of the total type is considered the best solution.

Adult↗
PubMedDate not supplied

[Cancer of the vulva].

UNLABELLED: Our study includes 50 patients operated on between on between 1970 - 1995 for vulvar carcinoma. The age of patients varied from 36 to 85 years old with a media of 59.4. The localisation of the lesions were: 42 (84%) on the major labia; 7 on the minor labia; 1 on the clitoris and 1 on the Bartholin's gland. Histopathologically there were 46 (92%) squamous carcinoma, 2 adenocarcinoma and 2 fibrosarcoma. The staging after FIGO classification: stage 1--7 patients (14%); II--22 (44%); III--20 (40%); IV--I (2%). Palpable lymphadenopathy in the inguino-femoral regions has been present to 24 (48%) patients, but with positive nodes (N+) only 16 (32%). Preoperative radiant therapy was applied to 21 patients (42%). All the patients were operated on: 1. total vulvectomy (vv) 15 cases (30%); 2. total vv + various lymphadenectomies 23 (46%); 3. partial vv 8 (16%); 4, different interventions 4 (8%). Iterative intervention for recurrencies: 9 cases (1 of them operated on by us 4 years anterior). Postoperative morbidity was present to 27 patients (52%): the main complication was the local infection of the wound +/- wound break-down; 5 of those patients presented also persistent lymphorrhagia. We don't noticed postoperative lymphedema of the inferior limb (limbs). Without postoperative lethality. Postoperative all the patients were submitted to a complimentary oncological treatment. The longest survival after the combined treatment was available specially for "N-"patients (but not exclusive). We verified 29 (58%) patients from the total of 50 (the rest being lost of evidence or having a short postoperative interval of time). The index of survival was: 1 year: 29 (100%); 3 years: 23 (79%); 5 years 16% (56%); and between 6 and 25 years 9 (31%). CONCLUSIONS: a) early diagnosis + therapy = good results; b) complex therapy is mandatory; c) optimal operation total vv + inguinal-femoral lymphadenectomy; d) the optimal prognosis is available for "N-" cases.

Adult↗
PubMedDate not supplied

[Scheduled reinterventions in the treatment of acute peritonitis].

UNLABELLED: This is a clinical series of 83 cases, admitted in the Surgical Department of Fundeni Hospital between 1988-1996 of severe acute peritonitis in which scheduled reoperations (at least one planned reoperation at 24-48 hours after the first operation) were performed. The main criteria for scheduled reoperations were; unresolved source of contamination, acute peritonitis older than 48 hours and the presence of multiple system organ failures. 63 cases (76%) were postoperative peritonitis. 203 planned reoperations were performed (minimum: 1, maximum: 10, mean: 2,4 reoperations per patient). In 12 cases (14,4%) a laparotomy "on demand" was necessary after the scheduled reoperations were stopped. The source of peritonitis was resolved in 61 cases (73,5%) and unresolved in 22 cases (26,5%). In 9 cases (10%) specific complications of the method (hemorrhages, fistulas) were encountered. The global mortality was 65,06%, with 55,73% mortality when the source of peritonitis was resolved and 90,9% mortality when the source was not resolved. CONCLUSION: scheduled reoperations have to be reserved for the most severe cases of acute peritonitis in which the mortality after the "classical" methods of treatment is extremely high.

Acute Disease↗
PubMedDate not supplied

[Surgical injuries to the main bile ducts and their sequellae in "open" biliogastroduodenal surgery].

There are studied 53 patients (1984-1995) with surgical injuries (and/or sequels) of the main biliary duct (MBD) produced during biliary and gastro-duodenal "open" interventions. The patients are classified in the following categories: I) 7 (13%) with the ductal accident diagnosed and repaired in the time of the same operation. Produced in our clinic (0.13% of the total predisposing operations), all patients healed and there was not postoperative mortality. 2) 46 (87%) patients admitted from others surgical units: a) 17 with an immediate or precocious diagnosis of the surgical MBD trauma and b) 29 with late diagnosis having various MBD strictures (6 of them have had corrective interventions which became ineffective in time). All the patients have had overadded around 3 risk factors. The principles applied in the treatment of this iatrogenic lesions were: # If the surgical injury was recognised during the causal operation--immediate repair: various ductal sutures or anastomosis with stent support maintained approximately 6-9 months. # The accident was discovered soon postoperatively: the remedial operation was postponed for a second time, after the surgical treatment of the evident complications (jaundice, angiocolitis, choleperitoneum, fistulas, etc). # The late diagnosed strictures of the MBD (without other local septic complications) benefited particularly by bilio-jejunal derivations (21 patients--72% from 29). The postoperative morbidity and lethality: 9 patients (19,5%/46), the main cause being different septic complications. 34 patients (64%/53), which we can followed, were alive between 2 and 10 years postoperatively. The best treatment of the surgical injuries of the MBD during the different biliary or gastroduodenal operations (practiced "à ciel ouvert") is their avoidance.

Adult↗
PubMedDate not supplied

[Mechanical digestive system suturing devices].

Between 1994 (December)-1996 (May) 150 patients have been operated on using one or many stapling devices. The staplers disposable to us were the "Linear Cutter" or GIA (Gastrointestinal Anastomosis), "Linear Stapler" (TA) and "Intraluminal Circular Stapler" or EEA (end-to-end anastomosis) types, produced by ETHICON (Johnson and Johnson Ltd. Company). The principles operations performed were various digestive resections, intervisceralis anastomosis and interventions of reconstructions (in oesophagus surgery, ileal pouch etc.). The advantages of staplers applications are: a) the reduction of the time of operation, of the anesthesia, of the blood loss; b) a soft manipulation of the tissues; c) a smaller inflammatory reaction and the prevention of intraoperative septic contamination and d) a better and faster take back of the functionality of the anastomosis. There were only 4 intraoperative haemorrhages easy controllable. Postoperative complications: a) 3 haemorrhages medically treated; b) immediate leakage 1 patient after colorectoanastomosis, treated by Hartman colostomy; precocious, 7 patients and after 4-6 month, 2 patients. Corrective iterative interventions were necessary only in 5 patients. The operative mortality-1 patient, the cause of death being a bronhopneumonia after a radical oesophagectomy with oesophagoplasty (oesophageal cancer). There was not postoperative mortality depending of stapling application. We don't observed late postoperative complications like stenosis of various anastomosis, quoted in the literature, because the time of following of our 150 patients is too short (maximum 18 months). The conclusions are that the stapling devices are a real surgical progress with the conditions of a correct indication and adequate tactics and operative technique. The economical effort is justified and entirely compensated by the major benefits obtained for the patients.

Anastomosis, Surgical↗
PubMedDate not supplied

[Spigelian hernias. The authors' own experience and a review of the literature].

There are presented nine patients with spigelian hernia operated on between 1964 and 1996 (33 years interval). These patients represent 0.19% of the totality of the patients operated for different hernias in the same period. The sex ratio female/male was 7/2. The medium age of the patients was 55 years old +/- 12-18, the extremes being 37 and 67 years. To all the patients the hernia was located on the right side of the abdomen. The main associated disease, the degree III and IV obesity was present in 8 from 9 cases. In 3 cases (33%) the evolution was complicated by incarceration of the big epiploon and to one patient (11%) by partial strangulation of a jejunum ansae, Richter's type. Two patients with very large, nonreducible hernias created possibilities of confusions with abdominal tumors. Generally, the diagnosis was established only on clinical basis. All the patients were operated on (the Bachy techniques with direct approach) without immediate or late complications (there were no recurrences).

Abdominal Muscles↗
PubMedDate not supplied

[Insulinomas--nesidioblastomas. Clinical experience].

Between 1980 and 1996, 16 patients (10 women) with pathologically confirmed insulinomas were operated on; they represents a median of 0.9 per year and 1.1 per cent from the total of pancreatic tumors. Median age was 47.2 (+/- 22.8) years old (range 23-68). Insulinomas occurred with following frequency in: head--2 patients, body and tail--11 patients and diffuse forms (nesidioblastomas)--3 patients. The specific clinical forms only with tumoral syndrome (without hypoglycemic manifestations) and one was an intraoperative discovery. In the case of the four patients two presented with splenic-portal hypertension +/- upper digestive haemorrhages and the other two only tumoral syndrome. The surgical approach was: the midline (ten), uni- or bilateral subcostal (five), and other incisions one. There were performed tumor exeresis through: enucleation (three), segmentary pancreatectomies (two), spleno-left-pancreatectomies (nine) and the extension of an anterior pancreatectomy (one). In one case biopsy alone was done. The tumors were not intraoperatively identified in three cases (blind left spleno-pancreatectomies). The malignancy index was 4/16 (25 per cent). Postoperative mortality rate was 12.5 per cent (two patients: one acute necrotizing pancreatitis and one pulmonary embolism).

Adenoma, Islet Cell↗
PubMedDate not supplied

[Rectal hemangioma--a pseudoneoplastic form. A case report and review of the literature].

A patient, 23 years old, is presented. He was admitted on in our clinic for a lower, very bleeding rectal tumor, the macroscopically characters evoking quite sure a malignant neoplasm. Three successive histopathologically examinations remained inconclusive and only the fourth suggested the diagnosis of benign glandular polyp. That conclusion strongly contrasted with all the data obtained by the macroscopically examinations. Nevertheless the therapeutically option was in favor of a sphincter-saving surgery, the practiced operation being a pull-through rectosigmoid resection (Babcock). Recovery of the patient which is in a good condition at present (two years after surgery). The histopathological examination of the operative specimen stipulated like diagnosis: rectal haemangioma with component parts of lymphangioma. Carrying on, the paper presented a review of the literature data referring to the very limited experience of others authors, regarding clinical aspects, diagnostics and therapeutically problems of the rectal haemangioma. In similar cases presenting voluminous rectal (or colonic) possibly benign tumors, haemangioma like, macroscopically diagnostic being difficult or unsure, but also without a certitude for a malignant tumor, it is recommended a sphincter-saving operation, adapted to the general status of the patient. In cases with malignant characters at the final histopathological examination, on the operative specimen, the transformation of the initial intervention in a amputation type surgery may be a possible alternative.

Adult↗