Biomedical subjects

C Bradea

Publications and source records attributed to C Bradea.

At least 19 recordsLinked to original sources

PubMed1995

[Laparoscopic cholecystectomy in acute cholecystitis].

Contrary to earlier opinions, the laparoscopic cholecystectomy (LC) is not a contraindication in the acute cholecystitis. The most important parameter in determining the feasibility of attempting laparoscopic cholecystectomy in the setting of acute inflammation appears to be the experience of the surgeon. 59 cases with LC are analyzed: 50 LC and 9 conversion. The operations were more difficult and lasted longer. The patients appeared to be at a greater intraoperative risk and the conversion rate was also higher. Neither lesions of the common bile duct nor deaths were recorded. The advantages of the method (the hospital stay was reduced, less postoperative pain, and early return to normal activities) should not make the surgeon disregard the risks and stubbornly employ LC in acute cholecystitis.

Acute Disease↗

PubMedDate not supplied

[Laparoscopic cholecystectomy evolving].

Between March, 31, 1993 and December, 31, 1997 in the Ist Surgical Clinic was performed laparoscopic cholecystectomy on 1458 patients (1290 females). Clinical selection of patients was made also by preoperative echography. Cholelithiasis was present in 94% of cases. Chronic cholecystitis was detected in 77.7% of cases and acute cholecystitis in 19.13% of cases. Laparoscopic cholecystectomy was realised by retrograde dissection. Conversion to open cholecystectomy was made in 6.1% of cases. Associated laparoscopic operations: appendectomies, genital adnexectomies, omentectomies. In uncomplicated cases (98%), evolution was good with early postoperative mobilization and discharge after 48 hours.

Adolescent↗

PubMedDate not supplied

[Incisional hernias after operative laparoscopy].

The objective of this study was to determine the possible risk factors of incisional hernias after operative laparoscopy. Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in the abdominal surgery, more incisional hernias were observed. Of the approximately 3,145 patients who underwent laparoscopy from march 1993 through march 2000 in the First Surgical Clinic Iassy, a total of 15 hernias occurred, which is an incidence of 0.477%. There were no acute complications, such as small bowel obstruction, secondary to herniation through the trocars. Risk factors such as chronic bronchitis or weight increase, which give rise to abdominal pressure, were present in some cases. Precautions such as fascial suturing must be taken to reduce the incidence of this minor complication of laparoscopic surgery.

Adult↗

PubMedDate not supplied

[Laparoscopic cholecystectomy in non-lithiasis cholecystopathies].

We made a study in 1st Surgery Clinic of Iassy between March 93--November 98, with 2246 laparoscopic cholecystectomies. The reason was to define the place and role of laparoscopy in non-lithiasis cholecystopathies (81 cases). In the same period were operated classically 888 calculous cholecystitis and 38 non-lithiasis cholecystitis. The laparoscopy has a major role in diagnosis to the patients with many abdominal symptoms. We discovered pericholecystic adherences, hepatic cirrhosis, acute appendicitis, etc. Sometimes, the laparoscopy was made for "second look" after surgical treatment for neoplasia, the metastasis diagnosis, for tumors visible echographically. In many situations the laparoscopic cholecystectomy may be considered like a preventive operation. The easy postoperative evolution is an argument to enlarge the indication for laparoscopic cholecystectomy in alithiasis cholecystitis.

Cholecystectomy, Laparoscopic↗

PubMedDate not supplied

[Cephalic duodenopancreatectomy with pyloric preservation in the treatment of pancreatic cancer].

UNLABELLED: Is the application of DPCPP in the treatment of pancreatic neoplasia a good reason? We have analysed 30 patients with cephalic duodenopancreatectomy (DPC) for biliopancreatic neoplasia between 1995-1999 in Ist Surgical Clinic of Iassy (13 with pyloric preservation). The indications were:--cephalic pancreatic neoplasia (adenocarcinoma--4 cases (one with cephalic chronic pancreatitis on the intraoperative microscopical examination);--Vater ampulloma (7 cases);--inferior common biliary duct (CBD 1 case);--duodenal adenocarcinoma (1 case). In the same time was operated 265 biliopancreatic diseases (203 mechanical jaundice with 132 neoplastic jaundice). RESULTS: --Better early postoperatively status of the patients--DPCPP does not give better prognosis;--there are necessary some technical skills to depase the important phases of DPCPP.

Adenocarcinoma↗

PubMedDate not supplied

[Laparoscopic treatment of the ovarian cysts].

Laparoscopy is widely used as a safety procedure in many clinical situations allowing diagnosis and/or surgical management in a minimally invasive fashion. Most laparoscopic cases allow patients to recover quickly. The conventional ultrasonography and endovaginal sonogram appear to be useful in the pre-operative selection for this surgery. Conventional pulsed Doppler (Duplex) and color Doppler sonography (CDS) have added a new dimension to pelvic ultrasonography. This study was undertaken to evaluate usefulness of operative laparoscopy in treatment of ovarian cysts. A retrospective study was carried on 35 operative laparoscopy cases performed between 1995 and 2000. Types of surgery performed were cystectomy, salpingo-oophorectomy, oophorectomy and wedge resection. The mean operation time was in the range of 65 to 120 minutes, mean while the mean postoperative stay was of 3,8 days.

Adolescent↗

PubMedDate not supplied

[Case of cystic metastasis of the liver].

The report is about a patient clinic of Iassy from oncologic clinic. He had pain in the right, back and inferior hypocondrium, with irradiation, vomitings, pain less (7 kg in 2 months), weekness. The echography shows three years ago, hepatic cysts (the patient refused the admitted in hospital). Computed tomographic (CT) exam made in jan. 1996 shows three cystic hepatic tumors (2 in right and 1 in left lobes). The CT function revealed sterile biliohematic liquid. The laparotomy made the sharp diagnosis--cephalic pancreatic tumor with cystic metastatic hepatic tumors. The surgical treatment was partial resection of pancreatic tumor and drainage of hepatic cysts, with good postoperator evolution. The intraoperative histological exam found the same kind of malignant tumor in the pancreas and liver. We present the case for his rarity.

Humans↗

PubMedDate not supplied

[Laparoscopic management of peritoneal dialysis catheters].

Continuous ambulatory peritoneal dialysis catheter could be placed also by open laparotomy as well as by laparoscopic techniques. We did a retrospective study on cases to compare the results of laparoscopies. There were included 42 patients which we divided in two groups of 21. Group A underwent 21 cases in which catheters was inserted by open laparotomy. Continuous ambulatory peritoneal dialysis was started in 24 to 48 hours later. Group B incharged 21 patients underwent laparoscopic placement of the catheter between 2000 and 2001. Continuous peritoneal dialysis was started early (after 6 hours). The mean operative time was 28 minutes in group A and 30 minutes in group B. Fluid leakage was noticed in 4 patients in group A and in 3 patients in group B. Peritoneal reactions occurred in 5 patients in group A and in 2 patients in group B. Tip migration occurred in 5 patients in group A (one of which was mobilized accidentaly early after intervention) in which was necessary 4 open reinterventions, and no patients in group B. In group B one patient underwent a simultaneous liver biopsy for cirosis and another female patient underwent ovariectomy for a giant ovary cyst. Laparoscopic placement of dialysis catheter leads to better function than does open procedure, it allows immediate start of dialysis and permits simultaneous performance of other laparoscopic procedures.

Adult↗

PubMedDate not supplied

[Minimal invasive treatment of the adnexal surgical pathology].

Laparoscopic approach has become the "golden standard" in managing a wide range of adnexial sufferings. Most laparoscopic cases allow patients to recover quickly. Conventional ultrasonography appears to be useful in the preoperative selection for this surgery. Conventional pulsed Doppler and colour Doppler sonography proved their importance in the diagnosis of malignancy. The aim of the study is to evaluate the advantages and the limits of the minimal invasive approach in managing surgical adnexial sufferings. A retrospective study was carried on 75 operative laparoscopy cases performed between 1998-2002. Surgical procedures were performed mainly for ovarian cysts (69 cases, 92%), but there were also treated other types of adnexial pathology such as: hydrosalpinx (2), piosalpinx (1), tubal cysts (2), ectopic pregnancy (7), pelvic adherences (7) and one case of hydatid tubal cyst. Types of surgery performed were cystectomy (36), ooforectomy (11), salpingo-ooforectomy (10), fenestration (10), salpingectomy (6), lysis of adhesions (7). The mean operation time ranged between 50 and 80 minutes and the mean postoperative stay was of 3.65 days.

Adnexal Diseases↗

PubMedDate not supplied

[Male gender-- difficulty factor in cholecystectomies for cholelithiasis].

Male gender has been recognized as a risk factor for an increased conversion rate of laparoscopic cholecystectomy and more severe disease in those with symptomatic cholelithiasis. The aim of this study was to determine the effect of male gender on the clinical presentation of symptomatic cholelithiasis, relation between male gender and acute cholecystectes, the operating time, the frequency of conversion and postoperative morbidity. The medical records of all patients with symptomatic cholelithiasis from 31 mars 1993 to 31 mars 2001 (4145 patients) were evaluated. These cases were divided into four groups: A--elective laparoscopic cholecystectomy group--patients with cholecystectes with elective laparoscopic cholecystectomy (3995 cases); B--patients with acute cholecystectes whose laparoscopic cholecystectomy was performed successfully (660 cases); C--acute conversion group converted to open surgery (240 cases); D--acute open group with elective open cholecystectomy. The study reveals that males suffer from a severe form of cholecystectes that raise difficulties when laparoscopic cholecystectomy is performed.

Adolescent↗

PubMedDate not supplied

[Cholelithiasis after gastric surgery--possibilities and limits of laparoscopic approach].

An increased incidence of cholelithiasis has been widely reported after gastric surgery. In the early phase of patient selection, previous gastric surgery has been considered a relative contraindication to laparoscopic cholecystectomy. Between 1999-2003, in our clinic, laparoscopic cholecystectomy was attempted on 3145 patients. Of these patients, 37 patients had gallstone, which occurred several years (mean 17.9 years) after gastric surgery for peptic ulcer (34 cases), gastric cancer (1 case) and hiatal hernia (2 cases). Surgical procedures that had been performed included Billroth I gastrectomy (14 cases), Billroth II gastrectomy (15 cases), truncal vagotomy and piloroplasty (6 cases), and Nissen (2 cases). On this group there were 19 chronic cholecystites, 17 acute cholecystites and one cholesterolosis with gallbladder polyps. One patient was diagnosed with gallstone in common bile duct, successfully removed preoperatively after endoscopic sphincterotomy. The laparoscopic approach was possible in 26 cases. The technical difficulty after Cuschieri was level III--26 patients and level IV--11 patients (reconversion). The mean operative time was 75 minutes. The postoperative evolution of the patients was good in 36 cases. One case had a biliary fistula. The mean postoperative hospital stay was 3.6 days for laparoscopic cholecystectomy and 9 days after conversion. The postoperative adhesions determine the main technical difficulty, but it proved to be a relative contraindication for laparoscopic cholecystectomy for gallstones after gastric surgery. Clear visualization of anatomic structures and landmarks, and scrupulous hemostasis are needed to perform a safe laparoscopic cholecystectomy in these patients.

Adult↗

PubMedDate not supplied

[Laparoscopic assisted vaginal hysterectomy (LAVH). Overview on 25 case series].

The aim of the study is to evaluate the laparoscopically assisted vaginal hysterectomy (LAVH) in terms of indications, uterine size, surgical procedures and their safety, intraoperative complications and blood loss, operative time, concomitant surgical procedures and postoperative period of complications. A total of 25 patients underwent LAVH between 1998 and 1993, in our surgical unit. The mean age of our patients was 44.2 years (range 36-66). The most common indication was fibromyoma. The mean size of the removed uterus was 11.5 cm. The mean weight was about 242 g. The mean estimated blood loss was 155 ml and the mean operative time 150 min. Intraoperative complications included one case of bladder injury due to thick adhesions. Postoperative complications included 2 cases of cystitis, and 3 cases of ileus. The hospital stay was 2 to 7 days.

Adult↗

PubMedDate not supplied

[Conversion in laparoscopic cholecystectomy].

Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. The aim of this study was to analyze the factors that make LC difficult and determine conversion to open approach: Our study includes: 6985 cases which underwent LC and 1430 cases with open cholecystectomy, between March 1993 and April 2005 in our clinic of general surgery. The overall conversion rate was 5.1% (deliberate conversion--299 cases, conversion of necessity--62 cases). The conversion rate has decreased from 17.5% in 1993 to 3.2% in recent years. The most conversion happen after a simple inspection or a minimal dissection caused by the existence of perforation (105 cases), the discovery of a difficult anatomic situation (63 cases) or of another pathology (14 cases); more rarely, the conversion was necessary in the principal time, doing to hemorrhage (26 cases), impossible dissection (41 cases), visceral injury (1 case) or even at the end of the operation, doing to hemorrhage, loss piece or stone (10 cases), and other situations (101 cases). Significant predictors of conversion were acute cholecystitis , choledocholithiasis, past history of acute cholecystitis, male gender, gall bladder wall thickness exceeding 6 mm. In conclusion, based on our experience, we suggest limiting OC to patients with proven contraindications to LC (i.e., Mirizzi syndrome or systemic illness incompatible with general anesthesia or pneumoperitoneum), attempting LC in all other cases. Decision to convert to open approach is a proven of surgical maturity. Conversion must be decided from the beginning, in the moment of the recognition of a difficult situation and not after the occurrence of a complication.

Adult↗

PubMedDate not supplied

[Incidence and management of the ovarian fibroma and thecoma. Experience of The First Surgical Clinic Iaşi].

The ovarian fibroma, thecoma and fibro-thecoma are a rare benign tumors growing from the connective tissue of the ovarian cortex. The general surgeon may confront in his practice solid ovarian mass, sometimes in emergency. Between 1995 and 2005, we report thirteen cases of ovarian fibroma (two bilateral) and two ovarian thecoma with mean age 53 years operated in First Surgical Clinic Iasi. Four of them were operated on as emergencies. Clinical ascites are found in three patients with large tumors. The early symptoms were pelvic pain and abnormal uterine bleeding. Patients with large tumors or ascites were admitted with compression symptoms or abdominal distension. Ultrasonography showed a solid uniformly hypo-echogenic mass, with very marked sound attenuation. We performed oophorectomy in six cases (laparoscopic approach in four cases) and salpingo-oophorectomy in nine cases (using laparoscopic stapler in three cases). There were no conversions to laparotomy. In all cases the diagnosis was established by histological examination. Laparoscopic approach is associated with significantly less operative morbidity, less postoperative pain, shorter hospital stays and shorter recovery periods, best cosmetic results.

Adult↗

PubMedDate not supplied

Laparoscopic wedge resection of gastric leiomyoma.

Gastric leiomyoma is a rare gastric neoplasia. The laparoscopic method may treat various gastric tumors, including benign leiomyoma by wedge resection without opening the gastric cavity. The laparoscopic approach to submucosal tumors of the stomach is technically feasible, is safe, and has good postoperative results. It should be considered a viable alternative to open surgery. Herein, we describe a case of laparoscopic wedge resection of gastric leiomyoma.

Aged↗

PubMedDate not supplied

[Laparoscopic esophagomyotomy in cardial achalasia].

Two patients underwent a transabdominal laparoscopic Heller myotomy for achalasia. All patients had barium esophagograms. preoperative endoscopy, esophageal manometry. There were no surgical morbidity and the average hospital stay was 5 days. Excellent result was reported by one patients and good result by one. Laparoscopic Heller myotomy is a safe and effective treatment for achalasia.

Cardia↗

PubMedDate not supplied

[Laparoscopic adhesiolysis].

The laparoscopic approach of the postoperative adhesions represents not only a way of diagnosing the pathogenic adhesions but also a superior alternative to the surgery of classical dissection of adhesions by laparotomy because of its obvious advantages: the evolution is simple, the bowel activity is quickly restored, the brief period of hospitalization, the reduced risk of recurrence. The authors present their experience derived from the 29 laparoscopic adhesiolysis; 3 urgent cases with subocclusions, 6 when rhe surgical intervention was programmed, with a painful postoperative suffering, and 20 with laparoscopic cholecystectomy. From among these cases, a conversion and a postoperative complication were recorded. The result after a period of time are satisfactory.

Adult↗

PubMedDate not supplied

[The value of laparoscopic cholecystectomy in the treatment of gallbladder pathologies].

We have prospectively studied all cholecystectomies performed in one year in our clinic in two groups: 190 cases performed laparoscopically and 98 open. We used standardized records and the EPI 5 program on an IBM compatible computer. There were no significant differences between groups regarding weight, sex and proportion of cases with acute cholecystitis. There were however major differences regarding age, type of habitat, ASA score and association with acute pancreatitis, obstructive jaundice and angiocholitis. Conversion of laparoscopic cholecystectomy to open procedure was imposed in 17 cases (not included in statistical analysis) due to technical difficulties (12 cases), haemorrhagic accidents (6 cases), injury of the common bile duct (1 case), stones lost in the abdominal cavity (3 cases), local peritonitis (5 cases). Laparoscopic cholecystectomy lasted a mean of 74 minutes. We encountered 3 specific complications: one CBD injury recognized intraoperatively and managed by Kehr's procedure (one CBD injury in the open cholecystectomy group), one small bowel perforation and one of biloma. Mortality averaged 0.5% in the LC group (one case of late postoperative stroke considered not related to the procedure) and 1% in the open cholecystectomy group. The hospital admission period was significantly reduced in the LC group (5 days vs. 12 days). LC appears as a safe procedure with a low complication rate. Conversion to open procedure is not a complication. Our study recommend LC as the method of choice in the treatment of gallbladder lithiasis.

Adolescent↗