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Biomedical subjects

C Vasilescu

Publications and source records attributed to C Vasilescu.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Imaging of chest wall disorders.

Pathologic processes that may involve the chest wall include congenital and developmental anomalies, inflammatory and infectious diseases, and soft-tissue and bone tumors. Many of these processes have characteristic radiologic appearances that allow definitive diagnosis. Sternal deformities can be visualized at radiography and their severity quantified with computed tomography (CT). In cervical rib, CT with multiplanar reconstruction may demonstrate relevant anatomic detail and the relationship between bone deformity and arterial compression. In Poland syndrome, radiography reveals an area of hyperlucency on the affected side, whereas CT demonstrates the absence of the greater pectoral muscle and clearly depicts associated musculoskeletal anomalies. Tuberculosis typically manifests at radiography and CT as osseous and cartilaginous destruction and soft-tissue masses with calcification and rim enhancement. Aspergillosis involving the chest wall manifests as pulmonary consolidations and permeative osteolytic changes of the rib and spine at CT and as an area of increased signal intensity at T2-weighted magnetic resonance (MR) imaging. Neurogenic tumors and hemangiomas also typically have high signal intensity at T2-weighted MR imaging. Apparent mass extension or unequivocal bone destruction seen at CT or MR imaging may indicate chest wall involvement by lymphoma. Radiologically, soft-tissue sarcomas typically appear as areas of soft-tissue density or attenuation, often associated with necrotic areas of low density or attenuation. At radiography, plasmacytoma typically manifests as well-defined, "punched-out" lytic lesions with associated extrapleural soft-tissue masses. Chondrosarcoma frequently appears as a large, lobulated excrescent mass arising from a rib with scattered flocculent calcifications characteristic of its cartilaginous mix. Familiarity with these radiologic features facilitates accurate diagnosis and optimal patient treatment.

Adolescent↗
PubMedDate not supplied

[Palliative total gastrectomy in advanced malignancies of the stomach].

The diagnosis of the malignancies of the stomach is generally late (stages III and IV to a medium value of 80% of patients). Therefore it is necessary a surgical treatment in order to effectuate the extirpation of the lesions and to warn or to treat the complications in course of the neoplastic disease. The indications and the results of the palliative total gastrectomy (PTG) are analyzed in the present study. Between 1992 and 1999 there were studied retrospectively and prospectively during three successive periods of time, 217 patients (pts.) with PTG. This group of pts. represents 22.1% of the total number of pts. operated on for gastric malignancies (carcinoma particularly). The indication of PTG was established only after one complex evaluation of the every patient from the point of view of his general and biological status. 142 (65.4%/217) of the analyzed pts. presented at the admission in the hospital various complications of the malignant disease (gastric different stenosis, digestive hemorrhages, loco-regional invasion). The lymph nodes metastases and the systemic metastases (in the liver especially) as well as the invasion in the neighbouring viscera imposed sometimes the extension of the PTG with partial or total extirpation of the invaded organs. A proportion of 61% pts. were submitted to those type of enlarged surgical interventions without radical intentions; all the operated pts. remained by necessity in R1 or R2 types of operations. The reconstructive preferred anastomosis was effectuated with an Y jejunal ansa à la Roux completed or not by a "J" reservoir. Microscopically pathologic lesions were: adenocarcinoma and carcinoma (82%), followed by primitive lymphoma (11.5%), and others malignant forms of lesions (approximately 6%). The general perioperative morbidity was 32.5% divided in: 12.3% having a surgical cause (the majority anastomotic leakages +/- septically complications or precocious occlusions); 20.2% complications depending by the general status and altered biology of the patients. Perioperative mortality was 10.1% (22 pts.) comparable with other experiences published in the international literature in those forms of advanced gastric cancer operated by PTG. The average outcome of the operated followed pts. was 16-18 month (extremes 12 months and 29 months). A better quality of life and a variable disease-free period was obtained. As a conclusion we think that the PTG is a advantageous modality of surgical treatment with an acceptable rate of perioperative morbidity and mortality. The outcome of operated pts. is superior comparable with that of nonoperated pts. or with that secondary to other palliative surgical interventions. The importance of adjuvant treatment (chimeo- or radiotherapy) remain to be appreciated in the future.

Adenocarcinoma↗
PubMedDate not supplied

[Laparoscopic splenectomy--lessons learned from a series of 40 cases. The advantages of the postero-lateral approach].

Until October 2000 in our surgical department 40 patients underwent laparoscopic splenectomy. Seven patients were converted to laparotomy for completion of splenectomy. All of these occurred in the first 20 patients and were due to bleeding. There was no postoperative mortality. Postoperative complications occurred in two patients: one abdominal wall hematoma and a postoperative hernia. Indications were idiopathic thrombocytopenic purpura, hereditary spheocytosis, autoimmune hemolytic anemia and others. In the last 30 cases we used the postero-lateral approach, that results in reduced blood loss, fewer patients that needed to be converted to open surgery and shorter postoperative stay. Accessory spleens can be successfully localized and with a carefull technique the capsular fractures can be minimized reducing the risk of splenosis.

Adult↗
PubMedDate not supplied

[Periampullary carcinoma or tumor of the ampulla of Vater?].

The term periampullary carcinoma is widespread in the medical literature. This is a consequence of the difficulty to establish the histogenesis of the tumor. The question is open if the tissular origin of the mass can be established after an accurate pathological examination and if the effort to distinguish between the so called "periampullary tumors" originating in the pancreatic tissue and those of a biliary, ampullary, duodenal or papillary origin can be useful; if there are significant differences among clinical signs, surgical approach and prognosis of these two sub-classes of "periampullary carcinomas". Between 1990 and 1998 54 patients were operated with the operative diagnosis of periampullary carcinoma in our department. In 35 cases a resection was performed. This 35 operative specimens were retrospectively analysed (operative protocols, macroscopical description of the resected specimens, reevaluation of the slides and new sections from the parafin blocks). Same macroscopic pathological features of the tumors were taken into consideration as suggestive for the pancreatic origin as the concentric development. On the contrary, the infiltrative and exofitic aspects were considered signs for a biliary respectively duodenal origin. The microscopic examination showed 32 adenocarcinoma and 3 undifferentiated carcinomas. In 9 cases a squamous metaplasia, in 22 cases the microscopic invasion of the duodenal wall and in 8 the invasion of the pancreas tissue were present. In 6 cases we found lymph nodes metastasis. The ductal pattern and the squamous metaplasia are suggestive for a pancreatic histogenesis. The papillary proliferation is more characteristic for a biliary or a duodenal origin. After this retrospective analysis we were able to establish the histologic origin of the tumor as follows: 11 with biliary origin, 10 with pancreatic origin and in 14 cases the diagnosis remains "periampullary carcinoma". The term periampullary carcinoma is not a well defined pathological entity. It seems to be an expression of the impossibility to define more accurate the origin of these tumors. Until now, the term remains still useful. However it is reasonable and useful to make the effort to limit such an imprecise diagnosis and to specify the pancreatic, biliary or duodenal histogenesis of the tumor. According to our data as well as to other authors, this accuracy is beneficial for the therapeutic strategy.

Adenocarcinoma↗
PubMedDate not supplied

[The periampullary carcinoma. Clinical and therapeutic alternatives].

BACKGROUND AND STUDY AIMS: An analysis of the diagnosis difficulties in periampullary carcinoma (PAC) is done, the consequences being the possible therapeutically insufficiencies. PATIENTS AND METHODS: During 10 years (1990-1998) 54 patients have been operated on for a PAC. Sex ratio: 34 males (63%)/20 females (37%). The pick of frequency was in the decade 61-70 years (20 patients) with extremes ages between 20 and 80 years. The main symptom was the cholestatic progressive jaundice with or without neoplasic pain (39 patients--72%). The intermittent jaundice was present only to 7 patients (13%) and the clinical forms without jaundice were manifested to other 8 (15%); superaded colangitic syndrome was present to 17 patients (31%). Other concomitances manifestations of the neoplasic disease were record to 23 cases (43%). Historical evolution of the illness until the cholestatic jaundice appearance was under 2 month to 23 cases, between 2 and 4 months to 24 patients and not sure determined to other 8. The biological preoperative investigations confirmed the clinically evident biliary retention syndrome in 85% of the cases and not yet clinically visible to other 15% of the cases. The ultrasonography was the most conclusive method from the imaging examinations because it have suggested the diagnostic of PAC to 43.5% from the patients submitted to this exploration. Computed tomography was diagnosis relevant only for the in site-regional invasion of the tumors or for the nodes or systemic metastases. Endoscopy and the endobiopsy proved to be valuable especially associated with ERCP (our experience regarding ERCP is not conclusive yet). Therefore the real preoperative diagnostic was established to 11 patients (20%), and for the rest of the cases there have been another presumptive preoperative diagnosis: cancer of the pancreatic head (11 patients), retentive jaundice without determined origin (24 patients), others (8 patients). Intraoperative exploration detected the periampullary tumor through palpation in 30 (55%) cases, through palpation and exploratory duodenectomy in 8 (15%) cases and/or by accessory signs (hydropic gallbladder, dilatation of the main biliary duct etc.). Organic metastases or duodenal stenosis was present in nine cases (6 with nodes metastases). The practiced surgery was: Whipple operations (in one--the majority--or two steps)--35 cases (65%); palliative surgery for biliary drainage 16 (30%) cases; others 3 (6%) cases. The postoperative staging of pT parameter (in situ or ex situ dimensional determined) reveled: pT1-12 patients; pT2--9 patients; pT3--14 patients; pT4--19 patients. Histopathological examinations confirmed the diagnostic of periampullary adenocarcinoma (32 patients) or carcinoma (3 patients) for the 35 patients with resectional operations. The determination of the tissular origin of the periampullary tumor was initially possible only in 11 (31%) operative specimens. A secondary study with many repeated sections in the wax included blocks specified the histogenesis of the tumors to other 10 patients, therefore for a total of 21 cases. We think that this histogenetically diagnosis aspect is important only for some predictive appreciations regarding the outcome of the operated patients and not for the elected therapeutically surgical method. RESULTS: The globally perioperative mortality was 8 (15%) patients. Three from this deceased were a consequence of palliative surgery applied to patients with advanced stages of neoplasic disease. The medium outcome for patients submitted to Whipple operation--in course of evaluation--is between 32 and 41 months to the patients which we can followed. For the patients with palliative operations the same distant survival is between 12 and 24 months.

Adenocarcinoma↗
PubMedDate not supplied

[Laparoscopic subtotal splenectomy in the treatment of hereditary spherocytosis].

Clinical manifestations of hereditary spherocytosis, the most common red blood cell membrane disorder, can be controlled by splenectomy. However, concerns regarding exposure of patients to a life long risk for overwhelming infections have restricted its use, especially în children. Subtotal splenectomy, as long as 80% to 90% of the enlarged spleen is removed, is a logical alternative. Subtotal splenectomy was effective în decreasing the hemolytic rate, while maintaining the phagocytic and immune function of the spleen. This surgical procedure should be considered în transfusion-dependent infants and children whit hereditary spherocytosis and în older patients whit erythrocyte membrane defects. Based on our experience în laparoscopy (120 laparoscopic splenectomies) and open subtotal splenectomy (5 cases) we performed 2 laparoscopic subtotal splenectomies in patients with hereditary microspherocytosis with good short term results. We have had no problem with blood loss and no transfusions were needed. The procedure can be performed safely and easily with all the traditional advantages of a minimally invasive approach. In order to evaluate the long term clinical benefit a minimal follow-up of 5 years is needed.

Adolescent↗
PubMedDate not supplied

[Frey operation--valuable alternative in the surgical treatment of chronic pancreatitis].

The "golden standard" of the surgical treatment of chronic pancreatitis with an inflammatory mass in the head of the pancreas seems to be the duodenum preserving resection of the head of the pancreas as described by Beger. However, in some cases, the inflammatory process may induce an encasement of the retropancreatic intestinal vessels making the dissection of the portal vein very difficult. The local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey operation) was developed in order to provide a simple and less time consuming procedure, that avoids the dissection of the portal vein and is especially indicated in cases with severe inflammatory and edematous alterations of the head of the pancreas at this level and with dilated pancreatic duct. Two patients with chronic pancreatitis with severe pain, addiction to analgesics and weight loss underwent a Frey procedure. In both patients an inflammatory mass in the head of the pancreas and dilated pancreatic duct were demonstrated. The freeing of the head of the pancreas from the portal vein was not possible because of the intense inflammatory process. The local resection of the pancreatic head and the longitudinal pancreatico-jejunostomy was successfully performed. There were no postoperative mortality or morbidity and the short and long term results (pain relief and nutritional status) are excellent.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

[Rectum resection with colonic J reservoir and coloanal anastomosis for rectal cancer].

A low anterior resection of the rectum followed by a colo-rectal or a straight colo-anal anastomosis often leads to poor functional results (increased frequency and urgency of defecation) due to the loss of the reservoir function of the rectum. In order to improve the functional results the authors performed in 7 patients colo-anal anastomosis with a J shaped colonic pouch. In all the cases a temporary diverting loop ileostomy was performed. This ileostomy was closed 4-5 weeks after the first operation. There was no operative mortality. After stoma closure, the functional results were improved during the first week. A colo-anal anastomosis with a colonic reservoir appears to be an optimal solution comparing with a very low colorectal or a straight colon-anal anastomosis.

Aged↗
PubMedDate not supplied

[Upper digestive haemorrhage of a rare cause: benign duodenal schwannoma].

The upper gastrointestinal bleeding is a common cause of admission to hospital. Neurogenic tumors of the duodenum are extremely rare and represent an unusual cause of gastrointestinal hemorrhage. The treatment is endoscopic or surgical total excision. In case of ulcerated large tumors situated periampullary pancreaticoduodenectomy (Whipple's or Traverso-Longmire's) represents an efficient solution. In addition, their high index of malignancy justifies this trend. We present a case of schwannoma of the second portion of the duodenum with several episodes of upper GI bleeding treated by Trasverso-Longmire pancreaticoduodenectomy.

Duodenal Neoplasms↗
PubMedDate not supplied

[Thoracoscopic splanchnicectomy--a method of pain palliation in non-resectable pancreatic cancer and chronic pancreatitis].

Severe upper abdominal pain is a dominant and distressing feature in advanced pancreatic cancer and in chronic pancreatitis. A way of palliation needs to be practiced in the non-resectable pancreatic cancer in order to control the pain. Between the many methods of palliation the thoracoscopic splanchnicectomy seems to be the best due its simplicity, no risk to the patient and the good results. In the Center of General Surgery and Liver Transplantation from Fundeni Clinical Institute we have practiced 50 thoracoscopic splanchnicectomies in a number of 49 patients during a period of 3 years. The morbidity was 2% and the mortality 0. We noticed a significant improvement in the pain score, the quality of sleep and the overall quality of life and consecutively a quick social reintegration of these patients. The quality of life is greatly improved (with a significant reduction of the pain score in 92% of the cases) after this minimally invasive procedure, a fact the qualifies this procedure as the technique of choice in these patients.

Adult↗
PubMedDate not supplied

[Severe upper gastrointestinal hemorrhage of a rare cause: aorto-esophageal fistula successfully treated].

Aorto-esophageal fistula is a rare entity, determining huge digestive bleeding with a very poor prognostic most often. We present the case of a patient with aorto-esophageal fistula of unknown origin, treated successfully in the Center of Surgery and Liver Transplantation from Fundeni Clinical Institute. A young man, 21 years old, was admitted in our clinic from another hospital for repetitive severe upper gastrointestinal bleeding, with hematemesis and melena, pale, asthenia, without any pain; the bleeding stopped when he was admitted. The upper digestive endoscopy and esophago-gastro-duodenal radioscopy with barium did not show any lesion. During the 7th day the patient presents sudden massive hematemesis with hemodynamic instability; during the surgery we found two subcardial ulcers (stress ulcers?) for which we have done excision and suture which temporary stopped the bleeding. After 14 days, the patient had another massive bleeding; the upper endoscopy shows 28 cm far from the dental arch a protrusive formation of 6-7 mm with a telangiectasis aspect and with a white spot (possibly a central ulceration); 1 ml pure alcohol was injected inside it with temporary bleeding ceasing. After 3 days the patient is bleeding again, with marked decrease in blood pressure; a Blakemore tube stopped the bleeding until surgery was performed. During the intervention an aorto-oesophageal fistula is detected; we made the excision of the fistula with simple suture of the aorta, subtotal esophagectomy, cervico-stoma and gastrostomy, with good postoperative evolution. After 4 months the digestive transit is restored by esophagoplasty with tubulized stomach placed behind the sternum. The diagnostic and treatment difficulties encountered in these kind of cases need to consider also an aorto-esophageal fistula diagnosis, especially for the cases with Chiari triad (mild thoracic pain, sentinel digestive bleeding and exsanguination). The Blakemore tube can save patient's life by ensuring temporary hemostasis and allowing the time for a definitive surgical intervention. The subtotal esophagectomy with cervicostoma and feeding gastrostomy, followed after few months by a esophageal reconstruction , is a solution for this extreme severe cases.

Adult↗
PubMedDate not supplied

[D2 lymph node dissection in gastric cancer surgery: long term results--analysis of an experience with 227 patients].

AIM: The main objective of the study was to evaluate the postoperative mortality and 5 year survival in gastric cancer patients undergoing a minimum of D2 lymphadenectomy. MATERIALS AND METHODS: A retrospective study was conducted on 1170 patients operated for gastric adenocarcinoma in the Department of General Surgery and Liver Transplantation of Fundeni Clinical Institute, between 1997 and April 2005. Only 443 patients underwent a curative resection, from which 216 patients had D1 resection and in 227 cases a D2 or D3/D4 lymphadenectomy was performed. Information about survival was available for 189 patients of those who had a D1 resection and for 210 of those who underwent a D2 or D3/D4 lymphadenectomy. RESULTS: Postoperative mortality was 6.5% in the group of curative resection, with 9.2% for D1 and 3.9% for D2/D3 D4. Five year survival according to Kaplan Meier curves was 32 % in the D1 group vs. 51,8% in D2/D3-D4 (p <0.0001). Significant differences were noted in the median survival-- D2/D3-D4 group 63 months vs. 28 months in D1 group. CONCLUSIONS: Our data support the gastric resection with a minimum of D2 lymphadenectomy in the radical surgery of gastric cancer. However, an accurate interpretation of the statistical interpretation between the different groups of patients is difficult, mainly because of the retrospective character of the study.

Adenocarcinoma↗
PubMedDate not supplied

Ischemic lesions of hepatocytes and sinusoidal cells during preservation of rat liver for transplantation.

In order to evaluate the effects of cold and normothermic preservation on liver morphology, rat livers were placed in Collins' and NaCl 0.9% solutions at 4 degrees C and 25 degrees C, for 3.12 and 24 hours. Hepatocytes morphology was remarkably well conserved during cold preservation; in normothermy, only after 24 hours we noted hepatocytes swelling and karyorhexis. On the contrary, sinusoidal cells lesions were earlier (at 3 hours) and became irreversible after 12 hours of cold preservation. The signs of irreversibility (sinusoidal cells detached from the adjacent hepatocytes, pyknotic nuclei and karyolysis) were observed at an earlier stage than in normothermic conditions and during preservation in NaCl 0.9%. The mean diameter of hepatocytar nucleus and the mean hepatocytar diameter were modified, compared with the control livers, only after 24 hours of preservation in Collins' solution. Mean sinusoidal area alone was modified at 12 hours of cold preservation in Collins' solution (9.80% versus 12.10% in controls). Both histological changes and morphometric data sustained the idea that in liver preservation, sinusoidal cell lesions appeared earlier than the hepatocytes lesions. In evaluating the reversibility of the ischemic damage, attention should be focussed on the events in the sinusoidal wall.

Animals↗
PubMedDate not supplied

Acute experimental pancreatitis--morphological evidence for the development of a multiple organ failure syndrome.

In order to evaluate the systemic lesions during acute pancreatitis (AP) we produced the disease in rats by ligation of the common biliopancreatic duct. The animals were killed at 4, 24, 48 hours and at 7 days. Serum values of amylase appear increased 24 hours after common biliopancreatic duct ligation, decreased after 48 hours and remain at a low range at 7 days. The pancreatic lesions were: interstitial oedema, pancreatic ducts dilatation, necrosis, hemorrhages and extensive fat necroses in the peripancreatic area, retroperitoneum and mesentery. We also found signs of systemic damage, suggestive for a multiple organ failure syndrome in the lung (hemorrhages, neutrophils accumulation, microthromboses), stomach (erosive and hemorrhagic gastritis) and mild kidney hemorrhages. Thus we succeed in producing a pathological picture similar to the multiple organ failure syndrome (MOFS) lesions in a rat model by a mechanism similar to human biliary AP. This model could be useful in therapeutic studies and in further research in the field of pathogenesis of MOFS during AP.

Acute Disease↗
PubMedDate not supplied

Decision analysis in the clinical and imaging diagnosis of acute cholecystitis.

The importance of clinical, laboratory and imaging data in the diagnosis of acute cholecystitis (AC) was studied in 825 patients with right upper quadrant pain hospitalized in the Surgical Clinic of the Fundeni Hospital--Bucharest, between January 1, 1986 and June 30, 1988. A number of 21 parameters were analysed in each case. Of these 825 patients, 259 were considered after surgery as AC. These 259 cases were divided, after the microscopical examination of the surgically-obtained specimens, into two groups: 1) pathologically confirmed AC (137 cases) and 2) pathologically non-confirmed AC (122 cases). The importance of every parameter in establishing a histologically confirmed diagnosis of AC was determined by the diagnostic probability calculated according to Bayes'theorem. The hierarchy of the value of parameters in the diagnosis of AC was based on their capacity to distinguish between the cases histologically confirmed and those detected on surgery, but without microscopically demonstrated changes of AC. The same decision criterion was used in building the decision trees in the exploration of the cases of presumed AC. In the 825 cases with right upper quadrant pain, the main and most frequent cause was chronic calculous cholecystitis (31.8%), followed by AC pathologically confirmed (16.6%), AC non-confirmed (14.7%) and chronic acalculous cholecystitis (12.4%). The most useful parameters in distinguishing between pathologically confirmed AC and pathologically non-confirmed AC were: 1) sudden onset of pain; 2) mild resistance to abdominal palpation; 3) frank peritoneal irritation; 4) stone impacted in the gallbladder neck (ultrasonography); 5) fever; 6) palpable gallbladder; 7) lithiasis (ultrasonography); 8) gallbladder wall with double outline (ultrasonography). Ultrasonography supplied a diagnostic probability of 85% for the correct diagnosis of AC in cases without a clinical picture suggestive for AC. The decision tree analysis supported the same conclusion: only ultrasonography gives a good distinction between pathologically confirmed AC and pathologically non-confirmed AC.

Acute Disease↗