Search PubMed⌕ Search

Biomedical subjects

D Tulbure

Publications and source records attributed to D Tulbure.

At least 19 recordsLinked to original sources
PubMed1995

[Amputation of the rectum via laparoscopy].

We report the case of a 66-year-old woman with a bleeding adenocarcinoma of the lower thirty of the rectum. The laparoscopic procedure was initiated with mobilization of the sigmoid colon. The left ureter was identified as it crosses the left iliac vessels. The peritoneum along the right side of the rectosigmoid mesentery was transected. The superior rectal artery was divided utilizing extracorporeal ligatures. The anterior rectum was separated from the uterus, the pararectal tissue was mobilized, the middle rectal arteries were ligated and the posterior rectum was dissected from the presacral tissue. The perineal component of the procedure was simultaneously performed. The sigmoid loop was extracorporeally transected with a linear stapler. The proximal sigmoid end was exteriorized through the colostomy site (site of the left superior port). The distal sigmoid end was replaced in the abdominal cavity and was grasped through the perineal wound; the anus, rectum and sigmoid were removed through the perineal wound. The feasibility of this procedure has been well established. However, it seems to be an alternative for the classical abdominoperineal resection as treatment for adenocarcinoma of the lower rectum. His superiority has yet to be confirmed by future studies.

Adenocarcinoma↗
PubMedDate not supplied

[Changes in cellular and humoral immunologic mechanisms in the postoperative period].

The study attempted to evaluate the effects of anesthesia and of surgical interventions on certain humoral and cellular components of the mechanism of specific immunity. A total of 64 patients suffering with benign and malignant affections of the stomach and of the colon that had underwent resections under general anesthesia of the hypnoanalgesia type were followed at three stages of their evolution--before surgery, at 24 hours after surgery, and 7 days after surgery. Blood samples were obtained for performing the following tests: count of lymphocytes, blastic transformations test, stimulated control (with PHA and PWM), rosetting test, total number of eosinophils, high affinity eosinophils, and other tests. Electrophoretic fractions, total serum proteins, and dosage of IgG, IgM, and IgA immunoglobulins were also measured. A total of 24 tests have been performed. The patients were investigated both globally and according to sex, type of affection (malignant, or other), and by age. The results indicated a depression of the majority of the results of tests excepting those which detect precursor B, and T-helper cells, which showed a stimulation. Differentiated behaviours were also noted in the various groups with regard to the intensity of the reaction, although not with its direction.

Aging↗
PubMedDate not supplied

[General surgical operations in patients with prior cardiac operations. Anesthetic and surgical risk].

The authors make an analysis of a group of 39 patients with cardiac interventions in their antecedents that later underwent general surgery. Of these 25 underwent planified surgery while 14 were operated as emergency cases. The surgery performed was of variable extension. Nine fatalities were recorded, representing 23,09%. Evaluation of the anesthetic and surgical risk factors revealed their dependence both on the myocardial hemodynamic efficiency (as determined by the previous heart surgery), and on the second intervention, emergencies presenting with a potentially increased risk factor. The authors stress the necessity to adapt the attitude of the anesthetist, as well as the intensive care, to particularities of the patient, and those determined by the second intervention.

Adolescent↗
PubMedDate not supplied

[The Bain circuit. Theoretical aspects and clinical use].

After a concise theoretical presentation of the present stage of semiclosed circuits, the authors assess their personal experience in the use of the Bain system. Under controlled respiration, adminstration of a fresh flow of gases of 70 ml per Kg of body weight-1 per minute-1 (between 4,5 and 6 1 per minute-1) prevents reinchalation. By its characteristics, which include: on optimal control of PaCO2 by a simple variation of the flow of fresh gases, universality, economy, the Bain system has demonstrated its utility in the anesthetics practice.

Anesthesia, General↗
PubMedDate not supplied

[Use of naloxone (Narcar) in anesthesiological practice].

The antagonising effect induced on respiratory depression by fentanyl and morphine was studied in two lots of patients. Recovery from respiratory depression was general and evident. A correlation was found between the amount of naloxone and the amount of the major analgesic used. Beside respiratory depression naloxone has also partially antagonised in some cases the analgesic effects of fentanyl and morphine.

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

[Total vascular exclusion in liver surgery].

II cases of major hepatic resections under total vascular isolation (TVA) are presented: 4 women and 7 men, age between 17 and 70 years (mean 39.6 years). In another 2 cases the method was abandoned because the patients did not tolerate the vena cava clamping. The main indication for TVA were large tumors located near the suprahepatic veins opening into the vena cava. The diagnosis in the 11 cases was: hepatocellular carcinoma--3 cases, cholangiocarcinoma--1 case, colo-rectal metastasis--1 case, hemangioma--3 cases, hamartoma--2 cases, diffuse suppuration of the right lobe--1 case. The warm ischemia time was between 25 and 50 min (mean: 36.8 min). There were no intraoperative complications. The mean quantity of transfused blood was 450 ml. Postoperatively two patients bled and were reoperated. Both subsequently developed liver failure and died and in both cases microscopy found histologic lesions of chronic hepatitis. The mortality was then 18.1%. Six patients (54.5%) developed postoperative complications. Worth noting are 2 cases of transient liver failure, both in patients with cancer. The ICU stay was between 2 and 14 days (mean 7.1) and the whole postoperative hospitalization was between 11 and 46 days (mean: 16).

Adolescent↗