[The diagnostic and surgical treatment problems in hepatic hydatidosis].
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Adolescent↗
Biomedical subjects
D Vasile
Publications and source records attributed to D Vasile.
[The diagnosis and therapeutic approach in acute necrotic-hemorrhagic pancreatitis].
The work contains the clinical and therapeutic analysis of a group of 72 patients with acute necrotic-haemorrhagic pancreatitis (ANHP), admitted in the period 1979-1989 to the Ist Surgical Clinic of the Municipal Clinical Hospital of Bucharest. The etiology of ANHP, its clinical forms of manifestation, the peculiarities of shock and its dynamic course are shown and discussed. Stress is laid on the criteria of severity, on the course and on the complications occurred. The therapeutic results are commented in detail and the mortality is studied in a complex way, by analysing both the terminal clinical manifestations and the results of anatomicopathological examinations.
Acute Disease↗
[Acute necrotizing pancreatitis following abdominal trauma].
We present 11 cases of acute necrotizing pancreatitis following abdominal trauma operated in our clinic during the last five years. All patients except one were male. All of them had obvious symptoms of acute diffuse peritonitis when they came to hospital. The diagnosis was established by CT scan in four observations. All operations were performed during 12-36 hours after they came. During surgery, there was complete pancreatic necrosis in seven cases and incomplete in the other four cases. Associated injuries following trauma were represented by: hemothorax--two cases, spleen injury--one case, lesion of mesentery--one case, intestinal lesion--one case. In all cases we performed a wide opening of the lesser sac, pancreatic capsulectomy, necrosectomy and multiple drainage of the pancreatic side (behind the peritoneum) and peritoneal cavity. The postoperative outcome was difficult in all cases. Postoperative morbidity recorded pancreatic leakage (three cases), pseudocysts (two cases) and a perforation of gastric wall. There were 10 cases cured and one patient died.
Abdominal Injuries↗
[The Fitz-Hugh-Curtis syndrome in laparoscopic surgery].
The Fitz-Hugh-Curtis syndrome was diagnosed intraoperatory at 7.1% of the laparoscopic cholecystectomies in our clinic. The attitude in all cases was to perform a complete adhesiolysis. The reasons we consider that support this are: 1. the adhesions that fix the liver to the diaphragma do not allow the surgeon a comfortable access to perform cholecystectomy; 2. if these adhesions are torn accidentally during operation it could end up to the glissonian sheath rupture and uncontrollable bleeding; 3. adhesiolysis might be imposed in order to introduce the ports under visual control; 4. the traction determined by the perihepatitis process against the parietal peritoneum could be responsible for postoperative right quadrant pain; 5. the hepatodiaphragma adhesions make impossible the suction of the intraoperative secretions. A complete adhesiolysis allow a correct lavage of the suprahepatic area preventing the possible retention of clots, bile or even calculi. We didn't notice neither a longer duration of the intervention due to adesiolysis nor intra/or postoperative complications.
Aged↗
[Ascites--a complication of chronic alcoholic pancreatitis].
We present the case a 44 year old patient previously diagnosed with chronic alcoholic pancreatitis with pancreatic ascites during hospitalization in the Gastro-Enterology department. As the conservative therapy performed for 21 days was not effective in diminishing the ascites, the patient was admitted in our Surgical Department and scheduled for surgical intervention. He was operated and we discovered a small dimension cyst (7/4 cm) developed in the body and tail of the pancreas, fistulized in the peritoneal cavity through an outlet positioned below the insertion of the mesocolonum transversum, fairly close to the duodeno-jejunal angle. We executed a cysto-jejunal anastomosis by using the first loop of the jejunum, secured with a politer drainage positioned as in WITZEL technique and drive out in the left upper quadrant. The postoperative evolution of the patient was difficult, but constantly positive. The patient left the hospital 32 days after the intervention. The clinical and ultrasound follow-up after three months were normal.
Adult↗
[Surgical treatment of great median upper and/or lower abdominal incisional hernias with mesh placed in the rectus sheath(behind the muscle)].
We present our experience concerning surgical treatment of great upper and/or lower abdominal incisional hernias, by the technique using a mesh placed in the rectus sheath. Durind 5 years, we operated 42 cases. The features of our trial were: average age--56 years; female prevalence--40 cases (95%); great obesity rate (15 observations--35%). The early postoperative morbidity was represented by (number of cases): thrombophlebitis (2), prolonged postoperative ileus (3), seromas (7), prolongs hemorrhagic drainage (3), hematomas (2). We recorded no death. The late postoperative morbidity (number of observations) recorded granulomas (3) and recurrency (2). We obtained good and very good results in 37 cases (88%).
Adult↗
[Technic, indications and contribution of choledochoscopy in the diagnosis and treatment of biliary diseases].
Choledochoscopy it's a common method of intraoperative exploring of the extrahepatic biliary ducts and partially of the intrahepatic ones. He is used both in the open and laparoscopic surgery. We consider the operative cholangiogram, preferably transcystic, as a first step who precedes the endoscopic exploration. The transcystic choledochoscopy has specific and relatively narrow indications: undulated biliary ducts, 1-3 gallstones. The transcholedocian choledochoscopy permit a direct and complete exploration of the biliary ducts. The important diagnostic help that fibrocholedochoscopy gives in, it's accomplished by the possibility of therapeutic maneuvers (especially the gallstones extraction), which offers the quality of a miniinvasive, elegant and harmless treatment technique.
Bile Duct Diseases↗
[Laparoscopic cholecystectomy of cirrhotic patients].
In a period of 9 years in our clinic were performed 18 laparoscopic cholecystectomies (1.5%) at cirrhotic patients. In most of the cases (16) cirrhosis was diagnosed intraoperative. Retrospective, suggestive for a chronic hepatic disease were: patient history (9 cases), transaminases elevations (all cases), low platelet number (8 cases) and some echographic findings (6 cases). Laparoscopic cholecystectomy was difficult in all cases. Conversion to open surgery was necessary in one case because of an important hemorrhage from gallbladder bed. No diseases were recorded. Laparoscopic cholecystectomy is proven as a secure operation and with incontestable advantages comparing to open surgery.
Aged↗
[Laparoscopic cholecystectomy during pregnancy].
Cholecystectomy is after appendectomy the second most frequent surgical procedure made in pregnant women. The operation is indicated in all cases of symptomatic gallbladder stones which do not respond to medical treatment and all complicated forms such as acute cholecystitis or acute pancreatitis. Laparoscopic cholecystectomy, considered in the beginning as a high risk procedure both for mother and child, is nowadays safer and useful comparing to open surgery. Our limited experience can confirm this. There were operated two pregnant (2nd and 6th month of pregnancy) with acute cholecystitis. There were no intraoperative incidents or accidents, no postoperative complications and no problems in pregnancy evolution after operation. This presentation emphasis the particular technical problems due to pregnancy during laparoscopic cholecystectomy, aspects concerning anesthesia and preoperative monitoring of mother and child.
Adult↗
[Gall bladder carcinoma].
The study comprises a lot of 989 cholecystectomies for gall bladder lithiasis performed in the First Surgery Clinic of the University Emergency Hospital of Bucharest throughout three years and a half (2000-June 2003). Half out of them--493 cases (50%)--were laparoscopic interventions. All of the organ material was submitted to pathological examination. In 4 cases (0.4%), all females, the pathologist surprisingly unveiled the diagnosis of gall bladder carcinoma in the 3rd stage of evolution for all of them. None of the observations presented beforehand or per operative hints suggestive for a malignant affliction. Three patients associated multiple pathology such as acute pancreatitis (obs No2), common bile duct lithiasis (obs No3) and cholecysto-duodenal fistula (obs No4). The postoperative evolution of gall bladder neoplasia of the 4 cases studied was extremely fast, the patients soon being readmitted in our clinic for jaundice, subhepatic tumoral mass and liver metastasis, on average after 31 days after cholecystectomy. That was why the reinterventions were confined to limit at exploratory laparotomies only.
Aged↗
[Ileosigmoid fistula due to an abscess of a periappendicular mass].
The paper debates the subject of the undiagnosed acute appendicitis. The formation of a complex ileosigmoid fistula due to an abscess of the periappendicular mass and the three steps peritonitis determined a particular approach in solving the case.
Abscess↗
["Rendez-vous" procedure. Mini-invasive treatment of biliary stones].
Mini invasive approach, laparoscopic and endoscopic, represents these days a therapeutically standard in treatment of concomitant biliary stones: gallbladder and extrahepatic bile ducts. Had been suggested different procedures known as "rendez-vous" procedures. When choledocholithiasis is diagnosed or supposed, using biochemical and echographic criteria, we decided to make an ERCP just before laparoscopic cholecystectomy under the same anesthesia. Using ERCP we could confirm the choledocholithiasis. The endoscopic sphincterotomy was followed by extraction of the stones using the Dormia basket catheter. The laparoscopic cholecystectomy that followed was technically made in the same way that any laparoscopic procedure is made, according to the gallbladder lesion, the ERCP making no influence to the surgical act.
Adult↗
[Colon cancer--diagnostic and treatment problems].
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Colectomy↗
[Therapeutic modes in obstructions due to colon cancer].
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Aged↗
[Breast cancer in men].
In 20 years we registered 10 observations of male breast cancer (MBC), representing 1.3% out of 767 patients with breast cancer. Two observations of gynecomastia have been noted as a possible risk factor for MBC. A tumoral mass behind the areola suggested the diagnosis in 9 patients, whether in one case the attention was drawn by a bloody nipple discharge. In 3 cases we noted local aggravation clinical signs, and 6 observations presented homolateral palpable adenopathy. Diagnosis was completed by radiology, scintigraphy and pathology. As for clinical staging, we had 1 case in stage I,3 patients in stage II, 5 in stage III and I case in stage IV. Surgical treatment was the major therapeutical mean of the complex oncological procedure. We performed radical mastectomy in 4 cases. MBC prognosis was poor. Only one patient of the 6 ones in stage III and IV survived to five years; among other 4 observations in stage I and II, 2 patients have survived to five years, and other 2 being followed-up through the oncological network.
Aged↗
[Difficult laparoscopic cholecystectomy].
The study analyses different situations encountered throughout the authors personal operative experience, susceptible to generate technical and tactical difficulties during laparoscopic cholecystectomy such as: postoperative perivisceritis, obesity, difficult liver mobilization, lipomatosis, acute and scleroatrophic cholecystitis, "porcelain gallbladder". They also point out different causes capable of generating important bleeding during the operation: cirrhosis, accidental adhesion tearing, anatomical arterial variations. Above all, the study presents the possible technical and tactical solutions which they applied when dealing with the already mentioned critical situations.
Acute Disease↗
[Treatment with Ginkor Fort in varicose veins].
The study shows the experience acquired in our clinic concerning Ginkor fort administration in varicose veins pathology. The research comprises 32 patients who were treated by the well-known classical procedures (hygienic-dietetic, contention, surgery) and by Ginkor fort administration. The study rendered 71% good results consisting in evident amelioration of symptomatology, both subjective and objective.
Adult↗
[Occult breast cancer].
In 20 years we registered seven observations of breast cancer presenting as an axillary mass (BCAM), meaning 0.9% out of the global breast cancer series (767 cases). All the cases were females. The main clinical sign was only the presence of axillary lymph nodes. Diagnosis was precised by the pathological examination of the excised nodes (six observations) or needle aspiration of the axillary lymph nodes. Mammography showed tumors less than one centimeter in three out of the seven cases. As for the stadialisation, we had two cases in the II-nd stage, four patients in the III-rd stage and one in IV-th. All the patients were operated on. There were four simple mastectomies anti three Patey radical modified mastectomies. Postoperative chemotherapy and radiotherapy were performed to all the patients. Only two of the seven patients survived five years after surgery.
Aged↗