Biomedical subjects
Publications and source records attributed to I Juvara.
Based on 17 observations the authors review the major etiopathogenic, evolutive, clinical and therapeutic aspects of pancreatic fistulae. In 14 cases the cure was achieved by medical treatment while surgery was resorted to in only three cases. The medical measures are discussed, as well as the indications for surgical treatment.
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In the paper a systematic analysis is carried out of postoperative complications of colon surgery, 118 patients had complications, out of a total of 400 interventions on the colon. The complications are studied in relation with the time of their occurence and the localization of the neoplastic process, as well as from the point of view of the influence exerted by age and the "background" of the patients. A review is also made of the therapeutic attitudes required by the various complications, of the results obtained and finally a detailed analysis is presented of the causes that led to death of operated patients.
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In spite of the contemporary progresses in the field of surgical therapies, of the use of antibiotics, and of resuscitation techniques, resection of the colon with closure of the distal end and terminal colostomy, as suggested by Hartmann at the start of the century, has still some indications. Moreover, beside the original indications, this type of intervention can also be aplied in the case of some other benign lesions, and extension of the colon resection may involve other areas beside the recto-sigmoid zone. The specific indications of the intervention are the severe, very extensive and usually complicated lesions of the colon, frequently associated with a general biologic deterioration, conditions that make highly improbably the success of other surgical procedures. In a group of 28 patients (4,6 percent of the total number of cases in which interventions on the colon have been performed), of which 15 neoplasies and 13 benign lesions, the following resections have been carried out: 19 sigmoid resections, one resection of the transverse colon, 3 rectosigmoid resections, one left hemi-colectomy, 2 sub-total colectomies, 2 interventions for dehiscence of anastomoses. Considering the critical condition of the patients the high post-operative mortality appears to be easy to explain, as well as the non-lethal septic post-operative complications. In 7 patients (25 percent of the survivors) secondary restoration of the transit was carried out (4 benign lesions, and 3 cases of neoplasy). Reconversion raises some tactical and technical problems concerning the time of the intervention, the route, the attitude in front of colostomy, the mobilization of the segments and the type of anastomoses.
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Problems of diagnosis, classification, and histologic definition, as well as possibilities of evolution are discussed, of teratomas or of tumours resulting from the disturbed development of the sacro-coccygeal area, in connection with a case of recidivating sacro-coccygeal teratoma in a woman aged 40 years. The therapeutic principles are also discussed The risk of malignant degeneration of these lesions, in parallel with their evolution in time, make necessary surgical exeresis immediately after making the diagnosis. Surgery should be performed with a maximum amount of comfort, under general anesthesia, preferably in the Kraske position, in view of the complete extirpation of pathological tissues. Resection of the coccyx and of the last sacral vertebrae allows to widen the approach, facilitating the complete exeresis, and avoiding the two risks which are characteristic for this intervention: lesion of the rectum, and haemorrhage which is difficult to control. The postoperative aspiratory draining is useful for the favourable evolution of the wound.