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Biomedical subjects

I Popescu

Publications and source records attributed to I Popescu.

At least 91 records · Page 5Linked to original sources
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

[The use of LapSim virtual reality simulator in the evaluation of laparoscopic surgery skill. Preliminary results].

The aim of this study is to establish if the results obtained in the evaluation of the candidates for the laparoscopic surgery competence using the LapSim virtual reality simulator are comparable with intraoperative evaluation. For this study has been evaluated in front of the LapSim and in the operating room a number of 12 surgeons who have achieved the criteria for laparoscopic surgery competence evaluation. The results of any one of the candidates have been evaluated, on Lapsim and by the exam committee in the operation room relating to four criteria: (1) utilization of 300 camera; (2) manipulation and coordination of laparoscopic instruments, suturing; (3) grasping and cutting; (4) clip applying. The evaluation has been made relating to the time need for every candidate to perform the asked task, and the subjective evaluation of the examining committee with marks from 1 to 10. The LapSim evaluation, in concordance with intraoperative evaluation managed to establish 2 candidates with deficiency in manipulation and coordination of laparoscopic instruments, and difficulty in the laparoscopic bidimensional field orientation. We consider this experiment only the beginning in the evaluation of the utility of virtual reality simulator in the training and examination of the results in laparoscopic surgery. We consider that large series of subjects with different levels of knowledge in laparoscopic surgery have to be evaluated to conclude if the benefit of laparoscopic surgery virtual reality simulator is the same as in airplane pilots.

Clinical Competence↗
PubMedDate not supplied

[Orthotopic liver transplantation in adult patients with cadaveric grafts. Experience of the Fundeni Center of General Surgery and Liver Transplantation].

We analyze the experience of the Center of General Surgery and Liver Transplantation from the Fundeni Clinical Institute (Bucharest, Romania) regarding orthotopic liver transplantation (OLT) in adult recipients, with whole liver grafts from cadaveric donors, between April 2000 (when the first successful LT was performed in Romania) and December 2004. This series includes 37 OLTs in adult recipients (16 women and 21 men, aged between 29-57 years--average 46 years). Other two LT with whole liver cadaveric grafts and two reduced-size LT were performed in children; also, in the same period, due to the acute organ shortage, other methods of LT were performed in 28 patients (21 living donor LT, 6 split LT and one "do mino" LT), that were not included in the present series. The indications for OLT were HBV cirrhosis--10, HBV+HDV cirrhosis--4, HCV cirrhosis--11, HBV+HCV cirrhosis--2, biliary cirrhosis--5, Wilson disease--2, alcoholic cirrhosis--1, non-alcoholic liver disease--1, autoimmune cirrhosis--1. With three exceptions, in which the classical transplantation technique was used, the liver was grafted following the technique described by Belghiti. Local postoperative complications occurred in 15 patients (41%) and general complications in 17 (46%); late complications were registered in 18 patients (49%) and recurrence of the initial disease in 6 patients (16%). Intrao- and postoperative mortality was 8% (3/37). There were two patients (5%) who died because of immunosuppressive drug neurotoxicity at more than 30 days following LT. Four patients (11%) died lately because of PTLD, liver venoocclusive disease, recurrent autoimmune hepatitis and liver venoocclusive disease, myocardial infarction, respectively. Thirty-four patients survived the postoperative period (92%); according to Kaplan-Meier analysis, actuarial patient-survival rate at month 31 was 75%.

Adult↗
PubMedDate not supplied

A rare indication for liver resection.

We present the rare case of a young female with a right upper abdomen tumoral mass and suffering abdominal discomfort. A combination of ultrasonography, computed tomography, magnetic resonance imaging and laparotomy was utilized to conclude a diagnosis of Riedel's lobe. Laparotomy and a resection of Riedel's lobe were selected as the correct therapeutic solutions.

Adolescent↗
PubMedDate not supplied

[Therapy of malignant liver tumors using microwave and radiofrequency ablation].

The aim of our study was to evaluate the efficiency for thermo-ablation with microwave and radiofrequency on patients with malignant liver tumors. From January 2002 to January 2005, in our Center of General Surgery and Liver Transplantation in 53 patients 70 sessions of thermoablation were carried out. The mean age was 58 years (25-79 years). Sex ratio men: women was 1.8 (34:19). The diagnosis was hepatocarcinoma in 38 patients (72%), liver metastases from colorectal cancer in 9 (17%) and from non-colorectal cancer (6-11%). The most tumors were single (36-68%). The mean diameter was 39.5 mm (9-94 mm). Percutaneous approach was used in 14 interventions (20%), laparoscopic in 2 (3%) and open approach in 54 cases (77%). We performed 54 sessions of microwave ablation in 42 patients and 8 sessions of radiofrequency ablation in 5 patients. Both methods were applied in 6 patients during 8 sessions. Tumor ablation was done together with liver resection in 10 patients (19%) and resections of other organs in other 8 patients (15%). Morbidity was 12%. The encountered complications were ascites, right pleural effusion and liver abscesses. There was no death. Total and partial necrosis was observed in 27, respectively 20 patients. Local recurrence occurred in one patient but distal liver recurrences were diagnosed in 13 patients. After thermoablation for partial necrosis, local or distal recurrences patients received arterial chemoembolization (5), systemic chemotherapy (23), liver resection (1) and transplantation (1). The mean survival at 1 year and 3 years was 77% and respectively 38%. Microwave or radiofrequency ablation is a simple treatment method, with proved efficiency and minimal risks whose main indication is unresectable tumor.

Adult↗
PubMedDate not supplied

[Thoracoscopic thymectomy in the treatment of myasthenia gravis].

A series of 151 thoracoscopic thymectomy performed in the Department of General Surgery and Liver Transplantation of the Fundeni Clinical Institute between April 1999 and April 2004 is analyzed. These were 89.34% from all the thymectomies performed in our department in this period. Thoracoscopic thymectomies were performed on 131 female patients (86.75%) and 20 male patients (23.25%), aged between 8 and 60 years. All patients were previously treated in the Neurological Department of the Fundeni Clinical Institute for at least 3 months. The thoracoscopic thymectomy was indicated for: myasthenia gravis without thymic neoplasia (141 cases), stage I Masaoka thymoma (8 cases), remnant postoperative thymic tissue (3 cases). We have used a left thoracoscopic approach in 73 cases and a right thoracoscopic approach in 76 cases. In 2 cases a mixed cervical and thoracoscopic approach was needed.. No mortality and morbidity 6.62% (10 cases). From this 151 patients 100 have been constantly followed for more then one year. From the other 51, 32 are in the first postoperative year, and the other 19, 12.58% have been lost in surveillance. The one year evaluation regarding the Research Standards of Myasthenia Gravis Task Force Foundation shows: improvement--90% (complete stable remission--14%; pharmacological remission--20%; minimal manifestation--56%), unchanged--8%, worsened--2%. Our results with a complete stable remission of 14% at the end of the first year and 50% at 5 years are at least comparable with literature results with other open or thoracoscopic approaches.

Adolescent↗
PubMedDate not supplied

[Pulmonary embolism--complication of proximal deep venous thrombosis in colorectal cancer. Diagnosis and management].

We present the case of a 57 years old male, without cardiovascular history, with colorectal cancer and proximal deep venous thrombosis, who develops a massive pulmonary embolism. The surgical treatment consists in embolectomy of right ventricle, pulmonary trunk, left and right pulmonary artery. The specifics of the case is discussed: etiology and prevention of pulmonary embolism (caval filter) and treatment: the contraindications of thrombolytic therapy and the indications and perspectives of surgical treatment.

Colorectal Neoplasms↗
PubMedDate not supplied

[Current treatment of hepatocellular carcinoma. Analysis of a series of 123 cases over a 5-year period].

We analyze a 123-cases experience over a 5-year period in the treatment of hepatocellular carcinoma (HCC). Liver resection, transplantation and hyperthermic ablation of the tumor were used according to the indication and patient selection. Systemic chemotherapy followed resection in 18 cases and hyperthermic ablation in 5 cases. Chemo-embolisation was performed in patients to be transplanted and in other two patients with tumor destruction. A number of 86 liver resections were performed in 84 patients (2 re- resections in 1 patient, subsequently transplanted) - 43 on normal liver and 41 on cirrhotic liver. Postoperative mortality was 4.7% in non-cirrhotic and 4.9% in cirrhotic patients. Survival in non-cirrhotic patients was 77% at 1 year, 65% at 2 years, and constant - 45% at 3 and 4 years, whereas in cirrhotic patients it was 60%, 56%, 56% and 36% (Kaplan-Meyer actuarial survival rates). Nine patients underwent liver transplantation (4 OLTs, 3 living donor LT, 1 split LT and 1 "domino" LT); postoperative mortality was 11% (1 patient). At present five patients are alive and well. One patient died by peritoneal carcinomatosis at 10 months; another patient died at 6 months by severe cholestatic recurrent C virus hepatitis and one patient was discharged with permanent severe neurologic disturbances. In 31 patients hyperthermic ablation of the tumor was used with zero mortality. Actuarial survival rates were 75% at one year and 67% at 2 years. In conclusion, in non-cirrhotic patients with HCC resection is the treatment of choice. In cirrhotic patients limited resections should be preferred and liver transplantation is the best solution in selected cases; local ablative methods may be used for some unresectable tumors. The role of adjuvant chemotherapy has to be determined in future comparative studies.

Actuarial Analysis↗
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[A rare cause of lower digestive hemorrhage--jejunal diverticulosis].

Small bowel diverticula are usually asymptomatic and rare. Digestive bleeding is a rare complication of jejunal diverticulum whose diagnosis and treatment are difficult. We report a rare case of hematochezia whose origin was a proximal jejunal diverticulum and not determined by endoscopic investigations. Bowel resection with primary anastomosis was the chosen surgical procedure. There was no complication until discharge nor was any recurrent bleeding or functional disorder of the bowel reported during follow-up. The clinical presentation, the different value of diagnostic tools and the therapy are discussed.

Aged↗
PubMedDate not supplied

[Central pancreatectomy--indications, technique, outcomes].

Central pancreatectomy is a conservative resectional procedure indicated for benign and low malignant tumors located in the neck and/or body of the pancreas. We report our experience on 5 patients and some considerations about this surgical technique from medical literature.

Adolescent↗
PubMedDate not supplied

[Double localization of pancreatic insulinoma. Diagnostic and therapeutic difficulties].

Insulinomas are the most common cause of hypoglycemia resulting from endogenous hyperinsulinism. Because most of insulinomas are less than 2 cm in size and rarely they not may be visible by CT scan or transabdominal ultrasonography. Intraoperative ultrasonography may be a solution. Although as surgical method is preferred enucleation because operative time is shorter and easier and the low frequency postoperative complications, pancreaticoduodenectomy Whipple is indicated in selected cases. We report a case of double insulinoma located in the head of the pancreas in which the diagnosis and surgical treatment presented difficulties which determined a particular clinical evolution.

Female↗
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↗