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Biomedical subjects

I Popescu

Publications and source records attributed to I Popescu.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

The causal diagnosis of obstructive jaundice. A Bayesian approach.

To compare the contribution of clinical, laboratory and imaging data for the diagnostic accuracy in establishing the cause of obstructive jaundice, the records of 333 patients operated on for a presumed obstruction of the biliary ducts were analysed. The final diagnoses, after surgery, were divided into six groups: stones of the gallbladder and biliary tract, pancreatic cancer, biliary tract neoplasms, ampullary carcinoma, postoperative stenosis of the bile ducts, intrahepatic cholestasis (biliary cirrhosis, chronic cholangitis) and other causes of jaundice (liver tumours, cysts, extended cancer of the upper abdomen). Twenty-three parameters (9 clinical symptoms and signs, 10 biochemical alterations and 4 imaging methods) were examined. Not every case had all the investigations performed but the number of each group of data was large enough to allow a statistically significant conclusion. The contribution of each of the 23 parameters in increasing the probability of correct diagnosis was determined using a computer program based on Bayes' theorem. This analysis showed that for patients which presented suggestive clinical signs and symptoms for stones of the gallbladder and biliary tract and for pancreatic cancer, the diagnosis can be predicted with a probability of 90% only on the basis of clinical findings. The probability of a correct preoperative diagnosis was increased to 99% by imaging methods. On the contrary, for patients with a less clear diagnostic probability (with ampullary carcinoma, intrahepatic cholestasis and other causes) only ultrasonography and computed tomography could increase the probability of correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Bayes Theorem↗
PubMedDate not supplied

[Surgical attitude in cancer of the ovary].

The authors start from the observation that some of the clinical forms of ovarian cancers determine hospitalization and resolution of the cases in surgical departments. They have also based their study on their personal experience acquired over a period of 20 years, during which they have operated on 180 patients. They noted that the best surgical attitude was not adopted in all of the cases and make an analysis of various methods applied, such as the radical ones, the conservative procedures, and those aimed at a reduction of the tumoral mass. The value of associated therapies is presented, consisting in surgery, chemotherapy and irradiation.

Adenocarcinoma↗
PubMedDate not supplied

[Duodenal tumors].

Explore the source record for details and available documents.

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

[Mechanical digestive system suturing devices].

Between 1994 (December)-1996 (May) 150 patients have been operated on using one or many stapling devices. The staplers disposable to us were the "Linear Cutter" or GIA (Gastrointestinal Anastomosis), "Linear Stapler" (TA) and "Intraluminal Circular Stapler" or EEA (end-to-end anastomosis) types, produced by ETHICON (Johnson and Johnson Ltd. Company). The principles operations performed were various digestive resections, intervisceralis anastomosis and interventions of reconstructions (in oesophagus surgery, ileal pouch etc.). The advantages of staplers applications are: a) the reduction of the time of operation, of the anesthesia, of the blood loss; b) a soft manipulation of the tissues; c) a smaller inflammatory reaction and the prevention of intraoperative septic contamination and d) a better and faster take back of the functionality of the anastomosis. There were only 4 intraoperative haemorrhages easy controllable. Postoperative complications: a) 3 haemorrhages medically treated; b) immediate leakage 1 patient after colorectoanastomosis, treated by Hartman colostomy; precocious, 7 patients and after 4-6 month, 2 patients. Corrective iterative interventions were necessary only in 5 patients. The operative mortality-1 patient, the cause of death being a bronhopneumonia after a radical oesophagectomy with oesophagoplasty (oesophageal cancer). There was not postoperative mortality depending of stapling application. We don't observed late postoperative complications like stenosis of various anastomosis, quoted in the literature, because the time of following of our 150 patients is too short (maximum 18 months). The conclusions are that the stapling devices are a real surgical progress with the conditions of a correct indication and adequate tactics and operative technique. The economical effort is justified and entirely compensated by the major benefits obtained for the patients.

Anastomosis, Surgical↗
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↗