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Biomedical subjects

N Angelescu

Publications and source records attributed to N Angelescu.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[The useless appendectomy].

The appendectomy is still the most frequent operation in general surgery, being after performed without complete investigation. Because the appendix, through its lymphoid tissue with implication in the immunoglobuline secretion, has an important role in immunitary system criteria were searched to justify the appendectomy and to reduce the number of useless appendectomies, the proportion of the normal appendices being around 15%. Instead the basic triad-fever over 38 degrees C, parietal reaction and leucocitosis over 10.000/ml--measuring of reactive protein C, echography, CT, laparoscopy and antileucocite antibody labelled with TC99, would contribute to a better selection of patients for appendectomy. Surgeon's responsibility regarding the technique and the moment of operation, oblige him to take the proper decision.

Appendectomy↗
PubMedDate not supplied

[Pseudomyxoma peritonei (gelatinous peritonitis )].

UNLABELLED: Pseudomyxoma peritonei (P.P.) is characterised by the presence in the peritoneal cavity of 3 elements--mucinous neoplasic cells, mucinous ascites and diffuses mucinous implants. We analysed the patients treated in our service and we made a literature review. The study is a retrospective analysis on the 1984-2000 period. 6 patients were diagnosed with P.P., 2 females and 4 men, with medial age 63 years (53-75). Clinical findings and biologic analysis were not specific and the imagistic explorers didn't permit the preoperative diagnosis. The patients were submitted to variate surgical procedures, based on the benign (4 cases) or malignant (2 cases) character of the disease and on the origin of the lesions: cystadenoma of the appendix with secondary tumours of the ovary (the 2 females) and, respectively, cystadenoma and cytsadenocarcinoma of the appendix, mucinous paraenteric cyst with pseudomyxoma retroperitonei, mucinous recto-sigmoidian neoplasm (the 4 men). We practiced intraperitoneal chemotherapy with Thio-Tepa in 5 cases (intraoperative in 4 cases) and systemic, with 5-FU and mytomicine, in one case. The operative morbidity and mortality were null. All the patients were follow-up (average 4.2 years). The global 5-year survival rate was 60% (100% in the benign disease and 0% in the malignant form). CONCLUSION: P.P. is a rare disease, still poorly understood. The origin of the disease is the appendix (70-80%) and less frequently the ovary. It was divided in two distinct forms: disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. The treatment associates radical surgery and intraperitoneal chemohyperthermia, in specialised centres, but the prognosis still remains poor (50-70% 5-year global survival rate).

Aged↗
PubMedDate not supplied

[Breast cancer-estrogens relationship].

Variations of estrogen (produced mostly in the ovaries) are under enzymatic influence of aromatases, acting also as oncogenes through the cytochrome CYP17 and CYP19. Their degradation trough methoxylation, resulting in both carcinogenetic and protector compounds, is influenced by 2, 4 and 16 +/- hydrolases. Tissue sensibility to oestrogen depends on the amount of receptors and the plasma level of oestrogen. They are regulating cell's growth and differentiation, depending on subject's age. Paraclinic markers such as the amount of regulating receptors, plasma oestrogen level, breast density and bone density are elements in evaluating breast cancer risk. Among the risk factors of occurrence and development of breast cancer were cited also early menarche, late term pregnancy, late menopause, postmenopausal obesity, smoking and the diet rich in fats and fatty acids, alcohol and antioxidant vitamins.

Aged↗
PubMedDate not supplied

[Conversion in laparoscopic surgery].

AIM: The conversion causes evaluation in dynamics. METHODOLOGY: The study is a retrospective analysis of the conversion to open surgery in 1993-2001 period, indifferently of the moment and the determinant cause. The yearly dynamics of the conversions was divided by operation types and surgeons. There were also analysed the moment and the cause of the conversion. RESULTS: There were realised 3961 laparoscopic operations (by 7 experienced surgeons and a lot of young surgeons), with 244 conversions (6.2%), percentage variable depending of the operation (3.3% in hernioraphies, 5.3% in cholecystectomies, 8.2% in gynecologic procedures, 12.1% in appendectomies, 33% in abdominal esophagus procedures, 33% in splenectomies) and on surgeon (until 0% and 8%); the differences until the surgeons don't depend on their experience and for the same surgeon, the experience accumulation doesn't reduce the conversion rate. The most conversions happen after a simple inspection or a minimal dissection (73.1% in cholecystectomy) caused by the existence of plastron, the discovery of a difficult anatomic situation or of another pathology; more rarely, the conversion happens in the principal time (23.4% in cholecystectomy), doing to hemorrhage, impossible dissection, visceral injury or even at the end of the operation (3.5% in cholecystectomy), doing to hemorrhage, loss piece or calculs. CONCLUSIONS: The conversion rate depends especially on the correctness of the indication of laparoscopic approach and not on the surgeon experience, what proves that it is a moment of surgical maturity. Decide from the beginning, in the moment of the recognition of a difficult situation and not after the occurrence of a complication, modifies neither the morbidity, nor the much discussed hospital stay.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[Analysis of 3100 laparoscopic cholecystectomies].

AIM: To evaluate the results of laparoscopic cholecystectomy (LC) in the 8 years period. PATIENTS AND METHODS: First LC in Coltea Hospital was performed in September 1993 and introduced for treatment of patients with gallbladder disease. From September 1993 to February 2001 LC was performed in 3100 patients. Mean age 51.2 years (ranged from 8 to 87 years) among 2512 women and 588 men. 232 (7.48%) of the cases were patients with acute cholecystitis. Intraoperative cholangiography was performed in 112 cases (3.6%). RESULTS: Conversion to open cholecystectomy (OC) was necessary in 111 patients (3.58%). Operative complications occurred in 16 (0.5%) patients: CBD lesions in 4 (0.12%) patients, bleeding from cystic artery--12 (0.38%) patients. In one patient CBD injuries was recognized at the time of operation and after conversion to OC primary ductal repair was performed. Postoperative complications occurred in 44 (1.41%) patients: a) local infection--in 15 (0.48%) patients (subhepatic abcess-3, wound infection-9. b) bile leakage--in 21 (0.67%) patients. c) haemoperitoneum because of the bleeding: from the abdominal wall at the trocar insertion site--in 2 patients, from a. cystica-one patient. d) obstructive jaundice due to stone in CBD--in 5 patients (endoscopic papillosphincterotomy and stone extraction was performed). There 21 reoperations due to complications: 13 laparatomies and 8 relaparascopies. Two patients (52 and 64 years old) died after LC-mortality 0.06 per cent. Mean hospitalisation day was 3.8. CONCLUSIONS: To prevent iatrogenic CBD injuries correct preparation with a clear identification of the anatomic structures is essential. Relaparascopy and endoscopic retrograde cholangyopancreatography can be successfully used in the treatment of complications after LC.

Adolescent↗
PubMedDate not supplied

[The therapeutical strategy for locally advanced breast cancer].

As for the other cancers, the strategy of therapy of breast cancers is going to a unitary standardization. In our department between 1984-1999 we are operated 1040 patients with breast cancers, which means 25.3% of all cancers treated. 688 (64.3%) were CMLA, 646 (96.7%) of them were in patients women and 22 (3.3%) men. The mean age was 52.4 years (3-84 years). All patients were divided into two trials and analyzed: retrospectively (A) 312 (46.7%) and prospectively (B) 356 (53.3%) patients, 51.2% of patients was in III and IV TNM stage. The patients from trial B were treated concerning with specific therapeutically protocol, adapted by age, anatomopathological form, volume of tumor, skin or thoracic wall invasion, inflammatory lesions, lymph node invasion and physiological period. The results were: the increase of number of radical surgical interventions, the decrease of the morbidity, the increase of survival and a better quality of life.

Adenocarcinoma↗
PubMedDate not supplied

[The capacity of preoperative ultrasonography in predicting technical challenges in laparoscopic cholecystectomy].

UNLABELLED: Ultrasonography is a nonsophisticated, cheap and safe exploration, that makes it the most used non-invasive method in the diagnosis of biliary diseases. Present study aims to evaluate preoperative ultrasonography's capacity of predicting technical challanges in laparoscopic cholecystectomy (LC). MATERIAL AND METHOD: The trial is represented by a sequence of 100 patients undergoing LC in 2001. The conversions to open procedure were excluded. Patients with certified lithaisis were re-examined by ultrasonography the day before surgery. The sonographic features as size, volume (scleroatrophic gallbladder), function (distension, contraction), wall thickness, hydrops, number and size of stones, infundibular position (impactation) of the stones, perivesicular liquid collections hepatic and pancreatic aspects, main bile duct caliber were registered. During LC, the difficulty in performing the procedure was measured using a 10 points-score of following parameters: 1 peritoneal and perivesicular adhesions; 2. Difficult grasping of the gallbladder; 3. Cystic duct's dissection; 4. Cystic artery; 5. Liver bed; 6. Difficult cystic stappling; 7. Gallbladder's wall efraction; 8. Need for intraoperative cholangiography; 9. operative bleeding; 10. Operative time. RESULTS: Gallbladder's and the number, the size and infundibular impactation of the stones was significantly associated to ultraoperative difficulties (p < 0.05), the other parameters having not a sensitive influence upon LC procedure. CONCLUSION: Preoperative ultrasonography is able to furnish valuable data in predicting LC challenges.

Biliary Tract Diseases↗
PubMedDate not supplied

[ Epidemiological and clinical-therapeutical considerations on 500 operated cases of uterine cervix cancer].

AIM: Optimization of the treatment on uterine-cervix neoplasia, in a general surgery department. MATERIAL AND METHOD: Between 1984-1999, in Colţea Surgical Department were operated 746 uterine-cervix cancers. We selected two trials of 250 females, similarly regarding age and stadium. The A trial (250 females) were treated and operated 1984-1989, the study being retrospectively, and the B trial (250 females) treated and operated between 1990-1995, the study being prospectively by introduction of cisplatyn and carboplatyne chemotherapy in the advanced steadies. In the B trial, on registrated many mutations with negative epidemiological implications as: the grow the number of new cases, the diminution of immunity, the abandon of the screening, a possible grow of irradiations (Cernobâl accident), and the belated of presentation to medical consultation. RESULTS: The complex treatment, comparative in two trials, show a grow of lifetime, at 5 years in B trial from 82.1-93.4% in the 1st and 2nd steadies, 50.7-60.4% in the II B study and 12.9-28.5% in the III study. In the IV study the grow of lifetime was under 24 month. CONCLUSIONS: The resumption of the screening. Complexes therapeutical protocols for each study. Widely introduction of polichemotherapy in the advanced steadies.

Adenocarcinoma↗
PubMedDate not supplied

[The effects of cicatrizant wound compresses].

Cicatrisant collagen compress are biomaterials performed from type I collagen purified. Experimental studies including trials carried out in vitro and in vivo, demonstrated the biocompatibility of these biomaterials and their effect on accelerating the process of dermic wound re-epithelization. A subsequent stage of our investigations consisted in clinical trial of these cicatrisant compresses. These were applied to post-traumatismal wounds of variable areas or to 2nd and 3rd degree of deeper burns. The obtained results demonstrated that collagen biomaterials as cicatrizing compresses are well tolerated by human organism, they do not cause inflammations, necroses or other undesirable phenomena at the site of application. Also it was found that these biomaterials are not antigenic, since anticollagen type I antibodies were not present in nome of the treated patients' serum and accelerate the epitelization.

Burns↗
PubMedDate not supplied

[Ultrasonically activated scalpel in laparoscopic surgery advantages and limits].

UNLABELLED: The disadvantage of monopolar coagulation, the limits of the bipolar coagulation and the frequent changes of instruments during laparoscopic procedures, are three elements that make the harmonic dissectors very useful in laparoscopic surgery. MATERIAL AND METHOD: In Surgery Clinic were operated with anatomic scalpel (HS), in the last month: 50 cholecystectomies, 25 appendectomies, 12 partial ovarectomies, 10 anexectomies and 2 splenectomies. We used 5 and 10 mm instruments, especially the ETICON scissors. RESULTS AND CONCLUSIONS: After our short experience with HS and in concordance with literature, we consider that: The advantages are: the features to coagulate nearest delicate anatomic structures (biliary tree, large bowel, blood vessels) the absence of the smog and the slag; the scissors is a versatile device which allow the dissection and the coagulation without changes the instruments. The limits are: hemorrhages after insufficient coagulation or prehension, the necessity of the learning curve, high costs of the disposable materials. The HS device represent a real progress, especially for that laparoscopic surgery which requires the coagulation of blood vessels placed in thick and fat structures.

Dissection↗
PubMedDate not supplied

[Radical surgery in gastric cancer].

In gastric cancer the surgery with radical visa require to extirpate all the tumor and the reminder of the tumor (Ro), together with the great omentum and with regional extended lymphadenectomy. To extirpate the tumor it is necessary to be done gastric resection or total gastrectomy, depending on the localization, the extension of the tumor and the histological type, followed by the reestablish the digestive transit. The lymphadenectomy require lymph node extirpation (D1, D2, D3) accordingly the 3 lymph node stations-N1, N2, N3-, depending on the localization of the tumor and the stage of the disease. There are presented the technics for gastric resection and total gastrectomy and for extended lymph node extirpation.

Adenocarcinoma↗
PubMedDate not supplied

[Incidents, accidents and complications in laparoscopic surgery].

Between 1995-1999 in Colţea Surgical Clinic were performed 2498 laparoscopic operations (1957 cholecystectomies, 541 other procedures). The laparoscopic approach consisted in 1 to 6 ports of 5 to 12 mm. Conversional rate was, 176% and reintervention was required in 0.76% of cases. In 4 cases (0.10%) parietal bleeding imposed conversion or early reintervention. Parietal emphysema was not significant in our trial. Wound infection or chondritis occurred in 0.72% of cases; only one patient had to be reoperated. Post-incisional hernia developed in 0.08% of patients. We don't treat patients with cancer by laparoscopic approach, but the 4 patients with unknown neoplasia in our trial didn't develop port metastases. Our trial suggests the real benefit of the laparoscopic approach also concerning parietal morbidity.

Adolescent↗
PubMedDate not supplied

[Considerations on 988 breast cancers].

AIM: Therapy schedule improvement. MATERIAL & METHOD: The study includes 988 patients (which 16 men) with breast cancer who underwent surgery between 1984-1998. Out of them 63.2% were in advanced stages. The patients were divided in 2 homogenous groups: trial A = 520 patients treated between 1984-1991 (in stade: I = 2, II = 240, III = 246, IV = 32) studied retrospectively, and trial B = 468 patients treated between 1992-1998 (in stade I = 3, II = 212, III = 235, IV = 18) studied prospectively. In trial B the complex therapy schedule was improved according to disease's stade, local breast aspect and patient's biological status, straining on neoadjuvant therapy. To the entire group 945 radical mastectomies (95.6%) were performed. Only 628 (63.5%) could be properly followed up. RESULTS: Global 5 years survival rate was 72% (improved from 69% in trial A to 72% in trial B). The survival rate varied according the stage from 100% (stade I), 88% (stade II), to 22% (stade III) and 2% (stade IV). In the advanced states, the local recurrencies at 5 years were of 22% and the methastases of 17%. CONCLUSIONS: The neoadjuvant therapy, selectively applied upon stade and patient improves the 5 year survival rate. Every patient with an advanced breast cancer can benefit of a complex, differentiated and well guided treatment. The adequate operation earn the important role in powering the neoadjuvant and adjuvant therapies. Further results improvement requires restarting the collectivities and high risk persons screening.

Adenocarcinoma↗
PubMedDate not supplied

[The place of conservative surgery in the complex oncologic treatment of breast cancer].

For a long time, breast-conserving surgery has been a subject of great interest and debate. Many researchers have tried to find strict criteria in selecting the patients who can benefit from such a treatment but this remains a goal to achieve in the future. In our surgical department, from 1984 to 2000, 1152 patients were diagnosed with breast cancer. 741 patients (64.1%) had advanced breast cancer and 411 patients (35.6%) were diagnosed in I and II stages. From the patients with early breast cancer only 57 (14.1%) had benefited of conservative surgery combined with adjuvant radiotherapy and chemotherapy. All patients received hormonotherapy. The surgical treatment consisted in a broad sectorectomy and axillary lymphadenectomy in all cases. We present the criteria for selecting patients in our study. The patients were followed for 2-5 years, with a mean period of 48 months and there were no significant differences between the trial with mamectomy and that with conservative surgery. There is presented a brief review of the literature in this field. Our conclusion is that the conservative surgery for breast cancer is a good method, which can be applied for selected patients and with a good follow-up.

Adult↗
PubMedDate not supplied

[The rectal cancer--between resection and amputation. Surgeon's decalogue].

The surgeon has the opportunity to use a lot of treatment choices taking into account the site, the progression and the aggressiveness of the rectal tumors. If the treatment of anal cancer have been the same over the last years there are a few problems regarding the rectal cancer, especially for the one, which is distal and locally advanced. The therapeutic choice must take into account the following factors: the site of the tumor, the circumferential invasion, the local and distant spread, the complications and loco-regional recurrences, the anatomical shape of the pelvis, the possibility of developing tumor implants on the residual rectum, the equipment of the hospital, the experience of the surgical team, the accuracy of stoma technique, and the previous results in patients survival. In a trial of 381 patients with recto-sigmoidian and anal cancers we performed 171 rectal amputations, 29 Hartmann procedures and 76 laparotomies and colostomies. From the 276 patients with colostomy 172 (62.31%) were followed. The survival rate was: 6-10 months for the patients with laparotomy and colostomy, 16-24 months for those with palliative procedures (55.8%) and 5-17 years for those with radical procedures. From the point of view of the authors the rectal amputation with colostomy it is an alternative between oncological safety and patients comfort. This kind of surgical procedure must be done in specialized centers excepting the emergencies.

Aged↗
PubMedDate not supplied

[Mini invasive surgery--"a new era"].

Miniinvasive surgery together with general anesthesia, the antibiotherapy and the transplant, the argon laser, the electric and ultrasound scalpel, the mechanical sutures and imagistic techniques are "a new surgical era". The cystoscope Nietze, the Veres needle and the insufflations system with flow and pressure control, the improvement of laparoscopes, the invention of endoscopes with optical fibers, the miniaturized video camera connected to a video monitor and the fabrication of instruments of 10, 3 and 3 mm diameter permitted the rapid develop of miniinvasive surgery. This, from a diagnostic method, progressed with success to therapeutics procedures in the field of general, thoracic, urology, orthopedic, vascular and neurological surgery. The miniinvasive surgery associated with endoscopic surgery resolve some of the illnesses with small tissues lesions, with decreasing the sufferance and the number of complications, also decreasing the hospitalization period and facilitate the socio-professional re-entrance and increasing the quality of life. The miniinvasive surgical practice need good open surgical skills and a "learning curve" for each procedure also need to keep fundamental principium. The conversion is not a fail but an aspect of surgical maturity.

Humans↗