Biomedical subjects
Publications and source records attributed to N Jitea.
Two cutaneous postoperative fistulas--pancreatic and biliary--was solved by an anastomosis of maturate fistulas traject with duodenum and respectively an Y jejuno loop (Roux) with good results.
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.
The evaluation of the frequency of complications that arise after colostomies performed for colorectal and genital neoplasm, and also the treatment possibilities for these complications. In Colţea Hospital, Surgical Department during 1984-2002 there have been admitted and surgically treated 891 patients with colorectal cancers, among which, 484 had rectosigmoidal neoplasm. We have treated 25 patients with complicated genital neoplasm (19 rectovaginal and recto-bladder-vaginal fistulas following cervical cancers, 5 pelvic tumoral blocks following ovarian cancers and a vulvar cancer with local invasion). For all these patients we performed: 25 Hartmann resections, 75 Reybard resections, 73 Dixon resections and 147 rectal amputations, with 294 colostomies (30 iliac anus in continuity-Audrey, 18 on a stick, 232 terminal and 14 cecostomies for protection or decompression). There were 48 complications following the colostomies: 10 cases of stenosis, 14 prolapses, 7 intestinal loop necroses and 17 parastomal hernias, all of them surgically managed. Terminal colostomies and colostomies for protection are still frequently used in surgical departments, having strict indications. Because they are frequently performed as emergencies, at patients with poor biological status they are often enough followed by complications, most of them with little gravity. The complications can be avoided by a proper therapeutic choice and in most cases can be managed with a surgical intervention.
The laparoscopic fundoplication became the gold standard of the laparoscopic antireflux surgery (LARS). Our aim is to indicate the evolution of the learning curve as well as its consequences on the patient's outcome. We studied the gastro-esophageal reflux (GER) cases treated laparoscopically in Colţea University Hospital throughout 6 years. We gathered a group of 40 patients with an average age of 54, 57 years and a sex ratio F:M = 1.67. The patients had either a simple GER disease, small and medium hiatal hernias (21 cases) or giant hiatal hernias (GHH--19 cases). Two equal groups resulted: group 1 consisted of the first 20 patients operated from 1999 to 2002, group 2 consisted of the rest of the patients. Operating time, hospital time, complication rate and postoperatory endoscopy were compared. The average of the operating time was calculated. For giant hiatal hernias, a separate average was also taken into account. The total operating time for GER, small and medium hiatal hernias was 115 min in group 1 and 80 min in group 2 meanwhile for GHH it was 143 min vs. 130 min. The average operatory time was 129 min vs. 105 min. All these differences were statistically significant but there were no differences concerning complication rate and post-operatory endoscopy. Although the learning of the laparoscopic fundoplication requires practice, the learning curve does not have influence on the patients' outcome.
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The authors present the experience of the clinic on a group of 26 patients admitted and operated in the Clinic of Surgery, the Colţea Hospital, during 1984-1987. The paper reports, in general, on the indications for biliary derivations and then specifies the morphopathological situations met intrasurgically. Their correlation with the indices of postsurgical morbidity (12.5%), postsurgical mortality (0.8%) and length of postsurgical survival (8.2 months) shows their efficiency.
The authors analyze five cases of concomitant development of two major complications of duodenal ulcers: perforation and haemorrhage. Particular problems of surgical tactic and technique are discussed.
The authors present 4 cases of "effort" thrombophlebitis of the upper limb that were diagnosed both clinically and thrombophlebographically, and in whom classical therapy was applied: total rest, anticoagulants, elevation of the limb. All the cases had sequels of variable intensity, and in 2 of the patients Roos' transaxillary route was used which revealed a double anterior scalenus muscle insertion, and compressive fibro-sclerous tissue. The pathogeny of the affection makes mandatory the removal of extrinsic or intrinsic factors which may generate a new thrombosis or vascular and neurologic sequels.
The paper reports on the authors' experience in the surgical emergency of a special category of patients: pregnant women with acute affections requiring surgery. The clinical aspects, sometimes deceptive, diagnosis difficulties and tactile and technical surgical attitudes are presented in detail.
The paper reports on 14 cases of perforating plantar disease of whom 11 belong to the so-called nonpainful chronic plantar ulceration by compression of the posterior tibial nerve in the tarsal canal. The authors show clinically, neuroelectrically and by neurography with lipiodol that in the case of a diabetic or alcoholic polyneuropathy, the posterior tibial nerve is more vulnerable to the compression existing in the tarsal canal due to the development of a fibrous sclerotic tissue. Exo-endoneurolysis of the posterior tibial nerve associated with a posterior tibial periarterial sympathectomy permitted healing in 7 ulcerations, 2 diminutions of the ulceration dimensions, and only 2 remissions. The four cases of unfavourable results were in patients with old lesions who continued alcohol consumption.
The authors present their personal experience on the basis of a retrospective analysis of 127 cases of nonlithiasic cholecystopathies operated between 1984 and 1987. Clinical and radiologic criteria were analyzed, that have led to surgery, and conclusions reflect the postoperative results.
Oesophageal temperature was recorded after induction of anesthesia, and further, at one, two and three hours. Temperature in the operation hall was continuously monitored. In relation to the temperature in the operating hall the effects on the patient were of three kinds: 1. operating halls with low temperatures (under 21 degrees C) where all the patients become hypothermic; 2. operating halls with an intermediate temperature (21-24 degrees C), where 67% of the patients remain normothermic; 3. operating halls with high temperatures (above 24 degrees C) where all the patients remain normothermic, although these temperatures are uncomfortable for the medical personnel, and increase the septic risk of the patient. When the oesophageal temperature of the patients falls by 0.5 degrees C chills will occur in 40% of the patients. Thermal falls of less than 0.5 degrees C will also determine chills but in only 10.5% of the cases. Immediate postanesthesia chills are also recorded in normothermic patients, but there is a direct relationship between the temperature in the operating hall, the degree of hypothermia and the frequency of chills, while the site of the surgery or the duration of the operation have but an unsignificant influence on intra-anesthetic temperature.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.