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Biomedical subjects

N Jitea

Publications and source records attributed to N Jitea.

52 records · Page 3Linked to original sources
PubMedDate not supplied

[Laparoscopic appendectomy in obese patients. A comparative study with open appendectomy].

The aim of this study is to show the advantages of laparoscopic versus classic appendectomy in obese patients. The trial includes 32 obese patients which underwent laparoscopic surgery for appendicitis in our clinic, compared to a similar trial of patients with open surgery. In both o trials we followed-up the operating time, postoperative pain, hospitalization and social and professional reintegration. We noticed that in laparoscopic appendicectomy patients postoperative pain and hospitalization are reduced, the bowel transit restants rapidly and spontaneously, there are no wound complications and patients recover faster. The disadvantages consisted in longer operative time and higher cost of the laparoscopic operation versus classic appendectomy.

Acute Disease↗
PubMedDate not supplied

[A case of abdominal pregnancy--a case report].

Rare anatomical variety, the ectopic abdominal gestation involve a high maternal and foetal risk. On report an abdominal gestation in the 2nd quarter of evolution at a 42 yrs. age of a female with multiple uterine leiomyomas, the diagnosis being establish by ultrasonography. The attitude in the same cases is decided by the foetal viability: if the foetus is in a life, the pregnant women is hospitalised and followed each day; if the foetus is dead, there are indication of surgery, the major problem being represented by the total or partial removed of the placenta.

Adult↗
PubMedDate not supplied

[Cancer of the head of the pancreas with a unique evolution].

Case report of a 67-years-old man with cephalopancreatic carcinoma and a peculiar evolution, undergoing several operations. The diagnostic was established 3 years ago through a peroperative pancreatic bioptic puncture, followed by choledochoduodenostomy considering the tumor as inextirpable. After 2 1/2 years symptoms of high occlusion and upper digestive bleeding caused by duodenal invasion and a Wölfler precolic gastrojejunostomy was performed. After 4 month the upper digestive bleeding relapsed severely imposing the second reintervention (cephalic duodenopancreatectomy with a special montage). The evolution was favourable, the clinical, biological and imagistic control at 6 month showing the absence of recidive.

Adenocarcinoma↗
PubMedDate not supplied

[A comparative study of the laparoscopic and classic treatments of inguinal hernias].

AIM: of this study is to compare two similar groups presenting inguinal herniae, one group having laparoscopic herniography and the other having a Bassini or Fruchaud repair. METHOD: Since September 1994, in our department, patients presenting with symptoms of unilateral or bilateral inguinal herniae to our practice were offered the transperitoneal or preperitoneal approach as an alternative of open surgical repair. We considered the first 50 patients operated by laparoscopic technic (35 M and 15 F), age between 22-72 years (group A), and similar group operated by Bassini or Fruchaud technic (group B). All the patients had general anesthesia and perioperative antibiotics. In the group A we used Prolene, Mercilene or Plastex mesh. The following parameters were assessed: 1) operative time from incision to closure: 2) amount and type of analgesia required postoperatively; 3) morbidity related to the procedure; 4) interval before returning to full activity; 5) early recurrence rate; 6) hospital cost. RESULTS: The mean operative time for unilateral herniae in group A was 70 +/- 10 minutes versus 40 +/- 12 minutes in group B. Group A required to return to work was significantly shorter for the patients in group A (7 +/- 3 days) compared with group B patients (25 +/- 10 days). Although no recurrent herniae have yet been found in patients from either group; follow-up was only 2-18 months in the two groups. The cost of hospital care of group A patients exceeded that of group B by approximately 1.7 more. IN CONCLUSION: was consider that although is more expensive, the laparoscopic procedure in treatment of inguinal herniae, has more benefits for the patients.

Adult↗
PubMedDate not supplied

[Diagnostic and treatment problems in primary malignant tumors of the small intestine].

Between 1984-1994, 8 cases of MTSI (7 males and one female, between 24-53 years age) have been operated in our Department, representing 2% from all malignant gastrointestinal tumours. The pain as a result of the obstruction, followed by chronic blood loss with anemia and perforation, (4 patients operated in emergency) were the most frequent symptoms, the tumors being localised on jejunum (3) and ileum (5) with a diameter to 3-15 cm. Lymphatic (4), hepatic (2) and peritoneal (I) metastases were present. We performed a wide resection of the bowel and mesentery, including lymph nodes (in 4 cases with radical intention). Histopathological findings: 4 adenocarcinoma, 3 leiomyosarcoma and a lymphoma. Postoperative treatment was selective and consisted in polychemotherapy (PCT) and cobalt therapy (60Co). There was no postoperative mortality, two local recurrences in 6 month. Survival rate at 5 patients was 32 month. At 5 years were in life 2 leiomyosarcoma and 1 adenocarcinoma and at 7 yrs, 1 leiomyosarcoma and 1 adenocarcinoma.

Adenocarcinoma↗
PubMedDate not supplied

[The role of clivarin in the preventive therapy of thromboembolism].

UNLABELLED: Our paper represents a synopsis of the main mechanisms by which low-molecular-weight heparins act as pharmacodynamic stabilizing factors of the liquid coagulation balance, in the postoperative period. Today we note three main phases in the coagulation mechanism: 1. partial thrombin activation; 2. positive thrombin-mediated feedback; 3. explosive thrombin formation. Low-molecular-weight heparins (Clivarine-mean molecular weight = 3900 D) act as selective inhibitors an factor X a (anti-thrombotic action), and as weak inhibitors on factor II a. The authors' experience includes 321 patients, who received Clivarin as preventive therapy for thromboembolic disease. Most of the selected patients are included in groups 2 and 3 for thromboembolic risk--and have undergone general surgery and oncological surgery. The dosage and duration of the treatment have been the usual ones. The main clinical observations we noted are: 1. excellent tolerability of Clivarine; 2. no modifications of usual biological values; 3. no adverse reactions were noted. There were no deleterious interferences between Clivarine and the usual postoperative medication of the surgical patient, 4. among the incidents, we note 12 postinjection haematomas, which were spontaneously cured. CONCLUSIONS: Low-molecular-weight heparins are considered today drugs of election in the medical and surgical thrombosis prophylaxis.

Contraindications↗
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[High obstruction in strangulated diaphragmatic hernia].

Case report of a 57-year-old man, admitted in emergency, because of high occlusion and severe dyspnea. The physical examination and the imagistics explorations established the diagnostic of strangulated left diaphragmatic hernia. After a short re-equilibration, the surgical approach was made by left thoracophrenolaparotomy and on realize the visceral reduction, the treatment of visceral injuries and the plasty of the pretty high diaphragmatic defect with a nylon mesh. The postoperative evolution was difficult, with hemorrhagic gastropathy, blocked evisceration, pneumonia and left pleural empyema. The control at 10 months show a patient appearing very well, with a voluminous eventration (who need surgical treatment) with normal image on the chest radiography, left hemidiaphragm in normal position and immobile, the gastrointestinal tract sitting intraabdominal, without parietal injuries.

Emergencies↗
PubMedDate not supplied

[Left lumbar sympathectomy via the retro-pneumoscopic approach. The technical considerations].

Retropneumoscopic lumbar sympathectomy is performed with an increasing frequency as a treatment of chronic obstructive arteriopathies; though the method has limited indications. We present the operative technique as it was performed în the Colţea Surgical Department in 2 patients. We highlights on difficulties advantages and disadvantages of the method.

Arterial Occlusive Diseases↗
PubMedDate not supplied

[The repair of voluminous postoperative abdominal wall defects with synthetic mesh].

Important postoperative abdominal wall defects, especially recurrent or multirecidivated ones, are raising multiple problems to the surgeon. We are presenting a homogeneous trial of 209 patients with such lesions, in which the abdominal wall repair was made with different kind of synthetic materials, with good results. In a single case the mesh was rejected, because a silent quiescent infection. In three patients undergoing iterative abdominal operations for other diseases we performed optical and electronic microscopical studies showing out that the material integration was done by normal biological reaction. This provides the materials' tolerability and a normal reaction of the organism.

Abdominal Muscles↗
PubMedDate not supplied

[Hydatid cyst of the head of the pancreas--a clinical case].

Case report of a 41-year-old man, admitted because of intense sclero-tegumentar jaundice, epigastric pain and brings. The altered general state, because of obstructive jaundice (the total bilirubyne 9.6 mg%, with D 5.8 mg% and I 3.8 mg%, the alkaline phosphatase 650 u.i./l) determined the effectuation in emergency of an endoscopic retrograde cholangiopancreatography, which included also a minipapilosfincterothomy. On obtained the spectacular improvement of the jaundice (the total bilirubyne 1.3 mg%) which permitted the extension of the imagistics explorations, establishing the diagnostic of cystic tumour of the head of the pancreas, but on could't specify the etiology. On made the surgical approach, founding a hydatic cyst of the head of the pancreas; on practised the parasite inactivation, the cyst evacuation, pericysto-jejuno-anastomosis on a loop in Y "à la Roux" and cholecysto-gastro-anastomosis. The postoperative evolution was favourable.

Adult↗
PubMedDate not supplied

[Immediate and early reinterventions in the surgery of colorectal cancer].

Out of 584 cases submitted to colorectal surgery 461 (78.92%) were performed for cancer. Thirty-three patients (7.16%) necessitated immediate (1) or precocious reinterventions for bleeding, fistulae, peritoneal infections, bowel occlusion, necrosis or stenosis of the iliac anus. We are out the technical procedures chosen for each class of complications asking for reintervention. We registered 4 deaths, in aged patients with hard associated morbidity, with emergency reinterventions. We appreciate that a correct preoperative preparation reduces the rate of reintervention and an early reintervention reduces the post-operative mortality.

Adult↗
PubMedDate not supplied

[The place of surgery in the treatment of locally advanced rectal cancer].

We considered as local advanced rectal cancer (LARC) tumours invading the serosa or adherent to neighbouring organs, tumoral fistulas, histopathologically proved invasion of regional lymph nodes, peritoneal carcinomatosis with or without neoplastic ascites. Out of 146 rectal cancers submitted to surgery between 1984-1996, 47 had LARC (19 man and 28 women aged of 19 to 88 years) developed in the inferior 2/3 of rectum. We performed in these cases 11 Miles operations, 12 posterior pelvectomies, 3 Dixon resections, 16 colostomies and 5 exploratory laparotomies. To these were associated 4 partial cystectomies, 4 anexectomies, 4 partial enterectomies and 2 excisions of hepatic metastasis. In 27 patients adjuvant or neoadjuvant therapy was associated. We registered 3 deaths, 6 parietal infections and 1 stercoral fistula. Postoperative survival was 3-6 months for 12 patients, 6-12 months for 13 patients, 1-2 years for 6 patients. After the complex treatment 6 patients were alive at 5 years. Surgery is the essential therapeutic act of LARC. Chemo/radiotherapy association increases the survival, but not significantly.

Adolescent↗
PubMedDate not supplied

[The classical or laparoscopic operation in inguinal hernias].

AIM: Results evaluation in two trials of patients undergoing classical or laparoscopic surgery for inguinal hernia. MATERIAL AND METHOD: We compared 2 homogeneous trials of 80 patients with inguinal hernias treated by classic procedures: Bassini, Shouldice, Lichtenstein (trial I) or by laparoscopic approach with Plastex, Mercilene or Prolene prosthesis (trial II) between 1995-1997. RESULTS: Postoperative morbidity consisted in trial I in 5 seromas, 2 hematomas, 4 cases with neuralgic pain, 1 with testicular hypotrophy and 4 recurrences. In this trial the mean operative time was 22 min. and the mean hospitalization was 7 days. In trial II we registered a parietal bleeding at a lateral port imposing the conversion, 3 serohematomas, 2 recurrences by displacement of the prosthesis and 2 cases of neurologic pain. The mean operative time was 50 minutes and the mean hospitalization was 3 days. CONCLUSION: In spite of the longer operative time and the higher cost (the price of the prosthesis), in trial II the benefits of shorter hospitalization, lower morbidity and rapid socioprofessional reintegration are significant.

Hernia, Inguinal↗
PubMedDate not supplied

[The place of laparoscopy in assessing and treating a pain syndrome of the right iliac fossa].

The study is considering a trial of 87 patients (61 women 17 and 76 years old) admitted in our clinic between 1995-1996. The preoperative diagnosis was coincident with the laparoscopic one in 10 cases the laparoscopic one in 10 cases the laparoscopy completed the diagnosis and in 12 cases it showed out other organ's disease, evicting useless operations. In the 87 patients we performed: 53 appendectomies, 20 oophorectomies, 15 partial oophorectomies, 9 right adnexectomies, 2 adhesiolysis, 2 lymph node biopsies, 1 epiploic fringe excision for necrosis, 1 appendicular stump removal. The evolution was favourable in all patients, the mean postoperative hospitalization was 48 hours.

Abdominal Pain↗
PubMedDate not supplied

[Laparoscopic cholecystectomy in acute cholecystitis].

AIM: Results evaluation of laparoscopic cholecystectomy in acute cholecystitis. MATERIAL AND METHOD: Between 1994-1997 we performed 65 laparoscopic cholecystectomies for histopathologically proved acute lithiasic cholecystitis. We studied clinic and echographic diagnosis, operative moment, conversion rate, operative time, postoperative morbidity and hospitalization. The cholecystectomy was performed within 72 hours in 18 patients (trial I), 4 to 7 days in 25 patients (trial II) and over 7 days in 22 patients (trial III). RESULTS: Diagnosis of acute lithiasic cholecystitis was always possible by clinical examination and ultrasonography. We performed 8 conversions in patients of trial II (2) and III (6). The mean operative time was 68 min. Postoperative morbidity consisted in 4 bile leakages in the liver bed, 1 subhepatic abscess, 5 right pleural effusions. The mean hospitalization was 4.4 days. CONCLUSIONS: Urgent laparoscopic cholecystectomy is a beneficial act for acute lithiasic cholecystitis. The operative moment is the most important factor of influence on conversion rate, operative time and postoperative morbidity.

Acute Disease↗