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Biomedical subjects

S Constantinoiu

Publications and source records attributed to S Constantinoiu.

At least 19 recordsLinked to original sources
PubMed1995

[Familial abdominal fibromatosis].

Two cases of abdominal fibromatosis are followed-up in two brothers patients development, each of them having a peculiar development. First of them underwent operation for a huge abdominal tumor with a retroperitoneal origin and intraperitoneal development which needed a complex partial resection with first jejunal loop enterectomy. The other patient had first surgery for fibrosarcoma of nuchal area and after that he underwent an operation for superior digestive haemorrhagia as a result of antral gastric fibroid tumor with transverse colic and mezocolic extension, which needed gastro-colectomy. The patients father was followed up for tangible abdominal tumors, but he rejected the proposed coeliotomia. The two brothers patients had a good postoperative development. The examination of the charriotype showed anomalies of the short branch of the 21st and 22nd chromosome (which are still normal).

Abdomen↗
PubMedDate not supplied

[Roux-en-Y gastrojejunostomy: indications, technique, results].

61 gastrojejunostomies were constructed between 1981-1999 in 58 cases (43 cases were operated between 1991-1999). 30 cases have previously suffered various gastric operations; in 28 cases the Roux-en-Y was the first gastric operation (27 operated on between 1991-1999). Radiologic and endobioptic studies were routine for diagnostic and follow-up evaluation, but various scintigraphic studies were performed in selected cases. The surgical technique was tailored for each case, according to the preoperative strategy. The indications for surgery were the following: 19-reflux disease; 14-severe peptic disease (9-reccurence, 3-postbulbar lesion, 2-juxtacardial ulcer); 8-peptic disease associated to reflux disease; 8-gastric cancer; 8-various early or late complications after gastrectomy; 1-lymphocytic gastritis. There were 4 early reoperations and 3 deceased. In 3 cases late reintervention was mandatory (for Zollinger-Ellison syndrome, peptic ulcer secondary to gastrectomy for cancer, Roux-stasis syndrome) and the Roux pattern was preserved; in 2 cases the antireflux effect of the operation was lost after the reoperation.

Adult↗
PubMedDate not supplied

[Problems and difficulties in patients with esophageal reconstruction].

The esophageal reconstruction, independent of the manner and indication represents a major challenge for any surgical team. The goal of the present study is the retrospective analysis of cases together with the technical possibilities of surgical approach, viewed through the diagnostical and therapeutical point of view. We analysed retrospectively 154 patients (140 post-caustical stenosis and 14 neoplasms) who have took benefit of reconstructive esophageal surgery, operated in the last 21 years (1981-2001) in the clinic of surgery, of "Saint Mary" Hospital. Although the esophageal substitution has multiple indications (malignancy, benign stenosis, iatrogenic fistulas, reflux disease with peptic stenosis, etc.), in our clinic the technique was performed for neoplasic lesions and post-caustical corrosive stenosis. In the first period of the study (1981-1990) the most utilised method of surgical approach was the gastric tubulisation after the Gavriliu I or II procedures; in a second period (1990-2001) it is obvious that the tendency was to use the colon or the whole stomach as principal visceras for reconstructions. About the immediate results, the majority of post-operative complications where minors, the most frequent problem being of pleuro-pulmonary nature. We have registered two deceases of patients with corrosive pathology and no post-operative mortality in the first 30 days in neoplasic patients. We evaluated the post-operative functional results using an evaluation score. The anastomotic functionality was good or excellent in most cases (80%), especially in non-malignant reconstructions. For the selection of the most suitable reconstructive procedure, a variety of factors must be explored and evaluated. After a long period in which the use of the colon, in different technical manners, represented the "golden standard" in esophageal reconstruction, we have observed a reevaluation of this attitude and also the more and more frequent utilisation of the whole stomach as esophageal substitute, especially in malignancy.

Adolescent↗
PubMedDate not supplied

[Medio-thoracic esophageal stenosis, produced by pseudotumoral ulcer].

A non-specific esophagitis developed in a young male, apparently determined by heavy abuse of alcohol. Shortly after, a stenotic pseudo-tumoral mediothoracic esophageal lesion was diagnosed. Although there was a high index of suspicion regarding the caustic origin of the lesion, cancer could not be excluded using current diagnostic methods. Temporary feeding jejunostomy was followed by uneventful total esophagectomy and gastric pull-up. Pathologic examination of the resected specimen was a surprise, revealing an esophageal ulcer based on massive severe non-specific esophagitis. Retrospectively, the ulcer was judged as primitive or idiopathic. We discuss some etiopathogenic aspects of common secondary esophageal ulcers (related or not to reflux disease), in contrast with idiopathic esophageal ulcers.

Esophageal Neoplasms↗
PubMedDate not supplied

[Intestinal obstruction by biliary ileus; clinical experience and literature review].

BACKGROUND: Gallstone ileus is an unusual and peculiar complication of biliary lithiasis. Less than 1% of gallstones migrate into the gut, causing 25% of non-strangulated small bowell obstructions in elderly population. Diagnosis is difficult, leading to late operation. Considering the median age of the patients and the fact that in most cases surgery is delayed, there is a lot of dispute regarding the best approach. Recent technical facilities in diagnostic and surgical practice seem to be irrelevant for the general outcome. MATERIAL AND METHOD: All 6 patients operated since 1981 (median age 67 years, 5 female) were retrospectively analyzed, to determine the most valid option. Biliary ileus was recorded in 0.16% of all operations for billiard lithiasis and 1.52% of all enteric occlusions. There was a mean delay of 4.2 days for onset of symptoms to admission and further 5 days to surgery. Particular elements suggesting the ethiology were absent in most cases. In all cases the gallstone migrated in the duodenum. The obstruction was jejunal (3 patients), proximal ileal (2 patients) and distal ileal (1 patient). Enterolithotomy was practiced in 3 cases, with subsequent cholecystectomy and fistula closure in 1 case; one-stage repair in 2 cases and enterolithotomy with temporary external drainage of the fistula (cholecystostomy) in 1 patient. RESULTS AND CONCLUSIONS: There were no specific (fistular) complications; 1 aged patient with distal occlusion died because of severe metabolic disorders. The most "favourable" cases were those with very large gallstones occluding the jejunum. Smaller stones were less symptomatic, resulting in delayed diagnosis and surgery; the more aboral the occlusion, more indication for abstention regarding primary repair of the fistula.

Aged↗
PubMedDate not supplied

[Long-term evolution of a T-tube in the common bile duct].

We present the case of an elderly and frail woman, admitted for obstructive jaundice 9 years after cholecystectomy, lithotomy and T-tube drainage. The presence of a T-tube remnant in the common bile duct was suggested by imaging techniques, along with a megacholedocus. Because of the risks associated with advanced biliary cirrhosis, the endoscopic retrieval and lithotripsy was the first therapeutical attempt but failed. Lithotomy and cholangio-jejunostomy by open surgery were followed by a surprising favourable course.

Aged↗
PubMedDate not supplied

[Osteo-articular manifestations after suppurative pancreatitis].

Osseous and joint manifestations (decalcification, osteolysis, osteonecrosis; poliarthrytis; periarticular fat necrosis) are sometimes encountered in chronic pancreatitis or carcinoma, but exceptional after severe acute pancreatitis, especially infected pancreatic necrosis. Pathogenesis of calcium deficiency in acute pancreatitis is multifactorial, including extensive lipolysis and metabolic disturbances. We report on a healthy, young male, that developed decalcification and polyarthritis consecutive to a long-outcome, severe acute pancreatitis. We comment upon hypocalcemia, as a rare complication of acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

[Preoperative modern evaluation of patient with esophageal stenosis].

It is well known the difficulty of a precise evaluation in the pretherapeutic stage of any esophageal pathology, especially that of obstructive lesions. Preoperatory information should be as accurate as possible, any evaluation error leading to surgical manoeuvres that can later be regretted. From the current practice one can easily observe that there is no typical exploratory protocol, each having its own specific limits, high costs that are not negligible, and some of them are not always immediately available. It is obvious that para-clinic approach has changed, due to technological progress that has increased the accuracy of medical information, but has also increased costs. The standard protocol has lead to a retrospective analysis of the esophageal obstruction cases that were hospitalized in the Sf Maria Clinic of Surgery, during 1981-2002, regarding diagnostic algorythm and treatment used.

Diagnosis, Differential↗
PubMedDate not supplied

[Small intestinal hemorrhage due to rare etiology. Diagnostic difficulties and therapeutic approaches].

Understanding of the pathogenesis, diagnosis, and treatment of lower GI bleeding has drastically changed during the last 50 years, but it continues to be a frequent cause of hospital admission and also a factor in hospital morbidity and mortality. Acute lower gastrointestinal hemorrhage (ALGIH) represents only 20% of the GI bleeding and the small intestine is the site of hemorrhage in about 1% of cases. Although in the last four decades, diagnostic methods for locating the precise bleeding point improved greatly, still the adequate localization of the lesion is very difficult to achieve through algorithmic approaches. We performed a clinical study and we retrospectively analyzed 5 patients (mean age = 59,8 years, 1 female) who had a surgical intervention for acute lower GI hemorrhage in the last decade, in order to emphasize diagnosis difficulties when the bleeding arises from small lesions in the small bowel that is not easily accessible for direct visualisation. Surgery was the treatment of choice in every case consisting in segmental resections of the involved small bowel, along with viscerolysis and exploratory gastro-jejunostoma. The mortality rate was 20% (1 postoperative death of cardiac etiology). There have been no specific postoperative complications in the other four patients and a good outcome was reported. The diagnosis is particularly difficult and when colonic and upper gastrointestinal evaluations fail to identify a source of bleeding, a small intestinal source should be considered. We can conclude that the most important factor in the management of ALGIH is determination of specific localization of the lesion.

Acute Disease↗
PubMedDate not supplied

[Biliodigestive anastomoses; a modality for resolving mechanical jaundice].

Over a period of 14 years a total of 1,996 surgical procedures have been performed on extrahepatic biliary pathways. In 182 cases (9.11%) biliodigestive anastomoses have been done for a therapeutical solution of mechanical jaundice. Biliodigestive anastomoses have been mandatory in 76 cases (41.76%) because of mechanical jaundice induced by biliary stones. In 106 cases the anastomosis was carried out in an attempt to solve mechanical jaundice that was not induced by biliary stones but by other causes. In 45 cases the lesions that had determined the jaundice were benign, and in 61 of the cases malignancy was at the origin of the jaundice. The following types of anastomosis were employed: choledochoduodenal anastomoses were done in 120 cases (65.93%); hepatic duct-duodenal anastomoses in 15 cases (19.23%); hepatojejunal anastomoses in 7 cases (3.84%); recalibration of previous anastomoses in 5 cases (2.74%). These surgical methods, applied in cases of various etiologies, most of them quite severe, in debilitated patients, with iterative surgery, were associated with early postoperative mortality of 8% (13 cases), and a general morbidity of 35% (65 cases), which included: fistulae, anastomotic stenoses, acute postoperative pancreatitis, angiocholitis and suppuration. The late results were good, depending on the etiology of the mechanical jaundice. The authors preferred choledochoduodenal anastomosis for benign lesions, and anastomoses with the diverticular apparatus, or the main biliary pathway in palliative surgery.

Aged↗
PubMedDate not supplied

[Comparative clinico-evolutive and therapeutic aspects in cancer of the right and left colon].

The paper reports on the casuistics of the colon cancer in the Clinic of Surgery of the "Griviţa" Clinical Hospital, for 21 years (1966-1986) with emphasis on the situs peculiarities on the right and left colon. Whereas the left colon cancer (LCC) started in 32% of cases with subocclusive and occlusive syndromes having special implications on the treatment and prognosis, in the right colon cancer (RCC) only in 3.5% of cases the diagnosis was established in the stage of subocclusive syndrome. During surgery the metastatic adenopathy was met in 57% in LCC and only in 37% in RCC, and the hepatic metastases in 17.7% in LCC and in 10.9% in the RCC cases. The immediate postsurgery mortality was present in 12% of the LCC cases and in only 9.3% of the RCC cases. In the last 10 years of the period studied, the patients were periodically readmitted into the hospital, reinvestigated, and monochemotherapy with 5-fluorouracil was applied in sequential cures. In this last period, the survival at 5 years was of 25 (45.4%) in the 55 patients operated for RCC and of 41 (37.6%) in the 109 patients operated for LCC.

Aged↗