Biomedical subjects
Publications and source records attributed to S Duca.
A case is presented, of a patient with biliary lithiasis complicated by cholecystocholedocian fistula, and prolonged mechanical jaundice. The low frequency of such cases is stressed and the difficulties encountered in making a correct diagnosis. Particularities of the observation are analysed, and the therapeutical attitude is discussed.
The author presents an original probe that can facilitate the different stages of surgery performed for sphincterectomy of the Oddi sphincter. The distal end of the probe is ellipsoidal, and is made of 3 thin metallic arms 30 mm long prolonged by a button-tipped rod 10 mm long. The probe is introduced by supraduodenal choledochotomy in the lower portion of the choledochus. The button-tipped rod goes over the papilla and is blocked by the anterior wall of the duodenum indicating the choice spot for duodenotomy. The papilla is elevated in the operatory field on the elipsoidal portion of the probe. The anterior wall of the infundibulum is first incised and the incision rims are sutured. The sphincterectomy proper is terminated by sectioning the papilla which is supported by the button-tipped rod, maintaining the ampullar region at the surface of the operatory field during the entire duration of the intervention.
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A group of 35 patients with nonparasitic abdominal serous cysts is reviewed in order to investigate the diagnostic and therapeutic features of these rare conditions. In most cases the cysts were localised in the liver. Other localisations were the kidney (9 cases), the mesenteric area (2 cases), the adrenals (2 cases), the spleen and the pancreas (one case each). The clinical symptoms were essentially determinated by the size of the cysts, regardless their visceral localisation. Ultrasonography was the most efficient procedure for their detection, although this method's precision for the visceral localisation of the cysts was not entirely reliable (6 errors). The low incidence of such abnormalities as well as the absence of any relevant diagnostic elements for establishing the nonparasitic character of the cysts, favoured the confusions with nonproliferous hydatid cysts, especially in cases of solitary cysts (7 patients). The most frequently used surgical procedures were partial cystectomy (18 cases) and total cystectomy (8 cases). A personal technique based on obliteration of the cavity with the bulging wall of the cysts, was used in two patients. When choosing the surgical procedure, the size, site and number of cysts were considered. Immediate and late postoperative results were very good.
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The case of a female patient, aged 37, with signs of partial intestinal obstruction, repeated cystitis and a tumoral mass in the hypogastrium is reported. Preoperative examinations could not establish the nature of the tumour. Colonoscopy as well as barium enema stopped at a sharp angulation of the sigmoid. Laparotomy evidenced an inflammatory tumour, with departure point in the urinary bladder, which involved the sigmoid and the uterus. After adhesiotomy a partial cystectomy was performed. The macroscopic aspect of the bladder was pseudopolypoid, while the microscopic one was typical for actinomycosis. The patient was discharged cured and was prescribed a penicillin course for 4 weeks.
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The aim of the conservative treatment of postoperative external digestive fistulae is to obtain a reduction of the output, thus favoring spontaneous closure and shortening outcome. A retrospective comparative study has been performed on two groups of patients with postoperative anastomotic gastrointestinal and pancreatic fistulae. Group A included 18 cases (14 anastomotic, 4 pancreatic fistulae) receiving conventional treatment only. Group B included 25 cases (18 anastomotic and 7 pancreatic fistulae) in which Sandostatin was associated to conventional therapy, using daily doses ranging from 0.1 mg to 0.3 mg, administered after variable intervals after fistulas' occurrence. Duration of treatment ranged from 1 to 25 days. In group A, 27.77% of the cases were cured in comparison with group B in which the healing rate increased to 56%. Global hospital mortality rate was 25.58% (11 cases). In group A this was 44.44% (8 cases) in comparison with group B with 12% (3 cases) only. As a conclusion of our study, the use of Sandostatin is remarkable effective in the treatment of external digestive postoperative fistulae. Thus a doubling of healing rate and a reduction by 73% of mortality rate was achieved.
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