Based on their personal experience involving 19 cases of benign, non-lithiasic stenoses of the Oddi sphincter (in a total of 2,500 interventions on the cholecyst and the choledocus), the authors review the etiopathogenic, diagnostic and therapeutic aspects. The difficulty is stressed, encountered in evaluating the reversibility of these lesions and the codification of the therapeutic attitudes.

Ampulla of Vater↗

PubMedDate not supplied

[Chronic pancreatitis of biliary origin. Certain aspects of diagnosis and surgical treatment].

Chronic pancreatitis of biliary origin, frequently localized in the cephalic segment, are generally dependent on the etiopathogeny of the biliary affection, the evolution of which is complicated by their presence. They have a less severe prognosis and in the large majority of cases they are reversible following radical surgical solution of the pathologic biliary component. The study was concerned with 90 cases of which 67 were associated to biliary lithiasis, 9 to non-lithiasic cholecystopathies and 14 were associated to chronic postoperative pancreatitis (of which 6 were lithiasic). The diagnosis were established only during surgey, by coroboration of surgical, cholangiographic and instrumental data. The surgical attitude developed according to results obtained by pre-and intra-operative examination, with the aspect of biliopancreatic lesions, preference being given to radical and decompressive interventions. Simple cholecystectomy was justified in only 27 cases while in 47 other cases it was associated with choledocotomy, in 19 cases with external biliary drainage, with choledocoduodenostomy in 27 cases, with oddian sphincteroplasty in 8 cases, with oddian sphincteroplasty associated to Wirsung duct sphincteroplasty in 5 cases and with choledocojejunostomy in one case. In 2 patients right splanchnicectomy was carried out. The postoperative results were very good in 41 cases, good in 33, mediocre in 13 and unsatisfactory in one case. Two patients died.

Adult↗

PubMedDate not supplied

[Bilocular gallbladder. Diagnostic problems and therapeutic indications].

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Adult↗

PubMedDate not supplied

[Acute biliary pancreatitis. Anatomoclinical and therapeutic aspects].

After an introduction on the role of the biliary factors in the etiopathogeny of acute pancreatitis the authors present an analysis of their personal experience in this field. A total of 46 cases are discussed, with acute biliary pancreatitis, which were diagnosed during surgical interventions. Of the 46 patients 13 had an oedematous form of acute biliary pancreatitis, 22 had necrotizing pancreatitis with associated haemorrhage, 3 had suppurated pancreatitis and 6 had a pancreatic abscess. In 6 patients the acute pancreatitis was either associated with, or triggered by acute non-lithiasic cholecystitis, and in 40 cases the acute pancreatitis was associated to biliary lithiasis. Surgery was performed as a result of inefficient intensive care, as an immediate emergency, in 56.42% of the cases, and as a late emergency (at 3-7 days) in 28% of the patients. Surgery was performed late in 14.71% of the cases. The surgical intervention was mainly directed to the treatment of the biliary lesions, and for the solving of pancreatic lesions, especially of the suppurative and necrotizing and haemorrhagic ones. The postoperative death rate was 34.7%, and death occurred in aged patients, in those with severe forms of pancreatitis of the haemorrhagic type, (8 cases), and with pancreatic suppurations (6 cases).

Adolescent↗

PubMedDate not supplied

[Difficulties of diagnosis and surgical treatment in gallbladder cancer].

After a review of the etiopathogenic data, as well as of anatomo-pathologic aspects of the cancers of the gall-bladder the authors stress the difficulties of diagnosis encountered in the pre-surgery stage, and during the surgical intervention. In view of an early detection of neoplastic lesions the authors suggest extemporaneous histo-pathogenic examination of the lithiasic gall-bladder. They prefer the transparietal-hepatic cholangiography, and the intraoperative transhepatic cholangiography for an exact assessment of the convergence point of hepatic canals, with a view to perform peripheral hepato-digestive derivations. In the 90 cases of cancers of the gall-bladder, of which 75 (87%) were associated (with 4 deaths), cholecystectomy with atypical hepatectomy in one case, cholecystectomy with choledochs drainage in 4 cases (with one death), cholecystectomy with choledochal-duodenostomy in 2 cases, cholecystectomy in 18 cases (with 3 deaths), cholecysto-gastrostomy in 2 cases, hepato-gastronstomy in 13 cases (with 3 deaths), hepato-cholangio-jejunostomy in 2 cases, and exploratory laparotomy in 35 cases. In view of prophylaxis of gall-bladder cancer the authors suggest that cholecystic lithiasis in patients over the age of 40 years should be treated by cholecystectomy.

Adenocarcinoma↗

PubMedDate not supplied

[Hepatic tuberculosis; difficulties of diagnosis and therapeutic management].

Micro, and/or macro-nodular lesions are frequently encountered in the liver in the course of the tuberculous disease, especially during primary dissemination, as well as during the secondary one. In some cases the evolution of liver tuberculous lesions will determine hepato-biliary symptomatology (hepatomegaly, icteric cholangitis) which makes necessary exploratory laparotomy. The authors present their experience in connection with 2 patients presenting liver tuberculous localizations during the primary dissemination. In one of the patients there were also active pulmonary lesions, while in the other one there were no manifest tuberculous determinations.

Adrenal Cortex Hormones↗

PubMedDate not supplied

[Details of diagnosis and surgical treatment in terminal choledochal lithiasis].

Lithiasis of the terminal choledocus raises problems of pre- and intraoperative diagnosis, especially when the evolution is complicated by sclero-inflammatory of the Oddi, chronic pancreatitis, or acute pancreatitis, or with angiocholitis and hepato-renal failure. The high frequency of the lithiasis of the terminal choledocus (37.72% of all cases of biliary lithiasis) makes necessary an improvement of the methods used for the exploration, and evacuation of this type of lithiasis, and for the recovery of the biliary flow. The clinical syndrome in this biliary lithiasis was predominantly of the painful type (in 20.63% of the patients), of the icteric type (58.75%), of the angiocholitic type (8.75%), or it was dominated by pancreatitis (5.95%) or peritonitis (3.06%). In the 126 cases of lithiasis of the terminal choledocus the authors have applied the following procedures: external biliary drainage (50 cases with one death), choledochduodenostomy (42 cases with 4 deaths), papillosplincterotomy of the Oddi (34 cases with 6 deaths). The high postoperative death rate (8.75%) may be related to the fact that surgery was performed in late stages in patients aged over 50 years, with severe anatomoclinical forms (icterocholangitis), with increased anesthetic and surgical risks, as well as that of postoperative complications.

Adolescent↗

PubMedDate not supplied

[Pseudocysts of the pancreas; details of diagnosis and surgical treatment].

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Abscess↗

PubMedDate not supplied

[Suppurated acute obstructive cholangitis. Anatomoclinical and therapeutic aspects].

A total of 134 cases are discussed, with suppurated acute obstructive angiocholitis, that underwent surgical treatment over a period of 10 years, representing 12,8% of the total number of organic obstructions of the hepato-choledocus. From the standpoint of the etiopathogenic mechanisms the angiocholitis was determined by biliary lithiasis in 59 cases, by sclerosis of the Oddi sphincter in 5 cases, by postoperative cicatriceal stenosis of the main biliary pathway in 2 cases, by hepatic hydatitosis in 16 cases, by Vater ampuloma in 10 cases by cancers of the main biliary pathway in 40 cases and by the congenital cyst of the choledocus in one case. The high frequency was noted, of the severe forms of ictero-uremigenic angiocholitis (representing 68 cases, or 50,7% of the total, with a death rate of 34%). Medico-surgical treatment should be performed as early as possible, and it must be intensive, complex, and adapted to the anatomo-clinical forms. The authors performed evacuation choledocotomy with external draining in 22 cases (3 deaths), and choledoco-duodenal anastomosis in 46 cases (10 deaths), choledoco-jejunostomia in 3 cases, Oddi sphincterotomia in 12 cases (2 deaths) ampulectomia in 5 cases (2 deaths). Peripheral bilio-hepatodigestive anastomoses were performed in 40 cases with 5 deaths.

Adolescent↗

PubMedDate not supplied

[Hydatid cyst of the pancreas].

The pancreatic localization of hydatidosis is exceedingly rare (between 0,5 and 3%). A double localization, in the lung and in the pancreas was encountered only by J. Caroli and by authors of the present paper. As a rule the diagnosis is made during the biliopancreatic complications by surgical exploration. The evolution of a patient aged 55 is discussed, who presented with an icterocholangitic syndrome suggesting neoplastic disease, with an image of hidatic cyst in the upper third level of the right lung. The diagnosis of pancreatic hydatic cyst was made by puncture, during surgery, and retrogastric cystogastrectomia according to Jedlicka was followed by irreversible acute hepatorenal failure.

Echinococcosis↗

PubMedDate not supplied

[Postbulbar hemorrhagic ulcer].

Although it is relatively rare (only 10,4% of the cases), post-bulbar ulcers have a rather complicated evolution. The authors have recorded 26 observations with digestive haemorrhage, 3 cases with perforations, 32 stenoses, and pancreatic penetration. These give raise to problems of surgical tactic and surgical technique. The frequency of haemorrhagic complications by post-bulbar ulcers, in relation with overall rates of duodenal ulcers, was of 32,5%. The authors present a study of 26 cases of post-bulbar haemorrhagic ulcers in patients with an average age of 47,4 years. Upper digestive haemorrhage was unique, massive, with vascular collapse (9 cases), without vascular collapse (9 cases)m and it occurred repeatedly in 8 patients. Since haemorrhage through penetrating post-bulbar ulcer in the pancreas is, as a rule, the result of vascular fistulae, the severity of the haemorrhage, the frequency of the relapse (sometimes of cataclysmal proportions), makes mandatory an early intervention, as near as possible to the onset of the haemorrhage. Radical interventions are to be preferred when angio-penetrating and haemorrhagic lesions are demonstrated. The authors have performed exploratory antro-pyloroduodenotomy followed by extensive gastrectomy of the Reichel-Polya type (in 20 cases with 5 deaths), Péan gastroduodenectomy (1 case), exclusion gastrectomy (3 cases with 1 death), and vagotomy associated to pylroplasty and haemostasis "in situ" in 2 cases.

Adult↗

PubMedDate not supplied

[Anatomoclinical and therapeutic aspects of nodular goiter].

Based on the experience acquired in the treatment of 500 patients with thyroid affections, of which 229 had benign nodular goiters and 12 had degenerated nodular goiters, the authors stress the necessity of very detailed preoperative exploration, that are capable to provide a series of essential elements for establishing the indication for surgery. Clinical exploration is also a significant contribution, as well as the peroperative exploration, including the histologic one. The trend is noted, as a result of exploration capabilities, and of improved pre- and postoperative treatment possibilities, to perform extensive, and even total resections.

Adult↗