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C Gheorghe

Publications and source records attributed to C Gheorghe.

14 recordsLinked to original sources
PubMed2005

Predictors of death on the waiting list for liver transplantation characterized by a long waiting time.

The number of patients dying while on the liver transplantation (LT) waiting list (WL) has continued to increase in recent years as a result of severe shortage of organs. Therefore, it is important to evaluate the existing models that predict death on the WL and to determine the independent predictors of death. The study cohort comprised 152 adult patients listed for LT in our centre over a period of 2 years (January 2001 to January 2003). The 12-month survival rate has been calculated by Kaplan-Meier method. The survival analysis performed by Cox proportional hazard model has evaluated the three parameters which compose the model for end-stage liver disease (MELD) score. Forty-four patients (28.9%) died while listed for LT. The survival rate was 92% at 3 months, 80% at 6 months and 69% at 12 months. Median survival was not reached. MELD score was found to be an excellent predictor of death at 12 months on our WL--c-statistic (area under curve) 0.84. In our survival analysis, only international normalized (prothrombin) ratio (INR) and serum creatinine were identified as an independent predictors of death (P < 0.0001). A new simplified version of the MELD score, which does not include serum bilirubin, is proposed and its c-statistic as predictor for death on the WL at 12 months is 0.86, as good as the original MELD score, when evaluated on our list. There is a fourfold increase in mortality on our WL for LT between 3 and 12 months after the inclusion. A simplified version of the MELD score, using only serum creatinine and INR might be taken into account when predicting 12 months mortality on WL with longer waiting time, but it has to be confirmed by other prospective studies.

Adult↗
PubMedDate not supplied

Effects of proton and gamma radiation on lymphocyte populations and acute response to antigen.

BACKGROUND: The clinical use of proton radiation in the management of cancer, as well as benign disorders, is rapidly increasing. The major goal of this study was to compare the effects of proton and gamma (60Co) radiation on cell-mediated and humoral immunological parameters. MATERIALS AND METHODS: C57BL/6 mice were exposed to a single dose of 3 Gray (Gy) protons or gamma-rays and intraperitoneally injected 1 day later with sheep red blood cells (sRBC). On 4, 10, 15, and 29 days after exposure, subsets from each group were euthanised; nonirradiated controls (with and without sRBC injection) were included. Body and relative spleen weights, leukocyte counts, spontaneous blastogenesis, lymphocyte populations, and anti-sRBC titers were evaluated. RESULTS: The data showed significant depression (p < 0.05) in nearly all assays on days 4 and 10 after irradiation. B lymphocytes (CD19+) were the most radiosensitive, although reconstitution back to normal levels was observed by day 15. T cell (CD3+) and T helper cell (CD4+) recovery was evident by day 29, whereas the T cytotoxic cell (CD8+) count remained significantly below normal. Natural killer cells (NK1.1+) were relatively radioresistant. Anti-sRBC antibody production was slow and low titers were obtained after irradiation. No significant differences were noted between the two types of radiation. CONCLUSIONS: Taken together, the data show that whole-body irradiation with protons or gamma-rays, at the dose employed, results in marked, but transient, immunosuppression. However, at the time points of testing and with the assays used, little or no differences were found between the two forms of radiation.

Animals↗
PubMedDate not supplied

[Liver transplantation--considerations over 8 cases operated in the year 2000].

In the year 2000, at the Department for General Surgery and Liver Transplantation from The Fundeni Clinical Institute Bucharest, seven OLTs and one living-related transplantation were performed in 6 adults and 2 children. Postoperative complications were: bile leakage, hemoperitoneum, lower gastrointestinal hemorrhage, parietoabdominal hematoma. There was only one postoperative death due to septic complications in the 18th p.o.d. and one late death due to pneumonia of unknown origin. After the results in the year 2000 there was an increased number of donors and referrals. We consider that now in Romania this is an established program that will continue depending on the number of donors and financing.

Adult↗
PubMedDate not supplied

[Post-caustic esophageal stenosis].

This study treats the last 13-year experience of the Surgical Department from the Fundeni Hospital Bucharest (Romania) regarding the surgery of the postcaustical esophageal stenoses. The series is composed of 25 patients (10 males and 15 women), with ages between 19 and 58 years. The patients were admitted in our unit at an interval between 2 months and 20 years from the caustical ingestion. In 20 cases we preferred seriate procedures (gastrostomy or jejunostomy as a first operation, followed after 2 months to 20 years by a reconstructive procedure). The reconstructive operation was accompanied by resection of the stenotic esophagus in 15 cases (60%); in 10 cases we performed a bypassing (without resection) presternal esophagoplasty. Resection of the esophagus implied a combined abdomino-thoracic approach in 10 cases and an cervico-thoraco-abdominal approach in 5 (depending upon the extent of the lesions). The early postoperative course was complicated by anastomotic leakage's in 5 patients (20%) and by pulmonary complications in another 5 (20%) cases. There were no postoperative deaths. The late follow-up showed a good functional result in 24 patients with medium weight gain of 2.6 kilograms and a normal social reintegration. In conclusion, we consider that the esophagus resection in postcaustical stenoses is indicated when there are no counterindications, with a low morbidity when it is performed in specialized surgical services.

Adult↗
PubMedDate not supplied

[Neoadjuvant radiochemotherapy in the treatment of esophageal squamous carcinoma:Preliminary results in a series of 15 patients].

The purpose of this study is to analyze the experience of the Center of General Surgery and Liver Transplantation from Fundeni Clinical Institute (Bucharest) regarding the results of neoadjuvant radiochemotherapy in the squamous carcinoma of the esophagus. During 01.01.2001-09.07.2003, 15 patients with squamous carcinoma of the esophagus were treated using neoadjuvant radiochemotherapy (RCT); 13 patients (86%) underwent esophageal resection (in 2 patients resection was not possible due to the mediastinal invasion). Complete histological response (the lack of malignant tissue on the esophagectomy specimens) was noted in 5 cases. The morbidity and mortality rates were 48%, respectively 6%. RCT increases the resectability in esophageal cancer and decreases the postoperative morbidity and mortality.

Adult↗
PubMedDate not supplied

[Upper digestive haemorrhage of a rare cause: benign duodenal schwannoma].

The upper gastrointestinal bleeding is a common cause of admission to hospital. Neurogenic tumors of the duodenum are extremely rare and represent an unusual cause of gastrointestinal hemorrhage. The treatment is endoscopic or surgical total excision. In case of ulcerated large tumors situated periampullary pancreaticoduodenectomy (Whipple's or Traverso-Longmire's) represents an efficient solution. In addition, their high index of malignancy justifies this trend. We present a case of schwannoma of the second portion of the duodenum with several episodes of upper GI bleeding treated by Trasverso-Longmire pancreaticoduodenectomy.

Duodenal Neoplasms↗
PubMedDate not supplied

[Orthotopic liver transplantation in adult patients with cadaveric grafts. Experience of the Fundeni Center of General Surgery and Liver Transplantation].

We analyze the experience of the Center of General Surgery and Liver Transplantation from the Fundeni Clinical Institute (Bucharest, Romania) regarding orthotopic liver transplantation (OLT) in adult recipients, with whole liver grafts from cadaveric donors, between April 2000 (when the first successful LT was performed in Romania) and December 2004. This series includes 37 OLTs in adult recipients (16 women and 21 men, aged between 29-57 years--average 46 years). Other two LT with whole liver cadaveric grafts and two reduced-size LT were performed in children; also, in the same period, due to the acute organ shortage, other methods of LT were performed in 28 patients (21 living donor LT, 6 split LT and one "do mino" LT), that were not included in the present series. The indications for OLT were HBV cirrhosis--10, HBV+HDV cirrhosis--4, HCV cirrhosis--11, HBV+HCV cirrhosis--2, biliary cirrhosis--5, Wilson disease--2, alcoholic cirrhosis--1, non-alcoholic liver disease--1, autoimmune cirrhosis--1. With three exceptions, in which the classical transplantation technique was used, the liver was grafted following the technique described by Belghiti. Local postoperative complications occurred in 15 patients (41%) and general complications in 17 (46%); late complications were registered in 18 patients (49%) and recurrence of the initial disease in 6 patients (16%). Intrao- and postoperative mortality was 8% (3/37). There were two patients (5%) who died because of immunosuppressive drug neurotoxicity at more than 30 days following LT. Four patients (11%) died lately because of PTLD, liver venoocclusive disease, recurrent autoimmune hepatitis and liver venoocclusive disease, myocardial infarction, respectively. Thirty-four patients survived the postoperative period (92%); according to Kaplan-Meier analysis, actuarial patient-survival rate at month 31 was 75%.

Adult↗
PubMedDate not supplied

[Pulmonary embolism--complication of proximal deep venous thrombosis in colorectal cancer. Diagnosis and management].

We present the case of a 57 years old male, without cardiovascular history, with colorectal cancer and proximal deep venous thrombosis, who develops a massive pulmonary embolism. The surgical treatment consists in embolectomy of right ventricle, pulmonary trunk, left and right pulmonary artery. The specifics of the case is discussed: etiology and prevention of pulmonary embolism (caval filter) and treatment: the contraindications of thrombolytic therapy and the indications and perspectives of surgical treatment.

Colorectal Neoplasms↗
PubMedDate not supplied

[D2 lymph node dissection in gastric cancer surgery: long term results--analysis of an experience with 227 patients].

AIM: The main objective of the study was to evaluate the postoperative mortality and 5 year survival in gastric cancer patients undergoing a minimum of D2 lymphadenectomy. MATERIALS AND METHODS: A retrospective study was conducted on 1170 patients operated for gastric adenocarcinoma in the Department of General Surgery and Liver Transplantation of Fundeni Clinical Institute, between 1997 and April 2005. Only 443 patients underwent a curative resection, from which 216 patients had D1 resection and in 227 cases a D2 or D3/D4 lymphadenectomy was performed. Information about survival was available for 189 patients of those who had a D1 resection and for 210 of those who underwent a D2 or D3/D4 lymphadenectomy. RESULTS: Postoperative mortality was 6.5% in the group of curative resection, with 9.2% for D1 and 3.9% for D2/D3 D4. Five year survival according to Kaplan Meier curves was 32 % in the D1 group vs. 51,8% in D2/D3-D4 (p <0.0001). Significant differences were noted in the median survival-- D2/D3-D4 group 63 months vs. 28 months in D1 group. CONCLUSIONS: Our data support the gastric resection with a minimum of D2 lymphadenectomy in the radical surgery of gastric cancer. However, an accurate interpretation of the statistical interpretation between the different groups of patients is difficult, mainly because of the retrospective character of the study.

Adenocarcinoma↗
PubMedDate not supplied

Fatal intestinal hemorrhage complicating ileal lymphoma after cyclosporine for unresponsive celiac disease.

BACKGROUND/AIMS: Unresponsive celiac disease may benefit from immunosuppressive therapy. Malignant small intestinal lymphoma is the most serious complication of celiac disease, also being noted as a complication of immunosuppressive therapy. The diagnosis of small intestinal lymphoma complicating celiac disease is notoriously difficult. Perforation is the most common complication of small intestinal lymphoma, frank hemorrhage being unusual. We report a case of massive, fatal hemorrhage from small intestinal lymphoma complicating unresponsive celiac disease treated with cyclosporine. The patient was presented with severe diarrhea and nutritional deterioration. Unresponsive celiac disease was diagnosed on the basis of clinical and histologic criteria with no response while on a gluten-free diet, corticotherapy and octreotide acetate injections. Cyclosporine therapy was advised. The patient had a remarkable clinical response. After 3 months from the start of the cyclosporine therapy, the patient returned with massive intestinal bleeding. The patient underwent emergency surgery diagnosing an enteropathy-associated lymphoma. We conclude that cyclosporine therapy for unresponsive celiac disease should be considered in select, severely ill patients only after a full-thickness biopsy of the small intestinal wall to disclose a latent super-imposed lymphoma, which course may be accelerated by immunosuppressive therapy.

Adult↗
PubMedDate not supplied

Esophageal tumor with an unusual histological appearance: a case report.

An unusual esophageal tumor in a 58-year-old man complaining of dysphagia and weight loss is herein described. Esophageal radioscopy and endoscopy visualized a huge polypoid tumor which was occluding the esophagus. After esophageal resection, the histological examination revealed miscellaneous benign cells (squamous, columnar fat cells, cartilaginous cells, and glandular structures) and two different malignant areas (spindler sarcomatous cells and squamous cells). There was no malignant invasion in the stalk, in the adjacent esophageal wall, or in the periesophageal tissue, and there were no malignant adenopathies. The postoperative course was favorable for one year, until the patient developed pain in the right superior back. A sarcomatous relapse was diagnosed by fine-needle biopsy under CT guidance, and the patient subsequently received radiation therapy.

Aged↗
PubMedDate not supplied

Long esophageal stricture in Crohn's disease: a case report.

Crohn's disease of the esophagus is rare, and it is very unusual for it to be located only in the esophagus. We report a case of Crohn's disease confined to the esophagus in a 26-year-old female. The patient was admitted because of progressive dysphagia, odynophagia and weight loss. A barium-swallow examination showed an irregular narrowing of the esophagus below the level of the aortic arch which was 15 cm long, with marginal ulcers and a pseudopolypoid appearance of the mucosa; a computed tomographic scan of the thorax revealed a thickened esophageal wall. Esophagoscopy revealed an esophageal stricture 25 cm distal to the incisor teeth, 2 mm in diameter, with "punched out" ulcers and pseudopolypoid mucosa. Endobiopsy specimens showed chronic lymphocytic infiltration into the corion in the absence of neutrophils, basal-cell hyperplasia and elongation of the stromal papillae. The patient underwent an esophagectomy through a combined cervico-abdominal approach followed by a cervical esogastrostomy. The specimen was 18 cm long, the thickness of the wall was 1.7 cm with fibrosis involving all layers of the esophageal wall and a cobblestone appearance of the mucosa. A heavy lymphoplasmocytic infiltrate extended from the mucosa deep into the muscularis, fibrosis and granulomas were found transmurally. Crohn's disease of the esophagus is a rare and specific entity which can present in various ways; strictures resembling those from reflux esophagitis or a tumor are common. Diagnosis may be suggested by the presence of a chronic lymphocytic infiltrate with or without non-caseating granulomas, and no histologic evidence of chronic reflux esophagitis.

Adult↗