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Biomedical subjects

C Iancu

Publications and source records attributed to C Iancu.

At least 19 recordsLinked to original sources
PubMed2004

Mini-invasive treatment of complications following laparoscopic cholecystectomy.

BACKGROUND: Even though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed. MATERIALS AND METHODS: Over the last 9 years 9542 laparoscopic cholecystectomies have been performed, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged > 65 years. RESULTS: The main postoperative complications were bile leakage and choleperitoneum (54 cases), haemorrhage (15 cases), subhepatic abscess (10 cases) and retained bile duct stones (11 cases). Classic re-interventions were practiced in 28.8% of cases with complications. Mini-invasive techniques were used in 42.2% of cases with complications: laparoscopic re-interventions (15 cases) for choleperitoneum, haemoperitoneum and subhepatic abscess and endoscopic sphincterotomy (22 cases) for prolonged bile leak on subhepatic drain and for early diagnosed remnant lithiasis of the common bile duct. All cases healed. Another 26 patients were treated conservatively. DISCUSSION: With a precise diagnosis and a good indication, the mini-invasive treatment of complications was completed with good results. 16 laparoscopic re-operations and 22 endoscopic sphyncterotomies were performed (for the treatment of bile leakage and remnant gallbladder stones).

Adolescent↗
PubMed2001

Effects of stathmin inhibition on the mitotic spindle.

Stathmin is a major cytosolic phosphoprotein that plays an important role in the regulation of microtubule dynamics during cell cycle progression. It has recently been proposed that the major function of stathmin is to promote depolymerization of the microtubules that make up the mitotic spindle. In this report, we tested the prediction that a deficiency in stathmin expression would result in constitutive stabilization of microtubules and lead to abnormalities in the organization of the mitotic spindle. Our studies demonstrate that antisense inhibition of stathmin expression in K562 erythroleukemic cells results in increased ratio of polymerized to depolymerized tubulin. These changes are associated with phenotypic abnormalities of the mitotic spindle and difficulty in completing mitosis. These studies also showed that inhibition of stathmin expression results in increased susceptibility of K562 leukemic cells to the pharmacological agents, like taxol, which are known to stabilize the mitotic spindle. In contrast, stathmin inhibition results in decreased sensitivity to vinblastine, an agent that destabilizes the mitotic spindle. Thus, our experimental findings are supportive of the model that stathmin is a microtubule-destabilizing factor that plays an important role in the regulation of the mitotic spindle. We also suggest a potential therapeutic approach for cancer based on the combination of stathmin inhibition with pharmacologic agents that stabilize the mitotic spindle.

Biopolymers↗
PubMed2000

Taxol and anti-stathmin therapy: a synergistic combination that targets the mitotic spindle.

Stathmin is an abundant cytosolic phosphoprotein that plays an important role in the regulation of cellular proliferation. Its major function is to promote depolymerization of the microtubules that make up the mitotic spindle. Taxol is an effective chemotherapeutic agent whose activity is mediated through stabilization of the microtubules of the mitotic spindle. We demonstrate that antisense inhibition of stathmin expression chemosensitizes K562 leukemic cells to the antitumor effects of Taxol and results in a synergistic inhibition of their growth and clonogenic potential. In the presence of stathmin inhibition, exposure to Taxol results in more severe mitotic abnormalities (hypodiploidy and multinucleation). This, in turn, results in increased apoptosis of the aneuploid cells during subsequent cell division cycles. This novel molecular-based therapeutic approach may provide an effective form of cancer therapy that would avoid the severe toxicities associated with the use of multiple chemotherapeutic agents with overlapping toxicity profiles.

Apoptosis↗
PubMed1992

[Late reinterventions after the surgical treatment of gastric and duodenal ulcer].

A number of 87 reinterventions performed during a 5-year-period for late complications of the gastric and duodenal ulcer surgery are analysed. In most of them (64 cases), the cause of the reintervention was a postoperative ulcer. A long afferent loop (6 cases), the dumping syndrome (4 cases), the stenosis of the anastomosis opening (6 cases) and the primitive neoplasm of the gastric stump (7 cases) represented other causes of reintervention. The immediate postoperative results were very good and good in 69 cases. The risks related to the specific character of this surgery materialized themselves in 14 postoperative complications (anastomotic fistulas, haemorrhages from the anastomosis, stress ulcers etc.), which required iterative operations; the postoperative death rate attained 3.4%. The analysis of these postgastrectomy syndromes is an opportunity to discuss about the failure factors in the surgery of the gastric and duodenal ulcer, the possibilities of exploration and the principles which should guide the reparative therapy.

Adult↗
PubMedDate not supplied

Ender nailing versus external fixation in the stabilization of type III open tibial shaft fractures.

UNLABELLED: Management of severe open tibial shaft fractures presents a difficult challenge to the orthopaedic surgeon. They are frequently associated with loss of limb, infection and high levels of morbidity. All the authors considered, now, that there are five keys to successful treatment: antibiotic therapy, radical debridement and pulsed lavage irrigation, stabilization of fracture with minimal further devascularization, early soft tissue coverage and early bone-grafting. It rests, also, a number of controversies in the management of open tibial fractures, not least of which is the method of fracture stabilization: the choice between intramedullary nailing and external skeletal fixation, the use of reamed or unreamed nails. MATERIAL AND METHODS: Fifty-seven patients with 62 open fractures of the tibial shaft type IIIA, B and C (Gustilo) were treated between 1.01.1994 and 31.12.1998 in the Department of Orthopaedic Surgery of the Emergency Hospital, Iasi, Romania. There were 29 cases type IIIA fractures, 26 cases type IIIB and 7 cases type IIIC (Mess score showed the viability of the limb). Our patients were 36 males and 21 females; their mean age was 36 years (range 17 to 70). Forty-six patients were injured in road traffic accidents and 11 in other traumatic incidents. In 33 cases the skeletal stabilization was achieved by Ender nailing under general or regional anesthesia. In 15 cases we used a bilateral uniplanar external fixator (Burghele) and 14 fractures were stabilized with an Ilizarov external fixator. We note a secondary amputation after the failure of the revascularization of the limb in a type IIIC fracture. RESULTS: All fractures united; the mean time to union was 30.2 weeks--in the external fixation group and 26.4 weeks--in the Ender nailing group. Malunions occurred slightly more frequently in the external fixation group that in the Ender nailing group (15.7% versus 5.8%). We noted--also--more secondary procedures required in the external fixation group. The infection rate was 3 of 33 (9.1%) in the Ender nailing group compared to 4 deep (13.8%) and 8 pin-tract infection (27.6%) in the external fixation group. CONCLUSIONS: Our study suggests that Ender nailing has several advantages over external fixation in the management of severe open tibial shafts fractures. Based on these results, over the last years, in our Department we use mainly the Ender nailing technique, as we consider it a better approach for these type of lesions.

Adolescent↗
PubMedDate not supplied

[Laparoscopic cholecystectomy: incidents and complications. Analysis of 8002 consecutive cholecystectomies performed at the Surgical Clinic III Cluj-Napoca].

Incidents and postoperative complications of laparoscopic cholecystectomy (LC) are analyzed based on a series of 8002 patients who underwent the procedure during a period of seven years. Conversion rate was 2.02% (161 cases) and 6 (0.07%) death were encountered. Intraoperative hemorrhage (2.43%) could be controlled by intraoperative haemostasis in all but 8 patients (bleeding from the hepatic bed and from the cystic artery) which required conversion. Lesions of the bile ducts occurred in 16 patients (0.2%), 13 of them being identified during the operation and solved by conversion or laparoscopic choledochorraphy (for a tangential lesion). Postoperative complications required re-intervention in 45 patients: 11 for bile leak, 19 for choleperitoneum, 6 for hemorrhage, 4 for subhepatic abscesses and 5 for remnant CBD lithiasis. There was 1 puncture of the Douglas pouch in a case of choleperitoneum, 7 laparoscopic re-interventions and 25 open surgery re-interventions. EST solved postoperative bile leaks (from the gallbladder bed) successfully in 7 cases and remnant CBD lithiasis (5 cases). So, 44% of the cases were treated by minimally invasive means (laparoscopic re-interventions or endoscopic procedures). The majority of the incidents and postoperative complications were linked to the presence of an acute cholecystitis and were partially due to some technical limits of the laparoscopic technique of the gallbladder bed peritonisation. The minimally invasive treatment of postoperative complications, was very efficient and offered optimum healing conditions.

Adult↗
PubMedDate not supplied

[Mini invasive treatment of complications following laparoscopic cholecystectomy].

UNLABELLED: Miniinvasive treatment can be used in many early complications following laparoscopic cholecystectomy. In this article are analyzed the indications and the efficiency of these techniques. MATERIAL AND METHODS: We analyzed here a group of 9542 laparoscopic cholecystectomy operated in 9 years. The main postoperative complications were: bile leak (54 cases), haemorrhage (15 cases), subhepatic abscess (10 cases) and early diagnosed remnant lithiasis of CBD (11 cases). Miniinvasive techniques that were used were laparoscopic reinterventions (15 cases) and EST (22 cases). RESULTS: Classic reinterventions were practiced in 28.88% of cases with complications. Miniinvasive techniques were used in 42.2% of cases with complications: laparoscopic reinterventions (15 cases) for choleperitoneum, haemoperitoneum and subhepatic abscess and EST (22 cases) for prolonged bile leak on subhepatic drain and for early diagnosed remnant lithiasis of CBD. All cases were healed. DISCUSSION: Along with a precise diagnosis and a good indication, the miniinvasive treatment of complications proved to have good results, converting the bad operative outcome into a postoperative success.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[Minimally invasive treatment of common bile duct calculi].

UNLABELLED: Miniinvasive treatment of lithiasis of the common bile duct hasn't reached yet a standard end point. There are multiple techniques used for it. In this study we evaluate its indications, possibilities and limits. MATERIAL AND METHOD: In a series of 14,024 biliary patients operated over 9 years 719 patients underwent open choledocolithotomy. In 173 (1.2%) of patients we used miniinvasive procedures as follows: 71 cases underwent sequential treatment, 91 laparoscopic treatment and in 11 cases the remnant calculi were extracted 1-6 days postoperative. RESULTS: Sequential treatment was the preferred treatment when the lithiasis of the common bile duct was detected preoperative. Transcistic extraction was more often performed for the lithiasis diagnosed intraoperative. The conversion to open surgery was performed in 13 cases, remnant calculi were early diagnosed in 11 patients and late diagnosed in 14 cases (the calculi were extracted by endoscopic sphyncterotomy). All patients were healed. DISCUSSIONS: The miniinvasive procedures have to be practiced as frequently as possible because of rapid healing and early recovery of the patients, despite some disadvantage of them. The choledocotomy and choledocoduodenostomy are exceptional techniques to be used in specific cases.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[Laparoscopic cholecystectomy for porcelain gallbladder].

The porcelain gallbladder is uncommon type of chronically inflamed gallbladder wall considered to be associated with a high frequency of adenocarcinoma and subsequently not suitable for a laparoscopic approach. In 12,000 patients chosen for a laparoscopic cholecystectomy 4 porcelain gallbladders were diagnosed. In 2 cases the laparoscopic approach was successful. One conversion was due to an unconfirmed suspicion of gallbladder cancer and the other one to a fistula between the gallbladder and the common bile duct. Patients with a preoperative diagnosis of porcelain gallbladder must not be excluded from the laparoscopic approach yet a low threshold for conversion must be maintained in those with a cancer suspicion.

Adenocarcinoma↗
PubMedDate not supplied

[A possible protocol for postoperative management in laparoscopic cholecystectomy].

The goal of the "Prospect" programme (sponsored by Pfizer) is to create possible evidence-based protocols related to the management of postoperative pain after certain type of surgical intervention (e.g. hernia repairs, hysterectomies, etc.). This article is introducing the protocol for laparoscopic cholecystectomy for both day-case and longer hospital admission cases. The protocol is designed for preoperative, intra and postoperative period, choosing only those measures which were effective for postoperative pain, published in the literature. We are also presenting an analyze of our 13,000 laparoscopic cholecystectomies, from "Prospect" protocol point of view, and what we should do to improve the management of postoperative pain.

Analgesics↗
PubMedDate not supplied

[The therapeutic options in tibial plateau fractures].

The authors report their experience in 49 fractures treated in the interval 1984-1988. In this series, 75.5% of the cases were treated by conservative methods (functional treatment-plaster-cast, continuous extension), the remainder of 24.5% benefiting from a surgical intervention (bolting, screws, uni- or bicondylar plates). In both circumstances, rehabilitation was par, of the treatment. The analysis revealed 61% good and very good results.

Accidents, Traffic↗
PubMedDate not supplied

Nonparasitic abdominal serous cysts. A multiple case report.

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.

Abdomen↗