Continuous electrocardiographic monitoring during percutaneous transhepatic cholangiography.
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Biomedical subjects
Publications and source records attributed to C Stanciu.
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A series of tests, including gastro-oesophageal sphincter pressure measurement, short-term pH tests, and 15-hour overnight oesophageal pH recording were applied to 42 normal subjects and 214 patients with typical reflux symptoms. The results were compared by multivariate discriminant analysis. Sphincter pressure measurements misclassified 32%, stressed provocative manoeuvres 14-5%, and the best single discriminator from the overnight pH study was time below pH 5, which misclassified 13%. However, a combination of the number of reflux episodes in 15 hours with their mean duration reduced misclassification to 8-8%. Using this function, a boundary between normal and reflux can be drawn, and the degree of abnormality can be expressed visually as well as numerically.
Continuous oesophageal pH measurements have been used to assess the influence of posture (lying, sitting, bed-up) on gastro-oesophageal reflux. The percentage of time during which oesophageal pH was below 5 and the number of reflux episodes was significantly reduced when patients were in bed-up position than when sitting or lying. There was no significant difference when sitting and lying positions were compared. The results suggest that by adopting the bed-up position (elevation of the head end of the bed with blocks of 28 cm), the patient will have a symptomatic benefit, the frequency of reflux is decreased, and acid clearing is improved.
Neither gastroesophageal reflux nor esophagitis were found to have a clear-cut relationship with gastric secretory output. Patients with esophagitis had significantly longer periods of reflux than those without esophagitis. It is concluded that the important factor in the genesis of esophagitis is the duration of contact between the esophageal mucosa with gastric contents rather than gastric secretory output.
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In the absence of radioopaque marker, the diagnosis of textiloma, a rare iatrogenic lesion, is difficult. The wide use of abdominal ultrasonography significantly improved the preoperative diagnosis, the most typical image being that of a echogenic area with a posterior shadow cone. Nine cases of intraabdominal textiloma, in the diagnosis of which ultrasound played the most intra-abdominal textiloma, in the diagnosis of which ultrasound played the most important role, are presented. Although the ultrasound image is not specific, it is nevertheless enough suggestive the diagnosis of textiloma and thus for indicating an early surgery, before complications occur.
A case of Nonne-Milroy-Meige syndrome with onset at puberty is presented. The syndrome is characterized by the association of trophic edema of the limbs with endocrine disturbances and malformations of some genes.
The gastroesophageal reflux acts as a trigger mechanism in the induction of a asthmatic attack, either as an aggravating or a releasing factor. Our study was underwent on 15 out of 100 followed up asthmatic patients who did not respond to the usual treatments and demonstrated the usual treatments and demonstrated the intervention of the gastroesophageal reflux. Its presence was suggested clinically by the symptoms (pyrosis, dysphagia, acid regurgitations) and confirmed in 5 patients by the barium examination in Trendelenburg and in the remainder of 10 by the esophageal pH, determination of gastroesophageal motility and endoscopic examination. Excepting the known allergenic conditions, the attacks were recorded during night or postprandially, being usually preceded by the above mentioned symptoms. The antispastic and antisecretory treatment improved the respiratory symptoms. The recognition of this association, i.e. bronchial asthma-gastroesophageal reflux, has a practical importance, the intervention of the esophageal component leading to the termination of the attacks.
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A total of 198 tumours of the pancreas have been hospitalized between 1972 and 1987 in the 1st Surgical Clinic from Jassy. Only 10 of these tumours were benign, and these included: 2 gastrinomas, 2 insulinomas, 2 cystadenomas, one fibrolipoma, 1 lymphangioma, one hydatic cyst and a Wermer's syndrome. The particularities are analysed, of these 10 cases of benign tumours of the pancreas, and it is stressed that most of the clinical and therapeutic problems are determined by tumours of the endocrine pancreas, and especially those which are hormonally active. Thus the symptomatology of these last tumours which is difficult to evaluate, especially at the onset of the symptoms will determine a considerable delay in the surgical diagnosis, many of the patients being hospitalized in other departments before reaching the surgeon. Present possibilities for diagnosis and treatment have kept pace with progresses achieved in the field of investigations, which provide useful data from the morphological and functional viewpoints. All the 10 cases mentioned above have benefited from the surgical treatment, that was adapted according to particularities of each patient. The authors stress the importance of the extemporaneous morpho-histologic examination (with serial slides) and when the tumours are difficult to identify by direct macroscopic examination they recommend intraoperative echography and direct hormonal dosages on samples obtained from the portal circulation before and during surgery.
Two new cases of megaduodenum by aortomesenteric shunt in young adults are presented. The role of some risk factors, the diagnostic and therapeutical elements are discussed, the importance of a thorough investigation of each case in view of individualizing the therapeutical management being underlined.
There is much controversy regarding the chronic nonspecific duodenitis as autonomous clinical entity. We have studied 36 patients (16 women, 20 men), aged 24-59 years (mean age 37.8 years), with biliary dyspepsia and endoscopic changes suggesting "duodenitis"; in all patients the following investigations were carried out: gastric secretion, barium X-ray and histological examination of the duodenal mucosa specimens obtained by endoscopic biopsy. There was no significant difference between the patients with duodenitis and normal subjects regarding the maximal acid output. Unspecific radiological changes were noticed in 55.5% of patients with chronic duodenitis. Endoscopy showed varied changes of duodenal mucosa including edema, erythema, erosions and hypertrophic folds. Histology confirmed the presence of inflammation. The patients have been followed-up for three years and none of them developed duodenal ulcer. We conclude that chronic nonspecific duodenitis is an autonomous clinical entity.
Twenty-eight patients with histologically proven reflux esophagitis were randomly allocated to receive either De-Nol (tripotassium dicitrate bismuthate) or placebo for three weeks. Significant decreases in symptoms frequency and severity were noted in De-Nol group comparing with placebo group (p less than 0.01). Objective improvement in esophageal endoscopic appearance was obtained in 78.5% of the patients treated with De-Nol and only in 14.2% of those receiving placebo. De-Nol appears to be an effective drug in the treatment of reflux esophagitis, but this should be confirmed by further studies.
The term "biloma" describes an intra-abdominal bile collection secondary to traumatic or iatrogenic injury of the biliary tree. We present a case of biloma treated by guided percutaneous needle aspiration.
Electrocardiographic (ECG) changes in nine patients under continuous ECG monitoring before, during and after balloon dilatation for achalasia were followed; of these, three had ischaemic heart disease (IHD). One or several abnormalities including sinus tachycardia, supraventricular or ventricular ectopic beats, S-T segment depression and T-wave flattening appeared during the procedure; these were more commonly found in patients with IHD. Despite the high incidence of recorded ECG abnormalities, these were transient, and no treatment was needed. However, it seems advisable to have resuscitation equipment and emergency drugs available during balloon dilatation for achalasia, particularly when this procedure is performed in patients with IHD.