Biomedical subjects

D Hrehoreţ

Publications and source records attributed to D Hrehoreţ.

5 recordsLinked to original sources

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

[Pyogenic liver abscess].

The objective of this study was to investigate and report changes in presentation, management and outcome of patients with pyogenic liver abscess (PLA). Between 01.01.1995-31.12.1999, 27 patients with PLA were treated in the General Surgical Service of the Fundeni Clinical Hospital. The incidence of cryptogenic abscesses was dominant (55.5%). The symptoms and the biological status are frequently nonspecific. The CT scan and echographic examination sensibility in the diagnosis of the PLA was 89.5% and 78.3%. The aerobe germs are most involved. All patients received antibiotic treatment in preoperative as in postoperative period. The surgical treatment was performed in 24 patients: in 9 patients (33.3%), the abscess was surgically evacuated and drained and in 15 patients (55.5%), a liver resection was performed. Percutaneous catheter drainage under CT or echo-guidance was performed in three patients (11.1%). The clinical evolution was good in 21 patients (77.7%). There was four complications (14.8%) and two death (7.4%). Although with a better prognostic, the PLA remains an important pathology.

Adolescent↗

PubMedDate not supplied

[Laparoscopic liver surgery: analyze the experience on 36 cases].

We analyze the experience in laparoscopic liver surgery in the Department of General Surgery and Liver Transplantation of Fundeni Clinical Institute between september 1998 and march 2003. This study includes 36 patients, 24 females (66.7%) and 12 males (33.3%) with ages between 25 and 67 and a mean age of 46 years. From the group of 36 patients with liver pathology considered for laparoscopic treatment 6 cases had multiple hepatic lesions with no preop diagnosis. The postoperative diagnosis was neoplasia in 4 cases, noncellular necrosis with chronic inflammation in one case and focal nodular hyperplasia in another case. The fenestration and drainage were used as laparoscopic treatment in case of 7 patients with nonparasitic liver cysts. Nine patients from our group had hydatid cysts. In 7 patients the treatment consisted in partial pericystectomy after inactivation and parasite evacuation. In 2 patients an ideal pericystectomy was performed for cysts located in segments II and III. The solid lesions selected for laparoscopic treatment were in 3 cases benign symptomatic tumors with no preoperative diagnosis, in 9 cases symptomatic hemangioma and in 2 cases malignant lesions. From these 14 patients in only 2 cases the lesions were located in the right antero lateral segments. Only in the case of metastasis a left lateral sectorectomy was performed, in all other cases a nonanatomical resection being performed. Conversion to open surgery was necessary in 11.11% of cases (2 hemangioma, 2 partial pericystectomies) for bleeding control. In our study we had no mortality and 11.11% morbidity. The follow-up was available in all patients for a mean time of 18 months (10 to 36). A CT scan was made in all patients with solid lesions 6 months after surgery and an ultrasound examination in all other cases. All patients were nonsymptomatic at repeated reevaluations. We are now at the beginning of laparoscopic liver surgery and these results need to be confirmed. The benefits seem to be those of any miniinvasive surgery: reduced trauma to the abdominal wall, early mobilization, shorter hospital stay, better aesthetics.

Adult↗

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

[Therapy of malignant liver tumors using microwave and radiofrequency ablation].

The aim of our study was to evaluate the efficiency for thermo-ablation with microwave and radiofrequency on patients with malignant liver tumors. From January 2002 to January 2005, in our Center of General Surgery and Liver Transplantation in 53 patients 70 sessions of thermoablation were carried out. The mean age was 58 years (25-79 years). Sex ratio men: women was 1.8 (34:19). The diagnosis was hepatocarcinoma in 38 patients (72%), liver metastases from colorectal cancer in 9 (17%) and from non-colorectal cancer (6-11%). The most tumors were single (36-68%). The mean diameter was 39.5 mm (9-94 mm). Percutaneous approach was used in 14 interventions (20%), laparoscopic in 2 (3%) and open approach in 54 cases (77%). We performed 54 sessions of microwave ablation in 42 patients and 8 sessions of radiofrequency ablation in 5 patients. Both methods were applied in 6 patients during 8 sessions. Tumor ablation was done together with liver resection in 10 patients (19%) and resections of other organs in other 8 patients (15%). Morbidity was 12%. The encountered complications were ascites, right pleural effusion and liver abscesses. There was no death. Total and partial necrosis was observed in 27, respectively 20 patients. Local recurrence occurred in one patient but distal liver recurrences were diagnosed in 13 patients. After thermoablation for partial necrosis, local or distal recurrences patients received arterial chemoembolization (5), systemic chemotherapy (23), liver resection (1) and transplantation (1). The mean survival at 1 year and 3 years was 77% and respectively 38%. Microwave or radiofrequency ablation is a simple treatment method, with proved efficiency and minimal risks whose main indication is unresectable tumor.

Adult↗