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D Poenaru

Publications and source records attributed to D Poenaru.

48 records · Page 3Linked to original sources
PubMed1993

A new prognostic classification for esophageal atresia.

BACKGROUND: Waterston's risk categories have been extensively used in the past for the classification and management of neonates with esophageal atresia. Advances in neonatal care have affected the prognostic usefulness of the Waterston classification. The purpose of this study is to formulate a new classification of risk factors that would more accurately predict outcome. METHODS: We retrospectively reviewed 95 consecutive cases of esophageal atresia and/or tracheoesophageal fistula treated at the Montreal Children's Hospital. Fifteen patients were in the Waterston class A, with a 6.7% mortality; 35 patients, in class B with a 5.7% mortality; and 45 patients, in class C with a 26.7% mortality. Logistic regression analysis of the influence of each risk factor (weight, pulmonary status, and severity of associated anomalies) on mortality was performed. RESULTS: Birth weight was not found to independently influence mortality. Only severe pulmonary dysfunction with preoperative ventilator dependence and severe associated anomalies had a prognostic influence. We therefore revised the classification to include only significant factors. The new high-risk class II consists of patients with either life-threatening anomalies or both major anomalies and ventilator dependence; the low-risk class I includes all other patients. These criteria radically changed the stratification of both the number of cases and the mortality among classes: the 82 patients in class I had a 7.3% mortality; the 13 patients in class II had a 69.2% mortality. Logistic regression analysis confirmed the validity of this new classification by showing displacement of individual variables by the revised classification but not by Waterston's. CONCLUSIONS: This new "Montreal classification" can simplify and improve the stratification of patients with esophageal atresia. It also reflects the more favorable outcome of low birth weight neonates.

Abnormalities, Multiple↗
PubMed1991

A more than 25-year experience with end-to-end versus end-to-side repair for esophageal atresia.

End-to-end anastomosis has become the standard technique for repair of esophageal atresia with distal tracheoesophageal fistula. End-to-side anastomosis with ligation of the fistula in continuity has also been advocated. For over 25 years both methods have been used in this hospital. The purpose of this report is to compare retrospectively the results obtained with these two techniques. Between 1962 and 1988, 111 neonates underwent repair of esophageal atresia and distal tracheoesophageal fistula. 74 patients had an end-to-end repair and 37 had end-to-side anastomosis with fistula ligation, according to the surgeons' preference. There were no significant differences between the two groups with respect to preoperative variables and Waterston classification. There was a significantly increased incidence of fistula recanalization (22% v 3%, P = .003) and mortality directly related to the esophageal atresia (16% v 3%, P = .03) in the end-to-side group versus the end-to-end group. The end-to-end group had a significantly higher incidence of gastroesophageal reflux. Logistic regression analysis showed that the end-to-side repair was associated with a greater overall mortality. We conclude that the end-to-end repair appears to be a safer procedure than the end-to-side technique.

Analysis of Variance↗
PubMed1991

Clinical outcome of seriously ill surgical patients with intra-abdominal infection depends on both physiologic (APACHE II score) and immunologic (DTH score) alterations.

The delayed-type hypersensitivity (DTH) response and the APACHE II score in 118 patients with surgical infections were measured prospectively and related to outcome. Logistic regression analysis generated the equation: [formula: see text]. The risk assessment as calculated by this model was compared to that using the APACHE II system alone in a separate group of 354 patients. There was an improvement in the predictive capacity of the APACHE II + DTH equation compared to APACHE II alone, as shown by a better fit of expected and observed deaths, an improved Goodman-Kruskal G statistic, and a larger area under the receiver operating characteristic curve. It is concluded that the DTH response (a broad marker of immunocompetence) is an independent prognostic factor in surgical patients and can be used in combination with the APACHE II score (a measure of acute physiology) to estimate better the outcome of surgical patients.

Abdomen↗
PubMed1991

Hepatocellular carcinoma: comparison of clinical features among ethnic groups in an area of low prevalence.

We retrospectively surveyed the clinical features of 73 cases of hepatocellular carcinoma at two hospitals over a 12-yr period. The population was heterogeneous, with 39% representing immigrants from regions of high hepatitis B and hepatocellular carcinoma prevalence. The yearly incidence of cases was constant over the 12 yr. Patient data were analyzed by grouping into three broad categories based on origin from known high, medium, or low prevalence hepatocellular carcinoma zones. In this fashion, differences in clinical presentation were observed. Asians (N = 12) were younger, invariably presented with pain; 82% had markers of hepatitis B and did not have features of chronic liver disease. In contrast, Westerners (N = 45) were older by more than a decade. One-quarter were HBV positive and almost two-thirds were alcoholic. The clinical presentation of this group was more varied, over one-third presenting with features of decompensated liver disease or variceal bleeds. Mediterranean patients (N = 16) had features intermediary between the two other groups. A logistic regression model clinically separated patients with hepatitis B-related hepatocellular carcinoma from those with alcohol-related hepatocellular carcinoma, suggesting different ongoing pathogenetic influences.

Adult↗
PubMed1990

Imipenem versus tobramycin--antianaerobe antibiotic therapy in intra-abdominal infections.

The authors compared broad-spectrum monotherapy with imipenem to an aminoglycoside-based antibiotic regimen for the management of intra-abdominal infections. One hundred and four patients who had intra-abdominal infection were randomly allocated to receive imipenem (52) or tobramycin plus clindamycin or metronidazole (52). Patients treated with imipenem had fewer febrile episodes and occurrences of breakthrough bacteremia, less antibiotic resistance and need for drug change; their hospital stay was shorter. The death rate from sepsis was 4% in patients who received imipenem and 13% in those who received the combined regimen (p = 0.08). Treatment was successful in 79% of patients on imipenem versus 67% of those receiving an aminoglycoside. Patient stratification by the APACHE II system and probability of death calculation using delayed-type hypersensitivity scores predicted a similar death rate for the two treatment groups. Imipenem appears to be a safe and efficacious alternative broad-spectrum antibiotic for treating patients who are seriously ill with intra-abdominal infection.

Abdomen↗
PubMed1987

Tracheomalacia: an experimental animal model for a new surgical approach.

Tracheomalacia was created by removing the posterior 50% of the circumference of eight cartilage rings (5-6 cm in length) from the intrathoracic trachea in each of 12 piglets while leaving the mucosa intact. In 6 animals an autologous, free tibial periosteal graft was applied over the defect (graft group). The remaining 6 piglets served as the control group. In all animals, a silastic stent was left in the trachea for 2 weeks to prevent immediate tracheal collapse. The presence of tracheomalacia was assessed 6-8 weeks after surgery. At bronchoscopy total tracheal collapse during coughing occurred only in the controls. As the animals went from quiet breathing to coughing, mean intrathoracic pressure increased from 5 to 80 cm H2O in both groups, and average sagittal tracheal diameter decreased by 10% in the graft group and 71% in the controls. During coughing, mean resistance to airflow across the defect increased by 0.005 +/- 0.002 cm H2O/liter/min in the graft group, by 0.083 +/- 0.96 cm H2O/liter/min in the controls (P less than 0.005), and by 0.027 cm H2O/liter/min at the same tracheal level in two normal pigs. At sacrifice 12 weeks postoperatively, bone and collagenized fibrous tissue had been produced by all grafts, without evidence of stricture. This study shows that experimentally induced tracheomalacia can be treated successfully by the application of an autologous periosteal tibial graft, which becomes incorporated into the weakened tracheal wall.

Airway Resistance↗
PubMedDate not supplied

[Radioclinical and morphological comparisons in non-lithiasic gallbladder diseases].

Confrontation of the clinical, radiologic and morphologic data in a lot of 274 patients operated for non-lithiasic cholecystopathies during the 1966-1972 period, led to the following conclusions: - the painful choleic syndrome whose duration and frequency increase progressively, refractory to the conservative treatment, is a basic criterion in establishing the surgical treatment; - any change in the radiologic image of the gallbladder, especially those evoking a partial or totally inefficient contractile effort are of diagnostic value, suggesting the necessity of the operation, when confirmed by a similar clinical context; - the morphologic substrate consists in inflammatory lesions (infiltrations, atrophy of the mucosa, sclerosis), or degenerative lesions (cholecystoses) due to the reaction of the gallbladder walls to the irritative-chemical action of the bile hyperconcentrated by intermittent stasis caused by an incomplete cystic obstacle; - both types of lesions may determine with time obstruction of the cystic duct (acute cholecystitis), changes in the choledochoduodenal confluence (odditis), co-affection of the pancreas and liver (cholecystopancreatitis, chronic reactive hepatitis); - the late results lend support to the surgical treatment in such circumstances.

Adult↗
PubMedDate not supplied

[Morphological and enzymatic studies of the supratumoral distended colonic loop in colorectal cancers (therapeutic aspects)].

The authors carried out experimental and clinical studies in an attempt to explain the causes leading to anastomotic dehiscences, a major complication of exeresis surgery of the left colon and of the rectum. In this view they have performed in dogs incomplete stenoses at the level of the sigmoid and also made parallel studies of the morphological and histochemical changes occuring in the supra-stenosis colon wall, with those of the supra-tumoral colon wall found in human colo-rectal carcinomas, in the "sub-occlusion" stage. Histological alterations are presented, characterized by marked edema in all the layers of the wall, leading to evidently hampered colon vascularization. From the enzymological viewpoint there was noted an intensive phosphatasic and ATP-ase reaction in all the layers of the colon wall. These studies led to the conclusion that it is necessary to evaluate the degree and the duration of the supra-tumoral colic distension before a decision is taken to carry out primary colectomy or rectal resection (single-step procedure), and not to avoid the practice of a seriated intervention when necessary. The reversibility of the lesions noted by the authors allows for the possibility to perform a resection after the colic wall to be anastomosed has returned to an almost normal condition, thus avoiding the dehiscence of the sutures.

Adenosine Triphosphatases↗
PubMedDate not supplied

The vascular morphometry of some brain stem parts.

With the view of following the vascular system of the cerebral trunk, there have been simultaneously injected coloured tracers combined with radio-opaque substances and radio-isotopes (32P, 22Ca) by intravital perfusion to 130 animals (dogs, rabbits and rats). The macro- and microscopical vasculature of the human brain stem was studied on 30 specimens of adults and children. The angioarchitecture of the diverse parts and sectors of the brain stem was studied as a whole in tetraline transparentised preparations and on histological section in comparison with the microradiographies and to incorporation of radioisotopes. A particular attention has been given to the irrigation of hypoglossal nuclei, the bulbar oliva, and the pontopeduncular region, all being zones with multiple sources of vascularization. The vascular morphometry has been macro- and microscopically performed, the data being worked out mathematically-statistically by computing some hemodynamical indices in order to estimate the circulation in different zones of the brain stem.

Adult↗