Successful management of postoperative chylous ascites with a peritoneojugular shunt.
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Chylous Ascites↗
Biomedical subjects
D Voros
Publications and source records attributed to D Voros.
Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection.
Forty-two patients with necrotizing soft tissue infection are reviewed. Bacterial culture revealed between two and seven types of micro-organism in each patient. All patients were treated with radical surgical debridement and a combination of antibiotics. In 30 patients, early diagnosis and treatment resulted in only two deaths. Delayed surgical intervention in 12 patients transferred from outside hospitals was followed by nine deaths. Predisposing factors and site of infection did not affect outcome. Of 26 patients with systemic manifestations of sepsis, 16 survivors responded well to initial surgical debridement.
Connective Tissue Diseases↗
Extracapsular (satellite) hydatid cysts.
Sixteen percent of hydatid cysts in the liver in 185 patients examined by computed tomography (CT) showed daughter cysts located exterior to the fibrinous membrane of the main hydatid cysts. We call these extracapsular or satellite cysts. Extracapsular cysts have the same appearance as endogenous daughter cysts. Preoperative demonstration of these cysts is useful for planning an appropriate surgical treatment and reduction of the recurrence rate.
Adult↗
Compression ultrasonography as a reliable imaging monitor in deep venous thrombosis.
Our experience at Hippokration Athens Hospital with high-resolution real-time ultrasonography of the deep veins of the lower extremities is described, drawn from the results of a prospective comparative study of 65 patients. We used a combination of sonography and contrast venography for the detection of deep venous thrombosis (DVT). Of the study group, 33 had clinically suspected DVT, 20 were asymptomatic high-risk patients, while 12 with varicosities of the leg and scheduled for saphenectomy were examined preoperatively for deep venous patency confirmation. For all patients, venography, the reference method, was performed within 12 hours of the ultrasound scan. Since 29 of the examinations were bilateral, the total number of extremities studied was 94. The sonographic criteria analyzed were the intraluminal echogenicity and the venous compressibility with the ultrasound transducer probe. In addition, the response of the common femoral vein to the Valsalva maneuver was studied. Among these three criteria, compressibility was by far the most accurate. Noncompressible abnormal veins were noted in all of the 24 extremities with proximal thrombosis and in six of the 12 with thrombosis limited to the calf veins. Thus, the sensitivity of the compressibility criterion was 100 per cent for proximal and 50 per cent for isolated calf venous thrombosis (83 per cent). All venographically patent veins were fully compressible (specificity, 100 per cent). Abnormal intraluminal echoes were found in 18 of the 36 extremities with thrombosis but not in those with negative findings on venography. Sensitivity of intraluminal echogenicity was, therefore, 50 per cent and specificity, 100 per cent. For the Valsalva criterion, the standard lower normal limit of 10 per cent was applied, leading to 40 per cent sensitivity and 93 per cent specificity rates. In comparison with venography, ultrasonography underestimated the extent of thrombosis in 60 per cent of the true-positive examinations, although never to a clinically significant degree. In conclusion, compression ultrasonography, a technique based upon the unique criterion of venous compressibility, is a highly accurate and objective noninvasive diagnostic method, and is also suitable as a screening test. We urge clinicians to support their therapeutic decisions concerning the management of DVT with it.
Adult↗
Clostridial sepsis: unusual clinical presentations.
We present four cases exhibiting the widely diverse nature of clinical infections due to anaerobic Clostridium perfringens. These cases exemplify the need for a thorough initial physical examination, immediate Gram staining of fluid from involved tissue, and recognition of the severity of the disease in any patient who has early septic deterioration after elective or emergency surgical procedures. Management of these infections includes both high-dose parenteral penicillin therapy and aggressive initial surgical debridement of all involved tissues.
Adult↗
Acute appendicitis complicating pregnancy.
Seventeen cases of acute appendicitis complicating pregnancy were analysed. The presenting symptoms were abdominal pain, nausea and anorexia. The usual physical findings were direct abdominal tenderness and rectal tenderness. Correct diagnosis was more difficult when gestation was advanced. This was reflected both by the severity of the disease process found at operation and by the increasing foetal mortality rate. Delay in diagnosis and treatment is the main factor causing high maternal and foetal death rates, especially when pregnancy is advanced.
Acute Disease↗
Anaerobic infections of the soft tissue and bones.
Severe soft tissue infections, usually necrotizing, are associated with a mortality of 40-60% and with amputations where the bones and joints are involved. The anaerobic bacteria associated with these infections are usually present in patients with underlying predisposing conditions (diabetes, vascular problems, immunosuppression). They are in the majority polymicrobial, endogenous or exogenous. There are many clinical and laboratory characteristics to establish the diagnosis of the different forms of these infections. Treatment of necrotizing soft tissue and bone infections requires early and aggressive surgical debridment. Timing of diagnosis and surgery influence essentially the outcome. Colostomy can be helpful in cases of perineal involvement. Antibiotic covering (broad spectrum) is mandatory as well as the systemic support of the patient.
Journal Article↗
MRI of abdominal hydatid disease.
Seventy hydatid cysts in 30 patients were studied with magnetic resonance imaging (MRI) and computed tomography (CT); all cases were confirmed surgically. MRI detected all cysts when confined to solid organs, whereas small-sized cysts (< or = 2 cm) may be missed when located in the peritoneal cavity. Hydatid cysts of less than 3 cm (noncomplicated) present no specific findings of hydatid disease. MRI findings suggesting hydatid disease demonstrate a relatively thick hydatid cyst wall, daughter cysts, and germinal membrane detachment. T2-weighted images proved to be superior to T1- or PD-weighted images in demonstrating hydatid cyst wall thickness, germinal membrane detachment, and daughter cysts. In all spin-echo sequences, the maternal cystic content presented much higher signal intensities than that of daughter cysts. This difference in signal intensity is more obvious in T2-weighted images, except in complicated, infected cases. CT proved to be superior to MRI in demonstrating wall calcifications.
Abdomen↗