Biomedical subjects

E Bratucu

Publications and source records attributed to E Bratucu.

3 recordsLinked to original sources

PubMed2000

Drainage of the common bile duct by the axial transomphalic extraperitoneal route.

AIM: A retrospective analysis was made of results obtained in 169 patients with axial transomphalic external biliary drainage, operated between 1984 and 1998. However, the authors' experience with this method covers a total of 773 cases in which this type of drainage was used between 1966 and 1998. METHOD: The technique is described in detail. The use of the omphalic ligament provides a completely extraperitoneal trajectory for biliary drainage tubing inserted between the two peritoneal layers of the ligament. RESULTS: Postoperative mortality and morbidity in the patients presented here were not related to the drainage procedure, but were related to the background illness, associated disturbances and the surgical procedures applied. Axial transomphalic biliary drainage has many indisputable advantages in comparison with other types of external biliary drainage. Indications and counterindications of the method are summarized. CONCLUSION: The technique is especially valuable because it protects biliary-digestive anastomoses and common biliary duct sutures, facilitating implantation of prostheses and reconstruction of the main biliary pathway, as well as benign and malignant stenoses.

Common Bile Duct↗

PubMed1998

Hepaticojejunostomy without suture.

Common bile duct (CBD) surgery sometimes demands performing 'a la Roux' hepaticojejunal anastomosis. This kind of stoma is technically easy to perform on a biliary stump of sufficient width (> 8 mm), sufficient length (> 0.5 cm) and with a resilient wall so that stitches will not cut off. In some cases, however, the anatomical conditions are poor: short or thin biliary stump. This situation is especially encountered in iatrogenic lesions of the main biliary channel, but it can infrequently be found in some malignant lesions of the CBD. The authors present their procedure of hepaticojejunal anastomosis without suture, which is adequate for the treatment of benign or even malignant stenosis of the CBD. The method realizes anastomosis of the segments without using sutures by simply keeping them in apposition with continuous traction exerted via a Foley-type balloon catheter which stents the anastomosis in an axial manner. The balloon is then inflated and traction is exerted on the catheter, enabling the two segments of the anastomosis to remain in place until complete healing (10 days average). We performed the procedure in 7 cases: 4 for neoplastic stenosis, and 3 for an accidental lesion of the CBD. There was no perioperative morbidity and 1 fatal outcome. The results prompt further evaluation of the method.

Anastomosis, Surgical↗

PubMedDate not supplied

[Cefepime (Maxipime) treatment efficacy in surgical patients ].

Between September and December 2001 in the "Caritas" Surgical Clinic of Bucharest has been conducted a clinical study for the efficiency of Cefepime (Maxipime) treatment in surgical patients. Introduced in therapy in the last decade of the XXth Century, Cefepime (Maxipime) is the most active 4th generation cephalosporin, due to its extended spectrum of activity and its high resistance against beta-lactamases. Cefepime (Maxipime) has a very large spectrum, including the majority of the microorganisms implicated in surgical infections: Enterobacter, Klebsiella pneumoniae/speciae, Proteus mirabilis, Bacillus fragillis, Pseudomonas aeruginosa, Serratia, Citrobacter and other Gram-negative bacilii, Gram-positive cocci (Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes). The clinical study included 30 surgical patients, the selection criteria being the severity of the present infection or the potential risk after major (abdominal) surgery. We introduced Cefepime (Maxipime) as first choice of monotheraphy, except: severe, life threatening nosocomial infections, when we associated Cefepime (Maxipime) with aminoglycosides; failure of another antibiotheraphy schema, when we associated Cefepime (Maxipime) with aminoglycosides; suspicion of anaerobe contamination, when we associated Cefepime (Maxipime) with metronidazole. The results of our study support the utilization of Cefepime (Maxipime) as the best choice antibiotic in severe surgical infections, especially in the intensive care and surgical units. Cefepime (Maxipime) can be synergically associated with aminoglycosides and imidazoles (metronidazole).

Adult↗