[Research on circulatory functional changes caused by painful trigeminal stimuli and prevention of such changes].
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Biomedical subjects
Publications and source records attributed to F Mandache.
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The authors statistic concerns 370 interventions for adenomatous polyps and rectocolic polyposis (105 segmental exereses, 32 total or sub-total rectocolectomies, 233 direct, endo-anal or laparocolotomy electroresections). The necessity is stressed of the early detection of isolated, or of multiple polyps, or of potentially malignant polyposis, either genetically inherited or acquired, and on their radical extirpation from the beginning, an attitude that improved late oncologic prognosis (98% survivals after 5 years).
The case is presented of a male patient hospitalized for severe arterial hypertension determined by chronic constitutional hyperadrenalism. Splanchnic-sympathectomy was performed, associated to medullar sclerosis of the left adrenal with 40% sodium salicylate (genetic chemical surgery). The results after 3 years were good, both clinically and paraclinically. The constitutional background was normo-hypoadrenergic and the ecologic balance of the patient became normal after surgery.
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The authors have carried out a populational study by performing psychomorphological and blood determinations, and have detected the presence of a chronic hyperactivity syndrome of the adrenals in 12,5 percent of the healthy young subjects engaged in various activities that they have investigated. In an experimental study the oxydative processes in the enzymatic cycle of Krebs were cut off by injecting the adrenal medullary area with a 40% solution of sodium salicylate, while the secretion of the adrenal cortex was maintained, as was demonstrated by the unaffected activity of the hexose monophosphate shunt in this tissue. The experimental results demonstrated that the adrenal medullary tissue represents a major pathogenetic link in the complex etiopathogeny of essential arterial hypertension, and this invalidates the role attributed by Volhard (in 1931) to the renal tissue, explaining the failure of haemodialysis, bilateral nephrectomy and kidney transplantation in preventing the recurrence of essential arterial hypertension.
Unilateral medullosclerosis associated with splanchnicosympathectomy was applied in 60 cases of severe essential arterial hypertension. In 21 patients this was associated with contralateral adrenalectomy. No deaths were recorded. The late results (2 to 20 years) varied in terms of the anatomoclinical stage of the disease when surgery was performed. Systolic pressures fell to 30-50 mm Hg, hypertensive oscillations disappeared, mean adrenalinaemia values decreased by 47.9% after unilateral medullosclerosis and slanchnicosympathectomy and by 72.2% after bilateral interventions in two stage. The constitutional hyperadrenergic psychosomatic background was modified and became normohypoadrenergic. There was no case of adrenocortical insufficiency, the secretion of corticoids being insured by activity of the hexose-6-mono-phosphate dehydrogenase shunt.
In 29 patients with abscesses of the anorectal region the wall of the purulent collection was sectioned not only toward the tegumental surface but also to the anal canal with partial sectioning of the sphincter in 9 of the cases with superficial abscesses, and complete sectioning of the sphincter in the remaining 20 patients that presented with ischio-rectal abscesses, and with deep posterior anal abscesses. No relapse was noted and in none of the cases did anal fistulae or anal incontinence develop. In contrast with the scars that develop following surgery for fistulae, the scars that develop after sectioning of the sphincter for anorectal abscesses are supple and do not lead to deformation of the sphincter.
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The selective inhibitory effect of sodium salicylate (2.5 M) on the adrenal medulla was investigated histopathologically, histoenzymatically, electron microscopically and biochemically. It was proved that the different behaviour of nicotinamide-adenine dinucleotide (NAD) and nicotinamide-adenine dinucleotide phosphate (NADP) linked dehydrogenases under the action of sodium salicylate can account for the survival of cortical cells, while the medullar ones are necrosed.
The syndrome of constitutional chronic hyperadrenalism was detected biochemically by blood cathecholamine assays as well as psychically and morphologically in 12.5% of the young apparently healthy subjects from Bucharest, investigated. Experimentally, the enzymatic cellular oxidative process in the adrenal medulla was blocked by chemical sclerosis of the adrenal medulla with a 40% solution of sodium salicylate (2.5 M), without influencing cortical secretion ensured bythe hexose monophosphat shunt. Chemical medullosclerosis associated with splanchnicosympathectomy and with or without suprarenalectomy on the opposite side performed in 60 patients with severe essential arterial hypertension resistant to drug therapy gave good results depending on the anatomical and clinical evolutive stage of disease.
Operations were performed in 58 patients with severe essential hypertension and in 105 patients with Buerger's thromboangiitis. No postoperative deaths were recorded. The mean adrenalinemia value decreased by 70.91% and that of noradrenalinemia by 10.34%. Systolic pressure decreased by about 30--50 mm Hg and the diastolic pressure by 10--30 mm Hg. The delayed results (1--20 years) were good in 62% of the patients with IIIrd-degree eye lesions and in 17% of the patients in the organofunctional stage II, in 17% of the patients in stage II--III of restricted necrosis, and in 4% of the patients in gangrenous stage III.