Natural history and the clinical importance of early and late grade 2 cellular rejection following cardiac transplantation.
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Adolescent↗
Biomedical subjects
H Doran
Publications and source records attributed to H Doran.
Severe mitral valve dysfunction due to unsuspected granulomatous myocarditis: successful cardiac transplantation following attempted mitral valve repair.
Granulomatous involvement of the myocardium is a rapidly fatal disease of uncertain aetiology rarely diagnosed premorbidly. We report a patient who presented with mitral valve incompetence and congestive cardiac failure who underwent a successful mitral valve repair but could not be weaned from cardiopulmonary bypass. Urgent heart transplantation was successfully performed and histological studies of the explanted heart revealed granulomatous myocarditis involving the mitral subvalvular apparatus. Endomyocardial biopsy may be necessary in young patients presenting with mitral valve disease of unknown aetiology.
Adult↗
Clinical importance of grade 2 cellular heart rejection.
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Adolescent↗
Pulmonary aspergillosis in patients with leukaemia.
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Aspergillosis↗
Role of corrective therapy in the rehabilitation of immediate post-operative fitting of lower extremity amputee.
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Amputees↗
[Acute abdomen and diabetic patients--difficulties of diagnosis and therapeutical decision].
We present a retrospective study based on 50 diabetic patients with acute abdominal diseases. Usually, clinical features were not typical, without defining signs of acute abdomen, despite frequent severe anatomo-pathological forms (6 of 12 acute appendicitis were gangrenous, with generalised or localised peritonitis; 15 of 22 acute colecystitis were gangrenous). In diabetic patients, with metabolic disorders and cetoacidosis, positive diagnosis and the decision of laparotomy are difficult problems, often delated, with a negative influence on the evolutions and prognosis of these patients.
Abdomen, Acute↗
[Abdominal hemangiopericytomas].
We present two cases of hemangiopericytoma, which are analyzed according to medical literature, although only few cases have been reported. Clinical, imagistic and histological findings of these rare vascular tumors are discussed.
Female↗
[Diabetic gangrene].
The large variety of the lesions in diabetic gangrene which require different therapeutical decisions explains our attempt to determine an useful way for the approach of the surgical treatment. Our aim was to avoid both an underestimation of the lesion, which may lead to an insufficient procedure, followed by reinterventions, as well as an overestimation--generating avoidable amputations. We have elaborated a scale of indices of therapeutical prognosis (ITP), using a computer programme, with the main risk factors. The result was a scale between 1 and 10; the value is proportional to the severity of each lesion. We have also analyzed the fiability of ITP on a prospective study including 72 patients with diabetic gangrene. The result was 93%, which has encouraged us to consider ITP useful in establishing a therapeutical attitude.
Adult↗
[Small bowel tumors -- peculiarities of diagnosis and evolution].
The authors analyze 13 cases of small bowel tumors. There are emphasized the difficulties of diagnosis, which is rarely established before the laparotomy. In the same time, clinical features are few and operations are often performed too late, in emergency, due to tumors complications (perforation, bleeding, occlusion). There are also presented new etiopathogenic hypothesis, recently mentioned in literature. Surgical treatment is followed by many post-operative complications. Five-years survival is low, under 40% of patients.
Adenocarcinoma↗
[Acute abdomen in diabetic patients --diagnostical questions].
The acute abdominal diseases in diabetic patients have some typical clinical features, which may be responsible for delated or even erroneous diagnosis. Severe anatomo-pathological forms of these diseases may advance, despite a rather discreet clinical evidence. The authors analyze a series of 132 diabetic patients with acute abdomen, operated between 1996 and 2001 in Surgical Clinic "I. Juvara", from Clinical Hospital "Dr. I. Cantacuzino"-Bucharest. The difficulties and also the inadvertences of diagnosis are detailed. Finally, a set of indices is presented, in order to help the differential diagnosis between acute abdomen and abdominal signs of the diabetic ketoacidosis.
Abdomen, Acute↗
[Organic hypoglycemia of pancreatic cause].
Insulinomas represent the most common cause of organic hypoglycemia. They are rare tumors: a review of the world literature reported a total number of 2000-3000 cases. The clinical diagnosis is based on the Whipple triad, which consists of: a) symptoms of hypoglycemia, b) blood glucose level: 40-50 mg/dl during the crisis, c) relief of symptoms after oral or intravenous administration of glucose. The most ticklish problem is the settlement of the accurate location of the tumor. Nowadays, there are many diagnostic methods; one of the best appears to be intra-operative ultrasonography. The authors analyse a series of 16 patients, operated between 1985 and 2002 in "I. Juvara" Surgical Clinic and present their opinions concerning tactic and technical aspects of different surgical procedures, with their advantages and limits. The results of the surgical treatment are detailed. There are also mentioned new imagery techniques and laparoscopic procedures, from recent medical issues.
Adult↗
[Late intestinal perforations after alloplastic repair of postoperative eventrations].
Late intestinal perforation is the most rare and the most serious complication following the repair of abdominal parietal defects with alloplastic material. The authors have gathered in 7 years 6 cases of perforations which occurred between 1 and 10 years after using nonabsorbable synthetic mesh prostheses made of polyester (4 cases) and polypropylene (2 cases) as parietal substitution materials. The perforations were discovered either by the appearance of complete enteric fistulas after exploration of circumscribed parietal suppurations (3 cases) or during surgery of suppurations without external fistulas. All cases involved perforations of the small intestine and in only one case there was also a perforation of the transverse colon. In 4 cases, where eventration relapse co-existed, the polyester prostheses were found partially or totally detached from the abdominal wall. The treatment of enteric perforation consisted of 5 segmental enterectomies (one of those a double one) followed by anastomoses and one enteroraphy. The colic perforation was excised and sutured. The mesh was totally removed in 5 cases and partially removed in 1 case (around the perforation). The postoperative evolution was simple in only 3 cases. In the other 3 cases anastomotic fistulas occurred and one of them (with reduced leakage) was treated by nonoperative management. It did not close spontaneously even after 12 months. The other 2 cases required multiple reinterventions (enterectomies, ileostomies, ileocoloanastomosis). One of these patients has been lost away after 200 days of hospitalization and multiple reinterventions. In all cases, the closure of the abdominal wall was simplificad by cutaneous suture only whereas consecutive relapsed eventrations remain to be treated by subsequent reinterventions.
Hernia, Ventral↗
[Protective transanal tube in colo-rectal anastomosis].
A particular issue of colo-rectal resection is represented by the great frequency of anastomotic dehiscences, which the medical literature has shown to vary between 3.25% and 30%. This justifies the surgical interest in perfecting methods aimed at reducing the frequency of this complication. One of these methods is the protective ileo- or colostomy, which has successfully reduced the frequency of dehiscences down to 4%. To the same propose a method that has been documented in previous literature and which consists of inserting an endoanal protective tube, above the anastomosis. The tube is connected to a plastic pouch and is maintained for 3-6 days, until transit has resumed. By applying this method to 38 cases, we noted only two cases (5.2%) of anastomotic leakage with small output, which were solved spontaneously after a few days. The basic nature and efficiency of this method have lead us to propose it as an alternative procedure to protective ileo- or colostomy. This method has the advantage of preventing further procedures. The quality of life of these patients is appreciably improved.
Adult↗
[Sacrococcygeal teratoma in an adult female operated with abdominoperineal approach].
The authors present the case of a 28 years old female with a mature, three-layers sacrococcygeal teratoma, which has been operated using an abdominoperineal approach. Teratomas are quite frequent in pediatric surgery; their incidence gradually decreases in adult population. Lately, significant progresses in the diagnosis and treatment of fetus and new born teratomas have been achieved; a review of the literature (2000-2004) is added. In adults, the diagnosis of teratomas is rather difficult. The symptoms are due to their size, to the compression of pelvic viscera or to their complications (infections, bowel obstruction, fistulas, malignancy). The treatment of teratomas is mainly surgical. The approach depends on the peculiarities of each case (size, invasion of the nearby viscera).
Abdomen↗
[Extensive necrotizing perineal infections in diabetic patients].
We present the pathogenic and the therapeutic features of the extensive necrotizing perineal infections in diabetic patients, based on the clinical experience of our surgical department (45 cases in 10 years) and on the data in the medical literature. We analyzed the case of a 45 years male with an unbalanced type I diabetes mellitus, which has been admitted for an extensive necrotizing infection of the lower abdominal wall (hypogastrium and both right and left lower quadrant), with crepitation on this area. The origin of this necrotizing infection was an upward extension of an insufficiently drained right ischiorectal abscess. The therapeutic management consisted in 6 consecutive surgical procedures (drainage, necrectomy, large fasciectomy), which permitted a favourable evolution and the healing of the patient. We used this demonstrative case for emphasizing the clinical, paraclinical and therapeutical peculiarities of the extensive perineal infections in diabetic patients.
Debridement↗
[Cystic lesions of the pancreas].
The lesions of the pancreas represent a very interesting chapter of its pathology. Although they seem very much alike, the different anatomo- pathological forms have well defined individual features, which impose the therapeutical attitude. The authors have analyzed a group of 62 patients, admitted in our clinic between 1974 and 2003. Most of them had pancreatic pseudocysts (54-86%); 6 (10%) had cystadenomas; 1 (2%)--cystadenocarcinoma and 1 (2%)--solid and papillary cystic tumour. The diagnostic methods are largely presented and compared to the literature; it is emphasized the importance of imaging procedures and of the histo-pathological examination. The different therapeutical procedures, their advantages and limits are also analyzed--the necessity of a conservative attitude, with the total or partial preservation of the pancreas, is almost unanimously recognized.
Adult↗
[Injuries of the extrahepatic bile ducts in laparoscopic cholecystectomy].
Laparoscopic cholecystectomy has become the "gold standard" for cholelithiasis. In laparoscopic technique, the incidence and the severity of injuries of the extrahepatic bile ducts are significantly higher (0-2,7%) than in open surgery (0,2-0,5%). The authors present a series of 18 patients with such lesions, operated between 1996 and 2005 in the surgical departments of 2 Clinical Hospitals: "Dr.I.Cantacuzino" and Coltea, from Bucharest. The injuries were: 2--of type A, 10--of type D and 6--of type E, according to Soper-Strasberg classification. There are analysed the causes and the circumstances in which these injuries have occurred, the clinical signs and imagistic findings and, most of all, their treatment. In complete transections of the common bile duct, a hepatico-jejuno-anastomosis using a Roux en Y-loop appears to be the best solution. It is emphasized the fact that an accurate diagnosis and surgical technique are essential for a favourable evolution. That's why these operations must be accomplished by experimented surgeons, from highly specialized departments.
Anastomosis, Roux-en-Y↗