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I Georgescu

Publications and source records attributed to I Georgescu.

32 records · Page 2Linked to original sources
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[External biliary fistulas selectively managed by endoscopic retrograde cholangiography with sphincterotomy and/or stent placement].

External bile duct fistulas are inherent postoperative complications that usually appear after biliary tract surgery, traumatic bile duct injuries and liver surgery for hepatic hydatid disease or liver transplant. The management is highly individualized, while the success and long-term results of endoscopic and surgical techniques are conflicting. The study included 32 cases with external bile duct fistulas managed by endoscopic retrograde cholangiography (ERC) with sphincterotomy and/or stent placement, including "rendez-vous" procedures in 2 cases. The causes of the external fistula were represented by cholecystectomy with/without retained common bile duct stones or strictures (22 cases), cholecystectomy and drainage of a subphrenic abscess caused by severe acute pancreatitis (1 case) and surgical interventions for hepatic hydatid disease (9 cases). Due to the prospective protocol of the study we were able to apply an individualized endoscopic treatment: sphincterotomy with proper relief of the bile duct obstruction (stone extraction) or sphincterotomy with large-size (10 Fr) stent placement for large-sized bile duct defects. The results consisted in closure of the fistula in 3.5 +/- 1.7 days for the subgroup of patients with sphincterotomy alone. Among the patients with stent insertion, fistulas healed slower in 14 +/- 3.5 days. There were no complications after endoscopic treatment; however the stent could not be passed in one patient that required subsequent surgery. In conclusion, endoscopic intervention is the treatment of choice for small external biliary fistulas complicating biliary tract surgery or liver surgery for hepatic hydatid disease. When the fistula is large, the placement of a 10 Fr endoprosthesis becomes necessary, while failure of endoscopic treatment leads to surgery with hepatico-jejunal anastomosis.

Biliary Fistula↗
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[Tracheal bronchia].

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

[Tuberculosis in children as an important indicator in the fight against tuberculosis].

In spite of the fact that tuberculosis in children is continuously declining (in the Brasov District it fell from 197 cases during 1960-1970 to 67 between 1977 and 1979), a large number of cases are still recorded in children under the age of 3 years (from a percentage of 23 of the total number of sick children in 1969 to 44.8 in the last period). Epidemiologic studies discovered infection sources in 91% of the vaccinated children (parents represented 68% of all sources). Thus the source in the proximity, and detectable through the epidemiologic investigation exceeds the protection provided by the BCG vaccination, which results in a better protection against extra-familial infections, more rare and sporadic. It appears that in tuberculosis sources BCG vaccination alone is less efficient and a more prompt application of other preventive measures should be considered, such as early detection, rapid removal of the source, removing the children from the infective environment. Considerations should also be given to a control of the parents, especially of the father, which appears to be the source of infection twice as frequently as the mother.

Adolescent↗
PubMedDate not supplied

[Obturation with an elastic balloon--the authors' procedure for the conservative treatment of external postoperative digestive fistulae].

UNLABELLED: A personal method for the conservative treatment of the postsurgical external digestive fistulas by means of obturation with an elastic balloon of adjustable pressure, used in Surgical Clinic I Craiova in the past 12 years is presented. Initially conceived as an elective method for the treatment of the fistulas exposed in evisceration, the procedure was later applied as a unique method or in association with other conservative procedure in almost all types of fistulas. 122 patients have been treated by means of our method (3 esophageal, 65 gastro-duodenal and gastro-intestinal, 27 intestinal and 27 colo-rectal fistulas), in 53 cases a unique method and in 69 cases as a therapeutically sequences within the conservative treatment of the fistulas. RESULTS: 115 patients (94.2%) have had a fair evolution; we have registered 7 death, which represent a mortality rate of 5.93%. CONCLUSIONS: Our method offers the following advantages: it considerably reduces the losses of digestive liquids through the fistula; it allows early resumption of normal nourishment; it allows early mobilization of the patients; it prevents the occurrence of new fistulas which are caused by decubitus lesions; it is a simple and economic method, which can be applied in any surgical department.

Digestive System Diseases↗
PubMedDate not supplied

[Severe acute pancreatitis. Its management and experience].

The authors examined a group of 91 cases of acute pancreatitis hospitalised and treated between 1992 and 1996, using multiparametric bioclinical scores like Ranson, Imrie, Apache II systems and morphological scores obtained through C.T., they have divided the examined group into patients with A.B.P. (acute benign pancreatitis)--59 (64.84%), who don't require exquisite therapeutical means, with positive healing and A.S.P.--32 (35.16%), who require a complex medico-surgical therapeutics with unforeseeable evolution and results. The purpose of the paper was the one of establishing a diagnostical and therapeutical strategy for the A.S.P. adequate to actual conceptions. The correct diagnosis of acute pancreatitis initially has been established at 59 (64.83%) and erroneous at 32 (36.13%) cases. The diagnosis of A.S.P. has been established in 32 (35.16%). The etiology has been lithiasic (biliary) for 31.25% and nonbiliary for 68.75% patients. The C.T. examination in the best way to diagnose necrosis and infections, to follow the evolution and especially the surgical indication, achieved by the authors in 30% of cases. The initial medical treatment has been fulfilled at all the patients and the surgical one at 29 (91.63%). There have been implemented explorer laparotomies in 33.33% cases, interventions on the pancreas in 72.66%, operations associated on the biliary ways 41.37%, necessity operations 13.8%, with different types of draining (conventional and open abdomen). The results have been taxed by locoregional complications in 72.41%, general complications in 44.51% and a general rate of decrease of 43.75%. It is recommended initial surgical abstention and gravity estimations, the reanimation of all A.S.P. for prevention and treatment of general complications, surgical treatment of A.S.P. complications. The A.S.P. treatment of biliary (lithiasic) etiology after two months and after C.T. to confirm inflammatory process remission.

Acute Disease↗
PubMedDate not supplied

[Resuscitation principles in severe acute pancreatitis complicated by multiple organ dysfunctions].

The first part renders very synthetically a few of the principal pathogenetical mechanisms implicated in PA, as well as general data about MODS, and then tackles therapeutical principles of great organic disfunction, the therapy of septic states and nutrition in PA. Hemodynamics dysfunction--the therapeutical objectives are correlated with the principal mechanisms implicated in cardio-vascular disfunction (the grown level of some myocardial depressive factors, the shortcoming of peripheral vascular resistance, a.s.o.). The therapeutical principles covets the volemic restoration, inotropic therapy, the correction of hydro-ionic and acido-basic disorders, the vasomotor therapy, the CID's correction, the myocardium protection against the free radicals of oxygen. The therapy is recommended to be individualized depending on the clinical data and the monitoring of some parameters (T.A, P.V.C., intrapulmonary pressure, EKG, hematocrit value, a.s.o.). Pulmonary disfunction--includes the therapy of some clinical forms of pulmonary complications, the restrictive syndrome, infections, the pulmonary shunt, the atelectasis and insists on ARDS which is a complication with vital implications. The therapy of curdling disorders--recommends blood, derivatives, antiprotease, the substitution of the consumed curdling factors, as well as the removal of the pathogenic factors which disturb the coagulation-coagulolysis equilibrium. Purge proceedings--covet the elimination from the organism of the toxic agents which generate cell-organic lesions. That's why it is moot the elimination of the pancreatic toxins before reaching the circulation (the thoracic tube draining and peritoneal lavage) as well as extrarenal purge proceedings (hemodialysis, hemofiltration and hemodiafiltration) with their benefits and limits. The sepsis and the immunotherapy--are tackled based on recent data from literature which besides antibiotherapy insists on the neutralization of various toxins and mediators by means of monoclonal and polyclonal antibodies, anti TFL antibodies, IL, a.s.o. Nutrition--is different presented, parenterally and enterally, each of them with their benefits and limits and with the recommendation to be used by means of the clinical form. There are mentioned some other additional treatments (pain removing, antagonisms of H2 receptors, inflammation and cytotoxicity inhibition, gastric decompression, a.s.o.).

Acute Disease↗