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Biomedical subjects

L Vlad

Publications and source records attributed to L Vlad.

18 recordsLinked to original sources
PubMedDate not supplied

[Pancreatic pseudocyst--diagnosis, evolution, surgical treatment].

BACKGROUND: The pancreatic pseudocyst (PP) represents one of the most common complications of acute and chronic pancreatitis, patients with this severe pathology often undergoing surgical treatment. PATIENTS AND METHOD: This paper evaluates 133 cases that underwent surgical procedures for PP in the 3rd Surgical Clinic Cluj-Napoca during January 1993-April 2003, from a diagnostic and therapeutic point of view, emphasizing the modern imagistic methods for diagnosis and the modern surgical approach to PP. RESULTS: In 105 cases (79%) an internal drainage procedure was performed (including three cases that underwent laparoscopic drainage procedures and one case undergoing a laparoscopy assisted drainage procedure, all four cases with favorable postoperative outcome), external drainage procedures were performed in 25 cases (19%) and in three cases (2%) a pancreatic resection was performed. External drainage was performed only when internal drainage was not possible. Postoperative complications occurred only in patients with externally drained PP. DISCUSSION: The results of this study confirm that the internal drainage of PP, especially using the limb of jejunum Roux-en-Y technique (67 cases, 50%), represents the best approach to PP surgery, laparoscopic procedures being a valid option in performing an internal drainage.

Adult↗
PubMedDate not supplied

[Laparoscopic pseudocysto-jejunostomy].

Laparoscopic surgery of the pancreas, acquisition of the recent years, finds application in the surgical management of pancreatic pseudocysts (PP). Among internal drainage procedures that can be performed through laparoscopic approach, the pseudocysto-jejunostomy technique (PJS) can be performed using only the standard laparoscopic instrument set. We submit the technique we used in performing a PJS on three patients admitted in our clinic. The postoperative outcome was favorable, having obtained identical results to those of the open approach. The mean duration of the interventions was 216.6 minutes. The mean postoperative hospitalization was 7 days. The laparoscopic approach allows internal drainage of PP in the form of PJS to be performed in good circumstances, also bringing about all the specific benefits of this type of surgery.

Adult↗
PubMedDate not supplied

[Hepatic hydatid cyst ruptured in the peritoneum].

Romania is an endemic region for hydatid cyst and has a high incidence of hepatic hydatid cysts. If the intrabiliary rupture is the most frequent complication encountered, rupture in the peritoneum is rare, with exact data not available. Between 1993-2002 160 patients with hepatic hydatid cysts were operated. Six of them had an intraperitoneal ruptured cyst. Ultrasound raised the suspicion of hepatic hydatid cyst ruptured in the peritoneum in 4 cases, in one case the intact cyst migrated in the lower abdomen were it was mistaken for an ovarian cyst. After a thorough lavage with hypertonic serum, the parasite was evacuated, the pericyst partially removed and the cavity collapsed with non-absorbable sutures. The postoperative course was uneventful. Prophylaxis with benzimidazolic drugs started days 2-3 PO. At a follow-up between 1-4 years no peritoneal hydatidosis was detected. In the intraperitoneal ruptured hydatid cyst the hypertonic serum and benzimidazolic drugs can be useful in preventing peritoneal seedings.

Echinococcosis, Hepatic↗
PubMedDate not supplied

[Laparoscopic cholecystectomy for porcelain gallbladder].

The porcelain gallbladder is uncommon type of chronically inflamed gallbladder wall considered to be associated with a high frequency of adenocarcinoma and subsequently not suitable for a laparoscopic approach. In 12,000 patients chosen for a laparoscopic cholecystectomy 4 porcelain gallbladders were diagnosed. In 2 cases the laparoscopic approach was successful. One conversion was due to an unconfirmed suspicion of gallbladder cancer and the other one to a fistula between the gallbladder and the common bile duct. Patients with a preoperative diagnosis of porcelain gallbladder must not be excluded from the laparoscopic approach yet a low threshold for conversion must be maintained in those with a cancer suspicion.

Adenocarcinoma↗
PubMedDate not supplied

[A possible protocol for postoperative management in laparoscopic cholecystectomy].

The goal of the "Prospect" programme (sponsored by Pfizer) is to create possible evidence-based protocols related to the management of postoperative pain after certain type of surgical intervention (e.g. hernia repairs, hysterectomies, etc.). This article is introducing the protocol for laparoscopic cholecystectomy for both day-case and longer hospital admission cases. The protocol is designed for preoperative, intra and postoperative period, choosing only those measures which were effective for postoperative pain, published in the literature. We are also presenting an analyze of our 13,000 laparoscopic cholecystectomies, from "Prospect" protocol point of view, and what we should do to improve the management of postoperative pain.

Analgesics↗
PubMedDate not supplied

[Radiofrequency ablation of liver tumors: technique and preliminary results].

Radiofrequency ablation is a therapeutic method more and more applied for unresectable liver tumors; the purpose of this study is to evaluate its advantages and disadvantages. A series of 14 cases with liver tumors was treated by radiofrequency ablation; in 5 cases (35.7%) a hepatic resection was associated. Laboratory data, complications, morbidity, mortality and survival were noted. Mean age was 57.4 years (40-70) for this series consisting of 8 women and 6 men. The mean number of tumors treated per patient was 2.2; the mean total tumoral diameter was 7.2 cm. There were no major technique related complications, nor perioperative mortality. Mean global survival was 507.4 days; one year mean global survival was 64.2% (9 cases) and two years mean global survival was 28.5% (4 cases). We presented the technique of radiofrequency ablation applied for liver tumors and our experience because it is less known and used in our country and there is a tendency to treat liver tumors by this mean.

Adult↗
PubMedDate not supplied

[The reinsertion of the duodenum into the digestive circuit. The indications and surgical technics in operated stomach syndromes].

The authors analyse, retrospectively, the experience of the Clinic of Surgery III. Cluj-Napoca, in the indications and surgical methods for reintroducing the duodenum in the digestive circuit in the syndromes of the stomach operated for benign affections. Between 1974 and 1987, the duodenum was reinstated in the digestive circuit in 37 patients, operated previously for duodenal ulcer (32 cases), gastric ulcer (3 cases), syndrome of mesenteric clip (2 cases). The primary surgeries that led to the exclusions of the duodenum from the digestive tract were gastroenteroanastomosis in 4 cases, and the gastric resections with gastrojejunal anastomoses of the Billroth II type in 33 cases (Reichel-Polya in 28 cases. Hoffmeister-Finsterer in 3 cases, Roux in 2 cases). The reintroduction of the duodenum in the digestive circuit, based on clinical and paraclinical criteria, was indicated in anastomotic ulcer (in 17 cases), gastric ulcer following gastroenteroanastomoses (in 1 case), syndrome of afferent loop (in 11 cases), persistent "dumping" syndrome (in 8 cases), association of plurideficiency syndrome (in 54% of the cases). The way of reconstructing the duodenum was adapted to the type and correctness of the primary operation, to the dominant clinical syndrome and associated lesions to the biological background and possibilities offered by the intrasurgical situation: reconversion by direct gastroduodenal anastomosis after degastrogastrectomy was used in 31 cases, the indirect methods by transposition of the afferent loop (Soupault--Bucaille) in 4 cases, or of the afferent one (Henley)--1 case gastrography and segmentary enterectomy in 1 case. The postoperative complications appeared in 35.1% of case, with a mortality of 8.1%. The therapeutic results were good and very good in 89.3% of the cases. The authors insist on the importance of maintaining the duodenum in the digestive circuit, during the primary surgeries for preventing some severe postsurgical syndromes.

Anastomosis, Surgical↗
PubMedDate not supplied

[Hemorrhagic juxtapapillary duodenal ulcer with choledochal and Wirsung's duct stenosis and duodenojejunal fistula following biliojejunal en-Y diversion. The surgical solution].

The paper reports on the clinical observation of a patient with bulbar duodenal ulcer placed in a juxtapapillary position due to a short bile duct, complicated with choledochal and Wirsung's stenosis and, finally haemorrhage and duodenojejunal fistula favoured by a gallbladder-jejunum diversion assembly. Three major surgeries, during 17 years, were required: cholecystectomy and choledochoduodenostomy for the choledochal stenosis induced by penetrating posterior bulbar ulcer; after 8 years, choledocholithotomy and gallbladder-jejunum derivation the loop in Y, (Roux) for the choledochoduodenostomy stenosis with the local lithiasis of the CBP; after 9 years, the resection of the proximal segment of the anastomosed jejunal loop with CBP and gastric resection with ulcer exeresis, followed by restoration of the gallbladder-jejunum anastomosis, gastrojejunal anastomosis and reimplantation of Wirsung's duct in the duodenal stump for juxtapapillary duodenal ulcer complicated with haemorrhage, penetration into pancreas, perforation in the jejunal loop anastomosed preduodenally and stenosis of Wirsung's duct. The final therapeutic result is good and lasts in time. The paper discusses the duodenum-gallbladder-pancreas interrelationships in the juxtapapillary ulcers, drawing the attention on the possibility of forming a duodenojejunal fistula in the patients with gallbladder-jejunum derivations.

Ampulla of Vater↗
PubMedDate not supplied

Nonparasitic abdominal serous cysts. A multiple case report.

A group of 35 patients with nonparasitic abdominal serous cysts is reviewed in order to investigate the diagnostic and therapeutic features of these rare conditions. In most cases the cysts were localised in the liver. Other localisations were the kidney (9 cases), the mesenteric area (2 cases), the adrenals (2 cases), the spleen and the pancreas (one case each). The clinical symptoms were essentially determinated by the size of the cysts, regardless their visceral localisation. Ultrasonography was the most efficient procedure for their detection, although this method's precision for the visceral localisation of the cysts was not entirely reliable (6 errors). The low incidence of such abnormalities as well as the absence of any relevant diagnostic elements for establishing the nonparasitic character of the cysts, favoured the confusions with nonproliferous hydatid cysts, especially in cases of solitary cysts (7 patients). The most frequently used surgical procedures were partial cystectomy (18 cases) and total cystectomy (8 cases). A personal technique based on obliteration of the cavity with the bulging wall of the cysts, was used in two patients. When choosing the surgical procedure, the size, site and number of cysts were considered. Immediate and late postoperative results were very good.

Abdomen↗
PubMedDate not supplied

[Sandostatin treatment in postoperative external digestive fistulae].

The aim of the conservative treatment of postoperative external digestive fistulae is to obtain a reduction of the output, thus favoring spontaneous closure and shortening outcome. A retrospective comparative study has been performed on two groups of patients with postoperative anastomotic gastrointestinal and pancreatic fistulae. Group A included 18 cases (14 anastomotic, 4 pancreatic fistulae) receiving conventional treatment only. Group B included 25 cases (18 anastomotic and 7 pancreatic fistulae) in which Sandostatin was associated to conventional therapy, using daily doses ranging from 0.1 mg to 0.3 mg, administered after variable intervals after fistulas' occurrence. Duration of treatment ranged from 1 to 25 days. In group A, 27.77% of the cases were cured in comparison with group B in which the healing rate increased to 56%. Global hospital mortality rate was 25.58% (11 cases). In group A this was 44.44% (8 cases) in comparison with group B with 12% (3 cases) only. As a conclusion of our study, the use of Sandostatin is remarkable effective in the treatment of external digestive postoperative fistulae. Thus a doubling of healing rate and a reduction by 73% of mortality rate was achieved.

Cutaneous Fistula↗