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M Grigoroiu

Publications and source records attributed to M Grigoroiu.

7 recordsLinked to original sources
PubMedDate not supplied

[Our experience regarding a series of adrenal surgical diseases].

AIMS: The problems of positive and differential clinic-pathologic diagnosis, the optimal therapeutic decision and importance of surgery in a series of patients with adrenal gland (AG) diseases was studied. MATERIAL AND METHODS: Between 1987-1999, 91 patients (pts.) with adrenal diseases were operated on. Sex ratio was 63 f/28 m and the medium age 42.3 years (extremes 14 and respectively 75 years old). The lesions were localized in medullar, cortical and in the both components of AG. 1) The cortical determinations were represented by 40 (44%) pts. with: a) Cushing's syndrome 37 pts. histologically grouped: 24 pts. (63%/37) with benign, diffuse hyperplasia of cortico-adrenal glands; 4 pts. with cortical benign adenoma; 7 adenocarcinoma; 2 with borderline lesions. b) Conn syndrome--3 pts. 2) Medullary lesions (Phaeochromocytoma)--30 pts. (33%/91) with following microscopically lesions: 22 typical phaeochromocytoma; 3 benign adenoma; 5 carcinoma and 1 medullo-adrenal paraganglioma. One patient have had bilateral medullo-adrenal lesions: left carcinoma and right benign adenoma). 3) Non functioning tumors (Incidentaloma)--21 pts. (23%/91) (17 malignant and 5 benign). The distribution of the whole group of 91 pts. was: 62 with benign lesions (diffuse hyperplasia or tumors), 26 malignant tumors, 1 both of them and 2 borderline lesions. The diagnosis was the result of clinically, biochemical-hormonal tests and imagery examinations (computed tomography especially) with postoperative pathological confirmation. The surgery applied was:--bilateral adrenalectomy 16 pts.;--right adrenalectomy 20 pts.;--left 26 pts. (two through laparoscopic approach);--tumor exeresis 26 and--3 biopsy of the tumors. The dimensions of the operatory specimens were: < 10 cm--67 pts.; 10-20 cm--16 pts.; > 20 cm--2 pts.; undetermined 6 pts. For malignant lesions the main parameters (in various associations) were: neighborhood invasion--18 pts.; distant metastasis--5; metastatic lymphnodes--13; the microscopic grading (G1-1; G2-9; G3-7 pts.). Three cases imposed iterative interventions for a recurring adenoma of the cortically AG or for restant tissue in Cushing's syndrome. There were necessary 28 supplementary operative (partially or totally) organs exeresis. All pts. with malignant lesions were postoperative treated with chemio- or/and radiotherapy. RESULTS: Postoperative morbidity: 18 (20%) pts.; depending of the surgery 8 pts., secondary of the patient general status 12. General postoperative mortality 4 (4.8%) pts. determined by severe cardio-vascular complications. CONCLUSIONS: 1--The surgical diseases of adrenal glands are difficult to diagnose and are based primarily on the clinical information's and confirmed by the hormonal and imagery examinations (errors are possible). 2--Operatory indications, especially for hyperplasic bilateral forms in Cushing's syndrome (one step or two steps surgery) must be very well documented and carefully established. 3--There are cases which impose recurrent operations. 4--A correct operative indication and technical surgery procedure are followed by good results. 5--The laparoscopic approach of the surgical lesions of the AG is a good alternative for the open surgical approach with the condition of a very correct indication. 6--Postoperative, the malignant lesions must be mandatory submitted to the adjuvant treatment.

Adenocarcinoma↗
PubMedDate not supplied

[Pyogenic liver abscess].

The objective of this study was to investigate and report changes in presentation, management and outcome of patients with pyogenic liver abscess (PLA). Between 01.01.1995-31.12.1999, 27 patients with PLA were treated in the General Surgical Service of the Fundeni Clinical Hospital. The incidence of cryptogenic abscesses was dominant (55.5%). The symptoms and the biological status are frequently nonspecific. The CT scan and echographic examination sensibility in the diagnosis of the PLA was 89.5% and 78.3%. The aerobe germs are most involved. All patients received antibiotic treatment in preoperative as in postoperative period. The surgical treatment was performed in 24 patients: in 9 patients (33.3%), the abscess was surgically evacuated and drained and in 15 patients (55.5%), a liver resection was performed. Percutaneous catheter drainage under CT or echo-guidance was performed in three patients (11.1%). The clinical evolution was good in 21 patients (77.7%). There was four complications (14.8%) and two death (7.4%). Although with a better prognostic, the PLA remains an important pathology.

Adolescent↗
PubMedDate not supplied

[Insulinomas--nesidioblastomas. Clinical experience].

Between 1980 and 1996, 16 patients (10 women) with pathologically confirmed insulinomas were operated on; they represents a median of 0.9 per year and 1.1 per cent from the total of pancreatic tumors. Median age was 47.2 (+/- 22.8) years old (range 23-68). Insulinomas occurred with following frequency in: head--2 patients, body and tail--11 patients and diffuse forms (nesidioblastomas)--3 patients. The specific clinical forms only with tumoral syndrome (without hypoglycemic manifestations) and one was an intraoperative discovery. In the case of the four patients two presented with splenic-portal hypertension +/- upper digestive haemorrhages and the other two only tumoral syndrome. The surgical approach was: the midline (ten), uni- or bilateral subcostal (five), and other incisions one. There were performed tumor exeresis through: enucleation (three), segmentary pancreatectomies (two), spleno-left-pancreatectomies (nine) and the extension of an anterior pancreatectomy (one). In one case biopsy alone was done. The tumors were not intraoperatively identified in three cases (blind left spleno-pancreatectomies). The malignancy index was 4/16 (25 per cent). Postoperative mortality rate was 12.5 per cent (two patients: one acute necrotizing pancreatitis and one pulmonary embolism).

Adenoma, Islet Cell↗