PubMed Health⌕ Search

Biomedical subjects

M R Diaconescu

Publications and source records attributed to M R Diaconescu.

At least 19 recordsLinked to original sources
PubMed1995

[Secondary hyperparathyroidism].

Secondary (renal) hyperparathyroidism appears in chronic renal failure, sometimes in patients on chronic dialysis. Other causes includes rickets and osteomalacia. These diseases are associated with poor calcium and vitamin D absorbtion from the small bowel. Two patients with chronic renal failure maintained on chronic haemodialysis from two and three years, respectively underwent subtotal parathyroidectomy: removal of three glands and preserving a half of a gland in situ. The diagnosis and surgical indication was made upon clinical (bone pain and severe itching), radiological (demineralisation, ectopic calcifications) and biochemical (hypercalcemia, hyperphosphoremia, increased values of alkaline phosphatases) arguments. Postoperatively the improvement is defined by a return to normal in the clinical, laboratory and radiological parametres. The most appropriate operation for secondary hyperparathyroidism is still unresolved one of two techniques is performed according to the preference of the surgeon: subtotal parathyroidectomy or total parathyroidectomy with autotransplantation of parathyroid fragments into forearm muscle.

Adult↗
PubMed1991

[The hyperfunctional thyroid nodule].

Authors report their experience of 22 years regarding 284 patients with hyperfunctional thyroidal nodules (279 operated), representing 12.4% of the 2,289 cases of thyroidal (875 hyperthyroid) diseases treated during this period. The diagnosis was established on the basis of the confrontation of the anamnestic symptomatology and of that found at the clinical examination--which confirmed the pure character of thyrotoxicosis by showing the presence of a thyroidal nodule--with the study of the global glandular function and the scintigram, completed with dynamic tests. Among the typical clinical and scintigraphic, usually severe, forms (with cardiothyreosis) may be distinguished asymptomatic or atypical forms (with dissociated or intermittent manifestations). The treatment of the toxic thyroidal adenoma is surgical, except some contraindications of a general order. The surgical treatment is aimed at achieving the permanent cure of the disease, without sequelae or functional and/or morphological relapses. The subtotal lobectomy (210 cases) is preferred as an exeresis procedure to the enucleoresection (45 cases). In most operated cases (93%) the immediate clinical and biological results were favourable.

Adolescent↗
PubMedDate not supplied

[A prognostic audit in colorectal cancer: between the clinical realities and the therapeutic principles].

A clinical series of 137 cases of colorectal cancer (98 + 39) was admitted in the IVth Surgical Clinic between 1987-1996 (double compared to the previous decade), consisting of 101 men and 36 women with an average age of 62. The diagnosis was established by physical examination (43 cases, most of them acutely obstructed), completed by biological, radiological and histologic examination of the surgically removed tumours. The pre- and postoperative staging revealed a large number of advanced forms: stage I--6 cases (4.3%), stage II--33 cases (263%), stage III--52 cases (36.5%) and stage IV--46 cases (32.3%). Surgery was performed on 118 patients, the tumours being removed by different types of resections according to location in 81 cases (operative rate of 86.1% and resectability rate of 59.1%, both being higher compared to the previous decade 56.8% of the surgical procedures were palliative and 41 patients (34%) underwent curative resections. The postoperative morbidity and mortality rate was 30.5% and, respectively 4.3% (5 deceased). The long-term survival followed on 44 cases revealed that only 20.3% were alive after 5 years from the operation.

Adult↗
PubMedDate not supplied

["Spontaneous", "delayed" and "occult" ruptures of the normal and pathologic spleen. Nosologic classification].

The anatomic particularities and the diversity of the splenic pathology determine a wide spectrum of the traumatic lesions of the spleen. The classical acute rupture with consecutive hemoperitoneum and mandatory surgical indication is opposed to the controversial "spontaneous" ruptures of the normal and pathologic spleen and also to the delayed and occult ruptures the lasts of them sometimes minimal or with chronic evolution. A series of eight cases all males with ages between 40-77 years is presented in order to exemplify all these entities. There are underlined the variety of etiologic conditions, the difficulties of the diagnosis which impose an insistent anamnesis and clinical examination (searching even a "trivial" trauma) completed with ultrasonography and CT scan which are preferred to radionuclide scan of arteriography and finally peritoneal lavage after punction, laparoscopy and even laparotomy. Splenectomy--often laborious--was effective in all our patients (obviously only temporary for the cases with nonhodgkin malignant lymphoma and respectively with splenic metastasis from a renal carcinoma). In some situations--especially in children--the conservative treatment can be considered.

Adult↗
PubMedDate not supplied

[Hyperfunctional parathyroid carcinoma].

The parathyroid cancer is mentioned in literature with an incidence of 0.5-5% in the etiology of the primary hyperparathyroidism. The authors present the case of a 45 year old female with diagnosis of "primary hyperparathyroidism" based on clinical, ultrasonographic and biochemical investigations. A right superior adenoma of 3 x 2 x 1 cm (150 mg) has been found and extirpated. The histological examination showed an adenoma with predominant "chief" cells. Three years after surgery the patient had a recurrence of the clinical and hypercalcemie syndrome (with more severe damages). The surgical reexploration showed the right thyroid lobe with a nodular aspect and in its inferior pole a enlarged parathyroid gland of one cm size was found. An en-block exeresis including the right thyroid lobe with isthmus as well as the mentioned lesion and the half of left superior parathyroid, the left inferior one together with retrosternal fat tissue have been performed. Frozen sections completed by paraffin examination established the diagnosis of hyperfunctioning parathyroid carcinoma. We have emphasize the issues that could suggest the initially preoperative true diagnosis: the large size of excised adenoma and the relatively quick recurrence of the phenomena of parathyroid hyperfunction. The surgical principles and strategies in the treatment of parathyroid cancer are also discussed.

Carcinoma↗
PubMedDate not supplied

[Prevention and therapy of postoperative thyrotoxic crisis].

Out of a group of 361 patients with various anatomo-clinical forms of hyperthyroidia--of which 328 had underwent surgery--hospitalized in the Surgical Clinic from Jassy between 1965 and 1974, a total of 17 observations are analised, from the clinical and the therapeutical viewpoint, that showed postoperative thyreotoxicosis crisis. The fact is stressed that the prophylaxis of the crisis is dominated by the principle that no case of hyperthyroidia should be operated on before it has been perfectly balanced from the endocrinological viewpoint. The complex treatment of the cases that are presented included a symptomatic component to which were associated oxygen therapy, tonics, vitamins, hepatotrop preparations, eventually antibiotics. The results obtained--complete recovery in all the cases--can be compared with the best from the literature.

Adolescent↗
PubMedDate not supplied

Management of perineal impalement injuries.

Between 1975 and 1990, 18 cases of sphincter and pelvic floor injuries, of which 7 isolated and 11 part of severe polytraumas, were treated. Thirteen cases benefited from primary repair. Colostomy was required in 9 cases due to the complexity of lesions, in other 5 cases the wounds drainage and colostomy were undertaken. Secondary repair was done after 2-6 months. The functional results in 11 patients indicate a good continence in 6 of 7 cases with primary repair. The results of secondary repair are satisfactory.

Adolescent↗
PubMedDate not supplied

[Upper digestive hemorrhage, physiopathologic and therapeutical considerations].

The study is based on the analysis of 158 patients admitted in the "Fourth Clinic of Surgery" with diagnosis of "Upper Digestive Haemorrhage" (U.D.H.) between 1998-2002, emphasising the importance of the physiopathological chains induced by the ulcer bleeding; 119 cases (76%) were diagnosed with gastro-duodenal ulcer, 20 with portal hypertension (20%), 14 subjects were with gastric carcinoma (8.8%) and 5 with miscellaneous etiologies so called "rare circumstances" of U.D.H. (two patients with Idiopathic Thrombocytopenia, one case with Dieulafoy gastric ulceration and two subjects with Haemorrhagic Gastritis). All the patients were admitted in the first moment in the Intensive Care Unit where haemostasis were successfully obtained with drug therapy adapted to the physiopathological changes induced by bleeding, in the majority of cases with light bleeding (8 cases, 5.4%) or medium bleeding (139 patients, 87.4%); only in 9 subjects (6%) with severe haemorrhage surgery was indicated (posterior bulbar ulcer in which the surgical haemostasis was necessary). In 88 patients (55%) surgery was performed as an elective procedure--74 from them had haemorrhagic gastric or duodenal ulcers with a medium amount of bleeding and 14 observations for gastric carcinoma with a chronic bleeding. In most all the cases the postoperative evolution was in good terms. Two observations with severe U.D.H. due to rupture of esophageal varices occurred on hepatic cirrhosis were out of therapeutical proof (1.2% deaths from all the admitted patients with U.D.H.).

Adult↗
PubMedDate not supplied

[Antibiotic prophylaxis in surgery for colorectal cancer].

The prophylactic use of antibiotics in the purpose of decreasing the frequency and severity of surgical infections is still controversial. The practical need of defining the concept of antibiotic prophylaxis gave rise to numerous polemics in the literature. This paper presents a retrospective study on 103 cases whom diagnostics were colon and rectum cancer, that were operated in the IV-th Surgical Clinic in 1993-2002 period; at these patients was done antibiotic prophylaxis local and systemic before, during and after operating. This method made possible the registration of a minimum number of cases with surgical infection (7 cases, representing only 7% of the operated patients): a case (1%) with peritoneal collection (needing the surgical evacuation of this collection) and in 6 cases, parietal superficial infections, which imposed the prolong of drainage for almost 7 days. Starting from the basic principles of antibiotic therapy, this paper aims at outlining practical guidelines for a judicious antibiotic prophylaxis.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Total parathyroidectomy with forearm graft in tertiary hyperparathyroidism].

Autonomic and persistent hypersecretion of PTH is a frequent and tormenting complication of the patients with chronic renal dialysis for end stage renal disease (ESRD). In these cases, surgery remains a therapy option with real effects on clinical status of patients, especially in perspective of a renal transplant. The authors present the case of a patient with tertiary hyperparathyroidism for which a total parathyroidectomy followed by autotransplantation of small glandular fragments in forearm muscles was performed. The postoperative clinical and immunological statuses were favorable with the disappearance of pruritus and osteoartralgia with improvement of psychic behavior and normalization of calcium blood level. Considering the parathyroidectomy as a palliative stage in the treatment of ESRD, the authors discussed a hierarchy system of both indications and surgical alternatives to be considered in this condition. In well selected cases this surgical method represents an attractive and easy possibility to control and later adjustment of the hyperfunction of remained parathyroid tissue, avoiding in this way a very risky intervention.

Forearm↗
PubMedDate not supplied

[Hyperthyroidism and coexistent thyroid carcinoma].

The association between thyrotoxicosis and thyroid cancer is a classical, rare and controversial entity. Within their series of eleven such cases the authors dissociate two distinct groups from clinical and pathological viewpoint. The first category is represented by one case of follicular thyroid cancer with clinically and biologically confirmed hyperthyroidism. The second group includes ten patients with thyrotoxicosis (three cases with Graves' disease, four with toxic multinodular goiter and three with toxic adenoma) and associated unsuspected occult or nodular carcinoma. None of these patients had received previous treatment with radioiodine. In all cases the diagnosis was established by pathological examination of the surgical specimen. Surgery is the treatment of choice in these lesions, the presence of carcinoma imposing the extent of operation. Five near total thyroidectomies and three near total lobectomies with ablation of the isthmus was performed in our cases associated with appropriate additional measures: TSH suppression or 131I treatment. Post surgical results were satisfactory without morbidity or mortality. The long-term survey was good (seven cases alive after 5 years).

Adenocarcinoma, Follicular↗
PubMedDate not supplied

[Bulbantrectomy with truncal vagotomy in the surgical treatment of duodenal ulcer].

Duodenal ulcer benefits of very efficient medical treatment. In currently medical practice exist many cases with complicated duodenal ulcer (by stenosis or penetration in neighbor organs like pancreas or biliary tract or painful forms etc.) to which surgical treatment is necessary. Based on the retrospective study of 116 patients operated between 1991-2002 years for gastric or duodenal ulcer, this paper demonstrates that bulbantrectomy associated with bilateral truncal vagotomy (63.7% of cases) is the best surgery in the treatment of duodenal complicated ulcer or resistant to the medical procedures. Provided by correct indication, the intervention is the most pathogenic, offering the best immediate and long term postoperative results. If the bulbantrectomy is contraindicated (critical general status, etc.), the alternative is a bilateral truncal vagotomy associated with a drainage procedure: pyloroplasty (6.9% of cases) or gastroenterostomy. When the vagotomy are contraindicated or cannot be correctly performed, a large gastrectomy (29.3% of cases) followed by gastroduodenal (preferable) or gastrojejunal anastomosis are practiced.

Adult↗
PubMedDate not supplied

[Minimally invasive approach of the cervical endocrine glands].

Improved preoperative functional and topographic diagnostic techniques and availability of intra-operative hormone monitoring, stimulated the introduction of video-assisted minimally invasive operations in parathyroid and thyroid surgical pathology. The first cases of such pathology operated on in our clinic are presented. The first one is a 62 year old man with renal hyperparathyroidism consecutive to a chronic renal insufficiency and hemodialysis from five and three years respectively. The technique of a minimally invasive gapless resection of all four "adenomised" parathyroid glands using laparoscopic and classic instruments is described. Fragments of one gland are implanted in the left forearm musculature. The second case was a 48 year old woman with a three cm diameter right toxic adenoma. With a lateral 15 mm incision, dissociation of the musculature and adequate moving of the retractors the excision of the thyroid nodule was done in 25'. The video-assisted minimally invasive approach allows magnification and adequate identification and removal of endocrine secreting tissues in thyroid and parathyroid pathology. The authors believe that these techniques represent a feasible and attractive alternative to conventional surgery.

Adenoma↗