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M Voiculescu

Publications and source records attributed to M Voiculescu.

At least 55 records · Page 3Linked to original sources
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Controversies and certitudes on the upper digestive hemorrhage through rupture of esophageal varices. I. Pathophysiology of portal hypertension and mechanism of rupture of the esophageal varices.

The frequency and severity of the upper digestive hemorrhage in patients with liver cirrhosis situate it among the main complications of this disease. Many studies have tried to explain the pathogenesis of portal hypertension and the mechanism of rupture of the esophageal varices, emphasizing the role of the venous flow in the rise of portal pressure and that of the local venous factors in the variceal rupture. Based on the recent data in the medical literature and on its own experience, the author presents--in this first part of a review of these problems--the methods of diagnosis and of evaluation of the response to therapy in patients with portal hypertension and with bleeding through rupture of the esophageal varices.

Esophageal and Gastric Varices↗
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Controversies and certitudes on the upper digestive hemorrhage through rupture of esophageal varices. II. The therapy of portal hypertension and of variceal bleeding.

The present-day therapy of portal hypertension and of variceal bleeding includes new drugs (propranolol, glypressin, somatostatin, a.o.) and methods of hemostasis (variceal sclerotherapy). This second part of a paper concerned with the upper digestive hemorrhage through rupture of the esophageal varices presents the main drug therapies and other various methods used to decrease the portal pressure, to achieve a direct hemostasis in case of active variceal bleeding and to prevent the rebleedings.

Catheterization↗
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Study of the risk factors for upper digestive hemorrhage, determined by post-mortem investigations in 39 cases of liver cirrhosis.

A retrospective study of the causes and the risk factors for upper digestive hemorrhage (UDH) was carried out by post-mortem investigations in 39 consecutive cases of liver cirrhosis (LC), in comparison with a control group of 40 patients with LC, free of UDH. The patients' age and the disease duration in the cases with ruptured esophageal varices or with hemorrhagic erosive gastritis (the main causes of UDH in the group studied) were longer than in the controls. The causes of UDH were: rupture of esophageal varices (in 43.7% of the cases), hemorrhagic erosive gastritis (41%), both (10.2%), and active duodenal ulcer (5.1%). The frequency of small esophageal varices among the ruptured ones (23%) was higher than that detected by endoscopic studies (13-15%), owing to the peculiarities of the group investigated and to the methods of evaluation. Ascites can be considered a risk factor for UDH, as an expression of portal hypertensions. Liver carcinoma, jaundice, prothrombinemia, albuminemia, bilirubinemia and Child index are not risk factors for UDH, some of them reflecting only a longer evolution of the disease.

Female↗
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Study of the prognosis factors in liver cirrhosis.

In a prospective study carried out on a group of 1210 patients with liver cirrhosis (LC), the diagnosis was based on clinical, biological and histological criteria, as well as on the prognostic significance of 20 clinical, biochemical and histological parameters. The group, including 830 males (68.59%) and 380 females (31.41%), with an average age of 49.27 +/- 13.18 years, was studied during periods of 6 to 16 months, the initial investigations being periodically repeated. The statistical significance of the prognosis factors was studied by uni- and multivariative methods, according to the model of Cox, with the help of an IMB computer. The survival rate for the group studied ranged from 6 to 204 months, with an average period of survival of 38.29 months. The multivariative analysis demonstrated that the prognosis factor with a best correlation with the death power is ascites, which has additional predictive significance in association with encephalopathy and/or jaundice. The multivariative analysis selects as clinical factors of unfavourable prognosis the cholestasis, the hepatocytolytic syndrome, the syndrome of liver deficiency and the age over 50. The limits of the biochemical parameters with unfavourable significance were: bilirubinemia level greater than 3 mg%, ASAT/ALAT = 50.24/70.33 u.i., prothrombinemic index less than 50% and albuminemia greater than 3 g%. The multivariative method proved also superior in appreciating the interrelations of the prognostic factors, emphasizing the significance of the clinical parameters (ascites, encephalopathy, jaundice), while the multivariative analysis differentiated the biochemical prognosis factors (bilirubinemia, ASAT/ALAT, prothrombinemic index, albuminemia) and their level of significance.

Adult↗
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The evolution of essential hypertension in a primary prophylactic survey. Ten-year longitudinal epidemiologic study (1971-1982).

The present work presents the evolution over a ten-year period of subjects with essential hypertension (EH) detected in a group of 5,000 men, aged 40-60 years, randomly selected in an urban environment. The prevalence of EH in the group studied was 20.5%, whereas "borderline" hypertension presented a prevalence of 21.4% reported in an earlier study. A proportion of 76.6% of the hypertensive patients were cared for in an outpatient unit; normal blood pressure values were obtained in about one third of the cases. This result is consistent in itself and, all the more so, bearing in mind ageing of the patients in the course of the study. The study had in view the annual incidence of essential hypertension and the evolution of atherogenic risk factors in hypertensive patients. The incidence of cerebrovascular accidents during the follow up period in this group was 6.85%, sudden death 1.7% and myocardial infarction 6.2%.

Adult↗
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The renal involvement in scleroderma. A clinical and morphologic study.

The main clinical, biologic, immunologic and morphologic changes characteristic of the sclerodermic nephropathy have been investigated during a mean period of 3.8 years in 21 patients with scleroderma, 19 women and 2 men, with a mean age of 36.1 years. The results obtained have revealed the frequent (38.1%) and early renal involvement, with constant arteriolar and glomerular lesions. Proteinuria was the most frequent (28.6%) and early sign of renal damage. The urinary sediment was poor and the immunologic investigations unconclusive. Dosage of urinary proteins by sensitive techniques (immunoquantitation) and renal biopsy have proved to increase the accuracy of studies for the detection of sclerodermic nephropathy in its initial stage.

Adolescent↗
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The value of cimetidine in the treatment of gastroduodenal ulcer.

The therapeutic effects of 1 g/day cimetidine in short-term courses of 21 days have been tested by a double blind study in 20 patients, of which 17 with duodenal ulcer and 3 with both gastric and duodenal ulcerations, in comparison with a similar group of patients who received placebo. The symptomatology was characteristic in all the cases, X-ray presence of ulcer in 17 patients and indirect signs in 3, endoscopic examination positive. The total volume of ClH nocturnal secretion, as well as the basal and maximal hydrochloric secretions decreased, but the differences with respect to the initial values were not statistically significant; the inhibition of gastric acid secretion by cimetidine amounted to 40%; ulcer healing was noted in 3 out of 17 cases. The adverse effects were rare: sleeplessness in 6 cases, asthenia in 4, dry mouth in 3. The differences between the results of cimetidine administration and those in the placebo group had no statistical significance. It is concluded that a short-term course of 21 days is not sufficient to obtain healing of the gastric or duodenal ulcerations.

Adult↗
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Dexamethasone isonicotinate aerosol therapy in patients with chronic bronchial asthma.

Dexamethasone isonicotinate aerosols were used for the management of 106 patients (33 men, 73 women) with bronchial asthma (mean age 32.7 years); 62 of the patients were steroid-dependent (maintenance dose 1 to 25 mg prednisone/day for 0.5 to 11 years) at the start of the study. A diary of symptoms (including consumption of antiasthmatic drugs) was kept; physical examination and measurement of pulmonary function (peak flow rate, forced expiratory volume in one second) were performed during a one-to-four week control period, as well as at various intervals (up to 14 months) after the start of corticosteroid aerosol therapy. Clinical subjective and objective improvement was accompanied by a significant increase in ventilatory function indices (e.g. the FEV1.0 rose from a control average of 55.5% of predicted to 72% after 4 weeks and 85% after 12 months). The antiasthmatic drug consumption decreased markedly. Administration of systemic steroids could be withdrawn in 49 of the 62 steroid-dependent patients (79%); in the remaining 13 the dose was only lowered. The side-effects were minor (hoarseness of the voice, oropharyngeal candidosis), and limited to a few cases. It is concluded that bronchial asthma can be successfully controlled in four fifths of the patients by very low doses of dexamethasone isonicotinate aerosols, with practically no systemic effects.

Adolescent↗