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Biomedical subjects

N Mircea

Publications and source records attributed to N Mircea.

At least 19 recordsLinked to original sources
PubMed1990

[Anesthesia at the "Coltzea" Clinical Hospital, a first line hospital during the revolution of the Romanian people].

Anaesthesia and postoperative course of the wounded victims of the romanian revolution in December 1989 at Bucarest are described. The author, a romanian anaesthetist, was an eyewitness of these events. During this four day period, between 21st and 25th December, 97 live wounded were admitted, 75 of them with very serious wounds, and hypovolaemic shock. The remaining 22 had superficial limb wounds. Twenty-one dead wounded were also admitted to hospital. The wounds involved: the head (3), the neck (4), the chest with an opened pleura (3), with closed pleura (8), the abdomen, including the intra-abdominal and retroperitoneal organs, and the pelvis (14), the upper (16) and lower (39) limbs, and minor skin and soft tissue lesions (10). Seventy-five patients were given a general anaesthetic with endotracheal intubation, 12 an intravenous general anaesthetic without intubation; for the remaining 10, a local anaesthetic technique was used. Four patients died during surgery because of extremely serious wounds, incompatible with life, and overwhelming haemorrhage for which surgical haemostasis was impossible. Two other patients died, one 72 h and the other 5 days later, because of severe infection and gangrene. Twenty days after these events, 91 patients still either recovered or were convalescing.

Anesthesia↗
PubMed1985

Ultrarapid induction.

We report 250 rapid induction anesthesias performed for the purpose of preventing regurgitation and vomiting in patients with full stomach. The anesthetic technique includes administration of morphine 20 mg and droperidol 5 mg intravenously 10-15 minutes before induction, a voluntary air hyperventilation at the anesthetist's command, during which induction drugs are introduced and an induction with a mixture containing suxamethonium 2 mg/kg and thiopentone 1.4 mg/kg, administered within 1-2 seconds. Eighteen seconds after the onset of injection the loss of lid reflex is observed followed 7 seconds later by masseter muscle relaxation. Within the following 5-10 seconds intubation is carried out in full fasciculation process, before cardia relaxation. With this technique, a mean intubation time of 35 seconds is achieved. The interval of maximum regurgitation risk is lowered to 15 seconds, so that ventilation by mask and cricoid pressure are no more necessary. The technique is indicated in the young and vigorous adult and contraindicated in the old and tainted patient, in coronary patients, in those with low heart output and slowing of circulation.

Adolescent↗
PubMed1984

Stress ulcers in intensive care (etiology, symptomatology and therapy).

The authors present a group of 48 patients with stress ulcers (36 men, 13 women) average age 56.2 years. The analysis of the cases allowed to establish, for the first time in medical literature, a correlation between the etiology, the symptomatology and the moment of onset of the haemorrhage, with important practical implications in the adoption of a treatment regime. These considerations permitted us to delineate four categories of stress ulcers: The first category included stress ulcers caused by a cerebral lesion and manifested through cerebral hypertension. The upper digestive haemorrhage occurred within 24-48 h after the aggression and required the correction of the cerebral hypertension and of the anaemia. The second category comprised stress ulcers brought about by a hypovolaemic shock through myocardial infarction, burns, frost-bite and multiple traumas. Haemorrhage in the upper digestive tract appeared within 3-6 days after the moment of aggression and required surgical control unless it was caused by myocardial infarction. The third category was represented by post-operative stress ulcers. These forms occurred usually late, between the eighth and the thirty-seventh day after the aggression, and were due to the super-imposition of the septicaemia on the post-aggressive systemic reaction. The chief aim of treatment here was the surgical control of infection. The fourth category encompassed the stress ulcers occurring after protracted coma, especially in patients with ventilatory assistance. In these conditions, the ulcers of the digestive tract and the consequent haemorrhage represented terminal elements of irreversible diseases, in which no treatment was effective.

Adult↗
PubMed1982

Risk of pulmonary complications in surgical patients.

The pulmonary complications in a group of more than 20 000 surgical patients between 1971 and 1980 were examined, as well as the pulmonary state of 100 surgical patients who died within 10 days of operation. The factors related to the patient's constitutions, nature of the surgical disease, operation and anaesthesia. Equal and homogeneous groups were considered in respect of each factor which were analyzed retrospectively from 1980 to 1971. The mean frequency of pulmonary complications in the Department of General Surgery was 12%. The main risk factors of pulmonary complications were: the duration beyond 4 h of the operation (59%), age over 70 years (48%), obesity (35%). They were followed in decreasing order by sepsis, hypovolemia and particular sites of operation. Severe pulmonary complications, bronchopneumonia, pneumonia and thromboembolism contribute to mortality.

Abdomen↗
PubMed1975

Gastro-intestinal haemorrhage from peptic ulcer. An evaluation of bloodless transfusion and early surgery.

Over a 3-year-period 72 patients with upper digestive tract haemorrhage due to peptic ulcer were transfused exclusively with isotonic sodium chloride and glucose solutions in equal quantities. The results are compared with 69 patients treated previously in whom conventional blood transfusion regimes had been used. Transfusion therapy was combined with emergency surgery involving vagotomy and draininage, with surgical haemostasis in situ. There were no significant differences between the two groups with regard to anaesthesia, surgery and post-operative managemement. Apart from anemia, there were less early and late complications in the group not receiving blood. The amount of crystalloid solutions administered varied between 7000 ml and 19,000 ml causing a diuresis of 1000 ml to 5300 ml within the first 24 hours. The use of this transfusion regime for haemodynamic re-equilibration in upper gastro-intestinal haemorrhage due to ulcer, in cases in which haemostasis can be obtained with certainty by emergency surgery, allows transfusion of stored blood and colloid solutions to be avoided and emergency surgery to be safely undertaken at the earliest moment. The severe acute anaemia which is caused appears to create no special problems.

Adolescent↗
PubMedDate not supplied

[Upper digestive hemorrhages of ulcerous nature (management and experience)].

A number of 135 cases were examined, presenting with superior digestive hemorrhage of ulcerative origin. The analysis of the cases was made by two comparable groups. In the first one of the groups the volemic re-equillibration was based on the administration of blood and surgery was carried out, in principle, on a "cold" condition. In the second group volemic re-equillibration was achieved exclusively with isotonic non-colloidal volemic solutions that were administered before, during and after surgery (0.9% NaCl solution and 5 g% glucose solution in equal amounts). Surgery was performed as an emergency and vagotomy was made, as well as surgical hemostasis. The results obtained have allowed for the conclusion that, by providing efficient surgical hemostasis and volemic re-equillibration with isotonic non-colloidal solutions blood transfusion and its untoward side-effects can be avoided.

Adolescent↗
PubMedDate not supplied

[Gastric consequences of toxicoseptic agression].

This study is concerned with gastro-secretory and motor answers. It was carried out in two groups of patients and the results obtained were compared. The following aspects were noted: a. the control group was represented by 10 patients that had been exposed to anesthesic-surgical aggression; b. the second group was formed by 20 patients with toxico-septic syndrome of various etiologies and in different stages of evolution; - secretory and motor gastric disturbances take on an evolutive dynamic character, according to the clinico-biological phase of the syndrome; in the acute stage absolute hypersection is noted, as well as from the viewpoint of the rate, of hydrochloric acid, and gastric hypomotility; in the chronic stage there is acid hyposecretion both insulin- and histamine-resistant and in 30% of the cases there is anachlorhydria; to the general-metabolic phase of inversion corresponds, at the gastric level; a return to normal of the motility and of the acid gastric secretion.

Anesthesia↗
PubMedDate not supplied

[General anesthesia in endoscopic examination of the digestive tract].

The authors made an analysis of 165 general anesthesias applied in the digestive fibroendoscopy and they establish the technology and the indications of this method, as follows: 1) uncooperative patient (in this category should be included children, psychopaths, mentally deficient subjects and a certain category of neurotics); 2) when difficult endofibroscopies are to be expected, during which therapeutic procedures are highly probable, such as resection of polyps, coagulation of bleeding surfaces etc.; 3) lack of tolerance to local anesthetics; 4) optimal instruction conditions should be provided for the beginner anesthesist; 5) the authors recommend that all such anesthesies should be carried out in hospital only. They also suggest as the most reliable technique the intra-venous general anesthesia and the oro-tracheal intubation of the patient.

Anesthesia, General↗
PubMedDate not supplied

[Critieria of brain death (personal opinions)].

The study reviews the literature dealing with cerebral death and raises some problems, not yet discussed in the literature, such as those in connection with the decerebrated pregnant woman, of which the following ones are stressed: 1. The pregnancy can continue in the decerebrated woman. If the answer is affirmative, development of the pregnancy represents represents a test of particular biological value in assessing the efficiency of ressuscitation therapy; 2. What are the effects of hipoxyia that led to decerebration of the mother on the psychosomatic development of the child, and the possibility to evaluate it in correlation with the age of the pregnancy; 3. What are the effects of prolonged forced ventilation and the artificial feeding on the development of the pregnancy? The study ends with concrete proposals for establishing criteria for cerebral death, stressing the need for an adequate juridical frame for organ transplantation.

Brain Death↗
PubMedDate not supplied

[Aspects of pulmonary function in states of hyperhydration].

The authors have investigated in 10 young and healthy men the changes occurring in the cardio-respiratory apparatus following the perfusion with non-colloid isotonie volemic solutions. Exploration of volumetry and of pulmonary mechanics have been performed, hemodynamic tests and pulmonary angiograms. The results indicate the development of slight interstitial oedema, without intra-alveolar transsudation or obstructive phenomena in the aerial pathways. The cardio-vascular apparatus shows satisfactory adaptability through central and peripheral mechanisms in conditions of hyperhydration.

Adolescent↗
PubMedDate not supplied

[Malignant hepatoma (clinical, biological and morphological comparisons)].

The authors make an analysis of 8 cases of malignant hepatoma discovered in 20 362 surgical patients between 1965 and 1975. The analysis of these cases allowed to conclude as follows: 1). In the presence of chronic digestive disturbances, or of hepato-splenomegaly, accompanied by progressive deterioration of the general condition of the patient, and of the use of large amounts of analgetic drugs, one should consider more than usually the possibility of hepatic neoplasia. 2). The first element to be considered in the frame of diagnosis of malignant hepatomas should be the morphological one. Of practical value in the diagnostic are the following: hepatic scintigraphy, angiography and bioptic laparotomy. 3). Of the conventional biologic tests (including the immunological tests), evaluation of serum alpha-foetoprotein is the only one with an orientative diagnostic value.

Adolescent↗
PubMedDate not supplied

[Treatment for spontaneous pneumothorax].

The present study refers to 67 cases of spontaneous pneumothorax admitted to intensive care unit. Symptomatic therapy and treatment of the pneumothorax is efficient. Minimal thoracotomy with continuous aspiration drainage indicated in severe pneumothorax and relapses after exsufflation, was considered the basic procedure in the symptomatic treatment.

Adult↗