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Biomedical subjects

P Andronescu

Publications and source records attributed to P Andronescu.

13 recordsLinked to original sources
PubMed1995

[Pancreatoduodenectomy with pancreaticogastric anastomosis].

There is not general agreement concerning the ideal way of preventing pancreatic leakage after duodenopancreatectomy. The aim of the present study is to present the experience of a three years period of performing a pancreatogastroanastomosis (PGA) after duodenopancreatectomy (DPC) in 12 consecutive patients. In 7 cases PGA was performed after closure of the gastric stump using a transverse incision of the posterior wall of the stomach. A total layer of nylon 9 points was doubled by an interrupted serocapsular suture. In one case only the seromuscular layers of the stomach were cut, adjusted to the size of the pancreatic section with a central hole for the duct of Wirsung. Four nylon 10 points were used to anastomose the latter to the gastric mucosa. PGA was performed in one layer interrupted suture between the pancreatic capsule and the seromuscular of the stomach. In 4 cases, after closure of the gastric stump an anterior gastrotomy was associated to the posterior incision of the gastric wall in order to perform PGA using an intragastric route. The postoperative follow-up showed a good evolution with only one anastomotic leakage that necessitated reintervention in the 10th day. PGA might be elective after DPC when appropriate dissection and mobilisation of the pancreas is possible.

Adenocarcinoma↗
PubMed1995

[The surgical treatment of pancreatic cysts and pseudocysts].

Pancreatic cysts and pseudocysts are now being detected more often as a result of wide use of abdominal echography and CT scan. Surgical strategy advocates resection whenever possible for true cysts and internal drainage for pseudocysts. The present study retrospectively analyses 8 cases of true cysts and 23 cases of pseudocysts submitted to surgery in a twenty years period. Conservative treatment and ultrasonography-guided percutaneous drainage were not discussed. Four true cysts with positive benign structure were treated by internal drainage and only two adenocarcinomas were resected. In two more malignancies internal drainage was done as a palliative procedure followed by lethal outcome. Pseudocysts were secondary to acute pancreatitis in 7 cases, chronic pancreatitis in 6 cases, abdominal trauma in 4 cases and were idiopathic in 6 cases. Caudal pancreatectomy was performed whenever distal localisation was diagnosed. External drainage imposed in 5 emergency situations but internal drainage was elective in 13 cases. In conclusion according to our experience internal drainage should be preferred as the main surgical treatment in all mature pseudocysts and also when benign true cysts are certified. Posterior transgastric cystogastroanastomosis is the procedure of choice.

Cystadenocarcinoma↗
PubMed1993

[A surgical cure of inguinal hernias by the Shouldice procedure].

Shouldice procedure became an elective technique in inguinal hernia repair as a consequence of the spectacular results of the Shouldice Hospital in Toronto (less 1% recurrence rate) and of other surgical centres in USA or western Europe. In the present study 73 cases of uncomplicated inguinal hernias who underwent a Shouldice herniotomy are analysed within a period of three years. Cremaster resection was routinely performed preserving a one inch proximal fragment which was used to calibrate the inguinal ring after reconstruction. Two continuous nonresorbable stitches were used to reinforce the posterior wall, as described by the author. Short postoperative follow-up showed good results in 64 cases but only 21 patients were reviewed within 6 and 12 month. Nevertheless no recurrence was reported in 3 years by any patient. According to these encouraging results Shouldice procedure might be considered as the procedure of choice in the treatment of inguinal hernias but much more data are necessary for pertinent conclusions.

Abdominal Muscles↗
PubMedDate not supplied

[Palliative total gastrectomy].

Gastric cancer, because of lymphonodulary and local extension, often allows only palliative surgery. This study tries to present the total gastrectomy as an alternative meant to improve the life of the patients who cannot hope to radical cure. Thirty-one patients were submitted to this operation during the last five years. The main indication for surgery was cancer extended to the gastric corpus, mainly on the posterior aspects and almost reaching the cardia. Because of lymphonodulary invasion over N2, hepatic and pancreatic and colonic invasion over N2, hepatic and pancreatic and colonic invasion and because of the metastases, the resections were palliative. The operations consisted of total gastrectomy and omentectomy, without trying to reach lymphatic stations over NI. All cases presented evidence of restant cancerous tissue involving the pancreas, the liver or the other lymphatic stations, but the main purpose was the ablation of the gastric tumor. Postoperatively we recorded 3 deaths, 9 anastomotic fistulae and an average survival of 9 months (6-13 months).

Aged↗
PubMedDate not supplied

[The therapeutic options in biliary ileus].

UNLABELLED: Gallstone ileus is a rare, serious condition, requiring emergency surgery. Although most data in the literature confirm the need for a conservative surgical approach, several authors report the one-stage repair of the cholecystoduodenal fistula. The present study deals with seven cases of gallstone ileus operated upon in a 20-year period. The patients were in their seventh decade; three men and four women. All the cases had clinical evidence of intestinal obstruction which was confirmed by radiologic examination, and emergency operations were performed. In three cases the one-stage strategy was used, consisting of enterolithotomy and correction of the bilio-digestive fistula by cholecystectomy and duodenal closure with good results in two cases and one death. In four cases a more conservative strategy was used, treating the intestinal obstruction only and no surgery was performed on the gallbladder or the fistula, having excluded further gallstones. Three patients had no further problems, but one required reoperation because of recurrent cholangitis. The bilio-digestive fistula may close by natural scarring or become a harmless alternative route for biliary drainage. CONCLUSION: Enterolithotomy alone usually is advisable in this serious form of intestinal obstruction, confining more major surgery to those cases in which recurrent biliary symptoms develop. However, if there are residual gallstones in the gallbladder, a 'one-stage' procedure is required to prevent recurrent ileus.

Aged↗
PubMedDate not supplied

[Colonic tuberculosis].

General improvement of life standard normally reduces tuberculous morbidity. However, the general surgeon is confronted with a significant rise of abdominal tuberculosis, especially the colonic form. Between 1990 and 1995, 6 patients with ileo-colonic tuberculosis were operated in the Surgical Department N. Gh. Lupu, of which 3 presented also the peritonitis form, and 2 patients had also a liver involvement. The clinical symptoms, the palpable abdominal mass in the right lower quadrant and the intraoperative aspect suggested usually a right colonic neoplasm. The diagnosis was established by histology. The management was right (ileo) hemicolectomy, followed by tuberculostatic treatment over one year. In conclusion, the diagnosis is still a matter of concern whenever a palpable abdominal mass is found, even in the absence of evolutive pulmonary tuberculosis. A frozen section from the resection piece is very important, because it enables early beginning of the tuberculostatic treatment.

Adult↗
PubMedDate not supplied

[Retroperitoneal tumors of nervous origin in adults].

UNLABELLED: Adult's retroperitoneal tumours of nervous origin are infrequent clinical entities with characteristic evolution and treatment. We review 13 cases, dealt with in N. Gh. Lupu Surgical Clinic between 1975-1994 and representing 20% of the retroperitoneal tumour admitted in our clinic during the same period. Most of the patients were males (sex ratio 10:3). The main symptom was the abdominal pain (84.6% of all cases) and all the tumours were extremely big (15-30 cm diameter). The surgical approach always tried to remove the tumour, which succeeded, even if in 4 cases some of the surrounding organs had to be removed also. The two postoperative complications consisted in a severe wound infection and an acute pancreatitis; the second evolved poorly and the patient was lost. No complementary therapy was used. None of the five patients followed up for five years presented clinical evidence of recurrent tumour. CONCLUSIONS: Due to an unexplained evolutive tolerance, adult's retroperitoneal tumours of nervous origin reach large dimensions and have late clinical expression, as the complications occur. Preoperative imagistic findings supply valuable informations for the subsequent surgical treatment. The surgical approach must aim to the ablation of the tumour, with or without the sacrifice of other organs which the tumours can include. This aggressive surgical conduite is sustained by the satisfying postoperative results.

Abdominal Pain↗
PubMedDate not supplied

[The treatment of inguinal hernias by the tension-free mesh-plug alloplastic technic].

The treatment of inguinal hernia using conventional procedures is related with a relative high rate of recurrency, discomfort and postoperative complications. This is the reason, why, in the last 6 months we began to perform the tension-free mesh-plug technique, starting from the American authors idea of preserving the sphincters-like action of the internal ring and the "sling" & "shutter" mechanism of the inguinal canal. Also, the dissection being minimal, it importantly reduced the possibility of postoperative complications (hematoma, seroma, ischemic orchitis). According to the hernia type, after the high dissection & ligation of the sac, on or more plugs are placed into the internal ring or/and the defect of the inguinal floor, reinforcing it with a second piece of flat mesh, from the pubic tubercle and beyond the internal ring. Though one experience is still small and of recent date, the results are encouraging: we didn't have postoperative complications and the patients discomfort was minimal.

Hernia, Inguinal↗
PubMedDate not supplied

[The indications for and limits to the surgical treatment of congenital dilatations of the intra- and extrahepatic bile ducts].

Congenital cystic dilatations of the biliary ducts are defects in the genetic program which are transmitted in an autosomal recessive way. Todani classified cystic dilatations of extra and intrahepatic ducts in 5 types. In classified cystic dilatations of extra and intrahepatic ducts in 5 types. In "N. Gh. Lupu" Surgical Clinical were treated 9 cases of congenital dilatations of the biliary tree during the last 40 years (1958-1998); five of them were belonging to the type V Todani (Caroli's disease), three to the type I Todani and one case in the type IV a of Todoni's classification. The mean age of the patients was 42.4 years, five of them being men and 4 women. Surgical treatment was particular to each case depending on age, associated diseases, the length of disease's evolution and the general state of the patient. The prognosis of this disease is a reserved one.

Adolescent↗