PubMed Health⌕ Search

Biomedical subjects

R Munteanu

Publications and source records attributed to R Munteanu.

12 recordsLinked to original sources
PubMedDate not supplied

[Laparoscopic reoperations].

The progress of laparoscopic techniques have made possible video-assisted miniinvasive surgery in patients with indication of reoperation. Knowing that there are many controversies against this type of surgery, the authors tried to formulate their own point of view in this matter by analyzing their experience in such particular cases. In this study there are included both laparoscopic re-operations (or re-laparoscopies), consecutive to video-assisted surgery, and the mini-invasive procedures performed for complications after open surgery. Of the total 3901 laparoscopic operations (in 3714 patients) we performed 34 laparoscopic re-operations for postoperative complications occurred in patients previously operated on in our clinic or in other departments (29 re-laparoscopies and 5 after open surgery) The objective of the study was to verify if the laparoscopic techniques are useful in diagnostic and treatment of the postoperative complications which need surgical re-exploration, and the conclusions have shown that laparoscopy may be appropriate in re-exploration of the surgical patients, if the rules of the operative management is respected and the well defined standards are fulfilled.

Appendicitis↗
PubMedDate not supplied

[The 10 principles of the camera person (or what a surgeon must do so that another one can see what he does)].

Miniinvasive videoendoscopic surgical techniques represent a revolution in all surgical fields and generate deep changes. Many principles of open surgery were put in doubt, some of them been considerate like dogma, the operating setup was changed, some mentalities and beliefs were modified and a new member of the surgical team appeared. This specialty doesn't exist in open surgery and its importance could not be minimized. This new kind of surgeon has particular knowledge and its actions during the laparoscopic procedures are different in opposition to open procedures. The following article refers at laparoscopic procedures but we are sure that exists several common points with others miniivasive techniques and some of this ideas are generally valid.

Feasibility Studies↗
PubMedDate not supplied

[The reposition technique for treatment of obstruction or migration of the peritoneal dialysis catheter].

Continuous ambulatory peritoneal dialysis are widely used in the management of patients with chronic renal failure. The permanent presence of the catheter into the peritoneal cavity generate a series of specific complications. Two of the most important causes of dysfunctional peritoneal dialysis catheter are obstruction and malposition. Failure to restore the drainage function of the catheter by conservative method should be followed by a surgical procedure: laparoscopic reposition or replacing the catheter. This paper present an original technique which has some major advantages: required local anesthesia; doesn't replace the existing catheter; the dyalysis program could be started very quick after procedure; it is a feasible and reproducible technique.

Adult↗
PubMedDate not supplied

[Laparoscopic approach in large hiatal hernia--particular considerations].

UNLABELLED: Large hiatal hernia are associated with permanent or intermittent protrusion of more than 1/3 of the stomach into the chest, single or in associated with other organs, a hiatal defect greater than 5 cm and various complications related to the morphological and physiological modifications. While the laparoscopic approach in small hiatal hernia and gastro-esophageal reflux disease is a standard procedure in large hiatal hernia persists a number of questions and controversies. Between 1995 and 2002 a number of 23 patients with large hiatal hernia (9 men, 14 women), mean age 65.8 years (range 49 to 77) underwent laparoscopic surgery. The majority of the patients had complications of the disease (dysphagia, severe esophagitis, anemia, respiratory and cardiac failure). In 16 cases was a sliding hernia (one recurrent after open procedure), in 2 paraesophageal and in 5 a mixed hernia (two "upside-down" type). In 7 cases we perform, in the same operation, cholecystectomy for gallbladder stones and in one cases Heller myotomy for achalasia. In all cases the repairs was performed by using interrupted stitches to approximate the crurae, but in three of them (recurrent and upside down hernia) we consider necessary to repair with a polypropylene mesh (10 x 5 cm) with a "keyhole" for the esophagus. In these particular cases we do not perform a antireflux procedure, in others 20 cases a short floppy Nissen was done. During the operation one patient developed a left pneumothorax and required pleural drainage. Postoperatively one patient had dysphagia treated by pneumatic dilatation and another die 3 weeks after the surgery because severe respiratory and cardiac failure. CONCLUSIONS: Laparoscopic approach is a feasible and effective procedure with good postoperatively results, but required good skills in mininvasive technique.

Aged↗
PubMedDate not supplied

[Cavitary viscera injuries during laparoscopy].

Intraoperative incidents of laparoscopic surgery resulting in cavitary viscera injuries are analyzed, based on a series of 6308 patients (6800 operations) operated during a period of 9 years. This retrospective study includes 11 cases: 6 intraoperative cavitary viscera perforations (esophagus, gastric fornix, ileum, sigmoid) have been recognized and solved in the same laparoscopic operation or after conversion. In 5 cases the diagnosis was established in the postoperative period as fistulas (urinary bladder) or diffuse peritonitis caused by various types of injuries (esophagus, small and large bowel) and required reoperations. We present a global view of these cases and also analyze the determinant causes of the complications, emphasize the importance of intraoperative identification of such injuries and specify the place of minimally invasive surgery in the treatment of such accidents with an optimum healing and low rate of postoperative morbidity and mortality.

Abdominal Injuries↗
PubMedDate not supplied

Psychologic investigation in the estimation of the effects of hypotensive therapy in hypertensive patients working in the railway and highway traffic security.

Sixty four hypertensive patients working in railway and highway traffic security (engine operators, drivers, switchmen, etc.) were studied clinically and paraclinically and were also submitted to psychologic tests since the characteristics of their work requires a normal psychophysical state. The patients investigated, mostly males (93%), mean age 45.2 years, had essential arterial hypertension (AH) stages I (36 patients) and II (28 patients). After 3-4 days of low salt diet, therapy with propranolol (8 to 360 mg/day) and diuretics was started in most of the patients. In 8 patients with AH stage II, hydralazine (50-100 mg/days) was added to the treatment. The psychologic tests used were: the pencil-paper test "Labyrinth", "Barrage" and "A.D. Praga" and a motor test "Piorkowsky" used 2 times, i.e., before and after treatment. After 15 days of treatment the blood pressure values decreased: systolic from a mean value of 155 +/- 25 mmHg to 136 +/- 81 mmHg; diastolic from 102 + 18 mmHg to 84 +/- 11 mmHg. The marks for the psychologic test were: very poor, poor, medium, good, very good. The post-therapeutic changes obtained were noted in percentages. Improvements obtained: for the "Praga" test in 54% of the patients, for the "Barrage" in 44% of the patients and for the "Labyrinth" in 66% of the patients. Improvements for the first "Piorkowsky" test (slow rate stimuli) were obtained in 54% of the patients and for the second (faster rate stimuli) in 69%. No decrease of psychologic performance was observed in any of the patients. Therefore the psychologic tests used may contribute to the follow-up of the effectiveness and of the side effects of modern hypotensive therapy especially in patients working in traffic security in whom the psychophysical state should be at its best.

Antihypertensive Agents↗
PubMedDate not supplied

[Thoracic sympathectomy via the thoracoscopic approach. The operative technic].

The authors describe the technique of thoracic sympathectomy by thoracoscopic approach in the variant in which the sympathetic chain is divided between T4 and T5 sympathetic ganglion associated with the division of the gray and white rami communicantes of the T2-T3-T4 sympathetic ganglions. The article emphasizes the importance of the 2nd sympathetic ganglion in the regulation of the blood circulation of the arm and the advantages of the thoracoscopic approach for this type of intervention.

Adult↗
PubMedDate not supplied

[Conversions and reinterventions in laparoscopic cholecystectomy].

From the introduction of the laparoscopy in our clinic, more and more of the cholecystectomies, reaching over 50% are done by this technique. Based upon the accumulation of an already important experience, the paper tries to analyze the situations in which, during or after laparoscopic cholecystectomy, intraoperative conversions (deliberate or of necessity) or reinterventions were necessary. We present a global view of the number of these cases and also (an in detail) analysis of the causes the imposed such decisions and of the solutions adopted. The percentages of 5.55 conversions and 1.49 reinterventions seem reasonable and acceptable in comparison with the initial results published by some experience surgeons in the field of laparoscopic surgery.

Adult↗