Biomedical subjects
R Nemeş
Publications and source records attributed to R Nemeş.
[Pulmonary aspergilloma successfully operated on in a patient with the pentalogy of Fallot].
Fallot disease occurs in 10% of congenital heart diseases. This case showed a clinical association between Fallot disease and a pulmonary aspergilloma. A 44-years male, with a history of Fallot disease (diagnosed in childhood) and a normal life, was admitted for repeated hemoptysis during last three months. Clinical examination revealed signs of Fallot disease: cyanosis, finger clubbing. CT scan and chest X-ray revealed a cavitary image in the right upper lobe. The CT image revealed a typical aspect of cavitary aspergilloma. The patient was referred to the thoracic surgeon, a right upper lobectomy was performed, which confirmed the presence of aspergilloma. Postoperative evolution was good.
[Chemical obliterans bronchiolitis after azotic acid exposure].
The authors present the case of a 48 years old man having an exposure to irritant gases (azotic and lactic acids) in a closed space, inhaling them for 5 minutes. Shortly after the accident the patient displayed the signs of corneal and conjunctival burn; several days afterwards respiratory symptoms appeared: shortness of breath, dyspnea to minor efforts, then nocturnal dyspnea and orthopnea. Chest X-ray, CT scan, complex lung function tests and bronchoalveolar lavaje, together with the history of recent exposure to irritant gases led to the diagnosis of hypersensitivity obliterant bronchiolitis. Oral corticoids in dose of 60 mg/day determined a substantial clinical, radiological and functional improvement. The authors make some comments on the need of early diagnosis and efficient treatment.
[Tracheomalacia and secondary tracheopatia osteocondroplasica - a case report].
Tracheomalacia is a condition of the neonatal and infant airway, characterized by weakness of the supporting tracheal cartilage and widening of the posterior membranous wall. Together, these factors cause tracheal collapse, especially during times of increased airflow. The diagnosis of major airway collapse depends upon an accurate history combined with proper endoscopic evaluation. Tracheomalacia can be caused by a diffuse process of congenital origin or by a localized abnormality. The cases of acquired tracheomalacia occur with increasing frequency both in children and adults and are often not clearly recognized. These lesions may result from indwelling tracheostomy and endobronchial tube, chest trauma, chronic tracheobronchitis, inflammation (relapsing polychondritis), secondary to pulmonary resection, tracheal malignancy (cylindroma), and idiopathically. We present the case of a 59 years old male with acquired tracheobronchomalacia, associated with tracheopatia osteochondroplasica, secondary to COPD and a chronic parenchimal infection, on a diabetes mellitus type II background.
[Exceptional etiologies in upper digestive tract bleeding ].
7 cases, considered as being true etiological exceptions selected from 756 upper gastrointestinal bleeding, are presented. The causes of bleeding were: pancreatic pseudocyst with intracystic hemorrhage broken into duodenum (2 cases), the nonepithelial gastroduodenal tumor (3 cases), the aneurysm of gastroduodenal artery broken into duodenum (1 case) and the aortoduodenal fistula in one patient with a bilateral aorto-iliac by-pass (1 case). The etiological diagnosis could not be established in any cases before the operations. All the cases were operated on, the operation being imposed by the severity of bleeding and having the haemostasis as a main purpose.
[Postoperative intestinal fistulae].
58 (6.25%) intestinal fistulae raised after 928 operations performed for varied surgical small bowel diseases were studied. The primary operation was performed for bowel obstruction, acute peritonitis, small bowel tumours, postoperative eviscerations and for entro-mesenteric infarction. We also noticed that the surgery was performed for the small bowel diseases in 47 (81%) acses and for the diseases belonging to other abdominal viscera in the rest, having an emergency character in 81% of cases. The small bowel fistulae were single (51 cases) or multiple having the following topographic distribution: jejunal fistulae in 25 (43.4%) cases and ileal fistulae in 33 cases (56.6). The coming out of the fistulae was directly in 41 (70%) cases and trough an intermediate route in 17 (30%) cases. The onset of the fistulae was certainly pointed by the coming out moment, early only in 39.6% of cases. This underlining the importance of an active exploration of the operative wound, imposed by the general and/or local premonitory symptoms. The treatment was complex, using conservative and/or surgical procedures; 23 (39.6%) patients were operated on. The mortality rate was of 29.4%. The parenteral nutrition and the therapeutical option for the conservative methods were the main therapeutical acquisitions, which improved the results and the prognosis of the intestinal fistulae.
[Critical evaluation of surgical treatment in slip hiatal hernia].
448 hiatal hernias, admitted in the last 20 years (1974-1998), 431 (96.3%) sliding hiatal hernias and 17 (3.8%) paraoesophageal hernias, are presented. The hiatal hernias were noticed under the well known etiopathologic circumstances: the predominance of the patients belonging to the female sex (66.07%), aged over 40 (83.25%); we also found in the natural history of the patients increasing abdominal pressure factors (10.79%), metabolic and deficiency disturbances (34.19%) or the concomitance of such a diseases, which admits a low trophicity of the connective tissue as a main pathogenic factor (35.12%). 231 (52.56%) cases were pure hiatal hernias and in 217 (48.44%) cases the hiatal hernia was associated with biliary and/or gastro-duodenal lesions, the hiatal hernia being considered as secondary. The clinical diagnosis was suggested by the gastrooesophageal reflux syndrome for the pure hiatal hernias associated with respiratory (30.32%) and/or cardiac (27.4%) signs. In the associated forms with biliary and/or gastro-duodenal lesions, the clinical picture was that of the hiatal hernia in 30.6% of cases and of the associated lesion in the rest. The clinical diagnosis was confirmed by x-ray examination in 82.7% of cases; the endoscopy was performed in 159 cases and proved the gastrooesophageal reflux and/or its consequences in 47.2% of cases. 420 (93.75%) cases were uncomplicated and in 28 (6.25%) cases we noticed one of the following complications: upper gastro-intestinal bleeding, incarceration or venous thrombosis of the hernial pouch. 336 (75%) patients were operated on, using a large scale of surgical procedures, surgical indication being established on clinical, radiological and endoscopic criteria, with utmost strictness for pure hiatal hernias (surgical treatment 68.3%) and generously for the associated forms. Both the early and late results were good: the mortality rate of 0.44% and the recurrence rate of 3.97%.
[Gastroduodenal artery aneurysm broken in duodenum. A rare cause of upper digestive tract hemorrhage].
The authors present a case of recidivated upper digestive tract hemorrhage, in which the bleeding initially stopped under conservative treatment. Imagery showed a piloro-duodenal stenosis. During the preoperative care the hemorrhage is resumed abruptly imposing emergency operation. The lesion was an intraoperative surprise imposing the hemostasis at first, and then the surgical management of lesions of the digestive tract.
[The megaureter--a possible complication after resected retroperitoneal tumor].
The authors present a very rare complication of a retroperitoneal tumor resection: unilateral iliopelvic segmental megaureter. This condition was subsequently complicated with a diffuse peritonitis caused by parietal microperforations.
[Primary retroperitoneal tumors--diagnostic and therapeutic difficulties].
This paper emphasizes the diagnosis and therapeutic difficulties in primary retroperitoneal tumors. There were analyzed 68 primary retroperitoneal tumors (1992-2002): 16 (23.5%) benign tumors, 39 (57.35%) malignant tumors and 13 tumors with unknown histological structure. The preoperative diagnosis was clinically suggested and confirmed by ultrasound and CT examination; the operability was always established by laparotomy. All cases were operated on: complete resection of tumor was possible in 39 cases (57.35%); partial resection in 11 cases (16.17%) and 18 (26.47%) cases were inoperable. There were 5 major intraoperative vascular lesions: 1 inferior vena cava lesion, 1 superior mesenteric vein lesion, 1 left common iliac vein lesion and 2 lumbar artery lesions. Postoperative mortality was represented by 2 cases. Postoperative complication was represented by 3 postoperative hemorrhages, 2 severe pulmonary infections, 1 postoperative evisceration, 1 postoperative acute pancreatitis and 1 acute myocardial infarction. In conclusion the primary retroperitoneal tumors represent a challenge for all surgeons, especially due to surgical approach difficulties, because of problems in tumors intraoperative exploration and resection and because of difficulties in hemostasis.
[Severe nosocomial infection of soft tissue in general surgery].
This paper aim is to emphasize the severity of soft tissue nosocomial infections, determined by anaerobic bacteria associated with Gram-negative aerobic bacteria: 50% mortality, higher economic costs, disabling morphologic and functional sequels. We present the pathogenic, clinical and therapeutically problems which characterize this type of postoperative infections.
[Severe acute pancreatitis--diagnostic and therapeutic strategy].
To establish the optimal diagnosis and therapeutical strategy in severe acute pancreatitis. 94 (56.9%) severe acute pancreatitis (79 males and 15 females, aged between 26 and 81), selected from 165 acute pancreatitis admitted in the last 5 years (2000-2004) were analyzed. The disease was assigned as severe when one or more of the following criteria were present: Ranson score >3 on admission or at 48 hours, APACHE II score >8, visceral failures, Balthazar CT score C, D or E and local complications (infected necrosis, pseudocyst or pancreatic abscess). Medical treatment (aggressive supportive intensive care therapy, minimizing pancreatic secretion and antibiotic therapy) was the first therapeutical step in all cases. 49 (52.1%) patients were operated on: 20 as early surgery imposed by biliary sepsis (16 cases) or by an acute abdomen with uncertain etiology and unfavourable evolution, and 22 as late surgery (at least 12 days after onset), imposed by the presence of the infected pancreatic necrosis, visceral failures or other local complications, the necrosectomy being the main surgical procedure for infected necrosis. 77 (81.9%) cases had a fair evolution. The conservative treatment led to a complete recovery in 37 (37.2%) cases. We registered an overall mortality rate of 12.7% and postoperative mortality rate of 14%; we also registered 5 (10.2%) postoperative complications: 4 pancreatic and 1 colonic fistulae. (1) The treatment of the severe acute pancreatitis must be performed only in the specialized multidisciplinary well equipped centers with very well trained staff. (2) Medical conservative treatment (aggressive supportive intensive care therapy and antibiotic therapy) is the main therapeutical method within the acute phase (first two weeks). (3) Very restrictive surgical indications within the acute phase. (4) Necrosectomy is the main surgical procedure for the infected necrosis.
[Postoperative biliary peritonitis--diagnosis and treatment difficulties].
AIM: To point out the severity of the postoperative biliary peritonitis (PBP) and to established the most proper ways of diagnosis and treatment. MATERIAL AND METHODS: 14 PBP (6 males and 8 females, age between 42 and 76 years) admitted in the last 14 years were analyzed. The PBP occurred after biliary surgery in 13 cases and after gastro-duodenal surgery in 1 case. The delay between the first operation and the establishing of the diagnosis and reoperation varied between 24 hours and more than 3 days. All the patients were operated on; the operation had to fulfill 2 main objectives: the treatment of the peritonitis and to solve the biliary lesions. RESULTS: 6 patients had a fair evolution. We registered 8 complications with a morbidity rate of 57,14% and 2 deaths with a mortality rate of 14,3%. CONCLUSIONS: 1. Postoperative biliary peritonitis is one of the most severe complications of the biliary and gastro-duodenal surgery, due to preoperative unrecognized biliary lesions or occurring as postoperative accidents or complications. 2. The clinical picture, deeply modified by the complex postoperative treatment makes the early diagnosis very difficult and leads to a delay of the re-operation. 3. The treatment is exclusively a surgical one, with two main objectives: the biliary lesion repair and the treatment of the peritonitis. 4. The postoperative biliary peritonitis are charged by a high postoperative morbidity and mortality rate, the delay of the diagnosis and the time of reoperation being the main risk factor.
[The pancreatic pseudocyst--late complication of the severe acute pancreatitis. Therapeutic options].
AIM: the assessment of the therapeutical methods in the pancreatic pseudocyst occurred after severe acute pancreatitis. MATERIAL AND METHOD: 30 (33.3%) pancreatic pseudocysts (18 men and 12 women aged between 28-64) occurred in the evolution of 90 severe acute pancreatitis in the last 5 years (2000-2004) were analyzed. The diagnosis was established on the clinical and imaging aspects on average 1 month after the onset of the severe acute pancreatitis. The treatment was different, depending on size, anatomo-clinical form, pseudocyst age, presence of complications and the biological status of the patient. 14 uncomplicated pseudocysts, with the diameter less than 6 cm, were treated conservatively, until their complete resorption. 6 cases were operated on (2 cysto-gastrostomy, 1 cysto-jejunostomy and 3 external drainage). We performed percutaneous external CT guided drainage in 2 cases and endoscopic drainage in other 8 cases (trans-papillary-trans-ductal drainage 3 cases and endoscopic US guided drainage in 5 cases: transgastric 2, transduodenal 2 and transesophageal 1). RESULTS: 28 (93.3%) cases had a fair evolution (complete resorption in 14 uncomplicated pseudocysts after 3-6 weeks of conservative treatment). We registered 2 gastro-duodenal bleeding during endoscopic US guided drainage, which required operation (haemostasis cysto-gastrostomy). Mortality rate was 0. CONCLUSIONS: 1. The pseudocyst is the main late complication of the severe acute pancreatitis (33.3% in our study). 2. The uncomplicated pseudocysts with the diameter less than 6 cm, benefit of the conservative treatment and monitoring in progress until their complete resolution. 3. There are 3 therapeutical methods for the pseudocysts more than 6 cm in diameter and/or complicated: the percutaneous external US/CT guided drainage, the endoscopic drainage and surgery. 4. The option for the drainage procedure must take into account the morphological and evolutionary aspects of the pseudocyst, the age and biological status of the patient.
Homeostasis changes induced by the action of ethanol on the materno-fetal complex in rats. IV. Late maternal effects following acute intoxication during the preimplantation period.
The possible late maternal effect on biochemical homeostasis of acute administration of ethanol during the preimplantation period was studied on pregnant albino female rats (Wistar strain). Females were injected i.v. with a 33.16% (v/v) solution of ethanol (4.80 ml/kg body weight) on day 2 and 4 of pregnancy, the animals being sacrificed on day 20. The effects on hepatic DNA biosynthesis and on some serum metabolites (proteins, lipids and some non-protein nitrogen compounds) were determined in the treated and in an untreated control group. In the treated group a non-significant increase of hepatic DNA concentration was found. Homeostasis changes of serum proteins involved: a slight increase of total serum protein content, hypoalbuminemia and hyperglobulinemia (non-significant values). Lipid metabolites showed also non-significant changes: increase of total lipids and decrease of cholesterol. Uric acid and urea (non-protein metabolites) concentration was increased. This increase, in spite of its significance level, must be taken into account and may be due to the presence of dead fetuses and to the consecutive renal lesions.
[Indications for temporary diversions and for primary resections in emergency colon surgery].
The authors make a critical analysis of indications for temporary derivations, and for "d'emblée" resection in the emergency surgery of the colon. This study is based on a series of 267 cases where emergency surgery was necessary for various conditions of the colon. All were operated in the I-st Clinic of Surgery from Craiova. The authors stress the inefficiency of cecostomy for the solution of occlusions due to neoplasms of the colon, and list the present indications of this type of temporary derivation, which include: protection of a colo-colonic anastomosis, and the solution of perforations (diastatic, traumatic) of the caecum. Supratumoral anus is considered as the choice solution for cancers of the left colon complicated by occlusion. Latero-lateral ileo-transverse anastomosis is considered as a temporary derivation, and is indicated in tumours of the right colon also complicated by occlusion. In cases of emergency the authors practice colonic resections by necessity, but they also perform colonic exeresis with relative indications. In cases of colonic resections by necessity the problem is mainly the opportunity of recovery of the digestive transit. Emergency colectomies with relative indications concern colonic cancer, or volvulus of the colon, and particular conditions are necessary for their performance. The authors consider the protection of colo-colonic, or recto-colic anastomoses as useful.
[Surgical treatment of gastric cancer].
Explore the source record for details and available documents.