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Biomedical subjects

R Nemeş

Publications and source records attributed to R Nemeş.

33 records · Page 2Linked to original sources
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[Clinical and therapeutic considerations on 201 operated hiatal hernias].

A total of 201 patients have been operated over the last 8 years, presenting with hiatal hernias. Five of the patients had para-oesophagian hiatal hernia while the remaining 196 had hiatal hernias following slippage. Some 107 hernias were isolated, and had a classical etiopathogeny, with gastro-oesophagial reflux in 85% of the cases. Cardio-vascular disturbances and digestive hemorrhage were present in 15% of the cases. In 89 patients the hiatal hernias were associated with various affections in the supra-mesocolic space. There were 54 patients with biliary affections and 35 with piloro-duodenal affections. The indication for operation was established on the basis of clinical symptoms which included gastrooesophagial reflux, radiological signs of the reflux and indirect signs of oesophagitis. The surgical procedures employed were various, and included a personal procedure. The immediate and the late postoperative results were similar to those reported in the specialized literature.

Aged↗
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[Obturation with an elastic balloon--the authors' procedure for the conservative treatment of external postoperative digestive fistulae].

UNLABELLED: A personal method for the conservative treatment of the postsurgical external digestive fistulas by means of obturation with an elastic balloon of adjustable pressure, used in Surgical Clinic I Craiova in the past 12 years is presented. Initially conceived as an elective method for the treatment of the fistulas exposed in evisceration, the procedure was later applied as a unique method or in association with other conservative procedure in almost all types of fistulas. 122 patients have been treated by means of our method (3 esophageal, 65 gastro-duodenal and gastro-intestinal, 27 intestinal and 27 colo-rectal fistulas), in 53 cases a unique method and in 69 cases as a therapeutically sequences within the conservative treatment of the fistulas. RESULTS: 115 patients (94.2%) have had a fair evolution; we have registered 7 death, which represent a mortality rate of 5.93%. CONCLUSIONS: Our method offers the following advantages: it considerably reduces the losses of digestive liquids through the fistula; it allows early resumption of normal nourishment; it allows early mobilization of the patients; it prevents the occurrence of new fistulas which are caused by decubitus lesions; it is a simple and economic method, which can be applied in any surgical department.

Digestive System Diseases↗
PubMedDate not supplied

[Severe acute pancreatitis. Its management and experience].

The authors examined a group of 91 cases of acute pancreatitis hospitalised and treated between 1992 and 1996, using multiparametric bioclinical scores like Ranson, Imrie, Apache II systems and morphological scores obtained through C.T., they have divided the examined group into patients with A.B.P. (acute benign pancreatitis)--59 (64.84%), who don't require exquisite therapeutical means, with positive healing and A.S.P.--32 (35.16%), who require a complex medico-surgical therapeutics with unforeseeable evolution and results. The purpose of the paper was the one of establishing a diagnostical and therapeutical strategy for the A.S.P. adequate to actual conceptions. The correct diagnosis of acute pancreatitis initially has been established at 59 (64.83%) and erroneous at 32 (36.13%) cases. The diagnosis of A.S.P. has been established in 32 (35.16%). The etiology has been lithiasic (biliary) for 31.25% and nonbiliary for 68.75% patients. The C.T. examination in the best way to diagnose necrosis and infections, to follow the evolution and especially the surgical indication, achieved by the authors in 30% of cases. The initial medical treatment has been fulfilled at all the patients and the surgical one at 29 (91.63%). There have been implemented explorer laparotomies in 33.33% cases, interventions on the pancreas in 72.66%, operations associated on the biliary ways 41.37%, necessity operations 13.8%, with different types of draining (conventional and open abdomen). The results have been taxed by locoregional complications in 72.41%, general complications in 44.51% and a general rate of decrease of 43.75%. It is recommended initial surgical abstention and gravity estimations, the reanimation of all A.S.P. for prevention and treatment of general complications, surgical treatment of A.S.P. complications. The A.S.P. treatment of biliary (lithiasic) etiology after two months and after C.T. to confirm inflammatory process remission.

Acute Disease↗
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[Resuscitation principles in severe acute pancreatitis complicated by multiple organ dysfunctions].

The first part renders very synthetically a few of the principal pathogenetical mechanisms implicated in PA, as well as general data about MODS, and then tackles therapeutical principles of great organic disfunction, the therapy of septic states and nutrition in PA. Hemodynamics dysfunction--the therapeutical objectives are correlated with the principal mechanisms implicated in cardio-vascular disfunction (the grown level of some myocardial depressive factors, the shortcoming of peripheral vascular resistance, a.s.o.). The therapeutical principles covets the volemic restoration, inotropic therapy, the correction of hydro-ionic and acido-basic disorders, the vasomotor therapy, the CID's correction, the myocardium protection against the free radicals of oxygen. The therapy is recommended to be individualized depending on the clinical data and the monitoring of some parameters (T.A, P.V.C., intrapulmonary pressure, EKG, hematocrit value, a.s.o.). Pulmonary disfunction--includes the therapy of some clinical forms of pulmonary complications, the restrictive syndrome, infections, the pulmonary shunt, the atelectasis and insists on ARDS which is a complication with vital implications. The therapy of curdling disorders--recommends blood, derivatives, antiprotease, the substitution of the consumed curdling factors, as well as the removal of the pathogenic factors which disturb the coagulation-coagulolysis equilibrium. Purge proceedings--covet the elimination from the organism of the toxic agents which generate cell-organic lesions. That's why it is moot the elimination of the pancreatic toxins before reaching the circulation (the thoracic tube draining and peritoneal lavage) as well as extrarenal purge proceedings (hemodialysis, hemofiltration and hemodiafiltration) with their benefits and limits. The sepsis and the immunotherapy--are tackled based on recent data from literature which besides antibiotherapy insists on the neutralization of various toxins and mediators by means of monoclonal and polyclonal antibodies, anti TFL antibodies, IL, a.s.o. Nutrition--is different presented, parenterally and enterally, each of them with their benefits and limits and with the recommendation to be used by means of the clinical form. There are mentioned some other additional treatments (pain removing, antagonisms of H2 receptors, inflammation and cytotoxicity inhibition, gastric decompression, a.s.o.).

Acute Disease↗