Biomedical subjects

R Terinte

Publications and source records attributed to R Terinte.

8 recordsLinked to original sources

PubMed1995

[Secondary hyperparathyroidism].

Secondary (renal) hyperparathyroidism appears in chronic renal failure, sometimes in patients on chronic dialysis. Other causes includes rickets and osteomalacia. These diseases are associated with poor calcium and vitamin D absorbtion from the small bowel. Two patients with chronic renal failure maintained on chronic haemodialysis from two and three years, respectively underwent subtotal parathyroidectomy: removal of three glands and preserving a half of a gland in situ. The diagnosis and surgical indication was made upon clinical (bone pain and severe itching), radiological (demineralisation, ectopic calcifications) and biochemical (hypercalcemia, hyperphosphoremia, increased values of alkaline phosphatases) arguments. Postoperatively the improvement is defined by a return to normal in the clinical, laboratory and radiological parametres. The most appropriate operation for secondary hyperparathyroidism is still unresolved one of two techniques is performed according to the preference of the surgeon: subtotal parathyroidectomy or total parathyroidectomy with autotransplantation of parathyroid fragments into forearm muscle.

Adult↗

PubMedDate not supplied

["Spontaneous", "delayed" and "occult" ruptures of the normal and pathologic spleen. Nosologic classification].

The anatomic particularities and the diversity of the splenic pathology determine a wide spectrum of the traumatic lesions of the spleen. The classical acute rupture with consecutive hemoperitoneum and mandatory surgical indication is opposed to the controversial "spontaneous" ruptures of the normal and pathologic spleen and also to the delayed and occult ruptures the lasts of them sometimes minimal or with chronic evolution. A series of eight cases all males with ages between 40-77 years is presented in order to exemplify all these entities. There are underlined the variety of etiologic conditions, the difficulties of the diagnosis which impose an insistent anamnesis and clinical examination (searching even a "trivial" trauma) completed with ultrasonography and CT scan which are preferred to radionuclide scan of arteriography and finally peritoneal lavage after punction, laparoscopy and even laparotomy. Splenectomy--often laborious--was effective in all our patients (obviously only temporary for the cases with nonhodgkin malignant lymphoma and respectively with splenic metastasis from a renal carcinoma). In some situations--especially in children--the conservative treatment can be considered.

Adult↗

PubMedDate not supplied

[Hyperfunctional parathyroid carcinoma].

The parathyroid cancer is mentioned in literature with an incidence of 0.5-5% in the etiology of the primary hyperparathyroidism. The authors present the case of a 45 year old female with diagnosis of "primary hyperparathyroidism" based on clinical, ultrasonographic and biochemical investigations. A right superior adenoma of 3 x 2 x 1 cm (150 mg) has been found and extirpated. The histological examination showed an adenoma with predominant "chief" cells. Three years after surgery the patient had a recurrence of the clinical and hypercalcemie syndrome (with more severe damages). The surgical reexploration showed the right thyroid lobe with a nodular aspect and in its inferior pole a enlarged parathyroid gland of one cm size was found. An en-block exeresis including the right thyroid lobe with isthmus as well as the mentioned lesion and the half of left superior parathyroid, the left inferior one together with retrosternal fat tissue have been performed. Frozen sections completed by paraffin examination established the diagnosis of hyperfunctioning parathyroid carcinoma. We have emphasize the issues that could suggest the initially preoperative true diagnosis: the large size of excised adenoma and the relatively quick recurrence of the phenomena of parathyroid hyperfunction. The surgical principles and strategies in the treatment of parathyroid cancer are also discussed.

Carcinoma↗

PubMedDate not supplied

[Upper digestive hemorrhage, physiopathologic and therapeutical considerations].

The study is based on the analysis of 158 patients admitted in the "Fourth Clinic of Surgery" with diagnosis of "Upper Digestive Haemorrhage" (U.D.H.) between 1998-2002, emphasising the importance of the physiopathological chains induced by the ulcer bleeding; 119 cases (76%) were diagnosed with gastro-duodenal ulcer, 20 with portal hypertension (20%), 14 subjects were with gastric carcinoma (8.8%) and 5 with miscellaneous etiologies so called "rare circumstances" of U.D.H. (two patients with Idiopathic Thrombocytopenia, one case with Dieulafoy gastric ulceration and two subjects with Haemorrhagic Gastritis). All the patients were admitted in the first moment in the Intensive Care Unit where haemostasis were successfully obtained with drug therapy adapted to the physiopathological changes induced by bleeding, in the majority of cases with light bleeding (8 cases, 5.4%) or medium bleeding (139 patients, 87.4%); only in 9 subjects (6%) with severe haemorrhage surgery was indicated (posterior bulbar ulcer in which the surgical haemostasis was necessary). In 88 patients (55%) surgery was performed as an elective procedure--74 from them had haemorrhagic gastric or duodenal ulcers with a medium amount of bleeding and 14 observations for gastric carcinoma with a chronic bleeding. In most all the cases the postoperative evolution was in good terms. Two observations with severe U.D.H. due to rupture of esophageal varices occurred on hepatic cirrhosis were out of therapeutical proof (1.2% deaths from all the admitted patients with U.D.H.).

Adult↗

PubMedDate not supplied

[Antibiotic prophylaxis in surgery for colorectal cancer].

The prophylactic use of antibiotics in the purpose of decreasing the frequency and severity of surgical infections is still controversial. The practical need of defining the concept of antibiotic prophylaxis gave rise to numerous polemics in the literature. This paper presents a retrospective study on 103 cases whom diagnostics were colon and rectum cancer, that were operated in the IV-th Surgical Clinic in 1993-2002 period; at these patients was done antibiotic prophylaxis local and systemic before, during and after operating. This method made possible the registration of a minimum number of cases with surgical infection (7 cases, representing only 7% of the operated patients): a case (1%) with peritoneal collection (needing the surgical evacuation of this collection) and in 6 cases, parietal superficial infections, which imposed the prolong of drainage for almost 7 days. Starting from the basic principles of antibiotic therapy, this paper aims at outlining practical guidelines for a judicious antibiotic prophylaxis.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Bulbantrectomy with truncal vagotomy in the surgical treatment of duodenal ulcer].

Duodenal ulcer benefits of very efficient medical treatment. In currently medical practice exist many cases with complicated duodenal ulcer (by stenosis or penetration in neighbor organs like pancreas or biliary tract or painful forms etc.) to which surgical treatment is necessary. Based on the retrospective study of 116 patients operated between 1991-2002 years for gastric or duodenal ulcer, this paper demonstrates that bulbantrectomy associated with bilateral truncal vagotomy (63.7% of cases) is the best surgery in the treatment of duodenal complicated ulcer or resistant to the medical procedures. Provided by correct indication, the intervention is the most pathogenic, offering the best immediate and long term postoperative results. If the bulbantrectomy is contraindicated (critical general status, etc.), the alternative is a bilateral truncal vagotomy associated with a drainage procedure: pyloroplasty (6.9% of cases) or gastroenterostomy. When the vagotomy are contraindicated or cannot be correctly performed, a large gastrectomy (29.3% of cases) followed by gastroduodenal (preferable) or gastrojejunal anastomosis are practiced.

Adult↗

PubMedDate not supplied

[The surgical treatment of parathyroid hyperfunction; comments on 16 cases].

16 cases of primary (13 cases) or secondary (3 cases) parathyroid hyperfunction are presented. The diagnostic circumstances are described: the tumor were incidentally discovered in patients with skeletal or urinary symptoms and following the artificial dialysis in patients with send failure. The treatment consisted in 12 adenoma excision and 3 subtotal paratyroidectomies (in 3 patients with hyperparathyroidism of renal origin. Associated operations on the thyroid gland (tactical or for removing thyroid nodules) and the operations for urinary lithiasis or skeletal disease were also presented. There was no postoperative morbidity or mortality.

Adenoma↗

PubMedDate not supplied

[Cholelithiasis following gastric surgery].

A retrospective study was carried out in order to verify the correlation between the biliary disease and previous gastroduodenal operations for various lesions. The 24 patients (18 males and 6 females with an average age of 54 years) reported were diagnosed with chronic or acute cholelithiasis (with common bile duct stones and cholangitis) which imposed emergency or short delayed surgery in most of the cases. The previous gastric operations performed 5 up to 23 years ago were classic gastrectomies with Polya (9 cases) or Péan (8 cases) anastomosis, truncal vagotomy with pyloroplasty or gastroenterostomy for gastric and duodenal ulcers, one hemigastrectomy, one antrectomy and one tumorectomy for benign gastric tumours (one schwannoma and two polyps), one enlarged subtotal gastrectomy for adenocarcinoma and, finally, one gastrotomy for a suspected bleeding gastric tumour. The causal connection between cholelithiasis and previous gastric surgery is obvious, anatomical changes and alterations in the kinetics of the duodenum and common duct being incriminated.

Adult↗