[Studies on the diabetogenic action of thiazides].
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Adult↗
Biomedical subjects
S Georgescu
Publications and source records attributed to S Georgescu.
Comparative study of helical CT scan angiography, conventional arteriography, and intraoperative findings for the evaluation of living renal transplant donors.
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Aneurysm↗
Liver hemangioma revisited: current surgical indications, technical aspects, results.
BACKGROUND/AIMS: New developments regarding the diagnosis of liver hemangiomas, surgical indication and therapeutic options emerged recently. We reviewed our experience from the point of view of these modern developments. METHODOLOGY: Fifty-seven patients with liver hemangiomas were retrospectively studied. The relationship between size, symptoms and treatment was assessed. RESULTS: Indication for surgery was the size of the lesion in 5 patients, symptomatology in 48 and uncertain diagnosis in 4. Increase in size was noted in four patients. Six patients had associated intraabdominal benign or malignant pathology. The treatment of choice was enucleation. Postoperative complications were noted in 6 patients and mortality was nil. In 3 patients the hemangiomas recurred and were reresected in 2. CONCLUSIONS: Hemangiomas should be resected when larger than 10 cm and when they become symptomatic. With the modern diagnostic work-up, uncertainty of diagnosis as an indication for surgery should be rare. Surgery remains the main treatment, with a low morbidity and mortality if performed in a specialized hepatobiliary unit. Enucleation is the surgical option of choice. In selected cases laparoscopic enucleation can be performed with good results.
Adult↗
[Laparoscopic cholecystectomy in non-lithiasis cholecystopathies].
We made a study in 1st Surgery Clinic of Iassy between March 93--November 98, with 2246 laparoscopic cholecystectomies. The reason was to define the place and role of laparoscopy in non-lithiasis cholecystopathies (81 cases). In the same period were operated classically 888 calculous cholecystitis and 38 non-lithiasis cholecystitis. The laparoscopy has a major role in diagnosis to the patients with many abdominal symptoms. We discovered pericholecystic adherences, hepatic cirrhosis, acute appendicitis, etc. Sometimes, the laparoscopy was made for "second look" after surgical treatment for neoplasia, the metastasis diagnosis, for tumors visible echographically. In many situations the laparoscopic cholecystectomy may be considered like a preventive operation. The easy postoperative evolution is an argument to enlarge the indication for laparoscopic cholecystectomy in alithiasis cholecystitis.
Cholecystectomy, Laparoscopic↗
[Cephalic duodenopancreatectomy with pyloric preservation in the treatment of pancreatic cancer].
UNLABELLED: Is the application of DPCPP in the treatment of pancreatic neoplasia a good reason? We have analysed 30 patients with cephalic duodenopancreatectomy (DPC) for biliopancreatic neoplasia between 1995-1999 in Ist Surgical Clinic of Iassy (13 with pyloric preservation). The indications were:--cephalic pancreatic neoplasia (adenocarcinoma--4 cases (one with cephalic chronic pancreatitis on the intraoperative microscopical examination);--Vater ampulloma (7 cases);--inferior common biliary duct (CBD 1 case);--duodenal adenocarcinoma (1 case). In the same time was operated 265 biliopancreatic diseases (203 mechanical jaundice with 132 neoplastic jaundice). RESULTS: --Better early postoperatively status of the patients--DPCPP does not give better prognosis;--there are necessary some technical skills to depase the important phases of DPCPP.
Adenocarcinoma↗
[Laparoscopic treatment of the ovarian cysts].
Laparoscopy is widely used as a safety procedure in many clinical situations allowing diagnosis and/or surgical management in a minimally invasive fashion. Most laparoscopic cases allow patients to recover quickly. The conventional ultrasonography and endovaginal sonogram appear to be useful in the pre-operative selection for this surgery. Conventional pulsed Doppler (Duplex) and color Doppler sonography (CDS) have added a new dimension to pelvic ultrasonography. This study was undertaken to evaluate usefulness of operative laparoscopy in treatment of ovarian cysts. A retrospective study was carried on 35 operative laparoscopy cases performed between 1995 and 2000. Types of surgery performed were cystectomy, salpingo-oophorectomy, oophorectomy and wedge resection. The mean operation time was in the range of 65 to 120 minutes, mean while the mean postoperative stay was of 3,8 days.
Adolescent↗
[Unusual hemorrhagic complication after surgery for severe generalized appendicular peritonitis].
The 22 year old male patient, was admitted in hospital for severe generalized peritonitis subsequent to acute perforated appendicitis and toxico-septic shock. On examination and relying on the previous history of the patient onset of the perforation was start assessed to have occurred some days earlier. Severe generalized, putrid peritonitis was found on surgery of the peritoneal cavity. Appendectomy was successfully carried out with a simple ligature of the appendix stump, and the ligature of the mezooappendix was performed without identifying the appendicular artery. Early in the postoperative stage there occurred diffuse bleeding localized in the peritoneal cavity. The source of the bleeding could not by found at the first reoperation. Subsequently the septic syndrome evolved simultaneously with the bleeding in a milder form, however, leading to growth in size of retroperitoneal hematoma. On marking the diagnosis, relying on CT examination, a new, second surgery was performed which afforded evacuation and drainage of the retroperitoneal hematoma. The authors have remarked and have tried to clear up the circumstances which had been conductive to the occurrence of hemorrhage, a thing absolutely unusual in the evolution of diffuse peritonitis by perforated acute appendicitis.
Adult↗
[An unusual case of liquorrhea nasalis].
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Adult↗
[Video-assisted thoracoscopic thymectomy--preliminary results].
Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy. From April 1999 to December 1999, we performed a total of 10 video-assisted thoracoscopic thymectomies for myasthenia gravis (MG). There were one male and nine female patients with ages ranging from 8 to 59 years. Thymoma was present in one of the ten patients. We considered that complete thymectomy was accomplished in all cases by examination of the thymic bed and of the resected specimen. There was no mortality or intraoperative complications. The median postoperative hospital stay was 4 days. Clinical improvement was observed in all patients after this short follow-up. Compared with a similar historical group of patients with MG who underwent transsternal thymectomy, the VATS group was associated with significantly less analgesic requirement and shortened hospital stay. We conclude that VAT thymectomy is technically feasible and is associated with a favorable postoperative course compared with the transsternal approach. We believe that complete thymectomy can be achieved by this approach. Further investigation with long-term follow-up is needed to further clarify the role of VAT thymectomy in thoracic surgery.
Adult↗
[The value and limits of subtotal gastrectomy in gastric cancer].
In the interval 1970-1988, in 321 of 670 patients with gastric neoplasm admitted to the 1st Surgical Clinic of Iaşi a subtotal gastrectomy was performed. Most patients were males (68.9%), more commonly aged between 50 and 70 years and in advanced evolutive stages. The gastric neoplasm were sited in order of frequency in the antrum (46.9%), body of the stomach (34.6%), eso-cardio-tuberosity (11.5%), linitis (4%), gastric stump and malignant ulcer (3%). Surgery was possible in only 59% of the cases (25% curative and 34.1% palliative). The surgical technique and its difficulties are detailed. In the 321 subtotal gastric resections 20 complications, 4 deaths (1.2%) and 20% survivals over 5 years were recorded. It is concluded that radioendoscopic and microscopic investigations, with their possibility of an early diagnosis, may cause a limitation of the indications of total gastric resection in the treatment of gastric neoplasm in favour a subtotal resection, more satisfactory from the functional viewpoint.
Adolescent↗
[Cholecystosis, the diagnostic and treatment problems].
In the interval 1981-1989 at the Ist Clinic of Surgery of Iaşi 230 cases of chronic cholecystitis were admitted and operated upon (cholesterolosis--24 cases, dysmorphosis--84 cases, dysplasia--22 cases). Most cases had a morphologic--dysmetabolic substrate--strawberry gallbladder, alone or associated with other lesions (lithiasis, cirrhosis, pancreatitis), rare cases being also found (porcelain gallbladder--1 case, calcium bile--2 cases, gallbladder diverticulosis--3 cases, longitudinal complete obstruction of cystic duct by gallstone--2 cases). This condition is more frequent in women in the 3rd dad 4th decade, the symptoms being discrete, uncharacteristic, but persistent. The diagnosis is based on duodenal catheterization, cholecysto-cholangiography and ultrasonography, the intraoperative and histo-pathologic confirmations being required. The increasing frequency of chronic cholecystitis makes necessary a more minute diagnosis and exigent surgical indication, pledges for long-term favourable results.
Adult↗
[Computed tomography in establishing the therapeutic management of lung cancer].
Computer tomography (CT), a noninvasive method of high complexity, compelled recognition in pneumological practice, becoming indispensable. The present study deals with 59 patients suspected of bronchopulmonary cancer, who were submitted to computer tomography, besides other examinations. CT contribution in establishing the diagnosis, the therapeutical line (particularly in determining the surgery moment) as well as the correlations (concordance and discordance) between the information offered by CT and by other conventional (radiological, bronchological) methods are analysed. The association of thin needle trans-thoracic biopsy (TNB) to CT ensures an important histologic confirmation which amounts to 75% of investigated cases, according to our statistical data.
Adolescent↗
[The cholestasis syndrome. A critical evaluation of an exploratory strategy].
The authors studied 160 cases of biliary stasis: 120 having intrahepatic cause (101 hepatic cirrhoses and 19 primitive biliary cirrhoses) and 40 extrahepatic cause (17 choledochal lithiases and 23 cancers of the pancreas head) and check up the diagnosis value of two investigation algorithms: echography, the first investigation, followed by hepatic biopsy puncture, if the intrahepatic biliary ducts are not dilated, or transhepatic cutaneous cholangiography if the intrahepatic biliary ducts are dilated in comparison with intravenous cholangiography in the first investigation. Echography has an increased diagnosis yield (96% sensitivity, 99% specificity), is cheap, noninvasive and is the first imaging exploration used in biliary stasis syndrome.
Adult↗
[Differentiated thyroid cancer].
In the interval 1979-1988, out of 1070 operated goiters 77 malignant thyroid tumors were recorded, 60 of them being differentiated: papillary--32 (53.4%), vesicular--12 (20%), mixed forms--16 (26.7%). The differentiated thyroid carcinomas had peculiar clinical biological and prognostic features and were framed: stage I--60%, stage II--23.4% and state III-IV--16.6%. Only 15 cases presented lymph node metastases. In 16 cases the thyroid tumor was associated with another thyropathy: Hashimoto's thyroiditis--5 cases, Basedow's disease--1 case. The surgical intervention was performed in two times: first total lobectomy or total lobo-isthmectomy [correction of lobioistectomy] with contralateral subtotal exeresis, then total thyroidectomy. It is insisted upon a careful surveillance of postoperative evolution (clinical, biological, scintigraphy) in order to detect the recurrence and apply a proper treatment.
Adult↗
[Choristomas].
The authors present 21 cases of aberrant pancreas with gastric and duodenal location (heterotopias under the shape of inclusions, nodules or true adenomas) included besides the rare cases of adenoma developed from Brunner and Lieberkühn glands in the "choristomas" category. Asymptomatic or with clinical phenomena and complications "borrowed" from the associated peptic ulcers (15 cases) the diagnosis of pancreatic heterotopias is usually an interoperatory or even histopathological surprise, the X-ray examination with the classical image "in cocard" and the endoscopy being rarely evocative. The surgical treatment is generally conservative and is dominated by the presence or lack of the concomitant peptic ulcer.
Adult↗
[The "cold" thyroid nodule].
The main problem posed by an (apparent) solitary thyroid nodule is cancer identification, present in about 10% of the nodules excised surgically. This percent might increase to 25-30% in the cold scintigraphic nodules. Therefore, a combination of all the methods for nodule assessment is necessary: anamnesis, physical examination, functional tests, therapeutic test with tyrosine and thyroid imaging, but mainly the intensive active exploration including puncture-biopsy with a fine needle and exeresis with extemporaneous and paraffin morphological checking. Starting from a two decades' experience of a group of endocrinologists, surgeons, anatomo-pathologists and specialists in nuclear medicine, in 2,289 thyropathies operated--of whom 1691 (poly)nodular goitres and 1,190 non-capturing nodules--the authors suggest an investigation algorithm for achieving a differentiated surgery in terms of the pre- and intraoperative morphological findings. This attitude permitted both the improvement of the surgeries of thyroid cancers and the exeresis of benign nodules under low-risk surgical conditions or avoidance of a "non-necessary" surgery.
Biopsy↗
[A mechanical suture method in the surgical treatment of esophageal diverticula].
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Diverticulum, Esophageal↗