[Neuropsychiatric emergencies].
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Biomedical subjects
Publications and source records attributed to S Oprescu.
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The article presents the case study of a 78-year-old , female patient with a gastric schwannoma, with the symptoms of a superior digestive hemorrhage and secondary anemia. A surgical operation was performed and the patient was healed. The preoperative diagnosis carried out by means of echographic, endoscopic and computed tomography examinations was gastric tumour. Histopatological examination performed during the operation led to the final diagnosis of gastric schwannoma.
The present paper tends to emphases by one hand the necessity of the histological examination, as a routine exam, on every surgical procedure, even minor ones, and by the other hand, the difficulties of the differential diagnostic, including by histological means, in lesser importance lesions. In this line we will present the case of female patient who had a lesion labeled as a postoperative granuloma and it proved to be a malignant neoplasia.
This article presents a 28 years old male patient case with a retroperitoneal collection of apendicular origin. After few comments about clinical and paraclinical aspects, the authors emphasise the particular aspects of differential diagnosis and surgical approach which, finally, lead to a full recovery of the patient.
This paper presents the case of a 69 year old patient who has a benign retroperitoneal tumor (lipofibroma) presenting differential diagnosis problems (in special preoperative one, and intraoperative technique difficulties, revealing the fact that, in this case, paraclinical investigations have an orientative value, without offering etiologic information, and do not allow a clear preoperative strategy. Tumor resection was performed under an intraoperative histologically diagnosis of lipofibroma of the retroperitoneal region. Postoperative evolution was good.
HLA B 35 antigen was assessed in 19 patients with viral subacute thyroiditis. The antigen was present in 68.43% of patients (no = 13). The relative risk (vs 500 health blood donors) is very high (12.27), with X2 = 33.4 and p less than 0.001. Despite the high relative risk, the presence/absence of HLA B 35 antigen showed no correlations with the main clinical features in our patients; no correlations can be made for: erythrocyte sedimentation rate, radioiodine uptake, thyromegaly, hyperthyroidism and evolution.
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In cases with postoperative shock and collapse a constant fall in the concentration of serum cathecholamines was noted. Thus adrenalin was reduced by 77%, noradrenalin by 86.5%, in direct proportion with the fall in the blood pressure, of the pulse amplitude and with the slowing-down (or the arrest) of the microcirculation. The reduction of serum cathecholamines also coincided with a decrease in the amount of buffer bases and of the diuresis. The adrenocortical vasopresor sympathicolithic mixture is indicated in the prolonged arterial hypotension following failure of therapy aimed at filling of the vascular bed associated with the administration of sympathicolytic drugs.
The authors have carried out a clinical study of acute medico-surgical complications occuring in patients hospitalized following psychical stress, myocardial infarction, operatory shock and after the earthquake. In patients with duodenal ulcers and hyperacidity due to vagal neurogenic origins it was noted the presence of a sympatico-adrenergic constitutional background in 38% of the cases. By applying chemical sclerosis of the adrenals medullary the role of the medullary was demonstrated in the production of acute digestive lesions due to stress, as a result of standard electrical stimulus and of their influence on the bioelectrical reactivity of the brain, on the active learning behaviour by conditioned reaction and on the number of the circulating eosinophils following injections of A.C.T.H.
The variations of catecholamines, cortisol and aldosterone in mixed shock (traumatic, hemorrhagic and septic) were studied experimentally and clinically. In the stage of collapse adrenaline decreased by 81.4% and noradrenaline by 62.6% as compared with the preoperative values. These decreases were found to be directly proportional to the decrease of arterial blood pressure, pulse amplitude and diuresis as well as to the slowing down or even stop of microcirculation. The value of plasma cortisol increased in the stage of collapse by 98.3% and that of aldosterone by 66.27% as compared with the preoperative values. Treatment with a pharmacodynamic sympatheticolytic-vasopressor-adrenocortical mixture is recommanded when the blood pressure remains below 50--60 mm Hg for 1--2 hrs and when the treatment for the correction of hypovolemia with fluids and sympatheticolytics has failed. Clinically, this treatment gave good results in 34 of the 58 cases studied (58.6%).