Revista de chirurgie, oncologie, radiologie, o.r.l., oftalmologie, stomatologie. Chirurgie最新文献

An analysis is presented, of the experience acquired in the II-nd Surgical Clinic of Cluj-Napoca in connection with 150 cases of postthrombotic syndrome followed and treated over the last 5 years (1983-1987). Considerations are made concerning terminology, and evaluation of diagnostic and therapeutic means applied. The post-thrombotic syndrome develops in a variable interval after the thrombophlebitis (months and even years). A series of factors prevent of enhance the development of the syndrome (98% diagnostic errors and therapeutic failures). Phlebography is mandatory in cases where surgery is considered. Noninvasive explorations (Doppler, plethysmography) limit the use of phlebography. The most efficient treatment is prophylaxis (consisting in the prophylaxis and the correct treatment of thromboembolic disease). The usual treatment is mainly medical and conservative (59.4%). Surgery is carried out in cases where the superficial, the communicating and the deep venous systems are involved.

Oesophageal temperature was recorded after induction of anesthesia, and further, at one, two and three hours. Temperature in the operation hall was continuously monitored. In relation to the temperature in the operating hall the effects on the patient were of three kinds: 1. operating halls with low temperatures (under 21 degrees C) where all the patients become hypothermic; 2. operating halls with an intermediate temperature (21-24 degrees C), where 67% of the patients remain normothermic; 3. operating halls with high temperatures (above 24 degrees C) where all the patients remain normothermic, although these temperatures are uncomfortable for the medical personnel, and increase the septic risk of the patient. When the oesophageal temperature of the patients falls by 0.5 degrees C chills will occur in 40% of the patients. Thermal falls of less than 0.5 degrees C will also determine chills but in only 10.5% of the cases. Immediate postanesthesia chills are also recorded in normothermic patients, but there is a direct relationship between the temperature in the operating hall, the degree of hypothermia and the frequency of chills, while the site of the surgery or the duration of the operation have but an unsignificant influence on intra-anesthetic temperature.

The authors have taken up previous studies by Martin (1969), and by Johnson (1973), and carried out an experimental study on white rats aimed at evaluating the morpho-functional changes of cells from the exocrine pancreas under the influence of 5-fluorouracil (Ftorafur), a cytostatic drug which is a general inhibitor of protein synthesis by cells. Ftorafur was injected in amounts of 2.3 mg/100 g of body weight, and a significant reduction was noted in the secretion of bicarbonates, amylase and lipase by the pancreas of the animals. Cytologic changes were also noted in the pancreatic tissue of these animals, indicating, on the one hand, a deficient protein and enzyme synthesis by the pancreatic cells, and a blocking of the mechanism of discharge of zymogen granules, on the other hand. The most intensive morpho-functional changes were noted following repeated administration of Ftorafur, probably due to the cumulative effects of this substance at the level of secretory pancreatic cells. The authors consider that 5-fluorouracil inhibits to a considerable degree the synthesis of pancreatic enzymes, and as such it can be used as a therapeutic means for the reduction of the external secretion of the pancreas.

Post-resection complementary immunotherapy was applied to 55 patients with superficial urinary bladder tumours (Ta, TI) with Calmette-Guérin bacilli (Pasteur strain) prepared by the "Cantacuzino" Institute. The treatment consisted initially in scarification and instillation in 19 patients, and in instillation alone inside the urinary bladder in 43 patients, according to Morales, and respectively Brosman protocols. In 7 patients only Morales immunotherapy was applied initially but after recidive and resection they too were treated according to the Brosman protocol. One should note that most of these tumours were of the recurring type, with multiple recidives in the antecedents in 60% of the patients, and that the surgical treatment, as well as instillation of cytostatic drugs had failed. In the present protocol transurethral resection was carried out in 93% of the cases. After immunotherapy the following aspects were noted: in 75.8% of the patients there were no recidives 25 months in the average after the start of the treatment. In the average 13 months elapsed between the start of the treatment and the occurrence of the first recidive, as compared with 7 months in the average for the controls. Most of the recidives in patients with instillations occurred in those in whom the tumour had gone beyond the basal membrane. In 2 patients with infiltrative recidives total cystectomy was carried out. With regard to degree of anaplasia following BCG instillation there was a down-grading in 43% of the cases. There was no fatality ascribable to BCG treatment in our series, and both general and local complications were insignificant considering the therapeutic benefit.

The authors present the case of a female patient aged 19 years with chorionepithelioma, multiple pulmonary metastases, and an unique intestinal metastasis, complicated by severe digestive haemorrhage and haemoperitoneum. Surgery was carried out in risky conditions and consisted in segmental enterectomy and subtotal hysterectomy, and bilateral adnexectomy. The postoperative evolution was unsatisfactory, and the patient died following continued digestive bleeding, probably due to coagulation disturbances induced by prolonged loss of blood. Although the disease is encountered and treated in ob-gyn departments, the general surgeon can be confronted by such complications of this affection which may take on extremely severe aspects, and where surgery, provided that is performed sufficiently early, can save the patient's life.

The authors present their personal experience on the basis of a retrospective analysis of 127 cases of nonlithiasic cholecystopathies operated between 1984 and 1987. Clinical and radiologic criteria were analyzed, that have led to surgery, and conclusions reflect the postoperative results.

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.

The paper reports on 14 cases of perforating plantar disease of whom 11 belong to the so-called nonpainful chronic plantar ulceration by compression of the posterior tibial nerve in the tarsal canal. The authors show clinically, neuroelectrically and by neurography with lipiodol that in the case of a diabetic or alcoholic polyneuropathy, the posterior tibial nerve is more vulnerable to the compression existing in the tarsal canal due to the development of a fibrous sclerotic tissue. Exo-endoneurolysis of the posterior tibial nerve associated with a posterior tibial periarterial sympathectomy permitted healing in 7 ulcerations, 2 diminutions of the ulceration dimensions, and only 2 remissions. The four cases of unfavourable results were in patients with old lesions who continued alcohol consumption.