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

The paper report on the case of a patient, who on the background of an A type hemophilia, suffering from hemophilic arthropathy, of the elbow and knee, presents bilateral luxation of the radius head. The major difficulties of the surgical treatment, the risks of the haemorrhagic complications and the long postsurgery evolution are discussed.

The paper analysed the technical possibilities for the treatment of juxtapapillary ulcer exemplified by the clinical experience of 62 cases of recognized juxtapapillary ulcer. The authors insist on the technique of the duodenum dissection, on the way of passing the suture threads at the level of the papilla and on the importance of a correct drainage.

The paper reports on the casuistics of the colon cancer in the Clinic of Surgery of the "Griviţa" Clinical Hospital, for 21 years (1966-1986) with emphasis on the situs peculiarities on the right and left colon. Whereas the left colon cancer (LCC) started in 32% of cases with subocclusive and occlusive syndromes having special implications on the treatment and prognosis, in the right colon cancer (RCC) only in 3.5% of cases the diagnosis was established in the stage of subocclusive syndrome. During surgery the metastatic adenopathy was met in 57% in LCC and only in 37% in RCC, and the hepatic metastases in 17.7% in LCC and in 10.9% in the RCC cases. The immediate postsurgery mortality was present in 12% of the LCC cases and in only 9.3% of the RCC cases. In the last 10 years of the period studied, the patients were periodically readmitted into the hospital, reinvestigated, and monochemotherapy with 5-fluorouracil was applied in sequential cures. In this last period, the survival at 5 years was of 25 (45.4%) in the 55 patients operated for RCC and of 41 (37.6%) in the 109 patients operated for LCC.

The paper reports on a case of mastitis with plasmocytes, with a clinical picture of acute suppurative inflammation, in a 49-year-old woman. After establishing the diagnosis by histologic examination and alleviation of the acute phenomena, simple mastectomy was applied. The anatomopathological, clinical and therapeutical data of the mastitis are discussed.

The author presents a case of perforating ulcer of Meckel's diverticulum, with secondary generalized peritonitis in a young patient, admitted and operated for acute appendicitis. The therapy used is described and several semeiologic characteristics of the evolution and treatment of the case presented are discussed.

The paper reports on the clinical observation of a patient with bulbar duodenal ulcer placed in a juxtapapillary position due to a short bile duct, complicated with choledochal and Wirsung's stenosis and, finally haemorrhage and duodenojejunal fistula favoured by a gallbladder-jejunum diversion assembly. Three major surgeries, during 17 years, were required: cholecystectomy and choledochoduodenostomy for the choledochal stenosis induced by penetrating posterior bulbar ulcer; after 8 years, choledocholithotomy and gallbladder-jejunum derivation the loop in Y, (Roux) for the choledochoduodenostomy stenosis with the local lithiasis of the CBP; after 9 years, the resection of the proximal segment of the anastomosed jejunal loop with CBP and gastric resection with ulcer exeresis, followed by restoration of the gallbladder-jejunum anastomosis, gastrojejunal anastomosis and reimplantation of Wirsung's duct in the duodenal stump for juxtapapillary duodenal ulcer complicated with haemorrhage, penetration into pancreas, perforation in the jejunal loop anastomosed preduodenally and stenosis of Wirsung's duct. The final therapeutic result is good and lasts in time. The paper discusses the duodenum-gallbladder-pancreas interrelationships in the juxtapapillary ulcers, drawing the attention on the possibility of forming a duodenojejunal fistula in the patients with gallbladder-jejunum derivations.

A 23-year retroactive analysis of a heterogeneous series of observations with unfavourable tardy results after antiulcer surgeries showed that the most failures requiring a second surgery appear after large resections with gastrojejunal or gastroduodenal anastomosis and after vagotomies associated with gastric drainage. The most favourable tardy results followed the vagotomy associated with limited gastric resection (hemigastrectomy). This kind of intervention prevents the appearance of the ulcerous relapses and lowers significantly the incidence of the other type of post-surgical iatrogenic complications. The optimal protection against the ulcerous relapse given by vagotomy associated with hemigastrectomy permits a tactical adaptation of the intervention to the lesional and physiopathological characteristics of each case.

The analysis of 130 cases of neglected peritonitis shows the seriousness of the disease, that increases considerably with the time elapsed from the onset of the disease till the admission into the hospital. The peritonitis may have different causes, the most frequent ones being acute appendicitis and perforating ulcer. The related affections, when present, amplify, modify or, on the contrary make the symptoms confused. When a neglected peritonitis is suspected, the surgery is required, followed by an intensive treatment afterwards.

The paper reports on the results of the endoscopic treatment in 16 cases of orthotopic ureterocele, out of which 11 developed on a simplex ureter and 5 on the superior ureter of the pyeloureteral duplicity (ren duplex). In 6 patients the pseudocystic dilatation of the submucous ureter contained calculi. The endoscopic treatment consisted of: the ureterocele resection in 12 patients (in 6 of them it was associated with the extraction of the calculi with Lowsley's lithotryptic clip): the ureterocele incision in 3 cases; and the endoscopic resection of the intravesical sac, with nephrouretectomy of the dysfunctional pelvis and the respective ureter in one case. The results recorded showed urographic improvement in 14 patients and uroculture sterilization in 11 cases of 14 with postsurgical urinary infections. Only in one case, the ureterohydronephrosis advanced, requiring the subsequent ureter-bladder reimplantation. No case of bladder-ureter reflux following the endoscopic resection or incision of the orthotopic ureterocele was recorded. Endoscopic resection or incision is a simple and efficient method for treating small or middle orthotopic ureteroceles, if the superior urinary system is recoverable. The method is simple and with low risks, and it can be applied as first therapeutic time in all the cases, even in those in which the chance of the definitive solution is less probable, as in the secondary surgical time the classical surgical correction of the uretero-bladder junction can be used.

The authors report their experience with 341 radical cystectomies, and 61 anterior pelvectomies for infiltrating urinary bladder tumours, of which 269 were followed at long periods of time after surgery. In 56% of the patients there was tumoural involvement of lymph nodes at the time when cystectomy was performed. In 88% of the cases the tumours were of G3 stage. Fifty-one percent of the patients had had one previous surgical procedure, and in 75% of the cases surgery was performed when the upper urinary apparatus was already dilated by tumoural obstruction, or when high serum nitrogen was present. Planned radical cystectomy was possible in only 26% of the patients. The technical procedure implies a significant change consisting in the exclusive use of the urethropelvic drainage, and this had excellent results. The urinary derivation used was adapted to the stage of development of the tumour, and after consideration of the condition of the upper urinary apparatus. In 130 cases cutaneous urethrostomy was performed, in 95 patients urethrocolic derivation, in 23 cases cutaneous transurethral ureterostomy, and in 6 patients substitution bladder was achieved. The global postoperative mortality of 16.6% was mainly due to the advanced age of patients, the advanced stages of the tumours, to high serum nitrogen, infections, and to operatory indications that were not always justified but were determined by clinical complications and the extreme discomfort of patients. The most frequent early postoperative complications included an association of toxic shock and high serum nitrogen. In the authors' experience preoperative radiotherapy did not have satisfactory results, and chemotherapy only resulted in inconstant improvement of the patients' condition The late results were not satisfactory, the deaths in the first two years after surgery being the result, almost in exclusivity, to a continued evolution of the neoplastic tissue remaining in the pelvic cavity, and that was due to the fact that the patients had been operated at a very advanced stage of the disease. Total cystectomy has an elective indication in urinary bladder tumours of the T2, T2a, or T3b type, with N0 and M0. It should be carried out as planned surgical intervention and presumes a mandatory urinary derivation that should provide a maximal renal protection.