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

The authors analyze five cases of concomitant development of two major complications of duodenal ulcers: perforation and haemorrhage. Particular problems of surgical tactic and technique are discussed.

A total of 111 nonselected cases are presented, of infiltrative urinary bladder tumours, in which endoscopic resections were performed. In most of the cases (83% of the patients) the tumours were of the transitional carcinoma type, the transurethral intervention having been planned in advance. In 35% of the cases resection was done by necessity, and in 3% of the patients resection was done as an emergency for hemostatic purposes. Haemorrhage was the most frequent of the surgical complications, and was reported in 5 patients. Renal failure was the most frequent of the medical complications. In 50 patients radiation therapy was carried out following surgery. The late results are as follows; 44% survivals at 2 years, 14% survival at 3 years, and 9% survivals at 9 years.

The authors present their experience with three patients with inclavated oesophageal foreign bodies, and secondary complications that have raised particular problems of diagnosis and treatment.

The authors report 12 cases of primary acute peritonitis-that were operated over a period of 10 years, representing 2.8% of the total number of acute cases of peritonitis, with the exclusion of cases of postoperative peritonitis. Since they are so rare it is understandable that primary acute peritonitis of the adult are less well known by the general practitioner in surgery. The particular background of these patients, frequently involving other forms of pathologic features, and the generally depressed immunological background explains the atypical clinical evolution, with attenuated local abdominal signs, a fact which retards the diagnosis, and hence the therapy. As a general rule adults come rather late in surgical departments, usually transferred from another department (diabetes, internal medicine, gynecology, communicable diseases, etc.). The surgeon also has difficulties in making a diagnosis. When the decision to operate has been taken--in most of the cases this happens at a late stage-peritonitis is usually is the purulent phase and careful drainage of the peritoneal cavity is necessary, associated to antibiotherapy that should be applied on the surgical table, and with massive doses. Preoperative etiological diagnosis is difficult. Direct bacterioscopy of the peritoneal exudate is decisive and it should be asked for by the surgeon even in the early stage of surgery. Exhaustive visceral surgical exploration, which should, in principle, eliminate secondary peritonitis is neither easy to perform, nor without risks in these patients, usually aged, obese, with multiple interventions in antecedents. Appendectomy, as a complementary gesture, is contraindicated. The prognosis in the adult, in contrast with that of children, is severe, with very high perioperative morbidity and mortality (above 50% in the authors' experience).

A case is presented, of a patient with late nonfunction of a biliojejunal anastomosis done 6 years previously for benign stenosis of the terminal choledochus. The malfunction was determined by compression of the anastomotic loop by a large pancreatic pseudocyst of the head and of the body of the gland, associated to another pseudocyst of the pancreatic body. Pseudocyst-jejunal anastomosis was performed, on the biliojejunal anastomotic loop, with good results. Clinical and therapeutical particularities are discussed, of this case.

Subtotal and total colectomy was the choice therapeutic solution for multiple colonic cancer, diffuse rectocolonic polyposis, multiple colonic polyposis, ulcerohaemorrhagic rectocolitis, and for two rare diseases; megacolon with extensive atrophy of lymph nodes, and acute ischaemia of the colon. A total of 35 cases are reported. Ileorectal anastomosis was the method used for this type of intervention. The opportunity of rectal conservation is discussed, in cases of rectocolonic polyposis and ulcerative haemorrhagic rectocolitis. The difficulty of making an optimal choice in complicated forms of ulcerohaemorrhagic rectocolitis is exemplified with the aid of clinical observations.

A total of 198 tumours of the pancreas have been hospitalized between 1972 and 1987 in the 1st Surgical Clinic from Jassy. Only 10 of these tumours were benign, and these included: 2 gastrinomas, 2 insulinomas, 2 cystadenomas, one fibrolipoma, 1 lymphangioma, one hydatic cyst and a Wermer's syndrome. The particularities are analysed, of these 10 cases of benign tumours of the pancreas, and it is stressed that most of the clinical and therapeutic problems are determined by tumours of the endocrine pancreas, and especially those which are hormonally active. Thus the symptomatology of these last tumours which is difficult to evaluate, especially at the onset of the symptoms will determine a considerable delay in the surgical diagnosis, many of the patients being hospitalized in other departments before reaching the surgeon. Present possibilities for diagnosis and treatment have kept pace with progresses achieved in the field of investigations, which provide useful data from the morphological and functional viewpoints. All the 10 cases mentioned above have benefited from the surgical treatment, that was adapted according to particularities of each patient. The authors stress the importance of the extemporaneous morpho-histologic examination (with serial slides) and when the tumours are difficult to identify by direct macroscopic examination they recommend intraoperative echography and direct hormonal dosages on samples obtained from the portal circulation before and during surgery.

The files were studied of 362 patients hospitalized in the Surgical Clinic from Tg. Mureş in the last 20 years with various primary or secondary pancreatic affections, and for whom curative, palliative or exploratory surgery was indicated. Of the total 307 had pancreatic cancers, 16 had Vater ampulomas, 23 had gastric cancers, and 5 had primary duodenal tumours. In six patients pseudotumoral chronic pancreatitis was found, 2 had retroperitoneal tumours, and 3 had pancreatic cysts, lymphoma of the spleen, and mesenteric tumour. A total of 212 palliative surgical interventions were performed, 75 radical interventions (pancreatic reactions), and in another 75 patients simple laparotomies were done. In 45 of the pancreatic resections the duodenum was also removed. The other 30 cases included 6 total resections, 6 subtotal pancreatic resections and 18 resections of the left part of the pancreas.

Chronic pancreatitis of biliary origin, frequently located in the cephalic portion of the organ, etiopathogenically dependent on biliary lithiasis, the anatomoclinical evolution of which is complicated by their presence, have a better prognosis, and are usually reversible following therapy of the biliary affections. Persistent chronic pancreatitis proper, usually of the recurrent type, associated with calcification and the development of pancreatic stones, and with pseudocysts, although rare in our country, raise diagnostic difficulties from the standpoint of surgery, and have a reserved prognosis. The authors have evaluated a total of 321 cases hospitalized between 1960 and 1987 with chronic pancreatitis of biliary origin (252 cases--78.5%), and chronic pancreatitis proper, not associated to biliary affections (69 cases--21.5%). Male patients totalled 33.6% of all cases. The authors stress the high frequency of chronic pancreatitis associated to biliary lithiasis (181 cases), in contrast with pancreatitis associated to nonlithiasic cholecystopathies (38 cases), or to postoperative cholecystic disturbances (33 cases). Chronic pancreatitis non-associated to biliary affections totalled 69 cases, of which 24 were of the persistent type, 13 were of the recurrent type, one had calcifications, two had pancreatic stones, four followed acute pancreatitis, six were complicated by pancreatic abscesses, and 9 were complicated by pseudocysts. The duration of biliary and pancreatic disturbances was between 3 and 5 years in 43.9% of the cases, and between 6 and 10 years in 21.3%. Chronic pancreatitis achieves a complex clinical syndrome, the dominant feature being the painful biliopancreatic syndrome associated to obstructive jaundice (42.4%), angiocholitis (47.6%), weight loss (46%), hepatic and renal failure (10.9%), diabetes (8.4%), and a tumoral mass (15.7%). Indirect surgical interventions aimed at suppressing the biliary factor were carried out in 291 patients, with very good results in 56% of the cases, good results in 32%, mediocre in 7%. In 2.4% of the cases surgery failed to improve the condition of the patients. Direct interventions on the pancreas, which consisted either in pancreatic decompression or in exeresis of the gland have been performed in 30 patients. Drainage of pancreatic abscesses was done in 6 patients (2 deaths), cystic-digestive anastomoses were performed in 8 patients, Wirsung-jejunostomy in 3 patients (1 death), cystostomy in one patient, distal pancreatectomy in one patient (deceased), viscerolysis and novocaine infiltration in 11 patients. In the 321 cases of chronic pancreatitis operated by direct and indirect procedures very good

The authors have considered the experience acquired in connection with 15 cases of chronic pancreatitis in whom surgery was performed, and define the parameters which make mandatory surgical interventions in this affection.