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1.
Surg Radiol Anat ; 39(11): 1285-1288, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28451829

RESUMO

Probably, the most variable anatomic pattern relates to the iliac arteries system. There are reported here multiple rare anatomic variants found in a single case, at CT evaluation: (a) the unilaterally present common trunk of origin of the obturator, inferior epigastric, and medial circumflex femoral arteries and (b) the medial insertion of the deep femoral artery (DFA) onto the femoral artery, which placed the DFA initially on the medial side of the femoral vein. Such rare, but possible, anatomic variations should recommend surgeons to plan the procedures on a case-by-case basis.


Assuntos
Artérias/anatomia & histologia , Artérias Epigástricas/anatomia & histologia , Artéria Femoral/anatomia & histologia , Artéria Ilíaca/anatomia & histologia , Variação Anatômica , Artérias/diagnóstico por imagem , Meios de Contraste , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
2.
J Med Life ; 8(3): 350-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26351540

RESUMO

AIM: identifying the variables that can help in quantifying/ predicting duration of hospital stay after inguinal hernia surgery. METHOD: 257 patients who were diagnosed with inguinal hernia underwent surgery between January 2013 and October 2014 and were prospectively registered and statistically analyzed by using linear regression with the aim of emphasizing, calculating and validating the predictors for duration of hospital stay. RESULTS: out of 257 patients, 50,7% underwent laparoscopic surgery (TAPP and TEP) and 49,7% had an anterior approach by using the technique described by Lichtenstein in most of the cases. From the variables registered in the study (age, recurrence, emergency surgery, ASA [American Society of Anesthesiologists] risk classification, surgery duration, local and general complications) only the age and presence/absence of complications were statistically associated with the modification of the duration of hospital stay in this pathology. CONCLUSIONS: the duration of hospital stay can be evaluated preoperatory by using a mathematical model, which takes into consideration factors that depend on the patient or the procedure, with results that can have a significant impact on planning the local resources.


Assuntos
Hérnia Inguinal/cirurgia , Tempo de Internação , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Fatores de Tempo
3.
Chirurgia (Bucur) ; 109(5): 693-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25375061

RESUMO

UNLABELLED: We hereby present a case report of a patient with an unusual neoplasic and surgical history. M.V. is a 54-year-old patient who had been operated, two years ago, for intestinal obstruction caused by a sigmoid tumor; a segmental rectal and sigmoid resection (Hartmann's procedure) was then performed. Two other surgical procedures were attempted during the last two years, in another surgical department: a colo-rectal anastomosis and a repair of the parastomal hernia, both failed due to postoperative adhesions syndrome. The patient was hospitalized for peristomal gangrene with necrotizing fasciitis. Emergency action was taken to resolve the parietal gangrene. The postoperative local evolution of the wound was favourable and allowed a skin graft for parietal restoration. An intestinal obstruction occurred 2 months later, caused by an extended metachronous tumor of the splenic flexure. The patient underwent other surgeries including the completion of the left hemicolectomy, total gastrectomy, caudal splenopancreatectomy and left adrenalectomy. The patient has a favourable postoperative evolution after 1 year. CONCLUSION: We noticed a very severe evolution of the peristomal gangrene and the rapid growth towards intestinal obstruction of the metachronous colonic tumor.


Assuntos
Colectomia/efeitos adversos , Neoplasias do Colo/cirurgia , Fasciite Necrosante/cirurgia , Gangrena/cirurgia , Segunda Neoplasia Primária/cirurgia , Estomas Cirúrgicos/efeitos adversos , Adrenalectomia , Fasciite Necrosante/etiologia , Fasciite Necrosante/microbiologia , Gangrena/etiologia , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Reoperação , Transplante de Pele , Esplenectomia , Resultado do Tratamento
4.
J Med Life ; 7(2): 246-53, 2014 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-25408734

RESUMO

Self-harm is a rare pathology, often seen in psychiatric patients but more frequently in the penitentiary environment. Of the many possible forms of self-harm, foreign bodies (FB) ingestion is by far the most usual in the Romanian prison environment. The paper aims to present the diagnostic and therapeutic aspects arising as a consequence of the digestive tract perforations consequent upon foreign bodies ingestion; a number of 45 cases which occurred over a 7-year period (2003-2010) in "Rahova" Penitentiary Hospital, were analyzed. We also examined the surgical particularities of case resolution.


Assuntos
Corpos Estranhos/diagnóstico por imagem , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Prisioneiros , Comportamento Autodestrutivo/complicações , Comportamento Autodestrutivo/epidemiologia , Adulto , Corpos Estranhos/cirurgia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Romênia/epidemiologia , Comportamento Autodestrutivo/patologia
5.
J Med Life ; 7(3): 421-7, 2014 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-25408769

RESUMO

Self-harm is a frequent pathology amongst psychiatric patients and in the penitentiary environment. Multiple self-aggression types are described, but, by far, the practice most frequently met inside the Romanian penitentiary environment is foreign body (FB) ingestion. The paper aims to show aspects pertaining to the presence of intraduodenal foreign bodies, both in simple cases and in cases that ended with a perforation, using a number of 47 cases registered between 2003 and 2010 in "Rahova" Penitentiary Hospital. The paper also focused on particular aspects linked to intraduodenal foreign body surgical accessibility.


Assuntos
Duodeno/patologia , Ingestão de Alimentos/psicologia , Corpos Estranhos/diagnóstico por imagem , Perfuração Intestinal/patologia , Prisioneiros/psicologia , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/patologia , Fatores Etários , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Radiografia , Estudos Retrospectivos , Romênia/epidemiologia , Comportamento Autodestrutivo/psicologia , Comportamento Autodestrutivo/cirurgia , Fatores Sexuais
6.
J Med Life ; 7(1): 67-74, 2014 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-24653761

RESUMO

UNLABELLED: Self-harm is a rare pathology, often seen in psychiatric patients but more frequently in the penitentiary environment. Of the many possible forms of self-harm, foreign bodies (FB) ingestion is by far the most usual in the Romanian prison environment. Our paper aims to present the diagnostic and therapeutic aspects arising as a consequence of digestive tract perforations consequent upon foreign bodies ingestion; we analyze a number of 45 cases which occurred over a 7-year period (2003-2010) in Rahova Penitentiary Hospital. We also examined the surgical particularities of case resolution. ABBREVIATIONS: FB - foreign bodies, EEA - end-to-end anastomosis.


Assuntos
Corpos Estranhos/epidemiologia , Perfuração Intestinal/epidemiologia , Prisioneiros/psicologia , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/patologia , Fatores Etários , Deglutição , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Estudos Retrospectivos , Romênia/epidemiologia , Fatores Sexuais , Ultrassonografia/métodos
7.
Chirurgia (Bucur) ; 109(6): 855-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25560514

RESUMO

Although decreasing in number, radiation induced rectovaginal fistulas are caused by some radiation injuries and chronic ischemic lesions. Most of the experienced authors recommend anterior rectal resection with coloanal anastomosis accessed through the abdominal-perineum area for high fistula. We present a patient with a fistula that developed 23 years after hysterectomy and radiotherapy. In this case we performed an abdominal-transvaginal rectal resection with transverse coloplastypouch, coloanal anastomosis and protection ileostomy three months after a terminal sigmoidostomy. The dissection of the distal rectum by posteriour colpotomy and coloanal transvaginalan astomosis is a technical variant that may prove advantage ous compared to the procedures featured in the literature as solutions by rectal resection for rectovaginal fistula.


Assuntos
Radioterapia Adjuvante/efeitos adversos , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Histerectomia/métodos , Reto/cirurgia , Resultado do Tratamento , Vagina/cirurgia
8.
Rom J Morphol Embryol ; 54(3): 581-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24068407

RESUMO

The deep venous channels in the walls of the right atrium are not routinely described in medical treatises although their existence has been remarked from some time. Our study demonstrates that the right atrium is opened for some of the anterior veins of the heart through a venous channel located deep in the myocardium of the vestibule of the right atrium. We suggest that no Thebesian veins drain into this channel. We achieved anatomical dissection in 14 adult human cadaveric hearts, which had been fixed in formalin solution, and we found the channel in 75% of cases. These channels were measured, photographed and presented in detail. We highlighted the importance of the proximity with the tricuspid annulus in order to avoid incidents during tricuspid annuloplasty. The authors intend that through a qualitative study to draw attention to such a structure often ignored. This vascular structure and its role in cardiac physiology and pathology have not been investigated yet. Although not constant, specialists in cardiology and cardiac surgery should be informed about this basic detail on the endocardium morphology.


Assuntos
Coração/anatomia & histologia , Veias/anatomia & histologia , Cadáver , Feminino , Átrios do Coração/anatomia & histologia , Humanos , Masculino , Veias/fisiologia
9.
Chirurgia (Bucur) ; 105(3): 355-9, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20726301

RESUMO

OBJECTIVE: We hereby analyzed a series of gallstone ileus cases operated on in our department starting from a Bouveret syndrome case. METHOD: Retrospective analysis of all gallstone ileus cases who underwent surgery in our department during the last 26 years. We took into consideration diagnostic elements, time from admission to surgery, type of surgery and post-operative outcome. RESULTS: During this period 9,143 gallstones were deferred to surgery; 27 biliary-digestive fistulae were discovered during surgery; gallstone ileus complicated fistula in 8 patients. Gallstone ileus was exclusively present in elderly women with associated comorbidities. Diagnosis was suggested by clinical features of acute or incomplete intestinal obstruction; it was sustained by imagistic studies with different degrees of relevance. The average time from admission to surgery was 2.6 days. Surgical approach varied from simple enterolithotomy to additional fistula repair. The outcome was uneventful in most of the cases with only one exception. CONCLUSIONS: gallstone ileus is a rare condition, occurring in elders with important comorbidities. The choice for surgical procedure depends on the obstructive syndrome's gravity and associated comorbidities; the type of intervention does not significantly influence post-operative morbidity and mortality rates.


Assuntos
Fístula Biliar/cirurgia , Colecistectomia/métodos , Cálculos Biliares/cirurgia , Íleus/cirurgia , Intestino Delgado/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fístula Biliar/diagnóstico , Fístula Biliar/etiologia , Fístula Biliar/mortalidade , Colecistectomia/mortalidade , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico , Cálculos Biliares/mortalidade , Humanos , Íleus/diagnóstico , Íleus/etiologia , Íleus/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
10.
Chirurgia (Bucur) ; 105(1): 123-5, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20405693

RESUMO

We hereby aim to account on a case of actinomycotic infection occurred in a female patient with an intrauterine contraceptive device (IUCD). The infection occurred as a pseudo-tumour which raised differential diagnosis issues with a malignant tumour. The diagnosis has been eventually established following the pathologic examination of paraffin-embedded tissues. Although the infection's gateway was the uterus, the subsequent invasion of the parietal, urinary bladder and lateral rectal walls did not seem to affect the fallopian tubes or the ovaries.


Assuntos
Actinomicose/diagnóstico , Dispositivos Intrauterinos/efeitos adversos , Infecção Pélvica/diagnóstico , Reto do Abdome , Doenças Uterinas/diagnóstico , Actinomicose/tratamento farmacológico , Actinomicose/microbiologia , Actinomicose/cirurgia , Adulto , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Laparotomia , Infecção Pélvica/tratamento farmacológico , Infecção Pélvica/microbiologia , Infecção Pélvica/cirurgia , Neoplasias Pélvicas/diagnóstico , Reto do Abdome/microbiologia , Reto do Abdome/cirurgia , Resultado do Tratamento , Doenças Uterinas/tratamento farmacológico , Doenças Uterinas/microbiologia , Doenças Uterinas/cirurgia
11.
Chirurgia (Bucur) ; 102(5): 531-6, 2007.
Artigo em Romano | MEDLINE | ID: mdl-18018352

RESUMO

One of the most important problems of the surgical treatment of the hydatid disease of the liver is the remaining cavity of the cyst. Its evolution is mainly decided by the existence and the debit of a biliary fistula. During 10 years (1997-2006), 138 patients with 166 hydatid cysts of the liver were admitted and operated in our clinic. Among them, 57 cysts had a biliary fistula, found during the operation, while in 11 other patients the fistula became obvious 1 or 2 days after the procedure. The incidence of biliary fistulas (68 of 166 cases, which means 41%) is higher, due to the location of the cysts, mainly in the central parts of the liver. There were 44 (65%) low debit fistulas and 24 (35%) high debit fistulas. Our surgical attitude regarding the cavities with biliary fistulas has considerably changed; while between 1997-2000 an anastomosis with a Y or Omega jejunal loop was the most frequent technique, nowadays we use the external drainage of the cavity, associated to endoscopic sphincterotomy, for fistulas with large volumes (more than 300 ml/day) and/or persistent. Whenever it is possible, we practice the direct suture of the biliary fistula.


Assuntos
Fístula Biliar/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Equinococose Hepática/cirurgia , Adolescente , Adulto , Idoso , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/parasitologia , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Equinococose Hepática/complicações , Equinococose Hepática/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
Chirurgia (Bucur) ; 101(4): 385-90, 2006.
Artigo em Romano | MEDLINE | ID: mdl-17059149

RESUMO

Laparoscopic cholecystectomy has become the "gold standard" for cholelithiasis. In laparoscopic technique, the incidence and the severity of injuries of the extrahepatic bile ducts are significantly higher (0-2,7%) than in open surgery (0,2-0,5%). The authors present a series of 18 patients with such lesions, operated between 1996 and 2005 in the surgical departments of 2 Clinical Hospitals: "Dr.I.Cantacuzino" and Coltea, from Bucharest. The injuries were: 2--of type A, 10--of type D and 6--of type E, according to Soper-Strasberg classification. There are analysed the causes and the circumstances in which these injuries have occurred, the clinical signs and imagistic findings and, most of all, their treatment. In complete transections of the common bile duct, a hepatico-jejuno-anastomosis using a Roux en Y-loop appears to be the best solution. It is emphasized the fact that an accurate diagnosis and surgical technique are essential for a favourable evolution. That's why these operations must be accomplished by experimented surgeons, from highly specialized departments.


Assuntos
Ductos Biliares Extra-Hepáticos/lesões , Colecistectomia Laparoscópica/efeitos adversos , Anastomose em-Y de Roux , Colelitíase/cirurgia , Humanos , Estudos Retrospectivos , Romênia
13.
Chirurgia (Bucur) ; 101(1): 81-2, 2006.
Artigo em Romano | MEDLINE | ID: mdl-16623382

RESUMO

The persistence of a hepato-jejunal fistula after 9 years from a peri-cystic-jejunostomy in the treatment of hydatid liver cysts is an amazing condition. We discover this kind of fistula during the operation for cholelithiasis. This association between fistula and a "after-hydatid" choledocholithiasis is an opportunity to discuss some pathogenic and evolutive mechanisms about both of two entities.


Assuntos
Fístula Biliar/etiologia , Equinococose Hepática/cirurgia , Fístula Intestinal/etiologia , Jejunostomia/efeitos adversos , Jejuno , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/cirurgia , Colelitíase/diagnóstico por imagem , Colelitíase/cirurgia , Feminino , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Radiografia , Resultado do Tratamento
14.
Chirurgia (Bucur) ; 100(5): 457-9, 2005.
Artigo em Romano | MEDLINE | ID: mdl-16372672

RESUMO

We purpose to make a metanalysis of a external drainage and his role in the treatment of the hydatid liver cysts when it was made a anastomosis between peri-cystic cavity and a isolated loop of jejunum. The paper watch 74 cases which were operated in "I. Juvara" surgical clinic and in which it was used the external drainage of peri-cystic cavity. The drainage roles consist in follow up of peri-cystic cavity evolution, but, more than that, in early diagnosis and treatment of secondary infection of cavity, the main postoperative complication. The drainage excludes the possibility of unfavourable evolution of postoperative infection, in which case the result of operation may be compromised.


Assuntos
Drenagem/métodos , Equinococose Hepática/cirurgia , Jejunostomia , Anastomose Cirúrgica , Humanos , Estudos Retrospectivos
15.
Chirurgia (Bucur) ; 99(2): 151-6, 2004.
Artigo em Húngaro | MEDLINE | ID: mdl-15279446

RESUMO

Late intestinal perforation is the most rare and the most serious complication following the repair of abdominal parietal defects with alloplastic material. The authors have gathered in 7 years 6 cases of perforations which occurred between 1 and 10 years after using nonabsorbable synthetic mesh prostheses made of polyester (4 cases) and polypropylene (2 cases) as parietal substitution materials. The perforations were discovered either by the appearance of complete enteric fistulas after exploration of circumscribed parietal suppurations (3 cases) or during surgery of suppurations without external fistulas. All cases involved perforations of the small intestine and in only one case there was also a perforation of the transverse colon. In 4 cases, where eventration relapse co-existed, the polyester prostheses were found partially or totally detached from the abdominal wall. The treatment of enteric perforation consisted of 5 segmental enterectomies (one of those a double one) followed by anastomoses and one enteroraphy. The colic perforation was excised and sutured. The mesh was totally removed in 5 cases and partially removed in 1 case (around the perforation). The postoperative evolution was simple in only 3 cases. In the other 3 cases anastomotic fistulas occurred and one of them (with reduced leakage) was treated by nonoperative management. It did not close spontaneously even after 12 months. The other 2 cases required multiple reinterventions (enterectomies, ileostomies, ileocoloanastomosis). One of these patients has been lost away after 200 days of hospitalization and multiple reinterventions. In all cases, the closure of the abdominal wall was simplificad by cutaneous suture only whereas consecutive relapsed eventrations remain to be treated by subsequent reinterventions.


Assuntos
Hérnia Ventral/cirurgia , Perfuração Intestinal/etiologia , Telas Cirúrgicas/efeitos adversos , Humanos , Perfuração Intestinal/cirurgia , Polipropilenos , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
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