Esotracheal Fistula in Esophageal Stenoses of Malignant Origin - Case Report.

BACKGROUND: Approximately 80% of acquired eso-tracheal or mediastinal fistulae are of malignant nature. The occurrence of an eso-respiratory malignant fistula is a devastating complication for both patient and doctor, and, if not treated, records a survival time of 1 to 6 weeks. MATHERIAL AND METHOD: We present a patient, aged 51, smoker,with progressive dysphagia, at first to solids, then to semi-solids and liquids, followed by manifestation of post-deglutition cough due to eso-tracheal fistula, incapability of feeding, and decline of the general condition. Surgical intervention consists of esophageal transstenotic endo-prosthesing by transtumoral drilling with prosthetic montage and the occlusion of the eso-tracheal fistulous orifice. RESULTS: The post-operatory evolution is favorable, the feeding per os resumes in 8 hours after surgery, good digestive tolerance. The radiologic examination using contrast medium, performed in 48 hours after surgery, reveals a permeable esophageal endo-prosthesis, without reflux of contrast substance in the tracheobronchial tree. CONCLUSIONS: The laparo-gastroscopic montage of prosthesis through transtumoral drilling, using siliconized semi-rigid prostheses, represents the only efficient palliative treatment of malignant eso-tracheal or eso-bronchial fistula.

Laparoscopic surgical treatment of umbilical hernia and small eventrations with prosthetic mesh using omentum overlay.

INTRODUCTION: Umbilical hernias and abdominal incisional hernias represent current pathologies which require numerous surgical alternative ways of treatment in prosthetic or non prosthetic,open or minimally invasive surgery. The method proposed by us is a less expensive option with no additional risks compared to other similar procedures as surgical technique. MATERIALS AND METHODS: We conducted a retrospective study between 01.01.2008 - 01.06.2013 in which we considered a number of 23 patients with umbilical hernia and eventration, patients who received laparoscopic intraperitoneal polyester mesh covered with omentum, procedure applied at the IInd Surgery Clinic, Clinical County Emergency Hospital Sibiu. RESULTS: Out of 23 patients with postoperative umbilical hernia and eventration cases in which we used this surgical technique,16 were umbilical hernias and 7 post incisional hernias. The average time of surgery was 1 hour and 40 minutes, recording 4 postoperative complications remitted under conservative treatment, with a mean hospitalization of 4.1 days. CONCLUSIONS: Proepiploic laparoscopic treatment using omentum is a reliable alternative to a more expensive and difficult procedure involving Dual Mesh.

Superior socio-medical alternative to feeding gastrostomy and jejunostomy in advanced esophago-gastric junction adenocarcinoma.

INTRODUCTION: The diagnosis of esophago gastric junction adenocarcinoma often occurs when the neoplastic process is surprised in advanced stages and blocks the esophageal-gastric junction causing dysphagia, stages in which curative therapy is more likely impossible to be accomplished. In these cases, the treatment goal is mainly to provide feeding capacity as naturally as possible and to start the adjuvant oncological treatment. The use of endoscopic esophageal prostheses provides the patient with the possibility to be fed orally and with a good social integration, but due to the technical incapacity to cross the tumoral stenosis with the endoscope, or due to the endoscopist s concerns regarding the sensitive areas (poles of the esophagus), there are reluctances in respect to this method (on average 20%). MATERIAL AND METHOD: We conducted a retrospective study aimed to determine the optimal therapeutic modality depending on the evolutive stages of the disease and to analyse the justification of the original procedure of laparogastroscopic esophageal stenting through tumoral drilling as a technical alternative to the reluctances or failures of endoscopic prosthesis and as a biological and social solution to the disabling gastrostomy for patients with advanced esophageal-gastric junction adenocarcinoma. RESULTS AND DISCUSSIONS: Staging was disarming, most patients were diagnosed in advanced stages, fact also supported by literature. Regarding esophageal stenting by transtumoral drilling, the results are significant especially in terms of postoperative morbidity CONCLUSIONS: Although our study regarding laparogastroscopic stenting by transtumoral drilling in esophago-gastric junction adenocarcinoma is limited, this original procedure brought us satisfaction whenever we used this approach.

Laparoscopic treatment of perforated duodenal ulcer -- a multicenter study.

AIM: The aim of this study is to evaluate the results of the laparoscopic treatment of perforated duodenal ulcer performed in 6 Romanian surgical centres with experience in the field of laparoscopic surgery. MATERIAL AND METHOD: Between 1996 and 2005, 186 patients with perforated duodenal ulcer were operated on in the centers participating in this retrospective study, all patients being ASA I-II. Thirty-nine patients (20.0%) presented mild peritonitis, 120 (64.5%) medium peritonitis and 27 (15.5%) severe (20.0%) simple suture was performed, in 110 (59.1%) suture with epiplonoplasty, for 1 (0.5%) only epiplonoplasty and 1 (0.5%) underwent excision of the perforation and suture. RESULTS: The operative time was between 30-120 minutes, with an average of 75 minutes. No death was noted. Average hospitalization time was 6 days, with periods varying between 3 and 18 days. Postoperative complications included: 5 patients (2,6%) presented infections of the abdominal walls, 1 patient (0.5%) duodenal fistula, 1 patient (0.5%) intra-abdominal abscess, 1 patient (0.5%) a superior digestive hemorrhage by "mirrored ulcer" and 1 patient (0.5%) duodenal stenosis 6 months after operation. The patients were administered 50% less analgesics, used 70% less dressings, 30% less antibiotics and had 60% less complications in comparison with those operated by the classical approach. CONCLUSION: The laparoscopic approach of perforated duodenal ulcer constitutes the first choice for patients without important co-morbidities, allowing a quick recovery and a significant reduction in the consumption of analgesics, antibiotics and dressing materials.

[Role of early biliary and pancreatic decompression by minimally invasive procedure in acute pancreatitis]. / Valoarea decompresiei biliopancreatice precoce realizata miniinvaziv în pancreatita acuta.

INTRODUCTION: Acute pancreatitis is an acute inflammatory process of the pancreas, with variable involvement of other regional tissues or remote organ systems. MATERIALS AND METHODS: In an ongoing effort to search for optimal solution in the management of acute pancreatitis, a serious and unpredictable disease, even in the context of therapies that are part of modem therapeutic protocols line, we offer an original pathogenic and mininvasive therapeutic approach. The purpose is to bring attention to this original treatment method and highlight its advantages. During a five year period (2006-2010), 60 consecutive cases of acute pancreatitis were admitted and treated at Clinic Surgery 2 from Sibiu. RESULTS AND DISCUSSION: Out of the 60 patients, 42 cases were mild pancreatitis and 18 cases were severe pancreatitis according to Atlanta criteria. All cases of edematous acute pancreatitis received conservative medical therapy in combination with laparoscopic biliary decompression. 6 cases of severe acute pacreatitis developed pancreatic abscess and pancreatic necrosis. CONCLUSIONS: The favorable evolution of cases treated laparoscopically, and length of stay varying between 7 and 34 days, requiring evaluation of laparoscopy in the surgical treatment of acute pancreatitis as the first and sometimes the only form of surgical treatment of cases (acute pancreatitis), selected dynamically.

[The transpleurodiaphragmatic laparoscopic approach of rear dome liver cysts]. / Abordul laparoscopic transpleurodiafragmatic al chistelor hepatice de dom posterior.

The localizations of liver cysts in the posterior hepatic dome (segment VII) and the hydatid cysts in particular, difficult to approach in "conventional" open or laparoscopic surgery, with significant parietal sacrifices and "demolition", requires a secure atypical laparoscopic approaching way, with positive results for both patient and surgeon, with minimal impact, with social and professional reintegration and faster healing. Transpleurodiaphragmatic laparoscopic approach using "Device for aspiration of liver hydatid cyst or ovarian cyst (OSIM 120809/30.04.2008 Patent - Dan Sabau) asociated with the remarcable performances of the fragmentation device for hydatid cyst content (OSIM Patent no. 120810/30.04.2008 - Dan Sabau) is the best way to approach these problems, accessible for surgeons with minimum experience in laparoscopic and thoracic surgery. The relatively low number of cases allows only formulation of preliminary positive conclusions on the method, they will be validated by subsequent results.

[Particular aspects of endoprosthesis in malignant advanced pharingeal-esophageal stenosis]. / Aspecte particulare ale endoprotezarii în stenozele maligne faringoesofagiene avansate.

INTRODUCTION: The esophageal neoplasm is currently the seventh cause of death through cancer worlwide. In the developing countries it is situated on the fifth place and has one of the worst prognostics for a neoplasm. Due to the specifical intratoracical topography, clinically inaccesible and without symptoms, the disease is rather incurable when the disphagia appears. MATERIAL AND METHOD: The esophageal prosthesis procedure through laparogastroscopical approach, used by us, is an original one, noninvasive, acknowledged both nationally and internationally. The endoprosthesis esophageal cases belong to three Clinics of Surgery (Clinic Surgery 2 from Sibiu, Clinic Surgery 1 from Braila, Clinic of Surgery 4, Bucharest) on a period of 14 years (1996-2009), identically coordinated. RESULTS AND DISCUSSIONS: Out of the 68 patients, 18 cases have been cancers situated in the medial and inferior third and 28 have been eso-cardial-tuberositary neoplasms. In the cases of the high malignant pharingeal-esophageal stenosis, the placement of the prosthesis (different prosthesis adapted to this particular situation) in areas of aerial-digestive junction implies significant technical difficulties especially in the option with the conservation of the larinx as a fonatory and respiratory solution. CONCLUSIONS: Our original procedure, simple and efficient presents numerous advantages which allow the widening of the indications of stent gastroenterology: firm traction, the possibility of catheterism through narrow lumens of 1-2 mm, sometimes anfractuous, the distal visibility, the visual placement or expanding of the prosthesis, the evaluation of the intraoperatory visceral or parietal methastasis and eventually the avoidance of the gastrostomic invalidation.

[Multiple splenic abscesses associated with normotensive hydrocephaly]. / Abcese splenice multiple asociate cu hidrocefalia adultului.

The paper contains a concise review of the current literature on the splenic abscesses and presents an unusual association of multiple splenic abscesses with normotensive hydrocephaly to an elderly patient, treated by ventriculo-cardiac shunting and splenectomy as an one stage procedure performed by a combined surgical team (neurosurgeon, vascular surgeon and general surgeon), with a favourable outcome. As far as the authors know, this is the first communication of multiple splenic abscesses associated with adult hydrocephaly treated by a simultaneous surgical approach.

[Esophageal endoprosthesis by laparo-gastroscopy with transtumoral approach in advanced esophageal and esophagogastric cancer]. / Endoprotezarea esofagiana laparo-gastroscopica prin foraj transtumoral in neoplasmele esofagiene si esogastrice depasite.

INTRODUCTION: Romania is part of the countries with low incidence of esophagus cancer (the mortality rate M/W at 100,000 peoples being 1.6/0.3), but the diagnosis of the disease, is most frequently incidental in stages that make any intention of radical treatment a desideratum frequently unattainable. MATERIAL AND METHOD: In the impossibillity of curative treatment we realised laparoscopic procedure of esophageal prosthesis (through traction not through pushing as in endoscopic procedures) at 60 patients with esophageal and esogastric cancer in advanced stages (distance metastasis, almost non-existing lumen, emaciation, severe decline of general state). The originality of the laparogastroscopic method has been international recognized. RESULTS AND DISCUSSIONS: This minimally invasive prosthetic original method presumes minimal agression, gastroscopic approach, the insertion of the prosthesis is made through traction not through pushing (transtumoral drilling, compresive and styptic insertion, etc.). The patient can eat at 8-12 hours after operation and the contact with the hospital is shorter, the hospitalization period was between 3 and 7 days. We had survivals between 5 months and 4 years. CONCLUSION: The method that we propose is simple and efficient is a solution for repairing the endoscopic failure, is an alternative for the crippling gastrostomy, or, for the cases when the preoperative most optimistic estimations might comply a sick person and unbalanced immunological, nutritional and psychological, to an intervention to vast in scope (anaesthetic and surgical), compared to the final solution, palliative, in fact.

Age-dependence of the anticonvulsant effects of the GABA uptake inhibitor tiagabine in vitro.

Epileptic syndromes frequently start at childhood and therefore it is crucial to test new anticonvulsants at immature stages of the nervous system. We compared the effects of the gamma-aminobutyric acid (GABA) uptake inhibitor tiagabine [(R)-N-(4, 4-bis(3-methyl-2-thienyl)but)3-en-1-yl nipecotic acid] on low-Mg(2+)-induced epileptic discharges in brain slices from rat pups (p 5-8) and juvenile animals (p 15-20). In tissue from rat pups, tiagabine slightly reduced epileptiform activity in hippocampal area CA1 but had no effect in the entorhinal cortex. In juvenile rats, epileptiform discharges were unaffected in CA1 but suppressed by 60% in the entorhinal cortex. While tiagabine increases its efficacy with age, in-situ hybridisation and PCR analysis show that mRNA coding for the neuronal GABA-transporter GAT-1 is already present at p 5. We therefore conclude that the increasing efficacy of tiagabine during ontogenesis is due to functional maturation of GABAergic synapses rather than to up-regulation of GAT-1 expression.

Blink-induced motion of a gas permeable contact lens.

The blink-induced dynamics of a gas permeable contact lens are analyzed. The lens is considered to be a planar, circular, porous disk of specified permeability. Specifically, this work investigates the effects of those variables that characterize the porous nature of the lens such as the permeability and thickness of the lens and the effective slip coefficient. The equations governing the dynamics of the tear film and of the lens are solved subject to physical constraints that limit the duration and extent of the lens motion. The motion of a permeable contact lens can be controlled by a proper choice of the lens material microstructure. Analysis of the results indicates that the motion of the lens is enhanced by lower values of the slip coefficient and higher values of the permeability, independent of the lens thickness. In addition, thicker lenses as well as thicker tear films cause the lens to squeeze faster and to slide slower.