[Hepatic hemostasis with packing in complex abdominal traumatic lesions: indications and postoperative outcomes]. / Impachetarea hepatica în leziunile traumatice abdominale complexe: indicatii si rezultate postoperatorii.

UNLABELLED: The purpose of this study is to review our postoperative outcomes with liver packing in complex abdominal trauma. PATIENTS AND METHODS: 76 liver trauma were admitted for operative procedures in the Surgical Department of City Hospital Timisoara between April 1994 - September 2009 and 16 cases were identified in our series as requiring liver packing. In all cases, this method was efficient, with no postoperative bleeding. In the same time, there were specific complications such as bile leak or abdominal collections. CONCLUSIONS: despite a second procedure for packs removal and the possibility for specific complications, liver packing is an efficient method for severe liver trauma or complex abdominal lesions.

[Intestinal fistula--a complication in the surgical treatment of the substitution mesh infection]. / Fistula intestinala--complicatie în tratamentul chirurgical al infectiei plasei de substitutie.

The infection of the substitute mesh, used in the treatment of the large abdominal eventrations is a very severe complication for the patient and also for the surgeon. The surgical treatment of this complication represents the ablation of the mesh with concomitant evacuation of the purulent collection and the annihilation of the infectious source. In the next stage, it will be applied a reconstruction method of the abdominal wall. The ablation of the mesh, especially if the infection was continuous for a long period, is very difficult and can have as consequences severe complications, one of them being the small intestine fistula. This paper presents the case of one patient with an infection of the substitution mesh that had a continuous evolution over a long period, approximately 3 years, and its ablation being complicated with a small intestine fistula.

[Liver trauma. Experience of Surgical Department, City Hospital Timisoara]. / Traumatismele ficatului. Experienta Clinicii de Chirurgie de urgenta a Spitalului Municipal Timisoara.

The present paper analyzes the liver trauma, underlying efficient diagnostic methods and treatment approaches. Liver trauma is frequent in Surgical Emergency Units and it is a challenge for the surgeon who has to deal with diagnosis and treatment problems and also to treat the associated lesions. The study analyzes 49 cases of liver trauma admitted in Emergency Surgery Clinic from Timisoara City Hospital between January 1995 and April 2005. A very good trained team specialized in liver surgery but also a multidisciplinary team is very important in liver trauma.

[The limits of surgery in the treatment of the icteric patients due to pancreatic head cancer]. / Limitele tratamentului chirurgical al neoplasmului de cap de pancreas la pacientii icterici.

Aim is to present the limits of surgery, determined by the dimension of the tumor and vascular invasion, in the treatment of the icteric patients with pancreatic head cancer. This paper is a retrospective study realized in Timisoara City Hospital, Surgery Clinic, on 68 patients, hospitalized for icteric syndrome due to pancreatic head cancer. Surgery was performed in 66 patients: 4 (6%) pancreaticoduodenectomy, Whipple modified technique, 62 (94%) palliative surgery which consists in a biliodigestive shunt associated with a gastroenterostomy, and 2 patients were not operated. In palliative treatment, 10 (15%) patients had complications and 3 (4.5%) died within 1 month after surgery. In the case of the patients with duodenopancreatectomy, there was no morbidity or mortality. Survival after one year was 0% in palliative treatment and 100% in pancreaticoduodenectomy. In icteric patients due to pancreatic head cancer, the possibility of pancreaticoduodenectomy without vascular resection is reduced (6%). Modified Whipple technique was imposed by the dimensions of the tumor (more than 3 cm) and vascular invasion, determining in the first place, the dissection of the vascular tree: portal, mesenteric, caval; and pancreaticoduodenectomy was performed only if there was no invasion.

[Synchronous sigmoid and superior rectal resection and left hepatic lobectomy extended to Spiegel lobe for a sigmoid cancer with hepatic metastasis. Case report]. / Rezectie sincrona, de colon sigmoid si lobectomie hepatica stângâ extinsa la segmentul I pentru un neoplasm sigmoidian cu metastaze hepatice.

The recent developments of surgical technologies allowed the achievement of some standardized interventions with anatomical and functional visa, which based on the improvement of anesthesia and intensive care, and not least by elaboration of efficient chemotherapy protocols, determined new horizons in the treatment of advanced cancers. This work presents a case witch was hospitalized at the Department of Hepatic Surgery, of City Hospital from Timisoara for a colorectal cancer stage IV (T3N1M1), with hepatic metastasis localized at the left hepatic lobe (II and III segments) and Spiegel lobe. A surgical intervention was performed, when in the same operating time was practiced a sigmoid and superior rectal resection (Hartmann) and also a left hepatic lobotomy extended to the first segment. The post operating evolution of the patient was favorable and also after fourth month from the surgery, when no signs of relapse were established at reevaluation.

[Deep liver wound treated by internal compression with Blakemore catheter]. / Plaga hepatica transfixianta rezolvata prin compresiune intrinseca cu sonda Blakemore.

High incidence of polytraumas of different etiology determines special problems of treatment, the emergency surgeon frequently facing serious and complex injuries the most frequently in unstable patients and therefore difficult to be treated. This paper presents the case of a 19 years old patient, victim of a heteroaggression; clinical examination reveals an unique abdominal wound, surgical procedure showed a liver lesion with massive hemoperitoneum. Authors expose a series of emergency procedures principles for unstable patients and also an unusual method in the treatment of a liver wound. Actually, this method means catheterization of the liver wound with a Blakemore catheter. The esophageal balloon is full fill to make a positive pressure on this wound. Good evolution of the case justifies this method to be used as an alternative procedure to other haemostatic methods (liver resections, hepatic artery ligature etc.).

[A retrospective study of 83 patients hospitalized for a jaundice syndrome in the Surgical Clinic of Timisoara Municipal Hospital]. / Studiu retrospectiv privind 83 de pacienti internati pentru un sindrom icteric în clinica de chirurgie a Spitalului municipal Timisoara.

This is a retrospective study done on 83 patients admitted to surgical department of Timisoara Emergency Hospital in the period between 01/01/1992 and 31/03/1995; 47 patients were males, 36 females with mean age 56.1 years. All patients suffered from jaundice mainly conjugated hyperbilirubinemia. The causes of jaundice were: malignant tumours in 19 (22.9%), chronic diffuse parenchymatous liver disease in 24, stone common bile duct 22, benign biliary strictures and papillary stenosis in 6, extrinsic biliary compression and inflammation in 12. Surgery was done in 47 patients and medical treatment in 36 patients. During hospitalization, complications occurred in 19 patients. The condition of patients at discharge was considered: cured in 30, improved in 38, stationary in 2 and deteriorated in 12. Mortality occurred in one patient.

[The rejection of a hepatic graft]. / Rejetul de grefa hepatica.

Hepatic graft rejection is an epiphenomenon of liver transplantation. Despite the immunosuppressive therapy, nowadays a level of 30-50% of acute rejection and 5-15% chronic rejection is always persisting. Graft rejection prophylaxis essentially represents the result of a subtle equilibrium of the chronic immunosuppression. This study presents the essential data concerning the graft rejection, such as: prevalences, classifications, clinical presentation and diagnostic, both anatomopathological and differential. Modern therapy of hepatic graft rejection is also presented.

[Liver transplantation. I. Its history. The indications. Clinical efficacy]. / Transplantul hepatic. I. Istoric. Indicatii. Eficienta clinica.

The aim of this study is to present the actual indications of the liver transplantation in adult as well as in children patients. A multicenter comparative study based on the already published reports in Europe and in the United States has been done in order to analyse the survival rates for different liver diseases subjected to liver transplantation, as well as the prevalence of these nosologic entities in different hepato-biliary centers. Such an analysis is badly needed in Romania, where the prevalence of liver diseases is relatively high, and in the context of the initiation of transplantation in our country.

[Posttraumatic pseudoaneurysm of the axillary artery after anterior dislocation of the shoulder: a case report]. / Pseudoanevrism posttraumatic al arterei axilare, dupa luxatie anterioara a umarului: prezentare de caz.

We present a case of a young patient, 44 years old, with a pseudoaneurysm of the axillary artery after anterior shoulder dislocation. The early diagnosis of axillary artery lesions after trauma is difficult in some cases. It's important to mention the possibility of accidental vascular surgery during reduction of the shoulder dislocation. In consequence, in all patients with a penetrating or blunt trauma of the shoulder is required a neurological and vascular examination; in any suspicions, an additional arteriography and computer tomography is indicated. Early repairs of vascular and neurological lesions are very important for the outcome of these patients.

[Unique forms of the postthrombotic syndrome]. / Forme particulare de sindrom posttrombotic.

A prospective study was made with a view to analyse and to identify two particular forms of the post-thrombotic syndrome. The post-thrombotic syndrome of the shank can be recognized on the basis of the clinical and of the phlebographic examination. It has a serious prognosis and can be treated either conservatively or by surgery according to case. Its frequency is probably higher than it was presumed on the basis of the first observations. The post-thrombotic venous obstruction may be a cause of arterial ischemia during effort but this occurs only in very few cases. This particular syndrome is manifested as intermittent claudication which occurs in the clinical picture of chronic orthostatic venous failure. The probable mechanism is the direct effect of increased pressure in the arterial and venous circulation in vessels with normal walls, as a result of an important obstruction in the return circulation. Lumbal sympathectomy appears to improve durable claudication and hyperhidrosis.