[Palliative total gastrectomy in advanced malignancies of the stomach]. / Gastrectomia totala paliativa în leziunile maligne avansate ale stomacului. Studiu retrospectiv si prospectiv etapizat, de-a-lungul a trei perioade (1.01.1992-1.01.2000).

The diagnosis of the malignancies of the stomach is generally late (stages III and IV to a medium value of 80% of patients). Therefore it is necessary a surgical treatment in order to effectuate the extirpation of the lesions and to warn or to treat the complications in course of the neoplastic disease. The indications and the results of the palliative total gastrectomy (PTG) are analyzed in the present study. Between 1992 and 1999 there were studied retrospectively and prospectively during three successive periods of time, 217 patients (pts.) with PTG. This group of pts. represents 22.1% of the total number of pts. operated on for gastric malignancies (carcinoma particularly). The indication of PTG was established only after one complex evaluation of the every patient from the point of view of his general and biological status. 142 (65.4%/217) of the analyzed pts. presented at the admission in the hospital various complications of the malignant disease (gastric different stenosis, digestive hemorrhages, loco-regional invasion). The lymph nodes metastases and the systemic metastases (in the liver especially) as well as the invasion in the neighbouring viscera imposed sometimes the extension of the PTG with partial or total extirpation of the invaded organs. A proportion of 61% pts. were submitted to those type of enlarged surgical interventions without radical intentions; all the operated pts. remained by necessity in R1 or R2 types of operations. The reconstructive preferred anastomosis was effectuated with an Y jejunal ansa à la Roux completed or not by a "J" reservoir. Microscopically pathologic lesions were: adenocarcinoma and carcinoma (82%), followed by primitive lymphoma (11.5%), and others malignant forms of lesions (approximately 6%). The general perioperative morbidity was 32.5% divided in: 12.3% having a surgical cause (the majority anastomotic leakages +/- septically complications or precocious occlusions); 20.2% complications depending by the general status and altered biology of the patients. Perioperative mortality was 10.1% (22 pts.) comparable with other experiences published in the international literature in those forms of advanced gastric cancer operated by PTG. The average outcome of the operated followed pts. was 16-18 month (extremes 12 months and 29 months). A better quality of life and a variable disease-free period was obtained. As a conclusion we think that the PTG is a advantageous modality of surgical treatment with an acceptable rate of perioperative morbidity and mortality. The outcome of operated pts. is superior comparable with that of nonoperated pts. or with that secondary to other palliative surgical interventions. The importance of adjuvant treatment (chimeo- or radiotherapy) remain to be appreciated in the future.

[Glucocorticoids in ophthalmology- therapeutic value and strategies of rational utilization]. / Glucocorticoizii în oftalmologie--valoare terapeutica si strategii de utilizare rationala.

This paper presents the most used glucocorticoids in the ophthalmic treatment, topic, periocular and systemic administrations, as well as the indications, contraindications and complications of this therapy.

[Specular microscopy--its clinical implications]. / Microscopia speculara--implicatii clinice.

Specular microscopy has multiple advantages in the clinical practice, allowing the study of the corneal endothelium in-vivo. We can observe corneal disorders, as well as the corneal status after intraocular surgery, of the posterior pole as well as of the anterior pole of the eye.

[Vascular risk factors in glaucoma]. / Factori vasculari de risc în glaucom.

The study realised in the Eye Clinic of the Central Military Hospital during February 1995-November 1997 analyses the impact of the vascular risk factors on the evolution of the primary glaucoma. The group consists in 533 patients which primary open angle glaucoma, from which 90.6% patients with primary open angle glaucoma and 9.3% with normal tension glaucoma. The assessment of the patients in order to identify the vascular risk factors it was performed on the basis of anamnestic questionnaire, following: degenerative vasculopathies, spastic vasculopathies, arterial hypotension and coronary insufficiency. 70.5% of the patients presented minimum one vascular risk factor. In the case of the patients with primary open angle glaucoma, we found a high frequency of the degenerative vasculopathies. In the patients with normal tension glaucoma the most frequent factor were: arterial hypotension and spastic vasculopathies. The coronary insufficiency had equal distribution in the primary open angle glaucoma and normal tension glaucoma. The parameters of the disease were affected faster in the patients with vascular risk factors. The outcomes of the study allow to estimate that the screening of the vascular risk factors has a distinct importance in the evolution and accurate treatment of glaucoma.