[Fatal postoperative pulmonary embolism]. / Emboliile pulmonare postoperatorii fatale.

A total of 76 cases were investigated in which fatal postoperative pulmonary embolisms were identified at the necroptic study. The following aspects are considered: the high incidence of fatal postoperative pulmonary embolisms in patients without favouring factors in antecedents (38%), and of patients operated for benign affections (50.6%); the rare occurrence of clinical signs of venous thrombosis in patients with fatal postoperative pulmonary embolisms (11.8%); the high incidence of early fatal postoperative pulmonary embolisms (46%)--in the first three days after surgery, of which 26.3% in the first 24 hours and the importance of their identification so as to exclude an erroneous interpretation of the cause of death, and finally the indications and the limitations of the prophylactic treatment with low amounts of heparin.

[The indications for subtotal and total colectomy]. / Indicatiile colectomiei subtotale si totale.

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.

[Indications for pancreatectomy in chronic pancreatitis]. / Indicatiile pancreatectomiei în pancreatita cronica.

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.

[Radical colectomy in cancer of the transverse colon]. / Colectomia "radicala" în cancerul de colon transvers.

The authors discuss the optimal surgical attitude in the cases of 44 patients with cancers of the transverse colon (excluding the angular localizations), representing 5.4% of the total number of colic cancers operated in the Clinic over the last 20 years. All the patients were in stages C and D (according to the Turnbull and Dukes classification), and the general index of resectibility of 79%. Segmental transverse colectomy should be reserved for patients of advanced age, as well as for those with organic disturbances, altered general condition, of when there is extensive loco-regional involvement, or metastases at distance. Fifteen patients were included in these categories. Extended transverse colectomy, with radical intent from the oncological standpoint, appears to be the optimal attitude in the cases of patients which do not have any of the contraindications mentioned above. Twenty patients were in this group. The postoperative death rate was 11.4% for the entire group of patients in whom resections were performed. Five patients (25%) have survived according to our data between 5 and 11 years after extensive radical colectomy.

[Surgical attitude in cancer of the ovary]. / Atitudinea chirurgicala în cancerul de ovar.

The authors start from the observation that some of the clinical forms of ovarian cancers determine hospitalization and resolution of the cases in surgical departments. They have also based their study on their personal experience acquired over a period of 20 years, during which they have operated on 180 patients. They noted that the best surgical attitude was not adopted in all of the cases and make an analysis of various methods applied, such as the radical ones, the conservative procedures, and those aimed at a reduction of the tumoral mass. The value of associated therapies is presented, consisting in surgery, chemotherapy and irradiation.

[The dumping syndrome. Surgical treatment]. / Sindromul dumping. Tratament chirurgical.

Data are presented, from the specialized literature, in connection with the frequency of the dumping syndrome, and the methods for its correction. An analysis is made of indications and of surgical methods used for the correction of this syndrome in a total of 74 patients of which 32 were operated. Preference was given to sub-diaphragmatic troncular vagotomy and to re-positioning of the duodenum with efferent loop, or by gastro-duodenal interpositioning of a segment of jejunal loop in an-iso-peristaltic position. The results of these interventions are, as a rule, favourable, but some disturbances may occur, dependent on the development of peri-visceritis, loop dysfunction, or duodenal dysfunction, as well as gastro-oestrophageal reflux.

[Recurrent postoperative ulcer]. / Ulcerul recidival postoperator.

A total of 96 patients have been hospitalized over a period of 20 years, of which 89 had been operated for recidivating post-operative ulcer (RPOU). Particular clinical and etiopathogenic aspects are stressed, such as RPOU manifested exclusively by digestive haemorrhage, pseudo-tumoral RPOU, ulcers recidivating after exclusion resection, and multi-recidivating ulcers. Prophylaxis of RPOU is best achieved by a correct primary intervention for ulcers, and the prophylaxis of the recidives should be achieved by a correct re-intervention. This presumes that a correct resection, or a correct iterative resection should be performed, as well as a correct sub-diaphragmatic vagotomy. In recidivating post-operative ulcers on the duodenal stump an important element is the insufficiency of the resection on theright, and the value is stressed of an extended resection of the stump, associated to vagotomy. In multi-recidivating ulcers after repeated interventions that have been correctly performed, gastrectomy of the total type is considered the best solution.

[Benign hepatic tumors]. / Tumorile hepatice benigne.

A total of 30 cases are presented, of benign hepatic tumours. As a result of the confrontation of data from the literature with the personal experience of the authors has evidenced the diagnostic difficulties in patients with benign hepatic tumors, especially because these can be erroneously considered as either malignant tumours or as liver cirrhosis. The clinical and the para-clinical pictures are not suggestive in all the cases, and the necessity arises of histopathologic confirmation which can be achieved by puncture and cytologic examination, or by intra-surgery biopsy. This is particularly useful because some of the benign hepatic tumours may benefit from a radical surgical treatment.

[Therapeutic attitude in some clinical forms of hepatic trauma]. / Atitudinea terapeutica în unele forme clinice ale traumatismelor hepatice.

Six cases of hepatic trauma are presented, that have raised particular problems of therapeutical attitude. The severity of the complications is discussed in this type of trauma, especially aspects related to hemobilia and hepatic suppurations which are accompanied by toxico-septic syndromes. The authors stress the role of sutures of deep hepatic wounds in the development of suppurations, as well as the opportunity of early re-interventions in such cases. Also some particular, more rare, clinical forms are discussed, that made necessary a differentiated therapeutical attitude.