[Technical solving variants of external biliary and pancreatic fistulas]. / Variante tehnice de rezolvare a fistulelor externe biliare si pancreatice.

Two cutaneous postoperative fistulas--pancreatic and biliary--was solved by an anastomosis of maturate fistulas traject with duodenum and respectively an Y jejuno loop (Roux) with good results.

[Immediate and early reinterventions in the surgery of colorectal cancer]. / Reinterventii imediate si precoce în chirurgia cancerului colo-rectal.

Out of 584 cases submitted to colorectal surgery 461 (78.92%) were performed for cancer. Thirty-three patients (7.16%) necessitated immediate (1) or precocious reinterventions for bleeding, fistulae, peritoneal infections, bowel occlusion, necrosis or stenosis of the iliac anus. We are out the technical procedures chosen for each class of complications asking for reintervention. We registered 4 deaths, in aged patients with hard associated morbidity, with emergency reinterventions. We appreciate that a correct preoperative preparation reduces the rate of reintervention and an early reintervention reduces the post-operative mortality.

[The repair of voluminous postoperative abdominal wall defects with synthetic mesh]. / Repararea defectelor parietale abdominale voluminoase postoperatorii cu plase sintetice.

Important postoperative abdominal wall defects, especially recurrent or multirecidivated ones, are raising multiple problems to the surgeon. We are presenting a homogeneous trial of 209 patients with such lesions, in which the abdominal wall repair was made with different kind of synthetic materials, with good results. In a single case the mesh was rejected, because a silent quiescent infection. In three patients undergoing iterative abdominal operations for other diseases we performed optical and electronic microscopical studies showing out that the material integration was done by normal biological reaction. This provides the materials' tolerability and a normal reaction of the organism.

Stress ulcers in intensive care (etiology, symptomatology and therapy).

The authors present a group of 48 patients with stress ulcers (36 men, 13 women) average age 56.2 years. The analysis of the cases allowed to establish, for the first time in medical literature, a correlation between the etiology, the symptomatology and the moment of onset of the haemorrhage, with important practical implications in the adoption of a treatment regime. These considerations permitted us to delineate four categories of stress ulcers: The first category included stress ulcers caused by a cerebral lesion and manifested through cerebral hypertension. The upper digestive haemorrhage occurred within 24-48 h after the aggression and required the correction of the cerebral hypertension and of the anaemia. The second category comprised stress ulcers brought about by a hypovolaemic shock through myocardial infarction, burns, frost-bite and multiple traumas. Haemorrhage in the upper digestive tract appeared within 3-6 days after the moment of aggression and required surgical control unless it was caused by myocardial infarction. The third category was represented by post-operative stress ulcers. These forms occurred usually late, between the eighth and the thirty-seventh day after the aggression, and were due to the super-imposition of the septicaemia on the post-aggressive systemic reaction. The chief aim of treatment here was the surgical control of infection. The fourth category encompassed the stress ulcers occurring after protracted coma, especially in patients with ventilatory assistance. In these conditions, the ulcers of the digestive tract and the consequent haemorrhage represented terminal elements of irreversible diseases, in which no treatment was effective.

[Continuous peritoneal lavage in severe post abortion peritonitis]. / Lavaj peritoneal continuu in peritonitele grave post-abortum.

PIP: The authors report on 7 cases of severe postabortum peritonitis treated with hysterectomy and postoperative perinoteal lavage. The technique consisted of placing the tubes subhepatically, parietocolic on the right, Douglas cul-de-sac on the right, supramesocolic on the midline, in the splenic recess, parietocolic on the left, and Douglas cul-de-sac on the left. Each of the left. Each of the 2-way tubes was irrigated clockwise every hour with a 0.9% sodium chloride solution, at room temperature, in a volume of 24 liters/24 hours at a rate of 1 liter/hour. The lavage lasted for 24-72 hours. Improvement of the toxicoseptic phenomena was obtained within this interval, with rapid resumption of diuresis and natural nutrition. Peritoneal lavage is an efficient procedure, completing the surgical intervention as demonstrated by survival of all patients, with a small number of complications and a brief period of postoperative hospitalization. (author's)^ieng

Risk of pulmonary complications in surgical patients.

The pulmonary complications in a group of more than 20 000 surgical patients between 1971 and 1980 were examined, as well as the pulmonary state of 100 surgical patients who died within 10 days of operation. The factors related to the patient's constitutions, nature of the surgical disease, operation and anaesthesia. Equal and homogeneous groups were considered in respect of each factor which were analyzed retrospectively from 1980 to 1971. The mean frequency of pulmonary complications in the Department of General Surgery was 12%. The main risk factors of pulmonary complications were: the duration beyond 4 h of the operation (59%), age over 70 years (48%), obesity (35%). They were followed in decreasing order by sepsis, hypovolemia and particular sites of operation. Severe pulmonary complications, bronchopneumonia, pneumonia and thromboembolism contribute to mortality.