Up-to-date aspects of meningoencephalitis. Anatomo-clinical researches.

The anatomo-clinical study of the deaths caused by meningoencephalitis at the Infectious Diseases Clinics in Bucharest in 1986 and 1987 showed the increase of morbidity, 194 lethal cases being registered. The most affected age group was up to 1 year, followed by older persons, then by children between 1 and 10 years, the male sex prevailing. The most incriminated pathogenic agents were meningococcus, pneumococcus, as well as negative Gram germs, Escherichia coli, whereas the favouring factors were especially malnutrition, premature birth, dystrophies, focal infections. The lesional pictures are described, underlying the frequency of vascular lesions, ventriculitis cerebral abscesses, as well as the role of demyelinizations and of the glial reactions in pathogenesis.

Chronic pancreatitis. Anatomo-clinical and surgical treatment characteristics.

Chronic pancreatitis of biliary origin, often localized in the cephalic region of the gland and etiopathogenetically related to biliary lithiasis whose anatomoclinical evolution is thus complicated, has a good prognosis. Chronic pancreatitis proper, persistent, recurrent calcifying with pancreatic lithiasis and with pseudocysts, more rare in Romania, raises difficulties of diagnosis and of surgical treatment, the prognosis being doubtful. In a group of 321 patients (33.6% males and 66.4% females) with chronic pancreatitis of biliary origin (252 cases) and chronic pancreatitis proper unrelated to biliary diseases (69 cases), indirect surgery--to remove the biliary factor--(291 patients) and direct surgery on the gland for pancreatic decompression or even gland exeresis (30 patients) were performed. The results obtained in the 321 patients after indirect and direct surgery were very good in 52% of the cases, good in 34%, moderate in 8%, failure in 2.5%; the mortality was of 2.9%.

[Chronic pancreatitis: anatomico-clinical and surgical therapy characteristics. Our experience with 321 cases]. / Pancreatitele cronice: particularitati anatomoclinice si de terapeutica chirurgicala. Experienta a 321 de cazuri.

Chronic pancreatitis of biliary origin, frequently located in the cephalic portion of the organ, etiopathogenically dependent on biliary lithiasis, the anatomoclinical evolution of which is complicated by their presence, have a better prognosis, and are usually reversible following therapy of the biliary affections. Persistent chronic pancreatitis proper, usually of the recurrent type, associated with calcification and the development of pancreatic stones, and with pseudocysts, although rare in our country, raise diagnostic difficulties from the standpoint of surgery, and have a reserved prognosis. The authors have evaluated a total of 321 cases hospitalized between 1960 and 1987 with chronic pancreatitis of biliary origin (252 cases--78.5%), and chronic pancreatitis proper, not associated to biliary affections (69 cases--21.5%). Male patients totalled 33.6% of all cases. The authors stress the high frequency of chronic pancreatitis associated to biliary lithiasis (181 cases), in contrast with pancreatitis associated to nonlithiasic cholecystopathies (38 cases), or to postoperative cholecystic disturbances (33 cases). Chronic pancreatitis non-associated to biliary affections totalled 69 cases, of which 24 were of the persistent type, 13 were of the recurrent type, one had calcifications, two had pancreatic stones, four followed acute pancreatitis, six were complicated by pancreatic abscesses, and 9 were complicated by pseudocysts. The duration of biliary and pancreatic disturbances was between 3 and 5 years in 43.9% of the cases, and between 6 and 10 years in 21.3%. Chronic pancreatitis achieves a complex clinical syndrome, the dominant feature being the painful biliopancreatic syndrome associated to obstructive jaundice (42.4%), angiocholitis (47.6%), weight loss (46%), hepatic and renal failure (10.9%), diabetes (8.4%), and a tumoral mass (15.7%). Indirect surgical interventions aimed at suppressing the biliary factor were carried out in 291 patients, with very good results in 56% of the cases, good results in 32%, mediocre in 7%. In 2.4% of the cases surgery failed to improve the condition of the patients. Direct interventions on the pancreas, which consisted either in pancreatic decompression or in exeresis of the gland have been performed in 30 patients. Drainage of pancreatic abscesses was done in 6 patients (2 deaths), cystic-digestive anastomoses were performed in 8 patients, Wirsung-jejunostomy in 3 patients (1 death), cystostomy in one patient, distal pancreatectomy in one patient (deceased), viscerolysis and novocaine infiltration in 11 patients. In the 321 cases of chronic pancreatitis operated by direct and indirect procedures very good

[Intra-articular teratoma of the knee]. / Teratom intraarticular al genunchiului.

An unique case is presented, never mentioned before the world specialized literature, concerning an intraarticular teratoid formation in the knee. Initially a sessile, pediculated formation 3/3 cm in size, on the interior aspect of the synovial sac, became free following an accident, and blocked the knee in the flexed position at an angle of 30 degrees, simulating rupture of the medial meniscus and intercondylar luxation.

[Osseous desmoid fibroma (2 case reports)]. / Fibromul desmoid osos. (Consideratii referitoare la doua cazuri).

Bone dermoid fibroma, described by Jaffe in 1958 is a benign fibroblastic tumour characterized by a remarkable tendency to expansion and to local recidives, without metastasizing. Some 38 cases have been reported to the present in the specialized literature. Two new cases are reported now, the first in the Romanian medical literature, one with localization of the tumour in the superior tibioperoneal metaphysis, and another located in the inferior femoral metaphysis. The first case recidivated after 3 surgical exereses over a period of nearly two years, and had to be amputated. The second case was solved by resection-arthrodesis of the Juvara-Merle d'Aubigne type, and is currently followed-up.

[Hepatic tuberculosis; difficulties of diagnosis and therapeutic management]. / Tiberculoza hepatica; dificultati de diagnostic si de conduita terapeutica.

Micro, and/or macro-nodular lesions are frequently encountered in the liver in the course of the tuberculous disease, especially during primary dissemination, as well as during the secondary one. In some cases the evolution of liver tuberculous lesions will determine hepato-biliary symptomatology (hepatomegaly, icteric cholangitis) which makes necessary exploratory laparotomy. The authors present their experience in connection with 2 patients presenting liver tuberculous localizations during the primary dissemination. In one of the patients there were also active pulmonary lesions, while in the other one there were no manifest tuberculous determinations.

[Pancreatic lithiasis]. / Litiaza pancreatica.

This disturbances was encountered in 4 patients out of a total of 4,000 intervention for hepato-bilio-pancreatic afflictions). In two cases the intervention was performed for a diagnosis of tumoral jaundice, in another case the diagnosis was made during surgery and in a fourth case it was a surprise discovery at the post-mortem investigation. The authors preferred a palliative intervention consisting in bilio-pancreatic decompression through bilio-digestive anastomosis.

[Papillary adenocarcinomas of the biliary tract]. / Adenocarcinoame papilare ale cailor biliare.

Papillary adenocarcinomas remain at present some of the rare tumours of the biliary pathways. They raise numerous problems in connection with the diagnosis and with the surgical attitude. The authors present their personal experience acquired in 8 cases of papillary adenocarcinomas of the biliary pathways in which, after removal by curettage external biliary drainage was performed (4 cases, 2 survivals for 3 and 10 months respectively). Cholecystogastrostomy was performed in 2 cases and choledocoduodenostomy in two more patients (survivals of 3 and 20 months respectively).