[The balloon dilatation of esophageal stenoses]. / Dilatarea cu balon a stenozelor esofagiene.

A number of 55 balloon dilatations were performed on 23 patients with oesophageal stenoses of various aetiologies. Among these, 22 displayed benign stenoses and only 1 case had a malignant aetiology. The number of dilatations per patient varied from 1 to 3. In the evaluation of the results, only the clinical criterion was taken into account, the radiological examination and the oesophageal passage scintigram being inconclusive in the respect. The balloon dilatation was successfully performed in 96% of patients. In the long-term follow-up, 82.4% of the patients with benign stenoses benefitted from this therapeutic procedure. In some patients it was necessary to repeat dilatation. The asymptomatic free interval was on the average of 11.5 months. It is concluded that the balloon dilatation is a simple, safe and readily applicable therapeutic method, that may be successfully used in the treatment of oesophageal stenoses of various aetiologies, allowing in most cases to avoid the surgical intervention.

The value of computed tomography in the diagnosis of the prehepatic portal hypertension.

The dynamic computed tomography (CT) is used by the authors in a complex system of investigations. It is preceded by a diagnosis stage which determines the "normal" character of the liver and it is followed by the angiographic exploration for the cases with surgical indication. 36 patients with CT diagnosis of prehepatic portal hypertension were studied; from these patients, 24 had an angiographic confirmation and 16 of them were operated. The most valuable CT signs which have been found by the authors were: the study of the portal vein at the hilum level and in the distal parapancreatic region, the hypoplasia of the left hepatic lobe and the absence of the ascites. The other signs were considered less important, only the localization of the porto-systemic shunts being to a certain degree important for surgery. It is underlined the early age of the patients (69% are under 30 years old). The diagnosis concordance was in the studied group 100% for the positive diagnosis of the syndrome, but only 79% for the localization of the obstruction. CT is the most innocuous diagnostic procedure which obtains a maximum of data on the portal system morphology.

[Personal experience with 2,500 closed heart mitral commissurotomies]. / Experienta noastra în peste 2 500 de comisurotomii mitrale pe cord închis.

Between 1953 and 1976 a total of 2527 mitral commissurotomies have been performed in the Clinic for Cardio-Vascular Surgery of the "Fundeni" Hospital. This group included cases with pure mitral stenosis (predominantly following rheumatic disease), but also cases of mitral stenosis associated with other cardiac lesions in which the major hemodynamic element was the mitral obstruction. Criteria are discussed for surgery, the preoperative preparation of the patient, incidents, accidents and complications, as well as technical difficulties of the digital and/or instrumental mitral commissurotomies on closed heart, either carried out for the first time in the respective patient, or as iterative intervention. Comparing the results in relation with the functional stage of the disease (62.5% of the patients were classified in the III-IV evolutive degree, according to the NIHA classification), pulmonary hypertension (61.6% of the patients had medium or severe pulmonary hypertension), associated lesions (present in 17% of the cases--mitral failure predominated, together with tricuspid or aortic failures), it is appreciated that the technique of mitral commissurotomy on closed heart is an useful therapeutic method (88.6% very good and good results, a global death rate of 3.9%) that can be applied in a large category of patients, although there is a trend toward open-heart surgery, with all medico-economical major implications.