[So-called biliary lithiasis after vagotomy]. / Asa-zisa litiaza biliara dupa vagotomie.

Reconsidering the problem of biliary lithiasis in the patient operated for gastroduodenal ulcers, and carrying out an analysis of 1 200 vagotomized patients, biliary lithiasis was noted in 11 of them. The authors make a review of the pathologic physiology of this association. The fact is stressed that biliary lithiasis following vagotomy is more likely a case of biliary lithiasis that has not been known to exist before surgery and that was not recognized during the surgical intervention. A larger statistical analysis could demonstrate that the incidence overlaps the general frequency of biliary lithiasis in a randomly investigated population.

[Treatment for spontaneous pneumothorax]. / Terapie pneumotoraxului spontan.

The present study refers to 67 cases of spontaneous pneumothorax admitted to intensive care unit. Symptomatic therapy and treatment of the pneumothorax is efficient. Minimal thoracotomy with continuous aspiration drainage indicated in severe pneumothorax and relapses after exsufflation, was considered the basic procedure in the symptomatic treatment.

[Anatomical bases of incomplete vagotomy]. / Bazele anatomice ale vagotomiei incomplete.

The results are presented, of an intraoperative anatomical study concerning the variable disposition of the vagal nerves in the abdominal section of the oesophagus. This study was carried out in a large number of patients with ulcers in which vagotomy was performed. All the patients were followed and in all periodical controls were made after surgery in view of detecting possible ulcerative relapses. The authors conclude that the negative results of vagotomy are due to the fact that this is usually incomplete. The study demonstrated the existence of many variants of the anatomical disposition of the vagal nerves at the level of the abdominal oesophagus, which the authors synthesize in a practical scheme which is available to any surgeon. The risk of an incomplete vagotomy is the highest when the patient presents an anatomical variant with a large number of branches.

[Critieria of brain death (personal opinions)]. / Criteriile mortii cerebrale (opinii personale).

The study reviews the literature dealing with cerebral death and raises some problems, not yet discussed in the literature, such as those in connection with the decerebrated pregnant woman, of which the following ones are stressed: 1. The pregnancy can continue in the decerebrated woman. If the answer is affirmative, development of the pregnancy represents represents a test of particular biological value in assessing the efficiency of ressuscitation therapy; 2. What are the effects of hipoxyia that led to decerebration of the mother on the psychosomatic development of the child, and the possibility to evaluate it in correlation with the age of the pregnancy; 3. What are the effects of prolonged forced ventilation and the artificial feeding on the development of the pregnancy? The study ends with concrete proposals for establishing criteria for cerebral death, stressing the need for an adequate juridical frame for organ transplantation.

[Malignant hepatoma (clinical, biological and morphological comparisons)]. / Hepatomul malign (confruntari clinice, biologice si morfologice).

The authors make an analysis of 8 cases of malignant hepatoma discovered in 20 362 surgical patients between 1965 and 1975. The analysis of these cases allowed to conclude as follows: 1). In the presence of chronic digestive disturbances, or of hepato-splenomegaly, accompanied by progressive deterioration of the general condition of the patient, and of the use of large amounts of analgetic drugs, one should consider more than usually the possibility of hepatic neoplasia. 2). The first element to be considered in the frame of diagnosis of malignant hepatomas should be the morphological one. Of practical value in the diagnostic are the following: hepatic scintigraphy, angiography and bioptic laparotomy. 3). Of the conventional biologic tests (including the immunological tests), evaluation of serum alpha-foetoprotein is the only one with an orientative diagnostic value.

[Aspects of pulmonary function in states of hyperhydration]. / Aspecte ale functiei pulmonare in conditii de hiperhidratare.

The authors have investigated in 10 young and healthy men the changes occurring in the cardio-respiratory apparatus following the perfusion with non-colloid isotonie volemic solutions. Exploration of volumetry and of pulmonary mechanics have been performed, hemodynamic tests and pulmonary angiograms. The results indicate the development of slight interstitial oedema, without intra-alveolar transsudation or obstructive phenomena in the aerial pathways. The cardio-vascular apparatus shows satisfactory adaptability through central and peripheral mechanisms in conditions of hyperhydration.

[Herpetic etiology of gastric and duodenal ulcer. II. Study in humans]. / Etiologia herpetica a ulcerului gastric si duodenal. Partea a II-a Studiu la om

By inducing experimental ulcers in the rabbit with the type 1 Herpes simplex strain, isolated from the herpes vesicles from a vagotomized patient, the authors demonstrate the protective role of vagotomy, the ulcerogenic capacity of the virus, which can be considered as an etiological factor of human gastroduodenal ulceration. They also discuss the possibilities for a new medical therapy of this disturbance.

[General anesthesia in endoscopic examination of the digestive tract]. / Anestezia generala in explorarea endoscopica a tubului digestiv

The authors made an analysis of 165 general anesthesias applied in the digestive fibroendoscopy and they establish the technology and the indications of this method, as follows: 1) uncooperative patient (in this category should be included children, psychopaths, mentally deficient subjects and a certain category of neurotics); 2) when difficult endofibroscopies are to be expected, during which therapeutic procedures are highly probable, such as resection of polyps, coagulation of bleeding surfaces etc.; 3) lack of tolerance to local anesthetics; 4) optimal instruction conditions should be provided for the beginner anesthesist; 5) the authors recommend that all such anesthesies should be carried out in hospital only. They also suggest as the most reliable technique the intra-venous general anesthesia and the oro-tracheal intubation of the patient.

[Ulcer recurrence after vagotomy]. / Recidiva ulceroasa dupa vagotomie

In the author's statistics concerning vagotomy with simple gastric draining, performed for gastric ulcers and duodenal ulcers (a number of 556 total abdominal vagotomies, 196 selective gastric vagotomies, 179 selective high vagotomies), ulcerous recidives occured 23 times (2,4%). The authors conclude on the following aspects: -- ulcerous recidives occur more frequently following classical, selective gastric vagotomy; -- the diagnosis of ulcerous recidive is difficult and it should be based on clinical and para-clinical explorations, as well as on "test-therapy"; -- the efficiency of iterative vagotomy raises the problem of the incomplete vagotomy in the etiology of the recidivating ulcers.

Awake tracheal intubation in anaesthesia.

Endotracheal intubation in the awake patient was used on 500 occasions. Indications and results are discussed and analysed.

Gastro-intestinal haemorrhage from peptic ulcer. An evaluation of bloodless transfusion and early surgery.

Over a 3-year-period 72 patients with upper digestive tract haemorrhage due to peptic ulcer were transfused exclusively with isotonic sodium chloride and glucose solutions in equal quantities. The results are compared with 69 patients treated previously in whom conventional blood transfusion regimes had been used. Transfusion therapy was combined with emergency surgery involving vagotomy and draininage, with surgical haemostasis in situ. There were no significant differences between the two groups with regard to anaesthesia, surgery and post-operative managemement. Apart from anemia, there were less early and late complications in the group not receiving blood. The amount of crystalloid solutions administered varied between 7000 ml and 19,000 ml causing a diuresis of 1000 ml to 5300 ml within the first 24 hours. The use of this transfusion regime for haemodynamic re-equilibration in upper gastro-intestinal haemorrhage due to ulcer, in cases in which haemostasis can be obtained with certainty by emergency surgery, allows transfusion of stored blood and colloid solutions to be avoided and emergency surgery to be safely undertaken at the earliest moment. The severe acute anaemia which is caused appears to create no special problems.

[Gastric consequences of toxicoseptic agression]. / Consecintele gastrice ale agresiunwi toxicoseptice

This study is concerned with gastro-secretory and motor answers. It was carried out in two groups of patients and the results obtained were compared. The following aspects were noted: a. the control group was represented by 10 patients that had been exposed to anesthesic-surgical aggression; b. the second group was formed by 20 patients with toxico-septic syndrome of various etiologies and in different stages of evolution; - secretory and motor gastric disturbances take on an evolutive dynamic character, according to the clinico-biological phase of the syndrome; in the acute stage absolute hypersection is noted, as well as from the viewpoint of the rate, of hydrochloric acid, and gastric hypomotility; in the chronic stage there is acid hyposecretion both insulin- and histamine-resistant and in 30% of the cases there is anachlorhydria; to the general-metabolic phase of inversion corresponds, at the gastric level; a return to normal of the motility and of the acid gastric secretion.

[Upper digestive hemorrhages of ulcerous nature (management and experience)]. / Hemoragiile digestive superioare de natura ulceroasa (conduita si experienta)

A number of 135 cases were examined, presenting with superior digestive hemorrhage of ulcerative origin. The analysis of the cases was made by two comparable groups. In the first one of the groups the volemic re-equillibration was based on the administration of blood and surgery was carried out, in principle, on a "cold" condition. In the second group volemic re-equillibration was achieved exclusively with isotonic non-colloidal volemic solutions that were administered before, during and after surgery (0.9% NaCl solution and 5 g% glucose solution in equal amounts). Surgery was performed as an emergency and vagotomy was made, as well as surgical hemostasis. The results obtained have allowed for the conclusion that, by providing efficient surgical hemostasis and volemic re-equillibration with isotonic non-colloidal solutions blood transfusion and its untoward side-effects can be avoided.

[The value of non-specific general therapy of shock caused by acute pancreatitis]. / Valoarea terapiei general-nespecifice în socul din pancreatita acuta

The shock in general, including that of acute pancreatitis, presents, according to our conception, as an energetic disease involving primarily the cell (by the intensive catabolic processes induced by the pancreatic lesion) and secondarily the most peripheral and mobile sector, that of the hemodynamic compartment. There is no etiological treatment of pancreatitis (the exceptions are very rare), and this is the reason for which we adopt a conservative attitude, and medical treatment, in the acute stage of the disease. The basic treatment of the shock of acute pancreatitis is considered to be the re-establishment of the circulatory volume with the aid of non-colloidal isotonic solutions that are given in large amounts (8-17 liters in a 24-hour period) under continuous perfusion. This technique is called hyperhydration or transrenal dialysis. Making use of this technique in the treatment of shock occurring in the course of acute pancreatitis the death-rate recorded was as low as 2,3% and the number of complications was very low.