[Sudden death in organophosphoric poisoning--an unaccountable pathophysiologic mechanism?]. / Moartea subita din intoxicatia cu organofosforice. Un mecanism fiziopatologic neexplicabil?

UNLABELLED: Sudden death related in literature to appear in IV-th - VIII-th day from organophosphoric intoxication does not have an unanimous accepted physiopathologic explanation. PURPOSE: Pharmacodynamic study of myocardial trichlorfon level in acute experiment. MATERIAL AND METHOD: Gas chromatographic determination of myocardial trichlorfon quantity in an experiment on white, male Wistar rats, daily sacrificed for the heart, until the tenth day from an digestive administration of a dose of 200mg/kg trichlorfon. RESULTS (mcg/g myocardial tissue): I day = 8, II day = 13.63, III day = 15, IV day = 18.96, V day = 19.6, VI day = 20.83, VII day = 21.21, VIII day = 21.33, IX day = 19.69, X day = 19.41. CONCLUSIONS: An organophosphoric direct toxic mechanism is suggested, through accumulation over time of a certain level of myocardial concentration.

[Staging and diagnosis in accidental hypothermia]. / Stadializarea si diagnosticul urgentelor hipotermice.

Core body temperature below 35 degrees C is defining arbitrarily hypothermia. There is no worldwide consensus concerning the staging and resuscitation strategies in such a vital emergency, not even in rewarming strategy. Accidental hypothermia has its own "survival chain", modifying some steps or the timing in the common cardiopulmonary resuscitation protocol, according to some particularities of the metabolism in such an accident. Taking into account the two major events during hypothermic conditions (ventricular fibrillation and coma), we have proposed a better borderline between the three severity classes, based on clinical, paraclinical and prognostic arguments. The interest in this special environmental emergency situation is coming not only from its incidence, but especially from its particular long time period in which the resuscitation maneuvers could be effective, so that a literature review mixed with our practical observations may be of didactical and legal benefit also.

[Consideration on serotoninergic syndrome based on a clinical situation ]. / Consideratii asupra sindromului serotoninergic pornind de la un caz clinic.

The diagnosis criteria for serotoninergic syndrome was first time proposed in 1991 by Sternbach, mixing clinical, biological and historical features. Drugs inducing serotonin accumulation by decreasing the synaptic recapture or increasing the serotoninergic transmission are responsible for the onset of this syndrome even in small amounts. We are describing a case of a young patient developing a comatose stage of serotoninergic syndrome as a result of Amitriptylinum and Sertralinum poisoning.

[The hemorrhagic duodenal ulcer: our experience in its diagnosis and treatment]. / Ulcerul duodenal hemoragic: experienta noastra în diagnostic si tratament.

AIM OF THE PAPER: To present our experience in the diagnosis and treatment of hemorrhagic duodenal ulcer. MATERIAL AND METHOD: Retrospective study of 80 patients who underwent surgery in our clinic during the past 5 years. Patient's age ranged between 19 and 76 years, the condition being most common during the IVth and Vth decades of life. There were 61 males and 19 female, 49 of them residing in urban areas. In 23 cases the patients presented with an acute hemorrhagic ulcer and in 57 cases with a chronic form. Hemorrhage was by hematemesis (30 cases), melena (36 cases) and hematemesis and melena (14 cases). According to the severity of hemorrhage we found: hemorrhagic shock grade I (mild hemorrhage) in 16 cases, grade II (moderate hemorrhage) in 19 cases, grade III (severe hemorrhage) in 33 cases, grade IV (very severe) in 11 cases and grade V (cataclysmic) in 1 case. Radiological and endoscopic examinations made the diagnosis in 78 and 95% of the cases, respectively. Treatment was surgical in all cases. The patients were operated in emergency, within the first 24 hours (14 cases), or delayed emergency, after 4-7 days (66 cases). Two surgical procedures were performed: truncal vagotomy with ulcer excision/suture and Heineke-Mikulicz pyloroplasty in 46 cases, and truncal vagotomy with antrectomy and Péan anastomosis in 34 cases. RESULTS: Postoperative course was favorable in 76 cases, complications causing death being recorded in 4 cases. CONCLUSIONS: Hemorrhagic gastroduodenal ulcer is a surgical emergency requiring an adequate diagnostic and therapeutic approach. According to our statistics, in most cases the treatment is surgical.

[The results of the Ravitch-Sutherland technic for surgical correction in pectus excavatum]. / Rezultate dupa tehnica Ravitch-Sutherland pentru corectia chirurgicala în pectus excavatum.

The aim of our study was to assess the functional and cosmetic results after performing a modified Ravitch-Sutherland procedure in children presenting with excavatum. A series of 31 children with ages ranging between 5 and 16 years, presenting with pectus excavatum, were operated between 1986-1996 in our service. In 5 cases surgical treatment was required by the presence of respiratory and/or cardiac functional impairment due to the malformation. In the other 23 cases operation was performed mainly for cosmetic reasons. In all cases a modified Ravitch-Sutherland procedure was performed. Modification consisted in renouncing at the plicature of the perichondra and in associating a diaphragmatic elongation and Bedouelle laparoplasty in all cases. Longitudinal sternotomy was performed in 2 cases with severely impaired ventilatory capacity. Functional and cosmetic results were good in all cases. In 2 cases, in which recurrence of the condition was observed, a second identical procedure was performed, with a good result. The interval between the operation and the moment of long-term evaluation ranged between 3 months and 11 years. We conclude that the modified Ravitch-Sutherland procedure represents an effective method for the treatment of pectus excavatum cases, offering good functional and cosmetic long-term results.

Clinical and evolutive aspects in ventricular preexcitation syndromes in child.

Ventricular preexcitation syndromes (VPS) are very important between cardiac rhythm disturbances in childhood, because their presence can change the clinical and ECG picture and thus the treatment can be very difficult. The authors studied 58 cases of VPS in children (2 weeks-15 years old) admitted in a period of 3 years. The surface ECG showed VPS aspects: in 30% of cases we noticed WPW syndrome type B and the rest presented VPS with Mahaim pathways and Lown-Ganong-Levine syndrome. 4 cases were familial and 1 child a hidden WPW syndrome. In 65% of cases the cardiac symptoms put the diagnosis and 1/3 of cases were discovered by common ECG. The most important cardiac sign of the children with WPW syndrome was the paroxysmal supraventricular tachycardia, 4 cases presenting wide QRS complex. Others types of VPS were without clinical symptoms. The intravenous administration of digoxin + propranolol was the therapy of choice for paroxysmal supraventricular tachycardia in infants and children until 2-3 years old, and propranolol and chinidine after this age. The children older than 2-3 years and/or those with ineffective preventive for recurrent treatment received dysopiramide and specially amiodarone with satisfactory results; it was not necessary the surgical ablation of the aberrant pathway. Ventricular preexcitation syndromes and wrong treatment can induce severe ventricular arrhythmia, so all the tachyarrhythmias with unknown etiology and especially those with wide QRS complex must be investigated very carefully, using and Holter test and the endocavitary electrophysiology, for a correct medical and/or surgical treatment.

[The results of the Ravitch-Sutherland technic for surgical correction in pectus excavatum]. / Rezultate dupa tehnica Ravitch-Sutherland pentru corectia chirurgicala în pectus excavatum.

The aim of our study was to asses the functional and cosmetic results after performing a modified Ravitch-Sutherland procedure in children presenting with pectus excavatum. A series of 31 children with ages ranging between 5 and 16 years, presenting with pectus excavatum, were operated between 1986-1996 in our service. In 5 cases surgical treatment was required by the presence of respiratory and/or cardiac functional impairment due to the malformation. In the other 23 cases operation was performed mainly for cosmetic reasons. In all cases a modified Ravitch-Sutherland procedure was performed. Modifications consisted in renouncing at the plication of the perichondrium and in associating a diaphragmatic elongation and Bedouelle laparoplasty in all cases. Longitudinal sternotomy was performed in 2 cases with severely impaired ventilatory capacity. Functional and cosmetic results were good in all cases. In 2 cases, in which recurrence of the condition was observed, a second identical procedure was performed, with a good result. The interval between the operation and the moment of long-term evaluation ranged between 3 months and 11 years. We conclude that the modified Ravitch-Sutherland procedure represents an effective method for the treatment of pectus excavatum cases, offering good functional and cosmetic long-term results.

[The value of the echographic exam in the diagnosis of intra-abdominal "textilomas"]. / Valoarea examenului ecografic în diagnosticul textiloamelor intraabdominale.

In the absence of radioopaque marker, the diagnosis of textiloma, a rare iatrogenic lesion, is difficult. The wide use of abdominal ultrasonography significantly improved the preoperative diagnosis, the most typical image being that of a echogenic area with a posterior shadow cone. Nine cases of intraabdominal textiloma, in the diagnosis of which ultrasound played the most intra-abdominal textiloma, in the diagnosis of which ultrasound played the most important role, are presented. Although the ultrasound image is not specific, it is nevertheless enough suggestive the diagnosis of textiloma and thus for indicating an early surgery, before complications occur.

["Biloma": its diagnosis and treatment by percutaneous echo-guided evacuation]. / "Biloma": diagnostic si tratament prin evacuare percutana ecoghidata.

The term "biloma" describes an intra-abdominal bile collection secondary to traumatic or iatrogenic injury of the biliary tree. We present a case of biloma treated by guided percutaneous needle aspiration.

[Hepatic abscesses]. / Abcesele hepatice.

The authors analyse 16 cases of hepatic abscesses recorded in a 10-year interval. The difficulties in assessing the etiology and diagnosis, as well as in indicating an effective treatment are discussed. The clinical aspects and investigation methods, among which scintigraphy, arteriography and especially echotomography are extremely useful in making the diagnosis and in localizing the collection, are reviewed. The bacteriological examination revealed the presence of various organisms in 14 patients, the examined specimen of pus being negative in the remainder of 2 cases. The treatment was surgical in most of the cases (15) consisting in an abdominal approach or posterolateral with rib resection (1 case) and drainage. In 3 cases the intervention was extended to cholelithiasis which was the underlying cause of the abscess. The ultrasound-guided transparietohepatic drainage was performed in 2 cases. No death was recorded.

Effects of ceruletide on post-operative intestinal atony: a manometric study.

The effects of ceruletide on jejunal motor activity were studied in seven patients with postoperative intestinal atony. Jejunal pressures were recorded by three perfused catheters with orifices spaced 5 cm apart, the proximal one being positioned 10 cm beyond the ligament of Treitz. Ceruletide (0.05 microgram/Kg i.v.) significantly (p less than 0.0001) increased the number and amplitude of jejunal contractions. The action of ceruletide was most obvious the first 15-minutes after administration, then its effect diminished progressively and ceased after 65-75 minutes. The adverse reactions of ceruletide were minimal and self-limiting.