[Recurrent postoperative ulcer]. / Ulcerul recidival postoperator.

A total of 96 patients have been hospitalized over a period of 20 years, of which 89 had been operated for recidivating post-operative ulcer (RPOU). Particular clinical and etiopathogenic aspects are stressed, such as RPOU manifested exclusively by digestive haemorrhage, pseudo-tumoral RPOU, ulcers recidivating after exclusion resection, and multi-recidivating ulcers. Prophylaxis of RPOU is best achieved by a correct primary intervention for ulcers, and the prophylaxis of the recidives should be achieved by a correct re-intervention. This presumes that a correct resection, or a correct iterative resection should be performed, as well as a correct sub-diaphragmatic vagotomy. In recidivating post-operative ulcers on the duodenal stump an important element is the insufficiency of the resection on theright, and the value is stressed of an extended resection of the stump, associated to vagotomy. In multi-recidivating ulcers after repeated interventions that have been correctly performed, gastrectomy of the total type is considered the best solution.

[Problems in the diagnosis and treatment of intrahepatic lithiasis]. / Probleme privind diagnosticul si tratamentul litiazei intrahepatice

Following the study of 44 cases of intra-hepatic lithiasis the authors have reached these conclusions:--intra-hepatic lithiasis (both primary and secondary) represents 3% of the biliary lithiases;--the characteristic element of the evolution of biliary lithiasis is the so-called "ageing phenomenon" leading to the formation of multiple stones, progressively obstructing the biliary pathways and finally involving the intra-hepatic segments. These are the so-called biliary panlithiases representing 50% of the cases with intra-hepatic lithiasis in the author's statistics;--cholangiography (both intravenous and intra-canalicular) should be considered as completed only when it provides a representation of the entire biliary system;--one cannot speak at present of a "remaining" or "forgotten" hepato-choledocus stone before the exclusion of the intra-hepatic "forgotten" stone;--the significant reduction of "post-cholecystectomy disturbances" depends on the correct diagnosis and treatment of all stones, indifferent of their site of occurrence (extra- and intra-hepatic).

[Significance of residual hepatocholedochal dilatation following principal methods of surgical treatment in benign stenoses of the terminal choledochus]. / Semnificatia dilatatiei reziduale hepatocoledociene, dupa principalele metode de tratament chirurgical al stenozelor benigne de coledoc terminal

Out of 305 cases, diagnosed and operated in the clinic over a period of 14 years, the authors have investigated in 164 of them--controlled between 2 and 14 years after surgery--the residual dilatation of the hepatic segment of the choledocus following the application of the major methods of surgical treatment of benign stenoses of the terminal choledocus duct. In view of reducing the disturbances that might occur after surgery of the biliary pathways, the material was investigated and, in the light of the data from the literature, the conditions are discussed, in which the residual hepato-choledocal dilatation should be considered as pathological, the methods of investigation, the difference between the duodeno-biliary reflux and the jejuno-biliary reflux, the anatomo-pathophysiological basis of a more complete and differentiated surgical therapy, the precautions necessary for avoiding remaining intra-hepatic abscesses that might complicate the postoperative evolution.