[Clinical aspects of the post-caustic esophageal stenosis on 116 cases]. / Aspecte clinice ale stenozelor esofagiene postcaustice. Consideratii pe 116 cazuri.

116 cases of post-caustic esophageal stenosis hospitalized in the Emergency Surgical Clinic of Iasi during the period 1982-2004 have been analyzed. The patients' ages, the 4th decade of age (24.13%) prevailed. The alkaline substances prevailed (84.48%). Eight patients benefited from an endoscopic examination in the 15th day from the injury, and presented lesion degree 1-2 C. Progressive dysphagia, retrosternal pain and weight loss-symptoms were in all cases. The most of the patients (65.50%) came for a medical consultation within the first 6 months. The diagnosis and localizing the esophageal stenosis were based on the endoscopic examination and radiology. The single or double stenosis esophagus prevailed. The corrosive substances represent a frequent cause of benign esophageal stenosis.

[Clinical aspects of cardiac stab wounds: report of 20 cases]. / Aspecte clinice ale plagilor injunghiate ale inimii consideratii asupra a 20 de cazuri.

Penetrating cardiac wounds are the most dramatic injuries which need a rapid diagnosis and surgical intervention. This clinical pathology has a high increasing incidence in the whole world. We aimed to present our personal experience in such cases. The study was carried out along a period of 31 years. From 1974 to 2004, 20 patients (mean age, 34 years; 17 male) with penetrating cardiac stab wounds were treated. The initial clinical presentation was cardiac tamponade ("blue injured"-8 patients, 40%), hemorrhagic shock ("white injured"-3 patients, 15%), both being implied with 8 patients (40%), one of the aspects being predominant. One patient was stabile. All patients were immediately transferred to the operating room. The left ventricle was found to be the most frequent site of injury (7 patients, 35%), followed by right atrium (6 patients, 30%), right ventricle (4 patients, 20%), left atrium (1 patient, 5%) and both ventricles (1 patient, 5%). There were 17 (85%) penetrating cardiac wounds, 2(10%) penetrant stab injuries and one (5%) non-penetrant cardiac wound. Cardiorrhaphy was performed in all cases. The postoperative complication was pneumonia in 2 cases. In the present study, the survival rate was significantly high (80%). In conclusion, these promising results suggest that a wound with a severe prognosis may be turned into a relative trauma, harmless for the patients who will survive until surgical admission.

[Traumatic injuries to the spleen in adults]. / Traumatismele splinei la adult.

The management of splenic injuries is still controversial, with an increasing trend toward non-operative treatment. The aim of this study was to assess for patients with splenic traumatic injuries, the treatment methods, the factors contributing in selecting appropriate management and the patients outcomes. Between 1994 and 2003, 77 patients were admitted and treated in our hospital for splenic traumatic injuries. There were 69 blunt (89.61%) and 8 penetrating injuries (10.38%). Nineteen patients were initially proposed for non-operative treatment, eventually only 5 patients (16.49%) were successfully treated (success rate 26.31%). Splenic conservation was used in 6 patients (7.79%; success rate 100%) and splenectomy on 66 patients (85.71%). Indications for laparotomy were: hemodynamic instability (35 patients), peritonitis (9 patients) and the presence of hemoperitoneum and splenic injury (22 patients). Overall mortality was 7.79%, with 4 deaths in splenectomy group and 2 deaths in proposed non-operative group. In conclusion, conservative treatment of splenic injuries can be performed with good results and an increasing number of patients can be treated in this way. For this purpose are necessary a perfect selection of the patients, a surgeon skilled in conservative splenic techniques and good techniques facilities.

[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.

[Treatment of duodenal ulcer by hyperselective vagotomy]. / Tratamentul ulcerului duodenal prin vagotomie hiperselectiva. Experienta noastra pe 100 cazuri.

In the treatment of duodenal ulcer the hyperselective vagotomy is recommended by the authors. On the other hand it has indications and contraindications which must be taken into account. The rational attitude is that of a differentiated surgical treatment, in which the various methods, classical gastrectomy included, find their indication from case to case.