Dimitrie Grama - Academia.edu (original) (raw)

Papers by Dimitrie Grama

© 2004 Hanief et al; licensee BioMed Central Ltd. This is an open-access article distributed unde... more © 2004 Hanief et al; licensee BioMed Central Ltd. This is an open-access article distributed under the terms of the Creative Commons Attribution License

World J Surg Oncol, 2004

Background: Hürthle cell carcinoma is a variant of follicular cell carcinoma of thyroid. It may p... more Background: Hürthle cell carcinoma is a variant of follicular cell carcinoma of thyroid. It may present as a low-grade tumour or as a more aggressive type. Prognosis depends upon the age of the patient, tumour size, extent of invasion and initial nodal or distant metastasis. Patient and methods: The case of Hürthle cell carcinoma is reported in a 79-year-old man who presented with a rapidly increasing lump on the left side of his neck, having had a right hemithyroidectomy for colloid goitre 24-years-ago. Fine needle aspiration cytology confirmed the presence of Hürthle cells, raising the possibility of a Hürthle cell neoplasm. The patient underwent staging and surgery. Histology showed Hürthle cell carcinoma and the patient underwent adjuvant therapy. The literature on Hürthle cell neoplasms is reviewed. Conclusions: Fine needle aspiration cytology may recognise Hürthle cell lesion but final diagnosis of carcinoma depends upon histological confirmation of vascular or capsular invasion. Staging and surgery in Hürthle cell carcinoma are similar to follicular carcinoma of thyroid with favourable outcome despite the controversy regarding the histological classification and adjuvant therapy. Elderly patients with Hürthle cell carcinoma need to be made aware of their poorer prognosis and should be offered more radical treatment.

World Journal of Surgical Oncology, 2004

Hürthle cell carcinoma is a variant of follicular cell carcinoma of thyroid. It may present as a ... more Hürthle cell carcinoma is a variant of follicular cell carcinoma of thyroid. It may present as a low-grade tumour or as a more aggressive type. Prognosis depends upon the age of the patient, tumour size, extent of invasion and initial nodal or distant metastasis.

Acta Radiologica, 1990

Eleven patients with biochemically confirmed endocrine pancreatic tumours were examined with intr... more Eleven patients with biochemically confirmed endocrine pancreatic tumours were examined with intra-arterial (i.a.) dynamic computed tomography (CT) and angiography preoperatively. Seven of the patients suffered from the multiple endocrine neoplasia type 1 (MEN-1) syndrome. All patients were operated upon and surgical palpation and ultrasound were the peroperative localization methods. Of the 33 tumours which were found at histopathologic analysis of the resected specimens in the 11 patients, 7 tumours in 7 patients were correctly localized by both i.a. dynamic CT and angiography. Six patients with MEN-1 syndrome had multiple tumours and this group of patients together had 28 tumours, of which 5 (18%) were localized preoperatively by both CT and angiography. I.a. dynamic CT, with the technique used by us, does not seem to improve the localization of endocrine pancreatic tumours, especially in the rare group of MEN-1 patients, as compared with angiography.

Acta Oncologica, 1991

The surgical treatment of endocrine pancreatic lesion in the multiple endocrine neoplasia syndrom... more The surgical treatment of endocrine pancreatic lesion in the multiple endocrine neoplasia syndrome type 1 (MEN-1) has remained a controversial issue. Histologic studies have revealed that the pancreatic lesions generally consist of numerous microadenomas, spread throughout the pancreas, together with occasional larger tumors. The patients may also harbor multiple, mainly gastrin secreting, duodenal microadenomas. A total pancreatectomy/duodenectomy should theoretically be needed for cure, but has not been recommended due to the associated mortality and morbidity, considering also the favorable prognosis of most MEN-1 patients. When pancreatic involvement in MEN-1 is biochemically diagnosed efforts should be made to localize the lesions by computed tomography, angiography and, in some patients, also transhepatic portal vein catheterization and venous sampling (PTP). Hypergastrinemia and the Zollinger-Ellison syndrome (ZES) generally constitute two-thirds of the clinically detected pancreatic lesions in MEN-1. Surgery may be undertaken in ZES-MEN-1 patients with focal lesions visualized by radiology or PTP in order to minimize the risk of malignant development in a gross tumor. Patients with insulin excess and hypoglucemia as well as the rare vipoma patient may, even in the absence of radiologically visualized tumors, be subjected to exploration, and these patients are usually found to harbor one or several gross tumors. The more frequent clinically silent, mainly PP-producing tumors should be removed when visualized by radiology. However, indications for surgery also have to emphasize an unusually malignant behavior in certain kindreds and patients may thus have to be explored when only biochemical data indicate the presence of pancreatic lesions. Pancreatic operations in MEN-1 should generally include a corpus and tail resection, together with enucleation of lesions in the pancreatic head, and in addition to that a careful duodenal exploration. Intraoperative ultrasound examination appears to be of considerable value by its ability to reveal also smaller lesions which may escape palpation.

Journal of Internal Medicine, 1995

Abstract. The efficiency of pancreatic tumour localization was prospectively evaluated in 12 cons... more Abstract. The efficiency of pancreatic tumour localization was prospectively evaluated in 12 consecutive patients with multiple endocrine neoplasia type 1 (MEN1), who were subjected to extirpation of 56 islet cell neoplasms of 0.2–4 cm in diameter (mean 0.8 cm) during pancreatic resection and enucleation. Computed tomography, angiography of the coeliac trunc and superior mesenteric artery, and percutaneous ultrasound correctly localized 7–12% of the tumours and 21–37% of the 19 lesions measuring at least one centimetre in diameter. Transhepatic portal vein sampling correctly located tumour sites in the proximal or distal portions of the pancreas in four out of six patients, but demonstrated unsatisfactory specificity. Intra-operative ultrasound and bidigital palpation of the pancreas had overall sensitivities of 86 and 45%, respectively, and eight lesions below 0.3 cm in diameter remained undetected with intraoperative ultrasound. It is concluded that diagnosis of endocrine pancreatic neoplasms is biochemical in MEN1 and that broad screening of tumour markers efficiently reveals pancreatic involvement decades before the development of a clinically overt disease. Intra-operative ultrasound is a requisite for pancreatic endocrine surgery in MEN1, and it obviates the need for conventional pancreatic imaging unless a pre-operative search for metastatic disease and anatomical aberrations is considered important.

World Journal of Surgery, 1992

Among 33 patients with endocrine pancreatic tumors due to multiple endocrine neoplasia type 1 (ME... more Among 33 patients with endocrine pancreatic tumors due to multiple endocrine neoplasia type 1 (MEN-1), 19 (58%) patients had hypergastrinemia, 7 (21%) patients had hyperinsulinism, and 7 (21%) patients had clinically non-functioning lesions. At least one gross tumor was found in all patients undergoing pancreatic surgery, including those with negative localization studies prior to operation. The patients also had additional macroscopic tumors as well as numerous microadenomas, and the lesions frequently were positive for immunostaining with multiple hormones, mainly pancreatic polypeptide, insulin, glucagon, and somatostatin. Duodenal endocrine lesions were found in 4 of 5 investigated patients and stained with gastrin and somatostatin antibodies. Distal, mainly subtotal pancreatic resection, was performed in 18 patients, eventually combined with caput tumor enucleation or duodenotomy, while a few patients underwent only tumor enucleation or a Whipple procedure. The long-erm outcome of operation was most favorable in patients with hyperinsulinism; only 1 patient had clinical recurrence. Patients with hypergastrinemia experienced only transitory lowering of serum gastrin values after pancreatic surgery and 47% of them had or developed metastases. Such tumor spread was seen in 57% of the patients with non-functioning lesions. Nine patients died from progressive tumor disease during follow-up. Consistent with previous studies, we found that surgery is indicated in MEN-1 patients with hyperinsulinism even if a lesion is not visualized by radiology. In addition, these indications should be extended to also include patients with only biochemical markers of disease, including elevations of gastrin, as these indicate the presence of gross tumors. This strategy should be applied especially in patients with aggressive family histories to possibly reduce the risk of malignant tumor progression. Parmi 33 patients ayant une tumeur pancréatique endocrine due à une néoplasie endocrine multiple de type 1 (MEN-1), 19 (58%) avaient une hypergastrinémie, 7 (21%) un hyperinsulinisme et 7 (21%) une lésion cliniquement muette. On a mis en évidence au minimum une grosse tumeur chez tous les patients, y compris chez ceux dont les examens préopératoires de dépistage tumoral étaient négatifs. Les patients étaient également porteurs de tumeurs macroscopiques et de nombreux microadénomes. Les lésions montraient souvent un immunomarquage positif pour de multiples hormones, principalement le polypeptide pancréatique, l'insuline, le glucagon et la somatostatine. Des lésions endocrines duodénales furent retrouvées chez 4 des 5 patients explorés; elles montraient un immunomarquage avec les anticorps angigastrine et anti-somatostatine. Une résection pancréatique distale, le plus souvent subtotale, a été réalisée chez 18 patients. Elle était éventuellement complétée par une énucléation tmorale de la tête ou par une duodénotomie. Peu de patients ont bénéficié d'une simple énucléation ou d'une intervention de Whipple. L'évolution postopératoire à long terme a été plus favorable en cas d'insulinome puisque seul un patient a eu une récidive clinique. Les patients atteints de gastrinome n'ont présenté que transitoirement une diminution des taux sériques de gastrine après la chirurgie pancréatique. Quarante sept pour cent de ces patients avaient ou ont développé des métastases contre 57% des patients porteurs de lésions sans traduction clinique. Neuf patients sont décédés en raison de l'extension tumorale au cours du suivi. Conformément à des suggestions antérieures, la chirurgie semble indiquée chez les patients atteints de MEN-1 avec hyperinsulinisme même si la radiologie ne visualise pas de lésion. Mais cette indication peut être élargie aux patients dont seuls les paramètres biologiques sont en faveur d'une grosse tumeur (dont l'hypergastrinémie). Cette stratégie pourrait convenir particulièrement aux patients ayant des antécédents familiaux importants; elle permettrait peut-être de réduire le risque d'extension tumorale. Entre 33 individuos con tumores pancréaticos endocrinos como componente del síndrome de neoplasia endocrina múltiple tipo 1 (NEM-1), 19 pacientes (58%) tenían hipergastrinemia, 7 (21%) hiperinsulinismo y 7 (21%) lesiones clínicas “no funcionantes”. En la totalidad de los pacientes sometidos a cirugía pancreática fue hallado por lo menos un tumor, incluso en aquellos con examenes de localización negativos anteriores a la operación. Estos pacientes también albergaban tumores macroscópicos, así como numerosos microadenomas; con frecuencia las lesiones demostraron inmunocoloración con diferentes hormonas, principalmente polipéptido, insulina, glucagón y somatostatina. Se encontraron lesiones endocrinas duodenales en 4 de cada 5 pacientes investigados, las cuales colorearon con gastrina y anticuerpos a la somatostatina. Se practicó resección pancreática distal (principalmente resección subtotal) en 18 pacientes, eventualmente combinada con enucleación del tumor (cuando éste se hallaba ubicado en la cabeza del páncreas) o duodenectomía; solamente unos pocos pacientes fueron sometidos a simple enucleación del tumor o al procedimiento de Whipple. El resultado a largo plazo fue más favorable en los pacientes con hiperinsulinismo, puesto que sólo uno presentó recurrencia clínica. Los pacientes con hipergastrinemia exhibieron apenas una disminución transitoria de los valores de gastrina sérica luego de la cirugía pancreática. Cuarenta y siete por ciento del conjunto tuvo o desarrolló metástasis, en tanto que la extensión local del tumor se presentó en 57% de los casos con lesiones no funcionantes. Nueve pacientes murieron por progresión de la neoplasia en el curso del seguimiento. En acuerdo con sugerencias previas, se considero quo la cirugía está indicada en pacientes con NEM-1 e hiperinsulinismo, aún en los casos en que no se visualiza radiológicamente la lesión, pero que la indicación puede ser ampliada para incluir también pacientes con sólo marcadores bioquímicos, tales como niveles elevados de gastrina, indicativos de la presencia de tumores macroscópicos. Esta estrategia debe ser aplicada principalmente en aquellos pacientes con historia familiar agresiva, con lo cual tal vez se reduce el riesgo de progesión maligna del tumor.

World Journal of Surgery, 1992

Eighty-five patients with endocrine pancreatic tumors associated with clinical syndromes of hormo... more Eighty-five patients with endocrine pancreatic tumors associated with clinical syndromes of hormone excess were retrospectively analyzed regarding symptomatology, means of diagnosis, and results of surgical and medical treatment during follow-up of 3–18 years (median 8 years). The combination of angiography and computed tomography was most successful in pre-operative localization of both primary tumors and metastases. Surgery provided long term cure in 39 of 44 patients with benign islet cell lesions, the majority having insulinomas. Forty-one patients had malignant tumors, which at the time of diagnosis or operation were associated with liver and/or regional lymph gland metastases in 56% and 24%, respectively. Sixteen patients with metastatic disease and/or very large tumors were considered inoperable, 5 patients underwent palliative resection of their malignant tumors, while grossly radical tumor removal was accomplished in 20 patients. Long-term cure was achieved in 5 patients by excision of primary tumors and localized liver or lymph gland metastases. Half of the patients, particularly those with insulinoma, gastrinoma, or vipoma, showed response to streptozotocin, in combination with other cytostatics, for a median of 24 months or a response to interferon for a median of 10 months. The overall 5-year and 10-year survival among the patients with malignant islet cells tumors was 54% and 28%, respectively. Absence of liver metastases at time of operation/diagnosis, smaller size of the primary tumor, grossly radical tumor resection as well as response to medical therapy predicted the more favorable survival. Les 85 patients atteints de tumeur pancréatique endocrine associée à un syndrome clinique endocrinien ont fait l'objet d'une étude rétrospective portant sur les symptômes, les moyens diagnostiques et les résultats des traitements, chirurgical et médical, au cours d'un suivi allant de 3 à 18 ans (moyenne: 8 ans). L'association d'une angiographie et d'une tomodensitométrie était plus efficace pour localiser en préopératoire à la fois la tumeur primitive et les métastases. La chirurgie a permis la guérison de 40 patients sur 44 porteurs de tumeur bénigne langerhansienne, en majorité un insulinome. Quarante et un patients avaient une tumeur maligne qui, au moment du diagnostic ou lors de l'intervention, s'était compliquée de métastases hépatiques et/ou ganglionnaires locorégionales dans 56 et 24% des cas respectivement. Seize patients présentant une tumeur disséminée et/ou volumineuse ont été considérés comme inopérables; 5 patients ont eu une résection palliative de la tumeur maligne tandis que 20 patients ont pu bénéficier d'une exérèse à peu près radicale de leur tumeur. Une guérison à long terme a même été obtenue chez 5 patients grâce à l'exérèse de la tumeur primitive et des métastases hépatiques et ganglionnaires. La moitié des patients, essentiellement porteurs d'insulinome, de gastrinome ou de vipome ont eu des résponses à la streptozotocine, en association à d'autes cytostatiques pendant une moyenne de 24 mois ou en association à l'interféron pendant une moyenne de 10 mois. La survie globale à 5 et 10 ans chez les patients atteints de tumeur maligne était respectivement de 54 et 28%. L'absence de métastases hépatiques au moment de l'intervention ou du diagnostic, la petite taille de la tumeur primitive, l'exérèse radicale de la tumeur aussi bien que la réponse au traitement médical sont des éléments prédictifs de meilleure survie. Ochenta y cinco pacientes con tumores pancreáticos asociados con síndromes clínicos de exceso hormonal fueron sometidos a un estudio retrospectivo en lo referente a sintomatología, métodos de diagnóstico utilizados y resultados del tratamiento quirúrgioco y médico en el curso de un seguimiento de 3–18 años (media 8 años). La combinación de angiografía y tomografía computadorizada apareció como el método más eficaz para la localización preoperatoria tanto de los tumores primarios como de las metástasis. La cirugía produjo curación a largo plazo en 40/44 pacientes con lesiones benignas de las células insulares, insulinomoas en su mayoría. Cuarenta y un pacientes tenían tumores malignos que en el momento del diagnóstico o de la operación aparecieron asociados con metástasis al hígado y/o los ganglios linfáticos regionales, 56% y 24% respectivamente. Dieciseis pacientes con metástasis y/o tumores enormes fueron considerados inoperables; en 5 se realizó resección paliativa y en 20 se practicó la resección macroscópica radical del tumor. Se obtuvo curación a largo plazo aun en 5 pacientes con enfermedad avanzada mediante la resección de los tumores primarios y de las metástasis hepáticas localizadas o de las metástasis ganglionares. La mitad de los casos, y esencialmente los de insulinoma, gastrinoma o vipoma, exhibieron respuesta bioquímica a la Estreptozotacina en combinación con otros agentes citostásicos, durante un periodo medio de 24 meses, o al interferón durante un periodo medio de 10 meses. La tasa global de sobrevida a 5 y 10 años en los pacientes con tumores malignos de células insulares fueron de 54% y 28% respectivamente. La ausencia de metástasis hepáticas en el momento de la operación/diagnóstico, un tamaño menor del tumor primario, la resección macroscópica radical y la respuesta a la terapia médica, fueron todos factores de predicción de una sobrevida favorable.

British Journal of Surgery, 1994

Laparoscopic cholecystectomy has rapidly become established as the treatment of choice for cholec... more Laparoscopic cholecystectomy has rapidly become established as the treatment of choice for cholecystolithiasis. There is very little evidence, however, to support the claimed benefit to patients. In the present study 30 consecutive patients below the age of 65 years without acute cholecystitis and with no signs of common bile duct stones were randomized to laparoscopic or conventional open eholecystectomy. Median (interquartile range) intravenous consumption of pethidine with a patientcontrolled injection device between 13 and 24 h after surgery was 125 (62–175) mg in patients who underwent the laparoscopic procedure and 200 (150–250) mg in those who had open operation. Urinary adrenaline and cortisol levels as well as those of plasma glucose, C-reactive protein and interleukin 6 were increased after surgery in both groups of patients, but without any significant difference between them. The mean(s.d.) duration of postoperative hospital stay (2·8(0·8) versus 1·8(0·6) days) and sick leave (24·0(4·4) versus 11·7(4·1) days) was significantly longer with open than laparoscopic cholecystectomy. The findings demonstrate obvious advantages of laparoscopic surgery as regards postoperative pain and convalescence, although factors reflecting the magnitude of trauma did not differ.

World Journal of Surgery, 1990

In a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas... more In a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas operated on in 15 centers were collected. In these 396 patients, 419 laparotomies (375 primary procedures and 44 reoperations) were performed. The rate of unnecessary laparotomies was 1.7%. Complications occurred after 132 operations (31.5%), requiring 27 reinterventions (6.4%). Ten (2%) patients died within 30 days of surgery. The success rate of first procedures in the centers was 94.9%. After reoperation, all but 2 (99.5%) of these patients were cured. The overall cure rate including those patients who had their primary operations elsewhere was 97.5%. Compilant les dossiers de 15 établissements internationaux, nous avons colligé les données concernant 396 patients présentant un insulinome bénin unique ou multiple, opérés. Chez ces 396 patients, 419 laparotomies (375 interventions de première intention et 44 reprises) ont été effectuées. Le taux de laparotomie inutile était de 1.7%. Des complications sont intervenues à la suite de 132 opérations (31.5%), nécessitant 27 réinterventions (6.4%). Dix (2%) patients sont morts dans les trente jours après l'acte chirurgical. Le taux de succès des interventions de première intention dans les centres de l'étude était de 94.9%. Après réinterventions, tous les patients sauf 2 (99.5%) ont été guéris. Le taux global de guérison, y compris les patients ayant été opérés une première fois ailleurs, était de 97.5%. En una revisión multiinstitucional se recolectaron los datos sobre 396 pacientes con insulinomas benignos solitarios o múltiples operados en 15 centros. En estos 396 pacientes se efectuaron 419 laparotomías (375 procedimientos primarios y 44 reoperaciones). Se registró una tasa de laparotomías innecesarias de 1.7%; se presentaron complicaciones después de 132 operaciones (31.5%), las cuales requirieron 27 reintervenciones (6.4%). Diez (2%) pacientes murieron dentro de los primeras 30 días después de la cirugía. La tasa de éxito del procedimiento primario realizado en estos centros fue 94.9%. Después de las reoperaciones la totalidad de los pacientes, menos 2 (99.5%), fueron curados. La tasa global de curación, incluyendo los que tuvieron su operación primaria por fuera de los centros del estudio, fue 97.5%.

Books by Dimitrie Grama

Supliment -Jurnal Israelian de vacanță · Jul 4, 2023, 2023

MILCHAMA* * (Război în ebraică) Poezii inedite, ricoșeuri și ricercare, scrise de umani (100%).... more MILCHAMA*
* (Război în ebraică)
Poezii inedite, ricoșeuri și ricercare, scrise de umani (100%).
Imagini: AI (90%), Beatrice Bernath, SAGA 2023
Dublin under dragon attack

participă - Adrian Grauenfels. CERASELA TOFAN DORVAL. Marcel Lupu. Dimitrie Grama. Daniela... more participă -
Adrian Grauenfels.
CERASELA TOFAN DORVAL.
Marcel Lupu.
Dimitrie Grama.
Daniela Toma.
Gabi Schuster.
Christian W. Schenk.
Julia Dragomir.
Emanuel Pope.
Eran Bar Ghil
Mariangela Gualtieri
Javier Lostalé.
Alfred Poplingher.
William Gay

O culegere de poezii din volumele publicate anterior de dr. Dimitrie GRAMA Ebook Editura SAGA 2022

World J Surg Oncol, 2004

World Journal of Surgical Oncology, 2004

Acta Radiologica, 1990

Acta Oncologica, 1991

Journal of Internal Medicine, 1995

World Journal of Surgery, 1992

British Journal of Surgery, 1994

World Journal of Surgery, 1990

Supliment -Jurnal Israelian de vacanță · Jul 4, 2023, 2023

O culegere de poezii din volumele publicate anterior de dr. Dimitrie GRAMA Ebook Editura SAGA 2022