[Severe arterial hypertension due to chronic constitutional hyperadrenalism. Splanchnic sympathectomy and left adrenal medulla sclerosis with 40 percent sodium salicylate (result after 3 years--genetic chemosurgery)].

The case is presented of a male patient hospitalized for severe arterial hypertension determined by chronic constitutional hyperadrenalism. Splanchnic-sympathectomy was performed, associated to medullar sclerosis of the left adrenal with 40% sodium salicylate (genetic chemical surgery). The results after 3 years were good, both clinically and paraclinically.

[Sphincterotomy in the surgical treatment of abscesses of the anorectal region].

In 29 patients with abscesses of the anorectal region the wall of the purulent collection was sectioned not only toward the tegumental surface but also to the anal canal with partial sectioning of the sphincter in 9 of the cases with superficial abscesses, and complete sectioning of the sphincter in the remaining 20 patients that presented with ischio-rectal abscesses, and with deep posterior anal abscesses. No relapse was noted and in none of the cases did anal fistulae or anal incontinence develop. In contrast with the scars that develop following surgery for fistulae, the scars that develop after sectioning of the sphincter for anorectal abscesses are supple and do not lead to deformation of the sphincter.

[Chemical medullosclerosis with 40-percent sodium salicylate, combined with splanchnicosympathectomy, with or without contralateral adrenalectomy, in severe essential arterial hypertension. II. Clinical, paraclinical and technical studies. Results for a period of 2 to 20 years (original concepts and therapy)].

Unilateral medullosclerosis associated with splanchnicosympathectomy was applied in 60 cases of severe essential arterial hypertension. In 21 patients this was associated with contralateral adrenalectomy. No deaths were recorded.

[Severe essential arterial hypertension; the physiopathogenic role of the adrenal medulla. I. Population studies and experimental research].

The authors have carried out a populational study by performing psychomorphological and blood determinations, and have detected the presence of a chronic hyperactivity syndrome of the adrenals in 12,5 percent of the healthy young subjects engaged in various activities that they have investigated. In an experimental study the oxydative processes in the enzymatic cycle of Krebs were cut off by injecting the adrenal medullary area with a 40% solution of sodium salicylate, while the secretion of the adrenal cortex was maintained, as was demonstrated by the unaffected activity of the hexose monophosphate shunt in this tissue. The experimental results demonstrated that the adrenal medullary tissue represents a major pathogenetic link in the complex etiopathogeny of essential arterial hypertension, and this invalidates the role attributed by Volhard (in 1931) to the renal tissue, explaining the failure of haemodialysis, bilateral nephrectomy and kidney transplantation in preventing the recurrence of essential arterial hypertension.

Physiologic and pathogenic role of the adrenal medulla in severe essential arterial hypertension. Populational and experimental investigations. Therapeutic implications.

The syndrome of constitutional chronic hyperadrenalism was detected biochemically by blood cathecholamine assays as well as psychically and morphologically in 12.5% of the young apparently healthy subjects from Bucharest, investigated. Experimentally, the enzymatic cellular oxidative process in the adrenal medulla was blocked by chemical sclerosis of the adrenal medulla with a 40% solution of sodium salicylate (2.

Chemical sclerosis of the adrenal medulla with sodium salyclate (2.5 M) - histopathologic, histoenzymatic, electron microscopic and biochemical studies.

The selective inhibitory effect of sodium salicylate (2.5 M) on the adrenal medulla was investigated histopathologically, histoenzymatically, electron microscopically and biochemically. It was proved that the different behaviour of nicotinamide-adenine dinucleotide (NAD) and nicotinamide-adenine dinucleotide phosphate (NADP) linked dehydrogenases under the action of sodium salicylate can account for the survival of cortical cells, while the medullar ones are necrosed.

[Treatment of duodenal stress ulcer by means of chemical sclerosis of the gastric mucosa induced with a 60 percent glucose solution (results after 1--5 years)].

Sclerosing of the gastric mucosa with a 60% fresh sterile solution of glucose was applied in 60 selected patients with chronic conflictual duodenal ulcers, hyperacidic gastritis by vagal neurogenic hyper-reactivity, associated with ischaemic gastropathy developed on an sympathico-adrenergic background. The immediate operatory results were good. The late results (between 1 and 5 years) were as follows: the clinical, radiological and metabolic results were good in 57 patients.

Variations of catecholamines in mixed shock. Therapeutic implications. Experimental and clinical investigations.

The variations of catecholamines, cortisol and aldosterone in mixed shock (traumatic, hemorrhagic and septic) were studied experimentally and clinically. In the stage of collapse adrenaline decreased by 81.4% and noradrenaline by 62.

[Role of the adrenal medulla in reaction of the body to stress (clinical and laboratory studies and experimental research)].

The authors have carried out a clinical study of acute medico-surgical complications occuring in patients hospitalized following psychical stress, myocardial infarction, operatory shock and after the earthquake. In patients with duodenal ulcers and hyperacidity due to vagal neurogenic origins it was noted the presence of a sympatico-adrenergic constitutional background in 38% of the cases. By applying chemical sclerosis of the adrenals medullary the role of the medullary was demonstrated in the production of acute digestive lesions due to stress, as a result of standard electrical stimulus and of their influence on the bioelectrical reactivity of the brain, on the active learning behaviour by conditioned reaction and on the number of the circulating eosinophils following injections of A.

[Surgical shock. Acute hypocatecholaminemia and therapeutic indications of an adrenocortical vasopressor sympathicolytic drug mixture. Clinical studies and experimental research].

In cases with postoperative shock and collapse a constant fall in the concentration of serum cathecholamines was noted. Thus adrenalin was reduced by 77%, noradrenalin by 86.5%, in direct proportion with the fall in the blood pressure, of the pulse amplitude and with the slowing-down (or the arrest) of the microcirculation.

[Polyps; rectocolic polyposis. Etiopathogenic and anatomoclinical data. Results].

The authors statistic concerns 370 interventions for adenomatous polyps and rectocolic polyposis (105 segmental exereses, 32 total or sub-total rectocolectomies, 233 direct, endo-anal or laparocolotomy electroresections). The necessity is stressed of the early detection of isolated, or of multiple polyps, or of potentially malignant polyposis, either genetically inherited or acquired, and on their radical extirpation from the beginning, an attitude that improved late oncologic prognosis (98% survivals after 5 years).

[Necessary technic. Double ligation of the duodenal stump without plugging].

Gastrectomy with ulcer exclusion, associated to double ligature of the duodenal stump without infundation is a technique easy to perform in ulcers with difficult duodenum. This technique was successfully applied in 34 patients with sub-bulbar chronic duodenal ulcers (with norm- or hypoacidity), complicated by penetrating bilio-pancreatic callous lesions (one case of pancreatic fistula was recorded, that was treated with X-ray therapy). In another 10 patients with complicated ulcers (perforations - 5 cases, bleeding associated with perforation - 2 cases) the authors used the same technique.

Medullosclerosis, contralateral adrenalectomy and splanchnicosympathectomy in severe essential arterial hypertension and thromboangiitis. Part II.

Operations were performed in 58 patients with severe essential hypertension and in 105 patients with Buerger's thromboangiitis. No postoperative deaths were recorded. The mean adrenalinemia value decreased by 70.

[Acute Meckel's diverticulitis perforated by a foreign body].

The authors present the case of a patient with acute, right iliac fossa abdominal syndrome, simulating acute apendicitis. In the course of the intervention it was noted that the syndrome was determined by an acute Meckel diverticulitis, perforated by a foreign body (fish bone). In view of making the diagnosis of acute diverticulitis, that cannot be assessed before surgery, the importance is stressed of the correlation of the clinical aspects with the apendicular lesions found in the course of the operation, and, when there is no satisfactory concordance, careful checking of the cecum becomes necessary, as well as of the right annexe and of the ileon over at least three feet.

[Treatment of duodenal ulcer with chemical sclerosis of the gastric mucosa. Preliminary results].

On the basis of experimental studies and of the results obtained, the authors have applied over the last two years, sclerosis of the gastric mucosa with fresh, sterile solution of hypertonic (66%) glucose in 25 patients with duodenal ulcers and cellular and vagal hyperacidity resistant to medical therapy. Mucosclerosis was associated with gastric drainage in 14 patients with duodenal ulcer complicated by stenosis or hemmorhage. Sclerosis of the gastric mucosa is a physiological intervention because it achieves the sclero-atrophy of the acid-secreting glands and vago-sympatic denervation in the gastric territory, while the storage function of the stomach is maintained.

[Experimental basis for a new surgical-therapeutic method for duodenal ulcer: gastric mucoslerosis].

On the basis of studies carried out by chronic experiments in dogs the authors noted, by clinical, chemical, radiological and histological methods, that the chemical sclerosis of the gastric mucosa performed with a sterile, fresh hypertonic solution of glucose at 60%, injected in the sub-mucosa, represents an intervention which is:--physiological, since the sclero-distrophy is achieved of the acid-secreting glands and "targeted" intra-gastric vago-sympathic denervation, while the storage function of the stomach is maintained;--feasible, since it can be easily performed from the technical view point, without hemorrhagic, perforative intra-operatory risks or hepato-renal toxicity;--fiable, since it was constantly accompanied by good clinical and functional results. The radiological examination of the barium passage in the stomach, antrum, pylorus and duodenum is normal.