Crohn's disease management: conclusions of a comparative study between UK and Romania.

Crohn's disease is a chronic inflammatory condition, which may affect any portion of the digestive tract from the mouth to the anus. It is a chronic medical condition which requires surgery when medical treatment fails or complications such as strictures, sepsis or fistulation develop (1,2,3). We retrospectively studied a group of 19 patients with Crohn's disease from "Coltea" Hospital, Bucharest, Romania, and another group of 16 patients with Crohn's disease from Bedford Hospital UK, all of them having undergone surgery; we compared their preoperative and postoperative treatments, including follow up.It was concluded that the implementation of clinical guidelines and protocols for the management of patients with Crohn's disease is needed in Romania.

Sparing anti-pseudomonas antibiotics in intraabdominal infections.

The progress of surgery allowed the timely source control of the intraabdominal infections (IAIs); the availability and use of the broad-spectrum antibiotics resulted in an important reduction of the morbidity and mortality over the last century. Nevertheless, this pathology remains a major challenge for surgeons, internists, infectious diseases and microbiology specialists. The increased bacterial resistance and its spread within institutions limits the antibiotic treatment options and patients'outcome. This phenomenon is more obvious in Gram-negative bacilli which are the main cause of the IAIs. This paper brings into discussion the criteria which would help reducing the use of anti-pseudomonas antibiotics in the initial empirical treatment when they are not necessary, and also outlines the available therapies for these infections.

[Synchronous gastrointestinal stromal tumor (GIST) and multiple digestive neoplasms, benign and malignant]. / Tumora gastro-intestinala stromala (GIST) asociata sincron cu multiple neoplazii digestive benigne, precursoare si maligne.

Gastrointestinal stromal tumors (GIST) are a broad category of mesenchymal, non-epithelial primary tumors of the digestive tract, located in the wall of hollow viscera, from the esophagus to the anus and often in adjacent mesentery and omentum. They are clinically unpredictable (may be discovered incidentally during an imagistic investigation or during surgery for other pathological entity, or at necropsy) and also have an unpredictable behavior (GISTs with very low risk, with low or moderate malignancy, which have benign histopathologic features but can recurr or can metastasize). The case we present here represents a rare association between a synchronous gastrointestinal stromal tumor (GIST) and multiple gastric benign and malignant tumors.

[Historic review of minimally invasive surgery in Romania--a new surgical era]. / Scurt istoric al chirurgiei miniminvazive in România--o noua era chirurgicala.

The minimally-invasive surgery developed during the last decades, having an important place within the operating techniques of many surgical specialities once high-performing instruments and devices were created. It is represented by laparoscopic, thoracoscopic, arthroscopic and endoscopic techniques (diagnostical and therapeutical). The introduction and development of such techniques at the global level allowed for them to be introduced in our country in a rather short period of time after their usage abroad. This article consists of a brief description of the minimally-invasive surgery both at the global and national level.

[Three centuries of surgery at Coltea Hospital]. / Trei secole de chirurgie la Spitalul Coltea.

The authors present the evolution of surgery at Coltea Hospital during the last three centuries. After a brief history of the Coltea hospital and its masters surgeons, the attention is drawn on the masters efforts to optimize the care, equipment and surgery techniques, things that became of national and world-wide importance.

[Adenoid cystic carcinoma of the breast--two case reports]. / Carcinom adenoid chistic mamar--prezentare a doua cazuri.

Adenoid cystic carcinoma is a rare type of breast carcinoma with a good prognosis. It represents less than 0,1% of breast carcinomas. We present two cases of adenoid cystic carcinoma diagnosed in the Surgical Department of Coltea Hospital in the last 3 years. The first case is a 66 years old patient with a breast tumor that has clinical and imagistic features compatible with a benign diagnosis. The frozen sections established the diagnosis of adenoid cystic carcinoma, confirmed by histopathologic examination of paraffin embedded tissue and immunohistochemistry. The second case is a 68 years old patient with a breast tumor located in the central quadrant of the left breast, with skin infiltration. Preoperatory fine needle aspiration is sugestive of a papillary tumor, so the cytologic exam cannot establish malignancy. The frozen sections established the diagnosis of ductal invasive carcinoma and histopathologic examination of paraffin embedded tissue and immunohistochemistry established the diagnosis of adenoid cystic carcinoma associated with ductal invasive carcinoma grade I and adenomyoepitelioma. The cytology had a false papillary aspect, in fact there was amorphous material contained in pseudoluminal spaces. In both cases the treatment was surgical resection with tumor excision and free resection margins. In the second case lymphadenectomy was also performed.

[Umbilical hernia in adults: laparoscopic approach with prolene mesh--is it a safe procedure?]. / Hernia ombilicala (HO) la adult: plasa de prolene montata laparoscopic este un procedeu eficace?

INTRODUCTION: The laparoscopic approach for umbilical hernia is more and more used, but few results are reported. The aim is to evaluate the efficacy and safety of using the Prolene mesh placed laparoscopically in umbilical hernia treatment. MATERIAL AND METHOD: Between 2004-2006, 21 patients with umbilical hernia, aged of 34 to 77 years, were submitted to intraperitoneal application of a Prolene mesh to cover the umbilical ring. The mesh was sewed by Protack staples or transfascial stitches. Before deflating the patients, the greater omentum was interposed between the mesh and the bowel. It is notice that 8 patients were obese, 6 patients had omental or bowel adhesions to the peritoneal sac and 5 patients had ascites due to liver cirrhosis. The patients were discharged 24 to 48 hours after the operation and followed up for 6 to 12 months. RESULTS: All patients were alive at the end of follow-up, without hernia recurrence or complications due to the Prolene mesh in the abdominal cavity. In 3 patients we registered subcutaneous seromas for 1 to 3 weeks (imposing evacuation by punction) and 5 patients kept a mildly deformed umbilical scar after the cure of large hernias. DISCUSSIONS: In the literature are mentioned the techniques using composite or two-layers meshes. Prolene meshes are not agreed by some authors, for the supposed risk of bowel lesions. In our trial were no such complications. CONCLUSION: Laparoscopic repair using Prolene intraperitoneal mesh in umbilical hernia is a safe, efficient and rapid method, avoiding infections complications in obese or cirrhotic patients.

[The sentinel lymph node technique in colorectal cancer using in vivo dye--utility and limits]. / Ganglionul santinela in cancerul colorectal folosind colorant intravital--utilitate, limite.

The aim of this work is to analyze the importance of sentinel lymph node technique in the treatment of colorectal cancer. There are presented data from literature concerning sentinel lymph node, especially papers about the place of sentinel lymph node method in the treatment of colorectal cancer. This work also shows the experience of Surgical Clinical Department of Coltea Hospital in the use of sentinel lymph node method in colorectal cancer (8 patients with colon cancer and 9 with rectal cancer). There are presented the criteria for inclusion in the study group (26 patients initially proposed for the study) and the exclusion criteria, the diagnostic method using an in vivo dye and the pathology study. The study of the literature and our experience leads to the conclusion that the identification of the sentinel lymph node in colorectal cancer doesn't modify the dissection of the lymphatic area. This procedure may change the adjuvant treatment for colorectal cancer. The discussion is still open concerning the importance of lymphatic micro metastases found by RT-PCR and immunohistochemistry methods. More studies are necessary to clarify these problems.

[Surgical relationship between France and Romania]. / Relatiile chirurgicale româno-franceze.

Because 2006 is "The Year of Francophony", we considered necessary to remember the relationship between France and Romania, focusing on the surgical relationship and on the great Romanian surgeons. We talk, shortly, about the Romanian surgeons formed or specialised in France, about their contribution in the developing of Romanian surgery and the contribution of French surgeons in the developing of Romanian surgery, since 19th century.

[The complications of colostomies]. / Complicatii ale colostomelor.

The evaluation of the frequency of complications that arise after colostomies performed for colorectal and genital neoplasm, and also the treatment possibilities for these complications. In Coltea Hospital, Surgical Department during 1984-2002 there have been admitted and surgically treated 891 patients with colorectal cancers, among which, 484 had rectosigmoidal neoplasm. We have treated 25 patients with complicated genital neoplasm (19 rectovaginal and recto-bladder-vaginal fistulas following cervical cancers, 5 pelvic tumoral blocks following ovarian cancers and a vulvar cancer with local invasion). For all these patients we performed: 25 Hartmann resections, 75 Reybard resections, 73 Dixon resections and 147 rectal amputations, with 294 colostomies (30 iliac anus in continuity-Audrey, 18 on a stick, 232 terminal and 14 cecostomies for protection or decompression). There were 48 complications following the colostomies: 10 cases of stenosis, 14 prolapses, 7 intestinal loop necroses and 17 parastomal hernias, all of them surgically managed. Terminal colostomies and colostomies for protection are still frequently used in surgical departments, having strict indications. Because they are frequently performed as emergencies, at patients with poor biological status they are often enough followed by complications, most of them with little gravity. The complications can be avoided by a proper therapeutic choice and in most cases can be managed with a surgical intervention.

[Therapeutic approach in locally advanced and complicated rectosigmoid and genital cancers]. / Atitudinea terapeutica în cancerele rectosigmoidiene si genitale local avansate si complicate.

Locally advanced and complicated rectosigmoidian and genital cancers raise many therapeutic problems for surgeons. The most frequently used therapeutic methods nowadays are: radiotherapy, chemotherapy, surgical procedures, immunotherapy and other modern methods that aren't in the current clinical use yet. In a trial of 456 patients with locally advanced and complicated rectosigmoidian cancers and 632 patients with genital cancers we performed 573 (52.6%) radical surgical procedures and 515 (47.4%) palliative procedures, 301 (27.6%) of these being permanent colostomy (257 terminal and 44 in continuity). All of the patients received radiotherapy or chemotherapy pre and/or after surgery. The survival was between 5-7 months in the trial of patients with permanent colostomy, between 12-36 months in the trial of patients with palliative surgical procedures and adjuvant treatment and between 5-17 years in the trial of patients with radical surgical procedures and neo- and adjuvant therapy.