[Completion gastrectomy associated with pancreaticoduodenectomy]. / Totalizarea gastrectomiei asociata cu dudenopancreatectomie cefalica.

The authors present the case of a male patient, aged 56, operated (partial gastrectomy) for peptic ulcer 20 years ago, who is admitted for epigastric pain and distension, frequent vomiting, asthenia and weight loss. Physical examination, barium meal and upper digestive endoscopy with biopsy established the diagnosis of carcinoma of the gastric stump, due to malignant transformation of adenomatous polyps, with duodenal invasion. Completion of gastrectomy and pancreaticoduodenectomy was performed, with good postoperative results. Although the extent of resection may appear excessive, our attitude was justified by the features of the lesion and good biological condition of the patient.

[Factors which may influence the surgical outcome in myasthenia gravis]. / Factori ce influenteaza rezultatele tratamentului chirurgical în miastenia gravis.

OBJECTIVE: This study intends to assess the factors which may influence the surgical outcome in myasthenia gravis. METHOD: 52 myasthenic patients were operated on in the IIIrd surgical unit, Iasi, undergoing extended thymectomy through a complete longitudinal sternotomy during a period of 21 years (1980-2001), the surgical outcome being variable. The following factors: age, clinical stage (Osserman classification), the history length and the histopathology of the specimen were analysed in respect with the surgical outcome which varied from complete remission and clinical improvement till no effect and death. Out of 52 patients, 28 were under the age of 30 years and 24 above 30 years of age. 5 patients were operated on in the first clinical stage, 34 in the second clinical stage, 10 in the third stage and 3 in the fourth. 21 patients had had under 1 year history of the disease, 11 patients under 2 years and 20 patients over 2 years. 40 cases presented non-tumoral pathology of the thymus gland and 12 cases presented thymomas. RESULTS: The best surgical results were recorded in patients under 30 years of age, operated in the first and second clinical stage, with a history under 1 year and non-tumoral pathology of the thymus. CONCLUSION: Myasthenia gravis is the only one acquired autoimmune disease in which surgical treatment offers the chance of complete remission if the following criteria are encountered: young patient, short history, initial clinical stage and non-tumoral pathology.