Magnetoacoustic Waves and the Kelvin-Helmholtz Instability in a Steady Asymmetric Slab: I: The Effects of Varying Density Ratios.

Recent observations have shown that bulk flow motions in structured solar plasmas, most evidently in coronal mass ejections (CMEs), may lead to the formation of Kelvin-Helmholtz instabilities (KHIs). Analytical models are thus essential in understanding both how the flows affect the propagation of magnetohydrodynamic (MHD) waves, and what the critical flow speed is for the formation of the KHI. We investigate both these aspects in a novel way: in a steady magnetic slab embedded in an asymmetric environment. The exterior of the slab is defined as having different equilibrium values of the background density, pressure, and temperature on either side. A steady flow and constant magnetic field are present in the slab interior. Approximate solutions to the dispersion relation are obtained analytically and classified with respect to mode and speed. General solutions and the KHI thresholds are obtained numerically. It is shown that, generally, both the KHI critical value and the cut-off speeds for magnetoacoustic waves are lowered by the external asymmetry.

Gastrointestinal Stromal Tumors - Diagnosis and Surgical Treatment.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract, previously classified as leiomyomas, leiomyosarcomas, leiomyoblastomas or schwannomas. They are now recognized as a distinct entity with origin in the mesodermal interstitial cell of Cajal, cells that express the c-KIT protein (tirozine kinase receptor). The definitive diagnosis is established by immunohistochemistry, more than 95% of GISTs being positive for CD117. Despite the major progress of chemotherapy, the treatment of choice is surgery, and it implies the complete resection of the tumor. The evolution of these tumors is unpredictable and the prognosis depends on localization, tumor size and mitotic index. Benign tumors have an excellent prognosis after surgery, with a 5 year survival of 90%, while malignant tumors resistant to radiotherapy and chemotherapy have a dismal prognosis even after surgical resection, with a median survival of 1 year. We studied a group of 15 patients diagnosed with TSGI in the Surgery Clinic of the œProf. Dr. Agrippa Ionescu Clinical Emergency Hospital, between 2003 and 2013, following the particularities of presentation, diagnosis and treatment, with focus on the prognostic factors according to available literature data.

Large oesophageal epiphrenic diverticulum resected by transhiatal robotic-assisted approach -- case report.

INTRODUCTION: Epiphrenic diverticula (ED) represent about 20% of oesophageal diverticula. They are considered to be pulsion diverticula, characterized by out pouchings of the oesophageal mucosa originating in the distal 10 cm of the oesophagus and are frequently associated with spastic oesophageal dysmotility. The most frequent clinical manifestations of ED are dysphagia, regurgitations and chest pain. Only symptomatic diverticula should be treated by surgery. The surgical procedure can be performed minimally invasively by robotic approach and consists of diverticulectomy,hiatus calibration and an antireflux procedure, usually adding an esophagomiotomy as well. CASE-REPORT: We present the case of 43-year-old male patient who was admitted for a four-month history of epigastric pain, pyrosis and regurgitations. Preoperative investigation shave shown an epiphrenic diverticulum 6 cm large in diameter.A robotic-assisted transhiatal diverticulectomy with a linear endostapler, hiatal calibration and a Nissen-Rossetti fundoplication were performed using a three-arm da Vinci Robotic System. Operative time was 150 min. Postoperative course was uneventful and the patient was discharged on postoperative day 9, without complications. Ten days later,he came back and was readmitted under emergency status for right chest pain, dyspnoea and fetid breath, being diagnosed with a right empyema secondary to a delayed fistula of the oesophageal suture line. A right minimal pleurotomy and pleural drainage under local anaesthesia were performed and an intravenous antibiotherapy was started with complete remission of symptomatology, the patient remaining asymptomatic after 18 months of follow-up. CONCLUSIONS: Robotic approach is a feasible and safe minimally invasive surgical option in the treatment of selected cases of ED. We consider transhiatal abdominal robotic approach possible in almost all cases of ED, regardless of size,thus avoiding thoracic approach and its possible major complications.The most common serious complication after surgery of ED is post diverticulectomy suture line fistula, but if properly and rapidly diagnosed it could be conservatively treated with very good results.

Occult thyroid carcinoma in our experience -- should we reconsider total thyroidectomy for benign thyroid pathology?

BACKGROUND: The reported incidence rate of occult thyroid carcinoma in patients operated for benign thyroid pathology has been much higher than expected in the last years,especially for multinodular goitre, which raises the question about which should the proper surgical management for these cases be. AIM: To assess the incidence rate of OTC in a single medium volume surgical center and to establish the correct indication for initial surgical management, as well as to identify the benign thyroid pathology most frequently associated with OTC. We also reviewed the relevant scientific literature on this topic. MATERIAL AND METHOD: We conducted a retrospective study in the General Surgery Clinic of "Prof. dr. Agrippa Ionescu" Clinical Emergency Hospital, Bucharest, on a series of 145 patients who underwent surgical interventions for preoperatively diagnosed benign thyroid pathology over a ten year period, between 1st January 2002 - 31st December 2012. All cases of known thyroid cancer were excluded. RESULTS: Incidence rate of occult thyroid carcinoma in our series was 6.9 % (10 out of 145 patients), 80 % of them being diagnosed with multinodular goitre and two cases (20 %) with Hashimoto's lymphocytic thyroiditis. 6.8 % of all patients with multinodular goitre were found to present occult carcinoma,but this association was without statistical significance(p 0.05). Incidence rate of occult cancer among patients with Hashimoto thyroiditis was proved to be as high as 28.6%,statistically significant (p=0.020). The mean size of postoperatively diagnosed occult microcarcinoma was 7 mm, ranging between 3 mm and 14 mm, 90% of them being smaller than 1cm. Histologically, papillary microcarcinoma was found in all cases. The mean age of the patients diagnosed with occult microcarcinoma was 47.8 years with majority of the female gender. The most frequent operation performed was total thyroidectomy (70.8%). Overall morbidity in our series was 6.9% with a 0.7 % mortality rate (1 case). CONCLUSIONS: In our opinion, primary total thyroidectomy should be performed as the procedure of choice for the most part of preoperatively diagnosed benign thyroid pathology and particularly for multinodular goitre and Hashimoto thyroiditis,in order to radically resect all possible foci of aggressive thyroid microcarcinomas.Abbreviations and Acronyms: OTC (Occult Thyroid Carcinoma), PTMC (Papillary Thyroid Microcarcinoma); TT(Total Thyroidectomy), MNG (Multinodular Goitre), GD(Graves' disease), TNG (Toxic Nodular Goitre), FNAB(fine-needle aspiration biopsy).

Port-site metastasis after laparoscopic surgery for colorectal cancer--still a real concern? Case report and review of the literature.

BACKGROUND: The recently published long-term oncological results of the large multicentric randomized prospective trials, such as COST, COLOR, and UK MRC CLASICC, have diminished once more the initial skepticism from the mid '90s, regarding the safety of laparoscopic approach for colorectal cancer surgery. The actual incidence of port-site metastases (PMSs) in the laparoscopic surgery for colorectal cancer is just arround 1%, being statistically simmilar to the wound metastases after open colorectal surgery. We followed up a series of 122 laparoscopic-assisted resections for colorectal adenocarcinoma, 49 for rectal cancer and 73 for colon cancer. The operations were performed at the Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, between 1st January 2002 and 31st december 2008. There was only one case of PMS (0.81%). CASE-REPORT: A 83-year old man developed a recurrent parietal tumor on the site of extraction minilaparotomy, 4 months after laparoscopic-assisted right hemicolectomy for a Dukes C, poorly differentiated (G3) adenocarcinoma of the cecum. DISCUSSIONS: We have reviewed the scientific relevant literature regarding the incidence and multi-factor etiology of PMSs in the laparoscopic surgery for colorectal cancer as well as the methods suggested for prevention of parietal tumour dissemination to the trocar or wound sites. CONCLUSION: PMSs consecutive to laparoscopic surgery for colorectal cancer are no longer a big concern enough to contraindicate this beneficial surgery for oncological reasons. However, PMSs continue to represent a reality which must be taken into consideration by any laparoscopic surgeon. There are different prevention measures that should be applied for reducing the occurence of this possible complication.

[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.

[Stromal tumor of Meckel's diverticulum--a rare source of gastrointestinal bleeding and a real diagnostic problem]. / Tumora stromala de diverticul Meckel--cauza rara de hemoragie digestiva si problema de diagnostic.

Although Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, complications in adults are rare, especially in the elderly. Lower gastrointestinal bleeding as a result of Meckel's diverticulum with ectopic gastric mucosa is unusual among the elderly. The case we report involved a 69 year old man with gastrointestinal hemorrhage found to be due a stromal tumor developed on Meckel's diverticulum. We considered our case interesting because of its rarity and of preoperative diagnosis difficulty.

[The laparoscopic procedures on abdomen with adhesions]. / Interventii chirurgicale laparoscopice pe abdomen cicatricial.

The scar abdomen is more and more seldom a contraindication of the laparoscopic approach. According to Rohr it is classified in scar abdomen after Mac Burney, suprapubic or supraumbilical approach and of the polyoperated patients. Our trial consists in 452 patients with laparoscopic operations consecutive open abdominal surgery (out of the 3900 patients undergoing celioscopic procedures between 1995-2001). The laparoscopic procedure was performed distant to the previous operation in 95.1%, on a neighboring organ to that initially conventionally operated in 4.1% or on the same organ in 3 patients (0.8%). We lead no preoperative fatalities, but the conversational rate was 12% (54 patients), due to the high-risk dissection or to the unsolvable bleedings by laparoscopic means (2 cases). The operative accidents consisted in visceral injuries soloed by laparotomy. Postoperatively we registered 5 port site seronas, 1 deep vein thrombosis and 1 pneumonia. The evolution and the mean hospitalization was the same for the scar abdomen patients with the operative procedure accomplished laparoscopically as for non previously operated patients. The data support the feasibility of the laparoscopic procedures on scar abdomen, using the "open laparoscopy" with a reasonably increased conversational rate.

Insertional polymorphisms of full-length endogenous retroviruses in humans.

Human endogenous retrovirus K (HERV-K) is distinctive among the retroviruses in the human genome in that many HERV-K proviruses were inserted into the human germline after the human and chimpanzee lineages evolutionarily diverged [1, 2]. However, all full-length endogenous retroviruses described to date in humans are sufficiently old that all humans examined were homozygous for their presence [1]. Moreover, none are intact; all have lethal mutations [1, 3, 4]. Here, we describe the first endogenous retroviruses in humans for which both the full-length provirus and the preintegration site alleles are shown to be present in the human population today. One provirus, called HERV-K113, was present in about 30% of tested individuals, while a second, called HERV-K115, was found in about 15%. HERV-K113 has full-length open reading frames (ORFs) for all viral proteins and lacks any nonsynonymous substitutions in amino acid motifs that are well conserved among retroviruses. This is the first such endogenous retrovirus identified in humans. These findings indicate that HERV-K remained capable of reinfecting humans through very recent evolutionary times and that HERV-K113 is an excellent candidate for an endogenous retrovirus that is capable of reinfecting humans today.

A HERV-K provirus in chimpanzees, bonobos and gorillas, but not humans.

Evidence from DNA sequencing studies strongly indicated that humans and chimpanzees are more closely related to each other than either is to gorillas [1-4]. However, precise details of the nature of the evolutionary separation of the lineage leading to humans from those leading to the African great apes have remained uncertain. The unique insertion sites of endogenous retroviruses, like those of other transposable genetic elements, should be useful for resolving phylogenetic relationships among closely related species. We identified a human endogenous retrovirus K (HERV-K) provirus that is present at the orthologous position in the gorilla and chimpanzee genomes, but not in the human genome. Humans contain an intact preintegration site at this locus. These observations provide very strong evidence that, for some fraction of the genome, chimpanzees, bonobos, and gorillas are more closely related to each other than they are to humans. They also show that HERV-K replicated as a virus and reinfected the germline of the common ancestor of the four modern species during the period of time when the lineages were separating and demonstrate the utility of using HERV-K to trace human evolution.

[Particular clinical aspect of breast cancer]. / Forme clinice particulare ale cancerului mamar.

This scientific work intends to evaluate some of the particular clinical aspect of this cancer disease comparing the present medical tendencies with the clinical experience of the Department of Surgery I--Clinical Country Hospital Constantza. The scientific works was performed on a period of 5 years (March 1993-March 1998) on a number of 269 cases of breast cancer diagnosed and treated in our clinic. From the whole group of patients 33 particular cases were extracted: 26 were female patients aged over 70 years, 3 cases of bilateral breast cancer, 2 were breast cancer in association with other neoplasic locations and 2 male breast cancer. These cases were analysed using the: tumor location, clinical staging, hystopathological forms and complex therapy applied. This research work reveals the fact that breast cancer might present some particular aspect to be taken in consideration during the diagnosis and treatment of this frequent disease.

[Analysis of 3100 laparoscopic cholecystectomies]. / Analiza a 3100 colecistectomii laparoscopice.

AIM: To evaluate the results of laparoscopic cholecystectomy (LC) in the 8 years period. PATIENTS AND METHODS: First LC in Coltea Hospital was performed in September 1993 and introduced for treatment of patients with gallbladder disease. From September 1993 to February 2001 LC was performed in 3100 patients. Mean age 51.2 years (ranged from 8 to 87 years) among 2512 women and 588 men. 232 (7.48%) of the cases were patients with acute cholecystitis. Intraoperative cholangiography was performed in 112 cases (3.6%). RESULTS: Conversion to open cholecystectomy (OC) was necessary in 111 patients (3.58%). Operative complications occurred in 16 (0.5%) patients: CBD lesions in 4 (0.12%) patients, bleeding from cystic artery--12 (0.38%) patients. In one patient CBD injuries was recognized at the time of operation and after conversion to OC primary ductal repair was performed. Postoperative complications occurred in 44 (1.41%) patients: a) local infection--in 15 (0.48%) patients (subhepatic abcess-3, wound infection-9. b) bile leakage--in 21 (0.67%) patients. c) haemoperitoneum because of the bleeding: from the abdominal wall at the trocar insertion site--in 2 patients, from a. cystica-one patient. d) obstructive jaundice due to stone in CBD--in 5 patients (endoscopic papillosphincterotomy and stone extraction was performed). There 21 reoperations due to complications: 13 laparatomies and 8 relaparascopies. Two patients (52 and 64 years old) died after LC-mortality 0.06 per cent. Mean hospitalisation day was 3.8. CONCLUSIONS: To prevent iatrogenic CBD injuries correct preparation with a clear identification of the anatomic structures is essential. Relaparascopy and endoscopic retrograde cholangyopancreatography can be successfully used in the treatment of complications after LC.

[ Epidemiological and clinical-therapeutical considerations on 500 operated cases of uterine cervix cancer]. / Consideratii epidemiologice si clinico-terapeutice asupra a 500 cancere col uterin operate.

AIM: Optimization of the treatment on uterine-cervix neoplasia, in a general surgery department. MATERIAL AND METHOD: Between 1984-1999, in Coltea Surgical Department were operated 746 uterine-cervix cancers. We selected two trials of 250 females, similarly regarding age and stadium. The A trial (250 females) were treated and operated 1984-1989, the study being retrospectively, and the B trial (250 females) treated and operated between 1990-1995, the study being prospectively by introduction of cisplatyn and carboplatyne chemotherapy in the advanced steadies. In the B trial, on registrated many mutations with negative epidemiological implications as: the grow the number of new cases, the diminution of immunity, the abandon of the screening, a possible grow of irradiations (Cernobâl accident), and the belated of presentation to medical consultation. RESULTS: The complex treatment, comparative in two trials, show a grow of lifetime, at 5 years in B trial from 82.1-93.4% in the 1st and 2nd steadies, 50.7-60.4% in the II B study and 12.9-28.5% in the III study. In the IV study the grow of lifetime was under 24 month. CONCLUSIONS: The resumption of the screening. Complexes therapeutical protocols for each study. Widely introduction of polichemotherapy in the advanced steadies.

Many human endogenous retrovirus K (HERV-K) proviruses are unique to humans.

BACKGROUND: Endogenous retroviruses contribute to the evolution of the host genome and can be associated with disease. Human endogenous retrovirus K (HERV-K) is related to the mouse mammary tumor virus and is present in the genomes of humans, apes and cercopithecoids (Old World monkeys). It is unknown how long ago in primate evolution the full-length HERV-K proviruses that are in the human genome today were formed. RESULTS: Ten full-length HERV-K proviruses were cloned from the human genome. Using provirus-specific probes, eight of the ten were found to be present in a genetically diverse set of humans but not in other extant hominoids. Intact preintegration sites for each of these eight proviruses were present in the apes. A ninth provirus was detected in the human, chimpanzee, bonobo and gorilla genomes, but not in the orang-utan genome. The tenth was found only in humans, chimpanzees and bonobos. Complete sequencing of six of the human-specific proviruses showed that full-length open reading frames for the retroviral protein precursors Gag-Pro-Pol or Env were each present in multiple proviruses. CONCLUSIONS: At least eight full-length HERV-K genomes that are in the human germline today integrated after humans diverged from chimpanzees. All of the viral open reading frames and cis-acting sequences necessary for HERV-K replication must have been intact during the recent time when these proviruses formed. Multiple full-length open reading frames for all HERV-K proteins are present in the human genome today.

[The place of surgery in the treatment of locally advanced rectal cancer]. / Locul chirurgiei în tratamentul cancerului rectal local avansat.

We considered as local advanced rectal cancer (LARC) tumours invading the serosa or adherent to neighbouring organs, tumoral fistulas, histopathologically proved invasion of regional lymph nodes, peritoneal carcinomatosis with or without neoplastic ascites. Out of 146 rectal cancers submitted to surgery between 1984-1996, 47 had LARC (19 man and 28 women aged of 19 to 88 years) developed in the inferior 2/3 of rectum. We performed in these cases 11 Miles operations, 12 posterior pelvectomies, 3 Dixon resections, 16 colostomies and 5 exploratory laparotomies. To these were associated 4 partial cystectomies, 4 anexectomies, 4 partial enterectomies and 2 excisions of hepatic metastasis. In 27 patients adjuvant or neoadjuvant therapy was associated. We registered 3 deaths, 6 parietal infections and 1 stercoral fistula. Postoperative survival was 3-6 months for 12 patients, 6-12 months for 13 patients, 1-2 years for 6 patients. After the complex treatment 6 patients were alive at 5 years. Surgery is the essential therapeutic act of LARC. Chemo/radiotherapy association increases the survival, but not significantly.

[Acute nonbiliary and nontraumatic pancreatitis. The diagnostic and treatment characteristics]. / Pancreatite acute nonbiliare si netraumatice. Particularitati de diagnostic si tratament.

Deeper knowledge of the etiopathogenesis of acute pancreatitis and the possibility to estimate the extend and gravity of pancreatic and peripancreatic lesions determined essential fluctuations in treatment evolution. Etiology of nonbiliary and nontraumatic A.P. recognises in the first place alcoholism (20-25% of A.P.) and in the second place less common causes such as: hypercalcemic states, hyperlipidemia (about 5-10% of A.P.). Diagnosis of nonbiliary A.P. leans upon: antecedents of chronic alcoholism, alteration on liver function tests and serum put levels and the results of cholecystocholangiography, abdominal ultrasonography and duodenum tubing. These reveal the absence of gallstones, cholesterolosis or anomalies of papilla of Vater (sphincter of Oddi). A number of 128 patients with acute pancreatitis were admitted to the clinic in the period 1984-1994 from which 48 with a non-biliary and non-traumatic. A complex medical treatment was applied to all patients but only 25 responded favourably, the remaining 23 necessitating surgical intervention, which was effected on de-shocked and re-equilibrated patients, diminishing thus the number or repeat interventions in the complications which may appear in such cases. Thus postoperative mortality fell from 58, 33 to 30, 76.

[The need for and efficacy of biliary diversions in icterogenic cancers of the pancreatic head]. / Necesitatea si eficacitatea derivatiilor biliare în cancerele icterigene ale capului pancreasului.

The authors present the experience of the clinic on a group of 26 patients admitted and operated in the Clinic of Surgery, the Coltea Hospital, during 1984-1987. The paper reports, in general, on the indications for biliary derivations and then specifies the morphopathological situations met intrasurgically. Their correlation with the indices of postsurgical morbidity (12.5%), postsurgical mortality (0.8%) and length of postsurgical survival (8.2 months) shows their efficiency.

[Criteria of the indications for surgery in chronic noncalculous cholecystopathies]. / Criterii de indicatie operatorie în colecistopatiile cronice nelitiazice.

The authors present their personal experience on the basis of a retrospective analysis of 127 cases of nonlithiasic cholecystopathies operated between 1984 and 1987. Clinical and radiologic criteria were analyzed, that have led to surgery, and conclusions reflect the postoperative results.