Types of radical hysterectomies : From Thoma Ionescu and Wertheim to present day.

The treatment for cervical cancer is a complex, multidisciplinary issue, which applies according to the stage of the disease. The surgical elective treatment of cervical cancer is represented by the radical abdominal hysterectomy. In time, many surgeons perfected this surgical technique; the ones who stood up for this idea were Thoma Ionescu and Ernst Wertheim. There are many varieties of radical hysterectomies performed by using the abdominal method and some of them through vaginal and mixed way. Each method employed has advantages and disadvantages. At present, there are three classifications of radical hysterectomies which are used for the simplification of the surgical protocols: Piver-Rutledge-Smith classification which is the oldest, GCG-EORTC classification and Querlow and Morrow classification. The last is the most evolved and recent classification; its techniques can be adapted for conservative operations and for different types of surgical approaches: abdominal, vaginal, laparoscopic or robotic.

Postoperative surgical complications of lymphadenohysterocolpectomy.

UNLABELLED: Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. METHODS AND RESULTS PATIENTS WERE DIVIDED ACCORDING TO THE TYPE OF SURGERY PERFORMED AS FOLLOWS: for cervical cancer - group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% II).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% II) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer. ABBREVIATIONS: PRS- Piver Rutledge-Smith, II- class II, III- class III.

[Latest approaches in the surgical treatment of cutaneous malignant melanoma]. / Actualitati în tratamentul chirurgical al melanomului malign cutanat.

Malignant melanoma is a disease with an unpredictable evolution. Detected in stage I and II has a great chance to cure, if it is correctly treated: excisional biopsy with safety margins in accordance with tumor thickness. Lymphoscintigraphy with sentinel node identification and biopsy became compulsory for staging malignant melanoma, the role of complete lymphadenectomy would be established by publishing the MSLTII data. The sentinel node is analysed using more and more sophisticated techniques (RT-PCR) in order to detect isolated tumoral cells, although their clinical significance is not known yet. Metastases occurrence is a dramatic phenomenon because chemotherapy, radiotherapy or biologic therapy have insignificant results. The only therapeutic modality which may increase survival in this situation is surgery for some carefully selected patients.

Interleukin-2 alterations in the immune status of patients with mammary neoplasm.

Immune control is achieved by the balance between tumour reduction mechanisms and the "immunological creeping" phenomenon. The purpose of this study was to look into the alterations of the immune effector component in the case of mammary tumours. The study included 42 cases of women with a clinical diagnosis of mammary tumour, initially referred for surgery, with a mean age of 45.07 (18-65 years of age). Neither radiotherapy nor chemotherapy had been given to the patients before surgery. Histopathological examination performed intraoperatively as well as later, under paraffin, revealed 12 cases of malign tumours. The control group consisted of 18 women (blood donors), apparently healthy, with a mean age of 41 (30-49 years of age). In both groups, the immune status was assessed by means of: lymphocyte counts, T-lymphocyte counts (TL), rosetting, lymphocyte blastic transformation test (BLT) under the action of polyclonal mitogens, immunoglobulin dosing and Interleukin-2 (IL-2) determination in lymphocyte cultures stimulated with mitogens. The conclusion of our results has been that even in the less advanced stages of mammary cancer, there occur alterations of the immune response represented by: A decrease in the total number of lymphocytes, especially through a decrease of the TL number; A decrease of the lymphocyte blastic transformation index on stimulation with PHA; A decrease of IL-2 concentration in cultures stimulated with mitogens through the impairment of the TL CD4+ (TL Helper) function. The decrease of IL-2 production capacity influences the transmission of the immune message to the cytotoxic TL and thus impairs the cytotoxic effector component whose role is to remove tumoral cells. Evidence of IL-2 involvement in the immunodeficiency of mammary cancer patients could prove useful for diagnosis purposes and could plead in favour of the therapeutic potential of this interleukin.