[Quantitative microscopic modifications of the diaphragm and the paraesophageal structures in hiatal hernia. Clinical aspects]. / Modificarile microscopice cantitative ale diafragmei si structurilor anatomice periesofagiene în herniile hiatale. Corelatii clinice.

In the last decade has seen an increase in hiatal hernia diagnosis. These issues led us to study and deepen the anatomic substrate of the changes that occur in the diaphragm muscle and periesophageal structures for optimum management of the disorder. The studied material was represented by fragments of the thoraco-abdominal diaphragm and tissues around the esophagus, biopsy sampling by classic open approach or celioscopic in patients with hiatal hernia, compared with a control group. Histological processing was carried out by current or special methods. After qualitative examining of the selected structures, quantification was performed using an interactive digital program. In the adult diaphragm with hiatal hernia was found in percentage volume reduction pillar of the diaphragm muscle fibers, increased the percentage of vascular lumina in the muscle portion of the crura, while the percentage volume of interstitial spaces increase. The changes of the percentage volume of connective tissue are significant, both crura suffering a fibrous transformation of muscle portions. Microanatomic changes are their quantitative objectivity suggest loss of elasticity and reduced functional capacity of diaphragm muscle in hiatal hernias.

[Clinical and therapeutic considerations on a case of benign phyllodes tumor]. / Consideratii clinice si terapeutice asupra unui caz de tumora phyllodes benigna.

Mamary phillodes tumours represent a fairly rare pathology. They can be benign, with a high risk of getting malignant (border line) or already malignant. More than 50% of phillodes tumours are benign and usually appear with women around 45 years old. We present this case for some particular features, with both elements, of either benign or malignant. The course is totally different in the two cases, which raised the issue of the treatment options. This is the case of a 57 years old female patient, who had been admitted with a right mammary tumour, of approximatly 40/50 mm that occupied the lower breast quadrants, with irregular outline, and with necrosis and hemorrhaging zones, mobile on the thorax wall, with right axillary adenopathy, in the latero-thorax group, of 1/2 cm wide, mobile and with a non-tumour aspect. The tumour appeared 1-2 years before and developped very much in the last 2 months when necrosis zones appeared; 3-4 days before presentation to the doctor and bleeding occurred. Intraoperatively, the tumour was fix compared with the back plan, with axillary ganglions being conglomerated, being almost invasive, thus suggesting neoplastic infiltration. The postoperatory histopathological exam with parafine preparation, highlighted the presence of an adenomixofibrom, with parcelled necrosis zones, with inflamatory infiltrate. The harvested biopsies from the axillary ganglions have highlighted a companion adenopathy with inflamatory character.

[Malignant peritoneal mesothelioma]. / Mezoteliom malign peritoneal.

This work presents the case of a hemorrhagic, necrotized peritoneal malignant mesothelioma in a 46-year old man, discovered during the emergency surgery, performed for an acute surgical abdomen/hemoperitoneum. Mesotheliomas are rare neoplasms of the pleura, peritoneum or pericardium, which are frequently associated with exposure to asbestos. The paraclinical investigations (echography) were not able to specify the diagnosis before the operation. The surgical intervention--tumorectomy, electrocoagulation, hemostasis with Gelaspon sponges-- had favourable results.