The Role of Ileostomy in the Prevention and Treatment of Anastomotic Leakage after Elective Rectal Cancer Surgery - A Retrospective Analysis of Specific Risk Factors, Outcomes, and Complications.

Background: The objective of this paper is to highlight the role and place of ileostomy from the perspective of the risk of anastomotic leakage (AL). Materials and method: This was a retrospective study of 74 (46.54%) low and ultra-low anterior resections from 159 cases of rectal cancer operated on in a seven-year interval (2015 - 2021). The cases were divided into two groups: Group A with protective ileostomy (47 cases = 63.51%) and Group B without protective ileostomy (27 cases = 35.49%). Results: The type of anastomosis was low colorectal for 15 cases and ileorectal for two cases, both in Group A, with either mechanical or manual sutures. Continuous loop ileostomy was the only fecal diversion procedure used for protection. The ileostomy-specific complications recorded in Group A were peristomal skin lesions (8 cases), early peristomal hernia (2 cases), and severe dehydration with acute renal-insufficency (7 cases). The closure of the ileostomy was performed in 42 cases (89.36%), with the time between the primary operation and the closure being 4.28 months on average, with limits between 12 days and 10 months. AL treatment was conservative in 13 (76.47%) cases and surgical in four cases, with the types of operations performed at reintervention being take-down of the anastomosis + left terminal colostomy + ileostomy closure in three cases (2 in Group A and 1 in Group B) and terminal ileostomy in one case in Group A. Conclusions: To reduce its specific complications, ileostomy should be performed in well-selected patients. Those with risk factors for leakage include males, the elderly, and those having important comorbidities, neoadjuvant chemoradiotherapy, low tumors below 5 cm from the anal verge, or complete circumferential stenosis and peritumoral inflammatory infiltrate.

Prevalence of musculoskeletal normal variations of the lower limbs in pediatric orthopedic clinic.

OBJECTIVES: To determine the rate of pediatric orthopedic clinic visits attributable to normal musculoskeletal (MSK) variations in children less than 12 years of age; to characterize the etiology and to characterize the etiology and management plan in this group in an attempt to identify areas that could be improved in pediatric orthopedic clinical practice. METHODS: The study was a retrospective evaluation of 2,321 consecutive patients who visited a private pediatric orthopedic specialty clinic in Jeddah, Saudi Arabia between 2011-2016. All consultations were recorded in accordance with the standard protocol  via data record form. RESULTS: We identified 764 (32.9%) patients with normal variation of the lower limbs, age birth to 12 years old. No significant association between gender and normal variation was noticed. The following types of normal variation were registered: 189 (24.7 %) genu varus or valgus, 257 (33.6%) in-toe gait, and 318 (41.6%) flexible flat foot. Seven hundred and thirty-seven (96.5%) cases were normal variations, while only 27 cases (3.5%) were deemed pathological and required further treatment. CONCLUSION: Normal variations represent the most common complaint in pediatric orthopedic private practice. Inappropriate referrals, useless follow-up visits, and excessive investigations were a common practice, overloading the health care system. None of the previous efforts made any notable improvement.

Müllerianosis of the urinary bladder: a rare case report and review of the literature.

The aim of this paper is to report a very rare case of müllerianosis (endosalpinx, endometrium, and endocervix) in a post-menopausal woman. Müllerianosis of the bladder is a very rare disease, which affects mainly the women of the reproductive age group, but with a good prognosis if the transitional bladder carcinoma is resolved. We present the case of a 64-year-old woman complaining of left lower abdomen pain, repeated lower and upper tract urinary infections, emergency urinary incontinence and hematuria. The surgical history shows that she underwent a hysterectomy, caesarean section and appendectomy. The clinical examination emphasizes a normal abdomen, with a normal aspect of the post-operative scars and a second-degree cystocele. An abdominal computed tomography (CT) scan with contrast and a cystography were performed and showed a 16 mm lesion-like tumor on the left bladder wall respectively a third-degree vesicoureteral reflux. These investigations were followed by a cystoscopy and transurethral resection of the bladder tumor (TURBT). The histopathology report described three types of tissues: endometriosis, endocervicosis and endosalpingiosis. Sequent to these results, a partial cystectomy with the re-implantation of the left ureter was performed. Once again, the results of the specimen confirm the diagnosis of müllerianosis. The immediate post-operative outcomes were good, the patient having no pains and no more hematuria. Six month later, a tension-free vaginal tape obturator (TVT-O) operation was carried out for urinary incontinence and two years later, a correction for a post-surgical abdominal hernia was performed. Müllerianosis of the bladder is a very rare disease, which affects mainly the women at the procreation age, but with a good prognosis. The differential diagnosis with a malignant tumor is very important to be carefully made. Currently, there is no golden standard to treat this disease. The cystoscopy and the histopathological examination of the specimen are indispensable for the certainty diagnosis.

The morphological profile of small bowel tumors - our experience.

AIM: The authors assessed the morphological profile of tumor masses belonging to the small bowel discovered in their daily practice. MATERIALS AND METHODS: 31 tumor masses located in different segments of small intestine operated between 2002 and 2013 in the 1st Surgical Department, Emergency County Hospital of Craiova, Romania, were analyzed. The investigated parameters were: tumor location and number, tumor dimensions, gross assessment, tumor extension and histological assessment. RESULTS: Tumor masses belonging to small intestine were rare. They usually expressed by their complications. In many cases, they were placed at the extremities of the small intestine. They were usually small but sometimes large and developing outwards intestinal wall. Commonly they had a fungating and ulcerated appearance. They were rather of mesenchymal origin than epithelial. However, some of them were inflammatory pseudotumors. Almost all neoplastic proliferations had a malignant phenotype, most often with regional extension. CONCLUSIONS: Our series of tumors had a morphological profile somehow similar with the profile described in the literature but with some particularities: the polarization to the extremities of the intestinal segment, a significant number of large tumors, clinical expression through different complications, the balance inclined in favor of mesenchymal origin of tumors and the clear predominance of malignant aggressive phenotype.

Prenatal diagnosis and perinatal outcome in congenital diaphragmatic hernia. Single tertiary center report.

PURPOSE: To evaluate the perinatal results for fetuses and neonates with left-sided congenital diaphragmatic hernia (CDH) and the role of the prenatal diagnosis in the pregnancy outcome. MATERIALS AND METHODS: We reviewed data from fetuses and neonates with left-sided CDH, managed from January 2009 and December 2013 in the University Clinic Hospital, Craiova, Romania. The following data were analyzed: the gestational age at the time of diagnosis, fetal karyotyping, presence of associated structural malformations, ultrasound (US) data (circumference and area of right lung, lung-to-head ratio - LHR, observed/expected LHR, hepatic herniation), the type of antenatal care, the pregnancy outcome, the place of birth and the conventional autopsy data, if performed. Perinatal outcomes were obtained by reviewing hospital documents. RESULTS: Twenty-one cases were identified. No fetal surgery was performed in our series. Mean gestational age at time of diagnosis was 29 weeks of amenorrhea (WA) (range, 16-37 WA). Associated structural malformations were noticed in nine (42.8%) cases, in which three fetuses had a normal karyotype and two had chromosomal abnormalities, and four fetuses were not investigated. Isolated congenital diaphragmatic hernia was confirmed in 12 (57.1%) cases. All early second trimester diagnosed cases were terminated. The overall mortality rate was 61.9%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 28.5%, 19%, 14.2%, and 38%, respectively. The perinatal mortality rate was 19% in cases with isolated congenital diaphragmatic hernia. CONCLUSIONS: The overall and perinatal mortality rate in congenital diaphragmatic hernia was still high in our series. Early perinatal deaths are associated with early diagnosis and with the presence of other structural defects. The prevalence of chromosomal abnormalities in perinatal death could not be determined from these data. In isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver and severe pulmonary hypoplasia, this being well correlated with antenatal ultrasound parameters used for the estimation of fetal lung volumes. The antenatal diagnosis allowed better counseling of the parents, description of associations and improving the neonatal care.

Gastrointestinal stromal tumors - a clinical-morphological study on 15 cases.

AIM: The authors present their experience in addressing the gastrointestinal stromal tumors (GIST). MATERIALS AND METHODS: 15 GISTs operated in the last five years (2008-2013) were analyzed. RESULTS: The preoperative diagnosis was difficult: established by clinical examination and CT in two cases; imagistic accidental discovery in four cases and revealed by evolving complications in nine cases (gastrointestinal bleeding in four cases and bowel obstruction in five cases). CT may be useful in the preliminary estimation of the tumor extent. Tumor location was: stomach four, duodenum one, small bowel seven, and colon three. Pathological examination set the main criteria for assessing the risk of recurrence and indication for adjuvant therapy: the tumor size, the histological type (spindle cell nine, epithelioid four, and mixed two) and the mitosis rate, while the immunohistochemistry examination established the correct diagnosis (positivity for CD117 and CD34) and criteria of aggressiveness (positivity for Ki67). All cases were operated, the surgical procedure being chosen according to the tumor location and stage. Adjuvant therapy with Imatinib 400 mg/day was performed in the 12 cases with high risk of recurrence. The therapeutic outcome was: a postoperative morbidity rate of 13.3%, four patients cured, one local recurrence under Imatinib therapy, a mortality rate of 6.6% and 10 patients in different phases of adjuvant therapy. CONCLUSIONS: GIST has been imposed over the last decade as the main type of non-epithelial tumor of the digestive tract. The preoperative imagistic investigations can be very useful for setting the surgical strategy. The improvement of the mitotic index and/or Ki67 labeling index (LI) determination could render more accurate the scales for prognostic assessment. The two steps algorithm - surgery + adjuvant therapy - still remains the only option to make this dangerous condition a curable one.

Correlations between cyto-histopathological tissue changes at the dental implant interface and the degree of surface processing.

The bone tissue is a specialized connective tissue adapted for support and protection. The bone physiology is balanced by the interaction between mechanical and metabolic factors. Current research focuses on the bone remodeling process after the insertion of dental implants, because, after the primary healing of the wound caused by the creation of the new alveolus, the proliferation and differentiation of the osteoblasts and fibroblasts will tip the balance of the healing pattern toward bone regeneration or fibrous encapsulation. Knowing and identifying the components of the connective and bone tissue prior to implant placement, researchers are investigating the quality and quantity of the bone matrix and the physiological stages of bone generation and resorption to improve the bone-implant interface. Our research included nine dental implant failures, without prosthetic supra-structures, immediately loaded or loaded after osseointegration. The analyzed samples were from the BIOMAT Research Center, Politehnica University of Bucharest, Romania, and experienced different modalities of surface preparation. Comparative analysis of the tissue at the bone-implant interface was investigated by scanning electron microscopy.

The pharmacists and homeopathy.

Presented at the end of the end of the XVIII(th) century by the German doctor Samuel Hahnemann as a form of complementary therapy, homeopathy has increasingly produced multiple controversies regarding the plausibility, effectiveness and safety of homeopathic remedies. Regardless, there are clients who require pharmacist's advice about their usage indications and effectiveness. As specialists in the field of medication, pharmacists must have basic notions about the principles on which homeopathic remedies have been based, given that it is the opposite of modern pharmacological theories. These describe in great detail the underlying mechanisms of action of the drug. Under these conditions, the ethical role of the pharmacist is to give accurate, impartial information regarding the homeopathic therapy, the current scientific proof on their therapeutic effects, including the placebo effect. This, doubled by a comprehensive, objective presentation of the options of medication-based treatment, guarantee pharmacists a clean reputation as competent authorities in the pharmaceutical field.

Analysis of aortic size in subjects died due to cardiovascular and non-cardiovascular events: a necropsy study.

Aortic size is known to be a predictor for cardiovascular deaths. The purpose of this study was to investigate whether aortic diameters measured on tissue samples obtained during autopsy from subjects that died of cardiovascular disease were bigger when compared to those from subjects deceased from other cause than cardiovascular disease. The study included 91 deceased subjects (average age 56 ± 18.1 years), which underwent autopsy to determine cause of death. Morphological measurements were completed on 364 aortic specimens obtained from four different sites, namely ascending aorta, aortic arch, distal thoracic aorta and abdominal aorta. Aorta showed the tendency to decrease in diameter from ascending aorta to abdominal aorta, the latter presenting with the smallest diameter. All studied aortic diameters were found to be larger in the cardiovascular population (p<0.01).

The place of prostate rebiopsy in the diagnosis of prostate cancer.

AIM: To highlight the role of prostate rebiopsy in the diagnosis of prostate cancer (PCa) in cases with an atypical small acinar proliferation (ASAP) diagnosis on the initial biopsy. MATERIALS AND METHODS: A retrospective study on 1525 patients who underwent prostate needle biopsy (PB) over a period of four years (2009-2012) was performed. For each patient the following were analyzed: age, prostate volume, digital rectal examination (DRE), serum total prostate specific antigen (tPSA), number of the cores taken. All PB were examined in HE staining and in difficult cases, immunohistochemistry (IHC) for basal cell markers was performed in order to establish a correct diagnosis. According to morphological criteria and IHC results, all PB were classified into four category of diagnosis: PCa, ASAP, high-grade prostate intraepithelial neoplasia (HGPIN) and benign (including normal tissue, inflammatory lesions, and prostatic atrophy). In ASAP cases, a rebiopsy was performed. RESULTS: PCa detection on the first biopsy was 69.77%, with a 3% incidence of ASAP and 1% of HGPIN, values similar with those in the literature. After rebiopsy the overall detection rate of PCa was improved to 71.01%, with a detection rate of 41.17% on the second biopsy. CONCLUSIONS: PCa diagnosis is the result of a complex algorithm including DRE, tPSA, transrectal ultrasound (TRUS) examination and TRUS-guided prostate biopsy. TRUS-guided prostate biopsy is the key step of this algorithm; it confirms the diagnosis of PCa and must be repeated in cases with a solid clinical suspicion of PCa, whenever histopathological features are inconclusive even after IHC staining.

Bilateral primary fallopian tube carcinoma: a case report.

Primary cancer of the fallopian tube is a very rare tumor nowadays, accounting for approximately 0.14-0.3% of all tumors of the female genital tract. From these, bilateral primary cancer is found in less than 25% of all cases. We report here a case of bilateral primary cancer of the fallopian tube in a 48-year-old woman, associating uterine fibromatosis.

Correlations between colposcopy and histologic results from colposcopically directed biopsy in cervical precancerous lesions.

INTRODUCTION: Cervical cancer develops from well-defined precursor lesions in a varied period of time. Detected in early or pre-invasive stages, cervical cancer is preventable and curable, so detection of precancerous lesions is very important. Colposcopy with directed biopsy is used in the evaluation and management of patients with cervical lesions, and described as the 'gold standard' for the diagnosis of cervical precancer. AIM: The aim of this study is to assess the accuracy of colposcopic examination and cervical punch biopsy, to determine the correlation between these two methods. MATERIALS AND METHODS: We examined 245 patients who present malignant findings at colposcopy and biopsy. Colposcopic findings in our study group: 28 (11.4%) cases were CIN I, 50 (20.4%) cases were CIN II, 150 (61.2%) cases were CIN III, 13 (5.3%) cases were micro-invasive carcinoma and four (1.6%) cases were CIS. Histological results in the 245 examined cases were: four (1.6%) cases normal, 26 (10.6%) cases CIN I, 55 (22.4%) cases CIN II, 138 (56.3%) cases CIN III, 15 (6.1%) cases micro-invasive carcinoma and seven (2.8%) cases of CIS. RESULTS: The correlation was 78.5% in the CIN I category, 84% in the CIN II category, 88.6% (133 out of 150 patients) in the CIN III category, 46.1% for micro-invasive carcinoma and 50% for CIS. The colposcopy method incurred fewer false negatives (four patients), giving a general accuracy rate of 98.3%. Sensitivity of colposcopic examination was 83.6%. CONCLUSIONS: This study demonstrated high accuracy and correlation between colposcopy and histology, comparable with results from similar studies in the literature. Sensitivity is lower, probably because biopsies were done in all cases, during diagnostic work-up. We also demonstrated the usefulness of these two diagnostic procedures as screening tests in preclinical cervical cancer. In our study, there were cases of under or over diagnose; the benefit of colposcopy and directed biopsy is to avoid over treatment of low-grade lesion, and under treatment of high-grade lesion.

Malignant melanoma of nasal cavity.

INTRODUCTION: Malignant melanoma rarely develops in the mucous membranes. Statistical data indicate that rhinosinusal mucosal melanoma was reported in less than 1% of all melanic tumors and in 2-8% of all cancers developed in the nasal fossae and sinuses. Due to reduce and non-specific symptoms and a high degree of invasion away, patients come for a medical expertise in advanced stages of the disease, which is leading to a poor prognosis. The average five-year survival is 20-30%. PATIENT AND METHODS: We present the case of a 65-year-old female patient coming from a rural environment, hospitalized for unilateral nasal obstruction and nasal mucosal changes of a blackish appearance on all of the walls. RESULTS: The endoscopic examination revealed a matter and of a blackish appearance nasal mucosa along the whole length of the left nasal cavity (septum, turbinates, floor, ceiling). Presumptive diagnosis of melanoma led to the excision of inferior and middle turbinate mucosa, floor and ceiling mucosa and the excision of the nasal septum, keeping the columella and the posterior portion. Histopathological and mostly immunohistochemical exams confirmed the diagnosis of malignant melanoma. To determine the phenotype of tumor cells, it was evaluated their immunostaining for HMB-45, Melan-A, S-100, vimentin, cyclin D1 and CD44 markers. The patient followed oncologic treatment and radiochemotherapy, presenting a favorable evolution with the absence of loco-regional recurrence or distant metastasis 24 months postoperatively.

Retroperitoneoscopic lumbar sympathectomy: prospective study upon a series of 50 consecutive patients.

BACKGROUND: Lumbar sympathectomy (LS) is still indicated for peripheral arterial occlusive diseases (PAOD) with critical ischemia beyond any vascular reconstruction. The retroperitoneoscopic approach was proven feasible and effective but its results were never evaluated in larger series. METHODS: Between January 2007 and January 2009, 50 patients were included in a prospective study (age range = 49-71 years; sex ratio: M/F = 9:1). Their comorbidities included arterial hypertension, n = 12 (24%); atrial fibrillation, n = 4 (8%); cerebral stroke sequels, n = 4 (8%); diabetes mellitus, n = 6 (12%); chronic coronary ischemic disease, n = 20 (40%); and obstructive bronchitis, n = 4 (8%). Fifty-one retroperitoneoscopic lumbar sympathectomies were performed (31 on the left side and 20 on the right side; 1 patient was operated on both sides). RESULTS: Intervention was successful in 50 cases (98.04%), with one conversion in the first three cases. Results were excellent in all patients, with warming of the extremity and regression of pain. The pathology report confirmed excision of the ganglia in all cases. Complications included 3 cases (6%) of accidental peritoneal tear and pneumoperitoneum which were resolved by insertion of a Veress needle in the hypochondrium; 2 (4%) retroperitoneal hematoma, and 6 (12%) superficial wound infections. Operative time was 65-105 min in the first ten cases and <40 min for the last 41. There was no neuralgia, sexual dysfunction, or postoperative mortality. Associated interventions included necrectomy in 10 cases. The limb preservation rate was 77.09% at 1 year and 58.69% at 2 years. CONCLUSION: For a larger number of cases, retroperitoneal LS has been proven effective and safe in PAOD beyond reconstruction.

Malignant fibrous histiocytoma of larynx with giant cell: case report and histological-clinical considerations.

INTRODUCTION: Malignant fibrous histiocytoma (MFH) is a tumor which has a mesenchymal origin, and an uncertain histogenesis. MFH with giant cell accounts for 3-15% of all malignant fibrous histiocytomas. OBJECTIVE: To explore the histopathology, the diagnosis and the treatment of MFH with giant cell of larynx. PATIENT AND METHODS: We report a case of a glottic MFH at a 59-year-old male, who has been smoking for 30 years, and was hospitalized in June 2008 at Emergency County Hospital of Craiova. RESULTS: The largely-sized tumor was originated in glottic area, upper a left vocal cord, with no paresis. The tumor determined respiratory failure and dysphonia. Patient underwent surgical excision of the tumor after an emergency tracheotomy. The immunohistochemical techniques proved positive for vimentin, smooth muscle actin, CD68, CD34, bcl2, EGFR, S100, Ki67, and negative for CD117, NFT, chromogranin, c-erbB2, CK34betaE12, MNF116, and p53. CONCLUSIONS: Malignant fibrous histiocytomas (MFH) with giant cell of larynx are very rare mesenchymal neoplasm (this case seems the first reported). The diagnosis of MFH of larynx was difficult and the immunohistochemistry could have been helpful.

[The pancreatic pseudocyst--late complication of the severe acute pancreatitis. Therapeutic options]. / Pseudochistul de pancreas, complicatie tardiva a pancreatitelor acute severe. Posibilitati si optiuni terapeutice.

AIM: the assessment of the therapeutical methods in the pancreatic pseudocyst occurred after severe acute pancreatitis. MATERIAL AND METHOD: 30 (33.3%) pancreatic pseudocysts (18 men and 12 women aged between 28-64) occurred in the evolution of 90 severe acute pancreatitis in the last 5 years (2000-2004) were analyzed. The diagnosis was established on the clinical and imaging aspects on average 1 month after the onset of the severe acute pancreatitis. The treatment was different, depending on size, anatomo-clinical form, pseudocyst age, presence of complications and the biological status of the patient. 14 uncomplicated pseudocysts, with the diameter less than 6 cm, were treated conservatively, until their complete resorption. 6 cases were operated on (2 cysto-gastrostomy, 1 cysto-jejunostomy and 3 external drainage). We performed percutaneous external CT guided drainage in 2 cases and endoscopic drainage in other 8 cases (trans-papillary-trans-ductal drainage 3 cases and endoscopic US guided drainage in 5 cases: transgastric 2, transduodenal 2 and transesophageal 1). RESULTS: 28 (93.3%) cases had a fair evolution (complete resorption in 14 uncomplicated pseudocysts after 3-6 weeks of conservative treatment). We registered 2 gastro-duodenal bleeding during endoscopic US guided drainage, which required operation (haemostasis cysto-gastrostomy). Mortality rate was 0. CONCLUSIONS: 1. The pseudocyst is the main late complication of the severe acute pancreatitis (33.3% in our study). 2. The uncomplicated pseudocysts with the diameter less than 6 cm, benefit of the conservative treatment and monitoring in progress until their complete resolution. 3. There are 3 therapeutical methods for the pseudocysts more than 6 cm in diameter and/or complicated: the percutaneous external US/CT guided drainage, the endoscopic drainage and surgery. 4. The option for the drainage procedure must take into account the morphological and evolutionary aspects of the pseudocyst, the age and biological status of the patient.

[Postoperative biliary peritonitis--diagnosis and treatment difficulties]. / Peritonitele biliare postoperatorii--dificultati de diagnostic si tratament.

AIM: To point out the severity of the postoperative biliary peritonitis (PBP) and to established the most proper ways of diagnosis and treatment. MATERIAL AND METHODS: 14 PBP (6 males and 8 females, age between 42 and 76 years) admitted in the last 14 years were analyzed. The PBP occurred after biliary surgery in 13 cases and after gastro-duodenal surgery in 1 case. The delay between the first operation and the establishing of the diagnosis and reoperation varied between 24 hours and more than 3 days. All the patients were operated on; the operation had to fulfill 2 main objectives: the treatment of the peritonitis and to solve the biliary lesions. RESULTS: 6 patients had a fair evolution. We registered 8 complications with a morbidity rate of 57,14% and 2 deaths with a mortality rate of 14,3%. CONCLUSIONS: 1. Postoperative biliary peritonitis is one of the most severe complications of the biliary and gastro-duodenal surgery, due to preoperative unrecognized biliary lesions or occurring as postoperative accidents or complications. 2. The clinical picture, deeply modified by the complex postoperative treatment makes the early diagnosis very difficult and leads to a delay of the re-operation. 3. The treatment is exclusively a surgical one, with two main objectives: the biliary lesion repair and the treatment of the peritonitis. 4. The postoperative biliary peritonitis are charged by a high postoperative morbidity and mortality rate, the delay of the diagnosis and the time of reoperation being the main risk factor.

Volatile induction and maintenance of anaesthesia (VIMA) with sevoflurane for surgical treatment of the choanal atresia in newborn.

A solved case of bilateral choanal atresia in a 10 hour newborn allowed the authors to make some pathogenic, clinic and therapeutic considerations. The paper underlines the high severity of the disease, which imposes the need of a quick diagnosis and an emergency surgical procedure assuring the airway patency and proper ventilation. The transnasal endoscopic approach is the procedure of choice, being quick, safe, providing direct and excellent visualization of the nasal cavity and posterior choanae, and having less postoperative morbidity than other surgical procedures. It is also emphasized the need of general anaesthesia with VIMA technique, which covers all the requirements of the anaesthesia in newborn.

[Severity factors of acute renal failure in severe acute pancreatitis]. / Factori de gravitate in insuficienta renala acuta din pancreatitele acute severe.

AIM: assessment of the severity factors of the acute renal failure (ARF) in the severe acute pancreatitis (SAP). 28 (32.55%) severe acute pancreatitis with acute renal failure (19 males and 9 females, aged between 30 and 67), treated by hemodialysis, selected from 86 severe acute pancreatitis with acute renal failure, admitted in the Hemodialysis Department of ICU in the last 6 years, were analyzed. The severity of the pancreatitis was assessed using the following criteria: clinico-biologic scores (Ranson > 3 and APACHE II > 8), the CT-scan (Balthazar score D and E and CTSI > 4), the presence of the organ and system dysfunctions assessed by Tran and Cuesta criteria and the presence of the abdominal compartment syndrome (abdominal pressure > 25 mm Hg). 8 dialyzed cases (28.5%) were operated on: 2 cholecystostomy, 2 cholecystectomy+choledocho-lithotomy+T tube drainage, 4 exploring laparotomy + drainage. RESULTS: The following severity factors were identified: 1. the association of the ARF with other system and organ dysfunctions, the highest mortality rate being provided by the following associations: ARF + more than 3 organ and system dysfunctions and ARF + ARDS in assisted ventilated patients; 2. the abdominal compartment syndrome with abdominal pressure > 25 mm Hg; 3. severe sepsis and altered biological status of the patients. We registered a general mortality rate of 53.57% (15 deaths) and a postoperative mortality rate of 75% (6 deaths from 8 operated patients). CONCLUSIONS: 1. Summing up the pathologic changes proper to the acute pancreatitis (enzymes and mediators releasing) with sepsis and abdominal compartment syndrome worsens the humoral and metabolic syndrome of the ARF. 2. The simultaneous presence of other organ and system dysfunctions makes the ARF in SAP one of the most severe forms. 3. ARF with anuria + ARDS in assisted ventilated patients and ARF + more than 3 associated organ and system dysfunctions are the clinical forms with the highest mortality rate. 4. The abdominal compartment syndrome is an important severity factor of the ARF because of its direct impact against the kidney and the organ and system dysfunctions which produces and worsens.

[Severe acute pancreatitis--diagnostic and therapeutic strategy]. / Pancretitele acute severe--strategie diagnostica si terapeutica.

To establish the optimal diagnosis and therapeutical strategy in severe acute pancreatitis. 94 (56.9%) severe acute pancreatitis (79 males and 15 females, aged between 26 and 81), selected from 165 acute pancreatitis admitted in the last 5 years (2000-2004) were analyzed. The disease was assigned as severe when one or more of the following criteria were present: Ranson score >3 on admission or at 48 hours, APACHE II score >8, visceral failures, Balthazar CT score C, D or E and local complications (infected necrosis, pseudocyst or pancreatic abscess). Medical treatment (aggressive supportive intensive care therapy, minimizing pancreatic secretion and antibiotic therapy) was the first therapeutical step in all cases. 49 (52.1%) patients were operated on: 20 as early surgery imposed by biliary sepsis (16 cases) or by an acute abdomen with uncertain etiology and unfavourable evolution, and 22 as late surgery (at least 12 days after onset), imposed by the presence of the infected pancreatic necrosis, visceral failures or other local complications, the necrosectomy being the main surgical procedure for infected necrosis. 77 (81.9%) cases had a fair evolution. The conservative treatment led to a complete recovery in 37 (37.2%) cases. We registered an overall mortality rate of 12.7% and postoperative mortality rate of 14%; we also registered 5 (10.2%) postoperative complications: 4 pancreatic and 1 colonic fistulae. (1) The treatment of the severe acute pancreatitis must be performed only in the specialized multidisciplinary well equipped centers with very well trained staff. (2) Medical conservative treatment (aggressive supportive intensive care therapy and antibiotic therapy) is the main therapeutical method within the acute phase (first two weeks). (3) Very restrictive surgical indications within the acute phase. (4) Necrosectomy is the main surgical procedure for the infected necrosis.