[Differentiated thyroid carcinoma. Diagnosis and therapeutic aspects]. / Carcinomul tiroidian diferentiat. Aspecte diagnostice si terapeutice.

The significant increase in incidence of thyroid cancer in the last decade, augmented the interest in reevaluation of treatment and diagnosis methods. Those aspects let us into making this retrospective study regarding the differentiated thyroid carcinoma. The clinical material consist in 70 C.T. patients, of which 54 (77.14%) C.T.D. patients, ages between 17-80 year old, sex ratio W/M 3.5/1.9. Preoperatively malignancy diagnosis was made by FNAC in 38.88%, intraoperatively by extemporaneous pathological exam 42.59%, postoperatively by paraffin exam 18.51%. Papillary CTD 30 (55.55%), follicular 20 (41.25%), Hürthle cells carcinoma 4 (7.2%). From the therapeutical point of view, the elective procedure of thyroidectomy was dictated by the histological type, staging and specific prognostic factors. There was 41 (75.9%) patients with total thyroidectomy (T.T), with a specific morbidity of 7 (12.96%) and 5-years survival rate of 88.88%. Preoperatively diagnosis of C.T was suspected through clinic, ultrasonography and scintigraphy arguments and confirmed by FNAC. The non conclusive cases were diagnosed intraoperatively by extemporaneous exam or postoperatively by paraffin exam. In most cases total thyroidectomy remains the essential surgical procedure. Also clinical, imaging and biological postoperative monitoring as well as suppress and substitution hormonotherapy are mandatory.

[Septic complications in acute appendicitis. Problems of diagnosis and treatment]. / Complicatiile septice perioperatorii în apendicita acuta. Probleme de diagnostic si tratament.

AIM: diagnostic improvement in complicated acute appendicitis (AA) by implementing the new sepsis concepts and modern imaging procedures; optimization of treatment with decreasing postoperation morbidity and mortality and improving the cost-efficiency indicator. 1495 cases of AA admitted between 2000 and 2004 have been assessed retrospectively and among them 306 (20.46%) had complications. On admission 80.43% patients were diagnosed with AA, 17.50% with acute abdominal syndrome and 2.07% with chronic appendicitis. On discharge there were 1158 (77.45%) cases of inflammatory AA and 306 (20.46%) cases of complicated AA (perforation, gangrene, peritonitis, plastron abscess). TREATMENT: 98.26% of patients under-went operation and 1.73% did not. SURGICAL PROCEDURES: standard appendicectomy in 1407 (95.77%) cases; laparoscopic appendicectomy in 30 (2.04%) cases; extraperitoneal approach in 15 (1.02%) cases; associated with surgical interventions on other organs in 75 (5.10%) cases. POST-OPERATORY MORBIDITY:128 (41.08%) cases out of 306; septic parietal complications in 102 (33.33%) cases; intraperitoneal complications in 26 (8.49%) cases. POST-OPERATORY MORTALITY: 6 deaths in patients aged over 68. AVERAGE LENGTH OF STAY IN HOSPITAL: 4 days for uncomplicated AA and 14.6 days for complicated ones. Perioperative septic complications are the result of evolution of late diagnosed disease, unjustified postponing of operation, surgical technique, patient health condition.

[Duodenal post-bulbar ulcers. Diagnostic and therapeutic problems]. / Ulcerul duodenal postbulbar. Probleme de diagnostic si tratament.

Our study upon 1235 cases of duodenal ulcers (1991 - 2001) revealed a decrease of its morbidity rate of 10 - 12%. However, the incidence of the post-bulbar duodenal ulcer (P.B.D.U.) remained constant - 9,33% (115 cases) from all duodenal ulcers. Its diagnostic and therapeutic difficulties, its peculiar etiology, pathogeny, topography and evolution are the consequence of the duodeno-bilio-pancreatic morphologic modifications, clinic polymorphism, radiologic indirect signs and difficult endoscopic localisation. Definitive diagnosis was set only intraoperatively. There are 2 forms of P.B.D.U.: proximal (D1 fixed) - 62,60% and distal (D2 above duodenal papilla) - 37,40%. Associated bilio-digestive lesions were encountered in 30 cases (26,08%). Due to its aggressive, endocrine-type etiology and pathogeny, evolution to severe complications and resistance to modern medical therapy, the PBDU should be of first surgical intent, considering a radical procedure whenever possible. Gastric 2/3 resection or truncal vagotomy with limited gastric resection were achieved in 90,43% of cases. We preferred the Bilroth II type anastomosis (65,20%) excluding the ulcerous lesion. Drainage of the duodenal stump was employed in 26% of cases. Specific postoperative morbidity of 12,17%, an early re-operations rate of 6,05% and postoperative mortality of 3,47% versus 2,05% for the duodenal ulcers, emphasize the severity of the P.B.D.U.