[The late results following conservative surgery in transitional cell pyelocaliceal and ureteral carcinomas]. / Rezultate tardive dupa operatii conservatoare pentru carcinoame tranzitionale pielocaliceale si ureterale.

The paper reports on the tardy results following conservative surgeries performed in 15 cases of transitional supravesical carcinomas (8 pyelocaliceal and 7 ureteral). In cases the surgery was necessary (patients with tumours developed on the conservative operation was made deliberately. a unique kidney, in uremia, infiltrative, highly anaplastic), and in 8 patients. Two years after the surgery, 80% of the patients were alive, after 3 years, 66%, after 4 years, 47%, and after 5 years, 33%. The conservative surgeries in the transitional pyelocaliceal carcinomas have deliberate indications for small, unique lesions, T0-T1 N0 M0 G1, technically easily accessible. For the ureteral tumours, the conservative surgeries may be extended to T3 lesions, but with N0 M0, observing the oncologic limits of exeresis in length, that permit the reconstruction of the urinary tract by a rational surgery.

[Urography and the isotopic renogram under diuresis enhance the diagnosis and the indication for therapy in congenital hydronephrosis]. / Contributia urografiei si renogramei izotopice sub diureza crescuta la diagnosticul si indicatia terapeutica a hidronefrozelor congenitale.

Analysis of a group of 276 patients with congenital hydronephrosis by dysfunction of pyeloureteral function shows that in the most cases the diagnosis has to be established by corroborating the data given by urography, echography, and isotopic renogram. In the cases of controversial hydronephrosis diagnostic, urography and renogram under diuresis induction are very important in practice.

[Total cystectomy in the treatment of infiltrative bladder tumors. The conclusions of an analysis of postoperative results in a series of 269 nonselected patients at late follow-up]. / Cistectomia totala în tratamentul tumorilor vezicale infiltrative. Concluzii rezultînd din analiza rezultatelor postoperatorii într-o serie neselectionata de 269 de bolnavi revazuti tardiv.

The authors report their experience with 341 radical cystectomies, and 61 anterior pelvectomies for infiltrating urinary bladder tumours, of which 269 were followed at long periods of time after surgery. In 56% of the patients there was tumoural involvement of lymph nodes at the time when cystectomy was performed. In 88% of the cases the tumours were of G3 stage. Fifty-one percent of the patients had had one previous surgical procedure, and in 75% of the cases surgery was performed when the upper urinary apparatus was already dilated by tumoural obstruction, or when high serum nitrogen was present. Planned radical cystectomy was possible in only 26% of the patients. The technical procedure implies a significant change consisting in the exclusive use of the urethropelvic drainage, and this had excellent results. The urinary derivation used was adapted to the stage of development of the tumour, and after consideration of the condition of the upper urinary apparatus. In 130 cases cutaneous urethrostomy was performed, in 95 patients urethrocolic derivation, in 23 cases cutaneous transurethral ureterostomy, and in 6 patients substitution bladder was achieved. The global postoperative mortality of 16.6% was mainly due to the advanced age of patients, the advanced stages of the tumours, to high serum nitrogen, infections, and to operatory indications that were not always justified but were determined by clinical complications and the extreme discomfort of patients. The most frequent early postoperative complications included an association of toxic shock and high serum nitrogen. In the authors' experience preoperative radiotherapy did not have satisfactory results, and chemotherapy only resulted in inconstant improvement of the patients' condition The late results were not satisfactory, the deaths in the first two years after surgery being the result, almost in exclusivity, to a continued evolution of the neoplastic tissue remaining in the pelvic cavity, and that was due to the fact that the patients had been operated at a very advanced stage of the disease. Total cystectomy has an elective indication in urinary bladder tumours of the T2, T2a, or T3b type, with N0 and M0. It should be carried out as planned surgical intervention and presumes a mandatory urinary derivation that should provide a maximal renal protection.

[Coexistence of surgical acute abdomen and acute myocardial infarct]. / Coexistenta abdomenului acut chirurgical cu infarctul miocardic acut.

Based on experience acquired in 10 cases the authors stress the difficulties of the clinical and the para-clinic diagnosis when such events occur simultaneously. The severity of the clinical picture (death-rate is over 90 per cent) requires great capacity of perception of therapeutic priorities, and the success cannot be achieved but through a close medico-surgical cooperation.