[The ostomy support team. A reality for ostomates]. / Elemente de management ale colostomelor. Echipa de suport si consiliere a pacientilor stomizati.

Stoma is a Greek word meaning mouth or opening. There are many types of surgical stomas and they may be raised on many areas of the abdominal wall. A stoma may be temporary or permanent, may be needed in any age group and may be sited on any part of the abdomen. The specific digestive pathology that could have as result of the surgical management a stoma is represented by colon, rectal and anal cancer, diverticular disease of the colon and rectum, Crohn's disease, ischaemic bowel, volvulus, trauma, Hirschprung disease, imperforate anus, fecal incontinence. This paper aim is to asses the management of fecal stomas and the necessity of a trained ostomy support team.

[Malignant peritoneal mesothelioma tumours. Evolution, treatment, prognosis]. / Tumorile maligne mezoteliale peritoneale evolutie, tratament, prognostic.

Malignant mesothelioma of the peritoneum is a rare neoplasm with a rapidly fatal course. The median survival range is from 5 to 12 months in untreated cases with little improvement seen in patients receiving multimodality therapy. Although most cases occur in the fifth and sixth decades, peritoneal mesothelioma can be seen in any age group. Approximately 30% of all mesotheliomas arise solely from the peritoneum. Asbestos exposure, primarily of the crocidolite variety, has been implicated in the pathogenesis of this malignancy, as was established in South Africa in the 1960s. Half of reported cases have a history of asbestos exposure. The diagnosis of peritoneal mesothelioma is often delayed, in part because of the usually long latent period (peaking at 40-45 years from the time of initial exposure to asbestos) and because the common presenting symptoms of weight loss, usually with a full abdomen, malaise, and abdominal discomfort, are mild and nonspecific. This paper aim is to present a case report regarding a patient diagnosed with malignant peritoneal mesothelioma with an unpredictable evolution.

Safety and efficacy of conservative management in acute severe pancreatitis.

Acute severe pancreatitis represents a disease with multiple complications and a high mortality rate. The clinical evolution is related to the acute systemic inflammatory response syndrome, due mainly to inflammatory mediators and pancreatic enzymes and to the infectious complications representing a peak in the incidence of death. This study aims to retrospectively analyse the outcome of patients diagnosed with acute severe pancreatitis, conservatively treated versus those surgically managed. This study includes 151 patients, each having been diagnosed with acute severe pancreatitis (CT using Balthazar's) distributed in term of age, sex and severity parameters. The conservative treatment has included antibiotics, and anti-inflammatory drugs. The imaging and biological parameters were further statistically analysed. The clinical-biological evolution has been paralleled by the CT severity index. The conservatively treated group had a better clinical-biological outcome (p<0.05), when compared with the surgically treated group. Morbidity was significantly higher in the group exposed to surgical treatment. Conservative treatment should be the first option in acute severe pancreatitis management.

Diagnostic features of benign pancreatic insulinomas. An analysis of three cases.

Insulinoma is a neuroendocrine tumour deriving mainly from the pancreatic islet cells that produces excessive amounts of insulin. Accurate preoperative detection and localization of insulinoma is essential for the selection of appropriate candidates for surgery. We present the case reports of three patients with benign pancreatic insulinoma. Preoperative assessment was performed by using transabdominal ultrasonography, computed tomography and magnetic resonance imaging. Their performances for the effectiveness in detecting and localizing benign insulinoma were compared. We concluded that an appropriate preoperative imaging assessment was in our case impossible, intraoperative inspection and palpation of the pancreas still being superior.

Features of pathological assessment in rectal cancer.

Rectal cancer diagnosis is established by collaboration between oncological surgeons, oncologists, pathologists and imaging specialists. By examining the macroscopic and microscopic aspect of the surgical specimen, the pathologist could provide the surgeon with information regarding the surgical procedure. Staging represents the clinical or pathological assessment of the extent of tumour spread. The clinical staging is a preoperative evaluation based on clinical and radiological information being used to determine the appropriate treatment for each case. The pathological staging permits the postoperative assessment that brings prognostic information. The aim of this paper is to present the suggestions of our multidisciplinary team for an accurate pathology assessment of rectal cancer.

[Malignant peritoneal mesothelioma]. / Mezoteliomul malign peritoneal.

Mesothelioma is a neoplasm originating from the mesothelial surface lining cells of the serous human cavities. It may involve the pleura, less frequently the peritoneum rarely, the pericardium, the tunica vaginalis testis and ovarian epithelium. Asbestos has been widely used in industry. A causal relationship between asbestos exposure and pleural, peritoneal and pericardial malign mesothelioma was suggested, the risk of cancer being correlated to cumulate exposure. Studies from National Cancer Institute, USA, show that the malignant mesothelioma is a rare and aggressive asbestos related malignancy. The symptomatology is insidious and poses difficult problems in diagnosis and treatment. This paper presents the case of a 59 year old patient with malignant peritoneal mesothelioma who worked almost 40 years as an electrician, exposed to asbestos fibers. He was hospitalized for important weight loss, abdominal pain and tiredness being diagnosed after imaging tests with a giant tumor, localized at the abdominal upper level, which seems to originate from the spleen's superior pole. During surgery we discovered a tumor with cystic parts, intense vascularized, which turn to be adherent in the upper side to the lower face of the left midriff cupola, to the spleen superior pole and 1/3 middle level of the great gastric curve. It was performed surgical ablation of the tumor, splenectomy with favorable postoperative evolution, the patient being now under chemotherapy treatment.

[Evidence-based colorectal cancer screening]. / Metode de screening in cancerul colorectal.

Colorectal cancer has been identified as an appropriate candidate for early detection and treatment of both asymptomatic individuals and those at risk of the disease. The lifetime incidence of colorectal cancer among persons at average risk is sufficiently high to justify screening the general population. This review presents the latest strategies employed in early detection of the colorectal cancer. An ideal screening test should satisfy some basic criteria: must be simple, secure, accepted by the population with valid and reproductive results. Despite the demonstrated benefits of colorectal cancer screening, incidence and mortality rates of this common cancer remain high. More optimally tailored screening tools are needed that combine the features of a potentially ideal screening test.

[Current strategy in colorectal cancer screening]. / Strategia actuala de screening in cancerul colorectal.

Screening programs should begin by classifying the individual patient's level of risk based on personal, family, and medical history, which will determine the appropriate approach for each subject. The individual's risk status determines when screening should be initiated and what tests and frequency are appropriate. To achieve these aims, care systems should establish standards and operating procedures. This review focuses on colorectal cancer screening methodology highlighting the latest available strategies.