[Visceral leishmaniasis--surgical aspects]. / Leishmanioza viscerala--aspecte chirurgicale.

Visceral Leishmaniasis is a multi-organic parasitic disease caused by an intracellular protozoon named Leishmania Donovani; the mean signs are: weight loss, cough, fever, hepatosplenomegaly, adenopathy and cutaneous lesions; death without treatment is the rule. The main treatment is a conservative one. Surgical treatment is necessary for complications, especially for those intra-abdominally. We wish to present a young female patient who underwent two subsequent interventions due to an unclear diagnosis. We emphasize the difficulties in achieving a certain diagnostic, because of the rarity of disease in Romania; there are also revealed surgical aspects, which are important because of very few available data in the literature.

[Fournier's gangrene--atypical onset for lower rectal cancer]. / Gangrena Fournier--modalitate atipica de debut in neoplasmul rectal inferior.

The onset for rectal cancer is often revealed by one of its complications. With lower frequency, for the rectum below peritoneal reflexion, the perforative-suppurative onset is possible. We wish to expose a 64 years old woman's case, presenting with Fournier's gangrene as a unique sign of a lower rectal adenocarcinoma. Diabetes mellitus determined the extension of infectious process to its ultimate form, and the poor postoperative evolution, leading to death as well. The need for rectal examination is obvious in perianal abscesses, even in absence of malignant signs.

[Ambulatory treatment of anal fissure]. / Tratamentul ambulatoriu al fisurii anale.

Not a long time ago, the standard treatment for anal fissure was surgical, inpatient care; this concept failed in the last years, ambulatory treatment becoming the rule and the inpatient care the exception. We wish to present here our results in 125 ambulatory patients, who were referred to our proctologic office with anal fissure. We used two methods: a conservative one, by applying topical 0.2% nitroglycerine, similar to other proctology practitioners, and one method of our own which is a minimal surgical procedure consisting of sphincterotomy. The average follow-up period was 6 months. Symptom-free and anatomic-free states were obtained in 61.2% for conservative treated patients and in 91.4% for operated patients, respectively. We had no postoperative complications, rebounds or sequelae. We consider the results at least equal in effectiveness to those of standard surgical treatment. This is why we underline that ambulatory treatment for anal fissure reaches the goal to be of a first line option.