Surgical Emergencies in Patients with Hemophilia A-What to Expect.

Surgical emergencies in patients with hemophilia A represent a major risk of mortality without proper multidisciplinary management and require prompt and effective treatment to prevent complications and improve patient outcomes. We present a short number of cases that were hospitalized in the I-II Surgery Clinic of the Emergency County Hospital "St. Spiridon" from Iasi, Romania, with hemophilia A requiring surgical emergencies. The timing of surgical intervention is very important, so the indication for surgical intervention must be made judiciously and without delay. Consequently, it is vital to ensure access to hemostatic support so surgery can be performed on these patients, ultimately saving their lives.

Right adrenal abscess -- an unusual complication of acute apendicitis.

Acute appendicitis represents one of the most frequent abdominal emergencies encountered in everyday surgical practice. Local infectious complications are not unusual and retroperitoneal abscesses after acute retrocaecal appendicitis have been previously described. The authors present the case of a 22-years-young female patient, admitted for a right iliac fossa abscess, secondary to gangrenous appendicitis. A right adrenal mass 35/40 mm was revealed during preoperative ultrasound evaluation, which evolved in an adrenal abscess that spontaneously drained 10 days after appendectomy and retrocecal drainage. Adrenal abscesses are exceptionally rare, with only a few cases being reported in the literature, but none of these after acute appendicitis.

Postoperative survival in advanced gastric cancer.

We assessed the postoperative survival in 143 consecutive patients with advanced gastric cancer. Police databases represented a very powerful research tool and allowed a response rate of 94.4%. Mean postoperative survival was 10 months - irrespective of stage - with 52.6% and 30.3% survival rates at 6 months and 12 months respectively. Long-term survival cannot be really commented with only 11 % of patients alive after 24 months. Statistical analysis demonstrated a lack of prognostic significance of tumour stage (except for stage 4), as well as lymph node spread. No real benefit in survival was evident for palliative resection in locally advanced gastric cancer. We were not able to prove a significant benefit of more extensive (D2) lymph node dissection. The only proven prognostic factor in our study appeared to be the oncologic quality of resection. Survival was significantly longer in R1 (no macroscopic residual tumor) cases vs. R2 macroscopic residual tumour cases (p<0.05), but no difference could be found between R2 (macroscopic residual tumor) cases and non-resectable cases.