[Fibrin-collagen patch (TachoComb) in general surgery. Indications and results]. / Foliile de colagen impregnate cu fibrinogen (TachoComb) in chirurgia generala. Indicatii si rezultate.

UNLABELLED: Adequate hemostasis is an important part of any surgical procedure, by open or minimally-invasive approach. The aim of this study was to evaluate the indications and the effect of absorbable fibrin-collagen patch--FCP (TachoComb). METHODS: We performed a retrospective study in the First Surgical Clinic Iasi, during 2000-2006. We evaluated the use and the results of FCP in different types of surgical procedures. RESULTS: A total of 245 patients underwent local hemostatic treatment during surgery. FCP was used in biliary surgery (50 patients), hepatic surgery (39 patients), surgery of the spleen (20 cases), pancreatic surgery (14), colo-rectal surgery (28), surgery of the thyroid gland (20), digestive sutures (39), thoracic surgery (3), surgery in retroperitoneum region (6), gynecologic and urologic procedures (7) and other types of surgical procedures (15). The results of the FCP use were: "very good" in 143 cases (58.4%), "good" at 64 cases (26.1%), "adequate" in 31 cases (12.6%) and "inadequate" at 7 patients (2.9%). CONCLUSIONS: The efficacy of FCP in local hemostasis is excellent. The use of FCP decrease the rate of conversions in laparoscopic surgery and is essential for spleen preserving surgery. The use of FCP in the treatment of digestive fistula is inadequate. FCP (TachoComb) is too expansive for some surgical units.

[Thermo-necrosis in nonresectable colorectal hepatic malignant tumors. Preliminary results]. / Termonecroza metastazelor hepatice nerezecabile de origine colorectala cu vapori de apa sub presiune. Rezultate preliminare.

MATERIAL AND METHOD: We report the 19 months followup results after thermo-necrosis with steam water of non-resectable colorectal liver metastases. The studied group included 24 (18 men + 6 women) cases, aged 39-85 (mean age = 61), that were subjected to thermo-necrosis procedure between 2004-2006. Thermo-necrosis was performed per primam (1 case with non-resectable primary tumor), or either synchronous (8 cases) or at up to 53 months (15 cases) after primary tumor resection, and implied delivering of 6.7 - 87 kiloJoules to targeted lesions (for a median of 5 targets per patient liver). Concomitant with thermo-necrosis, in 8 cases some metastatic lesions were also resected (for tumor mass reduction). Followup consisted in echographic, CT, clinical and laboratory evaluation each 1-2 month. RESULTS: The thermo-necrosis procedure was completed within 3 to 20 (median = 10) minutes, and no peri-operatory deaths or complication were recorded. After procedure, the treated lesions either shrunken or were stationary under imaging explorations; increasing images marked the time to tumor progression. Tumor progression was recorded in 12 cases, time to tumor progression ranging from 1 to 14 (median = 5) months; the follow up time for the remaining 12 cases ranging 3 - 18 (median = 8) months. Nine cases died at 6-15 (median = 9) months after thermo-necrosis; for the remaining 15 cases the followup time ranged 4-19 (median= 10) months. One year survival was 61%; median survival (50%) time was 9 months. CONCLUSIONS: Thermo-necrosis with steam water of non-resectable colorectal liver metastases associate low invasiveness, good compliance, and time interval for tumor progression and survival comparable or better than other thermo-necrosis techniques, representing a promising palliative therapy in secondary liver cancer.

[Comparative experimental study of the effect of various locally administered pharmacological agents on the appearance of peritoneal adhesions]. / Studiu experimental comparativ privind influenta diverselor substante farmacologice administrate intraperitoneal asupra aparitiei si intensitatii sindromului aderential peritoneal.

The paper evaluates the intensity of peritoneal adhesions induced by talc administration on Wistar rats, alone and in association with different other substances. The comparative study was performed on 40 rats, separated in 5 groups: group A was injected intraperitoneally with talc, group B with talc and streptokinase, group C with talc and heparin, group D with talc and dexamethasone and group E with talc and dextran. The adherence syndrome was evaluated after 3 weeks, scoring 5 parameters: number, density, strength, vascularization, topography and granulomas. The sum of these 5 parameters was defined as the adherence score. The best results in preventing adhesion formation are obtained with the intraperitoneal administration of dextran and streptokinase.

[Comparative experimental study of left colonic anastomoses in intestinal obstruction; the value of anastomoses protection with free peritoneal graft]. / Studiu experimental comparativ privind anastomozele colo-colice stângi efectuate in ocluzia colica; valoarea protezarii anastomozei cu lambou peritoneal liber.

The paper describes the concept of peritoneal graft used to reinforce the colo-colic anastomoses made in emergency conditions of left colic obstruction, experimentally induced by surgical ligature, on Wistar rats. The comparative study was done on 24 rats, divided in 3 groups: group A with colic anastomoses protected with peritoneal graft, group B with one-layer colic anastomoses and group C with two-layer colic anastomoses. After 8 days, 7 rats survived in group A, 2 rats in group B and 3 rats in group C. All surviving rats in groups B and C presented anastomotic leak with local peritonitis, while in group A the anastomosis were healed. For group A, bursting strength of the anastomosis was measured and the mean value found was 63.64 cmH2O. It was proved the importance of protecting the colic anastomosis with supplementary layers, which increase the mechanical resistance and also prevents minor spillage of the colic content during the first postoperative days.

[Tendencies and results in rectal cancer treatment]. / Tendinte si rezultate în tratamentul actual al cancerului rectal.

UNLABELLED: Rectal cancer is one of the leading cause of cancer-related death worldwide despite of multimodal treatment. OBJECTIVE: The aim of this study is to review the management strategies for rectal cancer and to determine morbidity after multimodal therapy. METHOD: Retrospective study about 276 patients with rectal cancer surgically treated in 1st Surgical Clinic of "St. Spiridon" Hospital Iasi, Romania, between 1998-September 2003. RESULTS: There were 166 men (60.14%) and 110 women (38.86%) with mean age 63.6 years (extreme 20-81 years). The tumor's staging was: stage I--12 cases (4.5%); stage II--59 cases (21.3%); stage III--134 cases (48.2%), stage IV--71 cases (25.7%). 37 patients (13.4%) received preoperative radiotherapy (20 Gy). The tumor was resectable in 204 cases (74%) with curative purpose in 190 cases (68.8%). The postoperative therapy was performed in 198 cases (71.7%). The postoperative morbidity was documented in 32 cases and 24 patients died during hospitalisation (8.7%). Long-term results are also exposed with a review of literature. CONCLUSIONS: Rectal cancer has been notoriously difficult to treat successfully but there are numerous attempts modifying existing therapeutic regimens or designing new ones.

[Laparoscopic assisted vaginal hysterectomy (LAVH). Overview on 25 case series]. / Histerectomia vaginala asistata laparoscopic (HVAL). Experienta preliminara pe 25 de cazuri.

The aim of the study is to evaluate the laparoscopically assisted vaginal hysterectomy (LAVH) in terms of indications, uterine size, surgical procedures and their safety, intraoperative complications and blood loss, operative time, concomitant surgical procedures and postoperative period of complications. A total of 25 patients underwent LAVH between 1998 and 1993, in our surgical unit. The mean age of our patients was 44.2 years (range 36-66). The most common indication was fibromyoma. The mean size of the removed uterus was 11.5 cm. The mean weight was about 242 g. The mean estimated blood loss was 155 ml and the mean operative time 150 min. Intraoperative complications included one case of bladder injury due to thick adhesions. Postoperative complications included 2 cases of cystitis, and 3 cases of ileus. The hospital stay was 2 to 7 days.

[Zenker's diverticulum--surgical management in a series of six cases]. / Diverticulul Zenker: asupra a 6 cazuri operate în Clinica I Chirurgicala.

Zenker's diverticulum is a protrusion of the posterior mucosal wall of the hypopharynx through the weakened muscular layer, between the oblique fibers of the inferior constrictor of the pharynx and the transverse fibers of the cricopharyngeal muscle (Killian's dehiscence). Pharyngoesophageal pulsion diverticulum is the most common of all the oesophageal diverticuli and is characterised by dysphagia, regurgitation, gurling sounds in the neck and aspiration. The current principles of surgical management includes a pharyngoesophageal myotomy accompanied by a diverticulectomy or a diverticulopexy. The same principles apply in both open approach and the endoscopic methods.

[Minimal invasive treatment of the adnexal surgical pathology]. / Tratamentul minim invaziv al afectiunilor chirurgicale ale anexelor.

Laparoscopic approach has become the "golden standard" in managing a wide range of adnexial sufferings. Most laparoscopic cases allow patients to recover quickly. Conventional ultrasonography appears to be useful in the preoperative selection for this surgery. Conventional pulsed Doppler and colour Doppler sonography proved their importance in the diagnosis of malignancy. The aim of the study is to evaluate the advantages and the limits of the minimal invasive approach in managing surgical adnexial sufferings. A retrospective study was carried on 75 operative laparoscopy cases performed between 1998-2002. Surgical procedures were performed mainly for ovarian cysts (69 cases, 92%), but there were also treated other types of adnexial pathology such as: hydrosalpinx (2), piosalpinx (1), tubal cysts (2), ectopic pregnancy (7), pelvic adherences (7) and one case of hydatid tubal cyst. Types of surgery performed were cystectomy (36), ooforectomy (11), salpingo-ooforectomy (10), fenestration (10), salpingectomy (6), lysis of adhesions (7). The mean operation time ranged between 50 and 80 minutes and the mean postoperative stay was of 3.65 days.

[ Rare sites of hydatic cyst]. / Chistul hidatic cu localizare rara.

The aim of this case report is to underline that the hydratic disease is still a healthcare problem in our country. Moreover, the atypical site of the cyst, as shown in the report, is a rare event and sometimes, an intraoperative or histological finding. Difficulties could arise from the operative management, during the radical procedures, to preserve some anatomic important structures. Modern imagistic data will certainly improve the preoperative diagnosis.

[Proposal for macroscopic examination of the heart , of the great vessels and of the lungs in forensic pathology]. / Propunere de examinare macroscopica a cordului, vaselor mari si pulmonilor în medicina legala.

Our work presents a kind of proceeding for the cardio-pulmonary dissection and forensic examination. As a result of the necessity to have right from the time of the autopsy more clear data regarding the cause of death, in order to be able to direct the judicial investigation towards a certain type of death, this proceeding presents, in our opinion, several important advantages--in comparison to the common examination method--such as the facility macroscopic diagnosis in some heart diseases: arrhythmogenic displasy of the right ventricle, mitral valve prolapse and other valvulopathies.