Multi-organ resections for colorectal cancer: analysis of potential factors with role in the occurrence of postoperative complications and deaths.

AIM: Multi-organ resection for colorectal malignancy is a topic of interest nowadays as it raises the issue of benefits versus increased morbidity. This study aims to identify factors that may influence the development of postoperative complications and death following multivisceral resection. METHODS: The study included 107 patients hospitalized in the Surgical Clinic III of Cluj-Napoca, who underwent multivisceral resections for colorectal cancer pathology. This is a retrospective study covering the period between 2006 and 2010. This study compares the morbidity and mortality following multi-organ resections for locally advanced colorectal cancer, with results in patients with uncomplicated colorectal resections. The study also highlights the impact that certain factors have on the development of postoperative complications. RESULTS: This study shows a higher incidence of death and postoperative complications in the case of multiorgan resections. The differences were found to be statistically significant as follows: postoperative complications: 26% after multiorgan resection and 14% after uncomplicated resection respectively (p = 0.001); postoperative death: 11% after multi-organ resection and 3% after uncomplicated resection respectively (p < 0.001). The factors that have influenced in a negative way the postoperative evolution of the patients were: diabetes, personal history of malignant disease, associated heart disease, major abdominal surgery prior enrolling, the number of resected organs and increased intraoperative blood loss (over 500 ml). CONCLUSION: In cases of locally advanced colorectal neoplasm, multiorgan resection should become the standard indication, as it offers patients their only chance of survival, comparable to that obtained in less advanced stages of the disease. This indication is underlined by the high resecability rate (R0) accomplished in our service. Preoperative compensation of the associated pathologies, the surgery performed by experienced teams, as well as providing an adequate intensive care are required to reduce the postoperative risks.

Is there a correlation between the CEAP score and the histopathological findings in varicose disease?

BACKGROUND: Varicose disease continues to represent an interesting subject. The factors triggering and maintaining vascular and cutaneous tissues alterations in chronic venous insufficiency are not fully known. PATIENTS AND METHODS: This is a prospective, statistical analysis study, performed in a consecutive series of 40 patients with varicose disease admitted and treated at the Surgical Clinic II, Cluj-Napoca. The aim of the paper is to evidence histopathological (HP) changes in the vein wall, as well as to correlate histopathological findings, classified into stages, with the clinical stage of chronic venous insufficiency (CEAP classification). Statistical analysis was performed using the Fischer F-test for the comparison of the variances of two selections and the Student t-test for the comparison of the means. For correlation, Pearson's simple correlation coefficient was used. The software used was Excel and Matlab 7. RESULTS: Following the statistical analysis, the mean of CEAP values was found to be higher than the mean of the histopathological stage values in all patients included in the study and in the different risk groups. The values of Pearson's linear correlation coefficient between CEAP values and histopathological stage values did not generally show a statistically significant correlation. CONCLUSIONS: CEAP classification remains the main pillar in the diagnosis and the treatment of varicose disease, even if there are some dissimilarities between the clinical appearance and the histopathological results. The presence of a correlation between histological and clinical aspects in varicose disease remains uncertain.

[Correlation of risk factors and complications in the conventional surgery of varicose veins]. / Corelatii între factorii de risc si complicatii în chirurgia conventionala a bolii varicoase.

The primary varicose vein disease, a largely spread affection, constitutes a present challenge and a major health concern because of its increased prevalence and the high expenses of treatment and patient care. Due to the modern instruments, preoperative investigations and the increased understanding of the physiopathological mechanisms in the alteration of venous return, this objective can be achieved easier. Nevertheless, according to ananalytical retrospective observational study performed at the Surgery Clinic II, Cluj-Napoca, on 957 patients with varices of lower extremities, postoperative complications occur in 11 percent, due to additional costs and patients' negative social and professional consequences. Another study performed at the same clinic on 1066 patients with primary varicose disease reveals the high incidence of the risk factors (62%) and progressive complications (44%). Furthermore, the study shows that patients tend to seek help at late stages of disease, which requires a longer hospitalization period and implicitly higher costs of postoperative care and treatment. A correct sanitary education of the affected population would reduce the treatment expenses. In addition, a more efficiently control of the disease, the prevention of progressive complications incidents, and the adequate surgical procedure that prevent the postoperative complications, would also reduce the costs. Considering the high number of surgical interventions involved in varicose disease treatment, the results presented in this study are of great significance for both surgeons and the institutions that provide the funds for treatment. surgical procedure that prevent the postoperative complications, would also reduce the costs. Considering the high number of surgical interventions involved in varicose disease treatment, the results presented in this study are of great significance for both surgeons and the institutions that provide the funds for treatment.

[Clinico-histopathological correlations of venous wall modifications in chronic venous insufficiency]. / Corelatii clinico-histopatologice ale modificarilor parietale venoase in insuficienta venoasa cronica.

The interest manifested for the conjunctive tissue pathology leaded to the study of the structural disorder that appears in the varicose veins walls. The study is a prospective one initiated in March 2007 made on 11 patients with varicose disease hospitalized at Cluj-Napoca within Surgery Clinic no. II. The purpose of this study is to point out the histopathological modifications in the varicose venous wall (great saphenous vein cross, communicating veins, perforating veins), as well as the correlation of histopathological results with the evolutive stage of chronic vein insufficiency (CEAP classification) and with the clinical score at these patients. The histopathological (HP) results for 2 of the patients revealed hypertrophy of the media, intimal hyperplasia (stage II) corresponding to a CEAP 3. Six patients were integrated in HP stage III due to the partial intimal fibrosis corresponding to a CEAP 6 for one case, CEAP 4 one case, CEAP 3 four cases. One patient had HP stage I with CEAP 3 and two patients had HP stage IV corresponding to CEAP 5, respectively CEAP 6.

[Surgical treatment of aorto-iliac atherosclerosis]. / Tratamentul chirurgical al bolii aterosclerotice aorto-iliace.

The occlusive aorto-iliac disease is the consequence of a diffuse atherosclerotic process aggravated by risk factors and existing co-morbidity. The treatment aims at correcting the risk factors, balancing and compensating the associated diseases, the surgical re-vascularization of the lower limbs (by pass, particular techniques for the aortic aneurysms, necessity interventions). Aortic and peripheral angiographic exploration is required for the establishment of surgical strategy. The lot studied includes 77 patients hospitalized in the period between 2000-2006 in the Surgery Clinic no. II, Cluj-Napoca. 33 cases had an obstruction of a single iliac artery. The bilateral affection has been present in 27 cases, while that of the terminal trunk of the aorta and of its bifurcation has been present in 17 cases. The most frequent intervention has been the aorto-bifemoral prosthesis, the prosthesis used being: Terom, Dacron and PTFE. The thrombendarterectomy was used as an independent method or associated with the by-pass. At the same time, the aortoiliac interventions were associated with aorto-inguinal bypass, crossover as well as disarticulations and amputations of toes. 26% of the 77 patients, had early post-surgery complications (hemorrhage, infection, the thrombosis of the graft). The re-vascularization failed in 3.8% of cases, a major amputation of the limb being necessary. 11 deaths (14.3%) were recorded which occurred as a result of systemic complications.

Cryoglobulinemic vasculitis with multiple digital necrosis in viral hepatitis.

Cryoglobulinemic vasculitis (CV) associated with viral hepatitis C (VHC) is halfway between classical autoimmune disease and neoplasia. The extrahepatic manifestations of viral hepatitis C are various, their majority being due to mixed cryoglobulinemia. Patients diagnosed with viral hepatitis C often have mixed serum cryoglobulins, but only 5-10% of them will develop clinically manifest cryoglobulinemic vasculitis. CV symptomatology is most frequently obvious at skin level. The clinical manifestation characteristic of CV is purpura. Digital necrosis as the last stage of trophic disorders associated with CV has been rarely described in the literature. All CV types may be complicated by renal impairment. A 10-30% proportion of patients with VHC infection will develop glomerulonephritis. The treatment of cryobulinemic vasculitis associated with viral hepatitis C is focused on the reduction of viral load, the control of vasculitis symptoms using corticoids, plasmapheresis, immunosuppressive drugs, and the reduction of the amount of cryoglobulins acting on B lymphocytes. We present a rare case of cryoglobulinemic vasculitis with multiple digital necrosis associated with viral hepatitis C.

[The place of surgery in the complex treatment of gastric cancer]. / Locul chirurgiei în tratamentul complex al cancerului gastric.

The fact that the first symptoms of gastric cancer occur when therapy, even surgical, is limited to palliative objectives, was the starting point of the present study. A clinical study was carried out in a group of 158 patients with gastric cancer admitted to the Surgical Clinic II of Cluj-Napoca in the past 10 years. The most frequent location of the gastric neoplasm was the antrum-pylorus, though there were also extended tumours that invaded the neighbouring organs. Secondary processes were evidenced in over 70% of the patients studied. This fact, together with the associated conditions, made us limit the gastric resection even for the cases in which we considered total extensive gastrectomy to be the best solution. The methods of restoration of the gastric passage were esophago-jejunostomy on the Y loop in the first place, followed by gastro-jejunostomosis with the other techniques of gastric reconstruction. Palliative procedures such as gastro-enteroanastomosis or nutritional gastro-jejunostomy were sometimes necessary. Good postoperative results were obtained in 69% of the patients, which emphasizes once again the importance of this study.

[Clinical, diagnostic and therapeutic problems in the postthrombotic syndrome. Our experience]. / Probleme clinice, diagnostice si terapeutice în sindromul posttrombotic. Experienta noastra.

An analysis is presented, of the experience acquired in the II-nd Surgical Clinic of Cluj-Napoca in connection with 150 cases of postthrombotic syndrome followed and treated over the last 5 years (1983-1987). Considerations are made concerning terminology, and evaluation of diagnostic and therapeutic means applied. The post-thrombotic syndrome develops in a variable interval after the thrombophlebitis (months and even years). A series of factors prevent of enhance the development of the syndrome (98% diagnostic errors and therapeutic failures). Phlebography is mandatory in cases where surgery is considered. Noninvasive explorations (Doppler, plethysmography) limit the use of phlebography. The most efficient treatment is prophylaxis (consisting in the prophylaxis and the correct treatment of thromboembolic disease). The usual treatment is mainly medical and conservative (59.4%). Surgery is carried out in cases where the superficial, the communicating and the deep venous systems are involved.

[Venous emergencies. Personal experience and viewpoint]. / Urgences veineuses. Expérience et attitude personnelles.

Based on a casuistic report of 226 cases, the authors propose a classification of venous emergencies, including acute deep thrombo-phlebites (with their anatomo-clinical and topographical varieties), the complications of varicose disease, venous traumatism and anorectal venous thrombosis. The authors touch on problems associated with clinical and paraclinical diagnosis, prophylaxis and active surgical therapy, respectively thrombectomy, ligation of the long saphenofemoral junction, the treatment of varico-phlebitis and urgent traumatic lesions, the thrombectomy and radical cure of haemorrhoids. The coupling of any of these affections presents a potential of great seriousness, sometimes a major vital risk which necessitates immediate therapeutic intervention. The classification of the idea of "venous emergency" in comparison with that of "arterial emergency", is outlined, and the authors mention that a surgical treatment in these affections is to be preferred.