[Differentiated thyroid carcinoma. Diagnosis and therapeutic aspects]. / Carcinomul tiroidian diferentiat. Aspecte diagnostice si terapeutice.

The significant increase in incidence of thyroid cancer in the last decade, augmented the interest in reevaluation of treatment and diagnosis methods. Those aspects let us into making this retrospective study regarding the differentiated thyroid carcinoma. The clinical material consist in 70 C.T. patients, of which 54 (77.14%) C.T.D. patients, ages between 17-80 year old, sex ratio W/M 3.5/1.9. Preoperatively malignancy diagnosis was made by FNAC in 38.88%, intraoperatively by extemporaneous pathological exam 42.59%, postoperatively by paraffin exam 18.51%. Papillary CTD 30 (55.55%), follicular 20 (41.25%), Hürthle cells carcinoma 4 (7.2%). From the therapeutical point of view, the elective procedure of thyroidectomy was dictated by the histological type, staging and specific prognostic factors. There was 41 (75.9%) patients with total thyroidectomy (T.T), with a specific morbidity of 7 (12.96%) and 5-years survival rate of 88.88%. Preoperatively diagnosis of C.T was suspected through clinic, ultrasonography and scintigraphy arguments and confirmed by FNAC. The non conclusive cases were diagnosed intraoperatively by extemporaneous exam or postoperatively by paraffin exam. In most cases total thyroidectomy remains the essential surgical procedure. Also clinical, imaging and biological postoperative monitoring as well as suppress and substitution hormonotherapy are mandatory.

[Pseudo-Meigs syndrome, a rare variant]. / Varianta rara de sindrom pseudo-Meigs.

The pseudo- Meigs syndrome is defined as a pelvic tumour, other than the ovarian fibroma complicated with ascites and hydrothorax that can be recovered after the tumour is surgically extirpated. The uterine leiomyoma is an extremely rare cause of this syndrome, only 24 cases have been recorded so far, most of them presenting hydropic degeneration or necrosis. The case exposed by us, a 50- year old obese,with nanism woman, presented clinical, biological and imaging characteristics of the syndrome; moreover, she had arterial high blood pressure for more than five years, fact that didn't need postoperative treatment. She was sent to the ER because she had severe respiratory insufficiency, arterial high blood pressure, tachycardia and, at the clinical examination, she presented massive right hydrothorax, ascites, and pelvic tumour. The biologic explorations (the benign cytology in the pleural liquid and ascites, CA-125 with ten times the normal value) and the imagery completed the picture of a Meigs/ pseudo-Meigs syndrome that implied the laparotomy. The H-P examination and the postoperative evolution confirmed the diagnosis. We presented this case in order to emphasize both its rarity and its real positive and differential diagnosis problems.

[Follow-up evaluation of omphalocele treatment in children. The experience of the department of Pediatric Surgery and Orthopedics No.1 University Hospital Craiova]. / Evaluare în timp a tratamentului omfalocelului la copil. Experienta Clinicii de Chirurgie si Ortopedie Pediatrica Spitalul Clinic Universitar Nr.1 Craiova.

Abdominal wall malformations are a frequent category of congenital malformations in the last years in all Departments for Pediatric Surgery from our country. The authors are presenting a serie of 35 cases of newborns admitted and treated in the Pediatric Surgery and Orthopedics Department of the Clinical University Hospital No. 1 Craiova and in the same time they are evaluating in time the results after different surgical technics. From the point of view of the surgical techniques applied in the last 20 years the authors are communicating their results with the following procedures: Gross, Allen-Wren, Fufezan, and also their results with a nonsurgical procedure (Grob). The authors are manchenning that it is possible to combine (depending on the anatomo-clinical) the surgical approach with the non-operative management of the case. Clinical parameters such as sex, birthweight, immaturity, associated malformations, size of the abdominal deffect are the main element to predict the outcome of these patients and to choose the right management strategy, thus it is very important to investigate the pregnancy evolution and the birth period. The good results (82.9% surviving) are representing the prove of a good therapeutic decision being impossible to use synthetic materials for substitution (silicon, dacron, teflon, etc.) and in the same time an important guide for our future activity.

[Intestinal tuberculosis in children. Differential diagnosis and treatment]. / Tuberculoza intestinala la copil. Diagnostic diferential, conduita terapeutica.

Lately, tuberculosis has became a top priority problem in health all over the world. The actual level of epidemiological indicates of tuberculosis Shaw that Romania is the country that has the most unfavorable situation in Europe except for Bosnia-Herzegovina. Tuberculosis incidence from 1996 to 1997 ranks Dolj county second in Romania from the point of view of the increasing rate (154.3% + 25.4% versus 107% + 4.3%). The National Programme of Controlling Tuberculosis for 1997-2000 has as main object the neutralization of a least 85% of the discovered contamination sources. At the same time with the pulmonary tuberculosis were discovered 17.2% extrapulmonary localizations. The purpose of these works is that of presenting in the frame of extrapulmonary TBC the localization of intestinal TBC with children (peritonitic form with infants and pseudotumoral with child). In class cooperation with the veterinary Medicine Service we have also studied the possibility of same sources of TBC infection of animal origin, knowing the fact that besides the human Koch bacillus were discovered bovine, ovine, poultry sources. Presenting a number of 16 cases of intestinal tuberculosis with children, rare cases of extra pulmonary tuberculosis, the authors also present 2 cases with children whose differential diagnosis had to be made ou a histopathological base between tuberculosis with an abdominal lymphoma or peritonitic carcinomatosis. The results of the surgical treatment that made the diagnosis with the help of the histopathological examination and the tuberculostatic treatment were very good, the evolution and the control in true of all the patients, proving that intestinal tuberculosis extrapulmonary form with children can be cured.

[Sacrococcygeal teratoma in children. Anatomo-clinical, therapeutic and prognostic considerations]. / Teratomul sacro-coccigian la copil. Consideratii anatomo-clinico-terapeutice si prognostice.

Presentation of potentially malignant tumours, highly frequently found in children, developed out of embrionary remnants. Study of clinical observation files, iconography resources, histopathological samples and surgical operation notes, corroborated with patient's reexamination several years later. There are presented nine clinic cases of tumours found in newborn, babies and even in young children, with teratome-like structure, that have malignant potential if excised late. Histopathological laboratory tests of the biotic sample are of paramount importance in establishing the structure of the tumour, its malignization abilities and the therapeutical conduct to be adopted. Other useful investigations: radiographs of the vertebral column, abdominal echographs, computerized tomography. Besides sacrococcygian, large and anesthetic, location in newborn, there are presented cases of intra-abdominal teratomes and one case of ovarian teratome. The study also contains a general opinion upon the patients operated on the reexamined several years later.

Histopathologic aspects in endometrium dysplasias.

The paper presents a study consisting of 87 cases of endometrial hyperplasias. Histopathologic examination allowed us to identify the singular glandulo-cystic and adenomatous hyperplasia and the coexistence of the two lesions, but also the association (for two cases) of chronic adenomatous hyperplasia to endometrial carcinoma. These aspects plead for considering hyperplasia as a precancerous lesion taking into account the physiological stage when it appears.