[Extensive necrotizing perineal infections in diabetic patients]. / Supuratiile perineale extensive la pacientii diabetici.

We present the pathogenic and the therapeutic features of the extensive necrotizing perineal infections in diabetic patients, based on the clinical experience of our surgical department (45 cases in 10 years) and on the data in the medical literature. We analyzed the case of a 45 years male with an unbalanced type I diabetes mellitus, which has been admitted for an extensive necrotizing infection of the lower abdominal wall (hypogastrium and both right and left lower quadrant), with crepitation on this area. The origin of this necrotizing infection was an upward extension of an insufficiently drained right ischiorectal abscess. The therapeutic management consisted in 6 consecutive surgical procedures (drainage, necrectomy, large fasciectomy), which permitted a favourable evolution and the healing of the patient. We used this demonstrative case for emphasizing the clinical, paraclinical and therapeutical peculiarities of the extensive perineal infections in diabetic patients.

[Sacrococcygeal teratoma in an adult female operated with abdominoperineal approach]. / Teratom sacro-coccigian la adult rezolvat prin abord mixt abdomino-perineal.

The authors present the case of a 28 years old female with a mature, three-layers sacrococcygeal teratoma, which has been operated using an abdominoperineal approach. Teratomas are quite frequent in pediatric surgery; their incidence gradually decreases in adult population. Lately, significant progresses in the diagnosis and treatment of fetus and new born teratomas have been achieved; a review of the literature (2000-2004) is added. In adults, the diagnosis of teratomas is rather difficult. The symptoms are due to their size, to the compression of pelvic viscera or to their complications (infections, bowel obstruction, fistulas, malignancy). The treatment of teratomas is mainly surgical. The approach depends on the peculiarities of each case (size, invasion of the nearby viscera).

[Cystic lesions of the pancreas]. / Leziunile chistice pancreatice.

The lesions of the pancreas represent a very interesting chapter of its pathology. Although they seem very much alike, the different anatomo- pathological forms have well defined individual features, which impose the therapeutical attitude. The authors have analyzed a group of 62 patients, admitted in our clinic between 1974 and 2003. Most of them had pancreatic pseudocysts (54-86%); 6 (10%) had cystadenomas; 1 (2%)--cystadenocarcinoma and 1 (2%)--solid and papillary cystic tumour. The diagnostic methods are largely presented and compared to the literature; it is emphasized the importance of imaging procedures and of the histo-pathological examination. The different therapeutical procedures, their advantages and limits are also analyzed--the necessity of a conservative attitude, with the total or partial preservation of the pancreas, is almost unanimously recognized.

[Organic hypoglycemia of pancreatic cause]. / Hipoglicemiile organice de cauza pancreatica.

Insulinomas represent the most common cause of organic hypoglycemia. They are rare tumors: a review of the world literature reported a total number of 2000-3000 cases. The clinical diagnosis is based on the Whipple triad, which consists of: a) symptoms of hypoglycemia, b) blood glucose level: 40-50 mg/dl during the crisis, c) relief of symptoms after oral or intravenous administration of glucose. The most ticklish problem is the settlement of the accurate location of the tumor. Nowadays, there are many diagnostic methods; one of the best appears to be intra-operative ultrasonography. The authors analyse a series of 16 patients, operated between 1985 and 2002 in "I. Juvara" Surgical Clinic and present their opinions concerning tactic and technical aspects of different surgical procedures, with their advantages and limits. The results of the surgical treatment are detailed. There are also mentioned new imagery techniques and laparoscopic procedures, from recent medical issues.