Aggressive Male Breast Cancer-Clinical and Therapeutic Aspects Correlated with the Histopathological Examination: A Case Report and Literature Review.

Breast cancer is often seen as a disease that occurs in women, but it can also appear in men in a very small percentage, below 1%. Men have a minimal amount of breast tissue compared to women, which has the potential to become malignant in a similar way to women, although much less frequently. A patient presented with advanced local invasion due to the low amount of breast tissue, with the tumor quickly invading the adjacent structures. Histopathological and immunohistochemical examinations have an extremely important role in the pathology of breast cancer. Given that male breast cancer is rare and there are not enough surgeons specializing in breast surgery in our country, there is a lack of experience in the management and early diagnosis of this type of cancer, which will be highlighted in this article.

[Lower limb varicosity in patients, with indication for total knee arthroplasty]. / Boala varicoasa a membrelor inferioare la pacientii cu indicatie pentru artroplastia totala de genunchi.

Preoperative treatment of the peripheral venous pathology in patients with indication for total knee arthroplasty (TKA) would reduce the risk of postoperative deep venous thrombosis (DVT). Between 1997 and 2004, 110 patients were evaluated for TKA. 35 had also varicose veins in the lower limbs. 4 patients were excluded because of absolute contraindications for surgery. 31 patients presented varicose disease, in different stages according with CEAP. The patients were treated surgically (Babcock or Muller technique), phlebotomy drugs and mechanical contention. In a single case the TKA was done without any preoperative treatment of the varicosities. TKA was done after 8-12 weeks. DVT prophylactic measures were undertaken in all 95 cases. Results were good except 2 cases of DVT and 1 case or pulmonary embolism in patients with preoperative treatment of the venous disease. The patient with no preoperative treatment of its varicose veins developed DVT with chronic, persistent oedema. Preoperative treatment of the varicose veins in the lower limb is mandatory for a successful TKA.

[A rare cause of upper digestive tract bleeding--pancreatic papillary adenocarcinoma]. / Hemoragie digestiva superioara de cauza rara--adenocarcinom papilifer pancreatic.

Authors present a rare case of upper digestive bleeding, the etiology of which is represented by a pancreatic papillary adenocarcinoma placed in the body and tail of the pancreas, with bleeding through the Oddi's sphincter, which causes difficult problems of medical and surgical diagnosis and treatment. The patient was known with acute cholecysto-pancreatitis of lithiasic cause, which has been surgically cured in 1977, being under treatment in the last years for the pancreatic injury which had been chronic pancreatitis and for hyperglycemia. The laboratory explorations emphasized a severe anaemia which was identified through upper digestive endoscopy (intermittent active bleeding from the major papilla) confirmed by echo and CT exam (heterogeneously body tissue of 10/8 cm diameter, involving the body and the tail of the pancreas). The medical treatment was complex, including proteic, hematologic, acido-basic, balance of hyperglycemia, and was followed by the surgical intervention consisting in body and tail pancreatico-splenectomy, followed by a postsurgical abscess, which required drainage. The surgical evolution was favorable. 6 months after leaving the hospital, the patient was admitted to medical diseases clinic with the diagnosis of deep right ileofemoral thrombophlebitis, duodenal acute ulcer and acute pneumonia of average right lobe, causing difficult problems of medical treatment. On this pathologic background, the diabetic failure also appears and the echo exam showing multiple secondary hepatic and peritoneal metastatic determinations. In medical literature we only met 13 similar communications, problems of diagnosis and treatment being very much alike to those presented.

[Osler's hereditary angioneurotic edema as rare but possible cause of false surgical acute abdomen]. / Edemul angioneurotic ereditar Osler--cauza rara de fals abdomen acut chirurgical.

The authors are presenting one case of Osler's hereditary angioneurotic oedema, rare genetic disease with dominant autosomal transmission linked to the 11-th chromosome, with clinical aspects resembling to those of surgical acute abdomen, with difficult diagnostic problems. The treatment consist in: fresh plasma administration, antihistaminic drugs and anabolic steroids. The simple laparotomy under general anaesthesia by orotraheal intubation being very dangerous. The patients with Osler's hereditary angioneurotic oedema must be followed-up by the allergology services and educated regarding the disease and it's risks to avoid diagnostic errors with following negative consequences.