Axillopexy.

The present paper is a presentation of our technique of axillopexy, used after the excision of the axillary lymph nodes in 29 cases of breast cancer patients. We have used this technique after Madden modified radical mastectomy or after quadrantectomy for tumors in the external quadrants of the mammary gland. We have studied and compared with a 30 case control group, the duration of the lymphorrhagia the moment of removing the drains, the presence absence of other local complications. We have also measured the time until the beginning of the oncological postoperative therapy. Every one of the aspects we have studied was improved in the axillopexy group.

Laparoscopic treatment of perforated duodenal ulcer -- a multicenter study.

AIM: The aim of this study is to evaluate the results of the laparoscopic treatment of perforated duodenal ulcer performed in 6 Romanian surgical centres with experience in the field of laparoscopic surgery. MATERIAL AND METHOD: Between 1996 and 2005, 186 patients with perforated duodenal ulcer were operated on in the centers participating in this retrospective study, all patients being ASA I-II. Thirty-nine patients (20.0%) presented mild peritonitis, 120 (64.5%) medium peritonitis and 27 (15.5%) severe (20.0%) simple suture was performed, in 110 (59.1%) suture with epiplonoplasty, for 1 (0.5%) only epiplonoplasty and 1 (0.5%) underwent excision of the perforation and suture. RESULTS: The operative time was between 30-120 minutes, with an average of 75 minutes. No death was noted. Average hospitalization time was 6 days, with periods varying between 3 and 18 days. Postoperative complications included: 5 patients (2,6%) presented infections of the abdominal walls, 1 patient (0.5%) duodenal fistula, 1 patient (0.5%) intra-abdominal abscess, 1 patient (0.5%) a superior digestive hemorrhage by "mirrored ulcer" and 1 patient (0.5%) duodenal stenosis 6 months after operation. The patients were administered 50% less analgesics, used 70% less dressings, 30% less antibiotics and had 60% less complications in comparison with those operated by the classical approach. CONCLUSION: The laparoscopic approach of perforated duodenal ulcer constitutes the first choice for patients without important co-morbidities, allowing a quick recovery and a significant reduction in the consumption of analgesics, antibiotics and dressing materials.

Synchronous ovarian dysgerminoma and breast carcinoma in a patient with positive immunostain of BRCA1.

Breast cancer is the most common malignant neoplastic process and the second cause of death for women. Ovarian cancer, despite having a lower incidence, represents an important cause of morbidity and mortality because it is usually discovered in advanced stages. The presence of both forms of cancer in a patient is associated with a high risk of BRCA1 gene mutations, which are responsible, together with BRCA2 gene mutations, for most of the breast and ovarian cancer family. Our case is special because it presents a synchronous and a rare association of a primary ovarian dysgerminoma (with an incidence of less than 1% of ovarian cancers) and a primary breast carcinoma in a patient of 46 years old. Immunohistochemical examination was performed using a panel of five biomarkers: oestrogen receptor, progesterone receptor, Herceptest, p53 and BRCA1. In our case, we identified a negative hormonal status and the absence of HER2/neu expression but a positive immuno-expression for p53 protein and BRCA1 protein. Postoperative course was favourable for the patient after each surgery, and she was discharged with the recommendation to perform a genetic counselling.

[Role of procalcitonin in monitoring the antibiotic therapy in septic surgical patients]. / Rolul PCT in monitorizarea antibioterapiei la bolnavul septic chirurgical.

BACKGROUND: Based on the need for rigorous monitoring of antibiotic and a proper assessment of patients with sepsis, procalcitonina as biological marker appears to have significant value, being proposed for both detection and for evaluation of bacterial infection and antibiotic management. MATERIAL AND METHODS: We conducted a prospective study on a group of 73 patients admitted in Surgical Clinic II you SCJU Constanta between 2010-2011, which is included in the study criteria ACCP/SCCM Consensus Conference in 1992. We have made determinations of the PCT, in dynamic, since the admission of patients, with imunocromatographic method, monitoring the antibiotics on the studied group depending on cut-off fluctuations and PCT. RESULTS: The level of procalcitonin reflect the degree of systemic inflammatory response. PCT dosages were performed in 17 patients without inflammation/infection in 21 patients with local infections, 20 with systemic infection (sepsis), 7 with severe sepsis and septic shock 3/MSOF. In the studied group we excluded 5 patients with associated pathology (on the first day after a major trauma, major surgery, burns, treatment with drugs that stimulate the release of pro-inflammatory cytokines, small cell lung cancer, medullary thyroid carcinoma) in that the PCT was in the absence of an inflammatory process cresct/infectious manifesto. Starting, monitoring and stopping the antibiotic was carried out based on PCT levels. The dosage of procalcitonin (PCT) revealed significantly elevated values in patients with severe sepsis and septic shock/MSOF. PCT was significantly lower in patients with sepsis compared with those with septic shock, and the difference between PCT values in patients with sepsis and severe sepsis was the limit of statistical significance. PCT values were not predictive of death, however. CONCLUSIONS: In conclusion, dynamic measurement of PCT may be a predictor for life-threatening infections with antibiotics that can monitor and direct the time and efficiency. The value of PCT as a guide of antibacterial therapy which can reduce mortality and morbidity in surgical septic patients remains to be fully evaluated by future studies, but we can say that the determination of this biomarker could be introduced in the dynamically protocol of tracking the clinical course of septic patients.

Urothelial carcinoma of the renal pelvis associated with cystic disease of the kidney.

Primary tumors of the renal pelvis and ureter account for about 8% of all urinary tract tumors. More than 90% of them are urothelial carcinomas. On the other hand, unilateral multicystic renal disease is an uncommon pathologic condition that may be mistaken for unilateral autosomal dominant polycystic kidney disease, multilocular cystic nephroma or cystic neoplasm. We present the case of a 54-year-old male known with arterial hypertension, admitted in the Second Surgery Department of Emergency County Hospital, Constanta, with intense right flank and right lumbar pain. This symptom started one month before hospital admission. Based on clinical features and imaging evaluations we established a presumptive diagnosis of unilateral autosomal dominant polycystic kidney disease. For these reasons, total right nephrectomy was performed. Pathologic examination of the nephrectomy specimen revealed high-grade urothelial carcinoma of the renal pelvis associated with unilateral multicystic renal disease. The particularity of this case lies in the uncommon association between two rare renal pathological conditions diagnosed by pathological examination.

[Old and new concepts in surgical therapy of gastroduodenal ulcers complicated or resistant to treatment]. / Concepte vechi si noi in terapia chirurgicala a ulcerelor gastroduodenale complicate sau rebele la tratament.

This article presents the old and the new therapeutic protocols in the gastroduodenal ulcer. In our opinion, subtotal gastric resection and bilateral subdiafragmatic vagotomy must be considered "historical" without having theoretical support in the era of the antisecretory and anti Helicobacter pylori medication, with similar or superior effects. Is considered as complete the era of the gastric large crippling resection of Péan and Billroth, as the era of Dragstedt's vagotomy and applied the new methods nonaggressive and miniminvasive.

Pancreatogenic diabetes pacient selection for pancreatic islet transplantation.

BACKGROUND: recently, insulin-dependent diabetes mellitus, can be treated by pancreatic islet allotransplantation. METHODS: This retrospective study involves 137 patients from the Surgery Department of Colentina Clinical Hospital, Bucharest, in the July 2000 - July 2008 period, who underwent pancreatic resections, the number of patients who developed pancreatogenic diabetes and their selection for the pancreatic islet transplantation. RESULTS: After pancreatectomy, 70 patients are diagnosed with diabetes, and 42 with prediabetic stages (IFG and IGT). 61 of these had average glycemic excursions (MAGE) over the normal, and 31 of the 70 patients diagnosed with diabetes, presented hypoglycemic episodes during treatment. CONCLUSION: The present criteria of patient selection for pancreatic islets transplantation are limited and can be applied to a small number of patients.

[Preliminary results for intraperitoneal chemotherapy in abdominal cancers]. / Date preliminare despre chimiohipertermia intraperitoneala (CHIP) în cancerele organelor intraabdominale.

The paper presents a review of the the last 20 years experience of some important oncologic and surgical centers all over the world on IntraPeritoneal Hyperthermic Chemotherapy (IPHC) applied by well known specialists in this domain: Sugarbaker P. (SUA), Takeshi S. (Japan, Elias D. (France), Deraco M. (Italy) and others. Then 20 cases of abdominal cancers with or without peritoneal metastases are presented, in which IPCH was applied using a Romanian apparatus of drainage - lavage with hyperthermic solutions of 5 Fluorouracil, alone or combined with cisplatin, over a 3 years period. The results are encouraging although the follow-up of this group is in progress.

Combined liver and islet transplantation using steroid-free immunosuppression.

Due to a vicious circle in which HCV favors insulin resistance and, alternatively, insulin resistance facilitates the persistence of HCV, HCV patients have often diabetes associated with liver cirrhosis. We present the case of combined liver and pancreatic islets transplantation performed in a patient with HCV liver cirrhosis associated with insulin-dependent diabetes. This is also the first case of islet allotransplantation in Romania. A 40-year-old male diagnosed with liver cirrhosis due to HCV infection and insulin dependent diabetes underwent combined liver and islet transplantation. Our therapeutic design was based on data provided by both the use of Edmonton immunosuppressive steroid-free protocol in islets cell transplantation and the findings of international studies on the effects of this protocol in liver transplantation for patients with HCV infection. Good metabolic control of the diabetes was obtained. The absence of anti beta cell autoimmunity could explain also the good tolerance for the transplanted islets, proved by the rapid and durable decrease of the insulin need, from 64 U/day to 20 U/day at one month post-transplantation, dose that was maintained for 16 months when the patient died due to recurrent HCV hepatitis. Islet transplantation can be associated to liver transplantation in order to improve the associated diabetes in cirrhotic patients.

[The role of intraoperative ultrasound in the diagnosis and treatment of hydatid liver disease]. / Rolul ecografiei intraoperatorii in diagnosticul si tratamentul bolii hidatice hepatice.

Liver hydatid disease still represents a frequent condition in Romania, especially among population of Dobrogea County, which may lead to life-threatening complications. To assess the role of intraoperative ultrasound (IOUS) in the diagnosis and treatment algorithms of liver hydatid disease. We could not find any similar studies in the literature in order to compare the results. The paper represents a retrospective study of IOUS performed for liver hydatid disease on a group of 43 patients admitted in the 2nd Clinic of Surgery - Clinical Emergency Hospital of Constanta. IOUS was intraabdominal (36 cases), transdiaphragmatic (7 cases) and was able to diagnose infected liver HC (7 cases), locate bilio-cystic fistulas (6 cases), hydatic cysts (18 cases) or relation with important anatomic elements (12). Ultrasound-guided frenotomy was performed in 5 cases and ultrasound-guided puncture in 9 cases. In 26 out of 43 patients (60.47%), IOUS influenced decision making during surgery. These data recommends IOUS in managing hydatid disease, allowing a complete diagnosis and optimal treatment, thus reducing postoperative morbidity.

[Pancreatic islets isolation from the brain death donors]. / Izolarea de insule pancreatice de la donator în moarte cerebrala.

The paper analyzes a number of 5 cases of pancreatic islet cells isolation, purification and culture extracted from the pancreas of brain-dead donors. For the isolation stage the authors used the "two-step" digestion method. The isolated pancreatic islet cells were morphologically and functionally analyzed by assessing their viability and purity. For the in-vivo experiments the authors used animals with Streptozotocin induced diabetes. The data clearly indicated a high efficiency of collection providing an optimal number of transplantable pancreatic islet cells.

[Preliminary data on post-pancreatectomy diabetes mellitus treated by islet-cell autotransplantation]. / Date preliminare despre tratamentul diabetului postpancreatectomie prin autotransplant de insule pancreatice.

The present study describes the first islet autotransplant program in Romania, and the first 3 cases of subtotal pancreatectomy for chronic pancreatitis combined with islet autotransplant. The primary objective was to pain relief by pancreatic resection, but also to preserve the endocrine function by islet autotransplant. Extensive distal pancreatectomy is effective in relieving pain, but should be limited to patients with small duct disease, in whom more conservative methods have failed, because of severe metabolic consequences. Islets were prepared by Liberase digestion of the excised pancreas, and infused unpurified into the portal vein in one case and in the omental pouch and peritoneum in two cases. All patients were relieved of pain, have achieved insulin independence, and positive C peptide levels, but one patient died of a acute bronchopneumonia 60 days post-transplantation. The mean islet yields were 2100 islet equivalents/Kg body weight. Islet autotransplantation can be considered a useful therapeutic option serving to prevent the occurrence of surgically-induced diabetes. The results have indicate that the omental pouch is a viable site for islet autotransplantation, that can accommodate a large tissue volume, is easy to access to implant, and the IBMIR (instant blood mediated inflammatory reaction) may be less severe.

[The use of Sono-Surgery in breast cancer surgery]. / Utilizarea Sono-Surg-ului în chirurgia neoplasmului de sân.

THE AIM: Of this research is presenting the using of Sono-surg as a technic possibility in breast cancer surgery. MATERIAL AND METHODS: Are presented and analyzed cases of mastectomy and laparoscopic oophorectomy in which since 1999, was used like element of hemostasis Sono-surg. RESULTS: In 23 cases of laparoscopic oophorectomy using Sono-surg, was reduce the time of intervention, incidence or usually complications. The idea of using Sono-surg in mastectomy too, make sure a perfect hemostasis even if the time of the intervention is longer. CONCLUSION: Introducing Sono-surg in surgical treatment of breast cancer is a therapeutic solution which may be used with postoperative profits.

[The anal incontinence-- study on 20 operated cases]. / Incontinenta anala--studiu pe 20 cazuri operate.

The authors present 20 cases operated for anal incontinence. Two techniques were performed: direct repair (18 cases) and Musset-Cottrell procedure (2 cases). The results were excellent in 12 cases, good in 5 cases and satisfactory in 3 cases. The method of choice seems to be the direct repair of the anal sphincter after a proper local and general preparation.

[Urinary complications after anorectal surgery]. / Tulburari urinare postoperatorii în chirurgia ano-rectala.

The prevalence of urinary complications after various anorectal operations was studied in a group of 273 patients. The overall prevalence of urinary complications was 26.7%; most of these complications affected men between 41 and 50, mainly after hemorrhoidectomy. In 10.6% of patients, bladder catheterization was needed. These urinary complications result from nervous reflexes originating from the anus and determined by the operative trauma and/or rectal distinction. In the treatment of these urinary complications, the role of the muses is essential for reassuring the patients. Parasympathomimetic drugs are often efficient. Urinary catheterization must be delayed until the 18th hour. Fluid restriction may be useful to prevent urinary retention.

[A new surgical technic in the treatment of uncomplicated hepatic hydatid cyst]. / O noua tehnica chirurgicala în tratamentul chistului hidatic hepatic necomplicat.

The authors are presenting a new surgical technique in the therapeutical arsenal of the II-nd Surgery Clinic, County General Hospital, Constanta starting with this year, 1997, for the surgical treatment of the uncomplicated hydatid cyst of the liver. Without any present evaluation of the results, the article describes the technique in accordance to the world scientific literature. This procedure consists of a minimum cystotomy with the extraction of the proligerous membrane and tight cystorafta after introducing 9/1000 sodium chloride in relative tension. The minimum approaching incision, the short time of the operation, the elimination of the "annoying" cavitary and intra-abdominally drin tubes, the fast social reintegration include this technique in the group of the minimum invasive surgical procedures and recommend its application in the uncomplicated hydatid cyst of the liver.