Surgical treatment of colon cancer: Colentina surgical clinic experience.

Most patients with colon cancer are surgically treated, with postoperative association of chemotherapy and possibly immunotherapy in advanced cases. Surgical treatment is chosen depending on the evolution stage, tumor topography and the existence of complications, colonic surgery being dictated by colonic vascularization. The radical character of the surgical intervention can be assured only in the early stages of the tumor. Colostomy is rarely necessary in patients with colon cancer. In the period of the last 5 years (2007-2011), 307 patients with colon cancer were operated in "Colentina" Surgical Clinic, radical intervention being possible only in 219 cases. 48 cases were emergency interventions for occlusion or perforation with peritonitis. Every time the mechanical preparation of the bowel was not possible, the intraoperative washout technique was used. Postoperative complications were met in 27 cases, being represented by bleeding (3 cases), peritoneal abscess (5 cases), anastomotic fistula (7 cases), abdominal wound infection (12 cases). In 5 cases the operation was done laparoscopically. Preoperative mortality was of 13 cases. Postoperative chemotherapy was done in the great majority of cases.

A primary hydatid cyst in the abdominal wall -- case report.

INTRODUCTION: A solitary primary hydatid cyst in the abdominal wall is an exceptional entity, even in countries where the Echinococcus infection has a high rate, being considered an endemic disease. CASE PRESENTATION: We report a case of a 70-year-old Caucasian man who presented to our clinic with a slow-growing painless parietal mass in the abdominal wall, right flank area. The diagnosis of cystic mass was established at the ultrasound exam. There were no findings that could describe a hydatic cyst. The punction at the surgical intervention revealed a "clear, stone liquid like"; due to the high risk of major injury of the abdominal wall, we performed partial resection of the outer cystic wall, proligerous membrane removal and drainage. The patient had an uneventful post-operative recovery. The histopathology confirmed the suspected diagnosis. CONCLUSION: Hydatid cyst should be considered in the differential diagnosis of every abdominal intraparietal cystic mass, especially in regions where the disease is endemic. The best treatment is the total excision of the cyst preserving an intact wall (complete cystectomy). Otherwise, removing the proligerous membrane with partial pericyst's resection (partial pericystectomy) and drainage should be considered.

Evaluating the treatment of metastatic colorectal cancer with monoclonal antibodies.

The ability to tailor biologic therapy based on the status of tumor biomarkers and monoclonal antibodies has become very important in the last years. The role of tumor biomarkers in treating colorectal cancer, specifically the K-RAS gene, was identified. K-RAS had a higher interest after Lievre and colleagues reported at the 2008 American Society of Clinical Oncology (ASCO) meeting, their analysis of K-RAS mutations in tumors from patients who did not appear to benefit from cetuximab therapy, providing additional data involving K-RAS mutant tumors and their lack of response to cetuximab, as part of first-line therapy for metastatic colorectal cancer. Furthermore, other trials evaluated the K-RAS status and the first-line treatment of metastatic colorectal cancer, the treatment of refractory metastatic cancer and dual-antibody therapy in the first-line treatment of colorectal cancer. Patients with mutant K-RAS colorectal tumors have no benefit from cetuximab, no matter the type of chemotherapy regimen.

Albendazole associated to surgery or minimally invasive procedures for hydatid disease--how much and how long.

Cystic echinococcosis is parasitic disease due to the larval stage of the metacestode Echinococcus granulosus in the liver (80%), lungs, kidneys, spleen, myocardium etc. Humans are accidental intermediate hosts. Diagnosis is based on laboratory and imaging studies. Treatment is multimodal, surgical and medical. Risks for dangerous complications and relapses are quite common. Adequate follow-up is needed. Albendazole has a central role in the medical therapy of the disease.

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.

[Primary pancreatic cystic neoplasms--diagnosis and treatment]. / Neoplasmele chistice primare pancreatice--diagnostic si conduita terapeutica.

The paper's purpose is to analyze the diagnosis and treatment methods of primary pancreatic cystic neoplasms. Between 1996-2007, 10 patients (3 male and 7 female), ages between 30 and 71, were committed and surgically treated in the Surgical Unit of Colentina Clinical Hospital of primary pancreatic cystic neoplasms: 2 serous cystadenomas (SCAs) and 8 mucinous cystic neoplasms (MCNs) (in one case there were liver and peripancreatic lymph nodes metastases). Following clinical and paraclinical evaluation, patients with serous cystadenomas received distal pancreatectomy and splenectomy, and MCNs patients received cephalic duodenopancreatectomy (3 cases), distal pancreatectomy and splenectomy (3 cases), segmental corporeo-caudal pancreatectomy (1 case) and choledocoduodenostomy and gastrojejunostomy (1 case). In patients with serous cystadenomas the post-operatory mortality and morbidity were null, and the long-term prognostic excellent, both patients, after 26 months and 5 years respectively, being in good health, with no evidence of illness. In patients with mucinous cystic neoplasms the post-operatory mortality was null, the post-operatory morbidity was 37.5% and the global survival rate was 50% in 5 years and 66.66% in 3 years. Primary cystic neoplasms are lesions that can be surgically treated, with good results. Surgical resection is the ideal therapeutic solution, while palliative surgeries alternatives are done in exceptional situations.

[Transtumoral drilling--an efficient solution and in many cases the only one available in the surgical treatment of Klatskin tumors]. / Forajul transtumoral--solutie eficienta si de multe ori singura posibila în tratamentul chirurgical al tumorilor Klatskin.

PURPOSE: Reviewing the cases and evaluate the efficacity of the trans-tumoral drilling in the Klatskin tumours which were operated in Colentina Surgical Department. MATERIAL AND METHOD: This is a clinical retrospective study on 109 cases of Klatskin tumours operated between 1998-2004. in 80 cases of them we could practice a biliary drainage using a trans-tumoral drilling. SURGICAL INDICATION: Malignant tumours of the main biliary duct developed at the level and above the junction of the two hepatic ducts , extended to the liver in many cases. SURGICAL TECHNIQUE: Through the choledochostomy, we performed with a special instrument the trans-tumoral drilling with the setting of a biliary axial drainage (40 cases), external biliary drainage through a semirigid trans-choledochal tube (25 cases), Kehr tube (9 cases), U tube (3 cases), internal drainage with intra-choledochal stent (2 cases), lost tube (1 case). RESULTS: In all cases we observed the early decrease of the jaundice. In the cases in which we used internal drainage, we had to perform a replacement of the closed tubes in 1-2 months after the first operation. Instead, the external biliary drainage, less expensive and periodically washed to preserve his permeability, proved his high efficiency. The average survival time was 8,9 months (between 5-20 months). CONCLUSIONS: The external biliary drainage through trans-tumoral drilling remains in many cases the only one available therapeutical solution for the Klatskin tumours.

[Cancer of the head of pancreas--resection vs. palliative surgery]. / Cancerul de cap de pancreas--rezectie vs. paleatie.

Pancreatic cancer remains a disease with high mortality. The unspecific symptoms for a long time make the diagnostic difficult. Between 1995-2004, only 85 from 465 patients with this diagnosis, had pancreatic resection. To them, we performed Whipple pancreaticoduodenectomy (60), pylorus preserving pancreaticoduodenectomy (15), pancreatico-duodenectomy with preserving of duodenum (2), pancreaticoduodenectomy with associated resections (5), subtotal pancreatico-duodenectomy (30). The reconstruction after pancreatic resection was pancreatico-jejuno anastomosis (26) and pancreatico-gastro-anastomosis (59). Morbidity was about 34% and the mortality was about 9%.

The importance of laser-biophotometry in vivo in medicine.

Infrared laser biophotometry limits to a relatively strait spectrum (0.85-0.89 mkm) and it is based on the absorption, dispersion and reflexion phenomena from the tissues. It was taken a study group of 180 people (students and other categories of people considered healthy). The determined medium reflexion coefficient in infrared in the intact tissues is an index with medium values (between 55.7-68+/-2.1 milliwatts), stable in time. The individual variations of the medium coefficient of reflexion in infrared (MCR IR) for the intact tissues do not exceed 3+/-2.1 milliwatts. The MCR IR values determined for intact tissues will be taken as reference point in the determination of the MCR IR for pathologically modified tissues (edema, hematoma, abscess) in the next part of the study. The obtained results allow the use of Laser-biophotometry in vivo method in the evaluation and observation of the pathological processes accompanied by water retention in the organism, differentiation of the processes concerning fat accumulation (obesity, metabolic X syndrome, etc.). Absorption particularities of radiation in Infrared, observed during this study, suggest physiotherapeutic factor graduation determined by individual particularities of the organism: the pigmentation degree of the skin tissue and the tissue structure (stroma density).

[Therapeutic options in gallstone ileus]. / Optiuni terapeutice în ileusul biliar.

Gallstone ileus is a rare, serious condition, requiring emergency surgery, specific to elderly age. The present study deals with 16 cases operated in 25 years period, with median age about 64 years old. The patients had clinical evidence of intestinal obstruction, confirmed by radiological examination and ultrasonography. Emergency operations were performed. In 7 cases had been treated radically both the obstruction (entero-lithotomy) and the bilio-digestive fistula (cholecystectomy, duodenal closure, enteral closure, colon-suture) with good results (only one death). In 9 cases, it had been treated only the intestinal obstruction, with only 2 cases of persistent cholangitis. Generally, we have used biliary drainage with Kehr tube in the presence of biliary stones and cholangitis. The biliodigestive fistula may close in evolution or become a harmless secondary route for internal biliary drainage.

[One case of multiple abdominal hydatidosis]. / Un caz de chist hidatic abdominal cu localizari multiple.

It is presented the case of a 45 years old female patient transferred in our clinic from Parasitology Clinic with the diagnosis of hepato-splenic hydatidosis. Preoperative echography presented 3 abdominal hydatid cysts (hepatic, splenic and free in the peritoneal cavity--greater omentum). Intraoperative exam confirmed the preoperative evaluation. The operation consisted in two ideal cystectomies associated with one partial cystectomy with evacuation and drainage. Postoperative evolution was simple.

[Late results after the Mark Belsey IV antireflux procedure in achalasia]. / Rezultate tardive dupa procedeul Mark Belsey IV în achalazie.

Cardial achalasia (cardiospasm, megaesophagus) represents the failure or lack of relaxation capacity of the inferior esophageal sphincter; it is the second esophageal disease and is considered a premalignant lesion. Treatment of achalasia is surgical but palliative, considering the lack of an etiopathogenic therapy for this moment. We present a retrospective study done on 19 patients (10 males and 9 females, with a mean age of 49 years) operated in "Colentina" Surgical Clinic in the period of 1996-1999 for achalasia (presenting symptoms-dysphagia, regurgitation, weight loss) by extramucosal esocardiomyotomy practiced on a length of 5-10 cm, by thoracic approach, followed by the Mark Belsey IV antireflux procedure. Results were good, without reflux pathology or dysphagia in the postoperative evolution.

[Pancreatic insulinomas]. / Insulinoamele pancreatice.

In the period of 1980-1999 (20 years) were operated 18 patients (8 males and 10 females) in "Colentina" Surgical Clinic, the average age being of 45 years, with hystopathologically confirmed insulinomas. The topography of these lesions was in the head of the pancreas (4), in the isthmus (5), in the body and tail (9). The classical clinical and biochemical signs were presented in 13 cases, the rest of the patients presenting atypical signs of disease. These patients had benefit from the surgical treatment. The approach was bi-subcostal in 11 cases and by upper and lower midline incision in the rest of cases. We practiced enucleation in 5 cases, corporeal-caudal pancreatico-splenectomy in 10 cases and cephalic pancreatico-duodenectomy in 3 cases. The malignancy of the tumour was hystopathologically confirmed in 30% of the situations. The postoperative mortality was in 3 cases, by acute pancreatitis, MSOF and myocardial infarction. We consider that in case of these generally benign tumours the most efficient therapy is the surgical one.

[Surgical procedures in penis cancer]. / Optiuni terapeutice în cancerele peniene.

In the period of 1980-1999 (20 years) in Colentina Surgical Clinic were admitted and operated 16 patients with the diagnosis of pennial cancer (histopathology--squamocellular carcinoma), 13 of whom being from Colentina Dermatological Clinic. The mean age was about 64 years old, 10 cases presenting phimosis. Surgical procedures undergone were represented by partial pennial amputation with bilateral superficial inguinal lymphadenectomy (10 cases), total pennial amputation with superficial inguinal lymphadenectomy (4 cases), respectively emasculation with bilateral inguinal-iliopelvic lymphadenectomy (2 cases). In the postoperative period 3 patients presented lymphedema and lymphorrhagia, solved by conservative management. All the patients benefited of favorable evolution on the period they have responded to the controlled postoperative follow up (1-3 years).

[Inflammatory optic neuropathies]. / Neuropatiile optice inflamatorii.

The article presents a study on 94 patients hospitalized in the Clinic of Ophthalmology of Cluj-Napoca, during 1993-1998, with optic neuritis. There are presented the clinical and functional aspects of optic neuritis, especially the importance of static perimetry, for the diagnosis, and her superiority, compared with the dynamic perimetry, in finding minor visual field defects in the diagnosis of the optic neuritis too. After treatment, 75% of the cases have a favorable evolution, but the static perimetry reveals sequela visual field defects at 85.3% of the eyes which suffered optic neuritis. According with this findings, static perimetry has a important role in the diagnosis of optic neuritis, in the revealing the functional sequela defects and in the monitoring of the patients.

[Anterior ischemic optic neuropathies]. / Neuropatiile optice ischemice anterioare.

The article presents a study on 82 patients hospitalized in the Clinic of Ophthalmology of Cluj-Napoca, during 1993-1999, with anterior ischaemic optic neuropathy (AION). There are presented the clinical and functional aspects of AION, especially the importance of static perimetry (PS) for the diagnosis, and her superiority, compared with the dynamic perimetry, in the monitoring of the patients with chronic nerve head ischaemia. After treatment, 32.9% of the cases have a favorable evolution, but PS reveals sequela visual field defects at all eyes which suffered AION. Long-term monitoring of the patients reveals unfavorable evolution at mare than 85% of cases, because of the chronic residual ischaemia, characterised by decreasing of visual capacity in PS. According with this findings, static perimetry has a important role in the diagnosis of AION, in revealing of the sequela defects and in the monitoring of the patients.

[Sugiura's procedure--a treatment modality for esophageal varices]. / Operatia tip Sugiura--o modalitate de tratament chirurgical a varicelor esofagiene.

This study present the "N. Gh. Lupu" surgical experience with Sugiura technic for bleeding caused by oesophageal varicose. Is a 5 years retrospective study with 30 patients who are submitted of this operation. After the results analysis our opinion is to do this operation in stabilised patient, but she is possible even in emergency.

[Therapeutical options in pancreatic pseudocysts]. / Optiuni terapeutice în pseudochistele pancreatice.

This paper presents the "N.Gh.Lupu" surgical clinic's experience, that consists in 65 cases of pancreatic pseudocysts operated in the last 10 years (1989-1998), 30 females and 35 males, with a mean age of 52 years old. The diagnosis was mainly based on the classical echography and CT-scanner, the clinical picture being non specific in the majority of cases. Although the predominant use of the nonsurgical interventional procedures is recommended, this presents the maiden attempts of the authors in this field, the surgical techniques used being as it follows: cephalic pancreaticoduodenectomy, distal pancreatectomy, cystodigestive anastomosis, external drainage. The perioperative mortality was null, the postoperative one consisting in 3 cases (2 cases in the early period and 1 case in the later period).

[Surgical treatment of pelvic subperitoneal tumors]. / Tratamentul chirurgical al tumorilor pelvisubperitoneale.

In the last 5 years in our hospital was operated 25 patients with pelvisubperitoneal tumors. Major clinical symptoms are compression and body mass effect. The localization and tumors dimensions, are established by CT and RMI. Surgical resection, difficult by the relations with iliac vessels and nerves, was do it in sub capsular manners and followed by chemo and radiotherapy. Our results are good, with 6 patients who passed 4 years postoperatively.

[The indications for and limits to the surgical treatment of congenital dilatations of the intra- and extrahepatic bile ducts]. / Indicatiile si limitele tratamentului chirurgical în dilatatiile congenitale ale cailor biliare intra si extrahepatice.

Congenital cystic dilatations of the biliary ducts are defects in the genetic program which are transmitted in an autosomal recessive way. Todani classified cystic dilatations of extra and intrahepatic ducts in 5 types. In classified cystic dilatations of extra and intrahepatic ducts in 5 types. In "N. Gh. Lupu" Surgical Clinical were treated 9 cases of congenital dilatations of the biliary tree during the last 40 years (1958-1998); five of them were belonging to the type V Todani (Caroli's disease), three to the type I Todani and one case in the type IV a of Todoni's classification. The mean age of the patients was 42.4 years, five of them being men and 4 women. Surgical treatment was particular to each case depending on age, associated diseases, the length of disease's evolution and the general state of the patient. The prognosis of this disease is a reserved one.