[Heterotopic accessory pancreas in surgical pathology: review of 23 years experience]. / Pancreasul accesor heterotopic in patologia chirurgicala: experienta a 23 de ani.

BACKGROUND: The abnormal presence of the pancreatic tissue in other digestive organs is rare but sometimes is the cause of some surgical diseases. MATERIAL AND METHOD: This retrospective study is focussed on heterotopic pancreas cases diagnosed in 2nd Surgical Clinic of "Sf. Spiridon" Emergency Hospital from Iasi between Jan. 1986 and Dec. 2008. RESULTS: 22 patients (15 males/68.2% and 7 females/31.8%) aged between 23 and 76 years were grouped in A group--clinical symptomatic cases (3 patients/13.6%), group B--coincidental cases (17 patients/77.3%) and group C--incidental cases (2 patients/9%). Group A patients presented with obstructing prepyloric polypoid tumors and recquired antrectomy and gastroduodenal anastomosis. 13 patients of group B (76.4%) recquired surgery for pyloroduodenal stenosis and in 4 cases of this group with severe upper-GI bleeding, a subtotal gastric resection (3 patients) or antrectomy (1 case) was performed. In group C patients jejunal HP was histopathologically diagnosed during extensive intestinal resection for colonic malignancies (ascendant colonic and transverse colonic cancers) with jejunal invasion. HP cases were categorized as type I in 40.9% cases (ducts, acini and pancreatic islets), type II in 45.4% cases (ducts and acini) and type III (exclusively with ducts) in 13.6% cases. In 76% patients HP was localized in mucosal and submucosal layers, in 16% intramucosal and in 8% in subserous layer. CONCLUSION: HP is most often an unexpected symptomless coincidental diagnosis during gastrointestinal surgical diseases.

[Anatomical and clinical evaluation regarding the removal of the peritoneal dialysis catheter]. / Criterii anatomo-clinice privind suprimarea cateterului dialitic (de dializa peritoneala)--studiu de evaluare a 9 ani de dializa peritoneala in centrul de dializa si transplant renal al spitalului "Dr. C.I. Parhon" Iasi.

AIMS: To describe CAPD technique survival and causes for catheter removal. The study included 320 end stage renal disease (ESRD) patients, initiated on CAPD between 1995-2003. Definitive catheter removal was required in 44 cases (15.1%), 11 of these (3.79%) receiving renal transplant. Causes for catheter removal were: mechanical obstruction by fibrin (8 cases/2.75%), obstruction by tub bower (1 case/0.34%), by omental muff (6 cases/2%); abdominal wall sepsis (30 cases/ 10.3%); non-responsive bacterial peritonitis (13 cases/4.05%), fungal peritonitis (7 cases/ 2.4%), fecal peritonitis (2 cases/0.68%); transfer to hemodialysis program (31 cases/10.6%); renal transplant (11 cases/3.79%); emergency surgical pathology for: necrotic-hemorrhagic pancreatitis (two cases), intestinal occlusions (six cases), locked hernias (three cases) and locked eventrations(three cases), appendicular peritonitis (two cases). Mortality associated with these procedures and underlying pathology was 1.73%.

[The contribution of cystography in the diagnosis of bladder trauma]. / Aportul cistografiei în diagnosticul unor traumatisme vezicale.

With the aim of the evaluation of cystography as a diagnostic method, this study has retrospectively analysed 22 cases of bladder rupture (19) or perforation (3). When performed, the retrograde cystography has made the accurate diagnosis immediately in all the 15 cases (100%). The adequate filling and the x-rays made after the bladder evacuation are the main conditions, that allow the visualisation of the contrast material extravasation. Out of the remaining 7 cases, the urographic cystography has made the correct diagnosis in 6 of them (86%) and the method should be indicated in cases with concomitant rupture of the membranous urethra.

[Surgery experience regarding the pathology of the greater omentum]. / Morfopatologia omentumului mare chirurgical.

This study followed the evaluation of the surgical pathology of the greater omentum. From the casuistry of Urology Surgery Clinic in Hospital 2 Iasi, we have selected 1500 omentum pathologic specimens (inflammatory, traumatic, tumoral) that were investigated macroscopically and microscopically. The specimens were harvested during 1993-2000. Acute inflammatory involvement of the greater omentum recognizes a primitive etiology in 8-10% cases and secondary one in 90-92% cases; these lesions are associated to some inflammatory processes of peritoneal viscera by direct or indirect mechanisms. Non-tumoral pathology was signaled in 201 cases, malignant and benign tumors were found in 198 cases. Acute catarrhallis and phlegmonous omentitis were identified in: peritonitis by digestive perforation (240 cases), bladder perforation (12 cases), broken pyosalpinx (18 cases), acute calculosic colecystitis (260 cases), hernia (75 cases), strangled eventration (65 cases). The conclusion of our study is that there is a specific pathology for the omentum but also the latter is largely involved in the emergency and iterative abdominal surgical pathology.

[A study regarding the anatomy of the main arterial pedicles of the greater omentum]. / Studiu privind anatomia pediculilor arteriali principali ai omentum-ului mare.

Hepatic artera takes part to the greater omentum vascularization by the right gastroomental artera (most frequently as a branch of the gastroduodenal artera). The investigations on 100 anatomical specimens from adult subjects revealed a mean value of the artera length of 19.30 cm and a diameter of 1.5-3 mm. The lienal artera participates to the greater omentum vascularization by the left gastroomental artera (with a mean length of 10-18 cm and a diameter of 1.5-2.0 +/- 0.3 mm. The arterial arch of the large gastric curvature has a length of 45 +/- 5 cm; the functional anastomotic point is localized at 10-15 cm left size reported to the median line of the large curvature.

[Laparoscopic management of peritoneal dialysis catheters]. / Montarea laparoscopca a cateterelor de dializa peritoneala.

Continuous ambulatory peritoneal dialysis catheter could be placed also by open laparotomy as well as by laparoscopic techniques. We did a retrospective study on cases to compare the results of laparoscopies. There were included 42 patients which we divided in two groups of 21. Group A underwent 21 cases in which catheters was inserted by open laparotomy. Continuous ambulatory peritoneal dialysis was started in 24 to 48 hours later. Group B incharged 21 patients underwent laparoscopic placement of the catheter between 2000 and 2001. Continuous peritoneal dialysis was started early (after 6 hours). The mean operative time was 28 minutes in group A and 30 minutes in group B. Fluid leakage was noticed in 4 patients in group A and in 3 patients in group B. Peritoneal reactions occurred in 5 patients in group A and in 2 patients in group B. Tip migration occurred in 5 patients in group A (one of which was mobilized accidentaly early after intervention) in which was necessary 4 open reinterventions, and no patients in group B. In group B one patient underwent a simultaneous liver biopsy for cirosis and another female patient underwent ovariectomy for a giant ovary cyst. Laparoscopic placement of dialysis catheter leads to better function than does open procedure, it allows immediate start of dialysis and permits simultaneous performance of other laparoscopic procedures.

Venous ulcer infection caused by Arcanobacterium haemolyticum.

A. haemolyticum has been described as an unusual pathogen causing pharyngotonsillitis and extra pharyngeal infections like ulcerative lesions infection mainly in patients with underlying condition (peripheral vascular disease, diabetes, alcoholism). A case of A. haemolyticum venous leg ulcer infection is reported in a 66 year-old diabetic male patient. Bacteriological diagnosis is based on conventional culture technique. But, due to its coryneform appearance and time growing, it is probably underreported.

Actinic keratosis--a histoenzymological study.

Actinic keratosis or senile keratosis is the most frequent premalign epithelial lesion that occurs in the elderly with a history of prolonged and intense exposure to the UV radiation and with an inborn susceptibility. Although the genetics and risk factors are clear nowadays, the histogenesis of this lesion is still under study. The histoenzymologic tests (such as those that demonstrate the ATP-ase and SDH-ase activity) are very useful for early detection of the structural and biochemical changes within the actinic keratosis lesion.

[Cutaneous dissemination of visceral neoplasms in women -reported to a clinical situation]. / Diseminarile cutanate ale cancerelor viscerale la femeie--în legatura cu un caz clinic.

The subject of this case report is a 65 years old female hospitalized for firm, raised, pseudoinflammatory and pseudoangiomatous painless nodular lesions, confluent in large plaques that were localized on the anterior, posterior and left sides of the neck, the anterior and postero-superior areas of the left thorax. These lesions developed in a 3 months period. Histopathological examination of the skin bioptical specimen revealed morphological aspects of an ovarian serous cystadeno-carcinoma metastasis.

[Continuous ambulatory peritoneal dialysis--the infectious complications. The experience of the Nephrology Clinic of Iasi]. / Dializa peritoneala cronica ambulatorie--complicatii infectioase. Experienta Clinicii de Nefrologie Iasi.

49 of 57 dialysis patients were included in CAPD programs. The age of these patients was ranged between 20-65 years. The mean dialysis interval was 19.7 months, the number of hospital admission being 182 (mean 1.7 +/- 1.2). The mean hospitalization interval was 26.2 +/- 2.0 days. The infectious abdominal wall complications included: exit site infections (10%), trumel infections (10%), properitoneal sepsis (21%). The inflammatory processes were resolved after conservator treatment using antibiotics and antiinflammatory drugs (8%). Catheter removal was necessary in 2% of cases and the passage to hemodialysis was decided in other 2%. Peritonitis occurred in 0.73% patients (1 episode per 6 months of CAPD). These clinical data are better than those reported since now.

[The cellular mechanisms of photocarcinogenesis]. / Mecanismele celulare ale fotocarcinogenezei.

UV radiations can act as a complete carcinogenic factor, being capable to initiate and also to promote the tumoral process. They usually act by altering the DNA and also the cell functions involved in cell differentiation. In the last decade important progresses were made in understanding the genetic bases of cancer by the discovering of the protooncogenes. Their normal function is vital for the optimal regulation of cell growth and differentiation; alter of their structure or regulation of their expression under the viral action, ionic radiations or chemical substances can determine cancer development.

[The arterial system of the greater omentum]. / Studiul sistemului arterial al marelui oment.

The aim of our study is to establish a pattern of distribution of the arteries of greater omentum. Right omental arteries supply the anterior lamina and the left ones the posterior lamina (in 82% there is an initial independent left-right distribution). In 18% it is mixed, the two territories being supplied by both anterior and posterior omental arteries. The classic pattern with three main arterial arches (one infra-gastric and two inferior marginal) was identified in 24% cases. More frequent (45%) is the pattern with two transverse main arteries, one superior and the other inferior (with a variable number of intermediate arteries). In 51% cases the infra-colic arch is dominant; in 14% cases it is thinner. The absence of arterial arches may be partly substituted by a dense capillary network. The laminar arterial distribution of greater omentum was expressed into more patterns.

[Retinoids. Photodamaged skin and the prevention of nonmelanotic skin cancer]. / Retinoizii. Fotoîmbatrînirea cutanata si prevenirea cancerului cutanat nonmelanotic.

Sun radiation produce structural and functional changes in skin structures which are known as dermatoheliosis. It becomes clinically manifest after the age of fifty when a general involution of the skin occurs. Vitamin A (retinol) is a critical factor in keratinocyte differentiation. A major progress in clarifying the control mechanism of cell growth and differentiation was the finding that the retinic acid shows hormone-like and morphogenetic effects. The retinoids, generic name for both the term including both natural products of Vitamin A as well as several thousands of synthetic products mimicking either its chemical structure or its biological effects, have proved efficient in a range of skin disorders, including dermatoheliosis. Their effectiveness comes from the overall impact on the skin structures, the ability to change the structure of the epidermis, dermis and sebaceous glands as well as the systemic effect on immunoreactivity. The prophylactic effect of retinol on various types of epithelial cancers has been well demonstrated. It has been proved lately that the association of retinoids and cytokines significantly improves the therapy efficiency in malignancy.

[The surgical problems of continuous ambulatory peritoneal dialysis: 3 years of experience]. / Problemele chirurgicale ale dializei peritoneale continua ambulatorie; experienta primilor 3 ani.

PURPOSE: This study presents the surgical problems of CAPD catheter insertion and mechanical complications in 37 cases (39 peritoneal dialysis catheters inserted for CAPD), being our experience along a time period of 3 years. MATERIALS AND METHODS: The catheters were of Tenckhoff-type, with double Dacron cuff (Fresenius Medicale Care). We used an open-type surgical procedure with spinal anaesthesia. RESULTS: In all the 8 cases with previous abdominal interventions the catheters were functional. We found an early catheter obstruction only in two cases, by means of a "greater omentum fimbriae". In the third case a partial omentectomy was performed. In 1 patient with parietal granuloma and frequent peritonitis a new peritoneal catheter was inserted (with a new tegumentary outlet). Hernia was found in 1 patient and was successfully cured by means of surgical intervention. This patient continued the CAPD treatment. In 2 cases we interrupted the CAPD treatment (one renal transplant; one converted to hemodialysis). 25 patients had no catheter-related complications. CONCLUSION: We wish to state that catheter occlusion and hernia must not lead to an abandon of CAPD treatment.

[The anterolateral structures of the neck and trunk]. / Unele aspecte asupra structurii antero-laterale a gâtului si trunchiului.

This work has in view the arrangement of the elements that form the anterolateral wall of the neck, thorax and abdomen. We insist on the behavior of the fasciae and the situation of the connective spaces related at the muscular layers that enter the structure of this segments. We have found the continuity of the deep cervical fascia (the superficial fascia, after the French anatomy), like a muff that surrounds the neck and the trunk; in the places where this deep cervical fascia is related to the bones (for example, the clavicle), it is continued by the periosteum. On the ventral midline, the deep cervical fascia is very dense and resistant and it is continued from the hyoid bone to the pubis. It is adherent on the connective deep elements, taking part at the formation of the "linea alba". On the posterior midline it is adherent at the fibrous elements that fix the fascia on the spinous process of the vertebrae. At the level of the neck, this fascia is very obvious and resistant; it becomes thinner according as it descent to the abdomen. At the cervical level it surrounds the sternocleidomastoid and the trapezius, at the level of the thorax it surrounds the pectoralis major and the latissimus dorsi, at the level of the abdomen it becomes very fine and it covers the rectus sheath in the anterior part; at the level of the obliquus externus abdominis is very difficult to demonstrate its existence. We followed then the behavior of the anterolateral muscles from the cervical and the abdominal segments. We have found the continuity of the anterior paramedian muscles: the first plane--the sternocleidomastoid, pectoralis major (its sternal fibres form the right sternal) and the rectus abdominis and pyramidalis. For the first and second planes we make an analogy between the muscles of the neck, the subclavius, pectoralis minor, serratus anterior. The second plane--the infrahyoid muscles, the subclavius, pectoralis minor, serratus anterior. The third plane--the scaleni, anterior, medius and posterior, intercostales, transversus thoracis, obliquus externus abdominis, obliquus internus abdominis and transversus abdominis. This work excludes the suprahyoid muscles--their origin, function, innervation and vascularization are debated in another study.