PELVIC ACTINOMYCOSIS MIMICKING A LOCALLY ADVANCED PELVIC MALIGNANCY--CASE REPORT.

We present the case of a former user of an intrauterine contraceptive device (IUD) for 10 years, diagnosed with a bulky, fixed pelvic tumor involving the internal genital organs and the recto sigmoid, causing luminal narrowing of the rectum, interpreted as locally advanced pelvic malignancy, probably of genital origin. Intraoperatively, a high index of suspicion made us collect a sample from the fibrous wall of the tumor mass, large Actinomyces colonies were thus identified. Surgery consisted in debridement, removal of a small amount of pus and appendectomy, thus avoiding a mutilating and useless surgery. Specific antibiotic therapy was administered for 3 months, with favorable postoperative and long-term outcomes. Pelvic actinomycosis should always be considered in the differential diagnosis of pelvic tumors in women using an IUD. The association of long-term antibiotic treatment is essential to eradicate the infection and prevent relapses.

A RENAISSANCE PROMOTER OF MODERN SURGERY.

The present paper aims, exploring the history of Renaissance medicine, to evoke the figure and work of the priest, surgeon and anatomist, Guido Guidi (Vidus Vidius) (1509-1569). The XVIth century is considered a period marked by artistic and scientific effervescence in the western part of Europe and Guido Guidi was a first order personality, grandson of Domenico Ghirlandaio and friend of Benvenuto Cellini. He was appointed by the King Francis I the first professor of anatomy and surgery at the newly founded College de France. On demand of the King, he wrote Chirurgia j Graeco in Latinum conversa Vido Vidio Florentino interprete, cum nonnullis eiusdem Vidii comentariis (1544), a beautifully illustrated original surgery book that became for the following two centuries the main source in teaching surgery. Our study realized a detailed assessment of the book and especially of its illustrations belonging to Francesco Salviati. Exploring the life of Guido Guidi, we were also able to point out other significant contributions in the field of anatomy and clinical medicine as De anatome the first book where are presented disarticulated, the bones of the skull base and also the discovery of the chickenpox. Some surgical personalities attributed to him both the elaboration of the term appendix vermiformis and the first description of an aneurysm, he treated with the help of Fallopio. Although forgotten today, Guido Guidi was a leading figure of the Renais sance medicine both in France and Italy.

[Surgery in advanced cervical cancer]. / Consideratii asupra tratamentului chirurgical în cancerul de col uterin avansat.

UNLABELLED: The aim of this study was to highlight the importance of surgical treatment in advanced cervical cancer (IIB-IIIB). MATERIAL AND METHOD: Data from 179 patients with cervical cancer, admitted in the Clinic of Emergency Surgery, "Sf. Ioan" Hospital, Iasi, between January, 1st, 2003 and December, 31st, 2009, were collected. RESULTS: A number of 11 cases (6.1%) cases were without any clinical response, so that they benefit by radical radiotherapy; a radical surgical intervention was performed in the other 168 cases (93.7%), in 4-6 weeks after chemotherapy. No intraoperative complications were evidenced, but after surgical intervention we recorded: urinary troubles--10 (6.5%); lymphedema--3 (1.9%); posttoperative intestinal occlusions--2 (1.3%); extended dynamic ileus--2 (1.3%); phlebitis--2 (1.3%).

[Therapeutic approach in kidney trauma. Assessments of 49 patients treated at surgical emergencies clinics]. / Orientari terapeutice în traumatismul renal. Evaluari pe un lot de 49 pacienti asistati în clinica de urgente chirurgicale.

UNLABELLED: The aim of this study is to contribute to efficiency of therapeutical interventions, using an optimal stadialisation followed by a maximum preservation of renal function. MATERIAL AND METHODS: A number of 49 cases with polytrauma, included urinary lesions, were studied between January, 2002 and December, 2009. Demographical, clinical, paraclinical data were collected, as well as those regarding therapeutical measures. RESULTS: From a number of 1436 cases with polytrauma, 49 (3.41%) suffered from urinary tract prejudices and 36 (73.46%) with major kidney lesions--11 (30.55%) severe at admission; 5 (13.89%) patients with multiple lesions and hypovolemic shock. The conservative treatment was applied in 24 (66.64%) cases and other types of surgical interventions for the other patients. CONCLUSIONS: The urinary apparatus is affected in aproximately 10% of cases of abdominal trauma due to road and falls from heights accidents, especially in patients of 26-50 age groups: 30.5% with severe lesions, 13.89% with hypovolemic shock at admission, and 1 death. The treatment was conservative in 66.64% of cases and various types of surgical interventions for the others patients.

[Urinary tract trauma: anatomo-lesional, etiological and clinical considerations]. / Consideratii anatomo-lezionale, etiologice si clinice in traumatismele aparatului urinar.

UNLABELLED: Urinary tract injuries are rare lesions and account for about 3%, of all injuries and 10% of abdominal trauma injuries. The aim of this study is to review retrospectively a series of patients with urinary tract injuries treated in a general surgery clinic. MATERIAL AND METHODS: A series of 41 consecutive patients with urinary tract trauma who hospitalized in Surgery Clinic of "St. John" Hospital of Iasi during a 7 years period (January 2002 - December 2008). The main analyzed variable was age, mechanism of injury, anatomical site of injury, associated injuries, and methods of treatment, morbidity and mortality. RESULTS: Urinary tract injuries accounted for 3.2% of all abdominal trauma injuries. Adults males were more affected with 90.2% of cases. Traffic road accident and falls represented over 50% of cases. Renal trauma were present in 73.7% of cases, and associated lesions were present in all cases. Conservative treatment was applied for 24 patients (58.5%), nephrectomy (total or partial) was performed in 9 cases, suture of the urethra 1 case, suture of the urinary bladder 5 cases and cystostomy in 3 cases. Conservative treatment failed in 24 cases (58.5%), urinary complications were present in 8 patients (19.5%) and one patient died due to associated lesions. CONCLUSIONS: Urinary tract injuries are rarely encountered in trauma settings, to a high index of suspicion is necessary to establish the diagnosis. Renal trauma is the most fervently lesions and conservative treatment represent feasible solution for these.

[Considering risk factors and prevention in uterine cervical cancer]. / Consideratii asupra factorilor de risc si a preventiei in cancerul de col uterin.

UNLABELLED: Cervical cancer is a disease with important medical and social involvements and a severe evolution in advanced stage. Its high incidence in Romania situated this country on the first place in Europe. MATERIAL AND METHOD: The paper analyzed retrospectively a sample of 51 cases suffering from cervical cancer in advanced stage. The most important risk factors, depending on environment, genetic and lifestyle peculiarities of patients, were quantified. RESULTS: Age groups of 35-65 were involved in 70% of cases, those of maximum genital activity in 50.9% of cases and after the menopause in 45% of cases. The sample features: medium level of education, low socioeconomic standards, precarious health education in 45.9% of women, over 50% never seing controlled with a Papanicolaou test or cytohormonal smear. Diagnosis was carried out in advanced stadium (IIB-IIIB) for 75% of cases. CONCLUSIONS: Though the cancer of uterine cervix is committed oneself to a precocious diagnosis, due to a low level of sanitary education, the absence of the prevention testing concerning cells of the vaginal-cervix, the deficit hygiene, the smoking, the cases are diagnosed tardily, in advanced loco regional stages.

[Gastroduodenal ulcer refractory to conservative treatment]. / Ulcerul gastro-duodenal refractar la tratamentul conservator.

This is a 20-year retrospective study on 205 patients in which surgery for gastroduodenal ulcer was performed. In 51 one of these patients (24,8%) surgery was required by drug therapy failure, cases labeled as drug-resistant ulcers. Some causes of drug therapy failure are discussed, failure being also recorded in patients who benefited from modem ulcer drugs that proved only partially effective. The authors emphasize that surgery can no longer represent a therapeutic option, an utter substantiation not only from the surgeon but also from the entire team of specialists in various investigation types and therapeutics being mandatory.