[Neurolysis of the posterior tibial nerve in the tarsal canal--a new therapeutic approach in chronic painless plantar ulcers]. / Neuroliza nervului tibial posterior în canalul tarsian--o noua abordare terapeutica a ulceratiilor cronice.

The paper reports on 14 cases of perforating plantar disease of whom 11 belong to the so-called nonpainful chronic plantar ulceration by compression of the posterior tibial nerve in the tarsal canal. The authors show clinically, neuroelectrically and by neurography with lipiodol that in the case of a diabetic or alcoholic polyneuropathy, the posterior tibial nerve is more vulnerable to the compression existing in the tarsal canal due to the development of a fibrous sclerotic tissue. Exo-endoneurolysis of the posterior tibial nerve associated with a posterior tibial periarterial sympathectomy permitted healing in 7 ulcerations, 2 diminutions of the ulceration dimensions, and only 2 remissions. The four cases of unfavourable results were in patients with old lesions who continued alcohol consumption.

[Tumors of the soft parts of the extremities. Anatomoclinical and therapeutic aspects]. / Tumorile partilor moi ale membrelor. Aspecte anatomoclinice si terapeutice.

A total of 60 cases are presented, of patients with tumours of the soft parts of the limbs, from a total of 14,000 surgical interventions. Of the total 18 were malignant tumours, while the remaining 42 cases had benign tumours. Tumours of the soft parts of the limbs include a large variety of histologic forms, and this raises particular problems of diagnosis and treatment. In the case of benign tumours the treatment is better codified, and consists in the removal of the tumour by simple enucleation. Recidives are possible because of the infra-clinical peritumoral invasion. In the case of malignant tumors the treatment is more differentiated, depending on the histologic type, the degree of malignancy, the stage of evolution, and on evolutive characteristics. Surgery remains an essential part of the treatment, and either limited or radical surgical solutions (amputation) are used. Frequently radiation and chemical therapy are associated, with good results. Six clinical observations are presented: rhabdomyosarcoma of the recidivating type, multi-recidivating fibrosarcoma, fibromyxosarcoma, varicose ulcers with malignant evolution, and two cases of liposarcoma. The cooperation is stressed, which should exist between the surgeon, the pathologist, radiologist and oncologist, for the diagnosis and treatment of these affections.

[Hyperlipoproteinemia, a factor of severity in acute pancreatitis]. / Hiperlipoproteinemia, factor de gravitate in pancreatita acuta.

The authors make a retrospective analysis of 95 cases of acute pancreatitis hospitalized between 1975 and 1979. In 3,8% of all the cases the acute pancreatitis was associated with hyperlipoproteinemia. The study of the 4 patients involved revealed the primary origin of hyperlipoproteinemia as a result of alimentary abuse in 3 of the cases. In a fourth case the increased serum lipoproteins were due to prolonged use of contraceptives. From the clinical viewpoint, pancreatitis associated with hyperlipoproteinemia was more severe, with signs of shock and collapse, respiratory failure, high serum nitrogen an hyperglycemia. The blood and the serum had a lactescent aspect, with a thick layer of chylomicrons. The serum and blood values for lipids were higher than 4000 mg%. The increase in the amount of lipids was especially due to high triglycerides values. From the anatomopathologic viewpoint the 4 patients presented as acute cases of cholecysto-pancreatitis with major and extensive haemorrhagic necrosis which involved almost the entire pancreas. The evolution of the four patients was difficult. Two of the patients recovered after a long hospitalization, and had definitive sequels - insulin-dependent diabetes. The other two patients died following septic complications (bronchopneumonia and visceral gangrene), and hypovolemia due to upper digestive haemorrhage.

[Phyllode tumors: anatomoclinical and therapeutic aspects (5 clinical cases)]. / Tumoarea phyllodes - aspecte anatomoclinice si terapeutice (5 observatii clinice).

The phyllodes tumour is a bi-tissular mammary tumour. It is essentially benign but potentially sarcomatous, presenting multiple clinical and histologic-aspects, and raises difficult problems of diagnosis and therapeutic attitude. Four histological types are described, from the adenofibromatous type to the sarcomatous one. The notion of local malignancy is discussed, related to the marked recidivating character of the tumour. The morphologic substrate of the recidivating character is the result of the absence of a true capsule of the tumour. The treatment is differentiated according to the clinic, histologic, and recidivating aspects, and consists in either sectorectomy or breast amputation. Five cases are presented, of phyllodes tumour, each of them with particular characteristics of evolution, and imposing differentiated therapeutic attitudes.