I. Juvara (1913-1996), a surgeon for all seasons.

Ion Juvara is a creator of a genuine Romanian school of surgery. If I. Juvara had lived and worked in a country that had been the proud owner of a Pantheon, undoubtedly he would have rested there to the end of time, among the eternal ones i.e. those who triumphed against time and who had never been defeated. If the first generation of Romanian surgeons represented mainly by Thoma Ionesco (1860-1926) was educated mainly abroad, the next generation was trained professionally at the Romanian school of surgery. Despite of the hostile period he lived in, I. Juvara kept intact his freedom of thinking and opposed with all his powers abuses of any kind, always preserving his integrity, avoiding with elegance the traps of the totalitarian regime. But even so nobody can state that the professor, who came from -Moldavia, as his master, N. Hortolomei, could not say at the end of his life that he hadn't had a fulfilled professional life, as he is considered even today the greatest surgeon of Romania in the latter half of the 20th century. He was, after all, a surgeon for all seasons.

Antoine Depage's relationship with Queen Elisabeth of Belgium.

The article describes the intimate relationship between H.M. Queen Elisabeth of Belgium and the great Belgian surgeon Dr. Antoine Depage. The brilliant academic career of Depage was followed during World War I by his prominent role in the 'Océan'-hospital in De Panne at the Flemish coast. His close connection with Queen Elisabeth, working as a nurse in the hospital, resulted in an intimate friendship, which was particularly hearty when Depage lost his wife in 1915, and during his illness in 1923-1925. The letters of Depage, present in the Archives of the Royal Palace, give an insight in this intimate relationship.

Assault induced stab injuries: epidemiology and actual treatment strategy.

OBJECTIVES: To investigate and analyse epidemiology, demographics and patterns of presentation of assault induced stab injuries in a main Belgian trauma centre. To evaluate surgical management, complications and postoperative follow-up of the stab wound victims. METHODS: One hundred and seventy assaulted patients, hospitalised because of stab injuries from January 2000 to June 2007 are studied retrospectively. RESULTS: Ninety-five percent of the assaults occurred on men and the mean age of the patients was 31.1 +/- 9.7 years. Ethnic minorities represent 77% of the patients hospitalised for assaults and 26.5% of all patients proved to be under toxic influence, predominantly from alcohol (21.8%). A decline of admissions of patients with stab injuries during the period 2002-2004 is recorded. However, the incidence doubled in the next two-year period. A weekend peak and circadian rhythm is apparent with more than 20% of the patients admitted between 4 and 6 am. The trunk is most frequently stabbed (54.5%) resulting in a laparotomy rate of 51%. One third of the patients who underwent thoraco-abdominal surgery revealed diaphragmatic injuries. Seventy-five percent of the patients left the hospital in a good condition while 2.4% had neuromuscular lesions. Two patients had serious vascular complications during follow-up. During the study period, no mortality was recorded. CONCLUSIONS: Stab wounds were recorded mainly in young and middle-aged men from ethnic minorities, whereas almost 27% were under the influence of drugs. A conservative approach was generally used resulting in a low laparotomy and thoracotomy rate without affecting mortality. Neuromuscular lesions are important long-term complications of stab injuries.

Laparoscopic retrieval of gossypibomas--short series and review of literature.

UNLABELLED: Laparoscopic removal of retained abdominal foreign bodies represents an obscure domain of minimally invasive surgery. Although not an infrequent situation in general surgical practice, there are very few papers presenting laparoscopic approache in these circumstances. An iatrogenic foreign body following surgery, is a serious complication that may lead to medico-legal problem. We present our experience and a literature review. METHODS: In the last 20 years 48 patients with abdominal foreign bodies were referred to us. Out of these four gossypibomas were managed laparoscopically. RESULTS: Retained swabs represent the most common iatrogenic abdominal foreign bodies. Removal of gossypiboma present more problems in laparoscopic environment due to encapsulation and difficulties in localisation, as retained swabs unusually display radio-opaque markings. There was one conversion due to dense adhesion to the gastric wall. Postoperative recovery was uneventful in all cases. CONCLUSIONS: Gossypibomas, among abdominal foreign bodies, represent a certain reality with significant legal implications. Prevention should prevail and all efforts should be made in such respect. Laparoscopic approach is possible in selected cases (small swabs, encapsulated, no complications).

Some notes on medical liability in ancient times.

Already in ancient times did medical liability occupy mankind. Various civilizations did give their own interpretation on the subject and proposed solutions. Original writings are rare and articles concerning ancient medical liability equally are hard to find. The only relatively trustworthy sources are of legal nature and find their origin in Greek philosophy and Roman Law. At a later stage, Arabic philosophers gave a renewed view on the statements of these previous civilizations and added their own way of thinking. All these influences still reflect in our modern western way of medical acting. Some of these ancient customs concerning medical liability will be discussed in this article.

Dissection of the common carotid artery: a case report.

Carotid artery dissection is an important cause of stroke in patients under forty years of age. A dissection of the common carotid artery is relatively rare. This condition can easily be overlooked because symptoms may be lacking or may seem trivial. Carotid artery dissection occurs mostly in previously healthy patients. Urgent treatment however, by means of coumarines or antiplatelet agents, is of life-saving importance, because this disease can lead to permanent neurological deficits or even death. We report a case of a 36-year-old patient who was admitted to the intensive care unit with hemi-paralysis and acute abdomen after a period of severe vomiting. A perforated bulbar ulcer was visible on abdominal CT scan. The patient underwent laparoscopic repair of the perforation. CT scan of the brain showed an extensive area of infarction at the region of the left medial cerebral artery. The cause of the infarction was revealed by angio CT of the supra-aortic arteries, showing a floating thrombus and a possible dissection of the left common carotid artery. Under Clopidogrel therapy, the right-sided paralysis partially recovered. Ten days post-admission, an endarterectomy of the left carotid artery was successfully performed. The patient recovered well and was discharged from the ICU 28 days after admission.

Acute colonic pseudo-obstruction in vascular patients (Ogilvie syndrome).

Two patients with acute colonic pseudo-obstruction are presented. Acute colonic pseudo-obstruction, first described by Ogilvie in 1948, is characterised by signs of colonic obstruction, but without mechanical obstruction to the intestinal flow. The current hypothesis states that it is caused by an imbalance between sacral parasympathetic excitatory nerves and sympathetic inhibitory nerves, thus inducing functional obstruction. It mostly develops in hospitalised patients with a variety of medical and surgical conditions. Two such patients with extensive co-morbidities, developed progressive colon dilatation with signs of acute peritonitis, and were operated on urgently. In both patients, right hemicolectomy and postoperative medical treatment resulted in complete recovery.

Tuberculosis of the thyroid gland. A case report.

Tuberculosis of the thyroid gland is a very rare condition. A case of a 47-year-old female with a history of a euthyroid multi-nodular goitre is presented. The patient developed hoarseness due to right recurrent laryngeal nerve paralysis, confirmed with indirect laryngoscopy. On repeated ultrasound, volumetric progression of a dominant nodule in the inferior part of the right thyroid lobe was noticed. Fine needle aspiration was inconclusive. Diagnosis was ultimately based on histopathology of the surgical resection specimen.

The prognosis of patients operated on for gastric cancer in relation to the percentage of lymph nodes invaded by tumour.

INTRODUCTION: In evaluating the type of gastrectomy and lymphadenectomy for gastric cancer, adequate prognosis has been dependant on the retrieval of at least 15 lymph nodes. We propose an alternative method in which the prognostic value is evaluated, according to whether or not more than 20% of the retrieved lymph nodes are invaded by tumour. MATERIALS & METHODS: Sixty-five patients (36 men, 29 women) with a median age of 69 years (mean age 68.9 +/-12.1 years) were evaluated, who were operated upon between 1985 and 1999 for gastric cancer by gastrectomy with either D1 or D2 lymphadenectomy. RESULTS: The average number of retrieved lymph nodes was 10.4 +/- 8.6. In 51 patients (78.5%) less than 15 and in 14 patients (21.5%) 15 or more lymph nodes were retrieved, according to the TNM guidelines. In our study, there is a statistically significant difference in prognosis between patients with less than 20% and those with more than 20% of the retrieved lymph nodes invaded by tumour, irrespective of the total number of lymph nodes resected. CONCLUSION: Gastric cancer patients in whom less than 20% of the retrieved lymph nodes are invaded, have a significantly better prognosis compared with patients in whom 20% or more of the lymph nodes retrieved are invaded by tumour, irrespective of the total number of retrieved lymph nodes.