Inferior Vena Cava Resection and Reconstruction for Tumoral Recurrence after Right Nephrectomy.

We report a 60 years old patient who was admitted for a local recurrence after a right nephrectomy performed 2 years ago (papillary renal carcinoma with areas of sarcomatoid differentiation - pT3a). CT scan showed a retroperitoneal mass with invasion of the inferior vena cava. We performed a complete en-bloque excision of the tumor with the infrarenal portion of the inferior vena cava and lympha-denectomy. The vascular reconstruction was performed by the interposition of a 20 mm diameter Dacron prosthesis. The postoperative course was complicated due to an episode of digestive bleeding (duodenal ulcer) which stopped after conservative treatment (antisecretory and hemostatics, including rFVIIa), but eventually favourable. At 6 months follow-up the patient presents no sign of tumoral relapse and a functional vascular prosthesis. The case is interesting due to the rarity of the surgical procedure and the indication. The surgical approach of the retroperitoneal tumors with vascular involvement is possible in centers with adequate technical endownment and human expertise.

[Axillary lymph node metastases in breast cancer. Anatomo-clinical correlation and surgical approach]. / Metastazele ganglionare limfatice axilare în cancerul mamar. Corelatii anatomo-clinice si atitudine chirurgicala.

AIM: To establish the incidence of the axillary lymph node metastasis in breast cancer and some anatomo-clinical correlations useful for surgical act orientation. MATERIAL AND METHOD: The data from 450 patients, who underwent surgery for breast cancer between 2000 and 2007, were analyzed statistically according to some parameters: the age of the patients, the size and the location of the tumor, the hystopathological type, the elapsed time from the discovery of the tumor until surgery. RESULTS: The tumoral stage was: stage 0--1.1%, I--7.11%, II--50.67%, III--33.78%, IV--7.33%. From the total amount of patients who underwent surgery, only 56.44% had axillary lymph node metastasis. The patients in the forth decade of life had more frequently axillary lymph node involvement, and also those from rural habitat (65.88%). The correlation between tumor dimension and lymph node involvement was: <2 cm--1.36%, 2-5 cm--48.71%, >5 cm--86.67%. The palpation of the armpit was associated in almost a quarter of cases with false negative or false positive diagnosis. There are a lot of locally advanced cases without axillary lymph node metastases. CONCLUSIONS: Axillary lymph node status is strongly correlated with the tumor dimension and the elapsed time between diagnosis and treatment. The numerous cases of axillary lymphadenectomy without lymph node metastases (43.55%), even in locally advanced cases, advocate for a wider application of lymphatic mapping and sentinel lymph node biopsy, to avoid the pathology associated with those axillary dissections.

[Surgical emergencies in elderly]. / Urgentele chirurgicale la vârstnici.

BACKGROUND: A higher number of elderly are seeking surgical care in the last years for different affections. The aim of the study was to analyze the characteristics of surgical emergency pathology in elderly and to establish several prognostic factors. MATERIALS AND METHODS: We did a retrospective study on 22.803 patients admitted in the First and the Third Clinic of Surgery from Targu-Mures between 1999 and 2006. The data were statistically processed. RESULTS: The elderly (> or =70 years) represented 15.10% of all cases and 20.70% of all emergencies. Almost half of them (47.80%) were admitted in emergency conditions, compared to only a third (32.53%) of the younger group. The malignancies represented 16.72%, meanwhile in the younger group only 6.98 %. Abdominal emergencies represented 83.59%, mostly due to intestinal occlusion and digestive hemorrhages. The operability ratio was 68%, close to the younger group (72%). The global mortality rate was 3.95%. CONCLUSIONS: Surgical emergencies affect elderly in a higher percentage than the younger group. The emergency condition, the elder age and neoplasia are the most important factors of negative prognosis, and more important when they cumulate, increasing the mortality rate up to fivefold compared to the elderly admitted in elective condition.

Introduction to the DAPPLE Air Pollution Project.

The Dispersion of Air Pollution and its Penetration into the Local Environment (DAPPLE) project brings together a multidisciplinary research group that is undertaking field measurements, wind tunnel modelling and computer simulations in order to provide better understanding of the physical processes affecting street and neighbourhood-scale flow of air, traffic and people, and their corresponding interactions with the dispersion of pollutants at street canyon intersections. The street canyon intersection is of interest as it provides the basic case study to demonstrate most of the factors that will apply in a wide range of urban situations. The aims of this paper are to introduce the background of the DAPPLE project, the study design and methodology for data collection, some preliminary results from the first field campaign in central London (28 April-24 May 2003) and the future for this work. Updated information and contact details are available on the web site at http://www.dapple.org.uk.