[Laparoscopic adhesiolysis]. / Adezioliza laparoscopica.

The laparoscopic approach of the postoperative adhesions represents not only a way of diagnosing the pathogenic adhesions but also a superior alternative to the surgery of classical dissection of adhesions by laparotomy because of its obvious advantages: the evolution is simple, the bowel activity is quickly restored, the brief period of hospitalisation, the reduced risk of recurrence. The authors present their experience derived from the 29 laparoscopic adhesiolysis: 3 urgent cases with subocclusions, 6 when the surgical intervention was programmed, with a painful postoperative suffering, and 20 with laparoscopic cholecystectomy. From among these cases, a conversion and a postoperative complication were recorded. The result after a period of time are satisfactory.

[A rare neurogenic tumor with thoracic growth]. / Tumora neurogena rara, cu dezvoltare toracica.

Of 70 operated mediastinal tumors, 15 were neurogenic tumors, one of them clepsydra-shaped, which manifested from the very beginning with spastic paraparesis of the legs. The treatment consisted in a two-steps surgery, the first at the Neurosurgical Clinical of Iasi (laminectomy and ablation of the rachidian tumor) and the second one, one month later, at the I-st Surgical Clinic of Iasi (excision of mediastinal tumor and parenchymal bridge within the conjugation hole). The microscopic examination confirmed the diagnosis of neurinoma (schwannoma) Antoni A and B with haemorrhagic areas. Examined at one year interval, the patient was clinically cured with normal thoracic aspect. The clinical peculiarities and therapeutical possibilities of the clepsydra-shaped neurogenic mediastinal tumors are detailed.

[[Mechanical jaundice of hydatid origin]. / Icterul mecanic de natura hidatica.

From the vast etiological sphere of obstructive jaundice there come out many rare forms, adequate means of investigation before and during surgery are hard to interpret, so the therapy brings up special problems. This paper reports the cases of obstructive jaundice of hydatid nature operated at the I-st Surgical Clinic of Iasi between 1979 and 1989. These cases have raised special problems of diagnosis, needing complex investigations. An important role in diagnosis had sonography. The type of surgery depended on the position and nature of the obstruction, the local and distant morphological and functional changes induced by it and the findings at cholangiography.

[The value and limits of subtotal gastrectomy in gastric cancer]. / Valoarea si limitele gastrectomiei subtotale în cancerul gastric.

In the interval 1970-1988, in 321 of 670 patients with gastric neoplasm admitted to the 1st Surgical Clinic of Iasi a subtotal gastrectomy was performed. Most patients were males (68.9%), more commonly aged between 50 and 70 years and in advanced evolutive stages. The gastric neoplasm were sited in order of frequency in the antrum (46.9%), body of the stomach (34.6%), eso-cardio-tuberosity (11.5%), linitis (4%), gastric stump and malignant ulcer (3%). Surgery was possible in only 59% of the cases (25% curative and 34.1% palliative). The surgical technique and its difficulties are detailed. In the 321 subtotal gastric resections 20 complications, 4 deaths (1.2%) and 20% survivals over 5 years were recorded. It is concluded that radioendoscopic and microscopic investigations, with their possibility of an early diagnosis, may cause a limitation of the indications of total gastric resection in the treatment of gastric neoplasm in favour a subtotal resection, more satisfactory from the functional viewpoint.

[Differentiated thyroid cancer]. / Cancerul tiroidian diferentiat.

In the interval 1979-1988, out of 1070 operated goiters 77 malignant thyroid tumors were recorded, 60 of them being differentiated: papillary--32 (53.4%), vesicular--12 (20%), mixed forms--16 (26.7%). The differentiated thyroid carcinomas had peculiar clinical biological and prognostic features and were framed: stage I--60%, stage II--23.4% and state III-IV--16.6%. Only 15 cases presented lymph node metastases. In 16 cases the thyroid tumor was associated with another thyropathy: Hashimoto's thyroiditis--5 cases, Basedow's disease--1 case. The surgical intervention was performed in two times: first total lobectomy or total lobo-isthmectomy [correction of lobioistectomy] with contralateral subtotal exeresis, then total thyroidectomy. It is insisted upon a careful surveillance of postoperative evolution (clinical, biological, scintigraphy) in order to detect the recurrence and apply a proper treatment.

[The surgery of intestinal obstruction in the elderly]. / Aspecte ale chirurgiei ocluziei intestinale la batrîni.

Out of 301 intestinal obstructions treated at the 1st Surgical Clinic of Iasi in the interval 1970-1987, 58 patients aged between 70 and 90 years (mean age 75 years) were recorded. Anatomo-clinically these 58 cases presented: strangulated hernia (19 cases), strangulated eventration (2 cases), strangulations on cords (4 cases), small intestine volvulus (8 cases), sigmoid colon volvulus (6 cases), volvulus of cecum (1 case), intestinal investigation (1 case), colorectal neoplasm (15 cases), peritoneal carcinomatosis (2 cases). The clinical and therapeutical aspects of these particular forms of obstruction in the elderly are discussed and the severity of their prognosis, given the terrain and late admission of such patients which sometimes make impossible a surgical intervention, is underlined. Ten deaths (17.1%) were recorded, representing a lower percentage as compared to other statistics published in the literature.

[Torsion of the great epiploon]. / Torsiunea marelui epiploon.

The diagnosis of epiploic torsion was made intraoperatively. Apart from resection of the necrotized epiploon, appendicectomy was also performed as the appendix presented acute inflammatory lesions. This anatomoclinical and etiopathogenic characteristics of this rare affection are briefly described.

[Megaduodenum due to aortomesenteric shunt]. / Megaduoden prin pensa aorto-mezenterica.

Two new cases of megaduodenum by aortomesenteric shunt in young adults are presented. The role of some risk factors, the diagnostic and therapeutical elements are discussed, the importance of a thorough investigation of each case in view of individualizing the therapeutical management being underlined.

[Hepatic abscesses]. / Abcesele hepatice.

The authors analyse 16 cases of hepatic abscesses recorded in a 10-year interval. The difficulties in assessing the etiology and diagnosis, as well as in indicating an effective treatment are discussed. The clinical aspects and investigation methods, among which scintigraphy, arteriography and especially echotomography are extremely useful in making the diagnosis and in localizing the collection, are reviewed. The bacteriological examination revealed the presence of various organisms in 14 patients, the examined specimen of pus being negative in the remainder of 2 cases. The treatment was surgical in most of the cases (15) consisting in an abdominal approach or posterolateral with rib resection (1 case) and drainage. In 3 cases the intervention was extended to cholelithiasis which was the underlying cause of the abscess. The ultrasound-guided transparietohepatic drainage was performed in 2 cases. No death was recorded.

[Problems of therapeutic management of cancer of the superior pole of the stomach]. / Probleme de conduita terapeutica în cancerul polului superior al stomacului.

This cancer is rare (17-30%) and has the worst prognosis. In the interval 1970-1987 to the I-st Surgical Clinic of Iasi were admitted and treated 648 patients with gastric cancers of which 98 (15.2%) with adenocarcinomas of the cardiac end of the stomach. In most patients the diagnosis was late: stage II and III-40 patients; stage IV-58 patients. Given the extension of the tumoral process, the exeresis was possible but in 36 cases (36.7%), as compared to 26-70% mentioned in the literature. The therapeutical management of these cases and the obtained results are presented.

[Appendicular carcinoid]. / Carcinoid apendicular.

The clinical findings in a woman with appendicular carcinoid stage II (without carcinoid syndrome) detected by histopathological examination of the appendicectomy specimens are presented. The histogenesis, pathology, diagnosis and treatment of these slow progressing malignant tumors, rarely accompanied by carcinoid syndrome, are reviewed.

[Clinical and therapeutic aspects of some rare forms of pancreatic tumors]. / Consideratii clinice si terapeutice privind unele forme rare de tumori ale pancreasului.

A total of 198 tumours of the pancreas have been hospitalized between 1972 and 1987 in the 1st Surgical Clinic from Jassy. Only 10 of these tumours were benign, and these included: 2 gastrinomas, 2 insulinomas, 2 cystadenomas, one fibrolipoma, 1 lymphangioma, one hydatic cyst and a Wermer's syndrome. The particularities are analysed, of these 10 cases of benign tumours of the pancreas, and it is stressed that most of the clinical and therapeutic problems are determined by tumours of the endocrine pancreas, and especially those which are hormonally active. Thus the symptomatology of these last tumours which is difficult to evaluate, especially at the onset of the symptoms will determine a considerable delay in the surgical diagnosis, many of the patients being hospitalized in other departments before reaching the surgeon. Present possibilities for diagnosis and treatment have kept pace with progresses achieved in the field of investigations, which provide useful data from the morphological and functional viewpoints. All the 10 cases mentioned above have benefited from the surgical treatment, that was adapted according to particularities of each patient. The authors stress the importance of the extemporaneous morpho-histologic examination (with serial slides) and when the tumours are difficult to identify by direct macroscopic examination they recommend intraoperative echography and direct hormonal dosages on samples obtained from the portal circulation before and during surgery.

[Perforated gastric ulcer]. / Ulcerul gastric perforat.

Out of 603 patients with perforated ulcer, 40 clinical cases with type I perforated gastric ulcers (this particular anatomo-clinical form being distinguished from the perforated duodenal ulcer) were selected. The perforated gastric ulcer type I, less common, is usually found in the patients over 45 years, with old, callous ulcers; in general, when the perforations are large, a malignancy is suspected, the removal of the lesion and the systemic control of the resected specimen being required. The primary radical surgical treatment is performed only in the patients in good general state, the excision of the ulcer followed by suture being reserved to the cases at high risk, with increased mortality (10%).