[Epidemiological aspects in breast cancer]. / Aspecte epidemiologice în cancerul mamar.

Breast cancer represents one of the main public health problem, with a special epidemiological interest, both at the national and international level. A retrospective epidemiological study during the last 11 years (1990-2000) concerning new cases and incidence of the breast cancer at the national level, in Dolj county and in the 1st Surgical Clinic Craiova was made, by using of a comparative analyses which parameters were processed by modern statistic methods. Time evolution equation of the new cases all over the county showed us that more than 208.52 new cases than in the previous year appeared every year. If such an increased rhythm were held, about 6800 new cases would be every year up to 2100. As concerning breast cancer frequency, both at national and local level, a significant increase can be noticed during the last period. At national level the incidence increased from 3.3@100000 in female in 1950 to 29.2@100000 in 1990 up to 46.2@100000 in 2000. We noticed an increase of the incidence with 58.2% at the national level and 86% in Dolj county, in 2000 compared to 1990. By using a comparative analyses on age grouped we could establish a significant frequency of cancer in the patients of 40-49, 50-59 and 60-69 years old, with two frequency peaks for 45-49 and 60-64 subgroups, both at national and county level and also in 1st Surgical Clinic.

[Diagnosis characteristics features in breast cancer]. / Particularitati de diagnostic în cancerul mamar.

Representing about 20% of all woman's cancers in all the world, breast cancer is a multifactorial disease with unknown mechanism facts which may explain the significant growth of incidence and mortality in the last few years. In the absence of screening program in majority cases the diagnosis is discovered too late. In this present study we have made a retrospective study on 487 patients during 1996-2000 at the 1st Surgical Clinic from Craiova. The purpose of this study was the defining of the population with an increased risk which has to be monitorized. In order to accomplish it, we have carefully supervised some of clinical parameters: sex, age, social environment, physiological and pathological antecedents, heredocolateral antecedents, and the constitutional type. The study method was the comparative analysis, and the evaluation according to the modern statistical methods. The risk factors, which can be surely used in defining the groups of population with an increased risk, which should be supervised for an active discover of breast cancer, as the resulted from our study, are: the age decades V, VI, and VII with maximum incidence in subgroups 45-49 and 60-64 years old; early monarch (67.15%); delayed menopause, over 50 years old (84.4%); long exposure to sexual hormones during the reproductive period (the period of menstrual cyclicity over 32 years old); the pathology of the benign tumor, the biggest risk belonging to the proliferative tumours (intraductal papiloma); hyperestrogenism. The only improving method of the therapeutical results in breast cancer is an early discover of it, which can be accomplished only by the implementation of a national program of active discover, in which the essential part belongs to the primary care helped by a widely-broadcast medical education.

[Exceptional etiologies in upper digestive tract bleeding ]. / Exceptii etiologice în HDS.

7 cases, considered as being true etiological exceptions selected from 756 upper gastrointestinal bleeding, are presented. The causes of bleeding were: pancreatic pseudocyst with intracystic hemorrhage broken into duodenum (2 cases), the nonepithelial gastroduodenal tumor (3 cases), the aneurysm of gastroduodenal artery broken into duodenum (1 case) and the aortoduodenal fistula in one patient with a bilateral aorto-iliac by-pass (1 case). The etiological diagnosis could not be established in any cases before the operations. All the cases were operated on, the operation being imposed by the severity of bleeding and having the haemostasis as a main purpose.

[Gastroduodenal artery aneurysm broken in duodenum. A rare cause of upper digestive tract hemorrhage]. / Anevrismul arterei gastroduodenale rupt în duoden. Cauza rara de HDS.

The authors present a case of recidivated upper digestive tract hemorrhage, in which the bleeding initially stopped under conservative treatment. Imagery showed a piloro-duodenal stenosis. During the preoperative care the hemorrhage is resumed abruptly imposing emergency operation. The lesion was an intraoperative surprise imposing the hemostasis at first, and then the surgical management of lesions of the digestive tract.

[Severe acute pancreatitis. Its management and experience]. / Pancreatitele acute grave. Conduita si experienta.

The authors examined a group of 91 cases of acute pancreatitis hospitalised and treated between 1992 and 1996, using multiparametric bioclinical scores like Ranson, Imrie, Apache II systems and morphological scores obtained through C.T., they have divided the examined group into patients with A.B.P. (acute benign pancreatitis)--59 (64.84%), who don't require exquisite therapeutical means, with positive healing and A.S.P.--32 (35.16%), who require a complex medico-surgical therapeutics with unforeseeable evolution and results. The purpose of the paper was the one of establishing a diagnostical and therapeutical strategy for the A.S.P. adequate to actual conceptions. The correct diagnosis of acute pancreatitis initially has been established at 59 (64.83%) and erroneous at 32 (36.13%) cases. The diagnosis of A.S.P. has been established in 32 (35.16%). The etiology has been lithiasic (biliary) for 31.25% and nonbiliary for 68.75% patients. The C.T. examination in the best way to diagnose necrosis and infections, to follow the evolution and especially the surgical indication, achieved by the authors in 30% of cases. The initial medical treatment has been fulfilled at all the patients and the surgical one at 29 (91.63%). There have been implemented explorer laparotomies in 33.33% cases, interventions on the pancreas in 72.66%, operations associated on the biliary ways 41.37%, necessity operations 13.8%, with different types of draining (conventional and open abdomen). The results have been taxed by locoregional complications in 72.41%, general complications in 44.51% and a general rate of decrease of 43.75%. It is recommended initial surgical abstention and gravity estimations, the reanimation of all A.S.P. for prevention and treatment of general complications, surgical treatment of A.S.P. complications. The A.S.P. treatment of biliary (lithiasic) etiology after two months and after C.T. to confirm inflammatory process remission.