[Tumors of the ampulla of Vater--local or radical resection?]. / Tumorile benigne ale ampulei lui Vater--rezectie locala sau radicala?

Duodenal ampulla is a complex anatomical and histological site and a tumor may arise from one of three types of epithelium: duodenal mucosa, pancreatic duct and distal common bile duct. Neoplasia from each of these locations may exhibit different growth models and though it is difficult to establish their origin before operation, surgical treatment for all resectable tumors is essentially alike. The outcome of these tumors is vitally influenced by the type of epithelium from which they derive. Benign adenomas appear to be a frequent precursor of carcinoma of the ampulla of Vater, therefore, a local resection can lead to an under treated early cancer which would have benefited from a radical excision, with a much better long term result. We consider acceptable to perform an ampullectomy whenever is possible to safely state the benignity of the tumor or when a major procedure is hazardous.

[Intraoperative and early postoperative intraperitoneal chemotherapy--adjuvant treatment for locally advanced digestive system cancer]. / Chimioterapia intraperitoneala intra si postoperatorie--tratament adjuvant pentru cancerele digestive local avansate.

UNLABELLED: Surgical treatment for locally advanced digestive cancers (invasion beyond the serosa, adjacent structures penetration and perforated tumors) is followed by a high rate of peritoneal recurrence and distant metastasis. Simultaneous intraperitoneal chemotherapy with surgical resection, which is continued over the early postoperative period act on the tumor cells which can be mobilized during the surgical dissection. This adjuvant treatment could lead to better control of local recurrence. Moreover, high levels of the agents are reached in the portal circulation which could be profitable for preventing hepatic metastasis. The main drawback of the method is represented by the impaired immunologic activity of the peritoneum, which can cause, at least theoretically, detrimental complications. OBJECTIVE: The efficiency of the intraoperative and early postoperative intraperitoneal chemotherapy is the subject of a prospective randomized study, started 8 months ago in our department. METHOD: Patients with locally advanced (penetration of the tumor beyond serosal layer, without liver metastasis) are randomized for adjuvant intraperitoneal chemotherapy or standard treatment. Intraoperative chemotherapy is commenced after surgical resection but before accomplishing any anastomosis. We use 50 mg of cisplatinum for washing the peritoneal cavity and continue to instill 20 mg/m2 of cisplatinum intraperitoneally in the first four days after surgery. (8 patients were selected to be treated according to this protocol). CONCLUSION: Immediate postoperative outcome does not seem to be influenced by this treatment. The disease free interval and the overall survival rates can not be assessed at this moment of the study.

[Upper gastrointestinal bleeding from a perforated gastric ulcer into left atrium, after esophageal resection and gastric replacement of the esophagus]. / Hemoragie digestiva superioara prin ulcer peptic pe grefon gastric intratoracic, perforat în atriul stâng.

Using the stomach as a substitution after oesophagectomy is the most common method. The stomach brought intra thoracic it seems that maintains or regains its capacity to secrete hydrochloric acid and therefore can develop specific conditions, despite total denervation following bilateral troncular vagotomy. We are presenting the case of a young patient who was operated on for a corrosive esophagitis. She had an oesophagectomy and a transposition of the stomach to the posterior mediastinum and anastomosed to the cervical esophagus. She presents with upper gastro-intestinal bleeding from gastric ulcer penetrating into the left atrium.