[Tailored surgical treatment for post-caustics stenosis of the upper digestive tract with complicated lesions. Clinical experience at our department in the last ten years]. / Diversificarea tratamentului chirurgical al stenozelor postcaustice ale tubului digestiv superior în relatie cu complexitatea leziunilor. Experienta clinicii a III-a chirurgie în ultimii 10 ani.

The ingestion of caustic substances generates severe lesions of superior digestive tract, leading to stenosis in 50% of patients, of which almost 50% will require surgical treatment. A number of 29 patients with caustic lesions were treated in the IIIrd Surgical Unit from 1993 to 2004. The most frequent corrosive agent was a strong alkaline solution. The location of the post caustics strictures was esophageal in 18 cases, esophagogastric in 7 cases and laryngo-pharyngo-esophageal in 4 cases. Surgical procedures consisted of 8 esophagoplasties with ascending colon and ileum, 12 with left colon, 3 with transverse colon and splenic flexure, and in 5 cases transhiatal resection with cervical esophago-gastric anastomosis. 5 patients required gastric resections of variable extent, in addition to the esophageal reconstruction: antrectomy with trunk vagotomy--1 case, subtotal gastrectomy--3 cases and total gastrectomy--1 case. In the group with pharyngeal lesions, esophageal reconstruction followed pharyngoplasty with cutaneous tube performed in the ENT department. Hospital mortality rate was 3,4 % (1 case). Postoperative morbidity of 20,6 % consisted of cervical anastomosis leakages in 2 cases and pleural effusions in 4 cases. Surgical treatment of the post caustics strictures of the upper digestive tract must be adapted to the location and severity of the lesions, requiring adequate operative experience and special pre- and postoperative care.

[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.

[Choledochal malignant hemorrhagic cyst, with cholangitis]. / Angiocolita supurata pe un chist coledocian hemoragic, degenerat malign.

The increased risk of cholangiocarcinoma in patients with congenital cystic disease of the biliary tree is well documented. The reason for the malignant transformation is taught to de related to chronic inflammation and bacterial exposure within bile ducts. Total excision of the choledochal cyst notably reduces the risk of cancer. Five to twenty percent of adult patients with unexcused cysts or treated with by pass will develop cholangiocarcinoma. We are presenting the case of a young female diagnosed with a choledochal cyst at age of four, treated with by pass procedure. Fourteen years later she presented with a severe angiocolitis, hemorrhage and malignant transformation within the cyst.

[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.