Implications of Hysterectomy on Vaginal Route in Gynecologic Pathology.

Vaginal hysterectomy was mentioned before our era by Soranus of Ephesus, and it is one of the most frequent surgical interventions in gynecologic practice; performed for the first time by Sauter of Constance, in 1822, who practiced a vaginal hysterectomy without ligation of vessels, carrying out the hemostasis with a swab dipped in alum. The essential argument for vaginal surgery is the advantage it brings. Current indications and contraindications encourage the frequent use of vaginal hysterectomy in benign pathology of the uterus, while the indication (Crossen, Rouhier, Campbell techniques) depends most of the times on the surgeon's experience and preference rather than on the critic evaluation of results. Material and methods: The study group included 84 patients, hospitalized from January 2013 to December 2015 in the Third Obstetrics Clinic. For the evaluation of results, we used longitudinal retrospective clinical-statistical method. Results and discussion: Practicing the surgery on vaginal route is mainly indicated in patients with severe anemias and different organic tares. When removal of the cervix is not indicated, or when or when there is an enlarged uterus or one with a small diameter, it is recommended to use laparoscopic hysterectomy. Conclusions: Vaginal hysterectomy is a technique that allows rapid removal of the uterus, with a minimal impact on the patient, indicated in the pathology benign uterine tumors (uterine fibromatosis associated with metrorrhagia, fibromatous uterus with cervical dysplasia, or fibromatous uterus associated with different degr4ees of uterine prolapse).

[Pancreaticoduodenectomy in surgical treatment of malignant tumors of Vater's region]. / Duodenopancreatectomia cefalica in tratamentul tumorilor maligne ale regiunii vateriene.

BACKGROUND: The optimal treatment of tumors of Vater's region represents a permanent interest of every physician involved in the treating of malignant diseases with such localization. AIM: This presentation proposes a pancreaticoduodenectomy (DPC) evaluation in the surgical treatment of tumors of Vater's ampulla. MATERIALS AND METHODS: Between 1999 - 2009 our clinic has treated a number of 37 cases with mechanic jaundice by malignant diseases (JMN). Out of these, 5 cases (13.5%) have been hospitalized with JMN (preoperative diagnose) by malignant tumors of Vater' region: 4 men and a woman, aged 46 to 72, from rural medium, who represent the aim of this paper. RESULTS. DISCUSSION: In 4 cases (10,.8%), intra-operatory exploration confirms the existence of tumors of Vater's ampulla or duodenal papilla (diagnosis having been established by preoperatory duodenoscopy) using DPC (Child Procedure). Postoperative evolution, either immediate or distanced, was favorable, implying no deaths. The microscopic exam of the extirpated piece confirms Vater's Ampulloma in two cases (5.4%); in the other two cases, the above mentioned exam reveals the small bowel's carcinoma at duodenal papilla. In the last 2.7% cases intra-operatory lymph node and visceral metastases have been observed, choledochoscopy revealing cholangiocarcinoma (confirmed by microscopic exam), the patient having suffered only a choledochoduodenostomy. CONCLUSIONS: Without being endowed with great experience in the field, the results of DPC treatment in these first cases of malignant tumors of Vater's region allow us to found the reasoning of the righteousness of surgical indication. DPC draws the hope of radical healing intention in the cancer with this localization.

[Cystic mucinous tumors of the pancreas]. / Tumorile chistice mucinoase ale pancreasului.

Mucinous cystic tumors (MCTP) are uncommon borderline lesions of the pancreas that may often be misdiagnosed as pseudocysts and have unknown propensity to malignity. During the last two decades in our clinic of 38 patients with cystic lesions of the pancreas two presented MCTP: a 48-year-old woman with a cyst located in the body and tail of the pancreas and a 59-year-old man with a tumor situated in the head of the gland producing an obstructive jaundice. Ultrasonography and computer tomography confirmed the presence of the cystic mass in both patients but the precise diagnosis was made only after the histologic examination of the removed lesions. With an attempted curative resection: distal pancreatectomy with preservation of the spleen in the first case and a Whipple procedure in the second one, both cases were cured. Pathology do not reveal malignant transformations. Both patients were alive, had no complaints or recurrences at 12 and 24 month after surgery. The treatment of choice in such cystic tumors is surgical removal as untreated these lesions may progress to neoplastic degeneration.

[Gastrocolic fistulas. Review of three cases]. / Fistulele gastrocolice. Consideratii în legatura cu trei observatii.

Gastrocolic fistula (GCF) is a rare and severe lesion appearing traditionally as a complication of inadequate gastric surgery or in the context of stomach or colon malignancy, but actually arising from many different gastrointestinal conditions. Three patients with GCF, admitted and operated in our clinic, are presented. The first case, a man aged 36 years, was a classical one, with a G(jejuno)CF appearing three years after a gastrectomy with Reichel-Polya reconstruction for duodenal ulcer, resolved by a "revision gastrectomy" en block with segmental resection of the jejunum and transverse colon. The second case, also a man aged 43 years, presented a spontaneous GCF determined by a gastric carcinoma, that required an en block enlarged gastro-colectomy. The last case, a 61 year-old woman, presented three weeks after an emergency concomitant cholecystectomy and appendicectomy, with clinical manifestation suggesting a subphrenic abscess. Although a contrast-enhanced CT revealed a communication between the great curvature of the stomach and the splenic flexure of the colon, no fistula was found at laparotomy (spontaneous healing?). However, the terminal ileum and ascending colon had a suggestive appearance of Crohn's disease (confirmed by pathology) and a right colectomy was done. Excepting the rare situation of spontaneous or after medical treatment healing, the mainstay therapy of GCF is the case-adapted surgery.

[Bulbantrectomy with truncal vagotomy in the surgical treatment of duodenal ulcer]. / Bulbantrectomia asociata vagotomiei tronculare in tratamentul chirurgical al ulcerului duodenal.

Duodenal ulcer benefits of very efficient medical treatment. In currently medical practice exist many cases with complicated duodenal ulcer (by stenosis or penetration in neighbor organs like pancreas or biliary tract or painful forms etc.) to which surgical treatment is necessary. Based on the retrospective study of 116 patients operated between 1991-2002 years for gastric or duodenal ulcer, this paper demonstrates that bulbantrectomy associated with bilateral truncal vagotomy (63.7% of cases) is the best surgery in the treatment of duodenal complicated ulcer or resistant to the medical procedures. Provided by correct indication, the intervention is the most pathogenic, offering the best immediate and long term postoperative results. If the bulbantrectomy is contraindicated (critical general status, etc.), the alternative is a bilateral truncal vagotomy associated with a drainage procedure: pyloroplasty (6.9% of cases) or gastroenterostomy. When the vagotomy are contraindicated or cannot be correctly performed, a large gastrectomy (29.3% of cases) followed by gastroduodenal (preferable) or gastrojejunal anastomosis are practiced.

[Upper digestive hemorrhage, physiopathologic and therapeutical considerations]. / Hemoragia digestiva superioara. Consideratii fiziopatologice si implicatii terapeutice.

The study is based on the analysis of 158 patients admitted in the "Fourth Clinic of Surgery" with diagnosis of "Upper Digestive Haemorrhage" (U.D.H.) between 1998-2002, emphasising the importance of the physiopathological chains induced by the ulcer bleeding; 119 cases (76%) were diagnosed with gastro-duodenal ulcer, 20 with portal hypertension (20%), 14 subjects were with gastric carcinoma (8.8%) and 5 with miscellaneous etiologies so called "rare circumstances" of U.D.H. (two patients with Idiopathic Thrombocytopenia, one case with Dieulafoy gastric ulceration and two subjects with Haemorrhagic Gastritis). All the patients were admitted in the first moment in the Intensive Care Unit where haemostasis were successfully obtained with drug therapy adapted to the physiopathological changes induced by bleeding, in the majority of cases with light bleeding (8 cases, 5.4%) or medium bleeding (139 patients, 87.4%); only in 9 subjects (6%) with severe haemorrhage surgery was indicated (posterior bulbar ulcer in which the surgical haemostasis was necessary). In 88 patients (55%) surgery was performed as an elective procedure--74 from them had haemorrhagic gastric or duodenal ulcers with a medium amount of bleeding and 14 observations for gastric carcinoma with a chronic bleeding. In most all the cases the postoperative evolution was in good terms. Two observations with severe U.D.H. due to rupture of esophageal varices occurred on hepatic cirrhosis were out of therapeutical proof (1.2% deaths from all the admitted patients with U.D.H.).

[Antibiotic prophylaxis in surgery for colorectal cancer]. / Antibioticoprofilaxia în chirurgia cancerului colorectal.

The prophylactic use of antibiotics in the purpose of decreasing the frequency and severity of surgical infections is still controversial. The practical need of defining the concept of antibiotic prophylaxis gave rise to numerous polemics in the literature. This paper presents a retrospective study on 103 cases whom diagnostics were colon and rectum cancer, that were operated in the IV-th Surgical Clinic in 1993-2002 period; at these patients was done antibiotic prophylaxis local and systemic before, during and after operating. This method made possible the registration of a minimum number of cases with surgical infection (7 cases, representing only 7% of the operated patients): a case (1%) with peritoneal collection (needing the surgical evacuation of this collection) and in 6 cases, parietal superficial infections, which imposed the prolong of drainage for almost 7 days. Starting from the basic principles of antibiotic therapy, this paper aims at outlining practical guidelines for a judicious antibiotic prophylaxis.