[The evaluation of immunoinflammatory response in acute bacterial peritonitis]. / Cercetarea rasspunsului imunoinflamator în peritonitele acute bacteriene.

AIM: To evaluate the immunoinflammatory markers that shape the evolution of acute peritonitis and to assess their utility in specifying the development of septic shock from peritonitis. MATERIAL AND METHOD: We conducted a prospective study on a sample of 100 patients with acute peritonitis, hospitalized during 2001-2005 and immunologically monitored. We realized 2000 dosages of immunoinflammatory markers for 15 days by 1200 simple radial immunodiffusion tests (IDRS), the Mancini-Carbonara method for C reactive protein, complement component C3, immunoglobulins and 836 ELISA tests to evaluate cytokines. Results were reported to a witness group. RESULTS: C reactive protein (CRP) values were significantly elevated in patients with peritonitis (12-310 ng%) vs. witness group (1.5-8 ng%). Postoperative, elevated values were maintained at the patients who will develop serious complications and were correlated with multiple organic dysfunction in deceased patients. Determination of circulating immune complexes have shown elevated values in patients with peritonitis. Dosage of pro/antiinflammatory cytokines may be specific to the severity of inflammatory response to infection. The level of procalcitonin was increased in patients with sepsis and severe inflammatory reactions and become an important prognostic tool. CONCLUSIONS: The study of biological markers in microbial aggression highlights the role of cytokines as messengers and important mediators of immunoinflammatory response. PCT test can be introduced in the daily tracking protocol for septic patients.

[Differentiated thyroid carcinoma. Diagnosis and therapeutic aspects]. / Carcinomul tiroidian diferentiat. Aspecte diagnostice si terapeutice.

The significant increase in incidence of thyroid cancer in the last decade, augmented the interest in reevaluation of treatment and diagnosis methods. Those aspects let us into making this retrospective study regarding the differentiated thyroid carcinoma. The clinical material consist in 70 C.T. patients, of which 54 (77.14%) C.T.D. patients, ages between 17-80 year old, sex ratio W/M 3.5/1.9. Preoperatively malignancy diagnosis was made by FNAC in 38.88%, intraoperatively by extemporaneous pathological exam 42.59%, postoperatively by paraffin exam 18.51%. Papillary CTD 30 (55.55%), follicular 20 (41.25%), Hürthle cells carcinoma 4 (7.2%). From the therapeutical point of view, the elective procedure of thyroidectomy was dictated by the histological type, staging and specific prognostic factors. There was 41 (75.9%) patients with total thyroidectomy (T.T), with a specific morbidity of 7 (12.96%) and 5-years survival rate of 88.88%. Preoperatively diagnosis of C.T was suspected through clinic, ultrasonography and scintigraphy arguments and confirmed by FNAC. The non conclusive cases were diagnosed intraoperatively by extemporaneous exam or postoperatively by paraffin exam. In most cases total thyroidectomy remains the essential surgical procedure. Also clinical, imaging and biological postoperative monitoring as well as suppress and substitution hormonotherapy are mandatory.

[Duodenal post-bulbar ulcers. Diagnostic and therapeutic problems]. / Ulcerul duodenal postbulbar. Probleme de diagnostic si tratament.

Our study upon 1235 cases of duodenal ulcers (1991 - 2001) revealed a decrease of its morbidity rate of 10 - 12%. However, the incidence of the post-bulbar duodenal ulcer (P.B.D.U.) remained constant - 9,33% (115 cases) from all duodenal ulcers. Its diagnostic and therapeutic difficulties, its peculiar etiology, pathogeny, topography and evolution are the consequence of the duodeno-bilio-pancreatic morphologic modifications, clinic polymorphism, radiologic indirect signs and difficult endoscopic localisation. Definitive diagnosis was set only intraoperatively. There are 2 forms of P.B.D.U.: proximal (D1 fixed) - 62,60% and distal (D2 above duodenal papilla) - 37,40%. Associated bilio-digestive lesions were encountered in 30 cases (26,08%). Due to its aggressive, endocrine-type etiology and pathogeny, evolution to severe complications and resistance to modern medical therapy, the PBDU should be of first surgical intent, considering a radical procedure whenever possible. Gastric 2/3 resection or truncal vagotomy with limited gastric resection were achieved in 90,43% of cases. We preferred the Bilroth II type anastomosis (65,20%) excluding the ulcerous lesion. Drainage of the duodenal stump was employed in 26% of cases. Specific postoperative morbidity of 12,17%, an early re-operations rate of 6,05% and postoperative mortality of 3,47% versus 2,05% for the duodenal ulcers, emphasize the severity of the P.B.D.U.

[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.