HYDROCEPHALY, SCHIZENCEPHALY, SPONDYLOCOSTAL DYSPLASIA, AND HYPOPARATHYROIDISM IN AN INFANT OF A DIABETIC MOTHER.

CONTEXT: Diabetes mellitus is the most frequent chronic complication in pregnancy and continues to contribute to increased perinatal morbidity and mortality in newborns. Macrosomia, respiratory distress syndrome, metabolic and electrolytic disturbances, and increased rates of congenital structural defects are well-known neonatal complications associated with maternal diabetes, even if well-controlled. CASE REPORT: A macrosomic infant born from an insulin-dependent mother, with uncontrolled diabetes and lack of adequate prenatal care, prenatally diagnosed with hydrocephaly showed a complicated postnatal course. Initial respiratory distress syndrome and transient hypoglycemia, rapidly corrected under treatment, were followed by persistent hypocalcemia and hyperphosphatemia due to hypoparathyroidism and evolving hydrocephaly. Ventriculoperitoneal shunting was followed by resolution of hypocalcemia, but seizures associated with schizencephaly and recurrent respiratory tract infections, aggravated by spondylocostal dysplasia, concurred to infant's demise at the age of 5 months. CONCLUSIONS: The reported case is rare due to multiple aspects: persistent hypoparathyroidism, uncommon association of schizencephaly, and even rarely association with spondylocostal dysplasia, all these conditions requiring a multidisciplinary therapeutic approach. Also, the reported case is evocative for challenges associated with infants born from diabetic mothers.

[CONTROVERSIES REGARDING THE ACCURACY AND LIMITATIONS OF FROZEN SECTION IN THYROID PATHOLOGY: AN EVIDENCE-BASED ASSESSMENT]. / INTÉRÊTS ET LIMITES DE L'EXAMEN EXTEMPORANÉ EN PATHOLOGIE THYROÏDIENNE. Revue systématique de la littérature et évaluation fondée sur les preuves.

Palpable thyroid nodules are present clinically in 4-7% of the population and their prevalence increases to 50%-67% when using high-resolution neck ultrasonography. By contrast, thyroid carcinoma (TC) represents only 5-20% of these nodules, which underlines the need for an appropriate approach to avoid unnecessary surgery. Frozen section (PS) has been used for more than 40 years in thyroid surgery to establish the diagnosis of malignancy. However, a controversy persists regarding the accuracy of FS and its place in thyroid pathology has changed with the emergence of fine-needle aspiration (FNA). A PubMed Medline and SpringerLink search was made covering the period from January 2000 to June 2012 to assess the accuracy of ES, its limitations and indications for the diagnosis of thyroid nodules. Twenty publications encompassing 8.567 subjects were included in our study. The average value of TC among thyroid nodules in analyzed studies was 15.5 %. ES ability to detect cancer expressed by its sensitivity (Ss) was 67.5 %. More than two thirds of the authors considered PS useful exclusively in the presence of doubtful ENA and for guiding the surgical extension in cases confirmed as malignant by FNA; however, only 33% accepted FS as a routine examination for the management of thyroid nodules. The influence of FS on surgical reintervention rate in nodular thyroid pathology was considered to be negligible by most studies, whereas 31 % of the authors thought that FS has a favorable benefit by decreasing the number of surgical re-interventions. In conclusion, the role of FS in thyroid pathology evolved from a mandatory component for thyroid surgery to an optional examination after a pre-operative FNA cytology. The accuracy of FS seems to provide no sufficient additional benefit and most experts support its use only in the presence of equivocal or suspicious cytological features, for guiding the surgical extension in cases confirmed as malignant by FNA and for the identification of other potentially confusing intraoperative findings.

[The transpleurodiaphragmatic laparoscopic approach of rear dome liver cysts]. / Abordul laparoscopic transpleurodiafragmatic al chistelor hepatice de dom posterior.

The localizations of liver cysts in the posterior hepatic dome (segment VII) and the hydatid cysts in particular, difficult to approach in "conventional" open or laparoscopic surgery, with significant parietal sacrifices and "demolition", requires a secure atypical laparoscopic approaching way, with positive results for both patient and surgeon, with minimal impact, with social and professional reintegration and faster healing. Transpleurodiaphragmatic laparoscopic approach using "Device for aspiration of liver hydatid cyst or ovarian cyst (OSIM 120809/30.04.2008 Patent - Dan Sabau) asociated with the remarcable performances of the fragmentation device for hydatid cyst content (OSIM Patent no. 120810/30.04.2008 - Dan Sabau) is the best way to approach these problems, accessible for surgeons with minimum experience in laparoscopic and thoracic surgery. The relatively low number of cases allows only formulation of preliminary positive conclusions on the method, they will be validated by subsequent results.

[Particular aspects of endoprosthesis in malignant advanced pharingeal-esophageal stenosis]. / Aspecte particulare ale endoprotezarii în stenozele maligne faringoesofagiene avansate.

INTRODUCTION: The esophageal neoplasm is currently the seventh cause of death through cancer worlwide. In the developing countries it is situated on the fifth place and has one of the worst prognostics for a neoplasm. Due to the specifical intratoracical topography, clinically inaccesible and without symptoms, the disease is rather incurable when the disphagia appears. MATERIAL AND METHOD: The esophageal prosthesis procedure through laparogastroscopical approach, used by us, is an original one, noninvasive, acknowledged both nationally and internationally. The endoprosthesis esophageal cases belong to three Clinics of Surgery (Clinic Surgery 2 from Sibiu, Clinic Surgery 1 from Braila, Clinic of Surgery 4, Bucharest) on a period of 14 years (1996-2009), identically coordinated. RESULTS AND DISCUSSIONS: Out of the 68 patients, 18 cases have been cancers situated in the medial and inferior third and 28 have been eso-cardial-tuberositary neoplasms. In the cases of the high malignant pharingeal-esophageal stenosis, the placement of the prosthesis (different prosthesis adapted to this particular situation) in areas of aerial-digestive junction implies significant technical difficulties especially in the option with the conservation of the larinx as a fonatory and respiratory solution. CONCLUSIONS: Our original procedure, simple and efficient presents numerous advantages which allow the widening of the indications of stent gastroenterology: firm traction, the possibility of catheterism through narrow lumens of 1-2 mm, sometimes anfractuous, the distal visibility, the visual placement or expanding of the prosthesis, the evaluation of the intraoperatory visceral or parietal methastasis and eventually the avoidance of the gastrostomic invalidation.

[Esophageal endoprosthesis by laparo-gastroscopy with transtumoral approach in advanced esophageal and esophagogastric cancer]. / Endoprotezarea esofagiana laparo-gastroscopica prin foraj transtumoral in neoplasmele esofagiene si esogastrice depasite.

INTRODUCTION: Romania is part of the countries with low incidence of esophagus cancer (the mortality rate M/W at 100,000 peoples being 1.6/0.3), but the diagnosis of the disease, is most frequently incidental in stages that make any intention of radical treatment a desideratum frequently unattainable. MATERIAL AND METHOD: In the impossibillity of curative treatment we realised laparoscopic procedure of esophageal prosthesis (through traction not through pushing as in endoscopic procedures) at 60 patients with esophageal and esogastric cancer in advanced stages (distance metastasis, almost non-existing lumen, emaciation, severe decline of general state). The originality of the laparogastroscopic method has been international recognized. RESULTS AND DISCUSSIONS: This minimally invasive prosthetic original method presumes minimal agression, gastroscopic approach, the insertion of the prosthesis is made through traction not through pushing (transtumoral drilling, compresive and styptic insertion, etc.). The patient can eat at 8-12 hours after operation and the contact with the hospital is shorter, the hospitalization period was between 3 and 7 days. We had survivals between 5 months and 4 years. CONCLUSION: The method that we propose is simple and efficient is a solution for repairing the endoscopic failure, is an alternative for the crippling gastrostomy, or, for the cases when the preoperative most optimistic estimations might comply a sick person and unbalanced immunological, nutritional and psychological, to an intervention to vast in scope (anaesthetic and surgical), compared to the final solution, palliative, in fact.