Contrast-enhanced ultrasound (CEUS) for the evaluation of focal liver lesions - a prospective multicenter study of its usefulness in clinical practice.

PURPOSE: To assess the value of contrast-enhanced ultrasound (CEUS) for differentiating malignant from benign focal liver lesions (FLLs) and for diagnosing different FLL types. MATERIAL AND METHODS: CEUS performed in 14 Romanian centers was prospectively collected between February 2011 and June 2012. The inclusion criteria were: age > 18 years; patients diagnosed with 1 - 3 de novo FLLs on B-mode ultrasound; reference method (computed tomography (CT), magnetic resonance imaging (MRI) or biopsy) available; patient's informed consent. FLL lesions were characterized during CEUS according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. For statistical analysis, indeterminate FLLs at CEUS were rated as false classifications. RESULTS: A total number of 536 cases were included in the final analysis, 344 malignant lesions (64.2 %) and 192 benign lesions (35.8 %). The reference method was: CT/MRI - 379 cases (70.7 %), pathological exam - 150 cases (27.9 %) and aspiration of liver abscesses - 7 cases (1.4 %). CEUS was conclusive in 89.3 % and inconclusive in 10.7 % of cases. To differentiate between malignant and benign FLLs, CEUS had 85.7 % sensitivity, 85.9 % specificity, 91.6 % positive predictive value, 77.1 % negative predictive value and 85.8 % accuracy. The CEUS accuracy for differentiation between malignant and benign liver lesions was similar in tumors with diameter ≤ 2 cm and those with diameter > 2 cm. CONCLUSION: CEUS represents a useful method in clinical practice for differentiating between malignant and benign FLLs detected on standard ultrasonography, and the results of this study are in concordance with previous multicenter studies: DEGUM (Germany) and STIC (France).

[Laparoscopic surgery for small bowel obstruction]. / Abordul laparoscopic al ocluziei intestinului subtire.

At the beginning of the laparoscopic surgery, intestinal obstruction was considered an absolute contraindication for this approach, because of the high risk of injuring the bowel. Today, the increased experience allows to apply this method in certain selected cases of small intestine obstruction. We realised a retrospective study, over a period of 7 and a half years (January 1997 - June 2004), regarding the patients admitted and treated in our department for small intestine obstruction, both by open surgery (88 cases) and by laparoscopic surgery (11 cases). We compared the preoperative characteristics of the two subgroups, highlighting the importance of a careful selection of the cases for the success of the laparoscopic approach. We analysed the postoperative evolution of these patients (return of bowel function, postoperative wound evolution, hospital stay, socioeconomic reintegration), which allowed us to draw the conclusion that some of the patients with obstruction of the small intestine may benefit from the advantages of the mini-invasive surgery.

[Bilio-pancreatic diversion with duodenal switch (DS) in morbid obesity--surgical technique]. / Diversia bilio-pancreatica cu duodenal switch (DS) în superobezitatea morbida.

Obesity is one of the biggest health problems nowadays with growing prevalence. Co morbidities and decreasing life-expectancy have imposed various treatments, of which surgery has the best efficiency. Bilio-pancreatic diversion modified with duodenal switch represents the procedure with both malabsorbtive and restrictive effects. This procedure has the best results in reducing excessive body mass and in maintaining this loss. Complexity of this procedure, early and late complications suggests that the main operative indication is for morbid obesity patients (body mass index BMI > 50 kg/mp). The procedure that we have done was a success in efficiency and in quality of life, but for conclusions is necessary more experience.

[Laparoscopic adjustable gastric-banding treatment for morbid obesity our first year experience]. / Tratamentul obezitatii morbide prin gastric banding laparoscopic. Rezultate la un an de la debut.

The authors present the results of a prospective study regarding their 1st year experience in laparoscopic adjustable gastric banding (LABG), which included 21 patients (5 males, 16 females), with an average age of 39 (between 20-53 years). The follow up was made at one and six months postoperative. The medium weight was 138 kg (between 95-172 kg), with a medium excess of body mass of 66.89 kg (extremes between 27.75 and 104 kg). The medium BMI (body mass index) was 48.9 (extremes: 34.5-66), 8 patients being superobese (BMI > 50). The average operating time was 120 min, all operations were finished laparosopically. Postoperative complications were: total disfagia (1 case), parietal suppuration (2 cases) and partial intragastric migration of the prosthesis (1 case). There were no deceased patients. The medium excess of body mass at 6 months after surgery was 46.57 (only 13 patients evaluated in this interval). After 6 months postoperative the comorbidities were healed at half of the patients. Although we do not benefit of a long time follow up, the favorable initial results permits us to state that LABG must find its place in the efforts of struggling against obesity and its consequences.