Cervical ultrasound assessment of thyroid nodules at risk of malignancy: single-center experience.

AIM: The increasing diagnosis of thyroid nodules makes proper assessment of their nature and course of treatment essential, considering that thyroidectomy may be unnecessary and only contribute to higher healthcare system costs. Although criteria have been proposed for the stratification of these patients according to risk by use of cervical ultrasound and fine needle aspiration biopsy (FNAB), not all medical units may be equipped or have access to trained medical professionals to perform FNAB. The aim of this study was to show that cervical ultrasound may be sufficient for the evaluation of thyroid nodules in the treatment decision-making process. PATIENTS AND METHODS: 206 patients with single thyroid nodules and nodular goiter were assessed through cervical ultrasound and FNAB for the correlation between pretreatment classification and final diagnosis on histological examination. RESULTS: 26.5% of single nodes proved malignant on paraffin studies, as compared to only 14% of nodular goiters. FNAB recorded a sensibility of 33.3%, specificity of 93.3%, false-negative rate of 50% and false-positive rate of 12.5%, whereas cervical ultrasound recorded a sensibility of 92.3%, specificity of 75.3%, false-negative rate of 2.8% and false-positive rate of 48.9%. CONCLUSION: Cervical ultrasound evaluation is a reliable method in the preoperative diagnosis of thyroid cancer patients.

Transversal incision of the vagina favors the remaining of the tape in the middle-third urethra compared to longitudinal incision during transobturator sling procedures for stress urinary incontinence.

BACKGROUND: To describe a new type of incision of the vagina during transobturator sling procedure and to evaluate by ultrasound the tape position at 3, 6 and 12 months after surgery. We conducted a prospective study including 51 patients with urinary stress incontinence who underwent sling procedure using the transversal vaginal incision. Tape position was evaluated by ultrasound at 3, 6 and 12 months after surgery and expressed as a percentage of the urethral length (the proximal third of the urethral length 0-39 %, the middle third 40-60 %, and the distal third 60-100 %). Informed consent was obtained from all patients prior to their inclusion in the study. All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and were approved by the Institutional Review Board and Ethical Committee of "Victor Babes" University of Medicine and Pharmacy Timisoara before the beginning of the study (no 7/17.04.2012). RESULTS: At 3 months after surgery, 3.92 % of the slings were located in the proximal third of the urethra, 88.23 % in the middle third of the urethra and 7.84 % in the distal third. At 6 and 12 months after surgery we obtained similar results: 9.81 % of the slings were located in the proximal third of the urethra, 82.35 % in the middle third and 7.84 % in the distal third of the urethra. CONCLUSION: The transversal incision of the vagina offers a minimal dissection along the long axis of the urethra favoring the remaining of the tape in the middle third of the urethra.

Non-keratinizing undifferentiated carcinoma of the nasopharynx.

Nasopharyngeal carcinoma is the predominant tumor type arising in the nasopharynx with cervical lymph nodes present in 60-90% of all cases at the time of presentation. The most frequent pathological varieties include squamous cell carcinoma well-differentiated keratinizing, moderately differentiated non-keratinizing and an undifferentiated type. We present a case of non-keratinizing undifferentiated carcinoma of the nasopharynx with parapharyngeal and middle cranial fossa space involvement in an 18-year-old male who has been admitted in our hospital for recurrent right ear otitis media. Symptoms consisted in mild conductive hearing loss, trigeminal V2 nerve anesthesia, right ear tinnitus, mild dysphagia, mild dysphonia, right hypoglossal nerve paralysis and right Claude Bernard-Horner's syndrome. Clinical examination revealed no lymph node masses, chest X-ray corresponding to a normal thoracic image. Cranial contrast enhanced CT scan showed a non-homogenous mass of 5.4/4.5/5.5 cm from the level of the right rhinopharyngeal wall, extending in the right parapharyngeal space, invading the right middle cranial fossa. Cranial MRI with contrast enhancement revealed a rhino- and parapharyngeal mass of 5.5/4.6/5.3 cm with intracerebral extension in the right cavernous sinus, right internal carotid artery being engulfed by the tumor mass with partial compression. Several lymph node masses of 1.7/1.2 cm were also revealed. We performed rhinopharyngeal biopsy, right tympanotomy and grommet tube insertion. The tissue specimens were processed with routine histological technique. Subsequent immunohistochemical reactions for pan-cytokeratin AE1/AE3 and leukocytes common antigen were performed. The histological examination of routine stained slides showed that malignant tumor cells had a syncytial pattern of growth in a background of small lymphocytes. The positivity of tumor cells for pan-cytokeratin established the final diagnosis of non-keratinizing undifferentiated carcinoma. The age of onset, the clinical signs and symptoms and minimum involvement of lymph nodes represents the particular aspects of the case.

Postoperative morbidity and mortality after liver resection. Retrospective study on 133 patients.

INTRODUCTION: Hepatic resection had an impressive growth over time, both by broadening the range of its indications and the occurrence of changes and technical tricks in order to reduce postoperative mortality and morbidity. MATERIAL AND METHODS: This study is a retrospective study presenting an analysis of 133 patients hospitalized in the Department of Hepatic Surgery in City Hospital Timisoara, between January 2000 and November 2011, in which a surgical intervention was performed, either for a primary hepatic tumor (benign or malignant) or a secondary liver tumor. All cases were analyzed in terms of etiopathogenesis, preoperative and intraoperative investigations, indication and type of hepatectomy performed, the surgical technique used and postoperative evolution. RESULTS: The study group comprises 133 patients. From the whole group, 100 patients (75.19%) were diagnosed with primitive liver tumors, in 70 patients (70% of primary tumors) HCC occurring on a cirrhotic liver. Liver disease was secondary in 33 patients (24.81%), colorectal tumors being most commonly involved (19 patients). Of all liver resections, 21 (15.79%) were major hepatectomies. The remaining were minor hepatectomies, including a trisegmentectomy (V, VI, VII), 51 bisegmentectomies and 60 liver resections limited to one segment. Vascular clamping was used in 89 cases (66.92%), pedicular clamping in 65 patients (73.03%) and selective extraglissonian clamping in 24 patients (26.97%) respectively. Of the 33 patients with liver metastases, 12 (36.36%) received synchronous resections. The most common complication in our study group was postoperative liver failure, found in 45 patients (33.83%), being irreversible in one case (2.22%), followed by the death of the patient. In 34 patients (75.55%), hepatic failure was seen in cirrhotic patients and the other cases were patients with major hepatec-tomies. Hepatic failure occurred in 35 patients (77.78%) with vascular clamping, four of them after selective clamping. 31 of the patients (68.89%) with postoperative liver failure were transfused, 25 patients (55.55%) receiving more than 2 units of blood. Of all patients, 3 (2.25%) died postoperatively. CONCLUSIONS: Respecting the principles of liver surgery, hepatic resection can be performed, even in cirrhotic patients, with acceptable morbidity and minimal mortality. The most common complication after hepatic resection, in our study group, was postoperative liver failure, which was mostly reversible.

[Postoperative complete abdominal dehiscence: risk factors and clinical correlations]. / Evisceratiile postoperatorii: factori de rise ssi corelattii clinice.

UNLABELLED: The purpose of this study is to review our clinical experience with abdominal wound dehiscence in the Surgical Department of City Hospital Timisoara. PATIENTS AND METHODS: 19.116 abdominal procedures were performed between January 1992 - March 2009 in our Department and 29 complete dehiscences were identified (0,15%). Significant risk factors in our analysis were intraabdominal infection, wound infection, emergency surgery, malignancies, digestive fistulae, hiperabdominal pressure, sex and age over 65 years. Less significant factors were the abdominal type of incision, the method of wound closure and heart or respiratory diseases. CONCLUSIONS: postoperative complete dehiscence is a constant presence in a surgical department; despite its low frequency, wound dehiscence is associate with a hight mortality and morbidity rate, and increase the costs and hospitalisation periode. Risk factors evaluation and their associations represente an important role in the therapeutic management of the surgical patient.

[Hepatic hemostasis with packing in complex abdominal traumatic lesions: indications and postoperative outcomes]. / Impachetarea hepatica în leziunile traumatice abdominale complexe: indicatii si rezultate postoperatorii.

UNLABELLED: The purpose of this study is to review our postoperative outcomes with liver packing in complex abdominal trauma. PATIENTS AND METHODS: 76 liver trauma were admitted for operative procedures in the Surgical Department of City Hospital Timisoara between April 1994 - September 2009 and 16 cases were identified in our series as requiring liver packing. In all cases, this method was efficient, with no postoperative bleeding. In the same time, there were specific complications such as bile leak or abdominal collections. CONCLUSIONS: despite a second procedure for packs removal and the possibility for specific complications, liver packing is an efficient method for severe liver trauma or complex abdominal lesions.

[Liver trauma. Experience of Surgical Department, City Hospital Timisoara]. / Traumatismele ficatului. Experienta Clinicii de Chirurgie de urgenta a Spitalului Municipal Timisoara.

The present paper analyzes the liver trauma, underlying efficient diagnostic methods and treatment approaches. Liver trauma is frequent in Surgical Emergency Units and it is a challenge for the surgeon who has to deal with diagnosis and treatment problems and also to treat the associated lesions. The study analyzes 49 cases of liver trauma admitted in Emergency Surgery Clinic from Timisoara City Hospital between January 1995 and April 2005. A very good trained team specialized in liver surgery but also a multidisciplinary team is very important in liver trauma.

[Deep liver wound treated by internal compression with Blakemore catheter]. / Plaga hepatica transfixianta rezolvata prin compresiune intrinseca cu sonda Blakemore.

High incidence of polytraumas of different etiology determines special problems of treatment, the emergency surgeon frequently facing serious and complex injuries the most frequently in unstable patients and therefore difficult to be treated. This paper presents the case of a 19 years old patient, victim of a heteroaggression; clinical examination reveals an unique abdominal wound, surgical procedure showed a liver lesion with massive hemoperitoneum. Authors expose a series of emergency procedures principles for unstable patients and also an unusual method in the treatment of a liver wound. Actually, this method means catheterization of the liver wound with a Blakemore catheter. The esophageal balloon is full fill to make a positive pressure on this wound. Good evolution of the case justifies this method to be used as an alternative procedure to other haemostatic methods (liver resections, hepatic artery ligature etc.).

[A retrospective study of 83 patients hospitalized for a jaundice syndrome in the Surgical Clinic of Timisoara Municipal Hospital]. / Studiu retrospectiv privind 83 de pacienti internati pentru un sindrom icteric în clinica de chirurgie a Spitalului municipal Timisoara.

This is a retrospective study done on 83 patients admitted to surgical department of Timisoara Emergency Hospital in the period between 01/01/1992 and 31/03/1995; 47 patients were males, 36 females with mean age 56.1 years. All patients suffered from jaundice mainly conjugated hyperbilirubinemia. The causes of jaundice were: malignant tumours in 19 (22.9%), chronic diffuse parenchymatous liver disease in 24, stone common bile duct 22, benign biliary strictures and papillary stenosis in 6, extrinsic biliary compression and inflammation in 12. Surgery was done in 47 patients and medical treatment in 36 patients. During hospitalization, complications occurred in 19 patients. The condition of patients at discharge was considered: cured in 30, improved in 38, stationary in 2 and deteriorated in 12. Mortality occurred in one patient.