[Spontaneous esophageal rupture in three patients]. / Ruptura spontana de esofag la trei pacienti.

Boerhaave's syndrome represents the most severe perforation of the gastrointestinal tract. The typical clinical presentation is by a sudden onset of pain after a vomiting effort on the background of an alimentary and alcoholic abuse. It usually associates the cervicomediastinal emphysema, altogether forming the Mackler triad. The atypical presentation and the rarity of this entity usually lead to the delay in diagnosis in 50% of the cases. The diagnosis requires native and hydrosoluble contrast radiological examination which may reveal, altogether with the esomedistinal or esopleural fistula, pneumomediastinum, cervical subcutaneous emphysema, pleural effusion or hydropneumothorax. The early diagnosis and surgical treatment in the first 24 hours after the perforation offer the best chances for survival. We present and analyze the cases of 3 patients with spontaneous esophageal rupture with their different evolution and the diagnostic and treatment steps in each case.

[Surgical treatment of Graves' disease]. / Tratamentul chirurgical în boala Basedow.

The surgical treatment of the Graves' disease is no longer a final solution but the main option, as for all the benign thyroid diseases. Between January 1994 and December 2003 in the 3rd Surgical Unit of the Sf. Spiridon Hospital of Iasi 805 operations were performed for benign thyroid disorders, 78 of which were performed for the Graves' disease. All the patients had been investigated and diagnosed in the Endocrinology Unit of the same hospital, where the necessary medical treatments had been administered. The patients transferred to Surgery had a medium age of 38 (extremes 17-79 years). Women had a greater proportion, as expected (sex ratio F: M = 4.57:1). Some patient had concurrent diseases (5 cases with atrial fibrillation and 3 with chronic hypocalcaemia). 58 total and 20 subtotal thyroidectomy were performed. There were few immediate (3 bleedings which needed reoperation for haemostasis) and late complications (2 cases of postoperative hypocalcaemia which received medical treatment). 4 relapses after previously performed subtotal thyroidectomy were diagnosed and treated. Total thyroidectomy is the treatment of choice for the Graves' disease. The frequency of complications is similar to that occurred after subtotal thyroidectomy, the functional results are immediate, predictable and stable, and the substitutive treatment is very efficient and easy to administer.

[Multiple perforated, poorly differentiated carcinomas of the small bowel]. / Carcinoame slab diferentiate sincrone perforate de intestin subtire.

The small bowel malignant tumors represent a rare pathology; in their diagnosis an important role is played by the clinical suspicion in front of non-specific symptoms. However, the therapeutic decision must not be delayed by excessive explorations, but it should be permanently adapted to the patient's condition; the operative exploration has the advantage of making an accurate diagnosis. The authors present the case of a patient admitted in emergency with the suspicion of a generalized peritonitis from a perforated peptic ulcer and who was subsequently diagnosed with multiple perforated small bowel malignant tumors. The patient's history offers data that could be interpreted in the context of the intraoperative diagnosis. This is the first reported case of multiple perforated poorly differentiated carcinomas of the small intestines.

[A case of stromal gastric tumor-uncommon clinical and pathological entity]. / Un caz de tumora stromala gastrica--raritate clinica si histopatologica.

Stromal gastric tumors represents an uncommon entity with difficult diagnosis, both preoperative and pathological. We present the case of a patient admitted for abdominal pain, with palpable tumor in epigastrium and right hypochondrium; abdominal echography, barium enema and abdominal CT-scan were not able to precise the involved organ. Operative exploration found at the level of horizontal portion of the stomach a solid tumor, which was resected, with good subsequent evolution. Pathologic diagnosis was stromal gastric tumor. We present latest news concerning diagnosis, prognostic and treatment for this type of tumor.