Continuous negative pressure wound therapy in the treatment of a gigantic trophic leg ulcer.

AIM: to present a therapeutic algorithm for chronic venous insufficiency complicated with ulceration, using etiologic treatment combined with local treatment by negative pressure wound therapy (NPWT) before and after skin grafting. MATERIAL AND METHOD: we are discussing a 59 years-old patient with a lower leg gigantic, circumferential trophic lesion. The aetiology was combined, post-traumatic and chronic venous insufficiency, with 30 years of evolution. RESULTS: the treatment was applied in two surgical steps. Initially the pathological refluxes were interrupted; secondarily a skin graft was applied, preceded and followed by NPWT until graft intake. The wound healed completely; patient developed secondary foot lymphoedema. CONCLUSIONS: 1. Case treatment particularity consists in using a combination of etiologic and local treatment, combined with adjuvant NPWT. 2. Secondary lymphoedema developed due to circumferential location of the lesion. 3. Continuous NPWT has proven its efficiency in chronic ulcer before and after skin grafting, reducing costs and duration of treatment.

[Obstructive jaundice by genodermatosis--case report]. / Icter obstructiv prin genodermatoza--caz clinic.

BACKGROUND: Neurofibromatosis type I, or Recklinnghausen disease, is the most frequently occurring neurofibromatosis, in 1/3000-11,5000 of children born. This disease is a genodermatosis with 1/3000-1/5000 autosomal dominant transmission. Incriminated in the pathological appearance of the disease gene is located on chromosome 17, gene product, neurofibromina, is a protein involved in controlling cell differentiation and proliferation. Skin manifestations can be associated with the same papillary tumors and the internal organ. Treatment is surgery for larger tumors. Worse prognosis in malignant developpment, with the lower quality of life in the presence of complications, as in this case: mechanical obstructive jaundice. MATERIAL AND METHOD: Patients aged 75 years, admitted for obstructive jaundice (progressive, pruritic), cutaneous papillomas (0.5-3 cm) on the trunk and several hyperpigmented brown spots (5-6 cm diameter). Cutaneous lesions (45 years old) have been previously diagnosed by histological examination. RESULTS: We did surgery under general anesthesia: cholecystectomy, intraoperative choledocoscopy of bile duct. In the last portion of bile duct we found pedicled tumors. We did partial excision of tumors and coledoco-duodenoanastomosis in healthy tissue. Histological examination showed neurofibrodermatoza type I. Discharge 12 days postoperatively. CONCLUSIONS: Preoperative diagnosis suggested the possibility of mechanical jaundice by malignancy. Etiologic diagnosis of this rare form of obstructive jaundice could not be established before surgery, only by histological examination of the excised tumors.

[Intramural intestinal hematoma--a complication of the oral anticoagulant therapy]. / Hematom intestinal intramural, complicatie a tratamentului anticoagulant oral.

AIM: The presentation of a rare complication of oral anticoagulant treatment involving abdominal surgery. MATERIAL AND METHOD: A 59 years old patient who received oral anticoagulant treatment with Warfarine for repeated episodes of thrombosis of the lower limbs, suddenly develops an occlusive abdominal simptoms, which did not submit under conservative treatment. Biologically the clotting times were modified and the abdominal CT showed lesions of the first jejunal loop. RESULTS: During surgery an amount of blood was found in abdominal cavity and a large haematoma of the first jejunal loop which required resection. The postoperative evolution was simple with discharge in the 12th day, surgically cured. CONCLUSIONS: 1. Intramural intestinal haematoma is a rare, but possible complication of the oral anticoagulant treatment. 2. Precise diagnosis is possible, avoiding unnecessary surgical intervention because the complication is treatable using conservative therapy. 3. Surgical intervention is required in case of a sudden onset, imprecise diagnosis and unfavorable evolution which could point associated intraabdominal lesions.

[Intestinal stromal tumors, rare cause of lower gastrointestinal bleeding. Case report]. / Tumora intestinala stromala, cauza rara de hemoragie digestiva inferioara. Caz clinic.

Gastrointestinal stromal tumors represent a heterogeneous group of mesenchymal tumors that can develop throughout the gastrointestinal tract. We present the clinical case of a patient with such malignancies occurred in the proximal jejunum and clinically manifested by a severe digestive hemorrhage with hemorrhagic shock and severe posthemorrhagic anemia. Pre-operative diagnosis was possible only through the Entero-MRI. The evolution was favorable after surgical extirpation. It's being discussed particular aspects of this lesion's entity and post-operative optimal attitude in this case.

[Minimally invasive surgical treatment of recent achilles tendon rupture]. / Tratament chirurgical minim invaziv al rupturii recente de tendon ahilian.

The Achilles tendon rupture represents a acute, invalidating pathology with a increasing trend. It affects the young active adult and the treatment indications have not developed a standard yet. The treatment can be conservative (cast immobilization) or operative. The aim of the study is the widespread of the authors experience with the percutaneous suture of the fresh Achilles tendon rupture, a accessible and effective treatment method of a lesion which is of a larger interest then just of the orthopedic surgeon. This minimal invasive technique combines the benefits of the conservative treatment--low complication incidence--with those of the surgical treatment were the union rate is higher. The suture material makes no difference. The use of 1,5 mm PDS cord or normal, braided 0 nylon has offered the same good end result. The costs are lowered by the short operative time and hospitalization period and the patients returned to the anterior activity at 6-8 weeks after injury. At the same time the cosmetic result is very good. This technique could be set as a standard for the treatment of the fresh Achilles tendon rupture.

[Suppurative complications of acute pancreatitis]. / Complicatiile supurative ale pancreatitei acute.

BACKGROUND/AIMS: This retrospective study investigated the management of the suppurative complication of acute pancreatitis in our clinic. MATERIALS AND METHODS: A retrospective study was made in the Surgery no. 1 Clinic of Timisoara during the period of 6 years (1996-2001) and on the subject of the acute pancreatitis with suppurative complications. RESULTS: As a result the study found a number of 16 cases of suppurative complications out of a total number of 224 acute pancreatitis (7.14%). The acute pancreatitis with suppurative complications was most frequent of biliary etiology (56.2%). All suppurations have occurred on serious necrotizing hemorrhagic acute pancreatitis background. The major elements that contributed to determining the diagnosis were: systemic toxicity, the permanent sepsis, the association of multiple organ failure, but the element that provided certainty in the diagnosis was the computed tomography (CT scan). The surgical mortality was 18.7%. CONCLUSIONS: The acute pancreatitis that evolves unfavorable under medical treatment must be operated. Necrotic tissues and purulent collections must be evacuated and drained efficiently. Open drainage through laparotomy lowered postoperative mortality. The early surgical intervention had a favorable effect on the prognostic.

[Our experience regarding neoplasms of the extrahepatic bile ducts]. / Experienta noastra în legatura cu neoplasmele cailor biliare extrahepatice si periampulare.

AIMS: We tried to study the cases of extrahepatic bile ducts tumors and to emphasize the main diagnosis methods in therapeutic--efficient phases. MATERIAL AND METHODS: This is a retrospective statistical study of nine years of experience (1993-2001); in this time there were admitted 34 patients diagnosed with neoplasm of the extrahepatic bile ducts and periampular carcinoma. In this study we included patients with malignant tumors of the gallbladder, of the choledocus, with Klatskin's tumor and with cancers of the ampulla of Vater. The patients were between 37 and 83 years old (an average of 64.6 yr.). The sex ratio, M/F, was 1.83/1. RESULTS: The most frequent sites were: the gallbladder (41%), followed by the ampullar carcinomas (26%), Klatskin's tumors (18%) and the tumors of the choledocus (15%). The peak of incidence was found in the eighth life decade (11 cases). The survival in this study group was significantly influenced by the time of the diagnosis. The results of this study confirm once more the severity of these tumors and the major difficulties of the early diagnosis. CONCLUSIONS: The only chance for a significant survival in these patients is offered by an early diagnosis. The therapeutical options are centered by the extended resection of the tumors. The prognosis is darkened by the advanced degree of evolution in the moment of the diagnosis.

[ A new technique for the treatment of varicose veins]. / O tehnica noua de tratament a varicelor.

UNLABELLED: The thoroughgoing study of the venous wall and venous flow using fundamental research and diagnostic techniques allowed us to apply new therapeutic methods in the primary varicose veins of the lower extremities (PVV). The aim of the present study is to present a relatively new method of conservative surgical treatment which combine the external valvuloplasty technique with the technique proposed by Franceschi (TF). MATERIAL AND METHOD: Between 1992-2000 we applied on 25 patients with PVV Mach II, the technique of external muffing of the long saphenous vein from its junction with the common femoral vein retrograde for 6-8 cm, for a venous diameter of 0.5 cm interrupting at the same time the long or the short ebbing (clinical and Doppler criterions). In 5 patients we performed the valvuloplasty using TF. The patients were annually evaluated; in the present we have a group of 10 patients up to 8 years after surgery. RESULTS AND CONCLUSIONS: 1. Conservative methods of external valvuloplasty associate with Franceschi technique have a solid physiopathologic and pathogenic basement. 2. The materials used for the external muffing (Dacron, PTTF, polyamide net) are very well tolerate. 3. Relapses were present in 8 years at 30% and in 5 years at 10% of the patients who undergo the operation.