Perianal giant condyloma acuminatum (Buschke-Löwenstein tumor). Case report and review of the literature.

UNLABELLED: Giant condyloma acuminatum, also known as Buschke-Löwenstein tumor (BLT) is a very rare sexually transmitted disease that affects the ano-genital region. BLT is a slow growing cauliflower-like tumor, but unlike simple condyloma, it is locally aggressive and destructive, malignant transformation occuring in 40-60% of cases. We present a case of perianal carcinomatous BLT and discuss some controversies about the nature and treatment of this disease. Our aim is to emphasize some basic points in the management of giant perianal condyloma acuminatum. CONCLUSIONS: The patient with BLT must be very carefully clinical and imagistic investigated in order to detect the tumor visceral invasion and to establish the extension of the surgical procedure. Wide perineal excision with histopathological margins control is the best surgical choice if the anal canal is not involved. The radical pelvic surgery is indicated only in patients with provable visceral invasion. Excision is mandatory even in very small condilomas to prevent BLT later development.

[Temporary total fecal diversion--ultimate solution for complex recurrent anal fistula]. / Colostomie terminala temporara--solutie extrema într-un caz de fistula perianala complexa multirecidivata.

Anal fistula is a frequent disease, but complex fistulae are relatively uncommon. The treatment for this pathology remains debated all over the world, and in cases of complex fistulae represents a challenge. We present a 55 years old male, operated more than 40 times in the last 15 years for perianal recurrent fistulas and abscesses. The fistula has had a progressive evolution despite all kind of surgery and has extended finally to entire perineal and gluteal region; more than 30 orifices were founded on skin surface and many internal anorectal orifices as well. The patient is weakened, anemic, in chronic sepsis. As a last resort, we decided to perform a terminal fecal diverting stoma at the level of sigmoid colon, with closure of distal end. There were subsequent operations necessary to resolve perineal and gluteal disease: extensive excisions of altered tissues, various full-thickness skin grafts and covering flaps. After 12 months the perineal region was clean, so remaking of colic continuity was possible. Continuous follow-up until 12 months revealed no sign of recurrence. We conclude that temporary total fecal diversion followed by wide excisions of perianal fistulous tissues represents an ultimate solution to complex recurrent perianal fistula, with good results at least in our case.

[Visceral leishmaniasis--surgical aspects]. / Leishmanioza viscerala--aspecte chirurgicale.

Visceral Leishmaniasis is a multi-organic parasitic disease caused by an intracellular protozoon named Leishmania Donovani; the mean signs are: weight loss, cough, fever, hepatosplenomegaly, adenopathy and cutaneous lesions; death without treatment is the rule. The main treatment is a conservative one. Surgical treatment is necessary for complications, especially for those intra-abdominally. We wish to present a young female patient who underwent two subsequent interventions due to an unclear diagnosis. We emphasize the difficulties in achieving a certain diagnostic, because of the rarity of disease in Romania; there are also revealed surgical aspects, which are important because of very few available data in the literature.

[Fournier's gangrene--atypical onset for lower rectal cancer]. / Gangrena Fournier--modalitate atipica de debut in neoplasmul rectal inferior.

The onset for rectal cancer is often revealed by one of its complications. With lower frequency, for the rectum below peritoneal reflexion, the perforative-suppurative onset is possible. We wish to expose a 64 years old woman's case, presenting with Fournier's gangrene as a unique sign of a lower rectal adenocarcinoma. Diabetes mellitus determined the extension of infectious process to its ultimate form, and the poor postoperative evolution, leading to death as well. The need for rectal examination is obvious in perianal abscesses, even in absence of malignant signs.

[Ambulatory treatment of anal fissure]. / Tratamentul ambulatoriu al fisurii anale.

Not a long time ago, the standard treatment for anal fissure was surgical, inpatient care; this concept failed in the last years, ambulatory treatment becoming the rule and the inpatient care the exception. We wish to present here our results in 125 ambulatory patients, who were referred to our proctologic office with anal fissure. We used two methods: a conservative one, by applying topical 0.2% nitroglycerine, similar to other proctology practitioners, and one method of our own which is a minimal surgical procedure consisting of sphincterotomy. The average follow-up period was 6 months. Symptom-free and anatomic-free states were obtained in 61.2% for conservative treated patients and in 91.4% for operated patients, respectively. We had no postoperative complications, rebounds or sequelae. We consider the results at least equal in effectiveness to those of standard surgical treatment. This is why we underline that ambulatory treatment for anal fissure reaches the goal to be of a first line option.

[Reconstruction of cervical esophagus by using laparoscopically assisted jejunal loop harvesting and microsurgical transfer]. / Reconstructia esofagului cervical utilizând prelevarea asistata laparoscopic de ansa jejunala si transferul microchirurgical.

For segmental cervical esophageal reconstruction, the free transfer of jejunal flap tends to become a standard procedure. Graft harvesting by laparotomy presumes increased morbidity at donor area level. There was described by now in the literature laparoscopic techniques for harvesting of jejunal graft, which have reduced the complications following laparotomy. We wish to present here an experimental model of laparoscopically assisted harvesting of jejunal flap used for reconstruction of cervical esophagus by free transfer. The harvesting of jejunal segment was achieved in 12 dogs; 4 cases subsequently underwent microsurgical free transfer. There are presented original contributions of authors. The harvesting average time was 115 minutes; the meantime graft ischaemia was 48 minutes in 4 cases with microsurgical transfer. Postoperative survival was 100%. Graft viability was achieved in 75% at 12 hours and 50% at 24 hours. No major operative accidents were recorded. We present a standardized experimental model, which could be an usefull guide in human therapeutics.

[Benign esophageal strictures--outcomes of coloesophagoplasty in Surgical Clinic II Timisoara]. / Stenozele benigne ale esofagului --rezultate ale reconstructiei esofagiene cu colon în Clinica a II-a Chirurgie din Timisoara.

Esophagoplasty is obviously a proper choice of treatment; postoperative outcomes should be very good because of benign type of lesions, but morbidity-mortality are high due to the complexity of the intervention. Our purpose is to emphasize the utility of coloesophagoplasty like a very feasible surgical option, based to our short and long term outcomes. This paper relies on the retrospective analysis of all cases admitted to II-nd Surgical Clinic Timisoara in a 20 years period (1983-2002), having coloesophagoplasty for benign esophageal stenosis. There were performed 45 such interventions (16 men, 29 women); the mean age was 35.7 years (15-68 years). The pathology included postcaustic lesions (42 cases), peptic lesions (2 cases) and esophageal leiomyoma (1 case). Postoperative morbidity occurred in 22.6% of patients. The graft functionality was good and very good in 86.6% of patients at discharge. Postoperative mortality was 6.6%.