Cryosurgery for isolated liver tumors or associated with complex liver resection: a series of 38 patients.

BACKGROUND: The aim of this prospective study is to assess the outcomes of cryosurgery for liver tumors, as a single treatment or associated to liver resections in conjunction or not with other visceral resections. MATERIAL AND METHODS: Between 2001 and 2011, in our institution,70 hepatic tumors have been treated through cryo surgery in 38 patients. Complications and survival were assessed,according to different types of hepatic tumors and treatment complexity. RESULTS: Operative mortality within 1 month was 2.6% related to cryosurgery. The median follow up was 25.8 months (range from 0-41.85 months). The number of complications was associated to complex treatment. The morbidity, mortality,disease-free and overall survival rates were not statistically significantly different between the different types of tumors (p value 0.05). The median disease free survival was 9.5 months, with cryosite recurrent disease in 21.5% patients, and 28.9% recurrences in other liver sites. CONCLUSION: Cryotherapy, single or associated with liver resections combined or not with other visceral resections is an effective procedure. The antitumoral effects of treatment were demonstrated, but complications and high local recurrence rate, especially in patients with extensive disease, should caution against its use.

Pheochromocytoma--from endocrinologist to surgeon.

We report the case an asymptomatic patient who underwent left adrenalectomy for a incidentally discovered large, cystic adrenal tumor. The patient presented no hypertension before or during the intervention. The hystopatological exam revealed a pheochromocytoma, with signs suggesting malignancy. One year after the surgery, the patient is still asymptomatic, the metanephrine levels are normal, and the 1231-metaiodobenzylguanidine scintigraphy showed no metastases. The indications and limits of laparoscopic adrenalectomy are presented.

[Sinistromedian (supra)hepatic resection. A putting up-to-date of Hjortsjo hepatic segmentation]. / Rezectie (supra)hepatica sinistromediana. O reactualizare a segmentatiei hepatice a lui Hjortsjo.

On the first case, in the inland literature of regulated resection based on the (supra) hepatic segmentation, the authors are widely discussing the anatomical and surgical aspects regarding the distribution in two vertical territories of the right anterior (paramedian) sector (SAD), also by the (supra) hepatic and by the portal (Hjortsjo) segmentation. In comparison with the classic, portal (Couinaud-Bismuth) segmentation, in certain fortunate situations, the vertical distribution (instead of the transversal one) of the SAD helps to preserve more hepatic parenchyma, which is such necessary for the cirrhotic or metastatic liver.

[457 inguinal and femoral hernioplasties with synthetic prosthetic materials]. / 457 de hernioplastii inghinale si femurale cu materiale protetice sintetice.

The authors retrospectively analyse 457 inguinal and femural hernioplasties with synthetic prosthesis materials, during a period of 10 years. There have been discussions going on about the prosthesis utilisation indications (advanced stages, complex inguinal hernia), type of prosthesis that has been used, the modalities of inserting a prosthesis and the surgical techniques employed. In 164 (34%) of the operations the mesh has been used as an reinforcement and 293 (64%) of the interventions were "tension-free" operations. The average reccurrence was approximately 1%, during a period ranging between 1 to 5 years.

[Giant cavernous hemangiomas of the caudal lobe. Clinical and therapeutically considerations]. / Hemangioamele cavernoase gigante ale lobului caudat. Consideratii clinice si terapeutice.

The authors present two cases of giant hepatic cavernous hemangiomas with rare topography--caudate lobe. The article debates at length the natural evolution of disease, the diagnosis and the treatment. It give emphasis to the fact that, at present, we are witnessing the limitation of surgical indications far these benign vascular tumors. On the other hand, when operation is indicated, the authors prefer tumorectomy by enucleating or enucleoresection (which are limited) instead of major hepatic resections.

[A rare cause of postoperative digestive hemorrhage]. / Hemoragie digestiva postoperatorie de cauza rara.

The author presents a rare case of postoperative gastrointestinal bleeding due to a hepatic vascular fistula. This was the result of corrosive attack on the liver in the portion who covered an acute perforate ulcer.

[The clinical and therapeutic characteristics of a bulky gastrinoma]. / Particularitati clinice si terapeutice ale unui gastrinom voluminos.

The case of a 55-year-old woman with a duodenal ulcer developing since 6 months is reported, in whom the surgical indication was early established on the basis of increasing of suffering and inefficacy of the medical treatment. Intraoperatively an exophytic pancreatic tumour sited on the upper border of the isthmus, sized 5/6/4 cm, was found. In view of the suspicion of gastrinoma and considering that total gastrectomy or splenopancreatectomy would be excessive taking into account the patient's state, option was made for exeresis of the tumour. The ulcerous suffering disappeared and the histological examination of the specimen (weighting 70 g) confirmed a benign gastrinoma. The peculiarities of the case and data from the literature dealing with gastrinomas are discussed.

[A solitary nonparasitic liver cyst]. / Chist solitar neparazitar hepatic.

The paper reports on an observation of hepatic nonparasitic solitary cyst, size 10/12 cm, noncomplicated, in a 77-year-old woman. The lesion was treated by digital enucleation and suture of the hepatic wound, with a good result. The paper presents literature data on the hepatic nonparasitic solitary cyst.

Radioreceptor assay of human prolactin using rabbit mammary receptors.

The purpose of this work is to develop the procedures for the preparation of the reagents suitable for the radioreceptor assay (RRA) of human prolactin (Prl). Human purified Prl (NIAMDD-hPrl-16) was labelled with 125I by the Chloramine-T or alternatively by the lactoperoxidase method. As reference preparation we used Prl isolated from the ethanolic step of the routine procedure for the preparation of human growth hormone (hGH) for clinical purposes. The lactogenic receptors were prepared from the pregnant rabbit mammary gland previously stimulated with insulin, cortisone and dried thyroid extract. The final receptor preparations obtained by ultracentrifugation contained 8.85-39.36 mg protein per ml. The prolactin was measured in the human sera and in our hPrl preparations by a double antibody radioimmunoassay (RIA) system using the NIAMDD reagents. We developed a RRA system for hPrl using rabbit mammary receptor preparations with a protein concentration of about 4 mg/ml. The comparative competition showed the same magnitude of the inhibition of the tracer receptor binding of hPrl and hGH. This interference of hGH makes difficult the assessment of the specificity of the hPrl-RRA system otherwise accountable by the structural and/or biological relationship of the three lactogenic hormones: hPrl, hGH and human placental lactogen (hPL). Studies concerning the preparation of a purified and solubilized rabbit mammary receptor and of an antiserum for it are in progress in our laboratory with the objective to provide a useful tool for the investigation of the lactogenic receptor structure and function relationship.

Benign gastric lymphomatosis (gastric pseudolymphoma).

The present paper reports on two cases of gastric lymphomatosis whose diagnosis could only be established by histologic examination of the operative specimen. Benign gastric lymphomatosis (BGL) is characterized by lymphoid infiltration of the gastric wall, predominant in the mucosa and sometimes in the submucosa, running a slow benign course. It must be differentiated from malignant gastric lymphomas and from inflammatory lymphoid reactions surrounding ulcers. BGL have not been treated medically to date. One of the patients initially underwent an eight months treatment with prednisone, then with prednisone and cytostatics, which resulted in clinical improvement but did not modify the pathohistologic picture. As BGL represents a precancerous state and cannot be controlled at present by any medical treatment, the surgical intervention is considered opportune.

Antagonism between pineal peptides and catecholamines. II. The action of a pineal peptide extract on the process of endogenous catecholamines secretion-excretion.

To determine the processes of adrenaline and noradrenaline secretion-excretion in rats and rabbits with/without associated insulin lente administration (20 U.I./kg rat b.w. and 6 U.I./kg rabbit b.w.), the authors used a pineal peptide extract that has now become available under the trade name of "Crinofizin". Under conditions of natural light, environmental temperature of 18-20 degrees C and fed ad libitum, Crinofizin did not cause significant alterations in the rat 24 hrs urinary excretion of catecholamines. Administration of insulin induced a more than two-fold increase in the two catecholamines both in the rabbit and the rat. Administration of Crinofizin one hour before insulin prevented totally or partially these effects of insulin. The drug acted as a blocking agent in the processes of endogenous adrenaline and noradrenaline secretion-excretion under hormonal stimulation, but not under basal conditions.

Studies concerning the effects of a pineal peptide extract on collagen metabolism.

The effects of Crinofizin (Cfz), cortisone, triiodothyronine (T3) and methylthiouracil (MTU), alone or in association with one another, on collagen metabolism of impuberal and adult rabbits were tested. These effects were assessed by the hydroxyprolinuria (Hyp) assay corroborated with observations regarding mortality, body weight, diuresis and excretion of nitrogenous substances. Cfz given alone stimulated weight gain and did not alter characteristically the Hyp. Cortisone and T3 given in various doses and ways without Cfz induced general phenomena of the antianabolic or catabolic type, affecting characteristically the Hyp, which was low after administration of cortisone and increased after T3; association of Cfz to both cortisone and T3 had general protecting and corrective effects and brought Hyp towards or at normal values. Chronic administration of MTU with or without Cfz did not have significant effects. The corrective value of Cfz by anabolic and anti-catabolic actions on collagen metabolism disturbed by cortisone or T3 in excess is discussed.

Histochemical and histoenzymatic action of crinofizin in cystic mastosis and prostate adenoma studied in cell and organotypic cultures.

The work deals with the study at cell level of the action of Crinofizin on some target organs. The effect of various doses of Crinofizin (0.2, 0.1, 0.01 and 0.001 ml/culture tube) was tested on multiplication and protein synthesis in human mammary tissue cells (cystic mastosis) and human prostate adenoma in cell culture. The morphologic aspect, enzymatic activity (LDH, G-6-PDH) and mucopolysaccharides synthesis were also studied. It was found that administration of Crinofizin results in preferential development of epithelial cells at the expense of the connective-fibroblastic ones. LDH and G-6-PDH, higher in the control cultures of the epithelial type than in the fibroblastic ones, becomes uniform by decreasing in intensity in the treated lots. Acute experimentation carried out on prostate organ cultures from rats of various ages (30, 60, 90 days and 2 years) treated with 0.2ml Crinofizin/ml culture medium indicates a decrease in connective tissue intrafollicular stroma, which is well developed in the case of adenoma. LDH and G-6-PDH activity, which is higher in the case of adenoma, decreases under Crinofizin administration to the levels in the adult control. The histologic aspect of the hypertrophied prostate organ cultures from aged rats, becomes after Crinofizin administration similar to that of the adult rat organ cultures.

The antagonism between pineal peptides and catecholamines. I. The action of the pineal peptide extract on some effects of exogenous adrenaline in the rat.

The effects of adrenaline alone or associated with Crinofizin, a pineal polypeptide extract, were studied on rats. The drug given 15 minutes before a hyperglycemic adrenaline dose counteracted the pharmacologic effects with lethal consequences of catecholamine as well as certain metabolic effects such as elevation of blood levels of glycerol, phospholipids and cholesterol. Post-adrenaline hyperglycemia was not reduced by Crinofizin under the given experimental circumstances. The glycogenolytic effect of adrenaline was slightly inhibited.