[Axillary lymph node metastases in breast cancer. Anatomo-clinical correlation and surgical approach]. / Metastazele ganglionare limfatice axilare în cancerul mamar. Corelatii anatomo-clinice si atitudine chirurgicala.

AIM: To establish the incidence of the axillary lymph node metastasis in breast cancer and some anatomo-clinical correlations useful for surgical act orientation. MATERIAL AND METHOD: The data from 450 patients, who underwent surgery for breast cancer between 2000 and 2007, were analyzed statistically according to some parameters: the age of the patients, the size and the location of the tumor, the hystopathological type, the elapsed time from the discovery of the tumor until surgery. RESULTS: The tumoral stage was: stage 0--1.1%, I--7.11%, II--50.67%, III--33.78%, IV--7.33%. From the total amount of patients who underwent surgery, only 56.44% had axillary lymph node metastasis. The patients in the forth decade of life had more frequently axillary lymph node involvement, and also those from rural habitat (65.88%). The correlation between tumor dimension and lymph node involvement was: <2 cm--1.36%, 2-5 cm--48.71%, >5 cm--86.67%. The palpation of the armpit was associated in almost a quarter of cases with false negative or false positive diagnosis. There are a lot of locally advanced cases without axillary lymph node metastases. CONCLUSIONS: Axillary lymph node status is strongly correlated with the tumor dimension and the elapsed time between diagnosis and treatment. The numerous cases of axillary lymphadenectomy without lymph node metastases (43.55%), even in locally advanced cases, advocate for a wider application of lymphatic mapping and sentinel lymph node biopsy, to avoid the pathology associated with those axillary dissections.

[Gastric stromal tumor with liver and subcutaneus metastasis. Case report]. / Tumora stromala gastrica cu metastaze hepatice si subcutanate. Prezentare de caz.

UNLABELLED: The gastrointestinal stromal tumours expand from the undefine mezenchimal cells of the intestinal wall and the origin is in the Cajal interstitial cells. The agresivity of GIST is difficult to be evaluate. Very importants factors for grading are the tumour localisation, the invasion of serosa or mucosa, the dimensions of tumour and the number of mytosis. We present a case with haemoragic gastric stromal tumour, with small dimensions, which was initially diagnosed as a "benign" tumour. Seven years after the operation, the patient presented voluminous liver metastases. After right hepathectomy and medical treatment with Glivec we followed up the case. Eleven years after the first operation she presented a subcutaneus metastasis in parietal region, which was confirmed with imunohistochemical exam. The patient is still under observation with higher doses of Glivec. CONCLUSIONS: The gastrointestinals stromal tumours represent a very rare group of digestive tract tumors, with malignant potentially evolution; the first choice of treatment is surgery, with complete ablation of the tumour. The medical treatment with Glivec is necessary in case of reccurence or metastases; the stromal tumours present a strange evolution, for this reason all the patients must be under medical observation, for the rest of their life.

Two-step hepatectomy with right portal branch ligature for a right lobe metastasis.

AIMS/BACKGROUND: Hepatic resection is the only treatment with possible curative effect both for primary and secondary tumors. An increase of the rate of resectability for tumors considered inoperable at first and a decrease of the postoperative morbidity and mortality can be realized by right portal branch ligature and two-step hepatectomy. METHODOLOGY: This paper presents the case of a patient with left bowel cancer with a hepatic metastasis. A right portal branch ligature was performed followed by systemic postoperative chemotherapy. RESULTS: The right portal branch occlusion was followed by right lobe atrophy and left lobe hypertrophy, confirmed by CT scan. Three months after the portal occlusion a right lobe hepatectomy was performed. The postoperative evolution was favorable; eight days of hospitalization were necessary. CONCLUSIONS: Portal branch ligature can be performed in certain cases of hepatic tumors to increase the resectability rate.

[Duodenum preserving cephalic pancreatectomy and pancreatico-gastrostomy in the surgical treatment of the chronic pancreatitis]. / Pancreatectomie cefalica cu pastrarea duodenului si pancreatico-gastrectomie în tratamentul chirurgical al pancreatitei cronice.

UNLABELLED: Cephalic pancreaticoduodenectomy had been introduced in surgery practice by O. Whipple, for the treatment for the cancer of ampulla of Vater, later this indication has also been extended to other pancreatic disorders including the cases of chronic pancreatitis. Cephalic pancreatectomy with the remaining of the duodenum used lately in the treatment of chronic pancreatic eliminates the disadvantages of the operation Whipple. Further on, we present a case of chronic pancreatitis where a cephalo-pancreatic resection has been done with the remaining of the duodenum, the pancreatic blunt being anastomosed with the stomach by pancreatico-gastrostomy, terminal-lateral, a cystoduodenostomy had being done to this patient. Ten months after the surgery, the patient is in a good general state, without subjective pain, putting weight, and a glucose metabolism without changes. CONCLUSIONS: Pancreatico-gastrostomy may represent a modality of solving the pancreatic blunt after the cephalic pancreatectomy with the remaining of the duodenum.