Hematochezia due to Caecal Angiodysplazia led to Diagnosis of a Transverse Colon Cancer in a Young Female Patient: Case Report and Literature Review.

We present an unusual case of a caecal angiodysplasia whose bleeding determined the discovery of a mid-transverse colon cancer in a 26 years old female patient. After the initial successful angiographic treatment of the caecal lesion the patient underwent laparoscopic - assisted transverse colectomy. The postoperative evolution was favorable, without resumption of bleeding episodes and rapid social reintegration. The histopathology revealed mucinous adenocarcinoma that penetrates the visceral serous with 7 lymph nodes invasion of 18 examined. As a result of the advanced stage, pT4aN2bM0 - stage IIIC, the life expectancy at 5 years is between 30 to 50%.

CT vs. MRCP in choledocholithiasis jaundice.

RATIONALE: Obstructive jaundice can raise problems to diagnostic imaging. The radiologist must choose the most appropriate examination that delivers the most important diagnostic information because the differences between a lithiasic obstruction and a tumoral one are vital. This information helps the surgeon speed up the process of decision-making, because the treatment may be very different in relation to the nature of the obstruction. OBJECTIVE: This study tries to demonstrate the diagnostic accuracy of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in detecting the obstacle in the common bile duct (CBD) and the possibility of establishing the lithiasic nature of the obstruction. METHODS AND RESULTS: A retrospective analysis was analyzed during an interval of 18 months that included jaundice patients admitted in the General Surgery Department of "Coltea" Clinical Hospital. They were examined by CT scanning and by MRCP, being suspected of choledocholithiasis. 63 patients were included in the study, 34 females and 29 males. 33 CT scans and 30 MRCP exams were performed. DISCUSSION: CT scan is useful in detecting residual or iterative choledocholithiasis in patients after cholecystectomy, contrast enhanced CT (CECT), being able to differentiate between lithiasic and non-lithiasic obstruction. MRCP delivers important anatomic details of the biliary tree; it is superior to CT in diagnosing the hepatocholedochal lithiasis; MRCP tends to replace endoscopic retrograde cholangiopancreatography (ERCP)--the diagnostic "gold standard" reducing the number of unnecessary invasive diagnostic procedures.

Perfusion techniques for minimally invasive valve procedures.

In this paper, we present, in detail, the simplified perfusion technique that we have adopted since January 2009 and that we have utilized in 200 cases for cardiac minimally invasive valvular procedures that were performed through a right lateral mini-thoracotomy in the 3(rd)-4(th) intercostal space. Cardiopulmonary bypass was achieved by means of the direct cannulation of the ascending aorta and the insertion of a percutaneous venous cannula in the femoral vein. A flexible aortic cross-clamp was applied through the skin incision and cardioplegic arrest was obtained with the antegrade delivery of a crystalloid solution. Gravity drainage was enhanced by vacuum-assisted aspiration. There were no technical complications related to this perfusion technique that we have adopted in minimally invasive surgical procedures.

The vascularization pattern of the colon and surgical decision in esophageal reconstruction with colon. A selective SMA and IMA arteriographic study.

INTRODUCTION: No matter the reconstructive technique, the fundamental concepts in visceral reconstruction have as main grounds the mandatory vascular support for the graft replacement. Individual vascular particularities can influence or even oblige the surgeon to choose a certain procedure. This is why the vascularization is beyond doubt the dominant factor in mobilizing the colon for reconstruction. MATERIAL AND METHOD: Our arteriographic study entails an investigation upon the vascularization pattern of the two main sources that participate in the arterial irrigation of the colon via the emerging vessels: superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). We did not consider certain patients upon a specific criterion; also, we did not exclude any patients due to various reasons. We took into account 49 patients as study group, all of them having registered into the clinic for a reconstructive technique, throughout the years from 2000 to 2010. From 1981 to 2012 there have been 187 reconstructive techniques performed due to post caustic pathology. From a total of 49 patients, 11 had suffered major abdominal surgeries, 5 of which had had unsuccessful reconstructive attempts. RESULTS: Out of the 49 patients on whom we have performed the exploration, arteriography showed a favorable situation for reconstruction in 31 of them. In the other 18 patients anomalies or atypical distributions were identified, in 5 of the SMA and in 13 of the IMA, respectively. Operative decision was modified in 22 patients. One important thing to note from the point of view of the segment to be moved: we had no graft necrosis in patients with preoperative arteriographic examination. CONCLUSIONS: Due to the need for good mobilization, arterial ligations should be adjusted and modified depending on the particular vascular distribution, to maintain a sufficient blood flow in the marginal artery, in order to reach the colic sections and the straight arteries near them.

[Non-surgical management of patients with blunt abdominal injury: the role of angiography]. / Aspecte ale tratamentului non-operator al traumatismelor abdominale închise: rolul angiografiei.

OBJECTIVE: We evaluated the efficacy of nonsurgical management of patients with blunt hepatic or renal injury using detailed angiographic examinations and transcatheter arterial embolization. METHODS: The study comprises 5 patients: 3 patients with blunt hepatic injury and 2 patients with blunt renal injury. All patients had CT evidence of hepatic injury, respectively renal injury. In one case with hepatic injury, emergency laparotomy was performed before angiography because of unstable circulatory status. DSA-angiography identified the site of bleeding in all patients, followed by selective embolization with particles of TachoComb. Nonsurgical treatment of hepatic or renal injury with transcatheter arterial embolization was successful in all patients. CONCLUSIONS: Our success rate for nonsurgical management of patients with blunt injury to solid abdominal organs should more extensive evaluation and use of angiography for solid abdominal organs injury and the subsequent management of solid abdominal organs injury without surgery.

[Progress of surgical treatment in the last 10 years. Comparative study of surgical interventions performed between 1993-1995 versus between 2003-2005]. / Evolutia terapiei chirurgicale în ultima decada. Studiu comparativ al interventiilor 1993-1995 vs. 2003-2005.

In the last decade of the past century, as laparoscopy was introduced in our clinic in 1993, minimal access therapy (MAT--endoscopy, angiography, interventional imagery) had a positive and constant evolution. Our paper retrospectively evaluates the interventions performed between 2003-2005 (group A) compared to those performed between 1993-1995 (group B). We observed a 17.08% (7056 vs 6026 interventions/year) raise in the total number of interventions in group A, with a significant 66% decrease (195 vs. 588 interventions/year) of interventions for gastro-duodenal ulcer and a 18% decrease (1211 vs 1490 interventions/year) of appendectomies, but a 63% increase (1560 vs. 955 interventions/year) of cholecystectomies, 53% increase (1186 vs. 773 interventions/year) of interventions for parietal defects and a 62% (626 vs. 325 interventions/year) increase of oncological interventions. The most frequent interventions were, in the order of frequencies: cholecystectomies (79.8% laparoscopically), appendectomies, interventions for hernia and eventrations, oncological operations and trauma surgery. The incidence of laparoscopic interventions was greater in group A, counting for 19% of the total number of interventions. In group A were performed 2334 endoscopies, 149 diagnostic and therapeutic angiographies. Postoperative mortality dropped with 29.64% and hospital stay dropped to 4.7 days. We believe that the incidence of MAT should rise, by performing more laparoscopic interventions and this change should lead to a revision of the surgical residents training program.

["Combined treatment" in the liver metastases of colorectal cancer]. / Tratamentul "combinat" în metastazele hepatice ale cancerelor colo-rectale.

Patients with liver metastasis after colo-rectal cancers are, from the point of une of their disease evolution in the final stadium (the IV th. stadium). Hence, we consider the attempt for liver metastasis treatment, as being desperate experiments to extend the patient's life, taking high risks and having chances of immediate failure. Since 1995 me've started a study about patients operated for colo-rectal cancers that will stand transarterial chemoembolization of their hepatic metastasis, 2-4 weeks before the surgical intervention for hepatectomy. We expose 17 cases to which we performed such a combined therapy, between 1995-1997. We had to postoperative death after major hepatectomies. The other patients are survived by our clinics.

Effects of intrathecal and systemic administration of buspirone on genital reflexes and mating behavior in male rats.

Buspirone was studied to determine whether the detailed profile of male sexual behavior observed following treatment with the prototypical 5-HT1A ligand, 8-OH-DPAT, can be generalized to other 5-HT1A agonist drugs. Systemic and intrathecal (IT) routes of administration were compared. Like DPAT, significant reduction in intromission frequency followed IT infusion of buspirone (80-160 micrograms) as did intraperitoneal (IP) injection (1-4 mg/kg). IT doses of 80-160 micrograms and all IP doses significantly reduced ejaculation latency. Intercopulatory interval significantly decreased following IP buspirone but not after IT infusion although there were trends in that direction. All IP doses and 80 micrograms IT significantly shortened the postejaculatory interval. Buspirone inhibited erection and/or ejaculation in the ex copula reflex test. A decrease in percentage of rats displaying erections and ejaculation occurred following either route of administration. Ejaculation was significantly inhibited at the low IT dose of 40 micrograms. We conclude that buspirone affects sexual behavior very much like DPAT or other 5-HT1A drugs, to the extent known. Sexual effects of buspirone were generally similar regardless of route of administration, but the effective doses were clearly lower with IT treatment.

[Anatomo-clinical studies on contraindications of biological treatment of the dental pulp in some chronic general diseases]. / Studii anatomoclinice privind contraindicatiile tratamentului biologic al pulpei dentare in unele boli cronice generale.

Anatomoclinical studies have been carried out on tissue samples obtained from patients with various chronic general diseases including cardiovascular diseases, diabetes, kidney diseases, liver diseases, acute and chronic leukemias, that had developed before the time when biologic therapy of the dental pulp had been recommended. In the presence of lesions of various severities of the dental pulp direct application of various biological techniques may trigger violent reactions, just as if the biological substances would represent deleterious factors. Vascular changes, followed by reactional responses in various stages of trophic changes, or dysplasia in the dental pulp, as demonstrated by microscopical studies show a certain degree of deterioration of the dental pulp which are counterindicative for biological therapy. When degenerative lesions of the pulpal connective structures, and vascular-nervous complex have occurred, or when leukemic invading processes have been identified biological therapy is completely counterindicated.