[Mechanical jaundice in a cystic tumor of the hepatic pedicle]. / Icter mecanic prin tumoare chistica a pediculului hepatic.

The present paper reports on an observations of mechanical jaundice by a rare cystic tumour of the hepatic pedicle. Although the diagnosis of obstructive jaundice is sufficient as an operatory indication, a series of imaging methods were used for establishing the situs and the nature of the obstruction.

[Juxtapapillary ulcer]. / Ulcerul juxtapapilar.

The paper analysed the technical possibilities for the treatment of juxtapapillary ulcer exemplified by the clinical experience of 62 cases of recognized juxtapapillary ulcer. The authors insist on the technique of the duodenum dissection, on the way of passing the suture threads at the level of the papilla and on the importance of a correct drainage.

[Pancreatic pseudocysts]. / Pseudochisturile pancreatice.

Clinical, evolutive and therapeutical aspects were studied, of 66 cases of patients with pancreatic pseudocysts hospitalized in the clinic over a period of 27 years. Particular modalities of onset were, those of patients with duodenal stenosis, mechanical jaundice, ascites and pleurisy, those in whom symptomatology suggested kidney or cholecystic disease. The intraoperative diagnosis raises the problem of differentiating a retroperitoneal tumor, identifying the possible association with a pancreatic cancer, and the condition when the pseudocysts are found at a certain distance from the pancreas itself. The therapeutical methods are codified, but recidives are possible. Cholecystectomy removes the biliary cause of pancreatitis which can determine the development of pseudocysts. The death rate of these cases was 6.3%.

[The indications for subtotal and total colectomy]. / Indicatiile colectomiei subtotale si totale.

Subtotal and total colectomy was the choice therapeutic solution for multiple colonic cancer, diffuse rectocolonic polyposis, multiple colonic polyposis, ulcerohaemorrhagic rectocolitis, and for two rare diseases; megacolon with extensive atrophy of lymph nodes, and acute ischaemia of the colon. A total of 35 cases are reported. Ileorectal anastomosis was the method used for this type of intervention. The opportunity of rectal conservation is discussed, in cases of rectocolonic polyposis and ulcerative haemorrhagic rectocolitis. The difficulty of making an optimal choice in complicated forms of ulcerohaemorrhagic rectocolitis is exemplified with the aid of clinical observations.

[Indications for pancreatectomy in chronic pancreatitis]. / Indicatiile pancreatectomiei în pancreatita cronica.

The authors have considered the experience acquired in connection with 15 cases of chronic pancreatitis in whom surgery was performed, and define the parameters which make mandatory surgical interventions in this affection.

[Surgical attitude in cancer of the ovary]. / Atitudinea chirurgicala în cancerul de ovar.

The authors start from the observation that some of the clinical forms of ovarian cancers determine hospitalization and resolution of the cases in surgical departments. They have also based their study on their personal experience acquired over a period of 20 years, during which they have operated on 180 patients. They noted that the best surgical attitude was not adopted in all of the cases and make an analysis of various methods applied, such as the radical ones, the conservative procedures, and those aimed at a reduction of the tumoral mass. The value of associated therapies is presented, consisting in surgery, chemotherapy and irradiation.

[The dumping syndrome. Surgical treatment]. / Sindromul dumping. Tratament chirurgical.

Data are presented, from the specialized literature, in connection with the frequency of the dumping syndrome, and the methods for its correction. An analysis is made of indications and of surgical methods used for the correction of this syndrome in a total of 74 patients of which 32 were operated. Preference was given to sub-diaphragmatic troncular vagotomy and to re-positioning of the duodenum with efferent loop, or by gastro-duodenal interpositioning of a segment of jejunal loop in an-iso-peristaltic position. The results of these interventions are, as a rule, favourable, but some disturbances may occur, dependent on the development of peri-visceritis, loop dysfunction, or duodenal dysfunction, as well as gastro-oestrophageal reflux.

[Reoperations on the extrahepatic bile ducts after surgery of the common bile duct or its indirect drainage]. / Reinterventii pe caile biliare extrahepatice dupa abordul coleducului sau drenajul sau indirect.

An analysis is made of 80 re-interventions on the extra-hepatic biliary pathways in patients who had underwent one or more surgical interventions on the main biliary pathway. The cases have been classified according to the type of the initial intervention as follows: re-interventions following cholecystectomy, choledocotomy and Kehr drainage, following sphincterotomy, and following internal and external biliary derivations. An analysis is made of the causes of re-interventions, and of the increased risk due to severe complications which are at the origin of high morbidity and mortality rates. Particular stress is laid on the necessity for a correct diagnosis, as well as a complete one for the first intervention on the biliary pathways, which will allow to make an adequate choice for a second surgical solution.

[Benign hepatic tumors]. / Tumorile hepatice benigne.

A total of 30 cases are presented, of benign hepatic tumours. As a result of the confrontation of data from the literature with the personal experience of the authors has evidenced the diagnostic difficulties in patients with benign hepatic tumors, especially because these can be erroneously considered as either malignant tumours or as liver cirrhosis. The clinical and the para-clinical pictures are not suggestive in all the cases, and the necessity arises of histopathologic confirmation which can be achieved by puncture and cytologic examination, or by intra-surgery biopsy. This is particularly useful because some of the benign hepatic tumours may benefit from a radical surgical treatment.

[Surgery of hiatal hernias]. / Consideratii asupra chirurgiei herniilor hiatale.

On the basis of a study performed in 141 cases of hiatal hernia that have been hospitalized in the clinic a series of clinico-therapeutical considerations are made, with surgical implications. The most frequently encountered type of hiatal hernia was that occurring through sliding. Very frequently there are morbid associations (in over 60% of the cases) and this indicates the necessity for a complex study of the patients and a careful selection of the predominant affection. Only 81 of the patients that have been examined - that is 57% - had surgical indications. Two types of interventions have been associated: the correction of the diaphragmatic hiatus was always associated with an intervention in view of avoiding the repetition of the gastroesophagian reflux. Good and very good post-operative results have been obtained in 78% of the interventions and mediocre results in 22% of the operated patients.