Multiple malignant tumors.

BACKGROUND: Due to the improvement in diagnosis and therapy for certain malignant tumors, we are now faced with patients who develop in time multiple malignancies. METHODS: We conducted a retrospective analysis of the patients diagnosed with at least two primary cancers that were admitted and treated in Cluj-Napoca Municipal Hospital. The study followed patients for a period of 7.5 years. RESULTS: We included in the present study 217 patients (4.33%) with two or more malignant primary tumors from 5003 cases diagnosed with a primary cancer. The most common sites for multiple malignant tumors were related to the breast, colorectum, urinary bladder, prostate and kidneys. CONCLUSIONS: We should always take into consideration the possibility of synchronous tumors and we have to keep in mind that a successful treatment of cancer might not prevent the onset of another primary mass.

GST gene variants in synchronous colorectal cancers and synchronous association of colorectal cancers with other cancers.

BACKGROUND: the present study evaluates genetic polymorphisms of three glutathione S-transferases (GSTM1, GSTT1and GSTP1) in patients with synchronous malignant colorectal tumors and the association of synchronous colorectal cancers with other cancers. MATERIAL AND METHODS: from 420 patients with a colorectal cancer admitted to our hospital between 2005-2012, we selected for genetic analysis 20 patients with multiple synchronous malignant colorectal tumors and 9 patients with asynchronous association of colorectal cancer with another cancer. We searched for GST genotypes, comparing the results with controls. RESULTS: the genetic analysis was possible only in 19 patients with colorectal synchronous cancers and 9 patients with asynchronous association of colorectal cancer with another cancer; we found a statistically significant difference for null GSTM1 genotype frequency between these patients and the control group; we found no differences regarding the frequency of null GSTT1 genotype and Ile105Val polymorphism of GSTP1 in patients with synchronous cancers compared with the control group. CONCLUSION: in our study we found the null GSTM1 genotype as a risk factor for multiple colorectal synchronous cancers and for an association of synchronous colorectal with other cancers

[Congenital choledochal cysts. Observations on 2 operated cases]. / Chisturile congenitale coledociene. Observatii în legatura cu doua cazuri operate.

The authors present two cases of congenital choledochal cysts treated by cyst excision with Roux-en-Y hepaticojejunostomy, followed by good postoperative results. One of the patients has been treated by early excisional procedure, while the other has initially undergone an enteric drainage by cystoduodenostomy, followed by complications, which required reoperations after 18 months. We have evaluated the peculiarities of both cases, the present data revealed by literature regarding biliary carcinogenesis related to congenital choledochal cysts, their classification according to pancreatobiliary malunion, as well as the treatment of choice in choledochal cysts, meaning excisional procedure with Roux-en-Y hepaticojejunostomy to prevent the risk of postoperatory complications which might appear after plain enteric drainage of the cyst.

[Traumatic diaphragmatic hernia. 2 case reports and review of the literature]. / Herniile diafragmatice posttraumatice. Observatii în legatura cu doua cazuri operate si discutia literaturii.

We have presented two cases of traumatic diaphragmatic hernia which have been diagnosed and operated in late stages, 6 months and 4 years, respectively, after the abdominal and thoracical traumatism causing diaphragmatic injure. The diagnosis was based on clinical and imaging results, while the treatment was meant to reduce the herniated organs in the abdomen and the closing up of the diaphragmatic defect, followed by good postoperative results. We have discussed the peculiarities of both case, the difficulty of early diagnosis and the techniques used to treat these cases. We have also presented data regarding posttraumatic diaphragmatic hernia and their treatment techniques.

[Sclerosing cholangitis in the evolution of a surgical hepatic hydatid cyst]. / Colangita stenozanta în evolutia chistului hidatic hepatic operat.

The retrospective analysis of 3 clinical observations points out the etiopathogenetic, clinical and therapeutical aspects of the diffuse stenotic cholangitis, which can occur after the surgical treatment of the hepatic hydatid cyst. Although rare (2.9% of hydatid cysts, 13% of those which communicate with the bile ducts), the diffuse stenotic posthydatid cholangitis represents a severe postoperative complication in cases of median cysts, exerting a compression upon the convergence of hepatic ducts and communicating with the biliary tract. Its presence should be clinically suspected if a mechanical icterus with septic angiocholitis, sometimes associated with an external biliary fistula (from the residual cavity), occurs in the postoperative course of these patients, especially if the primary operation has excluded the remanance of an obstacle at the level of the main bile duct. The lesional substrate is comparable with that of the primitive sclerosing cholangitis, from which it differs through its clear relation with the primary treatment of the hepatic hydatid cyst, through the rapid course of stenotic lesions which, although diffuse, may become more marked in certain segments, as well as through the constant suprastenotic dilatation of the bile ducts. In the pathogenesis are involved the caustic action of some scolicide solutions (2 per cent formaldehyde solution, hypertonic salt solution) on the wall of the bile duct and the cystobiliary communication which predisposes to the peroperative occurrence o-a migration syndrome and of angiocholitis. It requires an early surgical reintervention in order to solve the cholestasis and angiocholitis: according to the morphological situation, we have the choice between disobstruction and trans-stenotic calibration drainage, on the one hand, and biliodigestive derivations in the hilum, which are more efficient, on the other. The prognosis is burdened with the vital risk of septic angiocholitis and with the early occurrence of a secondary biliary cirrhosis or of stenotic recurrences. Prophylaxis consists in the performance of a primary surgical treatment, adequate in median and communicating hydatid cysts, avoiding the "blind" intracystic administration of scolicide solutions, which exert a caustic action on the bile ducts.

[Effectiveness of sympathoadrenergic blocking in prevention of postoperative acute pancreatitis]. / Eficienta blocajului simpatoadrenergic în profilaxia pancreatitei acute postoperatorii.

The role of the vascular factor (namely hypoperfusion) in the onset of pancreatic necrosis is a well-established fact. In the present study an analysis is made of the efficiency of drug blocking of alpha and beta adreno-receptors in the prophylaxis of acute postoperative pancreatitis, following surgery of the Oddi sphincter. Compared with a control group of 301 papillo-sphincterotomies performed in a previous period the application of adrenergic blocking in 127 patients in whom interventions were performed on the Oddi sphincter led to a significant reduction in both morbidity and mortality through acute postoperative pancreatitis, from 5 to 2,3%, and from 1,3 to 0,7% respectively.