[Stress urinary incontinence. Diagnostic and therapeutic aspects]. / Incontinenta urinara de efort. Aspecte diagnostice si terapeutice.

OBJECTIVE: The paper analyses the incidence, diagnosis and treatment options available for stress urinary incontinence (SUI) in women with pelvic floor dysfunction admitted to Craiova's Surgery Clinic IV. METHODS: This is a retrospective 10-year study comprising a surgical cohort of 420 patients with significant enough to alter quality of life SUI associated to ureterocele and cystocele and in 353 cases with rectocele too. The highest incidence of SUI was encountered between 50 and 59 years of age (range 39 - 81 years). In 21 of this case series the diagnosis of SUI was established soon after the surgical repair of the urethro-cystocele. The diagnosis of SUI was based on careful history and physical examination with emphasis on the gynecologic survey of the abdomen and pelvis but in the absence (for objective reasons) of urodynamic testing which is especially useful for SUI pathophysiological evaluation and thus surgery success rate prediction. All our 420 severe SUI associated with vaginal wall hernias underwent surgical treatment by either open Burch retropubic urethropexy or anterior colporraphy. RESULTS: Among anterior colporraphy treated patients SUI persisted in 19.3% of the cases (33 patients). Complications of Burch urethropexy procedure (despite its high ability for cure) in our case series include: urinary retention, hemorrhage into the space of Retzius, intraoperative injury to the bladder and long-term postoperative incisional hernia. Moreover, 5 patients (2%) of the group who underwent Burch operation were readmitted with recurrent urinary incontinence between 2 and 6 months after the aforementioned surgical intervention despite its good anatomical results in all of these cases. CONCLUSIONS: SUI is a prevalent disorder of women that can be diagnosed easily with history and physical exam. If symptoms persist and severely affect quality of life, despite modern noninvasive treatments, several surgical procedures are now available.

Primary neuroendocrine tumors - an extremely rare cause of obstruction of extrahepatic bile ducts: a case report.

Primary neuroendocrine tumors of the extrahepatic bile ducts are extremely rare - up to date, only 77 cases have been reported in the literature, which represents between 0.2-2% of all gastrointestinal carcinoid tumors. The paper focuses on the case of a woman patient, aged 37 years, admitted to the Clinic with the diagnosis of obstructive jaundice, unaccompanied by pain and where imaging indicates a tumor in the third average of the common bile duct (CBD). The surgery involved the excision of CBD, lymphadenectomy and restoring the biliodigestive continuity of Roux-en-Y hepaticojejunostomy. The histopathological and immunohistochemical examinations revealed the presence of a well-differentiated neuroendocrine tumor of CBD. Based on the case report and literature, we attempted to accurately identify and relate this type of tumor to other varieties encountered in the extrahepatic bile ducts, pointing out elements of a positive diagnosis, differential diagnosis, histopathology and immunohistochemistry, and referring to the therapeutic attitude, evolutionary methods and prognosis.

[The mirage of the first lesion (gallstones) and laparoscopic cholecystectomy are able to defer the diagnosis of colon cancer]. / Mirajul primei leziuni (litiaza veziculara) si colecistectomia laparoscopica pot întârzia diagnosticul de cancer colic.

The study's aim was to analyze a series of colon cancer cases in which the mirage of the first (clinically most obvious) lesion (gallstones) along with its minimally invasive approach - that explored only the biliary disease - had contributed to the delay of large bowel malignancy' diagnosis and treatment. 1327 patients aged between 17 and 83 years and diagnosed with cholecystolithiasis were operated upon laparoscopically in the Department of General Surgery of Craiova CFR University Hospital from 2000 through 2004. Four out of these 1327 patients (0,3%) were readmitted with the diagnosis of colon carcinoma between 1 and 16 months after the laparoscopic cholecystectomy. Our retrospective study gives a full report on these 4 cases insisting upon the links between their clinical - laboratory evaluations and final diagnosis. Despite the low laparoscopic cholecystectomy overlooked colon cancer' incidence it seems reasonable to both improve the technique of peritoneal cavity exploration during this type of surgery and extend the preoperative evaluation whenever the slightest suspicion of associated pathology is raised especially in patients over 50 years of age.

Neuroendocrine tumor arising de novo in the left upper thigh: a case report.

Neuroendocrine tumors (NETs) originate in the neuroendocrine cells of the neural crest (Kulchitsky cells). If neuroendocrine tumors arising in the digestive tract or lung may occasionally result in skin metastases, primary soft tissue or skin NETs are infrequent. The current paper presents the case of an elderly woman patient with neuroendocrine tumors arising de novo in the left upper thigh, accompanied by lymph nodes metastases in the left groin and in the left pelvic sidewall, in close vicinity of the iliac vessels. The diagnosis of NET was performed based on immunohistochemical tests. Such tumors show a slow growth and, generally, have a good prognosis. It is emphasized that complete surgical excision, in some cases associated with adjuvant external radiotherapy is the optimal therapeutic modality in dealing with such lesions.

[Tumour-host interaction and prognosis in patients with gastric cancer]. / Aspecte ale relatiei tumora-gazda cu implicatii în aprecierea prognosticului la pacientii cu cancer gastric.

The study analyzed the prognostic significance of a group of three histologic markers belonging to intra- and peritumorous stroma as derived from a series of 66 patients with gastric adenocarcinoma operated upon in Craiova CFR General Surgery Clinic. To this end we attempted to uncover any possible correlation between the three stromal parameters represented by type of angiogenesis, peritumorous inflammatory infiltrate and desmoplastic reaction and both the depth of malignant invasion through the gastric wall and the histologic type of gastric cancer. The results of our investigation highlighted that type A2 angiogenesis is displayed mostly by gastric carcinomas with well-differentiated tubular and secretory structure (class 2 Goseky) whereas type A3, angiogenesis is mainly a feature of gastric cancer with a poorly-differentiated tubular morphology (classes 3 and 4 Goseky). Moreover there was no statistically significant correlation between the intensity of inflammatory infiltrate and both the Goseky classes and the depth of neoplastic spread. Finally a clearly desmoplastic reaction was encountered in less than 50% of our patient series and represented almost a characteristic of both poorly-differentiated tubular structured malignancies and serosa invading tumors.

[Ovarian cancer--diagnostic dilemmas and unusual therapeutic response]. / Cancerul de ovar între dileme de diagnostic si "capriciile" raspunsului terapeutic.

The aims of this paper are both to highlight some dilemmas concerning the diagnosis of primary epithelial ovarian carcinoma mainly in its early stages and to underline the capricious responses of this type of malignancy to an otherwise well coded modern management. This study is based on the analysis of the records of 78 patients with ovarian carcinoma admitted for diagnosis and surgical treatment to the Department of General Surgery of Craiova C.F.R. Clinic from 1993 through 2003. The results of this analysis are difficult to interpret due to loss to follow up (in terms of response rates) of some of our 78 operated on ovarian carcinoma patients who went on with their platinum-based chemotherapy (following surgical cytoreduction) under the supervision of different Oncology Departments nationwide. Nevertheless, it is worth mentioning that most of this study patients (71.9%) presented with advanced-stage (III and IV) ovarian carcinoma which sometimes seemed quite confusing by its clinical polymorphism but its prognosis was very much related to both the degree of surgical cytoreduction accomplished and tumor sensitivity to chemotherapy. Finally, although this study does not allow us to draw firm conclusions it is an attempt to share out our current perception on the primary epithelial ovarian cancer management.