The Role of Helicobacter Pylori Infection in the Development of Gastric Cancer - Review of the Literature.

Helicobacter pylori (H. pylori), classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC), is linked to gastric cancer. The progression from atrophy to metaplasia, dysplasia, and carcinoma constitutes the pathway for intestinal-type gastric carcinoma development. H. pylori infection significantly increases gastric cancer risk, particularly in individuals with atrophic gastritis. Virulence factors like CagA and VacA disrupt host signaling pathways, contributing to chronic inflammation and carcinogenesis. Pro-inflammatory cytokines and dysregulated tumor suppressor genes further fuel this process. Eradicating H. pylori reduces gastric cancer incidence, especially in patients with atrophic gastritis and/or intestinal metaplasia. However, it may not prevent cancer in those with advanced pre-neoplastic lesions. Early detection and management of H. pylori infection are crucial in mitigating gastric cancer risk, offering significant benefits.

Helicobacter pylori Infection at Crossroads between Specialties.

Background: Helicobacter pylori (H. pylori) infection is one of the major current public health problems, its incidence being high worldwide. This condition is associated with other pathologies such as peptic ulcer or gastric cancer, causing a real challenge for specialists in the medical field. Methods:We conducted a retrospective study that includes a cohort of 275 patients who performed EGD and were tested for the presence of H. pylori by the stool antigen test, between July 2022 and December 2023. Results:The cohort had an average age of 62.79 ± 13.8 years old, with a male predominance 156 patients (56.7%) and the most frequent lesion is antral gastritis (149 cases, 54.2%). Gastric ulcer in those with positive tests in H. pylori had a double incidence compared to those in which the infection is not present (19.7% vs. 9.2%, p=0.012). Conclusions:: H. pylori infection still remains a condition that can be complicated by various pathological conditions that can evolve from a slight erosion of the gastric mucosa to digestive neoplasia that require complex multidisciplinary treatments, which is why understanding the mechanisms and applying therapeutic resources as soon as possible is essential.

Quality of Life in Patients Undergoing Emergency Surgery for Complex Colorectal Cancer: Protocol and Piloting of the Surgical Utilization and Recovery Patterns for Advanced Stage Colorectal Cancer Study.

Introduction: Globally, cancer is the leading cause of mortality, with colorectal neoplasia ranking third in terms of incidence and mortality worldwide. Patients face disease- and treatment-specific impacts, which can significantly influence their quality of life (QoL). Aim: This study aimed to propose a protocol to measure in-hospital and long-term QoL in patients with complicated colorectal cancer (CRC). Material and Methods: multicenter prospective observational cohort study. Results: QoL is a multidimensional concept that includes criteria for physical, mental, emotional, and social functionality as perceived by the patient. Periodically evaluating QoL offers measurable and objective tools to intervene at the appropriate time to decrease the Years of Life Lost and Years Lived with Disabilities for CRC patients. However, a structured and functional system requires dedicated and common institutional effort. A pilot study using this protocol included 69 patients, 65.12+-10.92 years, M:F ratio = 56.5:43.5%. Surgical procedure was right hemicolectomy, left colectomy, transverse colectomy, sigmoidectomy, total colectomy, rectal resection, and colorectal resection with stoma (ileostomy or colostomy) in 21.7%, 11.6%, 2.9%, 11.6%, 1.4%, 23.2%, and 27.5% of the cases, respectively. The mean Global Health Status Score, Symptom Score, and Functional Score was 82.36+-18.60, 11.89+-10.27, and 86.27, 74.50-94.11, respectively. Conclusions: CRC diagnosis has major effects on patients physical and psychological status, and concentrated efforts should be made by the involved medical team and healthcare systems to improve QoL throughout the treatment pathway.

Diagnosis and Treatment Difficulties in a Case of Synchronous Colon Cancer with Ovarian Metastasis and Peritoneal Carcinomatosis.

We present the case of a 46 year old female patient, with a personal history of breast abscess and total thyroidectomy for multiple thyroid cysts, who was investigated in a different healthcare facility for loss of appetite and weight loss. She was referred to our hospital with a suspicion of stage IIIC ovarian cancer, based on the paraclinical investigations which were made: a pelvic MRI (magnetic resonance imaging) and the ROMA score (23,16%). The colonoscopy done at the Clinical Emergency Hospital of Bucharest after admitting the patient revealed a circumferential tumor with an ulcerative and infiltrative aspect, which occupied in totality the lumen of the colon, near the splenic flexure. Biopsies were taken at this level. The histopathology result describes a welldifferentiated colorectal adenocarcinoma. A surgical intervention with complete cytoreduction was performed. Immunohistochemistry and histopathology reports of the tissue provided confirmed the origin of the tumor as being colonic, concluding that the primary tumor was a colonic mucinous adenocarcinoma with multiple peritoneal and bilateral ovarian metastases.

Nomogram for Prediction of Postoperative Morbidity in Patients with Colon Cancer Requiring Emergency Therapy.

BACKGROUND Postoperative complications are the major cause of mortality and prolonged hospitalization after emergency surgery for colon cancer. This study aimed to propose an effective nomogram to predict postoperative complications in order to improve the outcomes. MATERIAL AND METHODS We retrospectively analyzed 449 patients who underwent emergency surgery for complicated colon cancer at the County Emergency Hospital Clinic "St. Apostle Andrei" in Galati, in the period from 2008 to 2017. Postoperative complications were intestinal obstruction, leakage, bleeding, peritonitis, wound infection, surgical wound dehiscence, respiratory failure, heart failure, acute renal failure, sepsis, and Clostridium difficile colitis, within a month after surgery. Logistic regression models were used to identify the independent prediction factors, and a nomogram was created, based on the best model. RESULTS A total of 106 patients (21%) presented postoperative complications after emergency surgery for colon cancer; 51 patients (11.36%) died during the postoperative period. After identifying the risk factors through univariate regression analysis, we identified the independent prediction factors in 2 multivariate regression models. The model with the highest accuracy included the following 7 independent prediction factors: Eastern Cooperative Oncology Group performance status, Charlson score, white blood cell count, electrolyte and coagulation disorders, surgery time, and cachexia (P<0.05 for all). This model showed good precision in predicting postoperative complications, with an area under curve of 0.83 and ideal accordance between the predicted and observed probabilities. CONCLUSIONS The nomogram developed in this study, which was based on a multivariate logistic regression model, had good individual prediction of postoperative complications.

Achalasia at the Crossroads Between Specialties.

Background: Achalasia is a condition that can be treated either by surgery, such as Heller myotomy associated with an antireflux procedure, or by pneumatic dilation, the choice of type of treatment being a widely debated topic nowadays. Methods: We selected patients with the diagnosis of achalasia, calculating the Eckardt score on admission and they were treated by pneumatic dilation, respectively by myotomy associated with fundoplication. Therapeutic success at the end of treatment was analyzed, as well as that in subsequent follow-ups. At the same time, other important aspects of the study were quality of life and complications. Results: Forty-eight patients were included, 20 in the group of those treated by pneumatic dilation, and 28 treated by surgery. The results of the therapeutic success were to the advantage of the surgery, both after the completion of the treatment, and in the follow-ups from one year to 2 years (96.4% vs 90%, respectively 92.9% vs. 85%). The quality of life was better in patients with pneumatic dilation throughout the period. Conclusions: Surgical treatment of achalasia has a higher success rate than pneumatic dilation, but the latter is associated with a better quality of life.

Early Complications after Gastrectomies for Locally Advanced Gastric Cancer.

Background: The post-operative results as well as the short and middle-term outcome of surgical procedures for gastric cancer depend on several general and local conditions, mainly on the stage of neoplasia. Delayed diagnosis and intervention are correlated with a high rate of postoperative morbidity and mortality. Methods: 76 consecutive patients underwent surgical treatment for gastric cancer over a time span of 5 years (2015-2019), in the 1st Surgical Department of "Dr.I.Cantacuzino" Clinical Hospital. There have been 46 distal gastrectomies, 12 DI total gastrectomies and 18 DII total gastrectomies, 8 of them with multi-organ resection. Results: Among them, 50 patients had a favorable evolution, 7 developed complications which were manageable through a conservative approach, while 19 needed one or more reinterventions. We encountered 10 cases of severe sepsis and MSOF, followed by exitus. Conclusions: The surgical treatment of locally advanced gastric cancer poses many challenges both in terms of postoperative evolution and oncologic prognosis.

Inguinal Hernia - Is There Any Room Left for Classical Procedures?

Background: Nowadays, the repair of inguinal hernias is mostly achieved through a minimally invasive approach (TAPP or TEP) which has well-known advantages. However, the Lichtenstein mesh technique still has some particular indications. Methods: We reviewed 256 consecutive patients who underwent a Lichtenstein procedure during 5 years (2015-2019) in the Department of General Surgery of "Dr. I. Cantacuzino" Clinical Hospital. The vast majority of them - 180 (74%) were 60 or older and 105 (41%) were over 70. Severe cardiovascular diseases, diabetes mellitus and other significant co-morbidities were recorded in 128 patients (50%). Results: 240 patients had a favorable evolution, 12 experienced local complications, while in 4 we recorded severe cardiac post-operative events.1 patient died due to a massive myocardial infarction. Conclusions: The surgical treatment of inguinal hernias should be adapted to the age and biological status of the patient; surgical departments must be able to provide both a laparoscopic and an open-surgery approach.

Challenges and Solutions in Choosing the Surgical Treatment in Patients with Complicated Colon Cancer Operated in an Emergency - A Retrospective Study.

Introduction: Choosing the optimal treatment for patients with complicated colon cancer operated in an emergency remains a challenge. The study aims to identify the factors that influence the therapeutic decision in these patients. Patients and Methods: We included in this retrospective study 449 patients operated in emergency for complicated colon cancer, in the Clinical Emergency County Hospital "St. Ap. Andrei" Galati between 2008-2017. The patients data were collected from the observation sheets, the surgical, imaging and laboratory protocols. Results: The operations performed were: resections with a stoma in 37.63% of cases, resections with anastomosis in 36.97%, stomas in 16.26% and internal derivations in 9.13% of patients. Elderly age was correlated with stomas with or without tumour resection (p 0.05). Preoperative diagnosis of IDH was associated with resections with anastomosis, those with occlusion were associated with internal derivations and those with digestive perforations with resections with a stoma (p 0.05). The stomas were associated with the presence of intraoperatively detected complications (p 0.05). Conclusions: Complicated colon tumours operated on in an emergency require surgical treatment tailored to each patient. It is important to choose the type of treatment taking into account the patient's condition at admission, clinical-paraclinical data, tumour location, tumour complication and the presence of other complications detected intraoperatively.

Plasma Derived Products for Polypropylene Mesh Integration in Abdominal Wall Defects: Procedure Description and Partial Results.

Introduction: Abdominal wall surgery for parietal defects is done by implanting a type of mesh in the surrounding tissue above or beneath the fascia layer of the abdominal wall. The most common type of mesh used is polypropylene which sometimes takes a lot of time to be covered by the fibrous tissue. In an attempt to accelerate the cellular binding on the mesh and so to increase the recovery rate, we developed a protocol with plasma derived products to accelerate the mesh integration. Platelet rich fibrin (PRF) and platelet rich plasma (PRP) were evaluated in promoting the collagen synthesis and cell proliferation on the mesh surface. Material and Methods: We evaluated 32 patients with different types of abdominal wall defects which required polypropylene mesh implants in open surgery with the mesh implanted above the aponeurosis layer. We divided the patients into 3 groups: standard procedure, mesh augmented with PRF only, mesh augmented with PRP only. Results: Even though the number of patients involved in the study has a very small impact for a statistical analysis, the pattern observed in our prospective study reveals from the beginning that augmenting the standard procedure with plasma derived products improve the outcome (mesh integration) up to 65% faster integration. Conclusion: The technique that we used to augment the standard implant is cost-effective and simple to use in the surgical theatre.

When Should We Expect Curative Results of Neoadjuvant Treatment in Locally Advanced Rectal Cancer Patients?

This review on recently published literature aims to summarize published data on pathologic complete response following neoadjuvant treatment in biopsy proven locally advanced rectal cancer patients. Published articles referring to pCR rectal cancer patients were identified using PubMed search. Eleven relevant articles were selected, based on tumor, treatment, and patient characteristics reporting. As a conclusion, rectal cancer patients with the highest chances of complete clinical or pathological response to neoadjuvant treatment are males, who are around 60 years, diagnosed with well or moderate differentiated locally advanced rectal cancer.

Pancreatic Neuroendocrine Tumors - Case Series and Literature Review.

Background: Neuroendocrine tumors (NETs) are a heterogeneous group of tumors with various clinical manifestations and biological behavior. Among the most common neuroendocrine tumors (NETs) are pancreatic neuroendocrine tumors (PNETs). They are considered to be relatively rare tumors; however, more recent studies on NET epidemiology have demonstrated an increasing incidence and prevalence over the past 30 years. Aims: We intend to compare the strategy used in a real life clinical environment in the case of pancreatic neuroendocrine tumors, as opposed to an ideal model, as presented in literature. Materials and methods: Our case series consist in 18 patients with neuroendocrine pancreatic tumors diagnosed and treated in the Surgery I department of Clinical Hospital Dr. I. Cantacuzino over a 10-year period (2009-2018). We made a retrospective analysis of these patients, of their diagnosis particularities and choice of treatment and a review of the literature. Results: Out of these 18 cases, 13 had functioning tumors (11 insulinomas and 2 gastrinomas) and 5 non-functioning tumors. Most of the tumors were located in the tail of the pancreas (12 cases) the others were located in the body (1 cases) and the head of the pancreas (5. cases). Surgical treatment consisted in 10 enucleations (3 of them laparoscopic) and 8 pancreatic resections, 2 of them associated with splenectomy and in one case a liver metastasectomy was also performed. The mean follow-up was 12 months. No local or distant recurrences were found with one exception, one female which presented after one year with a cephalic pancreatic tumor that proved to be an adenocarcinoma. Conclusions: Diagnosis of PNETs may be difficult even in the presence of a hormonal hypersecretion syndrome. Nuclear imaging with octreotide is useful for locating the tumor and also for the detectionof any possible occult tumors which cannot be identified through the use of conventional imaging. All PNETs should be considered as potentially malignant, and the use of the term benign should be particularly avoided, which is why tumor grading based on the mitotic count and Ki-67 index must be established for every case. Surgical treatment remains the only with curative potential.

Acute Abdomen in Diabetic Patients - What Should We Do?

Diabetes mellitus is a well-known metabolic disease, with an increasing incidence around the world. The histological and clinical features of many diseases, including acute abdomen, are significantly modified in diabetic patients and thus the therapeutic approach should be carefully considered. Two main errors are possible, and they may equally cause a poor outcome of the patient: a delayed surgical procedure in peritonitis, due to its atypical clinical and biological expression, or an un-necessary laparotomy in a diabetic patient with acidosis, which transforms an already severe condition into a worse one. Therefore, in order to avoid confusion of diagnosis and treatment, the extended use of advanced imaging techniques (CT, MRI) or even a laparoscopic inspection of the peritoneal cavity may proove justified in many cases.

Skin Grafting in the Treatment of Diabetic Foot Soft Tissue Defects.

Background: According to the World Health Organization, cases of diabetes have risen from 108 million in 1980 to 422 million in 2014, with a more rapid rising in middle- and low-income countries. Diabetes causes yearly approximately 1.6 million deaths, and is a major cause of heart attacks, stroke, kidney failure, blindness and lower limb amputation. This article provides information on the treatment of a frequent complication related to diabetes, namely toe/ partial foot amputation. Broad, deep operative defects of the diabetic foot represent a reconstructive challenge. The aim of the study is to analyse the efficiency of healing methods using splitted skin graft corroborated with negative pressure therapy for wounds resulted after diabetic foot surgery. Second of all, the study intends to highlight the role of a sequence of the multidisciplinary approach, in this case general surgeon-plastic surgeon, in assuring the functionality of the pelvic limb. Methods: 63 diabetic patients were retrospectively analysed, patients that were admitted in Dr.I.Cantacuzino and Bagdasar-Arseni Clinical Hospitals, with different types of wounds resulted after diabetic foot surgery, between January 2016 and December 2017. Results: The reconstructions were successful in 56 patients, and, during the follow-up period, there were no complications. From the 7 patients with complications (skin graft necrosis, skin graft infection), one had an auto avulsion of the skin graft. Conclusion: Direct closure is feasible for small-sized wounds. Skin grafts provide effective coverage for large wounds, although they may often produce concave, caved-in, non-aesthetic closures. NPWT (negative pressure wound therapy) is also a very helpful procedure. Flap reconstruction often provides superior functional and aesthetic appearance. Adjacent tissue transfers may be used to close many wounds, but dermal restraint may hinder motion and lead to closure tension. Alternative solution of repair remains the reconstruction with free flaps, which also poses problems, due to arteriopathy.

Surgical Revascularization in Chronic Limb-threatening Ischemia in Diabetic Patients.

Introduction: Diabetes mellitus is one of the chronic diseases that showed a steady increase in the number of patients in the last decades. After the diagnosis of diabetes mellitus, evolution towards limb amputation goes, step by step, through neuropathy, leg ulcers and infection appearance. The existence of diabetic arteriopathy prevents ulcer's healing due to the limb's ischemic status. By restoring arterial flow in the lower extremity, we solve the most important cause for diabetic foot ulcers, namely ischemia. Material and Methods: In the Surgery Clinic of Dr I Cantacuzino Clinical Hospital, Surgical Repair of Diabetic Foot Compartment, the first revascularizations were made approx 5 years ago. During this time we have made constant efforts to lower the number of major amputations by diversifying the interventions dedicated almost exclusively to patients with ulcer of the diabetic foot. Results: The number of major amputations is lower after revascularisation and we have obtained complete ulcer's healing and a functional extremity. We have 80 patients in observation who underwent revasculariosation surgery, ages between 40 and 75 years, 46 men and 34 women. All of them were diabetic patients with critical ischemia and various associated comorbidities: 24% arterial hypertension, 14% polineuropathy, 12% dyslipidemia. The complications occured in the first year of follow-up were 14 cases of graft thrombosis and only 6 cases of major amputation. Conclusions: Before tempting any type of amputation, major or minor, after local infection control by treatment, debridement or dressings, and after vascular evaluation, it is essential to restore arterial flow.

Current Surgical Approach in the Pathology of the Arteriopathic Predominant Diabetic Foot.

Introduction: The diabetic foot is a complex pathologic entity characterized by the totality of modifications appearing on the foot during the evolution of the diabetic disease. This survey aims to elaborate an algorithm of treatment for patients with arteriopathic predominant diabetic foot lesions, with the purpose of reducing the number of debilitating interventions and improving the quality of life. Material and Method: There were analysed a number of 188 patients admitted to the Surgery Clinic I of the Dr.I.Cantacuzino Clinical Hospital, in the year 2017, suffering from arteriopathic predominant diabetic foot lesions, based on several inclusion/exclusion criteria. Results: According to the type of foot lesion, most patients had the diagnosis of wet gangrene of the toe/toes (51.06%), followed by ischaemic gangrene of the toe/toes (40.4%); the surgical interventions performed on these types of lesions in 73.9% of the cases consisted of minor amputations (transmetatarsal amputation of the toe/toes/foot). Conclusions: The treatment algorithm developed as a result of this survey represents a feasible treatment solution for the pathology of the arteriopathic predominant diabetic foot and failure to comply with this treatment may lead to treatment errors in a sense in which disproportional surgery can be performed in correlation with an inexact diagnosis.

Surgical Complications of Peritoneal Dialysis.

Peritoneal dialysis (PD) is a method of renal function replacement which has a series of advantages like greater autonomy of the patient with fewer hospital visits and better preservation of residual renal function, but it has also disadvantages. The main disadvantages are a limited life-time due to peritoneal membrane failure and the risk of infections. The main complication of PD remains peritonitis, which is responsible for the most cases of method failure. There are also other complications which incorrect treated may lead to failure of the method: mechanical complications, abdominal wall defects, exit site and tunnel infections. Encapsulating peritoneal sclerosis is a rare entity found in PD patients but with high morbidity and mortality. We have retrospectively analyzed the patients with end stage renal disease under peritoneal dialysis which were admitted to Surgical Clinic "I. Juvara" of the Clinical Hospital "Dr. I. Cantacuzino" between 2007 and 2017 for surgical complications related to PD. The patients were assigned in two groups: with non-infectious and infectious complications. We have found 109 patients which have had 126 surgical interventions related to peritoneal dialysis. Out of these, 30 interventions consisted in catheter removal for loss of ultrafiltration capacity, so these were excluded from analysis. The lot resulted consisted in 80 patients with 91 complications: 42 non-infectious and 49 infectious. Mean age was 60.5 (+-12.3) years. Sex distribution was 2.75/1 male/female. Diabetes mellitus was present at 45 (56,25 %) patients. Comparing the patients with non-infectious with those with infectious complications we found significant association between type of complications and the length of PD in the sense that infectious complications tend to appear later than the non-infectious. Also, the loss of peritoneal dialysis is strongly associated with infectious complications. Looking inside groups we found that abdominal wall defects are associated with the history of previous abdominal surgery (p 0,001). Regarding the morbidity and mortality only infectious complications had associated mortality in our study, there were no significant differences in morbidity rate between groups. Between all these patients we have also identified 16 with encapsultating peritoneal sclerosis. In most cases the diagnosis was established during the intervention for another complication. We have registered a 20% morality rate at these patients. Conclusions: Noninfectious surgical complications are not raising problems for diagnosis or surgical treatment, but an incorrect treatment may lead to failure of the PD. Infectious complications and especially peritonitis remains the main cause of method failure. These are generating the highest rates of morbidity and mortality from peritoneal dialysis complications. Even if the immediate surgical intervention for peritonitis related to peritoneal dialysis is usually unnecessary, surgical observation is absolutely mandatory in every case. The absence of a response to the proper medical treatment is an indication for peritoneal cavity exploration inclusive by laparoscopy/laparotomy. Any delay in diagnosis and definitive treatment can lead to loss of peritoneal membrane function and even death of the patient. Encapsulated peritoneal sclerosis is a rare but serious complication of PD. The risk for developing EPS increases with the duration of PD treatment. No predictive and reliable screening tests especially in the early stages of EPS were found. So, it is important not to underestimate the clinical symptoms, diagnosis being based on a high index of suspicion. The only established basic treatment of EPS is enterolysis of peritoneal adhesions, and time should not be unnecessarily wasted on conservative treatment.

Diabetes Mellitus as a Risk-factor for Colorectal Cancer Literature Review - Current Situation and Future Perspectives.

Colorectal cancer and Diabetes Mellitus represent a major public health issue, first, by the number of new cases which are at an alarming rate. Secondly, by the negative effect over the quality of life, socio-economic status and lifespan, representing high morbidity and mortality causes. Diabetes Mellitus is the disease of the century with a global prevalence (standardised-age) which doubled since 1980, rising from 4,7% to 8,5% in adult population. In 2012, the estimated number of fatalities caused by Diabetes Mellitus and other related complications was at 3,7 million, out of which 43% were patients under the age of 70. Neoplasia represents the second cause of death, after cardiovascular disease. The occurrence of Colorectal cancer (CRCA) is rated for men and women at 3rd and 2nd place. However, the rate of mortality from CRCA is in the 4th place, representing 8,5% out of the total cancer related deaths. 52% of these cases are recorded in underdeveloped countries, considering their level, this reflects a very low survival rate. Moreover, every year, approximately 1.4 million cases are being diagnosed out of which 55% appear in overdeveloped countries. Screening for colorectal cancer refers to the periodical evaluation of the asymptomatic patients who are at a risk of developing this type of neoplasia. The colorectal cancer contains a series of particularities which makes it ideal for screening. Since the end of the 19th century there has been a high suspicion that type II diabetes, through direct etiological mechanisms, may play a part in carcinogenesis (breast, endometrium, colorectal, pancreas, liver, non-Hodgkin's lymphoma). At the moment, the relevant published literature presents type II diabetes as an independent risk factor for colorectal cancer. Although, despite experimental proof, many epidemiological studies, case-controlled studies and meta-analysis, there still is the necessity for prospective studies which can intensify the existing results and can allow the colorectal cancer screening to adapt to these patients.

Surgical Management of Diabetic Neuropathy Foot Complications.

Background: Diabetic foot complications result from the association between peripheral vascular disease, neuropathy and a precarious healing process. Peripheral neuropathy observed in diabetics affects all components of the nervous system, contributing to the occurrence of leg ulcers, musculoskeletal changes, resulting in severe deformities. The clinical manifestation of these complications ranges from simple lesions to complex entities threatening the loss of pelvic limb or even life (1,2). Methods: In our surgery department, a significant number of patients with diabetic foot lesions are hospitalized and treated annually, 40% having clinical manifestations of diabetic neuropathy associated. In 2017, a total of 448 patients were hospitalized for complications of diabetes. We performed a retrospective analysis of 150 consecutive patients who underwent surgery for neuropathic diabetic foot lesions. Results: The analyzed patients had a favorable postoperative progression, benefiting from distal perfusion. Ray resection was the preferred surgical intervention. Major amputation was performed in 10% of cases with extensive gangrene and sepsis, amputation of the calf being preferred in all situations. Conclusions: The management of these patients is delicate, often multidisciplinary approach being necessary. A well-managed therapeutic attitude can make the difference between preserving or losing the pelvic limb.

Soft Tissue Infections in Diabetic Patients.

Background: the patient with diabetes has an increased susceptibility to infections, with negative evolutionary potential leading to increased morbidity and mortality compared to the general population. The cause is the alteration of immune defense mechanisms, the hyperglycemic environment leading to alteration of neutrophil function, suppression of the antioxidant system and humoral activity, systemic micro and macroangiopathy, neuropathy, depression of antibacterial activity of the genitourinary and digestive tract. Infections localized at the soft tissue (skin, fascia and aponeurosis, subcutaneous tissue, muscles) in the diabetic patient require a complex medico-surgical approach in which aggressive surgical treatment should be complemented by metabolic balancing and sustained antibiotic therapy. Materials and methods: these peculiarities will be exposed and analyzed in a retrospective descriptive study performed at the General Surgery Clinic. Juvara of the clinical hospital Dr. I. Cantacuzino, during the period of Jan. 2013- Dec.2017, which followed the type of lesions, their localization, the germs involved, the comorbidities, the biologic parameters, the antibiotic and surgical treatment as well as the postoperative evolution. The study does not include patients with localized infections in the diabetic foot, a particular pathological entity that will be analyzed separately in a separate study. Results: 150 diabetic patients with soft tissue infections localized in the upper limb, calf, thigh, perineum, abdominal and thoracic wall were identified. The most frequent localization was found in the lower limb (54%). The incidence of these infections was higher in males (55%), and the most affected age group was 60-69 years (38%). Most patients had type II diabetes (93%). Among the associated comorbidities, cardiovascular diseases and obesity are the most common, explaining to a large extent the complicated evolution, potentially lethal of this pathology. From the bacteriological perspective, a plurimicrobian flora is identified, staphylococcus aureus being most frequently encountered. The antibiotic treatment was initiated immediately empirically, subsequently according to the antibiogram; the most commonly used antibiotic classes being cephalosporins and carbapenems. Surgical interventions were in their majority of debridement and necrectomy, but in a few cases limb amputation was necessary. In particular, the number of surgical interventions performed in the same patient and in the same hospital stay was between 1 and 7 interventions. Conclusions: Soft tissue infections in the diabetic patient have a heterogeneous aspect with specific particularities requiring careful clinical examination, multidisciplinary treatment including rapid, serial surgical interventions to control the growing aggression of the germs involved. Fast and caseadapted therapeutic decisions, careful observation of the patient's general condition and of the wound several times a day are essential to achieving favorable postoperative outcomes.