Acute inflammation with induction of anaphylatoxin C5a and terminal complement complex C5b-9 associated with multiple intra-articular injections of hylan G-F 20: a case report.

OBJECTIVE: The purpose of this case report was to investigate local immune mechanisms present during an acute inflammatory flare initiated by viscosupplementation with hylan G-F 20 in a patient with osteoarthritis (OA) and past meniscectomy. EXPERIMENTAL DESIGN: A patient with a history of bilateral OA and partial left knee meniscectomy, who had received three injections of hylan G-F 20, was diagnosed with an acute flare reaction in the left knee. Her chart was evaluated for clinical, radiological, and laboratory findings and for clinical follow-up. Histopathological synovial examination and real-time polymerase chain reaction (RT-PCR) for genes with major roles in local inflammation and enzyme-linked immunosorbent assays (ELISAs) for markers of complement activation and cytokines were performed. To study the impact of the inflammatory and immune features we compared the case patient with groups of three representative OA and three rheumatoid arthritis (RA) patients. RESULTS: The patient exhibited evidence of highly increased acute phase reactant C-reactive protein (CRP) in the blood. The pathological examination of the synovial membrane identified abundant fibrinous exudate with numerous particles of hyaluronan surrounded by a dense infiltrate of neutrophils and eosinophils. The synovium had moderate hypertrophy and sclerosis as well as an inflammatory infiltrate predominantly composed of T lymphocytes and macrophages with scattered perivascular eosinophils and neutrophils. Immunoperoxidase staining identified numerous deposits of C5b-9 in the fibrinous exudates and the synovial membrane of the patient. Similar findings were observed in the RA patients, whereas deposits were rare in OA synovial samples. In addition, both anaphylatoxin C5a and the terminal complement complex C5b-9 were present at high levels, comparable to those in RA patients. The levels of mRNA for interleukin-1 beta (IL-1ß), IL-6, and the neutrophil marker myeloperoxidase (MPO) were markedly increased compared to those in the RA and OA patients. CONCLUSIONS: This present study is indicative of a pseudo-septic acute inflammatory reaction in response to local accumulation of hylan G-F 20 with the activation of complement and local invasion of pro-inflammatory cells.

Effect of dietary chromium supplementation on meat nutritional quality and antioxidant status from broilers fed with Camelina-meal-supplemented diets.

Poultry meat is a valuable source of nutrients and the enrichment with health-promoting substances such as polyunsaturated fatty acids (n-3 PUFA) is an important factor for consumers' choice. Camelina meal (Camelina sativa) is an animal feedstuff used to achieve this goal, but the administration of n-3 PUFA-enriched diets in broiler nutrition can accelerate the oxidative processes in meat leading to a decreased quality of final product. The aim of this study was to investigate the effect of the organic Cr as chromium picolinate (CrPic) on meat quality, fatty acid profile of fat and oxidative stability of meat from broilers fed supplemented dietary Camelina meal. An experiment was conducted on 240 Ross 308 broiler chicken aged 14 days which were assigned to 6 dietary treatments in a randomized complete block design with a 2 × 3 factorial arrangement. Within the treatment arrangement two concentrations of Camelina meal (0% and 3%) and three concentrations of Cr3+ (0, 200 and 400 µg/kg) were used. Dietary treatments were: (1) Control diet (C) containing a corn-soybean diet with no added Camelina meal or Cr3+; (2) a C diet containing an additional 200 µg/kg of Cr3+ as CrPic; (3) a C diet containing an additional 400 µg/kg of Cr3+ as CrPic; (4) a C diet containing an additional 3% Camelina meal; (5) diet 2 containing an additional 3% Camelina meal; (6) diet 3 containing an additional 3% Camelina meal. Chromium supplementation significantly (P<0.05) increased the CP concentrations and significantly (P<0.05) decreased the crude fat concentrations in breast samples. The Camelina meal groups presented higher values of unsaturated fatty acids, particularly n-3 fatty acids (P<0.05). In CrPic groups, increased retention of Zn and Fe (P < 0.05) was observed in breast samples, compared to control group, and thiobarbituric acid reactive substances values were significantly (P<0.05) smaller. Myoglobin fraction (metmyoglobin and oximyoglobin) concentrations differ significantly (P<0.05) from the control group, under the influence of Cr3+ supplements. This study found that broilers fed with CrPic supplements showed improved mineral composition and oxidative stability of breast meat, proving an effective protection of lipid molecules from oxidation in PUFA-enriched meat.

[Pancreaticoduodenectomy with or without pylorus preservation: a retrospective analysis of 137 patients]. / Duodenopancreatectomia cefalica cu sau fara prezervarea pilorului: analiza retrospectiva a 137 pacienti.

OBJECTIVE: We performed a retrospective study to assess the postoperative results, long-term survival and quality of life after pylorus preserving pancreaticoduodenectomy (PPPD) versus standard Whipple pancreaticoduodenectomy (WPD). METHODS: A retrospective study was performed in a nonselected series of 137 patients who were operated in the Surgical Clinics of "St. Spiridon" University Hospital Iasi, Romania, from January 1st, 1995 till December 31, 2005. Demographics, preoperative and intraoperative data, as well as postoperative morbidity, mortality and follow-up were analyzed. Quality of life, after to at least six months after discharge, was also studied. RESULTS: There were no significant differences noted in demographics data. Jaundice was more frequent in the PPPD group as for WPD patients (p=0.047). For the most patients the digestive reconstruction after resection were performed as in Child technique: the first anastomosis was pancreaticojejunostomy (end-to-end or end-to-side), the second anastomosis was hepaticojejunostomy (end-to-side) and the last anastomosis was gastrojejunostomy end-to-side (duodenojejunostomy in PPPD group). For 31 cases a pancreatico-gastrostomy were performed. We also noted 14 cases with pancreatico-gastrostomy and duodenojejunostomy end-to-end, and a Roux jejunal loop for 3 patients with previous gastrectomy and gastrojejunostomy (Reichel-Polya). The operating time was shorter in the PPPD group as in WPD (p < 10-3), but the mean blood loss was the same. Postoperative morbidity rate was 46.8% in PPPD group vs 39.2% in WPD (p > 0.05), but the reintervention rate was significant higher in PPPD group (30.6% vs 15%; p = 0.027). We also noted no significant differences of Delayed Gastric Emptying, postoperative mortality rate (14.5% in PPPD group vs 10.1% in WPD group) and mean survival time (42.42 months (24.94 - 59.89; 95% CI) in PPPD group vs 46.78 months (28.07 - 61.50; 95% CI) in WPD group; log rank test p = 0.643). Pathological exam diagnosed a malignancy in 109 cases (54 cases with pancreatic cancer); we noted chronic pancreatitis in 22 cases. Quality of life was also the same in the two groups. CONCLUSIONS: PPPD and WPD were associated with comparable results, but, there is a tendency of increase rate of postoperative morbidity and mortality for PPPD patients. We also noted that postoperative quality of life is the same for both procedures.

Invasive amebiasis.

Digestive amoebiasis with his invasive form is an unusual pathology encountered in the temperate zone. This could lead to a life threatening complication: systemic amoebiasis. A 55-year-old male was treated successfully of systemic amoebiasis in a third referral hospital. The diagnosis was established based on epidemiology data and microscopical identification of trophozoites of Entamoeba histolytica. The amoebicidal, antibiotic and supportive treatments was firstly administrated. The clinical picture of intestinal amoebiasis raised from dysenteric syndrome to necrotizing enteritis. The bowel perforation with localized peritonitis was followed by chronic enteric fistula. Amoebic liver abscess, as the most frequent extraintestinal complication, was concomitantly diagnosed and treated. Urinary amoebiasis was considered as complication in the context of systemic dissemination: any other location could become a site of an amoebic abscess. Multidisciplinary approach was the successful key in the management of the patient, including antiparasitic therapy and antibiotic prophylaxis, intensive care and multiple surgical approaches. The diagnosis of digestive amoebiasis and systemic complication may be delayed in nonendemic areas, leading to advanced and complicated stages of the disease. The surgical approach is most efficiently to treat a large liver amoebic abscess and intraperitoneal collections.

Xeonon accumulation in the red blood cell. A process latered by suppressors of the membrane active transport function.

Xenon passage across the erythrocyte membrane was investigated by performing several types of tests. The effects of some enzyme inhibitors (ouabain, NaF, dinitrophenol, low temperature), representing various modifications of the mentioned transport phenomenon, led to the conclusion of the existence of a strong correlation between the cellular energetic metabolism (and, hence, the energy supply for membrane processes) and the xenon accumulation into the erythrocyte. The experimental data obtained indicate that the xenon concentration in the cell water exceeds the concentration in the incubation solution by about 20%. The metabolic inhibitors practically equalise the xenon concentrations in the cell water and in the surrounding medium. The possible theoretical consequences of these facts are taken into account and analyzed.

[Spontaneous esophageal rupture in three patients]. / Ruptura spontana de esofag la trei pacienti.

Boerhaave's syndrome represents the most severe perforation of the gastrointestinal tract. The typical clinical presentation is by a sudden onset of pain after a vomiting effort on the background of an alimentary and alcoholic abuse. It usually associates the cervicomediastinal emphysema, altogether forming the Mackler triad. The atypical presentation and the rarity of this entity usually lead to the delay in diagnosis in 50% of the cases. The diagnosis requires native and hydrosoluble contrast radiological examination which may reveal, altogether with the esomedistinal or esopleural fistula, pneumomediastinum, cervical subcutaneous emphysema, pleural effusion or hydropneumothorax. The early diagnosis and surgical treatment in the first 24 hours after the perforation offer the best chances for survival. We present and analyze the cases of 3 patients with spontaneous esophageal rupture with their different evolution and the diagnostic and treatment steps in each case.

[Necrotizing fasciitis]. / Fasciita necrozanta.

The management of a right foot necrotizing fasciitis and severe sepsis in an old diabetic patient is presented. The early and aggressive surgery, adequate antibiotherapy and correction of organic disfunction (cardio-circulatory, renal, respiratory) eliminated the vital risk and resulted in a satisfactory morpho-functional recovery of the foot.

Dysregulation of p56lck kinase in patients with systemic lupus erythematosus.

In this study we investigated one of the possible mechanisms of p56lck down-regulation in peripheral blood lymphocytes (PBLs) from Systemic Lupus Erythematosus (SLE) patients and we correlated p56lck dysregulation with accelerated apoptosis in SLE PBLs. PBLs from SLE patients and healthy donors were isolated. p56lck protein expression and lck mRNA level were estimated by immunoblotting and RT-PCR, respectively. FACS analysis was used to evaluate the apoptosis and p56lck levels in apoptotic and non-apoptotic PBLs. A non-radioactive Tyrosine Kinase Assay Kit was used to measure p56lck activity. Our results demonstrated that PBLs from SLE patients displayed lower levels of lck mRNA and p56lck protein as compared to healthy donors. The apoptosis of fresh or cultured PBLs was enhanced in SLE patients, especially in anti-DNA negative group. The expression of p56lck was inverse correlated with apoptosis of fresh and cultured SLE PBLs, especially in anti-DNA negative patients. Double staining FACS analysis showed that p56lck expression was lower in apoptotic than in non-apoptotic PBLs. p56lck specific activity was directly correlated to apoptosis in SLE PBLs. While the low expression of p56lck may be the result of lower degree of synthesis, the increased specific activity could directly correlated to the extent of apoptosis in SLE PBLs. Based on our observations, we assume that the p56lck dysregulation could play a role in SLE pathogenesis.

Nasopharyngeal carriage of multidrug-resistant Streptococcus pneumoniae in institutionalized HIV-infected and HIV-negative children in northeastern Romania.

OBJECTIVES: The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and -seronegative children. METHODS: Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1-38 mo) and 40 HIV-infected children (age range, 39-106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates. RESULTS: Serotypes 6A, 6B, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 mg/mL); MIC50 and MIC90 to penicillin of the isolates were 2 mg/mL and 8 mg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21% of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to =/>3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin. CONCLUSIONS: No significant differences were observed in the resistance rates of S. pneumoniae in HIV-infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection.

Biochemical changes in the rat brain associated with dinitrophenol-induced brain edema.

The present paper was designed to the study of cerebral edema induced by intracarotid infusion of dinitrophenol. The determinations included variations in three lysosomal enzymes (acid phosphatase, cathepsin C and beta-glucuronidase), Na+-K+-ATP-ase, changes in cerebral RNA and protein concentrations and the synthesis of these macromolecules in vitro. In experimental brain edema a drastic drop in the activity of lysosomal enzymes took place. The acid phosphatase decreased to less than 30% of controls. Cathepsin C and beta-glucuronidase were reduced about 30% and 50% of control levels respectively. Protein concentration in the cerebral tissue also decreased by more than 50%. The concentration of RNA, RNA synthesis, and the level of Na+-K+-ATP-ase remained unchanged. Protein synthesis was stimulated by 75% (against controls). All these phenomena were suppressed when the animals subjected to the action of dinitrophenol were concomitantly treated with the antiacidotic substance, tris (hydroxymethyl) aminomethane.

Chromatin structure, number, volume and position of nucleoli in rat hepatocyte after treatment with benzo(a)pyrene and N-acetylaminofluorene.

In Wistar rat liver, after the acute treatment with two carcinogenic substances - benzo(a)pyrene and N-acetylaminofluorene - changes involving the nucleus are observed 2, 4 and 6 hours later. The electron-microscopic aspect of the chromatin, as well as the number and volume of nucleoli are altered. The parameters considered (number, mean volume and total nucleolar volume related to nuclear number) showed a movement of the nucleoli inside the nucleus from and towards the nuclear membrane, as a reaction to the chemical oncogenic stress. Thus, there is a relative variation of the number of nucleoli which come into contact with the nuclear envelope or occur within the nucleus. The number and volume are increased 2 hours after the treatment in the case of the nucleoli placed close to the nuclear membrane; the same process is observed after 4-6 hours in nucleoli located centrally. In the experiments described, the reversibility of most of these changes 24 hours after the treatment appears as being the rule.

Variations in the activTY OF SOME BRAIN AND PLASMA ENZYMES UNDER THE INFLUENCE OF +Gz acceleration.

The present paper refers to the activity of some enzymes associated with the cellular cytomembranes in the plasma and brain of guinea pigs exposed to the action of repeated +10Gz acceleration. Immediately after the last run, diminution of enzymatic activity in the brain supernate ran parralel to a rise in plasma enzymatic activity. Variations in enzymatic activity suggested the liberation of enzymes connected with the neuronal organelles, perhaps consequent to alterations in the permeability or structure of the neuronal cytomembranes. These alterations might also be interpreted as being accompanied by permeabilization of the blood-brain barrier, with release of enzymes from the neuronal structures into the plasma. Changes in the permeability of the neuronal membranes might be attributed to several factors: cerebral hypoxia following the hemodynamic and ventilation alterations induced by hypergravitation, the influence upon the membrane permeability of hormones released in excess under the stress of acceleration, and the strain to which the central nervous system neurones are subjected by the multitude of afferent impulses with a starting point in the various types of receptors stimulated by hypergravitation.

A possible correlation between unscheduled DNA repair and cholesterolemia in Wistar rat, modulated by vitamin E.

Cholesterol plays a critical role not only in modulating membrane structure and dynamics but also in its metabolic pathway, to interfere with cell growth and proliferation processes. Having this aim in mind, we have suggested an investigation, by radioisotopic techniques, of the effect of vitamin E (alpha-tocopherol, 3 mg/kg b.w. in daily doses, for 7 days) on the unscheduled DNA biosynthesis, induced by Romanian cytostatic Lomustin (Nipalkin or CCNU at the dose of 10 mg/kg b.w in acute administration, for 24 h), both on normally fed animals and on rats having a hypercholesterolemic diet, for 30 days. Considering the scientific data from the literature, according to which there is an inverse correlation between the serum cholesterol level and the risk of developing cancer, we tried to investigate the possible influence of Wistar rat cholesterolemic background on the nuclear unscheduled DNA biosynthesis, essential for the conservation of the cell genome integrity. So, it has been noticed that: 1) the DNA lesions induced by the alkylant and tested by the uptake of 3H-Thymidine (200 microCi/100 g b.w.) are reduced after vitamin E treatment, suggesting a protective effect of the antioxidant on the genetic material. 2) on a hypercholesterolemic background the administration of Lomustin produces a decrease of cholesterolemia, suggesting the development of a "facilitating environment" for CCNU action, which appears to confirm the data from the biographical sources. 3) using 3H-Cholesterol (150 microCi/100 g b.w.) to estimate its intracellular liver incorporation suggests a possible displacement of cholesterol from the tissue compartment to the serum one and reverse, event which appears to be correlated with unscheduled DNA biosynthesis. This sustains the idea of the intracellular cholesterol necessity during the nucleic acid biosynthesis as well as in genome aggression.

[The value of oesophageal transection and staple gun anastomosis in the elective or emergency treatment of esophageal varices bleeding]. / Valoarea deconexiunii azygo-portale prin transectie esofagiana în tratamentul electiv si de urgenta al hemoragiilor digestive superioare prin varice esofagiene rupte.

The transabdominal extensive oesophagogastric devascularization with gastroesophageal stapling, known as modified Sugiura procedure, together with other nonshuting operations are widely performed as the operations of choice for bleeding oesophageal varices, world-wide when the non surgical hemostatic procedure are not suitable. We present our experience in 10 selected cases, which have been operated on since 1994 till now in our unit, 6 elective and 4 as emergency, using the stapling technique of oesophageal transection. The results were good with no recurrence of re-bleeding in the postoperative period, with 1 death due to acute liver failure. We consider this procedure a good alternative, which remains the ultimate direct operation to control the variceal bleeding due to portal hypertension despite of many other procedures used to get the hemostasis in these cases of upper digestive tract bleeding due to portal hypertension.

[Surgical initial attitude in epithelial ovarian advanced cancer]. / Conduita chirurgicala în cancerul ovarian epitelial avansat.

UNLABELLED: The purpose of this work is to show the value of aggressive excisional surgery in epithelial ovarian advanced cancer (COEA). MATERIAL AND METHOD: Between May 1993-May 1997, there were 103 obs. with ovarian diseases; 28 obs. (27.1%) with COEA and 75 obs. (72.9%) with benign diseases. All the patients had a subtotal hysterectomy with bilateral anexectomy and omentectomy. The operation was extended to other anatomic elements; in the case of 4 obs., we practiced a segmentary resection of left colon, 2 obs. had an anterior resection of the rectum and a partial resection of the pelvic peritoneum, 15 obs. suffered an excision of tumoral masses from the gastro colic omentum and the right parietocolic space and 7 obs. had a resection of pelvic peritoneum and of the right parietocolic space peritoneum. The optimal cytoreduction with a tumoral residuum less than 2 cm was realized for 23 obs. (82.14%) and for 5 obs., the tumoral residuum was greater than 2 cm (17.76%). The medium survival of the patients with a tumoral residuum inferior to 2 cm was 41 months, at 4 years 54% of the observations being alive, compared to only 14 months for the patients with tumoral residuum superior to 2 cm, at 4 years the survival being only of 15%. All the observations have beneficiated of chemotherapy. The disease reappeared for 23 obs. after a variable period of time. It's treatment consisted of: surgery followed by chemotherapy for 18 obs. and chemotherapy of second line alone for 5 obs. CONCLUSIONS: The ovarian epithelial cancers, famous for an intermediary answer to chemotherapy, lead to an aggressive surgical management with partial extra genital organ sacrifices, to offer a chance of life.

Proofs concerning the existence, in the blood of hypertensive patients, of some serum factors influencing the vascular smooth muscle and the myocardium physiology.

Starting from the existence of some autoimmune diseases (i.e. bronchial asthma or miastenia gravis) we asked ourselves if some plasmatic factors do exist, influencing the receptor--mediator relations in cardiovascular system during some illnesses having unknown etiology, as arterial hypertension. For this reason, in this work was tested the hypothesis that, in some chronic cardiovascular diseases would exist factors circulating and affecting the functions of the cellular membranes of the arterial wall, particularly of the smooth muscle cells and myocardial cells. Our results show a significant modification of the calcium fluxes and of some neuromediators uptake at the hypertensive patients.

[Incidence, associated factors, and follow-up of hospital heart failure complicating acute anterior myocardial infarction successfully treated by primary angioplasty]. / Incidence, facteurs associés et devenir de l'insuffisance cardiaque hospitalière compliquant l'infarctus antérieur aigu traité avec succès par angioplastie primaire.

UNLABELLED: Heart failure (HF) complicating acute myocardial infarction (AMI) is of poor prognosis and is often associated with patient's characteristics and success of reperfusion strategies. However, few data is available regarding the high-risk subgroup of patients with anterior AMI treated successfully by primary angioplasty. The aim of the study was to assess the incidence, associated factors, and the future of HF occurring during hospitalisation, in the setting of anterior AMI treated successfully by primary angioplasty. METHODS: Eighty-five consecutive patients with anterior AMI treated successfully by primary angioplasty (final angiographic TIMI flow grade=3, without residual stenosis) were included. Clinical, biochemical, angiographic, and echocardiographic data were prospectively collected and compared between patients with (Killip 2 and 3) and without HF during hospitalisation. RESULTS: Fifteen patients had HF (18%) during hospitalisation and 70 did not. By comparison to patients without HF, patients with HF were more frequently diabetics, had troponin peak and CPK, leucocytes count, and fasting glucose higher, LVEF and wall motion score index in the left anterior descending territory (WMSi-lad) poorer, and a lower non-invasive coronary flow reserve (CFR) in the LAD 24hours after angioplasty (all, P<0.05). In multivariate analysis, fasting glucose, leucocytes count after angioplasty, CFR and WMSi-lad were independently associated with HF, even after adjusting with angiographic variables (all, P<0.05). At 6months, patients with HF had less recovery of LV function and higher frequency of adverse LV remodelling (58% versus 20%, P<0.01) by comparison to patients without HF. CONCLUSION: In conclusion, HF is not uncommon even after successful primary angioplasty for anterior AMI (nearly one patient out of 5), is associated with hyperglycaemia and inflammation, a poor microvascular reperfusion, and left ventricular systolic function, and is more frequently complicated by adverse LV remodelling and lack of LV recovery.

Myasthenia gravis associated with thymoma and toxic multinodular goiter. A case report.

Adequate antithyroid drug treatment or surgery usually generates remission of myasthenia gravis (MG) in patients with thymus hyperplasia associated with Graves' hyperthyroidism. The case of a 46-year-old woman diagnosed with MG based on the clinical picture, anticholinesterase drug test and positive electromyography (EMG) is presented. The cervico-thoracic computer tomography revealed a compressive nodular goiter and normal antero-superior mediastinum and led to the diagnosis of MG secondary to the hyperthyroidism. An uneventful total thyroidectomy was performed, but postoperatively the MG symptoms worsened. TC99m tetrofosmin scintigraphy revealed an area of hyperfixation in the antero-inferior mediastinum, suggestive for thymoma, as confirmed by a repeated thoracic CT scan. Following a longitudinal sternotomy, a well incapsulated tumor of approximately 6/5 cm located in the antero-inferior mediastinum was found and an extensive thymomectomy was performed. The postoperative course was uneventful and the patient was discharged 9 days later with complete remission of myasthenia. The pathology report of the specimen revealed a mixt thymoma or AB thymoma after Muller-Hermelink and WHO classification, with invasive capsular foci corresponding to Masaoka II stadium. In conclusion, scintigraphy proved to be useful in the diagnosis and decision making of a thymoma.

[The evaluation of mortality in abdominal surgery of patients aged over 75. A retrospective study on a series of 111 cases]. / Evaluarea mortalitatii în patologia chirurgicala abdominala la pacientii peste 75 de ani. Studiu retrospectiv.

UNLABELLED: Abdominal surgery of patients aged over 75 is a real challenge, regarding the risk-benefit ratio, especially in emergency cases. The aim of the study was to assess the mortality in elderly patients admitted for abdominal surgical conditions. MATERIAL AND METHODS: A retrospective study was carried out on a series of 111 patients aged over 75 that died during hospitalization for abdominal diseases in the 3rd Surgical Unit during the period 2007-2010. Data from the medical files, operating books and pathology reports were collected and analyzed. RESULTS: Of the 61 cases admitted for benign conditions, 11 deceased prior to surgery due to high ASA risk. 50 patients underwent surgery, mainly on emergency basis (42 cases). Most of the patients in this group suffered from intestinal infarction (22), followed by abdominal sepsis (16), intestinal obstruction (12) and digestive bleeding (10). Resection followed by anastomosis was performed in 17 cases; of these, anastomotic fistula with sepsis developed in 7 cases (41%). Malignant abdominal diseases were diagnosed in 50 patients, most frequently colorectal cancer (25) followed by gastric cancer (14), pancreatic cancer (5), billiary duct carcinoma (3), malignant ampuloma (2) and hepatoma (1). In this group, 46 patients were operated on, mainly in emergency (35). Of the 32 cases where resection was performed, anastomostic fistula with sepsis developed in 21 (65,6 %). CONCLUSIONS: the main cause of death was abdominal sepsis due to anastomotic fistula following resections, for both benign and malignant condition.