Loco-regional advanced colorectal cancer: diagnostic and therapeutic features.

The objective of this study is to analyze the main diagnostic and therapeutic aspects in locally advanced colorectal cancers, related to recent advances published in the medical literature. The paper analyzes 2nd Surgical Clinic cases of advanced colorectal cancers over a five year period: 224 such patients operated on, with 79.9% tumor resectability (64.4% with radical intent); in 12.94% extended resections were necessary in order to achieve primary tumor removal. Overall morbidity and mortality rate were 52.23% and 7.14%, respectively. In conclusion it has been emphasized that improvements are necessary to be made in order to achieve a good staging of disease and, as therapeutic feature, in locally advanced cases extended resections may be perform with acceptable risks for the patients.

Clinical, histological and immunohistochemical characteristics in patients with tumors of urinary bladder and renal failure.

Chronic renal failure in patients with tumors of urinary bladder appears because of either familial tubulo-interstitial pielonephritis evolution (Balkan Endemic Nephropathy) or invasion and obstructive uropathy. A group of 27 clinical cases with tumors of urinary bladder and renal failure was available for our study between the years 2004-2005. Simultaneity of the two serious diseases, neoplasia and terminal renal failure made the prognostic more difficult and determined some other complications to appear. Identification of some clinical and histopathological features in due time led to a therapeutic algorithm favorable to a prolonged survival.

Immunohistochemical determinations in evaluating the prognostic in patient with urinary bladder tumors.

A set of 50 cases of urinary bladder tumors in patients predominantly resident in BEN area was histologically investigated again, in order to establish new prognostic factors. Histological type, histologic stage and invasive pattern were correlated to immunohistochemical determinations. Determinations of C-erb B2, pRb, p53 and Ki67 were performed and aggressivity degree and proliferation and prognostic indice were also established.

[Crohn's disease. Clinical and therapeutical considerations]. / Boala Crohn. Consideratii clinicoterapeutice.

Crohn's disease is a chronic granulomatous inflammatory condition of the intestinal tract of unknown etiology. Most commonly the disease affects the small bowel, the colon and the rectum. The acute and aggressive forms can evolve fast, mimicking an acute surgical illness, requiring surgical intervention in emergency. Surgical therapeutical option, in this condition, must be determined strictly by establishing a correct intraoperative diagnosis, through macroscopic features and histologic evidence. Because it is an incurable disease with variable evolution, marked by recurrence, that involves repeated surgical intervention, the surgical treatment (often resection), must be most conservative from the small bowel. We present 3 cases of surgical interventions with emergency characteristics (bowel obstruction through fitobezoar, colonic tumors obstruction of colon splenic angle, urachal infected tumors). In these cases the diagnosis was established intraoperatively and the surgical intervention was adapted to the particular cases.

[Severe nosocomial infection of soft tissue in general surgery]. / Infectiile nosocomiale severe ale partilor moi în chirurgia generala.

This paper aim is to emphasize the severity of soft tissue nosocomial infections, determined by anaerobic bacteria associated with Gram-negative aerobic bacteria: 50% mortality, higher economic costs, disabling morphologic and functional sequels. We present the pathogenic, clinical and therapeutically problems which characterize this type of postoperative infections.

The place and the role of histological examination in diagnostic algorithm of urinary system tuberculosis.

The diagnosis of tuberculosis of renal and urinary tract is made by identifying Koch bacillus in special cultures and using histological examination of surgical removed pieces. Not in all cases the usual pathological techniques are very specific. Using special stain for acid-fast bacilli it can be certified the etiological diagnostic. Histological changes of renal parenchyma and/or upper urinary tract (renal pelvis and urether) structures in 57 patients clinical and paraclinical pyonephrosis diagnosed where studied. All the surgical removed pieces were studied using usual pathology methods. In order to find renal tuberculosis we performed on surgical pieces special staining (Ziehl-Nielsen), we noted the pathological finding in each case and we found 7 cases with certainly tuberculosis etiology.

Endometriosis - clinical approach based on histological findings.

Endometriosis is a benign disease defined by the presence of endometrial glands and stroma outside of the uterus and is associated with both pelvic pain and infertility. The most common sites of endometriosis, in decreasing order of frequency, are the ovaries, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, uterus, fallopian tubes, sigmoid colon, appendix, and round ligaments. The main treatment is surgical, but often-microscopic islands of endometrial tissue remain, which proliferate and are responsible for relapses. We tested the efficacy of two drugs (Medroxyprogesterone and Triptorelinum), administered for six months to prevent recurrence after surgery. Treatment with Medroxyprogesterone was 100% effective in terms of relapse, while Triptorelinum could not prevent recurrence of endometriosis.

Ureteral stenosis due to endometriosis.

Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, with potential to undergo malignant transformation. We report the case of a 36-year-old patient with a clinical and imagistic diagnosis of left vaginal pouch and left parametrium tumor. The patient presented lumbar and pelvic pain, dysuria and polakyuria. Ultrasound revealed changes in the left kidney confirmed by the CT scan, which also revealed the presence of a tumor in the left parametrium infiltrating the bladder, juxtavesical ureter, uterus and cervix. Laboratory tests were within normal limits. Surgery consisted of interadnexal hysterectomy, proximal colpectomy, left distal ureterectomy with ureterocystoneostomy. Pathological examination established the final diagnosis of infiltrative deep endometriosis involving the urinary tract. In the case of a young fertile patient with gynecological symptoms and morphofunctional changes of the urinary system, urinary tract endometriosis should always be a diagnostic option.

Study on the dynamics of cortisol secretions in hypertensive elderly patients.

Ageing is defined as a slow, irreversible process of cellular changes, that are due to a lack of balance between degradation and repair, a continuous interaction between physiological and pathological processes. Physiological aspects in elderly people are often confused with disease. Given these general considerations, we would make observations about the dynamics of cortisol secretion in healthy elderly subjects and patients with a diagnosed cardiovascular disease, more precisely hypertension. The study was conducted during 2003-2010, on a number of 135 patients older than 65 years of age, who were divided into two groups: one group counting 66 patients and consisting of healthy elderly controls (without systemic disease, renal, endocrine, or cardiovascular known issues) and group 2 who consists of 69 elderly patients who associate known hypertensive and other cardiovascular issues.