Particular aspects of treating rectal cancer: The watch and wait approach.

Background: Rectal cancer is one of the most common malignant pathologies worldwide. Currently, the standard treatment of this pathology consists of radio-chemotherapy followed by low anterior resection with total mesorectal excision or abdominoperineal proctectomy for medium/low rectal cancer. Objectives: In recent years, another treatment strategy has been proposed, stemming from the finding that up to 40% of patients receiving neoadjuvant treatment had a complete pathological response. This method, also referred to as the watch and wait approach, implies delaying surgery and following a rigorous protocol for patients who have developed a complete response to neoadjuvant treatment with a good oncologic outcome. The objective of this study was to highlight the merits of this approach in selected patients. Case Reports: In this study, we present two patients with low-rectal tumors who developed complete response post neoadjuvant therapy and for whom the watch and wait protocol has been applied over the past 4 years. Conclusion: Although the watch and wait protocol appears to be a feasible option in the management of patients with a complete clinical and pathological response post neoadjuvant therapy, more prospective studies and randomized trials comparing this approach with standard surgical treatment are required before establishing it as the standard of care for distal rectal cancer. Therefore, establishing universal criteria for the selection and assessment of the patients with a complete clinical response following neoadjuvant treatment is required.

Histopathological elements analyzed in dynamics in mechanical bowel obstructions - experimental study on laboratory animals.

Bowel obstruction is a syndrome that produces important alterations to the digestive tract, both macroscopically and microscopically. We conducted an experimental study using rats, Wistar strain, as subjects, dividing them into three groups. The group A consisted of six rats and served as control group, in the first day of the experiment a surgical procedure being performed to resect a small bowel and a colic segment to be analyzed microscopically afterwards. The 10 subjects from group B underwent a surgical procedure, in which we induced a mechanical bowel obstruction in the sigmoid colon, while to the 10 subjects from group C we induced a mechanical bowel obstruction in the small bowel. The initial protocol implied to observe the macroscopic modifications from five subjects from each group B and C after two days and afterwards to resect the digestive tract segment adjacent to the obstruction site. After another two days, a similar procedure was planned for the remaining subjects alive from both groups. A few subjects from group C died prematurely and the initial protocol had to be partially modified. The results highlighted an important distension of the digestive tract proximal to the obstruction, with important microscopically reactions, including edema, thrombosis, ischemic lesions and accumulation of polymorphonuclear neutrophils (PMN) and macrophages.

Traumatic Diaphragmatic Lesions - Considerations Over a Series of 15 Consecutive Cases.

Introduction: Diaphragmatic injuries are produced by blunt or penetrating thoracoabdominal trauma. They are potentially life-threatening due to the herniation of abdominal organs into the pleural cavities and severe associated lesions. The aim of this retrospective study was to analyse the clinical presentation and management of patients admitted with diaphragmatic rupture in our institution. Material and Method: We performed a 5-year retrospective study of patients admitted with acute blunt or penetrating diaphragmatic rupture in the Department of General Surgery of "Bagdasar- Arseni" Emergency Hospital. We have studied sex, age, mechanism of trauma, side-location, timeto-diagnosis, concomitant injuries, surgical treatment and outcome. Results: Fifteen patients (8 males, 7 females, mean age: 42 years) with diaphragmatic rupture (left-side: 13, right-side: 2) following blunt (8 patients) or penetrating (7) trauma were included. Patients with blunt diaphragmatic injury had larger tears and abdominal viscera herniation was observed in 6of these cases. A direct suture was performed for all 15 patients. Laparotomy was the surgical approach preferred in most of the cases. Mortality rate was 20%, mainly caused by severe associated lesions. Conclusion: Although traumatic diaphragmatic lesions are frequently associated with severe cerebral and thoraco-abdominal trauma that is also the main cause of death, a prompt diagnosis and treatment can lead to good outcome.

Therapeutical Aspects Regarding Pancreatic Pseudocysts.

Frequently appearing as a complication of pancreatitis, pancreatic pseudocysts are rare appearances in current medical practice. Multiple therapeutical options are available, from minimum invasive methods to complex open surgical techniques. The indications of drainage include symptomatic pseudocysts, large pseudocysts along with the development of complications such as hemorrhage, secondary infection, and rupture. Choosing the best drainage technique is often a challenge. Multiple factors need to be considered in managing a pseudoocyst, including its location, dimension and the patient's general state and comorbidities. Thus, a therapeutical algorithm may be of great use in choosing the most feasible technique for the diagnosed lesion that is also patient-adapted.

Histopathological diagnosis and its correlations with anatomoclinical features, surgical approach and postoperative prognosis in sacral tumors.

INTRODUCTION: Sacral tumors encompass numerous histopathological types. They represent an uncommon pathology and, when diagnosed, they are often in advanced stage of the disease, becoming a therapeutic challenge. The correct treatment of a sacral tumor should be established by a multidisciplinary team that will assess the exact anatomical, imagistic and histopathological characteristic of the tumors thus choosing an optimal surgical approach while taking into consideration the risk of recurrence. MATERIAL AND METHODS: We conducted a retrospective analysis of both primitive and metastatic sacral tumors in "Bagdasar-Arseni" Emergency Hospital, Bucharest, Romania, for a period of 10 years, studying demographic data, clinical signs, anatomical and histopathological features as well as surgical approach and postoperative prognosis. RESULTS: Sacral tumors were diagnosed with a peak incidence in the age group 60-69 years, being more frequent in women. Primitive sacral tumor was predominant and, in this subgroup, chordoma was the most frequent. Metastatic tumors appeared in older subjects. None of the histopathological types associated a preferred topography of the resection or increased resectability. Posterior surgical approach was chosen in most cases, total resection being a hard goal to accomplish due to the invasion of vascular and nervous structures. Bleeding was the most frequently reported incident, carcinomas recording the highest blood loss amongst primitive tumors. Overall prognosis was clearly favorable for subjects diagnosed with primitive sacral tumors. CONCLUSIONS: Interpreting imaging data in a clinical context, paying attention to histopathological examination and knowing each histological type characteristics is mandatory in choosing the surgical approach thus obtaining the best postoperative outcome possible.

Experimental study regarding the biocompatibility test of the Prolene (polypropylene abdominal mesh) product.

The polypropylene mesh, although is one of the most used prosthetic biomaterials for abdominal wall defects, proved not to be completely inert, generating from precocious foreign body inflammatory reactions (varying by individual reactivity, the amount of used material and its structure), to late complications such as chronic infections, stercoral fistulae or mesh migration. The present paper was aimed at studying the behavior of implants of this material in three different areas of the body of experimental animals, as follows: intramuscular, intraperitoneal and extraperitoneal. The observation time was 21 days and 90 days. We observed foreign body reactions induced locally by the mesh that remains temporary, generating a moderate number of macrophages and foreign body giant cells. The material did not systemically affect the healing and the scaring of the surgical wounds, but in all three implant areas, the polypropylene mesh generated locally a fibrous proliferation reaction of neoformation tissue, which wrapped and secured the implanted product on all surfaces.