[Pyogenic liver abscesses]. / Abcesele hepatice piogene.

BACKGROUND: Pyogenic liver abscesses were a relative rare disease. In the last decades the management of the liver abscesses was changed due to the new imaging and surgical techniques. AIM: To evaluate the clinical features, imaging techniques and treatment of the liver abscesses. METHODS: We performed a retrospective study during the last twenty years (1987-2007). The patients were divided in two groups: group I treated during the period 1997-2007 and group II, 1987-1996. We compare the clinical features, biological tests, imaging techniques and the treatment. RESULTS: Of the 71 patients with liver abscesses, 39 (54.9%) were included in group I and 32 (45.1%) in group II. The male/female ratio was 49/22; liver abscesses were more frequent to the males, in group I (63.3%) and more frequent to the women, in group II (63.6%) (p = 0.035). The mean age was 47.49 +/- 2.09 years old (range 18-85) with no difference between the groups (p = 0.059). The symptoms were similar in the two groups. We noted, as associated disease: diabetes--16% (N = 12), liver cirrhosis--7% (N = 5), malignancies--4.2% (N = 3). White blood cells were higher than 10000/mm3 in 51 patients (71.83%); a severe anemia with hemoglobin levels less than 10 g/dL was found in 25 cases (35.21%). All cases were investigated by ultrasound exam, but CT scan was performed in only 25 cases (19.71%). The abscesses were situated into the right lobe in 53 cases (74.6%), into the left lobe in 13 cases (18.3%) and into the both lobes in 5 patients (7%). The etiology was diverse: 25.4% after hepatic hydatid cysts, 12.7% with biliary origin, 22.5% with hematogenous and phlebitis origin and 39.4% with unknown origin (cryptogenetic). Treatment of the liver abscesses was surgical, by open (87.3%) or laparoscopic approach (8.5%), and percutaneous (ultrasound guided punction)--2.8%. One case was medical treated (antibiotherapy). Bacteriological exam found aerobic germs in 45 patients (64.28%), anaerobic germs in 3 patients (4.28%); the pus was sterile in 22 patients (31.43%). The intraoperative mean dimension of the liver abscesses was 74.26 +/- 4.35 mm (range 30-160), similar with dimensions measured by echography 72.29 +/- 4.84 mm (range 12-179)--p < 10(-3). Intraoperative bleeding was noted in 29 patients (40.8%). Univariate analysis revealed as prognosis factors for intraoperative bleeding, diameter of the liver abscess (p < 10(-3)), dimension of the residual cavity (p < 10(-3)) and the pus volume (p < 10(-3)). The multivariate analysis, by logistic regression, revealed as prognosis factors for intraoperative bleeding, pus volume (p = 0.006) and hemoglobin level (p = 0.035). Postoperative morbidity was 43.7%. Univariate analysis and logistic regression revealed the pleural effusion as prognosis factors for postoperative complications (p = 0.046) and, respectively, intraoperative hemorrhage (p = 0.010) and splenomegaly (p = 0.007). Postoperative mortality rate was 2.81%. CONCLUSIONS: Pyogenic liver abscess is a challenging disease with high rate of postoperative morbidity. Most of the abscesses are unique and situated in the right lobe of the liver. The imaging techniques, especially ultrasound exam and CT-scan, are essential for the diagnosis and the treatment of liver abscesses. The treatment is usually surgical, by open or laparoscopic approach; in selected patients the percutaneous approach can be performed.

Arthrodesis after failed total ankle replacement.

We present a series of 16 patients treated between 1993 and 2006 who had a failed total ankle replacement converted to an arthrodesis using bone grafting with internal fixation. We used tricortical autograft from the iliac crest to preserve the height of the ankle, the malleoli and the subtalar joint. A successful arthrodesis was achieved at a mean of three months (1.5 to 4.5) in all patients except one, with rheumatoid arthritis and severe bone loss, who developed a nonunion and required further fixation with an intramedullary nail at one year after surgery, before obtaining satisfactory fusion. The post-operative American Orthopaedic Foot and Ankle Society score improved to a mean of 70 (41 to 87) with good patient satisfaction. From this series and an extensive review of the literature we have found that rates of fusion after failed total ankle replacement in patients with degenerative arthritis are high. We recommend our method of arthrodesis in this group of patients. A higher rate of nonunion is associated with rheumatoid arthritis which should be treated differently.

Patient's satisfaction after outpatient forefoot surgery: Study of 619 cases.

INTRODUCTION: The number of outpatient surgical procedures performed in France on the forefoot has grown rapidly in recent years. OBJECTIVES: The goal of this study was to evaluate experience and satisfaction of patients undergoing outpatient foot surgery using a telephone questionnaire developed for this purpose. MATERIAL AND METHODS: In 2012 and 2013, every patient who was admitted to the day surgery unit at our hospital for an open procedure on their forefoot was called the morning after the procedure. A nurse went through the 14-item questionnaire with the patient. The same perioperative protocol, written instructions and treatment were used for all patients. RESULTS: Six hundred nineteen patients were included. The questionnaire response rate was 89% (n=540). Isolated hallux valgus surgery was performed on 319 patients (61%); 107 patients (20%) underwent hallux valgus surgery with lateral metatarsal osteotomy; 57 patients (10.5%) underwent first metatarsophalangeal fusion and 47 patients (8.5%) underwent a procedure on the lateral rays only. In the postoperative phase, 65% reported having satisfactory sleep quality, 32% had experienced nausea, 16% had experienced vomiting and 17% had experienced bleeding. Eighty percent of patients experienced pain (VAS ≥ 1); 80% of these patients had their pain relieved by the prescribed treatment and 4% had not taken it. Nearly all the patients (99%) were satisfied with the outpatient care; the overall satisfaction score was 9.4 out of 10. There was a significant relationship between the type of procedure and vomiting, pain, bleeding and fever. DISCUSSION: Outpatient care is becoming more common in response to economic challenges. The development of outpatient foot surgery appears to have satisfied the vast majority of operated patients. However, adjustments should be made to improve their tolerance to the pain management protocol. Although the logistics of performing follow-up call can be complicated, the patients appreciate receiving this call the next day. The call also seems to reassure both the patients and care providers.

[The hyperfunctional thyroid nodule]. / Nodulul tiroidian hiperfunctional.

Authors report their experience of 22 years regarding 284 patients with hyperfunctional thyroidal nodules (279 operated), representing 12.4% of the 2,289 cases of thyroidal (875 hyperthyroid) diseases treated during this period. The diagnosis was established on the basis of the confrontation of the anamnestic symptomatology and of that found at the clinical examination--which confirmed the pure character of thyrotoxicosis by showing the presence of a thyroidal nodule--with the study of the global glandular function and the scintigram, completed with dynamic tests. Among the typical clinical and scintigraphic, usually severe, forms (with cardiothyreosis) may be distinguished asymptomatic or atypical forms (with dissociated or intermittent manifestations). The treatment of the toxic thyroidal adenoma is surgical, except some contraindications of a general order. The surgical treatment is aimed at achieving the permanent cure of the disease, without sequelae or functional and/or morphological relapses. The subtotal lobectomy (210 cases) is preferred as an exeresis procedure to the enucleoresection (45 cases). In most operated cases (93%) the immediate clinical and biological results were favourable.

[Choledochal cyst in adults and cancer of the biliary tract]. / Chistul de coledoc la adult si cancerul caii biliare.

We presented 3 cases of cystic dilatation of common bile duct classified as type IC, IVB an IVA. All 3 were women, admitted for right upper quadrant pain and jaundice. Two cases proved malignant degeneration in cystic dilatation in first cas and in gallbladder in third. Only the 3rd case had a positive preoperative diagnosis achieved through echography, TPHC, ERPC. Surgical treatment consisted of cysto-jejunal derivation in the cas of the common duct malignant cyst inoperative and cholecystectomy associated with the excision of the dilatation followed by the hepato-jejunal anastomosis in the other 2 cases. Adenocarcinoma of the gallbladder was a pathological surprise. A better knowledge of the risk of cancer on cystic dilations of the common bile duct should lead to an earlier diagnosis of this disease and a preventive treatment by radical excision of the dilatation.

Nanostructured Silica-Based Organic-Inorganic Hybrid Materials-Evidence for Self-Organization of a Xerogel Prepared by Sol-Gel Polymerization.

A hydrolytic polycondensation reaction of a rigid, rodlike nonmesomorphous precursor leads to an isotropic sol and then an anisotropic birefringent xerogel (see scheme). Optical and X-ray structural analyses demonstrate a short-range order and the possibility of a crystalline order.

[The Wermer syndrome]. / Sindromul Wermer.

The difficult diagnostic and therapeutic management of patients having gastrinoma with multiple endocrine neoplasia type I (MEN I) has been discussed by reference to the literature and a personal experience of 2 patients with Wermer syndrome. The syndrome is often familial and might be inherited as an autosomal dominant trait with a high but variable degree of penetrance. Pancreatic islets, parathyroid glands and adenohypophyseal [correction of antehypophyseal] cells are the three localization main for endocrine involvement in MEN I syndrome.

[Tumors of the small intestine]. / Tumorile intestinului subtire.

On the basis of 20 observations of tumours of the small bowel a series of diagnostic, therapeutic and prognosis of these lesions are discussed. Malignant tumours of the small bowel (10 adenocarcinomas and 2 sarcomas in the present statistics) represent 1,9 per cent of the total number of malignant tumours of the small bowel. The patients were hospitalized following an acute complication occlusion, haemorrhage, perforation). Four of the patients benefited from a curative treatment, in 5 only a derivation was possible, and in 9 only exploratory laparotomy and bioptic sampling. Eight of the tumours were benign and consisted in : 3 fibromas; 2 neurogenic tumours; 2 adenomatous polyps, and one lipoma. All were discovered in the course of emergency surgery for occluding syndrome or haemorrhage, and benefited from a radical treatment. Two deaths were recorded in the entire series (one following embolism in the 10-th day after surgery and another in the 3-rd day with occluding shock). Both patients were in a condition of severe hydroelectrolytic imbalance.

Cystic parathyroid cancer. Case report.

A patient hospitalized for the assessment of a "thyroid nodule" is presented. Scintigraphically the nodule was cold. Thin needle aspiration biopsy by which 50 ml of a clear fluid was drawn, proved the nodule to be of cystic nature. Phospho-calcium findings allowed the diagnosis of primary hyperparathyroidism though the patient presented no subjective complaints. Histologic examination of the tissue removed intraoperatively revealed a cystic parathyroid neoplasm.

[Mechanical anastomoses in esophagogastric surgery for malignant tumors]. / Anastomoses mécaniques dans la chirurgie oeso-gastrique pour des tumeurs malignes.

The authors present their experience in employing for the first time the mechanical circular suture with I.L.S. stapler in the surgery of 10 malignant esophagogastric tumors sited in C (4 cases) and M areas (6 cases). The disease was in stage II in 2 patients and in stage III in the remainder of 4. Three upper polar esophagogastrectomies (Akiyama technique) and 7 total gastrectomies were performed in old patients (mean age 63 years) at high surgical risk. Neither death nor fistulas were recorded. The average hospital stay was 14 days. A series of 17 patients (mean age 59 years), at medium surgical risk, with total gastrectomy for gastric carcinoma and classical suture served as controls. Five fistulas, two deaths and a two times longer hospital stay were recorded. Although the high cost of staplers prohibits the routine use of this technique, the authors demonstrate the great advantages resulting from mechanical suture in esophagogastric surgery.

["Biloma": its diagnosis and treatment by percutaneous echo-guided evacuation]. / "Biloma": diagnostic si tratament prin evacuare percutana ecoghidata.

The term "biloma" describes an intra-abdominal bile collection secondary to traumatic or iatrogenic injury of the biliary tree. We present a case of biloma treated by guided percutaneous needle aspiration.

[Megaduodenum due to aortomesenteric shunt]. / Megaduoden prin pensa aorto-mezenterica.

Two new cases of megaduodenum by aortomesenteric shunt in young adults are presented. The role of some risk factors, the diagnostic and therapeutical elements are discussed, the importance of a thorough investigation of each case in view of individualizing the therapeutical management being underlined.

[Isolated traumatic lesions of the abdominal wall musculature]. / Leziuni traumatice izolate ale musculaturii peretelui abdominal.

Six cases of isolated traumatic lesions of the abdominal wall muscles (2 ruptures of the right abdominal muscle and 4 of the anterolateral muscles) are reported. The presence of a "fixed" hematoma or even of a true subcutaneous eventration, the case history (for finding out the injury mechanism or unusual muscular effort), the X-ray examination of the abdomen and especially the ultrasonography can establish the diagnosis. The treatment of this lesion is usually conservative, surgery (performed in 3 cases) being indicated only in those ruptures with large parietal defects or hematomas or in case of diagnostic doubts.

[The value and limits of subtotal gastrectomy in gastric cancer]. / Valoarea si limitele gastrectomiei subtotale în cancerul gastric.

In the interval 1970-1988, in 321 of 670 patients with gastric neoplasm admitted to the 1st Surgical Clinic of Iasi a subtotal gastrectomy was performed. Most patients were males (68.9%), more commonly aged between 50 and 70 years and in advanced evolutive stages. The gastric neoplasm were sited in order of frequency in the antrum (46.9%), body of the stomach (34.6%), eso-cardio-tuberosity (11.5%), linitis (4%), gastric stump and malignant ulcer (3%). Surgery was possible in only 59% of the cases (25% curative and 34.1% palliative). The surgical technique and its difficulties are detailed. In the 321 subtotal gastric resections 20 complications, 4 deaths (1.2%) and 20% survivals over 5 years were recorded. It is concluded that radioendoscopic and microscopic investigations, with their possibility of an early diagnosis, may cause a limitation of the indications of total gastric resection in the treatment of gastric neoplasm in favour a subtotal resection, more satisfactory from the functional viewpoint.

[Perforated gastric ulcer]. / Ulcerul gastric perforat.

Out of 603 patients with perforated ulcer, 40 clinical cases with type I perforated gastric ulcers (this particular anatomo-clinical form being distinguished from the perforated duodenal ulcer) were selected. The perforated gastric ulcer type I, less common, is usually found in the patients over 45 years, with old, callous ulcers; in general, when the perforations are large, a malignancy is suspected, the removal of the lesion and the systemic control of the resected specimen being required. The primary radical surgical treatment is performed only in the patients in good general state, the excision of the ulcer followed by suture being reserved to the cases at high risk, with increased mortality (10%).

[Malignant tumors of the digestive tract below the diaphragm in young people]. / Tumori maligne ale tubului digestiv subdiafragmatic la tineri.

We have retrospectively studied 1243 malignancies of the infradiaphragmatic tract treated in the First Surgical Clinic between 1978-1994 (678 gastric, 300 rectal and 256 colonic malignancies). Out of these 39 cases have been encountered in young patients (14 gastric, 13 colon and 12 rectal malignancies). The following particularities have been noted in this group: hereditary predisposition, more advanced stage at diagnosis, predominance of non-Hodgkin lymphomas and poorly differentiated forms. Young age does not significantly influence prognostic, with the control group. In young people the most important prognostic factors are tumor stage, cellular grading and tumor DNA index as determined by flow cytometry.

[Prevention and therapy of postoperative thyrotoxic crisis]. / Profilaxia si tratamentul crizei tireotoxice postoperatorii

Out of a group of 361 patients with various anatomo-clinical forms of hyperthyroidia--of which 328 had underwent surgery--hospitalized in the Surgical Clinic from Jassy between 1965 and 1974, a total of 17 observations are analised, from the clinical and the therapeutical viewpoint, that showed postoperative thyreotoxicosis crisis. The fact is stressed that the prophylaxis of the crisis is dominated by the principle that no case of hyperthyroidia should be operated on before it has been perfectly balanced from the endocrinological viewpoint. The complex treatment of the cases that are presented included a symptomatic component to which were associated oxygen therapy, tonics, vitamins, hepatotrop preparations, eventually antibiotics. The results obtained--complete recovery in all the cases--can be compared with the best from the literature.

[Unusual localizations of hydatid cysts]. / Localizari rare ale chistului hidatic.

In a total of 448 hydatic cysts that have been treated in the I-st Surgery Clinic of Jassy between 1947 and 1977 rare localizations were noted in 61 cases. Of these 47 were primary echinococcoses and 14 were secondary. The clinical and therapeutic aspects are discussed for each particular localization: the splenic localization was encountered in 16 cases, the peritoneal one in 10 cases, the diaphragmatic in 6 cases. There were also 2 renal localizations, 3 retro-peritoneal ones, 3 ovarian and salpyngean localizations, 3 thyroid, 7 endo-thoracic but extra-pulmonary, 5 muscular and 6 subcutaneous localizations. Radical surgery had immediate and late results that were quite satisfactory. No deaths or recidives were noted.

[Cephalic duodenopancreatectomy with pyloric preservation in the treatment of pancreatic cancer]. / Duodenopancreatectomia cefalica cu pastarea pilorului în tratamentul cancerului de pancreas.

UNLABELLED: Is the application of DPCPP in the treatment of pancreatic neoplasia a good reason? We have analysed 30 patients with cephalic duodenopancreatectomy (DPC) for biliopancreatic neoplasia between 1995-1999 in Ist Surgical Clinic of Iassy (13 with pyloric preservation). The indications were:--cephalic pancreatic neoplasia (adenocarcinoma--4 cases (one with cephalic chronic pancreatitis on the intraoperative microscopical examination);--Vater ampulloma (7 cases);--inferior common biliary duct (CBD 1 case);--duodenal adenocarcinoma (1 case). In the same time was operated 265 biliopancreatic diseases (203 mechanical jaundice with 132 neoplastic jaundice). RESULTS: --Better early postoperatively status of the patients--DPCPP does not give better prognosis;--there are necessary some technical skills to depase the important phases of DPCPP.