Pure pectus carinatum (not associated with pectus excavatum) solved by MIRPC (minimally invasive repair of pectus carinatum) associated with bilateral mamarian hypoplasia solved by bilateral breast implants.

We present the case of a young 24-year-old woman with an important but symmetrical pectus carinatum, not associated with pectus excavatum, without cardiorespiratory symptoms but with significant psychosocial implications for the patient, solved by the minimally invasive technique described by Abramson(reversed Nuss procedure) - MIRPC (Minimally invasive Repair of Pectus carinatum). The sternal malformation was associated with bilateral mammary hypoplasia, solved by bilateral breast implants 10 months later. The evolution was favorable and the aesthetic result was satisfactory for the patient.

[Morphometric vectorial method of analysis of the frontal sinuses]. / Méthode d'analyse morphométrique vectorielle des sinus frontaux.

The frontal sinuses are pneumatic cavities located in the thickness of the squama frontalis, which communicate with the nasal cavity through the frontonasal duct. These cavities develop by the pneumatisation extent of some anterior ethmoidal cells. Morphologically, there is a large variability of the frontal sinus shape, size and extent, the position of the intersinusal septum, the existence and number of intrasinusal septa. There exist morphologically atypical frontal sinuses as: uni- or bilateral frontal sinuses aplasia, supernumerary sinuses, great extent of the cavities. Paranasal sinuses can be explored by different methods, but the most accessible and easy to perform is conventional radiological imaging. The radiographs can be morphometrically assessed in order to prove the individuality of these air cavities.

[Rare indication of cephalic duodenopancreatectomy with total gastrectomy--periampullary carcinoma in moderate form of familial adenomatous polyposis]. / Indicatie rara de duodenopancreatectomie cefalica cu gastrectomie totala-- adenocarcinom periampular cu polipoza adenomatoasa familiala forma atenuata.

We present the case of a 52 years old man, with significant familial history, diagnosed with familial adenomatous polyposis-attenuated form, with no clinical and endoscopic surveillance until 2001 when he was admitted for an upper gastrointestinal haemorrhage episode. Upper gastrointestinal scopy revealed duodenal adenomatous polyps and gastric hyperplastic polyps. The patient underwent duodenopancreatectomy with total gastrectomy. The histopathological exam revealed duodenal G2 adenocarcinoma pT3N0, and gastric hyperplastic polyps with no signs of dysplasia. The surgical procedure was followed by chemotherapy. In 2002 the patient was admitted for rectal bleeding and colonoscopy showed 2 sigmoid polyps, appropriate for endoscopic removal and a poly-lobate polyp in the transverse colon. The patient underwent transverse colectomy (the histopathological exam--in situ carcinoma). March 2003--the patient underwent endoscopic removal for a rectal polyp (histopathological exam: moderate dysplasia). In 2005 was noted a pulmonary nodule, located in the postero-apical segment of upper left lobe, for which left superior lobe resection was performed (the histopathological exam: metastatic adenocarcinoma). In May 2006 was performed an exploratory laparotomy. Intraoperatively were noted: peritoneal carcinomatosis and multiple liver metastasis. The surgical procedure recommended in patients with attenuated form of familial adenomatous polyposis and suspect periampullary lesions is duodenopancreatectomy. The particularity of the case is the association of total gastrectomy for gastric hyperplastic polyps.

Disseminated tuberculosis with gradual evolution and unusual localization.

We present a case of disseminated tuberculosis (pulmonary, skeletal and lymph nodes) accompanied by subcutaneous abscesses and with unusual localization, osteolytic lesions of the skull caused by Mycobacterium tuberculosis var. hominis. Although the patient was immunocompetent, the disease had a gradual and unexpected progression. In the malign forms of tuberculosis, treatment must be extended for a year or more.

[Intraoperative exploratory endoscopy in surgery of the digestive tract]. / Explorarea endoscopica intraoperatorie în chirurgia tubului digestiv.

The intraoperative endoscopy as a way of the range of the surgical exploration of the abdomen is a valuable procedure combining surgical and endoscopical maneuvers. It proved useful in following conditions: A. delicate surgical approach of the anatomical segment; B. equivocal findings of the conventional endoscopy; C. as a way of achieving therapeutical goals. In 56% of the cases a transperitoneal approach was used and in the rest of the cases a conventional technique. Sterilization was performed using glutaldehide 2%, 20 minutes before the intervention. The methods was used in 50 cases, concerning reinterventions, as well as primary diseases of unclear origin. Some were high-risk patients. Therapeutically benefit was proven in all cases.

[An endoscopic treatment method for postoperative stenoses]. / Metoda endoscopica de tratament a unei stenoze postoperatorii.

The endoscopic procedures include a great variety of procedures for the treatment of the upper and lower gastrointestinal bleeding of the benign and malign jaundice, of the primary or secondary gastrointestinal strictures. The authors present the case of a patient with a postcaustic oesophageal stricture for whom the surgical treatment was an esogastroanastomosis. Quite early in the postoperative course the anastomosis got, very tight due to a anastomotic fistula, and we succeed to dilate it with endoscopic procedures.

[The therapeutic options in central hydatid cysts of the right hepatic lobe]. / Optiuni terapeutice în chisturile hidatice centrale ale lobului hepatic drept.

The authors of the article propose a method that is highly efficient and presents minimal risks in the treatment of hepatic hydatid cysts located in the central area of the right lobe. This "dangerous area" of the VIIIth segment generates the most delicate problems for the surgical treatment, due to limitation of therapeutic solutions and the highest rate of postoperative complications. The technique presented is that of external extraperitoneal transligamentous drainage introduced by D. Burlui in 1968. This technique should be considered as an alternative to lobectomies or wedge resections or to the direct external drainage of the remaining cavity, the latter being responsible for numerous complications. Considering the figures covering the past 35 years at Caritas Hospital, the authors note the decrease of corrective reinterventions from 27% to 10% after 1968. By associating cholecystectomy after 1983 they dropped to only 4%. The authors do not claim that the method should be universally applied but consider it obviously the choice in the treatment of hydatid cysts in the "dangerous area" in which other therapeutic methods are inappropriate (pericysto-digestive anastomosis) or excessive (right lobe resection), avoiding the problems of direct drainage.

[A rare cause of postoperative digestive hemorrhage]. / Hemoragie digestiva postoperatorie de cauza rara.

Despite all the diagnosis's technical progress achieved in the past years, there are possible haemorrhagic complications after abdominal surgery, creating problems of diagnosis and treatment. The author presents a rare case of postoperative gastrointestinal bleeding due to an ulcer of the jejunal mucosa, located quite close to a hepaticojejunostomy. The mucosal ulcer, with consequent severe, massive bleeding was caused by the migration of a thread from the hepaticojejunostomy, proved by histopathological examination.

[Stenosing hypertrophic antromyopathy]. / Antromiopatia hipertrofica stenozanta.

The authors describe a case of insufficiency of gastric evacuation, due to the a very rare injury of the antrum which they called:--"hypertrophic and stenosing antromiopathiae". By similarity with the pilor hypertrophy, but without altering the pilor which is intact, the hypertrophy involves especially the gastric antrum, the muscular tunic--mainly the circular fibres in the absence of any acute or chronic inflammatory process. In the interstice between the muscular fibres, there appear collagen fibres in spiral disposition, probably in a contraction. Due to the similitude of the clinical syndrome, the described disease could be ranged among the stenosant diseases of the pyloric pole of the stomach. Out of these, more frequently pointed out, although very rare too, seems to be the pilor hypertrophy at adults. Mention must be made that the two diseases are completely different, because in the "Hypertrophic and stenosing antromiopathiae", the pilor is macroscopic and at the same time normal from the histopathologic aspect point of view.

Hepaticojejunostomy without suture.

Common bile duct (CBD) surgery sometimes demands performing 'a la Roux' hepaticojejunal anastomosis. This kind of stoma is technically easy to perform on a biliary stump of sufficient width (> 8 mm), sufficient length (> 0.5 cm) and with a resilient wall so that stitches will not cut off. In some cases, however, the anatomical conditions are poor: short or thin biliary stump. This situation is especially encountered in iatrogenic lesions of the main biliary channel, but it can infrequently be found in some malignant lesions of the CBD. The authors present their procedure of hepaticojejunal anastomosis without suture, which is adequate for the treatment of benign or even malignant stenosis of the CBD. The method realizes anastomosis of the segments without using sutures by simply keeping them in apposition with continuous traction exerted via a Foley-type balloon catheter which stents the anastomosis in an axial manner. The balloon is then inflated and traction is exerted on the catheter, enabling the two segments of the anastomosis to remain in place until complete healing (10 days average). We performed the procedure in 7 cases: 4 for neoplastic stenosis, and 3 for an accidental lesion of the CBD. There was no perioperative morbidity and 1 fatal outcome. The results prompt further evaluation of the method.