Technical performance of colonoscopy -- multicenter study in university and non-university centers of Romania.

UNLABELLED: The aim of the paper was to evaluate the national availability of colonoscopy and the quality parameters of this procedure in our country. MATERIAL AND METHOD: During a 6 months period (01.07- 31.12.2009), we performed a prospective multicenter study in which 76 centers were invited to respond to a questionnaire regarding colonoscopy, 39 centers agreeing to participate. We assessed: the number of colonoscopies, the number of total colonoscopies and the causes of incomplete colonoscopies. RESULTS: During the study period, 16,083 colonoscopies were performed, 12,294 (76.4%) of them total colonoscopies. In 1,191 cases, stenosis was the cause of incomplete colonoscopy. If we consider this an objective reason for an incomplete colonoscopy, there were 12,294 total colonoscopies (82.4%). Comparing university centers with non-university ones, the proportion of total colonoscopies was 10,400/12,475 (83.4%) vs. 1,894/2,417 (78.4%) (p less then 0.0001). However, comparing the present study with previous ones, performed in 2003 and 2007, the proportion of total colonoscopies increased from 70.5% to 76.9% and 82.4% respectively (2003 vs. 2007 p less then 0.0001; 2007 vs. 2009 p less then 0.0001), while the quality difference between university and non-university hospitals persisted. CONCLUSIONS: the quality of colonoscopy in Romania increased in the last 5 years, while the quality difference between university and non-university hospitals persisted.

Polycystic liver disease with complications: fenestration by laparoscopic approach.

AIM: Isolated polycystic liver disease is a rare congenital cystic liver disease with autosomal dominant transmission. Its main feature is the presence of a large number of cysts of different sizes in the hepatic parenchyma, which have a benign evolution. METHOD: We present the case of an 80 years old male patient with massive polycystic liver disease, diagnosed three years ago by ultrasound examination and abdominal computed tomography scan. The evolution of the disease had been complicated by compressive symptoms, caused by the large dimensions of the cysts. The patient presented with abdominal pain, nausea, vomiting and lost weight. Cyst fenestration through laparoscopic approach resolved the symptoms. RESULTS: The patient was mobilized on the day of the surgery, and was discharged on the 9th postoperative day, after drainage tube removal. CONCLUSIONS: Isolated polycystic liver disease is rare. Surgical treatment is indicated only if complications occur. The laparoscopic approach is an alternate treatment method, if needed. The patients benefit from the advantages of minimally invasive surgery.

[Sentinel lymph node mapping in colorectal cancer]. / Determinarea ganglionului santinela în cancerul colorectal.

UNLABELLED: Colorectal cancer is the most common malignant tumor of digestive tract with high mortality due to local reccurences and metastases. These are due to micrometastases undetected by classical microscopic examination of regional lymph nodes. Sentinel lymph node SLN technique in colorectal cancer may lead to identification of micrometastases using immunohistochemistry. METHODS: We present our experience in SLN mapping in colorectal cancer using a limphofil dye, on 52 patients. We present the patients selection criteria in the study, the technique of SLN detection. RESULTS: Identification of SLN was performed in 48 cases, it failed in 4 cases. In 27 cases, 1 SLN was identified, in 21 cases 2 SLN were found. In 4 cases the SLN were false negative. In 30 cases SLN were negative on histopathology and immunohistochemistry. In 14 cases, SLN were positive, 4 cases presented micrometastases confirmed only by immunohistochemical methods. CONCLUSION: SLN technique in colorectal cancer: - doesn't change the surgical approach regarding the regional lymphadenectomy; - can modify the tumor stadialization by detecting lymph nodes micrometastases; - increase the number of patients who can benefit from the adjuvant chemotherapy and therefore, it may improve the prognosis.

[Long-term follow up after surgery for intractable ascites]. / Rezultate tardive ale tratamentului chirurgical pentru ascita netratabila.

The aim of the study is to evaluate the outcome of a selected group of 24 patients who underwent surgery for refractory ascites, in a 10 years period, 1995-2005. CLINICAL DIAGNOSIS: Alcoholic cirrhosis (n=18), inferior cava thrombosis (n=2), splenic vein thrombosis (n=1), cryptogenic cirrhosis (n=3), with association of variceal bleeding and refractory ascites. The surgical procedures consisted of porto-sistemic shunts (n=12), peritoneo-saphene shunts (n=10), mesenterico-caval shunt (n=1), mesenterico-right atrium shunt (n=1). Early results were very good: no postoperative mortality, no general haemo-dinamic failure, no renal fonctional failure, no encephalopathy. 7 of 10 peritoneo-saphene shunts had an excelent evolution, but in three cases the results were unsatisfactory, the patients continuing the medical treatment. Except one patient who died after 2 years, for B virus and alcoholic abuse, all the patients survived 5 or more years. There was not evidence of digestive hemorrhage or uncontrolable encephalopathy and thrombocytopenia. The grade of esophageal varices was mantained lower than II, ascites remained minimum or absent, and biological parameters were normal or slightly elevated. CONCLUSIONS: In the absence of the technical and economical possibilities of TIPS and liver transplantation, surgery for intractable ascites is a good option in selected patients, especially in the absence of viruses and alcohol consumption, and can improve complications in the natural evolution of the disease.

[Local recurrence after the sphincter-saving operations and abdominal perineal resection in rectal cancer]. / Recidiva tumorala locala dupa chirurgia conservatoare si rezectia abdominoperineala în cancerul rectal.

By local recurrence we define the appearance of the same anatomopathological type of cancer like the one initially described in the primary tumor, limited at the rectum or pelvis.The study is based on the analysis of all the cases with rectal cancer who undergone surgical procedures in Surgical Clinic No.2 Tg. Mures in the last 5 years. Using the most important parameters for each patient we identified some risk factors for the recurrence of the rectal cancer: surgical procedures--there were no major variations in the local recurrence between the sphincter-saving operations and abdominal perineal resections. The most frequent recurrence tumors appeared after Hartmann I operation; the moderate aggressive adenocarcinomas at the old patients and high aggressive adenocarcinomas in young patients, T3, T4 stages. The recurrent rectal cancer is more frequent in aged patients with high aggressive adenocarcinomas. There were no major differences in recurrence rate between the sphincter-saving operations and abdominal perineal procedures.

[Gastric stromal tumor with liver and subcutaneus metastasis. Case report]. / Tumora stromala gastrica cu metastaze hepatice si subcutanate. Prezentare de caz.

UNLABELLED: The gastrointestinal stromal tumours expand from the undefine mezenchimal cells of the intestinal wall and the origin is in the Cajal interstitial cells. The agresivity of GIST is difficult to be evaluate. Very importants factors for grading are the tumour localisation, the invasion of serosa or mucosa, the dimensions of tumour and the number of mytosis. We present a case with haemoragic gastric stromal tumour, with small dimensions, which was initially diagnosed as a "benign" tumour. Seven years after the operation, the patient presented voluminous liver metastases. After right hepathectomy and medical treatment with Glivec we followed up the case. Eleven years after the first operation she presented a subcutaneus metastasis in parietal region, which was confirmed with imunohistochemical exam. The patient is still under observation with higher doses of Glivec. CONCLUSIONS: The gastrointestinals stromal tumours represent a very rare group of digestive tract tumors, with malignant potentially evolution; the first choice of treatment is surgery, with complete ablation of the tumour. The medical treatment with Glivec is necessary in case of reccurence or metastases; the stromal tumours present a strange evolution, for this reason all the patients must be under medical observation, for the rest of their life.