Results of in vitro fertilization after diagnosis and treatment of chronic endometritis.

OBJECTIVE: A significant cause of infertility is the inability of the embryo to implant. Endometritis is one of the major causes affecting embryo implantation. The present study addressed the diagnosis and effects of chronic endometritis (CE) treatment on pregnancy rates after in vitro fertilization (IVF). PATIENTS AND METHODS: We conducted this retrospective study on 578 infertile couples treated with IVF. In 446 couples, we performed a control hysteroscopy with biopsy before IVF. In addition, we examined the visual aspects of the hysteroscopy and the results of the endometrial biopsies, followed by antibiotic therapy if necessary. Finally, the results of IVF were compared. RESULTS: Of the 446 cases studied, we diagnosed 192 (43%) with chronic endometritis, either by direct observation or based on the histopathological result. In addition, the cases diagnosed with CE we treated with a combination of antibiotics. The group diagnosed at CE and subsequently treated with antibiotic therapy had a significantly higher pregnancy rate after IVF (43.2%) than the group without treatment (27.3%). CONCLUSIONS: Hysteroscopic examination of the uterine cavity was particularly important for the success of IVF. The initial CE diagnosis and treatment were an advantage for the cases in which we performed the IVF procedures.

Breast-conserving surgery in breast cancer.

The breast cancer treatment is based nowadays on new surgical options: breast-conserving surgery, which applies at least for the first and second stage cancer, with radical intention. We have been practicing breast-conserving surgery for the last 16 years and we have performed 303 breast conserving operations from a total of 673. We recorded 12 local recurrences (3,96%) and 2 deaths due to cancer progression. Our protocol includes removal of the primary tumor with enough surrounding tissue to ensure negative margins of the resectable specimen, associated with axillary lymph-node dissection and postoperative breast irradiation. Our oncologist indicated chemotherapy on different postoperative conditions: tumor size, axillary lymph node involvement, patient's age, etc. The purpose of this paper is to emphasize our modest experience, nevertheless to draw the attention on important results, obtained by long-term monitoring of the patients who underwent breast-conserving surgery, in a two prospective protocols, and demonstrate the importance and applicability of breast conserving therapy. The conclusion of this study is that breast-conserving surgery followed by breast irradiation is reliable, as the results are similar with radical mastectomies; the main objective is to obtain a good cosmetic result, which depends on tumor size / breast size.

[Diseases mimicking advanced-stage epithelial ovarian cancer]. / Afectiuni mimând cancerul ovarian epitelial în stadiu avansat.

This paper draws attention towards 3 cases with different pathologies all of which suggesting however both clinically and by imaging means as the most likely diagnosis advanced-stage epithelial ovarian cancer since all these three postmenopausal women had been admitted to the hospital with ascites, pelvic masses and deterioration of the physical wellbeing (fatigue, decreased appetite, weight loss, pallor). Findings during exploratory laparotomy on all these three pacients included ascites (hemorragic in one case) diffuse tumorous implants throughout the abdominal and pelvic peritoneal surfaces (in two cases) and the ovarian tumour. Postoperatively, the final histopathologic diagnoses consisted of primary peritoneal carcinoma (one pacient), peritoneal tuberculosis (TB, one pacient) and hepatic cirrosis with an incidental benign adnexial mass (one pacient). Moreover, nonmalignant ovarian tumours were certified in all three cases under current presentation. The differential diagnosis of the ovarian cancer and a tailored approach to treatment for each of these three pathologic entities will also be described in detail.

[The primitive gastric non- Hodgkin lymphoma]. / Limfomul gastric primitiv non-hodgkinian.

THE PURPOSE: Of this work is to point out diagnostic problems together with the surgical indications in primitive gastric non-Hodgkin Lymphoma (LGNH). THE MATERIAL AND METHODS: Consist of 11 cases of LGNH (3.09% of 350 gastric cancers that underwent surgery between 1991-2000) of which 4 were women and 5 men, of an average 53 years of age. Three of the cases underwent surgery for various complications (HDS, perforation and pyloric stenosis) or for other clinical forms such as the pseudo-ulcerative one (4 cases) and the gastric carcinoma mimicking form (4 cases). Preoperative diagnosis was established by means of endobiopsy in 5 cases. SURGICAL TREATMENT: total gastrectomy (4 cases), inferior polar subtotal gastrectomy (5 cases) and 2/3 gastric resection (2 cases). RESULTS: Complications involving sub-phrenic abscess that triggered re-intervention in 2 cases; no immediately postoperative mortality. THE DISCUSSIONS AND CONCLUSIONS: Are enumerating the difficulties we encountered in diagnosing the cases and especially in the preoperative histologic diagnosis, the staging of the disease and setting the treatment with an emphasis on the surgical treatment. THE COMPLICATIONS: Induced by the disease, the diagnosis uncertainty and the early stages of the disease are as many eligible indications for the first linje surgical treatment in LGNH.

[Nosocomial infections in the Clinica Chirurgie CFR, Craiova]. / Infectii nosocomiale în Clinica Chirurgie CFR Craiova.

The authors present Craiova CFR General Surgery Clinic experience on hospital infections from 1991 through 1996. This study shows that the frequency of hospital infections in our clinic is greater than all the other postoperative complications. Over the investigated period of time we witnessed an increase in the incidence of the postoperative septic complications in addition to those directly linked to the operated interventions (e.g. wound infections, postoperative peritonitis) such as: pulmonary infections: urinary tract infections, catheter sepsis etc. Finally, the authors pointed to the consequences of the hospital infections such as: mortality and late morbidity rates, economic implications. Thus, it is worth mentioning that 30 deaths (75%) out of our clinic total of 40 over the studied period of time were due to a postoperative infections and treatments.