[Immunohistochemical screening of hMLH1 and hMSH2 gene mutations in patients diagnosed with colorectal cancer and microsatellite instability suspicion]. / Screeningul imunohistochimic al mutatiilor genelor hMLH1 respectiv hMSH2 la pacientii diagnosticati cu cancere colorectale si suspiciune de instabilitate microsatelitara.

STUDY AIM: Immunohistochemical screening of hMLH1 and hMSH2 gene mutations in patients diagnosed with colorectal cancers, suspected of having microsatellite instability, as diagnosed between January 2002 and December 2009 in the Surgery Department of the CF Clinical Hospital Cluj-Napoca (prospective non-randomised study). METHODS: Inclusion criteria were adenocarcinoma pathology finding and also minimum one of the revised Bethesda criteria for genetic testing of microsatellite instability in colorectal cancers. 110 eligible patients were divided in 2 study groups according to the number of Bethesda criteria met (group A - 1 criteria; group B - 2 or more criteria). Both groups were statistically compared considering the clinical and pathological parameters specific to the Lynch syndrome. We performed immunohistochemical staining to determine the expression of hMLH1 and hMSH2 genes in the tumors of all the patients. RESULTS: We found the differences in age, colorectal family history and right colon tumor site between the two groups to be statistically significant. Immunohistochemical stainings showed lack of hMLH1 gene expresion in 9 patients and of hMSH2 gene in 4 patients respectively. CONCLUSIONS: Immunohistochemical staining can identify patients who need to be genetically tested for mutations of the DNA mismatch repair genes, in order to establish the correct diagnostic of Lynch syndrome.

[Physiopathologic and clinical aspects of Krukenberg tumors]. / Aspecte fiziopatologice si clinice ale tumorilor Krukenberg.

Although described for the first time for more than one hundred years ago, Krukenberg tumors still retain some controversial aspects. The lack of consensus and consistency in using a single definition, the difficulty to admit the existence of a primitive form of the tumor, the lack of knowledge concerning the precise mechanisms of metastases and the absence of a distinctive and characteristic clinical symptoms which often contrasts the usually large dimensions of the tumor are some of the aspects which need further elucidation.

[Krukenberg tumors of gastric origin versus Krukenberg tumors of colorectal origin]. / Tumorile Krukenberg cu origine gastrica versus tumorile Krukenberg cu origine colorectala.

The aim of this study was to analyze the incidence and origin of Krukenberg tumors in our region to determine their clinical behavior and to compare some anatomo-clinical features of Krukenberg tumors of gastric origin versus those of colorectal origin. This is a retrospective, descriptive and comparative study of Krukenberg tumors diagnosed and treated in the IV-th Surgical Clinic of Cluj-Napoca. The epidemiologic features concerning global incidence, age, and menopausal status overlap the data from literature. Characteristic for our series of cases were the higher incidence of Krukenberg tumor of colorectal origin compared with those of gastric origin , significantly more frequent bilaterality of lesions of gastric origin and the prevalence of the unilateral left ovarian localization for Krukenberg tumors of colorectal origin. The differences in anatomo-clinical behavior between the Krukenberg tumors of gastric and colorectal origin may indicate different pathways of metastasizing and seeding.

Nonparasitic abdominal serous cysts. A multiple case report.

A group of 35 patients with nonparasitic abdominal serous cysts is reviewed in order to investigate the diagnostic and therapeutic features of these rare conditions. In most cases the cysts were localised in the liver. Other localisations were the kidney (9 cases), the mesenteric area (2 cases), the adrenals (2 cases), the spleen and the pancreas (one case each). The clinical symptoms were essentially determinated by the size of the cysts, regardless their visceral localisation. Ultrasonography was the most efficient procedure for their detection, although this method's precision for the visceral localisation of the cysts was not entirely reliable (6 errors). The low incidence of such abnormalities as well as the absence of any relevant diagnostic elements for establishing the nonparasitic character of the cysts, favoured the confusions with nonproliferous hydatid cysts, especially in cases of solitary cysts (7 patients). The most frequently used surgical procedures were partial cystectomy (18 cases) and total cystectomy (8 cases). A personal technique based on obliteration of the cavity with the bulging wall of the cysts, was used in two patients. When choosing the surgical procedure, the size, site and number of cysts were considered. Immediate and late postoperative results were very good.

[Acute diffuse peritonitis of a rare cause]. / Peritonita generalizata de cauza rara.

The authors report a rare case of acute onset of non-Hodgkin lymphoma with diffuse peritonitis due to bowel perforation of secondary jejunal involvement. The admission diagnosis in the 18-years-old male with acute abdominal pain for 4 days, guarding on physical examination and pneumoperitoneum on abdominal ultrasonography was peptic ulcus perforation. The palpable splenomegaly and cervical lymph nodes on ultrasonography examination might have raised suspicion of lymphoma. Surgical exploration revealed the peritonitis origin--jejunal perforation, proximal to a stenosing tumor, a gastric tumor and confirmed the splenomegaly. Small bowel resection--end to end anastomosis--and gastric tumor biopsies were performed. The pathological diagnosis was diffuse large B-cell non-Hodgkin lymphoma. Some therapeutic considerations on digestive tract secondary lymphoma are made.

Optical, size and mass properties of mixed type aerosols in Greece and Romania as observed by synergy of lidar and sunphotometers in combination with model simulations: a case study.

A coordinated experimental campaign aiming to study the aerosol optical, size and mass properties was organized in September 2012, in selected sites in Greece and Romania. It was based on the synergy of lidar and sunphotometers. In this paper we focus on a specific campaign period (23-24 September), where mixed type aerosols (Saharan dust, biomass burning and continental) were confined from the Planetary Boundary Layer (PBL) up to 4-4.5 km height. Hourly mean linear depolarization and lidar ratio values were measured inside the dust layers, ranging from 13 to 29 and from 44 to 65sr, respectively, depending on their mixing status and the corresponding air mass pathways over Greece and Romania. During this event the columnar Aerosol Optical Depth (AOD) values ranged from 0.13 to 0.26 at 532 nm. The Lidar/Radiometer Inversion Code (LIRIC) and the Polarization Lidar Photometer Networking (POLIPHON) codes were used and inter-compared with regards to the retrieved aerosol (fine and coarse spherical/spheroid) mass concentrations, showing that LIRIC generally overestimates the aerosol mass concentrations, in the case of spherical particles. For non-spherical particles the difference in the retrieved mass concentration profiles from these two codes remained smaller than ±20%. POLIPHON retrievals showed that the non-spherical particles reached concentrations of the order of 100-140 µg/m(3) over Romania compared to 50-75 µg/m(3) over Greece. Finally, the Dust Regional Atmospheric Model (DREAM) model was used to simulate the dust concentrations over the South-Eastern Europe.

[Natural history of alcoholic chronic pancreatitis in north-western Romania]. / Evolutia pancreatitei cronice de etiologie etanolica la bolnavii din nord-vestul României.

AIM: To describe the natural history of alcoholic chronic pancreatitis (ACP) patients form north-western Romania. METHODS: We performed a retrospective analysis and a subsequent prospective follow-up (mean = 7.3 years) of 99 patients with ACP. Average duration of ACP was 15.6 years. RESULTS: Patients were mostly men (93%), with a mean age of 42.9 years at the time of operation and 35.7 years at the disease onset. Indications for surgery were: intractable pain (12%), complications (83%) and suspicion of malignancy (5%). During the evolution, 35 patients needed two to four surgical procedures. Calcifications developed in 63.6% of patients, steatorrhea in 41.4% and secondary diabetes in 43.4%. CONCLUSION: ACP in north-western Romania is characterized by early onset of the disease and a severe evolution with multiple complications needing repeated surgery. The "burnout" of the disease, with calcifications, secondary diabetes and marked exocrine insufficiency leads to lasting pain relief.

[Ultrasound guided percutaneous drainage in the treatment of local septic complications of chronic pancreatitis]. / Utilizarea drenajului percutan ecoghidat în tratamentul complicatiilor septice locale ale pancreatitei cronice.

AIM: To evaluate results of ultrasound guided percutaneous catheter drainage (PCD) for local septic complications of chronic pancreatitis. MATERIAL AND METHOD: Between 1999 and 2002, PCD was used in 19 patients with chronic pancreatitis for 6 infected acute pseudocysts, 3 post-necrotic abscesses, 3 abscesses following pancreatic resections, 6 abscesses with none of the precipitating factors present (no acute episode or recent surgical/endoscopic interventions) and a tuberculous peritoneal empyema. In 17 patients, collections were unilocular. RESULTS: Trocar technique was used in 14 patients and Seldinger technique in 5. Sixteen patients were successfully treated with PCD alone (mean drainage duration = 32 days) without abscess recurrence during the follow-up period (mean = 35.6 month). Surgical treatment was necessary in 3 patients. Pseudocyst recurrence occurred in another patient after 9 months. CONCLUSION: PCD should be considered as the initial therapy for chronic pancreatitis local septic complications. Surgery is reserved for patients in whom PCD fails.

[Hemorrhagic juxtapapillary duodenal ulcer with choledochal and Wirsung's duct stenosis and duodenojejunal fistula following biliojejunal en-Y diversion. The surgical solution]. / Ulcer duodenal juxtapapilar hemoragic cu stenoza coledociana si wirsungiana si fistula duodenojejunala dupa derivatie bilojejunala în Y. Rezolvare chirurgicala.

The paper reports on the clinical observation of a patient with bulbar duodenal ulcer placed in a juxtapapillary position due to a short bile duct, complicated with choledochal and Wirsung's stenosis and, finally haemorrhage and duodenojejunal fistula favoured by a gallbladder-jejunum diversion assembly. Three major surgeries, during 17 years, were required: cholecystectomy and choledochoduodenostomy for the choledochal stenosis induced by penetrating posterior bulbar ulcer; after 8 years, choledocholithotomy and gallbladder-jejunum derivation the loop in Y, (Roux) for the choledochoduodenostomy stenosis with the local lithiasis of the CBP; after 9 years, the resection of the proximal segment of the anastomosed jejunal loop with CBP and gastric resection with ulcer exeresis, followed by restoration of the gallbladder-jejunum anastomosis, gastrojejunal anastomosis and reimplantation of Wirsung's duct in the duodenal stump for juxtapapillary duodenal ulcer complicated with haemorrhage, penetration into pancreas, perforation in the jejunal loop anastomosed preduodenally and stenosis of Wirsung's duct. The final therapeutic result is good and lasts in time. The paper discusses the duodenum-gallbladder-pancreas interrelationships in the juxtapapillary ulcers, drawing the attention on the possibility of forming a duodenojejunal fistula in the patients with gallbladder-jejunum derivations.

[The value and limits of endorectal sonography in the preoperative stage classification of rectal cancer]. / Wert und Grenzen der endorektalen Sonographie in der präoperativen Stadieneinteilung des Rektumkarzinoms.

The article deals with the valuation of endorectal and abdominal sonography in preoperative staging of rectal carcinoma. Data processing of 40 patients suffering from tumours of the rectum examined rectoscopically, by biopsy and via sonography showed that endorectal sonography can achieve preoperative staging (T) with a sensitivity of 89%, a specificity of 100%, a positive predictive value of 89% and a negative predictive value of 100%, the overall accuracy being 81%. Identification of pararectal adenopathies can be performed with a sensitivity of 16% and a specificity of 100%. Liver metastases were determined with a sensitivity and specificity of 100%. Hence, endorectal sonography is a valuable method for preoperative staging of carcinoma of the rectum.

[Cystic echinococcosis of the liver--problems of ultrasound diagnosis]. / Die zystische Echinokokkose der Leber--Probleme der Ultraschalldiagnostik.

The authors examined 100 patients with a total of 119 cysts of the liver. The diagnosis was subsequently confirmed via scintigraphy, radiology and laparotomy. This paper reports on a sonographic analysis of cystic echinococcosis of the liver, its sonographically demonstrable types, structures and complications and their differential diagnosis. In 58% of the cases the classical aspect of cystic echinococcosis was seen (Type A). 22.7% of the cases pointed toward a sediment within the cyst (Type B). 8.4% of the cysts were septated (Type C), whereas 6.7% had daughter cysts (Type D). However, only 4.2% of the cysts were important for differential diagnosis, since they had to be set off against other space-occupying growths on account of their solid tumorous structure.

[Ultrasonic diagnosis of echinococcal cholangitis]. / Ultraschalldiagnose der Echinokokken-Cholangitis.

The role of sonographic examination in echinococcal cholangitis is stressed based on a clinical case. Due to perforation of the hepatic hydatid cyst into the bile ducts the clinical picture of acute cholangitis occurred, this being difficult to differentiate from that of choledochal stones. The correct diagnosis was made by sonographic examination and was confirmed intraoperatively. The importance of emergency sonographic examination in severely ill patients is stressed.