Multiple Intestinal Lymphoma.

Gastrointestinal tract is the most common location for extralymphonodular lymphomas. The small intestine is affected only in 9% of the cases. Intestinal lymphoma may have single or multiple location. This paper describes a case of multiple location in the small intestine of a non-Hodgkin B-cell in a 53 years old patient, who was initially diagnosed with bilateral pneumonia with pleurisy with E. coli, steeper on the right side, but the persistence of symptoms as fever, malaise, despite appropriate treatment, required further investigation. The CT exam observed fluid collection in the hypogastrium around a digestive loop. The patient underwent surgery, the intraoperative foundings being: a large mesenteric tumor - 5 cm in diameter, a terminal ileal mesenteric tumor, a mesenteric tumor - 6 cm in diameter, omentum with nodular formations, a tumor - 3.3/2.5.1 cm in the abdominal wall, pseudotumoral appendix. Segmental. enterectomy with entero-enterostomy, excision of mesenteric tumors, appendectomy and omentectomy were performed. Pathological diagnosis was non-Hodgkin marginal zone B-cell MALT type lymphoma of the small intestine with extension to the appendix, meso, omentum and abdominal wall. Postoperatively, the patient received chemotherapy for remission.

Surgical treatment in stenosing rectal cancer.

INTRODUCTION: Rectal cancer represents an important health issue, which involves multidisciplinary treatment, posing a major surgical challenge, both in terms of diagnosis and treatment. MATERIAL AND METHOD: Between 2009-2013, we analysed 83 patients with stenosing rectal cancer operated on at the Clinic of General Surgery II of Colentina Clinical Hospital and at the Clinic of General Surgery I of "Prof. Dr. Al. Trestioreanu"€ Oncology Institute, in Bucharest. Gender distribution was: 51 males and 32 females. Average age was 65 years old. The most frequently encountered symptoms were colicky abdominal pain and rectorrhagia. 25 patients presented intestinal occlusion phenomena at admission, the other 58 cases being in subocclusive stage. RESULTS: In occlusive stages: 17 patients presented with resectable tumour, while 8 patients had locally advanced neoplastic forms (€œfrozen pelvis€), left iliac colostomy with tumour biopsy being the chosen approach. In subocclusive stages: 5 cases had unresectable tumours for which left iliac anus with tumour biopsy was performed; 53 cases presented with resectable tumour, for which the Hartmann procedure (12 patients) and left iliac colostomy with tumour biopsy (41 patients) were performed. Depending on the histopathological result, patients were submitted to radio- and chemotherapy.Tumour resection was possible in 70 cases (84.33%), only 34 of these (40.96%) being with radical intent. CONCLUSIONS: Treatment for stenosing rectal cancer is multimodal,represented by surgical approach, radio- and chemotherapy. The rationality behind surgery as a first therapeutic gesture in the given study group was represented by the need to treat occlusive type complications, patients benefitting subsequently from radio- and chemotherapy. The opportunity of a second surgical intervention, with the objective to remove the tumour, was established based on the therapeutic response to radio- and chemotherapy.

Genetics of colorectal cancer.

The occurrence of colorectal cancer is related to the interaction that takes place at several levels between hereditary factors, environmental and individual ones. Understanding the molecular basis is important because it can identify factors that contribute to the initiation of development, maintenance of progression but also determine the response or resistance to antitumor agents. Understanding colorectal cancer at the molecular level has provided data used for genetic tests of family forms, it defined predictive markers used to select patients susceptible to certain forms of therapy and also for the development of molecular diagnostic tests to detect early non-invasive cancers.

Molecular characterization of Echinococcus granulosus in south-eastern Romania: evidence of G1-G3 and G6-G10 complexes in humans.

Clin Microbiol Infect ABSTRACT: Echinococcus granulosus is the aetiological agent of cystic echinococcosis (CE), which is a public health problem in many eastern European countries, particularly in Romania, where the infection causes a high number of human and animal cases. To shed light on the transmission patterns of the parasite, we performed a genotyping analysis on 60 cyst samples obtained from patients who live in south-eastern Romania and who underwent surgery for liver or lung CE. DNA was extracted from the endocysts or the cyst fluids, and fragments of cytochrome c oxidase subunit 1 and NADH dehydrogenase subunit 1 mitochondrial genes (cox1 and nd1, respectively) were amplified by PCR and sequenced. We found that most of the samples analysed (59/60) belonged to the G1-G3 complex (E. granulosus sensu stricto), which contains the most widespread and infective strains of the parasite. We also identified the first human patient infected by a non-G1-G3 genotype of E. granulosus in this country. As the DNA sequence of this cyst sample showed maximum homology with the G6-G10 complex (Echinococcus canadensis), this is, in all likelihood, a G7 genotype, which is often found in pigs and dogs in most countries of eastern and south-eastern Europe.

Retrorectal dermoid cyst: a rare clinical entity.

The retrorectal space represents the anatomical site at which level we identify the embryologic reminiscents in which it can develop liquid tumors - cysts or solid tumors - neoplasia. These tumors are rare but pose a diagnostic and therapeutic interest. This paper presents the case of a young 18 years-old diagnosed incidentally at a gynecological examination, with a palpable tumor developed, at the retrorectal space. Imaging examinations - transvaginal ultrasound and abdominal - pelvic computer tomographic exam - have supported the presence of a cystic tumor with a maximum diameter of 7.8 cm., in the space retrorectal. The lesion presented surgical indication, so it needed a posterior approach with resection of the coccyx enough for the control and safety of the operation. Histopathological examination revealed a dermoid cyst. Five years after surgery the patient is presented in good general condition, asymptomatic without clinical and imaging signs of local-regional recurrence.

Surgical treatment of colon cancer: Colentina surgical clinic experience.

Most patients with colon cancer are surgically treated, with postoperative association of chemotherapy and possibly immunotherapy in advanced cases. Surgical treatment is chosen depending on the evolution stage, tumor topography and the existence of complications, colonic surgery being dictated by colonic vascularization. The radical character of the surgical intervention can be assured only in the early stages of the tumor. Colostomy is rarely necessary in patients with colon cancer. In the period of the last 5 years (2007-2011), 307 patients with colon cancer were operated in "Colentina" Surgical Clinic, radical intervention being possible only in 219 cases. 48 cases were emergency interventions for occlusion or perforation with peritonitis. Every time the mechanical preparation of the bowel was not possible, the intraoperative washout technique was used. Postoperative complications were met in 27 cases, being represented by bleeding (3 cases), peritoneal abscess (5 cases), anastomotic fistula (7 cases), abdominal wound infection (12 cases). In 5 cases the operation was done laparoscopically. Preoperative mortality was of 13 cases. Postoperative chemotherapy was done in the great majority of cases.

Albendazole associated to surgery or minimally invasive procedures for hydatid disease--how much and how long.

Cystic echinococcosis is parasitic disease due to the larval stage of the metacestode Echinococcus granulosus in the liver (80%), lungs, kidneys, spleen, myocardium etc. Humans are accidental intermediate hosts. Diagnosis is based on laboratory and imaging studies. Treatment is multimodal, surgical and medical. Risks for dangerous complications and relapses are quite common. Adequate follow-up is needed. Albendazole has a central role in the medical therapy of the disease.

The importance of laser-biophotometry in vivo in medicine.

Infrared laser biophotometry limits to a relatively strait spectrum (0.85-0.89 mkm) and it is based on the absorption, dispersion and reflexion phenomena from the tissues. It was taken a study group of 180 people (students and other categories of people considered healthy). The determined medium reflexion coefficient in infrared in the intact tissues is an index with medium values (between 55.7-68+/-2.1 milliwatts), stable in time. The individual variations of the medium coefficient of reflexion in infrared (MCR IR) for the intact tissues do not exceed 3+/-2.1 milliwatts. The MCR IR values determined for intact tissues will be taken as reference point in the determination of the MCR IR for pathologically modified tissues (edema, hematoma, abscess) in the next part of the study. The obtained results allow the use of Laser-biophotometry in vivo method in the evaluation and observation of the pathological processes accompanied by water retention in the organism, differentiation of the processes concerning fat accumulation (obesity, metabolic X syndrome, etc.). Absorption particularities of radiation in Infrared, observed during this study, suggest physiotherapeutic factor graduation determined by individual particularities of the organism: the pigmentation degree of the skin tissue and the tissue structure (stroma density).

[Therapeutic options in gallstone ileus]. / Optiuni terapeutice în ileusul biliar.

Gallstone ileus is a rare, serious condition, requiring emergency surgery, specific to elderly age. The present study deals with 16 cases operated in 25 years period, with median age about 64 years old. The patients had clinical evidence of intestinal obstruction, confirmed by radiological examination and ultrasonography. Emergency operations were performed. In 7 cases had been treated radically both the obstruction (entero-lithotomy) and the bilio-digestive fistula (cholecystectomy, duodenal closure, enteral closure, colon-suture) with good results (only one death). In 9 cases, it had been treated only the intestinal obstruction, with only 2 cases of persistent cholangitis. Generally, we have used biliary drainage with Kehr tube in the presence of biliary stones and cholangitis. The biliodigestive fistula may close in evolution or become a harmless secondary route for internal biliary drainage.

[One case of multiple abdominal hydatidosis]. / Un caz de chist hidatic abdominal cu localizari multiple.

It is presented the case of a 45 years old female patient transferred in our clinic from Parasitology Clinic with the diagnosis of hepato-splenic hydatidosis. Preoperative echography presented 3 abdominal hydatid cysts (hepatic, splenic and free in the peritoneal cavity--greater omentum). Intraoperative exam confirmed the preoperative evaluation. The operation consisted in two ideal cystectomies associated with one partial cystectomy with evacuation and drainage. Postoperative evolution was simple.

[Late results after the Mark Belsey IV antireflux procedure in achalasia]. / Rezultate tardive dupa procedeul Mark Belsey IV în achalazie.

Cardial achalasia (cardiospasm, megaesophagus) represents the failure or lack of relaxation capacity of the inferior esophageal sphincter; it is the second esophageal disease and is considered a premalignant lesion. Treatment of achalasia is surgical but palliative, considering the lack of an etiopathogenic therapy for this moment. We present a retrospective study done on 19 patients (10 males and 9 females, with a mean age of 49 years) operated in "Colentina" Surgical Clinic in the period of 1996-1999 for achalasia (presenting symptoms-dysphagia, regurgitation, weight loss) by extramucosal esocardiomyotomy practiced on a length of 5-10 cm, by thoracic approach, followed by the Mark Belsey IV antireflux procedure. Results were good, without reflux pathology or dysphagia in the postoperative evolution.

[Pancreatic insulinomas]. / Insulinoamele pancreatice.

In the period of 1980-1999 (20 years) were operated 18 patients (8 males and 10 females) in "Colentina" Surgical Clinic, the average age being of 45 years, with hystopathologically confirmed insulinomas. The topography of these lesions was in the head of the pancreas (4), in the isthmus (5), in the body and tail (9). The classical clinical and biochemical signs were presented in 13 cases, the rest of the patients presenting atypical signs of disease. These patients had benefit from the surgical treatment. The approach was bi-subcostal in 11 cases and by upper and lower midline incision in the rest of cases. We practiced enucleation in 5 cases, corporeal-caudal pancreatico-splenectomy in 10 cases and cephalic pancreatico-duodenectomy in 3 cases. The malignancy of the tumour was hystopathologically confirmed in 30% of the situations. The postoperative mortality was in 3 cases, by acute pancreatitis, MSOF and myocardial infarction. We consider that in case of these generally benign tumours the most efficient therapy is the surgical one.

[Surgical procedures in penis cancer]. / Optiuni terapeutice în cancerele peniene.

In the period of 1980-1999 (20 years) in Colentina Surgical Clinic were admitted and operated 16 patients with the diagnosis of pennial cancer (histopathology--squamocellular carcinoma), 13 of whom being from Colentina Dermatological Clinic. The mean age was about 64 years old, 10 cases presenting phimosis. Surgical procedures undergone were represented by partial pennial amputation with bilateral superficial inguinal lymphadenectomy (10 cases), total pennial amputation with superficial inguinal lymphadenectomy (4 cases), respectively emasculation with bilateral inguinal-iliopelvic lymphadenectomy (2 cases). In the postoperative period 3 patients presented lymphedema and lymphorrhagia, solved by conservative management. All the patients benefited of favorable evolution on the period they have responded to the controlled postoperative follow up (1-3 years).

[Sugiura's procedure--a treatment modality for esophageal varices]. / Operatia tip Sugiura--o modalitate de tratament chirurgical a varicelor esofagiene.

This study present the "N. Gh. Lupu" surgical experience with Sugiura technic for bleeding caused by oesophageal varicose. Is a 5 years retrospective study with 30 patients who are submitted of this operation. After the results analysis our opinion is to do this operation in stabilised patient, but she is possible even in emergency.

[Therapeutical options in pancreatic pseudocysts]. / Optiuni terapeutice în pseudochistele pancreatice.

This paper presents the "N.Gh.Lupu" surgical clinic's experience, that consists in 65 cases of pancreatic pseudocysts operated in the last 10 years (1989-1998), 30 females and 35 males, with a mean age of 52 years old. The diagnosis was mainly based on the classical echography and CT-scanner, the clinical picture being non specific in the majority of cases. Although the predominant use of the nonsurgical interventional procedures is recommended, this presents the maiden attempts of the authors in this field, the surgical techniques used being as it follows: cephalic pancreaticoduodenectomy, distal pancreatectomy, cystodigestive anastomosis, external drainage. The perioperative mortality was null, the postoperative one consisting in 3 cases (2 cases in the early period and 1 case in the later period).

[The indications for and limits to the surgical treatment of congenital dilatations of the intra- and extrahepatic bile ducts]. / Indicatiile si limitele tratamentului chirurgical în dilatatiile congenitale ale cailor biliare intra si extrahepatice.

Congenital cystic dilatations of the biliary ducts are defects in the genetic program which are transmitted in an autosomal recessive way. Todani classified cystic dilatations of extra and intrahepatic ducts in 5 types. In classified cystic dilatations of extra and intrahepatic ducts in 5 types. In "N. Gh. Lupu" Surgical Clinical were treated 9 cases of congenital dilatations of the biliary tree during the last 40 years (1958-1998); five of them were belonging to the type V Todani (Caroli's disease), three to the type I Todani and one case in the type IV a of Todoni's classification. The mean age of the patients was 42.4 years, five of them being men and 4 women. Surgical treatment was particular to each case depending on age, associated diseases, the length of disease's evolution and the general state of the patient. The prognosis of this disease is a reserved one.