[Borderline ovarian tumors and global radiation in relation with climate change impact]. / Tumorile ovariene cu potential malign scazut si radiatia globala.

UNLABELLED: There is limited information on borderline ovarian tumor detected intra-surgically and its most favorable treatment in relation with global radiation and climate changes. AIM: To study the pre-surgery and intra-surgery differentiation criteria of borderline ovarian tumors from invasive carcinoma, and to make a very complex analysis of the frequency, distribution, and variation in time of global radiation, temperature, and precipitation in North-East Romania. MATERIAL AND METHOD: The 54 patients (age range 20-78 years, mean age 46 years) included in this study had borderline ovarian tumors surgically treated during the last 22 years (January 1988 - December 2009) at the 4th Gynecological Clinic at Iasi, and representing 4.87% of the total 1107 ovarian tumors detected and treated during this interval. The histological types were: serous (18 cases), mucinous (27 cases), mixed (8 cases), and Brenner tumor (1 case). In order to analyze the impact of climate changes on borderline ovarian tumors a thorough study on the frequency of global radiation in relation with climate changes based on data recorded in the last 55 years was also carried out. RESULTS: The distribution of these cases depending on when surgery was performed was analyzed. In our study the frequency of ovarian borderline tumors (4.87%) is lower than in similar reports in the literature being due, in our opinion, to the influence of global radiation in relation with climate changes. CONCLUSIONS: In our study global radiation is probably responsible for a progression to invasive carcinoma in 0.7% of the borderline ovarian tumors.

[Ovarian tumors of low malignant potential (borderline ovarian tumors)]. / Tumorile ovariene cu potential malign scazut (tumorile ovariene borderline).

UNLABELLED: Ovarian borderline tumors are rare, their good prognosis depending on their stage at the time of diagnosis, and the presence of invasive implants. There is little information on tumor type identified intra-surgically, as well as on the most favorable treatment in borderline ovarian tumors. AIM: To determine the criteria of identification and presurgery and intra-surgery differentiation of the ovarian borderline tumors from the invasive carcinoma and benign ovarian tumors. MATERIAL AND METHODS: This study included 54 patients with TPMS (ovarian borderline tumors) surgically treated in the past 22 years (January 1988-December 2009) at the 4th Gynecological Clinic of the lasi "Gr. T. Popa" University of Medicine and Pharmacy. In this interval 1,107 ovarian tumors: 575 benign, 478 malignant, and 54 TPMS (4.87%) were recorded. The age of the patients with borderline tumors ranged between 20 and 78 years, mean age 46 years, and the histological types were: mucinous (27 cases), serous (18 cases), mixed (8 cases), and Brenner tumor (1 case). RESULTS: We have analyzed the distribution of these cases according to the time when surgical treatment was performed. The frequency of borderline ovarian tumors in our study is 4.87%, lower than in the literature. We believe that this low percentage in our study is due to missing the microscopic data in some macroscopic benign tumors. CONCLUSIONS: By this research we aimed at elaborating a therapeutic strategy for each case using with discernment the modern treatment (surgery, chemotherapy, radiotherapy), as well as new chemical drugs with the goal of obtaining better results and longer survival. There are no tumor markers which could predict the progression of a borderline ovarian tumor to invasive tumors, but the invasive course is only 0.7%.

[Comprehensive study of placenta praevia]. / Studiu complex asupra placentei praevia.

MATERIAL AND METHODS: The study was carried out on 53 cases with placenta praevia, admitted to the "Cuza Voda" Obstetrics and Gynecology Hospital, Iasi, where the prevalence was 3.84% between 2006 and 2009. RESULTS: The onset, increased with parity, was during the 8th month (30.19%), with hemorrhage (77.35%). An obstetrical pathological history was found in 33 cases (62.26%).

[Cytologic examination of the axillary lavage fluid obtained during modified radical mastectomy]. / Citologia lavajului axilar practicat în cursul mastectomiei radicale.

The axillary dissection is part of the breast cancer surgical protocol. We have cytologically analyzed the axillary lavage fluid obtained during 67 modified radical mastectomy. Our results showed good correlation between the node status, histological grading and the cytological diagnosis of the axillary lavage fluid. As some other dissemination assessment techniques showed important prognostic value, the cytologic analysis of the axillary lavage fluid also seems to be a prognostic parameter.

[Surgical strategy in laparoscopic repair of hiatal hernia and procedures for gastroesophageal reflux]. / Elemente de strategie operatorie în chirurgia laparoscopica a herniilor hiatale si a refluxului gastroesofagian.

The authors discuss about 68 celioscopy antireflux procedures, carried out for transhiatal hernia accompanied by gastroesophageal reflux, during a period of 8 years, between 1996 and 2003. The aim of this research is a clinical and technical comparative study, in fact between the posterior total or partial fundoplication and the anatomical procedures. In order to have a complete evaluation of the risks and results, the authors discuss the indications of each procedure, a series of specific intra and postoperative complications, including conversions and reinterventions, for each procedure. The authors also refer to the difficulty degree, the time required for each procedure, to find out the ways of improving these parameters. Although the number of patients is quite small, in this experience, posterior fundoplication seems easier and safer, whenever possible. The Nissen procedure, which technique is more laborious, seems to offer a better postoperative evolution and more long - lasting results in time.

[Classical and laparoscopic therapeutic options in surgery for hepatic abscess]. / Optiuni terapeutice clasice si laparoscopice în chirurgia abceselor hepatice.

Although lots of modern surgical and imaging techniques have been developed and last generation antibiotics are in use, the difficulties in the diagnosis and treatment of hepatic abscesses are still a rather sombre reality. Our research concerning 14 patients submitted to surgery within the last ten years can be thought of as a record, considering the poor number of cases in the last decades. So, our study also includes the possible clinical or imaging errors, the technical details of the surgery, the attitude towards the abscess cavity and the still obscure etiology in most of the cases. The correlation between the surgical risk and the rest of the hepatic volume, evaluated by computed scanning technique, represents another objective of this paper. In the large or in the multiple disseminated abscesses, the small area of the remaining functional hepatic tissue, was correlated to the postoperative slow or even bad evolution in two cases. The radiological, ultrasound and scanner control showing the reducing or disappearing of the abscess cavity after drainage in all the cases, represent an argument of the correct therapeutic approach.

[Choledochal cyst as a complex malformation of the intra and extrahepatic bile ducts]. / Chist coledocian congenital--anomalie complexa a cailor biliare intra si extrahepatice.

The authors present the case of a 64 years woman with a choledochal cyst along with a complex malformation of both intra and extrahepatic bile ducts. The patient was admitted with a diagnosis of acute and underestimated cholecystitis, which was in fact a real acute severe suppurated angiocolitis located at the cystic cavity level along with severe hepato-renal failure. As long as the choledochal cyst evolves as a stand-alone entity, it can frequently be associated with other malformations of the bile ducts--such as choledochal duct stenosis or abnormal connection of the common hepatic duct with pancreatic ducts. The main dilatation was engulfing the whole common bile duct with a fusiform aspect, and the cranial end is opening into a long hepatic duct from which were emerging several biliary segments branches, for both hepatic lobes. This aspect of a multistage convergence with four branches which is opening into a long hepatic bile duct and then in the choledochal cyst, represents an unusual malformation which does not respect the rules described by former published authors.

[Assessment of prognostic factors in breast cancer]. / Evaluarea factorilor de prognostic in cancerul mamar.

Prognostic factors predict the long term outcome of treatment, recurrence rate and overall survival. Treatment decision is based on assessment of prognostic factors. They are classified as clinical (age, menopausal status, tumoral growth rate, inflammatory signs), histological (tumoral stage, pathological type, grading, tumoral necrosis, lymph nodes status, margins status) and biological factors (steroidal receptors pattern, ploidy etc). There are tumor markers currently evaluated, being considered conventional and new markers that are not usually evaluated. Patients with negative lymph node will show no recurrences after surgery and/or radiotherapy in 70% of the cases. Factors with specific prognostic value are used for deciding on the therapeutic strategy in negative axillary node cases.

[Breast conservative surgery]. / Tratamentul chirurgical conservator al cancerului mamar.

Breast conservative therapy is considered an adequate therapeutical method for early stage breast cancer. Breast conservative treatment consists of partial mastectomy, axillary dissection and radiotherapy. Patient selection is based on clinical, histological and individual factors. The frozen sections examination provides prompt differentiation between benign/malign lesions and precise assessment of the oncologic margins of the specimen. Preoperative marking of nonpalpable breast lesion with hook wire represents a progress for breast conservative treatment. Sentinel lymph node biopsy represents an alternative to axillary dissection, in order to reduce subsequent morbidity.

[Carcinoid tumors, leiomyosarcoma and invasive adenocarcinoma metastasis of the Treitz angle]. / Tumori carcinoide, leiomiosarcom si metastaza invaziva de adenocarcinom, ale unghiului duodeno-jejunal Treitz.

Our paper studies the quite rare occurrence of the digestive superior occlusive pathology, namely some causes which might induce partial or even total obstruction of the digestive tract, at the distal anatomical limits of the duodenum, also known as the Treitz angle. The first two described cases were carcinoid tumors, obstructive and ulcerated in the lumen of the same angle. The last two cases were an obstructive leiomyosarcoma and an invasive mesenteric metastasis from a right colon cancer, which cause a total external compression of the Treitz angle, clinically manifested as a complete food intolerance, as a first symptom. Concerning the clinical evolution, these are totally different lesions, malign, metastasis and neuroendocrine tumors, which occurred at the same level, had a totally different clinical evolution and surgical approach, only three of them developing at good postoperative course. The imaging, clinical and pathological diagnosis problems, the different specific surgical solutions, the postoperative care and finally the rarity of this level of obstruction of the small bowel, are the aim of this paper.

[Malignancy risk in some benign mammary lesions]. / Riscul malignizarii unor leziuni mamare benigne.

We analyzed retrospectively 821 patients operated on in our clinic for benign mammary lesions and for breast cancer. Histopathology identified in some cases associated benign and malign lesions. Atypical hyperplasia is considered significant risk factor for malignancy. Women in this category need close surveillance.

[Practical aspects in diagnosis and treatment of benign breast lesions]. / Elemente practice privind diagnosticul si tratamentul leziunilor mamare benigne.

We analyzed 444 patients operated on in our clinic. Triple test diagnosis is the modern trend. Surgical treatment is not justified in all cases. When needed, partial mastectomy is commonly used. Surgical principles must be respected for good cosmetic results. Histopathology only certifies the diagnostic.

[Reasons for conservative treatment in breast cancer]. / Argumentarea aplicarii tratamentului conservator în cancerul mamar.

We analyze 112 patients with breast conservative treatment operated in our clinic in the last 5 years. Breast preservation surgery represented 30.35% of all cases treated for breast cancer in this interval of time. In other 63 situations conservative treatment was attempted but finally given up due to justified motivations and decision for mastectomy was adopted as optimal. Rigorous selection of patients for conservative surgery was our care. Tumor size, excisional margins, nodal status were the main criteria. Correlation with breast volume, age, patient's opinion were also important. Preservation of breast in women interested and cosmetic results were the purposes of our attitude. Breast conserving therapy may be indicated only respecting the oncological principles and close surveillance of patients is obligatory.

[Phyllodes tumor. The experience of the 4th Obstetrics-Gynecology Department]. / Tumora filoda. Experienta clinicii a IV-a obstetrica ginecologie.

The experience of the IVth Obstretrics Gynecology Department. Between the 1st of January 1994 and the 1st of November 2001 587 operations have been performed as treatment of breast tumors in the IVth Obstetrics and Gynecology Department. The phyllodes tumor has been diagnosed in 11 cases (1.8% of the benign breast masses). The genesis is unknown. Local trauma, pregnancy, lactation, high estrogenic levels have been suggested to have an influence upon the tumoral development. The most common aspect is a round, hard, unpainful breast mass. The diameter is variable (1 to 45 cm). The mammogram shows a well defined, high density, smooth contour opacity. A four degree classification has been described. Specific evolution features may involve local recurrences and metastasis. The surgical treatment is mandatory but radiotherapy, chemotherapy and endocrine treatment protocols have been brought up.

Abdominal pregnancy. Case report, review of the literature.

Abdominal pregnancy (AP) is a rare form of ectopic pregnancy (EP). It is a medical emergency because of high maternal and fetal morbidity and mortality. Early diagnosis is essential. Surgery is indicated as soon as the diagnosis is made. We present a case with AP in the third trimester with malformed fetus and left ovarian tumour. The fetus has been extracted at 33 weeks gestational age; the placenta and the ovarian tumour have been removed five weeks later. Pathology showed corpus luteum with hemorrhage, serous cystadenoma, follicular cyst. The fetus died, the woman successfully recovered.

[Cancer of the cervical stump]. / Cancerul bontului cervical.

Subtotal hysterectomy may represent, in specific conditions, a justified alternative to total hysterectomy. Some of the reasons may be vaginal stenosis, preservation of the menstrual function, conservation of the erogene cervical zone. The main disadvantage consists in developing cancer on the cervical stump. In order to reduce the risk of developing cervical carcinoma, total hysterectomy remains the procedure of choice for most women. Our study presents 16 cases with carcinoma of the cervical stump after subtotal hysterectomy from the lot of 313 cases with cervical neoplasms operated on at the Division of Gynecologic Oncology of the 4th Clinic of Obstetrics and Gynecology in Iasi. The main conclusion of this study is illustrated by the firm conviction of the authors that subtotal hysterectomy is an unjustified surgical procedure in women after 40 years old.

[The presence in pregnant women of the risk factor of serum antibodies against 9 viruses with significance in materno-infantile pathology and the transfer of these antibodies to the newborns]. / Prezenta la gravide cu factor de risc de anticorpi serici fata de noua virusuri cu semnificatie în patologia materno-infantila si transferul acestor anticorpi la nou-nascut.

Indirect enzyme immunoassay, performed with Labsystems (Helsinki) kits, in 30 mothers and their newborns, revealed that 100% of parturient women present IgG antibody to hepatitis A (HAV), herpes simplex 1, and measles viruses, constantly transferring these antibodies to their newborns. 78.6% of the women had IgG to rubella (German measles) virus, passively transmitting them to their offsprings. Serological markers (HBsAg and anti-HBc) of hepatitis B virus infection were present in 42% of the investigated women, anti-HBc being also present in the serum of the newborns. Between the identified risk factors (in the past obstetrical history, current pregnancy, labor and early postnatal period) and the spectrum of IgG antibodies present in mothers no significant correlations were revealed. The same obvious lack of correlation between IgG antibodies and risk factors in the neonate (prematurity, low birth weight, malformations) was also found. However, the presence of IgG anti-measles (2 case), IgM anti-rubella (1 case) and IgM and HAV (4 cases) was associated, in the same order, with interstitial pneumonia, hepatosplenomegaly and death, icterus neonatorum, cardiovascular and neurologic malformations. Neither mothers nor their offsprings presented anti-HIV antibodies, suggesting that in the investigated patients no perinatal transmission had occurred.

[Cancer of the cervix uteri in young people]. / Cancerul colului uterin la tinere.

The age-group distribution, risk factors, histopathological aspects, diagnosis, treatment and prognosis of 111 diagnosed and/or treated cervical carcinomas in women aged up to 40 years out of 478 cases with the same diagnosis were reviewed. It is considered that the incidence of 23.2% in this series is situated at the extreme of the high frequencies reported in the literature. Nineteen per cent of the cases were diagnosed in stages O and Ia, a well organize program for early detection being required. In our series, the 5-year survival rate was 73.3%. This finding, although in a small series of cases, supports the opinion that age has no influence upon the prognosis of this disease.

[Endometrial carcinoma in cases under 45 years of age]. / Carcinomul endometrial la cazuri cu vîrste sub 45 ani.

Twelve cases of endometrial carcinoma admitted to the I-st Clinic of Obstetrics and Gynecology of Iasi in the interval 1983-1988 are presented. The patients' age ranged between 33 years (1 case) and 45 years (1 case) with a mean age of 41.3 years. This study was underwent given the increased frequency of this lesion in the premenopausal women (9.3% of all cases recorded in the interval under study). The incidence of the disturbed menstrual cycle was of 58%, that of obstetrical antecedents and obesity of 33% and 50%, respectively. In two cases there was a carcinoma "in situ", the remainder of cases presenting disease in stage I (FIGO classification). The diagnosis was made preoperatively in 7 cases, the other 5 patients being operated upon for uterine fibromatosis. Adenocarcinoma was the most common histological type. The need of ascertaining the etiology of metrorrhagias no matter of patients' age and the role of risk factors and some methods of detection (endometrial cytology, endometrial biopsy) are underlined.