Accurate Diagnosis of Sigmoid Colon Endometriosis by Immunohistochemistry and Transmission Electron Microscopy - A Case Report.

Endometriosis is described as the presence of functioning endometrial tissue at sites outside the uterus. Up to 15% ofwomen in their reproductive period are affected by this condition. Endometriosis is mostly foundon the uterosacral ligaments, inside the rectovaginalseptum or vagina, in the rectosigmoid area, ovarianfossa, pelvic peritoneum, ureters, and bladder, causinga distortion of the pelvic anatomy. Colonic involvement is rare but is usually found at the level of the rectum or the sigmoid colon. Acute presentation with intestinal obstruction or perforation is rare. While malignant transformation of endometrial lesions is rare, findings of dysplasia on pathology sections can give rise to questions of management. Immunohistochemistry and electron microscopy can help decision making. We present the case of a 38 year old woman with intestinal obstruction caused by sigmoid colon endometriosis with moderate dysplasia in which transmission electron microscopy was used for postoperative diagnosis. Detailed analysis of these cases, while logistically difficult, can prove useful in understanding the etiology and pathophysiology of the disease.

Spontaneous rupture of a splenic hydatid cyst with anaphylaxis in a patient with multi-organ hydatid disease.

Hidatid cysts of the spleen are a rare occurrence, the spleen being the third most common organ for the development of Echinococcus Granulosus. Splenic hydatid cysts are commonly part of multi-organ hydatid disease. Diagnosis is often established when investigating a splenomegaly or by chance during an unrelated consult. It can also be diagnosed after rupture, be it following trauma (the most common occurrence)or spontaneous. Splenic hydatid cyst rupture requires immediate action and is a life-threatening condition. It results, most often, in splenectomy. We present the case of a patient with multi-organ hydatid disease that presented with a ruptured splenic cyst and developed anaphylaxis. The case was resolved by splenectomy and recovered well.

Stump appendicitis - an overlooked clinical entity.

Stump appendicitis is a rare disease, often overlooked. Thepossibility of stump appendicitis is not clear to all clinicians.It can represent a diagnostic dilemma if the treating physicianis not aware of this uncommon disease. Presenting symptomsare indistinguishable from those of primary appendicitis. Wepresent two cases of stump appendicitis operated in ourdepartment and their treatment. A heightened awareness ofthe possibility of this disease can lead to good initial surgical technique and prevention, and to early diagnosis in the eventof stump appendicitis.

The value of serum bilirubin level and of white blood cell count as severity markers for acute appendicitis.

Discussions regarding the correlations between elevated white blood cell levels and clinical and pathological stages of acute appendicitis are well known. Recent studies show that a high level of serum bilirubin could emerge as a prognostic marker for gangrenous or perforated stages of acute appendicitis. We studied the correlations between anatomical and pathological stages of acute appendicitis and white blood cell count, serum total bilirubin, and indirect serum bilirubin on a large series of cases, in the course of one year, in our department. Although there being a correlation between severe forms of acute appendicitis (gangrenous, perforated), elevated white blood cell count, elevated serum bilirubin (mostly the indirect fraction), none of the indicators proved to have a definitive diagnostic value. Cases with perforation and localized generalized peritonitis are more frequently associated with elevated bilirubin levels.

Rare urogenital malformation associated with complex vascular malformation -- case report.

BACKGROUND: Class 3 urogenital malformations are a rarely encountered in the clinical setting. The association with complex vascular malformations represent a challenge in diagnosis and intraoperative management with an enhanced degree of the complexity. CASE PRESENTATION: Young female presented to the emergency department with pain in the left lower quadrant and unspecific abdominal symptoms that appear regularly one week prior and during her menstruation. Diagnostic studies and intraoperative findings lead to the diagnosis of a rare urogenital malformation associated with complex vascular malformations. In conclusion the most helpful diagnostic study was the abdominal MRI. Regarding the functional status of the postoperative urogenital tract no clear assessment can be made yet.

[Lower limb revascularization--a continuous challenge]. / Revascularizarea membrului inferior--între deziderat si posibilitati.

Revascularization of the lower extremity in patients with diabetes or chronic obstructive arterial disease is a challenging, still unsolved problem. Modern day technique (stem cell therapy, hyperbaric therapy) has yet to deliver satisfactory results. Homogenous (safenous vein) or heterogeneous (terom, dacron, PTFE-teflon) by-pass surgery is limited because of technical difficulty and positive outcomes have a short duration. All these lead to, in most patients, to amputations as first line therapy or as an alternative to failed approaches. By-pass surgery is limited by graft obstruction. One of the current approaches is the use of omental flap autotransplantation.

[Enteral non-Hodgkin lymphoma in young age--difficult diagnosis]. / Limfom non-Hodgkinian forma enterala la tânar, caz subdiagnosticat.

Lately, we have been confronted with an increased number of malignant tumors of the large bowel, appearing at younger patients. Among all histopathologic forms of malignant colonic tumors treated in our Clinic, lymphoma is the fifth as frequency of apparition, respectively the fourth at patients less than 40 years old. We present the case of a 22-years-old patient, having colonic polyposis and multicentric non-Hodgkin lymphoma of the terminal ileum and ascending colon. This pathologic association represented for us an uncommon situation. The rest of malignant colonic tumors developed on patients with rectocolonic polyposis were adenocarcinoma.

[Complications in morbid obesity treatment--pylorus obstruction caused by a deflated intragastric balloon]. / Complicatii în tratamentul obezitatii--obstructie pilorica prin balon intragastric.

An aggressive array of new treatments and improvements of existing approaches for addressing morbid obesity were developed during the last two decades in response to the recognition that a new pandemic affects humanity, i.e. obesity. Initially used as a temporizing solution for other specific interventions used for obesity treatment, the endoscopic placement of an intragastric balloons has currently became in certain cases a complete therapeutic solution. Multiple studies emphasize the efficiency of this new therapeutic method, in some cases resulting in a 45 kg weight loss at the end of the monitoring period. The intragastric balloon, after endoscopic placement can be kept into position for an average period of 4-6 months. After this period, balloon extraction is recommended because of the complications that can occur with prolonged intragastric placement. This paper presents a case of pyloric obstruction by an intragastric balloon kept for 14 months. In this case, the initial approach was endoscopic, but the surgical approach offered the definitive therapeutic solution.