Primary axillary hydatid cyst.

Echinococcosis (hydatid disease) is a zoonosis caused by the larval stage of Echinococcus granulosus (or Taenia echinococcus). The adult form of the parasite lives in the gut of the dog, while the intermediate hosts, where the tapeworm develops to larval stage are cats, cattle, pigs and humans(considered to be accidental intermediate hosts). The parasite has a worldwide distribution, but the endemic areas are Canada and Alaska, Australia, New Zealand, South America and the Mediterranean region. Hydatid cyst can grow many years before the symptoms and clinical signs appear. The liver and the lungs are the most affected organs, but primary location of the hydatid disease in the axilla is extremely rare. In our country we did not find any records of axillary hydatid disease, while the literature contains only 12 cases of axillary location. We present the case of a woman, 60 years old, with a primary axillary location of hydatid cyst, who underwent a total cystectomy.

Histopathological factors as predictors for survival in colon and rectal cancers.

Colorectal cancer is one of the most frequent malignant diseases with a raising incidence in Romania. Survival at 5-years even was improved in the last decade, remains low especially because of delayed diagnosis. Many clinical-biological and pathological factors have demonstrate a good prognostic value over the time but there are not a wide consensus in this field. The aim of our study is to evaluate the accepted pathological prognostic factors of survival for colorectal cancer in relation to management adopted in a general surgical clinic. We included in our study 273 patients with colon and rectal cancers admitted in Surgical Clinic of Military Hospital of Craiova in which we evaluate the clinical-pathological features, location of the distant metastasis, postoperative staging, curability and survival. We established correlations, inside of a same stage of the disease, for pathological features (characters of the tumors, differentiation grade and location) and survival rate. Our results showed that curative resection is one of the most important factors that could improve survival. Tumor differentiation is correlated with survival only for the patients with stage II and III of the disease, perineural invasion and pathologic N stage representing important predicting factors for a shorter survival. Peritoneal washing for cytology prior to surgery is correlated with the stage of the disease and not with tumor differentiation.

The immunohistochemical profile of the adenocarcinoma of upper gastric pole.

Although gastric adenocarcinoma continue to be the second continues to be the second cause of death worldwide, its incidence and mortality appear to have decreased in recent decades. Despite this decline, adenocarcinomas from proximal stomach tend to be more frequent during the last three decade. Adenocarcinomas with this location it seems that are a different, specific subtype of gastric carcinoma. The purpose of this study was to clarify the differences between gastric adenocarcinomas from upper and distal gastric pole using the immunohistochemistry. For this reason, we investigate histopathological and immunohistochemically 77 cases of upper gastric pole adenocarcinoma selected from a number of 472 gastric tumors. The immunohistochemistry was performing only in 32 cases by ABC technique with the following primary antibodies: Cytokeratin 7, Cytokeratin 19, Epithelial Membrane Antigen (EMA), Carcinoembryonic Antigen (CEA), Lysozyme, Vimentin, p53 protein, CD34 and Ki67 antigen. The acquired results do not distinguish a peculiar immunohistochemically profile unlike distal gastric adenocarcinomas. Nevertheless, we pointed out the predominance of diffuse adenocarcinomas type according to Laurens classification, which immunohistochemically were strong positive to cytokeratins, EMA, CEA and lysozyme. Moreover, investigation of some antigens likes lysozyme, p53, Ki67 and CD34 seems to be useful for prognostic estimation of carcinoma with this topography.

Giant retroperitoneal sarcomas.

Retroperitoneal sarcomas are rare malignant tumors, which are developing from mesenchymal stem cells residing in muscle, fat, and connective tissues. Underlying the rarity of this kind of tumors in general population, the aim of this paper is to present three cases of retroperitoneal sarcomas operated in Surgical Department of Military Hospital of Craiova (a retroperitoneal liposarcoma, a dedifferentiated liposarcoma and a malignant fibrous histiocytoma). From clinical point of view, we note the poverty of symptoms and non-specificity of these and a great tolerability of retroperitoneal space that offers the possibility for a great development of the tumor. CT-scan and MRI are the best investigations for diagnosis but surgical exploration is the best way for a good evaluation of these tumors. From histological point of view, we try to present new features about these kinds of tumors in order to classify them. Results of surgery correlated with complementary therapies were good without per-operative mortality or postoperative morbidity but we noted a recidive of one tumor (with different histological pattern) 21 months after the surgical intervention. The rarity of retroperitoneal sarcomas, combined with the vast array of histologic subtypes, has complicated our understanding of these tumors and impeded the development of effective therapies.

[Madura's foot (mycetoma)]. / Piciorul de Madura (micetomul).

Mycetoma is a chronic disorder involving the skin, bones and soft tissues and is characterized by multiple discharge sinuses, nodules and swelling of the affected part. It may be caused by actinomycetes or eumycetes. It most commonly involves the foot but occasionally involve the hands, back or shoulders. We describe a 66-year-old male agricultural worker, hospitalized in Military Hospital of Craiova, for leg amputation caused by the disease evolution without response at treatment that was initiated 20 years ago.

[Primary anastomosis in perforated Crohn disease]. / Restabilirea primara a continuitatii digestive în boala Crohn perforata, neglijata.

Inflammatory bowel disease (IBD) comprises a group of diseases of intestine characterized by chronic inflammation of the bowel with periods of exacerbation and remission. The evolution of the disease needs, in some therapeutic moments, surgeon's intervention. We described the case of a patient hospitalized through emergency service of Military Hospital of Craiova which presented multiple ileo-cecal perforations, histological examination proving clinical supposition of Crohn's disease. The authors achieved, on the other hand, some considerations about etiopathogenical, clinical and therapeutic aspects of this disease.

[Present strategies in the diagnosis and treatment of thyroid diseases]. / Strategii actuale în diagnosticul si tratamentul chirurgical al bolilor tiroidiene.

AIM: Selective and critical presentation of the present exploring methods concerning surgical thyroid diseases and accomplishing a pre-surgical diagnosis as accurate as possible. Depending of the diagnosis--choosing the most appropriate surgical strategy according to the newest concepts in thyroid pathology. MATERIALS AND METHOD: Clinical-statistic study, carried out retrospectively over 1,108 patients having various surgical thyroid maladies hospitalized in 1980-1999 period. There have been operated 1,058 cases. Demographic structure as regards sex, F/M was 9.07/0.93 for goiters, whereas for thyroid cancer it was 3/1. RESULTS: Nodular goiters are the most frequent (77.31%), with a pathology benign majority (91.30%). The fundamental problem is the pre-surgical establish malign lesions that require a complex therapeutic protocol comparing to benign nodules. Benign lesions 91.30%, carcinomas 5.48%, others 3.21%. All types of thyroidectomies have been made: T.ST 69.37%, T.T for benign and malign lesions 7.65% and other procedures. Thyroid specific morbidity is 4.25%, whereas unspecific is 8.69%. The 0.08% mortality (1 case), virtually null, place the result between the best of the kind. CONCLUSIONS: Pre-surgical diagnosis, as accurate as possible, based on the clinic exam using the vacuum punction with a fine needle, finally confirmed by the paraffin exam, provided the choice of an optimal surgical strategy, followed by an appropriate post-surgical protocol. Total thyroidectomy is the preferred procedure is most of the thyroid cancer forms and in benign diseases is highly recommended (multi-nodular goiters, hyperthyroid, Basedow disease, cancer).

[Hydatid cyst--rare presentations]. / Chistul hidatic. Forme rare de prezentare.

Hydatid disease is an parasitic infestation due to germens from Echinococcus family, principal localizations of the disease being hepatic and pulmonary. We present two cases of disease, first localized primary on the buttock and second with multiple organ involving. We consider these cases interesting because of rarity and complexity of lesions.

[Severe acute pancreatitis. Its management and experience]. / Pancreatitele acute grave. Conduita si experienta.

The authors examined a group of 91 cases of acute pancreatitis hospitalised and treated between 1992 and 1996, using multiparametric bioclinical scores like Ranson, Imrie, Apache II systems and morphological scores obtained through C.T., they have divided the examined group into patients with A.B.P. (acute benign pancreatitis)--59 (64.84%), who don't require exquisite therapeutical means, with positive healing and A.S.P.--32 (35.16%), who require a complex medico-surgical therapeutics with unforeseeable evolution and results. The purpose of the paper was the one of establishing a diagnostical and therapeutical strategy for the A.S.P. adequate to actual conceptions. The correct diagnosis of acute pancreatitis initially has been established at 59 (64.83%) and erroneous at 32 (36.13%) cases. The diagnosis of A.S.P. has been established in 32 (35.16%). The etiology has been lithiasic (biliary) for 31.25% and nonbiliary for 68.75% patients. The C.T. examination in the best way to diagnose necrosis and infections, to follow the evolution and especially the surgical indication, achieved by the authors in 30% of cases. The initial medical treatment has been fulfilled at all the patients and the surgical one at 29 (91.63%). There have been implemented explorer laparotomies in 33.33% cases, interventions on the pancreas in 72.66%, operations associated on the biliary ways 41.37%, necessity operations 13.8%, with different types of draining (conventional and open abdomen). The results have been taxed by locoregional complications in 72.41%, general complications in 44.51% and a general rate of decrease of 43.75%. It is recommended initial surgical abstention and gravity estimations, the reanimation of all A.S.P. for prevention and treatment of general complications, surgical treatment of A.S.P. complications. The A.S.P. treatment of biliary (lithiasic) etiology after two months and after C.T. to confirm inflammatory process remission.