Thromboangiitis obliterans - case report.

Thromboangiitis obliterans (Buerger'€™s disease) represents an inflammatory disease of limbs'€™ small arteries and veins causing vascular thrombosis, and partial or total obstruction. It affects mostly male gender aged 40 years old. The peculiarity of our case is underlined by presenting a 62 years, chronic tobacco user and not compliant female patient known with thromb oangiitisobliterans for almost 15 years. The arteriographic and clinical features with concomitant and sever affected upper and lower limbs are highly suggestive, emphasizing the possibility of Buerger'€™s disease development even in female patients.

Can the epirubicin cardiotoxicity in cancer patients be prevented by angiotensin converting enzyme inhibitors?

PURPOSE: The aim of this study was to assess whether treatment with angiotensin converting enzyme inhibitors (ACEI) can prevent the alteration of left ventricular systolic and diastolic performance in cancer patients treated with different chemotherapy regimens containing epirubicin. METHODS: In this prospective study , 68 patients with different malignant tumors treated with epirubicin and perindopril in different chemotherapy protocols (study group), and a gender- and age-matched group of 68 patients with different malignant tumors treated with epirubicin without perindopril in different chemotherapy protocols (control group), were assessed by Doppler echocardiography. Left ventricular systolic function was assessed by measuring left ventricular ejection fraction (EF). Left ventricular diastolic function was assessed by Doppler ultrasound by evaluating the transmitral flow. We also assessed the QTc on the 12 lead electrocardiograms. RESULTS: At the end of chemotherapy the left ventricular systolic function was less altered in the study group compared to the control group and was superior in the study group (epirubicin+ACEI) compared to the control group (epirubicin alone). We documented a significantly deteriorated left ventricular diastolic function in both groups at the completion of chemotherapy. QTc time in both arms was also significantly prolonged. CONCLUSION: In the present echo-Doppler study we documented a preserved left ventricular systolic performance in patients with various malignancies treated with epirubicin plus perindopril. Although co-treatment with ACEI prevented the alteration of systolic performance, it failed to prevent the deterioration of the left ventricular diastolic performance impairment due to poor left ventricular compliance.

Calcific uremic arteriolopathy in hemodialyzed patients.

In the present article, we discuss the case of 67-year-old female patient diagnosed with inferior limbs calciphylaxis and hemodialyzed since 2006. The clinical manifestations and pathological lab findings are typical for this rare and extremely severe complication in chronic hemodialyzed individuals. The favorable treatment response to sodium thiosulfate, not often used as elected therapy in international studies, represents the particularity of the case.

[Heterotopic accessory pancreas in surgical pathology: review of 23 years experience]. / Pancreasul accesor heterotopic in patologia chirurgicala: experienta a 23 de ani.

BACKGROUND: The abnormal presence of the pancreatic tissue in other digestive organs is rare but sometimes is the cause of some surgical diseases. MATERIAL AND METHOD: This retrospective study is focussed on heterotopic pancreas cases diagnosed in 2nd Surgical Clinic of "Sf. Spiridon" Emergency Hospital from Iasi between Jan. 1986 and Dec. 2008. RESULTS: 22 patients (15 males/68.2% and 7 females/31.8%) aged between 23 and 76 years were grouped in A group--clinical symptomatic cases (3 patients/13.6%), group B--coincidental cases (17 patients/77.3%) and group C--incidental cases (2 patients/9%). Group A patients presented with obstructing prepyloric polypoid tumors and recquired antrectomy and gastroduodenal anastomosis. 13 patients of group B (76.4%) recquired surgery for pyloroduodenal stenosis and in 4 cases of this group with severe upper-GI bleeding, a subtotal gastric resection (3 patients) or antrectomy (1 case) was performed. In group C patients jejunal HP was histopathologically diagnosed during extensive intestinal resection for colonic malignancies (ascendant colonic and transverse colonic cancers) with jejunal invasion. HP cases were categorized as type I in 40.9% cases (ducts, acini and pancreatic islets), type II in 45.4% cases (ducts and acini) and type III (exclusively with ducts) in 13.6% cases. In 76% patients HP was localized in mucosal and submucosal layers, in 16% intramucosal and in 8% in subserous layer. CONCLUSION: HP is most often an unexpected symptomless coincidental diagnosis during gastrointestinal surgical diseases.

Preoperative Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio in Peripheral Blood of Patients with Gastrointestinal Malignant Lesions.

Local inflammation plays a very important role in the apparition and development of tumors and metastasis. The objective of this study was to investigate the significance of neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR) and platelet to lymphocyte ratio (PLR) in peripheral blood of patients with gastrointestinal malignant tumors. METHODS: Medical records of 145 patients diagnosed with gastrointestinal malignant tumor between January 2017 and December 2017 were analyzed retrospectively. Pretreatment neutrophil, lymphocyte, platelet and monocyte counts and NLR, LMR and PLR were investigated. RESULTS: The mean for NLR, PLR and LMR in patients with gastrointestinal cancer were determined. CONCLUSIONS: Determination of NLR, PLR and LMR can be easily done with a simple blood test and may be useful inflammatory markers as in our study we have observed the presence of increased inflammatory response in patients with gastrointestinal cancer.

Balthazar Score and Neutrophil-Lymphocytes Ratio in Acute Pancreatitis.

Acute pancreatitis is a pathological entity that poses numerous diagnostic and treatment problems. Severe form is a real challenge for a physician because it has multiple obscure causes, as well as a complex pathophysiology. Thus, the diagnosis is difficult and the choice of the right time for surgical treatment is controversial, the treatment being more frequently nonspecific, supportive for the various affected systems and organs. On a group of 337 patients, laboratory and imaging investigations were performed to diagnose and determine the severity score of acute pancreatitis and the correlation level between the neutrophil-lymphocytes ratio values and the Balthazar score, as a valid assessment method for local and systemic inflammatory changes. The distribution's study of acute pancreatitis by gender according to etiology confirms the predominance of the acute ethanolic pancreatitis in male, but also the higher proportion (54%) of male pancreatitis (181 man vs. 156 women) with gender ratio male/female 1.16/1. The neutrophil-lymphocytes ratio mean value varied according with the Balthazar severity score, that got higher as acute pancreatitis got more advanced and with a certain cut-off value can be considered a simple indicator to determine the severity of acute pancreatitis.

Electrocardiography and conventional radiology accuracy compared to echocardiography in evaluating left ventricular remodelling patterns in hypertensive patients.

AIM: The value of conventional radiology, electrocardiography and echocardiography in estimating the prevalence of left ventricular (LV) remodeling patterns in patients with newly discovered hypertension was less studied. The aim of the present study was to assess the accuracy of conventional radiology and electrocardiography compared to echocardiography in the diagnosis of left ventricular hypertrophy (LVH) and different remodeling types in male patients with recent primary arterial hypertension (PAH). METHODS: This cross-sectional study, enrolled 420 male patients with recent stage 2 PAH, diagnosed less than a year before, and 420 normotensive male subjects, using conventional radiological methods, ECG and also echocardiography. The ultrasound examination documented four types of LV remodeling, based on the measurement of LV parameters: concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodeling (CR) and the normal variant (NV). RESULTS: In the recent PAH group, echocardiography diagnosed LV patterns in different proportions (34.285% CR; 24.285% NV; 21.43% EH; 20% CH), whereas the standard radiological examination and ECG documented LVH positive criteria in a much lower proportion of cases, for these patterns. CONCLUSION: The ECG and radiological examinations detected LVH in patients with EH, and CH, but both examinations were inconclusive in those with CR and NV. This study comparatively reflects the effectiveness of echocardiography, electrocardiography and conventional radiology, in the diagnosis of LV patterns in newly discovered hypertension and also illustrates the arguments for and against the usage of these three imagery techniques.

Endocrine paraneoplastic syndromes in small cell lung carcinoma. Two case reports.

Paraneoplastic syndromes are frequently detected in many small cell lung cancer (SCLC) patients. In the present paper we report 2 cases of patients diagnosed with SCLC, in whom 2 distinct endocrine paraneoplastic syndromes were identified during diagnosis. In the first patient, severe hyponatremia and renal sodium loss with inappropriate antidiuresis was found during routine laboratory tests. Serum antidiuretic hormone (ADH) level was within normal limits, but the atrial natriuretic peptide (ANP) level was elevated. The second case presented with severe hypercalcemia secondary to an excessive parathormone (PTH) secretion. We discuss the 2 cases and review the literature.

Myocardial function in patients with breast cancer after therapy with anthracyclines and chest irradiation.

PURPOSE: To evaluate and compare the left ventricular performance in female patients with breast cancer treated with chemotherapy (CT) and either left or right thoracic irradiation (RT), using Doppler echocardiography. PATIENTS AND METHODS: Thirty-four patients with cancer of the left breast treated with surgical resection, adjuvant EC CT (epirubicin and cyclophosphamide) and conventionally fractionated left thoracic RT (study group) and a gender-and age-matched group of 34 patients with cancer of the right breast also treated with surgical resection, adjuvant EC CT and right thoracic RT (control group), were studied by echocardiography. Assessed were the left ventricular systolic performance by measuring the global ejection fraction (EF) and the shortening fraction (SF). Left ventricular diastolic performance was assessed by measuring the Doppler transmitral flow: the maximal velocity of the E wave (rapid filling/ Emax) and A wave (atrial filling/Emax) were measured. The ratio of Emax/Amax, the pressure half-time (PHT) of the E wave and the isovolumic relaxation time (IVRT) were also calculated. RESULTS: The left ventricular diastolic performance was altered in the study group which showed a significant decrease (p <0.001) of Emax. A wave was significantly increased in the study group compared with the control group (p <0.001. The mitral E/A ratio was subunitary in both groups but more depressed in the study group. The E wave PHT was more prolonged in the study group compared to the control group (p <0.001). The IVRT was prolonged in the study group compared with the controls (p <0.05). The left ventricular systolic performance was within normal limits in both groups. CONCLUSION: Our Doppler echocardiography study documented an impaired left ventricular diastolic performance in patients with cancer of the left breast treated with fractionated thoracic RT and CT. This impairment is due to poor left ventricular compliance.

Adaptive and Pathological Reshuffling in the Venous Wall in Special Hemodynamic Conditions-Acquired Arteriovenous Fistula.

Hemodialysis and peritoneal dialysis are the two possible choices in chronic renal disease in the uremic stage. Native arteriovenous fistula is susceptible to complications, some posing vital risk and requiring prompt treatment. We present the case of a patient undergoing hemodialysis on native AVF. An aneurism developed progressively on the arterialized cephalic vein. The AVF was abolished by closing the arteriotomy with a venous patch and excising the aneurismal venous segment. The pathology exam of the surgical specimen showed unequal vessel wall thickness due to hyperplasia of the media and subintimal space, with calcifications within the hyperplastic media.

["The fate" of a peri-cystic-jejunostomy in the treatment of the hydatid liver cysts]. / "Soarta" unei anastomoze perichistojejunale a cavitatii posthidatice hepatice.

The persistence of a hepato-jejunal fistula after 9 years from a peri-cystic-jejunostomy in the treatment of hydatid liver cysts is an amazing condition. We discover this kind of fistula during the operation for cholelithiasis. This association between fistula and a "after-hydatid" choledocholithiasis is an opportunity to discuss some pathogenic and evolutive mechanisms about both of two entities.

Does epirubicin affect left ventricular systolic performance in oncologic patients?

PURPOSE: In the present study the left ventricular diastolic and systolic functions were evaluated in patients treated with lower total doses of epirubicin using Doppler echocardiography. PATIENTS AND METHODS: Seventeen patients with different malignant tumors treated with epirubicin up to 450 mg/m(2) (study group), and a gender-and age-matched group of 29 patients diagnosed with tumors, who had not started treatment yet (control group), were assessed by echocardiography. Left ventricular diastolic function was assessed by measuring the Doppler transmitral flow. We measured the maximal velocity of the E wave (rapid filling) and A wave (atrial filling). The ratio of Emax/Amax, the pressure half time (PHT) of the E wave and the iso-volumic relaxation time (IVRT) were also calculated. The left ventricular systolic performance was assessed by measuring the global ejection fraction (EF). RESULTS: The left ventricular diastolic performance was altered in the study group. In this group we noticed a significant decrease ( p < 0.001) of Emax. A wave was significantly increased in the study group compared to the control group ( p < 0.001). The mitral E/A ratio was subunitary in the study group. The E wave PHT was prolonged in the epirubicin-treated group in comparison to the controls (p<0.001). The IVRT was prolonged in the study group in comparison to the controls (p<0.05). The left ventricular systolic performance was not significantly altered in the study group compared to the control group. Although the EF was lower in the study group the difference did not reach statistical significance. CONCLUSION: Our Doppler echocardiography study documented an impaired left ventricular diastolic performance in patients with various malignancies treated with lower total doses of epirubicin. This impairment is due to poor left ventricular compliance.

[The main utility of trans-anastomosis external drainage in the hydatid liver cysts treatment by peri-cystic-jejunostomy]. / Importanta drenajului extern transanastomotic dupa tratmentul chistului hidatic hepatic prin perichistojejunoanastomoza.

We purpose to make a metanalysis of a external drainage and his role in the treatment of the hydatid liver cysts when it was made a anastomosis between peri-cystic cavity and a isolated loop of jejunum. The paper watch 74 cases which were operated in "I. Juvara" surgical clinic and in which it was used the external drainage of peri-cystic cavity. The drainage roles consist in follow up of peri-cystic cavity evolution, but, more than that, in early diagnosis and treatment of secondary infection of cavity, the main postoperative complication. The drainage excludes the possibility of unfavourable evolution of postoperative infection, in which case the result of operation may be compromised.

Determining factors of diuresis in chronic kidney disease patients initiating hemodialysis.

BACKGROUND: Patients with stage 5 chronic kidney disease (CKD) begin chronic hemodialysis with variable diuresis levels correlated to a comparable low glomerular filtration rate. Residual diuresis influences long-term evolution of the hemodialyzed patient, modifying the prognosis even if optimal Kt/ V is achieved. AIM OF THE STUDY: The present study emphasizes the main determining factors of diuresis in a cohort of stage 5 CKD subjects at the beginning of hemodialysis. MATERIAL AND METHODS: 216 patients with stage 5 CKD starting chronic hemodialysis were included in the study, and were grouped according to their residual diuresis: group A (urine output ≤ 500 mL/ day); group B (urine output between 500-1200 mL/ day); group C (urine output ≥ 1200 mL/ day). RESULTS: Glomerular etiology, cardiac systolic dysfunction, severe malnutrition, emergency dialysis initiation and lack of permanent vascular access were proved to be associated with significant low diuresis. Age, gender, estimated glomerular filtration rate (GFR) and the presence of systemic hypertension did not influence the amount of daily diuresis. CONCLUSIONS: In CKD stage 5 patients, residual diuresis presents large variations in conditions of comparable low GFR. Factors influencing residual diuresis may be distinct from those that influence residual GFR.

A comparative analysis: storm water pollution policy in California, USA and Victoria, Australia.

Urban drainage systems historically were developed on principles of hydraulic capacity for the transport of storm water to reduce the risk of flooding. However, with urbanization the percent of impervious surfaces increases dramatically resulting in increased flood volumes, peak discharge rates, velocities and duration, and a significant increase in pollutant loads. Storm water and urban runoff are the leading causes of the impairment of receiving waters and their beneficial uses in Australia and the United States today. Strict environmental and technology controls on wastewater treatment facilities and industry for more than three decades have ensured that these sources are less significant today as the cause of impairment of receiving waters. This paper compares the approach undertaken by the Environmental Protection Authority Victoria for the Melbourne metropolitan area with the approach implemented by the California Environmental Protection Agency for the Los Angeles area to control storm water pollution. Both these communities are largely similar in population size and the extent of urbanization. The authors present an analysis of the different approaches contrasting Australia with the USA, comment on their comparative success, and discuss the relevance of the two experiences for developed and developing nations in the context of environmental policy making to control storm water and urban runoff pollution.

[Acute cholangiocholecystitis]. / Colangiocolecistita acuta.

In analysis of a group of 48 patients, the authors describe an entity they call acute cholangio-cholecystitis (or acute cholecystitis of choledochal origin) and define it by 4 obligatory criteria: 1. vesicular lesion of acute cholecystitis type; 2. the obstruction of the main bile duct in the direction of its junction with the cystic duct; 3. free duct communication between the gallbladder and the main bile ducts; 4. fluid content (purulent gallbladder) found identical over the whole biliary territory (the gallbladder the main bile ducts the intrahepatic bile ducts). This entity represents 7.6% of the total of acute cholecystitis and was met in 2.8% of the total of the interventions for the main bile ducts obstruction. The deficient biological background of the patients (60% over 60 years old), and other seriousness factors--vesicular destructive lesions associated with biliary peritonitis (7/48), the existence of the duct obstruction, usually calculous (42/48), but also hydatic (3/48) or tumoural (3/48), the multitude and seriousness of the associated lesions are emphasized. The surgery, performed in over 80% emergent cases, was directed to the decomprimation of the main biliary axis to which the increase of the gangrenous cholecyst, treatment of the duct obstructive factor, repair of the internal biliary fistulas, treatment of the consequent peritonitis were added. The results, very often good (71%), were shadowed by a series of complications (29%) which ended in deaths (14.5%). The paper pleads for the early surgery of the lithiasic biliary disease, before the appearance of the inevitable complications.

[The timely diagnosis of postoperative clostridial infection]. / Diagnosticul în timp util al infectiei clostridiene postoperatorii.

Authors report a case of clostridial myonecrosis postcholecystectomy. The causes of the occurrence of this severe, frequently lethal complication are reviewed, as well as the difficulties of an early diagnosis, the only factor able to save the patient. The curative treatment of the detected infection requires the initiation of a series of local and general measures and a permanent cooperation between the surgeon, the specialist in resuscitation and the infectionist.

[Malignant anorectal melanoma. Apropos 1 case]. / Melanom malign anorectal. In legatura cu 1 caz.

A case of malignant anorectal melanoma is reported, which was treated by anorectal-sigmoid amputation, operation which did not prevent the occurrence, after 6 months, of metastases in the inguinal lymph nodes. On the basis of the reported case, the main etiological, histogenetic, prognostic and therapeutic aspects of these rare tumours are discussed.

[The clinical and therapeutic characteristics of a neoplasm of the left superior colon]. / Particularitati clinice si terapeutice ale neoplasmului de colon stâng superior (CSS).

As "CSS" the authors name the left segment (1/3) of the transverse colon with the splenic angle and fixed segment of the left colon. The author's conclusion of a retrospective analysis upon 34 neoplasms situated in this colonic area is the fact that there are enough arguments to treat them as a unitary group. From the anatomic point of view these arguments are the common vessels and lymphatics reports, and from the clinical point of view these neoplasms have in common the symptomatology (generally the diagnostic is established later on) and a great tendency of a loco-regional invasion which generate severe complications. The surgical treatment with oncologic radical intervention is the same for any primary neoplasm localization (within the there segments of "CSS"). Multi-visceral resections are frequently necessary too.

[Postcontusion glaucoma]. / Glaucomul postcontuziv.

Secondary posttraumatic glaucoma. Blunt ocular trauma may cause transient or permanent high IOP, occurring immediately or in time after the injury. This study presents some clinical and therapeutical considerations about 16 cases which developed secondary glaucoma. The elevation of IOP was associated with hyphema, iridodialysis, zonular tears (with lens luxation or subluxations), alterations of the iridocorneal angle.