[Pancreaticoduodenectomy with or without pylorus preservation: a retrospective analysis of 137 patients].

Objective: We performed a retrospective study to assess the postoperative results, long-term survival and quality of life after pylorus preserving pancreaticoduodenectomy (PPPD) versus standard Whipple pancreaticoduodenectomy (WPD).

Methods: A retrospective study was performed in a nonselected series of 137 patients who were operated in the Surgical Clinics of "St. Spiridon" University Hospital Iaşi, Romania, from January 1st, 1995 till December 31, 2005.

[Pancreaticoduodenectomy for pancreatic head cancer, 54 cases].

Unlabelled: Pancreatic cancer has an increase rate in western countries. From the first pancreaticoduodenectomy (PD) performed by Kausch in 1909, the value of the resection in the treatment of pancreatic head cancer was disputed.

Aim: To assess the PD with or without pylorus preservation as surgical treatment for pancreatic cancer.

[The role of lymphadenectomy in the treatment of differentiated thyroid cancer].

Papillary and follicular carcinoma represent almost 90% of the thyroid malignancies, being responsible for 70% of the mortality generated by thyroid cancer. Lymph node involvement, far more significant in the papillary form, increases the risk of local recurrence and affects long-term survival. Due to the lack of prospective randomised studies to assess the benefit of lymph node dissection in addition to total thyroidectomy, there is no consensus regarding the need of routine vs elective central compartment lymphadenectomy.

[The role of fine needle aspiration biopsy in differentiated thyroid carcinoma].

Unlabelled: Fine needle aspiration biopsy (FNAB) in evaluation of nodular goiter generated a true revolution. It is generally assumed that the use of FNAB reduces the number of surgical procedures by 50%, while doubles the proportion of carcinoma in surgically treated patients. The aim of the study was to demonstrate the utility of FNAB in preoperative diagnosis of thyroid carcinoma.

[The assessment of empiric antibiotherapy in acute secondary peritonitis].

Unlabelled: The adequate use of antibiotics, according to the international guidelines of antimicrobial therapy, is, in addition to surgery, an important part of the management of intra-abdominal infections. The aim of the study was to assess the efficacy of empiric antibiotherapy in acute peritonitis of digestive cause.

Material And Methods: A retrospective study was carried out on a series of 75 cases of acute peritonitis, admitted in the IIIrd Surgical Unit, in the period 2003-2005.

[A rare complication of colostomy].

A case of a 64 years old female patient who had had a Miles operation 6 years ago for rectal cancer and at the present hospital admission she came in with a severe infection around her left colostomy. Initially, she presented a quite localized peristomal infection but, subsequently, the infection has evolved to an extensive necrotizing fasciitis of the abdomen, a large dehiscence of colostomy and severe sepsis. Repeated surgery and transverse colostomy, to put at rest infected left colostomy, plus aggressive medical treatment resulted in a good recovery, with the wounds healing and redo of the left colostomy.

Taylor's method: a therapeutic alternative for perforated gastroduodenal ulcer.

Background/aims: In the context of actual trends towards an efficient and less aggressive therapy of peptic ulcer, it seems that Taylor's method, in selected cases of perforated gastroduodenal ulcers (PGDU), comes again into attention. The aim of this study was to present our 16 years' experience with Taylor's treatment as an efficient option for sealed perforated ulcers, and to highlight the indications and advantages of this method.

Methodology: A retrospective study, and prospective since 1990, was carried out on a series of 64 patients out of 592 (10%) diagnosed with PGDU between 1987 and 2003.

[Differentiated thyroid cancer--peculiar morphological and clinical forms].

The most common clinical presentation of differentiated thyroid cancer (DTC), consisting of papillary and follicular adenocarcinoma (with their histological variants), is the solitary thyroid nodule. A review of the literature is performed in order to describe particular forms of DTC, in terms of incidence, diagnosis and treatment: occult carcinoma, carcinoma on aberrant thyroid tissue, "functional" thyroid carcinoma and familial non-medullary carcinoma. A particular interest is shown to the coexistence of malignancy with benign thyroid diseases, such as goiter, hyperthyroidism and Hashimoto's thyroiditis, as well as parathyroid adenoma.

[Differentiated thyroid cancer--staging and prognostic systems].

Differentiated thyroid cancer (DTC), including papillary and follicular carcinoma with histological variants, has an excellent prognosis; nevertheless a subset of these tumours is clinically aggressive and, in some patients, fatal. Treatment of DTC remains controversial, regarding the extent of primary surgical resection, the need for lymph node dissection and the role of postoperative radioactive iodine ablation. In addition to the widely accepted TNM classification, recognition of significant risk factors and developing of staging systems, such as AMES, AGES, MACIS, MSKCC and NTCTCS, has helped to identify the patients with a potential aggressive course of the disease and high risk of recurrence.

[Acute surgical pathology in elderly patients].

The consequence of demographic aging is an increase of surgical pathology of the elderly, concerning both number and complexity of the cases. To asses the nature of geriatric surgical pathology and the effect of co-morbidities on surgical outcome, a retrospective study was carried out on a series of 401 patients aged over 75, treated in the IIIrd Surgical Unit in the period 2002-2003. 132 patients were admitted as acute cases and 94 of them were operated: 62 required immediate surgery and 32 required delayed operations.

[Necrotizing fasciitis].

The management of a right foot necrotizing fasciitis and severe sepsis in an old diabetic patient is presented. The early and aggressive surgery, adequate antibiotherapy and correction of organic disfunction (cardio-circulatory, renal, respiratory) eliminated the vital risk and resulted in a satisfactory morpho-functional recovery of the foot.

[Laparotomy in the treatment of severe intraperitoneal infections].

A retrospective clinical study was carried out on a group of 18 patients with severe intraperitoneal infections due to various causes. The decision to use laparotomy was supported by the severity of sepsis (APACHE II score varied from 14 to 30), highly septic peritoneal fluid, the features of peritonitis, patients with impaired immunity. Open packing was realized with a Dacron mesh sutured to the fascial margins, associated with multiple peritoneal drainage in all cases.

[Completion gastrectomy associated with pancreaticoduodenectomy].

The authors present the case of a male patient, aged 56, operated (partial gastrectomy) for peptic ulcer 20 years ago, who is admitted for epigastric pain and distension, frequent vomiting, asthenia and weight loss. Physical examination, barium meal and upper digestive endoscopy with biopsy established the diagnosis of carcinoma of the gastric stump, due to malignant transformation of adenomatous polyps, with duodenal invasion. Completion of gastrectomy and pancreaticoduodenectomy was performed, with good postoperative results.

[Choledochal malignant hemorrhagic cyst, with cholangitis].

The increased risk of cholangiocarcinoma in patients with congenital cystic disease of the biliary tree is well documented. The reason for the malignant transformation is taught to de related to chronic inflammation and bacterial exposure within bile ducts. Total excision of the choledochal cyst notably reduces the risk of cancer.

[Factors which may influence the surgical outcome in myasthenia gravis].

Objective: This study intends to assess the factors which may influence the surgical outcome in myasthenia gravis.

Method: 52 myasthenic patients were operated on in the IIIrd surgical unit, Iaşi, undergoing extended thymectomy through a complete longitudinal sternotomy during a period of 21 years (1980-2001), the surgical outcome being variable. The following factors: age, clinical stage (Osserman classification), the history length and the histopathology of the specimen were analysed in respect with the surgical outcome which varied from complete remission and clinical improvement till no effect and death.

[Multimodality treatment outcome of invasive thymomas].

Unlabelled: The aim of the study was to analyze the progression of invasive thymomas associated with myasthenia gravis, after the resection and the progression of unresectable invasive thymomas with a combined chemoradiotherapy. The study was performed on two groups of patients: 8 patients with invasive thymomas and myasthenia gravis operated at the 3rd Surgical Clinic between 1986-1999; 4 patients with unresectable invasive thymomas treated at the Radiology-Oncology Clinic by combined chemoradiotherapy, between 1993-1998. The results are presented for each group of patients, separately.

The anatomical variants of the profunda femoris artery and of its collaterals.

The profunda femoris artery, the main nutritive artery of the thigh, has a great surgical significance. The high frequency of the occlusive arterial disease in the lower limbs caused by atherosclerosis, imposes as main therapy the reconstructive surgery. Because the profunda femoris artery remains patient in most of the cases of the occlusive arterial disease of the lower limbs, it means the only hope of saving an critically ischemic limb in a desperate attempt of a surgeon to avoid amputation.