Surgical Features after Neoadjuvant Treatment for Breast Cancer.

Unlabelled: Patients with breast cancer may receive neoadjuvant cancer treatment in order to benefit from radical surgery or to turn an indication for extensive surgery into a conservatory or oncoplastic operation.

Aim: To establish the main implications of therapeutic management of the cases of breast cancer treated initially with chemotherapy followed by surgery.

Material And Method: 35 breast cancer patients operated in 2020 after NACT (neoadjuvant chemotherapy) in Surgery Clinic of Coltea Hospital are analyzed, and the response after treatment is pathologicaly evaluated using the Residual Cancer Burden method The results of the analysis of the group of patients showed that most patients presented downstaging of the disease after neoadjuvant treatment with a proportion of 17,14% with complete pathologic response.

[The efficiency of lumbar transperitoneal laparoscopic sympathectomy--100 cases revue].

Lumbar sympathectomy, classical surgical technique applied in conventional arteriopathy treatment, has acquired new valence by the development of laparoscopic technique. In a period of ten years (2000-2009), a number of 100 patients with different cause of arteriopathy have been operated by transperitoneal lumbar sympathectomy. Mean age was 62 years.

[Giant parathyroid adenoma with hypersecretion and severe clinical course--clinical case].

Primary hyperparathyroidism is an uncommon disease, with late diagnosis due to insidious and various symptoms. Parathyroid adenoma is the most frequent cause of primary hyperparathyroidism. This paper presents the clinic of disease, the necessary exams to perform in order to obtain a positive diagnosis also the case of young man with long evolution period prior to diagnosis and with severe complications at bones.

[Three centuries of surgery at Colţea Hospital].

The authors present the evolution of surgery at Colţea Hospital during the last three centuries. After a brief history of the Colţea hospital and its masters surgeons, the attention is drawn on the masters efforts to optimize the care, equipment and surgery techniques, things that became of national and world-wide importance.

[Umbilical hernia in adults: laparoscopic approach with prolene mesh--is it a safe procedure?].

Introduction: The laparoscopic approach for umbilical hernia is more and more used, but few results are reported. The aim is to evaluate the efficacy and safety of using the Prolene mesh placed laparoscopically in umbilical hernia treatment.

Material And Method: Between 2004-2006, 21 patients with umbilical hernia, aged of 34 to 77 years, were submitted to intraperitoneal application of a Prolene mesh to cover the umbilical ring.

[The sentinel lymph node technique in colorectal cancer using in vivo dye--utility and limits].

The aim of this work is to analyze the importance of sentinel lymph node technique in the treatment of colorectal cancer. There are presented data from literature concerning sentinel lymph node, especially papers about the place of sentinel lymph node method in the treatment of colorectal cancer. This work also shows the experience of Surgical Clinical Department of Coltea Hospital in the use of sentinel lymph node method in colorectal cancer (8 patients with colon cancer and 9 with rectal cancer).

[Learning curve and his consequences in laparoscopic antireflux surgery].

The laparoscopic fundoplication became the gold standard of the laparoscopic antireflux surgery (LARS). Our aim is to indicate the evolution of the learning curve as well as its consequences on the patient's outcome. We studied the gastro-esophageal reflux (GER) cases treated laparoscopically in Colţea University Hospital throughout 6 years.

[The complications of colostomies].

The evaluation of the frequency of complications that arise after colostomies performed for colorectal and genital neoplasm, and also the treatment possibilities for these complications. In Colţea Hospital, Surgical Department during 1984-2002 there have been admitted and surgically treated 891 patients with colorectal cancers, among which, 484 had rectosigmoidal neoplasm. We have treated 25 patients with complicated genital neoplasm (19 rectovaginal and recto-bladder-vaginal fistulas following cervical cancers, 5 pelvic tumoral blocks following ovarian cancers and a vulvar cancer with local invasion).

[The rectal cancer--between resection and amputation. Surgeon's decalogue].

The surgeon has the opportunity to use a lot of treatment choices taking into account the site, the progression and the aggressiveness of the rectal tumors. If the treatment of anal cancer have been the same over the last years there are a few problems regarding the rectal cancer, especially for the one, which is distal and locally advanced. The therapeutic choice must take into account the following factors: the site of the tumor, the circumferential invasion, the local and distant spread, the complications and loco-regional recurrences, the anatomical shape of the pelvis, the possibility of developing tumor implants on the residual rectum, the equipment of the hospital, the experience of the surgical team, the accuracy of stoma technique, and the previous results in patients survival.

[Technical solving variants of external biliary and pancreatic fistulas].

Two cutaneous postoperative fistulas--pancreatic and biliary--was solved by an anastomosis of maturate fistulas traject with duodenum and respectively an Y jejuno loop (Roux) with good results.

[Considerations on 988 breast cancers].

Aim: Therapy schedule improvement.

Material & Method: The study includes 988 patients (which 16 men) with breast cancer who underwent surgery between 1984-1998. Out of them 63.

[Incidents, accidents and complications in laparoscopic surgery].

Between 1995-1999 in Colţea Surgical Clinic were performed 2498 laparoscopic operations (1957 cholecystectomies, 541 other procedures). The laparoscopic approach consisted in 1 to 6 ports of 5 to 12 mm. Conversional rate was, 176% and reintervention was required in 0.

[Ultrasonically activated scalpel in laparoscopic surgery advantages and limits].

Unlabelled: The disadvantage of monopolar coagulation, the limits of the bipolar coagulation and the frequent changes of instruments during laparoscopic procedures, are three elements that make the harmonic dissectors very useful in laparoscopic surgery.

Material And Method: In Surgery Clinic were operated with anatomic scalpel (HS), in the last month: 50 cholecystectomies, 25 appendectomies, 12 partial ovarectomies, 10 anexectomies and 2 splenectomies. We used 5 and 10 mm instruments, especially the ETICON scissors.

[ Epidemiological and clinical-therapeutical considerations on 500 operated cases of uterine cervix cancer].

Aim: Optimization of the treatment on uterine-cervix neoplasia, in a general surgery department.

Material And Method: Between 1984-1999, in Colţea Surgical Department were operated 746 uterine-cervix cancers. We selected two trials of 250 females, similarly regarding age and stadium.

[The capacity of preoperative ultrasonography in predicting technical challenges in laparoscopic cholecystectomy].

Unlabelled: Ultrasonography is a nonsophisticated, cheap and safe exploration, that makes it the most used non-invasive method in the diagnosis of biliary diseases. Present study aims to evaluate preoperative ultrasonography's capacity of predicting technical challanges in laparoscopic cholecystectomy (LC).

Material And Method: The trial is represented by a sequence of 100 patients undergoing LC in 2001.

[The therapeutical strategy for locally advanced breast cancer].

As for the other cancers, the strategy of therapy of breast cancers is going to a unitary standardization. In our department between 1984-1999 we are operated 1040 patients with breast cancers, which means 25.3% of all cancers treated.

[Analysis of 3100 laparoscopic cholecystectomies].

Aim: To evaluate the results of laparoscopic cholecystectomy (LC) in the 8 years period.

Patients And Methods: First LC in Coltea Hospital was performed in September 1993 and introduced for treatment of patients with gallbladder disease. From September 1993 to February 2001 LC was performed in 3100 patients.

[Conversion in laparoscopic surgery].

Aim: The conversion causes evaluation in dynamics.

Methodology: The study is a retrospective analysis of the conversion to open surgery in 1993-2001 period, indifferently of the moment and the determinant cause. The yearly dynamics of the conversions was divided by operation types and surgeons.

[The laparoscopic procedures on abdomen with adhesions].

The scar abdomen is more and more seldom a contraindication of the laparoscopic approach. According to Rohr it is classified in scar abdomen after Mac Burney, suprapubic or supraumbilical approach and of the polyoperated patients. Our trial consists in 452 patients with laparoscopic operations consecutive open abdominal surgery (out of the 3900 patients undergoing celioscopic procedures between 1995-2001).

[Strategy and tactic in the treatment of local advanced rectal cancer].

In local advanced rectal cancer (LARC) was defined at the work group in rectal cancer as a tumour what invade the serosa or neighbouring organs, associated with invaded perirectal or mezorectal nodes, with internal fistulae, peritoneal carcinomatosis and locoregional recidives. On a trial of 97 patients, the authors present personal experience, in comparison with literature data regarding therapeutic strategy and tactic of parameters: operability and the moment of operation, indication of preoperative radiotherapy, the type of operation, excision of the metastasis, adjuvant therapy and attitude of locoregional recidives. The survival of the patients was 21.

[The surgical possibilities in locally advanced gastric cancer (LAGC)].

Most frequently the diagnostic of gastric cancer is established in advanced stages. Practically, was noticed that local evolution advances the appearance of metastases. The authors are presenting 159 cases of locally advanced gastric cancer (LAGC) out of 211 gastric cancers submitted to surgery between 1984-1995.

[Laparoscopic cholecystectomy in acute cholecystitis].

Aim: Results evaluation of laparoscopic cholecystectomy in acute cholecystitis.

Material And Method: Between 1994-1997 we performed 65 laparoscopic cholecystectomies for histopathologically proved acute lithiasic cholecystitis. We studied clinic and echographic diagnosis, operative moment, conversion rate, operative time, postoperative morbidity and hospitalization.

[The place of laparoscopy in assessing and treating a pain syndrome of the right iliac fossa].

The study is considering a trial of 87 patients (61 women 17 and 76 years old) admitted in our clinic between 1995-1996. The preoperative diagnosis was coincident with the laparoscopic one in 10 cases the laparoscopic one in 10 cases the laparoscopy completed the diagnosis and in 12 cases it showed out other organ's disease, evicting useless operations. In the 87 patients we performed: 53 appendectomies, 20 oophorectomies, 15 partial oophorectomies, 9 right adnexectomies, 2 adhesiolysis, 2 lymph node biopsies, 1 epiploic fringe excision for necrosis, 1 appendicular stump removal.

[The classical or laparoscopic operation in inguinal hernias].

Aim: Results evaluation in two trials of patients undergoing classical or laparoscopic surgery for inguinal hernia.

Material And Method: We compared 2 homogeneous trials of 80 patients with inguinal hernias treated by classic procedures: Bassini, Shouldice, Lichtenstein (trial I) or by laparoscopic approach with Plastex, Mercilene or Prolene prosthesis (trial II) between 1995-1997.

Results: Postoperative morbidity consisted in trial I in 5 seromas, 2 hematomas, 4 cases with neuralgic pain, 1 with testicular hypotrophy and 4 recurrences.