Therapeutic possibilities and limits in multiple primary carcinomas: consideration of 38 cases.

The authors report their experiences of 38 cases of multiple primary carcinomas, of which 17 were synchronous and 21 metachronous. Some of them were localized to the same organs and others on different organs. It is important that diagnosis be established in due time for the first and most of all, for the second or third tumour.

[Considerations on 45 cases of injuries of the diaphragm].

The authors make an analysis of 45 cases of diaphragmatic trauma, of which 27 were wounds and 18 were ruptures. The wounds of the diaphragm, in most cases determined by bullets, were of small dimensions, but were accompanied by serious lesions of the organs in the vicinity, while ruptures of the diaphragm, determined by closed traumas, were extensive, but with less important lesions of the viscera. Rapid transportation, and efficient intensive care have permitted the performance of emergency interventions in all the patients with wounds, except 3 who died in the emergency room.

[Internal biliary fistula of lithiasic origin].

The authors present 17 cases of patients with internal biliary fistulae of lithiasic origin. Nine of these were of the cholecystoduodenal type, 2 of the cholecysto-gastric type, 2 had developed between the cholecyst and the colon, and 4 were of the bilio-biliary type, between the cholecyst and the choledochus. These cases represented 1.

[Synchronous multiple primary cancers of the colon].

The authors report three cases with double synchronous primary cancers of the large bowel, representing 1,57% of the total 224 cases with colon and rectal cancers they have operated. In all the cases it was possible to perform surgical removal of the tumours by right hemicolectomy and segmental sigmoidectomy in two of the patients and rectosigmoidectomy in the third one. The clinical and prognostic characteristics confirmed the opinion, that has been advanced in the specialized literature, that these tumours are relatively benign.

[Bipolar approach to biliobronchial fistulas].

On the basis of 4 cases (three bilio-bronchial fistulae of hydatic origin, and one post-traumatic fistula), the authors review the problems of etiology and of pathological physiology. After an interpretation of the results obtained they recommend the bi-polar approach (pulmonary and biliary) in the same surgical intervention. In relation with the condition of the patient the second stage of the intervention will be performed after 14 to 21 days (the abdominal stage being carried out after the thoracic stage).

[Surgical aspects of malignant plasmacytoma].

The case is presented of a patient presenting with a solitary plasmocytoma of the cecum (the 5-th case reported in the world medical literature), for which right hemicolectomy was performed. A second observation is presented, concerning an enteromesenteric infarction that developed on the background of multiple myeloma. Segmental enterectomy was performed.

[Unusual clinical and therapeutic aspects of intrathoracic goiter].

Out of the 220 cases of goiters operated in the clinic 19 were partially or totally intra-thoracic, as follows: --totally intra-thoracic: 7 cases; --partially intra-thoracic: 12 cases, of which: mediastino-cervical: 2 cases; cervico-mediastinal: 10 cases. Five of the totally intra-thoracic goiters were in the anterior mediastinum, while two were in the posterior mediastinum, in a retro-oesophageal position. Three of the 19 intra-thoracic goiters were malignant.

[Clinical and therapeutic aspects of traumatic diaphragmatic hernia].

The authors present 5 cases of diaphragmatic hernia occuring after thoracoabdominal trauma (in one case the hernia was in the right hemidiaphragm, associated with partial hepato-thorax, the other four were in the left hemidiaphragm and were associated with intra-thoracic herniation of the stomach, transverse large bowel, large epiploon, loops of the small bowel and of the spleen). In three cases the lesion was treated by the thoracic route while in the other two the abdominal route was preferred. In one of the cases splenectomy and segmental transverse colectomy were performed by the transthoracophrenic approach.