Surgical management of complicated parapneumonic pleural effusion in children.

Aims: We analyzed and examined the effect of different management strategies on short term outcomes for pediatric patients with parapneumonic pleural effusions.

Patients And Methods: We retrospectively reviewed 16 cases of children admitted and treated in our department of pediatric surgery for empyema or pleural effusions for a period of 30 months.

Results: When chest drains are used alone, patients can make a complete recovery, even with the cost of longer hospital stay.

[Gastric cystic duplication--case report].

Gastrointestinal duplication is a rare surgical pathology, with unspecified symptoms, which explains why these malformations are difficult to diagnose correctly before surgery. The authors present a case of a gastric cystic duplication, that was diagnosed before surgery, as a pancreatic pseudocyst. The accurate diagnosis was established by surgery and based on histopathological examination.

[Precocious diagnosis in children's intussusception--a necessity].

Intussusception is the most common cause of intestinal obstruction in children. Despite the fact that this is a frequent and well known disease, sometimes clinical presentation is various and difficult to interpret, which leads to delay in diagnosis and treatment. Late treatment will sometimes require intestinal resection, with high morbidity and mortality.

[Sandostatin treatment in postoperative external digestive fistulae].

The aim of the conservative treatment of postoperative external digestive fistulae is to obtain a reduction of the output, thus favoring spontaneous closure and shortening outcome. A retrospective comparative study has been performed on two groups of patients with postoperative anastomotic gastrointestinal and pancreatic fistulae. Group A included 18 cases (14 anastomotic, 4 pancreatic fistulae) receiving conventional treatment only.

Nonparasitic abdominal serous cysts. A multiple case report.

A group of 35 patients with nonparasitic abdominal serous cysts is reviewed in order to investigate the diagnostic and therapeutic features of these rare conditions. In most cases the cysts were localised in the liver. Other localisations were the kidney (9 cases), the mesenteric area (2 cases), the adrenals (2 cases), the spleen and the pancreas (one case each).

[Sclerosing cholangitis in the evolution of a surgical hepatic hydatid cyst].

The retrospective analysis of 3 clinical observations points out the etiopathogenetic, clinical and therapeutical aspects of the diffuse stenotic cholangitis, which can occur after the surgical treatment of the hepatic hydatid cyst. Although rare (2.9% of hydatid cysts, 13% of those which communicate with the bile ducts), the diffuse stenotic posthydatid cholangitis represents a severe postoperative complication in cases of median cysts, exerting a compression upon the convergence of hepatic ducts and communicating with the biliary tract.

[Late reinterventions after the surgical treatment of gastric and duodenal ulcer].

A number of 87 reinterventions performed during a 5-year-period for late complications of the gastric and duodenal ulcer surgery are analysed. In most of them (64 cases), the cause of the reintervention was a postoperative ulcer. A long afferent loop (6 cases), the dumping syndrome (4 cases), the stenosis of the anastomosis opening (6 cases) and the primitive neoplasm of the gastric stump (7 cases) represented other causes of reintervention.

[The malignant degeneration of colorectal polyps].

The authors make a retrospective analysis of problems related to diagnosis and therapy raised by malignization of adenomatous rectocolic polyps representing 38.7% of the total number of adenomatous polyps (98 cases), and 5% of cancers of the large bowel (759 cases in all). It is stressed that the rate of malignization increases in direct proportion with the number of polyps, and it is higher in segmentary or diffuse polyposis, predominantly in the sigmoidorectal segment.

[Emergency operations in colorectal cancer].

In a group of 161 patients subjected to emergency surgery of rectocolonic cancers with occlusive (111 cases), hemorrhagic (39 cases) or perforating (11 cases) complications, the authors analyze the immediate therapeutic results, as a function of the complication form and the surgical method used in emergency (primary colectomy, serial surgeries, palliative surgeries). Emergency colectomy (55 cases) performed deliberately in strictly selected cases or as the unique possible choice, was followed by immediate good results (the lowest rate of surgical morbidity and mortality) in comparison with the serial surgeries (cumulative morbidity and mortality). The paper discusses the indications of the proximal colectomy and of Hartman's surgery in primary emergency colectomies.

[Hemorrhagic juxtapapillary duodenal ulcer with choledochal and Wirsung's duct stenosis and duodenojejunal fistula following biliojejunal en-Y diversion. The surgical solution].

The paper reports on the clinical observation of a patient with bulbar duodenal ulcer placed in a juxtapapillary position due to a short bile duct, complicated with choledochal and Wirsung's stenosis and, finally haemorrhage and duodenojejunal fistula favoured by a gallbladder-jejunum diversion assembly. Three major surgeries, during 17 years, were required: cholecystectomy and choledochoduodenostomy for the choledochal stenosis induced by penetrating posterior bulbar ulcer; after 8 years, choledocholithotomy and gallbladder-jejunum derivation the loop in Y, (Roux) for the choledochoduodenostomy stenosis with the local lithiasis of the CBP; after 9 years, the resection of the proximal segment of the anastomosed jejunal loop with CBP and gastric resection with ulcer exeresis, followed by restoration of the gallbladder-jejunum anastomosis, gastrojejunal anastomosis and reimplantation of Wirsung's duct in the duodenal stump for juxtapapillary duodenal ulcer complicated with haemorrhage, penetration into pancreas, perforation in the jejunal loop anastomosed preduodenally and stenosis of Wirsung's duct. The final therapeutic result is good and lasts in time.

Pathogenetic interrelations between cholesterolosis and cholesterol gallstone disease.

In order to define the relationship between cholesterolosis (COL) and cholesterol gallstone disease (CGD), risk factors were comparatively investigated in a great number of patients. Sex, age and metabolic risk factors were the same for both diseases, but gallbladder anomalies and neuroendocrine disturbances were more often associated with COL. The lipid composition of the gallbladder bile was determined in patients with COL.