[Laparoscopic adhesiolysis].

The laparoscopic approach of the postoperative adhesions represents not only a way of diagnosing the pathogenic adhesions but also a superior alternative to the surgery of classical dissection of adhesions by laparotomy because of its obvious advantages: the evolution is simple, the bowel activity is quickly restored, the brief period of hospitalisation, the reduced risk of recurrence. The authors present their experience derived from the 29 laparoscopic adhesiolysis: 3 urgent cases with subocclusions, 6 when the surgical intervention was programmed, with a painful postoperative suffering, and 20 with laparoscopic cholecystectomy. From among these cases, a conversion and a postoperative complication were recorded.

[[Mechanical jaundice of hydatid origin].

From the vast etiological sphere of obstructive jaundice there come out many rare forms, adequate means of investigation before and during surgery are hard to interpret, so the therapy brings up special problems. This paper reports the cases of obstructive jaundice of hydatid nature operated at the I-st Surgical Clinic of Iaşi between 1979 and 1989. These cases have raised special problems of diagnosis, needing complex investigations.

[A rare neurogenic tumor with thoracic growth].

Of 70 operated mediastinal tumors, 15 were neurogenic tumors, one of them clepsydra-shaped, which manifested from the very beginning with spastic paraparesis of the legs. The treatment consisted in a two-steps surgery, the first at the Neurosurgical Clinical of Iaşi (laminectomy and ablation of the rachidian tumor) and the second one, one month later, at the I-st Surgical Clinic of Iaşi (excision of mediastinal tumor and parenchymal bridge within the conjugation hole). The microscopic examination confirmed the diagnosis of neurinoma (schwannoma) Antoni A and B with haemorrhagic areas.

[The value and limits of subtotal gastrectomy in gastric cancer].

In the interval 1970-1988, in 321 of 670 patients with gastric neoplasm admitted to the 1st Surgical Clinic of Iaşi a subtotal gastrectomy was performed. Most patients were males (68.9%), more commonly aged between 50 and 70 years and in advanced evolutive stages.

[Differentiated thyroid cancer].

In the interval 1979-1988, out of 1070 operated goiters 77 malignant thyroid tumors were recorded, 60 of them being differentiated: papillary--32 (53.4%), vesicular--12 (20%), mixed forms--16 (26.7%).

[Torsion of the great epiploon].

The diagnosis of epiploic torsion was made intraoperatively. Apart from resection of the necrotized epiploon, appendicectomy was also performed as the appendix presented acute inflammatory lesions. This anatomoclinical and etiopathogenic characteristics of this rare affection are briefly described.

[The surgery of intestinal obstruction in the elderly].

Out of 301 intestinal obstructions treated at the 1st Surgical Clinic of Iaşi in the interval 1970-1987, 58 patients aged between 70 and 90 years (mean age 75 years) were recorded. Anatomo-clinically these 58 cases presented: strangulated hernia (19 cases), strangulated eventration (2 cases), strangulations on cords (4 cases), small intestine volvulus (8 cases), sigmoid colon volvulus (6 cases), volvulus of cecum (1 case), intestinal investigation (1 case), colorectal neoplasm (15 cases), peritoneal carcinomatosis (2 cases). The clinical and therapeutical aspects of these particular forms of obstruction in the elderly are discussed and the severity of their prognosis, given the terrain and late admission of such patients which sometimes make impossible a surgical intervention, is underlined.

[Megaduodenum due to aortomesenteric shunt].

Two new cases of megaduodenum by aortomesenteric shunt in young adults are presented. The role of some risk factors, the diagnostic and therapeutical elements are discussed, the importance of a thorough investigation of each case in view of individualizing the therapeutical management being underlined.

[Appendicular carcinoid].

The clinical findings in a woman with appendicular carcinoid stage II (without carcinoid syndrome) detected by histopathological examination of the appendicectomy specimens are presented. The histogenesis, pathology, diagnosis and treatment of these slow progressing malignant tumors, rarely accompanied by carcinoid syndrome, are reviewed.

[Problems of therapeutic management of cancer of the superior pole of the stomach].

This cancer is rare (17-30%) and has the worst prognosis. In the interval 1970-1987 to the I-st Surgical Clinic of Iaşi were admitted and treated 648 patients with gastric cancers of which 98 (15.2%) with adenocarcinomas of the cardiac end of the stomach.

[Hepatic abscesses].

The authors analyse 16 cases of hepatic abscesses recorded in a 10-year interval. The difficulties in assessing the etiology and diagnosis, as well as in indicating an effective treatment are discussed. The clinical aspects and investigation methods, among which scintigraphy, arteriography and especially echotomography are extremely useful in making the diagnosis and in localizing the collection, are reviewed.

[Perforated gastric ulcer].

Out of 603 patients with perforated ulcer, 40 clinical cases with type I perforated gastric ulcers (this particular anatomo-clinical form being distinguished from the perforated duodenal ulcer) were selected. The perforated gastric ulcer type I, less common, is usually found in the patients over 45 years, with old, callous ulcers; in general, when the perforations are large, a malignancy is suspected, the removal of the lesion and the systemic control of the resected specimen being required. The primary radical surgical treatment is performed only in the patients in good general state, the excision of the ulcer followed by suture being reserved to the cases at high risk, with increased mortality (10%).

[Clinical and therapeutic aspects of some rare forms of pancreatic tumors].

A total of 198 tumours of the pancreas have been hospitalized between 1972 and 1987 in the 1st Surgical Clinic from Jassy. Only 10 of these tumours were benign, and these included: 2 gastrinomas, 2 insulinomas, 2 cystadenomas, one fibrolipoma, 1 lymphangioma, one hydatic cyst and a Wermer's syndrome. The particularities are analysed, of these 10 cases of benign tumours of the pancreas, and it is stressed that most of the clinical and therapeutic problems are determined by tumours of the endocrine pancreas, and especially those which are hormonally active.