Locoregionally advanced rectosigmoid cancer: diagnosis, surgical approach, late results

The colorectal cancer continues to be diagnosed in advanced stages in our country, mainly due to unapplying of a programmer of active diagnosis through screening on the population with risk for colorectal cancer, and inefficiency of primary care system. In the department of General Surgery CFR Craiova Hospital between 1991-2001 were operated a number of 231 patients with colon cancer and 104 patients with rectal cancer. The results, showing an increased number of recurrences in cases of resection performed for advanced loco-regional tumors of rectosigmoid, made us to reconsider the attitude of avoiding the abdominoperineal resection even when the distance between the inferior limits of the tumors and the anal edge exceeded the distance considered being standard for a low anastomosis performing. The follow-up of the patients with paraclinic technique that didn't prove efficient led in the most cases to a delaying in diagnosis of local recurrences until the moment of resectability was exceeded. The applying of efficient methods in early diagnosis of colorectal cancer and follow-up could provide in the future better results for anterior resections with low anastomosis.     

Ileosigmoid fistula due to an abscess of a periappendicular mass

The paper debates the subject of the undiagnosed acute appendicitis. The formation of a complex ileosigmoid fistula due to an abscess of the periappendicular mass and the three steps peritonitis determined a particular approach in solving the case.     

Ovarian cancer--diagnostic dilemmas and unusual therapeutic response

The aims of this paper are both to highlight some dilemmas concerning the diagnosis of primary epithelial ovarian carcinoma mainly in its early stages and to underline the capricious responses of this type of malignancy to an otherwise well coded modern management. This study is based on the analysis of the records of 78 patients with ovarian carcinoma admitted for diagnosis and surgical treatment to the Department of General Surgery of Craiova C.F.R. Clinic from 1993 through 2003. The results of this analysis are difficult to interpret due to loss to follow up (in terms of response rates) of some of our 78 operated on ovarian carcinoma patients who went on with their platinum-based chemotherapy (following surgical cytoreduction) under the supervision of different Oncology Departments nationwide. Nevertheless, it is worth mentioning that most of this study patients (71.9%) presented with advanced-stage (III and IV) ovarian carcinoma which sometimes seemed quite confusing by its clinical polymorphism but its prognosis was very much related to both the degree of surgical cytoreduction accomplished and tumor sensitivity to chemotherapy. Finally, although this study does not allow us to draw firm conclusions it is an attempt to share out our current perception on the primary epithelial ovarian cancer management.     

The modulator role of the hypothalamic paraventricular nucleus on immune responsiveness

Role of the paraventricular nucleus of the hypothalamus (PVH) upon immune modulation was studied by either mechanically destroying the PVH (PVHL) or by isolating the PVH (PVHI) with a knife-cut. PVHL or PVHI manipulations induced significant leukopenia characterized by a decrease in the number of neutrophils and lymphocytes two weeks post surgery. The numbers of circulating monocytes and eosinophils were not affected by PVH interventions. In addition, PVHL and PVHI were also associated with a reduction, relative to controls, in the phagocytosis by neutrophils and an increase in blastic transformation of T lymphocytes induced by phytohemagglutinin-M (PHA-M). Antibody titers rose against sheep red blood cells (SRBC) after either PVHL or PVHI were reduced. The magnitude of the SRBC antibody reduction after PVH manipulations was similar to that observed in rats that received a peripheral chemical sympathectomy two hrs prior immunization. Comparison of thyroid hormones blood levels two weeks after PVHL or PVHI revealed significant reductions in comparison with sham-operated group (SO), whereas blood corticosterone was not significantly altered. In summary, we provide evidence that lesion or isolation of the PVH selectively reduces circulating white blood cells and the primary immune response, while it enhances the cell-mediated immune function. Taken together our data showed that PVH modulates immune functions by altering both the peripheral sympathetic tone and thyroid hormone secretion.     

Intraprostatic injection of 96% ethanol in experimental animal model

Transurethral intraprostatic injection of ethanol (IIE) is a new low-invasive method in the treatment of benign prostatic hyperplasia (BPH). We made dog and rat experiments to prove safety and efficacy of IIE. The experiment was made on 10 rats and 10 dogs injected transurethrally (Prostaject device) with 96% ethyl alcohol in 10% volume of estimated volume of the prostate. The injection was followed by measurement of blood alcohol, the test for hemolysis. Transurethral ultrasound control of prostate size 1, 3 and 6 months after the injection and histological examinations 1, 3, 7, 14 days and 1, 3 and 6 months after the injection were made. It was found that blood alcohol after the above injection was not elevated. Necrosis was documented in all the cases but subsequently the necrotic site was replaced with sclerotic tissue. The necrosis involved only the prostatic capsule. The size of the prostate diminished by 29%. Thus, transurethral injection of ethyl alcohol (10% of prostate size) is safe and effective in achievement of prostatic gland ablation. Therefore, clinical trials of the method in patients with benign prostatic hyperplasia are justified.     

Accuracy of office hysteroscopy in the diagnosis of endometrial hyperplasia

In the last decade the advantages of office hysteroscopy performed without cervical dilatation and/or anaesthesia were fully demonstrated. Many authors consider office hysteroscopy the gold standard diagnostic method in the diagnosis of intrauterine pathology, with high accuracy and compliance. The best sensitivity and specificity are reached in the diagnosis of focal lesions as submucous myomas and polyps but controversy still persists regarding hysteroscopic accuracy in the definition of endometrial hyperplasia. The aim of this prospective study was to evaluate the efficacy of outpatient hysteroscopy in the diagnosis of endometrial hyperplasia and to compare hysteroscopic findings with histology. From April 2000 to May 2002, 145 diagnostic office hysteroscopies were performed at the Euganea Medica clinic. Sensitivity in the detection of endometrial hyperplasia was 89.36%, specificity 91.96%, positive predictive value (PPV) 82.36% while negative predictive value (NPV) reached 95.37%. Uniformity of histology associated with outpatient mini-invasivity and high compliance favour office hysteroscopy and represent important elements in its diffusion as a first level diagnostic method even in the diagnosis of hyperplasia.     

Use of thymodepressin for treating autoimmune cytopenia

AIM: To study influence of thymodepressin on the course of autoimmune cytopenia. MATERIAL AND METHODS: Thymodepressin is a new synthetic hemoregulatory dipeptide (gamma-D-Glu-D-Trp). It was used for the treatment of 22 patients with autoimmune cytopenia. RESULTS: Hemoglobin levels were elevated in autoimmune hemolytic anemia and platelet levels were high in idiopathic thrombocytopenic purpura. A thymodepressin course resulted in a fall of total lymphocyte count and activated CD3+CD69+ lymphocytes. CONCLUSION: The above results, safety, absence of toxicity and allergenicity, parenteral and intranasal useability open perspectives for further studies of therapeutic action of thymodepressin as an immunodepressant in autoimmune processes.     

Microcirculation in hypertension

Changes of microcirculatory vascular bed play important role in pathogenesis of essential hypertension. All components of the system of microcirculation including vessels and circulating blood are involved into pathological process. Resistance to blood flow is mostly formed in this system. Resistance depends on length, diameter of microvessels and viscosity of blood. In the process of the disease development the following signs of remodeling at the level of microcirculation emerge: decrease of density of vasculature, modification of the media/lumen ratio, increase of blood viscosity, slowing of angiogenesis, impairment of endothelial function. These phenomena can be both cause and consequence of hypertensive disease. Their heterogeneity depends on a variety of factors (duration, stage of the disease, etc.). It seems feasible to differentiate therapy in accordance with character and severity of changes in the system of microcirculation.