Аtypical giant lipomas

Department of General Surgery and Semiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: The giant lipomas represent benign tumors of soft tissues. They are come across rather seldom and require a surgical treatment. According to the data of different studies, single lipomas are more common for women, while multiple lipomas are mainly characteristic of men. These tumors can develop at any age however they are rarely detected in children and youths. Patients usually describe lipomas as slowly growing formations, which do not cause any discomfort. Material and methods: A short characteristic of giant lipomas as well as two cases of atypical giant lipomas – on the neck and retroperitoneal region – are reported in this paper. In the latter cases the giant lipomas have been removed surgically. A histological analysis has confirmed the primary diagnosis. The postoperative course has been uneventful. Results: Roughly 60% of single cutaneous lipomas contain clonal genetic changes: the most frequent chromosomal aberrations include breaks of 12q13-15, but there can be changes in the arms of 6p and 13q. These mutations are not characteristic of the multiple lipomas. Typically, lipomas are identified in the subcutaneous tissues of the trunk and upper limbs, but they can seldom be found in internal organs. Conclusions: At the first examination retroperitoneal lipomas can be taken for gastro-intestinal tumors. Abdominal lipomas are usually identified only when they become giant. Large-sized lipomas can compress the blood vessels and nerves in the vicinity and, as a result, induce abnormalities in blood circulation and paresthesia. There are difficulties in the surgical treatment of large, unusually located lipomas, which compress blood vessels, main nerves and internal organs

Treatment of Dieulafoy’s lesion by endoscopic band ligation

Catedra chirurgie generală, USMF „Nicolae Testemiţanu”, Spitalul Clinic Municipal nr.1, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Leziunea Dieulafoy este o patologie relativ rară, dar care pune în pericol viaţa pacientului. Ponderea printre hemoragiile gastro-intestinale este de 1-2%, dar mai degrabă este rar diagnosticată. Sunt utilizate diferite metode endoscopice pentru obţinerea hemostazei reuşite în leziunea Dieulafoy: (a) termice – electrocoagularea, termosonda şi coagularea cu argon plasma; (b) injecţionale – injectarea adrenalinei şi trombinei; şi (c) mecanice – ligaturare endoscopică şi clipse hemostatice. Scopul: Studierea rezultatelor ligaturării endoscopice şi a ratei de recidivă în tratamentul hemoragiilor active din leziunea Dieulafoy. Material şi metode: Diagnosticul leziunii Dieulafoy a fost stabilit în baza rezultatelor endoscopice primare sau „second-look” la 2 pacienţi. Într-un caz s-a depistat un vas proieminent izolat înconjurat de mucoasa normală în regiunea peretelui posterior al corpului gastric; în cel de-al doilea caz – un defect minor al mucoasei în zona antrală pe curbura mică; ambele cazuri cu hemoragie activă pulsatilă (Forrest IA). Terapia a fost aplicată imediat după recunoaşterea leziunii, în timpul aceleiaşi proceduri endoscopice. În ambele cazuri a fost efectuată bandarea elastică în două puncte: pe vas (un inel) şi mai proximal de-a lungul traiectului suspect al vasului (un inel). Rezultate: Hemostaza iniţială a fost obținută cu succes în ambele cazuri de leziune Dieulafoy, fără resîngerare în perioada precoce şi tardivă de supraveghere. Concluzii: Bandarea endoscopică reprezintă o metoda curativă efectivă şi sigură în tratamentul leziunii gastrice Dieulafoy.Introduction: Dieulafoy's lesion is a relatively rare, but potentially life-threatening, condition. It accounts for 1-2% of acute gastrointestinal bleeding, but arguably is under-recognised rather than rare. Various methods are used to achieve successful endoscopic hemostasis in Dieulafoy's lesion: (a) thermal – electrocoagulation, heat probe and argon plasma coagulation; (b) injection –epinephrine and thrombin injection; and (c) mechanical – banding and haemoclip. Aim: To study results of rubber band ligation and relapse rate in treatment of active bleeding Dieulafoy's lesion. Material and methods: Diagnose of Dieulafoy's lesion was made at initial or second-look endoscopy in 2 patients. In one case it was an isolated protruding vessel, surrounded by normal mucosa on the posterior gastric corporeal wall; in the other – minute mucosal defect in the antrum on the lesser curvature, both with active pulsatile bleeding (Forrest IA). Therapy was applied immediately after recognizing the lesion, during the same endoscopic session. It has been performed band ligation in both cases at two points: on the vessel (one band) and proximally, along suspected course of the vessel (one band). Results: Banding was successful in initial hemostasis in all two cases with Dieulafoy's lesion, with no rebleeding in early and late period of observation. Conclusions: Endoscopic rubber band ligation is an effective and safe therapeutic modality for the treatment of gastric Dieulafoy's lesion