A Proposed Therapeutic Algorithm Based on Multiple Case Analysis Regarding the Repair Options of Iatrogenic Biliary Lesions Following Open and Laparoscopic Surgery

Introduction: the problem of the iatrogenic lesions of the main biliary pathways is far from being completely clarified and still represents a serious surgical situation, during both open and laparoscopic surgeries. The outcome of these situations is closely linked with the actual moment of discovery of the lesion and the surgical methods for repairing such defects and implies a great number of options, such as reconstructive, derivative and substitutive techniques. Objectives: the goal of this paper is to present an algorithm of choices and their consequences for clinical conduit in the case of iatrogenic biliary lesions discovered in the course of open or laparoscopic procedures of the main biliary pathways, based on our experience. Material and method: We present a multicentric retrospective study of 53 cases of lesions following open and laparoscopic procedures, from a larger lot of 10.015 surgeries on extrahepatic biliary ducts recorded during a 40 years period of time, in 2 clinical hospitals. Out of these, 2127 interventions were strictly focused on the common bile duct, for various pathology. Conclusion: The choice of the optimum method is strictly correlated with the morphological nature of the lesion, which is different from one stage to the other, depending upon the moment of detection, and therefore have different surgical implications

A Retrospective Surgical Experience Regarding Open and Laparoscopic Procedures of the Hepatic Hydatid Cyst with an up to Date Complete Review of the Literature And a Focus On Original Romanian Techniques

Introduction: Even though the development of the recent anti-parasitic drugs has led to a high degree of efficiency, surgical treatment still remains the gold standard for a number of conditions. Material and method. The authors discuss a series of 90 cases in a multicenter and retrospective analysis that stretches over 20 years. Results and discussions. These cases have been diagnosed and treated – through different surgical methods, both classical and laparoscopic – for hepatic hydatid cysts. The paper also presents a short review of the major types of surgical procedures cited in the international literature, with a specific focus on the advantages brought by Romanian innovations in this field. Conclusions. Even though the classical open approach still assumes the first place among surgical procedures, modern laparoscopic techniques have earned a much appreciated place in providing positive results based on long-term assessment, with virtually no or only minor complications. In this regard the Romanian school of surgery has offered a significant contribution to this field

Gastrointestinal stromal tumor (GIST) of the Treitz’s angle– a very rare cause of high bowel obstruction

Gastrointestinal stromal tumors (GIST) are somewhat rare gastrointestinal tumors - approximately 1% to 3% incidence, but they are the most common mesenchymal neoplasms of the gastrointestinal tract. GISTs are usually found in the stomach or small intestine but can occur anywhere within the gastrointestinal tract, even in extremely uncommon locations like duodeno-jejunal flexure. Only 3% – 5% of GISTs are located in the duodenum and tumors occurring in the angle of Treitz are even rarer, most published studies being case reports. These tumors have a size ranging from small lesions to large masses and can cause digestive bleeding or high bowel obstruction. This paper is a case presentation illustrating an emergency situation involving a high bowel obstruction caused by a small tumor with an unusual location in the Treitz’s angle. A large percentage of duodenal GISTs are localized in the third and fourth part of the duodenum and may not be found through standard upper endoscopy; only the barium study of the upper gastrointestinal tract highlights the obstruction point. Preoperative diagnosis is difficult but non-invasive imaging techniques like ultrasonography and computed tomography of the abdomen can be helpful. Recently, targeted therapy with inhibitors of tyrosine kinase receptors (IMATINIB) has been introduced for the management of advanced and metastatic tumors. In our opinion the surgical resection with curative intent is the treatment of choice

An evidence based guide to a safe intraoperative approach of avoiding iatrogenic lesions during difficult laparoscopic cholecystectomies

Introduction: Although there are many sources for iatrogenic lesions during laparoscopic cholecystectomy, only a few stand out as being one of the most difficult to predict due to their nature of being very hard to diagnose before surgery. Materials and Methods: a short guide of cases with an evidence-based approach to avoid laparoscopic iatrogenic lesions. Results: these cases have been classified and presented into 3 main groups: cases with abnormal arterial layout, cases with heavy alteration of the normal anatomy, and cases with anomalies of the main biliary pathway. Conclusions: while not a complete guide covering all aspects of intraoperative traps during laparoscopic cholecystectomy, this series of cases points out some dangerous situations and some simple solutions to avoid those fiercely iatrogenic lesions of the ductal and vascular landmarks associated with an otherwise simple surgical intervention that has become the golden standard of the gallbladder lithiasic pathology

A Retrospective Surgical Experience Regarding Open and Laparoscopic Procedures of the Hepatic Hydatid Cyst with an up to Date Complete Review of the Literature And a Focus On Original Romanian Techniques

Introduction: Even though the development of the recent anti-parasitic drugs has led to a high degree of efficiency, surgical treatment still remains the gold standard for a number of conditions. Material and method. The authors discuss a series of 90 cases in a multicenter and retrospective analysis that stretches over 20 years. Results and discussions. These cases have been diagnosed and treated – through different surgical methods, both classical and laparoscopic – for hepatic hydatid cysts. The paper also presents a short review of the major types of surgical procedures cited in the international literature, with a specific focus on the advantages brought by Romanian innovations in this field. Conclusions. Even though the classical open approach still assumes the first place among surgical procedures, modern laparoscopic techniques have earned a much appreciated place in providing positive results based on long-term assessment, with virtually no or only minor complications. In this regard the Romanian school of surgery has offered a significant contribution to this field

A proposed therapeutic algorithm for colorectal cancer prevention, based on endoscopic polypectomies in patients with multiple colonic polyps

Introduction. Results from single medical centers having large numbers of patients with multiple colonic polyps that have undergone colonoscopy management are rare. Material and method. The present study is based on 2,000 cases enrolled during 2009 and 2017, including patients that underwent colonoscopy for various reasons in the Department for Upper and Lower Endoscopy of Witting Clinical Hospital, Bucharest, Romania. Results. Of the 2,000 patients examined during 2009 - 2017, 594 tumor formations were detected; 148 (24.9%) patients had colorectal malignancies, and 446 (75%) polypoid formations in 313 patients who had one or more colon polyps were found. Discussions. After performing statistical analyses on several general parameters (such as age, sex, overall clinical outcome of the patient) and polyp-related characteristics (such as: dimensions, location, histological type), we developed a stepwise algorithm for clinical management (with endoscopic polypectomy) of patients with multiple polyposis, with the goal of reducing unnecessary colorectal surgeries. Conclusions. We believe that this type of stepwise algorithm-based approach in the clinical management of patients with multiple polyposis can lead to a substantial decrease in unnecessary colectomies (no matter the approach, via laparotomy or laparoscopic procedures), with the accompanying benefit of avoiding the complications and negative long-life impact that they impose

Prevalence of colonic polypoidal colonic formations in a reverse endoscopic study. The experience of a single clinical center

Objectives. The present study has highlighted the number of tumoral protruzive formations found overall, in a sample of a population that is targeted at a hospital for a varied symptomatology study with patients admitted in the hospital, and not on a lot presumed healthy (without clinical symptoms), as in the case of screening. Material and method. The research was conducted as observational longitudinal study, on a 2000 investigations performed on patients hospitalised in the Witting Clinical Hospital between January 2009 and January 2017. Results. A number of patients out of 2000 colonoscopies were found with 594 tumor formations; of these, 148 have been identified (24.9%) cases of colon cancer 446 75%) and formations (of type polypoid. Conclusions. The study was able to identify more parameters with statistical significance, such as the number of colonoscopies which has varied in relation to the sex of the subjects investigated, the age of patients with colorectal cancer on age levels. The study also show that both sexes cancer occurs at a higher age than the occurrence of polyps, which suggests that early detection of polyps and resection can stop their malignization. Distribution of poliypectomies in relation to the type and degree of polyp malignization varied not statistically significant for both unique and multiple polyps, the maximum frequency being recorded at low dysplasia. Note that in the case of singular polyp, frequency of polyps with high-grade dysplasia was double compared to that recorded for multiple polyps (9% vs. 4%)

A Retrospective Surgical Experience Regarding Open and Laparoscopic Procedures of the Hepatic Hydatid Cyst with an up to Date Complete Review of the Literature And a Focus On Original Romanian Techniques

Introduction: Even though the development of the recent anti-parasitic drugs has led to a high degree of efficiency, surgical treatment still remains the gold standard for a number of conditions. Material and method. The authors discuss a series of 90 cases in a multicenter and retrospective analysis that stretches over 20 years. Results and discussions. These cases have been diagnosed and treated – through different surgical methods, both classical and laparoscopic – for hepatic hydatid cysts. The paper also presents a short review of the major types of surgical procedures cited in the international literature, with a specific focus on the advantages brought by Romanian innovations in this field. Conclusions. Even though the classical open approach still assumes the first place among surgical procedures, modern laparoscopic techniques have earned a much appreciated place in providing positive results based on long-term assessment, with virtually no or only minor complications. In this regard the Romanian school of surgery has offered a significant contribution to this field

Using Statistical Modeling for Assessing Lettuce Crops Contaminated with Zn, Correlating Plants Growth Characteristics with the Soil Contamination Levels

The aim of the study was to identify new mathematical models and strategies that can characterize the behavior of pollutants accumulating in the soil over time, considering the special characteristics of these chemicals that cannot be degraded or destroyed easily. The paper proposes a statistical model for assessing the accumulation of Zn in the lettuce (Lactuca sativa L.), based on three indicators that characterize the development of lettuce plants over time. The experimental data can be used to obtain interpolated variations of the mass increase functions and to determine several functions that express the time dependence of heavy metal accumulation in the plant. The resulting interpolation functions have multiple applications, being useful in generating predictions for plant growth parameters when they are grown in contaminated environments, determining whether pollutant concentrations may be hazardous for human health, and may be used to verify and validate dynamic mathematical contamination models

Clostridioides difficile Infection among Cirrhotic Patients with Variceal Bleeding

Clostridioides difficile infection (CDI) stands as the leading cause of nosocomial infection with high morbidity and mortality rates, causing a major burden on the healthcare system. Driven by antibiotics, it usually affects older patients with chronic disease or immunosuppressed or oncologic management. Variceal bleeding secondary to cirrhosis requires antibiotics to prevent bacterial translocation, and thus patients become susceptible to CDI. We aimed to investigate the risk factors for CDI in cirrhotic patients with variceal bleeding following ceftriaxone and the mortality risk in this patient’s population. We retrospectively screened 367 cirrhotic patients with variceal bleeding, from which 25 patients were confirmed with CDI, from 1 January 2017 to 31 December 2019. We found MELD to be the only multivariate predictor for mortality (odds ratio, OR = 1.281, 95% confidence interval, CI: 0.098–1.643, p = 0.042). A model of four predictors (age, days of admission, Charlson index, Child–Pugh score) was generated (area under the receiver operating characteristics curve, AUC = 0.840, 95% CI: 0.758–0.921, p < 0.0001) to assess the risk of CDI exposure. Determining the probability of getting CDI for cirrhotic patients with variceal bleeding could be a tool for doctors in taking decisions, which could be integrated in sustainable public health programs