The 48 year old patient, admitted to the Clinic IV for Digestive Surgery – Emergency University Hospital, presenting with symptoms of acute abdomen: intense diffuse abdominal pain, paleness of tissue and mucous membranes, nausea and vomiting. Pain started abruptly and agressively in the epigastrium 12 hours before admission to the hospital and then it spread to the abdomen, analgezic, not responding to the usual analgesic treatment. The anamnesis showed the patient repeatedly accused pain in the superior abdominal compartment, associated with nausea and vomiting, interpreted as dyspeptic syndrome of (probably) biliary etiology, responsive to the antispastic treatment. Intraoperatively, a diagnostic was established: hemoperitoneum due to the spontaneous rupture of a voluminous tumor (>10 cm), with extraluminal evolution in the gastric fornix and the macroscopic outlook of a GIST. Total gastrectomy is performed, with DII lymph node dissection (lymphadenectomy) and reconstruction of digestive continuity through Roux-en-Y eso-jejunal-anastomosis. The anatomo-pathological exam highlighted a gastrointestinal stromal tumor (GIST), TNM staging: pT4; pN0 (0/17); LV0; Pn0; R0. The patient had a favourable evolution. Since this type of pathology is extremely rare and difficult to diagnose, we believed it would be useful to present and review its micro and macroscopic aspects.
Breast cancer is a severe disease with high morbidity and mortality affecting both women and men from all around the world. When it does not get diagnosed in early stages it metastasizes to other organs and tissues, thus becoming incurable. In addition, between 25-50% of patients will suffer from a metastatic development after the initial treatment. The most common locations are the bones, the liver, the lungs and the nervous system. The current research is an analysis of the molecular, macroscopic and microscopic characteristics of tumors in a cohort of 67 female patients with bone metastases from an initial breast neoplasm.
We present the case of a 58-year old male patient admitted in the surgery section of the University Emergency Hospital of Bucharest and diagnosed with acute abdomen. The minimal clinical-paraclinical investigation (i.e., thorax-pulmonary Xray, biological probes) raises questions as to the differentiated diagnosis and other associated diseases, also suggesting the existence of voluminous diaphragmatic hernia. The CT thorax-abdomen examination confirms the diaphragmatic hernia suspicion, with intra-thorax ascent of the colon up to the anterior C4 level, but does not explain the abdominal suffering; thus we suspected a biliary ileus or acute appendicitis. Medial laparotomy was imperative. Intrasurgically peritonitis was noticed located by gangrenous acute apendicitis, perforated, with coprolite, for which apendictomy and lavage-drainage pf the peritoneal cavity was performed. Post-surgical status: favourable to recovery.
This article presents a 28 years old male patient case with a retroperitoneal collection of apendicular origin. After few comments about clinical and paraclinical aspects, the authors emphasise the particular aspects of differential diagnosis and surgical approach which, finally, lead to a full recovery of the patient.
Sclerosing of the gastric mucosa with a 60% fresh sterile solution of glucose was applied in 60 selected patients with chronic conflictual duodenal ulcers, hyperacidic gastritis by vagal neurogenic hyper-reactivity, associated with ischaemic gastropathy developed on an sympathico-adrenergic background. The immediate operatory results were good. The late results (between 1 and 5 years) were as follows: the clinical, radiological and metabolic results were good in 57 patients. Gastric chemical analysis, the values of the hourly basal output remained high in 16,6% of the patients, and those of acidity stimulated by histamine administration remained high in 13,3% of the patients. No peptic recidive was recorded. Unsatisfactory late results were noted in 3 patients (of which forced indication of the method in one patient and non-association of drainage in two patients).
In cases with postoperative shock and collapse a constant fall in the concentration of serum cathecholamines was noted. Thus adrenalin was reduced by 77%, noradrenalin by 86.5%, in direct proportion with the fall in the blood pressure, of the pulse amplitude and with the slowing-down (or the arrest) of the microcirculation. The reduction of serum cathecholamines also coincided with a decrease in the amount of buffer bases and of the diuresis. The adrenocortical vasopresor sympathicolithic mixture is indicated in the prolonged arterial hypotension following failure of therapy aimed at filling of the vascular bed associated with the administration of sympathicolytic drugs.
The variations of catecholamines, cortisol and aldosterone in mixed shock (traumatic, hemorrhagic and septic) were studied experimentally and clinically. In the stage of collapse adrenaline decreased by 81.4% and noradrenaline by 62.6% as compared with the preoperative values. These decreases were found to be directly proportional to the decrease of arterial blood pressure, pulse amplitude and diuresis as well as to the slowing down or even stop of microcirculation. The value of plasma cortisol increased in the stage of collapse by 98.3% and that of aldosterone by 66.27% as compared with the preoperative values. Treatment with a pharmacodynamic sympatheticolytic-vasopressor-adrenocortical mixture is recommanded when the blood pressure remains below 50--60 mm Hg for 1--2 hrs and when the treatment for the correction of hypovolemia with fluids and sympatheticolytics has failed. Clinically, this treatment gave good results in 34 of the 58 cases studied (58.6%).
