Journal de chirurgie

The idea of the possibility of childbirth in another route than natural still exists from mythology. The name derives from the Latin “caedere” – cut, sever. For many centuries, ever since the Roman Empire, the operation was performed only rarely and women who died in childbirth. Indications that cesarean would be performed even women are living since 1040 in Rabbi Gershon to Metz, Talmud's comment. In 1581 the first paper appears in France dedicated caesarean women live, but the first successful Caesarean operation are reported in France, only in 1689 from surgeon Jean Rulau, in Ireland 1748 from midwife Marie Donaly and in 1794 in Virginia (USA) from the country doctor Jesse Bennett. Mortality after cesarean on women living it was still very high. A significant decrease occurred in the 19th century it when decline spectacular after improvements are made of the operation. Mainly this is due to Frank E. Polin in US, Alfred Kehrer in Heidelberg, Max Sänger in Leipzig and Eduardo Porro in Milan. Their refinements of the technique were essential cesarean bringing a lot of one that is currently running. Classical caesarean is practiced today after Stark technique, method Joel Cohen. After a long and controversial trend for nearly two millennia, marked for centuries by almost prohibitive mortality, the current cesarean operation is a great success in perseverance deeply humanitarian attempts to save two lives, a mother and child.

Neck dissection is still considered a therapeutical surgical approach in the treatment of lymph node metastasis due to head and neck tumors. Radical neck dissections imply the “en bloc” removal of all the lymphatic tissue found in the lateral regions of the neck, including the sternocleidomastoid muscle, internal jugular vein and accessory nerve. During the years several variations of the original procedure have arisen, with the aim to reduce postoperative complications and morbidity, assuring a better quality of life, while preserving the same oncological efficacy. The presence of metastatic adenopathy lowers the patient's survival rate with approximately 50%. The surgical treatment of cervical adenopathies plays a crucial role in the future outcome of the patient's evolution. Although the current tendency is toward less radical types of neck dissections i.e. modified neck dissection, selective neck dissection, we still consider radical neck dissection as a trustworthy procedure in the treatment of head and neck tumors. Our aimwith this paper is to showcase the procedure, offer a technical description, underline its importance and emphasize some of the lessons we have learned during the treatment and follow-up of these patients.

Background: Minimally invasive parathyroidectomy is actually the gold standard in the treatment of primary hyperparathyroidism (PHPT) due to parathyroid adenoma (PA).

Material and Methods: A clinical retrospective study was performed on a series of 40 cases operated for pHPT by single PA from January 2013 to March 2015, in the surgical department of the “St. Spiridon” Hospital of Iasi, a refferal center for endocrine surgery. Biochemical markers achieved the diagnosis of PHPT and PA was localized using cervical US and MIBI scintigraphy. Conventional minimally invasive parathyroidectomy (C-MIP) was performed in all cases where PA was accurately localised by preoperative imaging, whereas conventional cervical exploration was necessary in cases with concomitant thyroid pathology.

Results: Preoperative localisation findings were concordant with the intraoperative findings, except for one case when conversion to bilateral exploration was deemed and the PA was identified on the other side. In 8 cases, additional thyroid pathology – uni/multinodular goiter and a papillary microcarcinoma imposed a conventional PT adenomectomy and concomitant lobectomy/total thyroidectomy. The values of calcemia and PTH decreased significantly postoperatively and reached normal range in all cases. With the exception of a transient reccurrent nerve paresis (in a patient with total thyroidectomy), no postoperative morbidity and mortality was encountered.

Conclusion: Conventional mini-incision parathyroidectomy (C-MIP) has an excellent cure rate and minimal morbidity, with a reduced hospital stay and cost compared with the conventional extensive approach.

Introduction: Peptic ulcer is still a very common pathology which exposes the patient to life-threatening complications. This retrospective observational study aims a comparison between current different therapeutic strategies and the advantages and disadvantages in order to improve them.

Material and Method: The study group is composed of 108 patients, 96 hospitalized in Emergency Hospital Bucharest (EHB) and 12 patients hospitalized in Louis-Mourier Hospital, Paris, for the period of 3 years. Were included in the study patients with peptic ulcer and with complications of peptic ulcer treated surgically.

Results: The most common location of peptic ulcer identified in our study was the anterior bulbar duodenum wall. The posterior lessions were penetrating in the pancreas in 78.56% of cases (correlation coefficient=0.034, p=0.002). The surgical treatment strategy adopted in most cases was the suture of the ulcer with or without epiplonoplasty (in 37.5% of cases in EHB and in all cases in Louis-Mourier Hospital), the differences were in the approach technique: most interventions in EHB were performed by laparotomy. The surgical management of perforation was in most cases gastrectomy followed by bulbantrectomy. The operation of gastrectomy was done at a rate of 65.52% by laparotomy (p=0.001). Regarding the reconstruction of digestive tract, most anastomoses were performed manually. They are mainly gastro-duodeno anastomosis Pean (37%) because it provides a physiological continuity.

Conclusions: Therapeutic management adopted in the two clinics were largely similar, mention the status of population-related differences, socio-economic status and the dinamics of risk factors (NSAID therapy, the incidence of HP, food etc..).

Acute severe ulcerative colitis is a potentially life-threatening condition that requires a pro-active approach with either effective medical treatment or timely colectomy. The possibility of free perforation in ulcerative colitis must be considered in fulminating cases. This report describes a 39 -year- old female with known ulcerative colitis on maintenance medical therapy. She was admitted for peritonitis, and intraoperative findings revealed a synchronous colonic perforation. After multidisciplinary discussion she was managed with total colectomy and end ileostomy.

Objective: Dyke-Davidoff-Masson Syndrome (DDMS) is one of the rare causes of recurrent seizures and can be missed in adults. It is associated with contralateral hemiplegia, mental retardation and facial asymmetry. Confirmed diagnosis can be made with characteristic radiological picture. Hemi-spherectomy is the treatment of choice.

Case: DDMS is usually diagnosed in childhood. Here a rare case of refractory epilepsy is being reported in a 23 years old pregnant woman which was diagnosed as DDMS on radiological findings of cerebral atrophy, ventricle enlargement, dilatation of sulci and osseous hypertrophy of calvarium with increased width of diploic space.

Conclusion: A proper history, thorough clinical examination and characteristic radiological findings provide the correct diagnosis of DDMS. CT/MRI must be performed in patients presenting with recurrent seizures.

Background: Therapeutic strategy for patients with colorectal cancer liver metastases (CRLM) is based on good monitoring and correct assignment to classes of liver resectability based on imaging criteria, taking into account the surgical risk.

Objective: To identify the post-treatment time frame for confirming resectability (conversion to resecability) or permanent unresectability. Methods: The study is a prospective analysis based on a Scientific Protocol (Surveillance of patients with colorectal cancer liver metastases) used in the Ist Surgical Oncology Unit, Regional Institute of Oncology Ia?i, Romania. Surgical treatment, oncologic treatment, response to therapy , postoperative surgical complications, were assessed at 3, 6 and 9 months after start of the study.

Results: In the interval July 2012 - January 2014, 106 patients were diagnosed with CRLM. According to the classes of liver resectability the patients were divided into four groups: group I (clear resectability), group II (possibly resectability), group III (susceptible resectability), group IV (unresectable metastases). Relevant for the study were only groups II and III. Thus, in group II patients the rate of conversion to resectability was 23.07% and in group III patients 26.66%. These results were obtained after 3, 6 and 9 months of therapy, respectively.

Conclusions: Rigorous surveillance of patients with CRLM according to a well-established scientific protocol, and their assignment to liver resectability classes represent the first step ofthe oncosurgical therapeutic strategy. An improvement in the rate of conversion to resectability could be achieved through regular assessment of treatment response based on international criteria that should include besides the number and size of target lesions the posttherapy morphological tumor changes.

Cleft lip and palate deformities are some of the most common facial and oral anomalies. Severe cleft forms are associated with severe nasolabial deformities, and present a significant surgical challenge in order to achieve a functional and aesthetic outcome. Presurgical infant orthopedics has been used in the treatment of cleft lip and palate for some centuries. Starting with the McNeil method, several methods and modifications had been developed by different clinicians over time. However, there is no consensus in the literature on infant orthopedic methods and their benefits. Therefore, the aim of this review is to discuss presurgical infant orthopedic methods and their advantages and disadvantages. Presurgical orthopedics allows not only the alignment of cleft segments, but also molding alar cartilages and nose tip. In addition, this procedure allows performing primary alveolar grafting or gingivoperiosteoplasty to establish a union bone at the cleft side as well. However, there have been some studies reporting that there was no positive effect of presurgical orthopedics on the maxilla and maxillary arch. There is still no consensus in the literature on the best protocol for orthopedic and surgery methods for the treatment of cleft lip and palate in infants.

Background: Video-assisted thoracoscopic sympathicotomy is a safe, effective and minimally invasive procedure, and its emergence greatly changed hyperhidrosis treatment. However, the possibility of standardizing interruption levels on the sympathetic chain has not yet been evaluated. This study sought to evaluate the frequency of compensatory sweating and the recurrence and satisfaction rates after bilateral R4-R5 video-assisted thoracoscopic sympathicotomy in patients with primary focal hyperhidrosis with involvement of the axillary, palmar, or both regions.

Methods: From November 2010 to February 2013, an observational prospective cohort study was conducted with 42 patients who underwent bilateral video-assisted thoracoscopic sympathicotomy. During the procedure, electrocautery was performed along the sympathetic chain at the levels R4-R5, and the nerve of Kuntz and the path between levels R4-R5 were also sectioned.

Results: No cases in which the video-assisted thoracoscopy had to be converted to thoracotomy were observed. Compensatory sweating was observed in 47.6% of patients within the first six months after surgery, decreasing to 30.9% at the end of this period. Hyperhidrosis recurrence occurred in only two patients. In total, 24.1% of patients with associated plantar hyperhidrosis reported that the condition disappeared after surgery. The satisfaction rate was 89.7% in the immediate postoperative period.

Conclusions: The frequency of compensatory sweating, the recurrence rate of symptoms and the satisfaction rate after sectioning by cauterization with electrocautery at the R4-R5 levels were similar to those reported for other types of interruption and other levels studied. Moreover, the interruption level adopted also had beneficial effects on plantar hyperhidrosis.

Background: Primary hyperparathyroidism (PHPT) is a common clinical endocrine disorder. It is the most common cause of hypercalcemia in the outpatient setting. This review presents a brief summary of the new trends of presentation, diagnosis and management PHPT.

Data Sources: PubMed (National Library of Medicine) articles, and Memorial Library archives of the University of Wisconsin System.

Conclusions: PHPT occurs at any age, but it is most commonly seen in people over the age of 50 years and postmenopausal women. The current presentation of PHPT shifts from the classical symptomatic form to the asymptomatic form; however, parathyroidectomy is still the treatment of choice for both symptomatic and asymptomatic forms. In the past, bilateral neck exploration and intraoperative identification of all 4 parathyroid glands was the standard of treatment, nevertheless, nowadays, with the introduction of the preoperative and intraoperative localization techniques, the minimally invasive parathyroidectomy has evolved