THE VARIATION OF INTRAOCULAR PRESSURE IN THE CONTEXT OF ABDOMINAL SURGERY

The human body can be envisioned as a high-performance machine that operates on the principle of "gears". As a consequence, any disorder at a certain level might lead to imbalances in other areas, which are sometimes difficult to detect and measure. One such relationship between two seemingly unrelated systems is that of abdominal surgery and intraocular pressure. The literature on this subject is poor, but available research suggests the occurrence of a change in intraocular pressure in the context of abdominal surgery. The present study analyzed the variation of intraocular pressure for two groups of patients who underwent classical or laparoscopic cholecystectomy. The present research is based on a prospective, non-interventional, observational, descriptive study, carried out in the IIIrd General Surgery Clinic of the University Emergency Hospital, Bucharest. The study included patients who underwent abdominal surgery during January 2018 - December 2019. The study gathered a total of 67 patients, separated into two groups: 52 patients who underwent laparoscopic cholecystectomy and 15 who underwent open cholecystectomy. No definite relationship between intra-abdominal pressure and intraocular pressure was found in the analyzed group, probably due to the small sample size, but further research is encouraged.

HEMATOLOGICAL PARAMETERS AND TUMOR SIZE IN RECTAL CANCER

Rectal cancer is a pathology that still has a high incidence, mortality and morbidity all around the world. As with other types of neoplasm, researchers all around the world are attempting to find statistically significant linkages between easy and inexpensive hematological parameters and the progression of this disease which is affecting approximately 1.8 million individuals. The present study aims to investigate whether biological parameters measured in rectal cancer patients change significantly with tumor growth. The results show a significant change in WBC (white blood cell counts) (p = 0.002).

SURGICAL APPROACH IN A CASE OF GENERALIZED MYASTHENIA GRAVIS

Myasthenia gravis(MG)is an antibody mediated, T cell dependent autoimmune disease characterized by a disorderof neuromuscular junction with progressive inability to sustain a maintained or repeated contraction of striated muscle. It is represented by antibodies directed against the nicotinic acetylcholine receptors (nAchR) of the post junctional membranes. We present the case of an 82-year-old patient, who was admitted to the hospital for plasmapheresis due to an aggravation of her auto-immune generalized myasthenia. The clinical examination at admission revealed ptosis, dysphagia, a medium effort dyspnea, difficulties in closing the mouth, dysphonia with a nasal voice and limited walking with a bent head and camptocormia, with Osserman score 46/100 (diplopia and bilateral ptosis). The thoracic scanner describes a tissue lesion in the thymus region with a diameter of 35 mm corresponding to a thymoma. The Magnetic Resonance Imaging confirmed the possible thymoma. A thymectomy using video-assisted thoracoscopic surgery (VATS) technique was performed according to the age and general status of the patient. Post-operative histological examination revealed a B2 type thymoma and the TNM staging system classifies the thymoma as being T1bNx.    

DIFFICULT INCISIONAL HERNIA NOSOLOGICAL SETTINGS AND APPROACH STRATEGIES

Even in the age of minimally invasive surgery, incisional hernias remain frequent complications where standard resolution is alloplasty in various technical variants. The revolution brought by the introduction of synthetic materials is overshadowed by the unsatisfactory results obtained in some lesional types that seem to go beyond the nosological framework of standard incisional hernias and which can be reunited under the name of difficult incisional hernias. Our work attempts to make a conceptual clarification in a lesional amalgam through the two compulsory targets required for surgical correction: to solidly cover the parieto-abdominal defect and to maintain intra-abdominal postoperative pressure to values that did not trigger the pathophysiological cascade of intraabdominal hypertension.

STRANGE CARDIAC COMPLICATION AFTER MEDIAN EVENTRATION SURGERY

A 51-year old patient comes to the hospital complaining of 20-30 bowel movements every day andabdominal pain following the introduction of a new medication for his cardiological problems(notable aspirin). His relevant medical history shows antecedents of hemorrhagic recto-colitis,non-stented coronaropathy, and a colectomy performed more than 10 years before. The diagnosiswas simple to make following laboratory, imagistic and clinical investigations – pouchitis andmedian eventrations following the prior surgery. The real problem appeared the next day followinghis eventration cure – cardiac tamponade in the context of antiplatelet medication. The patient wassuccessfully managed by the cardiothoracic surgeons. An intracardiac foreign body was found andeliminated during the intervention. Taking into consideration the fact that the patient had beentaking antiplatelet medication for almost a month, it is very likely that the foreign body hadmigrated there during or after the corrective surgical procedure for the eventration and created thehemopericardium in this particular context.

OUR EXPERIENCE IN THE SURGICAL MANAGEMENT OF PATIENTS WITH RECTAL NEOPLASTIC DISEASE

Colorectal cancer is one of the most commonly incriminated neoplastic pathologies and it has afairly high mortality rate. Although the therapeutic arsenal of rectal cancer has steadily improvedthrough the acquisition of biology, technology and pharmacology, the central role of surgicaltechnique is widely recognized in obtaining local control, on the one hand and a good quality of lifeof operated patient on the other hand. This article is a retrospective analysis of surgical proceduresfor rectal neoplasia conducted in order to determine to what extent technological development andcontinuous improvement of surgical techniques have influenced the evolution of patientmanagement with this pathology. This study was retrospective, observational, descriptive, single-center and it was held in the Department of General Surgery and Emergency III of the UniversityEmergency Hospital Bucharest during 1 January 2007 - March 31, 2016 and included a total of127 patients.

A RARE COMPLICATION OF ACUTE COLECISTITIS

Laparoscopic procedures are often preferred to open surgery due to their many advantages, theymay sometimes cause rare complications like intraabdominal, pelvic, and abdominal wall abscesses.We report a case of a 45-year-old woman who presented on multiple occasions to the hospital withsymptoms suggesting an infection involving the epigastric area. Following an exploratoryprocedure it was concluded that unretrieved gallstones from a previous laparoscopiccholecystectomy caused an abdominal wall abscess. This case shows that when establishing adiagnosis, the physician should consider that laparoscopic procedures can cause rarecomplications even after a long period of time.

Considerations on risk factors correlated to the occurrence of gastric stump cancer

Gastric stump cancer (GSC) is the malignant tumor that develops in the gastric remnant after partial gastrectomy was performed both for benign and malignant lesions. This paper presents the results of the case studies from the scientific literature, which focused on GSC, and has been published in the last 10 years. The search was performed with the help of the specific tools offered by the international databases. The subject was approached because of the constant rising incidence of GSC in the past few years, now reaching values between 1% and 7%. The outcome report is consistent and similar to the period that ended approximately 25 years ago, when general surgeons dedicated a significant part of their activity to treating gastric ulcer. Statistics revealed that the main risk factors are the following: the type of reconstruction after distal gastrectomy (Billroth I or Billroth II), the presence of duodenogastric reflux, the time between gastric resections, and the moment of diagnosis of gastric stump cancer, the initial pathology for which partial gastrectomy was performed, gender, age, helicobacter pylori infection, Epstein Barr virus infection and the presence of vagotomy. All the authors have significantly contributed to the article and have been involved in the writing of the manuscript in draft and any revision stages, and have read and approved the final version.

A RARE CASE OF A GIANT RETROPERITONEAL RECURRENT LIPOSARCOMA

We report the case of a giant retroperitoneal liposarcoma, with two rare histological subtypes: pleomorphic subtype at initial surgical resection, and dedifferentiated subtype at the recurrence. A 61-year-old male patient, presented at the University Emergency Hospital Bucharest, for progressive enlargement of the abdomen. The exploratory laparotomy found a deforming mass in the retroperitoneal area, with medial displacement of the left colon, from the splenic flexure to the recto-sigmoid junction. After assessing the resectability of the tumor, it was decided and performed an en-bloc excision of the tumor, without multiorgan resection and with macroscopic free safety margins. Due to the intersection with the genital vessels, their resection was imposed. The tumor was trefoil-shaped, with a diameter of 35 cm. After 7 months of chemotherapy, tumor recurrence occured, within the same location, confirmed as a dedifferentiated subtype. The same surgical procedure was performed, and the oncologist decided to continue with a more aggressive chemotherapy. Pleomorphic liposarcoma has a high rate of recurrence and has a high resistantce at chemotherapy. Due to its deep retroperitoneal location, the relations with the inferior vena cava, the aorta and the genital vessels are essential, in some cases multiorgan resections being necessary.The case presents a rare malignant tumor, a 35 cm diameter retroperitoneal liposarcoma, highly resistant to chemotherapy and with a high recurrence rate.

PECULIARITIES OF DIAGNOSIS IN THE PHYLLODES TUMOR

Phyllodes tumor (PT) is an uncommon and distinct category of breast cancer, being a particular form of intracanalicular fibroadenoma. A definitive diagnosis is difficult to make just based on imaging investigations and fine needle biopsy; also PTs are frequently misinterpreted as breast fibroadenomas. In the case of of a 26-year old woman with a suspected PT (based on clinical investigation) which was first diagnosed as a fibroadenoma using ultrasonography and preoperative biopsy, further investigation was needed. A limited resection was performed and the postoperative histopathology confirmed the diagnosis as PT.

Congenital agenesis of the inferior vena cava - cause of deep vein thrombosis

Agenesis of the inferior vena cava is an extremely rare abnormality, most often discovered by accident. This paper reports the case of a 41-year-old male patient, admitted to the IIIrd Emergency General Surgery Clinic of the Emergency University Hospital with the diagnosis of bilateral pelvic limb post-thrombotic syndrome. According to his personal history he had the first vascular surgical intervention at the age of 6. The surgical indication was determined by large hydrostatic varicoseveins of the lower limbs and the performed surgery was cosectomy with bilateral stripping of the great saphenousvein. Until admission to our clinic, the patient had repeated surgery for recurrent varicose veins of the lower limbs. The patient was diagnosed in our service with congenital agenesis of inferior vena cava, the evolution was good and the patient was discharged after 17 days. This paper presents the clinical,imagistic and therapeutic particularities of such a case. Imagistic detection of early vascular abnormality, identifying procoagulant factors and the close care of the local lesion areessential for patient evolution.

The economic analysis of two treatment procedures for incisional hernias - alloplastic versus tissular

Incisional hernias are a common complication of abdominal surgery. Research shows that their incidence reaches 10%-11% of the total number of patients subject to laparotomy. Recurrent hernias are the main complication of eventrations and its rate ranges from 5 to 54%, depending on both the surgical procedure used and the follow-up methods. The goal of this study is the comparative cost analysis of two procedures used in the treatment of event rations, tissular versus alloplastic, the former, leading very often to recurrence requiring a new surgical intervention. The analysis comprised 156 cases of surgeries performed for incisional hernia in 2007 in the clinic of Surgery III, SUUB (Bucharest University Emergency Hospital). Tissular procedures were used in 42 cases and prosthetic procedures in 114 cases. The medium-term postoperative follow-up has revealed 17 relapses (40.4%) in the tissular batch and no relapse in the batch where parietal prosthesis was used. If the short-term costs of the tissular procedures are low as compared with the prosthetic procedures, on the medium-term the costs increase by 24.35% due to the high rate of relapses of tissular procedures. Therefore, the tissular procedure must be abandoned due to the high rate of relapse, as this drives additional costs required for the alloplastic repair of the abdominal parietal defects in a subsequent surgical intervention.

Retrospective study minimally invasive management of postoperative lithiasis of the common bile duct

INTRODUCTION

Postoperative common bile duct (CBD) lithiasis holds a significant place in the bilio-pancreatic pathology, both due to its high frequency as well as to the diagnostic and treatment issues it triggers.

MATERIAL AND METHODS

Based on a 5-year experience (2008-2012), assessed retrospectively, totalling 51 patients with postoperative lithiasis of CBD, we tried to elaborate on several recommendations for the treatment of this pathology. The recommendations were guided by the existing alternative therapeutic options and by the ideas in the literature regarding the results achieved by every manner of treatment.

RESULTS

The rate of clearance of the CBD was of 93.6%,the morbidity rate was of 10.65% and the mortality rate was of 0%, which entitles us to deem the effectiveness of the minimally invasive treatment as maximum in the treatment of this pathology.

CONCLUSIONS

The endoscopic treatment of postoperative lithiasis of the CBD proved to be possible, efficient and we believe it good to be used as a principle; open surgery should be the solution in case of failures or of contraindications to minimally invasive treatment.

Is prosthetic repair of the abdominal wall in clean-contaminated surgical interventions possible?

The present study tries to provide an expressive, customized answer to the question in the title. The study relies on a ten-year experience (2000-2009), evaluated retrospectively on a group of 488 prosthetic repairs of incisional herniae, out of which 432 were performed in a clean environment and 56 cases in a clean-contaminated one. The two groups are superimposable based on the Apache score. The visceral surgical procedures associated to the surgery of the parietal defect were varied (cholecystectomy, appendectomy, enterectomy enterorrhaphy,colectomy colotomy-colorrhaphy, hysterectomy with adnexectomy). The assessment of postoperative suppurative complications showed no significant differences between the two groups (p 0.001). These results lead us to the idea of defining the indication for parietal prosthetic repair in a contaminated environment. The major factors of this decision are: the nature, the source and the amount of the septicinoculum, the duration of exposure, the intensity of the host inflammatory response (more difficult to quantify), and finally the surgical judgment. The last mentioned factor will evaluate the above-mentioned data and will take into account that not all bacterial contaminations are necessarily followed by an established infection. Thus, additional exaggerations - which would mean taking useless, ineffective precautions- as well as negative exaggerations - which would mean hazardous boldness- will be avoided.

Minimally invasive treatment of cholecysto-choledochal lithiasis - "Rendez-vous" technique

INTRODUCTION

In our paper we present the results of a study that was meant to provide a complex answer to the question:"Which is the most appropriate, most correct and least expensive treatment for mixt cholecysto-choledochal lithiasis(MCCL)?"

MATERIAL AND METHODS

Based on a five year experience (2008-2012), analysed retrospectively, during which 143 patients with MCCL were treated, we are trying to find answers to some of the questions that we have asked ourselves from the very beginning of this period. The answers were guided by alternative therapeutic options, for a pathology that does not have a "gold standard", with respect to the solutions available.

RESULTS

Given the fact that the period during which the study was conducted was chosen randomly and that the patients were included consecutively, the representativeness of the results is ensured for any other patient diagnosed with this pathology and admitted to a clinic with the same specialty, dimensions and equipment as the one presented.

CONCLUSIONS

This paper compares the results of our study to those of others, in terms of different or similar approach therapeutic options, developed in other minimally invasive surgery centres in the world, the final conclusions being encouraging for the therapeutic sequence that we practice.

Abdominal compartment syndrome -- a major complication of large incisional hernia surgery

The incidence of Intraabdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS) is underestimated within the surgery of large size parietal-abdominal defects, with the maximum transverse diameter above 10 cm, being considered the main risk factor for the development of intra abdominal hypertension, together with ventilatory restraint under 60% and obesity. Intraabdominal hypertension has a prevalence of at least 50% among critical patients and was identified as an independent life-threatening risk factor.However, doctors do not evaluate it properly and do not realize the potential lethal consequences of untreated intraabdominal hypertension. These consequences may be abdominal compartment syndrome, followed by multiple organ dysfunction and even patient death. The paper intends to highlight the importance of the early recognition of this pathology, as a key factor in the correct management of these complications.

Prognostic and predictive factors in colorectal cancer

Colorectal cancer (CRC) is an important public health problem; it is a leading cause of cancer mortality in the industrialized world, second to lung cancer: each year there are nearly one million new cases of CRC diagnosed worldwide and half a million deaths (1). This review aims to summarise the most important currently available markers for CRC that provide prognostic or predictive information. Amongst others, it covers serum markers such as CEA and CA19-9, markers expressed by tumour tissues, such as thymidylate synthase, and also the expression/loss of expression of certain oncogenes and tumour suppressor genes such as K-ras and p53. The prognostic value of genomic instability, angiogenesis and proliferative indices, such as the apoptotic index, are discussed. The advent of new therapies created the pathway for a personalized approach of the patient. This will take into consideration the complex genetic mechanisms involved in tumorigenesis, besides the classical clinical and pathological stagings. The growing number of therapeutic agents and known molecular targets in oncology lead to a compulsory study of the clinical use of biomarkers with role in improving response and survival, as well as in reducing toxicity and establishing economic stability. The potential predictive and prognostic biomarkers which have arisen from the study of the genetic basis of colorectal cancer and their therapeutical significance are discussed.

[Certitudes and controversy regarding neural elements preservation in total mesorectal excision technique (ETM)]

The total excision of the mezorect, as a technique of reference in the surgical solution of rectal cancer, is evaluated today through the view of the oncological and functional outcome. Within the functional outcome, the genito-urinary disorders which follow the damage of the pelvic vegetative nervous structures, still cause discussions and controversy among dedicated specialists in this area. The work plans to share an experience of over ten years of ETM practice, in which the technico-tactical accumulation have been realized progressively, outlining a relatively codificated attitude, centered on the "critical moments" of this intervention.

Peculiarities of diagnosis and treatment in the polyp-cancer sequence

Colorectal cancer, a public health problem with major social implications, has attracted major economic resources and specialized centers focused in the direction of obtaining an early diagnosis from effective screening means in the last decades. It is obvious that the therapeutic results and the social costs are primarily dependent on the precocity of diagnosis. The present paper aims to bring to attention a number of orientations, which may open a new perspective in approaching the genetic and molecular level of these lesions. Out of these, the value of the molecular screening based on the detection of the APC gene located on the short arm of chromosome 5, a method that allows the selection of the subjects to be subjected to further endoscopic screening is underlined. The optimization of the costs as well as the increased compliance of the subjects to such a method is thus accomplished.

[Posterior fossa epidural hematoma]

Posterior fossa epidural hematomas (PFEH) are rare entities, with dark prognosis due to their specific localization. Because the simptomatology is usually nonspecific or poor, the CT should be performed as soon as posible. MRI does not offer suplimentary benefits/informations in the great majority of PFEH. Depending on the bleeding source, the rate of clinical signs appearance and the gravity of evolution varies. Early diagnosis and surgical treatment should be performed in hematomas associated with mass effect or suplimentary injuries. In all cases, in PFEH patients a careful monitoring is necessary due to unpredictable evolution and rapid clinical worsening, requiring surgical intervention.

Map syndrome (MYH Associated Polyposis) colorectal cancer, etiopathological connections

The case presented raised our scientific curiosity and it is worthy of being brought in front of the medical audience because of several reasons presented below. Presently, there are 3 hereditary syndromes that have a demonstrated etiological relationship with the colorectal cancer: Familiar Adenomatous Polyposis (FAP syndrome), HNPCC syndrome (Hereditary Nonpoliposis Colorectal Cancer) and MAP syndrome.Discovered only in 2002, the MAP syndrome (MYH associated polyposis) is the first hereditary syndrome that has autosomal recessive transmission. The APC gene can be mutated in several ways during the colonic oncogenesis: congenital in the FAP syndrome, somatic in sporadic colorectal cancers and secondary to the MYH gene inactivation in MAP syndrome. MAP phenotype is similar to the FAP phenotype because of the somatic mutations to the APC gene. Colonic polyposis is lower than FAP syndrome and appeared later, in the 40's and 50's. Colorectal cancers are frequent and discovered in the same moment as the colonic polyposis. Patients are diagnosed mostly in cancer stages. Colonoscopy shows polyps disseminated around the entire colic frame. Treatment in these cases is total rectocolectomy with ileoanal anastomosis. When working in a general emergency surgery clinic, physicians are often faced with colorectal cancers in different evolutive stages, and mostly they are faced with their complications.

[Primary intracerebellar hematomas: surgical indications, prognosis]

Intracerebellar primary hematoma are produced by spontaneous hemorrhages in the cerebellar parenchima and usually present an sudden onset. In the present study we analyzed a serie of 34 cases of primary intracerebellar hematoma, in patients of both genders, between 35 and 80 years old. Taking in account the incidence of symptoms, the clinical picture was dominated by the gait disturbances, headache and consciousness disorders. From the analyzed cases, 50% had had surgical indication and 50% benefits on conservative treatment. Even though the evolution was favorable in the great majority of cases,the mortality in the surgical treated group was lesser (5,88%) comparative to the conservative treated group (17,64%). The main criteria for surgical treatment were represented by GCS (Glasgow Coma Scale) score < or =13 or blood collections exceeding 3 cm in diameter.

Locally aggressive colonic and rectal cancer--clinical trial

This clinical trial studies local invasions from primary colonic and rectal cancers (urinary bladder, abdominal wall, small bowls, uterus, vagina, stomach, bile tract, spleen, duodenum, pancreas, ureters, kidneys), with or without undiscovered metastasis. Primary locally aggressive colonic and rectal cancers include tumors that are staged T4N1-2Mx on diagnosis, and are often associated with a lower prognosis than earlier cancers. Diagnosis is based on thorough clinical evaluation, imagistic support: abdominal XR with contrast (barium enema), colonoscopy, abdominal and pelvic ultrasound exam, endoscopic endolumenal ultrasound exam, abdominal and pelvic CT/IRM with contrast (administrated both orally and intravenously), PET Scan, and intra-operatory confirmation. The primary symptom was pain. Locally aggressive colonic and rectal cancers, primary or secondary, can extend to any visceral or parietal structure. The ability to perform a total resection is based upon anatomical localization and on the fixation of other organs to the lesion. Identifying the anatomical extension provides a better appreciation of the purpose of the tumoral resection. Radical nuanced surgery is the base of treatment of the locally aggressive colon-rectal cancer. The studies have shown that in certain localizations of the colon-rectal cancer, the locally aggressive forms can be better controlled by using multimodal therapy, including radiotherapy, either external or guided intraoperatory radiotherapy and chemotherapy with much better results.

Selecting criteria for the right prosthesis in defect of the abdominal wall surgery

The article is debating a theme of great interest for the defect of the abdominal wall surgery--the use of biocompatible prosthesis. The surgeon is often confused by the avalanche of offers made by the mesh producers, making it mandatory for him to know very well the behavior of these alloplastic structures in the tissue environment. From this point of view, we have discussed both the physicochemical properties and the histological reaction brought by the most common type of meshes: polypropylene, polyethylene - tereftalat, polytetrafluorideethylene. This presentation brings out the minimal but mandatory criteria for any mesh to be accepted, but also the criteria that need to be taken into consideration when we try to improve the qualities of the mesh closer to the desideratum of the "ideal mesh". The main conclusion of this review is that we have to change the myth of the "ideal mesh" with "the right chosen mesh", that based on its chemical, physical, structural and biological qualities will adapt perfectly first to the patient's needs and second to the surgeon's needs.

[Late pancreatic metastasis from primary Grawitz tumor--surgical management]

Renal cell carcinoma (Grawitz tumor) is an epithelial tumor able, to develop, in some cases, very late metastases. The most frequent localization are: lung, bones and liver. Pancreatic metastasis are rare and appear late, sometime even after 12 years from primary renal tumor. In this cases the differential diagnosis must be made with primary pancreatic tumors. We present a case report of pancreatic metastatic tumor developed 5 years after right nephrectomy for renal cell carcinoma. We decide to perform cephalic duodenopancreatectomy (Wipple type).

[Incisional hernias with particular topography--alloplastic procedures]

The aim of the study was to analyse the particular features and treatment difficulties of paramedian incisional hernias.

MATERIAL AND METHOD

A retrospective study was performed on a series of 64 patients operated for incisional hernia with particular topography: right subcostal, right iliac and suprapubic area (following a Pfannenstiel incision). These cases represented 17.8% of the 360 patients with incisional hernias operated in our unit in the interval 2003-2007.

RESULTS

The majority of the cases were right hypochondrum (34 cases), followed by suprapubic (16 cases) and right iliac fosse incisional hernias (14 cases). An alloplastic reconstruction procedure with retromuscular polypropylene mesh was carried out in all cases. The follow-up was made at 1, 6 and 12 months. The most frequent local complications were juxtaprosthetic serohematic collections (4 cases - 6.3%), frequently associated with an extensive abdominal lipectomy (3 patients). Reccurence of the hernia was noticed in one case only (1.5%).

CONCLUSION

Mesh repair is the procedure of choice in incisional hernias, including those with particular locations, as justified by the low reccurence and morbidity rate.

[General principles of abdominal wall reconstruction--20 years of experience]

After 20 years of reconstructive abdominal wall surgery and almost five thousand surgical interventions for this pathology, most of them resolved with prosthesis, authors present a retrospective study concerning to increased biocompatibility, world dynamics of alloplastic solution and also the technical surgical problems that appears in incisional hernia repair. There are underlined two concepts: first--the maximal transversal diameter--that define the size of musculo-aponeurosis defect and the span of alloplastic substitution, in opposition to the old idea that allude to the size of hernia sack; the second concept--receptor prosthetic layer--define the interface between abdominal viscera and prosthetic material. This is not just a mechanical divider, being also a conjunctive and vascular support, helping prosthetic tissue integration.

[Intestinal tuberculosis--cause of acute surgical abdomen]

Tuberculosis, in its various forms, remains an important cause of morbidity and mortality in developing countries in immunodeficitary patients. The indicatives of epidemiology of tuberculosis show that Romania presents a fresh outbreak of the disease in the last few years. The purpose of this paper is to present from the various forms of extrapulmonary tuberculosis, the intestinal tipe which have a high incidence. The authors describe theirs preliminary experience of intraoperative small and large bowel emergencies resections in a short period (1 year) of three young patients (between 30 and 40 years old) with history of pulmonary tuberculosis. The pathology was complex (bowel obstructions, peritonitis) and so were the surgical operations (resections, devirations). The patients showed short and long term good results.

[The duodenal compression syndrome (DCS) due to an aorto-mesenteric shunt associated with primary intestinal malrotation]

It is presented the cases of a patient suffering from a rare surgical condition, Wilkie's syndrome, duodenal compression syndrome through aorto-mesenteric clamp, also known as the superior mesenteric artery syndrome (SMAS). The authors wish to underline the diagnosis difficulties which concurred to a delay of surgical cure, also presenting the surgical technique methods used for solving this case. Among the large number of operations till now proposed for the management of this syndrome, the chosen solution-resection of the first jejunal loop together with the duodenojejunal junction followed by prevascular lateroterminal duodenojejunal anastomosis--was imposed by the coexistence of an intestinal malrotation, forming the so called "common mesentery".

[The applications of informatics in ophthalmology]

The paper reports on the applications of information science in Romania in ophthalmology, and mainly in glaucoma, in the diagnosis of: degenerative affections of the fundus oculi, uveitis, strabismus, in functional exploration of the chromatic sense, ergo-ophthalmology, pupillary reflex and forms of the pupil, etc. The Romanian made computers Felix, Independent, Coral, Cobra, etc. were used.

The significance of the lung biopsy in congenital cardiovascular malformations

The microscopic changes of pulmonary arteries in 18 patients with congenital cardiovascular malformations were studied on lung biopsies and appreciated by the Heath-Edwards' scale. A correlation between the nature of the malformation and the patient's age on the one hand, and the severity of arterial lesions on the other hand, was observed, suggesting the utility of the lung biopsy for a better prognosis of the surgical corrective intervention. The role of inflammatory factors in the genesis of arterial changes leading to hypertension is also discussed.