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Unlabelled: The aim of this study is to emphasize the importance of knowing the predisposing factors of the occurrence of homolateral upper limb lymphedema after breast cancer surgery., Material and Methods: The study included 1104 patients with breast cancer, who were hospitalized in the IIIrd Surgical Clinic, lasi, between 2000 and 2010, for surgical treatment followed by oncological adjuvant therapy. The surgical intervention was conservative in 228 cases and modified radical mastectomy - Madden type - in 876 patients. Periodic clinical follow-ups were done every 3 months during the first postoperative year, every 6 months during the second year and annually thereafter., Results: Early lymphedema occurring in the first 14 postoperative days or between day 14 and day 21 was found in 8 patients. Late lymphedema, occurring up to 12 months or more after surgery, was diagnosed in 41 patients. Medium and severe lymphedema occurred at 42 patients. We evaluated the preexisting risk factors, the risk factors related to the type of surgery and those related to the cancer staging., Conclusions: It's ideal to identify predisposing factors of developing lymphedema related to breast cancer surgery before applying any type of treatment, There are therapeutic methods (general, drug therapy, physiotherapy) and methods related to the surgical act that influences the prophylaxis of lymphedema or have an amazing effect on already occurred lymphedema.

Unlabelled: It is well known that the diverticuli of the colon gets inflamed in 10-15% of cases, thus becoming clinical symptomatic as a diverticulitis, while in other 15% they will bleed, with the clinical aspect of an inferior digestive bleeding. Our study presents some clinical observations with diverticuli of the colon, that raised diagnostic and therapeutic problems., Material and Method: Between 2001-2010, 17 patients were admitted in the 3rd Surgery Clinic, University Hospital "St.Spiridon", Iasi, with asymptomatic diverticuli of the colon, that were put in evidence imagistically, intraoperative or on specimens after removal of the colon for other conditions;meanwhile, there were 15 patients admitted with complications of the diverticuli:5 patients had perforated diverticulitis (4-pericolic abscesses and one with peritonitis in the lower abdomen), 4 had rectal bleeding and the other 6 raised particular problems of diagnostic and treatment, being included in the present study., Results: Five out of six underwent operation. One patient refused the surgical treatment. Postoperative evolution was favorable in 4 out of the 5 operated patients., Conclusions: The complications of colonic diverticuli present on admission under clinical aspects that usually mimic a colonic cancer. In these situations the imagistic examinations do not offer enough details to elucidate the diagnosis. Our six particular observations strengthen the dictum of avoiding the "mirage" of the first lesion. The extent of the surgical procedure in the case of patients with colonic diverticuli admitted under the clinical aspect of a complication is sometimes disproportionate and encumbered of increased mortality and complication rate.

Purpose: To evaluate and compare the impact on quality of life of tamoxifen and aromatase inhibitors (AIN's) in adjuvant settings, at women with breast cancer., Methods: From a total of 441 patients with breast cancer with hormonal treatment, were selected 177 of patients with adjuvant hormonal treatment (95 with tamoxifen treatment and 82 with AIN's treatment). These patients have completed the EORTC QLQ C-30 and EORTC QLQ BR23 questionnaires after 1 month of treatment (baseline), at 2 year of treatment with tamoxifen versus aromatase inhibitors (exemestane, anastrazole, letrozole). Mean change score from baseline and 2 years of treatment were compared in the both arms (tamoxifen vs. AIN's)., Results: In both arms, after two years, a decreased QOL was observed as compared with the baseline. In the tamoxifen arm, global health status (GHS) and breast symptoms score (BRBS) were similar comparative with AIN's arm at baseline, with a similar status at 2 years measurement., Conclusions: The global health status (GHS) and breast symptoms score (BRBS) shows that there is no difference in the QOL at the women with breast cancer treated with tamoxifen, comparative with the women treated with AIN's. We conclude that AIN's did not have an adverse impact on overall QOL, comparative with tamoxifen, in adjuvant settings.

Aim: Changing the sequence of therapeutic options in stage II breast cancer: first, a core biopsy, followed by the evaluation of the tumoral markers, adaptation of the chemotherapy scheme and finally, surgical approach. Thus would be possible to improve the hope of life in some stage II breast cancer patients, in whom survival is poorer than in some stage III patients., Material and Method: 144 patients in stage II breast cancer were included in this study, over a period of 5 years (2000-2004). In all these patients the first therapeutic option was surgery (radically modified mastectomy type Madden), followed by systemic chemotherapy-FAC or FEC, 6 cycles, and finally Tamoxifen., Results: 34 out of them developed metastases in a period between 6 and 72 months, most of them in the first 26 months; 25 out of these 34 didn't have metastases in the axillary lymph nodes, and in 18 patients estrogen--and progesterone--receptors were highly positive. HER 2 neu was negative or low expressed in patients with metastases. CD 34 wasn't evaluate in the whole group., Conclusions: Early onset of metastases in the studied patients, in whom tumoral aggressiveness markers were not obvious, impose the evaluation of the angiogenesis markers and, when positive, chemotherapy as the first therapeutic option.

Unlabelled: The aim of this study is to point out the late diagnosis and initiation of treatment in male with breast cancer. At the same time, to show the importance of the correlation between different markers in assessing the prognostic, as well as the treatment for the patient., Material and Methods: Retrospective study on a group of 15 males with breast cancer, out of 1043 patients with the disease, in a period of 10 years. Eight patients were stage III of disease, 2 were stage II, one was stage I, and in other 3 cases the evaluation of the tumor and of the axillary lymph nodes was performed only by echography, considered stage II., Results: All patients underwent radically modified Madden mastectomy; 4 patients needed a partial resection of the great pectoralis muscle. Adjuvant chemotherapy was performed in 9 patients, and neoadjuvant chemotherapy in 2 cases. Three patients refused the chemotherapy, and one patient chose an alternative paramedical treatment. The treatment with Tamoxifen was done in 11 patients with high values of Progesterone and Estrogen Receptors (PR, ER). At the date of our study, 8 patients were alive, without clinical signs of disease (free of disease), while in 3 patients, alive, clinical signs of disease were detected (recurrence). Survival rate couldn't be evaluated in 4 patients., Conclusions: Breast cancer in male is usually discovered in locally advanced stages, although most of the patients are regularly screened for chronic hepatitis. Use of biological markers allows a more accurate evaluation of the aggressiveness of the tumor, as well as a more specific treatment for each patient. Modified radical mastectomy type Madden remains the preferred surgical approach. Surgical approach should be considered even in locally advanced cases, as well as in elder patients.

Unlabelled: Although the "gold standard" in the multimodal treatment of liver primary and secondary tumors is the surgical ablation, the rate of resection, despite the last decades advances, remains still low (10 - 20%). In addition, the interest for non-surgical ablation therapies is increasing. Among them, regional or systemic chemotherapy, intra-arterial radiotherapy as well as locally targeted therapies--cryotherapy, alcohol instillation and radiofrequency (RF) are the most valuable options as alternative to the surgical approach., Material and Method: Between February 2005 - January 2007, 9 patients with liver metastases underwent open RF ablation of their secondaries in the III-rd Surgical Unit, "St. Spiridon" Hospital. An Elektrotom 106 HiTT Berchtold device with a 60W power generator and a 15 mm monopolar active electrode was used., Results: Destruction of the tumors was certified with intraoperative ultrasound examination. Pre- and postoperative CarcinoEmbryonic Antigen (CEA) together with imaging follow-up was carried out, in order to determine local or systemic recurrencies. Six patients died between 6 month - 4 years after the RF ablation. Median survival is 29.2 months., Conclusion: RF ablation is a challenge alternative in non-resectable liver tumors.

The aim of this study is to justify an individual therapeutical attitude in breast cancer, related to diversity of breast tumors, aggressiveness grade and metastatic potential. Between January 2000--December 2001, 150 patients were admitted with breast cancer (stage II and III) and underwent surgery in our department. We selected 75 cases in our study. In 51 (68%) cases the first therapeutical method was surgery, in 15 (20%) cases surgery was performed after chemotherapy, in 2 (2.66%) cases after radiotherapy and after chemotherapy and radiotherapy in 7 (9.33%) cases. We evaluated several classical factors and new immunohistochemical markers with an important value for diagnosis, prognosis and therapy: oestrogen and progesterone receptors, c-erb B2, pS2 and p53 proteins, von Willebrand factor. Several factors had a predictive role regarding the response to chemotherapy. These predictive factors will improve the histopathological diagnosis. The oncoproteins and hormonal receptors also will evaluate with more accuracy the metastatic risk and will assure a better therapy decision.

Acute or chronic intestinal ischaemia can be the consequence of either intrinsic vascular disease, systemic disease, drugs or surgical procedures. In one quarter of the patients with intestinal ischaemia, no major vascular obstructions can be detected. Very rarely, the cause of ischaemia is splanchnic vasoconstriction due to cardiac arrhythmias or sepsis. The bowel becomes ischaemic as a result of underperfusion. The clinical picture resembles the one of occlusive intestinal ischaemia. From the pathological standpoint, the ischaemia is more intense on the antimesenteric border of the bowel an the lesions are more advanced in the mucosal than in the serosal layer. Often, the ischaemia involves other organs too: liver, spleen or gallbladder. The reconstructive vascular procedures are inefficient, the only therapeutical options remains the resection of the infarcted bowel, together with other organs involved in the ischaemia process. The mortality rate approaches 90%.

Acute or chronic intestinal ischaemia can be the consequence of either intrinsic vascular disease, systemic disease, drugs or surgical procedures. In one quarter of the patients with intestinal ischemia, no major vascular obstructions can be detected. Very rarely, the cause of ischaemia is splanchnic vasoconstriction due to cardiac arrhythmias or sepsis. The bowel becomes ischaemic as a result of underperfusion. The clinical picture resembles the one of occlusive intestinal ischaemia. From the pathological standpoint, the ischaemia is more intense on the antimesenteric border of the bowel and the lesions are more advanced in the mucosal than in the serosal layer. Often, the ischaemia involves other organs too: liver, spleen or gallbladder. The reconstructive vascular procedures are inefficient, the only therapeutical options remains the resection of the infarcted bowel, together with other organs involved in the ischaemic process. The mortality rate approaches 90%.