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The emigration of highly qualified staff is an issue which has currently raised lively debates in specialized literature both in Romania and abroad. The paper includes a mixed quantitative research, based on a questionnaire applied to a group of 47 Romanian doctors involved in the emigration process, and also a qualitative approach, which relies on the experience and observations of one of the authors, who works in the healthcare system and who resorted to documentation, analysis and abstraction. The main goal of our study is to identify the Romanian doctors' perception of the personal and professional advantages of emigration and the reasons for this decision, as well as to suggest a set of measures able to convince highly qualified healthcare professionals not to leave the country. The findings of our survey may be useful both for healthcare decision-makers and managers, and for the doctors themselves and emigration phenomenon researchers. [ABSTRACT FROM AUTHOR]

Informed consent is a vital document that should be obtained from the patient before performing any manoeuvres, either diagnostic or therapeutic. The principle of informed consent has gained important juridical interpretations and implications; therefore it has a great influence on daily medical practice. It is presented as fundamental ethical norm in major medical codes such as Hippocratic Oath, the Declaration of Geneva and the International Code of Medical Ethics. Most of the equivocal situations and issues in making life-saving decisions are encountered on emergency basis. This paper presents legal and ethical considerations regarding the informed consent for emergency treatment of patients. Medical decisions performed without informed consent must be dictated by the need to save the patient's life, unequivocally and well documented. [ABSTRACT FROM AUTHOR]

The incidence of pancreatic neoplasm has increased exponentially over the last decades in many parts of the world, and moreover it has become the fifth or even sixth cause of death by cancer in the Western countries. Still, little is known about this disease, since the main disadvantage encountered in pancreatic cancer is the fact that the diagnosis is established too late despite the development of new technologies, while also most of the studies carried out have not been able to identify the significant risk factors for pancreatic. In this way, in the present mini-review we want it to make a short description for the main molecular factors with predictive value for the survival rate in pancreatic cancer and by focusing especially on the CA 19-9. Thus, it seems that CA 19-9 should enter in the arsenal of methods for monitoring the condition of the operated patients and also be a tool for the prognostic evaluations. Also, some of the results we describe here are suggesting that tumor-metastatic involvement of LN 8a can be a strong predictive factor of aggressive tumor biology and, therefore, of the early existence of metastatic disease. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common type of cancer that affects women. Its aggressiveness depends mainly on the patient's age, on the tumor size and on the axillary lymph nodes status. The prognosis is the most unfavourable in the case of women under 35 years old, because they develop loco-regional and distant recurrence of the disease earlier than the older patients. Moreover, they usually are diagnosed in advanced stages of the disease. Considering all these aspects, the purpose of our study is to identify and analyse the biological, psychological and socio-economic implications of breast cancer, in the case of the Romanian young women. In order to reach this objective, we have conducted an empirical research on 42 female patients with breast cancer, aged between 26 and 45 years, hospitalized and operated by the same surgical team, between 2010 and 2013. Our results demonstrate that the early detection of breast cancer has multiple benefits, not only from the medical point of view, but also from the psychological and socio-economic perspectives. We noticed that young women diagnosed with breast cancer in early stages have a reduced scale of surgery, which involves a shorter period of hospitalization and a lower cost of treatment, a better life prognosis and a satisfactory psychological comfort, resulting in rapid social and familial reintegration. [ABSTRACT FROM AUTHOR]

The pancreatic cancer is a disease with exponentially increased incidence, especially over the last decades, being the sixth or even fifth cause of death by cancer in most of the modern societies. Moreover, it is estimated that almost 95% of the patients with this disease are presenting to the doctor in the advanced and unresectable stages. Thus, the only way of establishing a diagnosis in the early stage, potentially curable, would be a rigorous anamnesis that would reveal the early symptoms to 'send' the patient to the doctor in the early stage. In this way, all hopes are turning to early diagnosis and/or the discovery of an effective therapeutic agent. Thus, in the present report we will be interested in presenting the relevance for the serum determination of some tumoral markers, such as CA19-9 (carbohydrate antigen 19-9) and CEA (carcinoembryonic antigen) in our selected patients with pancreatic cancer. In this way, our results are showing the relevance in determining these specific tumoral markers, especially as predictors for recurrences after pancreatic neoplasm surgery, since the determination of the serum level of CA 19-9 seem to be relevant in the cases when the antigen level drops immediately after the surgery, then increases progressively, highlighting the emergence of recurrence. [ABSTRACT FROM AUTHOR]

Association of adenocarcinoma and tuberculosis (TB) of the sigmoid colon is a rare clinical condition even in an endemic country as Romania, with challenging diagnosis and treatment. Case report. We present the case of a 57-year-old female patient who was admitted on emergency basis for a diagnosis of obstructive sigmoid adenocarcinoma. The patient was operated on and it an obstructive sigmoid tumor with serosal invasion, adherent (invading) to the body of uterus and left adnexa and urinary bladder serosa, no liver or peritoneal metastases. A sigmoidectomy was performed "en bloc" with subtotal hysterectomy, left adnexectomy and extramucosal cistectomy. The histopathological exam showed a moderately differentiated, ulcerated adenocarcinoma, widely infiltrating the colon wall invading the myometrium. Ziehl Neelsen (ZN) stain identified the presence of metachromatic bacillary structures in the colonic wall, lymph nodes and adnexal areas. Postoperative course was uneventful and the patient was discharged 10 days postoperatively in good clinical condition. After one year when the patient completed the full course of anti-tubercular drugs, a thorough work-up was performed. Colonoscopy, CT of the thorax, abdomen, pelvis showed no signs of recurrence while tumoral marker CEA (1.62 ng/ml - n<3.4) and QFT (Quantiferon-TB Gold) test were within normal range. Discussion and conclusion. Although digestive tuberculosis is included in differential diagnosis for those patients presenting abdominal pain or obstructive digestive symptoms in endemic regions, in this case the absence of TB infection criteria and positive endoscopic biopsy for colonic adenocarcinoma did not allow a complete pre- or perioperative diagnosis.

Aim: To determine the correct therapeutic approach to the different grades of liver trauma., Material and Methods: The study is based on a retrospective analysis of treatment outcomes in 56 patients with abdominal trauma admitted over a 9-year period to in the IIIrd Surgical Clinic of the Iasi "Sf. Spiridon" Hospital. It is focused on operative or non-operative management of liver trauma, surgical technique used, morbidity and postoperative mortality. Data were collected from electronic medical records and observation sheets and processed and interpreted using Microsoft Excel statistical functions., Results: In the interval May 26, 2005-April 19, 2013 56 cases of abdominal trauma were recorded, 31 (55.35%) residing in urban areas, and 25 (44.64%) in rural areas. The mean age was 39 years, range 18-83 years old. The male/female ratio was 2.5/1 and the group consisted of 40 (71.42%) male patients and 16 (28.57%) female patients. The causes of abdominal trauma were: car accident in 29 (51%) cases, fall from different heights in 6 (10%) patients, workplace-related accidents in 8 patients (14%) and direct hit injury in 12 patients (12%). In our cohort, 51 (91%) patients with abdominal trauma have been emergency admitted, 3 patients (5%) were transferred from different medical units, and 2 patients (4%) were referred by a specialist doctor. Two or more simultaneous lesions were diagnosed in 53 (96%) cases. Of the 45 patients with traumatic liver injuries diagnosed on admission, 32 (71%) required surgical intervention. In the remaining 13 (29%) patients, the therapeutic management was conservative., Conclusions: Hepatic traumas are often severe, and frequently associated with multiple injuries. The non-operative management is indicated in liver lesions grade I, II and III according to the American Association for the Surgery of Trauma (AAST), if abdominal cavity organs are not injured. Higher grade liver lesions (over IV) in which the hemorrhagic risk persists or reappears require surgical intervention as soon as possible, and according to the type of lesion, the right procedure should be chosen.

Unlabelled: The aim of the study was to highlight correlations between serum biochemical markers and different degrees of liver inflammation or fibrosis revealed by liver biopsy in morbidly obese patients. We also wanted to emphasize that the occurrence of hepatocellular carcinoma (HCC) is increasingly associated with obesity, metabolic syndrome and nonalcoholic fatty liver disease., Material and Methods: A clinical retrospective study was carried out on a series of 13 patients operated for morbid obesity in our surgical unit. Included in this study were only the obese patients referred for bariatric surgery without other risk factors for liver disease and in whom a liver biopsy was taken during metabolic surgery., Results: The pathology report revealed different stages of nonalcoholic fatty liver disease in all 13 patients: pathological features of steatohepatitis (7 patients), hepatic steatosis (5 patients) and lesions specific for evolving cirrhosis (1 patient). Regardless of the pathological changes of the liver, except the patient with evolving cirrhosis, none of these patients showed changes in classical liver function blood tests., Discussions: Hepatic alteration in obese patients, ranging from simple steatosis to steatohepatitis or even cirrhosis, is not always correlated with the values of classical biological liver function tests. Literature data suggest the involvement of adipokines in the development and progression of steatosis as the hepatic expression of metabolic and chronic inflammation syndrome occurring in obese patients. Furthermore, these proteins secreted by adipose tissue seem to be related to the HCC occurrence. However, none of these studies show the exact pathway followed by the hepatic cell from simple fatty liver to hepatocellular carcinoma., Conclusions: finding and selecting the population at risk for fatty liver disease progression and for HCC development among obese patients is mandatory.

Large excision of tumor soft tissues is often complicated by infections, seriously undermined blood supply and venous drainage, tendon exposure, functional impairment. We report the case of a 67 years old woman admitted for a sarcoma of the right forearm occurring 14 years after a modified radical mastectomy and adjuvant chemotherapy for carcinoma of the right breast. A wide excision of the lesion and split-thickness skin graft was performed with uneventful recovery and satisfactory healing of the graft tissue and functional aspect of the arm. In the last few decades, there has been a search for solutions in tissue repair without need for auto grafts, such as biological substitutes that could repair or improve the function of tissue. In case none of these products are available, auto graft is a good choice and it may be commonly used in the surgical treatment of postoperative soft tissues defects after oncologic surgery.

Adenocarcinoma of the pancreas presents a major threat with a 5-years survival rate of 5%. Whipple pancreaticoduodenectomy (PD) is the standard procedure for cephalo-pancreatic neoplasm. After an extended resection and reconstruction of superior gastrointestinal tract the digestive physiology might be heavily disrupted. A literature review of metabolic alterations of patients who suffered a major pancreatic resection is performed, regarding micronutrients, lipid absorption and pancreatogenic diabetes. Long-term survivors following PD generally have a satisfactory nutritional status although with subclinical iron, vitamin D and selenium deficiency. These patients should be followed-up also regarding these micronutrients and properly dietary supplemented when necessary, also considering the increased life expectancy. Approximately 17-25% of patients will develop insulin-dependent diabetes but pancreatogenic diabetics have elevated levels of serum insulin and minimal or absent response to food intake, as opposed to a type I diabetics, where insulin serum is normal or elevated and there is an exaggerated response to ingestion of sugar.

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.

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.