1 Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Department of Visceral Surgery, Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania 3 ”Dan Setlacec” Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania 4 Department of Visceral Surgery, ”Ponderas” Academic Hospital, Bucharest, Romania 5 Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania 6 Department of Surgery, “Dr.I. Cantacuzino” Clinical Hospital, Bucharest, Romania 7 Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 8 Department of Obstetrics and Gynecology, “Alessandrescu-Rusescu“ National Institute of Mother and Child Care, Bucharest, Romania 9 Department of Obstetrics and Gynecology, “Dr. I. Cantacuzino” Clinical Hospital, Bucharest, Romania 10 Department of Surgery, “Sanador” Clinical Hospital, Bucharest, Romania 11 Department of Anatomy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 12 Department of Surgery, Ilfov County Emergency Hospital, Bucharest, Romania 13 Department of Anesthesiology, Fundeni Clinical Institute, Bucharest, Romania 14 Department of Surgery, ”Agrippa Ionescu” Clinical Emergency Hospital, Bucharest, Romania 15 Department of Obstetrics and Gynecology, ”Elias” Emergency Hospital, Bucharest, Romania 16 Department of Obstetrics and Gynecology, “Ovidius” University of Medicine and Pharmacy, Constanta, Romania 17 Department of Obstetrics and Gynecology, “Sf. Andrei” Clinical Emergency Hospital, Constanta, Romania 18 Department of Surgery, Ramnicu Sarat County Hospital, Buzau, Romania 19 Department of Surgery, “Titu Maiorescu“ University, Bucharest, Romania

Screening tests and national programs of early detection of breast cancer have been widely implemented worldwide, subsequently increasing the number of cases diagnosed in incipient stages, when the lesion has no clinical expression. In such cases a proper identification of the lesion is mandatory in order to achieve a radical result of the surgical procedure. Therefore, attention was focused on identifying the best imagistic methods regarding the accomplishment of an exact identification of the lesion which could further provide an adequate surgical resection and a proper oncological outcome and, in the meantime to provide the possibility of achieving a good cosmetic result. The aim of this paper is to study the role of indocyanine green as part of the therapeutic armamentarium which provides a correct identification of non-palpable breast lesions.

Mucinous borderline ovarian tumors represent up to one half of cases diagnosed with borderline lesions and are usually associated with favourable outcomes. When it comes to the therapeutic options in these cases, the initial trend was to adopt the same strategy as in cases presenting invasive mucinous lesions. However, studies conducted so far cam to demonstrate that the appendix presented tumoral infiltration in an extremely low number of cases especially if a normal macroscopical aspect was present and therefore routine appendectomy was no longer recommended. The aim of the current paper is to investigate in which cases appendectomy should still be part of the therapeutic strategy in mucinous borderline ovarian tumors.

Endometriomas represent a common finding among women at fertile age and usually associated with pelvic pain, infertility, heavy menstrual periods and dyspareunia. For a long period of time surgical resection has been considered the golden standard in such cases. However, although resection aims to take off only the cyst, in certain cases a decrease of the ovarian reserve and secondarily, to a decrease of the fertility is observed. Due to this reason, attention was focused on creating other methods for cyst destroying without impeding the ovarian reserve. The aim of the current paper is to discuss about the effectiveness and safety of sclerotherapy as part of the therapeutic strategy for endometriomas.

Lobular breast cancer represents a rare histopathological subtype of this malignancy, being characterized by a particular way of lymphatic spread. Therefore, the most widely known property of this tumor is the one of skipping certain lymphatic groups. Due to this aspect, the benefits of sentinel node identification were considered to be controversial so far. The aim of the current paper is to discuss about the indications and contraindication of this procedure in lobular carcinoma of the breast.

Although the necessity of performing radical mastectomy has significantly decreased over the last decades there are still cases in which this procedure is required, predisposing the patient to the development of long-term complications such as upper limb lymphedema. Meanwhile, due to the increased implementation of indocyanine green usage, the rates of this complication have decreased, preservation of the lymphatic vessels of the arm being more and more possible. Even though, upper limb lymphedema can be still encountered, in such cases vascular surgical procedures such as lymphovenous anastomoses might be performed in order to treat this complication. This is a literature review regarding the usage and effectiveness of indocyanine green administration in the upper limb lymphedema treatment.

Ovarian cancer is frequently associated with upper abdominal involvement necessitating extensive resections at this level. In such cases a significant increase of the postoperative complications is to be expected, the most commonly encountered one being represented by pleural effusion. Another complication which is described less frequently but which is associated with higher risks is represented by upper abdominal herniation at the level of the thorax. The aim of this paper is to discuss the risk factors and the therapeutic strategies in such cases.

Breast cancer represents the most commonly encountered malignancy in women worldwide. In the last decades, due to the improvement of the imagistic techniques and to the wide implementation of screening tests, a significant number of cases are suitable for conservative surgery therefore improving the quality of life. Although the postoperative morbidity after breast conservative surgery is reduced, the procedure can still be associated with certain complications such as breast lymphedema, or wound difficult healing. The aim of the current paper is to discuss the possibility of prevention and treatment of breast lymphedema by using innovative techniques such as indocyanine green.

Indocyanine green has been widely introduced in breast cancer protocol for sentinel node detection, for upper limb lymphedema prevention and for breast reconstruction. However, more recent studies came to demonstrate that these particles can be also used in order to provide an efficient intraoperative detection of metastatic deposits as well as for a more targeted delivery of cytotoxic drugs. The current paper aims to investigate the mechanisms of action, the principles and the benefits of indocyanine green as a therapeutic tool, part of the medical oncologic treatment of breast cancer patients.

Background/Aim: Retroperitoneal sarcomas represent very aggressive malignancies with high capacity of invading the surrounding vital structures. Case Report: We present the case of a 46-year-old patient who had been initially diagnosed with a large retroperitoneal mass 18 months ago. At that moment the mass was resected en bloc with the inferior cava vein, which was reconstructed using a cadaveric graft, the histopathological studies demonstrating the presence of a leiomyosarcoma. One year later she was diagnosed with recurrent disease invading the abdominal aorta and a liver metastasis. This time the recurrence was resected en bloc with the abdominal aorta, which was reconstructed by placing a cadaveric graft; atypical liver resection was also performed. The postoperative course was uneventful. Conclusion: Extended vascular resections and cadaveric graft reconstructions might be needed in order to achieve a good local control of the disease in patients with retroperitoneal sarcomas.

Despite known association of these malignancies, the incidence of a synchronous appearance of breast and ovarian cancer is low and the current literature does not directly address an approach to this clinical problem. We report 1year disease-free survival in a patient treated for serous carcinoma with solid genital pattern and invasive ductal carcinoma with trabecular pattern pT2N2Mx.The prolonged disease-free survival in our case may provide some guidance in this unusual clinical situation.

Arteriopathic patients represent approximately half of the diabetic patients. This study aims to prove that skin-grafting can be successfully used even in patients with vascular pathology.We analyzed a lot of 65 diabetic patients (13 arteriopaths, 23 neuropaths, 29 with mixed afflictions), who benefited from skin-grafting over defects of the lower limb. Skin defects resulted after topical surgery in patients with diabetic foot can be resolved by covering with free split-skin-grafts. Thus, major surgical interventions such as calf- or thigh-amputations can be avoided, post operatory treatment costs can be lowered and more accessible prosthesis can be acquired. Also, these patients can be socially and professionally reintegrated more rapidly.Skin-grafting can be used as a therapeutic method in arteriopathic diabetic patients, and, under certain conditions, successful results have been obtained in 12 out of 13 vasculopaths. In some cases, the precarious vascular bed kept the skin-graft from taking.

Inguinal hernia in adults is yet another source of controversies, being also one of the most frequent pathologies that require surgical treatment. Even if surgery progress brought up a series of innovative techniques, none succeeded to deliver best results in order to position itself as best practice. Nevertheless, many answers were provided by introduction of alloplastic materials, tension-free techniques and also minimal invasive procedures.

AIM:identifying the variables that can help in quantifying/ predicting duration of hospital stay after inguinal hernia surgery.METHOD:257 patients who were diagnosed with inguinal hernia underwent surgery between January 2013 and October 2014 and were prospectively registered and statistically analyzed by using linear regression with the aim of emphasizing, calculating and validating the predictors for duration of hospital stay.RESULTS:out of 257 patients, 50,7% underwent laparoscopic surgery (TAPP and TEP) and 49,7% had an anterior approach by using the technique described by Lichtenstein in most of the cases. From the variables registered in the study (age, recurrence, emergency surgery, ASA [American Society of Anesthesiologists] risk classification, surgery duration, local and general complications) only the age and presence/absence of complications were statistically associated with the modification of the duration of hospital stay in this pathology.CONCLUSIONS:the duration of hospital stay can be evaluated preoperatory by using a mathematical model, which takes into consideration factors that depend on the patient or the procedure, with results that can have a significant impact on planning the local resources.

Objective: We hereby analyzed a series of gallstone ileus cases operated on in our department starting from a Bouveret syndrome case.Method: Retrospective analysis of all gallstone ileus cases who underwent surgery in our department during the last 26 years. We took into consideration diagnostic elements, time from admission to surgery, type of surgery and post-operative outcome.Results: During this period 9,143 gallstones were deferred to surgery; 27 biliary-digestive fistulae were discovered during surgery; gallstone ileus complicated fistula in 8 patients. Gallstone ileus was exclusively present in elderly women with associated comorbidities. Diagnosis was suggested by clinical features of acute or incomplete intestinal obstruction; it was sustained by imagistic studies with different degrees of relevance. The average time from admission to surgery was 2.6 days. Surgical approach varied from simple enterolithotomy to additional fistula repair. The outcome was uneventful in most of the cases with only one exception.Conclusions: gallstone ileus is a rare condition, occurring in elders with important comorbidities. The choice for surgical procedure depends on the obstructive syndrome's gravity and associated comorbidities; the type of intervention does not significantly influence post-operative morbidity and mortality rates.

Scop: propunem o analizã a cazurilor de ileus biliar operate în clinicã, prilejuitã de un caz de sindrom Bouveret. Metoda: studiu retrospectiv al cazurilor de ileus biliar operate în clinica noastrã în ultimii 26 de ani, urmãrind elementele diagnostice, intervalul scurs pânã la operaåie, tipul intervenåiei şi evoluåia post-operatorie. Rezultate: în aceastã perioadã s-au operat 9143 litiaze biliare descoperindu-se 27 fistule biliodigestive din care 8 s-au complicat cu ileus biliar. Ileusul a survenit exclusiv la femei vârstnice cu comorbiditate importantã. Diagnosticul sugerat de semnele clinice ale ocluziei acute sau subacute, a fost susåinut de investigaåii imagistice a cãror valoare diagnosticã a fost diferitã. Intervalul scurs de la internare pânã la operaåie a fost de 2,6 zile. Atitudinea chirurgicalã a oscilat între simpla enterolitotomie şi asocierea acesteia cu desfinåarea fistulei biliodigestive. Evoluåia a fost favorabilã în majoritatea cazurilor cu o excepåie (1 deces). Concluzii: ileusul biliar este o afecåiune rarã, survenitã la vârstnici cu comorbiditate importantã. Alegerea procedeului chirurgical depinde de impactul sidromului ocluziv şi de comorbiditatea asociatã, tipul intervenåiei neinfluenåând semnificativ morbiditatea şi mortalitatea post-operatorie.

We hereby aim to account on a case of actinomycotic infection occurred in a female patient with an intrauterine contraceptive device (IUCD). The infection occurred as a pseudo-tumour which raised differential diagnosis issues with a malignant tumour. The diagnosis has been eventually established following the pathologic examination of paraffin-embedded tissues. Although the infection's gateway was the uterus, the subsequent invasion of the parietal, urinary bladder and lateral rectal walls did not seem to affect the fallopian tubes or the ovaries.

The persistence of a hepato-jejunal fistula after 9 years from a peri-cystic-jejunostomy in the treatment of hydatid liver cysts is an amazing condition. We discover this kind of fistula during the operation for cholelithiasis. This association between fistula and a "after-hydatid" choledocholithiasis is an opportunity to discuss some pathogenic and evolutive mechanisms about both of two entities.

We purpose to make a metanalysis of a external drainage and his role in the treatment of the hydatid liver cysts when it was made a anastomosis between peri-cystic cavity and a isolated loop of jejunum. The paper watch 74 cases which were operated in "I. Juvara" surgical clinic and in which it was used the external drainage of peri-cystic cavity. The drainage roles consist in follow up of peri-cystic cavity evolution, but, more than that, in early diagnosis and treatment of secondary infection of cavity, the main postoperative complication. The drainage excludes the possibility of unfavourable evolution of postoperative infection, in which case the result of operation may be compromised.