Nicolae Kretzulesco Turnescu was a pioneering Romanian surgeon in the 19th century. He obtained his medical license in Paris in 1853 and returned to Romania, becoming a professor and head of surgery at Coltea Hospital in Bucharest. He helped establish the first medical journal in Romania and the Romanian Medical Society. Turnescu introduced innovations like anesthesia and made improvements in surgical outcomes. He also published some of the first works by a Romanian surgeon abroad. Turnescu helped establish modern medical education in Romania.
This document presents a clinical case of a complicated giant ovarian cyst in an 86-year-old female patient. She presented with a history of progressive abdominal distension and recent worsening of left hypochondrium pain. Imaging revealed a large left ovarian cyst measuring 29x15cm axially and a Bochdaleck hernia. She underwent a minimal laparotomy where 5.5L of fluid was suctioned from the cyst and the cyst wall was excised along with the left adnexa. Histopathology found a mucinous cyst adenoma. The case was notable for the large cyst size, presence of an acquired Bochdaleck hernia, and anaesthetic risks due to the patient's age and
Surgical approach to intra-abdominal metastases from malignant melanomaSinzianaIonescu1
This document discusses the surgical approach to intra-abdominal metastases from malignant melanoma. A retrospective study over 10 years evaluated secondary intra-abdominal tumors from melanoma that required emergency or complication-related surgery. Surgeries for issues like intestinal necrosis, invagination, hemorrhage or perforation improved patient outcomes, with an average 14 month survival and 20% 5-year survival. Metastasectomy remains the only treatment that can provide a complete pathological response and favorable survival rates, even in a palliative context. Figures show examples of cutaneous melanoma, metastatic lymph nodes, FDG PET/CT findings, and intraoperative/CT images of small bowel invagination caused by melanoma.
1) A retrospective study analyzed 40 male patients with breast cancer treated between 2011-2021 at a Bucharest oncology institute to examine relationships between immunohistochemical markers, disease-free survival, and overall survival.
2) At presentation, 40% of patients had stage I invasive grade 2 tumors that were estrogen receptor and progesterone receptor positive, HER2 negative, and had high ki-67 levels (>50%).
3) Family history, high ki-67 levels, negative progesterone expression, diabetes, high BMI, and gynecomastia were associated with shorter disease-free and overall survival compared to other patients. Randomized controlled trials of both sexes are needed to better inform treatment guidelines for male breast cancer.
A liposarcoma of the retroperitoneum causing bowel obstructionSinzianaIonescu1
This document presents a case report of a rare dedifferentiated retroperitoneal liposarcoma that caused bowel obstruction. It describes the patient's presentation, surgical findings, and histopathological examination results. Key findings included lipoblasts and spindle cells on microscopy, as well as genetic abnormalities involving CDK4 and MDM2 amplification. While surgery is the primary treatment, targeted therapies are being explored that aim to disrupt the genetic alterations driving these sarcomas, particularly on chromosome 12. Retroperitoneal sarcomas can cause bowel obstruction when large tumors compress the intestines.
Nicolae Kretzulesco Turnescu was a pioneering Romanian surgeon in the 19th century. He obtained his medical license in Paris in 1853 and returned to Romania, becoming a professor and head of surgery at Coltea Hospital in Bucharest. He helped establish the first medical journal in Romania and the Romanian Medical Society. Turnescu introduced innovations like anesthesia and made improvements in surgical outcomes. He also published some of the first works by a Romanian surgeon abroad. Turnescu helped establish modern medical education in Romania.
This document presents a clinical case of a complicated giant ovarian cyst in an 86-year-old female patient. She presented with a history of progressive abdominal distension and recent worsening of left hypochondrium pain. Imaging revealed a large left ovarian cyst measuring 29x15cm axially and a Bochdaleck hernia. She underwent a minimal laparotomy where 5.5L of fluid was suctioned from the cyst and the cyst wall was excised along with the left adnexa. Histopathology found a mucinous cyst adenoma. The case was notable for the large cyst size, presence of an acquired Bochdaleck hernia, and anaesthetic risks due to the patient's age and
Surgical approach to intra-abdominal metastases from malignant melanomaSinzianaIonescu1
This document discusses the surgical approach to intra-abdominal metastases from malignant melanoma. A retrospective study over 10 years evaluated secondary intra-abdominal tumors from melanoma that required emergency or complication-related surgery. Surgeries for issues like intestinal necrosis, invagination, hemorrhage or perforation improved patient outcomes, with an average 14 month survival and 20% 5-year survival. Metastasectomy remains the only treatment that can provide a complete pathological response and favorable survival rates, even in a palliative context. Figures show examples of cutaneous melanoma, metastatic lymph nodes, FDG PET/CT findings, and intraoperative/CT images of small bowel invagination caused by melanoma.
1) A retrospective study analyzed 40 male patients with breast cancer treated between 2011-2021 at a Bucharest oncology institute to examine relationships between immunohistochemical markers, disease-free survival, and overall survival.
2) At presentation, 40% of patients had stage I invasive grade 2 tumors that were estrogen receptor and progesterone receptor positive, HER2 negative, and had high ki-67 levels (>50%).
3) Family history, high ki-67 levels, negative progesterone expression, diabetes, high BMI, and gynecomastia were associated with shorter disease-free and overall survival compared to other patients. Randomized controlled trials of both sexes are needed to better inform treatment guidelines for male breast cancer.
A liposarcoma of the retroperitoneum causing bowel obstructionSinzianaIonescu1
This document presents a case report of a rare dedifferentiated retroperitoneal liposarcoma that caused bowel obstruction. It describes the patient's presentation, surgical findings, and histopathological examination results. Key findings included lipoblasts and spindle cells on microscopy, as well as genetic abnormalities involving CDK4 and MDM2 amplification. While surgery is the primary treatment, targeted therapies are being explored that aim to disrupt the genetic alterations driving these sarcomas, particularly on chromosome 12. Retroperitoneal sarcomas can cause bowel obstruction when large tumors compress the intestines.
Surgical treatment methods and outcomes for patients with melanoma were studied between 2014-2018 at the Bucharest Oncology Institute in Romania. 123 patients underwent various surgical procedures for their primary melanoma tumors and relapses, including sentinel lymph node biopsies and lymphadenectomies. Better outcomes were seen in patients who underwent complete surgical excision of tumor sites and lymph nodes. When tumor tissues could not be completely excised, responses to adjuvant treatments were lower. Surgical treatment of melanoma at different stages improves outcomes and responses to other treatments, decreasing the risk of relapse.
This study compared surgical outcomes for colorectal cancer patients who were immunocompromised versus those who were not. The authors found that 75% of patients were immunocompromised due to factors like old age, chemotherapy, radiation, or low protein levels. These patients had worse outcomes, with fistula formation occurring in 23-30% of cases compared to 9-12% for immunocompetent patients. The study concluded that surgeons should consider creating a stoma instead of an anastomosis for immunocompromised patients to avoid life-threatening complications from procedures like anastomosis that have higher risks in immunocompromised patients.
This document summarizes the case of a 58-year-old patient diagnosed with three consecutive cancers - uterine cervix, ovary, and rectal - and their relapses requiring various surgical interventions. In 1999, the patient had a hysterectomy for stage IA2 uterine cervical cancer. In 2003, she was diagnosed with ovarian cancer and had bilateral adnexectomy and omentectomy. In 2016, she had surgery to remove a 2kg ovarian cancer relapse. In 2017, she was diagnosed with rectal cancer and received radiotherapy followed by abdomino-perineal resection. She later presented with vaginal bleeding from an ovarian cancer relapse in 2020 and an enteral-vaginal fistula from a non-resectable
Dr. Ionescu Sinziana discusses fever in the postoperative period. She defines fever and classifies it by degree of temperature elevation. The causes of postoperative fever can be infectious or non-infectious. Fever timing is important, with fever under 48 hours usually not infectious and fever over 5 days more likely to indicate infection. Clinical effects of fever include increased oxygen needs, confusion, and low blood pressure.
Tumor response to radiotherapy in rectal cancer.pptxSinzianaIonescu1
The study is currently ongoing, the above being preliminary results
From these aspects, the conclusion would be that radiotherapy can have both positive (p53, MMP13, TIMP3) and negative (MMP1, TIMP1) implications on tumor behavior, normal epithelium and stroma, therefore , in order to be able to correlate these changes with a clear prognosis it would be necessary to study markers within the same group in which to monitor also the clinical evolution of patients. The objective would be a prospective study in : patient survival, disease-free range and perioperative morbidity correlated with immunohistochemistry
MARTHA TRANCU RAINER THE FIRST FEMALE SURGEON IN ROMANIASinzianaIonescu1
Martha Trancu Rainer was the first female surgeon in Romania. She studied medicine in the late 1800s and became a specialist in surgery in 1904. During World War I, she worked at several hospitals in Bucharest, performing over 1,200 surgical interventions and 442 procedures of war surgery. She also provided over 4,000 consultations and managed a ward with 100 beds. Rainer was decorated for her service in 1919 and went on to become a corresponding member of the Romanian Academy of Science in 1935 and a titular member of the Academy of Medicine in 1938. She conducted extensive scientific research over her career, publishing over 100 papers on topics including experimental surgery, general surgery, and gynecology.
ROMANIAN CONTRIBUTIONS TO THE SURGERY OF THE RECTUM-THOMA IONESCUSinzianaIonescu1
This document discusses the history and contributions of Romanian surgeons to rectal surgery. It describes the work of Thoma Ionescu, who was an anatomist, surgeon, and university professor in the late 19th century. Ionescu made several anatomical discoveries and founded Romanian journals of surgery and the Romanian Surgical Society. The document also discusses Dimitrie Gerota's description of retrorectal lymph nodes, which are important in surgical oncology of the rectum. Gerota was also the teacher of sculptor Constantin Brancusi when he was a student. The total mesorectal excision technique introduced in 1982 has improved outcomes for rectal cancer surgery.
ROMANIAN CONTRIBUTIONS TO THE HISTORY OF THE SURGERY OF PORTAL HYPERTENSIONSinzianaIonescu1
Romanian surgeons made several important contributions to the history of portal hypertension surgery in the 20th century. Prof. Dr. Dumitru Burlui performed over 500 operations for portal hypertension between 1960-1980 and described various surgical techniques in his publications, including splenectomy, spleno-renal shunts, porto-caval anastomoses, and omento-esophagodiaphragmatic fixation to create shunts. He modified existing techniques and also developed new ones such as anterior gastric transection with variceal ligation. Burlui's work established him as a leading figure in the surgical treatment of portal hypertension.
SOFIA IONESCU THE FIRST FEMALE NEUROSURGEON IN ROMANIASinzianaIonescu1
Dr. Sofia Ionescu was the first woman neurosurgeon in Romania and Southeast Europe. She had a 47-year career in neurosurgery starting in 1943. She worked with the founder of neurosurgery in Romania, Prof. Dr. Dimitrie Bagdasar, and was part of the "golden surgical team" at the Neurosurgery Hospital in Bucharest from 1954-1975. Dr. Ionescu performed over 20,000 neurosurgical operations and published over 120 scientific articles during her career. She received several honors and awards for her contributions to the field of neurosurgery.
MARIA CUTARIDA CRATUNESCU THE FIRST WOMEN PHYSICIAN IN ROMANIASinzianaIonescu1
Maria Cutarida Cratunescu was the first female doctor in Romania. She founded several important organizations, including the first nursery in a factory to allow working women to have their children supervised. She faced difficulties advancing her career, being denied positions at hospitals, but eventually became a professor of hygiene. She was a pioneer for women in medicine in Romania in the late 19th/early 20th century, opening the path for many other female doctors. She contributed to medical assistance and public health through her work and advocacy.
PROFESSOR ION CHIRICUTA, A TALENTED SURGEON, A SKILLED MANAGER AND A DEDICATE...SinzianaIonescu1
Prof. Ion Chiricuta was a talented Romanian surgeon who made many contributions in the fields of oncology and surgery in the mid-20th century. He graduated from medical school in 1942 and went on to hold several leadership roles, including heading the Oncology Institute in Cluj, Romania. Chiricuta developed over 15 new surgical procedures and published hundreds of papers. He helped modernize the Oncology Institute in Cluj and was a skilled researcher who advanced the understanding of cancer.
KEY POINTS IN THE EVOLUTION AND STUDY OF ANATOMY IN ROMANIASinzianaIonescu1
Dr. Sinziana Ionescu, Prof. Dr. E. Bratucu, and Conf. Dr. D.N. Straja provide a history of the evolution of teaching and studying anatomy in Romania. Some key points include:
- The first written material on anatomy in Romania was produced in the 17th century by Alexander Mavrocordat.
- The first medical textbook, called "Dr. Kretulescu's manual of anatomy and physiology" was published in 1843.
- In 1855, Carol Davila united two small surgery schools and established the first medical library and anatomy museum in Romania.
- Functional anatomy concepts were developed in 1920 by Joseph Rainer.
-
Surgical treatment methods and outcomes for patients with melanoma were studied between 2014-2018 at the Bucharest Oncology Institute in Romania. 123 patients underwent various surgical procedures for their primary melanoma tumors and relapses, including sentinel lymph node biopsies and lymphadenectomies. Better outcomes were seen in patients who underwent complete surgical excision of tumor sites and lymph nodes. When tumor tissues could not be completely excised, responses to adjuvant treatments were lower. Surgical treatment of melanoma at different stages improves outcomes and responses to other treatments, decreasing the risk of relapse.
This study compared surgical outcomes for colorectal cancer patients who were immunocompromised versus those who were not. The authors found that 75% of patients were immunocompromised due to factors like old age, chemotherapy, radiation, or low protein levels. These patients had worse outcomes, with fistula formation occurring in 23-30% of cases compared to 9-12% for immunocompetent patients. The study concluded that surgeons should consider creating a stoma instead of an anastomosis for immunocompromised patients to avoid life-threatening complications from procedures like anastomosis that have higher risks in immunocompromised patients.
This document summarizes the case of a 58-year-old patient diagnosed with three consecutive cancers - uterine cervix, ovary, and rectal - and their relapses requiring various surgical interventions. In 1999, the patient had a hysterectomy for stage IA2 uterine cervical cancer. In 2003, she was diagnosed with ovarian cancer and had bilateral adnexectomy and omentectomy. In 2016, she had surgery to remove a 2kg ovarian cancer relapse. In 2017, she was diagnosed with rectal cancer and received radiotherapy followed by abdomino-perineal resection. She later presented with vaginal bleeding from an ovarian cancer relapse in 2020 and an enteral-vaginal fistula from a non-resectable
Dr. Ionescu Sinziana discusses fever in the postoperative period. She defines fever and classifies it by degree of temperature elevation. The causes of postoperative fever can be infectious or non-infectious. Fever timing is important, with fever under 48 hours usually not infectious and fever over 5 days more likely to indicate infection. Clinical effects of fever include increased oxygen needs, confusion, and low blood pressure.
Tumor response to radiotherapy in rectal cancer.pptxSinzianaIonescu1
The study is currently ongoing, the above being preliminary results
From these aspects, the conclusion would be that radiotherapy can have both positive (p53, MMP13, TIMP3) and negative (MMP1, TIMP1) implications on tumor behavior, normal epithelium and stroma, therefore , in order to be able to correlate these changes with a clear prognosis it would be necessary to study markers within the same group in which to monitor also the clinical evolution of patients. The objective would be a prospective study in : patient survival, disease-free range and perioperative morbidity correlated with immunohistochemistry
MARTHA TRANCU RAINER THE FIRST FEMALE SURGEON IN ROMANIASinzianaIonescu1
Martha Trancu Rainer was the first female surgeon in Romania. She studied medicine in the late 1800s and became a specialist in surgery in 1904. During World War I, she worked at several hospitals in Bucharest, performing over 1,200 surgical interventions and 442 procedures of war surgery. She also provided over 4,000 consultations and managed a ward with 100 beds. Rainer was decorated for her service in 1919 and went on to become a corresponding member of the Romanian Academy of Science in 1935 and a titular member of the Academy of Medicine in 1938. She conducted extensive scientific research over her career, publishing over 100 papers on topics including experimental surgery, general surgery, and gynecology.
ROMANIAN CONTRIBUTIONS TO THE SURGERY OF THE RECTUM-THOMA IONESCUSinzianaIonescu1
This document discusses the history and contributions of Romanian surgeons to rectal surgery. It describes the work of Thoma Ionescu, who was an anatomist, surgeon, and university professor in the late 19th century. Ionescu made several anatomical discoveries and founded Romanian journals of surgery and the Romanian Surgical Society. The document also discusses Dimitrie Gerota's description of retrorectal lymph nodes, which are important in surgical oncology of the rectum. Gerota was also the teacher of sculptor Constantin Brancusi when he was a student. The total mesorectal excision technique introduced in 1982 has improved outcomes for rectal cancer surgery.
ROMANIAN CONTRIBUTIONS TO THE HISTORY OF THE SURGERY OF PORTAL HYPERTENSIONSinzianaIonescu1
Romanian surgeons made several important contributions to the history of portal hypertension surgery in the 20th century. Prof. Dr. Dumitru Burlui performed over 500 operations for portal hypertension between 1960-1980 and described various surgical techniques in his publications, including splenectomy, spleno-renal shunts, porto-caval anastomoses, and omento-esophagodiaphragmatic fixation to create shunts. He modified existing techniques and also developed new ones such as anterior gastric transection with variceal ligation. Burlui's work established him as a leading figure in the surgical treatment of portal hypertension.
SOFIA IONESCU THE FIRST FEMALE NEUROSURGEON IN ROMANIASinzianaIonescu1
Dr. Sofia Ionescu was the first woman neurosurgeon in Romania and Southeast Europe. She had a 47-year career in neurosurgery starting in 1943. She worked with the founder of neurosurgery in Romania, Prof. Dr. Dimitrie Bagdasar, and was part of the "golden surgical team" at the Neurosurgery Hospital in Bucharest from 1954-1975. Dr. Ionescu performed over 20,000 neurosurgical operations and published over 120 scientific articles during her career. She received several honors and awards for her contributions to the field of neurosurgery.
MARIA CUTARIDA CRATUNESCU THE FIRST WOMEN PHYSICIAN IN ROMANIASinzianaIonescu1
Maria Cutarida Cratunescu was the first female doctor in Romania. She founded several important organizations, including the first nursery in a factory to allow working women to have their children supervised. She faced difficulties advancing her career, being denied positions at hospitals, but eventually became a professor of hygiene. She was a pioneer for women in medicine in Romania in the late 19th/early 20th century, opening the path for many other female doctors. She contributed to medical assistance and public health through her work and advocacy.
PROFESSOR ION CHIRICUTA, A TALENTED SURGEON, A SKILLED MANAGER AND A DEDICATE...SinzianaIonescu1
Prof. Ion Chiricuta was a talented Romanian surgeon who made many contributions in the fields of oncology and surgery in the mid-20th century. He graduated from medical school in 1942 and went on to hold several leadership roles, including heading the Oncology Institute in Cluj, Romania. Chiricuta developed over 15 new surgical procedures and published hundreds of papers. He helped modernize the Oncology Institute in Cluj and was a skilled researcher who advanced the understanding of cancer.
KEY POINTS IN THE EVOLUTION AND STUDY OF ANATOMY IN ROMANIASinzianaIonescu1
Dr. Sinziana Ionescu, Prof. Dr. E. Bratucu, and Conf. Dr. D.N. Straja provide a history of the evolution of teaching and studying anatomy in Romania. Some key points include:
- The first written material on anatomy in Romania was produced in the 17th century by Alexander Mavrocordat.
- The first medical textbook, called "Dr. Kretulescu's manual of anatomy and physiology" was published in 1843.
- In 1855, Carol Davila united two small surgery schools and established the first medical library and anatomy museum in Romania.
- Functional anatomy concepts were developed in 1920 by Joseph Rainer.
-
KEY POINTS IN THE EVOLUTION AND STUDY OF ANATOMY IN ROMANIA
protezarea anastomozelor bilio si pancreatico-jejunale dupa duodenopancreatectomia cefalica
1. Protezarea anastomozelor bilio si pancreatico-jejunale
dupa duodenopancreatectomie cefalica
Autori: Mihaila Daniela* , Poteca Teodor*, Ionescu Sanziana* , Bratucu Eugen* ,Straja Nicolae Dan*,
Popa Cosmin* , Grigore Corina* *Departament de chirurgie al UMF Carol Davila Bucuresti;
Introducere: Pentru tumorile zonei ampulare , de cap de pancreas , ale coledocului distal sau duodenale ,
se practica o interventie chirurgicala radicala (DPC) intr-un timp sau in 2 timpi , de ridicare a capului
pancreasului, duodenului si unghiului duodeno-jejunal, a coledocului terminal, antrului gastric si nodulilor
limfatici loco-regionali . In cazul unor comorbiditati,operatia poate fi asociata gastrectomiei sau
hepatectomiei , colectomiei drepte
Scurt istoric: Prima operatie de acest gen a fost efectuata de Kausch in 1909 si in 1940 Whipple a
perfectionat tehnica si a aplicat-o intr-un singur timp operator. In 1994 a fost efectuata si prima operatie
DPC laparoscopica.
Cazuistica :
158 drenaj axial si protezarea
anastomozei bilioenterice
42 Leziuni benigne
Anastomoze bilioenterice- 29
Repermeabilizarea
anastomozelor
stenozate-13
116 Leziuni maligne
Procedeu Whipple- 72
Anastomoza bilio jejunala- 44
Protezarea anastomozei bilio- si pancreatico-jejunala este
temporara asigurand siguranta suturilor . Avantajele
protezarii sunt : evitarea fistulelor, evitarea stenozelor,
facilitarea explorarii colangiografice .
Caz 1
Radiografie
preoperatorie
Imagine CT preoperator Imagine CT postoperatorie
Caz 2
Imagine CT preoperator Imagine CT postoperator Control Radiologic
Drenaje dupa duodeno pancreatectomie