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Spinu A.D.,University of Bucharest | Radulescu A.,University of Bucharest | Bratu O.,University of Bucharest | Bratu O.,Carol Davila University of Medicine and Pharmacy | And 4 more authors.
Chirurgia (Romania) | Year: 2014

Aim: Buschke-Löwenstein disease or giant condyloma acuminatum represents a rare, sexually transmitted disorder, with a slow evolution and the tendency to infiltrate in the adjacent tissues; untreated, the outcome is unfavorable. The hallmark is the development of one or various prominent-Sized vegetant tumors that usually ulcerate. Material and Methods: The present article summarizes both the etiopathogenic features and the current approach of treatment management. Results: Minimally invasive surgery along with local and systemic therapy is adequate in patients with small-Sized lesions or high intraoperative risk. The main treatment remains extensive surgery with wide resection and often reinterventions to complete the excision. Conclusions: Giant condyloma acuminatum represents a continuous surgical challenge, because of the need of exhaustive surgical procedures that should consider both the oncological principles and a better anatomical resolution. No standard treatment protocol can be established, because of the infrequency of the disease. Radical surgery including full thickness excision of the affected areas represents the "goldstandard" therapy. Other known forms of treatment present unsatisfactory results without statistical significance, the studies having been conducted on small groups of patients. An adequate, long-Term follow-Up of Buschke-Löwenstein patients is highly recommended, because of the increased recurrence rate. © Celsius.


Stoica R.A.,Sf Ioan Clinical Emergency Hospital | Enache T.,Panait Sarbu Clinical Obstetrics and Gynaecology Hospital | Iordache N.,Sf Ioan Clinical Emergency Hospital
Journal of medicine and life | Year: 2014

Ureteral lesions during open hysterectomy, vaginal hysterectomy or laparoscopic hysterectomy have a rate of 0.2% up to 6%. Multiple complications may occur if the lesion is not recognised intra operatively: hydronephrosis, anuria (bilateral lesion), ureterovaginal fistula, ileus, peritonitis. The rate of recognition of an intra operative ureter lesion is 30% and it could rise up to 90% when cystoscopy with ureteroscopy is used at the end of the intervention. The article presents the case of a 46-year-old patient with uterine fibromatosis, whose pelvic ureter was sectioned during surgery. The lesion was recognised during surgery because, at the end of each intervention, the diuresis was stimulated by injecting Furosemide in order to detect the lesions of the ureters and urinary bladder.


Balaceanu L.A.,Sf Ioan Clinical Emergency Hospital | Diaconu C.C.,Carol Davila University of Medicine and Pharmacy | Aron G.,Sf Ioan Clinical Emergency Hospital
Medical Ultrasonography | Year: 2014

We report the case of a 84-year-old admitted with symptoms of congestive heart failure. Ultrasonography revealed a hyperechoic nodule in the left lobe of the liver, with a peripheral hypoechoic rim, multiple irregular hypoechoic nodules in both hepatic lobes, portal vein, inferior vena cava, and right atrium thrombosis. On ultrasonographic and alpha-fetoprotein criteria the case was interpreted as hepatocellular carcinoma with Budd-Chiari syndrome. The particularity of the case is the initial presentation of the hepatocellular carcinoma as Budd-Chiari syndrome. The inferior vena cava and right atrium thrombosis, as a cause of secondary Budd-Chiari syndrome in a patient with hepatocellular carcinoma, has been rarely reported.


A correlation between urothelial bladder tumor incidence and exposure to various occupational toxic factors was established for more than a century. The aim of our study was to establish the relationship between these two features. We analyzed one hundred consecutive bladder tumor patients treated in "Sf. Ioan" Clinical Emergency Hospital, Department of Urology. These cases were studied concerning their occupation and pathological findings. We identified 58 patients having potential urothelial bladder tumors inducing occupations: dye industry, motor vehicle drivers and miners. Among these patients, the incidence of muscle invasive tumors was of 33%, of the high-grade tumors was of 69%, of the multiple tumors was of 60% and of the associated CIS lesions was of 38%. All these rates were significantly lower in the non-occupational hazard group: 12%, 26%, 29% and 14% respectively. Exposure to occupational toxic factors seems to influence the evolution of urothelial bladder tumor into more aggressive patterns. Further studies in this regard are necessary.


Geavlete B.,Sf Ioan Clinical Emergency Hospital
Journal of medicine and life | Year: 2012

This retrospective analysis evaluated the efficiency, safety, and medium term postoperative results of bipolar plasma vaporization (BPV) in prostate cancer (PCa) cases associating complete urinary retention. A series of 40 patients diagnosed with locally advanced or metastatic PCa and complete urinary retention requiring a Foley catheter indwelling underwent BPV aiming to restore spontaneous voiding. A total of 35 patients completed the one year evaluation protocol consisting of International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Q(max)) and post-voiding residual urinary volume (PVR), measured at 1, 3, 6 and 12 months after surgery. BPV was successfully performed in all cases with satisfactory efficiency, as confirmed by the mean operation time (42.8 minutes) and hemoglobin drop (0.7 g/dl). A fast and safe postoperative recovery period was described in this series (hematuria rate--7.5%; mean catheterization period--36 hours; mean hospital stay--2.5 days; early-irritative symptoms' rate--15%). At 1, 3, 6 and 12 months, satisfactory values were determined in terms of IPSS, Qmax, QoL and PVR. These parameters emphasized a stable evolution throughout the entire follow-up, as 88.6% of the patients maintained spontaneous voiding. The present trial confirmed the plasma-button vaporization as a promising therapeutic approach in PCa cases associating complete urinary retention. The technique displayed good efficacy, low perioperative morbidity, short convalescence, and satisfactory urodynamics and symptom score parameters during the one-year follow-up period.


Giuglea C.,Sf Ioan Clinical Emergency Hospital
Journal of medicine and life | Year: 2013

Plastic surgery is by excellence a surgery in permanent search for new reconstructive options. In the last 50 years researches in the field of allotransplantation led to obtaining promising results for solving difficult cases when autologous tissues are not available for reconstruction, despite all the bioethical issues of this subject. This field of composite tissue transplantation evolved constantly, the top of it being total face transplantation, successfully accomplished while being based on the knowledge accumulated. There are many clinical applications of CTA, hand transplantation or only flexor tendon apparatus, lower limb, partial or complete face transplantations represent the most important part for us, plastic surgeons for obtaining the best reconstruction possible.


Dragutescu M.,Sf Ioan Clinical Emergency Hospital
Journal of medicine and life | Year: 2012

High-grade obesity raises some specific problems regarding the endourological approach. The aim of our study was to determine if this pathology might influence the outcome of retrograde ureteroscopy. We evaluated the outcome of 88 ureteroscopies performed in highly obese patients during the last 5 years. The data were compared with the results of 88 consecutive ureteroscopies performed in normal weight patients. The success rate in the study group was of 91% by comparison with 95% in the normal weight group. The use of flexible ureteroscopes was imposed in 17% of the obese group vs. 11% in the control group. The complications rate (all mild) was of 6.8% in the obese group vs. 4.5% in the normal weight patients. The differences between the two groups, although present, were not statistically significant. However, in two cases with obesity, the weight of the patients was too high for the operating table, imposing supplementary sustaining measures. Ureteroscopic treatment of stones in obese patients is an acceptable treatment modality, with success rates similar to non-obese patients. Sometimes it may require some logistic measures in the operating theatre.


Geavlete B.,Sf Ioan Clinical Emergency Hospital
Journal of medicine and life | Year: 2013

The standard non-muscle invasive bladder cancer (NMIBC) endoscopic diagnosis suffers from the frequently unsatisfactory white light evaluation accuracy leading to residual lesions being left behind. Monopolar transurethral resection of bladder tumors (TURBT) is marked by a substantial morbidity rate requiring further amelioration. Small size tumors (under 1 cm) are feasible for "en bloc" resection. Bipolar TURBT was defined as being able to challenge the gold-standard status of monopolar resection due to the reduced complication rates. Plasma-button vaporization was introduced as a promising large bladder tumors' ablation modality. Narrow band imaging (NBI) cystoscopy became an increasingly popular method of enhancing tumor detection. The "en bloc" resection of small size or thin pedicle tumors provides the conditions for avoiding tumoral tissue scattering. Bipolar resection is characterized by decreased perioperative bleeding risks and faster patient recovery. Plasma-button vaporization gained confirmation as an innovative approach, able to dispose large tumor bulks under complete control while minimizing the associated morbidity. NBI cystoscopy is a useful tool in identifying CIS lesions, small papillary tumors or extended margins of large tumor formations. As a cost-free technique, it may be extensively used both during the NMIBC initial diagnostic as well as during follow-up evaluation protocol. Having in mind the various modalities of ameliorating the bladder cancer diagnostic and treatment, NMIBC management should be tailored in accordance with the particularities of each case.


Geavlete B.,Sf Ioan Clinical Emergency Hospital
Journal of medicine and life | Year: 2012

Secondary bladder neck sclerosis (BNS) represents one of the most common long-term complications after prostate surgical treatment. In this retrospective study, we aimed to evaluate our initial experience concerning the bipolar plasma vaporization (BPV) performed in patients with secondary BNS and to assess the efficiency, safety and short-term postoperative results of this approach. Between May 2009 and May 2010, a total of 30 male patients with BNS underwent BPV and were followed for a period of 6 months. BNS was secondary to monopolar transurethral resection of prostate (TURP) in 19 cases, to open surgery for BPH (open prostatectomy) in 8 cases and to radical prostatectomy for prostate cancer in 3 cases. The follow-up protocol included the International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Qmax) and post-voiding residual urinary volume (RV) evaluated at 1, 3 and 6 months after surgery. BPV was successfully performed in all cases. All patients were able to void spontaneously and were continent after catheter removal. The mean operating time was 9 minutes, the mean catheterization period was 18 hours and the mean hospital stay was 24 hours. Preoperatively and at 1, 3 and 6 months after surgery, the mean values for Qmax and RV were 7.2 ml/s and 110 ml, 23.9 ml/s and 20 ml, 23.8 ml/s and 28 ml, and 23.4 ml/s and 26 ml, respectively. Before surgery and at 1, 3 and 6 months, the IPSS and QoL scores were 22.6 and 4.1, 3.4 and 1.2, 3.6 and 1.4, and 3.7 and 1.4, respectively. BPV represents a valuable endoscopic treatment alternative for secondary BNS with good efficacy, reduced morbidity, fast postoperative recovery and satisfactory follow-up parameters.


Geavlete P.,Sf Ioan Clinical Emergency Hospital
Journal of medicine and life | Year: 2012

Nephroureterectomy with perimeatal cystectomy is still the gold standard in the treatment of urothelial upper urinary-tract carcinoma (UUTC). Ureteral endoscopic surgery was proposed as a complementary first step in nephroureterectomy, in order to obviate the low abdominal incision. Our goal was to establish the value of a novel method of endoscopic distal ureteral management in on step nephroureterectomy for UUTC: pluck technique by using bipolar plasma vaporization. During the last two years, we performed nephroureterectomy with pluck transurethral detachment of the intramural ureter by using bipolar plasma vaporization in 42 cases with UUTC (pTa in 16 cases, pT1 in 10 cases, pT2 in 9 cases, pT3 in 7 cases). The tumor was pyelocaliceal in 34 cases, ureteral in 7 cases, and both ureteral and pyelocaliceal in 1 case. The follow-up was performed by cystoscopy with urinary cytology, ultrasonography, intravenous urography and CT. The mean follow-up was of 14 months (range 8 to 26 months). All procedures were completed successfully. The complications rate was of 4.8%: 2 cases of hematuria, one imposing an endoscopic approach and another one treated conservatively. During follow-up, 6 patients had bladder recurrences, 1 had renal fossa tumors and 1 had secondary lymph-node invasion. The disease-specific mortality rate was of 4.8%. The endoscopic approach of the terminal ureter with bipolar plasma vaporization as part of one-step nephroureterectomy is a safe, facile and effective method offering good oncological results.

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