The bronchial stump fistula shown by patients undergoing adjusted pulmonary resections is an extremely severe condition affecting the prognosis of this patients. Within our study, we have used an innovative technique of closing the bronchial stump for 38 patients undergoing adjusted pulmonary resections. The suture of the bronchial stump was made through an innovative method, by practicing the suture with isolated 2.0 Prolene wires armed with patches of Polypropylene. The incidence of the bronchial stump fistula for the observed lot was of 5.26% (2 cases), smaller than the one reported in the specialty literature. In this respect, we consider that the use of Polypropylene in the techniques of closing the bronchial blunt can be beneficial.

Intravenous leiomyoma is a benign smooth muscle cell tumor of uterine origin that may grow into the pelvic veins and the inferior vena cava. It usually affects premenopausal women and the majority (90%) are parous. Because cardiac involvement is present in up to 10% of cases, it may be misdiagnosed as a primary cardiac tumor or a venous thrombus-in-transit. We describe a case of intravascular leiomyomatosis with cardiac extension and the morphological particularities of the removed tumor.

PURPOSE:To assess whether deoxycholic acid (DOC) and lithocholic acid (LCA) administered in a period of six months in a concentration of 0.25% may have a carcinogenic role in mice colon. METHODS:The study used C57BL6 female mice divided into four groups. The control group received a balanced diet and the others received diets supplemented with 0.25% DOC, 0.25% LCA and 0.125% DOC+0.125% LCA, respectively. After euthanasia, the lesions found in the resected gastrointestinal tracts were stained with hematoxylin-eosin and examined microscopically. RESULTS:No gastrointestinal tract changes were observed in the control group, while hyperplastic Peyer's patches in the small intestine, flat adenomas with mild dysplasia and chronic colitis at the level of the colon were found in all three test groups. The colonic lesions prevailed in the proximal colon. The highest number of flat adenoma lesions (8), hyperplasia of Peyer's patches (25) and chronic colitis (2) were found in mice fed with diet and LCA. CONCLUSION:Precancerous or cancerous pathological lesions could not be identified. Instead, adenomatous colonic injuries occurred in a shorter period of time (six months), compared to the reported data.

BACKGROUND Primary choriocarcinoma of the stomach (PCCS) is a rare tumor, with fewer than 60 cases published in the English-language literature up to December 2018. In this paper, we present the complex immunoprofile of one PCCS and a hypothesis regarding its histogenesis. CASE SUMMARY A 66-year-old previously healthy male underwent an emergency palliative gastrectomy for a gastric obstructive tumor. The histologic examination and immunoprofile of tumor cells showed a mixed tumor that consisted of choriocarcinoma (90%) and moderate differentiated adenocarcinoma (10%), with hepatic metastases (Stage pT2NxM1L1V1R0) and microsatelite stable status. The patient died one month after surgery. The tumor cells showed focal positivity for CDX2 (adenocarcinoma component), HCG (choriocarcinoma) and CD138 (plasmacytoid carcinoma component) and were negative for HER-2, α-fetoprotein, VEGF, maspin and markers of epithelial-mesenchymal transition. The gastric mucosa cells displayed positivity for CDX2, Hepar A and CD138. The complex immunoprofile and literature data synthesis prove that the gastric mucosa cells can present a multilineage differentiation. CONCLUSION PCCS should be considered as an aggressive variant of microsatellite stable gastric adenocarcinoma of an epithelial type, and not a germ cell tumor.

The thoracic wall resections for tumoral affections are laborious surgical interventions characterized by a high mortality and mobility. In order to create this paper we created a observational retrospective study in which we included 21 patients that have underwent parietal thoracic resections for tumoral affections. In all the patients we practiced the reconstruction of the thoracic wall using polypropylene mesh. The main postoperative complications were: seromas (14.28% of the cases), hematomas (9.52% of the cases), wound infection (4.76% of the cases), pneumonia (23.8% of the cases), respiratory failure (23.8% of the cases), paradoxical movement of the thoracic wall (52.38% of the cases). No deceases were recorded. In conclusion, the use of polypropylene mesh in the reconstructive techniques of the thoracic wall after thoracic wall resection represents a viable method, with good respiratory functional results.

A 75-years old man was hospitalized with symptoms which suggested gastric cancer. Thirty-eight years ago, he had undergone a Billroth-II gastric reconstruction for a peptic ulcer. At the present admission, he had presented with an eight-month history of recurrent haematemesis, epigastric pain, vomiting, and fatigue. The emergent endoscopy showed a type 0-IIc (superficial depressed) early gastric stump cancer in the anastomotic area and total removal of the gastric remnant and the jejunal segment was performed. The histological examination of the surgical specimen showed a gastric adenocarcinoma that invaded the mucosa and the submucosa, without lymph node metastases (pT1bN0 stage). Besides the tumour, enlarged vessels were observed in the submucosa and the muscularis propria, some of which were thrombotic. The surrounding normal gastric wall also presented submucosal oversized vascular spaces, some of which were protruding through the muscularis mucosae in the mucosal layer. Based on these characteristics and the recurrent haematemesis, a final diagnosis of early gastric stump carcinoma which was associated with Dieulafoy's lesion was made. This association has not yet been reported in the literature and it allowed us to diagnose the gastric stump cancer in a very early stage.

Continuous local analgesia reduces the need for systemic opioids and can be successfully used in the postoperative pain management after medium and large incisional hernias treated by open surgery.

MULTIPLE COLONIC AND GASTRIC METASTASIS OF ENDOMETRIAL ADENOCARCINOMA -CASE REPORT (Abstract): INTRODUCTION:In the gynecological malignancies endometrial adenocarcinoma is the second most common, giving early hematogenous and lymphatic metastasis to the lungs, brain and bones. CASE REPORT: We present the case of a 71 year old patient who underwent surgery two years ago for endometrial adenocarcinoma and followed postoperatively multimodal oncological treatment. The patient was admitted in January 2013 in the First Surgery Clinic of the Emergency Clinical County Hospital Târgu Mureş, Romania, for chronic anemia, consumptive disease signs and subocclusive syndrome. The preoperative exams (upper and lower gastrointestinal endoscopy, thoracoabdominal computed tomography and ultrasound) found a tumor invading right, transverse and sigmoid colon as well as gastric antrum and spleen. A subtotal colectomy with ileo-rectal anastomosis was then performed associated with distal gastrectomy and splenectomy. The histopathological exams revealed gastric and colonic metastasis from the endometrial serous cancer operated two years ago. The postoperative evolution was uneventful. CONCLUSIONS: Endometrial cancer can metastasize to the colon and stomach even without the presence of endometriosis. Multivisceral resections and preoperative exams of the digestive tract are justified in terms of subjective complaints of an occlusive simptomatology.