Background: Primary hepatic lymphoma represents a very rare location of non-Hodgkin lymphomas, whose treatment consists of liver tumor resection followed by chemotherapy. In some cases, however, upfront hepatectomy is not feasible due to insufficient volume of the liver remnant. Case report: An ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy) procedure was performed in a patient with a large primary hepatic lymphoma, whose estimated liver remnant represented only 13% of total liver volume, it was performed. During the first stage, we performed right portal branch ligation and in situ splitting, without right bile duct ligation. After the first stage, the patient did not develop biliary fistula, ascites or sepsis. The volume of segments 2 and 3 increased by 98% after eleven days, making possible subsequent resection of the tumor by a right trisectionectomy. The patient did not develop any complication, being discharged 9 days after the second stage of ALPPS. Postoperatively, the patient underwent chemotherapy, being disease-free at 13 months following operation. Conclusion: This is the first patient presented in the literature who underwent ALPPS for resection of a primary hepatic lymphoma. This type of tumor could be managed by ALPPS, with low morbidity and mortality rates. Abbreviations: ALPPS -Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy, PHL -primary hepatic lymphoma, PVE -portal vein embolization, PVL -portal vein ligation, FLR -future liver remnant

Cervical carcinogenesis evolves in several stages over a relatively long period of time (7-20 years) and it can be diagnosed by multiple non-invasive screening methods (PAP smear, HPV genotyping, colposcopy) and consecutively treated. It is known that 50% of CIN II cases regress spontaneous and 30% progress to CIN III or cervical cancer. Management of HSIL (CIN II) has a major importance for clinicians because many patients are young and it is important to preserve the obstetrical outcome. Therefore, in this study, 3 types of management for CIN II were proposed in nulliparous patients: 1. conservative management; 2. LOOP / LLETZ; 3. conization. The main goal of the study was to evaluate if, in very carefully selected cases, conservative and minimally invasive management may be a viable therapeutical option, in order to preserve obstetrical outcome of the patients, knowing that conization determine a moderate to severe shortening of the cervix and increases the risk of second trimester abortion or preterm delivery, especially by premature rupture of membranes; conization can determine infertility by cervical stenosis. In our limited study a less aggressive management of cervical lesions provided better obstetrical outcomes both in terms of getting pregnant and in duration of pregnancy. Although current management of CIN II is considered to be similar to CIN III, in carefully selected nulliparous patients (high social status, high education, compliant patients), with satisfactory colposcopy (squamous-cylinder junction visible in colposcopy, lesions at a distance from the cervical os and endocervical cytology without pathological changes) and the CL less than 30-32 mm, we can opt for conservative management (by follow-up) or loop diathermy (single or multiple) or LLETZ, with a rigorous follow-up, thus preserving the obstetrical outcome.

Many recent studies reported good to excellent long-term results of arthrodesis of the MTPJ for stage III and IV hallux rigidus. The results of this study suggest that similar results can be achieved by an experienced foot surgeon with total joint replacement in strictly selected patients.

Introducere: Rezecţia hepatică reprezintă singurul tratament potenţial curativ al tumorilor hepatice maligne primitive sau secundare. Cea mai ameninţătoare complicaţie a hepatectomiilor extinse este insuficienţa hepatică postoperatorie datorată volumului hepatic rezidual insuficient. Tehnica ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) creşte semnificativ rata rezecabilităţii tumorilor hepatice nerezecabile prin procedeele standard, ca urmare a inducerii unei hipertrofii mai importante într-un interval de timp mai scurt, scăzând astfel riscul insuficienţei hepatice postoperatorii. Scop: Prezentarea tehnicii clasice a procedeului ALPPS (trisecţionectomia dreaptă) şi a variantelor sale care au fost elaborate pentru reducerea ratelor înalte ale morbidităţii şi mortalităţii postoperatorii (care au fost raportate în seriile iniţiale). Tehnica: ALPPS implică doi timpi operatori. Primul constă în ligatura ramului drept portal şi partiţia "in situ" a ficatului la nivelul planului intersecţional stâng ("in situ splitting"). Spre deosebire de hepatectomiile clasice, porţiunea de ficat tumoral va fi lăsată pe loc, fiind vascularizată numai de artera hepatică dreaptă. Canalul hepatic drept şi venele hepatice trebuie prezervate, rămânând intacte după primul timp operator. Al doilea timp operator implică rezecţia porţiunii de ficat tumoral, prin secţionarea arterei hepatice drepte, a canalului hepatic drept şi a venelor hepatice eferente ale acestuia. De obicei, al doilea timp operator se desfăşoară la 7-15 zile de la prima operaţie. Concluzii: ALPPS este un procedeu chirurgical adresat tumorilor

Budd-Chiari syndrome (BCS) represents a rare medical entity which has an estimated incidence of 0.1 to 10 people per million every year. It is defined by the obstruction of the flow in the inferior vena cava or the hepatic veins. Various classifications have been proposed. So, it can be acute or chronic and primary or secondary. The chronic form is more frequent and is characterized by signs of portal hypertension. Liver transplantation is the ultimate therapeutic management of Budd-Chiari syndrome. Primary BCS is mostly a result of hematological disorders and hypercoagulable conditions. Secondary BCS appears due to invasion or extrinsic pressure of the veins from various reasons, including hepatocellular carcinoma (HCC), liver abscesses and cysts. We presented a rare case of a young lady with Budd Chiari syndrome and IVC thrombosis who were transplanted with hepatic left lobe from her sister.