No abstract

This paper presents a retrospective study conducted from December 2014 – December 2015 on patients admitted in emergency in our clinic for traumatic haemoperitoneum. We have analyzed the causes of production, the most common organs affected, the paraclinical investigations and surgical management of these cases. Abdominal ultrasound in emergency and, in selected cases, abdominal CT imaging tests are reliable and largely replaced peritoneal paracentesis. The most common injuries had affected liver (38.7%) and spleen (28.73%). Surgical exploration should be careful, often coexisting pathologies requiring multiple surgical solving.

Objective. The purpose of this study is to analyse histopathological and clinical characteristics of EOCRC. Colorectal cancer was formerly considered as a disease of senescent age; in the last years, it is a noticeable trend of growing incidence among young people (aged between 20 and 45 years). Few of newly diagnosed cases are inherited and most of them are sporadic. Material and method. The authors studied retrospectively a series of 33 cases of early onset colorectal cancer, 17 men and 16 women, with ages below 45 years, admitted between January 2009 and January 2015 in II and IV Surgical Wards of Emergency University Hospital Bucharest. Results. Colorectal cancer in young adults tends to be an aggressive disease with dominant distal location (68.5% of all cases), mostly adenocarcinomas (96.6%) with moderate to poorly differentiated types (51.4% G2 and G3), diagnosed in advanced stages (57.6% stages III and IV), with high frequency of complications (33% presented with peritoneal carcinomatosis and 9% died during hospitalization). Conclusions. EOCRC is a heterogenous group regarding etiopathogeny, localization and histopathological features of the tumor, with aggresive histopathological types, diagnosed in advanced stages. It may be necessary to elaborate new screening protocols for colorectal cancer in young adults and to fi nd clinical and biological markers that are indicating high-risk patients.

In the last century, foot and ankle related traumatic pathology became more and more frequent. A 75 years old male with associated peripheral arterial disease presented himself in ER with an infected, contusive wound at the left foot sole and calcaneum. After local treatment (debridement, hyaluronic acid derivatives and antibiotics), the wound evolution was good. During the extensive clinical and paraclinical investigations preceding cardiovascular surgery for the pre-existing peripheral arteriopathy), a pulmonary tumor in resectable stage was discovered. So, the patient underwent pulmonary bilobectomy and afterward a cutaneous free groin flap reconstruction of the foot. The local wound evolution was good, and the patient could stand and walk after a month. He is currently under oncological supervision. Although skin grafts are recommended in lesions affecting weightbearing zones, in this case, given the arteriopathy, it was preferred a free skin flap.  In this case with complicated, intricated pathology, the traumatic episode played also a beneficial role by helping the early diagnosis of an operable lung cancer.

The Tegument, the body's largest organ, also fulfills the protective function by preventing the pathogens from penetrating into the body. The barrier, once overcome, opens the gate to serious illnesses with varying degrees of severity. We present the case of an obese patient aged 63, BMI 40, admitted to emergency service for necrotizing fasciitis in the abdominal wall. Anamnesis and general clinical examination highlight the presence of a large area of necrosis in the lower abdominal wall, affecting the iliac fossa, the hypogastric region and the left iliac fossa, lack of substance at this level, limited supraaponvrotic, with multiple sepsis, isolated tissue areas granulation, anfractum edges, suggestive aspect for necrotizing fasciitis. Serious surgical interventions have been carried out, with the aim of broad, digital and instrumental debridement, the important lavage of the wound with hydrogen peroxide and betadine and antibiotic treatment according to the antibiogram. Subsequently, dressings were applied with negative pressure, with development of granulation tissue in the wound and in the end was chosen for secondary suture with favorable outcome and discharge from the hospital 33 days after admission. Precarius socio-economic status, poor hygiene in an obese, careless patient, without identifying other causes like diabetes or surgical history, have led to the development of a multilingual, life-threatening condition. Serious surgical attitude and postoperative care have led to a medical success, although burdened by significant costs, which could have been avoided with minimal effort especially from the patient.