Papers by Nicolae-Iustin Berevoescu
International Journal of Medical and Biomedical Studies, 2019
Background: Subcutaneous lipomas are one of the most common benign soft tissue tumors seen in cli... more Background: Subcutaneous lipomas are one of the most common benign soft tissue tumors seen in clinical practice. They may occur at any age, affecting men more often than women. In therapeutically neglected cases, these lesions may have unusual clinical features. Our case highlights one such form that may be found amongst subcutaneous lipomas. Case report: A 37-year-old man came to the Surgical Clinic for treatment of an ulcerated, pedunculated tumor, measuring 14.5/8/7 cm, located in the sacral region. Clinically, liposarcoma was considered as the diagnosis. Although preoperative fine needle aspiration cytology (FNAC) of the tumor showed mature adipose tissue fragments on all cytological smears, surgical excision was performed, with intraoperative extemporaneous histological examination of the tumor. Histopathological results showed a lipoma with unusual associated features: ulceration of the overlying skin and fatty tissue necrosis, with formation of abscess areas. Conclusion: Therapeutically neglected subcutaneous lipomas may have unusual clinical features, leading to difficulties for both diagnosis and therapeutic approach. This case complements the existing data, from the point of view of the clinical presentation, as well as the histopathological characteristics that a subcutaneous lipoma may have.
Chirurgia, 2008
The paper's purpose is to analyze the diagnosis and treatment methods of primary pancreatic cysti... more The paper's purpose is to analyze the diagnosis and treatment methods of primary pancreatic cystic neoplasms. Between 1996-2007, 10 patients (3 male and 7 female), ages between 30 and 71, were committed and surgically treated in the Surgical Unit of Colentina Clinical Hospital of primary pancreatic cystic neoplasms: 2 serous cystadenomas (SCAs) and 8 mucinous cystic neoplasms (MCNs) (in one case there were liver and peripancreatic lymph nodes metastases). Following clinical and paraclinical evaluation, patients with serous cystadenomas received distal pancreatectomy and splenectomy, and MCNs patients received cephalic duodenopancreatectomy (3 cases), distal pancreatectomy and splenectomy (3 cases), segmental corporeo-caudal pancreatectomy (1 case) and choledocoduodenostomy and gastrojejunostomy (1 case). In patients with serous cystadenomas the post-operatory mortality and morbidity were null, and the long-term prognostic excellent, both patients, after 26 months and 5 years respectively, being in good health, with no evidence of illness. In patients with mucinous cystic neoplasms the post-operatory mortality was null, the post-operatory morbidity was 37.5% and the global survival rate was 50% in 5 years and 66.66% in 3 years. Primary cystic neoplasms are lesions that can be surgically treated, with good results. Surgical resection is the ideal therapeutic solution, while palliative surgeries alternatives are done in exceptional situations
Chirurgia, 2005
When the conservative treatment of the chronic anal fissure (nitrates, topical calcium channel bl... more When the conservative treatment of the chronic anal fissure (nitrates, topical calcium channel blockers, topical nifedipine, lignocaine and cortisone compounds) proves to be inefficient, the surgery may be opted for. From among all surgical procedures (anal dilation, fissure excision, anal advancement flap) we have opted for closed internal and lateral sphincterotomy. During the period of 1990-2002, there have been performed by just one surgeon 47 sphincterotomies (15 men-32 women), average age 49 (23-76).
RESULTS:
There has not been any case of anal incontinence for gases or faeces, precocious or late; 1 para anal hematoma (2.12%) solved through puncture; 2 anal abscesses (4.25%), solved through incision and tegmen drainage. Control in 6 month's time and 1 year time: normal quality of life, without any subjective complaints; painless rectal touch, healing of the fissure, extensible anal sphincter, normal continence. The sphincterotomy was followed by the disappearance of the cleft syndrome with all patients. Although the literature contains citations of transitory and minimum incontinence in 2-4% of the cases, we have not noticed in any; no recurrences have been registered; morbidity is acceptable. The future will decide if, between sphincterotomy and the injection with the botulinum toxin, the latter one is to be preferred.
Chirurgia, 2010
The authors present the evolution of surgery at Colțea Hospital
during the last three centuries. ... more The authors present the evolution of surgery at Colțea Hospital
during the last three centuries. After a brief history of the
Colțea hospital and its masters surgeons, the attention is drawn
on the masters efforts to optimize the care, equipment and
surgery techniques, things that became of national and wordwide
importance.
Journal of Clinical and Investigative Surgery, 2018
Mucinous cystic pancreatic neoplasms (MCNs) are rare tumors, which generally occur in the fifth a... more Mucinous cystic pancreatic neoplasms (MCNs) are rare tumors, which generally occur in the fifth and sixth decades of women. Although some tumours are frankly malignant, all are in fact considered to be potentially malignant. We present the case of a 30-year-old patient, with a 16/11 cm tumor located in the pancreas body, which was diagnosed 8 months after birth. The preoperative assessment of the pancreatic lesion suggested the diagnosis of mucinous cystic neoplasm, without being able to determine its benign or malignant nature. Central pancreatectomy was performed with a good postoperative evolution. Histopathologic result was represented by mucinous cystadenoma. Two years after surgical intervention, the patient presented no signs of recurrence or pancreatic (exocrine or endocrine) secretion deficiency. Conclusions. Preoperative imaging evaluation could be suggestive for mucinous cystic tumour, but this cannot specify however the nature of the tumor. The postpartum occurrence could establish a possible relationship between hormonal levels encountered during pregnancy and the development of this tumor, taking into considerations the ovarian-type stroma and the presence of hormone (estrogen and progesterone) receptors in this neoplasm. Central pancreatectomy without anastomosis preserves the functions of pancreas, and also decreases morbidity.
International Surgery Journal, 2019
Pancreatic abscesses are rare and usually occur as a pancreatitis complication. The absence of ac... more Pancreatic abscesses are rare and usually occur as a pancreatitis complication. The absence of acute pancreatitis and the clinical presentation that mimics a neoplasm are very unexpected. A 49-year-old man, known with arterial hypertension and chronic infection with virus hepatitis B came to the hospital for weight loss, marked asthenia, nausea/vomiting and jaundice, associated with mild pain in the upper abdomen. At admission, without fever and no medical history of acute pancreatitis. Laboratory values showed an important inflammatory syndrome, near normal pancreatic enzymes and increased tumour markers. Abdominal computed tomography (CT) revealed a heterogeneous fluid collection with gas bubbles inside, localized into the lesser sac that tended to extend peri splenic, towards the anterior and posterior pararenal spaces and the pelvis. Surgery has led to evacuation of peripancreatic and left retrocolic abscesses, associated with debridement and peritoneal drainage. The culture yielded Streptococcus Anginosus. At 7 days post-intervention hemoperitoneum occurred and was required a second intervention for haemostasis. Subsequent favourable clinical and biological evolution, with patient discharge from the clinic 16 days after admission. Repeated CT scans of the abdomen showed resolution of lesions and at colonoscopy it was observed uncomplicated colonic diverticulosis. In this case is highlighted a rare presentation of a peripancreatic pyogenic abscess caused by Streptococcus anginosus, associated with colonic diverticulosis.
Ars Medica Tomitana, 2019
Rosai-Dorfman disease (RDD) is a rare idiopathic benign disease, self-limited non-Langerhans cell... more Rosai-Dorfman disease (RDD) is a rare idiopathic benign disease, self-limited non-Langerhans cell histiocytosis, most frequently presented as a massive bilateral and painless lymphadenopathy, associated with fever and weight loss. Extranodal manifestations of RDD represents a true diagnosis challenge for clinicians and surgical pathologists. A 64-year-old female, known with arterial hypertension and type 2 diabetes, presented to our Surgery Clinic for a left arm painless cutaneous tumour, having its onset one year before, and rapidly enlarged in the last two months. Physical examination revealed a firm and elastic cutaneous nodular lesion of 4 x 2 cm in size, prominent to the skin, with central ulceration area of 10 x 5 mm, located on the posterior side of the left arm. Surgery was performed, with lymphoma as a differential diagnosis at intraoperative extemporaneous examination. The RDD disease diagnosis was considered at histopathological analysis and confirmed by immunohistochemistry. Herein, we describe a rare case of purely cutaneous RDD presenting as unique cutaneous ulcerative nodular lesion, surgical treated only, and without local relapse after one-year follow-up.
Journal of Clinical and Investigative Surgery, 2018
We present a clinical case of synchronous colonic lesions, histologically different, associated w... more We present a clinical case of synchronous colonic lesions, histologically different, associated with streptococcus gallolyticus subsp. gallolyticus (Sgg)/ Streptococcus bovis biotype I, bacteremia and infective endocarditis. A 53-year-old female, without history of CRC in her family, known with total hysterectomy for uterine fibromatosis, presents to Emergency Department for marked asthenia, nausea, weight loss (10 kgs in the last month), febrile episode associated with severe anemia, symptomatology that has increased in the last two weeks. The patient was admitted in the Internal Medicine Department for further investigations, under the suspicion of sepsis of unknown cause. On blood cultures grew Sgg bacteria. Both transthoracic echocardiography and transesophageal echocardiography were performed and diagnosed infective endocarditis with vegetations of the mitral and aortic valves. Antibiotics treatment was initiated, with ceftriaxone and gentamycin, according to antibiogram results. Severe hypochromic, microcytic anemia, and lack of an infective origin site required digestive endoscopic evaluation, and showed gastritis, ulcerovegetative tumor of the ascending colon and polyp in the rectosigmoid. Resection of rectosigmoid polyp was performed through colonoscopy, and, also, right hemicolectomy with ileo-transverse anastomosis for the ascending colon cancer. Post-operative evolution was favorable. Histological result showed mucinous adenocarcinoma of the ascending colon and tubulovillous adenoma, with moderate dysplasia, in the rectosigmoid. At 6-month, endoscopic evaluation showed normal aspect of anastomosis without presence of other colonic lesions. Keywords colorectal cancer, streptococcus gallolyticus, polyp colon, infective endocarditis Highlights ✓ This case illustrates a direct link between Sgg and colorectal cancer; the presence of Sgg bacteremia/ infective endocarditis, requires evaluation of gastrointestinal tract, even in the absence of any digestive clinical signs. ✓ Following an episode of Sgg bacteremia/endocarditis, endoscopic colonic monitoring is recommended to detect the progression of possible new lesions.
International Surgery Journal, 2019
Scrotal lipomas are benign tumours rarely seen in clinical practice. They can mimic common affect... more Scrotal lipomas are benign tumours rarely seen in clinical practice. They can mimic common affections such as an an inguinoscrotal hernia, varicocele, hydrocele or a testicular tumour. Thus, in many cases, physical examination leads to a correct diagnosis, there are situations that require comprehensive imagistic examinations, to establish the preoperatory nature of the scrotal tumour. A 64-year-old male, known with arterial hypertension and gonarthrosis, came to the hospital for a painless scrotal tumour with a fast growth rate in dimensions over the last year. Physical examination detected an elastic, painless, irreducible, irregularly shaped mass of a right scrotal region. The scrotal ultrasound revealed a heterogeneous hyperechoic solid mass with 10x8.1x8cm in dimensions, localized in the right scrotal region. The magnetic resonance imaging (MRI) showed a globular shaped right scrotal tumour mass with well-defined margins, poorly vascularized at the lower pole. Surgery was performed, with excision of a mass about 10cm in major diameter from the right scrotal wall. Postoperative evolution was good, and the histological diagnosis of primary scrotal lipoma was made. One-year follow-up revealed no local relapse.
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Papers by Nicolae-Iustin Berevoescu
RESULTS:
There has not been any case of anal incontinence for gases or faeces, precocious or late; 1 para anal hematoma (2.12%) solved through puncture; 2 anal abscesses (4.25%), solved through incision and tegmen drainage. Control in 6 month's time and 1 year time: normal quality of life, without any subjective complaints; painless rectal touch, healing of the fissure, extensible anal sphincter, normal continence. The sphincterotomy was followed by the disappearance of the cleft syndrome with all patients. Although the literature contains citations of transitory and minimum incontinence in 2-4% of the cases, we have not noticed in any; no recurrences have been registered; morbidity is acceptable. The future will decide if, between sphincterotomy and the injection with the botulinum toxin, the latter one is to be preferred.
during the last three centuries. After a brief history of the
Colțea hospital and its masters surgeons, the attention is drawn
on the masters efforts to optimize the care, equipment and
surgery techniques, things that became of national and wordwide
importance.
RESULTS:
There has not been any case of anal incontinence for gases or faeces, precocious or late; 1 para anal hematoma (2.12%) solved through puncture; 2 anal abscesses (4.25%), solved through incision and tegmen drainage. Control in 6 month's time and 1 year time: normal quality of life, without any subjective complaints; painless rectal touch, healing of the fissure, extensible anal sphincter, normal continence. The sphincterotomy was followed by the disappearance of the cleft syndrome with all patients. Although the literature contains citations of transitory and minimum incontinence in 2-4% of the cases, we have not noticed in any; no recurrences have been registered; morbidity is acceptable. The future will decide if, between sphincterotomy and the injection with the botulinum toxin, the latter one is to be preferred.
during the last three centuries. After a brief history of the
Colțea hospital and its masters surgeons, the attention is drawn
on the masters efforts to optimize the care, equipment and
surgery techniques, things that became of national and wordwide
importance.