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The paper presents the 6 cases of liver shot wounds that were in supervision of the general surgery unit, County Hospital of Baia Mare, between the years 1990-1997. The patients were males, most of them being 20 to 30 years old. In 3 situations hunting rifles were involved, all followed by retention of metal foreign body. The wounds were plurivisceral in 5 of the 6 cases, the most frequently wounded was the right liver lobe. All the patients presented serious traumatic shock and haemorrhagic shock. Livertectomy was used in 40% of the cases being imposed by the dilacerant and transfixiant character of the wounds and also by the retention of foreign bodies in parenchime. We registered 2 demises, both in the first postoperatory hours. The paper proposes a few criteria that allow the application of a conservatory treatment:rapid favourable answer at deshocking therapy; hemodynamic stability; minimal hemoperitoneus (echographical and tomographical); absence of associated visceral wounds or, when they exist, of serious physiopathological consequences; access to performant means of imagistics.

The paper reports on 108 cases of hepatic hydatidosis, admitted to the clinic in the last 12 years, who wer subjected systematically to hepatic imagery, immunologic investigation at hydatic antigen, determination of eosinophil and hepatic biochemical exploration. All the cases were checked operatively. The females were predominant, 66.11%, the average age was of 42.88 +/- 11.94 years. The greatest part of the cases ranged within the 5th-7th age decades. The investigation shows that there exists, in Romania, an endemic region infested with Echinococcus tenia in the Danube zone. The most frequent contamination sources were the cats and dogs; only in 11.11% of the cases the patients were breeding animals. The most cases were discovered late and had an important hepatomegaly. The patients sought help from the physician an ailment in the right hypochondria in 52.78% of the cases, followed by fever (16.68%), biliary colic (12.96%), abdominal pain; (9.26%) and incidentally in 12.04% of the cases. The medium diameter of the hydatic cyst at its discovery was of 10.65% +/- 5.84/14.06 +/- 7.12 cm; only in 21.3% of the cases the diameter of the cyst was lower than 6 cm. The causes of the late diagnosis were: sporadic hepatic imagistic exploration; sensibility of scintigraphy was of 87.5% whereas that of echography was of 98% and that of the CT-scanning od 100%; other cause was due to the lack of immunologic tests at hydatic antigen; sensibility of hemagglutination inhibition is of 65% and that of contra-immunoelectrophoresis of 86%. Owing to the late discovery of the disease, a lethal evolution was recorded by rupture of the cyst and peritoneal inundation in a young patient of 29 years old. Hepatic echinococcosis was unilocular in 74.07% of the case, with predominance in the right lobe (67.5%). The complications rate was of 14.83%, with predominance of the suppuration (10.19%). The paper confirms the endemic state of the hydatic disease, in the Danubian zone of Romania and pleads for the necessity of improving the diagnosis by systematic application of the echographic examination and of better immunologic tests in the ambulatory.

The paper reports on an observation of hepatic nonparasitic solitary cyst, size 10/12 cm, noncomplicated, in a 77-year-old woman. The lesion was treated by digital enucleation and suture of the hepatic wound, with a good result. The paper presents literature data on the hepatic nonparasitic solitary cyst.

The paper reports on the development of the diagnosis algorithm in jaundices with conjugated bilirubinemia in children. The clinical hepatobiliary semeiology, the data of the objective clinical examination and the laboratory and paraclinical examinations of hepatic exploration are analyzed. The paper also presents the diagnosis phases in the main clinical biological syndromes met in the child with jaundice and conjugated bilirubinemia: acute hepatic syndrome, chronic hepatic syndrome and cholestatic syndrome.

The present paper analyzes the liver trauma, underlying efficient diagnostic methods and treatment approaches. Liver trauma is frequent in Surgical Emergency Units and it is a challenge for the surgeon who has to deal with diagnosis and treatment problems and also to treat the associated lesions. The study analyzes 49 cases of liver trauma admitted in Emergency Surgery Clinic from Timisoara City Hospital between January 1995 and April 2005. A very good trained team specialized in liver surgery but also a multidisciplinary team is very important in liver trauma.

High incidence of polytraumas of different etiology determines special problems of treatment, the emergency surgeon frequently facing serious and complex injuries the most frequently in unstable patients and therefore difficult to be treated. This paper presents the case of a 19 years old patient, victim of a heteroaggression; clinical examination reveals an unique abdominal wound, surgical procedure showed a liver lesion with massive hemoperitoneum. Authors expose a series of emergency procedures principles for unstable patients and also an unusual method in the treatment of a liver wound. Actually, this method means catheterization of the liver wound with a Blakemore catheter. The esophageal balloon is full fill to make a positive pressure on this wound. Good evolution of the case justifies this method to be used as an alternative procedure to other haemostatic methods (liver resections, hepatic artery ligature etc.).

The main goal of this paper is to give an overview of the personal experience in the investigation of the hepatic biopsy. There were analyzed liver specimens from 26 children hospitalized in Clinical Hospital "Sf. Maria" Iaşi. The first clinic diagnosis was post-viral chronic hepatitis and most of the cases provided the serologic markers. Histopathological exam revealed 2 cases of active chronic hepatitis and 24 cases of persistent chronic hepatitis. The interpretation of the lesions relied on Ludwig and Metavir scoring systems. The significance of these scores is very important because they allow one to identify the grading of the necro-inflammatory/histological activity and the staging of fibrosis. Thus, the result of these scoring systems make it possible to classify the cases into aggressivity based forms, indicate the therapy approach and estimate the prognosis as well as the clinical course.

The paper is based on 213 surgical interventions for hepatic hydatid cyst. The importance of monography in the early diagnosis, detection of multiple sites and postoperative follow-up of the cases suspected of recurrence is underlined.

Continuing the series of papers dedicated to determining some objective markers for chronic alcohol poisonings, this time we insist on the significance of metabolic disturbances in the series under study. The hepatic changes are useful in the diagnosis, in determining the consequences and in following up the therapeutical management. The study was based on the marked alterations in the lipid and protein metabolisms, these alterations being strongly connected with ethanol metabolization stages.

The present paper reports on an observations of mechanical jaundice by a rare cystic tumour of the hepatic pedicle. Although the diagnosis of obstructive jaundice is sufficient as an operatory indication, a series of imaging methods were used for establishing the situs and the nature of the obstruction.

The paper reports on a case of congenital cystic dilatation of the main bile duct in a female patient, 3 years old, with a clinical evolution of the disease from 2 years old. The anamnestic data corroborated with iv cholangiography and hepatobile echography specifies the clinical diagnosis that was intraoperatively confirmed. The case was solved by resection of the cystic bag, followed by hepatojejunostomy on the loop ablated "en Y" à la Roux.

The present paper reports on the recent possibilities of diagnosis in iatrogenic diseases of the liver. The iatrogenic diseases of the liver are diagnosed with difficulty since no clinical, biological and histological pathognomonic criteria are known. The hepatic lesions appearing after drug intake are extremely various, including: hepatocellular necrosis, cholestasis, hepatic granuloma, perisinusoid fibrosis, steatosis, pseudoalcoholic lesions, vascular lesions and hepatic tumours. Clinical criteria, very important for the diagnosis, are based on: appearance of the disease, regression of symptomatology when the treatment is interrupted and recurrence when it is administered again. The biological criteria are not specific but they may indicate the drug etiology of a liver disease. Increase in the serum concentration of aminotransferases might be the only biochemical disturbance and it might be overlooked if not systematically investigated. The immunological tests suggested for diagnosis of iatrogenic liver diseases are numerous but only a few of them are specific. Histological criteria cannot identify, for sure, the drug etiology of the lesions. They may suggest the possibility of a drug induced cause and may help in establishment of a correct diagnosis.