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We present the case of a 52-year-old male with severe hemophilia A with inhibitors, who was diagnosticated with acute lithiasic cholecystitis that required surgical intervention due to lack of favorable response to conservatory treatment. During surgery, hemostatic support was performed with activated recombinant factor VII (rFVIIa, NovoSeven®). The surgery was performed first laparoscopically with adhesiolysis, followed by subcostal laparotomy and cholecystectomy because of the findings of a pericholecystic plastron with abscess and massive inflammatory anatomical modifications. The patient presented postoperative complications, requiring a second surgical intervention, due to the installation of a hemoperitoneum. Hemostatic treatment with rFVIIa was given for a further 3 weeks postoperatively, and the patient was discharged in safe condition. A surgical intervention increases the risk of bleeding in hemophilic patients, which may have vital complications in the absence of adequate hemostatic support and the support of a multidisciplinary team with experience in hemophilic surgery.

Castleman�s disease is characterized by benign angiolymphoid hyperplasia. There are two clinical forms: the localized form in which one lymph node is affected, often paucisimptomatic, treated by radical surgical excision, without recurrence in most cases, and the multicentric form, characterized by systemic manifestations, polyadenopathy (mediastin, cervical region, abdomen, etc.) , organomegaly (e.g. spleen, liver), with a less favorable prognosis than the localized form. The etiology of the disease remains unknown; recent studies suggest the implication of human herpes virus 8 (HHV-8), especially in multicenter forms. We shall present the case of women, aged 23, with Castleman�s disease with retroperitoneal localization, who was admitted to the surgery clinic due to abdominal pains. The initial abdominal CT raised the suspicion of a hepatic lobus caudatus tumor, but the anatomical-pathological result confirmed the diagnosis of angiofolicular hyperplasia of the lymph nodes. Diagnostic methods, histological forms, treatment and prognosis aspects of Castleman�s disease are described below.

Acute mediastinitisis an uncommon but potentially devastating infection involving the structures of the mediastinum. The 2 most common causes of acute mediastinitis are esophageal perforation or median sternotomy. Conventional forms of treatment for acute mediastinitisusually involve surgical revision with open dressings or closed irrigation, or reconstruction with vascularized soft tissue flaps such as omentum or pectoral muscle. Vacuum-assisted closure is a treatment with a wound-healing technique based on the application of local negative pressure to a wound. We present the case of a 73 years old male patient admitted in our clinic with esophageal perforation that appeared possible after a endoscopic dilatation done for a esophageal stenosis in the inferior 1/3 part. Using a modified double-lumen naso-gastrig probe adapted to the negative pressure unit and using the same principle as in the negative pressure treatment of soft tissue wounds we have achieved positive results with successful cure of esophageal perforation. The toraco-abdominal Computer Tomography done with contrast substance confirmed the esophageal perforation, acute mediastinitis and bilateral pleuresia. The patient had a full recovery after 29 days of hospitalization with a positive check-up at one and two months after leaving our clinic.

Human echinococcosis is a zoonotic infection caused by larval forms (metacestodes)of the tapeworm of the genus echinococcus found in the small intestines of carnivores. Humans are only incidentally infected. The liver is the most frequent site for the cystic lesions seen in hydatid disease, followed by the lung, the brain, and other visceral. Surgery is the recommended treatment for hepatic hydatid cysts. However, drug therapy and percutaneousdrainage have recently been introduced as alternative treatments. We present the case of a 68 year old female pacient that admitted in our clinic for pain in the superior abdominal region. The ecography performed revealed a large cystic formation about 700 mL with a diameter of 10 cm in the right lobe of the liver. We performed a Percutaneous Aspiration-Injection-Reaspiration Drainage (PAIR) under Albendazol treatment before and after the procedure without any incidents. The histopathological examination concluded the diagnosis of hydatid hepatic cyst. Percutaneous drainage is minimally invasive and very effective in the treatment of hepatic hydatidosis. Percutaneous aspiration of a documented or suspected hydatid cyst was long considered to be contraindicated to avoid the risk of leakage of cyst contents, which can lead to anaphylaxis and seeding of intraperitoneal structures. In the our case report the hydatid hepatic cyst was a large univezicular cyst, with a approachable localization in the liver, on a pacient without any other medical problems that was suitable for PAIR, and after the procedure we didn�t identified any of the complication reported in literature. The effectiveness of PAIR method allowed a short period of hospitalization with ambulatory follow up with benefits on the both sides , the pacient social integration and medical system economy.