Endoscopic treatment of perforated ulcer

Cu introducerea în anul 1976 a agenţilor anti H2, s-a micşorat evident numărul cazurilor de tratament chirurgical adresate ulcerului uo enal sau stomacal. Necatând la aceasta, incidenţa complicaţiilor asociate cu maladie ulceroase, în special perforaţia, practic nu s-a schimbat. Din 1990. când Mouret a descris în primieră suturarea laparoscopică a ulcerului duodenal perforat şi Nathanson. care a e ectuat primul tratament cu succes al ulcerului peptic perforat, metoda laparoscopică a devenit o procedură folosită pe larg. Primele cazuri de tratament laparoscopic al ulcerului perforat în Moldova au fost efectuate în 1997. Studiul prezentat se bazează pe analiza a 54 cazuri de ulcer perforat (48 barbaţi şi 6 femei), spitalizaţi în secţiile de chirurgie a Centrul Naţional Practico-Știinţific in Medicina de Urgenţă cu vârsta medie 25, 16 ani (15-60 ani). Analiza clinică confirmă: tratamentul laparoscopic este .o metoda eficientă de tratament, reduce durata de spitalizare a pacientului, există o reluare rapidă a tranzitului intestinal, iar complicaţiile postoperatorie sunt reduse.With the introduction of H2 receptor antagonist in 1976 there is a significant reduction of elective surgical cases carried out for duodenal and gastric ulcers. However the incidence of complications associated with peptic ulcer disease particularly perforation has not changed appreciably. Since 1990 when Mouret reported the first laparoscopic sutureless repair for a perforated duodenal ulcer and Nathanson the first successful laparoscopic suture repair for perforated peptic ulcer, laparoscopic approach became a widespread procedure. The first cases of treatment laparoscopic of perforated ulcer in Moldova were performed in 1997. The study is based on the analysis of 54 cases of perforated ulcer (48 men and 6 women), hospitalized in the surgical department of the Republican Emergency Hospital, mean age 25, 16 (limits 16 - 60 years). The performed clinical analysis attests that laparoscopic treatment is a safe and efficient method, it reduces the hospitalizing period and has a low rate of complications

Alimentary tract duplications in pediatric pathology

Introduction. Alimentary tract duplications are congenital malformations which can occur anywhere from the mouth to anus. Their anatomical presentation varies widely and so their clinical picture, often making their management a challenge for the surgeon. Material and methods. We reviewed the medical records of 24 consecutive patients diagnosed and treated for ATD from 2006 to 2015 by our team. Results. The clinical presentation ranged broadly from recurrent abdominal pain or feeding difficulties to GI bleeding or bowel obstruction. Most of the ATDs were ileocecal (33%), followed by jejuno-ileal and colon, esophageal and duplication of the oral structures, rectal and anorectal. We feature an esophageal duplication cyst associating esophageal atresia. We also note a case of complex caudal duplication syndrome involving the ileum, appendix, cecum, colon and rectum assessed into a multidisciplinary team with very good outcomes. In half of the cases (50%) removal of the duplication required corresponding enterectomy. Conclusions. Alimentary tract duplications are rare malformations with a broad spectrum of anatomical particularities. Their clinical presentation and imaging studies can be misleading and in many situations intraoperative findings complete the picture of the case. Multidisplinary approach is mandatory in complex cases in order to bring up the best results

Lipoblastoma: a rare neoplasm of childhood

Introduction. Lipoblastoma is a rare mesenchymal tumor of the infancy and childhood, arising from embryonic fat tissue. It is considered to be benign since no metastases have been reported so far, but long term recurrence is well known. Most the tumors occured on the trunk or on the limbs, while head and neck or genitalia are exceptional sites. Material and methods. A revision of the lipoblastomas we treated in the last five years was made. We considered clinical and histopathological aspects, preoperative assessment, surgical approach and outcomes. Results. We experienced four cases of lipoblastoma in the last 5 years. Their age at presentation varied from neonates to early childhood. The anatomical distribution of the tumor broadly varied: posterior paravertebral space, gluteal region, neck and intrascrotal. The main preoperative study tool was computed tomography. Complete excision was possible in all cases and no recurrences were noted so far. Conclusions. Lipoblastomas are very rare neoplasms with unspecific localization and an atypical evolutive behaviour. Complete surgical excision and long term follow up is mandator

Results of medico-surgical approach to the treatment of pancreatic cancer in emergency

Catedra de Chirurgie nr. 1 “Nicolae Anestiadi”, Universitatea de Stat de Medicină şi Farmacie “Nicolae Testemiţanu”, IMSP Institutul de Medicină Urgentă, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Tumorile pancreatice (TP) reprezintă a cincea cea mai comună cauză de deces. Diagnosticul precoce rămâne o provocare, aceasta determinând rate considerabile de morbiditate şi mortalitate. Material şi metode: Studiu retrospectiv, 2014-2018, 147 pacienţi cu TP, B:F/1:1, vârsta medie 63,82±11,45ani. Adresarea a fost determinată de icter în 101(68,71%) cazuri, formaţiune intraabdominală − 29(19,73%), abdomen acut – 17(11,56%). Diagnosticul s-a stabilit: la 111(75,51%) − prin TC; la 9(6,12%) – prin RMN şi la 75(51,02%) – la CPGRE. În 128(87,07%) cazuri TP era localizată cefalic, în 19(12,95%) − corporeo-caudal. Pacienţii s-au repartizat în trei loturi: lot.I – stentare biliară la CPGRE sau transparietohepatică(58), lot.II – derivație bilio-digestivă(26), lot.III – rezecţie pancreatoduodenală(23) și pancreatectomie distală cu splenectomie(9). În 21,09% cazuri(n=31) s-a refuzat orice procedura terapeutică. Rezultate: Lotul I − 58(50,0%) cazuri, vârsta m=66,88±12,14ani, bilirubinemia m=250,47±146,33mmol/l, durata spitalizării m=9,81±4,8zile, mortalitatea p/op − 2(3,45%). Lotul II – 26(17,69%) cazuri, vârsta m=59,85±11,27ani, bilirubinemia m=112,0mmol/l, durata spitalizării m=22,58±10,32zile, mortalitatea p/op – 2(7,69%). Lotul III – 32(21,77%) pacienți, vârsta m=59,15±9,0ani, bilirubinemia m=87,0mmol/l în TP cefalice, în 8(34,78%) cazuri fiind stentați preoperator (bilirubinemia m=218,5±85,74mmol/l), durata spitalizării m=23,5zile, mortalitatea p/op − 6(18,75%), după duodenopancreatectomie(5), după pancreatectomie distală(1), din cauza complicațiilor septice(4), trombemboliei a.pulmonare(1), pancreonecrozei p/op(1). Concluzii: Examenul imagistic prin TC cu angiografie și/sau RMN este de prima intenție în diagnosticul și stabilirea tacticii chirurgicale în TP. Rata operațiilor rezecționale cu viză de radicalitate rămâne a fi sub limita mondială raportată, consecința diagnosticului tardiv și simptomatologiei nespecifice. Stentarea căilor biliare rămâne cea mai frecventă și, de cele mai multe ori, unica și ultima soluție în rezolvarea icterului mecanic compresiv.Background: Pancreatic tumors (PTs) are the fifth most common cause of death. Early diagnosis remains a challenge; consequently, morbidity and mortality rates are considerable. Methods and materials: Retrospective study, 2014-2018, 147 patients with PT, M:F ratio 1:1, age m=63.82±11.45years. At hospitalization jaundice was determined in 101(68.71%)cases, intra-abdominal tumor – 29(19.73%), acute abdomen − 17 (11.56%). The diagnosis of PT was established: CT in 111(75.51%); NMR − 9(6.12%), ERCP − 75 (51.02%). PTs were located in the head of the pancreas in 128(87.07%) cases, body or tail − 19(12.95%). The patients were divided into three groups: group.I – endoscopic biliary stenting or trans-parieto-hepatic drainage, group.II − biliodigestive derivation(26), group.III - pancreatoduodenal resection(23) and distal pancreatectomy with splenectomy(9). In 21.09%(n=31) cases patients refused any treatment. Results: Group.I − 58(50.0%), age m=66.88±12.14years, serum bilirubin level m=250.47±146,33mmol/l, hospitalization time m=9.81±4.8days, postoperative mortality − 2(3.45 %). Group.II − 26(17.69%), age m=59.85±11.27years, serum bilirubin level m=112.0mmol/l, hospitalization time m=22.58±10.32days, postoperative mortality − 2(7.69%). Group.III − 32(21.77%) patients, age m=59.15±9.0years, serum bilirubin level m=87.0mmol/l in patients with cephalic tumor, in 8(34.78%) cases biliary stent applied preoperatively (serum bilirubin level m=218,5±85,74mmol/l), hospitalization time m=23.5days, postoperative mortality − 6(18.75%), after duodenopancreatectomy(5), distal pancreatectomy(1), because of septic complications(4), pulmonary thromboembolism(1), postoperative pancreonecrosis(1). Conclusion: CT angiography and/or NMR are the first intention to diagnose and establish surgical tactics for PTs. The rate of radical resection remains to be under global level due to late diagnosis and nonspecific symptomatology, biliary stenting remains the most common and, frequently, the unique solution for jaundice in compressive mechanical jaundice

First coupling of the FRS particle identification and the FRS-Ion Catcher data acquisition systems: The case of 109In

6 pags. 5 figs.For the first time, the FRagment Separator (FRS) and the Multiple-Reflection Time-Of-Flight Mass-Spectrometer (MR-TOF-MS) particle identification (PID) systems at GSI have been coupled. This new approach adds to the standard FRS PID an additional unambiguous identification of the fragments and the possibility to identify and count long-lived isomeric states (>ms). For this purpose, single-event timestamp information given by a common clock was used to correlate both systems. Two methods were implemented to improve the signal-to-background ratio by more than a factor 2 in the high resolution mass spectrum obtained with the MR-TOF-MS for the 109In isotope. Moreover, the coupling of the systems allows an improvement in the on-line monitoring of the FRS-Ion Catcher (IC) efficiency and extraction time. In addition, range calculations were implemented in the on-line monitoring; a powerful tool for real-time optimization of stopped beam experiments.The ELI-NP group was supported by Extreme Light Infrastructure Nuclear Physics (ELI-NP), Germany Phase II, a project co-financed by the Romanian Government and the European Union through the European Regional Development Fund the Competitiveness Operational Programme (1/07.07.2016, COP,ID 1334) and by the Romanian Ministry of Research and Innovation under contract PN 19 06 01 05. This work was supported by the German Federal Ministry for Education and Research (BMBF) under contracts No. 05P19RGFN1, 05P12RGFN8 and 05P15RGFN1, by Justus Liebig University Gießen, Germany and GSI, Germany under the JLU-GSI strategic Helmholtz partnership agreement, by HGS-HIRe, and by theHessian Ministry for Science and Art (HMWK), Germany. O. Hall was supported by UKRI STFC, United Kingdom grant ST/P004008/1.Peer reviewe

Support of diagnostic tools in nonoperative management of splenic injuries

Clinica Chirurgie N1 „N. Anestiadi”, Clinica ATI „V. Ghereg”, USMF „N. Testemițanu”, Departamentul Imagistică, CNȘPMU, Chișinău, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Material şi metode: 60 pacienți cu Leziuni Lienale(LL) supuşi MNO. USG(FAST) în 100% s-a efectuat ca prim diagnostic al hemoperitoneului, TC–la 48(80%) pentru aprecierea severității LL, în rest LL a fost diagnosticată ecoscopic sau laparoscopic. În 88% s-a efectuat TC cu contrast, inclusiv cu angiografie (20,83%). Tomografic LL s-au gradat după scara Schweizer(I-V) și scorul Resciniti(1-6), iar cazurile cu angiografie–retrospectiv prin sistemul MDTC. Laparoscopia s-a efectuat la 16(26,67%) pentru argumentarea opțiunii în cazurile dubioase. Rezultate: USG-FAST pozitivă–36(60%), negativă–23(38,3%), în 1(1,6%)–neinformativă. Volumul hemoperitoneului ultrasonografic a variat între 100-750ml. Din FAST-negativi în timp s-au pozitivat 8(34,78%), sensibilitatea metodei constituind 81,8%. Sensibilitatea TC în constatarea LL–95,12%. Conform TC(Schweizer) LL s-au repartizat: gr.I-10(20,8%), gr.II-15(31,2%), gr.III-21(43,7%), gr.IV-2(4,2%); cele severe(III-IV)–47,91%. În 6(10%) eşecuri TC(Schweizer) constată LL gr.II(2) şi gr.III(3). Scorul TC(Resciniti) s-a calculat în 75%, media în gr.II–2,11±0,78; gr.III–4,35±0,84, iar la eşec–4±1,22. Media scorului(Resciniti) la reuşită–2,97±1,75, cu scor 5 în 8(22,2%) cazuri. Conform MDTC, în două eşecuri se constată pseudoanevrism lienal, LL de gr.II și III(Schweizer) devenind grad 4a, iar cazului de succes cu gr.IV(Schweizer) atribuindui-se gr.3. Laparoscopia în 2 cazuri constată ascită la politraumatizații cu LL la TC şi lichid liber în volum exagerat, iar într- un caz a indus eşecul prin dezvoltarea instabilității la aplicarea pneumoperitoneului. Concluzii: USG-FAST este metoda de rutină, rapidă și sensibilă în evidențierea hemoperitoneului. Scara şi scorul TC sunt necesare pentru stabilirea gradului leziunii şi hemoperitoneului, însă sunt doar orientative în prezicerea necesității operației. Sistemul MDTC pare a fi mai exact în prezicerea eşecului. Laparoscopia în cazurile dubioase, dar stabilizate, poate concretiza reuşita MNO. Material and methods: 60 patients with Splenic Injuries(SI) treated nonoperatively (NOM) were included. USG-FAST was used in 100% for hemoperitoneum diagnosis. CT was used in 80% (n=48) contrast enhanced CT (88%) and arteriography (20,83%). For SI grading CT Schweizer Scale and Resciniti score (RS) were preferred, MDTC system being used retrospectively in cases with angiography. Laparoscopy in 16(26,67%) appeared as NOM argument in uncertain cases (polytrauma, hemodynamic instability episodes, coma, excessive fluid volume). Results: USG-FAST positive–36(60%), negative–23(38,3%), non-informative-1(1,6%). Hemoperitoneum ranged between 100-750ml. 8(34,78%) FAST-negative became positive, the sensitivity of method being 81,8%. CT(sensitivity 95,12%) revealed: gr.I-10(20,8%), gr.II -15(31,2%), gr.III -21(43,7%), gr.IV- 2(4,2%); severe trauma(III -IV)-47,91%. In 6(10%) NOM failures were gr.II and III SI. RS was estimated in 75%, with average in gr.II: 2,11±0,78, gr.III: 4,35±0,84, NOM failure: 4±1,22. The average RS in successful NOM: 2,97±1,75, being 5 in 8(22,2%). MDTC system revealed in two NOM failures lienal pseudoaneurism, SI gr.II,III being changed in gr.4a and the successful gr.IV in gr.3. Laparoscopy noted ascites in 2 patients with SI and excessive fluid volume on CT and in one case produced NOM failure by instability development when applying pneumoperitoneum, whithout gr.III SI active haemorrhage. Conclusions: USG-FAST is a routine method, rapid and sensitive in revealing hemoperitoneum. CT scale and score are necessary for grading SI and hemoperitoneum, but are only indicative in predicting surgery. RS<2,5p is safe, between 2,5-4,35 needs follow up. MDTC seems to be more accurate in predicting failure. Laparoscopy in uncertain, but stable patients could confirm successful NOM

Production of Exotic Nuclei via MNT Reactions Using Gas Cells

The use of multi-nucleon transfer (MNT) reactions to produce neutron-rich nuclei in the heavy region has received an increased attention in the last decade. The feasibility of employing such reactions at the FRS Ion Catcher facility at GSI and the IGISOL facility at JYFL is studied using a combination of theoretical calculations and experiment simulations. The reactions are computed within a Langevin-type model, and the Geant program is used to simulate the transport of the resulting products within the experimental setups of the above-mentioned facilities. The angular distribution of ion release, possible target choices and target-to-beam-dump distances are discussed.peerReviewe