Half and Half nails in a healthy person

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ASPECTS OF ROMANIAN MARKETING ENVIRONMENT FOR INTERNATIONAL HOTEL CHAINS

The influence of global processes on economic development is reflected in the intensity of tourist streams and in the development of the hotel companies’ strategy. Because of that, is very important for a hotel and especially for one that belongs to an international chain to analyse the micro and macro environment, to know exactly which are the opportunities and the risks taken into consideration on a specific market. On the Romanian market the hotels that belong to international chains consider that the most important opportunity is the market development potential and the biggest risk is the infrastructure. Also, the own resources are the most important factor that is influencing directly the activity of a hotel belonging to an international chain in Romania. All those criteria are taken into consideration by the hotels in order to develop a long time strategy on the Romanian market

TECHNICAL ASPECTS REGARDING THE OBTAINING AND USE OF THE CAMELINE GROATS IN ANIMAL FEEDING

The by-products resulting from the extraction of oil from oilseeds represent alternative strategies for animal feeding, a new source of food. In the paper were presented some physical characteristics of cameline cakes resulting from mechanical processing with a pilot installation for the production of vegetable oils. To study the effects at the ruminal level, tests were performed on fistulized animals fed with fodder in which the camelina shrimp replaced the sunflower. The values recorded for pH dynamics indicated that camelina grist could replace sunflower seed without negative effects on ruminal metabolism under certain conditions

ETIOLOGIA SÂNGERĂRILOR GASTROINTESTINALE LA COPIL

Obiective. Identifi carea caracterelor clinice, endoscopice, etiologice la copiii diagnosticaţi cu hemoragie digestivă superioară şi inferioară. Material şi metodă. S-a efectuat un studiu retrospectiv descriptiv pe o perioadă de 3 ani (ianuarie 2010- decembrie 2012) pe 107 copiii cu vârsta între 1 şi 18 ani, internaţi pentru hemoragii digestive în Spitalului Clinic de Copii „Sf. Maria“ Iaşi. Lotul de studiu nu cuprinde hemoragii digestive din urgenţe chirurgicale, boli infecţioase, boli intestinale cu mecanism imunologic sau toxic. Analiza retrospectivă individualizată prin studiul foii de observaţie a cuprins date anamnestice, clinice, endoscopice şi histologice orientate pentru diagnosticul etiologic al hemoragiilor digestive. Toţi pacienţii au fost investigaţi prin endoscopie digestivă superioară/colonoscopie după ce procedura a fost explicată şi s-a obţinut consimţământul informat. Rezultate. Din lotul de 107 copii luaţi în studiu 39 (36,4%) au reprezentat hemoragia digestivă superioară (HDS), dintre care 6 cazuri (5,1% ) de cauza variceală iar 33 (94,8%) de cauză non variceală; şi 68 (63,5%) au prezentat hemoragia digestivă inferioară (HDI). În etiologia HDS gastrita erozivă a reprezentat 12 (30,8%) cazuri, esofagita 6 (15,4%), duodenita 6 (15,4%), ulcerul duodenal 4 (10,3%), ulcerul gastric 2 (5,1%), sindrom Mallory Weiss 1 (2,6%), etiologie multiplă 6 (15,4%) cazuri. Principalele aspecte etiologice ale HDI au fost polipul colo-rectal în 28 (41,2%) cazuri, colită ulcerativă 14 (20,6%), leziuni nespecifi ce 12 (17,6%) fi suri anale 9 (13,4%), sindroame de polipoză intestinală 3 (4,4%), malformaţie vasculară 1 (1,5%), diverticul rectal 1 (1,5%) caz. S-au practicat intervenţii endoscopice concomitente în cazul polipilor colo-rectali. Concluzii. Hemoragia digestivă inferioară a fost cea mai frecventă, corelată cu cauze minore: polipi colorectali, fi suri anale, leziuni nespecifi ce. Hemoragia digestivă non-variceală forma cea mai frecventă s-a asociat cu gastrita erozivă, esofagita, duodenita, ulcerul gastric. Endoscopia digestivă s-a dovedit a fi o investigaţie utilă în diagnosticul hemoragiilor digestive şi cu aport terapeutic în anumite cazuri

Abdominal Compartment Syndrome – a Surgical Emergency

Over the past six decades, abdominal compartment syndrome (ACS) remained a very controversial subject, both in surgical and non-surgical specialties. Doctors failed to understand why critically ill patients died in the ICU with distended abdomens without fi nding any cause or why postoperative patients with wound defects such as dehiscence died after suturing the wound again „very tightly”. After the concept of intra-abdominal pressure (IAP) was established and methods for measuring it and diagnosing intra-abdominal hypertension (IAH) were available for clinicians to use it, it became clearer that ACS was a very serious and life threating pathology and the need for a correct treatment is essential. In this article we will try to make a literature review of the past decade and see when and how to diagnose correctly a patient with ACS and also how the diagnostic and treatments methods changed over the years

Non-operative management of the sigmoid volvulus – case presentation

Sigmoid volvulus happens when the sigmoid wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions. This pathology generally affects adults, and it is more common in males. The etiology is multifactorial and controversial; the main symptoms are diffuse abdominal pain, distention and constipation, while the pregnant signs are abdominal distention and tenderness. Laboratory findings are not pathognomonic: abdominal X-ray radiographs show a dilated sigmoid colon and multiple intestinal air-fluid levels, abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy reveals a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation, or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%

Cholelitiasis in an adult patient with mild hereditary spherocytosis – a case report

Hereditary spherocytosis (HS) is an inherited abnormality of the red blood cell, caused by defects in structural membrane proteins. The condition is dominantly inherited in 75% of people. The severity of the disorder is related to the type and amount of membrane disruption, which is genetically determined. A patient who suffers from this disorder is commonly found in a surgical ward when the disease becomes unmanageable by a hematologist. Surgeons encounter complications such as: jaundice, splenomegaly, gallstone sand severe anemia. We present the case of a 66-year-old woman with a history of hereditary spherocytosis who presented at the emergency room for pain in the right upper quadrant, jaundice and anemia and was diagnosed with gallbladder stones and common bile duct obstruction

DIAGNOSTIC ŞI MANAGEMENT ÎN CONSTIPAŢIA CRONICĂ LA COPIL (Partea a II-a)

Constipaţia este o problemă comună care afectează copiii de toate vârstele. De cele mai multe ori etiologia este de natură funcţională, fi ind rezultatul retenţiei voluntare a scaunului. Un rol important în stabilirea diagnosticului îl au obţinerea unei anamneze complete şi efectuarea unui examen fi zic detaliat. În majoritatea cazurilor investigaţiile paraclinice nu sunt necesare pentru diagnostic, ele fi ind indicate atunci când există suspiciunea unei cauze organice de constipaţie (boala Hirschsprung, pseudoobstrucţie, hipotiroidism, diabet insipid, fi broză chistică, malformaţii anorectale congenitale) sau în cazurile cu rezistenţă la tratament. Diagnosticul precoce este extrem de important, fi ind asociat cu un răspuns mai bun la terapie. Acesta include efectuarea tuşeului rectal, colonoscopia, scintigrafi a colonică, videocapsulă şi manometria anorectală. Prima etapă a tratamentului constipaţiei funcţionale constă în dezimpactare. Polietilen glicolul este efi cace şi bine tolerat. După dezimpactare este iniţiat un program de întreţinere pe termen lung, din cauza frecvenţei crescute a recidivelor, cu medicamente ca uleiul mineral, lactuloza, polietilenglicolul şi sorbitolul. Regimul alimentar bogat în fi bre alimentare asociat cu educaţia familiei şi, atunci când este posibil, a copilului este esenţial. Întârzierea diagnosticului şi implicit a tratamentului poate duce la progresia spre o problemă cronică semnifi cativă de sănătate cu implicaţii fi zice, psihologice şi sociale

ETIOLOGY OF GASTROINTESTINAL BLEEDING IN CHILDREN

Objectives. Identifi cation of clinical, endoscopic, etiological characteristic of children diagnosed with upper and lower gastrointestinal bleeding. Material and methods. It was conducted a descriptive retrospective study over a 3 year period (January 2010 to December 2012) on 107 children aged 1-18 years hospitalized for gastrointestinal bleeding in ”St. Mary” Children’s Emergency Hospital, Iasi. The study group does not include gastrointestinal bleeding from surgical emergencies, infectious diseases, intestinal diseases with immunological or toxic mechanism. Individualized retrospective analysis included historical data, clinical, endoscopic and histological targeted for etiologic diagnosis of gastrointestinal bleeding. All patients were investigated by upper gastrointestinal endoscopy/colonoscopy after the procedure was explained and informed consent was obtained. Results. From the batch of 107 children, 39 (36.4%) presented with upper gastrointestinal bleeding (UGIB) 6 (5.1%) was variceal, non-variceal in 33 (94.4%) cases, and 68 (63.5%) presented with lower gastrointestinal bleeding (LGIB) The main etiologycal aspect of UGB was erosive gastritis 30.8%, esophagitis in 15.4%, duodenitis in 15.4%, gastric and duodenal ulcers 5,1% and respectivily 10.3% of cases, Mallory-Weiss syndrome in 2.6%, multiple etiology in 10 cases 15.4%. Causes of LGIB were colorectal polyps in 41.2.%, ulcerative colitis 20.6%, non specifi c lessions in 17.6% anal fi ssures 13.2%, intestinal polyposis 4.4 %,rectal diverticula 1.5% and vascular malformations 1.5%. It was practiced concomitent endoscopic surgery for rectal polyps. Conclusions. Lower gastrointestinal bleeding was the most common causes related to minor conditions: colorectal polyps, anal fi ssures, nonspecifi c lesions. Non-variceal gastrointestinal bleeding the most common form associated with erosive gastritis, esophagitis, duodenal ulcer, gastric ulcer. Endoscopy proved to be a useful investigation in the diagnosis of gastrointestinal bleeding and a therapeutic useful tool in certain cases