Perforated postbulbar ulcer

Catedra chirurgie 2, USMF,, N. Testemițanu “, clinica de chirurgie 2 SCM ,,Sf. Treime Chișinău, Republica Moldova, 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 2011Actualitatea: Deși, individualizat de criterii anatomice clare - intersecție cu artera gastroduodenală proximal și unghiul Treitz distal, tema care este pusă în discuție și astăzi, ca regiune a duodenului (D 1-2-3-4), delimitată cranial de artera gastroduodenală și caudal de orificiul papilei și mai jos de acesta, este sediul unde poate apărea ulcerul duodenal postbulbar perforat.Material și metode: Studiul cuprinde un lot de 12 bolnavi, spitalizați de urgență cu suspecție la ulcer postbulbar perforat în perioada 2000-2010. În raport cu numărul bolnavilor operați (692) pentru ulcer duodenal perforat în această perioadă, ulcerul postbulbar reprezintă un indice de 1,73%. În lot s-a constatat un număr de 10 bărbați și 2 femei cu vârsta cuprinsă între 41-60 ani. La internare s-a constatat că durerea și contractura musculară a peretelui abdominal a fost prezentă la 10 din 12 pacienți, iar la 2 bolnavi tabloul clinic, cât și examenul radiologic de ulcer perforat a fost absent.Rezultate: Referindu-ne la localizarea ulcerului postbulbar perforat constatăm că în majoritatea cazurilor leziunea a fost situate pe D1.Dacă la 10 pacienții simptomatologia clinică și radio- endoscopică era caracteristică ulcerului perforat, în 2 cazuri semnele clinice și de laborator au fost necaracteristice perforației ce ne-a impus la un examen suplimentar laparoscopia diagnostică care a constatat ulcer postbulbar perforat acoperit.Intervențiile chirurgicale efectuate la cei 12 pacienții cu ulcer perforat postbulbar au fost simplă suturare – 6 cazuri; excizia ulcerului perforat cu piloroduodenoplastie Judd asociat cu vagotomie tronculară bilaterală 4 cazuri; excizia ulcerului perforat asociat cu vagotomie selectivă proximală – 2 cazuri, cu rezultate bune la distanță. Concluzii: Perforația ulcerului postbulbar duodenal în peritoneal liber este rară și după datele noastre are o pondere de 1,73%.Actuality: Even though this region is clearly individualized by obvious anatomical criteria - intersection with gastro duodenal artery proximal and distal with the Treitz angle, which is the topic under discussion even today, the region of the duodenum (D 1-2-3-4), limited cranially by gastro duodenal artery and caudal by the papilla hole and below it, this is the area where post bulbar perforated duodenal ulcer can occur.Material and methods: The study includes a group of 12 patients hospitalized in the emergency suspecting post bulbar ulcer, in the period 2000-2010. In relation to the number of patients operated for perforated ulcer (692) during the same period, the post bulbar ulcer has an index of 1.73%. The group was with a total of 10 men and 2 women aged between 41 and 60. In terms of clinical and objective data on admission was found that pain and muscle contraction of the abdominal wall was present in 10 of 12 cases and in 2 cases clinical and radiological signs of the perforated ulcer were absent.Results: Referring to the perforated post bulbar ulcer localization we find that in most cases the lesion was located on the D1 segment. If 10 patients had clinical and radiological signs which indicated a perforated ulcer, in 2 cases clinical and laboratory signs were uncharacteristic for perforation that required us to a supplementary examination which was diagnostic laparoscopy which showed covered post bulbar perforated ulcer.Surgeries performed on the 12 patients with perforated ulcer were simple suturing – 6 cases, perforated ulcer excision with pyloric plasty Judd associated with bilateral nonselective vagotomy – 4 cases, and excision of ulcer perforation associated with selective proximal vagotomy – 2 cases, with good long term result. Deaths were not registered. Conclusions: Perforation of post bulbar ulcer in peritoneum is rare and by our data is 1,73%.Actuality: Even though this region is clearly individualized by obvious anatomical criteria - intersection with gastro duodenal artery proximal and distal with the Treitz angle, which is the topic under discussion even today, the region of the duodenum (D 1-2-3-4), limited cranially by gastro duodenal artery and caudal by the papilla hole and below it, this is the area where post bulbar perforated duodenal ulcer can occur.Material and methods: The study includes a group of 12 patients hospitalized in the emergency suspecting post bulbar ulcer, in the period 2000-2010. In relation to the number of patients operated for perforated ulcer (692) during the same period, the post bulbar ulcer has an index of 1.73%. The group was with a total of 10 men and 2 women aged between 41 and 60. In terms of clinical and objective data on admission was found that pain and muscle contraction of the abdominal wall was present in 10 of 12 cases and in 2 cases clinical and radiological signs of the perforated ulcer were absent.Results: Referring to the perforated post bulbar ulcer localization we find that in most cases the lesion was located on the D1 segment. If 10 patients had clinical and radiological signs which indicated a perforated ulcer, in 2 cases clinical and laboratory signs were uncharacteristic for perforation that required us to a supplementary examination which was diagnostic laparoscopy which showed covered post bulbar perforated ulcer.Surgeries performed on the 12 patients with perforated ulcer were simple suturing – 6 cases, perforated ulcer excision with pyloric plasty Judd associated with bilateral nonselective vagotomy – 4 cases, and excision of ulcer perforation associated with selective proximal vagotomy – 2 cases, with good long term result. Deaths were not registered. Conclusions: Perforation of post bulbar ulcer in peritoneum is rare and by our data is 1,73%

Some considerations for diagnosis and treatment in postbulbar perforated peptic ulcer

Catedra chirurgie nr. 2, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Sediul atipic, unde poate apărea ulcerul duodenal perforat şi astăzi continuă a fi o problemă pe cât de stringentă, pe atât şi de actuală. Material şi metode: Lotul de studiu cuprinde 14 bolnavi, spitalizaţi de urgenţă cu suspecţie la ulcer postbulbar perforat, în perioada 2000-2015. În raport cu numărul bolnavilor operaţi (794) pentru ulcer duodenal perforat în această perioadă, ulcerul postbulbar reprezintă un indice de 1,76%. În lot s-a constatat un număr de 10 bărbaţi şi 4 femei, cu vârsta cuprinsă între 41-60 ani. La internare s-a constatat că durerea şi contractura musculară a peretelui abdominal a fost prezentă la 10 din 14 pacienţi, iar la 4 bolnavi tabloul clinic, cât şi examenul radiologic de ulcer perforat au fost absente. Rezultate: Referindu-ne la localizarea ulcerului postbulbar perforat constatăm că în majoritatea cazurilor leziunea a fost situată pe segmentul D1. Dacă la 10 pacienţi simptomatologia clinică şi radio-endoscopică era caracteristică ulcerului perforat, în 4 cazuri semne evidente clinice lipseau, ce ne-a impus la un examen suplimentar, laparoscopia diagnostică, care cu fermitate a constatat perforaţie acoperită. Intervenţiile chirurgicale efectuate la cei 14 pacienţi au fost: simpla suturare a ulcerului – la 8 pacienţi, excizia ulcerului cronic cu piloroduodenoplastie largă asociată cu vagotomie tronculară bilaterală – 6 cazuri, cu rezultate bune precoce şi la distanţă. Concluzii: Perforaţia ulcerului duodenal postbulbar este rară şi are o pondere de 1,76%.Introduction: Atypical headquarters where perforated duodenal ulcer may appear remain a both acute and current problem. Material and methods: The study group includes 14 patients urgently hospitalized with suspected perforated postbulbar peptic ulcer, during 2000-2015 years. In relation to the number of patients operated for perforated duodenal ulcer during this period (n=794) postbulbar ulcer shows the rate of 1.76%. There were 10 men and 4 women, aged 41- 60 years. Ten from 14 patients had pain and muscle tension on admission at the hospital, and in 4 cases there were no clinical and radiological signs of perforation. Results: Referring to location of perforated postbulbar peptic ulcer we can find that in most cases the lesion was located in the segment D1. If clinical, endoscopic and radiological signs in 10 patients were typical for perforated ulcer, in 4 cases obvious clinical signs were missing, and we were imposed to do an additional exam – diagnostic laparoscopy which firmly established the covered perforation. Surgeries performed in the 14 patients were: a simple suturing of the ulcer in 8 patients and chroni c ulcer excision with wide piloro-duodenoplasty associated with bilateral truncal vagotomy – in 6 cases, with good early and late results. Conclusions: Perforation of postbulbar duodenal peptic ulcer is rare and has a rate of 1.76%

Improved flexibility and equity for airspace users during demand-capacity imbalance - an introduction to the user-driven prioritisation process

ATFM slot-swapping represents the first step towards the participation of airspace users (AUs) in air traffic management and airport collaborative processes. SESAR is advancing this through development of the user driven prioritisation process (UDPP) to achieve additional flexibility for AUs to adapt their operations in a more cost-efficient manner in the presence of unforeseen demand and capacity imbalances that require the application of delays to flights. The contribution of this paper is twofold: (i) to present the challenges achieved so far with respect to UDPP concepts, in particular regarding fleet delay apportionment and selective flight protection; (ii) to pave the way towards future UDPP concepts through the introduction of enhanced selective flight protection

Полиорганная недостаточность в хирургии

Department of Surgery N 2, State University of Medicine and Pharmacy "Nicolae Testemitanu"Multiple organ insufficiency syndromes complicate the postoperative evolution in urgent surgery in 10-28% of cases. In purulent complications of acute abdominal inflammatory diseases, its frequency can be up to 60%. Difficulties in appropriate diagnoses and treatment and high lethality, which can be up to 95%, determined the actuality of this study. The main cause of multiple organ insufficiency syndromes are infectious complications, particularly in inadequate management, which cause immune, metabolic, and homeostatic disturbances. Синдром полиорганной недостаточности осложняет течение послеоперационного периода в 10-28% случаев. При гнойных осложнениях острых воспалительных заболеваний органов брюшной полости, частота его достигает 60%. Трудность своевременной диагностики и лечения, высокая летальность, достигающая 95%, обусловили особую актуальность и сложность исследования этой проблемы. Основной причиной развития синдрома полиорганной недостаточности являются инфекционные осложнения, особенно при их несвоевременной диагностике или неадекватном лечении, вызывающие нарушения иммунного статуса больных, метаболизма, а также системы гомеостаза

LARS-like symptoms in the general population may suggest the significance of postoperative functional problems and emotional implications of rectal surgery

Background & Aim. Sphincter-saving rectal surgery is prone to cause changes in bowel function associated with Low Anterior Resection Syndrome (LARS). Our aim was to assess LARS-like symptoms within a population of 50-80-year old in order to understand the functional disturbances and emotional impact of LARS. Materials and methods: We used a questionnaire to evaluate LARS with the following categories of symptoms: flatulence control, anal incontinence, frequency, clustering and urgency of the stools, and the psycho-emotional impact created by the presence of these symptoms. We calculated the severity of LARS on 343 responders. Results. The average age of the responders (57.4% females) was 60 years. Overall, 48.1% of those questioned had no LARS-associated symptoms, while the rest presented either minor (39.9%) or major (12%) LARS-like symptomatology according to the assessment scale. Women have a higher relative risk (1.32) of having minor or major LARS. The frequency of stools did not correlate with the overall LARS score. The psycho-emotional impact was mostly influenced by the presence of incontinence (p=0.001) and urgency (p=0.05). Discussions. The study highlights the need to integrate the initial status of patients into the overall quantification of the effects of surgery on the quality of life. Age does not influence the prevalence of LARS, but symptoms seem more prevalent in women. The psycho-emotional impact is relevant to the general population, so explanations given during the informed consent and accurate description of potential consequences of surgical intervention increase compliance to ensure better post-operative control of the symptomatology. Conclusions. Deriving a normative LARS-like score may alter the interpretation and discussion of LARS scores for future rectal cancer patients, and it also provides a better understanding of the emotional impact of such symptoms on certain population subsets or cultural groups

The biocompatibility of titanium in a buffer solution: compared effects of a thin film of TiO2 deposited by MOCVD and of collagen deposited from a gel

This study aims at evaluating the biocompatibility of titanium surfaces modified according two different ways: (i) deposition of a bio-inert, thin film of rutile TiO2 by chemical vapour deposition (MOCVD), and (ii) biochemical treatment with collagen gel, in order to obtain a bio-interactive coating. Behind the comparison is the idea that either the bio-inert or the bio-active coating has specific advantages when applied to implant treatment, such as the low price of the collagen treatment for instance. The stability in buffer solution was evaluated by open circuit potential (OCP) for medium time and cyclic voltametry. The OCP stabilized after 5104 min for all the specimens except the collagen treated sample which presented a stable OCP from the first minutes. MOCVD treated samples stabilized to more electropositive values. Numeric results were statistically analysed to obtain the regression equations for long time predictable evolution. The corrosion parameters determined from cyclic curves revealed that the MOCVD treatment is an efficient way to improve corrosion resistance. Human dermal fibroblasts were selected for cell culture tests, taking into account that these cells are present in all bio-interfaces, being the main cellular type of connective tissue. The cells grew on either type of surface without phenotype modification. From the reduction of yellow, water-soluble 3-(4,5-dimethyldiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT cytotoxicity test), MOCVD treated samples offer better viability than mechanically polished Ti and collagen treated samples as well. Cell spreading, as evaluated from microscope images processed by the program Sigma Scan, showed also enhancement upon surface modification. Depending on the experimental conditions, MOCVD deposited TiO2 exhibits different nanostructures that may influence biological behaviour. The results demonstrate the capacity of integration in simulated physiologic liquids for an implant pretreated by either method

g factors of coexisting isomeric states in Pb-188

The $g$ factors of the ${12}^{+}$, {11}^{\ensuremath{-}}, and {8}^{\ensuremath{-}} isomeric states in $^{188}\mathrm{Pb}$ were measured using the time-differential perturbed angular distribution method as g({12}^{+})=\ensuremath{-}0.179(6), g({11}^{\ensuremath{-}})=+1.03(3), and g({8}^{\ensuremath{-}})=\ensuremath{-}0.037(7). The $g$ factor of the ${12}^{+}$ state follows the observed slight down-sloping evolution of the $g$ factors of the ${i}_{13/2}^{2}$ neutron spherical states with decreasing $N$. The $g$ factors of the {11}^{\ensuremath{-}} and {8}^{\ensuremath{-}} isomers proposed as oblate and prolate deformed states, respectively, were interpreted within the rotational model, using calculated and empirical $g$ factor values for the involved single-particle orbitals

LARS-like symptoms in the general population may suggest the significance of postoperative functional problems and emotional implications of rectal surgery

Background & Aim. Sphincter-saving rectal surgery is prone to cause changes in bowel function associated with Low Anterior Resection Syndrome (LARS). Our aim was to assess LARS-like symptoms within a population of 50-80-year old in order to understand the functional disturbances and emotional impact of LARS. Materials and methods: We used a questionnaire to evaluate LARS with the following categories of symptoms: flatulence control, anal incontinence, frequency, clustering and urgency of the stools, and the psycho-emotional impact created by the presence of these symptoms. We calculated the severity of LARS on 343 responders. Results. The average age of the responders (57.4% females) was 60 years. Overall, 48.1% of those questioned had no LARS-associated symptoms, while the rest presented either minor (39.9%) or major (12%) LARS-like symptomatology according to the assessment scale. Women have a higher relative risk (1.32) of having minor or major LARS. The frequency of stools did not correlate with the overall LARS score. The psycho-emotional impact was mostly influenced by the presence of incontinence (p=0.001) and urgency (p=0.05). Discussions. The study highlights the need to integrate the initial status of patients into the overall quantification of the effects of surgery on the quality of life. Age does not influence the prevalence of LARS, but symptoms seem more prevalent in women. The psycho-emotional impact is relevant to the general population, so explanations given during the informed consent and accurate description of potential consequences of surgical intervention increase compliance to ensure better post-operative control of the symptomatology. Conclusions. Deriving a normative LARS-like score may alter the interpretation and discussion of LARS scores for future rectal cancer patients, and it also provides a better understanding of the emotional impact of such symptoms on certain population subsets or cultural groups