Redefining the Epigravettian and Epipalaeolithic in the Rock Shelter of Cuina Turcului (the Iron Gates Gorges of the Danube, Romania), with Special Emphasis on Art Objects

The Cuina Turcului rock shelter is located on the Romanian bank of the Iron Gates Gorges of the Danube. Archaeological investigations conducted in the 1960’s revealed, in the lower part of the deposit, the existence of two habitation levels, whose cultural definition has changed several times over the years. Due to lithic material features, hard animal materials, C-14 dates and especially personal ornaments and art object, we consider that the first layer belongs to the Epigravettian and the second to the Epipalaeolithic. The richness, diversity and particularities of portable art in the Epigravettian layer I justifies its defining as a regional independent facies, called Clisurean.L’abri sous roche de Cuina Turcului est situé sur la rive roumaine du Défilé des Portes de Fer du Danube. Les fouilles archéologiques entreprises dans les années soixante du XXe siècle écoulé ont mis en évidence l’existence, dans la partie inférieure du gisement, de deux niveaux d’habitation dont l’identification culturelle a, depuis, été corrigée plusieurs fois. Compte tenu des caractéristiques du matériau lithique, du MDA, des datations C-14 et notamment des parures et des objets d’art, nous considérons que la première couche appartient à l’Épigravettien, alors que la deuxième couche appartient à l’Épipaléolithique. La richesse, la diversité et les particularités de l’art mobilier en particulier provenant de la couche de l’Épigravettien I justifie la définition de celui-ci comme un faciès régional distinct, appelé Clisurean

The modern concept in the evaliation of economic effciency for gastrointestinal surgery

Catedra Chirurgie nr. 1 „Nicolae Anestiadi”, Laboratorul Chirurgia Hepato-Pancreato-Biliară USMF „Nicolae Testemiţanu”Safety and efficacy are not the only parameters of interest in the choice of medical technology – costs are playing an increasingly important role. There is growing interest in “value for money”, which can be assessed economically by comparing the costs and consequences of alternative courses of action. A number of different economic evaluation methods may be used: cost-minimization (only costs examined with no consideration given to consequences); cost-effectiveness (in which a unidimensional clinical outcome is assessed, for example, life-years gained); cost-utility (multidimensional outcomes measured, for example quantity and quality of life); and cost-benefit (where outcome is considered in monetary terms). În alegerea tehnologiei medicale securitatea şi eficacitatea nu sunt indicii unice, cheltuielile joacă un rol excepţional de important. Astfel creşte interesul în ce priveşte „raportul între calitate şi preţ”, ce poate fi apreciat din punct de vedere economic, făcând comparaţia cheltuielilor şi consecinţelor al intervenţiilor medicale alternative. Pot fi utilizate o mulţime de diferite metode economice de evaluare: minimizarea costurilor (numai cheltuielile, investigate fără cercetarea consecinţelor; cost - eficacitate (aprecierea rezultatul clinic unidimensional, ca exemplu – obţinute anii de viaţă); cost - utilitate (rezultate clinice multidimensionale, ca exemplu cantitatea şi calitatea vieţii); şi cost - beneficiu (rezultatul este prevăzut în forma monetară)

Posttraumatic splenic pseudocyst

Department of Surgery no.1 Nicolae Anestiadi Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. Posttraumatic splenic pseudocyst is a rare complication of splenic trauma. In the specialized anglo-saxon literature, the unique cases of formation of the posttraumatic splenic pseudocyst are described. Case report. The 65-year-old female patient is admitted to the Emergency Medicine Institute of Chisinau, the Department of Surgery no.1, presenting abdominal pain in the left hypochondrium with ascending irradiation. From her personal history we note: 4 months ago she suffered a trauma by falling down in the mountains, falling from her own height on a stonebench. At the primary consult, she was examined clinically and paraclinically, the home patient monitoring was prescribed. For 3 months the patient undergoes an imaging examination (USG, Angio-CT), but without establishing a definitive treatment behavior. At the onset of symptoms, she is hospitalized and repeatedly undergoes a laboratory and imaging examination. Results. Imaging investigations indicated a giant posttraumatic splenic pseudocyst, located on the diaphragmatic surface of the spleen, with dimensions 141x90x118mm and volume ~ 750ml, with hyperechogenic, fibrinous, polymorphous, floating elements, the biological picture is not relevant. Laparoscopic surgery - pericystectomy with spleen preservation was performed. Postoperative evolution was favorable. Conclusions. The posttraumatic pseudocyst may be a consequence of the nonoperative attitude of the traumatic spleen injuries, its evolution requiring careful clinical and imaging monitoring in the dynamic. Laparoscopic surgical resolution presents a safe solution, as an alternative for posttraumatic splenic pseudocysts, the spleen preservation remaining the main objective of the treatment

Corp strain (baterie) in tractul gastrointestinal.

Ingestia de corpi străni (baterii) reprezintă o situaţie clinică obişnuită întâlnită la pacienţii pediatrici. În majoritatea cazurilor bateriile trec facil prin tractul gastrointestinal şi sunt eliminate în mod spontan fără a provoca careva leziuni, totuşi în literatura de specialitate sunt descrise cazuri de complicaţii potenţial fatale provocate de bateriile blocate în tractul gastrointestinal. Ingestia corpilor străini de către adulţi este rară, în majoritatea cazurilor fi ind vorba de pacienţi psihiatrici sau accidente. Prezentăm cazul clinic al unei paciente care a ingerat accidental o baterie, blocată la nivel de joncţiune ileo-cecală, fi ind necesară extragerea chirurgicală a acesteia pentru a evita o eventuală complicaţie. Cuvinte-cheie: corp străin, baterie, tub digestiv

Vagotomia laparoscopică – avantaje şi perspective în tratamentul maladiei ulceroase

Autorii prezintă un studiu clinic prospectiv realizat pe un lot de pacienţi cu boala ulceroasă, spitalizaţi în secţiile de chirurgie ale CNPŞDMU, operaţi prin diferite tipuri de vagotomie laparoscopică. Analiza clinică confi rmă că vagotomia laparoscopică este o metodă efi cientă de tratament, care reduce durata de spitalizare a pacientului, fi ind posibilă o reluare rapidă a tranzitului intestinal, iar complicaţiile postoperatorie sunt reduse

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

Laparoscopia „trează” în algoritmul diagnostico-curativ al pacienţilor asimptomatici cu traumatism abdominal deschis

În lucrarea de faţă autorii prezintă rezultatele utilizării laparoscopiei la 77 de pacienţi asimptomatici cu traumatism abdominal deschis. Este examinată informativitatea metodei în vizualizarea leziunilor intraabdominale şi acurateţea acesteia în stabilirea indicaţiilor pentru laparotomie. În fi nal se argumentează utilitatea practică şi limitele metodei în abordarea pacienţilor cu acest gen de traumatism

A Middle Palaeolithic wooden digging stick from Aranbaltza III, Spain

Aranbaltza is an archaeological complex formed by at least three open-air sites. Between 2014 and 2015 a test excavation carried out in Aranbaltza III revealed the presence of a sand and clay sedimentary sequence formed in floodplain environments, within which six sedimentary units have been identified. This sequence was formed between 137±50 ka, and includes several archaeological horizons, attesting to the long-term presence of Neanderthal communities in this area. One of these horizons, corresponding with Unit 4, yielded two wooden tools. One of these tools is a beveled pointed tool that was shaped through a complex operational sequence involving branch shaping, bark peeling, twig removal, shaping, polishing, thermal exposition and chopping. A use-wear analysis of the tool shows it to have traces related with digging soil so it has been interpreted as representing a digging stick. This is the first time such a tool has been identified in a European Late Middle Palaeolithic context; it also represents one of the first well-preserved Middle Palaeolithic wooden tool found in southern Europe. This artefact represents one of the few examples available of wooden tool preservation for the European Palaeolithic, allowing us to further explore the role wooden technologies played in Neanderthal communities