Gastroduodenal ulcer with bleeding – a reconsideration of therapy

Spitalul Clinic de Urgență Sfântul Pantelimon, București, România, 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 2011Introducere: Complicația hemoragică a ulcerului gastroduodenal cunoaște o incidența în creștere în ultimii ani. Studiul își propune reevaluarea atitudinii terapeutice în cazul ulcerului gastroduodenal hemoragic, cu stabilirea unor criterii de gravitate în care intervenția chirurgicală se impune. Material si metode: Studiul analizează retrospectiv un număr de 337 de pacienți cu diagnosticul de ulcer gastroduodenal hemoragic, internați și tratați în Clinica Chirurgie a Spitalului Clinic de Urgență „Sf. Pantelimon”, în decurs de 3 ani, în perioada ian. 2008 – dec. 2010. S-au analizat datele din foile de observație, protocoale operatorii, rezultate histopatologice. Rezultate: Majoritatea hemoragiilor digestive superioare de cauză ulceroasă au fost rezolvate cu tratament medicamentos (278 bolnavi). La restul de 59 de pacienți a fost necesar un tratament chirurgical, dintre care la 43 pacienți intervenția a fost impusă de pierderea de sânge ce amenință viața, iar la 16 pacienți intervenția a fost impusă de criteriile de gravitate/criteriile prognostice: repetarea sângerarii la scurt timp, criterii endoscopice de gravitate, grupa de sânge rară, etc. La 32 de bolnavi s- au practicat rezecții gastrice subtotale cu diferite tipuri de anastomoză iar în 27 de cazuri s-a practicat ulceroexcizie și hemostaza in situ. Concluzii: Evoluția ascendentă a terapiei farmacologice și endoscopice a scăzut semnificativ necesitatea intervențiilor chirurgicale. Intervenția chirurgicală rămâne mijloc terapeutic util în cazurile cu sângerare masivă și în cazurile neglijate terapeutic.As a complication of gastroduodenal ulcer, bleeding is more and more frequent. The study aims to reevaluate the therapeutic approach together with the development of criteria recommending surgery. Material and methods: The study evaluates 337 patients diagnosed with gastroduodenal ulcer, complicated with bleeding, between January 2008 and December 2010. Data was collected from patient charts, operative recordings, histopathological results. Results: The majority of upper GI bleeding, following the development of an ulcer was managed with medical therapy (278 patients). The remaining 59 patients required surgery, imposed in 43 cases by life threatening blood loss, and in 16 by gravity/prognostic criteria: frequent recurrence of bleeding, endoscopic gravity criteria, rare blood group, etc. Subtotal gastrectomy with various types of anastomosis was performed in 32 cases while in the remaining 27 cases we performed the excision of the lesion and in situ hemostasis. Conclusions: The evolution of pharmacological and endoscopic management significantly reduced the necessity for surgery. Surgery remains a useful therapeutic tool in cases with massive bleeding and in neglected cases

THE STUDY OF ACCLIMATIZATION OF GRAPES OF MEDITERRANEAN ORIGIN TO THE WEATHER CONDITIONS OF THE WINE-GROWING REGIONS OF SEGARCEA

This study was carried out during 2019-2020 on plots belonging to the wine-growing areas of Segarcea, famous wine areas in point of extracting red wine with remarkable qualities in the south of the country. The significance of the work consists in improving the useful climate of the wi ne area of Segarcea by introducing into the culture beside black grapes varieties, renowned varieties like Feteascăneagră, Merlot, Cabernet-Sauvignon, Pinot noir, etc., other grape varieties of Mediteranean origin, such as Syrah and Marselan. The aim is to rigorously monitor the weather conditions with a direct impact on the soils with a production potential, observing the dynamics of its establishment and maturation index for each variety during the period studied

Carotid paragangliomas: case report and imaging review

Background: Presentation of case reviews depicting the imaging characteristics of carotid paragangliomas, associated with a thorough analysis of the anatomical morphological features and the current therapeutic strategies.Materials and methods: We present the cases of 3 patients diagnosed with carotid paragangliomas in our clinic, illustrating diagnostic imaging elements by computer tomography (CT) and magnetic resonance imaging (MRI), but also the postoperative aspect of the carotid system, with respective anatomical, clinical and surgical considerations.Results: The imaging aspect of the carotid paragangliomas is characterised by a mass of soft tissue with intense contrast enhancement and with “salt and pepper” MRI appearance on conventional spin-echo sequences. The postoperative evolution of the patients included in the article was favourable, without any perioperative complications or signs of local tumour recurrence.Conclusions: Carotid paragangliomas are rare, often asymptomatic tumours, but with potential for increased malignancy, which raises the need for good knowledge of the cervical region pathology as well as the features of neuroendocrine tumours. CT and MRI examinations are essential for diagnosis, staging and, implicitly, for establishing the therapeutic strategy

Current management of abdominal stab wounds

Spitalul Clinic de Urgență ”Sfântul Pantelimon”, București, România, 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 2011Cunoscând faptul că atitudinea de management selectiv non-operativ a devenit un standard pentru plăgile înjunghiate, studiul nostru și-a propus validarea atitudinii diferențiate față de plăgile înjunghiate ale abdomenului anterior. Materiale și metodă: Studiul este descriptiv, retrospectiv, analiza fiind centrată pe o experiență de 11 ani (2000-2010) cuprinzând 64 cazuri de plăgi abdominale anterioare. Media de vârstă a lotului studiat a fost de 32 ani (17-65), lot alcătuit din 41 bărbați, 23 femei. Etiologia a fost la toate cazurile reprezentată de agresiune fizică cu armă albă. Rezultate: 48 cazuri (75%) au fost supuse laparotomiei exploratorii immediate datorită semnelor de iritație peritoneală, instabilității hemodinamice sau semnelor paraclinice (hemogramă, biochimie, ecografie abdominală, CT) ce sugerau leziuni de organ. 16 cazuri (25%) au fost monitorizate clinic și imagistic, laparotomia exploratorie fiind necesară în 3 cazuri. Mortalitatea a fost nulă, morbiditatea de aproximativ 18% a inclus supurații parietale, 1 relaparotomie pentru hemostază suplimentară într-o plagă hepatică. Durata spitalizării fost similară la pacienții operați și la cei tratați non- operativ. Concluzii: Studiul relevă că nu s-a înregistrat morbiditate majoră prin acest abord selectiv, pacienții supuși laparotomiei tardive fiind fără risc vital. Aceste observații confirmă concluziile din literatură, și anume faptul că o perioadă de observație de 24 ore este adecvată pentru această patologie.Selective, non-operative management is now a standard for the management of abdominal stab wounds. Our study wishes to validate the differentiated approach to stab wounds of the anterior abdomen. Materials and method: Our study is descriptive and retrospective, centering on an eleven year experience (2000-2010), comprising of 64 abdominal stab wounds. The studied population was made up of 41 male and 23 female, with a median age of 32. All wounds were produced by stabbing. Results: 48 cases (75%) were subjected to immediate surgery because of the presence of peritonitic signs, hemodynamic instability or explorations that suggested organ injury (CBC, biochemistry, abdominal ultrasound, computed tomography). 16 cases (25%) were monitored clinically and by imaging studies, exploratory laparotomy being needed in only 3 of these cases. We recorded no fatalities, and overall morbidity was around 18% (surgical site infections, and one reintervention for supplementary hemostasis in a liver laceration). Duration of hospital stay was constant. Conclusions: Our study shows that the selective approach did not lead to major morbidity, the patients subjected to late laparotomy presenting no major or life threatening complications. Our observations confirm the recent consensus, stating that a 24 hour surveillance period is adequate for this pathology

Complicated small bowel tumors – limits and possibilities in emergency

Spitalul Clinic de Urgență ”Sfântul Pantelimon”, București, România, 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 2011Tumorile intestinului subțire sunt rare, reprezentând aproximativ 1-2% din neoplasmele gastrointestinale. Prognosticul lor este rezervat din cauza diagnosticului dificil preoperator și descoperirea lor în stadii avansate, însoțite frecvent de complicații. Materiale și metodă: Studiul este descriptiv, retrospectiv, efectuat pe o perioadă de 5 ani (2006-2010) și include 13 bolnavi operați în clinica noastră. Studiul evaluează elementele demografice ale lotului, mijloacele diagnostice folosite și eficiența lor și atitudinea terapeutică. Rezultate: Lotul a fost alcătuit din 13 bolnavi cu o medie de vârstă de 66 de ani, dintre care 8 de sex masculin și 5 de sex feminin. Cazurile au fost internate în regim de urgență datorită complicațiilor: 8 bolnavi s-au prezentat în ocluzie intestinală, 4 bolnavi s-au prezentat cu anemie severă și hematochezie sau melenă, iar 1 caz a prezentat pneumoperitoneu. Radiografia abdominală simplă a indicat intervenția chirurgicală de urgență în 9 cazuri (prezența de nivele hidro-aerice sau pneumoperitoneu) fără să aducă informații suplimentare legate de etiologie, stadiu evolutiv. Endoscopia digestivă superioară a exclus patologia gastro-duodenală la bolanvii prezentați cu hemoragie digestivă. La acești bolnavi intervenția chirurgicală a fost recomandată de cantitatea mare de transfuzii necesară pentru menținerea hemodinamică a bolnavilor. Soluția terapeutică a fost reprezentată de enterectomia segmentară și anastomoză primară în 13 cazuri și colectomie asociată în două cazuri; în două cazuri a fost necesară o derivație digestivă, în amonte, de protecție. 4 cazuri au prezentat metastaze la distanță. Concluzii: În ciuda arsenalului diagnostic și imagistic existent, diagnosticul tumorilor de intestin subțire se pune în majoritatea cazurilor la momentul explorării chirurgicale. Prezența complicațiilor îngreunează actul chirurgical și managementul postoperator al bolnavului, mărind mortalitatea.Small bowel tumors are a rare entity, accounting for about 1-2% of gastrointestinal tumors. Their prognosis is poor because of the difficult preoperative diagnosis and their discovery in advanced stages, frequently associated with complications. Materials and method: The study is descriptive, retrospective, over a 5 year period (2006- 2010) and includes 13 patients operated on in our clinic. The study evaluates the demographical characteristics of the group, the diagnostic tools that were used and the therapeutic approach. Results: The group was made up of 13 patients, with an average age of 66 years, 8 male and 5 female. The cases were admitted on arrival because of complications: 8 patients presented with intestinal obstruction, 4 with severe anemia and melena or hematochezia and one patient presented with pneumoperitoneum. Plain abdominal x-rays prompted immediate surgery in 9 cases (free air under the diaphragm or air-fluid levels) without bringing further information regarding etiology or disease stage. Upper gastrointestinal endoscopy excluded gastro-duodenal pathology in the patients presented with digestive bleeding. Surgery was performed, in these patients, owing to the large amount of blood transfusion necessary to stabilize them. The procedure performed was segmentary enterectomy with primary anastomosis in 13 patients, associated with colectomy in 2 cases; in two cases we associated a by-pass of the tumoral segment. Metastatic disease was found in four patients. Conclusions: Despite the sophisticated imaging and diagnostic modalities, diagnosis of a small bowel tumor is often achieved only at the time of surgical exploration. The presence of complications makes surgical and postoperative therapy difficult and increases mortality

The employee as 'Dish of the Day’:human resource management and the ethics of consumption

This article examines the ethical implications of the growing integration of consumption into the heart of the employment relationship. Human resource management (HRM) practices increasingly draw upon the values and practices of consumption, constructing employees as the ‘consumers’ of ‘cafeteria-style’ benefits and development opportunities. However, at the same time employees are expected to market themselves as items to be consumed on a corporate menu. In relation to this simultaneous position of consumer/consumed, the employee is expected to actively engage in the commodification of themselves, performing an appropriate organizational identity as a necessary part of being a successful employee. This article argues that the relationship between HRM and the simultaneously consuming/consumed employee affects the conditions of possibility for ethical relations within organizational life. It is argued that the underlying ‘ethos’ for the integration of consumption values into HRM practices encourages a self-reflecting, self-absorbed subject, drawing upon a narrow view of individualised autonomy and choice. Referring to Levinas’ perspective that the primary ethical relation is that of responsibility and openness to the Other, it is concluded that these HRM practices affect the possibility for ethical being

Applications of Hilbert Module Approach to Multivariable Operator Theory

A commuting $n$-tuple $(T_1, \ldots, T_n)$ of bounded linear operators on a Hilbert space \clh associate a Hilbert module $\mathcal{H}$ over $\mathbb{C}[z_1, \ldots, z_n]$ in the following sense: $$\mathbb{C}[z_1, \ldots, z_n] \times \mathcal{H} \rightarrow \mathcal{H}, \quad \quad (p, h) \mapsto p(T_1, \ldots, T_n)h,$$where $p \in \mathbb{C}[z_1, \ldots, z_n]$ and $h \in \mathcal{H}$. A companion survey provides an introduction to the theory of Hilbert modules and some (Hilbert) module point of view to multivariable operator theory. The purpose of this survey is to emphasize algebraic and geometric aspects of Hilbert module approach to operator theory and to survey several applications of the theory of Hilbert modules in multivariable operator theory. The topics which are studied include: generalized canonical models and Cowen-Douglas class, dilations and factorization of reproducing kernel Hilbert spaces, a class of simple submodules and quotient modules of the Hardy modules over polydisc, commutant lifting theorem, similarity and free Hilbert modules, left invertible multipliers, inner resolutions, essentially normal Hilbert modules, localizations of free resolutions and rigidity phenomenon. This article is a companion paper to "An Introduction to Hilbert Module Approach to Multivariable Operator Theory".Comment: 46 pages. This is a companion paper to arXiv:1308.6103. To appear in Handbook of Operator Theory, Springe