The surgical treatment of patients with adrenal tumors

USMF “N. Testemițanu”, Catedra Chirurgie nr 2, 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. Conform datelor OMS ponderea tumorilor suprarenale constitue 0,6%. Conduita terapeutică şi chirurgicală a acestor pacienți depinde de natura acestora, dimensiunile şi rezultatele analizelor histologice, respectând criteriile de diagnostic şi tratament pre- şi postoperatoriu. Scopul lucrării - aprecierea particularităților clinico-paraclinice si elaborarea tratamentului contemporan al pacienților cu tumori suprarenale. Material şi metode. Studiul este bazat pe un lot ce cuprinde 116 pacienți tratați în Clinica Chirurgie nr. 2, USMF „N.Testemițanu” pe parcursul anilor 1996-2011, din care 20(26,72%) cu aldosterom, 15(12,93%) cu corticosterom, 16(13,79%) cu feocromocitom, 10(8,62%) cu androsterom şi 44(37,93%) cu tumori hormonal-inactive. Raportul pe sexe indică predominarea sexului feminin (85 de bolnave, 73,28%) față de cel masculin (31 pacienți, 26,72%), vârsta medie constituind 36,7 ± 1,3 ani. Prin abord laparoscopic au fost operați 34(29,31%), prin abord deschis- 82(70,68%) bolnavi. Rezultate. S-a propus un algoritm contemporan de diagnostic în baza căruia s-au stabilit indicațiile pentru tehnicile adrenalectomiei. În adrenalectomia deschisă s-au constatat: complicații intraoperatorii - 6(7,3%) cazuri, în adrenalectomii laparoscopice - 0 cazuri; complicații postoperatorii în AED - 7 (7,6%) cazuri, în AEL - 1 (1,09%) cazuri, pierderi sanguine în AED -350±50ml, în AEL - 80±10ml; durata spitalizării după operație în AED - 7 (5-16) zile, în AEL - 3 (3-4) zile; necesitatea postoperatorie a opioidelor în AED - 2 (1-3) zile, AEL - 0,5 zile. Conform valorilor postoperatorii ale TA, rezultate bune s-au înregistrat la 18(46,15%) bolnavi, satisfăcătoare s-au atins la 20 (51,28%) bolnavi; iar rezultate nesatisfăcătoare – la 1 (2,56%) pacient. Concluzii. Rezultatele obținute demonstrează corectitudinea programului propus de diagnostic şi tratament chirurgical al bolnavului cu formațiuni de volum suprarenale, iar alegerea corectă a accesului chirurgical în adrenalectomie este imperativă pentru reducerea traumatismului intraoperatoriu şi reabilitarea mai curândă a pacienților adrenalectomizați, AEL fiind prioritară atât din punct de vedere chirurgical, cât şi socioeconomic. Introduction.Recording WHO data, the adrenal tumors represent 0,6 % from all tumors. The surgical approach and therapy depends on nature of them, and histological results, without miss the diagnostic criteria and pre- and postoperative treatment. The goal of the study was appreciation of the clinical particularities and to propose a modern surgical treatment to the patients with adrenal tumors. Material and methods. The article is based on a study which included 116 patients treated in Clinic of Surgery 2 of State Medical University ”N. Testemitanu” during the period of 1996-2011 years, 20(26,72%) of them were with aldosteromas, 15(12,93%) with corticosteromas, 16(13,79%) pheochromocytomas, 10(8,62%) with androsteromas and 44(37,93%) patients with non-active tumors. The sex ratio demonstrated female predomination (85 patients, 73,28 %) versus male (31 patients, 26,72%), the age 36,7 ± 1,3 years. Were performed adrenalectomy by transabdominal approach in 82(70, 68%) cases, laparoscopic adrenalectomy in 34(29, 31%) cases. Results. A contemporary diagnostic algorithm was proposed which established the indications for adrenalectomy techniques. In open adrenalectomia there were operative complications in 6(7,3%) cases, in laparoscopic adrenalectomia - 0 cases; postoperative complications were established in OAE - 7 (7,6%) cases, in LAE - 1 (1,09%) cases; blood loss in OAE -350±50ml, in LAE - 80±10ml; the length of hospital stay in OAE - 7 (5- 16) days, in LAE - 3 (3-4) days, postoperative pain medication in OAE - 2 (1-3) days in LAE - 0,5 days. Good results were assessed in 18 (46,15 %) patients, satisfactory results were achieved in 20(51.28%) patients, and unsatisfactory results at 1 (2.56%) patient. Conclusions. The results demonstrate the correctness of the proposed program of diagnosis and surgical treatment of the patient with adrenal tumors, it is very important to select the correct surgical approach for adrenal removed to minimize the operative trauma and quicker return to normal activity of patients, and laparoscopic approach is preferred by surgical and economical point of view

A Compost Treatment Acts as a Suppressive Agent in Phytophthora capsici – Cucurbita pepo Pathosystem by Modifying the Rhizosphere Microbiota

Phytophthora capsici Leonian (PHC) is a filamentous pathogen oomycete that causes root, fruit, foliar and crown rot over a wide host range, including the economically and nutritionally important summer squash (Cucurbita pepo var. cylindrica L.) crop. PHC chemical control strategies are difficult to adopt, due to the limited number of registered chemicals that are permitted and the scalar harvest system. For these reasons, other strategies, such as the use of waste-based composts that can act as suppressive agents against several soilborne pathogens, have been studied intensively. It is well known that compost’s microbiota plays an important role to confer its suppressive ability. In this study, four different composts were analyzed with both 16S rRNA gene and 18S rRNA gene real-time PCR amplification and with 26S gene amplicon-based sequencing; the total abundance of the bacterial and fungal communities was found to be higher compared to literature, thus confirming that the four composts were a good inoculum source for agricultural applications. The core mycobiota was mainly composed of 31 genera; nevertheless, it was possible to observe a clear predominance of the same few taxa in all the composts. The four composts were then tested, at different concentrations (1–10–20% v/v), to establish their ability to confer suppressiveness to the Phytophthora capsici (PHC) – Cucurbita pepo pathosystem in controlled greenhouse pot trials. A total of 12 compost mixtures were considered, and of these, one (Trichoderma-enriched compost at 10% v/v) was able to statistically reduce the disease incidence caused by PHC (by 50% compared to the untreated control). Hence, the microbiota composition of the most effective compost treatment was investigated and compared with untreated and chemical (metalaxyl) controls. Mycobiota sequencing showed genera differences between the three treatments, with relative abundances of several fungal genera that were significantly different among the samples. Moreover, PCA analyses clustered the compost treatment differently from the chemical and the untreated controls. These findings suggest that suppressive activity of a compost is strictly influenced by its microbiota and the applied dosage, but the ability to induce a shaping in the rhizosphere microbial composition is also required

Wess-Zumino sigma models with non-Kahlerian geometry

Supersymmetry of the Wess-Zumino (N=1, D=4) multiplet allows field equations that determine a larger class of geometries than the familiar Kahler manifolds, in which covariantly holomorphic vectors rather than a scalar superpotential determine the forces. Indeed, relaxing the requirement that the field equations be derivable from an action leads to complex flat geometry. The Batalin-Vilkovisky formalism is used to show that if one requires that the field equations be derivable from an action, we once again recover the restriction to Kahler geometry, with forces derived from a scalar superpotential.Comment: 13 pages, Late

Study of the Reliability of Statistical Timing Analysis for Real-Time Systems

Presented at 23rd International Conference on Real-Time Networks and Systems (RTNS 2015). 4 to 6, Nov, 2015, Main Track. Lille, France.Probabilistic and statistical temporal analyses have been developedas a means of determining the worst-case execution and responsetimes of real-time software for decades. A number of such methodshave been proposed in the literature, of which the majority claim tobe able to provide worst-case timing scenarios with respect to agiven likelihood of a certain value being exceeded. Further, suchclaims are based on either some estimates associated with a probability,or probability distributions with a certain level of confidence.However, the validity of the claims are very much dependent on anumber of factors, such as the achieved samples and the adopteddistributions for analysis.In this paper, we investigate whether the claims made are in facttrue as well as the establishing an understanding of the factors thataffect the validity of these claims. The results are of importancefor two reasons: to allow researchers to examine whether there areimportant issues that mean their techniques need to be refined; andso that practitioners, including industrialists who are currently usingcommercial timing analysis tools based on these types of techniques,understand how the techniques should be used to ensure theresults are fit for their purposes

Prognostic factors in atypical meningiom

Atypical meningioma represent an intermediary group between the benign meningioma (grade I) and anaplastic meningioma (grade III), and are known for high recurrence rate and short life expectancy. After modification of the classification World Health Organization in 2007, subsequent studies have tried to find prognostic factors for recurrence and survival, which are inconstant from author to author. This paper aims to present a short review of the most important prognostic factors in atypical meningioma

Paricularități de diagnostic în ulcerele gastroduodenale pe fundal de ciroză hepatică

Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction Problemele chirurgiei gastroduodenale pe fundalul patologiilor hepatice cronice de-a lungul anilor impun multiple discuții interdisciplinare legate de diagnostic si tratament. Complicațiile ulcerelor gastroduodenale la pacienții cirotici până-n prezent determină discuții majore a morbidității și mortalității atât pre- cât și postoperatorii. Foarte frecvent simptomatologia primară la pacienții cirotici cu ulcere hepatogene este hemoragia gastroduodenală – fenomen ce impune fificultăți chirurgicale majore. Material and methods În studiu au fost incluși 15 bolnavi cirotici internați în mod urgent în Clinica Chirurgie Nr 2 fiind diagnosticați cu hemoragie ulceroasă gastroduodenală. Ciroza hepatică a fost confirmată conform datelor cartelei de ambulator sau diagnosticată folosind metode clinice, biochimice și histologice. Tot lotul de bolnavi la momentul internării a fost investigat endoscopic, unde la FEGDS în 100% cazuri a fost stabilit ulcer gastric sau duodenal complicat cu hemoragie. Results . În aprecierea stării morfofuncţionale a stomacului și duodenului au fost folosite următoarele metode diagnostice: FEGDS, rhoentghenoscopia stomacului şi duodenului, duodenografia. Din toţi pacienţii investigaţi au fost 11 bolnavi cu anamneză ulceroasă și 4 bolnavi cu ulcere gastroduodenale primar depistate. La 8 pacienți (6 bolnavi cu anamneză ulceroasă și 2 cu ulcere primar depistate) după stoparea medicamentoasă a hemoragiei, în timpul FEGDS de control au fost prelevate câte 3 – 4 bioptate din regiunea antrumului (curbura mică) pentru a identifica H.pylori. În urma sintezei rezultatelor obţinute am determinat la 6 pacienți (2 cu ulcere primare și 4 cu ulcere gastroduodenale în anamneză) testul pozitiv la H.Pylori. Conclusions diagnosticul precoce a H.pylori la pacienții cu patologii hepatice cronice va avea un efect curativ benefic, deoarece această infecție rămâne a fi un factor de risc suplimentar în geneza hemoragiilor ulceroase gastroduodenale la pacienții cirotici

From de Sitter to de Sitter

We obtain D=6, N=(1,1) de Sitter supergravity from a hyperbolic reduction of the massive type IIA* theory. We construct a smooth cosmological solution in which the co-moving time runs from an infinite past, which is dS_4\times S^2, to an infinite future, which is a dS_6-type spacetime with the boundary R^3\times S^2. This provides an effective four-dimensional cosmological model with two compact extra dimensions forming an S^2. Interestingly enough, although the solution is time-dependent, it arises from a first-order system via a superpotential construction. We lift the solutions back to D=10, and in particular obtain two smooth embeddings of dS_4 in massive type IIA*, with the internal space being either H^4\times S^2 or an H^4 bundle over S^2. We also obtain the analogous D=5 and D=4 solutions. We show that there exist cosmological solutions that describe an expanding universe with the expansion rate significantly larger in the past than in the future.Comment: Latex three times, 22 pages, references adde

Minimally invasive surgical treatment of algic syndrome of advanced pancreatic cancer and chronic relapsing pancreatitis

Catedra 2 Chirurgie, LCȘ „Chirurgie Reconstructivă a Tractului Digestiv”, USMF “Nicolae Testemițanu”, SCR Chișinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Sindromul algic refractar la tratamentul antalgic în cancerul pancreatic nerezecabil (CPN), pancreatita cronică (PC) severă, statusul biologic precar al pacientului în cazurile în care o intervenție cu viză patogenică este contraindicată impun intervenții chirurgicale limitate la paliația durerii. Scop: Evaluarea splanhnicectomiei toracoscopice (SPLT) în tratamentul sindromului de durere în PC recidivantă și CPN. Material și metode: Studiul include 18 (23,08%) pacienți cu PC, 36 (46,15%) pacienți cu PC recidivantă și 21 (26,92%) pacienți cu CPN, 3 (3,85%) pacienți cu cancer cu localizare nepancreatică nerezecabil, desfăsurat în perioada anilor 2008-2014 în Clinica 1 din cadrul Catedrei 2 Chirurgie. Lotul de pacienți cu PC a inclus 47 (87,04%) bărbați și 7 (12,86%) femei, vârsta medie – 52,2 ani (limitele: 28-72 ani). Lotul de pacienți cu CPN – 19 (90,91%) bărbați, 2 (9,09%) femei, vârsta medie – 58 ani (limitele: 45-78 ani). Rezultate: S-au practicat 62 (79,49%) SPLT pe stînga, 12 (15,38%) SPLT pe dreapta. Patru (5,13%) pacienți au necesitat și SPLT dreaptă la 8 săptămâni după SPLT stângă datorită răspunsului terapeutic minimal. Efectul analgetic pe termen scurt (<3 luni) este denotat de eficacitate în 54 (100%) cazuri de PC recidivantă și 20 (83,3%) cazuri de CPN. Între 3-6 luni eficacitatea analgeziei s-a menținut la 36 (66,6%) cazuri de PC recidivantă (continuând ulterior după 6 luni) și 16 (67%) cazuri de CPN. Mortalitatea perioperatorie a fost 0. Spitalizarea medie postoperatorie a fost de 3,3 zile (2-5 zile). Concluzii: SPLT este o procedură paliativă, fezabilă, sigură, ce prezintă avantajele abordului minim invaziv în special în lipsa de complicații, și implicit costuri mai mici în controlul durerii din CPN și PC refractară la tratamentul antalgic conservator. Protezarea endoscopică și SPLT reprezintă soluții miniinvazive cu implicații asupra ratei de supraviețuire în cazurile de CPN complicat cu icter mecanic.Introduction: Refractory algic syndrome to analgesic treatment in unresectable pancreatic cancer (CPN), severe chronic pancreatitis (CP), the precarious biological status of the patient in cases where surgery is contraindicated, require procedures that are limited to pain palliation. Purpose: The rating of thoracoscopic splanchnicectomy (SPLT) in the treatment of pain syndrome in relapsing CP and CPN. Material and methods: The study includes 18 (23.08%) patients with CP, 36 (46.15%) patients with relapsing CP and 21 (26.92%) patients with CPN 3 (3.85%) patients with unresectable cancer, held during the years 2008-2014 in the Clinic N 1. The patients with CP included 47 (87.04%) men and seven (12.86%) women, the average age – 52.2 years (28-72 years). The patients with CPN – 19 (90.91%) men and two (9.09%) women, average age – 58 years (within 45-78 years). Results: There were performed 62 (79.49%) left SPLT, 12 (15.38%) right SPLT. Four (5.13%) patients also required SPLT on the right on 8 weeks after SPLT on the left due to the minimal therapeutic response. The analgesic effect on short-term (<3 months) had an efficacy in 54 (100%) relapsing CP cases and 20 (83.3%) cases of CPN. Between 3-6 months, the analgesic efficacy was maintained at 36 (66.6%) cases of relapsing CP (continuing after 6 months) and 16 (67.0%) of CPN. The perioperative mortality was 0. Mean postoperative hospital stay was 3.3 days (2-5 days). Conclusion: SPLT is a feasible and safe palliative procedure that presents the advantages of the minimally invasive approach, especially in the absence of complications, lower costs in CPN and CP pain control during the conservative analgesic treatment. The endoscopic prosthetic and SPLT presents some minimally invasive solutions that can increase the survival rate in CPN cases