Esophaegeal reconstruction with stomach

Catedra chirurgie FECMF, USMF „Nicolae Testemiţanu”, Chișinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Substituţia esofagului cu stomac devine o metodă de elecţie în tratarea proceselor maligne după esofagectomie subtotală sau totală. Această variantă de substituţie captivează prin avantajele ce le deţine grefa gastrică: material chirurgical tenace, vascularizare bogată, stofă disponibilă pentru înlocuirea întregului esofag, se aplică o singură anastomoză, se execu tă tehnic-ergonomic prin aplicarea aparatelor performante de sutură mecanică. Scopul lucrării: De a ne împărtăși cu experienţa proprie în plastia esofagului cu stomac. Material și metode: Am recurs la plastia esofagului cu stomac la 51 pacienţi cu vârsta – 20-74 ani. Bărbaţi – 39, femei – 12. Indicaţii pentru extirparea esofagului și substituţia ulterioară a acestuia cu stomac au servit neoplasmele esofagului toracic – 14, neoplasmele joncțiunii esofago-gastrice – 19, stenoza peptică și esofagul Barrett – 15, stenoza post-caustică a segmentului inferior – 3 cazuri. Rezultate: Am folosit trei variante de ascensionare a grefei: intrapleurală pe stânga (procedeul Sweet) – 2 cazuri, intrapleurală pe dreapta (procedeul Lewis) – 28 cazuri, plastia totală cu anastomoză cervicală prin trei căi de acces (procedeul Akiyama, Skinner) – 12 cazuri, prin două căi de acces (procedeul transhiatal – Orringer) – 9 cazuri. Rezultatele postoperatorii precoce și la distanţă în perioada anilor 2000-2015 se încadrează în statisticele mondiale, alcătuind 5%. Concluzii: Utilizarea stomacului ca substituient al esofagului este indicată și justificată în chirurgia cancerului esofagian.Introduction: Substitution of esophagus with a stomach after total or subtotal esophagectomy becomes the method of choice in treatment of esophageal malignancy. This type of reconstruction is attractive due to advantages of the gastric graft: tenacious material, reach vascularization, enough length of the graft for total esophageal substitution, construction of single anastomosis with ergonomic use of mechanical suture. The aim: To share the personal experience in esophageal reconstructions with stomach. Material and methods: The esophageal reconstruction with a stomach was performed in 51 patients with age ranged between 20-74 years. Male – 39, female – 12. Indications for esophageal extirpation with subsequent reconstruction with a stomach were: thoracic esophageal carcinoma – 14, carcinoma gastro-esophageal junction– 19, peptic stenosis and Barrett’s esophagus – 15, post-caustic stenosis of inferior esophagus – 3 cases. Results: We used three different types of graft ascension: left intrapleural (Sweet procedure) – 2 cases, right intrapleural (Lewis procedure) – 28 cases, total plasty with cervical anastomosis through 3 accesses (Akiyama, Skinner procedures) – 12 cases, and through 2 accesses (Orringer transhiatal procedure) – 9 cases. The early and long-term postoperative results since 2000 till 2015 years are in correspondence with international statistics and represent 5%. Conclusions: Utilization of the stomach as a substitute for the esophagus is indicated and justified in surgical treatment of esophageal cancer

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The requirements for the memory structuring of intelligent systems are discussed. Simultaneously with the introduction of information into memory there should take place the processes of association links (bonds) formation, hierarchy systematizing, classification and concept formation. The growing pyramidal networks (GPN) meet these requirements. Many years of experience of GPN application for data analyses in chemistry and material studies proves their sufficiently high potential

Environmental Protection of the Arctic Region: Effective Mechanisms of Legal Regulation

The legal regulations on environmental issues that arise in the Arctic due to intensive exploitation of its oil and gas resources need to be explored. There are gaps in environmental regulations over the Arctic region both at international and domestic levels. For Russia, at least two basic problems can be seen in the legal norms: the absence of a coherent approach to the Arctic environmental legislation and policy, and the need to develop effective mechanisms of environmental protection in the process of the Arctic development. In recent years, the Arctic states have expanded legislation on the Arctic issues. Currently, the most effective legal instruments targeting the protection of the fragile Arctic environment have been created by the Arctic countries. The introduction of a system of integrated environmental management is the first step that should be taken. Deep scientific research should be the obligatory foundation of any Arctic project. Moreover, much attention should be paid to the analysis of biological diversity preservation schemes. Lastly, special laws are needed in Russia to ensure: the regulation, prevention, and response to pollution by oil and other containments; the protection and rational use of Arctic resources; and the conservation of the Arctic marine areas and natural landmarks. These ideas are based on a comparative analysis of the legal rules contained within the laws of Norway, Canada, and the United States

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The questions of designing multicriteria control systems on the basis of logic models of composite dynamic objects are considered

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The article is devoted to the issue of formation and increasing digital competence of future primary school teachers. The article addresses the issue of the implementation of blended learning in higher education, analysis methods and software applications with which scientific and teaching staff engaged in educational activities. The characteristic features and needs of the new generation Z have been determined, the concepts of macro, meso and micro trends in European education have been analyzed. The authors discovered the meaning of Personal learning environment (PLE), substantiated the idea that giving students the opportunity to work in a qualitatively formed e-environment will allow them to acquire professional and soft-skills for later life, create their own e-portfolio, manage their own educational formal and informal learning process throughout life. There are highlighted and described the characteristic features of informal learning in the article. The emphasis in the work is on the personalization of educational trajectories of students, thanks to PLE tools. The use of ICT, in particular, network services, allows us to create the appropriate pedagogical and technological basis for the maintenance of modern informational systems of educational purposes, which are the priority in the basis of any educational process, the formation of digital competence, and the effective organization of the educational environment of an educational institution