Appendicopathies in emergency surgery - a substantian problem

Catedra Chirurgie, FEC MF, USMF „N. Testemițanu”, Chișinău, 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 2011Dacă pînă în prezent au fost atinse succese notabile în chirurgia apendicitei acute, nu ne dă posibilitatea să constatăm faptul că problema este rezolvată definitiv, au rămas probleme neclare şi discutabile: 1) nu este perfectă diagnostica; 2) sunt divergenţe în privinţa tacticii chirurgicale; 3) lipsesc intraoperator criteriile unice a modificărilor macroscopice; 4) sunt divergenţe în diagnosticul clinic şi rezultatele morfohistologice. Studiile din literatura franceză au constatat faptul că la 20% din cei operaţi s-a înlăturat apendicele neafectat. Au fost studiaţi 235 pacienţi cu vîrsta 14-80 ani. Femei-bărbaţi 1,5:1. Durerea manifestată la 100% bolnavi caracterizată prin (spontană, permanentă, intermitentă, difuză, localizată, violentă, transfixiantă, iradiere topografică). Defens muscular, meteorism, pulsmetria, temperatura corpului s-au manifestat în raport variabil. Simptoamele subiective (diaree, constipaţie, vomă, s.Koher, greţuri) prezente la toţi bolnavii. Prevalenţa s. obiective (Blumberg, Rowzing, triada Dieulafoy, Bartomie-Mihelson, Coop) a fost notată la bolnavii cu semne evidente de apendicită acută. La 80% - hiperleucocitoză. Polinucleoza a fost marcată variabil: normal, moderată, notabilă, excesivă şi majorată enorm. USG abdominală : pneumatoză intestinală, apendice vizualizat, mobil, imobil, îngroşat, lichid în cavitatea abdominală notate variabil. Intraoperator s-a înregistrat lichid seros, serohemoragic, seropurulent, purulent cu variaţii. S-a constatat faptul că 22% nu au modificări patomorfologice în apendice. Coeficientul identificării diagnosticului clinic cu cel patomorfologic este în raport 4,5:1. Acestea sunt cazurile apendicopatiilor cu manifestări clinice evidente şi cu lipsă de substrat patomorfologic, mai bine spus, apendice neafectat. Concluzii: 1. Apendicopatiile diferă radical de apendicita acută prin faptul că ele se manifestă clinic printr-un complex simptomatologic evident de apendicită acută şi cu lipsa totală a substratului patomorfologic. 2. Pentru a clarifica aceste probleme definitiv, va fi necesar un studiu clinic mai profund si identificarea mai sigură a modificărilor patologomorfologice. 3. Extirparea apendicelui alterat în apendicopatie, cauză a fenomenelor dureroase sau a crizelor repetate, se impune ca singura măsură de a vindeca răul prezent şi de a evita pericolele viitorului.The fact that until now has been achieved notable success in the surgery of acute appendicitis doesn’t give us the possibility to say that the problem is entirely solved; there still are many confusing and contestable problems: 1) the diagnosis is not perfect. 2) there are many divergences about the surgical tactics. 3) there are no unique criteriafor macroscopical changes during the operation. 4) there are different opinionsamong surgeons as for clinical diagnosis and morphological characteristics. The study of French literature have concluded that in the case of 20% of operations unaffected appendix has been removed. 235 patients aged 14-80 years in rapport of 1,5:1 women and men have been examined. The pain manifested at 100% of patients was characterized as spontaneous, continuous, intermittent, diffuse, localized, violent, topographical radiation. The muscle defense, flatulence, pulsation, high temperature occurred in several cases. Subjective symptoms (diarrhea, constipation, vomiting, Koher’s sign and nausea) have been noticed at all the patients. The prevalence of objective symptoms (Blumberg, Rowzing, Dieulafoy triad, Bartomie-Mihelson, Coop) has been noticed at the patients with obvious signs of acute appendicitis. 80% manifested hyperleukocytosis. The mark of polynucleosys was variable: normal, moderate, noticeable, excessive and increased enormously. The ultrasound check of abdomen showed intestinal pneumatosis, visible, mobile, immobile, thickened, fluid appendix in the abdominal cavity has been detected in several cases. Intraoperative serous, sero-hemorrhagic, seropurulent and purulentliquid was noticed 22% of patients had no pathomorphologicchanges coefficient was 4,5:1. These are the appendicopathy cases with clinicalmanifestations and lack of pathomorphological base, batter said: normal, unaffected appendix. Conclusions: 1. Appendicopathies differ radically from acute appendicitis in that they manifest clinically evident symptomatic complex of acute appendicitis and total lack of pathomorphological substrate. 2. To clarify these issues ultimately a deeper clinical study and a more reliable identification of pathomorphological changes would be necessary. 3. The removal of altered appendix in appendicitis, cause of pain phenomena or repeated crisis imposes itself as the only measure to cure the present disease and to avoid future dangers

Abdominal non-parasitic megacysts

Catedra Chirurgie FECMF, Spitalul Clinic Republican, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Entitate în aparenţă rară, chistul neparazitar al organelor cavitaţii abdominale reprezintă una din cele mai dificile și complexe probleme ale chirurgiei. Importanţa acestuia rezidă, în primul rând, în heterogenitatea histologică, posibilitatea degenerării maligne și similitudinea semnelor clinice cu ale altor entităţi nozologice. Ne-am propus studierea retrospectivă a 29 cazuri de chisturi masive și gigantice, operate în Clinica Chirurgie Generală a Spitalului Clinic Republican, în perioada ianuarie 2010 – aprilie 2015. Material şi metode: Au fost analizate retrospectiv 89 cazuri de chisturi abdominale neparazitare. Din cele 89 – 20 (22,5%) au fost chisturi masive cu dimensiuni de la 6 cm până la 15 cm, gigantice – 9 (10,1%), de la 16 – 30 cm şi 60 (67,4%) – mai mici de 6 cm. Chisturile ovariene din numărul celor gigantice și masive au prevalat – 17 (58,6%), iar restul au fost chisturi ale splinei – 4 (13,8%), pancreatice – 8 (27,6%), biliare – 1 (3,4%). Rezultate: Complicaţiile cele mai des întâlnite au fost infectarea chisturilor, hemoragia intraabdominală și malignizarea lor. Metoda cea mai accesibilă și sensibilă de diagnostic a fost examenul ultrasonografic. Din tehnicile de tratament, excizia sau drenarea chisturilor sunt cele mai des utilizate. Concluzii: În pofida tehnicilor moderne de diagnostic, această afecţiune rămâne uneori târziu identificată, ajungând la dimensiuni gigantice de 30 cm. Cele mai des întâlnite forme de chisturi au fost cele ovariene, acestea având o tendinţă marcată spre complicaţii: torsiune a chistului ovarian, malignizare, hemoragii. Pentru a nu ajunge la dimensiuni gigantice și complicaţii ce pun în pericol viaţa pacientului, este necesară profilaxia şi tratamentul la timp.Introduction: Apparently rare entity, non-parasitic cyst of abdominal cavity is one of the most difficult and complex surgical issues. Its importance is given primarily by histological heterogeneity, the possibility of malignant degeneration and clinical signs similarity to other nosological entities. We performed the retrospective study of 29 massive and giant cyst cases, operated in the Republican Clinical Hospital between January 2010 and April 2015. Material and methods: There were retrospectively analyzed 89 cases of abdominal non-parasitic cysts. From those 89 – 20 (22.5%) were massive cysts sized 6 to 15 cm, giant – 9 (10.1%) sized 16 to 30 cm and 60 (67.4%) – less than 6 cm. Among the giant and massive cysts ovarian ones prevailed 17 (58.6%), the remainder were spleen cysts-4 (13.8%), pancreatic – 8 (27.6%), biliary – 1 (3.4%). Results: The most common complications were cysts infection, intraabdominal bleeding and malignisation. Most accessible and sensitive method of diagnosis was ultrasound examination. Mostly used treatment techniques are excision or drainage of cysts. Conclusions: Despite the availability of modern diagnosis techniques, this affection is tardily identified, thus reaching giant dimensions of 30 cm. The most common cysts forms were ovarian, with a tendency toward complications: ovarian cyst torsion, malignancy, bleeding. In order not to reach gigantic size and life-threatening complications the prophylaxis and timely treatment are required

Search for gravitational waves associated with the InterPlanetary Network short gamma ray bursts

We outline the scientific motivation behind a search for gravitational waves associated with short gamma ray bursts detected by the InterPlanetary Network (IPN) during LIGO's fifth science run and Virgo's first science run. The IPN localisation of short gamma ray bursts is limited to extended error boxes of different shapes and sizes and a search on these error boxes poses a series of challenges for data analysis. We will discuss these challenges and outline the methods to optimise the search over these error boxes.Comment: Methods paper; Proceedings for Eduardo Amaldi 9 Conference on Gravitational Waves, July 2011, Cardiff, U

Uniqueness and comparison theorems for solutions of doubly nonlinear parabolic equations with nonstandard growth conditions

The paper addresses the Dirichlet problem for the doubly nonlinear parabolic equation with nonstandard growth conditions: ut = div (a(x, t, u)|u|α(x, t)|∇u|p(x, t)-2 with given variable exponents α(x, t) and p(x, t). We establish conditions on the data which guarantee the comparison principle and uniqueness of bounded weak solutions in suitable function spaces of Orlicz-Sobolev type

Recent results for the search of continuous waves with the LIGO and Virgo detectors

The 'First Generation Era' of gravitational wave detectors is now over, but the data analysis effort for the search of continuous gravitational waves is still ongoing and active. Many results have been produced but still many searches are underway. I present and discuss here the most recent results for this search, together with short discussions on analysis which are now underway and plans for the near future. The discussion on long-term plans and perspectives for the so-called Advanced Detector Era are beyond the scope of this paper

Estimating transient detection efficiency in electromagnetic follow up searches

During the most recent LIGO-Virgo science run (Dec 17 2009 to Jan 8 2010 and Sep 2 to Oct 20 2010) multi-messenger searches were performed using several partner telescopes. This resulted in large data sets with images covering several square degrees of the sky. Analysis of these images is currently underway using a variety of different tools. We present an overview of these efforts, in particular the development of new tools which enable us to establish the efficiency for transient images in the fields. This is critical in establishing the sensitivity of gravitational wave and electromagnetic multi-messenger searches to the astrophysical signals we expect to be associated with gravitational waves