Histopias : narration, narrativization, and interpretation of history in Julian Barnes's A History of the world in 10½ chapters and David Mitchell's Cloud atlas

Comme beaucoup d’autres romans historiques postmodernes, Une histoire du monde en 10 chapitres et ½ de Julian Barnes et Cartographie des nuages de David Mitchell misent en fiction une vision personnelle sur l’histoire et examinent la relation entre les narrations historiques et les fictions. Outre ces projets metahistoriques et metafictionnels, les deux romans proposent un récit historique original de la vie humaine sur la terre. Les narrations de Barnes et de Mitchell s’étendent sur des milliers d’années et sont caractérisées, à tour de role, par la continuité et par la discontinuité. Celle-ci est déterminées par une série de catastrophes, soit naturelles soit liées aux activités humaines, qui donnent aux diverses histoires constituant les romans une puissante note dystopique. Barnes et Mitchell ont une raison très pratique pour choisir le mode dystopique: un monde en crise, surtout un monde proche de sa fin ou de son commencement, est un phénomène qui peut être analysé plus facilement en même temps comme fragment de l’histoire et comme version à échelle réduite de l’ensemble de l’histoire. Une histopie est donc une fiction qui utilise de différents moments de crise, fictifs ou mis en fiction, en tant qu’épisodes d’une histoire fragmentaire du monde.Like many other postmodernist historical novels, Julian Barnes’s A History of the World in 10 ½ Chapters and David Mitchell’s Cloud Atlas fictionalize a personal view of history and examine the relation between historical and fictional narratives. Apart from these metahistorical and metafictional projects, the two novels put forward an original historical account of human life on earth. Barnes’s and Mitchell’s narratives span millennia and are marked by the interplay of continuity and discontinuity. The latter is shaped by a series of natural and man-made catastrophes, which account for the dystopian character of the various stories that make up the two novels. Barnes and Mitchell have a very practical reason for choosing the dystopian mode: a world in crisis, and especially a world near its end or near its beginning, is a phenomenon that can be more readily analyzed as both a fragment of history and a small-scale version of history as a whole. A histopia is a piece of fiction that uses various moments of crisis, fictional or fictionalized, as episodes of a fragmentary history of the world

Les apports de la linguistique à la théorie des contrats : prolégomènes à une interprétation dialogique et polyphonique du contrat

Nous présentons ici la première des trois étapes d’un projet de recherche portant sur l’élaboration d’une théorie contractuelle renouvelée fondée sur une interprétation dialogique du contrat. Dans le premier texte, qui paraît ici, les auteurs cherchent à inscrire le contrat dans une perspective dialogique englobant plusieurs aspects méthodologiques et conceptuels propres à la linguistique et à la théorie littéraire. Le dialogisme, en favorisant la considération de l’altérité intrinsèque au jeu interprétatif qui anime tout contrat, se présente comme une avenue théorique stimulante pour contrer la réification contemporaine des contractants. À titre d’approche interprétative, il peut permettre de faire place à deux individus socialisés et pleinement personnifiés. En considérant l’entente contractuelle non plus comme un bien économique produit à grande échelle et porteur du discours monologique démultiplié, mais bien comme une norme juridique privée inévitablement appropriée par les deux contractants, les auteurs veulent repositionner l’interprétation des contrats au sein même du volontarisme. Par l’intermédiaire du dialogisme, chaque contractant peut inscrire sa pleine capacité juridique dans le processus normatif. D’entité abstraite dépourvue de complexité, le contractant deviendrait véritable acteur dans l’élaboration et la compréhension de l’entente contractuelle.The following paper presents the first of three stages of a research project seeking to develop a renewed theory of contract based upon a dialogical interpretation of the act of contracting. The authors attempt to frame the contract within a dialogical perspective that draws together several methodological and conceptual considerations found in linguistics and literary theory. By favouring consideration of the intrinsic “otherness” found in the interpretative exchange that forms the substance of any contract, dialogism comes to the fore as a stimulating theoretical approach to counter contemporary reifying of contracting parties. As an interpretative approach, this makes it possible to deal with two individuals, socialized and fully personified. By no longer considering a contractual meeting of the minds as a mass-produced economic commodity grounded in multiparous monological discourse, but indeed as a private legal bond inevitably appropriated by both contracting parties, the authors want to resituate the interpretation of contracts within the bounds of voluntarism. As such, dialogical discourse becomes the medium allowing each contracting party to root their full legal capacity in this normative process. Contracting parties cease to appear as abstract entities devoid of complexity, instead to become dynamic actors in the formulation and understanding of their contractual agreement

Therapeutico-surgical options in hydatid cyst of the left hepatic lobe

Catedra 2 Chirurgie, Clinica Chirurgie 2 USMF „Nicolae Testemițanu”Se prezintă cazul clinic de chist hidatic hepatic gigant depășit și neglijat de către pacientă, pentru mai mult de 15 ani. Acesta a fost depistat la timp, în anul 2000, însă, din cauza neglijenței pacientei, a fost operat tardiv.There is presented a clinical case of giant hepatic hydatid cyst outdated and neglected by the patient, for over 15 years. It was detected on time, in 2000, but due to patient’s negligence, the operation was delayed

Insuficiența hepatică postoperatorie - cauză semnificativă a mortalității la pacienți cu chisturi hidatice gigante complicate

Background. Giant hydatid cysts usually lead to diffuse irreversible damage to the liver, aggravating the results of surgical treatment and their presence is accompanied by high mortality. Objective of the study. Analysis of factors that predispose to the development of liver failure in patients with complicated echinococcosis Material and Methods. 347 patients with hepatic hedadidosis were operated on in the clinic between 2000 and 2020. The diagnostic algorithm included: USG, Doppler, EFGDS, CT, MRI in cholangiography regime, serological and biochemical analyzes. Results. In 33 (9.5%) cases, giant hydatid cysts located in more than 4 segments of the liver were detected. Of which, in the preoperative period, liver cirrhosis was detected in 4 (12.1%) patients, the early stage of portal hypertension was detected in 7 (21.2%), mechanical jaundice in 9 (27.3%), reactive hepatitis in 10 ( 30.3%) patients, hydatid cachexia in 3 (9.09%). Postoperative liver failure developed in 9 (27.3%) patients who underwent urgent surgery. Mortality rate - 7 (18.1%). Conclusion. Predisposing factors for the development of postoperative liver failure are as follows - large destructive lesions of the liver parenchyma, small volume of the remaining parenchyma, decreased blood supply, cachexia, old age, the presence of concomitant pathologies. Introducere. Chisturile hidatice hepatice gigante, de regulă, determină leziuni difuze ireversibile ale ficatului, agravând astfel rezultatele tratamentului chirurgical și sunt insoțite de o mortalitate înaltă. Scopul lucrării. Analiza factorilor predisponibili evoluției insuficienței hepatice la pacienții cu chisturi hidatice gigantice complicate. Material și Metode. Studiul este axat asupra 347 pacienți cu hidadidoză hepatică operați în perioada aa.2000 – 2020. Algoritmul diagnostic a inclus: USG, dopplerografie, FEGDS, CT, IMRCP în regim colangiografic, analize serologice și biochimice. Rezultate. În 33 (9.5%) cazuri au fost depistate chisturi hidatice hepatice gigante, ce au inclus mai mult de 4 segmente ale ficatului. În acest grup, preoperator s-a atestat ciroză hepatică la 4 (12.1%) pacienți, manifestări clinice ale hipertensiunii portale - la 7 (21.2%) pacienți, icter mecanic- în 9 (27.3%) cazuri, hepatită reactivă la 10 (30.3%) pacienți, cașexie hidatică la 3 (9.09%) bolnavi. Insuficiența hepatică postoperatorie a evoluat la 9 (27.3%) pacienți operați după indicații vitale. Mortalitatea generală în acest lot a constituit 7(18.1%) cazuri. Concluzii. Factorii predisponibili ai insuficienței hepatice postoperatorii în chisturile hepatice gigante sunt polimorfi, primordial fiind reprezentați de leziunile destructive voluminoase ale parenchimului hepatic cu funcționalitate redusă a parenchimului hepatic restant, hipoperfuzie arterială și portală

Risk factors in the development of acute appendicitis complications

Department of Surgery No 2, Laboratory of Liver Surgery, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: To study the risk factors of the development of acute appendicitis (AA) complications in adults in order to improve the results of surgical treatment. Material and methods: The research included 449 patients with AA treated surgically during the years 2015-2017 divided into 2 groups: 117 patients who were admitted with complicated appendicitis (intra- and extraabdominal complications) and 332 patients with non-complicated AA were randomly selected from the same period. The rate and characteristic of the complications evolved during the pre- and postoperative period in these two groups were specified and analyzed. Results: In the acute complicated appendicitis group (CAA), there was a predominance of women with a ratio of 1.60 versus 1.26 in the uncomplicated acute appendicitis group (NAA). The proportion of people aged> 60 years was significantly higher in the case of CAA-23.1% (n=27), while in uncomplicated AA it was only 3.9% (n=13). In the case of AA complications, there was an emphasis on late addressing, the debut-addressing term being higher compared to uncomplicated AA. The low socio-economic status has a significant negative impact on the evolution of AA and its complications, as well as on the results of appendectomy. Thus, uninsured patients (n=59, 49.6%) formed almost half of CAA group. Associated comorbidities were established in 76 or 16.9% of cases, respectively in CAA-21.4% vs 15.4% in NAA group. In summary we note that the presence of associated uncorrected comorbidities has an obvious negative impact on the development of AA. Conclusions: Our findings suggest that clinical assessment is most important for identifying individuals at risk of developing complications of AA and the above-mentioned risk factors are useful for emergency surgical decisions

Inversia fluxului spleno-portal în cadrul hipertensiunii portale cirogene (corelaţii clinice şl hemodinamice)

Rezumat. Obiectivele studiului dat au constituit investigaţiile hemodinamicii portale cu utilizarea imagisticii Doppler-ultrasonografice şi evaluarea frecvenţei inversiei fluxului spleno-portal venos la 51 pacienţi cu ciroză hepatică şi hipertensiune portală. Fluxul hepatofugal spleno-portal inversat s-a atestat mai frecvent în categoria Child- Pugh „C”. Nu s-a constatat conexiune între prezenţa fluxului inversat şi prevalenţa varicelor esofago-gastrice.Summary. The objectives of presents study was to dynamic studies on portal hemodynamics by Doppler ultrasound investigation and evaluation of the frequence of reversal splenoportal blood flow in 51 patients with liver cirrhosis and portal hypertension. Reversed hepatofugal spleno-portal flow was quite frequent in Child-Pugh „C" class). In patients with reversed blood flow was no related prevalence of esophago-gastric varices

The reevaluation of the role of duodenal dysmotility in the etiopathogenesis of vesicular cholelithiasis

Department of Surgery No 2, Laboratory of Liver Surgery, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Gallstone disease and chronic calculous cholecystitis are the most prevalent gastro-enterological diseases requiring a surgical treatment. This disease occupies a special place in the pathology of the hepato-bilio-pancreatic area, which is important for the etiological diagnosis as well as for the resonance and the complex impact on the function of the adjacent organs. Besides, gallstone disease can result in serious outcomes, such as acute gallstone pancreatitis and gallbladder cancer. This article analyzes the clinico- morphological characteristics of gallbladder stones. At the same time, the role of duodenal dysmotility in the ethiopathogenesis of cholestasis was reevaluated through the contemplation of the contemporary concepts of lithogenesis. Conclusions: The pathogenesis of gallstone disease is suggested to be multifactorial and probably develops from complex interactions between many genetic and environmental factors and the state of adjacent organs. Based on its anatomical and physiological features, the duodenum is a completely unique crossroads where the digestive pathways of the stomach, liver and pancreas meet. The sealing functionality of these organs allows them to be cataloged as an integral system, and the duodenum due to its specific role exerts ”the pituitary function” of the gastrointestinal tract. Therefore, any disruption of the duodenum activity may not be etiopathogenetically reflected on the hepatobiliary-pancreatic disease, and biliary cholelithiasis is no exception in this regard. The achievement in the study of the pathophysiology of bile stones formation and the pathogenesis of gallstone disease can help to improve the complex medico-surgical treatment of this category of patients

Assymetrical spleno-portal flow changes in the cirrhotic patient (connection-clinical-imaging)

Clinica nr. 2 Chirurgie cu LCŞ Hepatochirurgie, Catedra Chirurgie Nr2, USMF „N.Testemiţanu”The patients Child class "A" denotes a proportional distribution volume of the portal intrahepatic hemocirculation (comparable with healthy subjects) with a slight upward trend while patients in group Child "B" and "C" evolving expressive distortion of intrahepatic portal hemodynamics with a significant deprivation as liver lobe.Reduced hepatic functional reserve is associated with a progressive hemodynamic redistribution in the territory and establishing a pool portal splenic venous hiperdinamice movement, recorded is a positive correlation between increased venous congestion in the splenic vein territory and Child score. It was found a clear tendency to increase intake flow in the formation of splenic venous outflow on the left portal branch and a direct connection between the report SBF/ PBFand category Child-Pugh, correlation becomes more expressive on reducing the extent of liver functional reserves. La pacienţii categoriei Child ”A” se denotă o distribuire volumetrică proporţională a hemocirculaţiei portale intrahepatice (comparabilă cu subiecţii sănătoşi) cu o tendinţă de creştere usoară a circulaţiei sanghuine pe lobul hepatic stîng, pe cînd în grupa pacienţilor Child ”B” şi „C” evoluează o denaturare expresivă a hemodinamicii portale intrahepatice cu o deprivare hemocirculatorie semnificativă a lobului hepatic drept. Reducerea rezervelor hepatice funcţionale se asociază cu o redistribuire progresivă a hemocirculaţiei în teritoriul bazinului portal şi instituirea unei circulaţii splenice venoase hiperdinamice, consemnîndu-se o corelaţie pozitivă între creşterea stazei venoase în teritoriul venei splenice şi scorul Child. A fost constatată o tendinţă evidentă de creştere a aportului afluxului venos splenic în constituirea fluxului pe ramura portală stînga şi o conexiune directă între raportul SBF/PBF şi categoria Child - Pugh, corelaţie ce devine mai expresivă pe măsura reducerii rezervelor hepatice

Postoperative hepatic insufficiency as a cause of mortality in patients with giant complicated hydatic cysts

Department of Surgery no. 2, State University of Medicine and Pharmacy „Nicolae Testemitanu”, 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 Giant hydatid cysts usually lead to diffuse irreversible damage to the liver, aggravating the results of surgical treatment and their presence is accompanied by high mortality. Purpose analysis of factors that predispose to the development of liver failure in patients with complicated echinococcosis Material and methods 347 patients with hepatic hedadidosis were operated on in the clinic between 2000 and 2020. The diagnostic algorithm included: USG, Doppler, EFGDS, CT, MRT in cholangiography, serological and biochemical analyzes. Results In 33 (9.5%) cases, giant hydatid cysts located in more than 4 segments of the liver were detected. Of which, in the preoperative period, liver cirrhosis was detected in 4 (12.1%) patients, the early stage of portal hypertension was detected in 7 (21.2%), mechanical jaundice in 9 (27.3%), reactive hepatitis in 10 ( 30.3%) patients, hydatid cachexia in 4 (12.1%). Postoperative liver failure developed in 9 (27.3%) patients who underwent urgent surgery. Mortality rate - 7 (18.1%). Conclusions Predisposing factors for the development of postoperative liver failure are as follows - large destructive lesions of the liver parenchyma, small volume of the remaining parenchyma, decreased blood supply, cachexia, old age, the presence of concomitant pathologies

The reactivation of central limfocirculation by cervical decompresion of thoracic duct in treatment of cirrhotic patients with advanced ascites

LCŞ Hepatochirurgie, Clinica 2 Chirurgie „Sfânta Treime” a Catedrei Chirurgie nr.2, USMF “N. Testemiţanu”Managementul sindromului ascitic rămâne a fi una din problemele dificile ale tratamentului medico-chirurgical în ciroza hepatică. Acest fapt este determinat de cunoaşterea incompletă a mecanismelor de evoluţie a ascitei. Lucrarea dată are drept scop studierea rolului decompresiei ductului limfatic toracic în reactivarea limfocirculaţiei centrale în ascita cirogenă avansată şi ameliorarea tratamentului chirurgical.The management of ascites syndrome remains one of the difficult problems in medical & surgical therapies of liver cirrhosis. This is determined by the insufficient knowledge of ascites evolution mechanisms. This trial is meant to research the role of the decompression of the thoracic lymphatic duct in the reactivation of the central limfocirculation in decompensated ascites and amelioration of the surgical treatment