Choledocoscopy in the surgery of mechanical jaundice

Universitatea de medicina si farmacie “Gr. T. Popa”, Iasi, clinica a IV-a chirurgie, 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 2011Scopul lucrării: Diversitatea etiopatogenică a icterului mecanic justifică explorarea coledocoscopică, necesară unui diagnostic de certitudine. Material şi metodă: Între anii 2002 - 2011 am utilizat coledocoscopul flexibil la 58 de pacienți internați cu icter mecanic. La 21 (36,2 %) dintre aceştia icterul s-au dovedit a fi de etiologie neoplazică: 5 (8,6 %) cazuri cu ampulom vaterian (care au beneficiat de duodenopancreatectomie cefalică), 14 (24,1 %) cazuri cu neoplasm al capului de pancreas şi două (3.4 %) cazuri cu colangiocarcinom). Ceilalți 37 (63,8 %) de pacienți au avut o etiologie litiazică, la care coledocolitotomia asistată coledocoscopic şi asociată colecistectomiei a permis vindecarea. Rezultate. Discuții: Dintre pacienții cu suspiciune de icter mecanic neoplazic, în două (3,4 %) cazuri a fost necesară coledocoscopia care a certificat diagnosticul de colangiocarcinom atât prin aspectul imagistic, dar mai ales datorită posibilității prelevării biopsiei şi examenului histopatologic. În explorarea icterului mecanic. cu etiologie litiazică examenul coledocoscopic permite vizualizarea calculilor în 16 (27,5 %) cazuri la care celelalte explorări imagistice erau neconcludente. În toate cazurile controlul coledocoscopic a certificat absența calculilor în calea biliarặ principalặ la finalul intervenției, oferind astfel siguranță privind acuratețea actului chirurgical. Concluzii: Coledocoscopia aduce siguranță în chirurgia căii biliare principale atât în ceea ce priveşte diagnosticul, permițând vizualizarea şi prelevarea biopsiei în leziunile tumorale ale căii biliare principale cât şi în tratamentul litiazei biliare, oferind posibilitatea controlului imediat (intraoperator) al căii biliare principale după coledocolitotomie.Abstract. Background. The diverse etiology of mechanical jaundice requires a choledocoscopy to allow a correct diagnosis. Methods: Between 2002 and 2011, we used flexible choledocoscope, in 58 patients with mechanical jaundice admitted in our clinic. 21 (36, 2 %) cases proved to be of neoplastic etiology: 5 (8, 6%) cases diagnosed with vaterian ampuloma (treated by cephalic duodenopancreatectomy), 14 (24, 1 %) cases with pancreatic head cancer and two (3, 4 %) cases with cholangiocarcinoma. The remaining 37 (63, 8 %) cases were caused by lithiasis, treated by choledocolhitotomy associated with choledocoscopy and cholecystectomy. Results. Discussion: Among patients with suspected neoplastic mechanical jaundice, in two (3.4 %) cases choledocoscopy was necessary, in order to sustained the diagnosis of colangiocarcinoma, by macroscopically appearance, and also by the biopsy sampling and histological examination. In mechanical jaundice of lithiasis etiology, the choledocoscopy permitted the visualization of stones in 16 (27, 5%) cases in which, other imagistic investigations were inconclusive. In all cases choledocoscopic control certified the absence of gallstones in the bile duct at the end of the surgical procedure, and thereby provides safety of the surgical act. Conclusions: Choledocoscopy adds certainty in the main bile duct surgery both in terms of correct diagnosis, allowing visualization and biopsy sampling of the main bile duct in tumor lesions and in treatment of gallstone disease, allowing immediate control of the main bile duct after choledocolithotomy

Optical properties of hydrogenated amorphous silicon

A detailed study of the optical properties of sputtered hydrogenated amorphous silicon films with varying hydrogen concentration is presented here. The energy dependence of the absorption coefficient is looked into, in detail, from a point of view of understanding the well known Tauc rule and the alternate relations being proposed in recent years. Spectroscopic and band‐structural models like Wemple-Didomenico and Penn are then utilized to analyze the optical parameters near the band‐gap region of the wavelength spectra. Extensive comparisons of our results are made with those of sputtered a‐Si:H films of other workers, glow discharge prepared a‐Si:H, chemically vapor deposited and evaporated a‐Si, and also crystalline silicon. The similarities in the variation of the optical properties of a‐Si:H with increasing hydrogen concentration (or decreasing measurement temperature) to that of crystalline silicon with decreasing measurement temperature lead us to interesting conclusions. Thus, it seems that decreasing disorder (topological or thermal) in a‐Si:H is equivalent to decreasing thermal disorder in c‐Si, at least as far as the disorder‐optical property relationships are concerned

STRUCTURAL MODELLING OF REVERSIBLE PHOTODARKENING IN a-AsxSe

Reversible photodarkening in amorphous As -Se films is attributed to photopolymerization. The difference between As-rich and Se-rich films is due to the initial predominantly molecular structure of the former and to the structural instability under heat of the latter

La conductivité électrique des couches microcristallines des métaux à conduction mixte (beryllium et plomb)

Microcrystalline continuous beryllium and lead films deposited by vacuum evaporation have a negative temperature coefficient of the resistance and anomalous values of the Hall and magnetoresistance constants. These anomalies are attributed to electrons thermically excited into the minima of the conduction band situated above the Fermi level.Les couches continues de béryllium et de plomb à très petits grains obtenues par évaporation sous vide présentent un coefficient de température de la résistance négatif, ainsi que des valeurs anormales de la constante de Hall et de la magnétorésistance. Ces anomalies sont attribuées aux électrons thermiquement excités qui se trouvent dans les minima de la bande de conduction situés au-dessus du niveau de Fermi