INCORPORATING THE RURAL AREAS’ PARTICULARITIES IN THE WATER SUPPLY MANAGEMENT SYSTEMS IN ROMANIA

The existence of the safe water supply and sewerage systems, especially in the rural areas of Romania, are mandatory for the insurance of the public health. In this context, a series of Romanian regional water and sewerage services suppliers developed Total Quality Management Systems, starting with the implementation of multiple ISO standards and in response to the need for answering to high requirements, both for constant development / modernization of the infrastructure and expansions to new consumers, as for the permanent improvement of the water supply, sewerage and wastewater treatment’s quality. The Total Quality Management Systems inter-relate a series of quality components, all of them functioning in a unitary–integrated way, using specific rules and procedures for assuring the increase of the delivered services’ quality and performance. The results begin to be seen on all areas of the concerned water suppliers’ activity: from the operational field to the commercial, staff’s performance, environmental and customer care ones. one of the main fundaments of the monetary creation – aspect which is indissolubly related to the idea of evolution, more precisely, to the idea of economic development

Emergency Backwards Whipple for Bleeding: Formidable and Definitive Surgery

Introduction. During the past decades, the safety of pancreatoduodenectomy has improved, with low mortality and reduced morbidity, particularly in centers with extensive experience. Emergency pancreatoduodenectomy is an uncommon event, for treatment of pancreaticoduodenal trauma, bleeding, or perforation. We herein present a single center experience concerning nontrauma emergency pancreatoduodenectomy for pancreaticoduodenal bleeding. Methods. From January 2007 to December 2015, from a population of 134 PD (70 males and 64 females, mean age 62.2, range 34–82), 5 patients (3.7%; 2 males and 3 females, mean age 64, range 57–70) underwent one-stage emergency pancreatoduodenectomy for uncontrollable nontrauma pancreaticoduodenal bleeding in our tertiary center. Results. All the 5 patients underwent a backwards Whipple with a morbidity of 60% and a mortality of 20% (1/5). The other 4 patients were recovered and discharged with a median postoperative length of stay of 17 days (range 14–23). Conclusion. Emergency pancreatoduodenectomy is a definitive life-saving procedure allowing for a rapid control of bleeding when other less invasive approaches (transcatheter arterial embolization or interventional endoscopy) are exhausted, unavailable, or unsafe. It should be particularly considered in neoplastic disease and tailored by surgeons with a high level of experience in pancreatic surgery