Results of medico-surgical approach to the treatment of pancreatic cancer in emergency

Catedra de Chirurgie nr. 1 “Nicolae Anestiadi”, Universitatea de Stat de Medicină şi Farmacie “Nicolae Testemiţanu”, IMSP Institutul de Medicină Urgentă, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Tumorile pancreatice (TP) reprezintă a cincea cea mai comună cauză de deces. Diagnosticul precoce rămâne o provocare, aceasta determinând rate considerabile de morbiditate şi mortalitate. Material şi metode: Studiu retrospectiv, 2014-2018, 147 pacienţi cu TP, B:F/1:1, vârsta medie 63,82±11,45ani. Adresarea a fost determinată de icter în 101(68,71%) cazuri, formaţiune intraabdominală − 29(19,73%), abdomen acut – 17(11,56%). Diagnosticul s-a stabilit: la 111(75,51%) − prin TC; la 9(6,12%) – prin RMN şi la 75(51,02%) – la CPGRE. În 128(87,07%) cazuri TP era localizată cefalic, în 19(12,95%) − corporeo-caudal. Pacienţii s-au repartizat în trei loturi: lot.I – stentare biliară la CPGRE sau transparietohepatică(58), lot.II – derivație bilio-digestivă(26), lot.III – rezecţie pancreatoduodenală(23) și pancreatectomie distală cu splenectomie(9). În 21,09% cazuri(n=31) s-a refuzat orice procedura terapeutică. Rezultate: Lotul I − 58(50,0%) cazuri, vârsta m=66,88±12,14ani, bilirubinemia m=250,47±146,33mmol/l, durata spitalizării m=9,81±4,8zile, mortalitatea p/op − 2(3,45%). Lotul II – 26(17,69%) cazuri, vârsta m=59,85±11,27ani, bilirubinemia m=112,0mmol/l, durata spitalizării m=22,58±10,32zile, mortalitatea p/op – 2(7,69%). Lotul III – 32(21,77%) pacienți, vârsta m=59,15±9,0ani, bilirubinemia m=87,0mmol/l în TP cefalice, în 8(34,78%) cazuri fiind stentați preoperator (bilirubinemia m=218,5±85,74mmol/l), durata spitalizării m=23,5zile, mortalitatea p/op − 6(18,75%), după duodenopancreatectomie(5), după pancreatectomie distală(1), din cauza complicațiilor septice(4), trombemboliei a.pulmonare(1), pancreonecrozei p/op(1). Concluzii: Examenul imagistic prin TC cu angiografie și/sau RMN este de prima intenție în diagnosticul și stabilirea tacticii chirurgicale în TP. Rata operațiilor rezecționale cu viză de radicalitate rămâne a fi sub limita mondială raportată, consecința diagnosticului tardiv și simptomatologiei nespecifice. Stentarea căilor biliare rămâne cea mai frecventă și, de cele mai multe ori, unica și ultima soluție în rezolvarea icterului mecanic compresiv.Background: Pancreatic tumors (PTs) are the fifth most common cause of death. Early diagnosis remains a challenge; consequently, morbidity and mortality rates are considerable. Methods and materials: Retrospective study, 2014-2018, 147 patients with PT, M:F ratio 1:1, age m=63.82±11.45years. At hospitalization jaundice was determined in 101(68.71%)cases, intra-abdominal tumor – 29(19.73%), acute abdomen − 17 (11.56%). The diagnosis of PT was established: CT in 111(75.51%); NMR − 9(6.12%), ERCP − 75 (51.02%). PTs were located in the head of the pancreas in 128(87.07%) cases, body or tail − 19(12.95%). The patients were divided into three groups: group.I – endoscopic biliary stenting or trans-parieto-hepatic drainage, group.II − biliodigestive derivation(26), group.III - pancreatoduodenal resection(23) and distal pancreatectomy with splenectomy(9). In 21.09%(n=31) cases patients refused any treatment. Results: Group.I − 58(50.0%), age m=66.88±12.14years, serum bilirubin level m=250.47±146,33mmol/l, hospitalization time m=9.81±4.8days, postoperative mortality − 2(3.45 %). Group.II − 26(17.69%), age m=59.85±11.27years, serum bilirubin level m=112.0mmol/l, hospitalization time m=22.58±10.32days, postoperative mortality − 2(7.69%). Group.III − 32(21.77%) patients, age m=59.15±9.0years, serum bilirubin level m=87.0mmol/l in patients with cephalic tumor, in 8(34.78%) cases biliary stent applied preoperatively (serum bilirubin level m=218,5±85,74mmol/l), hospitalization time m=23.5days, postoperative mortality − 6(18.75%), after duodenopancreatectomy(5), distal pancreatectomy(1), because of septic complications(4), pulmonary thromboembolism(1), postoperative pancreonecrosis(1). Conclusion: CT angiography and/or NMR are the first intention to diagnose and establish surgical tactics for PTs. The rate of radical resection remains to be under global level due to late diagnosis and nonspecific symptomatology, biliary stenting remains the most common and, frequently, the unique solution for jaundice in compressive mechanical jaundice

A Middle Palaeolithic wooden digging stick from Aranbaltza III, Spain

Aranbaltza is an archaeological complex formed by at least three open-air sites. Between 2014 and 2015 a test excavation carried out in Aranbaltza III revealed the presence of a sand and clay sedimentary sequence formed in floodplain environments, within which six sedimentary units have been identified. This sequence was formed between 137±50 ka, and includes several archaeological horizons, attesting to the long-term presence of Neanderthal communities in this area. One of these horizons, corresponding with Unit 4, yielded two wooden tools. One of these tools is a beveled pointed tool that was shaped through a complex operational sequence involving branch shaping, bark peeling, twig removal, shaping, polishing, thermal exposition and chopping. A use-wear analysis of the tool shows it to have traces related with digging soil so it has been interpreted as representing a digging stick. This is the first time such a tool has been identified in a European Late Middle Palaeolithic context; it also represents one of the first well-preserved Middle Palaeolithic wooden tool found in southern Europe. This artefact represents one of the few examples available of wooden tool preservation for the European Palaeolithic, allowing us to further explore the role wooden technologies played in Neanderthal communities

Appendiceal mucocele – clinical case

Nicolae Anestiadi Department of Surgery no. 1, Nicolae Testemitanu, SUMPh, PHI EMI, 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 Appendiceal mucocele is a rare surgical emergency, which poses special problems of diagnosis and treatment. Macroscopically it shows a distended appendix of mucus. The diagnosis is made based on imaging examination, intraoperatively and exclusively histopathologically. There is a slight prevalence in females and it has a frequency of 0.2-0.3% of all appendicectomies. Purpose The aim of the study is to present the clinical and paraclinical characteristics and treatment features of the appendiceal mucocele. Material and methods We present the case of a 67-year-old female patient, treated laparoscopically in PHI EMI from appendiceal mucocele. The disease started 2 days earlier with abdominal pain syndrome. From the patient's reports, it appears that she consulted a doctor two months ago for episodes of insignificant abdominal pain with a variable duration of 1-2 days, which spontaneously gave way to hygienic-dietary treatment measures. The patient was not examined clinically and paraclinically. Results At admission the patient did not show signs of acute surgical pathology. An abdominal ultrasound showed a tumor formation, with a cystic character, with a diameter of 66x74mm in the right iliac fossa. Colonoscopy ruled out the malignant pathology of the rectum. The blood count and urine test showed no changes. The treatment option was the surgical one - laparoscopic appendicectomy with special caution in order to prevent contamination of the peritoneal cavity, the appendix being externalized in a protective container. The postoperative evolution was favorable, the patient being discharged on the 7th postoperative day. Histopathological examination confirmed the diagnosis of appendiceal mucocele. Conclusions Appendiceal mucocele is a rare surgical condition, with nonspecific symptoms, the high degree of suspicion of neoplastic processes causing the need for a detailed paraclinical examination. Imaging investigations (ultrasound, CT) are conclusive in making a positive diagnosis. The therapeutic attitude is the surgical one, and the histopathological data allow the confirmation of the diagnosis, also drawing objectives for the subsequent monitoring of the patient in dynamics

Principalele rezultate ale cercetărilor de la Ciuperceni — Tr. Măgurele / Principaux résultats de recherches de Ciuperceni — Turnu Măgurele.

Boroneanţ Vasile, Vlad I., Terzea Elena, Neagu Th., Serini V., Coteţ P., Popescu Dorin, Postolache Tatiana, Azvadurov Hacic, Roman Ştefania, Cârciumaru Marin. Principalele rezultate ale cercetărilor de la Ciuperceni — Tr. Măgurele / Principaux résultats de recherches de Ciuperceni — Turnu Măgurele.. In: Materiale şi cercetări arheologice, N°15 1983. A XV-A sesiune anuală de rapoarte, Muzeul jedeţean Braşov – 1981. pp. 14-16