Синдром Пейтцa-Егерса (эпидермальные гипермеланозы или Лентигиноз периорифициальный)

Peutz-Jeghers syndrome (PJS) is a Hamartomatous Polyposis syndrome that is characterized by concomitant presence of gastrointestinal polyposis and melanocytic maculele at the level of the lips, mouth and fingers. It is an autosomal dominant syndrome which appears with a ratio of 1:200000 births. PJS clinical diagnosis can be suspected if two or more polyps of Peutz-Jeghers type are detected in the gastrointestinal tract or if one Peutz-Jeghers polyp is associated with the characteristic pigmentation or with case history of heredocolaterale of PJS. We present a clinical case which creates difficulties in diagnosis, being a rarely encountered nosology. The following disease requires surveillance and monitoring in dynamics due to the increased risk of malignant: gastric, colo-rectal, lung, pancreatic, ovarian and breast cancer.Синдром Пейтцa-Егерса включает гамартоматозный полипоз, который характеризуется наличием желудочно-кишечного полипоза и скоплением макул меланоцитов в области губ, слизистых оболочек полости рта и пальцев. Заболевание передается по аутосомно- доминантному типу, распространенность которого составляет 1:200000 родов. Клинический диагноз предполагается, если находят два или более полипов типа Пейтцa-Егерса в желудочно-кишечном тракте, или если данный полип ассоциируется с характерной пигментацией, или наличием наследственности с данным синдромом. Описываем клинический случай, который представляет сложности в диагностике, так как данная нозология редко встречается. Болезнь нуждается в наблюдении и мониторинге в динамике, представляя повышенный риск для малигнизации: рак желудка, колоректальных новообразований, легких, поджелудочной железы, яичника и молочной железы

Lax-Phillips scattering theory for PT-symmetric \rho-perturbed operators

The S-matrices corresponding to PT-symmetric \rho-perturbed operators are defined and calculated by means of an approach based on an operator-theoretical interpretation of the Lax-Phillips scattering theory

Bilateral purulent psoitis

USMF “Nicolae Testemiţanu”, catedra Chirurgie Nr.2Psoita purulentă ori abcesul psoasului prezintă o afecţiune necrotico-purulentă cu origine în grosimea muşchiului psoas, cauzat de procese patologice situate între mediastin, spaţiul pelvin, membre inferioare (2). A fost descris pentru prima dată în anul 1888 de Minter (7). Din punctul de vedere al etiologiei cca. 45% sunt primare iar 55% secundare complicaţiile altor afecţiuni ( traumatice, tumorale sau inflamatorii cu localizare uro-genitală sau la nivelul tubului digestiv), iar spectrul microbian răspunzător de apariţia acestei patologii este dominat de stafilococul auriu, apoi m. tuberculosis, asocieri polimicrobiene, germeni gram negativi (E. coli, salmonella, etc.), Actinomyces Israeli, etiologia amoebiană (1,5). In literatură se regăsesc câteva situaţii predispozante pentru această afecţiune cum ar fi defectul de sept atrial, alcoolismul şi imunodeficienţele de orice tip; există şi o predispoziţie anatomică dată de prezenţa de ganglioni limfatici în grosimea muşchiului psoas (4, 6)

Melanoma with digestive metastases (Case report)

Catedra 2 chirurgie, USMF „Nicolae Testemiţanu”, 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: Melanomul cutanat reprezintă o leziune pigmentară cutanată cu originea în melanocite, celule pigmentare prezente în epiderm, uneori în derm. Există patru tipuri de melanom cutanat: melanomul cu invazie superficială, melanomul malign lenticular şi melanomul lenticular întins care au o capacitate de creştere superficială în dimensiuni, fără penetrare în profunzime. Cel de-al patrulea tip, melanomul nodular, se prezintă de obicei ca o leziune cu invazie în profunzime, capabilă de metastazare precoce. Sediile obişnuite de invazie hematogenă sunt ficatul, plămânul, structurile scheletale, creierul, camera anterioară a ochiului. Caz clinic: Pacient V, 46 ani, internat în mod urgent, cu diagnosticul de ocluzie intestinală acută, peritonită, anterior tratat pentru melanom cutanat. Prezentarea noastră este semnificativă prin faptul, că diagnosticul de metastaze digestive a fost stabilit la 4 ani după excizia melanomului cutanat. Examenul intraoperatoriu, radiografia toracelui şi imagistica nu au evidenţiat leziuni de alte localizări metastatice. Perioada postoperatorie – simplă, externat la tratament ambulator în stare satisfăcătoare. Concluzii: Incidenţa melanomului malign este în creştere, metastazele digestive necesită să fie luate în considerare. Actul chirurgical opţionează pentru terapia paliativă, în unele cazuri fiind prelungită supravieţuirea pacientului.Introduction: Melanoma is the cutaneous pigmented lesion originated in melanocytes, pigment cells normally present in the epidermis and sometimes dermis. There are four types of cutaneous melanoma. Melanoma with superficial invasion, lenticular malignant melanoma, lenticular spread melanoma with superficial grow without penetration in depth. The fourth type, nodular melanoma, is usually a lesion with deep invasion, characterized by early metastasizing. The typical sites of hematogenous invasion are liver, lungs, skeletal structures, brain, and the anterior chamber of the eye. Clinical case: Patient V, 46 years old, previously treated for cutaneous melanoma was hospitalized in emergency with the diagnosis of acute intestinal obstruction and peritonitis. Our presentation is significant by the fact that digestive metastases were diagnosed 4 years after excision of cutaneous malignant melanoma. Intraoperative exploration, chest radiography and imaging revealed no metastatic lesions in other locations. The postoperative period was uneventful; patient was discharged in satisfactory condition for out-patient treatment. Conclusions: The incidence of malignant melanoma is continuously growing and digestive metastases needs to be taken into consideration. Surgical option usually is a palliative therapy, which in some cases can prolong patient survival

On elements of the Lax-Phillips scattering scheme for PT-symmetric operators

Generalized PT-symmetric operators acting an a Hilbert space $\mathfrak{H}$ are defined and investigated. The case of PT-symmetric extensions of a symmetric operator $S$ is investigated in detail. The possible application of the Lax-Phillips scattering methods to the investigation of PT-symmetric operators is illustrated by considering the case of 0-perturbed operators

Оценка противовирусной терапии у больных с циррозом печени вирусной этиологии C и D

Summary: Study group: 49 patients, 17 (34.69%) women and 32 (65.31%) men with hepatic viral cirrhosis, Child-Pugh stage A: 24 – D viral etiology and 25 – viral C genesis. Average age: 44.41 ± 0.4 years in women and 47.59 ± 0.6 years in men. Purpose: evaluation of the antiviral treatment response at 12 weeks and 24 weeks after initiation and assessment of laboratory results during antiviral therapy in patients with liver cirrhosis C and D. In patients with liver cirrhosis HDV, treated with Peg-INF undetectable viral load was achieved at 12 weeks in 28% cases and after 24 weeks of treatment it is observed in 25% of cases. In the group of patients with liver cirrhosis HCV, treated with Peg-INF + Ribabirină – 12 weeks of treatment – 75% of patients responded positively: 48% achieved complete EVR and 24% – EVR part. Evaluation of patients at 24 weeks of treatment show a positive virologic response in 56% cases. In patients with liver cirrhosis HCV and HDV, where the virological response was absent, more severe, and early complications of antiviral therapy are observed: the blood count shows anemia, major leukopenia and thrombocytopenia.Pезюме: Группа исследования: 49 пациентов, 17 (34,69%) женщин и 32 (65,31%) мужчин с циррозом печени вирусной этиологии, стадия Child-Pugh А: 24 – вирусной этиологии D и 25 – вирусной этиологии C. Средний возраст: 44,41 ± 0,4 лет у женщин и 47,59 ± 0,6 лет у мужчин. Цель: оценка ответа на противовирусное лечение на 12-ой неделе и на 24-ой неделе после начала лечения и оценка лабораторных показателей во время противовирусной терапии у больных с циррозом печени С или D. У пациентов с циррозом печени HDV, леченных Peg-INF, была достигнута авиремия на 12-ой неделе в 28% случаев и на 24-ой неделе лечения – в 25% случаев. В группе пациентов с циррозом печени вирусной этиологии С, леченных Peg-INF + рибавирин, наблюдается на 12-ой неделе лечения положительный ответ у 75% пациентов: у 48% достигнут полный ранний вирусологический ответ, у 24% – частичный. Оценка противовирусного лечения через 24 недели после начала показала положительный вирусологический ответ в 56% случаев. У пациентов с циррозом печени вирусной этиологии С или D с отсутствием вирусологического ответа на противирусную терапию обнаруживаются осложнения более тяжелые и раньше: в анализе крови – анемия, лейкопения и тромбоцитопения