CONSIDERATIONS REGARDING THE BAIA MARE AREA METEOROLOGICAL CONDITIONS IN THE LAST 5 YEARS WITH HELP OF ENVIRONMENTAL INFORMATICS

Ever since “the environment” gained its place in the public international agenda (environmental legislation, sustainable development or disaster and hazard management) it has been bundled with data, information, knowledge and information systems. Environmental Monitoring Systems (EMSs), Environmental Monitoring and Analyzing Systems (EMASs) and especially Environmental Information Systems (EISs) are integrated part of what we call Environmental Informatics (EI) platform.In this context, as we speak, the are of EI is becoming more complex due to the current context and trend of making the EISs available to the public and end-users access; this phenomena is based on the assumption that public and environmental information end-users awareness, participation and acting is improved by the rate of access to the environmental information to solve the complex problematic covered by the research, engineering and environmental protection fields. The aim of the present paper is to introduce and describe an innovative possibilities of forecasting and monitoring the environment meteorological specific conditions in Baia Mare urban area using a specialized EISs software

Unusual cause of right iliac fossa pain: sigmoid perforation due to ingested rabbit bone. Case report

Disorders of an organ not usually found in the right iliac fossa, such as the sigmoid colon, are an uncommon cause of right iliac fossa pain. We present a case of right iliac fossa pain caused by a sigmoid perforation due to involuntary ingestion of a rabbit bone, and describe the main features of this condition

Combined resection and multi-agent adjuvant chemotherapy for intra-abdominal desmoplastic small round cell tumour: case report and review of the literature

Desmoplastic small round cell tumor (DSRCT) is a rare, highly aggressive malignancy with distinctive histological and immunohistochemical features occurring in young population with male predominance. We report a case of DRSCT occurred in a 17 years old patient which presented with a large upper left quadrant abdominal mass that was treated with a very aggressive surgical approach and multi-agent chemotherapy. At a 12 months follow-up he is free of recurrence. This kind of tumour has a very poor prognosis. No standard treatment protocol has been established. Aggressive surgery combined with postoperative multi-agent adjuvant chemotherapy is justified not only to relieve symptoms but also to try to improve the outcome

Peritoneal carcinomatosis

Several gastrointestinal and gynecological malignancies have the potential to disseminate and grow in the peritoneal cavity. The occurrence of peritoneal carcinomatosis (PC) has been shown to significantly decrease overall survival in patients with liver and/or extraperitoneal metastases from gastrointestinal cancer. During the last three decades, the understanding of the biology and pathways of dissemination of tumors with intraperitoneal spread, and the understanding of the protective function of the peritoneal barrier against tumoral seeding, has prompted the concept that PC is a loco-regional disease: in absence of other systemic metastases, multimodal approaches combining aggressive cytoreductive surgery, intraperitoneal hyperthermic chemotherapy and systemic chemotherapy have been proposed and are actually considered promising methods to improve loco-regional control of the disease, and ultimately to increase survival. The aim of this review article is to present the evidence on treatment of PC in different tumors, in order to provide patients with a proper surgical and multidisciplinary treatment focused on optimal control of their locoregional disease. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved

Intra and postoperative complications in hydatid disease

Catedra de chirurgie nr.4, USMF ,,Nicolae Testemițanu”, Spitalul Clinic Republican, Chișinău, Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Chistul hidatic este provocat de larva Taenia Echinococcus granulosus. Evoluția se caracterizează prin afectarea distructivă a organelor şi ţesuturilor, în special a ficatului şi pneumonului. Complicațiile intra și postoperatorii au un impact important în evoluția postoperatorie și în perioada de reabilitare. Scopul. Scopul studiului a fost de a analiza complicațiile intra și postoperatorii în boala hidatică și a elabora un șir de măsuri de prevenire. Material și metodă. Lotul de studiu a inclus 2300pacienți cu boala hidatică tratați în secția de chirurgie toracică a SCR. Rezultate. Complicații intraoperatorii am avut în 48 cazuri (2%): dintre care 36 cazuri (75%) complicații de ordin tehnic chirurgical: ( revărsarea lichidului hidatic-11cazuri (30.5%), hemoragii-17 cazuri (47.2%), diseminări microbiene-8 cazuri (22.2%); complicații chemo-toxice 4 cazuri (8.3%) și complicații de altă geneză 8 cazuri (16.6%). Complicații postoperatorii am avut în 154 cazuri (6.7%): dintre care supurarea plăgii 83 cazuri (53.8%), hemotorax36 cazuri (23.37%), fistule biliare 35 cazuri (22.72%). Complicațiile de ordin tehnic se evită prin izolarea minuțioasă a câmpului operator, hemostaza se obține prin suturi intratrabeculare a vaselor sanguine atrăgând atenția de a nu leza ducturile biliare, capsula fibroasă nu se înlătură. Pentru a minimaliza diseminările microbiene posibile se recomandă rezecții pneumonare, antibioticoterapie intravenoasă intraoperatorie. Stabilirea diagnosticului topografic preoperator și ecografia intraoperatorie la necesitate duc la reducerea erorilor chirurgicale. Complicațiile postoperatorii se previn prin managementul terapeutic oportun cât și îngrijiri medicale minuțioase. Concluzii. Complicațiile intra și postoperatorii pot fi minimalizate respectând minuțios algoritmul elaborat, stabilind diagnosticul topografic și îndeplinind corect intervenția chirurgicală.Introduction. Hydatid cysts are caused by the larvae of Taenia, Echinococcus granulosus. Development of the cysts is characterized by the impairment and destruction of organs, especially in the liver and the lungs. Intra and postoperative complications have a significant impact on the patient’s recovery and rehabilitation period. The Aim. The purpose of the study was to analyze the intra and postoperative complications of hydatid disease and to develop a series of preventative measures.Materials and Method. The study group included 2300 patients with hydatid disease treated in the Thoracic Surgery Department of the RCH. Results. Intraoperative complications occurred in 48 cases (2%): of which 36 cases (75%) were technical surgical complications: leakage of hydatid liquid – 11 cases (30.5%), haemorrhaging – 17 cases (47.2%), cross contamination – 8 cases (22.2%); Chemotoxic complications – 4 cases (8.3%) and other complications – 8 cases (16.6%). Postoperative complications occurred in 154 cases (6.7%): suppuration of wounds – 83 cases (53.8%), hemothorax - 36 cases (23.37%), biliary fistula - 35 cases (22.72%). Technical complications can be avoided thorough isolation of the operating field, hemostasis is achieved through intratrabecular sutures with attention not to damage bile ducts, the fibrous capsule should not be removed. To minimize potential cross contamination, resection of the lung is recommended and intraoperative intravenous antibiotics should be administered. Topographical preoperative diagnosis and intraoperative ultrasound are necessary to reduce surgical errors. Postoperative complications are prevented by appropriate therapeutic management and thorough medical care. Conclusion. Intra and postoperative complications can be minimized through careful diagnosis and proper surgical practice

Esophageal surgery – the experience of the department of surgery of CME faculty of SUMPh “Nicolae Testemitanu”

Catedra chirurgie FECMF, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Esofagul, pentru chirurgi, rămâne un segment deosebit al tractului digestiv atât din cauza particularităţilor anatomo-topografice a organului, a căilor de acces către acesta, cât şi a tehnicilor operatorii asupra respectivului. Scopul lucrării: De a ne împărtăşi cu experienţa Clinicii de 30 ani în domeniul chirurgiei esofagiene. Material şi metode: Clinica de Chirurgie FECMF a USMF „Nicolae Testemiţanu” – secţia de chirurgie toracică şi chirurgie generală a Spitalului Clinic Republican îşi are direcţia cercetărilor, studiilor practico-ştiinţifice ale intervenţiilor pe esofag din 1974. Fişierul clinicii deţine mai mult de 1000 operaţii pe esofag. Rezultate: Punct de pornire au servit traumele esofagului adunând 70 cazuri. Alți 83 pacienţi – operaţi pentru diverticul, 192 cu hernii a hiatusului esofagian, 226 suferinzi de diferite forme de stenoze postcaustice, 118 pacienţi s -au operat pentru boala de reflux gastroesofagian, 115 cu achalazii, cu neoplasm esofagian s-au operat 92 pacienţi, esofag Barrett au avut 34 bolnavi, neoplasm al joncţiunii esofago-gastrice – 37 pacienţi. Avem 32 cazuri cu ruptură spontană de esofag (sindromul Boerhaave). Concluzii: Aceasta este experienţa Clinicii, în baza căreia s-a susţinut o teză de doctor habilitat şi două teze de doctor în medicină.Introduction: Esophageal surgery represents very special kind of digestive surgery, because of multiple factors – anatomical-topographic features, specific surgical access and surgical technique. Aim: To evaluate our clinical experience of 30 years of esophageal surgery. Material and methods: Since 1974, in the Department of Surgery of CME Faculty of SUMPh „Nicolae Testemitanu”, thoracic and general surgery departments of Republican Clinical Hospital, were performed about 1000 clinical cases of esophageal surgery. Results: Our first experience in esophageal surgery, as a start point was esophageal injuries – 70 patients, followed by esophageal diverticula – 83 patients, esophageal hiatus hernia – 192 treatment cases, esophageal stricture of various origin – 226 cases, 118 patients have been treated for gastro-esophageal reflux disease, 115 cases with achalasia of esophagus, 92 patients have been treated for esophageal cancer, 34 cases – with Barrett’s esophagus, gastroesophageal junction cancer – 37 cases. In addition, we have experience of 32 cases of spontaneous esophagus rupture (Boerhaave syndrome). Conclusions: The experience of the Clinic mentioned above was reflected in a thesis of doctor habilitatus of medical since and two thesis of doctor of medical since

Dificultăţi diagnostice în tuberculoza pleuropulmonară

Autorii prezintă experienţa secţiei de chirurgie toracică SCR în diagnosticul cazurilor primare de tuberculoză pulmonară, depistate în ultimii ani, analizând detaliat pacienţii depistaţi în 2004. Din 23 de pacienţi 9 au avut procese pleurale, iar 14- pulmonare. Se confirmă importanţa diagnostică a metodelor invazive - bronhoscopia, biopsia pleurală şi pulmonară

Tracheostomy and surgery of the cervical trachea

Catedra Chirurgie FEC MF USMF „N. Testemițanu”, Chișinău, Moldova, Secția chirurgie toracică, Spitalul Clinic Republican, Chișinău, Moldova, 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 2011Introducere. Succesele terapiei intensive şi reanimării în traumatismele grave, care necesită ventilație mecanică prelungită a cauzat creșterea numărului de pacienți cu stenoze posttraheostomice, care necesită corecție chirurgicală. Scopul. Atenționarea societății medicale (anesteziologi, reanimatologi, chirurgi) la conduita optimă a acestor pacienți pentru evitarea complicațiilor mutilante ce impun intervenții laborioase pe segmentul cervical al traheii. Material şi metode. În clinică (1980-2011) s-au operat 50 pacienți cu stenoze ale traheii cervicale: posttraheostomii – 34, postdecubit de manşon - 6, posttraumatice – 8, fistulă esofagotraheală – 2, bărbați – 36, femei – 14. Vârsta pacienților între 13-50 ani, media fiind 28,4. Peste 1/3 (36%) din numărul de operații revin pe ultimii 5 ani. S-au efectuat diferite intervenții: rezecții traheale „în pană” – 9 cazuri, rezecții-anastomoze circulare – 20 cazuri, rezecție anastomoză circulară a traheii cervicale şi 1/3 superioare a traheii toracice prin cervico- sternotomie – 4 cazuri, rezecție laringo-traheală fenestrată cu osteoplastie anterioară – 6 cazuri, excizia fistulei traheo-esofagiene – 2, rezecția laringo-traheală – 1 caz. În 4 cazuri n-am reuşit refacerea definitivă a lumenului traheal şi s-a aplicat fistula traheală, condusă ulterior prin tub traheostomic „T”- stent. Am avut un singur deces. Discuții şi concluzii: În complexul terapiei intensive cu ventilație prelungită trebuie să fie incluse şi metodele de profilaxie a complicațiilor posibile cauzate de traheostomie. -Traheostomia se efectuează cu indicații rezervate, în mod programat, pe tub de intubație, aplicată prin tehnica inferioară cu incizie orizontală sau în lambou (procedeul Björk), de către chirurgi experimentați. -Importanță deosebită o are managementul tubului şi manşonului traheostomic, controlul endoscopic al traheii şi a bronhiilor.Introduction. Success of intensive therapy and reanimation in serious injuries requiring prolonged mechanical ventilation caused an increasing number of patients with stenosis after tracheostomy requiring surgical correction. Purpose. The warning medical society (anesthesiology, Reanimathology, surgeons) at optimal care of these patients to avoid complications that require laborious interventions at cervical segment of trachea. Material and methods. In our clinic 50 patients were operated with stenosis of the cervical trachea: after tracheostomy - 34, the sleeve decubitus position -6, posttraumatic -8, tracheo-esophageal fistula -2, men- 36, women – 14. Patients aged between 13-50 years, averaging 28.4. Over one third of the operations (36%) upon the last five years. Different interventions were performed: tracheal wedge resections – 9 cases, circular resection anastomosis -20 cases, circular resection anastomosis of cervical trachea and of 1/3 superior of thoracic trachea by cervico- sternotomy – 4 cases, fenestrated tracheal resection with larynx Previous osteoplasty – 6 cases, tracheo-esophageal fistula excision – 2, laryngo-tracheal resection – 1 case. In four cases we could not restore permanent tracheal lumen and tracheal fistula was applied, subsequently led by tracheostomic tube “T” stent. We had one case of death. Discussion and conclusions. •In the complex intensive therapy with prolonged ventilation must be included methods of prevention of possible complications caused by tracheostomy. •Tracheostomy is performed by experienced surgeons with indications reserved, on intubation tube, by technique with low horizontal incision or flap. •Particularly important is the management of tracheostomy tube and sleeve, endoscopic control of the trachea and bronchi

Evolutionary trends in esophageal reconstruction

Catedra Chirurgie FEC MF USMF „N. Testemițanu”, Chișinău, Moldova, Secția chirurgie toracică, Spitalul Clinic Republican, Chișinău, Moldova, 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 2011Introducere. Există diferite metode de substituție a esofagului rezecat în dependență de caracterul şi localizarea procesului patologic de calea de acces, de înlăturarea segmentară sau extirparea totală a organului, de materialul de substituție folosit şi metoda de ascensionare a grefei. Scopul: Relevarea tendințelor de reconstrucție a esofagului, în clinica de Chirurgie FEC MF. Material şi metode. În fişa noastră de observație (1977-2011) deținem 240 cazuri de intervenții reconstructive pe esofag. În timp ce registru de patologii indicate în rezecții de esofag, material de substituție utilizat şi căile de ascensionare ale transplantului rămân în ansamblu aceleaşi, în structura lor se observă diferite preferințe. Dacă în primele decade de lucru 90% din volumul total de intervenții dețineau operațiile pentru stenozele postcaustice, în ultimul cincinal (2007-2011) 56% din intervenții au constituit procesele neoplazice. Grefa gastrică serveşte drept material de substituție preferabil 40% (în trecut 17%), colonul deținea 48% acum 30%, jejunul rămâne la nivelul precedent - 30%. Cu referire la căile de ascensionare a grefei folosim mai frecvent calea prin mediastinul posterior – 40%, retrosternală – 25%, intrapleurală – 35%. Concluzii. Toate metodele de substituție a esofagului cu consemnarea avantajelor şi dezavantajelor în fiecare caz individual au dreptul la existență. În clinica Chirurgie FEC MF s-a stabilit următoarea tactică de reconstrucție esofagiană: 1) în stenozele postesofagita peptică și esofag Barrett - rezecția esofagului afectat cu substituția lui cu segment jejunal a la Roux prin laparotomie și toracotomia; 2) în cancerul esofagului mediu toracic - extirparea esofagului cu substituția lui cu grefă gastrică din curbura mare prin trei căi de acces – toracotomie, laparotomie, cervicotomie; 3) în stenozele postcaustice extinse și în cancerul treimii superioare a esofagului utilizăm extirparea esofagului cu substituția lui cu colon prin trei căi de acces. Introduction. There are different methods of substitution of resected esophagus, it depends on the type and localization of pathological process, surgical approach, segmental resection or total extraction of esophagus, depends on the material of substitution used and the method of graft preparation. Purpose. The development of reconstructive surgery of esophagus in the department of surgery, CME Faculty. Materials and methods. In our statement of observation (1977-2011) we have 240 cases of reconstructive interventions in the esophagus. While the indications for esophageal resection, replacement material used and methods of graft preparation remain the same, different preferences can be observed in their structure. If the first decade of work 90% of the total volume of interventions were operations for postcaustic stenosis, in the last five-year 2007-2011, 56% of interventions were the neoplastic processes. Gastric graft is preferable substitute material 40% (in the past 17%), colon had 48% now 30%, jejunum remains at the previous level of 30%. With reference to the way of ascension graft, frequently used path through the posterior mediastinum 40%, retrosternal -25%, intrapleural – 35%. Conclusions. All methods of replacement of the esophagus to record the advantages and disadvantages in each individual case have the right to existence. In the department of surgery CEM was established following tactics of esophageal reconstruction: • In stenosis after peptic esophagitis and Barrett esophagus – resection of esophagus and substitution with jejunal segment Roux by laparotomy and thoracotomy; • In medium thoracic esophageal cancer used esophageal extirpation and its substitution with gastric graft by thoracotomy, laparotomy and cervicotomy; • In extended postcaustic stenosis and cancer of the upper third of esophagus used esophageal extirpation by three pathways.Introduction. There are different methods of substitution of resected esophagus, it depends on the type and localization of pathological process, surgical approach, segmental resection or total extraction of esophagus, depends on the material of substitution used and the method of graft preparation. Purpose. The development of reconstructive surgery of esophagus in the department of surgery, CME Faculty. Materials and methods. In our statement of observation (1977-2011) we have 240 cases of reconstructive interventions in the esophagus. While the indications for esophageal resection, replacement material used and methods of graft preparation remain the same, different preferences can be observed in their structure. If the first decade of work 90% of the total volume of interventions were operations for postcaustic stenosis, in the last five-year 2007-2011, 56% of interventions were the neoplastic processes. Gastric graft is preferable substitute material 40% (in the past 17%), colon had 48% now 30%, jejunum remains at the previous level of 30%. With reference to the way of ascension graft, frequently used path through the posterior mediastinum 40%, retrosternal -25%, intrapleural – 35%. Conclusions. All methods of replacement of the esophagus to record the advantages and disadvantages in each individual case have the right to existence. In the department of surgery CEM was established following tactics of esophageal reconstruction: • In stenosis after peptic esophagitis and Barrett esophagus – resection of esophagus and substitution with jejunal segment Roux by laparotomy and thoracotomy; • In medium thoracic esophageal cancer used esophageal extirpation and its substitution with gastric graft by thoracotomy, laparotomy and cervicotomy; • In extended postcaustic stenosis and cancer of the upper third of esophagus used esophageal extirpation by three pathways