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The author of the present work analyses the notion and the structure of the forensic expertise report, the particularities of the graphological expertise report, in particular, taking into account the present penal-processual legislation of the Republic of Moldova and the judicial practice regarding the judicial expertise of the handwriting and signature. He brings arguments in favour of a legislation suggestion of improving and optimisation of the graphological expertise report and its evaluation by the criminal investigation authority and the judge., {"references":["1.\tGhid de expertize judiciare. Coord. M. Gheorghiță. Chișinău:\"Angela Levința\", 2005. 103 p.","2.\tБЕЛКИН, Р.С. Сущность экспериментального метода исследования в советском уголовном процессе и криминалистике. Москва: Юрид. Лит-ра, 1961. 250 с.","3.\tШЛЯХОВ, А.Р. Структура экспертного исследования и гносеологическая характеристика выводов эксперта-криминалиста. В: Труды ВНИИСЭ, Вып.4. Москва, 1973, с. 20-32.","4.\tДУЛОВ, А.В. Права и обязанности участников судебной экспертизы. Минск, 1962, 137 с.","5.\tLegea Republicii Moldova Cu privire la expertiza judiciară şi statutul expertului judiciar nr.68 din 14.04.2016. În: Monitorul Oficial al Republicii Moldova nr. 157-162/316.","BELIBOV, L., FLOREA, L., GROSU, V. Metodele de verificare și apreciere a raportului de expertiză judiciară de către ordonator. În: Legea și viața, octombrie, 2019, p. 55-60.","7.\tCodul de procedură penală al Republicii Moldova, adoptat prin Legea Republicii Moldova, nr.122-XV din 14.03.2003. În: Monitorul Oficial al Republicii Moldova, nr.104-110.","8.\tVOINEA, D. Principalele criterii de apreciere și valorificare a expertizelor criminalistice în procesul penal. În: Revista Română de criminalistică. Nr.5, 2013, p.1425-1427.","9.\tLegea Republicii Moldova Cu privire la expertiza judiciară şi statutul expertului judiciar nr.68 din 14.04.2016. În: Monitorul Oficial al Republicii Moldova nr. 157-162/316.","10.\tLegea Republicii Moldova Cu privire la expertiza judiciară şi statutul expertului judiciar nr.68 din 14.04.2016. În: Monitorul Oficial al Republicii Moldova nr. 157-162/316.","11.\tRaportul de expertiză al CNEJ al MJ RM nr.1653/103 din 21.07.2015 pe cauza penală nr.20143300608.","12.\tRaportul de expertiză repetată nr.9431 din 02.10.2015 al CTCEJ al IGP MAI RM pe cauza civilă 2-331/15.","13.\tCodul de procedură penală al Republicii Moldova, adoptat prin Legea Republicii Moldova, nr.122-XV din 14.03.2003. În: Monitorul Oficial al Republicii Moldova, nr.104-110.","14.\tMARTIN, J-C. et al. Investigation de scene de crime. 3 e edition revue et augmentee. Lausanne: PPUR, 2010. 237 p.","15.\tDOLEA, I. Drepturile persoanei în probatoriul penal: conceptul promovării elementului privat. Chișinău: Cartea Juridică, 2009. 416 p.","16.\tRaportul de expertiză grafoscopică al CEXIN, nr.032 din 27.01.2014 pe cauza penală nr.2011515143 a SUP IP Ciocana.","17.\tRaportul de expertiză CEXIN, nr.105 din 19.02.2014 pe cauza civilă nr.2-3032/13 a Judecătoriei Botanica, mun. Chișinău.","18.\tCATARAGA O. et al. Metodica tip de efectuare a expertizei judiciare grafoscopice. Cod MT 4.01, adoptată la 10.04.2017 de CȘM al CNEJ de pe lângă MJ al RM.","19. OSOIANU, T. et al. Tactica acțiunilor de urmărire penală. Chișinău: Cartea Militară, 2020. 339 p."]}

Preparing Comparative Materials in Order to Require a Graphic Expertise of the Signature The author of the present work analyses issues regarding the preparatory means that are necessary when the investigation officer requires a graphological expertise, especially collecting comparative specimens. He proposes various sources, these samples can be taken from, tactical and organisational procedures of obtaining free, conventionally-free and experimental comparative specimens. &nbsp

În lucrare autorul supune analizei unele probleme teoretice și practice actuale cu privire la expertiza judiciară a manuscriselor folosită în activitatea de descoperire și cercetare a infracțiunilor. Se propun precizări cu privire la teoria identificării grafoscopice, dar și soluții practice în domeniul cercetării documentelor care urmează a fi luate în considerare de către experții grafoscopiști în activitatea lor cotidiană.

The Notion and Classification of Signature in Grafology The authors of the present work analyses modern signatures from a historical-evolving point of view and proposes a definition and classification of signatures based on the graphic information a signature contains. Examining the stages of the signature identification examination carried out by the expert, the author highlights some specific features of signature investigation, that must be taken into consideration by the graphologic specialists. În lucrare autorii analizează semnătura contemporanilor noştri în aspect istorico-evolutiv, propune o definiţie şi o clasificare a acestora după volumul de informaţie grafică cuprinsă în conţinutul lor. Examinând etapele cercetării identificatoare a semnăturilor de către expert, autorul scoate în evidenţă unele particularităţi în cercetarea semnăturilor, demne de a fi luate în considerare de către specialiştii grafoscopişti.

By establishing the renal supleetion procedure, the patients with cronic renal failure also have an acceleration of arterial hypertension. The management of this situation calls for the understanding of the generating mechanisms (hipervolemia by the reduction of natriuresis and hiperreninemia) and the adaptation of the therapeutical approach for every patient. It imposes an individualized dialization prescription taking into account the residual renal function and an antihypertension treatment, in which the role of the conversion enzyme inhibitors is intensely debated.

Inflammatory processes of the thyroid represents a main proportion of the gland's pathology but the majority of them are treated by medical methods, surgery being indicated.In 14 cases (3%) from 464 operations for different thyroid conditions we have encountered authentic inflammatory lesions in 9 cases of Hashimoto's thyroiditis (two associated with papillary thyroid carcinoma and one with malignant lymphoma), two cases of Riedel's thyroiditis and respectively de Quervain thyoiditis, tuberculous thyroiditis and actynomicosis one case each. The common lymphoplasmacytic infiltration in Basedow's disease was not considered likewise as the inflammatory nespecific lesions encountered in benign and malignant pathology of the gland. The clinical and imagistic data, biological evaluation and titer of anticorps but particularly the paraffine examination together with intraoperative estimations are decisive for the diagnosis.Firm diagnosis of thyroiditis was rarely affirmed before operation, surgical indication being formulated on clinical criterions dominated by cancer suspicion. Among these are diffuse or (multi)nodular thyromegaly with a dominant nodule with recent appearance and rapid growing in temporal and geographic proximity of Chemobyl disaster, with hard consistence, celsian or compressive features and adenopathy. More added the imagistic signs but especially suspect aspects of the FNAB (follicular or with Hürthle cells smears) and also of the frozen sections. Certainty diagnosis was established by paraffine examination not always without hesitations or reexamination (Hashimoto's thyroiditis diagnosed in one case was finally a malignant lymphoma). Large removal decided after intraoperative findings induced for the most of patients a definitive hypothyroidism.All the diagnosis resources must be exhausted for the diagnosis of the inflammatory lesions of the thyroid to avoid unnecessary surgery. On the other side the chronic overstimulation by the TSH of the glandular tissue affected by the immune process, represent an important factor of producing neoplasia.

The optimal treatment of tumors of Vater's region represents a permanent interest of every physician involved in the treating of malignant diseases with such localization.This presentation proposes a pancreaticoduodenectomy (DPC) evaluation in the surgical treatment of tumors of Vater's ampulla.Between 1999 - 2009 our clinic has treated a number of 37 cases with mechanic jaundice by malignant diseases (JMN). Out of these, 5 cases (13.5%) have been hospitalized with JMN (preoperative diagnose) by malignant tumors of Vater' region: 4 men and a woman, aged 46 to 72, from rural medium, who represent the aim of this paper. RESULTS.In 4 cases (10,.8%), intra-operatory exploration confirms the existence of tumors of Vater's ampulla or duodenal papilla (diagnosis having been established by preoperatory duodenoscopy) using DPC (Child Procedure). Postoperative evolution, either immediate or distanced, was favorable, implying no deaths. The microscopic exam of the extirpated piece confirms Vater's Ampulloma in two cases (5.4%); in the other two cases, the above mentioned exam reveals the small bowel's carcinoma at duodenal papilla. In the last 2.7% cases intra-operatory lymph node and visceral metastases have been observed, choledochoscopy revealing cholangiocarcinoma (confirmed by microscopic exam), the patient having suffered only a choledochoduodenostomy.Without being endowed with great experience in the field, the results of DPC treatment in these first cases of malignant tumors of Vater's region allow us to found the reasoning of the righteousness of surgical indication. DPC draws the hope of radical healing intention in the cancer with this localization.

The aim of this study was to assess the epidemiological data on the rheumatoid arthritis in Iaşi, Romania and in North East Romania. These data are useful for informing the policy makers, the public and above all the practitioners regarding such a disabilitating disease. The epidemiology plays an important role in understanding the etiology of the rheumatoid arthritis because there are notable differences in incidence between various populations.This retrospective study followed 517 patients in 2009 and 499 patients in 2010 at the Rheumatology Clinic of the Rehabilitation Hospital, Iaşi, Romania, based on the following parameters: sex, age, rheumatoid factor, anti-CCP antibodies, the Steinbrocker functional classification, the stage of the disease.The highest rates of rheumatoid arthritis were recorded in the age group of 69-60 years, followed by the age group of 59-50 years. Most of the patients were in the third stage of the disease, with limited functional capacity.The clinical and evolutive data of the patients with rheumatoid arthritis at the Rheumatology Clinic of the Rehabilitation Hospital, Iaşi, Romania in the time interval 2009-2010 correspond to the European data in this field.

Revascularization of the lower extremity in patients with diabetes or chronic obstructive arterial disease is a challenging, still unsolved problem. Modern day technique (stem cell therapy, hyperbaric therapy) has yet to deliver satisfactory results. Homogenous (safenous vein) or heterogeneous (terom, dacron, PTFE-teflon) by-pass surgery is limited because of technical difficulty and positive outcomes have a short duration. All these lead to, in most patients, to amputations as first line therapy or as an alternative to failed approaches. By-pass surgery is limited by graft obstruction. One of the current approaches is the use of omental flap autotransplantation.

The optimal surgical treatment in patients with refractory renal hyperparathyroidism (RHP) on hemodialysis for end stage renal disease is still a point of controversy. The high percentage of recurrences after standard surgical procedures i.e. subtotal parathyroidectomy (SPTx) and total parathyroidectomy with autotransplantation (TPTx + At) reactualised the practice of total parathyroidectomy (TPTx).Fortythree patients with RHP underwent surgery between 1994-2009. There were 24 SPTx and 6 TPTx + At, both procedures determining 20.7% (6 cases) recurrences so in the last five years TPTx was performed in a series of 13 cases (7 men and 6 women, with median age 43, 6 years; range 22 - 65 years and median dialysis time before PTx 8,2 years; range 3 -12 years. Parameters studies included demographics, preoperative and follow-up laboratory tests, surgical techniques, pathology results and postoperative immediate and medium term results.Main indications for PTx were severe bone disease, soft tissue calciphycations, neuro muscular phenomena, grossly elevated iPTH and sometimes hypercalcemia. TPTx was done in 12 patients, the 13th one suffering a completion PTx one year after outward exeresis of only two glands. Postoperatively the majority of symptoms markedly improved and the values of calcaemia, phosphatemia and alkaline phosphatasis normalised together with low or no measurable level of iPTH. One patient required a re-exploration for a cervical hematoma but no one presented permanent hypocalcemia or recurrent hyperparathyroidism. Pathology revealed nodular hyperplasia in all the cases, a parathyroid carcinoma but also an incidental thyroid papillary microcarcinoma in a complementary thyroidectomy.TPTx alone proves to be an equally safe and successful as another techniques currently used in management of RHP eliminating the hyperparathyroid status but being superior with regard to aparition of recurrences. The procedure is indicated especially in cases with aggressive, refractory forms of RHP without the prospect of renal transplantation.

Gall blader abnormalities are very rare. The diagnosis is difficult, more often appears during operation or necropsy. The authors present a clinical case with double gall blader, into a 50 years old man. The diagnosis appeared during laparoscopic cholecystectomy. The colecistectomy was performed for chronic cholelithiasis. Even it is rare, this pathology should be known, to avoid biliary ducts iatrogenic injuries during operations. The authors made a mustering of literature.

Mucinous cystic tumors (MCTP) are uncommon borderline lesions of the pancreas that may often be misdiagnosed as pseudocysts and have unknown propensity to malignity. During the last two decades in our clinic of 38 patients with cystic lesions of the pancreas two presented MCTP: a 48-year-old woman with a cyst located in the body and tail of the pancreas and a 59-year-old man with a tumor situated in the head of the gland producing an obstructive jaundice. Ultrasonography and computer tomography confirmed the presence of the cystic mass in both patients but the precise diagnosis was made only after the histologic examination of the removed lesions. With an attempted curative resection: distal pancreatectomy with preservation of the spleen in the first case and a Whipple procedure in the second one, both cases were cured. Pathology do not reveal malignant transformations. Both patients were alive, had no complaints or recurrences at 12 and 24 month after surgery. The treatment of choice in such cystic tumors is surgical removal as untreated these lesions may progress to neoplastic degeneration.

Parathyroid carcinoma is a rare endocrine neoplasm with difficult histological diagnostic and unpredictable evolution. More unusual are the cases appearing in the course of end-stage renal disease on maintenance dialysis (22 observations in medical literature). A 46-year-old man suffering of chronic glomerulonephritis and renal failure for 13 years, having been on hemodialysis for three years, complains of asthenia, adynamia, muscle weakness, progressive osteoarticular pains, itching. The preoperative iPTH was 71/ng/ml, seric Ca2+/1.23 mmol/l, seric Ca/2.6/mmoli/l, seric P/2.02 mmol/l. Clinical and ultrasonographical examinations revealed a left "thyroid nodule" of 44 x 37 mm but no images of the parathyroid. Upon surgery, three parathyroid glands (two from the right side and the superior left one) were identified and excised after the frozen section. The fourth gland was not found but the resected "nodule" together with the adjacent thyroid lobe proved a parathyroid carcinoma upon paraffin examination. The clinical course after operation was uneventful. The authors underlined the criteria and difficulties in the pathologic diagnosis of parathyroid carcinoma and also the principles of surgical treatment based on their experience of three cases.

Reoperative thyroid surgery may be necessary in recurrent simple goiters, thyrotoxicosis and especially cancers of the thyroid gland. The present series reviewed 33 cases representing 7.3 % from our experience consisting of 440 thyroid operations. Five patients had undergone two prior operation. Details of original procedures were available only for 26 patients, the first operations being carried "extra muros" in 20 cases. There were 25 women and 8 men with mean patient age 44.5 (range 22-75) years, which had undergone one prior operations. The interval between the primary operation and the second one varies between 5 days and 44 years. Eleven cases had benign lesions: eight with uni or bilateral nodular goiters and three thyrotoxicosis (two with Basedow-Graves'disease and one with toxic adenoma) for which nodulectomy, subtotal lobectomies or thyroidectomies were performed. In twenty one cases the surgical indication was done for persistent or recurrent thyroid carcinomas (16 papillary, two follicular and one case each of medullary, anaplastic and malignant lymphoma). Among these 6 patients underwent completion total thyroidectomies associated in 9 another patients with radical or modified neck dissection and in the 6 remaining cases conservative procedures (lobectomies, tumoral excision) of the gland or nodes were done. Complications, includes two recurrent laryngeal nerve palsy, two spontaneously healed esophageal fistulas and one case each of permanent hypothyroidism and hypoparathyroidism. Reoperative thyroid surgery constitute a valuable surgical procedure for persistence or recurrence of benign and especially malignant thyroid lesions but is associated with significant increased risk of functional and anatomic complications rate than those of the initial surgery.

This study presents the CT imaging and histological aspects of a lot of cavernous sinus disease that include primary and secondary neoplastic processes, congenital lesions, infectious and inflammatory processes, and vascular abnormalities.All 47 patients were CT explored with and without intravenous contrast, using specific protocols for orbit and brain. We studied the topography of the tumors, their impact to neighborhood regions and post-treatment results. For all patients we performed histological examination.We found 26 cases with sellar origin of the tumor and 21 cases of para-sellar origin, with a significant extension in 22 cases. The most frequent histologic type of tumors were represented by hypophyseal adenoma (17 cases), followed by meningiomas (9 cases) and cranio-pharyngiomas (5 cases).CT imaging allows a fast and accurate analysis of sellar and para-sellar tumors, with a tumor extension assessment. The clinical and imaging diagnosis is confirmed by histological examination.

Gastrocolic fistula (GCF) is a rare and severe lesion appearing traditionally as a complication of inadequate gastric surgery or in the context of stomach or colon malignancy, but actually arising from many different gastrointestinal conditions. Three patients with GCF, admitted and operated in our clinic, are presented. The first case, a man aged 36 years, was a classical one, with a G(jejuno)CF appearing three years after a gastrectomy with Reichel-Polya reconstruction for duodenal ulcer, resolved by a "revision gastrectomy" en block with segmental resection of the jejunum and transverse colon. The second case, also a man aged 43 years, presented a spontaneous GCF determined by a gastric carcinoma, that required an en block enlarged gastro-colectomy. The last case, a 61 year-old woman, presented three weeks after an emergency concomitant cholecystectomy and appendicectomy, with clinical manifestation suggesting a subphrenic abscess. Although a contrast-enhanced CT revealed a communication between the great curvature of the stomach and the splenic flexure of the colon, no fistula was found at laparotomy (spontaneous healing?). However, the terminal ileum and ascending colon had a suggestive appearance of Crohn's disease (confirmed by pathology) and a right colectomy was done. Excepting the rare situation of spontaneous or after medical treatment healing, the mainstay therapy of GCF is the case-adapted surgery.

Meropenem is a new carbapenem with excellent activity against different Gram-negative and Gram-positive bacteria. Its good antibacterial activity is closely related to high hydrolysis resistance by bacterial beta-lactamases. The aim of this study was to evaluate antimicrobial activity of meropenem by comparison that of oxacillin, gentamicin, clarithromycin and ciprofloxacin against 458 staphylococci collected during 2004 period from healthy individuals. Minimum inhibitory concentrations were determined by agar dilution technique. Meropenem has an activity clearly superior to the other tested agents. Resistance rate is zero for all investigated strains.

Duodenal ulcer benefits of very efficient medical treatment. In currently medical practice exist many cases with complicated duodenal ulcer (by stenosis or penetration in neighbor organs like pancreas or biliary tract or painful forms etc.) to which surgical treatment is necessary. Based on the retrospective study of 116 patients operated between 1991-2002 years for gastric or duodenal ulcer, this paper demonstrates that bulbantrectomy associated with bilateral truncal vagotomy (63.7% of cases) is the best surgery in the treatment of duodenal complicated ulcer or resistant to the medical procedures. Provided by correct indication, the intervention is the most pathogenic, offering the best immediate and long term postoperative results. If the bulbantrectomy is contraindicated (critical general status, etc.), the alternative is a bilateral truncal vagotomy associated with a drainage procedure: pyloroplasty (6.9% of cases) or gastroenterostomy. When the vagotomy are contraindicated or cannot be correctly performed, a large gastrectomy (29.3% of cases) followed by gastroduodenal (preferable) or gastrojejunal anastomosis are practiced.

Autonomic and persistent hypersecretion of PTH is a frequent and tormenting complication of the patients with chronic renal dialysis for end stage renal disease (ESRD). In these cases, surgery remains a therapy option with real effects on clinical status of patients, especially in perspective of a renal transplant. The authors present the case of a patient with tertiary hyperparathyroidism for which a total parathyroidectomy followed by autotransplantation of small glandular fragments in forearm muscles was performed. The postoperative clinical and immunological statuses were favorable with the disappearance of pruritus and osteoartralgia with improvement of psychic behavior and normalization of calcium blood level. Considering the parathyroidectomy as a palliative stage in the treatment of ESRD, the authors discussed a hierarchy system of both indications and surgical alternatives to be considered in this condition. In well selected cases this surgical method represents an attractive and easy possibility to control and later adjustment of the hyperfunction of remained parathyroid tissue, avoiding in this way a very risky intervention.

The aim of this study is to present our experience concerning a rare form of gastric tumor--gastrointestinal stromal tumor (GIST).We reviewed data of four patients with gastric stromal tumors, which have been admitted in our department from 1998-2002.There were two females and two males with age of 75, 70, 65 and 63 years old. The average duration of symptoms until hospital admission was 7 days. During surgery we discovered proximal gastric tumors with 4, 5, 10 and 20 cm in largest diameter. We performed excision of the whole tumor with a security limit of 2 cm or gastric resection (one case), without limphadenectomy. One patient developed an anastomotic fistula with a good evolution under conservative treatment. All patients left the hospital in a good condition. Histopathological and immunohistochemical study diagnosed gastric stromal tumors by identifying the CD 117 maker. Postoperatively neither one of our patients received chemotherapy or radiotherapy. One female and one male patient died of peritoneal metastasis at nine months and respectively two years after operation. The other two patients are in a good condition up to date, without metastasis, one and respectively three years after surgical treatment. CONCLUSIOUS: Correct diagnosis, complete tumor resection and surveillance are essential steps in management of gastric stromal tumors.

The aim of our study is to analyze the five-year survival for patients with operated rectal cancer in our clinic during a five-year period (1997-2001).Our epidemiological clinical study is based on prospective analysis of 196 cases of rectal cancer operated between 1997 and 2001. Survival evaluation was prospective cohort follow-up study. We have used Epiinfo 2000 software package for data analysis.The five-year survival was 54.08% if we take into account all deceases including other causes and 64.28% for exclusive deaths caused by rectal cancer and metastasis. The survival at 5 years (S5) was: stage A S5 = 85.3%; stage B1 S5 = 76.6%; stage B2 S5 = 71%; stage C S5 = 68.7% and stage D S5 = 8.6%. The follow-up in month (e5) was: stage A e5 = 58, stage B1 e5 = 46; stage B2 e5 = 36, stage C e5 = 20 and stage D e5 = 6. The values for S5 and e5 are in accordance with the literature.Despite progresses of rectal cancer management, the five-year survival doesn't transcend much over 50%. Because the five-year survival for A stage is 85.3% in our study, we may conclude that at present introducing of screening program represents the only chance for improvement of results.

The study is based on the analysis of 158 patients admitted in the "Fourth Clinic of Surgery" with diagnosis of "Upper Digestive Haemorrhage" (U.D.H.) between 1998-2002, emphasising the importance of the physiopathological chains induced by the ulcer bleeding; 119 cases (76%) were diagnosed with gastro-duodenal ulcer, 20 with portal hypertension (20%), 14 subjects were with gastric carcinoma (8.8%) and 5 with miscellaneous etiologies so called "rare circumstances" of U.D.H. (two patients with Idiopathic Thrombocytopenia, one case with Dieulafoy gastric ulceration and two subjects with Haemorrhagic Gastritis). All the patients were admitted in the first moment in the Intensive Care Unit where haemostasis were successfully obtained with drug therapy adapted to the physiopathological changes induced by bleeding, in the majority of cases with light bleeding (8 cases, 5.4%) or medium bleeding (139 patients, 87.4%); only in 9 subjects (6%) with severe haemorrhage surgery was indicated (posterior bulbar ulcer in which the surgical haemostasis was necessary). In 88 patients (55%) surgery was performed as an elective procedure--74 from them had haemorrhagic gastric or duodenal ulcers with a medium amount of bleeding and 14 observations for gastric carcinoma with a chronic bleeding. In most all the cases the postoperative evolution was in good terms. Two observations with severe U.D.H. due to rupture of esophageal varices occurred on hepatic cirrhosis were out of therapeutical proof (1.2% deaths from all the admitted patients with U.D.H.).

The prophylactic use of antibiotics in the purpose of decreasing the frequency and severity of surgical infections is still controversial. The practical need of defining the concept of antibiotic prophylaxis gave rise to numerous polemics in the literature. This paper presents a retrospective study on 103 cases whom diagnostics were colon and rectum cancer, that were operated in the IV-th Surgical Clinic in 1993-2002 period; at these patients was done antibiotic prophylaxis local and systemic before, during and after operating. This method made possible the registration of a minimum number of cases with surgical infection (7 cases, representing only 7% of the operated patients): a case (1%) with peritoneal collection (needing the surgical evacuation of this collection) and in 6 cases, parietal superficial infections, which imposed the prolong of drainage for almost 7 days. Starting from the basic principles of antibiotic therapy, this paper aims at outlining practical guidelines for a judicious antibiotic prophylaxis.

The anatomic particularities and the diversity of the splenic pathology determine a wide spectrum of the traumatic lesions of the spleen. The classical acute rupture with consecutive hemoperitoneum and mandatory surgical indication is opposed to the controversial "spontaneous" ruptures of the normal and pathologic spleen and also to the delayed and occult ruptures the lasts of them sometimes minimal or with chronic evolution. A series of eight cases all males with ages between 40-77 years is presented in order to exemplify all these entities. There are underlined the variety of etiologic conditions, the difficulties of the diagnosis which impose an insistent anamnesis and clinical examination (searching even a "trivial" trauma) completed with ultrasonography and CT scan which are preferred to radionuclide scan of arteriography and finally peritoneal lavage after punction, laparoscopy and even laparotomy. Splenectomy--often laborious--was effective in all our patients (obviously only temporary for the cases with nonhodgkin malignant lymphoma and respectively with splenic metastasis from a renal carcinoma). In some situations--especially in children--the conservative treatment can be considered.

The parathyroid cancer is mentioned in literature with an incidence of 0.5-5% in the etiology of the primary hyperparathyroidism. The authors present the case of a 45 year old female with diagnosis of "primary hyperparathyroidism" based on clinical, ultrasonographic and biochemical investigations. A right superior adenoma of 3 x 2 x 1 cm (150 mg) has been found and extirpated. The histological examination showed an adenoma with predominant "chief" cells. Three years after surgery the patient had a recurrence of the clinical and hypercalcemie syndrome (with more severe damages). The surgical reexploration showed the right thyroid lobe with a nodular aspect and in its inferior pole a enlarged parathyroid gland of one cm size was found. An en-block exeresis including the right thyroid lobe with isthmus as well as the mentioned lesion and the half of left superior parathyroid, the left inferior one together with retrosternal fat tissue have been performed. Frozen sections completed by paraffin examination established the diagnosis of hyperfunctioning parathyroid carcinoma. We have emphasize the issues that could suggest the initially preoperative true diagnosis: the large size of excised adenoma and the relatively quick recurrence of the phenomena of parathyroid hyperfunction. The surgical principles and strategies in the treatment of parathyroid cancer are also discussed.

Our article yields new statements about macroscopic anatomy of the sympathetic lumbar chain, after the dissection of 480 corpses in a 15 years period. Our observations state new conclusions, with implications in surgical practice, about the function and the vegetative territory of the lumbar sympathetic chain.