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Introduction: Minimally invasive esophagectomy (MIE) has gained popularity in the surgical treatment of esophageal cancer over the past three decades. By introducing minimally invasive techniques, esophageal oncological surgery has advanced in terms of safety, radicality, functional preservation and quality of life post-esophagectomy of the patients. Material and Method: We present the experience of the Center of Excellence in Esophageal Surgery at Sf. Maria Clinical Hospital regarding total (MIE) through total 3D HD thoraco-laparoscopic modified McKeown triple approach. In between January 2015 - December 2021, 24 patients (M) were treated for thoracic esophageal cancer. The average age of patients was 57 years. Most of the esophageal tumors were midthoracic (62.5%), 83.3% were squamous carcinomas and half were moderately differentiated. Most of the esophageal tumors were locally advanced tumors (cT3N1 – 58.3%), 18 patients were staged III. 70.8% of patients received neoadjuvant chemo radiotherapy. Results: Thoracoscopic esophageal mobilizations were successful in all 24 patients, no conversion to thoracotomy. Laparoscopic gastric mobilizations were successful in all 24 patients, conversion to open technique was performed in 7 patients for creation extracoporeally of the gastric conduit through an epigastric minilaparotomy. The esophageal substitute was represented by the gastric conduit. The intraoperative blood loss was minimal. The average duration of surgical interventions was 360 minutes. All the surgical interventions were considered with curative intention (R0). The rate of intraoperative complications was 20.8%. The rate of early postoperative complications was 66%. Distribution of postoperative complications according to the Clavien-Dindo Classification (0-33.3%, 1-16.6%, 2-4.1%, 3a-12.5%, 3b-8.3%, 4a-0%, 4b-8.3%, 5-16.6%) highlighted a rate of 33.3% of major complications. The advantages of MIE observed in the studied group in the postoperative period were: reduced postoperative pain, improved comfort and early mobilization of the patients. Conclusions: The early outcomes of using the minimally invasive approach in the treatment of esophageal cancer in our clinic include the reduction of perioperative morbidity, the duration of hospitalization and a faster recovery.

Regardless of the reconstruction surgery used, the fundamental concepts of visceral reconstruction are based on the vascular support needed for the substituting graft. The vascular factor is the main element of any reconstruction technique, as an underlying condition for the visceral material stretch and, along with other factor, for the suture safety. In the case of the stomach, a consistent vascular flow and the minimal vascular anatomy variations are the first theoretical argument. A second argument is based on the intraparietal vascular network features allowing for supplementing visceral perfusion as the blood flow is stopped in one or more pediculi. Graft hypoperfusion is, however, a potential cause of failure, and the most frequently invoked complication is, therefore, a high risk of anastomosis fistulae. A series of modern techniques - arteriography data for the pre-operative vascular reconstruction or Doppler laser fluorometry intraoperative assessments, graft oximetry, laser speckle (spot) scan or the use of indocyanine green staining (ICG) - represent methods of early determination of the gastric graft perfusion/microperfusion quality used in reducing such risks. The doubts regarding the gastric perfusion mandate the use of vascular augmentation techniques. If such techniques are not used, the final outcome is uncertain and difficult to correct.

Forest vegetation across Southern Carpathians is distributed in altitudinal layers. The aim of this study was to highlight the productivity differences between the Southern and Northern slopes of the Southern Carpathians for Norway spruce, silver fir, birch and black alder. Data from 45 forest management plans (46.329 stands from the Southern slopes and 32.787 stands from the Northern slopes) were used. For each stand, the mean diameter, mean height, age, standing volume, current volume increment and production class were assessed. Elementary statistical methods were used to identify the factors influencing productivity. Significant differences between the Southern and Northern slopes were recorded for silver fir. The volume and the current volume increment were higher on the Northern slopes. In the case of birch and black alder, the same two parameters recorded higher values on the Southern slopes. As regards Norway spruce, insignificant differences were recorded between the two slopes. The correlation between structure type and stand volume was positive and statistically significant in the case of Norway spruce, silver fir and birch, but it was negative in the case of alder. Analysing the correlation between stand volume and the main stand characteristics also revealed a statistically significant positive correlation between age and stand volume for all analysed species. The results of this study are especially interested for the forest managers and forest owners whose aim is to obtain a higher productivity for the studied species.

Introduction: Idiopathic megacolon (IM) is a rare condition with a more or less known etiology, which involves management challenges, especially therapeutic, and both gastroenterology and surgery services. With insufficiently drawn out protocols, but with occasionally formidable complications, the condition management can be difficult for any general surgery team, either as a failure of drug therapy (in the context of a known case, initially managed by a gastroenterologist) or as a surgical emergency (in which the diagnostic surprise leads additional difficulties to the tactical decision), when the speed imposed by the severity of the case can lead to inadequate strategies, with possibly critical consequences. Method: With such a motivation, and having available experience limited by the small number of cases (described by all medical teams concerned with this pathology), the revision of the literature with the update of management landmarks from the surgical perspective of the pathology appears as justified by this article. Results: If the diagnosis of megacolon is made relatively easily by imaging the colorectal dilation (which is associated with initial and/or consecutive clinical aspects), the establishing of the diagnosis of idiopathic megacolon is based in practice almost exclusively on a principle of exclusion, and after evaluating the absence of some known causes that can lead to the occurrence of these anatomic and clinical changes, mimetically, clinically, and paraclinically, with IM (intramural aganglionosis, distal obstructions, intoxications, etc.). If the etiopathogenic theories, based on an increase in the performance of the arsenal of investigations of the disease, have registered a continuous improvement and an increase of objectivity, unfortunately, the curative surgical treatment options still revolve around the same resection techniques. Moreover, the possibility of developing a form of etiopathogenic treatment seems as remote as ever.

Esophagectomy is a major surgical procedure with morbidity, and mortality related to the patient'scondition, stage of the disease at the moment of diagnosis, complementary treatments and surgicalexperience of the surgeon. Minimally invasive esophagectomy (MIE) may lead to a reduction inperioperative morbidity and mortality with an acceptable quality of life and similar oncologic resultsto an open approach. We present an experience of the Center of Excellence in Esophageal Surgeryregarding totally MIE through thoracolaparoscopic modified McKeown triple approach, followedby esophageal reconstruction by gastric intrathoracic pull-up and cervical esophagogastricanastomosis and feeding jejunostomy in a patient with thoracic esophageal cancer who underwentpreoperative neoadjuvant chemoradiotherapy. The short-term outcomes of the totally minimallyinvasive esophagectomy procedure were very encouraging. The overall operative times were:thoracoscopic - 120 minutes, laparoscopic - 130 minutes and cervical - 50 minutes with a total of360 minutes. The intraoperative blood loss was 200 ml. The postoperative outcome was favorablewith early feeding on the jejunostomy. The control of cervical anastomosis was performed in the 6thday postoperative and the patient was discharged in the 10th day postoperative without anysymptomatology. At the first and third-month follow-up was not reported any postoperativecomplications. The totally minimally invasive approach using advanced technology of endoscopicsurgery allowed for this patient a simple postoperative evolution, no major complications and agood recovery after extensive surgery. The solid experience in open esophageal surgery ofUpper Gastro-Intestinal surgeons provides a fast learning curve of complex minimally invasivesurgical procedures with reduced perioperative morbidity. Long-term follow-up can confirm theresults from the literature regarding the survival, which is expected to be for these patients atleast equivalent with outcomes after open esophagectomy.

Geographic studies conducted in Southern Bărăgan Plain involve elements of water analysis related to the management of water resources. This is a problem because the studied field is a sensitive area to ensure the need for water, especially at certain times of the year, such as those related to the vegetation phases of the crop plants. Hydric phenomena and processes are unique manifestations that introduce disturbances in the economic activity linked mainly to agriculture, but also damage to constructions. In addition, they also generate environmental problems through the many interferences that may occur. Analyses in this regard require the adoption of a working methodology, observations and experimental and itinerant measurements, as well as the use of databases from meteorological stations as well as cadastral or pedological ones or from the agricultural department

Cartea aceasta reprezinta un suport de curs, pentru introducerea in domeniul teledetectiei, adresata studentilor geografi de la nivelul de licenta. Desigur ca punerea in tema, cu notiunile de teledetectie, poate fi facuta in orice etapa a activitatii profesionale, mai ales atunci cand, prin proiectele urmate, suntem pusi in contact cu imaginile de teledetectie si mai ales cu exploatarea acestora. Desi este o lucrare scrisa intr-un format accesibil, pentru intelegerea continutului sunt necesare cunostinte de profil sau studii efectuate in paralel, legate de cartografie, informatica, dar si alte discipline din categoria celor fundamentale pentru geografie. Cartea este rezultatul unei activitati indelungate, legate de pregatire si predare, ea se bazeaza pe o intensa documentare, iar toate acestea au condus la o autenticitate a continutului, acesta fiind dirijat, pe parcursul capitolelor, catre sfera geografiei, inclusiv prin imbinarea termenilor geografici cu cei de teledetectie.

Chylothorax is a rare complication, especially after esophageal cancer surgery. It may occur mainly in the thoracic stage of esophagectomy. The management of chylothorax is usually conservative, surgical reoperation with thoracic duct ligation being reserved for those cases refractory to that treatment. We discuss issues of diagnosis and therapeutic attitude, as evidenced by the literature, although a general consensus has not been established, most likely due to the low frequency of this complication. We emphasize the minimally invasive thoracoscopic approach, as it has been applied for two cases with this type of complication. A high rate of suspicion for thoracic duct injury should be maintained in all patients after esophageal surgery, with any pleural effusion entering the differential diagnosis of chylothorax.

Esophagectomy is standard indication for surgical treatment of resectable esophageal cancer, but it can also be performed for the management of benign conditions. Esophagectomy is followed by esophageal reconstruction using other parts of the digestive tract and is associated with increased postoperative morbidity and mortality. Gastric interposition with intrathoracic or cervical esophago- gastric anastomosis is currently the preferred technique for reconstruction after esophagectomy. The incidence of esophagectomy performed by the minimal invasive approach has increased in recent years due to the advanced technology of endoscopic surgery and image enhancement that provides a better estimate of anatomical plans, facilitates access to narrow spaces and more precise dissection with less tissue trauma. Randomized clinical trials have found a significant reduction in postoperative respiratory complications, decreased hospital stay and equivalent oncological results to open esophagectomy. We present the operative technique of minimally invasive esophagectomy performed in our clinic by three-stage modified McKeown approach thoracoscopic, laparoscopic and cervical with esophageal reconstruction with stomach.

Breast cancer is one of the most severe health issues globally, but the therapy advancements and the constant adaptation of treatment protocols radically changed its prognoses. This article review of the literature from a surgical perspective, thus allowing for the optimum detection and placement of its role and benefits in the surgical and oncology therapeutics. The role of surgery becomes controversial, with sometimes "pretentious" techniques, hard to quantify benefits and challenges that require a thorough assessment prior to opting for surgery. Another interesting aspect is the relative lack of guidelines for such cases with an extreme lesion plurimorphism. This is the very reason for the term "advanced breast cancer" NOT covering all possible situations, leaving room for niches difficult to frame within a therapy plan.

Dedifferentiated liposarcoma is a liposarcoma that contains a well-differentiated liposarcoma component juxtaposed to areas of high-grade non-lipogenic sarcoma and was believed to occur from well-differentiated liposarcoma after several years. Dedifferentiated liposarcoma most commonly occurs in the retroperitoneum, while an intraperitoneal location is extremely rare, only seven cases have been reported in literature. Many pathologists recognize that a large number of intra-abdominal poorly differentiated sarcomas are dedifferentiated liposarcomas. We present the case of a 73 years old patient known with multiple cardiovascular comorbidities, stroke sequelae and a large abdominal mass evolving for 3 years. He was referred to our clinic for abdominal pain and bowel disorders. Instead of all clinical and imagistic aspects suggested a gastrointestinal stromal tumour, the histological exam revealed the diagnosis of a dedifferentiated liposarcoma.

Autorul aduce o viziune proprie asupra geomorfologiei ca stiinta de studiu, in cadrul geografiei precum si a altor stiinte si domenii aplicate. In continut putem sesiza nivelul de cuprindere al stadiului actual atins de geomorfologia romaneasca, autorul „stapaneste” acest aspect, reusind sa transpuna in pagina, de o maniera ce tine cont de normele stiintifice ce au trebuit atinse in demersul sau. Suntem pusi in fata unei lucrari elaborate pe baze de cercetare a terenului si a materialului bibliografic, toate acestea fiind puse in lumina noilor directii urmate de geomorfologie, prin caracterul sau tot mai aplicat.Lucrarea este scrisa intr-un mod cursiv, clar si concis, aspecte sporite de materialul grafic si cartografic, care are la randul sau are rolul de a veni in completarea analizei din cadrul textului. Hartile si schitele sunt complexe, cu o tipologie variata legata de continut, complexitate si grad de cuprindere a elementelor reprezentate, scarile de proportie fiind adaptate extinderii subiectului reprezentat.

The treatment of esophageal cancer has become more effective due to advances in surgical techniques, multidisciplinary approach, appropriate use of neoadjuvant therapy and perioperative care at centers of excellence in esophageal surgery. Esophagectomy is one of the most complicated and demanding procedures among all gastrointestinal surgeries with a very long learning curve in which excellence can only be achieved through improvement during all the surgical career. The results of esophagectomy are related not only to the volume of cases operated but also to the experience of surgeons in the management of postoperative complications. Initially, minimally invasive esophagectomy has encountered obstacles to implementation in several centers due to the cost and complexity of esophageal cancer treatment. Several meta-analyses and clinical trials published so far support the feasibility of the minimally invasive approach, the advantages of the post-operative period and the equivalence of oncological outcomes with the open technique, which is an important step in imposing minimally invasive techniques as a standard in the treatment of esophageal cancer. In this paper, we aim to analyze recent advances in minimally invasive esophagectomy, the evolution of endoscopic surgical techniques through our personal experience and the results of studies published in the medical literature in the last years.

Somatostatinoma is a rare neuroendocrine tumor which especially develops in the pancreas. There are few communicated cases about extra-pancreatic localization, having as a particularity the absence of somatostatin hypersecretion syndrome and frequent association with von Recklinghausen neurofibromatosis. We present the case of a 42-year old patient with Von Recklinghausen neurofibromatosis admitted in our clinic with a chronic upper digestive obstruction syndrome. The presence of a first jejunal loop somatostatinoma was an intraoperative surprising diagnosis that imposed jejunal resection and association of complementary specific treatment. Despite the therapeutic correct management, the status of the patient deteriorated very fast, confirming the aggressiveness of this neoplasia.