Prezentari de Cazuri AMANUNTITEEEE

7/21/2019 Prezentari de Cazuri AMANUNTITEEEE

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ABCESUL PULMONARACHALAZIA CARDIEIAPENDICITA ACUTARTERIOPATIA OBLITERANT A MEMBRELOR INFERIOARE.BOALA BASEDOW

CANCERUL ESOFAGIANCHISTUL HIDATIC HEPATICCOLECISTITA CRONIC LITIAZICCOLECISTITA LITIAZICDIVERTICULUL ESOFAGIANEVENTRAIA POSTOPERATORIEHDS - VARICE ESOFAGIENEHEMANGIOMUL HEPATICHEMOROIZII

Hern! "e#$r!%& 're!()& ne*+#(%*!)&HERNIA INGHINALHERNIA OMBILICALHERNIA INGHINAL RECIDIVAT. HIDROCELUL.APENDICITA CRONIC DUP BLOC APENDICULAR.HIDROCELULICTERUL MECANIC , COLEDOCOLITIAZAMAMELA SECRETANT

NEO CAP PANCREASNEOPLASMUL RECTALNEOPLASMUL TIROIDIANOPERAIA DIONOPERAIA MILLESPANCREATITA ACUTPLAGA PENETRANT ADOMINALSTENOZA ESOFAGIAN POSTCAUSTICTRAUMATISMELE ABDOMINALETUMORA BRONHOPULMONARTRAUMATISMUL ABDOMINAL

TUMOARE DE CEC PALPABILTUMOR MAMAR BENIGNTUMORA PULMONAR LOB INFERIOR ST/NGTUMOARE SIGMOIDIANTUMOARE DE COLON TRANSVERSTUMOAREA MAMARTUMOARE RETROPERITONEAL ST/NGULCER DUODENAL CRONICVARICE HIDROSTATICE. VARICOFLEBITA

VARICE HIDROSTATICE


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ABCESUL PULMONAR

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EAMENUL LOCAL

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INCIDENTE 9 ACCIDENTE INTRAOPERATORII -(%!8!re! n*+re*)& ! )+r!*+)+#e

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MORTALITATEA INTRA- 9 POSTOPERATORIE !(r+!(e ?er+PROGNOSTIC "!1+r!3%7 $+ !' 1)!# 8!n!)+ne# %!3+r$#7

)+r!*+)+#%e 'e !*ee!9 (!r)e 8!$ (!r)e! +($8& 8e 3$*$r& 'e 3$ne re?$%)!)e.RECOMANDRI LA ETERNARE *+n)r+!%e (er+'*e *%n*e 9

r!'+%+*e7 #n!8)*! re8(r!)+re7 e1)!re! n+2e%+r ($%#+n!re e1en)$!%

8*:#3!re! %+*$%$ 'e #$n*&PARTICULARITATEA CAZULUI 3+%n!1 )Kn!r 5 !n7ne"$#&)+r *!re e8)e >n'r$#!) (en)r$ )r!)!#en) *:r$r*!% '$(& $n)r!)!#en) !n)3+)* (re+(er!)+r "&r& re?$%)!) e"*en).


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ACHALAZIA CARDIEI

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Pen)r$ 8$8;nere! '. (+?)1 !# !1$) %! '8(+?;e e2!#en$%r!'+%+* *$ 8$38)!n;& 3!r)!)& *!re 'e*e%e!?& $n e8+"! '%!)!)7 *$ !8(e*)'e r'*:e "&r& (!8! e8+!8)r* >n #+#en)$% e2!#n&r. M-!r #! " "+8)$)%e e8+!8)r+8*+(! - *!re ># +"er& n"+r#!; !8$(r! n!)$r+38)!*+%$%$ n *!? 'e !"e*;$ne 3enn& en'+8*+($% )re*e "&r& '"*$%)!)e

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M+#en)$% *:r$r*!% e8)e +()#7 3+%n!1$% !1Kn' + 8)!re ener!%&3$n&7 8)!3%& :e#+'n!#* *$ (r+3e 3+%+*e >n %#)e n+r#!%e.

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Dn)re *+#(%*!;%e !ne8)e?e ($)e# en$#er! %e?$n !%e 'n;%+r73$?e%+r 9 %#37 %e?$n !%e *+r?%+r 1+*!%e7 n)$3!re >n e8+"!7#(+83%)!)e! n)$3!;e 9 *e% #! )e#$)7 8n'r+# Men'e%8+n re$r)!)e*$ !8(r!re! *+n;n$)$%$ >n !r3+re%e )r!:e+-3r+n8* - #(%*& %!1!7!8(r!;e 3r+n9*& #e'!)! .

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In)er1en;! *:r$r*!%& (r+($8& e8)e e8+*!r'+#+)+#!e2)r!#$*+!8! - He%%er *$ !3+r' !3'+#n!% *!%e! 'e !3+r' (+!)e " 9)+r!*+)+#e 8)Kn! .

B+%n!1! 8)& >n 'e*$3) '+r8!% *$ #e#3re%e 8$(+er+!re >n !3'$*;e %!=0 r!'e7 *$ 8+n'! 1e?*!%! 9 -5 %n 1en+!8e 9 $n 8$% 8$3 %+#3e (en)r$!**en)$!re! %+r'+?e. C!%e! 'e !3+r' + re(re?n)& %!(!r+)+#! #e'!n&2"+8$3+#3%*!%&. D$(& ?+%!re! 9 e2(%+r!re! *!1)&; (er)+ne!%e 8ee2($ne +n*;$ne! e8+!8)r*! 9 e8+"!$% !3'+#n!%7 *!re 8e re?e*! 'e $r-#(re$r 9 8e )r!*)+ne!?! *$ $n %!) *!re (er#)e *+3+rre! e8+"!$%$)+r!** n# !3'+#en *$ *K;1! *#. M+)+#! 8e e2e*$)! (e + '8)!n;! 'e -0 *#. 8e*)+nn' "3re%e #$8*$%!re (Kn& %! #$*+!8!7 #!ne1r! e2e*$)n'$-8e D$(& n)r+'$*ere! $ne 8+n'e F!$*:e) >n e8+"!. In*?! 8e e"e*)$e!?! (e"!;! !n)er+!r! ! e8+"!$%$7 *r!n!%7 (Kn& *Kn' *#($% 1?$!% n$ #! e8)e8$"*en) !r '8)!% ($n! %! $n:$% H8. D$(& $n !$)+r 'e(!8n' *r!1!)!e%1e)!n! . O(er!)! e8)e *+#(%e)!)& 'e 8$)$r& 8)+#!*$%$ %! 3$?e%e

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Inrr%e (+8)+(er!)+r 1+r 1?! *+#3!)ere! '$rer7 + (+?;e*+#+'! >n (!)7 !8$r!re! $n$ !(+r) :'r+e%e*)r+%)* 9 *!%+r*7 *+re%!)e *$1!%+r%e +n+r!#e 8er*e7 re8(e*)1 500 #%5< +re 9 000 *!%+r5< +re.

Se 1+r #+n)+r?! P7 TA7 '$re?!7 (re*$# 9 )e#(er!)$r!. T$3$% 'e'ren 8e 1! 8*$r)& >n "$n*;e 'e *!n))!)e! 9 *!%)!)e! 8e*re)%+r. S+n'! 'e

!8(r!;e 8e 1! 8$(r#! >n ?$! (+8)+(er!)+r7 8!$ >n "$n*;e 'e re%$!re!)r!n?)$%$ n)e8)n!%.Re#$% n;!% 1! " :'r* $r#n' *& )re()!)7 >n "$n*;e 'e )+%er!n)!

8! 8e '1er8"*e !%#en)!)!.Dn)re C+#(%*!;%e (+8)+(er!)+r #e'!)e ($)e# en$#er! - 'n)re

*e%e ener!%e -IM7 I. ($%#+n!r7 AVC7 *!re ne*e8)& )r!)!#en)#e'*!#en)+8 #e'!).

-'n)re *e%e %+*!%e -8$($r!)! (%& (+8)+(er!)+r7 OI7 e18*er!;!*!re 3ene"*!?! 'e )r!)!#en) *:r$r*!%.

Dn)re C+#(%*!;%e (+8)+(er!)+r )!r'1e ($)e# en$#er! (e %n!e1en)r!)e7 #!%n?!re! (%&7 *:e%+' !% (%&7 :erne :!)!%!7 8n'r+# 'ere"%$2 e8+"!!n7 9 *e%! #! "re*1en) 8)en+?! re?'$!%! 8!$ re*'1!n)! *!re!re 're() *!$?e n8$"*en;! #+)+#e >n (r+"$n?#e 9 >n %$n#e7!(r+(ere! 9 *+!%e8*en)! 3$?e%+r #+)+#e7 e8+"!)!. n !*e8) $%)# *!?n)er1en;! *!re 8e (r!*)*! e8)e $n (r+*e'e$ 'e e8+!8)r+8)+#e%!)er+%!)er!%& >n)re (!r)e! '%!)!)! ! e8+"!$%$ 9 (!r)e! "$n'*! !8)+#!*$%$. .

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P!r)*$%!r)!)e! *!?$%$ *+n8)! >n "!()$% *& e8)e 1+r3! 'e + !n+#!%e"$n*;+n!%& ! e8+"!$%$7 %! + 3+%n!1! )n!r!7 "&r& )!re +r!n*e !8+*!)e.

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5


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APENDICITA ACUT

A# !1$) 'e e2!#n!) 3+%n!1! C. M. >n 1Kr8)& 'e @ !n7 e%e1& 'n #e'$%$r3!n *!re 8-! n)ern!) >n 8er1*$% n+8)r$ %! '!)! 'e . 0. == >n $r#& *$0:7 >n *+n'; 'e $ren;&7 (en)r$-'$rer !3'+#n!%e %+*!%?!)e >n "+8! %!*& 're!()&-re;$r7 1&r8&)$r-8$3"e3r%)!)e

-n!(e)en;&-!'n!#e7 !8)ene "?*&.Dn !n)e*e'en)e%e :ere'+*+%!)er!%e n$ re;ne# n#* 8e#n"*!)1 (en)r$

3+!%! !*)$!%&.An)e*e'en)e%e (er8+n!%e "?+%+*e MJ!n7 $%)#! #en8)r$!;e

6. 5. ==@. **%$r re$%!)e5 ?%e7 S7 N7 A-ne!!. Dn !n)e*e'en)e%e(er8+n!%e (!)+%+*e re;ne# 3+%%e n"e*)+-*+n)!+!8e !%e *+(%&re7"r!*)$r! P+$)e!$-C+%%e8 #+3%?!)& >n !(!r!) (8!) >n ==0.

Men)+n *& 3+%n!1! n$ e8)e *+n8$#!)+!re *r+n*& 'e#e'*!#en)e7 *!"e!7 !%*++% 8!$ )$)$n.

Dn 8)+r*$% !"e*;$n !"% *& 8$"ern;! !*)$!%& '!)e!?& 'e *r*!5n #+' 3r$8* >n (%n& 8)!re 'e 8&n&)!)e !(!ren)& (rn!(!r;! $ne '$rer !3'+#n!%e %+*!%?!)& >n e(!8)r$ *$ *!r!*)er *+%*!)17"&r& r!'ere7 'e n)en8)!)e #e'e n8+;)& 'e re;$r7 1&r8&)$r n;!%!%#en)!re !(+ 3%+!8e7 !'n!#e7 !8)ene "?*&7 8$3"e3r%)!)e @7 . n

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-!(en'*e*)+#! 8$38er+!8&-!(en'*e*)+# n*+#(%e)e-)e:n*! %!(!r+8*+(*&.

C. V!r!n)e 'e re"!*ere ! (ere)e%$ !3'+#n!%-!3;nere! 'e %! 8$)$r! )e$#en)!r& ne*e8)& (!n8!#en) ?%n* >n *+n'; 'e!8e(8e 9 !n)8e(8e )#( 'e -6 ?%e $r#!) 'e 8$)$r& (r#!r& >n)Kr?!)&7


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(re*e'Kn' !8)"e% n*'en;! 8$($r!;%+r (+8)!(en'*e*)+#*e ! 8*&?$) *$Y-5 A**'en)e 9 n*'en)e n)r!+(er!)+r -!(en'*e*)+#! '"*%& '!)+r!)&*& 'e !3+r' ne*+re8($n?&)+!re7 %(8! *+n"+r)$%$ !ne8)e?*7 )+(+r!"e!(en'*e%$ 8$3:e(!)*7 re)r+-*e*!%7 %+-(e%1n7 :ern!r7 ne*e8)&

(re%$nre! n*?%+r 9 !8$r!re! $n$ *K#( +(er!)+r !'e*1!).,r$()$r! !(en'*e%$ 8!$ 'e8*:'ere! %$#en$%$ ne*e8)& ?+%!re! *+re*)& !*K#($%$ +(er!)+r 9 )+!%e)! *+re8($n?!)+!re '$(& >n'e(&r)!re!!(en'*$%$. -r$(ere! #e?+!(en'*e%$ 8!$ 'e8"!*ere! %!)$r 'e (e #e?+$ *$:e#+r!e #!81& #($ne :e#+8)!?!.-'e9r!re! 8er+!8e *e*$%$ ne*e8)& !(%*!re! $n+r "re ne(ene)r!n)e >n 9U 8!$ >n 3$r8&.-:e#!)+#$% 8$38er+8 *e*!% #($ne !*ee!9 !))$'ne. -'er!(!re! %!)$r 'e

(e 3+n) 9 'e8*:'ere! *e*$%$ %! n1e%$% #(%!n)&r !(en'*$%!re ne*e8)&re(en8!re! 3+n)$%$7 %!)$r!7 8$)$r& *$ "r >n 8!$ +r!n?!re! $ne 3$r8e8$(%#en)!re.-r$()$r! (%!n$r%+r (!re)!%e 9 #$8*$%!)$r%e *$ :e#!)+!#e >n #!8!#$8*$%!r& 8e re?+%1& (rn !(%*!re! $ne %!)$r :e#+8)!)*e7 *+#(%e)!)e 'e>n*:'ere! *+re*)& ! (ere)e%$ !3'+#n!%.->n;e(!re! 8!$ %e?!re! $ne !n8e n)e8)n!%e ne*e8)& 8$)$r& -'!n+8)*$%n)r!+(er!)+r '"er& 'e *e% *%n* 8!$ e28)en;! 9 ! !%)+r %e?$nn)r!(er)+ne!%e *:8) +1!r!n 're()7 (+8!%(n2 're()7 SE$7 '1er)*$%Me*e% 8e 1+r re?+%1! 'e %! *!? %! *!? n)r!+(er!)+r.-%e?!re! $re)er$%$ 8!$ ! 1!8e%+r %!*e 're()e re*+n8)r$*;! !*e8)+r!.

Inrr%e (+8)+(er!)+r 8$n) *e%e *+#$ne n)er1en;%+r 'e !#(%+!re#e'e.-!n)!%*e7 #+3%?!re (re*+*e7 re%$!re )re()!)& '!r *K) #! (re*+*e ! $ne!%#en)!; n!)$r!%e-ree*:%3r!re :'r+e%e*)r+%)*& 9 !n)3+)er!(e *$ Pen*%n& G


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-:e#+r!! (rn (%!! 'n (ere)e ne*e8)& :e#+8)!?! (rn 'er!(!re!%!)$r%+r 'e (e #e?+$ *$ 9+* :(+1+%e#* ren)er1en;e-%!)$r! !r)ere 9ree*:%3r!re 1+%e#*&.-:e#!)+#$% (%& ne*e8)& e1!*$!re.-)$%3$r&r 'e8)1e "$n*;+n!%e '%!)!;e !*$)& 'e 8)+#!*7 (!re?e%e

n)e8)n!%e 8e e1)& (rn ree*:%3r!re :'r+e%e*)r+%)*&.3 ener!%e-%(+)#! *+re*)!re! 'e?e*:%3re%+r7 :'r+e%e*)r+%)*e. -8n*+(!7 8)+($%*!r'+re8(r!)+r re8$8*)!re ener*&.-re)en;e !*$)& 'e $rn&8+n'!.C+#(%*!;%e (+8)+(er!)+r (re*+*e! %+*!%e-(er)+n)! %+*!%?!)& 8!$ ener!%?!)& '!)+r)& )+2*)&; 'e+8e3)e ! "%+re

'n %$#en$% !(en'*$%!r ne*e8)& '!n+8)*$% (re*+*e7 ren)er1en;e7)+!%e)! *!1)&; (er)+ne!%e7 'ren!e 9 !n)3+)er!(e.-(er)+n)! 'e ?$! ! -! (rn 'e8"!*ere! 3$r8e *e*!%e ne*e8)& ren)er1en;e9 >n'e(&r)!re! "+*!r$%$ 'e >n8Kn;!re (er)+ne!%&7 )+!%e)&7 'ren!e 9!n)3+)er!(e.-*+n)n$!re! (r+*e8$%$ 'e (er)+n)& 9 (+8)+(er!)+r '!)+r!) $n+r !3*e8e>n*r$8)!)e7 re?'$!%e n)r!#e?en)er*e7 >n)re !n8e >n D+$%!87 8$3:e(!)*e78$3"ren*e #($n ren)er1en;e (en)r$ )+!%e)&7 'ren! 9 !n)3+)er!(eener!%&.-+*%$?! n)e8)n!%& (re*+*e #e*!n+-n"%!#!)+re (+8)+(er!)+re ne*e8)&ren)er1en;e7 )+!%e)&7 'ren!7 (%*!)$r! !n8e%+r.-n"e*;! (%& *e%$%)!7 !3*e8$%7 *e%$%)! 8$3*re()!n)& 8$3 "!8*! S*!r(!

(+83% "!)!%&7 !nren! *$)!n!)& (r+re81& *r+n*& -ne*e8)& n*?7e1!*$!re7 )+!%e)&7 re*+%)!re (en)r$ !n)3+r!#& 9 !n)3+)er!(e.-(%e"%e3)! *$ !3*e8e :e(!)*e #$%)(%e 9 8e()*e#e E. C+%7 !er+3!*)er7G ne!)1 ne*e8)& )r!)!#en) !n)*+!$%!n) 9 !n)3+)er!(e.-"8)$%! 8)er*+r!%& '!)+r!)& %!)$r n*+re*)e ! 3+n)$%$ !(en'*$%!r 8!$'e"*en;e%+r 'e >n"$n'!re #($ne )r!)!#en) *+n8er1!)+r 8$"*en) >n#!+r)!)e! *!?$r%+r (en)r$ 1n'e*!re! )r!e*)$%$ "8)$%+8. F8)$%e%e

(er88)en)e ne*e8)& n)er1en; +(er!)+r 8e*$n'!re *$ e2*?! )r!e*)$%$ 9>n*:'ere! +r"*$%$ n)ern !% )r!e*)$%$.C+#(%*!;%e (+8)+(er!)+r %! '8)!n;&-!3*e8$% ($%#+n!r (rn e#3+%e 8e()*& 8!$ (rn *+n)$)!)e 'e %! $n!3*e8 8$"ren* ne*e8)& !n)3+)er!(! 9 'e %! *!? %! *!? n)er1en;e*:r$r*!%& *$ 'ren!.-e#(e#$% )+r!** (r+'$8 (rn !*e%e!9 #e*!n8#e #($ne (%e$r+)+#e7'ren!7 !n)3+)er!(e 9 )r!)!#en) 'e 8$8;nere.-(er*!r')! ne*e8)& !n)3+)er!(e 9 'ren!.

-!3*e8$% ne*e8)& 'ren! 9 !n)3+)er!(e.C+#(%*!; (re*+*e nen"e*;+!8e

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-:e#+r!! *+%*! n)r!%$#n!%& *e re?$%)& (rn 8Kner!re! %! %+*$% 'e!#($)!;e ! !(en'*e%$. D$(& *e 8-! e%#n!) %!)$r! 3+n)$%$ >n"$n'!)7ne*e8)& ree*:%3r!re :'r+e%e*)r+%)*&.-'e:8*en;! (%& n8+;)& 'e 8$($r!;! (%& ne*e8)& >n'e(&r)!re! "re%+r 9)+!%e)! (%&.

-e18*er!;! ne*e8)& ren)er1en;e 'e $ren;& $r#!)& 'e (%!8)! (ere)e%$!3'+#n!%.-n1!n!;! 3+n)$%$ !(en'*$%!r < *!?$r >n %)er!)$r& ($n*)$% *!re !'e)er#n!) n1!n!;! ! "+8) 3+n)$% >n"$n'!) !% !(en'*e%$ -ren)er1en;! 9)r!)!#en)$% n1!n!;e.C+#(%*!; (+8)+(er!)+r )!r'1e 9 8e*:e%!re-+*%$?! n)e8)n!%& (rn 3r'e - ren)er1en; 9 !'e?+%?&.-e1en)r!;! (+8)+(er!)+re ne*e8)& (%!8)! (ere)e%$ !3'+#n!%.-:ern! n:n!%& 're!()& (+8)!(en'*e*)+#e (rn 8e*;+n!re! ner1%+r

#+)+r ! (ere)e%$ !3'+#n!% n"er+r-ne*e8)& *$r! :erne.-**!)r*e! ne8)e)*& 1*+!8&7 *:e%+'&7 '$rer+!8&.-!(en'*)! (+8)!(en'*e*)+#e !(!re >n *!?$% (%!8)r+n$%$ (er!(en'*$%!r

"&r& !(en'*e*)+#e. n *!?$% !(en'*e*)+#e n*+#(%e)e 8!$ >n *!?$r%e >n*!re 3%+*$% !(en'*$%!r n$ ! "+8) >n"$n'!)7 ne*e8)& ren)er1en;e 9*+#(%e*)!re! !(en'*e*)+#e.-r!n$%+#$% 'e "r #($ne n*?e7 e2)r!ere! "re%+r 8!$ 'ren!$%#*r+!3*e8e%+r 'n $r$% "re%+r.

Se 1! e2)ern! 3+%n!1! >n ?$! ! -


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ARTERIOPATIA OBLITERANT A MEMBRELOR INFERIOARE.

A# !1$) 'e e2!#n!) 3+%n!1$% B. N. 'e 8e2 #!8*$%n7 >n 1Kr8)& 'e n 8er1*$% n+8)r$ %! '!)!'e !n$!re ==7 (rn )r!n8"er 'n C%n*! Me'*!%& 7 (en)r$ '$rer %!n1e%$% (*+r$%$ 9 !#3e 8)Kn7 !**en)$!)e %! #er87 !(!r;! $ne (%& %!n1e%$% 1Kr"$%$ :!%$*e%$ 8)Kn "&r& )en'n;& 'e 1n'e*!re7 8en?!;e 'e!#+r;e!%& %! n1e%$% (*+r$%$ 9 !#3e 8)Kn.

Dn !n)e*e'en)e%e :ere'+*+%!)er!%e n$ re;ne# '!)e #(+r)!n)e(en)r$ 3+!%! !*)$!%&.Dn !n)e*e'en)e%e (er8+n!%e "?+%+*e 9 (!)+%+*e re;ne# :erne

n:n!%& 're!()& +(er!)& >n =07 !#($)!;! (+8))r!$#!)*& ! "!%!ne'8)!%e ! 'ee)e%+r 5 9 #Kn! 're!()& =7 HTA 8)!'$% 5 '!n+8)*!)&*$ !n >n $r#& 9 )r!)!)& *$ N"e'(n7 F$rn!)r%7 A8(!*!r'n !r)er+(!)e*r+n*& +3%)er!n)& '!n+8)*!)& >n ==0.

C+n';%e 'e 1!;&7 'e #$n*& 9 'e #e'$ ne !)r! !)en;! !8$(r!"!()$%$ *& 3+%n!1$% e8)e $n 1e*: "$#&)+r 50 ;&r (e ? )#( 'e !n7*+n8$#& !%*++% 00-500 (e ?7 )&re 9 5- *!"e%e (e ?. . A*)$!%#en)ee8)e (en8+n!r '!r ! %$*r!) !n >n #n& *! #ner. E8)e *++(er!n).

Dn 8)+r*$% !"e*;$n !"% *& 3+!%! !*)$!%& '!)e!?& 'e !(r+2#!)15 !n7 *Kn' 'e3$)e!?& %en) (rn '$rer 'e 8*$r)& '$r!)&7 n)er#)en)e7 %!n1e%$% !#3e 8)Kn7 8$3 "+r#& 'e *r!#(e #$8*$%!re7 !(&r$)e >n+r)+8)!)8# (re%$n) 9 !**en)$!)e %! #er87 >n 8(e*!% (e (%!n >n*%n!) 9!(+ (e (%!n (%!) +r?+n)!%7 *!re-% 8%e8* (e 3+%n!1 %! re(!$8. Tre()!)!*e8)e '$rer 8e n8+;e8* 'e (!re8)e?7 #e#3r$% "n' 8en83% %! "r7

3+%n!1$% ($nKn' !*e8)e !*$?e (e 8e!#! *+n';%+r (re*!re 'e #$n*& 'n#n& $#e?e!%!7 )e#(er!)$r! 8*!?$)&7 ($r)!re! *?#e%+r 'e *!$*$* . Se

(re?n)& %! #e'*$% 'e n)re(rn'ere "n' '!n+8)*!) >n ==0 *$!r)er+(!)e *r+n*& +3%)er!n)& ! #e#3r$%$ n"er+r 8)Kn 9 8e (re8*re)r!)!#en) !#3$%!)+r *$ 1!8+'%!)!)+!re 9 !n)!%*e7 (e *!re 3+%n!1$% n$-%$r#e!?& *$ re$%!r)!)e.

L! !*e8)e !*$?e 8e !8+*!?& >n8&7 )$%3$r&r 'e (er*e(;e )!*)%& !#e#3r$%$ n)ere8!)7 '$rer%e *$ *!r!*)er 'e *%!$'*!;e n)er#)en)& 'e1n#! "re*1en)e 9 !(&rKn' '$(& !(r+2#!)1 00 # 'e #er87 *!%#Kn'$-8e >nre(!$8 9 re!(&rKn' %! #er8. De !(r+2#!)1 6 %$n7 '$rere! *!(&)& $n*!r!*)er *+n)n$$7 8%n' 3+%n!1$% %! re(!$8 '$(& *r*! 0 # 'e #er87 !r 'e

!(r+2#!)1 %$n& !*e8)e '$rer (er88)& 9 >n re(!$87 "n' !**en)$!)e *$#e#3r$% n"er+r >n (+?;e +r?+n)!%&7 "n' *!%#!)e >n (+?;e 'e*%1&7 !r'e !(r+2#!)1 5 8&()Kn (+?;! (*+r$%$ n$ #! n"%$en;e!?&

55


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n)en8)!)e! '$rer. C+n*+#)en)7 %! n1e%$% :!%$*e%$ 8)Kn7 3+%n!1$%*+n8)!)& !(!r;! $ne (e)e r+9 'e !(r+2#!)1 *#. '!#e)r$ (e *!re!*e8)! + %e!& 'e ($r)!re! n*&%;n)e ne!'e*1!)e. n 'e*$r8 'e @-0 ?%e7%! !*e8) n1e% !(!re + $%*er!;e7 >n8+;)& 'e '$rer n)en8e7 "&r& )en'n;e 'e1n'e*!re7 3+%n!1$% !(%*Kn' %+*!% *+#(re8e *$ *e!$r 'e (%!n)e.

D#(+)r1&7 !(!re *+%+r!;e r+9e 1+%!*ee ! >n)re$%$ 'ee)7 8e*re;e($r$%en)& %! !*e8) n1e%.Se (re?n)& >n Ser1*$% (+%*%n* !% C%n* C:r$re 7 "n'

n)ern!) %! '!)! 'e n 8er1*$% C%n* C:r$re *$ '. !r)er+(!)e+3%)er!n)& ! #e#3r$%$ n"er+r 8)7 HTA e8en;!%& 8)!'$% 5 >n 1e'ere!

)r!)!#en)$%$ *:r$r*!%.L! n)ern!re 3+%n!1$% e8)e >n 8)!re ener!%& 3$n&7 !"e3r%7 !(e))(&8)r!)7 )r!n?) n)e8)n!% (re?en)7 #*;$n 8(+n)!ne7 "?+%+*e7 "&r+'"*&r (+n'er!%e >n $%)#e%e 6 %$n7 r)#$% n*)e#er!% )$%3$r!)7 *$

(er+!'e 'e n8+#ne n+*)$rn&7 TAJ60=0 ##H. Dn e2!#en$%+3e*)1 (e !(!r!)e 9 88)e#e 1+ !r!)& '+!r '!)e%e *$ 8e#n"*!;e

(!)+%+*& 9 !n$#e -2!n)+!#e 9 2!n)e%e8#e (re?en)e 3%!)er!%-!#($)!;! (+8))r!$#!)*& ! "!%!ne%+r '8)!%e ! 'ee)e%+r 5 9

're()e- r!%$r 3r+n9*e '8e#n!)e (e !#3e%e *K#($r ($%#+n!re-**!)r*e (+8):ern+)+#e 're!()& >n re$ne! n:n!%& 1n'e*!)&

(er (r#!#.E2!#en$% %+*!% E2!#n 3+%n!1$% >n +r)+- 9 *%n+8)!)8#7 >n re(!$8 9 %! #er8. L!

n8(e*;e *+n8)!) #e#3re%e n"er+!re 8#e)r*e7 "&r& #+'"*&r 'e*r*$#"ern;&7 #er8 9*:+(&)!)7 *$ #(+)en;& "$n*;+n!%& %! n1e%$%

(*+r$%$ 8)Kn7 I. D. J0 # %! n1e%$% #e#3r$%$ n"er+r 'r. "&r+'"*&r 1?3%e. Te$#en)e%e !#3e 8)Kn 8$n) (!%'e7 >n)n8e7 *$ %(8!

(%+?)&;. L! n1e%$% (*+r$%$ 8)Kn *+n8)!) + %e?$ne *$)!n!)&$%*er!)1& 'e !(r+2#!)1 5 *#. '!#e)r$7 %+*!%?!)& %! 1Kr"$% :!%$*e%$+1!%!r& "&r& 8e*re;e !*+(er)& 'e + *r$8)&. Te$#en)e%e 'n $r 8$n) $9+re'e#!;!)e7 :(ere#*e7 *$ )en)& *!n+)*&7 ?+n& *e 8e >n)n'e (Kn& %!

$#!)!)e! '8)!%& ! "e;e '+r8!%e ! (*+r$%$ . Se *+n8)!)& 'e !8e#ene!)$%3$r&r )r+"*e %! n1e%$% :!%$*e%$ 8)Kn.P!%(!re! 'en+)& + 8en83%)!)e '$rer+!8& %! n1e%$% :!%$*e%$ 8).7!**en)$!)& %! #9*&r (!81e 9 !*)1e. P$%8$% %$!) 3%!)er!% 8#e)r* !r!)& +'#n$!re %! n1e%$% !r)ere "e#$r!%e 8)Kn 9 !38en;! 8! >n !1!% !r)er!

(+(%)ee7 !r)er! )3!%& (+8)er+!r& 9 !r)er! '+r8!%& ! (*+r$%$ !r %!n1e%$% #e#3r$%$ n"er+r 'r. !38en;! ($%8$%$ %! !r)er! (e'+!8&.

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A$8*$%)!;! e1'en)!?& $n 8$"%$ (r+)+#e?+88)+%* 'e r!' %! n1e%$%!)rere "e#$r!%e 8)Kn.

E"e*)$Kn' )e8)e%e *%n*e !# *+n8)!)!) $r#&)+!re%e . )e8)$% )+%er!n;e 'e e"+r) )#( 'e *%!$'*!;eQ ># !r!)& $n n'*e'83!?* 'e 0 # 5 (!98e* J50 (!9#n

5. )e8)$% 8*&r;e MASTER )+ 8)e(8 )e8)7 )e8)$% *$ **%+er+#e)r$% 9 !%*+1+r$%$ r$%!n) %e-!# *+n8'er!) ! " n$)%e 3+%n!1$% !*$?n' '$rer 9 >nre(!$87 re8(e*)1 9 >n %(8! !(!r!)$r. )e8)$% 'e (+8)$r& (en)r$ #e#3re%e n"er+!re RATSCHOW SAMUELS

)r&'e!?& + +38)r$*;e %! n1e%$% !r)ere "e#$r!%e 8)Kn .ALEANDER 7 (!%')!)e! )&%(. D$(& e2er*;$% *$ (*+!re%e !(!rKn'r!('7 %! !)Krn!re !(!rKn' )$%3$r&r 'e re*+%+r!re %! n (+?;e+r?+n)!%& 9 (r+*%1& ! #e#3r$%$ n"er+r 8).7 !(&r$)e %! $n 1e*: "$#&)+r9 *+n8$#!)+r 'e !%*++% (re*$# 9 'e e2!#en$% !r)er+r!"* e"e*)$!) >n8er1*$% C%n* Me'*!%e .

Pen)r$ (re*?!re! '. 9 8)!3%re! *+n"$r!)e 3+%+*e !*)$!%e !3+%n!1$%$ !# *+n8'er!) ne*e8!r& + e2(%+r!re *+#(%e#en)!r& ;n))&7re(re?en)!)& 'e . E2!#en$% (en)r$ e*+n+#! ener!%& ! +r!n8#$%$ :e#+%e$*+r!#!LJ@=00## *$3 H)*J


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8er*7 *&$)!re! *e%$%e%+r %$(*e7 re!*)! W!%%er-R+8e7 (r+3! %!)e27 !n)*+r(!n)n$*%e!r.-"3rn+ene#! - *re9)ere! "3rn+en$%$ 8er* 9 8*&'ere! !*)1)!;"3rn+%)*e ! 8er$%$ e8)e (re?en)& >n )r+#3!n)! +3%)er!n)& CRAVEN7COTTON

-*er*e)!re! re!*;%+r (en)r$ Re))8 !%$)n!re (e %!#& 9 #! !%e8!%$)n!re! *!n))!)1& >n )$3$r 9)n'$-8e r+%$% !*e8)+r! >n !(!r;!)r+#3!ne)e +3%)er!n)e.-*&$)!re! *r+%+3$%ne%+r7 ! :e#!%$)n&r %! re*e - *r+%+3$%ne#e-(r+3e%e 'e '8(r+)ene#e - *+!"e*)!re! "*!)$%$-*re!)nn!7 *%e!ren*e %! *re!)nn& 9 e1en)$!% $r+r!"! 1 -8)!re! rn*:%+r-e2!#en$% "$n'$%$ 'e +*: #-!r ($)e! e1'en;! #+'"*&r *!re*)er8)*eAT 9 HTA (%&* !)er+#!)+!8e7 'e8en 1!8*$%!r !r)er!% !**en)$!)-r!'+r!"e 8#(%& 'e 3!?n 9 ! #e#3re%+r n"er+!re *!re ># (+!)e

e1'en;! %e?$n +r)+(e'*e *$ r&8$ne) 1!8*$%!r 9 #! !%e87 %e?$n )(*e*$ *!%*"*&r !r)er!%e *! (%&* !)er+#!)+!8e 8+%)!re7 #$%)(%e7 '8e#n!)e8!$ *$ !8(e*) )$3$%!r re$%!) (e )+!)& >n)n'ere! #e'+8*%er+?!MONEBERG7 *$ %(8! !*e8)+r! >n )r+#3!ne)! +3%)er!n)&. De!8e#ene! (+) !(!re !%)er&r +8)e+!r)*$%!re7 +8)e+(+r+?&7 !n+#!% +8+!8ere8(+n8!3%e 'e +3%)er&r (rn *+#(re8e e2)rn8e*&7 +8+!8e *+n8e*$)1e$n+r )r!$#!)8#e7 'e:8*en;! *:8)*& !r)er!%&.-RBW 9 WDRL (en)r$ e2*%$'ere! #e?!+r))e %$e)*e.-ECG - !2 'e1!) %! 8)Kn! *$ 8e#ne 'e HVS 9 )$%3$r&r 'e ne(+%!r?!re-O8*%+#e)r! - *$ 8*&'ere! n'*e%$ +8*%+#e)r* %! n1e%$% #e#3r$%$n"er+r 8)Kn *+#(!r!)1 *$ #e#3r$% n"er+r 'r. 9 !38en;! +8*%!)%+r %!n1e%$% !r)ere '+r8!%e ! (*+r$%$ 8).7 *$ '8(!r;! *+#(%e)& ! $n'e%+r'*r+)e *!r!*)er8)* (en)r$ AT .-!n+r!"! )r!n8"e#$r!%& 8)Kn& re%e1& $n 8)+( *+#(%e) 'e < *#. 'e %!e#eren;! !r)ere "e#$r!%e 8$(er"*!%e 8)Kn *$ rene*)!re >n *+%!)er!%e >n)re#e! n"er+!r& ! *+!(8e. L! n1e%$% !#3e 8e 1?$!%?e!?& '+!r !r)er!)3!%& (+8)er+!r& 9 (er+ner&7 *$ !38en;! 'e %! e#eren;! !r)ere )3!%e!n)er+!re.-E2!#en$% D+((%er ># (er#)e 8)!3%re! 8*&'er 'e3)$%$ (rn 1!8e%e

e2!#n!)e-3+(8! #$8*$%+-*$)!n!)& #-!r " $)%& (en)r$ '!n+8)*$% '"eren;!%7 *$!%)e !r)er+(!) >n 8(e*!% *$ )r+#3!ne)! +3%)er!n)&7 >n *!?$% 'e "!;&

($)Kn'$-8e *+n8)!)! (%&* !)er+#!)+!8e %! n1e%$% 1!8e%+r7 *$ 8*%er+?&7 "&r&*+!"e*)!re! 1ene%+r.-+8*%+r!"! #e*!n+-e%e*)r*& 9 re)r+r!'& )r!n81er8!%& !%&)$r 'e"%e3+)er#+r!"! *$ %$#n! re"%e*)!)&7 'e)!% (r1n' 8)!re! !r)ere%+r 9 !*r*$%!;e *+%!)er!%e.

In *e%e 'n $r#&7 '!)e%e 'e !n!#ne?& 3+%n!1 'e < !n7 1e*:

"$#&)+r7 *!re !*$?& '$rer *$ *!r!*)er 'e *%!$'*!;e n)er#)en)& %! n1e%$%!#3e 8)Kn7 n8+;)e 'e (!re8)e?7 '$rer #!r*!)e %! n1e%$% :!%$*e%$8)Kn *$ #(+)en;& "$n*;+n!%& 9 !(!r;! $ne $%er!; %! !*e8) n1e% "&r&

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)en'n;& 'e 1n'e*!re7 ! e2!#en$%$ +3e*)1 %e?$n )r+"*e *$)!n!)e !%e"!nere%+r %! n1e%$% #e#3r$%$ n"er+r 8)7 *$ $%*er!;e !*r+#!%& !:!%$*e%$ 8) 'e !(r+2#!)1 5 *#. '!#e)r$7 !*+(er)& 'e + *r$8)& !%3$e9 %(8! ($%8!)%+r %! !r)er! (+(%)ee 8)Kn& 9 >n !1!%7 *$ '#n$!re! %!n1e%$% !r)ere "e#$r!%e 8)Kn 9 8$"%$ (r+)+#e?+88)+%* 'e r!'$% I %! !*e8)

n1e%7 TAJ60=0 9 (!r!*%n*e e2. D+((%er 9 !r)er+r!"! ne (er#)*+n)$r!re! $n$ '. (+?)1 'e ARTERIOPATIE OBLITERANT AMEMBRELOR INFERIOARE STADIUL < CU GANGRENA USCATINCIPIENT A HALUCELUI ST/NG7 HTA ESENIAL STADIUL 5.

C$ )+!)e *& '!n+8)*$% (+?)1 e8)e 3ne 8$8;n$)7 e8)e ne*e8!r&)re*ere! >n re18)& ! $n+r e%e#en)e 'e '!n+8)* '"eren)!%. B+% !r)er!%e +r!n*e *r+n*e +3%)er!n)e !. Tr+#3!ne)! +3%)er!n)& 3+!%! WINEWARTWER7 3+!%! BUERGER

*!re !re *& e%e#en)e (!r)*$%!re 1Kr8)! >n)re -n 8er7 !n)*+r(!n)n$*%e!r *%n* !(!r !r)r!%7 )$#e"er !r)*$%!re7 8er+?)e7!%3$#n$re7 #+'"*&r re)nene7 "e3r& #! #!re 'e @ r!'e *e%8$8.

'. Ar)er)e%e re$#!)8#!%e - !(!r r!r7 !"e*)n' (re(+n'eren) !r)ere%e(er"er*e !%e #$8*$%!)$r 9 !r)*$%!)%+r7 !r)ere%e 'e %! 3!?! *reer$%$7!r)ere%e *+r+n!re7 ($%#+n!re7 *%n* e1+%$Kn' >n ($8ee !*$)e.

e. Ar)er)e%e 8(e*"*e - n"e*)+!8e !*$)e 9 re))8ene 8$n) n8+))e 'e"en#ene 8e()*e7 e1+%$n' >n *!'r$% $ne 3+% n"e*)+!8e7 *$ e1+%$;e 'e+3*e 8(re !nren! $#e'!.

". Ar)er)! #!%!r*& e1+%$e!?& 8(re !nren! $#e'& *$ 8n'r+# R!n!$'r!17 !n)e*e'en)e%e #!%!r*e7 e2!*er3!re! +r!r& ! '$rer%+r !**e8e%e8#$%)!ne %! )+!)e *e%e < e2)re#)&)7 #! r!1e %! e2)re#)&;%e8$(er+!re7 re?$%)!)$% )r!)!#en)$%$ !n)#!%!r* ($n '!n+8)*$%.

. Ar)er)! %$e)*& 8e e2*%$'e (rn e"e*)$!re! RBW-$%$7 *%n* ($;n (rn'e!r)ere%e 'e +r*e *!%3r$ (re?n)& +#$r 8"%)*e 9 8)!re! )re(+ne#e

(!%%'$# ($ne '!n+8)*$%.:. Ar)er)! TBC 8e #!n"e8)& 8$3 "+r#! e'e#$%$ n'$r!) B!?n7 !r '. 'e*er))$'ne 8e "!*e (e 3!?! 8e#ne%+r 'e #(ren!re 3!*%!r& IDR %!

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)$3er*$%n& (+?)1& 9 e1'en;ere! 3!*%%+r +*: >n r!n$%+#$%)$3er*$%+8.

. Ar)er)e%e 1r!%e 'e #$%)e +r )re* ne+38er1!)e 9 (e "+n'$% %+r e1+%$e!?&)!r'1 + !r)er)+(!)e +3%)er!n)&.

. Sn'r+#$% Ler*:e - 3%!)er!%7 '$rere n)en8& >n #*$% 3!?n7 *$ )$%3$r&r

#n+re7 en)!%e7 !r)er+r!"! ($nKn' '!n+8)*$% 'e *er))$'ne !%!"e*;$n.5. B+% !r)er!%e "$n*;+n!%e !. B+!%! R!n!$' 9 "en+#en$% R!n!$' 8e *!r!*)er?e!?& (rn *r?e

3%!)er!%e 'e 8(!8# n)er#)en) !%e !r)ere%+r #* 9 ')!%*e. E1+%$;! %+r>n "!?e 8n*+(! %+*!%&7 !8"2e %+*!%& 9 "!?! 'e re1enre7 "n' *!$?!)e 'e"r7 e#+; n)en8e7 "$#!) 9 %(8! *%!$'*!;e n)er#)en)e ($nKn' '.

3. B+!%! %1e'+ re)*$%!r 9 r!*e#+8 >n *!re )e$#en)e%e 8$n) #!r#+r!)e7*!n+)*e !**en)$!)e %! e2($nere %! re*e7 ($%8$% "n' (er*e()3%.

. B+% ne1!8*$%!re !. P!re8)e?! 8en%& ! (*+!re%+r - e8)e $n 8n'r+# n$#! 8en?+r!%7 *$!38en;! 8e#ne%+r 'e +38)r$*;e 1!8*$%!r&

3. C%!$'*!;! *+? 'e *!% - !re + 8#()+#!)+%+e ($;n 8)ere+)(?!)&7n8+;)& 'e )$%3$r&r 8"n*)erene7 (r+3! R+#3er "n' (+?)1&.*. C%!$'*!)! n)er#)en)& DEERINE - 3+%n!1 n$ !$ '$rer * n$#!8en?!;e 'e 8%&3*$ne ! e2)re#)&;%+r (rn 'e"*) #+)+r7 *!re (+!)e '$*e

(Kn& %! *&'ere '!*& 3+%n!1$% n88)& 8& #e!r&.". T$#+r%e +8+!8e *+#(re81e - 8$n) e2*%$8e 'e e2!#en$% r!'+%+*. G!nren! $#e'& - %(8! 8e*re;%+r 9 ! "en+#ene%+r 8e()*e 9 )+2*e +e2*%$'.F!;& 'e *e%e e2($8e7 '!n+8)*$% 'e"n)1 e8)e 'e ARTERIOPATIEOBLITERANT A MEMBRELOR INFERIOARE STD. < . G!nren&n*(en)& ! :!%$*e%$ 8)7 HTA e8en;!%& 8)!'$% 5.

Evoluia cazuluiF&r& )r!)!#en) !"e*;$ne! (+!)e e1+%$! *&)re !r!1!re (rn

!**en)$!re! )$%3$r&r%+r )r+"*e %! n1e%$% :!%$*e%$7 8$(r!n"e*;e *$!(!r;! !nrene $#e'e7 8)!re )+2*+-8e()*& $r#!)& 'e 'e*e8.

C$ )r!)!#en) *+n8'er *!?$% *$ n'*!;e *:r$r*!%&7 )r!)!#en)$%#e'*!% n)rKn' >n '8*$;e '+!r *$ ))%$ 'e (re&)re (re+(er!)+re 9 !n$#e1!8+'%!)!)+!re7 8(!8#+%)*e7 !n)!%*e 9 %+*!% !% %e?$n%+r *$)!n!)e.

Tr!)!#en)$% *:r$r*!% e8)e 8n$r$% *!(!3% 8& !'$*& !#e%+r!re.Indicaia chirurgical !re $n *!r!*)er !38+%$)7 >n *+n'; 'e $ren;&

!#Kn!)&.Riscul operator (e 8*!r! ADRIANNI-MOORE e8)e IV 3+%n!1

)r!)!)7 +(er!;e #!re .Momentul operator*+n8'er ! " +()#7 3+%n!1$% "n' e*:%3r!)

3+%+* 9 :e#+'n!#*.Intervenia chirurgical (re8$($ne + (re&)re (re+(er!)+reener!%& )r!)!#en) !n)3+)* *$ 8(e*)r$ %!r7 !n):(er)en81 #en;nKn'

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)+)$ (er"$?! !r)er!%& 1!8+'%!)!)+r 9 !n)*+!$%!n)7 (re*$# 9 (re&)re!(8:*& ! 3+%n!1$%$ >n 8)$!;! >n *!re !#($)!;! e8)e 8n$r! 8+%$;e+(er!)+re . Pre&)re! %+*!%& (re8$($ne )r!)!#en)$% %e?$n *$)!n!)e (rn

(!n8!#en)e %+*!%e7 +2en+)er!(e 9 3&r3erre! #e#3r$%$ n"er+r 8)Kn(Kn& 'e!8$(r! %ne M!%!ne.

Anestezia - (re"er !ne8)e?! ener!%& (rn IOT7 ne$r+%e()!n!%e?!"n' *e! *!re ># *+n"er& *e% #! 3$n *+n"+r) +(er!)+r 9 *!re e8)eFen)!n%Dr+(er'+% *e% #! ($;n )+2*& (en)r$ 3+%n!1.

Riscurile anesteziei #(+83%)!)e! n)$3&r7 %e?$n !%e %#37r$()$r! 'n;%+r 9 !n)ren!re! !*e8)+r! >n !r3+re%e re8(r!)+r7 8)+($%*!r'+re8(r!)+r #($n *$n+!9)ere! )e:n* n)$3!;e 9 n8))$re! $ren)&! re8$8*)&r *!r'+re8(r!)+r.

Instrumentarul - )r$8e 8(e*!%e (en)r$ *:r$re 1!8*$%!r&7 *!re)re3$e ne!(&r!) 8& *+n;n& (en8e S!)n87 (en8e B$%'+7 9n$r$r %!8+$r

(en)r$ 8$8(en'!re! 1!8e%+r 7 "+!r"e* COOPER7 !*e !)r!$#!)*e 9 "renere8+r3!3%e.

Dispozitiv operator +(er!)+r$% 'e (!r)e! 're!()& !$)+r$% I - >n "!;! !*e8)$! !$)+r$% II - >n 're!()! +(er!)+r$%$

Intervenia chirurgical(r+($8& e8)e + +(er!;e 'e re*+n8)r$*;e !r)er!%&9 !n$#e 3-(!88 "e#$r+(+(%)e$ *$ 1en& 8!"en& !$)+%+& 9 *+#(+r)&

$r#&)+r )#( +(er!)+r n*?e >n )r$n:$% S*!r(! (en)r$ 'e8*+(erre! !r)ere"e#$r!%e *+#$ne7 8$(er"*!%e 9 (r+"$n'e *$ +*+%re! (!*:e)e%+r!n%+n!re7 !'*& + n*?e !r*$!)& 8(re n*?e >n re$ne! (+(%)ee 9 1+

(&)r$n'e >n "+8! (+(%)ee (rn !3+r' #e'!%7 *$ 'en)"*!re! !r)ere(+(%)ee7 *!re e8)e 8)$!)& *e% #! (r+"$n'. D$(& 'e8*+(erre! !*e8)e! 1+(re(!r! 9 1+ (!%(! %$#en$% 8&$. n *+n)n$!re 1+ (r+*e'! %! 'e8*+(erre!1ene 8!"ene n)erne7 1+ %!)$r! *+%!)er!%e%e !*e8)e! >n)re (en8e 9 %e 1+8e*;+n! (re(!rKn' !8)"e% re"+n$% !$)+%+ (en)r$ 3-(!88!re. C%!#(e?!r)er! "e#$r!%& *+#$n& (r+"$n'& 9 8$(er"*!%& *$ !r)er+)+#e*+n8e*$)1&. He(!rn?!re %! n1e%$% !r)er+)+#e7 (r+2#!%7 '8)!% 9

(r+"$n' *$ (re(!r!re! ;e8$)$%$ !r)er!% (en)r$ 8$)$r&. V+ *+n)n$! *$!n!8)+#+?! *!(&)$%$ '8)!% 1en+8 *$ !r)er! "e#$r!%& >n)r-$n $n: 'e 0-n )$ne%$% !8)"e% *ree!). C%!#(!re! !r)ere (+(%)ee $r#!)& 'e!r)er+)+#e 9 !n!8)+#+?!re! *!(&)$%$ 1en+8 8!(:en *$ !r)er! (+(%)ee *$"r 'e 6.0. De*%!#(!re. C+n)r+%$% r$r+8 !% :e#+8)!?e. S$)$r! (%&%+r

*$)!n!)e *$ 'ren! 8$3*$)!n!) 1! n*:e! n)er1en;!. A '+$! 1!r!n)& (en)r$*!re !9 " ($)$) +()! e8)e $)%?!re! 1ene 8!"ene >n 8ne '$(& 'e1!%1$%!re. n

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*!?$% >n *!re n$ e8)e !**e83%& 8e (+!)e (r!*)*! 3(!88 *$ re"+n 'e+re)e2.

In*'en)e 9 !**'en)e n)r!+(er!)+r . :e#+r!! *e% #! "re*1en) #($ne :e#+8)!?!5. nee)!n9e)!)e! !n!8)+#+?e *!re (re8$($ne *+re*;! !*e8)e!

. #(+83%)!)e! (re(!r&r 1ene 8!"ene 8!$ #(+83%)!)e!re!%?&r (r+*e'e$%$ !%e8 '!)+r)& (r+*e8$%$ !r)er+(!) e2)n87 "r!3%)&;1en+!8e7 #($ne %$!re! $ne 'e*? n)r!+(er!)+r *$ 8*:#3!re! )e:n*(!)*: 1en+8


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PROGNOSTICUL CAZULUI-3$n - re8))$)+ $+ !' 1)!# e) !' 8!n!)+ne#-3+%n!1$% (en8+n!)-'8(en8!r?!) (rn *+n)r+!%e (er+'*e %! --6-5 %$n7 !(+ 'n !n >n !n

PARTICULARITATEA CAZULUI

-3+%n!1 )!r!)7 )#( >n'e%$n!) 9-! ne%!) !"e*;$ne! !$nn' %!n)er1en;e >n)r-$n 8)!'$ )!r'1.

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BOALA BASEDOW

A# !1$) 'e e2!#n!) 3+%n!1! M.E. >n 1Kr8)& 'e n8+;)e 'e)re#$r&)$r !%e #Kn%+r7 3+%n!1! +38er1Kn' >n !*e%!; )#( (rn!$)+e2!#n!re7 !(!r;! $ne "+r#!;$n )$#+r!%e >n re$ne! *er1*!%&!n)er+!r&7 (r+)r$?! %+3%+r +*$%!r *$ )$%3$r&r 'e 1e'ere n;e(&)$r

Se ren)erne!?& >n %$n! "e3r$!re ! !n$%$ >n *$r8 >n C%n*! 'een'+*rn+%+e7 $n'e 8e ($ne ' 'e 3+!%& B!8e'+. S$3 )r!)!#en)n)r!8()!%*e8* *$ C!r3#!?+% 6 )!3%e)e ?7 D!?e(!# ! 0 # 2 )!3%. ?7

Pr+(r!n+%+% 5 )!3%?7 !*$?e%e 8$3e*)1e (er88)&7 >n (%$87 !(!r )r!n8(r!;!%e (!%#e%+r7 n)+%er!n;& %! *!%'7 )+%er!n;! *re8*$)& %! "r7 '8"!ene8e%e*)1&7 r&$9e!%&7 8*&'ere (+n'er!%& #!r*!)& n *+n';%e


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$n$ !(e)) (re?en). D$(& + 8()!%?!re 'e %$n& >n !*e8) 8er1*$ 8e (re8*re)r!)!#en) !#3$%!)+r *$ T:!#!?+% ATS -< )!3%?7 8e'!)1e 9 3e)!

3%+*!n)e7 8*n)r!"!7 !r&)Kn' :(er*!()!re %+3!%& %! n1e%$% %!n'e)r+'e. In)r$*K) "+r#!;$ne! )$#+r!%& *re9)e >n '#en8$n !$nKn' %! 2n r+)!;e %!)er!%&7 GIFFORD - '"*$%)!)e >n r&8"rKnere! (%e+!(e8$(er+!re 8e#n$% BALET7 COWEH 9 TOPOLANSI ne!)1e .-)e$#en)e *!)"e%!)e7 *!%'e7 $#e'e7 ne)e'e7 $n: "r!3%e *$ 8)r!;$n)r!n81er8!%e.-!(!r!) +8)e+!r)*$%!r #+3%)!)e !r)*$%!r& (&8)r!)& (re?n)& >n8& 8en?!;e

'e +3+8e!%& #$8*$%!r& %! n1e%$% 'e%)+?%+r 8n'r+# 'e $#!r '$rer+8 9 !%#$9*:%+r *+!(8e%+r 9 !#3e%+r - 8e#n$% )!3$re)$%$ (re?en) .-!(!r!) re8(r!)+r "&r& #+'"*&r 'e*e%!3%e *%n*7 '+!r (+%(nee 50re8(#n-!(!r!) *!r'+1!8*$%!r 9+* !(e2!n >n 8(!)$% * 8). Pe LMC 8).7?+#+)e *!r'!*e )!:*!r'*e AVJ=0#n >n *$r8$% e2!#n&r7 8$"%$88)+%* r!'$% VI %! "+*!r$% #)r!%e 9 8$"%$ 88)+%* (e *!r+)'! 8)Kn&7TAJ00 .-!(!r!) 'e8)1 - *!1)!)e 3$*!%& nr)& *$ #$*+!8e n+r#!% *+%+r!)e7

(re?n)& )$%3$r&r 'e 'e%$);e 9 '8"!e ne8e%e*)1& %! n1e%$%!3'+#en$%$ 8e *+n8)!)& (re?en;! $ne **!)r* (+8)!(en'*e*)+#e1n'e*!)& (er (r#!#7 >n re8) re%!) "?+%+*e7 TR "&r& #+'"*&r.

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-!(!r!) en)+-$rn!r #!ne1r! G+r'!n+ ne!)1&7 #*;$n "?+%+*e-SNC +ren)!)& )e#(+r+-8(!;!% ROT (re?en)e7 (re?n)& )re#$r&)$r'8*re)e %! n1e%$% #e#3re%+r 8$(er+!re7 #! e2(r#!)e %! 'ee)e7 e1'en)e>n e2)en8e 9 !3'$*;e.-e2!#en$% 8Kn%+r "&r& #+'"*&r

EAMEN LOCAL-In8(e*;e >n re$ne! *er1*!%& !n)er+!r& 8e *+n8)!)& (re?en;! $ne"+r#!;$n )$#+r!%e 'e 26 *#7 8)$!)& 'e'e8$()$% *!r)%!$%$ )r+'7 *$)e$#en)e 8$(r!!*en)e 'e8)n8e 9 (%$r%e *er1*!%e 9)er8e "+r#!;$ne!)$#+r!%& e8)e $9+r !8#e)r*&7 #! 3+#3!)& >n 're!()!7 "n' #+3%& >n 8en8*r!n+-*!$'!% >n 'e%$);e. Te$#en)e%e 'n $r "&r& #+'"*&r.-P!%(!re "+r#!;$ne! )$#+r!%& 'e8*r8&7 %+3$%+!8&7 'e @262< *#7 e8)e 'e*+n88)en;& e%!8)*&7 *$ 8$(r!"!;! nere$%!)&7 (re?en)Kn' 3+8e%$r7ne'$rer+!8&7 3ne 'e%#)!)& n"er+r 9 8$(er+r7 "&r& n"%)r!re!

)e$#en)e%+r 8$(r!!*en)e7 *$ #+3%)!)e %#)!)& %!)er+%!)er!%&7 #+3%& >n8en8 *r!n+-*!$'!%7 $r#Kn' #9*&r%e *+n'$*)$%$ %!rn+-)r!:e!% %!'e%$);e. P!%(!re! "+r#!;$n 'e8*+(er& "re!#&) )r+'!n. N$ 8e'e*e%e!?& !'en+(!)e re+n!%& SCM7 8$(r!*%!1*$%!r-A$8*$%)!;! 8$"%$ 88)+%* %! *!r+)'! 8)Kn& r!'!) %! n1e%$% %!n'e.

Dn e%e#en)e%e 'e !n!#ne?& 9 'n e2!#en$% +3e*)1 (e !(!r!)e 988)e#e #-!# +ren)!) *&)re + !"e*;$ne 'e )( en'+*rn7 *&)re $n '!n+8)*'e (r+3!3%)!)e 'e 3+!%& B!8e'+7 *!re # 8e (!re 3ne 8$8;n$) 'e

(re?en;! )e)r!'e *!r!*)er8)*e $9&7 e2+")!%#e7 )!:*!r'e7 )re#$r&)$r .Pen)r$ (re*?!re! '!n+8)*$%$ 9 8)!3%re! *+n"$r!;e 3+%+*e

!*)$!%e ! 3+%n!1e !# *+n8'er!) nee8!r& + e2(%+r!re *+#(%e#en)!r& ;n))&7re(re?en)!)& 'e

. E2!#n&r (en)r$ e*+n+#! ener!%& ! +r!n8#$%$ 9 8)!3%re!#+#en)$%$ +(er!)+r -:e#+%e$*+r!#! %e$*+(ene[ >n %#)e "?+%+*e-%*e#e n;!% n+r#!%&7 !(+ :(er%*e#e 'e +rne %*+en+%)*& >n%#)e "?+%+*e.-$ree 9 *re!)nn! (en)r$ e2(%+r!re! "$n*;e ren!%e-+n+r!#! *!%*e#! (en)r$ e2(%+r!re! "$n*;e (!r!)r+'ene7 n!)re#! 9

!%e#! >n %#)e "?+%+*e-(r+)ene#! >n %#)e "?+%+*e-TS7 TC >n %#)e n+r#!%e-e2!#en$% 8$#!r 'e $rn& "&r& #+'"*&r-ECG )!:*!r'e 8n$8!%&7 AVJ00#n-TR7 TV - "&r& #+'"*&r (!)+%+*e-*$r3& (+n'er!%& n (re?en) !8*en'en)&J5 .5 8&()Kn-*$r3& "e3r%& - !"e3r%& (e n)re!! (er+!'& ! n)ern&r-'$re?! 600 #%5< +re (+%$re [

A9 #! " !1$) ne1+e 'e VSH *re8*$)7 )e8)$% %! +'7 r!'+r!"e)+r!*+-!3'+#n!%& (e +%.


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E2!#n&r (en)r$ 8)!3%re! '. (+?)1 9 ! '!n+8)*$%$'"eren;!% !. e2!#n&r 3+%+*e -)!3%+$ 8!n$n *+#(%e) *!re ne-!r " !r&)!) %e$*+(ene7 %#"+*)+?&7#+n+*)+?&.

-*+r)?+%$% 8er* *re8*$)-*+%e8)er+%e#! 8*!?$)&-r!(+r)$% *re!)n&*re!)nn& *re8*$) (rn *re9)ere! 8n)e?e 'e *re!)n&-8*n)r!"e !r!)& n)re!! %!n'& :(er)r+"!)& *$ *+n)$r 'e +r!n (&8)r!)9 :(er*!()!n)& *$ + *$r3& ! +'+*!()&r )(*& "2!re r'*!)& >n (r#!+r&7 $r#!)& 'e + 'e*re9)ere r!('& n (!n)! 'e "$!Q *! e2(re8e ! $)%?&r+'$%$ r!(' >n *$r8$% 8n)e?e )r+2ne. .-PBI +'$% %e!) 'e (r+)ene *re8*$) 8!$ +'e#! *re8*$)& (e8)e


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C$ )+!)e *& '!n+8)*$% (+?)1 e8)e e1'en)7 e8)e ne*e8!r& )re*ere!>n re18)& ! $n+r e%e#en)e 'e '!n+8)* '"eren;!% . C$ !%)e "+r#e 'e :(er)r+'8#

!. :(er)r+'8#$% !r)"*!% 8!$ +'3!8e'+$% 3+!%! +*:er7!)r+en 'e*%!n8!) (rn 8$(r!'+?! *$ e2)r!*)e )r+'ene7

re8(e*)1 '$(& )r!)!#en)$% $9%+r 8#(%e *$ 8+%$)e L$+%. G$9!(re*e'e :(er)r+'8#$%7 "n' + :(er)r+'e 8e*$n'!r&.3. H(er)r+'! (r#)1& ($r& (re?en)& 8n'r+#$%$ :(er)r+'!n

>n !38en;! $8 9 ! e2+")!%#e n)re!! %!n'& "n':(er*!()!n)&7 !r "en+#ene%e 'e :(er)re+?& !(!r *+n*+#)en) *$:(er)r+"! %!n'e.

*. ATT P%$##er - n+'$% *!%'7 :(er*!()!n) 8*n)r!"*7 re8)$%(!ren*:#$%$ :(+"$n*;+n!%7 *$ "en+#ene 'e )re+)+2*+?&!**en)$!)&7 e1+%$;e r!('& 9 18*er!%?!re *!r'!*&.

'. :(er)r+' re!*)1e !(!re >n *$r8$% $n+r 3+% n"e*)+*+n)!+!8e8!$ n)+2*!; 8e e2*%$' (rn !n!#ne?&.5. C$ !%)e !"e*;$n )r+'ene

!. *!n*er$% )r+'!n 'e +3*e :(+"$n*;+n!%7 8*n))!"* n+'$%re*e7 (+!)e " >n8& :(er"$n*;+n!%7 EHP ($ne '!n+8)*$% 'e *er))$'ne

3. )+r')e%e !*$)e n8+;)e 'e 8e#ne%e ener!%e7 RIC e8)e "+!r)e#*& >n *+n)r!8) *$ +'e#! *re8*$)&7 PBI *re8*$) >n )#(7 >n )#( *e BEIe8)e 8*&?$)

*. Tr+')! 8$3!*$)& 'e $er1!n '$rer )+r!**e r!'!)e >n "!*e8 9+**($)7 RIC #$%) 8*!?$)7 EHP 8)!3%e8)e '!n+8)*$%

'. )r+')! *r+n*& %#"+#!)+!8& H!8:#+)+ - :(+"$n*;e )r+'!n&7MB 8*!?$)7 %(8! 'e re!*)1)!)e ! ;e8$)$r%+r *$ TSH.H(er!#!%+$%ne#! e8)e $n e%e#en) #(+r)!n) >n '!n+8)* !%&)$r 'eEHP.

e. )r+')! *r+n*& "3r+!8& %e#n+!8&7 Re'e% -%!n'! '$r&7%e#n+!8&7 "2&7 "&r& !'en+(!)e7 *$ "en+#ene 'e :(+)r+'8#7EHP ($ne '!n+8)*$%.

". )r+')! TBC !n!#ne?!7 8e#ne 'e #(ren!re 3!*%!r&7 B8($)&7 IDR )$3er*$%n&7 EHP e%$*'e!?& '!n+8)*$%.

. )r+')! %$e)*& RBV7 VDRL7 EHP (re?en;!7 +#e7 ($n'!n+8)*$%.

:. e*:n+*+*+?! %!n'e )r+'e - IDR C!88+n (re*+*e7 e+?n+"%!7!8(e*)$% n)r!+(er!)+r EHP ($n '!n+8)*$%.

. DET - $9! 8#(%& "en+#ene 'e :(+)r+'8#7 !(!r >n ?+neen'e#*e

. C$ !%)e !"e*;$n !. ne1r+?e%e - ne1r+)* 8$n) (e8#9)7 8*&'ere! (+n'er!%& >n8+;e9)e

8*&'ere! !(e))$%$7 8$n) 8en83%e %! "r7 e2!#n&r 'e %!3+r!)+r >n %#)e

n+r#!%e.3. (!r!3!8e'+$% ($3er)&; 8e e2*%$'e (rn 1Kr8)& 3+%n!1$%$


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*. )!:*!r'! (!r+28)*& !(!re 9 '8(!re 3r$8*7 >n)re !**e8e ($%8$%e8)e n+r#!%7 RIC 9 S 8$n) n+r#!%e

'. "e+*r+#+*)+# - ere)8# 1!8*$%!r7 8*&'ere (+n'er!%& *$ !(e))(&8)r!)7 )re#$r&)$r '!r "&r& e2+")!%#e 98!$ :(er)+"e )r+'!n&7 RIC 9 Sn+r#!%e.

e. 8#(!)*+)+n%e 'e *!$?e 1!r!)e n)+2*!) *$ !%*++%7 n*+)n!7*!"e!7 e2*%$8e (rn !n!#ne?& 9 e2!#en 'e %!3+r!)+r". TBC ($%#+n!r7 e2!#en r!'+8*+(* ($%#+n!r7 B 'n 8($)&7 IDR

)$3er*$%n&7 8e#ne 'e #(ren!re 3!*%!r&7 8$n) (+?)1e7 RIC 9 S n+r#!%e'!*& n$ 8$n) !8+*!)e *$ 3+!%! B!8e'+ .n '#en8$n (+!)e '$*e %!*+#(re8! +r!ne%+r 1e*ne7 *$ '8"+ne - !"+ne7 '8"!e !**en)$!)&78n'r+# C%!$'e-Bern!r'-H+rner.-*$ )r!)!#en) *!?$% e8)e 'e n'*!;e *:r$r*!%& !38+%$)&7 )r!)!#en)$%#e'*!% 1enn' >n '8*$;e '+!r *$ ))%$ 'e (re&)re (re+(er!)+re 9'$re!?& 5- 8&()Kn -< 8&()Kn *+n8)n' >n (re&)re ener!%& 9%+*!%&7 '$(& *$# $r#e!?&

-(en)r$ !$r!re! $n$ 8+#n %n9)) +re? 8e 1+r !'#n8)r! 8e'!)1e-:(n+)*e '!?e(!# ! 50 # *+#(r. 52-2 e ?7 "en+3!r3)!%2 *+#(r. (e ?7 ne$r+%e()*e #!+re %e1+#e(r+#!?n >n '+?e"r!*;+n!)e7 *+#(r. ! 07 5 # 525 (Kn& %! 52 (e ?7 *+*)!% %)*.

-1)!#n+)er!(e B57 C7 A-3e)!3%+*!n)e n'er!%7 (r+(r!n+%+% 5 )!3%. Pe ?7 >n)rer$()e *$ n!n)e! +(er!)e

-ATS *!r3#!?+% 6 )!3%. (e ?7 ):!#!?+% -< )!3%. (e ? >n)rer$()e*$ 5-< 8&()Kn (re+(er!)+r >n)r$*K) !*e8)e! "!* (!ren*:#$% "r!3%7:e#+r!* *+ne8)e )r+'!n& .

-8+%$;e L$+% (*?7 >n*e($)& *$ 0- ?%e >n!n)e! +(er!;e(en)r$ ! ($ne %!n'! >n re(!$8.

-'e*+ne*)!re 9 *+n"+r) (8:*-(%!8!re! 3+%n!1e >n)r-$n 8!%+n ?+%!) *$ #!2#$# -5 (!)$r.-%+*!% )+!%e)! re$n *$ !(& 9 8&($n (re+(er!)+r.Tr!)!#en)$% *:r$r*!% e8)e 8n$r$% *!(!3% 8& !'$*& 1n'e*!re!7

n'*!;! *:r$r*!%& !1Kn' $n *!r!*)er !38+%$) "+r#! 8e1er! 'e:(er)r+'e 8)!'$% 5 *!re n$ ! r&8($n8 %! )r!)!#en)$% en'+*rn+%+**+re*) *+n'$8 )#( 'e -6 %$n >n *+n'; 'e (r+r!#!re.

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R8*$% +(er!)+r (e 8*!r! A'r!nn-M++re e8)e 5 +(er!;e #!re-#%+*e %! + 3+%n!1& "&r& !%)e )!re .

M+#en)$% +(er!)+e e8)e +()#7 3+%n!1! "n' e*:%3r!)&:e#+'n!#* 9 3+%+*7 ($%8$% "n' 8)!3%?!) %! + "re*1en;& 'e =0 (e#n$)7 e8)e 3ne 8e'!)& '+!r#e 6- +re (e ? *$r3& (+n'er!%& e8)e >n

*re9)ere. .In)er1en;! *:r$r*!%& (r+($8& e8)e )r+'e*)+#! 8$3)+)!%&3%!)er!%&7 (re!)re! (re+(er!)+re *+n8)Kn' >n (re!ne8)e?e !)r+(n& +"+%& 9 "+%& #!%n7 3+%n!1! n$ 1! ner! %*:'e 9 8+%'e >n '#ne!;!+(er!;e.

Ane8)e?! -+()e? (en)r$ + !ne8)e?e ener!%& IOT :!%+):!n7 ne$r+%e()!n!%e?e *!re># +"er& $n *+n"+r) +(er!)+r #!2#7 "n' ($;n )+2*& (en)r$ 3+%n!1& 9*!re ># (er#)e + +2en!re 'e!%&7 *+n)r+%$% "$n*;%+r 1)!%e7 %&8n'

ne#+'"*!)e (%!n$r%e !n!)+#*e. De?!1!n)!$% !*e8)e #e)+'e e8)e *& n$(e#)e *+n)r+%$% n)er)&) re*$ren;!%e 3+%n!1! ne*++(er!n)& 9 (+!)en'$*e *+%!3!re! )r!:ee >n *!? 'e )r!:e+#!%!*e D$(& n'e(&r)!re!8$(+r)$%$ re(re?en)!) 'e 8+n'! 'e n)$3!;e #($ne )r!:e+8)+#e 'e$ren;& .

A**'en)e%e !ne8)e?e #(+83%)!)e! n)$3!;e #($ne*$n+!9)ere! )e:n* 9 ren)$3!re!7 %e?!re! 3$?e%+r7 %#37 "!rne%$7 9*+r?%+r 1+*!%e %e?$ne! 'n;%+r *$ !8(r!re! !*e8)+r! >n !r3+re%e)r!:e+3r+n9* #($ne re?+%1!re #e'!)& e2)r!ere! 'n;%+r *$ %!1!

3r+n:+8*+(* n)$3!re! '+!r ! $ne 3r+n9 're!()&7 n)$3!re! e8+"!$%$3+#3!re >n e(!8)r$ %! 1en)%!;e - #($ne ren)$3!re!7 !8(r!re!*+n;n$)$%$ !8)r* re$r)!) >n !r3+re%e )r!:e+-3r+n9* *$ 8n'r+#Men'e%8+n #($ne %!1! *$ 8+%$; !%*!%ne7 !8(r!; *$ 3r+n:+8*+($%7 HCCn '+?e #!r7 !n)3+)er!(e IMA7 8)+($% *!r'+-re8(r!)+r #($ne #&8$rener*e 'e re8$8*)!re.

In8)r$#en)!r$% - *+#$n !1Kn' (en8e :e#+8)!)*e "ne M+8$)+7(en8e )!r S)%%er7 'e(&r)&)+!re *$ 'n; 9 'e(&r)&)+!re F!r!3e$"7 !r!"eM*:e% 9 (en8& 'e ($8 !r!"e7 )r$8! 'e )r!:e+8)+#e.

D8(+?)1 +(er!)+r

-3+%n!1! >n 'e*$3) '+r8!%7 *$ e2)re#)!)e! *e"!%*& n :(ere2)en8e#+'er!)&7 re$ne! *er1*!%& !n)er+!r& "n' 3ne e2($8& 8$(+r) *+#+'>n)re $#er 9 (en)r$ *!(7 #e#3re%e 8$(er+!re >n !3'$*;e (e 8$(+r)$r7#e#3re%e n"er+!re $9+r "%e*)!)e7 #!8! *e1! #! r'*!)& 8(re e2)re#)!)e!*e"!%*& !8$rKn' *+#+')!)e! ne*e8!r& 3+%n!1e.

-e*:(! +(er!)+re +(er!)+r$% %! 're!()! 3+%n!1e7 !$)+r$% >n "!;!+(er!)+r$%$7 !$)+r$% 5 %! *!($% 3+%n!1e.

O3e*)1e%e n)er1en;e *:r$r*!%e 8$n) >n'e(&r)!re! %!n'e )r+'e(&8)rKn' + %!#& "n& 'e ;e8$) )r+'!n n+3% (re)r!:e!% -0 7 !'*& -

(en)r$ "e*!re %+3 *$ #en!!re! ner1%+r re*$ren; 9 ! %!n'e%+r(!r!)r+'e.

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TEHNICA 8e (r!*)*& + n*?e !r*$!)& +*:er >n re$ne!*er1*!%& !n)er+!r&7 *$ *+n*!1)!)e! *r!n!%&7 e2)re#)&;%e !)nKn'#!rne! (+8)er+!r& ! MSCM7 *$ ($n*)$% *e% #! 'e*%1 %! 7 *#.'e!8$(r! "$r*$%;e 8)ern!%e. In*?! + 1+ (%!8! (re"er!3% >n)r-$n (%!n*er1*!% *$)!n!) 9 1! n)ere8! (e%e!7 ;e8$)$% *e%$%!r 8$3*$)!n!) 9 #$9*:$%

(e%+8 !% K)$%$. V+ (r+*e'! !(+ %! e%3er!re! %!#3+$%$ *$)!ne+-#$8*$%!r *r!n!% (Kn& %! #!rne! 8$(er+!r& ! *!r)%!$%$ )r+'7e1'en;n' #$8*$%!)$r! 8$3:+'!n& 9 #!rne! !n)er+!r& ! #$9*:$%$SCM. He#+8)!?! nr)&7 *$ %!)$r! 1!8e%+r #! #!r $$%!re%e!n)er+!re . C!$'!% - %!#3+$% 8e (re(!r& (Kn& %! "$r*$%;! 8)ern!%&. n*+n)n$!re 1+ 8e*;+n! r!"e$% #e'!n !% #$8*:%+r 8$3:+'en7 *$n'e(&r)!re! %!)er!%& ! !*e8)+r!7 (&)r$n?Kn' >n %+! )r+'!n&. Se 1! ?+%!%+3$% )r+'!n 're() 9 8e 1! !(re*! #!*r+8*+(* 1?$!% 9 (!%(!)+r*!8(e*)$% !*e8)$! 8)r*) (er*!(8$%!r 9 '$(& %!)$r! (e'*$%%+r 1!8*$%!r

)r+'en #%%+*$7 8$(er+r 9 n"er+r 8e 1! (r+*e'! %! 8)#?!re! %!n'e$r#!)& 'e :e#)r+'e*)+#e 8$3)+)!%& 're!()& #en!n' ner1$% re*$ren)(re"er!3% (rn '8e*;e7 %!n'e%e (!r!)r+'e 9 (!8)rn' + %!#! 'e ;e8$))r+'!n n'e#n (re)r!:e!% *$ 8$)$r& !*e8)e )r!n8e >n)re (en8e *$ "re >nQ. A(+7 1+ (r+*e'! 8#%!r (en)r$ %+3$% 8)Kn 9 %+3$% (r!#'!%L!%$e))e . C+n)r+%$% :e#+8)!?e . S$)$r! )r!n9e *$ "re nere8+r3!3%e.L!1! !% %+e )r+'ene *$ 8er "?+%+* *&%'$;. Dren! '$3%$ !% %+e)r+'ene 're()e 9 8)Kn e2)er+r?!)e 'e*%1 (rn *+n)r!n*? 8!$ (rn

(%!&. Re"!*e# r!"e$% #e'!n !% #$9*:%+r 8$3:+'en. Fre 'e *!)$) >n8$3*$)8. A"r+n)!re! (%& *$ !r!"e M*:e% (e %n! 'e n*?e.P!n8#!ne)$% 3+!) *$ #$%)& 1!)& 9 "!9e >n*:ee n)er1en;!. In)r!+(er!)+r

(e8! 8e )r#)e %! e2!#en :8)+(!)+%+* e2)e#+(+r!ne$ 9 'e"n)17 !r'!*& !*e8)! !r!)& (re?en;! 8e#ne%+r 'e #!%n)!)e7 !)$n* 8e 1! *+#(%e)!n)er1en;! *$ ne* '88e*)+nQ.

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