rurgie si

oa. BAscA loNasigtent uriive.sibr

Y.OL,I

COI{F. DR. .ZAMRN TUOOR.

DR. JIA U I{IHAIasistent sniversitlr

SI FARMACIEGENEAALAPEOIATBIGA

sTtTUTtft- 0tI'LTATEA DE

MEDICINAMEDICINA

CHIfiUftGI.E

GUBSpediatriea

!l!u!e il! bIll rupsllaar! {saulltl 01 .lcllosshlrtr .!t.

.d,frmatt. ootGsaltatl r-nir/rro-r:oo. lari d.o*tl. a ,t*tt

ou '

flrc?ant! lrrstrv crelcutrr

no,ryr aprl -

p." a.ou.r,oij ::::::.T'J-:t:::'il":,(lA5A) ca:rs tat:rebu.llta lerbrult Lat.fatG I! !!q.lul ]rI Dtnl!,V||u, !c|ri.rr.!, tl6!u!1ar, Brrrtl, l{ltlrr{, rnrro fubullt{lt{ l!t!'rtrrrr olt ra1 salcot! r ,i.qrr,l.! hDlala"

!.ottrll atttl.alol. caratlt !'!o ou!.routl. s" !.o;

ta!ltatr rit'.tt{ !3tf':t!!1' !u

rrr.,. r, rnr.:rerr1r., ,";T;'::';:l]il,.l"l'"', hr.por'*a-Dlntle

.c.!tl, ,.cl.d, trallt1tlrlr alealtrn! 6rtc ooa r3ttlrovant iJrtrririA frar4ttorer aalctlcl rr fao llcertv i.! pr._o.!t {o .1!o{ ZO_30 t

Uaul al! aaortl trotcd eott.reaa!0.,.6 ,. dosy.lrr ,.n. ,, ,..'ij"Iiii J:ff:' 5 ErGu"' {t!gth cr crbll.totlo fsta !! ccrr.ltr i'. 5.furu!l! u,.ul redltr0l lrDgrloa

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luturcl. ,!oqttl, C.l rudqfl lup.tt.rrl ,l 1qt6!q].L _

nturll !e:11.,{. ruperl.lr 91 iro!, rugurl 1at6!au q!, ta.fert.ot _mrSu:ll E8t!'lr:ll tdltrnl, la,r is a1;11su1 eortr:. iuaqrl r. GIr6fl. adlturul r,ate{.! (fra.l)"I! av.lutla, t!u$rr.l. f,lortalrlurgtldu-.o, dl aartqlo p!r{.t

dtsta,l{ h attl$rgufl lecurlda.fL: drl

!1 ilo! srtsrll; dt!illl tatqrnt prr.! faztuista lUff iptdL serlal, Saa_

- ,

rltr lal t"6cvo!t. UEA df.a hcr0lbu3o rlte !a1 bl.l! d.r[ltrtl,ssaLl,tl !&t b.lpopl,aala!. [qrl!8 arta lal il.torEst! oa lr. ]utar'sll, !a1 lrrglt!, s!1a-t15at!-

.!t.l D!!rl ar.rdrt. lpqr rb{F.!!,rl d.a orttarr rlo dtqtllo!.

0.- ftldre leb.tat{ bLl,Etera,ll _ poat. fl 6cupl!t! rau 1!or}

l,tal rlecelt pu!f,s4 gr, Looherertsr o.E tiertr aI !! frrlu.tf,Lrulll'! lebicle 1ltt6rd,t,r o 4cr'c1e,,rr p"x,.d tu;:"3: fr::::::::"ff:ff

. lezodeflll-zero dfteltq,r! pentru buz5, [axller !t paLat.

DL! punct de vedEfe aastollq_gLl&ro eatst{ ul."!r{t.a,!sta follorl.- Itlurl dc br'e 8upgrL!6r{ ,r!rpl.a, qaJ.e kterelaala bura

r.gt! tt blra r,lbl. loBrta, prt lt rltlurte p6 l'art r rttl3{ prpeftea dloepil e bulsl ,upr!laa?.a rau hil.qtgtl|l.3.- Ftrult ea buzl lutrrollo&rE ociplet! _ h eqgrte c8tunl.

s.tc htarolet 0t pregul !a!l!ar...C.- flrur!. ac brua ,upatl.rarE orq'll,o6tc! f,lrur& 1cDtsla rup6drall sr coatr,JffiI ou I llrur'd 1a rlvalu:L erceital da.ltare, !,elat ,1,rII Drlit4r.

.

A.- lllrl"s il buzl srlnll uo{lqtele1{ _ es fu.tlt|ertc lsL!6!. Aparo t&or!1 ca,. n{ol aroofE l.a }u!E regl, Eau p!at6 r!!.bapo hlsa slb{, Fqltlsl leu t ta,l; I}rae} rufrndu,.re 'clrtre n6,t,ii[ oe u!tcat Alt!a!l, ao pr|ea!.ntl ca o itgt teclurio, iAuDgntdL rn tocoagaulors oels dour hc.l!.r. lltpe raeu d pe'tes, f.lutr't 6st .6_f.tqai.l, lE?tft{. ssptrtl ae!&1 6rtr dertrrt,4$r f,lru!{.

|tI fl co{p1tcatl. }raiq fl ltrstdq{ ,au rrr" !a ,.fta 1!.o.*|l,._trr cFef dcu!.dsp!e!1ud oq dtta Es.t.lt leu llrurr oa bt.lar.rFrl r!,rgtrto-.eu 4u busa roqr.c, busa elbl" pr.p&ttli lalefrta alaoolor aoul fkulr, ta obEe:n I u! telut epitauat !rru"

tr! folqe1r qoEplele sl po@ltrqata o! fllula arsaCat d.niararDugrulLs r!dl,a!r, d9 ol! Eal nritc orr. p.qnea:& Sa sroo!.czlla,vent tt cu ffuula pBltth!. Estr . lEl?.!tratlc arsv& fl al!.l.rtl_o.!I d:h puaot il.. vsib:r sst.tlc. Df|ttll atlt aJ1iE81 l4|r.artrtL

t! tllurth labiaLo !14|I. ,1 s!4r1eta, ?3!e oc q{,bl sal

hat Erlt elto aspotul eltir.o a1 ,!tr:, oqrtluhlo In ,amo!,. oGplr'oatr epar tulburrLt d, luotlulr, dsl.rca rrau urqro!,uner ruoor,-salor, crtte haLdetlte ,.deqt{r,lor de oil .rlglta ruga:{.aaas ,l_!ofs!L!Gltq, 6ttto, aEltasltic. Sts"fai ilo ruirltla a aoart.a o._pl1 I.!l Ce dortt.

S eioclazE uleorl ou r,lte talfojtratlr.l dancir{r ie oa.rr3,r,!s-!ec iai. , oto. oers futu!'sod pr.&aaltlod vltr.lo

frateeentul ltr oh1lurEloel. [a!e!tul oprlator grta ala!

tq tuactte de fo.lee elatodcE a flrurll labla.le prlou! ,l d. t!.trF

tetea, qop{lulul, tt Eat putt! de vlj:stL ta fr:5ete d, f1lu la.btrI{ ol,qr1ll sugalu.]. taebuls rE elbE oeL pBtt!, 6000 tr..f! fcrDllaih ff8utrl Lauets toEtlloeC, greutatea srtcat'ulul rl ,t! {a ?rOO-mDo fr. In eoaest{ f,!,euli pe 1fugl rclrsFalea ra, trobtstg rI lcrrp0a! tttttlul,lEteB pr&gdd. larher t{ a peld.tutrd ntrt.r.

tl regasa:ria ftsurlt .1ab1a1e um&tF !r!gtre}!t!: 4r|r1 bu:lel tuprfloqre sg f,r.q r ll-qtr! colttqul,, bur| iupelrt?s:t5 al. . piFtc tl alta a ft'trril, d a{O! aceeagi. t"rr tr-!., reptnl Eral ,1 ,ra.

3,-a ob6qF

?sltrrr !eal1sq,!,ea aortor aosldrlais tlabutg !I rf,6ctu&!10 tblrlol cale tlaDrleerE lsEbou.rl t!iutg!.1uLe! (fffl,lerd_fqr

tul cuLls$tust sI f1 po itot" ,"at.,r-

roa, Ul!4uli, atc.) seu petruLatle (J.e Uesurtrf) pcriru e

6ptt6LjLalscgu de p lacgtqlla flsurll.fce hcr.cie 1& 0eitlrl gLaglr!-r4D1ar pentru a EobL1lEa D!i-edecolqra buael, oby&Jr,!.,nalaL6 de po planut gsor. tr&ul,natrsbute t1&6 decalail d.e p@ plaFluf. .E6a peatru s F[tee s{_1fera nor&a,l-{ (ffg, z,:, +1"

cele d,.u! buze. trreai qxoLE'.& tegutulut pttlLl !.rrr iloopecmtl d alt* 6 fl6rrl:ll 6e .rscorand,s ,.n frsu!,Lle la osr celo Aru.Ibecibura cu aoeeaE nttlIttl&er. (tehaioe V9a11).

ope]letl,a sc electueBsll ou! ,lEltszis tslrqr&L& ou f,.o,T.,

De.rfuzle au E]llaoE{, rsr iirjou! pteld.arrte sau6b,oe.

lol'og{ er st'g6 I'a asvol go,ltnr e

2.

PIg" 3. rtg. 4.

lllartl aroolrrc ra froa xl elt .8ll lal prtLd, tr ,uqottealttantl Clrtr. oalr drul plltr. s1s bqart flrqr.to. Deoolrrse

I lLa rrtrrprr.l.ltr,o. lp.t !a o!.1r!o lsrbcu!1!,c l.[ lrl.lctlc dolpt -^ -.lfilfr l. orro . adcptSr. So crldeatlqzl tn ooatr.-a.uafe bta.,rbr.-

talrd dr. Darte tr. il. eltr a flrll!f,l, Crl,EEo14 trsbul! et lb6re-ll lf fr rplr. Nr,ezol[ a.oterloarl pstrtrrt a putt !E-tl r!1a p6r1t1sllllrll rertlid. Froesul 4 e'co&!E letla trcbnle oxatlit" Ltaleaa aflttll .I qu tlo rub ts!!tc!r. 30 fac apor, lutufr orblculen-Itll (ou ,-4 flro dr ltlc|r lJ}rodats q)f, oa,"1tai6a, bucal.!), s teataril.Lar fi Euooaral glllg1ye-ls.bleLe. sfut aut.rt ca::e cutElsar{

ftbloulrflrl ou ortCut orcratl cto. d.r tesla lsDsntrlrlul ds nL!*.

lalar$tl{ Ir ryloB. I! CLLdeB d,. Chlrlr.fgle tl ortoped.lo lotelltl-ll a lpttalulul Clllrlo Ceatrql d6 Copl1 ("Cr. llerqndlegoui ), !u-lltfr ortloulsd cu flr d. Ay1.! J/oo.

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Uoooc. F-[oDau:. dehlalatrtrttr 1-r.! lrlttbl.t f.artc rar. Plat4 !q larI leaooperttiaa pl!|r.!t.

ln tllura lebta,1! btlaletell, tL.qll opelatorl 61!1t uf,!0lto-tt lt r. Grolroeel tsutul, gp1te11al lotu de pe 61 d.ouI pi!!1 delurl tllurctI ll re leaa laclsta EEocalel fu bontul GllgiyFlsblsll l lrtarali as dooleezI p5n!11o Eo1 d. pe planul oaos Erllal 'r 6e

alr.ol orblcrf,eflrl dcoFsrt tl da alta na tirurll"; ae eictEcaz:

tarutul cptta1la1 rogu d.eopertr. gt dc s,lta 6 tiugursll:i !6d1an pds-- I tllltarFse palte !a oeltral[. se

aleitubleezd paltee de burl de pe

Eutursle Eealtarr tqt:Dentul f lrldd

tl,r. 5,Itr r trlrtllnd.rr-* pu93n tegumf:rrf

aul ||rt t n|r tl pe-tet$'l a'llicrl"otr'

proc6alco -

Bargtl ' - ss rezeoE o

bu16 ps.f,to i1La buta [ugErelul. de-snb 8@ptul Bta1;-S6 -!3f,4e6 pra-

!6 6utursas8 orbXtu];}fl1l Pesto :'

0,!ugr!s16 arga !ed,1s.E? c! autulear! tsglrre[ta1a lr tsalreltrilreLul Eeelaa. Sa rutuleetd apol luooela lablall tl qc|' dlraLnAlvo-fabie1.

In poBtopetato! spesrtrl rgte suprcvqgheat peatru cq bu.ta

rloer6 si nu fl traulo&tlaet!. U[eofl rpllcE! aparats ahlptrt.lonbrIe supl!'loQle cu Bntebretu.l 5lr orteEale pa b!et; alttollg6! Dttril copllu1ul .16 Pat.

Alhetltatta co!6tI le adal4trtrero cu Ulalr:.ltr dc oeal'

te, 6Epl. s htelzloo suptul '

blbeloau]..I ! fac alltlbletlc! pdct1t!6 1oo. o0o u,/k&!. otrp al

DlclJll 20 4gr./ks.corp ttlp 4e 4-5 !tIo.

IB generalr reEutteiul stct lo eltc cel ' Corlt . l l t lol l t

epare corpllcatlr. tenet'a.Le ft loqale. CrEpltrcatllle 3Dera'lc

nitrlfestE prL!. llr'fcctll a.1e BtboreLul b!o!.ho-pu]-tnoa4t. C61'

le! dsstacrea 6utrEi.1, tleauloaee d.e ifilnr etc.

Pot apq.re i! tlep hperfectlunl stetioe ca! clcetrice

1d5, letractlll' a.acote (dedtellrl) 14 d.velul !6{u.1ulna:lai d.efo:aetl. etc.

Se recor,andli ca retutr'E!]6 Pla! tentlu tlarlJl l"a 14-15 8.r1r

"liftr La oere t!Es!tr811' f

trat.rll .tl.:.otlo1 tl r.c&1rnl prtrSpnlc A.rod, la otct-praduo tlrlrlr palrillrrL

llr punat 4r ved.rr.. raatcrlc .:l!tl tl.url p.Lttal g&U$ t|UDldL. Flaura palatlal e!4lp1rtlrlt iatlaa. a. lr anodrllb!|l fa lurtl laolurtyt !. a.rcta!! t!.6v3!t su tl|ura hDtdlll |ln burtlau.

tlrurr pqlatr..nl l|lo.Epletg pratq)u!. d,steata Erl ral,atltO ruttnuttrtc tr lltyllul palatulnl r!q,l. tl 31 1E trt. haab ro.artl f|rrl 8!8tcrlol .rt. Lrrtclerlt rlurrl rllu]' ,afrtt&

I,1 lllulr paLrtld so4'l,rtI u!,aa!l v|!ar[l |r Clletta tra li-dr rrOlant, 3Ltrtd qltc udt orr a frnf p&latf-a& ttrura ata aI-tld llfrllt.. Doet. fl {. la 2-3 D. 1. 3,Fa oN. lltrt{ar I.tFla Ddatllr !t.praplr cu q!.fts!e& !1s1oDrtc1.tl,o, alt.tlthtrr!. ir tl,lol pelrtlnr itl 'etr carcqralrleltrd. l,a! tutctla8t. I!ttFlslt boorplatc 4r flrurl palatt.al, L! otr6 tltE!3 axittt !|rrth lEotI au !xl!t! tulburlrl treotlrl!3h. I,| tilrEr l.!c.elatl,0u llltlretrtr a1 r palatdul la1e, or il1?ldtr|lra !trtoltldi ?r!t-atrftutrl'' pqlrt.31o!u.1u1, rtc. o.ptlul p!.!lnt!. tulbrElll ta

'|ro-tiun tt l. fo!atl..

I! f!.!urr cc4let5 pe lfu:t tqlburlrtl Aa, ructlu!., frrartfc,rpere f,recyent iJrtlo.tlt r1s cl[l.r. !6aplret.rl,l !rq].d..rr,1a! ootltulul deflr1ltit.

J1g$Clglggtgl-- paLat.sohtti.r. 6!ts Elf tttelir oorterf ou Ltp.tsurlr.1l r pelatu1u1 caracterizstl plll1 prtetxta nnel flturl oale tceart! ralforetl. tletllr|lert! p plrtatt tl llrlor oorrEi

tl psatru r tarrlvr oeztrl ctt rr,1 rcpsi. alr{rl !rftr!o. ltttgat-!ar.rt!i glia utuliraletl tsq andh oul rI .0 rltr.atala aotl-

, t!.tb t-slcetLlle btersulartr tt flrb r.|ra!|ul rt|lrtat htlr d! f.rllrs uetoiloE a f,lltrtll pdat'lllc.

lLllent&ror aopllutrut s f.o cir xtls;trtta rfu gtr bibelr.lll

lattlri Ludaa oalre !i aju,uti pirl lr t!,rr,n8ar garoti, ril phrlltahlda prx! r'.rlBo, fi! trllurll. d. 18r!f, oPrratlr

ri ccqLet 6eu psrt1a.1 pe18tu1 dur (ccce) '.u

nele (vELrf-E dgu.C plrt1.

DEbft.]ogLc ttlr c!. pelatul' !e l.tE?az{ t4 t1[Fd

i 6-.. dt! u.o!re. a aoBt p!luiGt"l atletrlcg PG:iali' alll

tlarl.19.ll ,prc Bt.uaCsu!. lcgie pleloat1tl Ee autglg plcqeaele

16 !ard! ![ t! .tcrobldl !a f.tl.a!.qf!. cf,rc*Ltat{ tn Ju!.lal rt!rit@:, C.. 1A lqal," I8 tl xstlc s{re

t.l do e rr!,. Ir ft'lrtl. o.rG ',.d - 3 i,.. *r' *.*,r;:::j'rHi::::r.-i I

lrt.r.r.a* tt ?I1rL pclatlr.rgrfrftr r. pretr ,ao. tr JnnA-11

Itortbenrtrtl 4 /& lulrat.tl. t tl llohlu (c.rl, ltDt.t' rupl)

'i aNtl otr lllaudt lo dlr, ..

arD[ orra trr Lrlrlftlr lEatEt( renul,shld. ) | ,|! L P aa ttl.r.r t.r.rr,ta orlo. fal aa dlrlt*t1..

t.rt-atalatEr ratr,llrt.la artFtorr,la !t!t Duar. liraa , t'at aprraa!rutll p|rltil.e ||ir ..q)1.1. rh

Dll3ll .tr!.brrl.rtr. 6.loalla tl.3lllrtr r. Dr.a@

auDI rutlfl al. Plars!'l.rn r.l'

aut tcrqtun. Btt. llsrralarF

lir rTe-6-Iil ac 1q !'eoldlvlt.f,tultaiuJ' fottatr.r alte Lu i

tuatt. rio !r$l6t.a toruturt.lcrral exs paXetnlul. llltllsa Pala;tuXnt; drtn* eaYltltll buoa-lo tt

uraqrr. l,!p!t6vlttbr,1. neooletrillh ep !s,'b{l'fiul tt lottpsarrl -!E-tlrluo! coqtrltutla 1a e.r.cierd, v'rbl$ll' oolllrilul."

Coiobona ssie e nallcrlA'ttG ogla6trlta1! a ftt'l' s' 9!'r'[t!oltda ea ti l!gu![ lttBEtl 18t!r*1 ita {16. P'atc tt' r ltttttl o'F

salr ,.BooryletC. I! fof,Ea oorolgt{, llsu'a pQ$tt' 'r

Ia ort

!ct.t!a 81 oohlulrll 61 llt,tasoitI 1llc]uttr btrta lqlatiolrl'' tlslr llrcqaplotE de f,teuli poqt 31 !'bftttoa!{ 1'|ltore'fua bula 't'-

La aoaartt v$l'tl rolq)ulr rpcrrctol |laryrlt|r.oa lr!!rat1[!,'1ar.r|latod'.t pcrntta rf,.otqset.lraot rprnlt!.

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uFln lt.,rll.slrlr -oE rotultrtc aletrri,o fi fuao tt.|rela a! !u.d orlttrtc. gcl rrl

tdtl .pa!it.Ft, .Ir6!.asl h ,unr:. ,t!rtd. {. e tr:b D.atrruos tt_

lntur'laorart r! l,rta tr vorbearor gereot. lgrh.rerr ca,nastr aourtrt.lo! t.plrl|!'. i. rupletbr prlrtuhl ruturtt ,r, {a:.urffrr.r& blrtl fl rtto..tltu{i.+ trrqr.utlo.t

.. p..t. laFllr D[et!r1r.al. l.

"brtr |l. t|! .Jr, ,.i! pdatnl {b rst. cbirs,.!_ru it.rl_.1 tlr.tatto plal l'a rtrrta ac 9-{ |[1, oLnl t! fror i.otc.!r]rtl,ra.flrLilvlo

nr gltr|!.o& a. Cltatrtlo ,r. ortopqd.tlo td$ntr.U r Spttalulur

cl't,'to ca!!rq'l na orptt ru! Buour.tit rurs,atltrttloraftr" . rr.o- i lO r s! .o r.i|ltrrvlli iaollttlLn l8t!-u! ttry t.a turul ,lrltct AG I anl gl 6 f'unf.

tlrptl gr.1llo!.pct ! at rpqllatlet rhtr Lnotll, {i._rt r!fu! f,t.u-lllt r'al|!.a, lntl-c atagl|nl pqrt., pe:lntrril Ac l. 1uet[ pcaDrus4 Ief|gcrBt:er sE !u p!.ducd dl,tloul,tEtf ia tresaret tlolsial. Coatt_:aEh cpal lrcltL a.3J.ulrful rrcadsl drttaro.Ia 3-l e. t! ,rt.rl.ri. r,ocrtae rg:r3ird. rr.or.t6 i-ryror. pir{

.la rttl.frtt f$ll!gts!l. ilpa! su lroclrt.s|rl trocl& f,tblorq.cca!: latrtla.l. fraoturll epo_..flnlr ptor!3rti.4.!r rduqtd !pr.e tll1. rerlle.il rclroul'et*q ,U* ]lul, pelrt3a" Dlo.tb ia orlttannld taqoqsa lrtall" t6!f,4om o*_ i ,914t. Elodatun aa Da lartllea Dortsrloac! a 1a[al.! pslatlrro. i 'ff[r;,.l p&oLtul riaoutr! t r.lqalNa postdfq.lr lq6stL rpcrittr 1. tact| tl' a. Drrtra rDlrl r flrlllt. lprl ruturlt on fl,rc eyrF

F!r. 7.

,triaad, tlteq l&teial 4c atlpa EetalE detBtltrd-o d 0!r&6' Ilr

t.!ua ggg5tggl5 f,lprrs llrdotFlat{ latEreseas[ pl'oep4 lder!oar{''

otlrlu1 laoll!;tlaEal tl aoss{aao tatrsl da nar pllrl ettesFo da

aaltt 1rjelo aLsre lsFllalg i rr telEtd futFur llfun'Llbnl care

12.-

3r allohl.Oa fu. foaLo !t!a.1o. OoloboEa lstc ud ,aqPostc fl Blletllo ooryltl 6au llorEp]'etl, aau poeds ,!.pe o parts tt lnooqrltl iG partra odelaltl

Pattlu l&rr.sn !fut elqrtta,lo a.ou! tlpul' Ae fllurt s or. o!r!!datitqsr{ alrlpa nars_l|,, d.oschi&hi oe!.ltatr r4lalE fl c.l o!l!!doro.tnAr in rta,lf artplt !.ralo.

hatarontuL 6te oh1!1!lralorl. Sa rGooDllill r 6e ,ro dult

rlrria {6 1 a!. ra folrs 1[oo41str 'drloa'[

so 'nofaos b!,or aluDu,ullul dtJr plco{ssl,o oulosoutq d.a ],a ohllopla3tu.. trn fofioele ln_

ooQIGta !uprloa,!9 va t!6bui rI lefaoea oe,!lUl l,as !e1, plooapatrfelr.aard tt t.3u!6!tcle f,stl ft trasu].u1. Ftrurl oeEliqld l! oa-!6 aplazir faclala est6 nLnor.I. so reFgld p ,a plast!.a ou la'lbolllLao ts'uqnts tlt{hGrrlo'er', d?eptu.[Shruitaro. r! aaznl uael eplartiite3lnents:le voE folosl tl $!et{ d6 tetttqcrt palloulat..

lreCloatotrla. a6te o lalf,old4tla ooagellltall1sular! e f,atsl!1 !o ptoduos plltrtr-un dlaot d6 &ezoclolr1as,le l.Etle t!tgr:.:reJ.c ua_rlf'r,r 6upo!1c! tr. cel lrf,r:igr. Ilsu!t,, corltLtruC oodtt rule bucalltl" rs Lsar6apt{ spne obraa [A.rL.a{ dtule&EtunLle Frrl!. fl aJErte ua.oll pfuI le urcqh.; a:.teorl. se dllltjraE{ cpr6 rslluna tryore}I.l.ooartl tlEurl poet f1 ud seu bllatera,lt

.|Bp6aiul ctetr.o d,

fstal ertr dl,Etlatlos. Se aloolarl qi flbrrocoaabolr.trotatstrtu:' orte cht?urcloal, s va

fectsa dq,I LE luat. tr0.cod6t{ 1|1 rezectta fl ertl4a:lea llrlcoasei rogll de-eLutgul f,tsurltuff1 sa blLatereli tGcotlslltulres u!er" cevLtdll buoel de d.lnen8lunL !r6ltna.1s prl! auturl ll1 tr1 pl.nurt &le obrszulur. (!0ucoaB6,!u!cbi, tl tedurelt).

Ifi! post-opelator aliheltattg, va ft adnltlisirail, au aJ utorul

u.ncl ao$de. 56 ra all'1onta lo-lp zl1e pit-a graj. :!fu vom eplrcapallaq&e|tt pc !,lags ope!,atofie, p].&ga se va deehJecta zllalc" Co_Fllul !}r ?reb!.ls sd fte rEltet, s& alr !lp, sE.r2u {erehtd{ t&rg&rm.

L'

oo4leteIlero8iods,. !3la o atrctluaa oaract.r.r,ratl DrlD rlura Er.al!

totta tl d.. qaturE cop{qntts,l[ d.sto!!t! utul' oroe6 dr Eelodctol!.a_tf tlltlrr !itr8!re1e larllsr rupgnlqr gt ol Lqfe!1o!, sr,q dobltdlt!ttt'! o!cet:tlsalea uaor plrt alc qoDllurll btrcelc, tlteciroq6r,ltluntlos, poat-alrurl, itc.

Ilataliettul Grio ch1!ur61cal. gr lreettreazE la r!!st. y6,rlats3f fueotr'. dr'oanrsa oare 1.-e plcdus. I!, atGctlu.oll coDtenltEloatrmtlc sr yl, etcctua i-o Jurul, Irl.rstcl d.. 1!-24 1ltnl.

Xn cele ctqtigate, btglrrntr& chl.lttrticall a..rciuca,ze Leal.tBi! d olrca ur! a! Aa la producalea clcet!12!.!11 Lu crces aaoelourllo! bulalr. Opcratta conett i.q !rectla tegleentulu1 s6uI oloatrlcel pLoE 1a dtlellsludlc gurll norrele. Uucoesa buoa1trart. apol t6rt!l-q*E aprr e:rtrligr 91 rutqretE La t.gr&eat.,

Firtul. cotllenltele a,1 fllrt,

IlEtr:le coErerltale a.L bu.!6Lol siat lE1for!:t1f colteq1teleorre ra iltlb.ero rcletlv !af. sfut sttqeia atlt pa burole auDeri_otr'c clt !1 pc oeLa LEflicar|, El re! pG bula Eupertoa,rdr ra,ltrlctelrt pc 6ea,. l-atedoed. D. cel &aL Eult. orl sllt douE fj.stu-l.t ra! voE tlltllll o atlglr.lE ftctull. S. produc prt-ntrso ltpsd dsooaLesceit[ tltre uugurele Dsd.r.qn

,1 rqsiul bazdl. fEcto!11 a!l-e-b&!g! Itllt leduDosclrtf, dar ccl, eleal{sr trcbul! luet tn coralde_trtf. qELb aoste flstdr Er plezllttE oe.uaa Eg'u let tFccveltdou!. dep!slud rltqat pa burel. lrlPclioeTr rau ,-uJ!1oar6 ter&l_Dotc X!tl*-q.!. tuld do sec tepatat cu epLt.1tE. O !ortle ,tlatiliroduaE cstlt&tlv tr pgata ertarlorlra. f3ttLc bu.s. aup!!r.os!6rcu tlrferlqrA (ccl t'at ad"6a) 1ee6 dr alollt.

Trat6&entU1 .sta chl.rur6to8:, -

6c GfeotEoazu dupf, ytr.dtt delr3 ra1 S1 cot1.stg l]a ar!tui!$er Lof tJr bLoo 91 rlfacGre. pladttcE

!tstul,e qo!,qe!lte]-c arlceurloq].s.!esLEi lls:.tomatll cere dlrl?C dtq prl!| laDtd br.!.hl"alt. sr

1/t

obserT! etrterlo! d9 itagur ac o ftstultr pt.la oelo !. a1rh{hl aseortte ft1e.utA, sl.teorl prFulrntl. I! JuluX ortflolulullos togunentele ot.rt oolgest!.rr. fraeotuL flstulo! a. drabLdcri. le n6l suLte orl tr oonductul auAlt lT, altool l dloLad spreuith:.d ldandlbulol gl re iadleapt' Bple Eastol.E. Trec l.,.altrtsq6au ltapoie tlerYuLul f4claL.

"acest !epo! tlotu1 bla6 curoscutslre a evXt& lerara 6a.

ilretsIoentul Et chlrurglosl" (ffE. Brgrl.O) tl o(}u.6*d ,Jx orr.

Frg.8.

tirpa,ree trqootului flDtd.e8 tgnte{6es,Ea dle ruredtoerels cFLtslt{t

-

6e Ye opera i! qfa'.a fenolenc_Lor l_dlanatofll &outo

-

se ve !ep!a' trasctul" f,lltul.o8pt1ll 1.!t!oduoor d9 3lbastlu {tatletdL o!

-

ac ?e dlls?qa tlreestu.l flrtrlosevladrFgc h TedcJlf sr.ltcr:6a lcrl_r11 &e!'r .rJ tasia:..

F1G.9.

Inoi!1a ?a porn!, Al! fata trag!:rului, degittdc spt3 t!:ahtulEh{tbul.1. El vr fl dlr1J.tl rpr6 lsstcldl.

kct rr!'aror traectulul sE flr cftrrerlt.

.YlhsCsrsg{9eg3-.sle_p-S.9! -

rrrr

I$

I

FlE. 10.

ractg?tsata ell'.ulc prla.panttdr aub for.rr6 da tuEsrte Da{torlq,-

_lr_

t!t!r ttr.ur tl ood.rulr b,trodl (tts. tl)o .locrt.I,

tlr. li.

rL&t nnLoc tau luLtltla, rllurta -l

' flcqvant plcru.lLoshJi. gilrt aoopauta l

al. tetullant! ['orrd,. !1 ru e ar o$il,-laGLEoE. gfut tr|lotl badtla. gr rr6ci-rz{ lmgor! ctl rrofostord.a. lrstasslltul6str qblrllgloal. sa a-ttrt t4rcqE't

:cr lruil aartllaalrar' dtf.l ,erta

" irlalt .

UtlgclgSgCjlg.lggjel - ItBt !aLte:..!ettl oorclttslo .1. t ,- ltalaa ruGuba, rasets n3of,o:rna?o, fdr! c lttuctutll histolotl"ol

aenrau (ffc. l2). 8o g!o!|c llub !r1 lulte fo!l!3 cltatoot

-

he!&lgisatr pxan situri la

ept6er& da::!; Bpit6 olt 1 er

o npat&o :!o!t6r YigLaoao ol.to

aqb pr.aLul16e {llltatE ilr etla

4at qufte !!{ d!5lt8,f,6 Ps t6!tt-

-

htlenglo6|r1 iunorsl, &pa]tt Ea o tunocGt8r dc dtEetts&nt YeFllsbllos de ta ul1 btb rtc grgnr puttait 6{ oirDttrd! 3 hctffqt6i s:r&nd!,E la elter!.or dar Ee ettlllita tlr prsfqld.lr. !u-ol' irsilf,loi {1'lenslurlle El ooloratle sub lroairusa tlfflti'lE Tr8'1! la'Dghlrtq

ala ueofetsst!.! tse pxesfiltg ca ullto {lqqEurtt vasorrla':ct f,firE ooat'"!tate' daJ: n&l1lenistt' tte veae ralolilo dr 14 porltlrlr betal!-

d,onu1ul;

[c68tuj' hen&lGle! efut fordatl dll! .ldotoltn folrt slbt!'rel 5aprezttrt! ce tltgts cavallo cF!6 oeaEdod tEt! el ss' tt aEdtat'-

4

r1;' l-2"unor eupual qa4resLll

t6

h uaul butete. lcst lrgtanglra eltc altte.ntr't da u.aulta rr'3r uJr, t

,-*-":"ffiT.sb!o''it- latrlnlt sl !l' rqr ls tetr, !r

|ade r.&toulitr oa,ra colrllr{oa fui.el, itrr looul. d, ullfq,stsplla s o*n.,. parp!,

.vrdsntr.;T:H. * ru ea"'l'!

toeato f,orto anetc[o_c:.i,nl'66 do bele&Arfirle *e iqtl.Lnegodivsr'6la rogr.ub.!. alo ,etalt Dteoepo, rcdutc f!.ntsJ.L, bur.,t1ulcr p$.tlCLr!, oto.

{b iu ! naro putd!.e dap'of,u!,r.n , ptu!,p!,e *** ff:: fn:T::j:::llctr|nlrar3 ctsarl.-srrroblaL ($l,td:oD Stu!3ersyebbr)prla ao'"ul!r'r' d tlp sprlepll'r 5r,auo6! ooe$rttal qr r ,a.reoraloflclentE d-nta16. D aEoterll, u|lo!rl, Bpale o ttloLbooltcplrdr( SllrdsrN trerrbccb-Iefr.t t ). lc saala ae oblkl c& t! .fetr orhsranglor cut&lat s6 detqn|tli, veLas,res, tloebocttelo$ SszI uneorl en honellgteeno:La heparr,c, 6ta. ETolutla 10! Epoata,alest Epfe srtiadr. ulc6ra!, 1r3rctare, elagenele ou a,oerEla.

fra,ts,Dentu: rt dlfe::ettl,at t-a fuEqtle da folsa oltu!,o!!

-

Ltr he8aaEloB&ete plare. fir!. tsd,!.!tE la extlsle, au !e f,eoentcl-ua tretanett oh&urteal g!.ss addto'.treers prsAaLso! ?kg"cotp/ st ttry de 15-aO ul:,e. Se !4! poet faoe orlcterqptE (p6dE qarbonLcl), srent;eNrte!&pte, l4J eotLr. sclerorsirtoi-

la heruingLaalBl,e tutlors1e ertdtipefe esto obLlgatolleirqfl treluie 6rttr?at fu tote].r.tats a,ltfl- sil'era!a ar: sete, hefiostes{ este &!eu de efactuei"

glrtula tetuEtrieror ln lFnangj.o;ele uq,;t lidlcd F:rob:,!Ne"EEts ara16 uE6o!l" r{ recurlFE le larBbou!:t pedloulate aal, cuEI l,E hers.ngtroanol ?e3lud! leza1c l..u qa!6 folqdr.n lsnbglr!!c]|late dl! !t*uteg front&l{ il, ia odl lralpbro].s Xa&bdu!{..err!t ouLars. c!et61 Ce ioG{ilErt libgr egFprset got fr. apl-icate

-1?ll.tra s.tnltrte bnllo.

. $ blatrtlraoel oycrlnesla tl o''l'rolalo ye tlebrll d lltr,tt-.l ltrtnf ore aJ'te!1c-teloar. !1. e:'ol rI o*lJtrlb trll!,r L|'.!!t ..

P.airn aoarta erta rerelt d! oala !al, @,lie t'l r! f,aoat

FaLllf e!'t!1otre.ftt, ilebolref,lr,. D61 trataeoatul rrt. oro-

,hr ru rcuulieto llt atreral buoer illtrrolll,ate ta {ltrrtala toFlllrto ..

!r.darrlgt!!1 ft?l -

E! futlJ.IlEao Gt ler oa hrantrlaaaela.

llff rffometfl 419 yasolo! llEtr&tlos. looliod rfu.t .otathta ot

lllla rtol s6Tor!o, oorqudela4 ',!trs

al,r. !r fatlr Ilrtrsral.8rrL.

lllrtlo. slrrt oroeptlcDal ila lar lailLJd.t. ollnl,el bod,tstl ts-

,a.llr[ oste dqfoEAtIi s@ Liilado ltocrmt la otratr bEta ,up6t1-atll, rubranitlbularr lal lat brrsa' Ld.rlosll' lg4tatlElr rrleoho.'

arl. [. sa tqflltreaz[ 0l fu tqrgoht. fotlrllelte]'e gq)talBoslta auttD.ot nollal qru sL!.t braucat6 {o olt6Ye capljlBra raotlllle. Lltdpiro plsrhtE r3lunl bdurcte' sltellild ou &?'iele dsltlsalbi-

la. r16rir,aa, lodutoloa6e. ?rzl.at6 patloado ils tlsefaotls lal so-

.antuail Eau ro[rEig. orettfea ts dt4eqstBl as deiotloetl rr!r,lntlaEatll a teautulul lllf.tla - l|rflaEBtts q1u.o.B[ ps oafa lldaFtlod pni! coEuaj,cetee ou Ya51 lLafot1oe df! JT.

llata&qntut erte shlfiSgl'ca.1. Sr Bfsotqcas5 6rt' eBetts&t'r

aensrelL fonstl ta 6x,tfiqpa!a teflitulur' lida.ltteEstas fu *oiau-

tate dt!.tr-oaEt$ eeu i.!. etepe, IlEhrio sg iu t'e;Is aerruf lao*fnoaoalnl Ltrt $teilon; s! Ltt&ilrrEe vas:Ii-f,&ola1o 6Pts ; fitto stncrI'rlls.

V1lxAcarr e6ta dtfloll,E; dureatd lu.d.t lldc!ea fuptoA16{olcetlizarea pr{*l. aslcoiul e6tet''o al f,t.tc! lo6t-rpeletQr erteDocLGat.

Petol orla oavltEtll buoqls!

l4aqroilod+a -

qobst{ la niillsr fu toEto dt!9!r!t'nn!lt launu&al p&ltLal a ttlblf. oeuil! oqro o ple4uc sfut dlvslroi o1

|l.1 flrorelt' ltofatloEu]. altf,ur! cqvpl1i6! delrlid'Bi t!4c!'t1orL'

rzg,. Lt. f&!1tc0.O altg cau.ll d Dqcro6losLe d1fusl ests

Flg. 15.

Llele ra ertrtodseell dr-! oaritstrr buoslt (ft. 1!), lLat r&lt. ln iu.rqrlt1llt e !I da[t& RsspirBtLe elta putln

ea, gfsctrl,adrFaa ps oqlc aerjll'.lla est d.tflc$E. De osl,o Dar, lute.1.tu!s!.tI! oopilul ou lta$rrr.te raulul' ou tetlaa Lu1t!. oar iJutS! ptd

tulit 1"l!ibtt. l{tr sts d dlBorxaLunl prea Eerl, &u plozLntf o

Iqrlzatle abund.Erlt{ subllntlreu oalo sg aJult$ oe l-Ela edevdlo,te llacufl.{ c1.!6eLd.

Itaolotloala ual poate fl tenqretl de olrlqte lJlt!&llrclraleadevdlat lrlcluzlL do eucaes!., hnaogtoaEg, flbroetls, cto.produc hlprtlof,tl pertLa]s s,l, Llnbu.

Tlatsuentul etrte cbtlultlsal gt ee efootuoaue 6u!g6ner&Lg, la ylrste d.lferite fu fuaotle d.c cs,ura o|,re a plodu!naorotlorla, de r{suntut alleentqr, resplrlrtor, eattlo, rtc.

5L co.!'EtE lu nozootla cr.lllfornl e pgftli &lts!1oar6 ri,bll (fts. 14 91 15). Sc va f,eq o benostazi rlErrro&rl atlt Ds

lel !l rear!,g lublllrt,t,l olgt ps eraouLatsla Ea,u !.ssutuLlldaae tedairs ertll?et.

x'ls. 14. FtS. 15.iB f6"rdelo d,e eacroBtosi peltl&3,I &oeests va fl qrtlrpeti.

sutrura cl.o! d,oul tre,rye al pldgtl odgtr&igrll s9 poet f,aoo ouoatgut otroEat eau oblgauJ,t, Dr. 2_3 e,Flicat p6 Euroulatlrd

,1 cug:t$6 d$ etd fts.E pe srcog' a busali aeu subtlllgua.l.lix poGt-opeleto! epars ed.e!!ul l,rJqtril oa,rq dlsper.e d.,nDg

-dou.6 sElrtEilr'ii aa,lqorl eat6 ngyole aS reourgqn la trehgoEtonl.spErlfau tul,bu!&rl do rerpt!ot!.. Al.1b6a1stle poaiq f,l pera4torq,ll

-19

b Drhrle all!, apol l!.ohl.d{ tr.4 ds ?-8 rll.o.Cblst fiuootds gls plaruulul bEosl (0loaortllat+a!. RaIt la)ge tatiLlralo :relNtIT rar. 8o aatorasE rrno! tlolqrtL rlo rpt-

tallulsl aLaad,l llrbltlotuala l[ tubFuooarE lper s. i@!*ta sbt r-llor rubllnlnal.r Osoblet de e pert. a fr64q1u1 Untlial. .l,ltoonl,rlrt blletsle.1e. 8fu* At d,lasrslnni, rrlabr,Lo. Lo palDsJs. sgr! {o-,r.!lbILo, e1q6t1sr, nsdursroaso. Pr1! Dalll.roa :,ar t1 a lr,sbL{,rllld3nd e'ga|lecsl|c lr3e61uas, !!r-n ca.nel|r]' ltr' grrta ss al1ar,a!a i.dreti,s ansoss&, ytEaossg; mrdard llraorl aoEate follatt nlIr.rnofe'],E oh{ct1qe se. pot sysena gponta.nr d.a! se rufac. Pr taotlElaun ohlEi osi forest {s o l!eebra.e.[ flbroei6 le ortat:lor! lar i!,lntorler 66ts tel}ot*i its ut opltslta iis ttp eebltofa!, {lspu! dts-oontl|tuu ps &e![bt&aa ItbroaEl. ooltt!.lutql aEesttll c!1st erte rt$-006, gal-ben ssu bllmi ieaFazl Ia doglatttt' f.or.4tlor 3tq. ?ot fl

oolfi:rd.et oir Llda,ngtoe$g de ba![ {.8 llstE' cbtsts dorrlotilor fl-bto&mer sto.

Itasrt tuldorsta loate llraaerta sfiud,tt itivo*louu. gulrsAd{bEIdrL {,rr $ara o.*nrml.o& prta pasaj d dt'ieiasfiqbl :refase. eL$stcXorubre"ndf,bulars Ar,eeoiaag qc{ohtl spErta{ oa g[Go:|cto obtst{q6 slrb-''

-16

b&n [fbuXe!,tq!q!ig4'alu4 6to otl5rr!g{o&-l'. 5o e?Ec*qea!6 sub efiest 6te go?

. ,

!!ral& u I.0.n. ss sxllr?{ gel r!el' adasar ehlatutr wqeld !a tollsF.:

lr.iei" se tqBe bbEeldz! statttt 8{ 4rqt! re}nrx slrbrtrwuel.. stre

-24Fo!:!ole cllrtlca a"1s tlsuflolentBl re6ptreto!11 Bi.nt

Ie: A La for:tre utoe.r, le fo!.&e

;ltaYe Ger d.etBIDllS ooq.rt6c

lul lledj,at d.rqrd aegtstc'

i Dl! pulot de vedsr. gl$lg-oopl].ulare udtoatoc lafntttqrer stl ou grl.la

r1r. 16.LatriloEchLe5, lla,Iraubula ertc dusl Lra-.p.1,, Eo.htonul qtelr, p:laqr!.l }lroal plas

tnllt diuoatr regplr[ lnsur cstc Gl,agotlo' iltptr61o; pollpltalc,ats:nul sr rtlactd tl1 lrsptr. ceasa losEtl ,'lEuflolente leFPtlaF

torll, se 6atola0t. Casoptos.l l! oldta5tlao t' .| p&tDndr'J"!' lltlt"b41 ln tlEula pal!,t{n!. Ia fcllr,l apsta, lli;uadta aelE]'ut i!cEiutq rolp1lat.rtt st. bloostl.

Copllul ss eltleltaul ;teu, ttebulc culoat tt patte-a allsaptl

ti t!ss! oaadlbule balllta. tG trtrele' vB fl gaYel gl alireaiet.' Ptrtra a roEplla ea1 uto!, nou ngacutul. Ya f,l culcai ventre'l.

Ir fol!le ds LuteB.tltate lsdle, oopllul Ya fl ptotetrt rsDl

lator ou oa&uls tlp latc' Guedeil' eto.' ctl aetstull oetaltcE Ia

a., da t &lllntoraleel e agool&t5, se sfecttras.l t$abeosttltq toaselt!c.6yqn1.|1tul coaat[ la ootstltullee ulst' s!rlota tt$sl1o nWI'd"qarlulr:la.

Gu aosat r'r$rtr!t1 terepeuttoc ss al! poslDilltetee enalibu-1!1 s& so itettoltar l!.!ba sr atltrtorlzeral' EarSltLlo flturti pe-

l-att-Df, ts oDtoplat lcspr.satt a so tlburltlteelG.

Le ristror.a, tll3ajllr1 v8 !t operat. 9e cf,ectues&I &o!{ ttpull d6aprfatLt !

-

oS6n*tt ld Dorali.r oela qoertl fu su&!8 f,eial' lltedca! e

llrldi ic ptirrllor brrodr'allpl:oa ta prealat!'! ara eldat !-lrptafe '

;tWpdlrriibr

-

qpcrdiitr lnt DilhaDl caf' qolst! ttr driattodsa*a 118b11 qu

rJ$*{|:,u} & Airql l1tef il tlte! trecute prlti b&ze ll.'bllt apol prtll3!oa!16- ob"eJi-lsr !l lnaodsto pe bollrdolait-rirll lEedlat lD'&lnter '

hroalrr

laarto fbe sG oxtraa ilup8 dos8 lutr!., ttry Ln sarc lt srlro-

l|lrl !a lare perte stuldtoEul dG bruflolnt[ re!pl,!eto!t. pllnaatrattue! uand.lbdel' letrtLart1 1!.ab!1 la potltl! a!t!rleB!I.

[.nlqaoqg]ql !! solla br.fld.a -

lLqt ua1f,or!8lu oclts!,ltala

lla oavraxulul 91 6 t!y611!ur11ot sal,e. Cauaa oarc La plealuor alta

alaullrqqtI. ,loaul ile spalltt! estr ctpltost prt! d,stlit*,il, E. la

lal"oltalea..ebftolotloE aolttali. La dftl|fltu]. qelrl dc I iou.llptlrllrl de ylatl cEbltotlsrAr 1a eh]r1o[u]. otr trGl lt:tatErl, tlbffta blaeto])or lpr potul'atrterlor al eoblt olutul' .dtodtalul t.{e3rorqe fornfud placa nerralS. lcee6ta sr al.lrolt{ tr- ta +!4n|-tarrd htT-tr.a tub l.acellld ou regiuioa iloisall sDre Po1ul antrll-

a! tl anbrlgtuLu!, 1oo utlde to Yot fo?ua vesloulefg cra.qLsno ilL!

aat. ra 1ue llagttc cteelu.].. ltltlDs, Pelte ce do v* tubu.l'ttr, tra!|trretndrFlr ljr oaaal !ura1 Ya fl !31!r!ea oocolgl'an!. voliblrlsaraaoLnd. Eat lultr lubul 4eura1 ooocttlirt ve rEnfue Xa atrchl- lui

Lt-!a lr sr Ya terdaa cu tt1!n oen{rlt'cgroonltent cu pnocasBl Ag laturare a p1lstt B'ural! tr'6cAqF

rul oautE sI il.lbraoe'acegt e-Dr,l reulsl.

Fectorl Ealf,otfdstlvl eeculosoull ploAr& trlddts futt5l'll

ln natureree ettt a tubufut sul3elt aoetta dnlaian fu fat! {i3

DlrcI !e!ra:.[ ce fu splta biflda, sau tulbulliil i! il"Toltaroeo!lrsru.].u.l

-

Elqr9ac?alle, sau 'lsr'oltarl.

chlstlo fu gubttrtrtr

aarobrall' hlaboeefn1lo.

loats &ceatel as lraduc ol''lio plllr 11p9e ds drrroltero pal-

Ita!,' aoa?ulsll' st!&bfsr' ato.

o llpsd 46 natularo' l&obl.drc

ta dstrllrld Epqrltls lqenlltooelulul'

Dl! pu[ct de Yder E aioa]-prtolot{ot loe6isl pet flt

-

fggS4Foq.ilC - trullort e6tr for&et{ at! ior{rent' Laptit'dlre

l1 llobfd c.fa1olr6]rl- dtran;

?r

e plbetgt vsrtabro ocLlloo

-

I1elo!!dlrssel _ p Xt!r6 teauturll! rlesortsc Erl ,ru

llE a6sla.tl aub6trJ!.t8 aelroagl fE I oslttll reryerl, ,orn&tEmrlt AlJr aubstal1t{. ali.all,l-

saotaloolstqocl _ tuaore e6ie foriDqt! dt!. tolut eoreblel

oentrEl clruie eo g{aeqle u! o,b:tat ee eo,ltfu.o Llohl'da!.

sod.lu]. aoeato! tueorf, poet fl! oel !!al ,rocve!, Cafl:olttr-aeza.1E. [!rEo!a erto foleetg aujl teEraat, do N,spcq,ll.!8q.1, l,s, perlfenta aooparl,t d.o feetite ru]'tL perf; sp!! slarrEtaf,rlleatul este otoatllolal s8u foalt !ubtt!., blds{et a. vror .eal3htae.

CXail orlflctnl ai!.t!r .aselc lreE8IE ,'. ,rd,lt._artltaro asti

foelts !!r.t, se oiaqrr8. ontr tu!rq,:a,a st3 puLgat:ill. I! qoaastl

c{.1-t r,!e tra.ra lad6p&rtee&X Al"qbll oodq,!:i (f,lA. 1?); &cortr.r

Dlrtttcrtloul ittlralt1a1 alt tIoEt otr oh1.t. a..rEold! srtr

l.E rntlos&s, llpoartr ftbr.qEr ato.

[f3!gggg!}} Bq.6tor DAllofioetll est6 pEr oblru!8loa1, {a'r(lf,arsatXet fu luqgtlr d6 looe11rare. dL!Leea turg!l!, troslDsrt a3u[entrl.1ul., Eallorrlatl!!. eroor,etor .o!:Fioare leu a],c aj,tor apa-!.to o8le pot sau !u fl oqtpatlblle ou yr.ata, sau La u!ta!t! La

c.! de ruptu.ll e tagu!6nto1ot. Do o:841l1t-gt!9993!g]-999!gL!gl

Doct6 11 opcrat dln pr1&61r tlLE dupE a.egiere aleoaloce ollftclul,

olos occlpltql oate foBts !tls. Opolati4 cotlltI ll1 lnclrla oLrog-

trr! B toSrloert.lolt, lltatrra t!e&sf1r1r,!ta 6 lptoristdlgaL.! gi

.oopllree cu porlost tl apol ou teg1rrnolt. c oflfta! lul ooollltal.

urnllltooelelc latraparloiale ftlrrd. d9 41asnt1u.E1 elcl ql con-

tuqdcbll! ou ohlstel,r d,ellolilr pot fl trtryqllsato 11 ops:ratlB !s

.taotut t[ a @l !rr!.UtrllroogLoL. !q!g!1Jelg 6e oporae!6 dsoblosl dupl vb6ta do

ls-24 1ud. Rszlatenta ooptlulul esto dal !ler6; abeaaLurse orlfl-

olulu!. csoa at loduc rpoltqar hldlloctaUE post-opcreto! 6t p!o-

auoa 81 !ar.

Iritrventi,8 16 face p g{.Ls cxoetanl4d lL.3Bdooledaai"?e oale g419gf ttqr.l prholPall' rtlt t 1lcllLa clrcuL4-

r! rau fu I a tgr&entolor t! Jur1if. ooletll1ul tudorll3 disctla

trgunoltuLuL twrcrll, d lptouedlac; dlBoctl'a Leptotenl'ltsl'd de

oriflclul o!oa; l,t gatula lptonEllJltelEl; vldenllelea ort'floLu-

lu.i. osos prltl doole!a d.urel sater alo tatloataalr1

DaoI ollflolu1 troltoBatal 6sts ou Al6!ir:uX sub I c!' orlfL-

clu1 t1 4oope!14 prt& tabEialee di! osuf,. frotltel a urlul fralaeltt

itt! pellcst pe ca.e-L sutur5l la t'sutu1 tlblos 'tt!

Juttrt oese-

tor DetaL?. I)aoN orl'fielul sttg El !la:6, ra tlgbul rI-1 obturEt

ou tFelo! ocag troolttt ilr.8 creasia lliaqlt llttodut ltrttre aure

lrtsf &l @4,

r&. aapoat obllc adasa eo!8Etrld,i 3rlstlebatr@tLi de oa!q:-o Ls,ct t loqraBt1a.aa,srls ti!'t dctqrs&tc. I!t9rna, d1r,6!sa!e sll,d"ca! de Lr tueolrt o&rg .f.a. ttlphtorelrl a,1o oealor aesa.le. erirlall]'ctls oessf"e qa!al"!, f,lotrtalor crbltarg au

-qr'.!r|n'' .i,l-f.*tt acsst6q, yg! alstslntuacoadultr tslspb!'t lcl.Itr.1?.

O al,tl loss1tlelo "ata

cce aoolpltau. _ tnuqls 6sie 4s,rc,p.!!lt6 lau lltl ae Ded (f&. If). Ortftc'll"l eatc 11.6. cortlautuL

osta pu! Ltchldl.an (llcht"aIlts [irtt &f lar.jat-fr-1tE. t qogLLslrlX!laisryslr16tr1c sLai srt!lr C, re!a. fnlolaott d.a lrolu! de, dr nillhsa U!6i cfu'ere.lleate eolte lroqlltocIo au ocat sa r.auc .mt !(1]t 8&u lal trr4ir,a uEptLa l}re!1rll3e Aj.#.!s.l"S, de:r sf, rqfeo f,s8,rrts

24

Xn poat_opefato! Ta ttebul. sA oo[tbete lafeottB p!l_Bineres, de antlbtotrce c&r sg stl:Ebetg r*"r""" O"r"i"l*I"r* r.- grllg_llglggag jSIg jg - nEarlga eprnlrtt ar obscryl l.! lr-.|Ular loEbo-oaclatt ca o nlal!;r loelor aplatlt4t! ou usul t8u doulatlllof t prlJ' cero se eltdl-ql lB ertello! Ucbl{ cetal'o:la}liu |rtI t iadt.r i , laieral ae af l ! ut l pltel lu rubtlro, Dal fs o-tarlorr rt l t

l l iofurent acopetl t d6 pel l t cloatr lcl cheLold'er ! tc. Ertra lo!| ! !

aar llal gr4vd l.E care lntlltdto patsllst'!. 116 ldenrbrsLor lltotlotrat

l'loontlnEjd de &aterll fece]"e, urhlr plclqale strtrbc aeurg1931-

trr vurua -equl!, tsl-]'aft' eto. tsoolel3es ou alt aaLfot.Ilrtll

l t ta freeveatl .

pe&tolllad., a,EplcllLn6, cloftrtibuie sx repied.icdq

".u**t"ot"

Beutlrlolng' otc.

rreser, d. ,o.dro' 20_30 *;:ffX'euLul colebre] prrr

coepl.tcetll tlr poat_opefetor l.nedls,te gl terd,tvar 6deEulbrel, ooalrulBl1, abcs qefbte1, ealll.agoeaoefallte, erc.Reuultetul, poet-operato" este !4 furctle d.e Loqaltzarc,laa$r,i cran!.ette asoclate, al.i E,lforx0&tlt vlscarEl, oto"lea occlpltal.{ are rrl p:,ognoatl.c tlel butr. Lesr.rrllll odoef,a,lloet

rnLofoof,all, chlst:.e htracngatlqul.

ucefallot hldfooef,s'l^let llltunec!

Decesele p:roparetorir, r15 tr. seche'ele rrri sre' u"

t;::;:'""*"!tr' as olf!6e&! le 10-

, op8l.atl& p ce1 e.o'do crald.&nd re fectue&d d.e

!e co4st& irl t!re, l& telaple osuLui froats,L cu rabeterq, Lu:Lr{ar,

vlde[tleree ollfictului flodto-Dazal i ll,getu:e ,L seoooLtuLu:L i obtul*ree orlf lcluLuL r**._"_*

-"iX;; ;iI;

-

Lejo6 plgtettcd. g6fecerr.lptanurlLor. lulqora exterloerE Ital.S va fl operetl ultrlo!.

b.- spl l l4 bt f fdq aco!er l tddou.aeDttel lu l r t

d.rvoltalea &idEveL 68te loal"laturan slr oonstltu1lra rraul Jah*xJ

rrrrrro-i. 3u1bur6r11e neutale slrt Eal lredubEt copll!' prez1lrtA EltoE'

iJ ,10 anoliiuCl4 redusx a1c D6rnb!1cr lafrloa!" exlrte l|tooutl-

[ . a, i i de url l l { 91 Ecteri l fecalQ' lot l l , - tat aa ' t1- lotr lol taica !eD-

lrr lor lBferlo4re egto rcdug6.

c.- l,lenLBfo.lul dorso-1onbalr tumolotl h re8luna lonbo-sr-

i ,rr l . I eete neaoopcl l t i de tegunell t de eapect ao!roa] ' t cu blpertrtoo'

r l l , clsetl lci , etc. conti .4e LLcbld cefalorehlAleE Dule !aic! te

(,rrrcsie la !.1ve1u1 oanalulul neu!41. Tueo):a esi fomatd d1!: teE1r'

||lolr1, ieltouenl-age, 1lcbld ceta!-otebidisn' Clbic' loilLltatea oelF

t,rnlar l&fel l .DAle este pletratE. Co'ct l i ienta de urtnd gl Eatf, i i

I icF.l oeas6::1

:[ aelill1gooeiele leaooprlie clr teEuneilte de aEpoot aotea] t

ou hlpeftricc,git cu ctcntlici, aa! ca?e rlu 4senlrttd cu rup tuta

teguxeniuluLr lntelvenli4 c!'irl:rgicald ae va efecNu& lr1 Jurxl vir6'

tet d d.oi ed, clad lcade !o!lt poeibllltstea lor-m5rli ht'ilacefe-

1lei .

I! nij-.i!,,4oce1efe irirxoralet l&tereentla chld'61ca1E Eq Po&te

cfrctua ia o virei l ql- f lal na-re sl codstE t! ert l t?area tuaotl t

'l"rlcnat+esen 1r8{r'":reni:!:' Fpinelct bifide ou t-JXbql"ltl d6 8otiLlir-

tc, cel l t : , .de:t!e ste ccl lgefvatof i pansame|lt ' steri la' &nttbtot lcd'

Co.trvul"si.l1, dssvoltaree pstho_hotorle, coleota.fsa aspectuLostetlo, sfut plobleEe de rezolvat t! tle.

Spha-blf,lda -

t]teeenal S! vorbllee cu.re!t5 bl-fidttatee arou_rllo! Tert6br,&l cu ebeerta apof,Lzelor spr.lroaEo. ,o ,u*na*iu ,*i_fonostla eate eul.t let eoDplerE! este yolbe de o LtpEE dea eld,uvel spl.EErtl La cqle s &d.au5 rlouaiLfe8 &{cu.rllo! Trtebr&_1er l1psl d,c nerodrnlsq,1.a & pE!tr1o! idot.

Cauzele cele pfoduc a,csrsttrt ,,rortrar h4tt

"""r*0, '*oott*n

nal fof,oette lnt noo'eoacute;

tal. ;ofl ca la to&te u41for&atMe cong6ql'

.aspoctela eli..s.l.o lntSl,att si4t r

!!.ets,uentul, fa qptaa br.f,idE ou prozenta un6l uotlutEtltbontc pelttlu eate:lll fsca,le E1 urlal (ecospreblle) se tqoEtol! Ee Olrcu4srsr'ls nlezluAet rn. Se fu.tloduce lJl oenslul nalu]'e!

L" ''{l - t r tt r lN-+-{

sevrotlo: secfo-l qnbefl. loesrea, go

Flf .20" Fts. 21.

d.6ut. U.leos,z5 r antu.la te!u!6.[tele,re (Fu. 1.9,20,2r.22).

autu.reezl dula

dl! lasaautrrleazl pest st!*ta.l !!o

Fxs'i

pu sau fdr.5 l&qtutt d.e aegala- I:

II.. }TTOIoEIA B3GrurII CFNYTCAISBgto Joarte verlef,{. O perte d1'1 afetlnlrt

c orCeD.r.tah, altele dlrt Aob$rd.lto.gee Do.l Bla p&!te d.r.ir, afecttu41le EaLfollietl?E slnt Dalf,or!

Eatlt drLiats d.b d.eEyolte.na petoXoglcEta alqurj.l,or g1 gaatut:1-1sr br.a,lr.lr,le, altla dla deroltElrea chlstlc$ a ya,seLEr llEfau.ce,d"yolters tunors'ltr e t&ntrlodror libtretlot, tr&u.datr6lre ar.eEutchlrrlrrl' aiarit1o-e1e1A!_lrastoldten, degeaeleac ents ohlsiicE etlG!.ful tllolla, 6trvolta!. ta!D!a1{ c lbilauLu!, etc.

I'ts. 19.

nplaoa tru.feLln gl

rpol, p!lat!.-o lnat_rlo dlsptuuhtul eleso c!au I laEboud

BLat Ealforaa i1l

@'xf"*ie#*W(+@

Ir patologia re3lulll crvlcaLo llrolud.lt

l.- ghlBie ti tl!ti|l! 41. l1dsl neillono!-

chlste epid.motilc aubEerLl4!.

-

chlsts d.e sa|rel tlteoSloa-

ft8iulo guprtlotale qorltostsllAl

2.- ghlet gl f15tu1o a1e rGludt' latoro-co:rvlgaLt -

vcttl'-

lll a16 fanielo! tl arcurllor bla!}l.qlo. IB acelta tnolu{Qrt

-

obl'ste btlhlels

-

fl8tu]c b|'aliiAle.3.- Ltderyr.onlrl cbtstlo e1 realunll cetrloa16'

4.- [ortlooltsul.5.

-

ldeoopatllle tulorels-Lstleratoril - routr'

-

crDlo

-

t{tlofqleChl.ste sl ftstul eplttere''cs ale tlllsl ledletr!

I[ reGiunea cervLcalEr o91 !a!' eAeaee sub!lltod! tt' gupla-

hlold,la! ae obaervl trlcX tuqolele - ctt o cllsetl - lotnndt' sE

togu.dentele sup"BLacente ile ce19 !a'1 8u1te gr! ila aspeot !o:!oA"l'

Acestea stnt qbl,Ete epldeitaglile datorete Etro! 18j1uul'' totgdeml-

oe. UDeorl acste truoret oresc lrt Yolulqt dBt' tiu depalosc At!ltsl

rnea de 3/) cn !e palpale EtBt reldtBdt' fu uneeatll ELtollrtlt

d.e d.e61utltl. ClEd se tnfoteazg' ttulleltele sltPraladents 5!'!t

oolgegtlYe. Uaeorl pot ftstlrllta' Ss oo!f,ulitI e'lese ou olLatslc

nucol.de tl caEBl tlregglos'

trateroontul eEte cblrurgioa"l' Ss extttlpi Prlntn-o lact'!'''

ovqlardr ttatrgve!6e1[ cera clrcuEsorlo chlEtul' OrebuLq cttl'r?atl

troiroaEe'l chlstutul h totatliett altfsl' iecldl?eaal'

Chistel &ucolde ttleo-htotillctlg - se lor3eatl pdE letotolt

tla celslul'd ti!o-8loat s&u a uaet poltlutd d1I slt oe! u|lgtgl

ln cee de-e dou8 sgpie,ll|la da Yts't6 aabrlolarl tota'ne! qocou!

(bszs thibit ) cu GIBlila tlrolde degolBrA tB leGlu!a titolillaat'. / ,

-2aSe Eai .ouDeEie gl qaaatul lul. Bochdetek.at ce1 u&t edeeee lrapole gsu]'ul hlold,tlsce prtIl osuL htptd..

-?q

ln post-operetgt.

ln feaelsl evolutla 6ste buld, fErI ooEpllcetll roEplrctolil'

tvr apare ?lecYent daox r5dg1!l ca!4lulu! t1!eo61o! !u lllrt

lltlrpat6.

118tu1e supelf tc1l16 .Danto-ste!!a1e - slat flo oo!3en1tsl'

l l [ dobiDdlt. se t l i i1re6c !6fat iv t&! ' Ce]e coqgsnltalo r ' d!t-

lalt[ d1a teoutut sltuat titre -tteeltatca antsrlogrd a 4lculul

| (utur) br;.blql' 9L !glu.lrog plecorilla]E' cel' dobtldtts plovla

alr dtyelss ,.!c1u!11 otoderelo' su sau f,CrI fornalic do obl6ta ca-

ta ao f16tu11teaz6. lu tleeqt rcurt 1-l't5 oui aint o4!b lltglllt

tltu4tc pe 1t!14 sodlan6 d 1a Bertoa la stelB' uneorl o}rle! Ga

llol d,epr8lunl" tggoeltere. Sc 8socla!& trocYnt ou llbloohondloe'

ta.

Tratasentul 6te chLrurglcal tl con8tt t! srtilparea 1of,

[!tntr-o lticlrle oY8]"6r8 t!a&5aer5el6'

Cbiste e! fiEtul 1gl!erqqe4&14! - a$bole derlvb a''a & do-

u{ fBr:.t} sau 8a!t btaD}llef,' ChlEtu1 branbLal eets situet de le u!-

aLlul !nalbulel ptnx deaeupra fu.rculltei stertlaLe' X! partea Eu-

potloerEt ee af16 eub dE9oh1u1 atelno-clldodBstoldle[ gl dhLer

hapola ss'. Alrele oa o iumoreiE de dtuen61rrld vartaltlt ou teEu-

nsntelesup?alacentedeaepectaorea' l " . I .aps. lparee6t6lgt toE' !

alurloe6i.. Se poate coufulda ugor cu l1Bfaiglgtrul obl6tlc' tereto-

nulXetero-oersl-c4lrd&!e'cestaareport tuBl iLLet lce' i l ie l!41

lbdurale; cu dupltoatlt farbGtelet cu sdenopetlX tutlgtals' Gtc'

1!1 ca.zul. il1 cate exedenu]- ou-trlc Et' oele paracllnlog tu elucl'deate

dtagnostlculr s leorllgs 1a punctta-blopsie'

Aceeat8 tusoretg chtstl.cd poet fl l-ooella&tl oflrrlas aE-+uE-

St1 rarglrxfl altertoa:le a nugchl'ulul Etertro-clldoaa6tEldlan pltd '

La futcuftta Eiern8'16. Ijl 1osel"1z5!11e luterloalc' {Llgstlqul

dlfelentlal sG poate tacF 1 cli Ae6eEere6cetrta cblgilcE ds alerrdI

tt foicet hlPeltrof, l l 'Le de ttnuF' betnoltda!loeEer 9tc'

Ace8t csltal Ee ef l5pqftea c4t!a1dr

9f14&.' se obeefv5 o turgtlrd eEfteee uler [ucr.,

"rr*oot"*t

de dtuensiu[l Yerleblle' ledeItd pe Lr-nla eed.lat]d a gitu].ul', sub .osd. h{o1d. geguee[te].e EuplBlace.nte, Wor detl-aae, oq coJ.o.r,atllxolneld. Le palpa.fe eat6

Lestic5, fLuctueotd, led.urroasb.. clnds supraln-f,ecteezd, f,lstullztchtd, qucord, f i ls[t. se ooou.,

u"u' la ertgrlo! ae evacqlazE ur ]1rltute f, lstute de csr1al t lreogLoE.slcoafirldqt edesoa cu ehl.steLe

rtmfan&ioa'e, ed.enoa&e, ,roo* u"t f,lstulele epldelooide' rarorl

ne, f lbloarae. In Dod ercepti.naL, s:cazuri de6cllse 1! lltereturisponren au se vrrdeci ***;::

cale epa'e dese.elescentE

*t*g*l eBte chLrurgioeL rl corat5 i[ exttrlalee la b].ocq chi6tuLu{, f1stut61

t aosulul hiold. Se efectueazlLe o!1co vlfat{, dar deoblceldupi 2-3 ent (t le. 23).

I! &are, tlrllli opere,tollslnt! hcizle ovalerE, tr.as_velaalE i"a regiuaea oer?ical5.Se t.t lciaeazl ptelea, foscia

r t8.23.o-hl^{dr6F{

cervlcaL{ euperf ictal i ' mrgclsat elao-hXolditll gl tlreo_hlr.ur. h1ord. !,. se t:!.ao !lo,.ea,, :'::':' ;:t::".'.:: :X.":JXJ:"cu ne,lbrelle tbo-h!.oldtanE,auechri Elriohrordred Er

""J:#;:j'j:":lT"Tj:ff:?osu1 hloLd. Se leuod parteedo ra,t rel. ra oez cE," ,J;::'l;:::"::t:"'n"":;::ba.bt1s, se ra sutura bregE. !sr6 de {io!{t ce eaesteziq ge.neleLd sEila ou lntubet! olotlsJreeL[.f1 suturat{ cu fi'. releBorbe,}

uusculsiufe sui:6 g!" su}hloLdiaaE r'tL. se dreaeeEi, deoarece sgngeres6*.

30tl

.to6sie chlrta s pot tJrrgcta. glero fu dt!!!tdd. !tf!le suple-lacelte Bs ootlstlo|leazg ,1 cllltul As?!nr.dtu.r.o!

ten gl 1a pal,psite. U!.erl abcedaz! 91 ae tler3for,In! tq ftrtnt4.Ch16te1e lE*ero-oorvioale, dert?et d1ll af dotlea galrt bre,bl4!deobtcel prezlatE dtcful Ia dt1ut1t16 91 sfurt ad.!eat! dr ooraurnale Sl Dlc al oaul.ul hlqtd.

Shgurul t!'s,taaellt e6te cel chlrrlrgj.cal ,1 oo!.st!. i.[ Grtrr?o,..

rea lorletlu.Ell tueolel, chlstlqe. In sazul h oare chlstqL gEteiafectet 8l dlsectla este dtftcl ld, | le put6D Ltl lta la o stelllaclzle a chlstulul, urnatE d.s eyacuaree pu:rolulnl. &t-!pa.!eatlaoctu].ul flstutos ae vq lace u].ted.o!.

grcepttorlal d. ler sllt descllse oaznrl dG Ear!upr.al.1r,:.o aturofti ohlatlce.

Illstule lq,telo-oerelcale sLqt fut EaJorttatea cezurll.o, da o!1rgiaE ooruenltalE, f1l-ad lretull a1e celel de a doua ,a!t (!e.at)bralh1al. Se tEeesc pe rE'lgt]lea antertoa,lE a EtornoolldoEastoldla_!ru.lul., ls t!& tfel dtfelite.

pqt fl f,istule coeplete 91 coEulxlcE cu,er1EGLe la tll.y.lulf,osetol lul. Rose!-allller sltuatE !,e peleile postero_supllor aJ.ferfurgelul. fa cazul acesta leptefe llgelat E6 poate eLlEi.aa !.ncantl.tate ELcE plln flstu]d. lltqli, tlaectuL llstdoa au coauDl'_El cu extellorul sau !u cotru.llc5 cu ferhtele. !e

rtrlo. s! !vq_cuhzd o 6ecretle aelo-ltucoa.aE gqu ![uco-purlrleatE.

I! eazul- fu care gc l_dfcteerE apare Jel.E dureloasa 1at&_cerclcer'dr te8!.eebtele p!1ftsturoaso afut coltestly. ofr.rlclulerterto? al tlalerrtuLul flstuLoa 6e prezl+tE cE

,o Elcg depreEiu.ae1e erte!.tor, plin c&! sc vacueaza sec:letllle algscllae t0a1 aus.Se pot erldell la d1-! pll lele zlle d.upI leFtre, alteorl Dal t i!_ztu. I-o t 1.!pu: deglutltl.1 aa obselr[ Dobl]ig6!1 eLc orlf,lorrdul.],q p&l-Fare, de ls orLflci!f,, Grtortr dg-aJ.u!6rr. ba!.al-ELl ertenle estef,no*leLdo*eEiatoldlaaulnt ae peLpoezl v! rcatrdol!, rolatjy d.u?,

lgart tlaaol tlttnlca alta talatlv .1!.r9.' arr oclari.u-

t!,brG6a ou oora!.l Ela fl .lc 11 orulul hto14, tr.ca pr1.ut!!

Aod osrottal. .Ju,qfbal rau rlt pfu[ la tos.tr Roocallllllr d,lDt|!lrr..

laeltc t1atu1. llJrt ull !|n U!lg!gIgL!:' cl&Gtrlce lcu aalDG-htor. Crltlistoa d. rror!!1! cG s. 3aaculat[ prl.D trsoctPl tlstu-lar. da oal. El lultr orl a!t. r.Curl.

Dlaltoltlcu1 iutgrcltlll t1 puten taca ua.oll cu tlstu.lelc

tart !upu.!atl1 o!ot{,o! .ls rc3ltrlll coFLoalc 1et9!a1. (lBCrctc.)trs r vl!.dr!I dolodatl !po!iaa. lratalqltul e6t oblrutllcal

l!. ooalil h trtlrparcr cit D1 co41tl . tracctulul fr.stulo8.

loarlta sc lsel1rlatI fur EalG slttrlt sr PrectlcE o pr1!! fuclzle

?Lt. 21.

orela![r tlat1gtela4lEt ct!cru,6cr11Ddtlalectul f lstdoe (ft .24 91 25).Se

dlseoi d1! aproape i!! aproap6 ttaec-

tul t1ste1o8 pfuE se ovldelll.rll eel

dou.l carotlda pllattc cate dluaulee-

ts spra farllEo. 8fctulrn q Cloor' ln-

oltlc le !a lst de degot sub ulabiuf

Ds.Edlbulclr tot trs-as?6r9al' r de 2-3

o!.; p!r-o 'aceaatd 1ltcl.l erterlorl-

!E! tlasctul flltu1os dlsecqt .!te!l-

or. 11 trectlotrh 91-1 lltaiulxt! cit

G1 a. p:.oapa dc fe'rLbte. fu a! leculo

ltotodet! le rdrtutlar64 ln fa!Lqae '

tlaeotuluL flstulos t1 116a-

tura 61 ls ao6t ttlTalr.rpol' ltzegtl' a&

tru a,! sbsorYat ltclodatt !*l't'''ta trasctulu.'' gtul.oE' vir8ta

oportuli pentru operalle e!t! 2dl ad'

rtdfeErloellelo ghletiqg--9-9Ig!9g19, 8fut o4lf ortalil conterl te'

1., con8t$8d lllt!-@ dlBllazJ'c chLs*tcu 4 vaselot lt'lfatLo 6'1e fe-

Jlurtl setf,lca]. 5s &ltsloac !t!q Lrrti$ dg L8 !6J!!.61ont3e 61 l!c]*sd'

-''.-q''..4r.

-32Se obsered ttloe d,a La na6te!e, slnt sltuat

snbl8gdlbulsr. SgBt .do

veriabllo. ?s,! uultocula!,reellt4te al.trt sultr,loddrlle. yle lLdetlcc d.Lq realu!.eevE s$rt loplegeatcte dccblstloo, avtaa lc 1rt6r1o! uDtel,l,lr Ds a cInrl auplatdll sG orE &d,e6qa cepllerc rqatll,ae oepot lrp fu Lnterlorul trr!,ofllcL16tloo ltlfslgless,toase tltL E prod,ucc !.oEouEfangt

ertorlgrul aceatlrl etd.otetlu orlst{ o sof!.dsnla}E d.a iosuttll'. f|t latrt olu1 rcesto! dltatatli ohlatloo as l5sert6 u.4a!o-olt!!r., beEattc, brun, Terzu!., ets. Dln too l.to. lod a,ceEreLetelu ohlrtlce atut spteto pertlal de r oordqgn f,lbro8ss. Io_trs d.fplaztlle chl8tLcc tlefatlse ss &6seac 3s!a11od Lldrattqtqrpect loflral. tcegtla ilau senzetla, La pelpere de rj't1du.re!11"tlate l.[tr tuDolj.le cbl.6tlcc. ttrd.rLua 6ceatq! t.,iot

""t" o""f"-

bl]'I (fts. ?6 aL 27). dr 1e dlEellstuooa, qnel nuol, Ls, dl&en8tut,Eqaatruoaao, oouphd intrage tliuaeaupra-olsvlsular!, pdtruad l-a eedlo-sth. LqflltleaEl beza l,tnut,:tE tnahlre, sEgf,agd, etc.

Di! pu4ctr d,e ved.e! sllnladgt tulol'l d.e dlEenslutll va,rlibtlc

t .3.4 regluDea orlrlcal{. Si.!t ud. saueul.tlloou.1are,

-Au pertoad,a d.e sta&naretl eftele Ae cregtele ]rap!.d5. .lcee,stLclgta!. este provocati de o tdla,!a-lls o, &Gesto! l.tdandto6, !!featl?

-33v.[lta prfr lnflamallB vsslor llDtetlqr qu struotu.rl norndl;

cervLcelE ca].e s-4u Lotctat, vala oqlajdT\..

( /! ::'\ coraudlcE ou osv!.i6tl1s ohi.stlor.i -i.'*

'. i legu.oelrtlr supla-r.sont6 uloonl

.f_ .ll -' sint !or!tel' cl!.d llE analoatela chlstl.

/ , - L ce 6L4t t0tc1, eau gi]!t subtletcr tredspel i l\ , i-, rot, se gbservi leteaua veaculerl rrF

-) ,"' r /'tl : ,

-

:,- .4 ,1 perf1c1.aL{ clrd llds,n3toe,lele 8t!t B-,1 . :L f

r i !I' I F{^ r,a palpale acest tuoorl silt qlag-k-l { . . \ " '!18.27. tlce, fluctuenie, lealuleloesgr urllot sau

l ,of l01ate. 9rebu1 cercatatd cu ateni le ertbderea lar la l tgludlo

t nveclnete. Trebulesc ef ectuqte lsalogralllr toEotrEfllt E8a11aat1-

no8copi& la leeole, petltvu a gtl AacB se grtl!*l sau Dlr ia Eedlq!-

ttn. ll.teo"l. pe 6ub clqvicul'l se prelulgeEc ta 8x115, cavltatea

lleuralit etc. Baza llrabelr cavitatee htoeldr fa!a, 8i!t looultl do

aleotlo efe locallzirlL l ltafang !.oEqt oss e.

loate aceste l"osa]r.zErl trebuLeEo birta Svaluate pslttu 'e 1ua

o etltud.lde telepeuttcd adecvat5. De cele lal oll-l.te o!1 idelanJa-

ldn doar prl! aspoctul egtetle. 8aleotL ploduc tulbulErl ile lsspL-

r8lie, deglutltle. ltEfangioaoele Eari care Je!,eat[ rspll'atla'

do8lutllia lot fl operate dllr prleele zlle dnp5 trrttere, p!ott'-

tlnd d.e rezistelrla !1ou a6scutulul.. I! ltEfalrSlos'Eele doi, opera-

tla poate fl tenpo!1zat6. Ss pat coDfrude cu telatoane sfrloalct

hona4gloarne. Le tlrEte lsl usjFl '

coafuala ss face olr llPoalaot iu-

morl chistlce de arc b!anhl'e1, d.egererescote obl6tlce il5 tladl'

tholde ectopice, ad.e&opatlt tullofat, tu6o!1 berlljl tt rr1lc!

de 1an! le'pati c cervlc4L.

r lcale slnt:

-

isctztl]e sA fie efeotuatg tltalsver6al - t! etuf 1u!t ql tulto-

r l lor ( f t8. 28);

-

s5 evidentleh de ie i-oceput vase16 !1e!1! Jugd&ra' cerotlder. / .

r lc .25.

l1$" ?6.

-

BI au lez6! rorylr.r larelpe clt poslbrl Ed rfe!r.!,, orrt*lout*'

sub.andlbuf i!ul' fa.ca foIllauu[o v,soulorletvoasE d

ou rlr'r ltt oortrota latlnrt

rlc. ea.

t{ de le looul etru;-

sE |lu ettkp!.u ,! totau

t!t!-ua tl@ 1,l!trarti oelrel coltou.Dacrlu tfabeea, poat6edseu]' glotlo,-

la cezut olad rthde!r

tloaoelor !6 faoo la nodtestlE,4r11tr, bari thb,!t, lnqlrlLls sI.tle edegyete peltri,u fieqaf s:.t let

-

ooitt de.!d! d:retleJu1 oblltatordetoritE l.letofael abtndertei

-

errblh{atter.ee de e4tlblot loe sd fts reBul{,-

t!tsz.r6!tMo ltelatlva ilrqtrofl. !gcesg!.

I cazulLre eu rtorg'' &argt

ldepop-ettlte acute oervical -siEt tlflalletlt aLe ga'!llolri_ro.r cl'iceli s1tuatl. sirhaq,j

---v'4 qd Ei&!rt (

totdtanr -+-

.-

t lbu1ar, carotldieaL, palotLdtett,toidl.nlr etc. rpoEl4ao 4" o1 ---r r/*'s'r'qr-oajl

oere a l!f,ecttllo! slllt cerii.leta!,e, plEgtle dtur !"gLunee f,e0118, ptelse cepulut, etc,loate .oegte lD-f,ctr.1 !

olt atafiLococul. ttot bile aectqdzeta'

'qgeatul petotea

lottolo elatouo-olr.[tqe a16 aoeEton lrfeotlj, sfutl]l P** - tn eceste tu'.enatu siat lnreresardtvergc t"ree dG gertllod c 1 ---i-* e:{! .lltreresateioa1L. DeobLoel genauolul t!f,ectst

::"T'-:::: ":t. @i Darle' csl.dla Ju! sil1t &al edcr aa vorru; exl.atE rrrr prolea llrtas d.e pelledellti.

d.evh

tLa lurot d9 vedele cllalc, epar sta:.oa febriLE, !ll.!,iFteqooptluLnl, uoeo!1 sl-trdlo! alapsptlri la legiunea ceJ|eloe,lI eper.. / ,

-.",,'***okFI''.--"ilFry!l,,

tuDiecfl!. L. pa:.pard sr ivld.qtlasi uaul leu nt nrlti $atlt-anl d.o dlunslutrl dltrl.to. d.lr!l, dulortotl, leuoblu!|btll Da DIl-tul suple tl rubls.o.nt. fsSuaetrtLe supraleo|ntr ooqtrstlva, d&ldu.tr loqslI oregsutl.

b) ldnofl(laoalsl ! Lltotlt dllu3o a16 ,61ual1o! arlrvlorla.nht !rfl-6riet1 atlt ga.nGllo.all clt 9t lesutullh tLB Ju.tr. Dtnlunct d vd6!e c1hlo bopltu.]' este !tat, tebrll, prLrrlra t!.urllnB-rtallar va.r'aE, ere uaorl d.1s.r9. lltcorll Btalga torlc{ ortrtoorte acooltrratEt apatlo, oolll lroloEtlatl, subf.bftl , vlt,eltu-t l fravdl l ta, oto.

YoE g6sl dltersa locallsE l de ad,eaoflsGDoaser subalaulo-En-dtbulers, lat gro-oefylcal-e, edoaofleBloru]' t udrlg (subtlqnd,lbulsr,tlotmoaul tLeldaos" ) of,u1tta corylcall. Irt toate, sq obrr7d o iu-.ofoc!1s locald, co satte isglt!nte1or, cll.dule IooB).& oleaout!,r.nslbl l l tato le palpsla (Biare d6 agltatte La copoul nlo). !ceu-t!f,lle nol, idlltlst, ltxdulat l,a bceput, epol fluotuelte. Ded!u se LBterrLas eu trEta&e[t

t1elglo teEla1 gl looat, Frogrrostl-oul rd-rqlae lrylcvtElbll i!a,l cu sa!5 l]! f,tegnoaul Lud,rtt, fl.sg4o-nul lernlos tl oeluJ.lta necrozantd

-

irontrozd soptr,cE e vaeelor eulr.outaaate. Septlcedl le, aepticoploeai l le, !ec!oza16 teg!,uenta.reIocalg 6fu.t oo!ryllcatllle 06].6 r03t f!crette.

frqtaneltul est loceL tl telrrleL. Csi laoa,l. ootst! b lrtafuz5, ta aplloe! d.e coq)r66o !se1 Looala gu dlTelrso solutill t&!rlvaool. Ce]. Eeneral se adlesez6 austitrelll 6tlr1l teretal prtuiporfuzl"!. cu gl.ucozi 1O F, a&1.!oaclrt, llptde+ etc. petxtro ooplllDdcl cu alrdroa.me d.lgpeptloe, conbat!e arxe&ier., troEboottoletrl-

11, tc. Se ednillstres,zi Bedicetl 5! geleral tlEtlte pe staftlo:

ooc (0!ac11hd 100 og,/k8r.corp, certadotuE 2-t W./gE./sL, t'l\aonlclD 2c Ea./Lg. corp/zLt etc.).

IE faae]e do colectalG se fsc t lclz1l transrlBeLel ou erecll4lIoo pulolu1u1.

F E! l!t[l tfstaEe!.tulu1 conpl- ss rugegte de oele eel nul,tetll Jr{tularea procesulul fuf,ectlos.

TortlcollguL nuscr]la-! c6$ice1 _ ssta o afec!lu.r1 a regluar.ic lttoaLs ca,ract6rkst! prrlr letoro_doy1olee extteqlt&tl!, qef sl 1cCauzel.e oar produo acBat{ afes!1uae slat Eultlpls. VoI! deacrr.s

ausel, &ta zlsuL torti.ooLls eucula! ,oongenttalr. Este glegtt d(,"-luolt eEtfel, deoarece eate dete ntnat csL E&1 flocvnt ale cauretrauuatlse ale lu8chtulul ste rno-ql. eldoDeBtoldlen ll EAt pntr! decauze coutenLtale.

6a ro! fac !.ac1r11 eulttpte!,!f,leEator peatru a eyLta dlfuziun.la.

ertroBitxtll oetallocr (lo blpettrg?le | !mtfataL latDta

Fls.29.

tlTel aceaeiE se datoleet! utral blFclrlarF1,, !11 prqvocaiG prln 6t5nJoal:rse otroutathl

trl agd. toecenlo prb Latroaiyla!r rsu p!1,!vasoconsirLctle. coluq1 priylt. sFrc paa-

tea opua5 Lgulurll. Dl8terla dbirc nastol-d.5 gl clavtoule so leAuca. Ls t,lcrca;erde e-laslg g capu}:l, stelaFolgt d,o-tlegtql-dlanul sc evldenttezE oa o sostd[. lparaBcolLoze orlcau, c&r 16 hceDEtr alis

dq cauzE ruaoul.aitEr ,.ar !&!. tXrgr,t rs poqte p6lDanltlta prlJr agitl-

llqEii de foljd a vrteblolor. se poaie solfqrlila' cu tolit'aolltdf,! poste 7C_@ % dt, oazull .epqre tn itt[pul nagtrllot petylner bqzl-ne dlFtoclca, p!:h trectlunl

.fcctuate Fc copl1. uugchlulgtefilo-clelCor8stoldts! se iupei aFs.re rlll bellatoE :.rx ,nierl orul

tecll ldusouLalci acegt heruatoo 6e pqlpeazi ca o ro:lvdn d ealLnt?af1sl,1le 5.! utltjtoa!.ele ztle dupd. nastere; helaaiol'lrl ae lezoarbeijt.ta kvazLe sa cu fibroblagtl., DlrSchlu.t Etruoeleldo4EFtoldlaq seacurtesz& pft/1 fibrozare, se traasforud 1!tf_o coer.d& d.r:rE. acle,rgaa6. trcast ploce de tlatrsf,arnH."l ar.e Lqc fu 3_6 1u!.1.

lral l.&r 6e iatl.lleac tortlcoLlBurl ldu6culalE congeult6,le dato.rare rl!o! dtsplazj.t muscu]&fe _ hlpopLezLt nuEoul,are oslgenltaL

"1,4 acegtl cop!{ factoruL trautiatlc eet6 exc1u6 deoarece e_!, obe!-wat tortloolls 1a nou aEscull1, prlE cezalianai fu acelesl ,Lnp !.use paLpea6! r'ollya tu&ora1El ta rrugcidu]. ste"nocleiaomsstotdts,a.lD tot*Lcol, lsuL Ftrau.!!a.. l c" d1s pu.Eo1, de vedele cl l . ic, pir i l l l1obserA l-E reptdaialle cele u.!|!qaz& aasterj.lr latero_d.etrl,ere6,arulIrL, oorloo!.j"tent pot palpa o11r6-turqr.&1g 1! !iugclj-u:, ste'rrocl.eldo-Eaatol.dlen. leJi attrplltuli{ttea h1+cdrl1o! rf,lu.all" celvicel,e Es_"ec,t icdulE.

:E L{ail !!. c]111 c8,t 6 ul:ElezE .l1&q.!e:.j-l apar seEael, E! aic_o (atu{*o d.c laterod.v!! 8 oapdul {rf t . A9, 3Q)r do 1t4t!e;. 6

@ @e(l'iT fi''r* fti)d cause @!!ggr apl&tfu urda alTerslo! qodtE ltalc D{:rtlLot ro! alc rccl-u!1l, gqrirtoeLc reu a1c pir-

tllor osoaEc ou sau fIlSflacturl et Altetralot

ngltl ootqpsE6frta a1c !etl-&,1,1 oe!T1s613. ErFraenlrl

Ftg.30.

qLr.lio gl ladlografto preolzeez{ dtagaostlalrl'.ltliudtlea d tolttcolig d .ggglEllggglggA eoltt!, oliorl'e

speclfloe tl lespeclfloe tltebul luat8 t-a ools!.delare la puaorea

d,iaanostLoulutr 996 ;41 grgcveat$ lnfleoaltQ a regt dl os!"loalcesie ega uisuf. g!gb!gJ35!S! cauzat do ttfleaBtta artlcui stll.lot!

ELci ele vertebrelor ocll.rlcaf.e' AeeEte4 6t!t produss ia ulra !,let

aalgdaleotonlt' tltf,latlett!' aLe slststlu]"ul iluetto oorrloelt eto.foatloollquf d,e oPuzo t$slfotoatlYe osoq6?! 1!d!|o81]! FllDDGl-'

=tr'etl ca.na.cterl.zet pllta Dalfolsetit osoeso tsltelref r co!8enltaL,'

eEte relettT u8or d.e dlrlosilcet ds'torltE cateoiereloir sllrlqe t1

r:edlologle e cartct grlstlcQ ! re6lr1nsa aerYls&l[ n Edurt[{ r" !{Ltciri"l

? /-\

'a'i

3E .-

?oqtl .colLsul do cauz clcat!1cteleEelfof,loeti!. cloalc (,fBC, 6tc. )

folt ic01l6 de oeuze distrof io. osoasar (tu&orl q-{r { lslopla_htaia n-- . . - {

- - - r

rox, chlste

.nevrigmeLe, etc.)t qsDeotr. l ^.1{n.^ ^a , .-

-**-

I aspeqtul cLtrlc, Bl lor egtq oareo_

aa laoosar !a!!Lo!11 tl

ahlturllo&1.

blat&oertul ah$uttioal j:lrilt t! teaotollr tas|ltt:llot E " .rrre a1s nulchlulul atrEeckldolatioldla! ilc p! ste:E 4,"1:.:"t"

far-li?tufut gl nrtohlul ouoh1c1i118!. orloc llltlrvttttlr t.aootplo'

tl va glota r'.olitlvli It pott-opo!8tsr udl euto:rt' t'ooBoal 1t!o-

Lll1tar64 ta aperat Shlpsat tlp Ul!e'rI' r'ltlt ![. I! oetal tn or-

!. trtr &obl-l1sfu 1r cParat thlpret t dtodftl" alaJrrl' alenGalit-

l. rG tor leloa lroooca llr pthele 7-A !t'l'o' lperatsl i&t'P6at !r

oi' do tlobtllzare ta fl lcnttlut 3o slle, apol so !a sooatt fi !l

ooatland or1 f1!1ota!apr'!.

clr cit ooptl'ul ost nal !!a'!r' ou ettt ni illt1ot1l Ts' f,t 5,!l.

torrenlla. looasta va souol,t4 tglptoda bLp6Larl s !8u{oiielsl

. t rao c11alotralt o 1dlea.

I! ceu dt !eo!a1!l' oopllu'l te t! !e4''!at '

iler !l1 sl acf! -

no ae ia. a.!. It3trttl a aa ilcteoei gti"rotlrtr e!4totdou rs8la!r1i'

tru eren 6tpe!1ntt t! sXulatrsa tEltaollllhL 6tq$loclelito lsttg

lar.qe, opcletLc Pe oelre tt rl.1 rutort' o PtaatiqI.'

clr, lL Prroloct DI TRIGIULAT

+e!!111 et orertletl+ i-t:aflarDsttct

Ptt|l Lenta 4lsflagaatlo& l-ot'lGe! p!tru$l'!a vltotte-

10! ebao!!filglg t-! oaYltataa toraotoE losEata so prg&rot Ptt! 9rl-'

ftot!- sau lBpiud dlEfr.'afstLor. otljlallle dtatratlatlei ttlrt fu"

totaeeula, co4scltlte |r!& opllnl 1! d'rroltar! r itlaflqg8lrlul'sl.at !iauor'!atLt, eg!eltials' Elrll.l1e Alef,leglatloe tEi:Fatloo

Fs btllaesc tef l-e ooP,.l gl leaul-tI dLa asoeallole$a tlsoerglof

ebdlld.lle1q prLtl eoslo solutl'1 d! oonti$dtais 'lc

itlrltatttElrt '

79

ccarollitdrll r.|ullrtrrls,tr tlei8$Jrtulul

el.o ld!!i.lo! !!ott llr ta pXug ar reotlo$eezl p1"1:"o1' t"ooJ:j:I191-j-:ttp:go'91luloole,{ Ill pLag[; adsrea .st. roors$ gd obslffi! plrqletul a3tour

terizat pr:l-n dur,6rl de l_[tenrpectul !&dio1o81o

-

geod.{ jltat. nloc' tl,ulta,'g do n{!q4r'l; Eg-

vertebFel, fari ertensle ," "tt""o***u

t& furte!1orul oortlcalol

sa n o!r.e.'tqze dleg.osttcu'. obrel supfe E1 Eubtaonte * pot

lurolu .a spontan6 se ca.rqoterl!o&za prX! htpetlqft eoc6.atus._td s homifetel lespectl.ve" coaldi ftbloasd qor$X i!rtllgtbi1a q

et eraoci eidoFgst oiAle.rrului, D6dif j"c fu i osteoertlcuLas yF!s}.rale!Trate'ent.l trebde f,cut re tiup c5c1 r.rluolr.o. devx$ def,lq{.ttvor lreverEibLle.kgjahe4bl est cqnselv8to! La, copr.lul picE f.a 3_4,a,ar 4{

-cblllu.raicaL epol. l,s eulaar se vor f,acs &asejo, el.oagatil e].e !6gl,u-nl-t oervlceLo, dlylse ape!&te ortopedlca ds fedreeer. a cE'pu-lu,.(DaterieL slnttlc, cauolucr a5sulete ou .!l'alp arezate l.t]. groepeaulraoigvicrfl arx). loato aoesi! ro,,rere d.6 htenertate

"".1:: ::tr}::':::"::t ::Hi:T"r.!ut61oa1 ya !zolya e!otilrrles.l;***19,!*!1=gggp6rtru l]ltEfrel1tta ohiruglogl{ ate rrll.ata 4e(-lj"$ tfustE 14.oero ta post-opelqtor so loata coop!& o$ oopi.*Lul, pi?l'tru & a6 ofaotu& l,s oa.blJretgL! d CpX p.!oogd,a6:.41 .larapolrti_

reptrt trsllEvelral a'nte.llor coloe4le 6au stllplt lul Uskor. Dln tt otJ.ftstJ. borli4Le.

apd.!ut6 l.! ul:ra ra6! ooaiuzl,r. abdolllalo Bau pll3lLo ou lat

re aq,rea illaflagtsuLu1.Pltl|u a lltelogo let blae

ree!l-!.tl! p6 sourt aobrloLogle fernirlt d.lefraeulul 9i a !a1ftlllor asoar.et6.

sepqrd ga,vitata qelo&!.og fur oavlteta abdon{nqt & gi torBelce.aodtsat, d1lr pa:rtsa doLseld gt eed!.eud se ileevolti ave[sbd.

fuzlrtlea oaeEtqr f,on[atlud ae f,orlesaE dtaflsCFul. O llpse d.eyoltsr' a aoesto! folrdat1llld yq itte!..elBe apa"lti& u!o! eplazllh|'td.taflq4t!, oltf,icl1 lal sa,rl, seu EaL Dtol, aoolrsjilt aau !E

voltenaa aq::EBl{ a pErtllor oolpo!6l1te ele dj&fra8llrdql'r Daed fBolluL ueuo:ost!.v s, ectlonat iaellti d.e luta e irela do yLatd,

D:1u1. Vlacrelo ae vo:r. gdei eso6lrslolate l,u tsrace leaoopelrteaao plgutopelttonea,l 91 es Duneso gBbrtoaqle. De obloet la aoestocazl|tl trtl..].rtu olllLcil toafi. dlefragaetlse sltuete Dostels-el lel cu gqaoa ln stfua, aulit o!:l"f,tcij. el lui !oohd.rla*,lulale autorulu1 oBre a ile!c:.16 !.a LE4E qnbrlo1oglq, dtafrqSraul.rlj..

41

rare' b1papL&uto6. loeei tlp ds bar416 se &r:!e8ts

oonEtart tl4lurlzarger doatoltelsa hqlildtaff, aaiqtrrrtr' stial

tlrzlu dclt o1 4lre!t' dscaee gl &r8lLle dleftog[etl'

trecverrto pa parlee Eitnedr ?9-85 S 8{u arrlj3{"

1!r lrj"rte& E-'rt erioa.r& r re*ro6tordsl s*S'&i gt dr8p!

!11 con!9enttl}Xe gt ertf:let:-le hlatq8Elilt asof,agl'a4o oave

x,!$ig o !.ipoplasi-e e eLellesteLor oEnsiltl1tiv ale oljl-

,{ofaglelr *1- prtu3 oL a poate so&stit${ s hefllf'e hlatsl;t'

crllJ ris.l" .lufta 01L* d64voLt;iriLt ll3eoryf'ete 6' dfefcagaulu1 t

tei irl ,lquE carrrli sto$eoui' e"l' organul he"$tatt t&!:

40

Elef!&glruL ge f,orEeaza S.noepLnd. ou eEptdntaa a E_a d.o vletE llrolul 4aftegqlslqrerrt^ hery|la estQ ra'rai fte&tuL futr bu-eabltqaar8 Db. ps,rte8, anterloB|lE e eabrloqulul polaerto spr roopr: trlf,lolr!1, dtaf,se,grnajte gI vlsesrol"e ss s3g&J oaod'

t;n to):aslox llat putls, 5e tlal pot tattrns or-lJtpMg-&t!lo:t u! 6ept tfa,IayerEal -

Feptn]. t:taasrrEal al lu1 El,a! * aexg

aeroaaa pl!.r:o-pelltolteel{. lceste grOe varlete de f,orroe rr:6 9L wleli d.e I'cqlsse & rdezenterulrd {ee|aerxtgPtl s6au&}

-patqlogLoe d.e uslfotqatll d.e d.Ls,fra,aoulul 6i.at strlns legate al . (to rlJJlaon st9-q{1 gi lti'pdpl'asle ds vontfl'r L stfs#" gxl4tE

Eatreltul f.a gers faotoruL ua,lfoirlatlT.e doter&laat oprlrea ia burdrl ie pre6Lu$e Lu cl-l:a1l14'ils e!te3'"6-vengaBg*pu1u5&e':ea!

rtructurlj. elroruale s vaEelo? sargbl'ne(hi''ex'b::4ft d psLd

'l o r or!d.ny. cr gf trsa pre*ilna-l:t s,1'terL

"42;

Iec$eic-gtsI3e!*sci$lsg&. ou ne.ntredr&r,ol-& n&Vtefe r. prefl llrts ulr0Etoa.}eB sl!rytoEet oLogl. e ! aouct-e,not!s, diapletc, po:,LFleto, af6bxll. f,a exasenuite$poctl

-

aceeir& este elieeveto Sxsnf4tnd heRf,torecl6o6n|]riqt.dre ,ndrl.nea fl& tF, r1ljnel'sl-ixl1'i l,{, IJ4;r"outr6* seson6 tiB b:adg*l5'.he a.l_tornfnd nu. hlFsrdot1oritats; La qussulffGtlgul, veal"*u1e.l, 6ste sbs6n*N as fiud r&otcote lddroriarrco"ea,rd{acE o 65otn ttr Lalrlt$racelg ,!"pt

l. feirogtern&lic&rall-&c Lo petr{topr[ th &co6&$]r. rogluao

Sr[Eriieoul f6]illologda erc!,b&. erlsteata r.mor leal".all.9il rree.i,"te,*e:r +oR"6Ici+H o*f.e4;{, e,era..re redusd aq oa.[,Ltats&l-4" li,r{,s}:t i,r$} {}bseyT6 {i:lseqltL]xurtEtl r aontu.t uS6tga$.

Ia e&r!inr,S. f,o&"tq r.8.re aa iagcurga le ,.rr6qgrlli.f,3s, do' .S,,&llx ,oo olttua' Lrronf l_stnt{s tespl,!&1io!i

F!l.o dl8t ensLel)&?1.u.

:Ir fr:.rirlBts !g&3dg1g ri.r&tonato].6gr& eatE! qat putljr&a s,cDantrl'"ltdu-sFr cE rlc4zL$ unor lnf,egtr-L lrfjll1opE:l$orxef,e soa" d.e aitx,aagdBroo In &ceE* saE a,p&f Rur*,j, vLL l,e bar,tIvl Etll' vlfu$atu"tt. sj"&trtor ale se ,i,ed,r.oree,6g ?r.lb. ale&arepg?,l tJ.,s do F{}ooot, ds pu$cgi,. Reeliogf&fta puf,iuo]l'erg y a*f6ta1!a u$or' ;1jae,eitxrt htd.roc"ej:r,ee l,& !.tyotu.L csvltdtt{ *ef,&qtce

Sa produc k!I!:L dLaq!rr-rg!l!* Frdxlr Aq_e]rpt_ej" {ia,r D4,Lt ri&i r"e.re" I& cLlEl"ce l]oEsln$. }a uaL2O. hes&tl rusf,re]satlad ati.ngt s_aq tntiinit lg hof,alLoa &repta Lu ul,ttn.il ZO d s.ai. O:Lf,lolul lssi'e ep,{ si6, pr:Ln

ffi;Jro*r (r'*"vl !! ilreptq (uessFn " gt'at bet

;-"" ";"

bltrlar' sLs eecsagloleazs ".t Y,:-frti:of *rn"fot, l! f,uno!1s dq E[rl8ea

orlflotulnto I 6a-

.u no.tn 56et xobulatlag hep&ixc' oolo!fl1'ltlgsrtt$'l5ub!&

o p4rts ilrn sio@o'

-tanatolosla sst !Da! sult ceu @t pstte ssssEt@t&

iEs fuBl

Iilil;.nl]li'"t sl ile sreaur il coq)rogt3 'mrpa'a aodutrnl'

o"r- sr """"tt

borall ss pot 6trlatrssla' U'" *:Tt T-: -

;;t:- ;, d'e'copst!-r68 aostor b$11 osto tgtiq:.Etoalre'

.-;* "-t"o

raaloloslo' a1t6or1 ptoilllo **t:t11 :i::;;;rn"*, stare il6 agltetts

le Dnlar 5$r' iiutred lo'q'

;;;,t; EE'! aarr l"n eprgsetru' n'*"'111: il- ". ""-

,"i1""*-""n""u," X i.[":"::r:#i::"fil; ;Eo peEts gee oErdlaea

(l!1 gagl

;;;-;** (tu eqz as Latostltr' oolon' ctorao)'

lot ladv1d9d. iaf , raa8laiar lst5l l .eved!.gj lb '1t1t ' .q l ! |roroete plelEopelltoaedls

ee'ts trbulo "t

t:1::8:":-Hroroete plssvv-----

rpie ,,u 6a Bnoiuoa o qsgodrrn*-

.

operttoBea'l * *::" :::-:;. servr.oa.l. rrrrst o u'c*larsnorrueldr foreat5 dtrt etotgs[o , . .- ^---art. rt ltp:-:'"1;;;:";;;t

pf,Elua'l' abdo'tn.l' e'68outr rr rtF

de rezrstentA a illaflas&llxrd ta eceEi *t::

:::::*:.":J:li ;":::::i

-'I"ll-**t""*t coq)r314 pu1loorurul' aosdrtr

"

I"*" + aPerE eiuetooetol:::;:"J::ilt:":ffi:J:Ir1 f,ata, uauL

gopll ou f,enonetre 'lq

trlaurreresvo

lva tretul sd fecotr diaetr-ogtloSUqg!94!4.su3

-

boalE nsq-ofbel6rltellro _ / ^-?{,.m tolel ooagsrt-'

. loalforDatltls colgenl'ialn llllEolsro

(rf,lte!| -*

:::

, Aisplazle poLlchisttoS pul!o!a![' ohl'sts asltos

btoalioe adn'

-

se lrroan$ !?ls or,'-

a.rl8aJeaz$ l..n to!&ce q.1 8a1 freovent flaa.tu:l, {:e_r eol.$lrirl ]. ;.;"";;;" pur'norers ar ,.orr decnt'lur'

glept o8ret ol ogte f,espketqrie ste &a1.. rdus5, Oescoperir:lLe

lsr. 6fuit ljrtluplgtog,r rl.t ocasta uBut en urrl rsrd{.61-rgic certlazI 6 opao{tEts In cq?ltste{, toraclcs d.reap*}i eau L!,aq].l!.s

te19, 6obsttetie Pltlloaard)arrl,e$.

i. l

ge coltfefudlc! ,atrod.ucefee

- -

-"v*sqee:r u &edLu

ru rrps'aera tubuL d,tgEttT. :or:1 andor,4usle cu orlgn

'.ttx!4 r&1tt1etr& pu].[oaulur Te f! ourcat pe p.trta au h

FAira _-_._r-_ opue. {e va tatlqduce o son,tetl6 Sastrlod p.rttru e

vac -

*"''v(.ucc a aolr(ad"r.oisrra qrrtrbrorroe

";;*:t:'*t*

sBstrr.o sl ,eerur.

v! coloote ac'doua, ros'lrleti a plered laf,ecttlle purno,'

!&r, sro. ," ," ""r.rlr]1"

'r''e ed'dat'tllad biosrbola,t d,Fr !rd{ca+r- 6^

-

veld peatrro atl&entatle palltt !dtqatle. se Te add.rdar re palet

qd*'or ds pnearr,"a *roro-""

tsle'ouJr ptot"o "oo*oteo"e,

?e f,i addatstrat *

"ooo.ortt*udg

tntri-puleq.[Er1E. lola.zeide eodlrrcsr.' ,*,**r"1"111::.::.1-' p/ke.1oe sr or* il-!suf1cle!t! o""p1o*toot"li

pleeludl art.rlo-vaoase asocjrG, l.lter.vatla ohi?qr.losr!

p!lber'. 16-44 o!o r!. fornele topelaliq

""

,a "r""** nts

.'a telrp'tlza.

r.r .'r.l!!. oLrru:::r ae oolJ

"t3*@ seu toleci.g.

rferd oalee bdo&Lra"l E O";;

t""trylgl ot cbLrui.gloaL. Irtelvlgte de uroon. petrt?B fo?lele BqpraFacute Fregurune luarsa

-

Eltrilr,o&ul rlurqyaEcuLa! dfu-

sref,'ro o oa I i1e r..*"**"-j,JiTitil:]:_ :&rolutlg Fpo&tang ta br -- q'e ,l,]u-!6scutulste E],r eftrt,.Er tn o"r" nor"*tt"

dtef,reehatLog f,orue,brqnlotlurrlo*afe.

rel-eter 6e produc frecneat-;

_ eunoagtejlee cqao}1ire,sr.a Poa sd fl es1 eere u, ajTt

P02 tt lcoe !a s14ge., deror.n rar,6e no"rr*r'

* aL ?coz sub 40 sttntr.e-puleorano.

o! veEcular ellterlale gd

.

?tqg la ef,LaFea aeeFtoEvntlrator Eecalulc, o"o

"

rro*o"t, aou aEEcutur ve fl

sG colf,rar.,rr ^r ,-, puit tn lncubeto! ln &edru

, l*ru." cotrgerutale clq.rogDe,

ta Dau.A6saEtulut.-

atnezla de osofeg!-47

l.- ltr'trtcltctt tl ollar t.loltl arcntual,al. Eltoloatlt

ilgestlr aaootat, tat la E'ola orrartl 6oatrrt!1 obj'nl!-rl.c pelet.lut atE6dr hr1' dllb3tet, i|l qez {o 6al.ltsto

do!"pgtrurAr:rer la qart tai6a sbilod!81!' p!!.! orltlolr|l ill'-Ea lrlttodqos o sotitd XdLato! ln torece petru cgelt's''se

lpol ae lcduo au bltli3ta rlsorla l.a oavltetes

'sg fl! aitrtl oI |lu rupeu eDl'r.!a ll tlalf,ornettlfc e8o-oare p r lrr partcol Tlatq to! tl rezolrats ta acelql tllp

t1t ate ibro&s!, 1nt6stllr, 6tc.). orttlctu:l 'tlafranatlcsu !1ro la!sorbsbllo trogutt 1o |rgr p!'! Drgl.trlle

Unoorl. loster!.ot fl l6t6!e1r.s' !6segto grsu brrrelt-

d,lafragEetlo. It! caz ala abseltu (loarl l9r)I re to|r tlecat.b Jutrrl u|r6! cosair. g. d,ssor,[ oatqt''

'ls Plqsttl ds AIE-

ou Ia&bou !!sau].ar pdloBlat 'tb

natel'e dolsel' s61r su lolti

lstrld tlntrtto.

trn ar at.qtuat roe'tta plastit ' Dlea'b s16tolrtto gavttgtoa

lltlL oo&tra!.!A!'ag itrolato.]t. iL tsaEa belonltLl !ilissi!-

In post-spqrator ToD lerrttae aou l6soutra ! vetttJ'1e!t'' Deoa-

D!t!u a bbuaEtdtt raatlletta pul4uoaer 24-4a otc tl qhl.8t

rsuli. !a !3tot q !a Ya trc3 pe !ltra.3l ecrtlaqqr"loraal! de

pltru oorootaroo aoltliit'L

Ilgrlir.tlls 14 llost-operato! sr tor fa'oo orr eseaAt atetl!1e

!l t! PDalPelrt.t?rogaqsttoa]. YltBl ap''niir fa fflr8f a' DlforlatlLls eEoola'

pldJtrolare, set'dt aee tt potiallttates 'l'

collEtaro e ao'dbssL

a lealftloulrttor itr plresfiae Jrtedo'4noet! xtrap|rl8olarl'

ttalltetee egtr 5l Jut d! 5O-?5 f 9lotrar to:|!61J trat"

h braL4. altattqglAt! ot to!i!t' telq!6t! - !|u fu ool' ileroc'

tr litlrptEtct, rotttl ' fperat'! !e tt

'f'otuat 1r e vtr|t! Bl

I-46

E&r6o olaa copl,Lul slportg &al bLao opratia.laeeagi atltudl46 opt'Btorj.. g edoptd& ia oadrul

d1&fre&latloe rtroxl.for.dtErre, cu lrenllunea cg sscul"eve& Ederente l$tfeo au pell eard.utr, d,r.Eeotle f,tcllldrFse

LE a6yoto? p&rtlo1 Bau tota3., eaoul so poate LEsa pe60 ohlitereer$ orl-tlotuL- b.6nx1&T ptrLD EuturA tot su f,tro&Jrloa, r{iase9 a&terior n pBtefl a&gatad ou 6q.tu}& d,sapelldloe rlfold.

ProgrostLcul ttr u].tleu.e d.olr{ foxoe aats !!ai. {,usu,rl tn 80-90 t d.ta' oazurl.

Syqntratltl o dtef regnat loe f ErE siEptonatol ogloops!ezf., p aele]-efte 1a opergn; operetLe oon'sta X.!.fra8elr]'ul ou flre tlereFoTbabtle. Reaultatolo slnt bu[o.

Hertllq hlats,l-d. s1 la1pozltlll.e cartllo-ttgLel%LLglg?!i!' hsltde htat].E fu.tele&e! asoensLoacrea tn

stouaoului pttn b.r,atn8ul, eeofaglair.dause dgte ulDEtoalres,: hlpEplezie elleat1or--colstl-

1ooo.-rsgtora]et p1l"{e!1, [e!rb!alr.e LatueFBerltolli (lesttu].ur. sonJu&ctiv t! Julful y&selo! serEts flemo;gestrice ) r.tata Desessofagu]'ur, gl r llga.leatelar gastdoe.

lorgtl blpaptrazls ste Eel [[l,t seu [at patt!dctml"a!. irnno{to fo!n6 Ebat@g-o1ltd.cai ea poate fl.ilsftJtltk6. 3oala a fost des6lls5 ar.! punct de red.erelaaS ile Suadet].aoa tt Bl,Lla,rd., cllnlo A Lalql'gr leAiologla?lrqltai .[Lrttr.!C. Datle qale losL ooEpleto anatonlc ei clto tul!!.zsezd B!.Eard. D*L.iel tl Sauvtralll.

Dt! truriot d yed.e|rs oaitaaolqtoLqrlc. datqrtid6l6DeateLor q&atoaloe d.esorigs nat gur yo! fultl1lr1it! (desqbl.s[), ult ulahl ElEs desch.1s, lfegllrneatrobll,I t! fu,lotl,. di posltlr, sugarllqr., eop.lluLul.,

-41

lar|rif a1e sto$aqulut tn ssatasi'ouf,' a4ttrl'6s'

Ort ".-*

do Yodoro radloloElo lkollrrrrd 1 luparto l'! 3 ooto-

1.- uernLl prtri "rlrn"-ctre 5'o o&re 1llol"l1detr,::::""::"":::":

;";-roffi"ttt *trq 1 subdlartas'sllo tu turotl. 4s

lr. "*rr**,

91 sqota6d t! siorlaou]. (partl&r 8au total) altg

!ubdtaflA8lat 1o i

rt.- hdrnla lBlse8ofa6leqa 9ti!45 8!g'lUg!lg!L-11

oata '!ata- '

!! cerdta Eiat latre-abdgEl'Jc&l' dar Etouqcu]. so af,Il esoelBtl}

fo ""af."tfo

paraegofaglso ltba saB illeptt

1!X.- brableEolog cotrae,ata] 6au s6cu'ailarn

cs E lnptgEa r rltllloili r!eovd'f:43g!Sg9!.:::":mr::"

,,,."ffffi ;;;"; *1 :::':::.:: i:X;ffiX:tphfllt ca o colrseolltE

L eaotag!"r,o! t':-,---.t" b,'oe.16 datortta

ooo6i obaervx$ u!ofl gl uLcerst'-l la ootds"rlLe

btioe'16 d41

lofdtNdlll v6laatutllor' aa6. toaliBe ate

su84ruL 6ceae t! greutate ' udn119 ElDt hlpsroro&gt

l'

ooEeti?atte' La olatsenul f,lulo oonstetl&i teeutd

adtpos s]'&b rgpr'

,.",* ** ouianeg le'es' :ffi:. ilj'i,.ffii"ffi1;rlrugar Eub dezfoltat

pon'lero-sra bs*' ,'"-r. *""". Doll"pnes , aato-

pulaonar senlf,estate !3:!! !uE' olasozdr dlEpnet

polt'pn(

"iti Esplrallltof, vzjts6turtlo!'

a"lieorl chlat t'61tr16urt prLa

''eu!'dl

r6a c5t1o! traheo-broEtlo'

AceEtf,fluxgastroesofag'.eB!'oauceegofagit ' 'F}tr:6;ul,cerBlii la tlivlul

eaoragqrir" cu !4tlesarea luooasolt saue t''

;;;;".,, siri lnrer6sar6 *ru:::*: il"S"ilil,I"

iua '$eol"L c l lntc p! !n h 'e!"ateneze luP""*-- '

ll*, o'*'" '

rezultatul - eierl s j!g!!lgllg'

&Si.1;g3f euga:rulul ""t"lll*"*' alteoll rlu' uneoll' aaie

ar-ltati. pirorls, dur6ri retlost6rtralor r95e

cPpllut 33i_ [are I aor:tl ,

o e&!.atle

,+s

gttatll, gt vErsdtull q,ll.eeltete. Sste hlpotrofloLezlu4ea erstoeo-p&tologtoE poete fl D&! evansatg!

oepiLcd, uj.cere esofeqiene peptiqg, cq" pot cblelr per,fonEstlt prod.ucS-trd eo*Lqt1r1l"tq, 6tenoge esofaglere averaate,

La gxeneoul ledlgLbglc tqreco-abdo&1nal rpe 6oln -

{nagi&e eeric6 roed.last 1&sl.6.Pelltru precisarea d,l8goostloulu{ se ef,sctueazE E!,

rttat care ne eletB 91 n8,t btlre tLpul d heruls el gradulLor eaofagleae, ?Etru expl,orerea in end.lruntlDe s @1poz1cerd.lo-tuberozitare. a hon1l,tLof, btatale cu ootlsgolatLe 1lro-flziologlce t]'e steu La dlspozttlg e*an1a6rLl,e pareclree pH-ului egofogle!, f,diocbe,ntqg}&fj-e,

gofa8oaoopla,DtaFnostlcul dlfereottEl La dlvolae gf,upG d, Tlrstd rte

-

y5.rs6turlle: prLn Freeell de qll8e4ie .,sos,En !11o!1c. stenEzd de pLlo!, asoclat5 sq,u !u cuta. dupl!,catle d.e pi.lor, d.lafr,Ae pt:epl.1orlo. etenoz{ doetc. la sugelr, rsgurgttatitl.e d.la ac[iazl"e, etenozEco.EgenltaLE d6 eEofag, eto.

frstapentr:-1 este lJr.ltlal consereatoT, la sugar, fu flraLpozitle cardlo-tubefozltar5 gt tll heru1ll prlacolllul t0lc al. E&re, au b.ernll plLrl a1u.necq,!e fllate tasau parBeaof,sgleno eu heuatenoesA, etoroll, uloe! pedotrrtaaienoze e6ofa6tene iratalnarltul eElq chllu.rgica] de la

lrete.rxehtd. co!6eleq,tor oooet6 fut tlnerea sug&rlj.ul fntie 6elllseziodd fos::te &utt tlrqp cu aJuto:"ul

.nhs&acu"ilorn,1o!r etc., Ea1 cu seE$d dupX deseo I

Se reco!)Ilndd adttrlnl.8trerea de antlBpatloe s!" ,ntatrop1uir belXadola, roed.lcatle a:lcj,ltrE, cioettlEa,nt6!1url ds albud.D,E, a!t1-!tc!1oea oale eC ognbetg leslu.Eilbopul-loaa:t d 48pttstl.

-49

crzul ta cars tn 2-3 :'u!1 8ub acest trets$8nt err et rcclgt

odla desorJ-e, 6e va ilrtervenl curu:gloal'

lrR$enteL qhlrlrfglss'X Yt?aasat

tr1 abdooen a stoF-aculul Et e pleltl atito{tllelc e 6aF

dltntsl dl&trs Plllort'

l,trlghlullrt Elss p!1lltr-ull pf,ooeilsll ailtireflutt tunile

pllsatuta uts66r' (!t!:' 3tr '3211"34) s

,.'. :)

prooeaeul !b4.1, llLlsotrt stllllotd'

etc. slni foarts allt tloosiles !Iterr'"

torlt. I,a copl! g! ttl cltdog a toB?

epLlaat plroeedeul 1u'' trlFse8 6ir !"Rl-

f,.[telferltl Pot fl t6ctto Pe

cal6 abdoi.La16, toraclcd' la! la !e-

vole' l.4 oaz a6 to4lloatlt' leilastl-

ltter otc. pe cale coobltlEtf ptL! tote'

\,T

r&. ,1.

1' ls.33.

fie''rj.-,/

?lancilll thntoe 1a operatj'e 1u'' NlsFenl

-

r"n*"""n,u $edlanS pe ca1 abdoslllel''

tet foart6 !uae.

FLA. 32.

s6 pEtrurd' ia caYt

50

tatoj ponltonalf . es lnqlzoaad lrg&eel]tu:' trlunghluLsr

' fl-qarul"uLr 6e LBilepg.rteaz&te lobu.l stfug bepattc, sepofitorreu: preeaotgl_ar?. SezA

sofqgu: rleleaflld llefqltsuture{xu 5 plltertl. qu l-ababtl,e I se troce l!4pelanayea tllberozlta,te eae autureaze ildjti.Le cele desofegul, oa uB liaJrgon in JS*e ereat l!. soe,r* f,eL u!ent t-!fl u:lo

Sai^t autqrl. &soctez{rettt gi. ptl,ofotoEl-e ea*raprouqqasg d.e teaEa tr:ecarll leoleudl|il aerrllor ve81.

NLsE! pe BOO de Ea.zlr:rl epreotzE ca 85 S *euultateeultulr1to&t gt 3 S cgecurl.

ID oazUrlle iJl cate a 6pdl:ut steaoz4 eBofaglalld, oaesofaBitel pptlc ilo refl,lrr, se ,!'eoxr8e Le d.tlatatlt,llclzte Longltudlllalu cu aEtrEg trs,aEvemele e bre8elac 6duos stguae

-

f,ete ante:rloalE _ gl se autulee,rd t&d.lef!agl!.

.Al,teorl ss poet recrr:ge Le rezectl.l eEofagr"elePulrele Ae FhEU JeJrneri 6au qol,l.cg.

firrlla d.laff&qneti cE trau4etiedI! Btatlstloa clh{cll, pe 20 de enli

,r0 &Tut ?i.r ooatuzll abdo.d.-aale putGlnlee Bq'u la pt{gl toreco_abdDatorl tU

lest1c1tEti i clesout e lesutu.r iLor, e6tfl deae 1lttLllesc fqalt ::a!. l{eqal1lsdul t.upet.ll d.lafrqgnului.tel4lDat d clegterea brusaE. Lq vsl o!1 aarl e preEiuallnii'rf.. nupitu'a 6ste cei Del ad6sea de partee stinSd fftldf,rc?elt ?upt octirlul ta&dito6. presluDee negatlvE

. / .

detollnln&, s,6ptretl& unor vlaoe.r6e dec{ te8l1tssa hsmte Atsf,tqgn'

tlcE qcrt5 post ttauDatl-c5," Dla8losttcul' tu pu u pu base ae+aLos

olfu:loe 91 redlologloa. Cl'llllc, cdpllu]- esis goa4t!, {$tarlt[ YLo-

lehtt trauftetf6nul"ui 6r, pretlltd tl: pluF dlspqes, pollpta' ol'aoo'

z{. I,e ers$enul bld.tor&ceiul r'eepc$tiY ad ra ob69r.r!! AfMlJlusrse

erdpldaEll1or cost.1e, s&tltate ireu bdleraoEoltitet tre pesqutloo Su

Ee y8 s.usL. ltut:lnit veztouLsrr el rxlleorl gqrglr'taent8b t! f:lllotle dd

orgenul aseGnslorat.

te radloliraflo se Ya obs6sva opecLtste { tr' aazul escalrsloaxit!'!

tobulu! ttla aeu drept hepEt,'c) sau l&agi4t hldfoqsrl'ge ln cBtll

!.rxteBtlnll'lul. subglliPrl! torolorars, ilateLor de &aael'czg, e exsngnrrllr$' sUll'a tl

rBdlologle se pulle dlagao6iloul de supturg do a!-e3!n - tu hflsiio

dtafragbatlcs colscutive. oA'tg tllag4oEttcu:L'pEE' lairv,ntta ehl'

rurglcA,]d s 1!4tqn' dupA o preelabtlu terapLo de deEooarn sa Dtt

rer5 cllea de abold eb8o4L[a"tg pnlfir a4tlofarea ttst eorpltI ayiscerelor. suturs d.tafraasqlnl't cu fLrs tlt nun dnpd reeducale&

yiaqerelor fu abdoBenr o oousLderds Buflctenlgb Ir1 oc'ur1L6 Duor

lezluli lal cotrpletgr aagctet 9t' cu rupturg dc gfgeEe paferqchlla-

ioeae' dostgur, se ve faoe lrat tutll heeoataza qoegtor otlgene' RF

eninarea poat-oprato! tlebule 8d f!'e lEsdla:[' strat llrtd pltru s

,!enwD.e la p{iIer|etrl! 4o:xtr411 functltl vf!elo,'letgfoqta esof,!419!von desori cele eel- f,recreat boll nalforlatlY cgngoli'ta]'g

Eaudgbibd. ' te 'dgo4leceego'4au1aleei lacEpl lopatologlof ,oal .

te bogatE gl varl4ta.

l! qedruL loXllo! lB&Lfor&a'ti?e- oltdD airezlq co4Lil sau pa'

tfali de esofag' stetroze eaof,agla'o5t dupltoetllle d esots' :l"l"rv1!u'

:.ele esofagq-tla,heeler blehlgaofaguL ql qardl"ospasDoul'

IB aoest capltol 1e boltla dobfudtte vots descrls a!su;-:"l'r

eEofaglEll Post-cauatioe'

-92

A@rXa d.e,. ssofea : lste o nalf,ord&tl oon6enttelEdia sscolul tfXI sete se irtthest su o fleeyaDtd. iia I/25OA-lrou r!5soutl,. Cauael"e qere prod.uc ecast6 eelfornstte slnts!rt. Ig!9699!9, Da]for:raatle Ee xpllcl prtur actlu,|lequalforr&tlvt esupna qlbrlotrului d6 4-8 odptxntnt. 1r aoeestgoadl LtltesttruL prl&ltl,ttr portlutree 6a DrorhBll, s6 dedubleeElprtntr-rr!. septr ln plan flontel

'

la eaofag (pqsterto!) gitnabeo (aEt6rla!) 11 ne1 tir!1u apare o ibsrJonere d.lpui.|!onll.. F8of,qglt le taoelut a,! eEpeot tubular, apot Aevlac co!donal prl^[ m:ltlpllcaroe tsgutulul pltolta].$ 4csta treptat a5.?!oarbe, dupg landler gt &aL!e! {1 la aspectul Lur0gnal,. O tulrBt fu vacuol!.zaroc ept teltulut 1[trslrr!01lr8l eofqgle|lr peatr!rr strezl,& d6 sofag, e:rsqtL!.Jos laooEItetlbllE ou Yr'4te deol Iruqste tletetE cbtrqr8lca1. lqeastd rBugh.alo Qu auoc3 q

irl 1941 c. HalEEt.

Dtu pulot ilo ,fgg9*,-glgS.oEopstobg!9, cunoegteu Gt dult.

lurl d atrlLc Ao ssof,ag (aupd cul eu foat elaslf,lcBt ileToabt, trad.atr croB6). Ildtfeaqri ds cLq.6ltloere' oepEtul Buprtorrll sof&gulul ert nal btle d'euYoltBti se a3'1d Ettuat le nll.ele

d.lforti i! report cu Yerteblo1e do l.& C?-f4.

von sdopte, apr sl@ltf,los,rer cl&ci3ia&rea pe 4 tipu.lt

i.ono-petologloe dupd oua urleez[ (f,!t. ,5 e]lL.- t lpnl I

-

pgtul 6uletlors9 terelnE ft!

deget Ae n{t1u8d'e8te b1!c

tat L! aroskeg1 l[t l ler ce:t$e gs tete"!36La idf,iuf i1r't

-13Ih,. oqpltuf ilrftrlor lrtq Bt blpoplE

ls 9l' a' drgehlila prltttr.'

"' - acBtt4 as96t14' Dlltasta trtrl oa'

flrtut[ trl trahrq sau la llfu

vE rlale intls ! on'-205 ao' fubul dlgesit" lig aetrt' lBto

a[atoEo-patologlc[ ca'! tc Ptetszl o1 r!41 b1lne 1a o rolol-

ohlrurEloel! prtur aqestotlotd cso-ssofagLand trBlnFtrdbal'I

ora nai f,tocrcnta forrdl aSUetjr- sazurl (watarst6!) t

2.- tlpul II -

oxo Aotrl osptr '

trltlnb la degst ae BLnugE

lrpltu,l pt'oz!!61 ee 4fl6 sltuat aeobloeg 14 alf,e: d' 1ul T1; este

*t *.t itoEsoltEi ca Ld ttplll I; eap6tul tt:til "l-llTl'jllio a"gut de o!nuE!, nu oonrtd'od

cu grbotols tlaho''bronftot tgle

llpollatlol itl8telta :'atrg qapeta eFtc foerle lnari' tubuL dlBe8tlt

oo "",, """.,,

fali ooagtatat p. fsilioSrafla abdontDalc tlp go1nl

btrreltla chlnurSlo&]'I ! toraos ssto butlld d6oarc El1estooo-

tr-.ro-e"sfegts'pE au Poat fl ef,ctuat!' 53 tltlltrett cu o freo-

?rntB il. 9 t (gatstst@)'3.- tlplrl IIt - oaPItuI superior

c6te blns ilssrolt&t' ts aeE-

ohldg l! treboe '

la lrl'Telux lul c?-12r capltul *:t": e:to hlpo-'

plazto ti laobig lg tlegt '1o

u!'ou96 c1 8 teraL!{ 1s dt6!e dlferl'

t. t!' Esillattl.l'

4.- ttpt[ tY - esp6tu1 sr4srlot osts !41 l1l1 aesvo]tat' se

desebldo 14 trsle. aeesupra btfurcatle!;

"*U:* *"::::-::t".:-

n"rrt"r", s deabl'& Et l 5n iraheg aau i!' broabi'a dteapt6;

dls-

*** t * qele douA cap6to rerlaa8 de 1a'1;j cd' i aEgstouoze

ego-egof,aglaul poei fl 6au au feetuatEi tubul (Ugestl" ate h1-

peraetai lar po8lbllliatea Bpatilllel brollbop[eutlotr1el egie ral

fleoventdi PulDolul gufere "aJuru!

ailt Ptia qouirEloa).ea ou Eto-

!|aou1, clt !1 ou osof,agd aalo-glnds"arsEn soorstM tn sl|borel

tr&1t9o-broaho-alTeolatt tlrDocfud aLvo119'

se ldEl deEcrlu oouisslodri I'arti'' obie! p ioetE futildsrea

trabet gl eaofggutult greu oodtarablls cu viatat dstolltf

eb6a-

tsl 6eptulu! sperator 1ltr tte!6' !l sofa3'

it*. r5.r.

55

Ittatt& 4E sofsA (pa!tlsl{) ee esoctsaE adlsseoll culltlttd, ou 4a:,f,o&stll corlgsrlttel^e ds oord,. stnoza.al6at$rl,a sJto-::ecta1$., ahe,oBahl,u!,sr etcn

SlrtrDtoqq!91osleDlagaogtlor!1 d6 atrezla d.E eagfa8 ae pune Wor Aaod E

!eai.datole 4s rurenne6fl, cu s?ainr'ta!.eB atertE a agutLlrpuL &a.ne]|relo! d dezobatructle e a8l.l,ol eriene. Dfu,ae ye rstlrr hjluq,E!,tosu1 la! La, d.ezobatructla oailordas! 6 l.loea,ro$ a ea l.ltloduc sond& fdtEtoa .ar. LO_lA tlal.d.e 6-1,0 cq" ds a,fos,ale Ai-olvel,X' oe ve lntlnplna 9

Ie nl4ute16 ca'r ultuees{ dupg t1egtele, se ee, obdarlve otle BalLyar{ p!l-oro*!ezal&. AqEesta egto satl?A socrtatlnotba.L alo gla&dele 6alLT6j.o der csre r1u sJ ql1go in ston&c,llpse!. de coatlnuitete e esofEgulu1. Ea utple cepituLesofa${rrt Sl Be futoarc to f,&rtnge i o p&rte Eela alvoluf. bu,.zelof aeu ugfLD.elo!'i al-td pa]fte Fe eDejeezd t]lrele tra!eo**!'rougl.c prodqctrd gf,eu+Ett L! lespbatLe.devl-le clarioelo, aliBprelc, polipq.elcrte! La auscult&lie aefreorenie .roahraurl puhoaarB. Dacg asllrEE eceate seoretll,a$ecutuL resFlle ugor, se colorea.ux nor4a1" f.a fata acestui t,clIt{c d.legnosttcul se fuupuao

-

strert.s d.s gEofego Se rl& efeci$! e:aiasla

"ed.1@1ogt6 cers;d futfues,sed d.atel,e c1lntce"

Fredenul radlologis |Ia oonsta trx efeotuaf,ee ur1el redit oreca-abd-o-{

" "T e np8 goln. Pe radloglEf,ie puten obsrva s{iu

bloDhopauDolrls d.e aapl"tatls.

Pentru e Dur lt1 eyldenlx LocLl ul]de eEof.rlul t8lco6ti . !u1ta:ea de cele ldal E'J.1e