Manual de Chirurgie Vol 2 - Traian Pătrașcu - PDF

ATENTIE! INFORMARE CU PRIVIRE LA DREPTURILE DE AUTOR ACESTA ESTE UN MATERIAL INTERN AL UNIVERSITĂȚII DE MEDICINĂ ȘI FARMACIE „CAROL DAVILA”, DISTRIBUIT PENTRU A FACILITA PREGĂTIREA STUDENȚILOR ÎN CONTEXTUL EPIDEMIEI COVID-19. ORICE REPRODUCERE SAU UTILIZARE A ACESTUI MATERIAL, INTEG...

ATENTIE! INFORMARE CU PRIVIRE LA DREPTURILE DE AUTOR ACESTA ESTE UN MATERIAL INTERN AL UNIVERSITĂȚII DE MEDICINĂ ȘI FARMACIE „CAROL DAVILA”, DISTRIBUIT PENTRU A FACILITA PREGĂTIREA STUDENȚILOR ÎN CONTEXTUL EPIDEMIEI COVID-19. ORICE REPRODUCERE SAU UTILIZARE A ACESTUI MATERIAL, INTEGRAL SAU PARȚIAL, ÎN ALT SCOP DECÂT CEL MENȚIONAT ANTERIOR, FĂRĂ PERMISIUNEA SCRISĂ A AUTORILOR ESTE INTERZISĂ. ORICE ALTĂ UTILIZARE SAU REPRODUCERE VA FI SANCȚIONATĂ CONFORM LEGILOR ÎN VIGOARE. PENTRU ORICE INFORMAȚII ȘI SOLICITĂRI ADRESAȚI-VĂ AUTORILOR.  Universitatea de Medicină și Farmacie Carol Davila Facultatea de Medicină DEPARTAMENTUL 10 CHIRURGIE GENERALĂ    ‘‘”†‘ƒ–‘”‹      $g    Curs de CHIRURGIE   ‡–”—•–—†‡ì‹‹           ‘ŽǤ  †‹ƒ—Ž è‹                          i  Ǧ        †‹–—”ƒ‹˜‡”•‹–ƒ”£Ƿƒ”‘Žƒ˜‹Žƒdzǡ — —”‡è–‹ǦʹͲʹͲ  ǣͻ͹ͺǦ͸Ͳ͸ǦͲͳͳǦͳ͵ͻǦͻ  ͻ͹ͺǦ͸Ͳ͸ǦͲͳͳǦͳͶͷǦͲ Descrierea CIP a Bibliotecii Naţionale a României Curs de chirurgie : pentru studenţii din anul IV şi V / coord.: Mircea Beuran, Traian Pătraşcu. - Ed. a 2-a. - Bucureşti : Editura Universitară "Carol Davila", 2020 2 vol. ISBN 978-606-011-139-9 Vol. 2. - 2020. - Conţine bibliografie. - ISBN 978-606-011-145-0 I. Beuran, Mircea (coord.) II. Pătraşcu, Traian (coord.) 616 Editura Universitară „Carol Davila” Bucureşti a Universităţii de Medicină şi Farmacie „Carol Davila” Bucureşti este înscrisă în Nomenclatorul Editurilor de carte medicală agreate de Colegiul Medicilor din România, în conformitate cu prevederile Deciziei 12/ 2018. Prof. univ. dr. Mircea Beuran (coordonator) Prof. univ. dr. Traian Pătrașcu (coordonator) Conf. univ. dr. Sorin Păun (redactor carte) Conf. univ. dr. Horia Doran (redactor carte)   AUTORI  PRENUME și NUME POZIȚIA GRADUL TITLUL DISCIPLINA DIDACTICĂ PROFESIONAL ACADEMIC Ž‘”‹ ‘Achim •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡‰‡‡”ƒŽ£è‹ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ‡•‘ˆƒ‰‹ƒ£ǡ’ǤǷˆǤƒ”‹ƒdz ‹Š‡ƒAlecu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‘Ž‘‰‹ £ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ •–‹–—–—Ž ‘Ž‘‰‹ Ƿ”‘ˆǤ”Ǥ ŽǤ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ‘”‹‹„‡”‹— g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ Alexandrescu ‡†‹ ‹£ •–‹–—–—ŽŽǤ —†‡‹  –ƒ˜‹ƒAndronic •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”ƒ† Š‹”—”‰‹‡ ǡ’Ǥ‹˜‡”•‹–ƒ” —‹˜‡”•‹–ƒ” †‡”‰‡ì£— —”‡è–‹ ‹Šƒ‹Š‡‘†‘”Angelescu g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡ ”‰‡ì£Ž‹ƒ• ‡‹•Aslan •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡’ǤŽǤ‘Žì‡ƒ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ‡–”‹è‘”Banu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤǷˆǤƒ–‡Ž‹‘dz ”‹•–‹ƒBălălău g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤǷˆǤƒ–‡Ž‹‘dz ‹Šƒ‹Bărbulescu g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ‘Žì‡ƒ ‹ —Žƒ‡Berevoescu  •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ‘Žì‡ƒ ‹” ‡ƒBeuran ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£— —”‡è–‹ ‡„”— –‹–—Žƒ”ƒŽ  ƒ†‡‹‡‹†‡ g–‹‹ì‡ ‡†‹ ƒŽ‡†‹ ‘Ÿ‹ƒ ‘†‹ ƒƒ‹‡ŽƒBîrlă f‡ˆŽ— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‡‡”ƒŽ£è‹ ‡†‹ ‹£ •‘ˆƒ‰‹ƒ£ǡ’ǤŽǤǷˆǤƒ”‹ƒdz Ž‡šƒ†”—Blidaru ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‘Ž‘‰‹ £ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ •–‹–—–—Ž ‘Ž‘‰‹ Ƿ”‘ˆǤ”Ǥ ŽǤ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ‹‘ƒBobic Ǧ ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤǷˆǤƒ–‡Ž‹‘dz ƒ”‹—•Boeriu Ǧ ‡†‹ •’‡ ‹ƒŽ‹•– Ǧ Ǧ Ž‡šƒ†”ƒBolocan g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ ‡†‹ ‹£ ’ǤŽǤ‹˜‡”•‹–ƒ”†‡”‰‡ì£ — —”‡è–‹ †”‹ƒBordea g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ‘Žì‡ƒ ”‹•–‹ƒBordea f‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‘Ž‘‰‹ £ǡ ‡†‹ ‹£ •–‹–—–—Ž ‘Ž‘‰‹ Ƿ”‘ˆǤ”Ǥ ŽǤ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ”‹•–‹ƒBotezatu •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ‘Ž‡–‹ƒ ‹” ‡ƒBrătucu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ’ǤŽǤ†‡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ‡ˆ”‘Ž‘‰‹‡Ƿ”Ǥƒ”‘Žƒ˜‹Žƒdz ”ƒ‡ƒBurcoș ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ‘Žì‡ƒ Ž‡šƒ†”—‘•–ƒ–‹ •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ǡ Carâp —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤǷˆǤƒ–‡Ž‹‘dz †—ƒ”†— ‹ƒCatrina g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽ‹‹  Ƿ”Ǥ Ǥƒ–ƒ —œ‹‘dz †”‡‹Cărăgui Ǧ ‡†‹ •’‡ ‹ƒŽ‹•– Ǧ Š‹”—”‰‹‡ ‡‡”ƒŽ£è‹ •‘ˆƒ‰‹ƒ£’ǤǷˆǤƒ”‹ƒdz Ž‡šƒ†”—Chiotoroiu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ’ǤŽǤ†‡”‰‡ì£ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ — —”‡è–‹ ‹’”‹ƒCirimbei •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ •–‹–—–—Ž —‹˜‡”•‹–ƒ” ‡†‹ ‹£  ‘Ž‘‰‹ Ƿ”‘ˆǤ”ǤŽǤ ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ‹‘ƒŽ‡ƒCirimbei •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ •–‹–—–—Ž —‹˜‡”•‹–ƒ” ‡†‹ ‹£  ‘Ž‘‰‹ Ƿ”‘ˆǤ”ǤŽǤ ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ Ž‡ƒ‹‘Ž‡–ƒComan •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”ᑖ Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’‹–ƒŽ—ŽŽ‹‹ †‡”‰‡ጔᠥ dzƒ‰†ƒ•ƒ”Ǧ”•‡‹dz ‘—싏‹‘Coman •‹•–‡– ‡†‹ ’‡ ‹ƒŽ‹•– ‘ –‘”ᑖ Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’‹–ƒŽ—ŽŽ‹‹ †‡”‰‡ጔᠥ dzƒ‰†ƒ•ƒ”Ǧ”•‡‹dz †”‹ƒConstantin •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‡‡”ƒŽ£è‹ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ •‘ˆƒ‰‹ƒ£’ǤǷˆǤƒ”‹ƒdz Žƒ†‡‹•Constantin ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤǷˆǤƒ–‡Ž‹‘dz ‹Ž˜‹—Constantinoiu ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‡„”— Š‹”—”‰‹‡ ‡‡”ƒŽ£è‹ —‹˜‡”•‹–ƒ” ‘”‡•’‘†‡– •‘ˆƒ‰‹ƒ£ ƒŽ ƒ†Ǥ†‡ ’ǤǷˆǤƒ”‹ƒdz g–‹‹ì‡ ‡†‹ ƒŽ‡ ‘ –‘”Á ‡†‹ ‹£ ƒ†—Costea ‘ˆ‡”‡ጔ‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” Š‹”—”‰ ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ ƒ‹‡ŽCristian ‘ˆ‡”‡ì‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ‘Žì‡ƒ Žƒ—†‹— Daha g‡ˆŽ— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ •–‹–—–—Ž ‡†‹ ‹£  ‘Ž‘‰‹ Ƿ”‘ˆǤ”ǤŽǤ ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ”ƒ‰‘èDavițoiu g‡ˆŽ— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ǡ — —”‡è–‹ †”‡‹Diaconescu •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ •–‹–—–—ŽŽǤ —†‡‹ ‘•–ƒ–‹Dimitriu g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ‘Žì‡ƒ ƒ‹‡ŽƒŽ‡ƒDinu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‡‡”ƒŽ£è‹ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ •‘ˆƒ‰‹ƒ£ǷˆǤƒ”‹ƒdz ‘”‹ƒDoran ‘ˆ‡”‡ì‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤǷ”Ǥ Ǥƒ–ƒ —œ‹‘dz ‘‰†ƒDorobanțu g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ •–‹–—–—ŽŽǤ —†‡‹ ”ƒ‹ƒDumitrașcu g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ •–‹–—–—ŽŽǤ —†‡‹ ƒDumitrescu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ǡ — —”‡è–‹ ‹Šƒ‹†”‹ƒEftimie •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ •–‹–—–—ŽŽǤ —†‡‹  –ƒ˜‹ƒEnciu •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ǡ’Ǥ‹˜‡”•‹–ƒ”†‡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ”‰‡ì£Ž‹ƒ• ”ƒ‰‘è Ene ‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£— —”‡è–‹  ‹ –‘”Florescu Ǧ ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”ƒ† Š‹”—”‰‹‡ǡ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ Ž‹ƒ•  ƒ„”‹‡Ž†”‡‹Gangură •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ǡ — —”‡è–‹ ‘‰†ƒGașpar g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£— —”‡è–‹ǡ  — —”‡è–‹ ‡‘†‘” Ž‘”‹Georgescu •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ 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Ƿ”‘ˆǤ”ǤŽǤ ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ Ž‘”‹‹Šƒ‹ŽIordache ‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£— —”‡è–‹  ”‹•–‹ƒIorga g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ†‡‡ˆ”‘Ž‘‰‹‡Ƿ”Ǥ ƒ”‘Žƒ˜‹Žƒdz ‡‘”‰‡Jinescu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£— —”‡è–‹  ƒƒ—”ƒManda Ǧ ‡†‹ ’”‹ƒ” ‘ –‘”ƒ† Š‹”—”‰‹‡ ǡ  ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ — —”‡è–‹ ”‹•–‹ƒMarica Ǧ ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ ‡‡”ƒŽ£è‹ ‡†‹ ‹£ •‘ˆƒ‰‹ƒ£’ǤǷˆǤƒ”‹ƒdz ƒ”‹ƒ—‰—•–‹ g‡ˆŽ— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ •–‹–—–—Ž Marincaș ‡†‹ ‹£  ‘Ž‘‰‹ Ƿ”‘ˆǤ”ǤŽǤ ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ‘‰†ƒ–‡Ž‹ƒ ‘ˆ‡”‡ì‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ Mastalier-Manolescu —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ‘Ž‡–‹ƒ ‘ƒ‹ ‘Žƒ‡Mateș ‘ˆ‡”‡ì‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‡‡”ƒŽ£è‹ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ •‘ˆƒ‰‹ƒƒǡ’ǤǷˆǤƒ”‹ƒdz †”‹ƒMiron ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ Ž‹ƒ• ‹Ž˜‹—Morteanu  Ǧ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ’ǤŽǤ†‡”‰‡ì£ǡ ‡†‹ ‹£ — —”‡è–‹ ‘Motofei g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ’ǤŽǤ ‡†‹ ‹£ DzˆǤƒ–‡Ž‹‘dz g–‡ˆƒNeagu ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ ‘—ጔNegoi ‘ˆ‡”‡ì‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á ’‹–ƒŽ—ŽŽ‹‹ †‡”‰‡ጔ£ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ̶ Ž‘”‡ƒ• ƒ̶ ‹‡ŽƒNoditi •‹•–‡– ‡†‹ ”‡œ‹†‡– ‘ –‘”ƒ† Š‹”—”‰‹‡ ‘Ž‘‰‹ £ǡ —‹˜‡”•‹–ƒ” Š‹”—”‰‹‡Ǧ •–‹–—–—Ž ‘Ž‘‰‹ Ƿ”‘ˆǤ”Ǥ ‰‡‡”ƒŽ£ ŽǤ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ‘”‹‹” ‡ƒOprescu ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ’Ǥ‹˜‡”•‹–ƒ” —‹˜‡”•‹–ƒ” ‡†‹ ‹£ †‡”‰‡ì£ǡ— —”‡è–‹ ƒ‹ ‘Žƒ‡Păduraru g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ǡ — —”‡è–‹ ”ƒ‹ƒPătrașcu ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤǷ”Ǥ Ǥƒ–ƒ —œ‹‘dz ‘”‹‘•–ƒ–‹Păun ‘ˆ‡”‡ì‹ƒ” ‡†‹ ”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£— —”‡è–‹ ƒ”‹—•‡’–‹‹— ‡” ‡–£–‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ Petruțescu 薋‹ì‹ˆ‹  ‡†‹ ‹£ ’ǤŽǤ‘Ž‡–‹ƒ ’”‹ ‹’ƒŽ ‘•‹Ž‡šƒ†”—Popa g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ‘Ž‡–‹ƒ ”‹•–‹ƒ‘•–ƒ–‹Popa •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ ”ƒ‰‘胎‡–‹ f‡ˆŽ— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‡‡”ƒŽ£è‹ Predescu ‡†‹ ‹£ •‘ˆƒ‰‹ƒ£ǷˆǤƒ”‹ƒdz ‹”‰‹Ž‹—Prunoiu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ •–‹–—–—Ž —‹˜‡”•‹–ƒ” ‡†‹ ‹£  ‘Ž‘‰‹ Ƿ”‘ˆǤ”ǤŽǤ ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ‹Šƒ‡ŽƒRadu •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”ƒ† Š‹”—”‰‹‡ ‘Ž‘‰‹ £ǡ —‹˜‡”•‹–ƒ” ‘„•–‡–”‹ £Ǧ •–‹–—–—Ž ‘Ž‘‰‹ Ƿ”‘ˆǤ”Ǥ ‰‹‡ ‘Ž‘‰‹‡ ŽǤ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ‡–”—Radu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ†‡‡ˆ”‘Ž‘‰‹‡Ƿ”Ǥƒ”‘Ž ƒ˜‹Žƒdz £œ˜ƒScăunașu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ‘Žì‡ƒ ƒ—”‡ì‹—Simion g‡ˆŽ— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ •–‹–—–—Ž ‡†‹ ‹£  ‘Ž‘‰‹ Ƿ”‘ˆǤ”ǤŽǤ ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ —šƒ†”ƒ‹ƒƒSinescu ‘ˆ‡”‡ì‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡Žƒ•–‹ £Ȃ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ‹ ”‘ Š‹”—”‰‹‡‡ ‘•–”— –‹˜£ǡ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ Ž‹ƒ• ‘‰†ƒSocea g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤǷˆǤƒ–‡Ž‹‘dz ƒ•‹Ž‡£œ˜ƒStoian g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ǡ — —”‡è–‹ ‘‰†ƒStoica •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£— —”‡è–‹ ‹ ‘Žƒ‡ƒStraja Ǧ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ •–‹–—–—Ž ‡†‹ ‹£  ‘Ž‘‰‹ Ƿ”‘ˆǤ”ǤŽǤ ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ ‹ –‘”Strâmbu ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ’ǤŽǤ†‡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ‡ˆ”‘Ž‘‰‹‡Ƿ”Ǥƒ”‘Žƒ˜‹Žƒdz ‡ŽSuliman •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ǡ  — —”‡è–‹ ‰‡ŽƒȘandru Ǧ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‘Ž‘‰‹ £ǡ ‡†‹ ‹£ •–‹–—–—Ž ‘Ž‘‰‹ Ƿ”‘ˆǤ”Ǥ ŽǤ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹  ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ ‘•–‡ŽȘavlovschi —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ǡ — —”‡è–‹  ”ƒ‰‘èȘerban ‘ˆ‡”‡ì‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á Chirurgie IV, Sp.Universitar de —‹˜‡”•‹–ƒ” ‡†‹ ‹£ Urgență ‘ƒTănase •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£ǡ— —”‡è–‹ ƒ”‹ƒTomescu •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ǡ  — —”‡è–‹ ‹„‡”‹—Trotea •‹•–‡– ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ǡ — —”‡è–‹ Žƒ—†‹—Turculeț ‘ˆ‡”‡ì‹ƒ” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£ǡ— —”‡è–‹ £—ìVasile ”‘ˆ‡•‘” ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ǡ  — —”‡è–‹ ‹” ‡ƒƒVenter Ǧ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ†‡”‰‡ì£ǡ— —”‡è–‹ ƒ‹‡ŽVoiculescu g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ì£ǡ  — —”‡è–‹ g–‡ˆƒVoiculescu g‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ǡ ‡†‹ ‹£ ’ǤŽǤ‘Žì‡ƒ ‹Ž˜‹—Voinea Ǧ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ‘Ž‘‰‹ £ǡ ‡†‹ ‹£ •–‹–—–—Ž ‘Ž‘‰‹ Ƿ”‘ˆǤ”Ǥ ŽǤ”‡•–‹‘”‡ƒ—dzǡ— —”‡è–‹ —‰‡‹ƒŽƒ—†‹ƒ •‹•–‡– ‡†‹ •’‡ ‹ƒŽ‹•– ‘ –‘”Á Š‹”—”‰‹‡ ǡ Zărnescu —‹˜‡”•‹–ƒ” ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ǡ — —”‡è–‹ ƒ” ‹• –ƒ˜‹ƒZărnescu f‡ˆ†‡Ž— ”£”‹ ‡†‹ ’”‹ƒ” ‘ –‘”Á Š‹”—”‰‹‡ ǡ ‡†‹ ‹£ ’Ǥ‹˜‡”•‹–ƒ”†‡”‰‡ጔ£ǡ — —”‡è–‹    Chirurgie-Curs pentru studenți CAPITOLUL 12 APENDICELE CECAL 12.1. PATOLOGIA CHIRURGICALĂ A APENDICELUI CECAL Traian Pătrașcu, Eduard Catrina ANATOMIE ’‡†‹ ‡Ž‡ ‡ ƒŽȋ˜‡”‹ˆ‘”Ȍǡ‘”‰ƒ˜‡•–‹‰‹ƒŽ —•–”— –—”£Ž‹ˆ‘‹†£ǡƒ‡šƒ– ‡ —Ž—‹ǡ•‡ †‡œ˜‘Ž–£ Á Œ—”—Ž •£’–£Ÿ‹‹ ƒ ͺǦƒ †‡ ˜‹ƒì£ ‹–”ƒ—–‡”‹£Ǥ ‹–—ƒ– Á ˆ‘•ƒ ‹Ž‹ƒ £ †”‡ƒ’–£ǡ Á Ž‘Œƒ ‡ ƒŽ£ǡƒ”‡‘Ž—‰‹‡‡†‹‡†‡ͷǦͳͲ ǡ —˜ƒ”‹ƒጔ‹‹‡š–”‡‡ǡÁ–”‡ͳȂʹͷ ȋͳȌǡ†—’£—‹‹ ƒ—–‘”‹ ƒŒ—‰Ÿ† Š‹ƒ” ’Ÿ£ Žƒ ͵͵  ȋʹȌǡ — †‹ƒ‡–”— ‡š–‡”‹‘” †‡ ͷ Ǧ ͺ  è‹ ‡Ž ‹–‡”‹‘” ˜ƒ”‹ƒ„‹Ž †‡ ͳǦ͵  ȋʹȌǤ ’‡†‹ ‡Ž‡ ‡ ƒŽ ‡•–‡ •‹‰—”—Ž ‘”‰ƒ †‹ ‘”‰ƒ‹• ƒ”‡ — ƒ”‡ ‘ ’‘œ‹ì‹‡ƒƒ–‘‹ £ ‘•–ƒ–£ǤȋͳȌ‘œ‹ጔ‹ƒƒ’‡†‹ ‡Ž—‹ˆƒጔ£†‡ ‡ ‡•–‡˜ƒ”‹ƒ„‹Ž£ȋˆ‹‰ǤͳȌǡ†‹”‡ ጔ‹ƒ •ƒ’‘ƒ–‡ˆ‹†‹ˆ‡”‹–£ǡ†ƒ”’— –—Ž†‡‹•‡”ጔ‹‡’‡ ‡ ‡•–‡Á–‘–†‡ƒ—ƒ•‹–—ƒ–’‘•–‡”‘‡†‹ƒŽŽƒʹǦ ͵  •—„ †‡• Š‹†‡”‡ƒ ‹Ž‡‘—Ž—‹ǡ ˆ‹‹† •‡ƒŽƒ– ’‡ •—’”ƒˆƒìƒ ‡š–‡”£ ƒ ‡ —Ž—‹ †‡ Ž‘ —Ž †‡ Á–ŸŽ‹”‡ ƒŽ ‡Ž‘” –”‡‹ –‡‹‹ —• —Žƒ”‡Ǥ ȋ͵ǡͶȌ ƒ”‹ƒ„‹Ž‹–ƒ–‡ƒ ’‘œ‹ì‹‡‹ ‹ˆŽ—‡ጔ‡ƒœ£ •‹’–‘ƒ–‘Ž‘‰‹ƒ ç‹ •‡‹‘Ž‘‰‹ƒ ƒ’‡†‹ ‹–‡‹ ƒ —–‡ ’”‡ — ç‹ ‘’Ž‹ ƒጔ‹‹Ž‡ ƒ ‡•–‡‹ƒǢ †‡ ƒ•‡‡‡ƒǡ ‘•–‹–—‹‡—‡Ž‡‡–†‡”‡’‡”’‡–”—ƒŽ‡‰‡”‡ƒ‹ ‹œ‹‡‹ç‹–‡Š‹ ‹‹ Š‹”—”‰‹ 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B ˆ— ጔ‹‡ †‡ •‹–—ƒጔ‹ƒ –‘’‘‰”ƒˆ‹ £ ƒ ƒ’‡†‹ ‡Ž—‹ǡ £”‹‡ƒ ç‹ ˜‹–‡œƒ †‡ ‹•–ƒŽƒ”‡ ƒ ’‡”ˆ‘”ƒጔ‹‡‹ǡ ’”‡ — ç‹ †‡ ƒ’ƒ ‹–ƒ–‡ƒ ‘”‰ƒ‹•—Ž—‹ †‡ ƒ ”£•’—†‡ Žƒ ƒ‰”‡•‹—‡ƒ ‰‡”‡‹Ž‘” ‹–”ƒ’‡”‹–‘‡ƒŽ‹ǡ’‡”‹–‘‹–ƒ’‘ƒ–‡Á„”£ ƒç‹‡ƒ†‹ˆ‡”‹–‡ˆ‘”‡ƒƒ–‘‘ Ž‹‹ ‡ç‹‡˜‘Ž—–‹˜‡ǣ Peritonita difuză, generalizată Á ƒ”‡ ‹ˆ‡ ጔ‹ƒ ƒˆ‡ –‡ƒœ£ Á–”‡ƒ‰ƒ ƒ˜‹–ƒ–‡ ’‡”‹–‘‡ƒŽ£Ǥ  ‡ƒ•–£ ˆ‘”£ †‡ ’‡”‹–‘‹–£ ƒ’ƒ”‡ Žƒ ˜Ÿ”•–‹ ‹ •ƒ— Žƒ ’ƒ ‹‡ì‹‹ ˆ‘ƒ”–‡ –‹‡”‹ǡ Žƒ „‘Žƒ˜‹‹ — ‹—‘†‡’”‡•‹‡ •ƒ— Á ƒœ—”‹Ž‡ Á ƒ”‡ ‡˜‘Ž—싃 •’”‡ ’‡”ˆ‘”ƒጔ‹‡ ƒ Ž‡œ‹—‹‹ ‡•–‡ ˆ‘ƒ”–‡ ”ƒ’‹†£ǡ ‡ ƒ‹•‡Ž‡†‡ƒ’£”ƒ”‡‡ƒ˜Ÿ†–‹’—Ž†‡ƒ‹–”ƒÁƒ 싗‡Ǥ Peritonita localizată ƒ’ƒ”‡ ƒ–— ‹ ƒ† ‡˜‘Ž—싃 •’”‡ ‰ƒ‰”‡£ è‹ ‡ ”‘œ£ ƒ ’‡”‡–‡Ž—‹ ƒ’‡†‹ —Žƒ” ‡•–‡ ƒ‹ Ž‡–£ǡ ’‡”‹–‘‡—Ž ç‹ ‡’‹’Ž‘‘—Ž ƒ— –‹’—Ž ‡ ‡•ƒ” †‡ ƒ Ž‹‹–ƒ è‹ Á‰”£†‹ ‡ˆ”ƒ ጔ‹ƒ•‡’–‹ £ǡ‹•–ƒŽŸ†‘„ƒ”‹‡”£Ž‘ ƒŽ£ ƒ”‡ƒ’£”£ƒ”‡ƒ ƒ˜‹–ƒ–‡’‡”‹–‘‡ƒŽ£Ǥ ‡•––‹’†‡ ’‡”‹–‘‹–£’‘ƒ–‡Á„”£ ƒʹˆ‘”‡ƒƒ–‘‘’ƒ–‘Ž‘‰‹ ‡ǣ Ǧ abcesul periapendicularǡ ƒ”‡ ‡•–‡ ‘ ‘Ž‡ ጔ‹‡ ’—”—Ž‡–£ ˆ”ƒ £ Á ƒ”‡ •‡ ƒˆŽƒ ƒ’‡†‹ ‡Ž‡‰ƒ‰”‡‘••ƒ—ˆ”ƒ‰‡–‡‡ ”‘œƒ–‡†‹‡ŽǤ„ ‡•—Žƒ’‡†‹ —Žƒ”ƒ’ƒ”‡ˆ”‡ ˜‡–Á ƒœ—Žƒ’‡†‹ ‹–‡Ž‘”ƒ —–‡‘„•–”— –‹˜‡ —‘‡˜‘Ž—싇ƒ‹”ƒ’‹†£•’”‡’‡”ˆ‘”ƒì‹‡Ǥ‡”ˆ‘”ƒì‹ƒ——‹ ƒ’‡†‹ ‡ǡ •‹–—ƒ– ”‡–”‘ ‡ ƒŽ •ƒ— Á ’‘œ‹ì‹‡ †‡• ‡†‡–£ǡ ’‡Ž˜‹£ •‡ Á•‘ì‡è–‡ ƒ‹ ˆ”‡ ˜‡– †‡ ƒ„ ‡• ’‡”‹ƒ’‡†‹ —Žƒ”ǡ •’”‡ †‡‘•‡„‹”‡ †‡ Ž‘ ƒŽ‹œƒ”‡ƒ ’”‡‹Ž‡ƒŽ£ •ƒ— •—„ ‡ ƒŽ£ǡ ƒ”‡ ‡˜‘Ž—‡ƒœ£ ƒ‹ ’”‘„ƒ„‹Ž £–”‡ ’‡”‹–‘‹–£ ‰‡‡”ƒŽ‹œƒ–£Ǥ  ˜‘Ž—싃 ƒ„ ‡•—Ž—‹ ƒ’‡†‹ —Žƒ” ’‘ƒ–‡ ˆ‹ £–”‡ǣ Á Š‹•–ƒ”‡ǡˆ‹•–—Ž‹œƒ”‡•’‘–ƒ£‹–‡”£Á‘”‰ƒ‡Ž‡ ƒ˜‹–ƒ”‡Á˜‡ ‹ƒ–‡ȋ‹Ž‡‘ǡ ‘Ž‘•ƒ—”‡ –Ȍ •ƒ— ‡š–‡”£ Žƒ ’‡”‡–‡Ž‡ ƒ„†‘‹ƒŽ — ‡˜ƒ —ƒ”‡ƒ ’—”‘‹—Ž—‹ Á –—„—Ž †‹‰‡•–‹˜ ”‡•’‡ –‹˜ Žƒ 4  Chirurgie-Curs pentru studenți ‡š–‡”‹‘” •ƒ— †‡• Š‹†‡”‡ •‡ —†ƒ”£ Á ƒ”‡ƒ ƒ˜‹–ƒ–‡ — ’”‘†— ‡”‡ƒ ƒèƒǦ—‹–‡‹ peritonită generalizată în trei timpiǢ - plastronul apendicular (periapendicular) ”‡’”‡œ‹–£ — „Ž‘  ‹ˆŽƒƒ–‘” ˜‹• ‡”ƒŽǡ ‘ ’‡”‹–‘‹–£ ’Žƒ•–‹ £ǡ ƒ†‡œ‹˜£ǡ Á ƒ”‡ •—– ‹–‡”‡•ƒ–‡ ‡ —Žǡ ƒ”‡Ž‡ ‡’‹’Ž‘‘ǡ ƒ•‡ †‡ ‹–‡•–‹ •—„ጔ‹”‡ǡˆ‹šƒ–‡’”‹–”Ǧ‘‹–‡•£”‡ƒ ጔ‹‡ˆ‹„”‹‘‹†£ƒ†‡”‡ጔ‹ƒŽ£è‹Á ƒ”‡•‡ ”‡ì‹ƒ’—”—Ž‡–£‡•–‡ ƒ„•‡–£ •ƒ— 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”‡‘—”‡–‡”ƒŽ£†”‡ƒ’–£ǤȋͳǡʹȌ  Š‘‰”ƒˆ‹ƒƒ„†‘‹ƒŽ£’‘ƒ–‡˜‹œ—ƒŽ‹œƒÁ’‡•–‡ͺͲΨ†‹ ƒœ—”‹ƒ’‡†‹ ‡Ž‡‹ˆŽƒƒ–•—„ ˆ‘”ƒ —‡‹ •–”— –—”‹ –—„—Žƒ”‡ ˆ£”£ ’‡”‹•–ƒŽ–‹ £ǡ ‡ ‘’”‡•‹„‹Ž£ǡ — — Ž—‡ ‡–”ƒŽ †‹Žƒ–ƒ– †‡Ž‹‹–ƒ–†‡‘•–”— –—”£ƒ‹‡ Š‘‰‡£•’”‡‹–‡”‹‘”Ȃ— ‘ƒ•ƒǡ’‡ƒŽ‘ —”‹Á–”‡”—’–£ȋͷȌ狃Ž–ƒ •Žƒ„‡ Š‘‰‡£Áƒˆƒ”£Ǧ”‡•–—Ž’‡”‡–‡Ž—‹ ‡†‡ƒጔ‹ƒ–ǡ ”‡è–‡”‡ƒ‡ Š‘‰‡‹–£ì‹‹ ‰”£•‹‹‹ †‹ Œ—” è‹ ’”‡œ‡ìƒ Ž‹ Š‹†—Ž—‹ †‡ ”‡ƒ 싇 Á ˜‡ ‹£–ƒ–‡ƒ ƒ’‡†‹ ‡Ž—‹ ‹ˆŽƒƒ–ǡ ƒ •‡ †‡ ‹–‡”‡•ƒ”‡ ’‡”‹–‘‡ƒŽ£ǤȋͺȌƒŽ‘ƒ”‡ƒ†‹ƒ‰‘•–‹ £ƒ‡ Š‘‰”ƒˆ‹‡‹•‡”‡†— ‡‘†ƒ–£ —’‡”ˆ‘”ƒì‹ƒƒ’‡†‹ —Žƒ”£Ǥ ȋͷȌ ‡ †‡ ƒŽ–£ ’ƒ”–‡ǡ ‡šƒ‡—Ž —Ž–”ƒ•‘‘‰”ƒˆ‹  ’‘ƒ–‡ ‡˜‹†‡ጔ‹ƒ £”‹”‡ƒ ‰ƒ‰Ž‹‘‹Ž‘” ‡œ‡–‡”‹ ‹ ç‹ Á‰”‘烔‡ƒ ’‡”‡–‡Ž—‹ ‹Ž‡ƒŽ Á ‡–‡”‹–ƒ „ƒ –‡”‹ƒ£ — Yersinia enterocolitica •ƒ— Campylobacter jejuniǡ ‡‡ƒ ‡ ’‘ƒ–‡ ‡˜‹–ƒ ‘ ƒ’‡†‹ ‡ –‘‹‡ ‹—–‹Ž£Ǥ  ‘‰”ƒˆ‹ƒ ’‘ƒ–‡ǡ †‡ ƒ•‡‡‡ƒǡ ‡š Ž—†‡ †‹˜‡”–‹ —Ž‹–ƒ ‡ ƒŽ£ ’”‡ — ç‹ ’ƒ–‘Ž‘‰‹ƒ ”‡‘—”‡–‡”ƒŽ£ •ƒ— ƒˆ‡ 싗‹Ž‡ ƒ‡š‹ƒŽ‡Žƒ•‡š—Žˆ‡‹‹Ǥȋ͵ǡͺȌ ‘‘‰”ƒˆ‹ƒ ‘’—–‡”‹œƒ–£ȋȌ”£Ÿ‡‘‡š’Ž‘”ƒ”‡†‡‡š ‡’ጔ‹‡ǡ”‡œ‡”˜ƒ–£ ƒœ—”‹Ž‘” — •‹’–‘ƒ–‘Ž‘‰‹‡ ƒ–‹’‹ £ ç‹ †ƒ–‡ ’ƒ”ƒ Ž‹‹ ‡ ‡”‡Ž‡˜ƒ–‡ǡ —–‹Ž£ ƒ‹ ƒŽ‡• Žƒ ’ƒ ‹‡ì‹‹ Á ˜Ÿ”•–£ǡ ’‡–”— ‡š Ž—†‡”‡ƒ —‘” ’”‘ ‡•‡ –—‘”ƒŽ‡ •‹–—ƒ–‡ Á ˆ‘•ƒ ‹Ž‹ƒ £ †”‡ƒ’–£ǡ ƒ ‹• Š‡‹‡‹ ‡œ‡–‡”‹ ‡ •ƒ— ƒ ƒˆ‡ 싗‹Ž‘” ‰‡‹–‘—”‹ƒ”‡ǡ ‹ƒ” Žƒ ‘’‹‹ ’‡–”— †‹ƒ‰‘•–‹ —Ž †‹ˆ‡”‡ì‹ƒŽ — ƒ†‡‹–ƒ ‡œ‡–‡”‹ £Ǥ ȋ͵ǡ͸Ȍ –‹Ž‹œƒ”‡ƒ •—„•–ƒጔ‡‹ †‡ ‘–”ƒ•– ƒ•‹‰—”£ ‘’ƒ ‹ˆ‹‡”‡ƒ ‡ —Ž—‹ ç‹ ƒ•‡Ž‘”‹Ž‡ƒŽ‡ǡ ‡‡ƒ ‡’‡”‹–‡†‹ˆ‡”‡ጔ‹‡”‡ƒŽ‘”†‡ƒ’‡†‹ ‡Ǥƒ”‡‘”‹ǡƒ‹‡•–‡—–‹Ž‹œƒ–£’‡–”— †‹ˆ‡”‡ì‹‡”‡ƒ †‹–”‡ ’Žƒ•–”‘—Ž ƒ’‡†‹ —Žƒ” è‹ ˆ‘”ƒ •ƒ ƒ„ ‡†ƒ–£Ǥ ȋͷȌ ‘‘‰”ƒˆ‹ƒ ‘’—–‡”‹œƒ–£ ‡•–‡ ‘–”ƒ‹†‹ ƒ–£ Žƒ‰”ƒ˜‹†‡ †ƒ–‘”‹–£ ‡ˆ‡ –—Ž—‹ –‡”ƒ–‘‰‡ è‹ ”‡è–‡”‹‹ ”‹• —Ž—‹ †‡‡‘’Žƒœ‹‹Š‡ƒ–‘Ž‘‰‹ ‡Á ‘’‹Ž£”‹‡ǤȋͳͺȌ šƒ‡—Ž ‹ƒ‰‹•–‹  ’”‹ ”‡œ‘ƒì£ ƒ‰‡–‹ £ ȋ Ȍǡ ƒ”‡ •‡•‹„‹Ž‹–ƒ–‡ è‹ •’‡ ‹ˆ‹ ‹–ƒ–‡ ƒ’”‘’‹ƒ–£ –‘‘‰”ƒˆ‹‡‹ ‘’—–‡”‹œƒ–‡ǡ è‹ †‡è‹ ‡•–‡ ‘ ‡š’Ž‘”ƒ”‡ ƒ‹ • —’£ ‡•–‡ ‹†‹ ƒ– ƒ ˆ‹ —–‹Ž‹œƒ–£ƒ–— ‹ Ÿ†”‹• —Ž‹”ƒ†‹‡”‹‹‡•–‡ˆ‘ƒ”–‡ƒ”‡ȋŽƒ ‘’‹‹•ƒ—Á•ƒ” ‹£ȌǤȋ͸ǡͳͻȌB•ƒ” ‹£ǡ — •‡ ˆ‘Ž‘•‡è–‡ ‰ƒ†‘Ž‹— ‹–”ƒ˜‡‘• ’‡–”— £ –”ƒ˜‡”•‡ƒœ£ ’Žƒ ‡–ƒ è‹ ’‘ƒ–‡ ˆ‹ ’‡”‹ —Ž‘• ’‡–”—ˆ£–ǤȋʹͲȌ ƒ’ƒ”‘• ‘’‹ƒ‡š’Ž‘”ƒ–‘”‹‡–‹†‡ •£ †‡˜‹£ —œ—ƒŽ£ Á ƒœ—”‹Ž‡ †‡ •—ˆ‡”‹ì£ ƒ„†‘‹ƒŽ£ ƒ —–£ǡˆ‹‹†‡•‡ì‹ƒŽ£Á‡š Ž—†‡”‡ƒ’”‘ ‡•‡Ž‘”†‡‹Ž‡‹–£ǡ–‹ˆŽ‹–£ǡƒ’ƒ–‘Ž‘‰‹‡‹‰‹‡ ‘Ž‘‰‹ ‡•ƒ—ƒ 7 Cap. 12 Apendicele cecal ƒŽ–‘” ƒ—œ‡ †‡ ƒ„†‘‡ ƒ —–Ǥ B ƒœ—Ž ƒ’‡†‹ ‹–‡‹ ƒ —–‡ǡ Á ƒˆƒ”ƒ ‘ˆ‹”£”‹‹ †‹ƒ‰‘•–‹ —Ž—‹ ’‡”‹–‡è‹’”ƒ –‹ ƒ”‡ƒƒ’‡†‹ ‡ –‘‹‡‹Žƒ’ƒ”‘• ‘’‹ ‡Ǥȋͳǡ͵ǡʹͳȌ  Diagnosticul formelor particulare de apendicită acută ’‡†‹ ‹–ƒƒ —–£‡•–‡ ‡ƒƒ‹ˆ”‡ ˜‡–£—”‰‡ጔ£ƒ„†‘‹ƒŽ£Ǥ‹ƒ‰‘•–‹ —Ž†‹ˆ‡”‡ì‹ƒŽƒŽ •‹†”‘—Ž—‹ ƒŽ‰‹  ƒ„†‘‹ƒŽ ƒ —– ‡•–‡ —‡‘”‹ †‹ˆ‹ ‹Ž †‡ ‡ˆ‡ –—ƒ– Š‹ƒ” ç‹ ’‡–”— Š‹”—”‰‹‹ ‡š’‡”‹‡–ƒጔ‹Ǥ B ’Ž—•ǡ ‘”‡ –‹–—†‹‡ƒ è‹ ’”‡ ‘ ‹–ƒ–‡ƒ †‹ƒ‰‘•–‹ —Ž—‹ ç‹ ƒ‹ ƒŽ‡• ƒ †‡ ‹œ‹‡‹ –‡”ƒ’‡—–‹ ‡‹‡†‹ƒ–‡‡•–‡†‡ƒš‹£‹’‘”–ƒጔ£Áƒƒ‰‡‡–—Žƒ’‡†‹ ‹–‡‹ƒ —–‡Ǥ ‹ƒ‰‘•–‹ —Ž ƒ’‡†‹ ‹–‡‹ ƒ —–‡ •‡ „ƒœ‡ƒœ£ Á ‘† ‡•‡ጔ‹ƒŽ ’‡ –ƒ„Ž‘—Ž Ž‹‹ ǡ ‹˜‡•–‹‰ƒጔ‹‹Ž‡ †‡ Žƒ„‘”ƒ–‘” ˆ‹‹† —–‹Ž‡ ˆ‹‡ ’‡–”— ‘ˆ‹”ƒ”‡ƒ •—’‘œ‹ጔ‹‡‹ Ž‹‹ ‡ ˆ‹‡ ’‡–”— ‡š Ž—†‡”‡ƒ ƒŽ–‡‹ ’ƒ–‘Ž‘‰‹‹Ǥ ‹ˆ‹ —Ž–£ì‹Ž‡ †‡ †‹ƒ‰‘•–‹  ƒ’ƒ” ƒ–— ‹ Ÿ† –ƒ„Ž‘—Ž Ž‹‹  Á„”ƒ £ ˆ‘”‡’ƒ”–‹ —Žƒ”‡†‡–‡”‹ƒ–‡†‡Ž‘ ƒŽ‹œƒ”‡ǡ˜Ÿ”•–£ǡ•–ƒ”‡ˆ‹œ‹‘Ž‘‰‹ £ȋ‰”ƒ˜‹†‹–ƒ–‡Ȍǡ‘’‡”ƒì‹‹Á ƒ–‡ ‡†‡–‡ȋƒ’‡†‹ ‹–ƒ’‡„‘–ƒ’‡†‹ —Žƒ”ȌǤ  Forme particulare de apendicită acută după sediul apendicelui  •‹†”‘ †—”‡”‘• ƒ„†‘‹ƒŽ ˆ£”£ ‹’Ž‹ ƒ”‡ƒ Á ‘† •’‡ ‹ƒŽ ƒ ˆ‘•‡‹ ‹Ž‹ƒ ‡ †”‡’–‡ –”‡„—‹‡ •£ ‘”‹‡–‡œ‡ †‹ƒ‰‘•–‹ —Ž £–”‡ ƒŽ–£ ’ƒ–‘Ž‘‰‹‡ •ƒ— •£ ‡š Ž—†£ ‘ ƒ’‡†‹ ‹–£ ƒ —–£ — •‡†‹—’ƒ”–‹ —Žƒ”Ǥ Apendicele retrocecal Ǧ ’”‘ ‡•—Ž ‹ˆŽƒƒ–‘” ƒ’‡†‹ —Žƒ” •‡ †‡œ˜‘Ž–£ Á •’ƒጔ‹—Ž ”‡–”‘’‡”‹–‘‡ƒŽǤ —”‡”‡ƒ •’‘–ƒ£ ‹”ƒ†‹ƒœ£ •’”‡ ˆŽƒ —Ž †”‡’–ǡ ”‡‰‹—‡ƒ Ž‘„ƒ”£ †”‡ƒ’–£ǡ ”‡ƒ•–ƒ ‹Ž‹ƒ £ †”‡ƒ’–£ •ƒ— ‘”‰ƒ‡Ž‡ ‰‡‹–ƒŽ‡ ‡š–‡”‡Ǥ ƒ ’ƒŽ’ƒ”‡ •‡‡Ž‡ ’‡”‹–‘‡ƒŽ‡ Ž‹’•‡•  ‹ƒ”†—”‡”‡ƒ˜ƒˆ‹”‡•‹ጔ‹–£†‡ƒ•—’”ƒ ”‡•–‡‹‹Ž‹ƒ ‡†”‡’–‡ǡ —„‘Žƒ˜—Žƒç‡œƒ–Á†‡ —„‹–Žƒ–‡”ƒŽ •–Ÿ‰Ǥ‹’–‘ƒ–‘Ž‘‰‹ƒ’‘ƒ–‡ˆ‹Á•‘ጔ‹–£†‡•‡‡—”‹ƒ”‡ç‹†‡•‡†‹‡–—”‹ƒ”‘†‹ˆ‹ ƒ–‹ƒ” „‘Žƒ˜—Žƒ”‡–”ƒœ‹–‹–‡•–‹ƒŽ‘”ƒŽǤ Apendicele mezoceliac ‡•–‡ •‹–—ƒ– Á „ƒœƒ ‡œ‡–‡”—Ž—‹ǡ Á–”‡ ƒ•‡Ž‡ †‡ ‹–‡•–‹ •—„ጔ‹”‡ǤŸ†•‡‹ˆŽƒ‡ƒœ£ƒ’‡†‹ ‡Ž‡‡•–‡Á ‘Œ—”ƒ–†‡ƒ ‡•–‡ƒ•‡ ƒ”‡•‡ƒ‰Ž‘‡”‡ƒœ£Á Œ—”—Ž •£— ‡Ž †‡˜‡‹† ƒ•–ˆ‡Ž ‰”‡— ƒ ‡•‹„‹Ž ’ƒŽ’£”‹‹ ƒ„†‘‹ƒŽ‡ •ƒ— ’‡ ƒŽ‡ ”‡ –‘Ǧ˜ƒ‰‹ƒŽ£Ǥ šƒ‡—Ž Ž‹‹  ‡•–‡ ‡ ‘ Ž—†‡–ǡ ’”‡†‘‹£ •‡‡ †‡ ‘ Ž—œ‹‡ ‹–‡•–‹ƒŽ£ — ‡˜‘Ž—싇 ‹•‹†‹‘ƒ•£Ǥ „•‡ìƒ ‹–‡”˜‡ì‹‹Ž‘” Š‹”—”‰‹ ƒŽ‡ ƒ„†‘‹ƒŽ‡ Á ƒ–‡ ‡†‡–‡ è‹ ƒ•‘ ‹‡”‡ƒ •‹†”‘—Ž—‹ˆ‡„”‹Ž’‘ƒ–‡‘”‹‡–ƒ†‹ƒ‰‘•–‹ —Ž £–”‡ƒ’‡†‹ ‹–ƒƒ —–£‡œ‘ ‡Ž‹ƒ £Ǥ Apendicele pelvin - †—”‡”‡ƒ’‘ƒ–‡ˆ‹”‡•‹ጔ‹–£Á”‡‰‹—‡ƒ•—’”ƒ’—„‹ƒ£•ƒ—Á’‡Ž˜‹•Ǥ ‡‡Ž‡ƒ„†‘‹ƒŽ‡•—–•£”ƒ ‡’”‡†‘‹Ÿ† ‡Ž‡’‡Ž˜‹‡Ǥ‘Žƒ˜—Žƒ —œ£†‹•—”‹‡ç‹–‡‡•‡ ˜‡œ‹ ƒŽ‡•ƒ—–‡‡•‡”‡ –ƒŽ‡Á•‘ጔ‹–‡†‡ˆƒŽ•‡• ƒ—‡— ‘ƒ•‡Ǥ‹ƒ‰‘•–‹ —Ž‡•–‡†‹ˆ‹ ‹ŽǡÁ‘† ’ƒ”–‹ —Žƒ”ǡŽƒˆ‡‡‹•‡‹‘Ž‘‰‹ƒ’—–Ÿ†—è‘”†— ‡Žƒ ‘ˆ—œ‹‹ —‘ƒˆ‡ 싗‡‰‡‹–ƒŽ£ǡ —ƒ–Ÿ–ƒ‹ —Ž– — Ÿ–ƒˆ‘•–†‡• ”‹•£‹ˆŽƒƒì‹ƒ ‘—£ƒƒ’‡†‹ ‡Ž—‹è‹‘˜ƒ”—Ž—‹†”‡’–ȋˆŽ‹”–ƒ’‡†‹ —Ž‘Ǧ ‘˜ƒ”‹ƒ‹‡—Žƒˆ‘›ȌǤBƒ ‡ƒ•–£Ž‘ ƒŽ‹œƒ”‡ǡ†—”‡”‡ƒŽƒ”‘–ƒì‹ƒ‹–‡”£ƒ ‘ƒ’•‡‹ˆŽ‡ –ƒ–‡’‡„ƒœ‹ (semnul obturatorului)’‘ƒ–‡•‡ƒŽ‹œƒ’”‡œ‡ìƒ‹ˆŽƒƒì‹‡‹ƒ’‡†‹ —Žƒ”‡Ǥƒ„£”„ƒì‹ƒˆ‘•– †‡• ”‹•£ è‹ ƒ• ‡•‹‘ƒ”‡ƒ –‡•–‹ —Ž—Ž—‹ †”‡’–ǡ ’”‹ ‘–”ƒ –—”ƒ —è Š‹—Ž—‹ ”‡ƒ•–‡” †‡–‡”‹ƒ–£†‡‹”‹–ƒì‹ƒ†‡˜‡ ‹£–ƒ–‡ƒ——‹ƒ’‡†‹ ‡’‡Ž˜‹‹ˆŽƒƒ–ǤȋʹʹȌ Apendicele subhepatic ǦŽ‘ ƒŽ‹œƒ”‡ƒÁƒŽ–£ǡ•—„Š‡’ƒ–‹ £ƒƒ’‡†‹ ‡Ž—‹ ‡ ƒŽ†‡–‡”‹£ —•‹†”‘†—”‡”‘• ‡’‘ƒ–‡‹ƒ‘ ‘Ž‡ ‹•–‹–£ƒ —–£ǡ‘ƒˆ‡ 싗‡Š‡’ƒ–‹ £•ƒ—”‡ƒŽ£Ǥ‡‘”‹ •‡’‘ƒ–‡ƒ•‘ ‹ƒ Š‹ƒ”——è‘”•—„‹ –‡”• Ž‡”ƒŽȋ•‡†‡• ”‹•†‡ ƒŽƒ‰—‹‡”ǡ‹ƒ”Žƒ‘‹†‡•ƒ˜ƒ–—Ž ”‘Ÿ‘‡ƒ”—Ǧ£’Ž‡• —ȌǤȋʹʹȌ Apendicele în fosa iliacă stângㆇ–‡”‹£—–ƒ„Ž‘— Ž‹‹ ‘„‹è—‹–†ƒ”Ž‘ ƒŽ‹œƒ– Á •–Ÿ‰ƒè‹ ƒ”‡ǡÁƒ„•‡ìƒ——‹†‹ƒ‰‘•–‹ ƒ–‡”‹‘”†‡•‹–—•‹˜‡”•—•–‘–ƒŽ•ƒ—‹ ‘’Ž‡–ǡ’‘ƒ–‡ ˆ‹ ’—• ’‡ •‡ƒƒ —‡‹ †‹˜‡”–‹ —Ž‹–‡ •‹‰‘‹†‹‡‡Ǥ šƒ‡—Ž ”ƒ†‹‘Ž‘‰‹  ƒ„†‘‹ƒŽ è‹Ȁ•ƒ— –‘”ƒ ‘’—Ž‘ƒ”’‘ƒ–‡ƒŒ—–ƒŽƒ’”‡ ‹œƒ”‡ƒ†‹ƒ‰‘•–‹ —Ž—‹ƒŽˆ‘”ƒì‹‡‹’”‡‘’‡”ƒ–‘”Ǥ Apendicita herniară. ‘ ƒŽ‹œƒ”‡ƒƒ’‡†‹ ‡Ž—‹ ‡ ƒŽÁ•ƒ —ŽŠ‡”‹ƒ”’‘ƒ–‡†‡–‡”‹ƒǡ Á ‘†‹ì‹‹Ž‡——‹’”‘ ‡•‹ˆŽƒƒ–‘”ƒ —–ǡ ‘ˆ—œ‹ƒ —‘Š‡”‹‡•–”ƒ‰—Žƒ–£•ƒ— Š‹ƒ” ‘’Ž‹ ƒ–£ —ˆŽ‡‰‘—Ž’‹‘•–‡” ‘”ƒŽǤ‹ˆ‡”‡ì‹‡”‡ƒ˜ƒˆ‹”‡ƒŽ‹œƒ–£‹–”ƒ‘’‡”ƒ–‘”Žƒ†‡• Š‹†‡”‡ƒ•ƒ —Ž—‹†‡ Š‡”‹‡ǡ Á ƒ„‡Ž‡ •‹–—ƒì‹‹ ˆ‹‹† ˜‘”„ƒ †‡ ‘ —”‰‡ì£ ‘’‡”ƒ–‘”‹‡Ǥ ‡ƒ ƒ‹ ˆ”‡ ˜‡–£ ˆ‘”£ †‡ 8  Chirurgie-Curs pentru studenți Š‡”‹‡ ƒ”‡ ‘ì‹‡ ƒ’‡†‹ ‡ ‡ ƒŽ ‡•–‡ ‡ƒ ˆ‡—”ƒŽ£ †”‡ƒ’–£ǡ —”ƒ–£ †‡ Š‡”‹ƒ ‹‰Š‹ƒŽ£ †”‡ƒ’–£ ȋŠ‡”‹ƒ ›ƒ†Ȍǡ †ƒ” ƒ— ˆ‘•– ‘–ƒ–‡ ƒœ—”‹ †‡ ƒ’‡†‹ ‹–£ Á •ƒ —Ž †‡ Š‡”‹‡ ‘„‹Ž‹ ƒŽ£ǡ ‘„–—”ƒ–‘”‹‡ •ƒ— Š‹ƒ” ‹‰Š‹ƒŽ£ •–Ÿ‰£ǡ Á ƒœ †‡ •‹–—• ‹˜‡”•—•ǡ ƒŽ”‘–ƒì‹‡ †‡ ‡œ‡–‡”•ƒ— ‡ ‡š–”‡†‡‘„‹ŽǤȋͳȌȋʹ͵Ȍ  Forme particulare de apendicită acută după vârsta bolnavului: La vârstele miciǡ„‘ƒŽƒ‡•–‡ˆ‘ƒ”–‡ ‰”ƒ˜£ǡ †‡‘ƒ”‡ ‡†‹ƒ‰‘•–‹ —Ž‡•–‡†‹ˆ‹ ‹Žǡ’”‹–”Ǧ— –ƒ„Ž‘— Ž‹‹  ƒ–‹’‹  †‘‹ƒ– †‡ ˆ‡„”£ ƒ”‡ ç‹ ˜£”•£–—”‹ ˆ”‡ ˜‡–‡ǡ ‘ ƒƒ‡œ£ è‹ — ‡šƒ‡ ‘„‹‡ –‹˜ †‹ˆ‹ ‹Ž †‡ ‡ˆ‡ –—ƒ– Žƒ ‘’‹‹ǡ Á ‰‡‡”ƒŽǡ ‰”‡— ‘‘’‡”ƒì‹Ǥ B ’Ž—• ‡˜‘Ž—싃 ‹ˆŽƒƒì‹‡‹ £–”‡ ‰ƒ‰”‡£ è‹ ’‡”ˆ‘”ƒጔ‹‡ •‡ ˆƒ ‡ ƒ‹ ”ƒ’‹† ‹ƒ” ‹•–ƒŽƒ”‡ƒ ’‡”‹–‘‹–‡‹ †‹ˆ—œ‡ ƒ’ƒ”‡ ƒ‹ ˆ”‡ ˜‡–ǡ †‡‘ƒ”‡ ‡ Žƒ ‘’‹‹ ƒ”‡Ž‡ ‡’‹’Ž‘‘ ‡•–‡ ‹ ‘’Ž‡– †‡œ˜‘Ž–ƒ– ‹ƒ” ƒ’ƒ ‹–ƒ–‡ƒ ’‡”‹–‘‡—Ž—‹ †‡ ƒ Ž‘ ƒŽ‹œƒ ‹ˆ‡ ጔ‹ƒ ‡•–‡ ƒ‹ ‹ £Ǥ ‹’–‘ƒ–‘Ž‘‰‹ƒ ç‹ ‡šƒ‡—Ž Ž‹‹  ’‘– ˆ‹ ‡ ƒ”ƒ –‡”‹•–‹ ‡ǡ‹ƒ”†—”‡”‡ƒ•‡’‘ƒ–‡”‡‹–‡•’‘–ƒǤ‡”‡‰—Ž£ǡ•‡”‡ ‘ƒ†£‘’‡”ƒጔ‹ƒŽƒ ‡Ž ƒ‹‹ †—„‹—ǡ”‹• —ŽÁ–Ÿ”œ‹‡”‹‹–”ƒ–ƒ‡–—Ž—‹ Š‹”—”‰‹ ƒŽˆ‹‹†—Ž–ƒ‹ƒ”‡†‡ ƒ– ‡ŽƒŽ—‡‹ ‹–‡”˜‡ጔ‹‹‹—–‹Ž‡Ǥ La vârstniciǡƒ’‡†‹ ‹–ƒƒ —–£’‘ƒ–‡ˆ‹†‡ƒ•‡‡‡ƒƒ‹‰”ƒ˜£ ‘’ƒ”ƒ–‹˜ —ƒ†—Ž–—Ž –Ÿ£”ǡ †‡‘ƒ”‡ ‡ ƒ’ƒ ‹–ƒ–‡ƒ †‡ ƒ’£”ƒ”‡ ç‹ ˆŽ—š—Ž •ƒ‰˜‹ • ƒ†ǡ ‹ƒ” ‡˜‘Ž—ጔ‹ƒ •’”‡ ’‡”ˆ‘”ƒጔ‹‡ ç‹ ’‡”‹–‘‹–£‡•–‡ˆ”‡ ˜‡–£Ǥ‡‡Ž‡Ž‘ ƒŽ‡†‡ƒ’£”ƒ”‡•—–”‡†—•‡ǡ‹ƒ”•‡‡Ž‡‰‡‡”ƒŽ‡ȋˆ‡„”ƒǡ Ž‡— ‘ ‹–‘œƒȌ •—– ƒ‹ ’—ጔ‹ ‹–‡•‡Ǥ ‡‘”‹ ‘•—Ž–—Ž Š‹”—”‰‹ ƒŽ ’‘ƒ–‡ ˆ‹ Á–ƒ”œ‹ƒ– ’”‹–”Ǧ‘ ƒ†”‡•ƒ„‹Ž‹–ƒ–‡ ƒ‹ ”‡†—•£ •ƒ— ’‘ƒ–‡ ˆ‹ Á‰”‡—ƒ– †‡ ƒ•‘ ‹‡”‡ƒ ƒŽ–‘” ƒˆ‡ 싗‹ ƒ”‡ ƒŽ–‡”‡ƒœ£ •–ƒ”‡ƒ ‰‡‡?