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a'
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;:it'tnii
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d* rnl:qrc*1li:zii s,* *rai *iei;nrerizfr inci
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irnnnorleprirtrlati
{ex.:
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{d*si
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bac:terii mesir*eifice. p* meetiu Sah*ur*ud pcmtrc.l Can<triela albi**ns *to"
Chiaruvdia trachoniatjs, {-ireaptasrn* ur:ca$ticrmn
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q:t-risnuita::
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fi ide*tifreai*r g:e cuifur:
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fi;ir* ex,'idefitiazfi nuanleroas* ieei,;ocite p*iimrcrf*nuclaae-e si **r:i {i,rarm
n*gatiei dispusi lrr
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- l,'erle1'!roie Jrlrat:ai:e cu
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musctrii p$fifis eu rnargiml* lor 6:l1i${11s'Il':rtr *P$cnfttfl
- oasele iliaci:
- marg,inea sup*rtoarfi a sfunficei
pi'ibiene
'i1' '":::'
f
''!
t-
L
l--
l--
t--
l--
l_-
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l_
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:
i:ur; r:";rt.li e:gl'i:"{ja r*n *i;l si;'l-r'BI Ii :l r: r tir dia rfi :
*
;q:fit*nlcil*. cn5;l*ns;i si satu;rtii* dlri*l:i!*t
*
*:w:rtu alc X'': iin asjr'Ii rarf i llgi:afi cc l tlplaadft ilga [e
-1
. i.ift []'i +It i\i:i.ij,' i I.i T i;|,"1.Yii i.,,i {-} A5 :rr
- *ntr.* ii*;r *la.l fls,;,r+l'iitfr rne;t*df;. da *xn1r-rrat'*, ri apara't"r-ilui r*nr-:-lrrtlierr:--srfll:1*ai
.-
1i*r"tvui*
sf'*riiei:ca r:i:u**tjvii e {i.tt;uiiiitr *Si}qx: fii-'l-tu}ii; srytei{*;t;'*
iir*grefr;i tLrl,rar,*:ni.i;l"q5 s'; r:'ib+ttle*rr! rrur sati:ti[set,* c1* r:*ntt'ai;f itliiate. fuirtl'*ls.*llth{i*,
;iti,i ;111. Fn:licl.tladasi*a e1+ n S *lhraiir*r* sgl*;-lirr r:r ratriri g::*: r"iniah-i.
i:ii.il-",siii*iei* tir sr;r'r[t':pi i,;ilirier p*i ]:: iiinii.r si l;u:i,ixl-lc*.
r*le:i;
i*;rde* d**j- lti-iil,l.[;'it,-, rri r]:i*i.ifi{*.
i.-lijiiz;rr--.:
1*:: t:+t* iiitr t'a ?s: c* *rai rr,'rti"xrtsa
Ilimtl'* sr-li-:irtardsl* i-.iq$*r c*i r?3aj. fi*:t;1,;::it s'*: eiiiiizr;l:r;l A.t n,*j
'JrXistsr*lli
iitl
.;:;r;ur:rE;:;litle
iir.; ?501i,i, pr<.rilil* tlti*diil u-ir:sf*l ria bitle tsi*l;lt ll*
"h*lruwi.
ras f-iro$:*ilrui
Ttit'i r'ia* 4ilc*
I")i*fr:* *:bsfsltL':l',r il*i-i:nir:e" fir#"i itiilii L e:;ii: {ii*:ar,i.qir*.
F,r;euri: Jt,i'".':,;
ui
;:rrl
fi
,;!;.
iji{r:i:iii.1ti rliirri.t:.
- il $u al? : grr'i i l.r. rlltl i,rl'fl . xl'atrsi-*i l atii. itili i ad r:. i;ri ri cne'c-tic.
-
.;1i!l,,i;l
ail*i'alea stfrrii gerr*i':ll,:" vErs5n+ri" dimi:*" hip+.t**si*.nilr" FiLic'iltri;a
(i1r"fl{}sdn}1,;i,
f.tili:u::ad rorptret+rii pixr eil*m gi*f.i*,
gg},i:!$?fi
hyflitsi+.
- fr;;i;'i,., i5"i:1.'ri. i"tr,1: car-c'li*i';stlti',li{ri'- -*ii".
uiii!. l,;nrl.
.Prolila-.ii* r*ectfflct" ;?{hu,er:+* culrx[i" ;rr *l*trui
-r'jinci.
i* l',;spr,'ciatu;i t-iqiliL]alifr il
u'.1:l:';ii:iiii.*iUtrr:l :iti.'
I-r:ri l:
-'
ui.rmlidniiicatii a [:is *1 u t
-"
- itt sulici*iris !-1;ri; i'ti{.r -;'un ai i:
' l.r;l'; i:rrnir:niu
- **:rtiafuidlq;*iii iu:]aii1,e
*
itrfnX*r*.ntr la ic,d
is*
r;* ei'e+ftifi tiat*I?i*rlir;lfifil-rgfilfiri*ic ei
;miii;ti;:"gt-r,t
- heiii ;,ri*rgic*
- insxr tj e-i ei?t:-r c ;vrrii*re spiratr:i:lr: ( s + v;r *fe c{ur+ tr' -tasrE*mt
^ -..-1i,,:,-*i-.',
L d: u-tt,'rul [1-
I
*
h*i;qh Basr-iiitt.'
:i(r *ollti'{iiJicli,,i r-rr<!r+ic;r iurn*ii "+i'*ril!c ri a pr*dusullii d;
r.,+i1c*:;iiq.
ilii*titat*",a d* str?rstarrfB d* c+mtrast utiljzeti
n:eu'aru
* *r*gl';'r.{i* i.v^
nariav*
Ie ,xei*}li
r
ltti!';-. 1i.r-]ti
(lft
.
]."1:;rlil:t,:nr:tr urograt?c tr+tuni*
;:rr'*c;,jal
.i*
*fi;cfuar*a utrti ttrii,-r,4i'afii rcn;tli: ailr:ple
t]*irtflu
a d*s*,*Fcd elenlil"rii
'-:;lle,nrli
sa$ altt ibnuatH ;ii *Eprcelr 1"66!ii;i,';aic5
qiir*i:ili"
iar
1:r';
ciu ;rltl
ilili,.i
si
'-';:r-ifi1'q:
;cr"Xjltirle ieh;^,i;l
,l.i'rii
*-ili!:;, it:.'fE:iI !i:
-:.r:t
Lr\r,L{ltA ril'r,q:"1,iifi.
ii-r- ec*i:r** dureaii$ 2*4 ;:rrirrule.
Tilit::a el;.piil)6rc ss faco ia 5-7 ndn*te itnp3 ierrnifiaroa injeeffr:*i sui:r*tant*i tl*
i:q-"rntfagt.
tr--lnnfrt*are+ exp,rlriere s* ef'eotueazfi tra 15 tlinute rluph rnie,:t;ire. Se
i:ol
electtia si
rilrli*grafii iarcli.,'s la 4fi-{rLi rniniltc.
'lu
cnnditiile tu}truir5riic,t^ele s*ct*ii* r*nst*.
i
l"
l_
t-
L-
I'
l
?.i
)
I
;
l--rslr-'r:r-'i si: uriijr*ani *-r:rys.r*fiit
i-)u *ti*.lEltusis';lir'sllt'tt5 it vri'q;Ir:l sirii}l'lii-aril
suileri*aic s ha:,:ifii.icl;.
,;.*
aiidq"rl-r.+1 urtu{ rii*pr;,ziii:i ad.tpfaf :re"r:rrtui si-;*p"
i:*rif-u
;r ali:*Hfi';t
irra;igqriiie,;al.L;t1,*r:.
?ra ;in;:tel*::
ti'srq:isssir15
;.
t
t
r
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r
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t* pl :sraf; ai rie* r;hii.l i l;.-'
I-li:*gtnfl;:
,:;ni;
iri.ii*,ili;l fu:l tuli:ur;il'i. ;r-is l;u:*.e'';t.io-i
*hsfaerri cr"a s,-ldiffil iit I:azii-irt" *rr-:ffli
'
v*ricfl, t"r*rtt:E'
tti.]hr:r"3d $ee.,l'*f.*r;; a#*ei;*.t.i: ex; tt;li:ulr'*ri r.l'e e:<';r*iir'
r*,rudt" ici f*lhr.er"tri ;11* *:tur*tii.:l
prir:
lli'dolittl
,qi ?n *rr:run tr::ii6i;{ii?ifii lifir:r
;rler rirri*ldaeitii im'*ir:'*pt*;x.
lii'd.;*:1li
,ii i* Irictliifi',iti'"'i; si
sN Ahr'EF,ilJE?;{F}&
Jt ffr-+frsr"le*:
F,a *sia li* iirg,*ffiujfi,.;l irrdi*#.[il lil a;Tsrrnaij; ti* tifotali*
,;rlfqrpii]"
i1i iuli:ma9-e fiill ;Ilj;iiltit.i.tluii
pi*"ki'*a[i':;a"t ri ai'"t tll'r]tijr*1{}il,
i*+-:aii.r;ll"r:a t?i"-,,;t"tl,ilr;r t:*ipi sf;:fril'ti {;*i;i*j*
efi1-1*r*1ix*d
'i'
t-l
ffi,E, T F:l Et {.F-t} E }i L{-} {i Et ;h F'i E',a ffi Sl'la ffi { } { iFt iX E}.4
,t<.i:r;:;itt,"3 in.;i*sr-lgati*
X-,rkr
*ar; se r:tr*u isaf*rlrmiii ci{l: fractili tll"1,1:it}!:
i:r{n
i*ier'i*Ttl**
iie; siii;starti+ cl* er.rq-i,itr'a-st irt sist,Jttlui ilr*E#1',-i.ilielg:*aljc*aj.
f-r, fune.r.i* dr iil,;cd de aefunildgtrar* ;ilsml:sia*i*i d* ,;;r:lria:s*;1,
r.r';tei"*Fiei6gynii*
1]11ffi'+
li: tr; ;r+r:*netcntit eau r*tr*gtail3 si ii d*sc*lidcrrti"
A,,ealiii u:-r,c.rt'igatl* r'epi"*intrr * nr*t**iE dial4ncsti*fr o*rnhi*a1.fi: l;rcli*iogiefi si
uigtvtrrt.}ental* {cisr u'+irtei;i }.
Iglgtiq,illtitls-t
r'i"i:i';r*pi*1*gr;*fi*i
!'= r*i:x"i:zkrtli :
i . l{;:iicXriu! fi:rut u:
q-'Y-i'i}-ik:
.1.. i',i*=.ri:,'riilli z*raa
r-ri'eteluiui tr* ul'"*gr;rfie
-1" Itt earuiin car* i-ll1i nt: * rtai. ixl's:ru1;:tij s:':trq:i*ltt*
t. Ei*t"nsttlris
{-it ririririt- *'u#ii
5. ]!::iaglli L;i:ri.r-are
persist*i:t* *rct*r;tle s*al
i:ia1*oa1-i';';;tir
{r. t-:itL.l"rgi; poziliirSi i**::plicai-..iiE
c*i.;csais rlin tr;rotxl i'il'iqi:$ sillillitiir
,I. Fisiule
r:i'cferai*
ii. ,iricrgji 1;r suhs.i*ni!- cie cclnrast aci1?r. i"v. ie
*aeierati
+u ur*t*!iu i*desul
Fr,:gEtirea
1:a*ientui*i
er:tr.' ac#sa$i ea si in ean* ei*lu:aeopi*i +tl.*.rn*&rkti$entrri
ea i*
siilratjiis irt i;ar* *:sistfr u;: dreaaj d*fi*i*u n] tractrefu"ri uii:l*r s$Lrsfr{it s* .1{iffiin:tistr*azE
aniihir-iiir;a isr*Lttr {tt1
F{otl*dz-ira.
m'm--*p6
*prrai*r s* mtrc.rJil* dir,ers{: tilrud r1* s*iu*s rgret*ril}*, i* i}lt*[t*
'-le
t*:*.na. *xsrcrxitfitii ,ir*tui* i.l*tund,*. s.irii;3" api-t:;+l3" tip fluir:r, tfu bultri si
,i* ii*al;t {laalit*;:'
E,_nro dor:s*hire r?e lsl*l*Xie ffilfi1o-1,yr) rti: insiruffixefttirie s tracfirkd
';ri-i.lar
t ca.tefsds?i1 i'ffi*t]'ri-
-.rozi*ai.
u,r*tr*eistr:ser.rpii:-
rn'*t*{i}$c*i:ii;i.
canil *st,; fi:i*s:l il:strure**farul eu iii;':i**nr-:i
c+l
inai mi* *.1', pe*rdrc a1in1r-crea :;e.*pmlui l.tx*ntigatiei. in e;izul ur*tr:r o-Pii;ir-igr";*ti*:
ir;
f*l,,s,Jsie o;rtt:teiu.l *u iliamretrul cet
qrai
naare car* $s adi:i:t*asfr p* hi:ii:l*tull ui:si*i:al'
ri*oax,eee
*crst*"
1-rc
mleura- arranriilrji d*slinde m$ci);6rja ui*tor*lll sc],lEail';1 risc*lt firl:"nfuii iie
+Si fals* sau do ine,;i$cir* a s*ndei in torlur:zil3triie iirtricrai* {xingfuing-ud},
u&:'rS i}{eslia
*:"ist3.
2r
ilsi,arr letrs5 s*:ae;iii:.i*ll:*ii cr:i $i*i ci*.s;n tr;li*rtuJ lntulue*r:;tj al'ur,;terui-tri" d* a***i;
r;t;xnxleiti'r-ri
il'olilaie sfr {i* t*;rffr, ;r{.*;:li ic utira,',ritie*re* sun*X*i in rii*at-rli $$etcran. ;,I"*easi*
*:eh*i* i$*.ut$ irr *.";uf tirdti:r-ailcri st crl
g.r:siuri
trljnd*" folosir:el r"1.sr?ht;i! sc5rita ,,ii;tcsc+uiijui.
Tt1 eaz*l in ;;;u'c
gr.litti;r
rrJ.l ;:'irii*$sii:3i si
;-.*,
lliLr;tt ;rl-]Elu sing,=, pr*eedui:;t ir*?:*i*: r:gr*trr
,-'t;tt;i':r,i
:'i1.,,.:!;.ll ilrli-.iii,t, i;i ll; r,;{'ti,;i'it!i.-. I'irrg;i i. i,;tt;:llnl,;r ii...,,-t}l iic t:ru-[i*n::
infi::;trlis';llE. ri
,;i;i:e
;l':.';rnsfi'
ll;*lft
il* hnn**i. agu*xlrriai.ii, 2*-:$ e*r" lu.cru sirr"r-]
gri r-;.,*df;*ii
gcn*:';li ;an'"11 sr $i$lid ii e'ci:^i:ltsrntli. nl; r*;iirrshuir: insisiat l.,rinrlcioiuct r:iajri rte rr:{'*c.i*al"o;r
t;ritil e,].ls*ur r*rtir:grafii, p*lliral ;: ai:rre+ie p,;zifie s{}n,jei ial,s de neper,:l* a*;lton:ica:" l}iic;j
u{iJii;';
":'.i
- l.'itt..
,-rn::lii<.'l:at;i
!'t=tl-;,-"1 [i"'
,-;;i-,iltli
ri *1e:-t.*., ]:r t,:ilrf [.; lr i;*;i
";ri.r
r, t!]i.iU,":is;-;:,j
eal prl.llil-l
,;i
,;*iplli
i-i urilur::rs;-t
'";.,"-rrl
traia*tukli ru"*,fr:ral. se im{*r*ia*z[ 5-1t] $-ri srjbsfa,fiui
ixiji*itL:ilca
(r;rpee'{t*.i',;l
fi"'lir:l*iJ"i*:ii * b.:rjx*i*}uli iu l*t*rir:;rri ;itr}&ril[iitt];
i;i,";lur;ali,;*,1.
i.ryarmr** iLetlxi;: fiiqrrlt5 e.ii ;tiii-- n*:-rrfi
r:r;
hlanrlo{i.-. ru:mlariri* fid;nir:is !r*}na",,-ului t
in'i*i}*,tt" Fi*rjc*iul {r-i':*l;ui ;-ir
;11,:iqis6s: - p* liin6:11. r!*res"e:
*
iX l*t:r";ri*iii i"l.c"xil d*
i,g{:f.rrii.qf'
u.iI;elrti*
1ri;1n+nii;..'iti5
ilnrir:si;snt;l
-;iniil:tr*i furi,i:ilrti il,;pii:,;'st,,: rll iil,-i]i lii rtiI Ulr i.:i,i.i li,!;rr
i:ilrl ;ti',-iiirl" ';i.'';i:r;illrlli-,,; il
il:Jirigj';i:ll;t.
l]*rrtl'ri "ri'btlrt.':'r,r
tiii.i.t'I'fit*'fi:Iii:i ni;ri lr,=l-rui.,
it:ir:;
j,;;i
i,..:lifa",'-r*
*liJiirili d;t ilti-rl,i;itrl;, ii.: +,-intrail I]f; ;':tisui;-.t t-'c r,iilli-|fi u-r-;tr,l;li;j +ri+ r-tll;r:;-i
;r:,i,il trr i!r mrr;ili+riirii
'-{r+tir-di
ln intrrr!{rn*. ,,,, rr0,r, fiXin
,;si,-
,;t*ciiiai.
I +;lr. ;t+c..;i:.r fi!irid
"i'*rr*ziin?.:i
triul ic * urr;1*r*-pi*i*$ *fr *ri d*:; e:,;riii** te.
tla-tp* vi;ltuliz;tt"i:a inir*prli-ti erp;Lrat c;riicc;-pi*1*;*i.rrsicr,etr" wr; fliln inilirxa[
ii;r
i
-i-,].ii
itlft:. rluXl#. **
'a:e*iectul
il ,l*st iifll*,tii sE stL';q in pici*ar* ei s,I se piimi:e].*si+
efa,rftlai.
-H-*tesltia
"qui:fita$tsi
rte cclnil:a-{t r}r c;lil,* xi-ic;ra-r s*pe.ru*ar:c p* fi}r:u'l taldirr est* palr:i+gi*f; st
i''i:'-:(.iil)i-:ni]'.i
1''[rtif
gi; gi;
Liietr;;:a'irj*i*gri#ia *sa*n*er:tfr u* r';a.lii:*;e:ot
"[:*iosirld
t;o*#e eu extre*ritala;a ir: fbl::ti
i-k' iiulir- L;i!-L' s.ii i;rri,iitr.,l,, ti[;ct ;rj ;',1:.tirii l;rrir.i*j
{.:i-tii{!;i
i'iior.,:l:lsui. ]ujrrla*j il:i::cil:$i; ;i;
sluii?;rei. ni*;reE;ir "u"scii". l.*:.rlir:iiriil ill-rii.rffiLl{*;i i.in*tri-*l"i"ti p*mii ia nii*1i-ll *i:sia*,:liiiui.
f;li,li trici i;i",.r- iiui itr,-.itir't*iuri.'l i)i.i:ir-
|)(rritri
rl;clria.
liEierir]
r';ali:ir i'i;.iiii;r=i';ii
ap;"'r;i*rlui *i*3***liucai si I ;-ri'sfejr-rlui prirt prxrc.tii:na;:e;l tr"enseujan;rtf; *c,*glhid;rX5 ir
gisf*n:r.d*i
s*ie*l*r intruu:ci;a-l si ixir:*t;ii'rs siirirflffint*i ciil r,ontrrasi
irr:a
fiillil ris
Eluii.otirr,
. liiiitefi ii astf, el o pieiogl a f}* rt*t er,:g,l':r rl fr
"
{_j
gs:E-{}{-}Et_t
F
g.&
trr$I'FE i}#}gA}}&,
_:1f.:Vsr:sddoi.ra
l Ul$fg.
l:.; *--1i:liltE;l-i
';+rliia.;ui
iei'rt1,.;'di:i;ai i:irli:,1rlri E.-ndre -fir:r'!-ljfin
.;;i!l
l(*1;:l*rl. F* aecst i;*1*tul r.; intrl'nrlr,rr ?:i l,*zii:r: ui.imr3 4tlii mi s,u'i:stayitl ils
.,;l*ntil;rsi
i{-,:rlistr-r* 3f-}9c}. li* utt-rpie p:rxt"ii:
*,'e;ri*s
tiri-a*r5 i;i i:iapaciuriea ri fizisri*gi.:8. Iii pr*ciic;l
s*
it-ltri:ctuc* sutts{tint;i ile **rttr;rsl pd*lS callrl aperc seilrffria
qie
nii,;tjruiu. inoi*ent ir. cai'r lr
,*xtrage
s*a*-la ureffo-rr*r:cal* si s# f;*s-r*
r-r #:{Tiulltr'r: radir":lugjcfi. I}*r-,,5 *:ialmina;-e.t si-ii
ef*:*tu*t
1:ara{rir
cti<J.*nii;rr:a r*ilu:it*ui
:.,'.;zi**r-lret,;rai
s,; rrrai r?i;u iifi sii$,*u rnii:riolta} tr: c
riciia *:iflun*iri sr fa*e in [iiui: c,-.- irr:]rrarru] urinaaz]i.
"t
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A;+;istfr i*Ii-i'rj;;i t-*rii<;k,p$r,Ii alt*ci.af:i txiii"u lllilizatri;." .,r
1:iariitli,
iljn iliti:'i'ts"
tn",r1,1..;
,til?ffiruuii*
"-er.i*ii
,"iridc-ir,
-iiini'I"
rls'::t cliag,u*sllcai* o,;*Sr:afi*. Tr:fi"rsi. *n
,-t*n**:ruu
ur:e1r, ";:iui*gra.tia
,;st* fq;ari* u#Ifi" *ir1i;rc' *"lrligatorirr Lte e,fet:[r.rat" r-.sfr r:'efluxul ='/o"{-iL1cd.ii]N}t*rfi1"
lil**nosfi*L ,:+r-itir,
*i ri:flu.Eiriwi
rr*d**urcteriil sL. pxiitii
iri#
b*;:l
i;isii:i5'nli.*i" l-a f';!.,
kafru:qui
-*..*;,ic,<j$ilel.sr*l
*tt; gl;teir, rial:i: :rp;*.re in rilfitE*r.lir-l} u*lt--rl*rii
.,,ozl*ii
1I1lrl,B;lf, .t;
sruhsf;urt.r.
rJ* ci'iiltulst si;:r;ilirx
a*1fu d*-ca it{.lfi'f*
p"'r
fiir:rul uliatj*liai'
XJui:I
11'ritlmk,:1". l'rfiirmi *ste d* 3 grsilr=:
- e*iistafita
ile
*;**irar+t imtrl{ in lrreicn* infed*r in tilttp-i;[ clst+:,si"]fie: n:i;:itr,r:::i;
_
rul*g{asrnn
di;:
,.6rrtl;r*f umpS'* rrl"rt*1u|,
;:*i"-,ts6l
rtuili sl oalir;nj';
- r;'lldt5til*,
rlictrr-:';ialii;*ala
srlvit cXitataL*
f* af"tr;l r,:,tftixixluj ",;s7i6s6x'siErral
ei*t<,,gi"ir.[-k r*lr*gpaii]. ttl;ei rs's* itlt'ii*';itii
-iti:
- {r*i.lr:-r x t.iil*lel *','*rj':i;
litim arr:
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ch-* *'fillt n* f*mri*, s,.i
ii:-,i
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si crimirarat-tr}*
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},o*
uretr} si iti
l,rzica Ira,.:ii:r.ilrrlil,i.
c*-miii"rrl stt,;a[ici ;utlllofiri,:s irr+ciificart]
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ffif:ifflg:
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in
p,;,rfude 1en13r. C**uxiumsa i{intr* p$ixg# c.i.l sulrstaulS Eie
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sr m*tful
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q;;3.oc pri*ii--rin;ip;]r'at c*re +bir.crcaza n"lcarul_urcI.rli si arc ui:
.r;g-i-
ec*tr.al
si ? clai:::e aut#statios
c,3 morlli* apalafu atas# de p*nis. i)*rrtr3 a rexliza i-:
*iu:u*
a ur+it'oi
cste n*se*ar c:t p*tisiutr sE Ji'; frncii*n;d
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e'atrs exartrimat{,*r' iar hazimui si
iu'eilir;i
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ia 45
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in ri.lag,**sfi*u} ***gr-afii, *riir;: c'rpdnsii i*k'* I si i{} ir,fl{.r.
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ai:f, cot.ra*t*l
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cl* **ait iiilt sil"li*i*l"t ft.&fis{it_l;Xg:tr_til;i,
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rsflri;i;t suh {irmlfr ct* ue;oiltrt. Ile*uriie suiii rr:c;rrfii:riair.e de ci.isi;:ii:l
!-ri*:-$eiricifii.
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;s i,{ii. {i
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la nr-",*lut i.mnfi nee**c*:t:,.*:.tj.E*r ii:g5tr:i.
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El:c$i'ufilr is-i ;u'e trli!"'irars *lepiitui irr sfi.iqliui ur;:irafiihui r**r.r*urete::,:*r;ezjeai.
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si u,?jl,: *ti* il*.;itsfiiE *1.*giiil*a
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si fri:;lllrn
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in
xrr*e.uhit.
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{pl*::fr
rr:nals).
C+lalrr:ici:c;: +u tlaciefil,trl csfe
,;senlialfr.
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bl*eat s,r r 1natr1rjr",1-il
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pe s**a"ium*
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i-;irnsri;:i;.,iti;
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liiclic*?ui
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$* ie lua in oirlsiaii:;:ay*
rtrim,;nsiutrea *,0:;r lr*ii tm:tue deterftlfura[il ee*:pq-:laf,c"
Cn*miur*i dnicFsiul*i ii,"ifFr 11*t-. irip'*rei:*g*rl dstr:r"itE eiaps*i*i til:1"*ai;e
{]'oi:itri*ri
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1*,:rfilmes.i11i-ii6';i*
a mai'griilil f'mffi't"*Xfi'
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ii* rXittkg urit'lHi**re?*
c*;:irp*n *trt* aie llar*ri
e:i:imului.
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;-.;r*nehru:i.lat*s.
l.;-i ei+ili rir ln[ensitag# i:*r';i ilvllti lnii:E d*est a l+p]i*ei
oo.,-,,,in:.a
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r-irit*r*rl'1'
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'*ii"r
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Piel*ra.licual
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lirir*r:iri <"irarar,;.
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r"
r'ruasp:*t"stlEt:
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*
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*
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ar,tr-rg*nr.
h-upe*e*g*::,:ii.
p,:tc*al';i
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L *n{iii'li1:
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ii'br**tti*ariiale. c:*''"r il*ir:ctr1::aiii mr*{rfi
X:r*xirta}ii.
Este situatfr ?ta l'egfr;rrea pe;{rr*;il"t. are *
[r;l:ni apilo:i:-rraiir, ifiniifr. ;i-r ] urf]*':
,:*n;ar.jiaie
iltit*ri*afla
I.s ',irr:-rta :rrir-iirului,
i')fi]!ii:-)x;r
c;rnift"i;si.c ;rta .l(i:r si r]'iiisoar';r ;;r medic 4(i'l{i'35 ryun
g-:t diant*1reie tr;ms:,ersa1, a.*ler*p,.istrt*i' si sagital. Frrigtrntc esi,: *ii-cuini;erir+5 r!* utr feur"ti
.lih|rl" il.j!!ti. itLEIl iil ceptula *rur1.trr*i,;.;r.
Asp*rtaal tiE:**s';r{?q: a} t*sttc*u}u!
l-*siiuuh.ri arr o kui'l't':i ci,-rir-l.llI uu riii*ensiuit'; dl
.i,.J'f.,5
clr: si +{}nlLr',}+1.
S:itnr*fima paren*"hriml;iui te,stic*iar
,;sk
cm*Src*E. i-iil gg:anr*al3i. *u *u*Ecnitalc
rmertrl*"
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p*st*l'l+*rfl
a gianriei. Ee*p";rfi* c* u:,.deieaiirz?1
sup:'atesir*uiai'li r:u riiai:lrtr*] d* l3=i* im-t:r si ccri]ul.
maxi;:n5 11* 4 rltsr.
{-1eie s:r}rte i-n.;e-nrsuri ale sar*tului s*
.o{zutlizeaz$
in m"*d n*naal sut' fium* tr*ui
!i!fit ;,r'34*ir U:1i.;
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e:cfr;{testic$iar}. sifr*:rtfr pe mar.$**;l
irci:i.:nf eaput. {*:rm;ltirntc i{:{rgrri:}
si tu*f ldtrct*s tlcula:' si a,-'e* ;t gl"ani;mca
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Frilttre f*lryr:icil* k*rgi;i-i*:e utilizate 1r**",r,:ur in stuiXiu] tt";rc*-aitti *rln,.ti sr-li;rii+r
il,.-.'*l-<F,igati* scimfigr"a-J]cfr a's*alfr *sie iirriail pdtl pr,'tihiiitat*;t ri,; a fiirrrrru ifif$rfitlatii
:[ilcr:ii*na.].a ?nt:'illr l-rlil5rx{ as:xttu=ix}te ;+i ifi
trrius
du a su'grun* ar.:est* irifr:r.:natij rl**i i!ftaiiz*
,-;r
rtii i;;i ir
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Prill*apaii:Iu: i;*rtrit+ ia *;lg',* trc'hui* s,{ ::&lig:unclft icitrag{isfifia *,;i*tigXafiuli r'*nalfi ?l:r,
i1,-rrir*lrir-rl *runcfi',:ir:gi*i s lt*t :
- *""m1**r*; fiirt;,tjei pi;"1'.:*i:hirn;:ie ia prina'.ii:;li. e'at;r ri--- filn;rre giorl+rr"tlalfi
tl-iFFt si
s*+;:eti ;t t ll'1,; il"kcui lt,t':.;r;*i I a{e*Sumii*r i:,:n *"1'; dfu;:*.
*
f,;i,.//i.i11iffr* funati*i
i,,ar"**,;h&tuine
in<ii'ii<tliair; a fimHl-r,ri rirrechi in eaml] ti-**i ilr*iriliit
ru:ii*t*r;rla sar biiar*ratrs.
- #*l#s.riijrfflr*# tiii?."8!:ifi.ilni r*rraX im i;az ** i:.idm;m*:[i'r;a:i si tHder*;atri*re,;l iillre siiil'6:1f;
,"tilai:rre
a sist*irr*t'uii r:Lrlsu:t*I si * adel'&ratfr *-[:sttti';tir:"
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- st*bilir** *arr,z,*i hip,;rf*nsiunii art*riale ssc,um,rjar*
iry;n
iiemernstr:i,1'ca r-rnti
ffieiit;L=irtii clr r*ti$;r ri;ili pr*z;rtrtfi st*nrlzr:i d* afi-*r.t rrn;11&.
- e3*pisial*a prui:*seinr rlieliliuil*art: de ripatirl r*nnl sj a rfts*;nefr*tui *c*slu:ra ;isri;:r;l
fu$c.tiei .r*n"ttr* {**:m ori maiigri: sar-i
.henigpe.
ctr*ste *tc.
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i;rfur
ine.r*ip*rar*n c.ii fitctirioid !x r3ir.'erse
Fr,fillarals
radj*iai:,n;loei:ti*'*:. hljr;et;ii i...'"
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pr*rlusrr
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s;iFilarirriL;ir rertalii suili:
::).ic. l)iirii
-
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filtrare E1*;lterlriaiB. fErH s*r;reti* -qau ms*r*tic tutruiai'ft, fii*tiv **ntre c;lre estc ulilizat
1:*rltr*
Etucli,=rea filtrfrrii gt*rnerulare
{eaie.*trarsa
GI.'R}, a sistenruiui de eiremaj irttra- si
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h)
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A"sest acdnl c$fe elimfutitt apri};rr}B
*i;mplet pi"in secr*ii* &lbuk-rE- si nuruai in prilpr:rti* cte 5- l* tir pl'i:r
"fiitr;rre .glcilr*:
+laifi. $;
pr:t axprlor:* functi;r
parcmehir:ralfi
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[r.:lr]!iorffi'6 a r$ilis]ffi*{*pnilri in cclflti#rla reruilii *nt':
i:r*p*rfio::u*5-
ti} stilr*a fun*iionaifr a
i:.*iirtrel*r rubuiare. Er,ste trtitrizat in seintig;r"afia rettai& staticfi r:e luntiz*azf; infbnnatii ;r-qnp$a
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r*nale drnarr-:lce srci,,*ntfulJe.
h'li:u'i-r"utr nu ***et+ir3 * pr:*gfrtir*
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a s*a 50{} inl r*ai sau ;ri:5.
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v*nirat
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priu rinichi ni
ii'tilr: *riliiu"s *Ntr;,l]'*fi;r1r.
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ds! 2{i i* ?tl s.}{:
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ne pr'rmite
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si de tlr**;rj.
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iar *u aiut*iuj
eal;ulatt:rItrui
s,; ohiin curheie nefi:*gi.afice $Brfflat p*i:riti
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itttermii$tii si r.listriirutiai rnclir:ac,tivj{atli
pe cel*
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,rru*irro l+i;+sp**:&rl c*rr,.lp:r nefi:r.:grati*e.
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gl**r*rutrotrq;,p
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rlis***tt;ltrbn*tiosl;iI FL. ifiie li in,4uc urcpatiile t;Lr::irui:b:"re rrtri* sari
"trilnt*rair.
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pnr.;n+irfu irai'; ci tirinali:.
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TErxicit;ate;i na iliaE*sp*rimx :L - t--ieicsp+rina
A *str * paptir.ifr fun"$.e5. ** aa:ir',s'r*
itl"x,xl*r*ugrresir,'fi ir* tmq:i*i!.i.:i r*.istu! i'iljehiuJui traasprtra;:Liel. sare inefr pr:;rl.r) *;ii;tr;I
n*{}*t+xi'ritat*" f*pt cf
trl*"tt*
fi cH grr{1 ilt'br*ntiai *iirdc. de roj*tutr +elui*r *cn[.
fl"4rr:.riix*nt* r*r:unte au *rfrat e;] ?.l; :riir*,;le r.idi{i:xt;rli;iice seric.tc apar ltr*ctifeci{r sindlarv
!i1 sslr*z;e irri'rillsr"l ar:l}lft rEi ncfr'*t*:;jii;laf*a prur Cir:ir:'si-:r:rfu:;i {; cu fc;r,[i arifiiitea_ $d+]:*za
liii:,ulxr}. ;t*ui;5 :rper* f*ilr-lr r;Ix' fuLl.1 pdrrr* 1u&*{ di* i* ii'atmi:}antr.. As#.e,]. rlt-ri#i$*
;:;:r.Licttnr,;-iic,'trif"1 ;u-t
"!:i*;t
ci* aird.tr ,if ili:*glfr"ara;i i:rirr;duerr t*i:a}';i*i *roreetire" ele putii::rd f
':htj*ul*
:'i:rai rapid cl**at remltr;ltele tri'grsjei si in girn,:a"al.
lrre*edf,itrt
,;u
2-$-48 ,'i m.*difi*fi*
s*gx;nifi *ativ* hi*chimice.
i,-oem pr$ira*ii t,icsmEiarp
{-},:iti:ia av{e.r'*i t'ti;trle s,;te i} i;r:iitX;ii+aJie rerii.. rfuir rfu:arnati,;i1." ff t1"finsli1fii"]illiui r*itat.
ot l:flffit upar,; infi:a*1t*ra{r-rr" cfurd *st+ rlct*ctatfr rirxrJ r4fiil pfist*peralor,
ci*rl se ffiildfsr+t$
*ib:ic
irrir:
anude. h'Iecanisnaul r:oliiriei inclucir ecrlpr*siu*ea" ercbolifi sam lr*:nb+zn.
$*iretigraftr renal5 de p*r-iuri* +r,ic1*niiltz5 absefiia perf,iziei si a firneti,;i r*iralr:. *ri:r
rinichiutri:i ai:ft;:lind ic'foi-r,;tilrE. L.iragnriseicui rlciiniti:; necesirfr angir:gr:afia d* e*uir"tst.
(lor
m pticittii ur"iciaE-sr
ilhstt ucii* il.ratey'*id
poate fi prcrlusfr de *amzs
''intrinsei:i t*heh#lri
cle sfrrlge,
*alc,rdi, stemczfl uret*raifi) sau extdxl.s*+i #irnJ'ilceLc,
hernatr:ane*, ahc*s*]. Asp**t*i* clini+*
r,ri r*rt*ltateli: studiil*i: rariionucl.idier clqri*d dL* gl:*d.u! oi-"'ritructeei. ist ;tr:est #&2, pfrEltl'li fi
*xai1;d* * sirnplfi &ilatare uroteral& dcfl dl *bs!'mle;il.r orgerrie;fi s* r*ol]lgs la festui
fam'rac*dinamic cB l;uriis*rxi{tr {"ri*s*ris
ant*{elr}.
fj;;irav*zaye* trix*r#
- apffre la locul aliAstcim{lu$i
:-rr*tar*-r,*rii;41* imesij;:i
p*sl.*poyat*r, ctai.si tardfu.,. datoril-t nrerr:zei urctera-ie. Scrlrtigrafic se caraeteriir*azft pdfifr-u:
ini* for*p*nic,E uritiaffi ilipsa
riizualizftrii
rezicii ua-imar*) cu aparitilt trmi*j acurmitrGri *r****"t*
nesislcmati r.al c ?n an:rirtrrrc*,
Ll
*
r-1
t1
r-1
rr
il
_1 i\
t_
L-
L-
t_-
L-
{ l;t,
F,}. E \.' - ffi i[ {-} F} S f rq T fl F,$'T'
g
CE
j
}-Af-+-q S E tr}H {} S'f ATS {:4"
C.ffr+ras&dr{Jpsa{
B T * f) S iA TEi S'l-I{j {_rllJt
A
ktdi*;rtia c*a r*ai &'i:cv*n3fi este itr st*dliia{,** rxxs;culin-1 sr heli.iufr**tilisr*.
l}e
prar:ti*fr ls sutlie*tli cli ;]zii{Jrii}dnftic s;!u. *}ig*sprrurd*. cr+ mi:,ei smi* al FS}l n*13n*J.
Ei*1:sia testict*lrfr r,t pr:rctic$ cie ;lscfi-refir;r ia o*trriii cu ie6*emie clli$fr
*[: iltur.iic;';rpiu"
fta*fi t*sti*ui*k s*ni d* sru*nt,ii eg;rI*, *r*is tedi*i,r it5 }:i*3:sia utlilarerujh.
j)*iefi
e..jstfr
clisS-:re-rp*r'rli in*:rr tcstielrl* satl ,;:,{isiii *n{}r.ilaiii aJe opictririi*ruiui sn* d*fu1'*m{ul*i.
hir:ps*r
I*tsticular;ii s* kllpunc.
Ei*pxin cl} a**l sar* pdm ap*ir*ti* nu r.,e, pr*cii*S, i*fi'u+;it r l r:f'brft m.r.{.*rial sufrcie*i"
5e prefurfl. bi*psia pcin r:p*xrtiu deseSrisfr.
Arr*sli;afu p*iltfr ii I**aifr, *rhieiiari5 sau gencml,fr.
h,lsxiul d* r**litar* esl* pr:lnr-* ifiei.zi*-, s,;rr.r*rIfr dtre' I -? offir
rlf rafbr*n m*eii;rm" Sr:
lux*arfr in pla,g*
i*ati*uiul sr sr* ifir:izeaz5 vagi*akr. Sr: raper*az$ *Ih*gfur*ea cu rut {ir 4-t} si
sa'*i';rsch;i.ie p* {}.5 *ln. S* exprimf, p;lrnnc}dnu-r! t*stir;ular. crir6 sd pr'*:1:r,eax6
c6 * foar{bc6
fim$ sa* u'u lama bisturiului" S* in*idel* r,nglraia si pi*l*a sr;r,::hrlui. ,\.tateriillutr hit:pti; te
punt ir eoluti* I3*r"d*. .f,*mli.er sfiu Ftr*li*r,de. hhr se pr*f*rfr
flirunciul,
clc*"+.1.*i_re
dist*rsi*n*azfr epi*elirrX gemni*el.
fie i:*c*mand5 Tl h" r**paus ssxrffi].
B tilP s J A lti{{l s l-A?ii-A
,'lIliie$i rfe e:t;tar:.;mu1 *,Iinic si e.-{*lftiniiiilr ci.; irb,:;'at,.r:'. i:inpsia
i:r*stati.;i
?si g$.srr:ir
1**r:1 hi.rs* cic{inrt im algriritrmd diugn*sii0i*# car}i-,1=lui*i
*:-*statiu.
Exisifr m;ri mutrte ,;.iii C,=r r*aiizal'e a r:i.
{*lalea tra*suretral}
*
ftEi ftrd * r,fiis}are tie*sr:bii}. clec;aree* ecn fi:ai
-tffita.*
I}srte
ii
*,:rililiiot'suspecti
a fl canc*rr:si sunt la peritrerta gland.ei si depai:te rie
p.;",*trrft.
Rezultatrri pczitirr al *agrr;cpfuhd rie pr<;siaii otrrim* prrtn ae*astii rxet*dfr
jl.rili*fi
*
un'ari* miasil'fi a prc:rrl.atei cramfultr*. in ac*st xri*illen{* nici ia examanul i:linir- ruu rxistfr dr*}ij
a$ii*llt? ruuurji n*eluiilur prreistatici.
Cnrnfrreii $Lj
trltlt
crca in diagnosli*ul riifrreatiai eu nrb*rcul*r:r p;trandularg,
iilmfq:mul
si prost;itita
gr:lnul*mat*a
s.t.
Carle& srrprapuLilantl at"e
;rntini
aetr*pii. fijnd praciic abead.o*at$
ilifi caris;:
pericoluir-ri
lezftrii piexurilor vfinoarie
i:edprr_rstalice.
C;atre* perine*flS
*
tr*Xnavri] esle iri pazitir: gin*c,*1*gicfr.
Executarrf*i ale un rJ*g*t
reetal pentru a g;hicla a.cui. Duilfi as*psiii regtunii sc f*c* ancstezi* cu lid**airui ia nir,,elui
grerineuiui
si sr pf;tluneJ.e cu acul de hiopsie la 1 cir: inailrt.ca si inaf.ara anusului. Azi a*eastii
'biopsie
p*ate fi ghiclatfr ecoE'a{ic nernaifiincl nec.esar degetui r*olal. I$e preler,*az.T
S-,1
pr:obe. Se aclministrcaz.l 3 zile chrpfi proe.eElurB antibiaticc.
39
Bir.rpsia tr"aersr"ectal# nea*sit& ei prcgatir* ri* 1-2 zile a c*}mului cu Cr$imicina 4xtr
dfizi si hrletnrnidazol 4thizi" $e iuipure reE$m hidrozaharat si eiismft in seara si dirninea*r
brcpsret.
Instnlrtrefile $isoesarc: ace Yirn Sihrertran, Tru {]ut, Traruenatr" Turknl. Franz*n.
Pcritia h*lna*triui : genupeatoral& szu gi.necotogicfi..
Nu riesesit6 ;rnest*rie.
Existil riscui s*pti+, putfi*tl mxg* pf;nfr ia sqpticetnii.
T*at* met*dels prfisupun um risc d* canc.erizars a haiaetului.
Ris*lri
*
hemcragic, heimospenrd*, hematurio
40
a 1..,:r
I r.: ,
I
"''
I .i'-. .
i.:...
t-
I .:.:.
I ...:
:
.:,:
I J-,.:r: .
I
!
nrl::,
I :.'-,_i
I
d:.::|":'
I ,..::r:,, ,,
u,!:t 4....
,:i;?,1-
',ilAr'j.\' - Eir.J.g.3d-.8${,lflFFEA
'8ft,A{jr{-'i}.,E_r}
[
jIarriAFe;
rr\-$'F]f,Lr&,gi:];T.&&
E1 ,ruE,F-iAFi.E 63;,q{;NL}S!T'5C',,& Sg r'f,EJr,{}{ti {:1.&+,IEA_]RGE{-1,{LL}j
flHEF*Si,t#trEe-tF:.
.,,$t'- E;;*,,*gt, F. ff*trf *.sr"ic;
pfF.{:i
.'.Tl j.:r:i g'*"lri.}rJ;},r;T-rl-l.ri pg
Fil'f;"[
j
E]iFi,i]iiAgl
gi*
*,r]st:_r#FIillii
'"-la
*!*m**i r-iq: prjfiinflill
ir*itd+ ';-1* *::e* misilr.'.,ii'; e*iJr:srcpi*ii = *-*]il:rat<.rr"i; g;rn
i;ri;tp*tui,*f1"
i:*i:;r: i:cr.rjll:rhr;ii gfr
*r;ir;igltr$r* e;r i:iusicm{*i s;j n:.i
i.riraii*,
ici;;;i,-:-ir:ti;riG.
r sil *i**ia;a"
"+'r'':.';tj"r;i !;l il*iil;l Jr:lt tri-fji(i
,:;;
ri in +*;,-u! riitJtl:!'r;tllggtlli
ut"iirt.*,.,:./t,-,;ii.
l.:
rr;*isi" ?vl*iriic ci# e$iLilsi:*pi*- c*kr suifr*i*mt si! $# lnrqti,l*:.:c
Fe ur*tra 5-tri3 r,*l eii,,ta.^ui:t g*-l
*mr:ui*;:r-:' Isfr, fu11pa;gant sS. sc ;asigur:r: st*rilitat*;i gcstril,;i.
{.!flsi}lltxi
si ag*st*da uretralll
tr-"iE:*fti.l ::cail;:;il'** r-l-r'etr*i:isfr;:su;*gliti
*i;rg1*ellir*" _l4;t nUrrgi e:U anrsX+z:c ir:e;ll5 ur*f::ai;{ si
;t;;niiuii ss;i'!.rii ir I1:ti;.='ir('lili ;i'r],'r ["J,:c.itrfi irirll]si;
-u,;zi;;:ir
ti tli:: t:o*ir fur:irulil;-rrlir U.t".tLi
irll*l"i"suir*iieli.
i-'a:i;uci, im *al*l*:amc-* i3:*ui**t an:;i*s.
3:a.,ieiri
rr*c**i:oi'agl rii,'.i ijFlr.i,
flffi:ee;rE
i:*teniaa'*a ,tn*.qieri*i
.f-"
aaie i:*tr*reno;ss3 s;*l; ;;iuar
a::*s{*::i* rlgicnaJ5. Ir**ft:i_r
;fii.tilfififii'Lr
n'"1*s+o"ipia* r-fiai f,r:xfiplolifi
{:'ez*e.l"i*
*trd*sc*pici," ilt*tli.ti*, rpil*i;*r:pie
g"
i$'dicr{}s+{i}:ir:.
nr:*"*s**piri p';:ttni
irsigllr.are* c.;nflo:-iuiuj cfuu=r_:r*egcai"
ge
l:i;i:rA ;iit*stezi;l
::rglr,fl *id sA a;
;r.,*rrerialA.
E I
g{"8
.il
ge
-ir
il $ ST' & $+ il {JF} HA
Frtiil'citini;: {l'*ci*!;i ui:r-:lrl :*fil.-=Zi::l;,
-,':;tuaLz;rc*
irr*,;i;r ;r aei;.sg,;ie. lri *"iui*r.ili
tltiilr :nstrr*tm*ritc; *pti** s*jjsfic*t*
ierec*:le*ap*i
,;;iL* :;i: i:i-rf.i*rjuc iii a.shr*r*l* urkir p:i*
*$iticiilc *eit:r,*trs: msatr urctEnl irretr*iislr-rsc..;;:iai. r"r*;rt arci*l-*l {"lrrct*r*s*ri3:i;r"
t$'*ttrrr:r-]-*fl{iscc'piai
sl* l slr.{bi1[afiii riir;{tui-;]r. anaJosue..l
E*-nin} a aji1r1ge ifi ra:vtt5ti, c,a, i*
a;: m:i n*firr;l;er:pi+i g:r:ir*utarmte.
l-,rrt i}c'isr*n+*;:ia reprr";zir-1il* tsplr>r'ar* aJlal'atutrui *rirt.rr i::r{i:srii-
{u"r*tra si
,uezicc
tirulala) *ul rrjrt.ieimlt ufior 1*stl-r_iltie*t,* t-r*rnite "oist*s,;*ag;*',. L}gi*sc*prri
rellr*rc$,{ pr1E111p1
rrftd*s';t}ll dffi iet*d; ::n,:dir:icrr;:i" {lff1{i ;rstfe1 strinlouul *rlnrulr ;rl trrlur.*:r. spl*ri*}}e
sr&:*s,cfifii6 iii* *,*rn*niil* m*#a":l* in r:;u'* :lctrsitr.i llu ;lplieal-rifit;ite . {.-i.Fl-.L..
Fil*rirrr,;i*#e.
{. . hiru rg* ki:;lr*s**pic a. r;i*st;:o
*nteroie,gie"
diJil*lierli*
*-h.
h,'{*tri *tili;lilt5 ?m ciec*nfrl* lr'*r:uie, ur*llr-.ristt:sc+*Ll.
cii d*aiifbl si u.e}cna]t* f*,jr*j+i rtr
fuir.r*rltj,g"',tie fiiitr* * au la
'ba:rii
{ilr*terr:peei*grr.fia}. si:a restrias clirr ;.llriir;atii *ita,r5 au ,x,:auri..*
*n*tccl*l*r m*d*m+ d* ilrr,esiigatii im*gistie*- in spraiar e**ggajia.
{lu 1*ate a*este;t" ci*tfosciipLii r*man* trn insirurlrni ek !:;izii ?it arnrfimcfltffiril
Iir-'-;!lui ur*l*g si nu tr*buie sfr ilpsoasc.i tlirr nir;i un s*ra{eiu cl* *rr:fur$e.
{.rr.q.ll.
f .}
,il
7-
.$ ffi c$.icattiiXe fi rs:ir'*cist*:;e*
pi*i
I l? ttOJ-i til{1.!l'irLi
it L.
: . uemati*ie
ffiicril* isi r-*aes'r:e*.,i;yri*.{
ei c5r*.i s*diu ftLl p*at# l? pr*,;iile*
i}rm
T-ry\'' siifla$ s;}:!{:
?. re,:*harea 11* hie;Psii rredt;a-lc
I" an**:aiii co,r:geniral*
ala tx.rcf,.-liui urinar hd'el'ir-x: {v*lvu=
urotral*, clui:nic.itaa* pi*1*rur*l*r*i}.
re{ltm vczir.*ur*trra
*tc.I
4. *fectr*lr'* a ut-eteropi eI *E;nfi il*r
5" cit*lr:gia si 6ist*X,:rps
iutai'ar$iui
iuisar super{*r eu ajuiCIizli c*tef*r*t*r' sri
pe*ilcr ek
tr ri, ,utt o c
I *,t c,sp !t;t";Feu
lit::
I
"
fi*tei*otrtul
*nn::i*i *i:ntnr';thrr
2" traiargertt ifistibti*,ra}
p* *r-rnda ureteralti
a &]1!:,:Ii"ur:tr rr$teifutrs irurit*
n_ Btr*.d llr:aria.
'fraiar*eftrLll
*alearHjrx' uret*raji interiosi itiret*il#
cle;sclet}" ahartsl*naiii
*rlaii{ * u islv*nE,iirea
uretai'r.rsrt:pt1icii
Em*tr. umremfa:'
fil J-cffi*'rie ile ggaclul c"le ftrrxiiiiiitaf*
?lt gent:ratr, erid*scttilp*1* -ei;
ripct-", fre*at'e
grupa arii*ri :ri'arllta.i*. d*i: si h*iitc'
,.tir tt n! t;
/
* lt c i,; t t; ;i t e p t t hl i r ! g i ti
"'
i. Optie* urai
-bnrr5
*'iataritd sistemlrlili ctt
i:tisnte
eilincirice }itopi.litls
f,. ianatr lirc.ratir"r mai iarg car,: pet"mite xtil|zar'*s ul1*i garrle r';r#
aacr-sorii {'eat$tfrrs,
s*llde ur*tarale,
ffisfr
att;'} {Fi.q';'J',1
WY
lflfit
:.
*
PtrT,LqE
El:i-:-"]i.ii]I(
),,,iF.8 S/ ,BlilI'ITa'E' L.lTi{.}L{:lI; ii\.,Ii:i',T}aii,itii/,i}i}lil
-1
_1
"1
"l
il
il
il
r-
$
t
l--
t
d
Lt
--I
i
-l
!
!
\
.J
I
._J
!
L
-.J
I
1nafl
?nli:;rfi in fl*:tibijs *i
el* rrtstnirnr:nte
,1ri? f,
-t,.,:',t'ti.i
!
''!)r,-t.) t'r- ^ r'
r- J.) j
,..i,),,.1..:i E..t; _:! u:1L,'Ii
11-i.'
i,
l rL("J
Jir'
*. ].;"ruri*'rr m:*i lnrg al s.ir;i*:t:u.ilx c"re i:'igal'* e.ri',+z**lic"rr* mai
'hr*r-':.*
4. lur'[anip*i;*:r *tai far-:iill .'lr mai
pr*ei*E.
-.i.:ti; rut*ie ie ;;',si,u},scry:rr";& x
ik:;;ih
i i:
L i.l*nf*r'i
mlai smar*
i;**fu-u
*;;*ieet
f. f'*siliiiigat*:a *j;*,rn*.,:ii *:iilm-r::;irii si lri *it} p,:riti* ii*e.ai *.;;l c];tsi;E qci,l::l**r;i*g,ic$j
3. Fasalul mai ris*"r
1l*:l{x
uri ci-.rl r,"rri';;ilidparinlfia:
4. li:]rr-qi*ilir:rtr:* ile rgrsr**ir;: ffi?ai fit*ili e[ lii r#rdri*ii l*rgir:, pri*
atl.g;mlam; a*deliui
i-lrs f :r-*m**:rt*r"*hii
E i r:: il a {ii t: i e ; o t! i fi
{. ) i'i
g
ri # *
j;,1;,;
iil,i; r.'itp ru1ru I r
jgi*'
[]i.l t*;1i,,:;]- *-*iirtii r- l.;st-i*.rstc 1i;*r{-c mir.r'r; cl* aii;tiise,E:i;i-** ili r**;r i:r
ill.i=,rjs[Lj
dfutr*rtsiltr:ff,c si in*iiflatiil: ei* *iilia;i:-e. ii'i.
pfinei*itl
au ili.:1,3n*:3si ol*rlami* *,arnllr,, ?;ri.rtirl,
I T;;ar:*
*
elsi* i:u*fai;tji-rnai* ilic ul*';ai itle;xiliihil sl r-r,pl*xria rnv*[isl:] *_{t*u? :ii
r:iatr*s+t-i:Lii tei.
5*;:r:;isl:ari ir ilnitirti illmrji:r,; si variaz5 de ia ,!-:2 {rl}: I* e.ei*
lledlel*,r**.
1-riir*
l"r
16':5 {-)}:1* p;r*ientfr ur*}r,'g:i*i aelu}'ti.'n'*;l*;;s 14* *i}nsct*s:5 la sjsirrrir* e"h trtg;l*r
3:ti;:r}r-*i:
l*h;ri,;t ,il,+ .:*.i'rtis;ir.- f;ii:C pi:erarlt;i si *u- urr ;:*i-'rir-t*t ri* *r,,'eruat:e ;:l lii:ilickliul *is i;l.url;rlr."
Luxre*,,il l*urii r,:*n{ir"ir: **i*j;ril* *llJftidr}ic a}a ,;rst+ecc,p*liri
I;: r;;:pEii$
disf*lt*ar:a frfii* p-r11611r35r1] +ri o fi:r*;rstril prtn
c*r'* eir"r:utr* iie,h_idr* iitg;r*1,
"'ilr^iiosti"
cplica si
6rt,;
li r;mrti:uicre dir;rsr}:, in:,.lrul*+rr": il-r-;i{,rii.
2. h,landrenul
*
arer r<11*i de, * r;bsfffii;t fir'*astra, p*r:r,'it.inci pasaiul t"-*ii de-;l lLrmgul ur*til*i.
c;it ir:;r g:r.rtrin ll*urn*fi,;.
3.
'-all*l
- *sl* tiispoei.t'lr,'ul ps c:m'*
ge
ffitr{.}riti:;tri: *pel*a. El
"tr*
ui:ilI scu 2 c.anaJe iurr.t- :,.i:
i;t{:l
r:a:'i, r"c arfr*rJuc iflstnucffi:f*lc a***r+*lji is*nil* ilr*:teral*. p*&re *ic..i. i-* r1};{!Efiiitai*:i
dislrtlil ea::uJ ar* ent nistrrr, numit s*;adta
{cief,*,;tr:r'. xrigieur} dr-
1;.tmiic
i:ri*nta;.ea
iesirurrtent*Iq:r' ;l*ci.s*-rii im ciireci*r cl*t{tfi. E;r asiu mirnii:utatii ifi;i *x-i*c*i j:ri*ii*rin
siste;ri
d* r"u:rgt'#.
4. {-{:1i';*
*
r*;:i'*zirle:5 erl*t'irtnfui li*:}:il ;:} uisf*s'*i;i;:tiui. *{t ;r=,;;i6e-i r*i.ul
,je
a r.aie.:;;
lirglrdi:utrc;r *nd*Iu-,tlul"rlit
ilftiit.{-urt
f*nc;c*{ d*: fi}:re *X.'rii*ri: e arr Eii.*r ;qiiee*litt in exleri*;: Lt i;
surst iXr Il;ri.ulii r"*e* s; il* :l
i:rr,iua
ireiagfuiile printr.+ piis;:rii si ci* ; l* traltsrdtr !* *.;;1rj.uj
*:lamieiat*r*]"ru eu trri sisi-fltn d* }*aTrils si:*c;*I*.
i-':x.andll;ti*rud p*#t* pt*r;i rl*:*ci p;'iri r;ci:**rlu}
-*ptii;i:'
..i*ti.l, eta*fr *esiic,iui *r*l6gjc
*sfe elstu#, ia *eh**il s*
iuate
aelapta ria siel*ur erlr1,:virier: ear* pr*ia inuigfu:.:a, * ::nag*-Lfic.;i
si
,:
ir;lrmixiie p*
$it t*onitor" In ac';si f*i. r..onfuii:til exandnar*itriui
*sfe rmid.t rnai mal.* sj
r"isiui coilta.tninarii cu 1i*1ud*: bi*L.gice este nriilt tprri rdr.
'I*tqrriail.
<ti"ntr** *.tafilirt;rra. s-*liiarit. ei:i1-'sci:pi;* clevi** pr*hli;a.
t-:r;muifurc?
p*rii*ip-t-r'e;l
viu*al# si ccl*rlsiti c*trti-,orerrti ai e-r:idpel c.hu'*.rgj*iliu
{'ii-qisfent. ;lyli:sterjsi}"
ill t*ncti* itr* un$riui ikr ia ;;'li"* pr*iar.l it*agii-lii*" ui,ei*ii* ;iu mei mpit*.p-adc:.
tr. ilati,:.a iir: 1;o
*
i:i'ei,t
irn;rgi*i siisr *xul *lst*sc.i;pul*i,
i:ria,irrcX-
in*iit-l*. Irutr* iri cc;:rip*n*ntu
ril*trr,iE:*ruiui.
2. {-.rpli';a
et*:
"x,}"
*
pil"*i* unaglrni l;i
-3{i"
iati iii: a;a.L!i insiiau'?l*ntmkd.
*vi!fi1J uijli*l-tea cr;a iilfii
iargE. L*t': fr:l*sii::l J;l *icti*sccrlln* dc
q:-.'aiu;tt* gi
rrpe;'at+i:ir.r, tlitr.jcilill 6i ]* rerfictiit
dftd.Dscopiefr. Pln,este haxr si peretii antrrciatu';r[i ai a'cr-rcij urinari:.
3. i-)prlicil* rte 70". ,Q*o. pn:'esr ia unghirtn dr- 7{}o si lit}" taia de a.qsri eisfr:sor.ipul*i. fiini.I
iul*sita excittsirr in
.;istr:scr4:ia
ciiagilosticd perrlr* l,t::uatriaar*a r"l,oniutrili vqzi*ai.
4. Cpiiaile u.* ungld nui mare d* 9(]" pttr,'esc relr+p'ari si c*l*g h{i--rrnarii desL,re *olul
vorical.
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i{'- i E i,li:. i -,* ;:.e*;i.l;l.si
f}fr0ir;'!tt-
cl"ta;r
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l{ {'1'{-ii'ii'l l;i
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.iiltila ui.r:zhJ.i-:*1*r*:;c g;:rsirriui
si Eul:r:iil*'+-;; llit:,fl'iri :t; ;r iasfi-rilxi;:li*jj],,i.i" ;init:lsi;r-rp,r:I
l:r; ;rttti u iir
t-i{
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i u
l,1r}i,; i-..}"r .l 1,, ir,,ei*.; :
iri *it;:ui i.* *;ll'l: fff'*iil d-i*-il
frr.r ;u iilt niiJii; EI-i;ltI.,f, ii'ch-r-[i,r i]]Jtfroii,::fi.I r-{i.l;ltafi;;
;ii-.*i{{iti*,t;!*.';llui?- llr'r"r,rj"rlli-r:-Tli;; ir.}i" Sitr;*tia a*d;r*xt;x *: lnifii;dnr rnili tar t*;}*r,:i";*+l.p:l;l
t.lfugn*sti*:a. ilrT:i?'ii:;*;ni:r*;*i:.* r+piii* in rr;;r,;ciis *"a*sur*ii"*ii!.
i:'u'E:;i e* ;i.fil {l'L:#Tl'{ tI* ip6s1x1i r-rreti:ai.
si t"i:s* n*vi*u}al;i"
,;iei*nr:*i:r*},
ffi:tEr fi\,si-ir;;ji +ij
insteuvt:ltli&ilui. *xaffiiji!.arr;a [reh*i* str:3"re|;i ni $fi eisi,:Ec*i-] ,;ir
,:ailhi* *raj mi*' *",:i:tii* fi:il-,i+i?l
p$tli,r# *r:fifir:tmr.r i:rr:i:sliga*iei. l'i i-?tsigtil e,$ url itsinlr.*,lmf ;naii.r,,;i,,,:i p+_rtr cla ;,.r:m1:lir:;riLi
.fo:n*dit-*u {"s$rrg*iar:.** lafbeli*} sau 93 r"lisfant?l qsritr:fi:ri
uleie'*ici tr:t*l
qeedr:ntr
i:*n*-*
un
Ei*s-t
ili i:il-,*;sijr:
I-a .qunie*tli *r:ritlaij, Br*sir& i,ip;ire d* ca!:trru utriflri-si s., eu lnuc*;l.st ii; e.-cd**:re r_r:.
,
,',*nmi'i la ttii.e]*i ur*rr*i hr*bar*. r,iai*sr.:r:pul l";i
i:*dsul
sul?r r-..,-:irr.lrst,, fu crir*ml*3i,r *i
e,irlar rxxi muli. pontr* a i;* **g;ai;l *6i in;ri
i:r.lt.in
trar;mtari,; prier riiirr*1ei"*X si,r!;ti ?* utefi"a
pr*:;tr;ttit;i. Sf:nri.er,-ai slrl;tt *ste recun*s*r,$ c!-i u$iit*:ti ii.:trrjis tai';1u.r-iin;- t:tlr"r.,;+:a:,ffi r-tr*t-,air:
ie tri-".,*li;l urr.trer rumni:rmrcas*" <.lispuse: rarti*i in *?nrnru.l r,:.r**1.
CiclirtE tr*cui {.ir sfinar*rapa.r* urotr:a prr:stnt:lc5
r,}-rlri:irlr trft1?tli;}.ll1}ini
gi
l*;i:ii
Frr,tiiii;r:i.
L* x-;i"'*11j! cr:liillri le z:icai cislr:sr:i:i*ri k"*hlri* ltdi+.:t Erg*t1.i] .t j:*laaitr: rri;r:.iatris;ri;a
emiltit*ninal* ia rreziiii u;::"rer*.
lr:,rr:,:ct:cr uv'*i;":i litxi*lne sa fa';,;: muit n:ili .{-a*i], inlr"r,cili*"tnr1 dir,;tci.
,;istlrs*+put
1-re
ran'etr3 flr$ r;n g*rsi c*;itpin:*$iaf ur*ala'iril si arra&r;iilrXu*i in dir*cEki oin"h:lic.*i*r"
tJ&?ii
;$utiei i-ri r,ezica
ilr.nar5. !l:.;h*i* sfr tree*m in *:i*rrrina;"u;; sirrt*mretii:d ;l
*;rsiu;c.
{lu * *pfic;i {trc
j}lJo
m*j itut# s* k:**lir.*;;r} ;tr"tat*i* r-lr*t*ral*. apr.;ciixdu.-s*
ria*,;ririm*tita?r;;l ;1.*'-stilra si *;illrataa urirdi g*
cilrr: * *imri;:r*" 3*+i s; *.taa-r-rklee;ia iii;i*ii-;l
ri1rzi4sl,
.t'csp+eti,.:
z,:o;l tXrn lia:rE**3 l,ar_ical +r:plins. intr* cai.; ri*t15 n:e;lte ,gi **i"
i-i::r'ls;1.::li
icr*ecti* r".,rpur:r retr+triE*na,ir si a p*r*:i*i*i
*,rzi;;li
;ir:sicr.i*r.
Int*rceil:lci cist,rr,,*r:pr-,.i,;;; f.i-{n ?r axrd sI*" se ryxai::ri:*ca:lij
i:er.*t-d }ai*r:;-ri!.
=rer;qiilfi
;r*,i
,i
j ,;..;.n.;"i-*i:irti
si c:r i:.r:ti;i du TrJo str: 9{rt.
F,.-r;arcr;1rid eis.i*sei:pilr s# t*rc1litl6 clr fulsgt*ctia rlcriluXgi r,*zit;:1 si r
1rq;rer*jr"ii
-r,,crjrai
antt:i{,:r. .rl;e*s{.a sr: fltr:* ii[,;;,ri E:it ilr-:tic;i i1a T{]n sa* S*o. ?rr ti*"lp c* iictud+l r,le ii{g*ri: rsis
flt;fiir,u$t p': ieae;t c.ist*s,*t,'g]iriui inl' m#na stfingl n r:,.1;:mi;:a1,:ru[-ui rteirros,*azi r;,gjur-r*;l
lti*,*-,gast::ici
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*flq.:t"rc;Li r,1*r infixrri ats$tie. *hiar da.cfr pr:ziti;t *xa*dmaf*r^i1ili *ct* inc*cli*dii (?tt
';ar
*fi nu
i:xiulfr sistsr,m e,irc'e*r,"ider:i. de*;rece X;i * *xan:imarc n'irpi'l{ci;}18
ltr:f
ti s';5.pate i}i* rred*rr
tuir:l*ltl*
*,'rrir;ak:
]*saiirat* iri aceilstii r*ni.
I a lrfii:situi *:.;airriofirii" vrid,rir *ste golil# S,t li*1.dd si iru+tr"umtr,niui es[e, e;-t[r'ar'] cc
biii;ridlet*"
X* c*;i*i in i:are t*a** *,q[i: infrr-:rd'lrs-I *i* ajutr:ruI rxandreflllnlri, *safi]imaru:a iner:p* clt
i*sp**tin vesi*,ti i;i"aft:* fiinqi ittr'*stigat*-
p* mdsur5. ee +;[rag,em Cist{iflc{}pl}1.
lrut* gini pmt*ltlgtce E& ffi ruts'*:)c{scn:s*:+r
pi r
1" l-i* ut"r*iril;
..r."i. 4,,- .,.,';.r'i -.
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*
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-
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i'*.:iiiuii)
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p*st*ri*ar* - Ji: *opi-i
ifil iut'ir.'E rii
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i lr:'* ;ir-i T ii
{il'!tilt iU 1I}
* jlir+r"1.*fi*
C,.: ;;r'*si;rii
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*
fi*tt.lia lirclri.il;i
*. i;l i,*dcl: luinar*
*
funr*ri r,x;..icale
* -ve;'i^*E
fki$atE *u *eir;ie si c*I**ne
- dir.'srticuli vazieali
- *aiculi r'*zicaii
,
*
fifircfilit* a-f*+riunl fodlamrit{,oi'ii
l cis ii t;:. i"naiacopiachie )
- fustrd#:ii:tri*r-i,5
- iJTlsi3i.llii ;tle m*ate,1or tlreteral';
'"".-i.'o^.,-.i -' (:: !lU' tJil.-.l
- e'l'.lpiici,tataa ;tr eatek:r ;:ret*ral*
*
a6snc*a nteatuiui rlt'ciLrai
*
mca{ cet*ilir:
- ulinh r+ar;ghinr-*1*ttt.ir sau
Pur*icntii $e
rre*t
- il'r*;ite r*fluante
"
'Ii]llleeicatr,ft
-:i*ri*;i r1ublfi.
:
i
q TRli'r
H 94 *,${l{}}r* EA
Ittpr*zintil me{ocl* rte fu:r.estigffre il
ill.*t*tx.rsr"xrap ireil ciriar si a r*ricirigilri ctr
.rpar*tetltri urirrai
{iiret*rtis*";rpiff
trfrflsiir$trali}"
],iriu*ipia1" uriiters,icl)}]ia fi,tr se deosehestc
t'ri**ipalele rlif,erent* oonrltilu in: anatomia difi:dtli a
uret*nrlui c* insirunt*rtt* sp*cinle mutrrit,*
uretr.,,;ri:Eiefi'os+{h1,pe:
1
* c#ila nr,t,wrai* alc
cri r"irult dv tfihfii$il* *is{l,s,a*iriei"
urelrultri si il trastului urinar suserinr"
4_5
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TlrL=.i;f I'iir'& a,;llfiri::ii*aiici *f .
i- ;r si cistr*sc*apel*, ui"e,tei*s*ixrir,:,1* .'-r* iiepa.ri.,
*i r-'., ;i;li;ii il'rt*r:'rt'led-igrfi
,Jr-
;gll,ill'rifi.t*,gtiL :,*rt:ri-i#iii-
f c'i*sir* $ri*i:* re*r*yit'rl* I-i*til,;i*,;,.nlr.ri*i i* $ r rfi\rri,r';.
ilt tt;rre. ili rigi$e sr: tl*..ahil*, H,:;iaiii
{*;r:i*i****pu;
d#fl*:;i.,4.{.i,t;riirjeir:
i r'ei lc;etif $e.' urr:{s:'q rq{:r.iF:r*i
1 l-reim *'**u1:*: r;pr*:*r:riI irata*tt*iill iii: *1;u[.l* pr-rtffi;
+*}'';ulii ;sifrl*ti il, 1 i-:
i-rderi*ard si iniilcr,t:i{r ;i lm *t*r'u!ui" i}in
'g-ru::lct
{:.;, 1,'r}{-1rir{i iii,:i;lcti*,.
,*a
si: i:xi;*,a;ic, il:l:
-! . i .,i r e l,;: ;" t;;ir'i,,I:,j* i r;
it
i; ! t; l,:;
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qlii'*ii:*
-';;i,*u.li
m""i*raii :ulr:*ri'-rri
- ,;alc;:"tt
rr:naii
- *rr,ile,;lt;:lr'um *re;ien-riui ,-r-l
;:ei;-rrli
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,'
i-r ;ti$et:,f; i-tclti:i ntrr'-'i i:'i.i:+r'-,: ictiiia { rralt
- **,,*Lr"iar*;:,-:itcliilg**i ruxiigx+
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*
urLxtiit'iraa aiupE ti;lt;*r:iurrtr-ll i:;rytiifiia,';1ij't' ;li turlr*tx,:l ;:;"+i'lijai*
i,:t;:!i,l":,
.J^. lrrgi*:"*,!:it7;it-t igf'.1.i;9iir,;.:r.i i;iia ,iuc,ti
i:tntrei
iiiiczt::
*
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*
fixtrsgrn:efi ei* c*rtrri :+t::5hii: strlr{ud asc*issioitair cfiu rlii:te
*
r*aeutia *a*,r {ulgp.l'*n"r i,;iitr,rril*r i: +t*l{*l*
- dillatcr*a s**
gsci:ron
;*:e;i srri.eturi] ur i'tr* f*r*].*
I ;l;:teros*crpia uu *sie ffil g*st. i:i-1$+ei+'llrr ec*lijti piin
c+:rrpriieatiils
Fe
a:.r! e ir pfiff{"r.1
iix irriertiiirt
t,;ai+
f*1s5. p;rtri:atf iiax ar,ul.qii ie::+t*r:tl*i s? *arr, prit r"le+r:lit,r unc*d, *11*;-.',;nti*
i:i"ri::*rgio;r1a descl:-is5 si ie
"listacl*
isfri*fam'i
urcterr.ltre. r,;firi:,
y*?ie*-ui'*1*rul.l.
I]r. ;ieisit.,
*ret*ros.;opia ciiagncs';is6 tgsl-lriie *f,br:.ti;at$ r!.*;rr ri*p':;{ *c s*i*ia.lt,s r:l*t*-rel.ti *r inr*s{ig";rni*
etr*i
i.:utic
ic.vaair,'u at: i.,i:ct *piilrrriu.
TJr*t.;r*gcopi*.
s* i'*i'iiizer;rzii cl* ci,.i*.ri ?ci *nestrd* r*gi-*rxr3.i1 f.r*i:i;*res{*:de, ar!*Er*;+r:
1:cririex-;iii I
in i:+zjt ir
Er
i*"' r:i+gi;a.
Fi E FE{{}S {l{}tr Lt T-Rq H $i {-lLiT'i1f"{A?;L
Repe'*eint* rtzluiii::ir'*;I ;ri]fir";ltllii,ti pi,;1i;+alic.e;li
strd"i;di;*rr1" sirairriie ;:narc]I:fiie.* ftlil
l*tnirr:i. Insin:enentl,t] fi!'fi r{?"r
,-:aijl-.r-u rj*: 2ii-3{i {11,r
si al esf* fu:tr*clm in a*','lt*ili il*1rfr
clii;ita-cea paog::*sir,.1 a lrai*{rnliui tran-ti:imi**:i^ x.lljn:lli diixt;rli:r' iiilrd u"[rl lti:t {*ac;r
iriL"r-rsc+J",uiui.
{i.u ajtrtr:ru:i n*fr*s,;*puisi s* i-r"ai*:rzii i:;tlcuiii rsrall ffi;ri :nasr
,-1.*
3 e.rrt sa* c}d;il:
er:rali{*i,rti. {laicriiii renali sunt *.vtr;irii
qjtr*cf
c-rl ptt*18. *ei l*e dirua;tsilrtrr ll'rni ml;rri
rr***silanc! !n g:r+a1"t'ui-l ljtctr'iri,: ultlarjrrtdLrl s:r* ciq,ctruhidrar#rr$. ?n ,:.tai:ii r1* p*i*trc,gp;r
Eiiazi,;ii" ne&osi*piit po.rtd
fi utilizatd iir trafareeilfi:lefiefu:sc*pic .rl sinrlrrrnir.itrui dc
j*n,:tilxle
{ cnricpieitt*mje} +au al turn(\rili}!' urclctrirls inrlu
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,;iuirrse*p-,uXi.ci.
aca,sia su frerisfi:i"mut
e!fultl.-ur.r riistt-{.;i?ie&i
t:";pl*r;t+r
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t,. ffi er,*cti* te"amsalr-etrxEia
E.e;:re ritirn t*irrd';n uirir"urgi*41;l *nti*e **3:ir:i d* *ie*ii* iltrgz;if,r
ic,. ft.atail?cr{*ij
a"t*ntlruuiul si;tf i:a*re::nlui *,: pr*st;lt$
{fLl-F--Pi" a! aint*l"ri*rrc"j,eaj*
i'f;"j.}i^vl: dar si #.F
;tk*r r;m,i,itfrtl pm*3.,1g*i"1
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c*pa*irat*
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rJf;x*}l
s*ridei F*!e.1,.
**;rt* fi dr*pi s;l* "ctt eiils". hf;rtelLrlui
cie fai:ric.arie trstr vad*J. cie kt *ar*si.rr* si sir*ci,* ds
i:lastiu, i;l sclui* silic*nat* :.;** ar:inatc cu srirai5 mefah*6 p**tnr
firentin*rs;r c,alilrruiiai
irim*rai"
{1.,-,"i1",:. 1.,i
llir:r'rcnsiunil,:
si calibni. somdeior uretrc=vezicale se aleg adecrrat irulgrurli si
ealii:rulul
urctral. CalihruX r.,ad;rzi
il* Ia I Ciranier
ja
2f-: {-lhan'rer.
Pintru s*nrlaiul obisnr-ut"
!a aduit s* ulilizcazl snntie cu etdjbr"u 16-?ti {lir. {.Itilizarea
gn*i
s*n4c d* calil;rr: pr.nff maro
pr{}41*
fi caur'a rte inf*l*riurtii a sr:ndci sau d* str:ictrr.i urstral* ult*riciarr, pitn
6r,iuni1e
51
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{
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lnriririniee si i$e.heffii$r*l risr3plfi peret*{ui uretral; o s*nEid. de *afihru. pr*a rnic i,"a
ir*rnite
$o&rg*roa rrrittei pr- i#n_g# st:il.d5. Sr:ndelc 22-24 flh su iralu:nas cl*
,;apacitate
n:are s,;
J}:l*se..;s etrup# o!:*ratii pe pr*statfi. ?n sc*pul asiggutrfir:ii dr*najmlui ade$vat ri a h*mrristazei
6rrix
trai;tiun*a bai.orr*s{dlri in cnl
{'ur*;tsr:iomia irreatratriii
pennit* salit:lrr ri:ai irmrc a3
*r:nde:i,i, *une*riutenf cr: lal'a,! vari*a\ prin eafeter sutrn'epuE:ia* qinsfituit
fur$rar:p*r:at*t'].
S*nSeio rtrestjnate utilizfrrii la fbmei, *a si **1* pCIuiru r.lu pr*iatr-ic^ au iungirne miai mici,
F$;.b../.
-
s'[}l'Ilg i.,'rqEiE{'J-PTZfCALE /q#Ltr}'Clr##ti/i 5Y ?HE? Cl,4i
{'
,S*rudra F*iey c#. 3 cdi: se flrio.,iesta pcntr-u insfit$irea ia,ajului rqezieal ccmtimlu la paci*nti
c$ h*mahlri* filecrsscopie5
{pentru
prev*nir*a frrr::rur6rti c}re*guril*r},
'I{JR-F,
TI-rI{.-V.
precurm si pantru tar,nj cu solutii anfisepti.o* la paci*nti cu
"qtaza
v*eieal.{ mssilr- infrtt;ltX
(c*ns*eulirr[ chstnr*tiilar snbl*zicale].
l\tnteri:rle necesfi !'e
;rentru
sontta.i
+
,Vrspe;1fcs - n'l5.i"!usi sterilc
- comprsse sterils
lubdfian[ steril
{giicerinB,
gel cie xiloc.tin} }
- dezinfectitnl outanr:$-ffrucos
ib*tadinfi]
- seringfi de uni*i f*l*sintf, de 10 cc"
- ai:ii distilati sterild
- recipienl sterii peutru rec*ilatea urinei ?n r.'cNtsrea examsnului
- tfrvitX renalE
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si i
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*r, paiir:rii;,r.i"
ri*zhr*cili,
cu l'**;ttbretre
infei:i*ar* ,;rlz,*ni*.].c
sau ou genain*,irir
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dac,;l** *tam"aa.;r.}.
*
I.)eo;i,k:i;ct'*a gklrci*tii;
sc a;:rauiazji catri-t.ru} rnsaiuiuil
ur*tle.l si al Hrels.i:i si sx ftli;*
ri*;dn I ci:i i,., ioi:;ri;i.
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s* *i*gp s*rtdi: de oaiihru aeleeaxtr uref"rr:i" sr
,.trrs*tri,jr:
a-r-r.tl,-alaiui
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n:1.*milsrk:r: so.: urmrJl,; r*ff{it}d* c*
ii] mi apa st*t-i-[i:; lq* aseari !m aprr.;pi*r:r puxrg&
cc;i*c.tuxr* *e tffin5: t$:dla r*a.aJ;i i;c as*az*
intro **aps*te b*ln*l.mXui.
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5e !**rra*# im;!sx.:,qiie .qt*rti*.
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ui ini}*,x. ray
oai:5iul
qlistsl
in$?s deg,;tcl* lg?sia.r sj rr-ric.
'i' 5'; infvsiduil* s'-:tlda pe urunrfr" prruisul
frind tinur im p*ziii* qffirii*al#^
eu mf;rue sifr*grl, eri;r.;r
{;:xe;1ir"rnat"
t}t}pm intr*dust*l't-n pr*xilo:r l{i +m;+u t;rier-rnkiireae* p*nisui, ir; *nrrfo,wn.e
s*l-,
alai:* 5" iraetiune"
**$a c'fr facllit,i:azii trcc*ffia rriintului sirr:dei cfifl u!.e{ra iru}b*ra in ee.r
.$]r{}$t;ltic'ii.
,&'jringe;:aa r'armiui
sr-)rrii*i in v*r-ica r.tiitrarfr- sste *fiBrria-fu.i rle ai:*r-itia urir:ei;
soncLr ss i?rtr:{rdu*e **mprla! p6nii ia i:$urcati;r extr.e$*tEtii ilistalr.
*
s* u*i1:I* hal*trasid eu 5-1G cc-ap;f st,+{ilii si se retrage eu hisnrlete s*$rla c* hal*masui in
n*1
*
lir **m*i;feari s*fida Ia p-ueg;i
s*r*cr*ar* c;ir* Ee plaseazi
decii-!... iFig.ri.J.)
+
fi* r**atr,:t*az# gl;:ndu! p*mtru g:ret.e*ri;:e*
urt,:i pamf;m*ze.
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a'
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plt*ni*
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ss in;tt dut,* ?n tu,,;ahil iir*tl;rj
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i:siil,'a *Lr:l
i]*iit:r"il
i.;;l si liaionrsrii lrj atuii+I in ialrr.ler.tui l,rrral:al.
'B 5a gnli-i-[t:*2fr.
-[:tai'+rr;i'u]
e u :r-l{} cr si. s* tr:ro,;l.ir:n.;;r.rli
s**si;l c* h*i*n:lEaai i* **i
'i {-
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f,##Ja
/,r ifffr,,:ltfil;G *:ri{.
tfile r'ficC:?.ii i;tiiis;ti;tiuj;:!
tit p!;;.-rirr: s{erii ;;i si_a?ijtti.
:1. i i ii
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i:i"iti
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' 1,.J!.,,.,r., i,/ 1./.,'." ,.i
- *fbc*u;t;"tt; ,tcittii,:t-iuliti tfu rdlrc o eciiil:d
i:ei tie x.tirsc*i*a
i:sc
uretrd, {:r"}nsJrrrnyn*
.prr"*:ilfrtiiiLi ts liisngii tl*ie#a,;trc !* ,y*xtjrt
.!"tc
i I t ta
yL
itr.iui t; i,
il"^ r.it;t;d p{soitii,
l*.br"i7iere *_prx,, tiiyff/;r re ie
vt:r-yu.!ui,s*rctlei (:t,!
.!E.qei r,i:r;t*l, c$r_*::$trer;
ul'c{rt>t",trzit:*!ti
tun{ purti ;tl*rit,i{t c*r.e pot
run lritit'ogei c*rc' st
lii!,3J itati,
;trs:tic
"!.i
r;u g,ei ti* xili;ctiintii
- :totrC*!* it:,:;tifii;le ru;fac*,t*tet"izdrii in!*r.tsiitenfc ,ititl ttcot}rlrltt: cu
t:t;tit.,eitzd s! ie\ri#e *htriecr.,s
Ttrin
u;ti*zire .
- itxs:r;sibililitlt:*
;ie c*iete!.irrlr* t] r{t1?.ti rsteal itre{rai siestptit: s,tit;
re:oit,ttfd y;rui #iirtt*t,ett tneat*its! cu ttn i:uiiu
{,tuh
d*esiezie f*co"iti
,v {", 2t. t?t {;t i,Jt.rxru ! e tri iyl i
ytt
i
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de ase*tr,,ie*, o iirtt*zci s/.rdms<ip og{*.fr ;'gral-it;tta pril:
".ili:vsiri
slifrr". rf*poi ,;'are sovsti*ie$
?li'erff'l:-r'g;i ca i n orttc
-/i
t=J'b ch t ai
-
lii:r1iylt
crtie{et'i:ttrtd; tft';c{?it;!rv uretr;:le sc po{
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,st:rit"l+' cu cttlti'}! olh'#t' l4-i:
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r: r_r i} Eli SA,iT:-li Ai
Telenica catetenlsrrrului pe mamtlren lm pr*statici
Intrgdrrcerea *x inanilren a unei sofide uretro-verj*ai* sie pemlte muuai'in ffi${litl
$pitfllicasc si pcrsoaneltr exprerimenlatr.
Aq*st p-roqedeq ppafe fi i]til la
;:r*staxici
cu tretra pr:ste$*arfi deforrttatS, cl*viat#
later;:l seu crl unghi antencr asr:utit, ra si in caz cte caXe fa1s6 uretrali rrult*tli c$in teetatir,e
pr*t.*ci*trfe d'* sondaj, mai cies c$nd mu s*all titil*iat e$rrrje "ctl cioc"' in rnedirE urol*gic'
*;itetryrismpi inlr:a*p*ratnr 1* TL[{-P sau i;r pacientii aflati irrstiiat post Tl-rR-P
*
repunerea
$n.ii s*nd* iesite in+idental sau sshinlba#ca uirsi s*nde.*.o1m*tatein':sclost eonti;:xt -
-qe
fae.e
d* r:hicci cu rnanr{re*.
hlanrirenul
(Frg^d"S.j esto constituit <trinrr-* tlid:natalic;-i de'ralibru I {lh. crr
c:*remitatea ?ncurtrat5 ni v"fufiil b*nt" Acesta so itrtrr:cluc* intr*t, sondl cu itirner ustplut in
pr*alabrl cu ulei ck glicedni steril. arrsnd
,Sii*
ca. riar{r.ll r*.anc1r*nului si nu ia't5 pltn
5h
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ire
qi*+Llbi6.
d,:l.sa,ii
*s{e' u?}
'a1*r-r*r'rzt inir,rrianl ai su*r-.*sBtr:ri n:enot'r*i. flcncfui asffel "act?rfitfr',
go
irtic,eiueu prr;
ui:;ri riirilr::rc'i*s' ntr*I;!
ri; piir,r l;rgl:ir:.ltn^ iluf'I,"=,f i.ii;it
-";:rIui
*i ,n oiruei ir, 1,,;.ri;.;l
ir*str:tinard:
ter a*'*rst imr-1fiitllt" i* tirnr: ++ ;nina stang{ .irmpi::l$r* s*r:4a
*?r,;infr,-a.
**t5n*
dr';;t6il* J:*iriif,tr e*.tTlFi*i rffifiiiqire$ill *rx:*t-igaits- fitlrr{ffi's:i ilrr.,r:rei u*j+i e[r, ir:ft:q:ducsro:
'rll
iir*pul a**st*i uluhXa ;r,r;tirmi *.:<{ysrnitaf*a sorrcici *ju*E* ilt
r,,*ei*i.
rn'G.11.c'.
-::i.;.iA?r'r!:.:jr'ltif,,T;iLr'C,ir5;r.Ti1lii
I'i?,h,[]iT {_.,JtE'ffia.}-lEZItl,:tlr
A,*fii{iem*eE* s*me{rr,$ unui ureEr*-r,*zie;aE
"o
tc;l*.,/*Js;i lt;"r:lrE;Jr7; t'aurzg d.* *ser* a car$lirrsc$ulr;i
gi
ri.* urclrllragie un**;:j ;;[rua-r*ieml;i.
lxu l*sisfari, i*fa:.lr;61 *el*sr:a fiste r,Gr-h* d+ * strie&iri C"" urelrS cfru a+tsefltr#. g:*at* riii.eri.rti
ci:;ta'c ifu"*pt cr,use*.iett.{ a;ra*rtr*tiziirii iiltr"r:g*** a xl'*ti-ci. lr,,filni a:..p*runerrtnt*
i:*t
ttrlusi s;t
r*?:i:i* t**ta[iv;r
'*-*
glrfiEiaj
e;-i *
glritd5
rnai s',.ltfiil*.qfr.U eU {} S;:r_-ldI "l:Ll i]iiiijr,*a;-i:
l.:rlxrdl
unE:rri r*g15sii:*a trai,;ctuiui *raii:ri.
*
d;rxl/.;,''st; i;*ittit;t:;uil;l ril i*;i;
;Ntsstt;iird: rcajiEe*zE En drens.; iresuficirmt al ,i;ri1xei
s,Ericalo ei
i:*aie
f, cau;za C*, ur*{ri:ragre. {-rmfiarea ?:;r1**asi:hd esi.s rfulr*r*:as6. F*rrtru
*r,ttal"ea acestui a,-:cident, sofid* *retr*-lerioaia *:*"i:uis lntrr-rclusi *omtr-rier
{q:l. fuifureatia
ajllnsi ia rceatuI m:*tral; si rimilarea hal*nasului s.e sfri;turazfr lISrfr *a d*i-rci:t sii fi*
ir;r*tiofia,st.
*
f{trua;turirs *x
..:iic;,trj?:
Frti?tr;
;rp*re ia g*lil*a
F{e.:i
irr;rnxt*ria r;si-c rl:-l*$ar abucicgsl-d* +rl cheaq*ri:
fr*&tij
v*:li*;rle cl;
,lfrt*
-1*S +cr.
+
?art4ii;r'sis:.?: str&fl.E$tr4::*;t planriului de i;Itre *nfl*iul
i:r*p6tial
pr*x rtraint, far:*dz;lt* ei*
-:ti:stsi"*ti e*libi'uhii
irer:j;iil ti;'ttctt'a1.i scrid*i. Fcrate -fi pi'e-rre:*it.{
i:r*l
roual*larc;l
i$ilnd*im
l*
sn-ilrsitilt
'g;llr,;*ti'.rii
11* si]1rrl;ri, Par;ifr:nli;* *$rsslitrlita
lx;ftlr;
fi ree6:sa or*rrorul'sfil1
fliifirc
nectsiia :-n*izi'; ri,:rnali +u iristLiiiii a lneiui*i
ilr*p66*1. silh ;ig*stede i*cal;i. i:*nt*.r ff #Litrjil
r*cairii;r gi"tn,1uI.
'! Pi'i-rsisr-;jr; iL:.*'r;gnur;,
iri-in
as*psie ir$lrfi.ei*riie a rn;:ner*-*.[or rl* flr:ftd*j
L:rus+[ Ei re;ri*ii iiflcfii ii; riist*rmi*:
fi *r,ifat$ p:i*
*:ai:ri*nmr*;r g*.iir-fr
*
,
{
L
l*
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ri* *rs**te",:es", o_iittr;rit s{rrin,r* ptsat.*.,*} r'e::oh:*t*.
Strir#
o'dbi,rrri,rJlrc",
dttpd c*r* s**ti*itti
':i
r sti rs-v e zi t isi
;:t
o*te
_fi
ef e c{u.si
-
{;e.yztvu
c*tet'e,,ir*re,a sfi"ii:f.reliL:t, trretrt:!.r:,seJlofJil/{r.si s#r:dc su ctsp*t o#r.,*;r' }4^}!
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/
il Z ; t A L E A F L,l T, i irr, SX Cff*lf s'f Efr fL
'Ieletliea
cclteterisffrulari pe meardrem l* pr*st*ttci
Intrqrrhraer*a cu manelreR a unei sfirula uretro,-terj*ale se parmite nuuai
'ln
metliu
spitalicesc si persaanelor experimen**e.
Aorst prrl**rl*u poaiq {i q.._tt 1* prostatlei e',;r tmetr-p p*steri"oaq6! ri*ftrnitatd, rt*rriat5
lat*ral stii rr unghi alrtericr as*rtit, ca si ir *az tte cal* X"ahA ureta'alE rezultat5 rlin tarttatir,e
pre*cclenfe rl.e snndaj, raai ales c;&nd nu s-au iitilizat s*nde
o'cu
cioe". iti me,rliu'tx*l*gie'"
*at*tedsnrni itrtraopr*rat.:r t*
'ILIR-P
sail la pac,ientii aflati irnattiat p*st TUTI-P
*
repuner*a
unri sonrle iasite incidental ssu schimbarta unei s,Jn*c u*lntatate in ac*st i;onte:<t - se fac.e
dr*hiccieuinandrun.
L,fandrenul
{Fr'.g.6"8.]
esie constituit elinr.r* tijd rnatali.cii de slalihri} fi Ch, cn
extremitatea incuri:at6 si r,'Srful bonl" Acesril ss Aitrr:duse ints-o sondX cu lurner urrc;lut irr
prealahrl cu ulei tle giicedni
-qt*ril.
arrAnit pp:"ii ca liir{'*l mandrenului sS nr: ia*I pdn
'
.sEl.$.7.:
lr.iil,\E i R{ft Ei{ s?EftJi-,i.,1 sdlA,fi.flI
fiEgi-Jt
r:
- i,'Y Z ! {: A L E C Lr PETriSL.4 rrf,-i &/
t
';s'ter
Llr.il ei*ei':mt ilT{;*l'aan1 eli s&*r.;*gilhli ltmn*l,'l*.i. Sc;tel,; asifel
,'arrttaii-,'
ss intt*{ilirs
i},j
x"*irii detiji**-* par*lu:I
r.u
1-.,Xi,;n
inghkrti;i. as$iel i*;i:r r.,lir&li *i sfr a.iringfi i* !]r.*rr;r
T-r*""1,;r'ii;a;'iL,
i.n ;l;-.*ai ffiilffietut- lrl {i*r* *il ffi*ffi.c.
gtarrgi
irmpin"g,; s*ll:ida ?mIui:lrar, rnilea
drr;;r.3:i5 r*1r";l.r* **mpirli lraaxei *is*i *r*;ut$iui inir*;;rs* il.l-ri*r.s-r-i c*jei ,je ietlqld***,ie;: l;.:
ti"ra:pu] *,;*s{ei uii:ble cr:tia;.ut {::x[r*ir*taf*;,i ri*mti*i ;l.i*mg".'iie l,i:dc;i.
rq,,'ii.C).8.
*;'r,l..ir\,,ii:'i&l\i:1r*Ei,ili{,l-,{'lr,i7iti.ISi;}n{I}E
L'RI:ip,,J^!TZi{::,i;.[
g.aais{esete},*
rnrae! rr
}ral
am alx'*trc.}*v'erie *i
" i .;i.. 1^.^,!, ,t ,,,'.,r-.,''
,,,,."*iit". cirtiu;: d* estr, a *atel*dsmuiui *l rl.* ur+tl'*raroa un';*ij si:u;.rra1**m[ii.
"l''Ju
iffieisf&fi. i*tru*61 *d*sc* *ilt** ri*:*;* *[c, * sfidaft:ri cle.uri:ir5 ***ii**rr*tri
fr*st*
uii*ri*r
ei:a-re dr*ilt cl,rr.lg+r-:fot{E a t;'au*':afizfuii i;rtrr:g**$ ;r r:r;-triii. i.',f*lrd *xi:*rimeffiats LX}t f*tr-isi sE
r03:*t* tt*lativ;t *r e;.rnel.aj ci; ii s<,.n,ii$ rAai :;rrtrlire
g"tli
Lr$ s.r sl:fi.Cid.
uu,;t]
f:irftt' C;*i:* p*l:g;t
ufi i:d:i rur:asi:'*"i t r,:ir".i triu i ut,i i F.iEi.
*
tjtgii*rs.# iiitiotr,isi-d*i fn icpr
.4:.*s,l*:t'ir:ri.
reaiissar.E En chena-i iesufisicrii. ai uit*r:
r'e:iicatr* sr puafle
f, sauza ii,; rirr:.tr*ragie. Umllarea i:air:$as$lui *st* dur*ri:a*E. Fanhtr
eltiare;e ac*Elui ar,crdenf. s+fi{Lr riretrr-r-l.eei*ala h:*huir: ingl"r:d*s5 armq:l*t
1*u
fulf*.reatia
ajainsd la rneai::I ur-rei.rai'! si un:ftarea ha;$ilasitlui i;e r:fcct*r;rzfr f,{r,} *a si*milutr sc fi*
tt',rrtlr\ea,nl
;r *r! !ILr!ti:t I
"
*
.ft'*,,m*,ft.r-ir.{
s;
.r:l,}c?.r1it1
[]ci;r.il.i
*p;r* la gr.:iirr;:
irc.metuiia L:s,(ri r.rlld(J i alrctfiri*:.it,1 c,t:
,r:lraaguii;
\ -i.ifir:.; r.:i r",fiir;
.1{ii; ...
n"
!';t'r17ix'tt;2.7: $1ra*s.lirire;t
4andmlui
#,* **trc sinficiirI prr:pr.:liai
i;i:*;i
rtramt. favr;dsat5 d*
{;uf,tjlri'cti-
c*iihr"uJui
;:ol*;*r ;krt*r*t* ,qE:r'rciei. Foals fi
i:i'*ir**itt
prin r**atrct;ir'*a gji;ndr;irii i;l
:lii:-l;litd
6:r'#e,-:iirsii
d". e**ila-j, P;:rafi:'nc'zil *#fistifrJi;*
i.*i;*i.*
di l.*dru;it i'ilami;li srln
?,'{iirifl
*ec*-tta l-r-r*irie ii*rs;rtrii *li L'isiud*l ,:
ic*lariui nrr;pufi.tl, suh iifi*si*z1e 3*caki,
p*nti"u a
it*ir,r
re c,"1] *', ;,r. gli.l*.dui.
* pi.*.sf*Irir;
rGri.rftls.ix.*:
irdn
asci;si* in.qutl*i*i:i*;i lnan*,ry*i*r ti* sc,*cl"ti
pr*.:i hrtrc*f; ;:
".ird*:i
a,Jkit;-i i* riisi.*;tsi*:
p*at* fi sn.it.rr#
i::'in
fra*ti*n;rr*a
gciiril
l*
i
-l
Fi elar'*;+
n'
ei d
gfiee
u E"$'
u
t.t E.G {}ei
g+-lri.g.ie
m e$l.ttq;rsEf,*ti eq,
Fr:zitis 11* fl--q*i'* u scr:t.}ei se sfaiiiiilsf'; dt:pfr l.mrlpl*re'a
{pdn
s*itr1fri ;r r,,*::ii:ii ,'ri
r+;ir*grr** i:r,:ig:"euil;ai ;; **netr,;i" p**5 cf;nd clrynajn:1 este *-1rrit, c1*1;5 car* r+* rei*trcdm*;:
il*srrie I-:,1 c*:t rrlr.*:tr** dri,;ma.*mini p* s*r:rtrii.;*nfrr:n;i
lloi:idft
-.-Erdirq,.e;rjs;atr5
**irt,e*a1rill$ a
t,,'ii:,;r-r ri t:i
q{-}Ii(1il
i
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l!fir:l i,,nLtr;' ;'runUf +SililiC.'
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t-]Op.i*
t;;,- :it:*:j-
*
{..lai d**.il he*;d d* l**r*'#iarrt c}u: i erx }iiti"r:i*, }i3:ir* LEnin j}fi tatit vesrtralir, i:rr c*al*ltd
i:r:
fal.x
r?*l'saJii a prnisuilri. llt:*tr*qrdt# ii*. lssaie i-iiii:lr;
p*r c lunginl* a,[e 3-4. rfii, s:,r:lt .'rr.:eti,r.ti:ird.i: L:u r:
L|:at*bo* in e;i,t* clq;il$r h;rftd+lrte e;tru s* lip*rr; p* s*meta. f,i:i,; cl*trfi trrenzi ir:ngiiri;;trin*ir stlmt
fu;rt* i-r"liyt; *1* st. lit t*,r{r-rr!;*:ri.*i cnenian
i:r
n elt* el*r*ii h*tl;i dir-p"ixs- c'fu cul*r.
i'
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i'sl lr*rh+!* nin:atii" l?-cai:*;i er:rtmllatt*nta.rd e E*r:*:iei
;:i:
lata iirter:lii a **apse'i csi,;
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ill s*cnarii tuit;r,
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si *r:ltirqliil s5m fi'*iit-li* inttiuiii p*x-ttiL] il rtm [ra';tic]ii*
${-'r!td;r,. tc tirrq:ul iii:phei-ilii. iraci*:n{;u.l
r,* puitt}rr i-.r:**r-}ltiile,cit s*nda si g:*ttisui :lt: iri;et;;
r.i ::tiq t : r'iliti-L] i'I,*:'.'t i i: r ;-r :l i'itii i:.lY i;l; tr;tl iici.
i*m grrilr.lna"*rr sslm{g*, .F ok:5,"
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e,;.lgii"aineilairj6
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csz ei* ,;.;:paeitate rni,;i r.,*zii:3lfi. li:rtr41ri
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lezic;rl ir si riis*mrifi iarn neoirlari*rr sall ri*cl ar'lsarofi lie!ftattryi ei.
u:
li*i:[i*flax-*a
g*nrlsi:
t]*air
ii s;ilu.ti"t"5 iii raz de s*pai:;l dsfr;i;i: ilae.I mn ssl$ cfi*,icfita"
fuIr:*ta:rra si asp mi:a r,;prt*ifi r{,'r r+i;:I"tirjtk:gia
3r*
crulahil trit}r-,tui+uli-li pl-at* iiucrl i.n'fifi;rl i;t
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o:*raspu*ziii*::, ii *rar:i r:a*titilti ini*i
{tiiti:r;r.
ryJi cl* et*r Eau hair"rtai^r.
'F s*fida "?nfi:iatruit#". ail*r*ntii la fi:ut*r:;asa ur"*t*Ii*i5, cu biai*fiasuj
{'cr.-$itri{iifisa rteg.*nfi-lrii *ste *s*$xial5} poete .fi filrtat5 im r;:ltt'*gere
i:*r,**ragrrl 11* r"rhi sei ?nsE ti^afi dtc*rii."
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iL Badl,j*n*j sriprai:i:hiarl cer s*luta* artXis*pti+fi si ir*-nar,; eu ';*r'ttpud
steriie.
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r*ai**L si i:*p,:r;ra;u mat'gi*ii superi*ar* a sir,rf;z,;ii .qe, fur{iitrefi.rfr *u xilinl lszfu liisl*a"
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'lrcear
si se ?ndepElteaz* tr*enrutr
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1:;-in
legclsEcnfi s!
P3 5; a:ifr <ireptuiui altr';i*minai
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pretcni iesirea scs:+frliff diri l*mertull lerjr;ai i:clnt* e,ti. $ai:cmpta*ia lezicii'
T. 56 fixearii la pial* cfitetr.lli. f*hsinel mr"r fir ile siit'dr6 -qinteXiel
nonabsorbahitr;:i'
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iic ,.evcrifie,ft
psfirrsabilitatea si pt-':ritia 0i]1'{iot5 a cafetcrului
prin irtgarea ;t.:*siu.ia tu
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fi iru*cuil- [r-] tln airul ctrr rJiamett,r
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re fl*t'fr s* lcallfuxb;-i {uhul iir: r,:li+Ei:strxni*
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l*t*t'tiiu;* in **r$exf.itj r;*fuxatiru
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;rcrrtj ;:hsfl11sii1,.*
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lir'
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liriezice.
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i:rist
iu:*ter*sc*pi*. *::.rttactij endrle*pic* elc
caii:ttli ur*f*l'aii sau clil;rtaiii r;u l-raion
iriren4iul
uletcral int*ia se instit*ie irr ac*sie eanlrj ia
?irn p ul *r'*: tctr.ler:r;piai
).
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s.trr, cir_ersr+si" [;e
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r:a#iaijj si eirfu:urgj;:
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Iv(*ntiri*'ar L}ilir-i st?rg
1-}*aio .r-;r*iiit* *!fu;dxar,;a
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g:ilxl
r:ist*i*rmie:
mtdian;ii sau rxtrarrezjcixJ;i. F,kx'n*stt* $rlxfirlxr atr ;lo*starr in{*rtr*mfii estr i;r*ar-ea uffiiai {ucl*j
ailfireXltx;',1. {lr*terr:tru: clilafatrr ** reirnpi;u.}teiiui dupi
irr*anahr};.r
r*yn*d*lar:t; prin *:,:er-rie *au
pli*aiui';tre
1f,CIhnica
i'"atri*iustriil. t-U-lhi$ F*litan*-X,*arJhett*r, Gi*n-,,trfi*i*rs$fi" C*he*
{al'*rrsa:'*
lra-ns*trfu;*ttal}1 - sunt imlraler-i';a}r" iar tr:hni*;i fit"$e$ir. .14,'asrric.1c - s* exec.utfl in
ittli.tti*rfi *.v[ral'eai*..qiE, 1-,r: pra*i*n*ii lr*rxtrd*i r.qau c*lld c*neliliil* ]r:catre $Lt s1xpi, a6tre{:r,.r3t*1
iefuxiail*r **mptre:;e, r*impXa.ntitrca ure{enrl*i s* p*at* f,ae,; pri* spat*}ar*il oiip5trilui
urst*rai si elersaraa e:-iti-eitritfitii uret*lale; ilt rnanson.
iri
q;a:-r
dr clupii.-,it;it*
1-tfsiolrttir,=l"alJ-
c*6-iple65, U(ll.J,i este ncLl*Eilrfr ?* **r, ct* i'*fh.r.:i
ix.:*: ur*ton:l p*lului inferi*r Eall f:!* ambe'le luet*r,*) sau rrxf,B*ur"6{*}: #X1$t1"1}ctir,i
-
urer*rtrc*J.
A'tti}:els urrt*rt suul rc,ix-:pla*t;:tr; eii * si-ngurd uniia{* icitr-un tunel suiriliuctr, uruc
*l'tli::etlux" llesohiderea eclspi$fr a rmuia rtrinfi:e ureters sari rlistr$ctir!
i:arem*idrnup.ri
c.oresplrnz5t*r ui:mlia din sisfeffietr* rk drcila.!. impune heminefiee,tomia.
-
3"I. Imtem'eratii de
"sritrg]:r$ilr'e" aa deficittrfu.u! ele strbs{ant#. *re+tera[*
'
F:etr*itui ile su.ilstantff u.reteral5 &parr: c,*l urai adesea clin nrcesitatex {1.t; * inrtop*lta
*
3:'*rtiu:la
rtrr ur*t*c. <1c, *hicei ttr tr*im*a ird-er:i*ara ifisruli p*rsisierrt,i sau rettrux clup*
{.1{l}ls, lcziffi*
qrel*r'ale
p*straegiotm-aXli*, {istuil* uretere}e +lupd interri+nfii r-,fuiru;:gi*13*
rnukiprfu *r*.).
lliqrl,ig-Isslgf c*nstfi in insizia tran*nr*rsal5. r-i.Lrlie as*enetr*nt$ a perr*[*leti vsziea]
antsli*r, inrrpre p,1:'tea opusii. ce&a c.e p*rxrite' aecrusir;naroa rr*dsii Im partea in c,gl.,;
ut'otcruj s$;fe scufiat; a<h;enlic*a ver.ic"rli este sufunata la tcndcnui nredial al psrrasuhii. ial.
turcielul ilripectiti rcLlli:lac tal
Qpeqctuq-Frttt!,rl-aEqpt! ccrnst& in cre;iree urui laurb*u r,,sgisal
*afii $* l'Esf,i'Angc
i*sJrr* uretprutr scuriat; uretsfi* spatmlat u* ilttptraiit**uli ilt trrnelul subnulcr:s creat la nirelul
l*rrtl'toului
r,ezical iar hrnhc,ui iezical s* tlri:ulariz*lu:;i.
!-Iry-t-srqrtteEiq,-
tronsu&18$14 uunstfi in tl'*oer*a ur;'terutrui. se*tir$ra.l de*sr.lpr;l
rdveXutrui p*t*logic. prin spaliui retroperito*eal. de prat1ea urstenrlui sin*tr:s si agast*rslr:za
ler:nino-ia.terala la acesta. Intenenria
,;ste
cr;nn'ainiiicarl la pacientii litiazi,;i ssu cu
t':rcfuol*rapi*
1:realairila "
L)-Qpfu.tags;L.ios,qrijer-:eBq]-,{Eqgts
Farndtr
cobcr;irea dnichiului" F:sie realizalriX;r
ntunai pe
i:artea
clrtapLii. {lanst}rin sec.tion;r$&
ar'Elloi
rsna}e (suh
clamparc dr: arter* l"ermlfi
si c.'!ampar* a *av*i ctl
llensx
$atfurski" ccncomitent cu refiigerare localfi cu gdreaf"
] si
!:fl fffi a.s.fr]mitzilro l.enofl s5 pe *av6.
AqAEltUXgga- q{ql!I!X&-lq
trluq:n*rn_it4fu
est*: apfirabilJ ilupa excizii ureterak-:
iirnitate. Ext1"eff*[;itile u.rstcralc $e a.itastofiloz.*azi rtrp;i spatularea pe rualginile opuiq#^
Q1
l-,jJ.Liiili4iia-]i_1'L{rajii'iiq;sii
*st.* u::t
1'lrr:*,;ll'E;ii
,.:itlr*,::gi*.:i
i,lral+r.. ll.t<j'l*;lr
1::1 F,-].l.Lliir,
il.ra*:'alir;*. t-itilil:aszl un sugfii''"I?t
i*tesffo;ii
il*rc1r'il e1i*:ir:t*r'i :t}'*rt:i"it'
?. J:i
"
t -i x"*t"*rt-i$i'ea
p tltltt'u {,? t*p"c}za r"ctrt:
p rr*-?i*pl *aif;
]:)rut ;ri:*riJ fi:lditiafx [:-;**striadll,n*ai
."rii*pllbifift,
liL' i**ntiiir:# sj i;l*i*'1;:ll
r'-i]:':.i*l{':l''j t-ili?:t
{i;ri:{}.1;,r!"*i1 e,::}*ti*!.rr.i.l.,,i:rnqdlrfii
si rlcs*eliiicEli".
t.-rrut*}:*i'.; s*
i:*ziii*it*;rzE]lnirapi'"iti';--gre;i'i
{l:.:i*ri:i!*}ki, lxill
iiE;tl}i'il
p*Iiriln*'i;'ii
p;;ir*'iai sr'-ii ri'"'"r-t';
-'
l*ti; i*lt*ii.=';i
';r-*t';:
ir:ri't:'l'rsa tl;*t*r*l*ri*
tr:ansr:* l'i;il*n'ialhil;iX'*i''n1'
t .4. {
j
rc!.sr-"*3}tc-ri.*q'cei?q
i*,f *ii:ii*ie :t'::i.{;dr;ta'rl*
qJi:
i;lut;*-ll*ni
al* **li;u'id*1" lli:*nei";lJi: ES$''T-'
{nt:ii!-*};tiut"
Lri]ri-i,r-itir;rtii,li* r*
i:*i.
t'*rtrt*i
,lkt f**r-o'*:11'#.i*
'tt:;rri*lt:lr;"
inu'iz.rF s:r: ndi:lt:i*;:;:3
'!i;c*.lisiL;i
c*ntr,.lt*
pu.- o*icu}. *{ile sii fi}i*:#,E* r'tl * *et'i;it r}-r +aicC' sg
';i;d-fiu;'i
t'l*nt+ufu-ijit:t'i** 'iisiali
-si
.$
"
YFli ffi E -i,',+"T'
g g
E
itr'El-i
"&$,BE
3,i.I]*r$u;atii*e-rrt;*r'eee"itl'rlt;'el"sIlt-Ecl{:#Ettilli'nt'';
]r*sihi'liratil*
a*ilffijrr ii= a::j:#rftlrar
I
,*l'*::ra.1*1'r.li l.l.rjrrc;: p*a ruijl*a'o* m:n-ini irl'i'"xzr';*
{*r*na-lr
uri,t*1"*ir :*'*u-''*- $efi:i}s;-ci}d*t
rorr'*ul
ilti#'i' i:"1'':*-::ru"*t'ii;;nteXil
if,get* *'* u'{ii:;r;:;"';;;
:;-i-:
iuftfiranl{lt ilils,Atli rl*ir tt*r^r{l'tl siLualii 11* m:g"-tt} n";rtzq:}"iitiiiia
tttlt"'uli itl-"'e'rir'
,iit lr :-,1 it'. i.,-,rin
ir"l i.itl*.
;rl}ltrl* itl.*rfis ,".,rini. iiiiffia[.;i, *tr.i:ii ?::, "1o^;o
a il*'
1:lt'l;;;'
.
i'e-dia';;l'i';il
?a e:irs;l'
{.ri,,ci*ciuj i:it*sri-n;ri se ;flfl:iti; kt c;'1p5.:t;'ll
pr*:;*n*!, a*lb*l*
?-ii:*lflr': *li*t fulrpl;l*t*t* kt ;l*'rst
rnirr;;l ,rit;
i:rixe*:ii*
r-*:rttl st*iliL:d
tfu-} pip-raii- irr t;'i c*el*iilr uxtr*rx!flrt* ;t
';#fis:i*'Jti'Iirti
.i.-1. [-isrli,eti!
:lrilr;s:
r' s:(]i:alrilit i'ili?l!;,fli]g?
{k:a*;tau ?ll. r,ro*ri:o: rir-*il
'';*:r*rt,*i'
mter+ti:r:ti. r:n ;::i*':;tllism *rtiii'ett}t*i #ubh'l *at'e $t
******=a
pu;* eatoidl'r;:a;:e
intcu:ut*ntii.
;li*:.trlx,:u1;wi;:a;:*a
fo:{*lEtinai# faci$f*aa;i
*ai;;lcit*ttu;l
fir#re ft r*=*ror**t ,i f* pi**ir,*e sc*rul5, 'irtrerr=3:r-it,d
sirlri;*-t- a tl:cu*u!a;:it
'*a
iii:
;'mt*slinai
$i
Itn rl*X..
X:*:"'i
t i c I I i r,'-' ; ;l l"J ;i i i! I s ! i';'-' nl o'-tri-' i rirli
"
ld*z*r.:,;al*tr*
ni*
3ri*dd;: si tii: i'nci-iana *liliz,;x:,:;:i il**rrsi ttnni:r;:l. o#e#i si *u-*i*tra;l
;ae**rlcnt, d*iiii:*trarizaii:
ict
i;orti-1}rr*i
,;*s*i;r si 'iu.)iica.
"lil:
calu l;c td-cclu+ll;Lit u:-' i";""'rt*'-oi' -ii;
;;; ;- *" 1*r:f*;lr.i r:nlr*l* urci*l*.
h,,Ieearusruul
amtitefhlt al rrallel il*':.r-r-e';ai*
":sie
aripii{icat
pi:ic pii*al-rrai:ea
pod-i::nti it*aie. i-,:}r';:': r* ;:1.fi::sti:tTt*,-ea;*
1e pi*ia'
[r]
;$. 3. t
-,
retsrr;s$g*r
*_iir$ ostermiea
{ir'*tarni:l55mE::ir'i*sf*fid.?
*st* fi t*mr# *fc ri*drra.{i* *:tr*rr5 e"fififffi}rrit#
elsr* *:tip sfuripia
tr:iurie" d*l'
."u
e*n:xrt'ir;afii n;:*c#i**:
;aeid.*ra nii:**J*re*ue,h.
reir,*f,ai*r*;e-
-
6+;*toonefi:rc;,
as**nd*ffiI
uromigen5. f,-avq:r-izar*a
fi e*plai{mcluru *.*ii*u.
Est* ir: gem*ral r:iadtil
3:ec:i*nfiler
r4rstai$i, c,* exj:**tatir,.,i
dc; vinff,
:lurai aalrdidati gr*tlflu ri;:nvatii. ud;iare o,:n:pir*x* sau silhsti*iltir,e
*i *ai.* nti
*trtanafrl-
liflmcturrul anai fo.er_:mp*fc*.r[. clry*fiiculit;r *ci&r:6" ri:prearrt5,
e**kaiitdicaf.ie
;riis{jr}trte.
i"ti: i:ii*i*reraag:i*
i:*nr,*uI
pr*alabilli.
insrifici*ct;t rsnals sl arreterane rtilatate su*t **n*:airrr*];-*;i
r*I;ri-ir.'e.
d,.
d-iE{
EBtg
j
Eq"#AA VE"fl E{_,8[ { &IIEAffi H
-6.
-q,
{'icariit
*rsli* rhti"ut.ei{.uhr
inr:i!t',siii:
*
trrr;t*tus:# ile i:ariri r;;;
ruptur;r c$rj 1ff:,*$r5 mr*rl:?:ramr:*sfr
- S i i"l cil"lri r!i"clr*tr + .l i t
i]=: !--ru.r.,.t iI.il i,i i
r
Fu:.;"i; i
- tlr*rur! sau la:,4; riezi;al ii; ao.*nom:eeii:mia pr,*staii*il
tr**srru::jc;rl*
*
ilsee ffiu o*ntl:a.{jr$i*ar.ie
ci* *j'*es*ar* a cistrr:sifc,*ti*-.i
X:*r;ut;in*
'fcllgii;"
*cns{5 ia aheird nirttiian sutru'apuir;nn" ru *tirf**,rr**
*."nru,:edt*:ira}d
.r
trt*i'tteiul anten-nrr-ezicai si c.isttrtor.nit
minirriii
jntre j
fir"i dr: fi.aitiune:
"-.;;;;;;;r;.
re;iliz*iis-{ {.1} 1}it cateier t'!e trp h.fak:c;*lt
sau l}t:;rzer, r;isi*railr
etarrsj! p" t-,_lir;'ln*hidere
?s
:;tl';1 ; 1,tj *sl n [r ;a,''ti c: ;.
4.3. C Istc;iitue
qrft?i:]
:'i'l';';cr;;]-j; C*l+ui rezir;ai
rirue <i* ctirn*ilsiu.r:i rm*ri saru liLfuza rreziralli
mriitiplS.
T-eludc, ah*rqiul *sfe sk1.:iXar cu i-l:itarrre:lr.ia pi-*c,:ilent5.
elal: ii,;c+i*re;i p*r.;lu**ul*
esl"' x?illi altlpi5' kll*p*ctfur sreelr'.fi
urimar* r,trup* r,xtrafiersa caiouliia3r esre ****u*"1 ilEti* ;,
*:xclucic tr*atrErt{ l,ez,r,;-.alr e*crcq_ffiIt*nt*.
I$rufis1:ir l,l.ap*utiur in
,;az
cle acleriom 5!r-: pr#slalh
este unn;rioarca:
- .{det+tniil dr pic'slata de diuruusiuni
mari (6/7 ;m,r se re.roh,i c.orr,;<:miiunt
rrri*
;rcl*n r:m raiurriic prostati ea transl czi cala.
sca.ffittd, cfrfr? lnl
a*+-*n:r5 r.- s{*g::r5
rerz*trr,'il
?ntr^lur ai *1*i[ea i.lrxp"
ca:reterizat
iufrr **lr ei*u*
r,ezir:ii si uretrci, clupir c:are
sectionat la niri*:trul ach-rlui
- ,Aileraomlul d* pr*statfr de {ii?nensiuni nd*i,,*redii s*
enil+suu1',ic"
d*pd,inrir,,o;irea
cistoiomi*i. paciennrl
frmd
interle*Iii s]u s{.}nd;I ructr**lru;riq;ai;i.
{eiwicd: fulcizie su[.r fi:nna d* "y"
ile
i:er*tele
ant*dor aI
lacirl
"\'I"-ului vezical *ste &trafl si s*furaf in inekit muscular
r,ezical.
4.3. Flastia
'trtr:-1r't
a es!!u}&i r,exicaf
Utilizatd ir,i *h';ttuotirtr* dc ccl :rrui*atr l* c*pii, eefuafu:reirts
est* ilrloeui*i rie
i *}u:icile rrn rlus*rrguc'e
"
83
l
i
J!
4.
3.. {". ls'L*s:i*tsyri;i grxr* u
-lfi
,,i*u;:ritiii; riu;"rul i:i *ar iie tam*gfi
"*':ijir,ra,
rrun*;r'e,.
*;-i i:i*tr:sii i,: l-t ul: *lolei-r;t:
l:*;:,*,iai lrigriirl*. fi*iiiftii'il-rJftir, uie'k*i*.*f,l **':.*t*l :i:ihlr'-,ri;i:ii.i eu. fi:st l'*i;tr:lri:li; llurrlaj. ]a
*anrrjX* ri* rcir,tr+::j; iil riir.r*r"ticiEi
-rr*zi**l
sa* ;ld*llrtc;:l:c,ie*,tra ini$v*i*t
rljsi'r'*sr*ri cir ttlfi:';lt.
4.fi. {-llst*cttr}}tii:r sl.*llpEil
l-nt*l tr*niia t::C*p**te;:::** xrd*i
u,'
*;'-iea
*Ii t;t5ij pai.i:n*i** * **a:n*+i:3*"'j+* :
- ilistii*r ilii*sridlu#
';*
rrt:;'-lr;;] nue*a
rlr*'rai'i!. ia:" l*r-lsrafjii*, iiuiif l'*pt*';l**ia$.r:,;i*
* ri;:1,;a r--i,*f*r16ljrxtgii:i3i.;i
,;i,oits*il1ilIt'
!,rrjfii cii','r*l-ii'li
i,li'Ili;l."ti, si,:ltpi;::;::a[i*ii
plil:
!'dt*?x1jii su'irii;:it. 1t*i:l+uti:ii ;4ai-; e#tltii-rl:Jj.ri;:f.i
F,l*uLlsl*ir-l!
pattlcgj'=-, i'*siaut
- F'istrjlc iirrzug4l-iiiiseilflaii F*ntraclii:fl:raii!c;i
s"tu txit:
3-iri{}flri"l}s:ii:}* eliges;ir,'* i';11
*:cr**nsi* uc,rit;ll}
^ \i*zir;;: i?r{.}
r-rF,r,{i;i
;;*riitri';;t
{*i;';1,ri.:i*t'u;**-s'r-ib:+i-lfiil:icr "'e::i';aiii
it-i{';l,ii;"i;'rji,\
4. $. i-lisfr *rt*s*ia[ E *{i lc;it*
{.-:i$tsoilit}:d*. r';u't'ic,;,lit *sl#. irr,r.il**1-A
-i;r
g;a*l*r*ii l)Lt *ii&{li:t' :uei**i
i t:xzi"ni
"i'Z-T+
iia: sr
a**i;fur;m =.:ezicai
'll.i
$*H *;I:r**i: itr. ai[u on-re l]lti lt
;l*i'Lti
fi
r-:,]fitfl,:]iili p*'in li:2,'=+{.r.:
lrir:ri,iri.I:efreid si;Ecnii institratir;riali" I;i pacirutli
,-;r"l;'x*tastazr.
oisi*i;i.rrr*i* "du s,#hofii'="
i-"l"iirr
fi *rc.n*se;.; ir:
prez*nt;n i;i:npfuln:attliti;ryni *ii*i*e r"a,]r$flt.ij i"x*;tgcrar"o"
disi-lli** dns;:li p*lui"rr*].
rri-.*i ;: l;i il';lt;,' t;-l c:i{
qr';
I rp i,a:r';1J
g;;'6
"
?-.-j:i;,i, . ;6i;ir'"iitilt i a,ll it-j ir: ;!',i,,1:rl;ilirrl iri:;Lrir:";l.r)1}rir:
q.!i;l:.I i-r;".]i:ii{i'};:i
i;;i'
jirr;:lr.-
lolfr:i.:
r;oir
kr;
irll;ri':rai;t tl: ;'1.';i;-r1'r{?
1115i.1*;1i1j:r111'' ;5[x1i1rr'
]i:fl-ri:-:r
J--.a *,toi*ns:i ii* iie.-=l ielm"rirlitr, cis[uct*t:::i;l radisgla *c:tt'-oiI
'iti
iir:;;:"'m$ilft
!,:i{r]l!r-4i4
ri +'.'ltir.j-'.
+-'j. *qiir}:s{Et$-ti:;,'-'r'7ir:tlii i:tt+:till.'aEu #:l;ur Ii{t(;t{}l-tlil: ris'-i3'::d!*
Iirihstitllii*
."r*r.icclE
r:rL+t+:g."i*::i iiup;I r:tsf*,;:1.c;n*s l',1<iie*15 prr:*i* {.i r"*aiJr.rl:i
i:i}r
:";:,,t'\'(:;i?c rj;ai;- il+r;i:ca]* li:tl ;,-'lr*e f ioi+il dtilpt c*ii si:llr,l;?ii)'iluii;huitriil':lr;'
E-Sz{r,'drx-+ijlaai fisiff.+trygU;J
+crlsiE ?* a"a**ita;:s$ ;r a}ii:*;(. 4"* t.*'ir i1**ir {k-- tS-J*
*l:li *.i: vatrr,..r iia;-:cecai5\. {ielElr*i*.ri;*i'u; aq:*ghli;'l ci rsl'rl*:rltliaE*;l llli {u:x.: lll
u''[-i"
Q;iti "'i]r'"'1,
i:i] [:i'*ilIga u*u; t'*:lctrr",,Ll ?n C;,E"r: S+ lmpla*lears r;ru:te,r*]a i;i;ar'*'1r i]nilFiiiili]':.].',u;i7.d i.i u:ailii.
!;irir-.,,.:-,
i'r4xg.iji1i
i;-i:t[;:ldr.. i;iilliiii J;il-13cri;it*;1 ris;l.l'; ;.i;1';iii'+1-!"1.
L-tr:-{tYl$lilrE!i.:
; eiil.l@J'La, !r
t rrs** u-ti tt;:rE suftt s-satlfu
i
ei e, s'"r.'L"lr'tif,;tiei rre ri.'ai* *lt'3ir:Pi{:x'
1*t*i-'.,urrii;i est"c fi*,-:c;r,irkr p;ri;irnlil*i' i:u. i"ir-, hrfl* ful*d, r;* int+gtu-r ci* r:*litart'' if.irii
raetilrf*r:.lpi'; pr*aia!:ilii) si ir +iu'* s:dLrt-6r:i1 groat* f," ild,3Hzti-iii..;r* n'ra:mdtri rlt: r';:r**,sliti ilr*g;liili*.
4. I - 3:l*t*:c'e*ixt.r: pl *sti;r d * m lit'lr"E:
lrtJi**iii.. -
irgziei
nuci pcslirdlnrle$ciic il"BLr-
,:iqtifa
illt'rrsiitiil.l5.
'-rii;ti*r
tr"t,ni;;i.
lli rlrx; ii ;5 i: i,fl
3r:ttJt,'ii
i sa u g:;i:+Ii';itlir;',';t'll:j :a
-
*",*
zic 5 hiperc *n-tla r',ti I ;i
,''i, itc v' it :;il t, t: t s liiy t: <t'.
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