Treatment of recurrent varicose veins caused by phenomenon of inguinal neovascularization

Catedra Chirurgie Generală, USMF “N. Testemiţanu”, Chişinău, Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Refluxul venos patologic în regiunea joncţiunii safeno-femurale deconectate anterior este o cauză tipică a recurenţei postoperatorii a maladiei varicoase. Erorile tehnice şi fenomenul de neovascularizare sunt responsabile în masură aproape egală pentru reapariţia refluxului. Scopul studiului este analiza comparativă a diferitor modaliţăţi de tratament al varicelor recidivante la nivelul coapsei cauzate de fenomenul neovascularizării. Metode. Examenul duplex ultrasonor al pacienţilor spitalizaţi cu recurenţa varicelor în regiunea superioară a coapsei a determinat prezenţa neovascularizării inghinale ca sursa de reflux în 19 cazuri. Timpul mediu de la operaţie – 45,6 luni. Au fost stabilite următoarele tipuri de neovascularizare conform clasificării Fisher: tipul B2a – 6 (31,5%); B2b – 9 (47,3%); B2c – 4 (21%) cazuri. Rezultate. Trei variante de tratament au fost utilizate: scleroterapia cu spumă – 4, excizia varicelor cu anestezie infiltrativă – 12 şi disecţia repetată în regiunea inghinală cu excizia venelor dilatate în zona jonctiunii safeno- femurale – 3 cazuri. Toate şedintele de scleroterapie s-au complicat cu tromboflebită, cauzată de imposibilitatea realizării unei compresii adecvate în treimea superioară a coapsei. Disectia inghinală repetată consumă mult timp (durata medie a operatiei – 143 min.) datorită procesului cicatriceal pronunţat, iar într-un caz a fost asociată cu lezarea venei femurale rezolvată prin aplicarea suturii laterale. În lotul cu excizia varicelor subcutanate complicaţii nu au fost înregistrate. Însa, la un pacient cu tipul B2c de neovascularizare la duplex-ul postoperator s-a determinat persistenta refluxului venos în regiunea inghinală. Concluzii. Excizia venelor subcutanate dilatate de la nivelul coapsei cu anestezie infiltrativa este metoda de electie în tratamentul recurentei maladiei varicoase cauzate de fenomenul neovascularizării. Disecţia inghinală repetată trebuie rezervată pentru venele nouformate de calibru mare.Introduction. Pathological venous reflux in the region of previously disconnected sapheno-femoral junction is a typical cause of varicose veins recurrence after surgery. Technical failure and phenomenon of neovascularization either are responsible for reappearance of reflux with near equal frequency. The aim of study is a comparative analysis of various treatment modalities for recurrent thigh varicose veins caused by phenomenon of neovascularization. Methods. Duplex ultrasound examination of the patients, admitted to the department of surgery with recurrent varicose veins in the upper thigh, revealed the inguinal neovascularization as a source of reflux in 19 cases. Mean time interval from surgery – 45,6 months. There were the following types of neovascularization according to the Fisher classification: type B2a – 6 (31,5%); B2b – 9 (47,3%); B2c – 4 (21%) cases. Results. Three types of treatment were used: foam sclerotherapy – 4, superficial varicose veins avulsion under tumescent anesthesia – 12 and redo inguinal surgery with excision of dilated veins at the sapheno-femoral region – 3 cases. All sclerotherapy treatments were complicated with thrombophlebitis due to inability to provide the adequate compression in the upper thigh region. Redo surgery in the inguinal region was time consuming (mean operating time – 143 min.) due to significant scarring and in one case was associated with inadvertent injury of femoral vein repaired by lateral suture. There were no complications in the group with avulsion of subcutaneous varicose veins. However, in one patient with type B2c neovascularization the persistence of inguinal reflux was determined by postoperative duplex ultrasound. Conclusion. Avulsion of dilated subcutaneous thigh veins under tumescent anesthesia is a method of choice in the treatment of varicose veins recurrence caused by phenomenon of neovascularization. The inguinal redo surgery should be reserved for cases with large diameter of the new-formed veins

First experience of endovenous laser ablation

Clinica Chirurgie Generală, USMF “N. Testemiţanu”, Chişinău, Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Tehnicile minim-invazive de tratament al maladiei varicoase şi a insuficienţei venoase cronice se bucură de o popularitate în creştere, ablaţia endovenoasă cu laser (EVLA) fiind un lider al “revolutiei endovenoase”. Scopul studiului este analiza critică a particularitaţilor tehnice, managementului periprocedural şi rezultatelor precoce dupa EVLA la bolnavii cu maladie varicoasă a membrelor inferioare. Metode. Experienţa noastra iniţială include 26 de pacienţi, trataţi cu EVLA a venei saphena magna (VSM). Cinci (19,2%) pacienţi au fost bărbati, vîrsta medie a bolnavilor – 42,2 ani. În conformitate cu sistemul CEAP toţi bolnavii au fost catalogaţi ca: C2s-6; Ep; As, s,p; Pr. Extinderea refluxului safenian în raport cu clasificarea Hach a fost urmatoarea: tip II – 15 (57,7%), tip III – 8 (30,8%), tip III si IV – 3 (11,5%) cazuri. Rezultate. Majoritatea intervenţiilor - 86,9%, au fost efectuate cu anestezie locala infiltrativă. In 6 cazuri, din motivul sindromului algic in timpul EVLA, a fost administrată o anestezie generală de scurtă durată. Tentativele de introducere a fibrei laser prin puncţie s-au soldat cu succes în 18 (69,2%) cazuri, la ceilalţi pacienţi practicindu-se un acces deschis spre VSM. Crosectomia a fost evitată în toate cazurile. Monitoring-ul continuu prin ultrasonografie duplex a fost efectuat la toate etapele tratamentului. Intervenţii adiţionale au fost efectuate simultan cu EVLA în 9 (34,6%) cazuri: flebectomia prin procedeul Muller - 2, scleroterapia - 3, ablatia chimică/ termica a venelor perforante incompetente - 4. Scanarea duplex la a 7-a zi şi la o lună postoperator a demonstrat ocluzia VSM în 25 (96,1%) cazuri. Concluzii. EVLA a VSM este o metodă efectivă de tratament al maladiei varicoase şi a insuficienţei venoase cronice. Aspectele tehnice ale procedeului reprezintă un subiect pentru ulterioarele cercetări cu scop de optimizare şi standardizare.Introduction. Minimally invasive ablative techniques designed for treatment of varicose veins and chronic venous insufficiency are gaining in popularity, endovenous laser ablation (EVLA) being the front runner in the “endovenous revolution”. The aim of study is a critical analysis of technical peculiarities, periprocedural management and early results of EVLA in patients with varicose veins of lower limbs. Methods. Our initial experience includes 26 patients, treated with EVLA of the great saphenous vein (GSV). Among these 5 (19,2%) were men, median age – 42,2 years. According to the CEAP classification all patients were catalogued as C2s-6; Ep; As, s,p; Pr. Extension of saphenous reflux according to the Hach’s classification: type II – 15 (57,7%), type III – 8 (30,8%), types III and IV – 3 (11,5%) cases. Results. The majority of interventions - 86,9%, were performed under tumescent local anesthesia. In 6 cases the short term general anesthesia was applied due to the pain sensation during procedure. The attempt of puncture introduction of laser fiber was successful in 18 (69,2%) patients, in remaining cases the open access to the GSV was performed. The crossectomy was avoided in all cases. Continuous duplex-ultrasound monitoring was used during all steps of treatment. Additional interventions were performed simultaneously with EVLA in 9 (34,6%) cases: Muller’s phlebectomy - 2, sclerotherapy - 3, thermal/chemical ablation of incompetent perforators - 4. Duplex scanning at day 7 and one month postoperatively showed the occlusion of GSV in 25 (96,1%) cases. Conclusion. The EVLA of GSV is an effective method for treatment of varicose veins and chronic venous insufficiency. Technical aspects of procedure should be a subject of further research with aim of optimization and standardization

The Kazhdan-Lusztig conjecture for W-algebras

The main result in this paper is the character formula for arbitrary irreducible highest weight modules of W algebras. The key ingredient is the functor provided by quantum Hamiltonian reduction, that constructs the W algebras from affine Kac-Moody algebras and in a similar fashion W modules from KM modules. Assuming certain properties of this functor, the W characters are subsequently derived from the Kazhdan-Lusztig conjecture for KM algebras. The result can be formulated in terms of a double coset of the Weyl group of the KM algebra: the Hasse diagrams give the embedding diagrams of the Verma modules and the Kazhdan-Lusztig polynomials give the multiplicities in the characters.Comment: uuencoded file, 29 pages latex, 5 figure

Thermoelectric properties of tetrathiotetracene iodide crystals: modeling and experiment

A more complete physical model for nanostructured crystals of tetrathiotetracene-iodide that takes into account the interaction of carriers with the neighboring one-dimensional (1D) conductive chains and also the scattering on impurities and defects is presented. For simplicity, the 2D approximation is applied. It is shown that this model describes very well the temperature dependencies of electrical conductivity in the temperature interval between 180 and 300 K, and of the Seebeck coefficient between 50 and 300 K, the highest temperature for which the measurements were reported. For lower temperatures, it is necessary to also consider the fluctuations of dielectric phase that appear before the metal–dielectric transition. It is found that the predictions made in the 1D approximation are valid only if the crystal purity is not very high, and the electrical conductivity is limited up to ∼3.5×106Ω−1m−1 and the thermoelectric figure of merit up to ZT∼4

Tetrathiotetracene thin film morphology and electrical properties

The electrical properties of organic thin films are determined by their chemical constituents and the morphology of the films deposited. In this paper the morphology of vacuum sublimed (7∙10-6 mbar) tetrathiotetracene (TTT) thin films is shown to be strongly affected by the thermal deposition temperature (222-350 K) and rate of deposition. Mostly needle-like morphologies are identified by scanning electron microscopy. Optimal TTT purity (a pre-requisite for device preparation via subsequent oxidation) is evidenced by their initially low electrical conductivity. Altering the TTT morphology, by variation of the evaporation parameters, strongly affects this base electrical conductivity. Four probe conductivity measurements and charge extraction by linear increasing voltage methods are used to characterize film electrical properties. In-plane conductivity of up to 7.03∙10-5 S/cm is achieved for pure TTT thin films. Subsequent aerial oxidation resulted in a 3.4-fold increase in electrical conductivity

Combination therapy with rituximab and cyclophosphamide in the treatment of anti-neutrophil cytoplasmic antibodies (ANCA) positive pulmonary hemorrhage: case report

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with pulmonary hemorrhage is rare in childhood. Standard treatment includes corticosteroids and cyclophosphamide (CYC), which is associated with a high level of toxicity. We report a white female with ANCA positive pulmonary hemorrhage who was treated with cyclophosphamide (CYC) and rituximab (RTX) combination therapy

Rolul factorului uman în generarea discordanţei deciziei de tratament pe exemplul unui model de apreciere a frecvenţei respiratorii

Studiul de tip prospectiv a fost efectuat asupra a 63 pacienţi internaţi într-o unitate de terapie intensivă. Scopul a fost evaluarea rolului factorului uman în generarea discordanţei deciziei terapeutice, comparând înregistrarea manuală cu cea automată a frecvenţei respiratorii (parametru luat drept model experimental). Valorile frecvenţei respiratorii, înregistrate manual, au fost semnifi cativ diferite faţă de cele redate de monitor. Disordanţa deciziilor de corecţie a funcţiei respiratorii, luate în baza datelor scrise, au fost semnifi cativ diferite faţă de cele luate în baza monitorizării. Monitorizarea pacienţilor este indispensabilă pentru luarea unei decizii de tratament corecte şi reduce semnifi cativ impactul factorului uman în generarea discordanţei

Treatment of acute limb ischemia (ALI) in patients with COVID-19 infection: assessment of outcomes

Scopul lucrării. Analiza rezultatelor tratamentului IAE la bolnavii cu infecție cu coronavirus de tip nou (COVID-19). Materiale și metode. În perioada iulie/2020 – aprilie/2023 au fost tratați 62 pacienți; vârsta – 70 (25%-75%IQR 65-74) ani; bărbați – 40 (64,5%). IAE a survenit la 67 extremități: superioare (19/28,3%), inferioare (48/71,6%). Timpul debut IAE–spitalizare: 48,8±58,5 ore. Repartizarea cazurilor în funcție de gradul IAE (Rutherford): I – 7 (10,4%), IIA – 10 (14,9%), IIB – 34 (50,7%), III – 16 (23,8%). Etiologia IAE: tromboză (43/64,1%), embolie (22/32,8%), anevrism periferic trombozat (2/2,9%). Pentru diagnosticarea IAE s-au utilizat selectiv: duplex scanarea (20/32,2%), CT-angiografia (16/25,8%), angiografia cu substracție digitală (1/1,6%). COVID-19 s-a confirmat prin testul polymerase chain reaction (PCR), la 45 (72,5%) pacienți fiind documentată afectarea pulmonară. Rezultate. Tratamentului chirurgical au fost supuși 50/80,6% pacienți (52 membre); 12/19,3% (15 extremități) – tratați conservator (anticoagulante). Spectrul intervențiilor: embol- (22) și tromb-ectomie (18), bypass (2), trombectomie+tromboliză intraoperatorie (1), tratament endovascular (1) și amputație primară (8). În 10 (19,2%) cazuri s-a intervenit repetat pentru retromboză: amputație (5) sau trombectomie (5), asociată în 2 observații cu tromboliză intraoperatorie. Rata amputațiilor pe durata spitalizării (9,4±9 zile) – 19,4% (n=13); rata decesului – 43,5% (n=27), fiind influențată semnificativ de prezența sau absența afectării pulmonare – 55,5% vs. 11,7% (P=0,002; testul χ²). Către follow-up-ul de 21 (25%-75%IQR 19-28) luni rata supraviețuirii per general și fără amputații: 56,4% (n=35) și 57,1% (24/42), corespunzător. Concluzii. IAE la bolnavii cu COVID-19 se asociază cu rată elevată de amputații și deces, corelată cu prezența injuriei pulmonare. Abordul curativ convențional nu asigură rezultate clinice optime, frecvența retrombozei fiind înaltă.Aim of study. Analysis of results of ALI treatment in patients with novel coronavirus infection (COVID-19). Materials and methods. Between July/2020 and April/2023, 62 patients were treated; age – 70 (25%-75%IQR 65-74) years; males – 40 (64.5%). ALI occurred in 67 extremities: upper (19/28.3%), lower (48/71.6%). ALI onset–hospital admission time: 48.8±58.5 hours. Distribution of cases (Rutherford): grade I – 7 (10.4%), IIA – 10 (14.9%), IIB – 34 (50.7%), III – 16 (23.8%). Etiology of ALI: thrombosis (43/64.1%), embolism (22/32.8%), thrombosed peripheral aneurysm (2/2.9%). Duplex scanning (20/32.2%), CTangiography (16/25.8%), digital subtraction angiography (1/1.6%) were selectively used for diagnostic purposes. COVID-19 was confirmed by polymerase chain reaction (PCR) test; acute lung injury being documented in 45 (72.5%) patients. Results. Fifty/80.6% patients (52 limbs) underwent surgery; 12/19.3% (15 extremities) – treated conservatively (anticoagulants). Spectrum of interventions: embol- (22) and thromb-ectomy (18), bypass (2), thrombectomy+intraoperative thrombolysis (1), endovascular treatment (1), primary amputation (8). In 10 (19.2%) cases repeated surgery was performed for early re-thrombosis: amputation (5) or thrombectomy (5), associated in 2 observations with intraoperative thrombolysis. Amputation rate during hospitalization (9.4±9 days) – 19.4% (n=13); while mortality rate was 43.5% (n=27), being influenced by presence or absence of lung injury – 55.5% vs. 11.7% (P=0.002; χ² test). At 21 (25%-75%IQR 19-28) months follow-up the overall and amputation-free survival rate was 56.4% (35/62) and 57.1% (24/42), respectively. Conclusions. ALI in COVID-19 patients is associated with a high rate of amputations and death, correlated with the presence of lung injury. Conventional curative approach does not ensure optimal clinical results, frequency of re-thrombosis being high