Магнитно-резонансная томография сердца в оценке аллотрансплантатов, имплантированных в позиции легочной артерии

Centrul de Diagnostic German, Chişinău, Centrul de Chirurgie a Inimii, Spitalul Clinic Republican, ChişinăuTwenty patients with decellularized pulmonary valve allotransplantats in pulmonary position were examined with a 1.5T magnetic resonance imaging unit to assess the diagnostic value of magnetic resonance imaging and clinical performance of the pulmonary allotransplantats replacement. The imaging protocol comprised time-resolved magnetic resonance angiography, axial and short axis cine imaging, for right ventricle functional analysis and phase-contrast velocity encoding imaging, for pulmonary valve and allotransplantats flow evaluation. Time-resolved magnetic resonance angiography yielded diagnostic image data in all examined patients and found normal anatomical and functional information. Axial cine imaging shows right ventricular ejection fraction 51.7 ± 11.7%, median 54.3%. Phase-contrast velocity encoding imaging revealed 7.7 ± 2.6 mm Hg peak pressure gradient, median - 7.1 mm Hg for pulmonary valve allotransplantats and 8.6 ± 4.66 mm Hg peak pressure gradient, median - 8.3 mm Hg, for pulmonary allotransplantats minimal diameter. Regurgitation fraction of pulmonary allotransplantats valve was 14.1 ± 15%, median 14.4%. Magnetic resonance imaging yields clinically relevant information in patients with decellularized pulmonary allotransplantats. Decellularized pulmonary allotransplantats showed good peak pressure gradient and were associated with normal right ventricle function.С целью определения диагностических возможностей метода и оценки морфологического и функционального статуса аллотрансплантатов было обследовано двадцать пациентов с имплантированными аллотрансплантатами в позиции легочной артерии методом магнитно-резонансной томографии. Протокол исследования включил четырехмерную магнитно-резонансную ангиографию, аксиальные срезы cine для функционально-морфологического анализа правого желудочка и фазово-контрастную флоуметрию для изучения гемодинамики аллотрансплантата. Четырехмерная магнитно-резонансная ангиография во всех случаях показала нормальную ангиографическую анатомию и функцию аллотрансплантатов. Фракция выброса правого желудочка при волуметрии cine аксиальных срезов была 51,7 ± 11,7%, медиан 54,3%. Максимальный градиент легочного клапана аллотрансплантатов, рассчитанный методом флоуметрии, был 7,7 ± 2,6 мм рт. ст., медиан 7,1 мм рт. ст. и 8,6 ± 4,66 мм рт. ст., медиан 8,3 мм рт. ст. для минимального диаметра аллотрансплантата. Фракция регургитации легочного клапана аллотрансплантатов составляла 14,1 ± 15,0%, медиан 14,4%. Магнитнорезонансная томография сердца предоставляет клинически исчерпывающую информацию о морфофункциональном состоянии легочных аллотрансплантатов и правого желудочка. Максимальный градиент аллотрансплантатов и систолическая функция правого желудочка у исследуемых пациентов были в пределах нормы, что указывает на удовлетворительное состояние имплантируемых легочных аллотрансплантатов

Hygienic estimation of training conditions of pupils with chronic respiratory diseases

Hygiene Department, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaAmong the chronic respiratory diseases, children frequently suffer of recurrent bronchitis and chronic asthma. Statistics show that recurrent and persistent chronic bronchitis represents 26-42% of all bronchopulmonary diseases. Some of the most common diseases recorded in medical practice, both in children and adults, are diseases of the respiratory system. Respiratory diseases in the Republic of Moldova have little tendency to increase, and the average prevalence consists of 37,4% of general morbidity. However, chronic bronchitis and asthma morbidity have a high tendency to increase. The prevalence of chronic bronchitis in Republic of Moldova is 3,21±0,12‰, and 1,34±0,08‰ for asthma. A decisive role in the pathogenesis of these diseases is evaluating risk factors such as ecological harmful factors, food, passive smoking, intra and extra domicile environment (habitual exhaust, household chemicals, dust, pollen and damp), weather conditions, additives and alimentary dyes, pharmaceutical remedies used without a medical prescription, and the lifestyle of the family. The training conditions of children in the schools were investigated from 6 rural locations. We evaluated 2000 microclimatic indices, 2000 of concentration of CO2 and CO, and 70 probes for determination of fungals poluation. During the study in the winter, air temperatures were very low. In the school Gordineşti, district Edineţ, temperatures were registered at 15o C. At the beginning of the lessons the average temperature was 12,8 oC ±0,4, and 13,6 oC ±0,1 at the end of the day. Temperatures were recorded as lower than the hygienic norm temperature levels (18-20 oC) in the following schools: „Feteşti”, the district of Edineţ, „Mihai Eminescu”, and „Mihai Sadoveanu” from the district of Cahul. Relative air humidity in the classrooms varied during the lessons, but exceeded the hygienic normative levels (the hygienic norm being 30-60%) in all investigated schools. The concentration of carbon dioxide exceeded admissible limits at the end of the lschool day in all schools, the biggest values being registered in Feteşti, „Ion Inculeţ” and „Mihai Eminescu”, which exceeded the hygienic normative (MAC - 0,1%) 3 times during the day. Air pollution in the buildings from fungus (Penicillium, Mucor) and high relative air humidity presented the main factors in the development of chronic respiratory diseases among children

Antibiotic therapy in the treatment of acute otitis media

Department of Otorhinolaryngology, District Hospital of Orhei, the Republic of Moldova, Department of Pharmacology, Dunarea de Jos University of Galati, RomaniaBackground: Acute otitis media is an infection of abrupt onset that usually presents with ear pain. Worldwide acute otitis media affects about 8-11% of people a year. In acute otitis media, antibiotics may speed recovery but may result in side effects. Antibiotics are often recommended in those with severe disease or under two years old. Material and methods: Our study included a retrospective analysis of 117 patients with acute otitis media, whose medical records were examined. The information was analyzed statistically. Results: The results demonstrated an increased involvement of older people and women. The use of antibiotics to treat acute otitis media is determined by Cefazolin in 49-50% cases, Ceftriaxone - 49%, Cefotaxime – 48%, Cefoperazone – 14%, Amoxicillini Clavulanic acid in 16% of cases. Antibiogram was released for 53 patients, and according to it: Cefazolin – 23%, Amoxicilini Clavulanic acid – 15% and the rest were treated with cephalosporin third generation. Conclusions: Depending on severity, the treatment requires the use of antibiotics with broad spectrum. Antibacterial therapy according to antibiogram is contemporary and has the advantage of assessing the appropriate antibiotic

On the energy of a non-singular black hole solution satisfying the weak energy condition

The energy-momentum localization for a new four-dimensional and spherically symmetric, charged black hole solution that through a coupling of general relativity with non-linear electrodynamics is everywhere non-singular while it satisfies the weak energy condition is investigated. The Einstein and M\{o} ller energy-momentum complexes have been employed in order to calculate the energy distribution and the momenta for the aforesaid solution. It is found that the energy distribution depends explicitly on the mass and the charge of the black hole, on two parameters arising from the space-time geometry considered, and on the radial coordinate. Further, in both prescriptions all the momenta vanish.In addition, a comparison of the results obtained by the two energy-momentum complexes is made, whereby some limiting and particular cases are pointed out.Comment: 20 pages, 9 figure

Fournier gangrene (clinical case)

Catedra de chirurgie nr. 5, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Spitalul Clinic Militar Central, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Conform datelor contemporane, gangrena Fournier(GF) este o variantă a fasciitei necrozante rapid-progresive de etiologie polimicrobiană, cu afectarea preponderentă a organelor genital externe, perineului și zonei ano-rectale, cu o letalitate de la 15-50 %. Factorii predispozanți sunt atît de ordin local cît și general (diabeticii, imunocompromișii, fumătorii, avitaminoza) Scopul: Atenționarea medicilor de alte specialități despre apariția acestei patologii pe fondalul altor maladii. Material și metode: Pacientul V., vîrsta 20 ani, internat în secția Boli Infecțioase a SCMC cu febra 39,5°C, amigdalită lacunară. Peste 5 zile de la internare este solicitată consultația chirurgului ce a stabilit diagnosticul de erizipel, forma necrotică a hemiscrotului și coapsei pe stînga, GF, orhoepididimită acută secundară ischemică pe stînga, cu hidrocel reactiv. Rezultate: Pe 28.09.18 s-a efectuat necrectomia cu prelucrarea flegmonului coapsei și hemiscrotului pe stînga, procedeul Bergmann cu evacuarea ~ 30 ml lichid seros purulent colectat pentru aprecierea microflorei (Str. faecalis) și antibioticogramei (sensibil la Cefotaxim, Fosfomicin, Ofloxacin). Pe 29.09.18 s-a efectuat necrectomie etapată sub anestezie generală. Tratamentul chirurgical a fost complementat cu antibioticoterapie, dezintoxicante, anticoagulante, terapie infuzională. La a 18-a zi de la prima intervenție s-a efectuat prelucrarea secundară a plăgii cu externarea la domiciliu fără dereglări funcționale. Concluzii: GF rămîne a fi o patologie gravă, puțin cunoscută de specialiștii altor domenii, iar diagnosticul precoce complementat de tratamentul chirurgical agresiv, etapat, cu suport antibacterial-infuzional rămîne a fi cheia în salvarea pacienților.Background: Fournier gangrene (GF) is a type of fast-progressive necrotizing fasciitis of polymicrobial etiology, affecting predominantly external genitalia, perineum and anal-rectal zone, with 15-50% lethality cases, according to the contemporary data. The predisposing factors are both local and general (diabetics, immunocompromised, smokers, avitaminosis). Aim of the study: To caution doctors of different specialties of this pathology onset on the background of other diseases. Methods and materials: Patient V, 20 years, was admitted to MCHC Infectious Diseases Department with fever 39.5°C, lacunar tonsillitis. Surgeon’s consultation was needed 5 days after admission and the diagnosis of erysipelas, necrotic form of hemiscrotum and left thigh, FG, acute ischemic secondary orhoepididymitis on the left, with reactive hydrocele was put. Results: Necrectomy was performed on 28.09.18 treating thigh and left hemiscrotum phlegmon, Bergmann procedure with the evacuation of ~ 30 ml of purulent serous liquid collected for culture (Str.faecalis) and antibioticogram (sensitive to Cefotaxime, Phosphomycin, Ofloxacin). Sheduled necrectomy was performed under general anesthesia on 29.09.18. The surgical treatment was supplemented with antibiotic therapy, detoxifiers, anticoagulants, infusional therapy. On the 18th day after the first intervention, the secondary treatment of the wound with home discharge was performed without functional disturbances. Conclusions: FG remains a serious pathology, so far little known by other fields’ specialists, and the early diagnosis supplemented by aggressive, staged, antibacterial-infusional treatment remains to be the key in saving patients

Tratamentul unor sindroame algice de origine neurologică prin metoda de electrostimulare transcraniană (ESTC)

Catedra Anesteziologie şi Reanimatologie Nr.2 USMF “N.Testemițanu”, Congresul II Internaţional al Societăţii Anesteziologie Reanimatologie din Republica Moldova 27-30 august 2009Electrostimularea transcraniană cu aplicarea fronto-occipitală a electrozilor şi utilizarea pachetelor de curenţi impulsiformi cu frecvenţa 77,5 Hz şi valoarea sumară a curentului 4,5 ma, s-a dovedit a fi eficientă în tratamentul bolnavilor suferinzi de migrenă şi nevralgia nervului trigemin după 6-10 proceduri, contribuind şi la ameliorarea parametrilor hemodinamicii intracerebrale şi centrale. Studii aprofundate a savanţilor din ultimile decenii au demonstrat eficacitatea experimentală şi clinică a electrostimulării transcraniene cu curenţi impulsiformi rectangulari, având parametri cu valori critice. Metoda constă în influenţa transcutană, transcraniană a curentului electric impulsiform, care stimulează sistemul antinociceptiv cu actizarea structurilor endorfinice, serotoninergice ale creerului cu dezvoltarea efectelor analgezice, antistresorii, imunomodulatorii etc. Scopul acestui studiu a fost de a evalua eficacitatea metodei ESTC în tratamentul pacienţilor cu migrenă şi nevralgia nervului trigemin, care cu greu se supun tratamentului tradiţonal medicamentos. Cu ajutorul ESTC noi am tratat 25 pacienţi, inclusiv 20 femei şi 5 bărbaţi cu vârsta medie 43±6 ani, cu sindrom algic localizat central şi periferic, având durata medie 9±4 ani, care s-au tratat cu diverse remedii medicamentoase, dar fără rezultate importante. Bolnavi cu migrenă au fost 18, iar cu nevralgia nervului trigemin 7. Pentru ESTC am folosit aparatul DES produs de Î.S.CESID. Pacienţii au primit câte o cură de tratament care includea 7-10 şedinţe cu durata de 30-40 min. fiecare. În cadrul studiului s-a cercetat reoencefalografia, parametrii hemodinamicii şi evoluţia clinică. S-a constatat micşorarea esenţială sau chiar dispariţia durerii din prima şedinţă ESTC. Analgezia apare peste 15-17 min. de la iniţierea procedurii şi durează timp de 3-24 ore. Cu fiecare şedinţă durata efectului analgezic creşte şi ajunge la maximum după 4-5 şedinţe. Trebuie de menţionat că la bolnavii cu migrenă eficacitatea tratamentului se observă de la primele proceduri în proporţie de 85% iar remisia durează 3-7 luni după o cură de tratament. La bolnavii cu nevragia trigeminului efectul apare din prima procedură, iar după 4-6 proceduri durerile dispar definitiv. Hemodinamica intracerebrală şi centrală sa caracterizat prin ameliorare esenţială şi stabilizare. Astfel metoda ESTC s-a dovedit a fi eficientă în tratamentul migrenei şi nevralgiei nervului trigemin în cadrul monoterapiei. Este necesară continuarea aprofundată a studiului

Поражение сердца при саркоидозе

Department of Cardiac Emergency and Rhythm Disorders, Institute of CardiologyCardiac sarcoidosis is a rare but potentially fatal condition that can mimic more common conditions. Recent advances in imaging technology that allow easier detection of cardiac involvement confirm that minimally symptomatic or asymptomatic cardiac involvement is far more prevalent than previously thought. Often the first manifestation of cardiac sarcoidosic is sudden death or a cardiac arrest. Because of the potential life-threatening complications and potential benefit of treatment, all patients diagnosed with sarcoidosis should be screened for cardiac involvement. We studied a 57 year old female patient with acute onset of this illness manifested by recurrent ventricular arrhythmias and progressive heart failure. We confirmed cardiac involvement by magnetic resonance imaging after discovering characteristic mediastinal lymphadenopathy at the high-resolution computed tomography. Corticosteroid treatment and the implantable cardioverter-defibrillator improved the long-term clinical condition. At the end of the 8th month of supervision the patient retained her asymptomatic clinical condition.Поражение сердца при саркоидозе редкое заболевание, но возможность смертельного заболевания могут имитировать частые заболевания. После первых проявлений поражения сердца при саркоидозе возникает внезапная смерть или остановка сердца. Так как это может быть опасным для жизни осложнением и потенциальным эффектом лечения, у всех пациентов с диагнозом саркоидоз может быть поражено и сердце. Возникновение клинических проявлений при поражении сердца в саркоидозе сопровождается неблагоприятным прогнозом. Представлен клинический случай пациентки, 57 лет, без сердечно-сосудистой патологии в анамнезе, с острым началом саркоидоза, проявленным тяжелым поражением сердца, с выраженной дисфункцией левого желудочка и с желудочковой тахиаритмией. Применение кортикостероидной терапии и имплантация дефибриллятора-кардиовертера улучшили состояние пациентки на длительный период времени

Метод паравазального эндоскопического склерозирования варикозно расширенных вен пищевода этоксисклеролом

Curs Chirurgie, facultatea Stomatologie, USMF „Nicolae Testemiţanu”, Conferinţa naţională ştiinţifico-practică în domeniul otorinolaringologiei pediatrice, 30 octombrie 2009, Chişinău, Republica MoldovaThis study examines paravasal endoscopic sclerosation with 0.5% Aethoxysklerol in 66 patients aged 30-65 with hepatic cirrhosis and portal hypertension. Endoscopic paravasal sclerosation was done to produce primary and secondary prophylaxy of haemmorages. 29 patients suffered from hepatic cirrhosis in the subdegenerative stage and 37 the decompensated stage. After ESG the esophagian varices of the 2nd and 3rd degree were found in 24 patients, and in esophagean varices of the 3rd degree in 42. Cataral esophagitis was seen in 14 patients and erosive esophagitis in 52. The survival index for 6 months was 94.3%, 1 year - 80.0%, 3 years - 65.7%, and 6 years - 48.6%. The recurrence of of haemorrhage was not seen in the first six months, and in 1 year in 3.45% of the patients, in 3 years 11.5%, and 6 years 26.1%. Patients treated with paravasal endoscopic sclerosation with 0.5% Aethoxysklerol after one year showed a higher mortality rate due to gasro-esophagean causes. No complications after the endoscopic sclerosation were observed. Endoscopic sclerosation method with 0.5% Aethoxyklerol is an effective one for haemorrage profylaxy of esophagean varices.Исследование посвящено эндоскопическому склерозированию (ЭС) расширенных вен пищевода 0,5% раствором этоксисклерола у 66 больных циррозом печени и портальной гипертензией. Этой категории больных ЭС выполнено с целью профилактики первичных и вторичных кровотечений. Возраст больных колебался от 30 до 65 лет; из них 29 страдали циррозом печени в стадии субкомпенсации и 37 – циррозом печени в стадии декомпенсации. У 24 больных, при ФЭГДС, было выявлено варикозное расширение вен пишевода II-III ст. и у 42 – варикозно расширенные вены III ст. У 14 больных был выявлен катаральный эзофагит, а у 52 больных – эррозивный эзофагит. Индекс выживаемости до 6 месяцев составлял 94,3%, до 12 месяцев – 80,0%, до 3 лет – 65,7% и до 6 лет – 48,6%. До 6 месяцев рецидивов кровотечений выявлено не было, до 12 месяцев кровотечений было у 3,45% больных, до 3 лет – у 11,5% и до 6 лет – у 26,1% больных. Анализ смертности больных после ЭС этоксисклеролом в отдалëнные сроки показал, что после первого года наблюдения среди причин смерти превалируют рецидивы кровотечений из варикозно расширенных вен пишевода, связанные со снижением эффекта ЭС. Осложнений после ЭС не было выявлено. Таким образом, ЭС с использованием 0,5% раствора этоксисклерола – это надежный метод профилактики кровотечений из варикозно расширенных вен пишевода