Первичные иммунодефициты у детей: этапы диагностики

Department of Pediatrics, 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 MoldovaPrimary immunodeficiency (PID) is a genetically heterogeneous group of diseases that cause serious damage to one or more components of the immune system. The diagnosis is established on the bases of clinical signs of alarm for PID (OMS), on biological, immunological, genetic exploration and instrumental genetic tests. Doctors’ and patients’ vigilance (attention) in the world is very low and most patients with recurrent infections remain undiagnosed or hipodiagnosed. Prevalence of primary immunodeficiency is much higher than expected. Early diagnosis and appropriate therapy for PID help to achieve stable general condition of patients in most cases of PID.Первичные иммунодефициты (ПИД) представляют гетерогенную группу генетически детерминированных заболеваний, которые включают нарушения в одном или нескольких компонентах иммунной системы. Диагноз устанавливается на основании тревожных клинических признаков ПИД (ВОЗ), биологических, иммунологических, генетических исследований и инструментальных тестов. Настороженность врачей и пациентов к ПИД во всем мире очень низка и большая часть пациентов с тяжелыми рецидивирующими инфекциями остаются недиагностированными или гиподиагностированными. Распространенность первичных иммунодефицитов гораздо выше, чем ожидалось. Ранняя диагностика и своевременное лечение ПИД способствуют стабилизации общего состояния больных в большинстве случаев

The use of amniotic membrane in the treatment of severe burn injuries

Clinica de chirurgie plastică și microchirurgie reconstructivă a locomotorului, IMSP IMU, Catedra de ortopedie și traumatologie, USMF „Nicolae Testemițanu”, Centrul Republican de Leziuni Termice, Spitalul Clinic de Traumatologie și Ortopedie, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Arsurile reprezintă o problemă majoră a sănătății publice, datorită frecvenței înalte a cazurilor letale, dar și a consecințelor grave medicale și sociale, fiind cauza spitalizării îndelungate, mutilării si invalidizării pacienților respectivi. Arsurile profunde produc defecte dermo-epidermice, care nu regenerează ”per primam intentionem” și a căror soluționare necesită asistență medicală specializată. Promovarea regenerării plăgilor post-arsură și restabilirea structurii și funcției tegumentului recuperat utilizând substituenți biologici de piele, reprezintă o adevărată provocare pentru clinicieni. Obiectiv. Determinarea eficacității clinice a membranelor amniotice (MA) umane procesate în calitate de pansament la pacienți cu arsuri profunde si grave; influența asupra evoluției plăgilor, timpului de regenerare și rezultatului estetic al sechelelor. Material și metode. S-a efectuat un studiu descriptiv-retrospectiv a unui lot de pacienți cu arsuri de gr. III și IV în tratamentul cărora s-a utilizat MA în calitate de pansament biologic. Concomitent s-a studiat un lot-control de pacienți, la care s-au aplicat metode tradiționale de tratament. MA s-a aplicat pe locurile donatoare de piele, și pe plăgi post-arsură după debridare tangențială precoce. Rezultatele au fost comparate cu cele obținute în cazul folosirii metodelor tradiționale de tratament la pacienți cu arsuri similare. Rezultate. La folosirea MA pe plaga debridată se diminuează sindromul dolor, pierderile electrolitice și proteice, se stimulează producerea țesutului granular și cicatrizarea, reducându-se timpul de regenerare. Utilizarea MA în calitate de pansament al locului donator de autogrefă promovează epitelizarea mai rapidă a plăgii cu constituirea unui epiteliu mai fin decât în cazul tratamentului tradițional. Concluzii. MA în calitate de pansament biologic promovează generarea țesutului granular și epitelizarea plăgii arse debridate și a zonei donatoare.Introduction. Burn injuries represent a major problem of public health due to high incidence of lethal cases, and due to severe medical and social consequences, causing long term hospitalization, patient’s mutilations and invalidity. Deep burns cause dermo-epidermic defects, which don’t heal per primam intentionem, requiring specialized medical care. Promotion of wound regeneration, structure’s restoration and function’s recovery using temporal biological substituents represents a true challenge for clinicians. Purpose. Determination of clinical effectiveness of use of amniotic human membrane as biologic dressing in patients with severe burns; of influence on pathology’s evolution; of regeneration’s time of the wounds and patients hospitalization. Material and methods. It was performed a descriptive retrospective study in a group of 11 patients with 3rd and 4th degree burns treated with amniotic membrane as temporal biologic dressing. At the same time was studied a control group with severe burns, treated with standard methods. Results. The study group was formed by 4 men and 7 women. In 7 cases AM was applied on skin’s donor sites, in 4 cases – on post burn wounds after tangential surgical debridement. Results were compared with those obtained in use of standard treatment methods in patients with similar diagnostics. Conclusions. Using AM on debrided wound diminishes pain, electrolytic and protein losses, stimulates production of granular tissue and promotes epithelization reducing regeneration’s time. Using it as biologic dressing of donor site, promotes wound’s epithelization with formation of a new, thin and gentle epithelium

Managing of a complex case of synchronous bilateral kidney tumors associated with Hodgkin lymphoma

Abstract Introduction: Renal cell carcinoma is one of the most common tumors in adults, accounting for approximately 3% of all cancers. Association of renal tumors and other neoplasia is a rare event. Surgical treatment strategy of synchronous bilateral renal tumors and the value of lymph node dissection are subjects of debate. Objective: To present the management of a complex case of synchronous bilateral kidney tumors associated with Hodgkin lymphoma. Materials and method: We present the case of a 64 years-old woman admitted for abdominal pain, loss of appetite and weight. Abdominal CT showed a massive left kidney tumor with lateroaortic, interaoticocaval and laterocaval lymph node enlargement and extension in the subhepatic inferior vena cava, and a 4 cm upper pole tumor of the right kidney. No distant metastases were revealed on the thoracic CT. The surgical strategy involved a left radical nephrectomy, caval thrombectomy and extensive lymph node dissection as the first step. We made an anterior transperitoneal triradiate incision with bilateral coloparietal dissection. First we went on the right side in order to approach the thrombosed inferior vena cava. The left renal artery is ligated near the aorta. We applied a tourniquet on the suprarenal caval vein just above the tumor thrombus, on the infrarenal cava vein and on the right renal vein. Next we incised the inferior vena cava at the ostium of the left renal vein with the extraction of the thrombus and caval wall suture. Then we moved to the left side and standard perifascial nephrectomy and en bloc thrombectomy was performed. After that we performed an extensive periaortocaval lymph node dissection. Considering that we had no restant tumor tissue, and there was a wide exposure of the right kidney, we decided to perform a right superior polar nephrectomy in the same intervention, with electrothermal bipolar sealing system and a fat flap compression of the tumor bed. Results: Postoperative creatinine rose to 2.5 mg/dl and then slowly decreased to a normal value. Histopathological examination sowed bilateral clear cell carcinoma Fuhrman II and III and Hodgkin lymphoma in the LND specimen. Consequently specific treatment for Hodgkin lymphoma (chemotherapy with an EVA protocol -etoposide, vinblastine and doxorubicin) was initiated. Favorable response and oncological outcome were registered at 1 year follow-up. Conclusions: Although synchronous bilateral renal tumors surgical strategy usually involves two consecutive operations, first addressed to the largest tumor, a concomitant operation is possible in selected cases. LND in RCC has a double role, diagnostic and therapeutic and must be performed. Proper treatment of two simultaneous neoplasia could provide healing or increase the patients' survival