A practical approach to the use of low molecular weight heparins in VTE treatment and prophylaxis in children and newborns.

Low-molecular weight heparins are currently the most commonly used anticoagulants in children and newborns. However, since thrombotic complications rarely occur outside large children’s hospitals, physicians often encounter some practical problems inmanaging these treatments when a pediatric thrombosis specialist is not available. The drug of choice is enoxaparin, due to its favorable FXa/FIIa ratio and the availability of pharmacokinetic and pharmacodynamic data. The treatment of acute thrombosis should be started with two daily injections but when compliance is an issue, a single daily administration schedule could be chosen for secondary prophylaxis ensuring careful measurement of the post 24-hour anti-FXa activity. Furthermore, a subcutaneous device may be a useful tool and a topical dermal anesthetic could be effective in controlling pain without affecting anti-FXa levels. In neonate and toddlers, where mini doses are frequently needed, the dead space of syringes and needles could represent an issue and therefore the use of insulin syringes without dead space is advisable,while a dilution of the drug is useful with other syringes. This article derives froma nonsystematic review of the available literature, with special attention to recent international guidelines and expert recommendations, combined to authors’ clinical practice in large tertiary pediatric hospitals and will provide concise and practical information for the use of low-molecular weight heparin in childhood and infancy in a sort of “answering frequently asked questions.

The estimation of the peculiarities and the activity degree of the consisting inflammatory processes in the benign prostatic hyperplasia

Secţia Urologie, IMSP Spitalul Clinic Municipal “ Sf. Treime”, Catedra Morfopatologie, USMF „N. Testemiţanu”, Secţia Ştiinţifică Morfopatologie, IMSP Institutul de Cercetări Ştiinţifice în Domeniul Ocrotirii Sănătăţii Mamei şi Copilului, Catedra Urologie şi Nefrologie Chirurgicală, USMF „N. Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. The conducted study has the aim to estimate the histopathological peculiarities of the inflammatory processes, evaluated in prostatic nodular hyperplasia, the character and the activity of these processes in the area of nodular hyperplasia structures, and the border limit in the adenectomy. The results of the morphopathological study allowed detailed diagnosis of the prostatic hyperplasia. Severe modifications of inflammatory origin and considerable implications of the structural-architectonical components indicate concomitant persisting or coexisting of chronic or acute prostatitis. The establishment of the lesion character, activity degree of the inflammatory process, saving border limit in the surgical management regarding the residual cavity of cleavage and postoperative prognosis was the second aim of the study. It facilitates the choice of the best therapeutic and surgical approach. The character of the inflammatory processes coexisting with prostatic benign hyperplasia was evaluated. A clinical-morphological concept of inflammatory associations in prostate benign hyperplasia was formulated

Rhinitis in the geriatric population

The current geriatric population in the United States accounts for approximately 12% of the total population and is projected to reach nearly 20% (71.5 million people) by 2030[1]. With this expansion of the number of older adults, physicians will face the common complaint of rhinitis with increasing frequency. Nasal symptoms pose a significant burden on the health of older people and require attention to improve quality of life. Several mechanisms likely underlie the pathogenesis of rhinitis in these patients, including inflammatory conditions and the influence of aging on nasal physiology, with the potential for interaction between the two. Various treatments have been proposed to manage this condition; however, more work is needed to enhance our understanding of the pathophysiology of the various forms of geriatric rhinitis and to develop more effective therapies for this important patient population

ТАРГЕТНАЯ ТЕРАПИЯ ИЛИ ОБЛУЧЕНИЕ ВСЕГО ГОЛОВНОГО МОЗГА ПРИ МНОЖЕСТВЕННЫХ (>3 ОЧАГОВ) МЕТАСТАЗАХ: С ЧЕГО НАЧИНАТЬ ЛЕЧЕНИЕ?

Лучевая терапия (ЛТ) на весь головной мозг является общепринятым стандартом при множественных (более 3-х очагов) метастазах в головном мозге. Но эффективность ЛТ различна  в зависимости от нозологической формы опухолевого заболевания и биологических характеристик опухоли. Так, если при раке молочной железы эффективность (частота полных и частичных регрессий метастазов в головном мозге) ЛТ на весь головной мозг при церебральных метастазах достигает 60%, то при меланоме не превышает 10%. При проведении  ЛТ на весь головной мозг (без противоопухолевой лекарственной терапии) медиана выживаемости колеблется от 1,5–3,0 месяцев при меланоме до 4,0–6,5 месяцев при раке легкого и раке молочной железы. Большинство летальных исходов (до 70–80%) у пациентов с церебральными метастазами связано с системным прогрессированием опухолевого процесса. Следует также учитывать риск когнитивных нарушений при ЛТ на весь головной мозг, который увеличивается у пациентов с более длительной выживаемостью (1 год и более), с относительно хорошим прогнозом. Многие пациенты, получающие таргетную терапию, живут более одного года. В связи с этим остается открытым вопрос о последовательности использования противоопухолевой лекарственной терапии и ЛТ на весь головной мозг у групп больных с относительно хорошим прогнозом, получающих таргетную терапию. Эффективность  таргетной терапии при метастатическом поражении головного мозга по литературным данным, а также по результатам собственных исследований, достигает: 50–66% при HER2-позитивном раке молочной железы с медианой выживаемости больных до 17,5 месяцев, 30–44,5% при меланоме с мутацией V600EBRAF с медианой выживаемости больных до 8,0 месяцев, 76–87% при аденокарциноме легкого с мутациями EGFR с медианой выживаемости больных до 18–22 мес., 55–69% при аденокарциноме легкого с транслокацией ALK с медианой выживаемости от 15 мес. до 49,5 мес. На основании данных этих исследований можно предложить проведение таргетной терапии в качестве первой линии лечения как одну из возможных опций в лечении больных с множественным метастатическим поражением головного мозга. Необходимы дальнейшие исследования по изучению таргетной терапии у пациентов с церебральными метастазами

Features of the Acoustic Emission Control for the Monitoring of Pipeline System of oil Heater Boilers

The paper present the results of the control for pipeline system of oil heater boilers using Acoustic Emission (AE). The object of control is oil heater boiler with spirally shaped pipe, which consist of 4 coils. In accordance with methodology of testing, the boiler was subjected to loading in several stages, successively increasing the work pressure in the pipelines of up to 5 bars. According to the test a conclusion was made, that it is feasible and effective to use the Acoustic Emission method to monitor pipelines system of oil heaters in boilers in operating conditions