The treatment of the diaphyseal bones defects using the method of induced membrane (preliminary study)

Department of Orthopaedics and Traumatology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: The management of segmental long-bone defects is a challenge. The literature has described many techniques, but each is fraught with specific difficulties. Masquelet’s technique of induced membrane is now a reference surgical procedure for the treatment of complex lesions requiring bone regeneration. The concept of induced membrane was introduced by Alain-Charles Masquelet in 1986. The Masquelet method consists in formation of an induced membrane by a foreign body which has secretory properties, influencing positive on the regeneration and strengthening of the cancellous bone grafts. Aim: to investigate the morphological properties and characteristics of induced membrane which was modeled in an experimental group of rabbits in order to asses and to optimize the effectiveness of the Masquelet method in the clinic. Materials and methods: Experimental work was done using a group of rabbits (n=10) with the weight 5,5±0,5kg and the age 5 months. The investigation had 3 steps. The first step of the study consisted in creating the bone defect, filling it up with an antibiotic-impregnated cement spacer and stabilizing it with a plate. The second step of the study was 21 days later, consisting in incision of the induced membrane, removing the spacer and filling up the space with cancellous bone chips collected from iliac crest. At this stage we sacrificed 5 rabbits in order to perform the histological and morphological examination. At the sixth week we switched to the third step – ablation of metal construction and the radiological control exam. At this stage we sacrificed 5 rabbits to study the morphological aspect of the healed bone. Results: The histo-morphological examination performed at the 21 days demonstrated the presence of an inflamator process characterized by neutrophilic, eosinophilic elements and regeneration’s elements – fibroblasts. Also, it was determined a pseudo synovial metaplasia and a villous hyperplasia with formation of an synovial epithelium on the internal face of the induced membrane. The histo-morphological exam performed at the 6 weeks has demonstrated the continuation of the neoformating process and of the bone modelation, the regeneration process prevailed over the inflammatory one. The morphological aspect was formed by agglomerations of fibroblasts, myoblasts and collagen and numerous vascular buds, that promote a good neoangiogenesis and osteogenesis of the bone. Conclusion: The morphological study demonstrated an intense process of cell proliferation and differentiation, which highlights the biological role of induced membrane by foreign body with secretion of the osteoinductive factors, promoting the vascularization and corticalization of the bone. The Masquelet method is an effective method that allows getting the consolidation of the bone in case of critical size bone loss

Morphological evaluation of the different methods used for protection of colonic anastomosis

First Department of Surgery “N. Anestiadi” and Laboratory of Hepato-Pancreato-Biliary Surgery, Medical University "N.Testemitanu", Chisinau , RMIntroduction: Despite the performances of modern medicine, especially of colorectal surgery, anastomotic leakage remains one of the most dangerous postoperative complications, without significant trend of decreasing. Morbidity and mortality increase considerably after the development of an anastomotic leakage. Anastomotic leakage presents an important problem of public health with major socio-economic impact and can be considered one of the quality indicators of specialized surgical centers' activity. There are multiple studies running in order to create and assess the efficacy of colonic anastomosis local protection methods. Aim of study was morphological evaluation of the methods used for local protection of anastomotic zone and their influence on the anastomosis healing. Materials and methods: Sixty three rats were divided in three groups: colonic anastomosis was performed and topical latex tissue adhesive was applied in the group I (n=21); colonic anastomosis with local application of collagen patch in the group II; colonic anastomosis without local protection in the group III. Results: Anastomotic leakage was not determined in the group I vs the group III, where were detected 5 cases of anastomotic leakage. According to the present study’s data in the group I was determined early diminution exudativ-detersiv process’ activity vs groups II and III (p<0.01). Latex tissue adhesive has positive influence on the processes of neoangiogenesis and fibrilogenesis in the anastomotic zone on the 14th POD vs the group II and III (p<0.05). According to ours data latex tissue adhesive has considerable compatibility with colonic tissue that represents the absence of giant like „foreign bodies” symplasts and insignificant immunologic reaction of large bowel. Aggressive bacterial colonization in this group has contributed for appearance of anastomotic leakage, formation of abscesses and granulomatous processes like „foreign bodies”. Mentioned processes considerable have complicated synchronous evolution of neoangiogenesis and fibrilogenesis in the anastomotic zone, resulted in decreasing of the primary healing, appearance of anastomotic deformations and expression of the adhesion process vs anastomosis from the groups I and III. Conclusion: Using of latex tissue adhesive for local protection of colonic anastomosis improves anastomotic healing, processes of neoangiogenesis and fibrilogenesis. Using of collagen patch for local protection of colonic anastomosis doesn’t have any advantages and provokes delaying of regeneratory processes and persisting of an inflammatory process

Preliminary results in the treatment of the diaphyseal bones defects of the lower limb using the method of the induced membrane

Plastic, Reconstructive and Microsurgery Clinic, State University of Medicine and Pharmacy ”Nicolae Testemițanu” Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016Introduction: The management of segmental long-bone defects is a challenge. The literature has described many techniques, but each is fraught with specific difficulties. Masquelet’s technique of induced membrane is now a reference surgical procedure for the treatment of complex lesions requiring bone regeneration. The concept of induced membrane was introduced by Alain-Charles Masquelet in 1986. The method consists in formation of an induced membrane by a foreign body which has secretory properties, influencing positive on the regeneration and strengthening of the cancellous bone grafts. Aim: To investigate the morphological properties and characteristics of induced membrane which was modeled in an experimental group of rabbits in order to asses and to optimize the effectiveness of the Masquelet method in the clinic. Materials and methods: Experimental work was done using a group of rabbits (n=10) with the weight 5,5±0,5kg and the age – 5 months. The investigation had 3 steps. The first step of the study consisted in creating the bone defect, filling it up with an antibiotic-impregnated cement spacer and stabilizing it with a plate. The second step of the study was 21 days later, consisting in incision of the induced membrane, removing the spacer and filling up the space with cancellous bone chips collected from iliac crest. At this stage we sacrificed 5 rabbits in order to perform the histological and morphological examination. At the sixth week we switched to the third step – ablation of metal construction and the radiological control exam. At this stage we sacrificed 5 rabbits to study the morphological aspect of the healed bone. Results: The histo-morphological examination performed at the 21 days demonstrated the presence of an inflamator process characterized by neutrophilic, eosinophilic elements and regeneration’s elements – fibroblasts. Also, it was determined a pseudo-synovial metaplasia and a villous hyperplasia with formation of synovial epithelium on the internal face of the induced membrane. The histo-morphological exam performed at the 6 weeks has demonstrated the continuation of the neoformating process and of the bone modelation, the regeneration process prevailed over the inflammatory one. The morphological aspect was formed by agglomerations of fibroblasts, myoblasts and collagen and numerous vascular buds, that promotes a good neoangiogenesis and osteogenesis of the bone. Conclusion: The morphological study demonstrated an intense process of cell proliferation and differentiation, which highlights the biological role of induced membrane by foreign body with secretion of the osteoinductive factors, promoting the vascularization and corticalization of the bone. The Masquelet method is an effective method that allows getting the consolidation of the bone in case of critical size bone loss

Drug-resistant epilepsy: modern concepts, integrative mechanisms, and therapeutic advances

Background: Drug-resistant epilepsy is the cause of severe disability. Multiple questions remain unanswered both in terms of pathogenesis and therapeutic management. For this narrative review, PubMed database and Infomedica library were searched by using “drug-resistance in epilepsy” and “treatment of drug-resistant epilepsy” as key words. The following filters were applied: “Clinical Trial”, “Meta-analysis”, “Multicenter Study”, and “Randomized Controlled Trial”, covering the period of 01.01.2005–06.01.2021.Several hypotheses have been proposed, i.e., pharmacokinetic, intrinsic severity, gene, target, transporter, and neural network hypotheses. Many controlled trials showed different results in terms of seizure control after combined methods of therapies. Immunotherapy, palliative epilepsy surgery alone or associated with neurostimulation procedures including vagus nerve, trigeminal nerve, or deep brain stimulation may be efficient, however, seizure freedom is not always achieved. Genetic epilepsies might benefit from gene and exosome therapy; however, further studies are needed to verify their safety. Conclusions: Neuroscience of drug-resistant epilepsy faces many challenges. Inflammatory mediators, biomarkers, and genes might allow the identification of new treatment targets, contribute to an earlier diagnosis, and assess the clinical outcomes