Surgical strategy in treatment liver abscesses

Catedra de chirurgie nr. 2, USMF „Nicolae Testemiţanu”, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Material și metode. Lucrarea prezintă experienţa clinicii pe o perioada de 20 ani (1995-2015), asupra unui lot de 112 pacienți. Vârsta pacienților: 19-72 ani, cu prevalarea sexului feminin (68,75%). Diagnosticul s-a bazat pe datele investigațiilor de laborator si imagistice. Abcesele solitare, in majoritatea cazurilor (82,14%) au afectat lobul drept al ficatului. Cauzele de apariție a abceselor hepatice: colangiogene (26), postraumatice (18), parazitare (34), metastatice portale (7), metastatice arteriale (4), neidentificate (23). Cele mai frecvente manifestări clinice au fost febra, durerea abdominală si hepatomegalia. Germenii microbieni decelați ca responsabili de producerea abceselor: E.coli,St.Aureus, Bac Piocianic, Proteus. Rezultate. Tratamentul chirurgical practicat a constat in asanarea focarului septic realizat preponderant in ultimii ani prin puncția ecoghidata transcutanata si laparotomii. Tratamentul general si local practicat prin schimbarea de drenaje (fistulografie) a determinat dinamica schimbărilor focarului septic si a contribuit la obținerea rezultatelor satisfăcătoare in cazuri clinice concrete. Mortalitatea postoperatorie - 6(5,3%) pacienți. Concluzii. Tabloul clinic a abceselor hepatice este polimorf si necesită metode contemporane de diagnostic: tomografia computerizată si rezonanta magnetică nucleară ne permit de a concretiza diagnosticul topic si diferențial; drenarea transcutanată ecoghidata computerizata sunt metode contemporane de perspectivă; antibioticoterapia selectivă prin recanalizarea venei ombilicale şi trunchiului celiac prin puncţia aortică în cazuri concrete sunt o componentă importantă.Material and methods. Study presents the clinic’s experience of a period of 20 years (1995-2015) by the group of 112 patients. Patient’s age varied from 19 to 72 years with the prevalence of female (68.75%). The diagnosis was based on laboratory indexes and image methods of investigation. Solitary abscesses in majority cases (82.14%) affected the right lobe of the liver. Causes of abscess developing were: cholangiogenic (26), posttraumatic (18), parasitic (34), portal metastasizes (7), arterial metastasizes (4), non- identified (23). The most common clinical manifestations were fever, abdominal pain and hepatomegaly. Microbial germs identifiable as responsible for the abscesses developing were: E.coli, St.Aureus , Bac.Piocianic, Proteus. Results. Surgical treatment consisted in drainage of septic focus practiced predominantly by echo-guided percutaneous puncture especially in recent years and by laparotomy. Practiced general and local management via changing of drains (fistulography) determined the dynamic changes and contributed to obtaining of satisfactory results in concrete clinical cases. Postoperative mortality was 6 patients (5.3%). Conclusions. The clinical picture of hepatic abscesses is polymorphic and requires contemporary methods of diagnosis such as computed tomography and magnetic resonance which allowed us to concretize the topical and to perform the differential diagnosis. Echo- guided or computerized percutaneous drainage is contemporary methods of abscesses management. Selective antibiotic therapy through recanalyzed umbilical vein and via celiac trunk by aortic puncture in concrete cases is an important component

Strategies of the treatment of cardiac prosthetic valve thrombosis

Department of Cardiac Surgery, Republican Hospital, Chisinau, the Republic of MoldovaBackground: The article deals with the analysis of principal causes of valve prosthesis thrombosis and “pannus” thrombosis. The diagnosis and contemporary treatment strategy of prosthesis dysfunction have been considered. Material and methods: In our department 1670 patients with extracorporeal circulation were operated on, among them 1260 had valve pathology that made up 74.2%. 1164 heart valves were replaced, 145 of them were biological prostheses and 1019 were mechanical ones of different types. Prosthesis thrombosis took place in 28 patients that represented 60% of the number of patients with prothesis disfunction and 2.2% of the total number of operated patients from which 21 patients, their age ranged from 35 to 63 years old. The surgical treatment was performed to 9 patients, thrombolysis – to 19 patients. Results: During last 6-7 years the thrombolysis treatment with ateplasum and reteplasse has been successfully implemented in the therapy of thrombosis valve prothesis. Thrombolysis was performed to 19 patients. The results are the following: in 17 cases good outcomes (a complete recovery of the prosthesis function with transprosthetic gradient and the normalization of systolic pressure in right ventricle) have been registered, one case has been complicated with transitory ischemic ictus. Out of 19 patients who underwent the thrombolysis treatment, there were 2 lethal cases. Conclusions: The patients that are in a critical state with prosthesis thrombosis (acute pulmonary edema, hypotension, heart insufficiency NYHA IV) should immediately receive EchoCG confirmation of the need of intravenous thrombolitic therapy. The thrombolysis efficacy in prosthesis thrombosis is high; the rate of embolic complications is low, which can be used as the first line treatment for all patients with prothesis thrombosis (in the absence of contraindications). In the case of partial response to the thrombolysis treatment, the patient can be operated on in good hemodynamic conditions and with low surgical risk

Efficacy and safety of lifileucel, a one-time autologous tumor-infiltrating lymphocyte (TIL) cell therapy, in patients with advanced melanoma after progression on immune checkpoint inhibitors and targeted therapies: pooled analysis of consecutive cohorts of the C-144-01 study.

BACKGROUND: Patients with advanced melanoma have limited treatment options after progression on immune checkpoint inhibitors (ICI). Lifileucel, a one-time autologous tumor-infiltrating lymphocyte (TIL) cell therapy, demonstrated an investigator-assessed objective response rate (ORR) of 36% in 66 patients who progressed after ICI and targeted therapy. Herein, we report independent review committee (IRC)-assessed outcomes of 153 patients treated with lifileucel in a large multicenter Phase 2 cell therapy trial in melanoma. METHODS: Eligible patients had advanced melanoma that progressed after ICI and targeted therapy, where appropriate. Melanoma lesions were resected (resected tumor diameter ≥1.5 cm) and shipped to a central good manufacturing practice facility for 22-day lifileucel manufacturing. Patients received a non-myeloablative lymphodepletion regimen, a single lifileucel infusion, and up to six doses of high-dose interleukin-2. The primary endpoint was IRC-assessed ORR (Response Evaluation Criteria in Solid Tumors V.1.1). RESULTS: The Full Analysis Set consisted of 153 patients treated with lifileucel, including longer-term follow-up on the 66 patients previously reported. Patients had received a median of 3.0 lines of prior therapy (81.7% received both anti-programmed cell death protein 1 and anti-cytotoxic lymphocyte-associated protein 4) and had high disease burden at baseline (median target lesion sum of diameters (SOD): 97.8 mm; lactate dehydrogenase (LDH) >upper limit of normal: 54.2%). ORR was 31.4% (95% CI: 24.1% to 39.4%), with 8 complete responses and 40 partial responses. Median duration of response was not reached at a median study follow-up of 27.6 months, with 41.7% of the responses maintained for ≥18 months. Median overall survival and progression-free survival were 13.9 and 4.1 months, respectively. Multivariable analyses adjusted for Eastern Cooperative Oncology Group performance status demonstrated that elevated LDH and target lesion SOD >median were independently correlated with ORR (p=0.008); patients with normal LDH and SOD <median had greater likelihood of response than those with either (OR=2.08) or both (OR=4.42) risk factors. The most common grade 3/4 treatment-emergent adverse events (≥30%) were thrombocytopenia (76.9%), anemia (50.0%), and febrile neutropenia (41.7%). CONCLUSIONS: Investigational lifileucel demonstrated clinically meaningful activity in heavily pretreated patients with advanced melanoma and high tumor burden. Durable responses and a favorable safety profile support the potential benefit of one-time lifileucel TIL cell therapy in patients with limited treatment options in ICI-refractory disease

Risks and pregnancy management in the patients with heart valves prostheses

Department of Cardiac Surgery, Republican Teaching Hospital, Chisinau, the Republic of MoldovaBackground: We have performed a systemic review of the literature to determine pooled estimates of maternal and fetal risks associated with 3 commonly used approaches: 1) the administration of oral anticoagulants throughout the pregnancy, 2) replacing oral anticoagulants with heparin in the first trimester of the pregnancy, and 3) the administration of heparin throughout the pregnancy. The prenatal care of women with artificial heart valves remains one of the most complex issues for cardiologists and obstetrician-gynecologists all over the world. Pregnancy and labor of women with artificial heart valves are usually associated with a high risk. During the pregnancy appears not only the risk of the cardiac pathology progression, but also of the manifestation of subclinical running hereditary thrombophilia and/ or antiphospholipid syndrome, in the above mentioned case the risk of thromboembolic episodes pathologies increases manifold. This overview presents the updated data on the ways of administration of anticoagulants that are most frequently used in the obstetric care. It outlines the principles of the rational anticoagulant therapy during the pregnancy and labor of women with artificial heart valves, as well as the laboratory monitoring of the performed treatment. The question of the management of pregnant women with mechanical valve prostheses is quite controversial and there is no universal consensus in this regard. Here there is an increased risk of complications for both mother and fetus: abortion and placental hemorrhage. Conclusions: Anticoagulation in pregnant women is individual. Therefore, the therapy strategy should be adequate to ensure a minimum level of anticoagulation and bleeding complications