Spleen injure treatment early and late results analysis

Catedra Chirurgie Generală, Semiologie USMF “N.Testemiţanu”Most cases of spleen injuries require splenectomy which may result in multiple early and late postoperative complications. The goal of this work isthe comparative analysis of the treatment results and the assessment of the quality-of-life index in the case of patients who undergone splenectomy compared to the patients who undergone organ-preserving operations and nonoperative treatment methods. Intervenţia chirurgicală de elecţie în leziunile lienale mai continuă şi până în prezent a fi splenectomia, care induce cu sine multiple complicaţii postoperatorii atât în perioadele precoce cît şi la distanţă. Scopul lucrăriia fost efectuarea unui studiu comparativ asupra rezultatelor tratamentului şi a calităţii vieţii între grupele de pacienţi splenectomizaţi comparativ cu cei ce au beneficiatde tratament organo-menajantsau non-operator

Contemporary treatment of hiatal hernia and gastroesophageal reflux disease

Catedra Chirurgie Generală, Semiologie USMF “N.Testemițanu”The Gastroesophageal Reflux Disease (GERD) is the primary concern for the XXI century gastroenterology due to the hereinafter mentioned facts:GERD ranks among the most common gastrointestinal diseases among mature population; 10% of global population suffers from GERD, fact which caused the appearance of the term ‘Gastroesophageal Reflux’ in the 10-th edition of the International Classification of Diseases. Boala de Reflux Gastroesofagian (BRGE) pentru gastroenterologia secolului XXI reprezintă preocuparea primordială din mai multe considerente. Enumerîndu-le, vom menționa următoarele momente:BRGE ocupă locul celei mai des întîlnite maladii gastrointestinale în rîndul populației mature sau 10% la nivelul populației globale, fapt ce a indus apariția noțiunii de Reflux Gastroesofagian în a 10-a ediție a Clasificării Internaționale a Maladiilor

Spleen injure treatment results analysis

Introduction: In the case of abdominal injuries the statistics of the spleen damage is 57% while the mortality - up to 36,6%. Most cases of spleen injuries require splenectomy which may result in multiple early and late postoperative complications and even death (21,4%). The post-splenectomy syndrome that appears to be a common complication has a negative impact upon the patient’s quality-of-life index and social adaptation. Goals: The analysis of the treatment results and the assessment of the quality-of-life index in the case of patients who undergone splenectomy compared to the patients who undergone organ-preserving operations and non-operative treatment methods. Objectives: 1. Research of the frequency and type of early post-splenectomy complications in case of patients who undergone splenectomy compared to patients who undergone organ-preserving operations and non-operative treatment methods. 2. Research of the frequency and type of late post-splenectomy complications in case of both group’s patients. Materials and Methods: The authors have studied 48 medical records and carried out a survey of 46 patients who had suffered from spleen injury and undergone treatment at the National Scientific-Practic Center of Emergency Medicine, RM, 2009-2011. Results and Discussion: The average age of the researched group was 38,72± 17,93. Early complications in the case of post-splenectomy patients have appeared in the case of 60% of patients, 44,66% being infectious complications; in the case of patients who undergone organ-preserving operations - 6,25% while the late complications. The late post-operative period in the post-splenectomy patients’ group was marked by a larger number of infectious complications’ cases (36,33±14,99 compared to 36,33±14,99 and 14,44±7,24 in two other groups) and by a significantly lower quality-of-life index. Conclusions: 1. The frequency of early complications in the post-splenectomy group is 9 times higher than in the case of the group of patients who undergone organ-preserving operations. Most complications are caused by infections (pneumonia, sub-diaphragmatic abscess, peritonitis). 2. The late complications in the post-splenectomy group have a mostly infectious nature (increased incidence of infections and increased frequency of chronic diseases’ exacerbations). The use of organ preserving tactics in cases of spleen injuries allows to improve the quality-of-life index of operated patients in the late post-operative period

Contemporary treatment of hiatal hernia and gastroesophageal reflux disease

Introduction: The Gastroesophageal Reflux Disease (GERD) is the primary concern for the XXI century gastroenterology due to the hereinafter mentioned facts: • GERD ranks among the most common gastrointestinal diseases among mature population; 10% of global population suffers from GERD, fact which caused the appearance of the term ‘Gastroesophageal Reflux’ in the 10th edition of the International Classification of Diseases. • GERD requires a long-lasting antacid medication (min 3-6 months) and frequently repeated treatment courses inducing a high treatment cost. • Patients suffering from GERD are exposed to the high risk of morphohistological inflammatory, metaplasia and cancer complications (Reflux Esophagitis, Esofag Barrette, Esophagial Adenocarcinoma). Goal: Optimisation of contemporary individualized treatment of HH and GERD. Objectives: • Research of drug treatment schemes to elucidate the most efficient treatment schemes in curing the GERD depending on its evolution • Research and description of indications, methodology and short-term results of laparoscopic surgeries performed under GERD treatment by comparing the efficiency and gaps created by the implemented technologies. • Research of endoscopic methodology of GERD surgery to elucidate strengths and gaps among the short- and long-term results. Materials and methods: The authors highlighted the principles of the GERD treatment basing on data received after the retrospective, descriptive and monocentric study performed at the Municipal Clinical Hospital Nr. 1, Chisinau, Republic of Moldova, during 2010 - 2012. The authors have studied medical records of a group of 30 patients hospitalized according to the schedule into the section ‘Aseptic Surgery’ being diagnosed with GERD and HH. Results: • Medical treatment: Is implemented step by step (step up/down) depending on the clinical and paraclinical evolution, is long-lasting (2-6 months) with disease’s relapse in 87-90% of cases at 12 months after the cessation of the treatment, PPI appear to be the most efficient causing 61% of clinical resolution cases compared to 41% in H2 blockers’ case. • The endoscopic treatment: is poorly studied with short term results (12 months) that shows the reduction of the ER in 62% cases and healing in 40%. The abandoning of the PPI post operative treatment in 87% of cases. Is a bridge between the drug treatment and the laparoscopic one of the GERD. • The surgery tactics could be applied in only 10% of the total number of GER patients who face at least several conditions: HH and GER symptoms, complications (ER, EB, AE, SDH), the conservative treatment failed or appeared to be impossible, too young age (being an asset in the choice of the therapeutical technique). Conclusions: The study of the GERD modern treatment methods, both drug and surgery, has concluded that a patient who suffers from GERD needs an individual approach taking into consideration the stage and the evolution of the disease to deal successfully with it

Molecular and Physiological Mechanisms of Aging

Кафедра Патофизиологии и клинической патофизиологииMolecular and Physiological Mechanisms of Aging The analysis of basic conceptions of the origin of aging were presented in the article. There were exposed contemporary data about molecular, cellular and physiological mechanisms of aging, including the role of DNA damage and repair, of the telomere and telomerase, of the system of the growth hormone – insulin-like growth factor-1 and the development of the ageassociated pathologies. Mecanisme moleculare şi fiziologice de îmbătrânire În articolul dat sunt prezentate concepţii contemporane referitor la originea îmbătrânirii. Accentul se pune pe elucidarea mecanismelor moleculare, celulare şi fiziologice, care relevă îndeosebi rolul leziunilor, reparaţiei ADN-ului, a telomerilor şi telomerazelor, precum şi al sistemului format din hormonul creşterii şi factorul de creştere insulin-like I în procesul îmbătrânirii şi dezvoltării patologiilor asociate cu vârsta

Benign Paroxysmal Positional Vertigo after an episode of cerebral circulatory disorder consequent to neurosurgical treatment – case study

Introduction. Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. It is described as short episodes of dizziness in trigger positions. They can be caused by many other disorders. In most cases, however, the etiology remains unknown. Aim. The paper presents the course of the disease and repositioning maneuvers in a female patient with cerebral circulation disorder after brain surgery. Material and methods. The work shows a case of a patient with numerous neurological disorders where BPPV has significantly intensified the already existing balance disorder. Results. The discovered BPPV was found to be multiple canal and unilateral; posterior and horizontal canals on the left side were affected. Performing TRV diagnostic and Epley maneuvers on the left side during the first visit caused displacement of otoliths to the superior canal. The treatment of this complication required performing positioning maneuver for the superior canal on the left side. The treatment resulted in balance control improvement. Conclusions. Disorders which co-existing cerebral circulation disorders and those imposing a long-lasting lying position as well as may be risk factors in BPPV symptoms.Wprowadzenie. Łagodne napadowe położeniowe zawroty głowy (BPPV) są najczęstszą przyczyną zawrotów głowy pochodzenia obwodowego. Charakteryzują się one krótkotrwałymi epizodami napadów zawrotów głowy, wyzwalanymi w tzw. pozycjach krytycznych. Mogą występować wtórnie do różnych stanów chorobowych. Jednak w większości przypadków etiologia zaburzeń pozostaje nieznana. Cel pracy. Opis przebiegu choroby i manewrów repozycyjnych u pacjentki z zaburzeniami krążenia mózgowego po przebytym leczeniu operacyjnym mózgu. Materiał i metody. W pracy opisano przypadek pacjentki z licznymi obciążeniami neurologicznymi, u której wystąpienie BPPV znacznie nasiliło już istniejące zaburzenia równowagi. Wyniki. Rozpoznane BPPV miało charakter wielokanałowy i jednostronny; zajęte były kanały półkoliste tylny i boczny po stronie lewej. Po wykonaniu na fotelu TRV manewrów diagnostycznych i manewru repozycyjnego Eplay’a po stronie lewej w trakcie pierwszorazowej wizyty doszło do przemieszczenia otolitów do przedniego kanału półkolistego lewego. Powikłanie to wymagało wykonania manewru repozycyjnego dodatkowo dla przedniego kanału półkolistego lewego. Po tym manewrze uzyskano znaczną poprawę stanu równowagi. Wnioski. Stany chorobowe przebiegające z zaburzeniami krą- żenia mózgowego oraz wymagające długotrwałego unieruchomienia mogą być czynnikiem ryzyka wystąpienia objawów BPPV

The Impact of the Angular Head Movement’s Velocity during Diagnostic Maneuvers on Proper Benign Positional Paroxysmal Vertigo Diagnosis and Therapy

Based on the current state of the BPPV field, there are no guidelines that specify an angular head movement’s velocity (AHMV) during diagnostic maneuvers of BPPV. The aim of this study was to evaluate the impact of AHMV during diagnostic maneuvers on proper BPPV diagnosis and therapy. The analysis covered the results obtained in 91 patients with a positive result of the Dix-Hallpike (D-H) maneuver or the roll test. The patients were divided into four groups based on values of AHMV (high 100–200°/s and low 40–70°/s) and the BPPV type (posterior: PC-BPPV or horizontal: HC-BPPV). The parameters of the obtained nystagmuses were analyzed and compared to AHMV. There was a significant negative correlation between AHMV and latency of nystagmus in all study groups. Furthermore, there was a significant positive correlation between AHMV and both maximum slow phase velocity and average frequency of nystagmus in the PC-BPPV groups, whereas it was not observed in the HC-BPPV patients. Complete relief of symptoms was reported after 2 weeks and was better in patients diagnosed with maneuvers performed with high AHMV. High AHMV during the D-H maneuver allows the nystagmus to be more visible, increasing the sensitivity of diagnostic tests and is crucial for a proper diagnosis and therapy