The applied morphology of the neurovascular apparatus of the thoracic aorta (Monograph) Author: Tamara Hacina, PhD in Medical Sciences, assoc. prof. Pontos Publishing House, 2015; 238 p. ISBN: 978-9975-51-690-0

Catedra de histologie, citologie și embriologie USMF „Nicolae Testemițanu

Clinical and treatment aspects of a rare cause of intestinal obstruction

Clinica Chirurgie II, Târgu Mureş, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: Ocluzia intestinală reprezintă 20% din totalul cazurilor de abdomen acut chirurgical din România. Cunoaştem 4 tipuri majore de cauze: sindrom aderențial peritoneal post-operator, tumori intestinale, volvulus intestinal, hernii sau eventrații abdominale strangulate. Herniile abdominale interne (paraduodenale, transmezenterice, pericecale, intersigmoidiene, paravezicale) reprezintă 0,2%-0,4% din toată patologia herniară. Material şi metodă: Vom relata cazul unei paciente internate în urgență cu abdomen acut chirurgical şi semne de ocluzie intestinală. Pacienta în vârstă de 21 ani acuza dureri abdominale, grețuri, vărsături, absența tranzitului intestinal de 8 ore. Clinic: apărare musculară la palpare, mai accentuată peri-ombilical; imagistic: câteva nivele hidroaerice mici peri-ombilical. Se practică laparotomie exploratorie, se constată înglobarea intestinului subțire începând de la Treitz şi până la joncțiunea ileocecală într-un sac peritoneal separat, adițional; intestinul gros (cecul, colonul ascendent, transversul cu epiplonul, descendentul şi sigmoidul) având o topografie normală în jurul acestei pungi peritoneale. Ultima avea un defect de aproximativ 1,5 cm diametru aproape de joncțiunea ileocecală prin care a ieşit o ansă de ileon terminal, fiind strangulată la acest nivel, dar viabilă. În rest organele cavitații peritoneale şi a spațiului retroperitoneal cu aspect şi topografie normală. S-a practicat excizia pe circumferință a acestui sac în care se conținea tot intestinul subțire, considerându-se un defect congenital, astfel jejunul şi ileonul au luat o poziție normală în cavitatea peritoneală. Concluzie: Herniile abdominale interne sunt o entitate chirurgicală întâlnită mai rar, din acest motiv am considerat importantă aducerea la cunoştință a acestui caz care deocamdată nu suntem siguri în ce categorie din clasificarea herniilor abdominale interne se poate încadra, fiind un defect congenital, care s-a manifestat la vârsta de 21 ani.Introduction: Intestinal obstruction represents 20% from all cases of acute abdomen in our country. There are 4 major causes: postoperative adherences, intestinal tumors, intestinal torsion and strangulated hernias. Internal abdominal hernia represents 0.2-0.4% of all types of hernias. Materials and methods: It is a case of a 21 years old woman admitted in the emergency department with clinical signs of acute abdomen and intestinal obstruction. She complained of abdominal pain, nausea, vomiting and absence of intestinal transit for about 8 hours. Physical examination revealed acute pain with muscular involuntary guarding, especially in the mid- abdominal area. Upright roentgenogram of the abdomen showed some small air-fluid levels periumbilicaly. No previous operation. Pregnancy test was negative. It was performed an exploratory laparotomy. Intraoperatory we found that the small bowel from the Traits till the ileocecal valve was in an aditional hernial sac. Near the ileocecal valve the sac had a defect and through it the part of the ileum herniated, being strangulated, but viable. The large bowel and the organs of the abdominal cavity had a normal aspect and position. The entire sac was removed, being considered a hereditary defect. The bowels took the normal position in the peritoneal cavity. Postoperative course was simple. Conclusion: Internal hernias are extremely rare surgical entities and are diagnosed only when became complicated especially with intestinal obstruction. Our duty was to report this case because we are not sure how to classify this type of hernia; this hereditary abnormality witch was silent till the age of 21

Comparison of basic neurocognitive violations in patients with residual schizophrenia with and without history of ischemic stroke

Relevance. The cognitive symptoms associated with schizophrenia have been a subject of controversy and are often viewed through a dualistic lens. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), these cognitive symptoms can be further elucidated within specific neurocognitive domains. Many of the symptoms of schizophrenia manifest behaviorally and can be challenging to differentiate from the consequences of organic brain impairment, especially when these symptoms involve the frontal and temporal cortex or have a diffuse presentation. Aim – to evaluate neurocognitive deficit in patients with residual schizophrenia with history of ischemic stroke. Materials and methods. A comprehensive study was conducted involving 100 patients diagnosed with recurrent schizophrenia (ICD-10: F20.5) at the Communal Non-Profit Enterprise "Regional Clinical Institution for the Provision of Psychiatric Care". We selected 59 patients: 32 patients with residual schizophrenia without history of stroke (Group 1, G1) and 27 patients with residual schizophrenia with history of stroke (Group 2, G2). Neuropsychological testing was used to evaluate neurocognitive violations. Due to massive distortions that brought to testing results by schizophrenia negative symptoms, only general evaluation was made to reflect critical or non-critical to no violations in separate functions. Statistical method of chi-square test was used to compare results in groups.  Study results. To compare neurocognitive violations in G1 and G2 we performed neuropsychological testing in basic neurocognitive domains. G2 patients, diagnosed with both schizophrenia and a stroke, generally exhibit heightened cognitive impairments compared to G1 patients with only schizophrenia. Notably, deficits in Sustained Attention, Divided Attention, Processing Speed, Working Memory, Mental Flexibility, immediate memory, implicit learning, and both expressive and receptive language are more pronounced in G2 patients. However, for functions like Selective Attention, Planning, Decision-Making, recent and very-long-term memory, and interpersonal understanding, the added influence of a stroke in G2 doesn't drastically differentiate them from G1. In essence, while schizophrenia inherently poses cognitive challenges, the co-occurrence of a stroke amplifies certain deficits but not others. This data suggests a complex interplay between schizophrenia and stroke in influencing cognitive function. Conclusions. The coexistence of schizophrenia and a history of stroke in G2 patients frequently exacerbates certain cognitive impairments when compared to those diagnosed solely with schizophrenia. This underlines the compounded cognitive challenges faced by patients with comorbid conditions. However, for some cognitive domains, the severity of impairments is primarily governed by schizophrenia, irrespective of the presence of an additional stroke history. This comprehensive analysis underscores the complex interplay of multiple conditions on cognitive function and emphasizes the importance of individualized care and intervention strategies tailored to the specific cognitive challenges faced by each patient group

Structural changes of the vascular wall in patients with chronic cerebral ischemia depending on the presence of the metabolic syndrome and the concentration of the vasculoendothelial growth factor

Background. Chronic inflammation and enhancement of free-radical oxidation follow metabolic syndrome. Nowadays, much attention is paid to vasculoendothelial growth factor, one of the most important factors of endothelial dysfunction. There is an evidence of its possible involvement in degenerative and atherosclerotic vascular processes. The objective: to determine changes in the structure of the vascular wall in patients with chronic cerebral ischemia, depending on the presence of metabolic syndrome and the concentration of vasculoendothelial growth factor. Materials and methods. In a prospective study 49 patients with chronic cerebral ischemia were examined. The patients were randomized into 2 groups: the main group consisted of 27 patients with chronic cerebral ischemia with metabolic syndrome. There were 22 patients with chronic cerebral ischemia without metabolic syndrome in the comparison group. The severity of atherosclerotic lesions of the arteries of the head and neck was investigated taking into account the structural changes of the vascular wall, the presence of intraluminal formations, as well as their ultrasonic characteristics. In the serum of the studied patients the concentration of vasculoendothelial growth factor was measured by enzyme-linked immunosorbent assay. Results. At the concentration of vasculoendothelial growth factor >300 pg/l, differentiation into layers of the intima-media complex was more often lost in patients of the main group than in patients of the comparison group: 35.7% and 0% of the examined, respectively. At this biomarker concentration, excess thickness of the intima-media complex of the common carotids (≥0.9 mm) was observed in 36.4% of patients in the main group versus 13.4% in patients in the comparison group. Also at a concentration of vasculoendothelial growth factor >300 pg/l in patients of the main group the presence of plaques was observed in 33.3%, while in patients in the comparison group plaques were not observed. Conclusions. Early and late manifestations of atherosclerotic structural vascular lesions in chronic cerebral ischemia with metabolic syndrome may have another quantitative biomarker of vascular endothelial damage. In these patients, the manifestations of the atherosclerotic process at all stages occur at a concentration of vasculoendothelial growth factor >300 pg/l, while atherosclerotic changes in patients without metabolic syndrome are minimal at this concentration

Prematuritatea (reviul literaturii)

Naşterile premature sunt şi în Republica Moldova o problemă majoră, continuă de sănătate, având o prevalenţă înaltă cu consecinţe sociale şi economice importante. Profilaxia şi tratamentul naşterilor premature sunt declaraţii ale strategiei prioritare pentru politica de sănătate şi medicina din republică. Orientarea spre naşterea fiziologică la termen este o tendinţă permanentă, urmărindu-se asigurarea unor noi modalităţi de reformare continuă a domeniului prematurităţii

Исследование качества жизни больных циррозом печени

The study presents the results of life quality evaluation patients with liver cirrhosis of viraol etiology. Was used the special questionary SF-LDQOL. Wasestablished that quality of life of patients with liver cirrhosis is diminished and progressively deteriorates of funcțional class B to the class C. The article presents the results of medicamentos hepatoprotective therapy and its influence to the quality of life.В работе представлены результаты определения качества жизни пациентов с циррозом печени вирусной этиологии. Был использован специальный опросник SF-LDQOL. Результаты исследования выявили, что качество жизни больных циррозом печени снижено и прогрессивно ухудшается от функционального класса В к классу С. В статье представлены результаты медикаментозной синдромальной гепатотропной терапии и ее влияние на качество жизни

Țesutul nervos. Sistemul nervos: Note de curs

Univ. de Stat de Medicină și Farmacie Nicolae Testemițanu, Catedra histologie, citologie și embriologieRolul ţesutului nervos în organism este determinat de proprietăţile principale ale celulelor nervoase: de a percepe iritaţiile, excitabilitatea, capacitatea de a elabora şi a transmite impulsul nervos. Funcţiile speci-fice ale ţesutului nervos sunt: perceperea excitaţiilor, stocarea şi proce-sarea informaţiei, elaborarea şi transmiterea impulsului nervos. Având o stare de specializare foarte înaltă, ţesutul nervos asigură legătura dintre ţesuturile şi organele organismului şi mediul înconjurător, integrarea şi adaptarea organismului. Ţesutul nervos este format din celule nervoase, care au un rol spe-cific, şi din nevroglie, iar nevroglia are un rol trofic, de susţinere, de apă-rare şi creează un micromediu optim pentru neuroni. Toate aceste elemente alcătuiesc un sistem morfologic unitar funcţional – ţesutul nervos. Principalele elemente ale ţesutului nervos sunt celulele nervoase sau neuronii – celule specializate, cu proprietăţi fundamentale – excitabilitatea şi conductibilitatea–foarte bine dezvoltate. Membrana celulei nervoase este extrem de reactivă la stimuli, răspunsul său fiind instantaneu gene-rat şi transmis rapid sub formă de unde de depolarizare a plasmolemei, cunoscute sub denumirea de impulsuri nervoase, care se propagă la o distanţă considerabilă în lungul fibrelor nervoase, extinse la mare distanţă de corpul celular. Concepţia actuală despre ţesutul nervos a fost formulată de Ramon y Cajal: „Celulele nervoase sunt aparatul generator şi conductor al undei nervoase. Iată faptul esenţial”. Ţesutul nervos este ţesutul de bază al tuturor organelor și constituie un sistem unic – sistemul nervos

Aspecte contemporane de tratament chirurgical în cancerul laringian

Au fost trataţi 1451 de bolnavi cu cancer laringian stadiile I, IIa, IIb, IIIa,IIIb, Iva în perioada anilor 1986-2006. S-au efectuat tratamentele radioterapeutic, crioterapeutic, laseroterapie şi combinat în diferite variante de asociere a radioterapiei, intervenţiei chirurgicale şi hipertermiei. Hipertermia electromagnetică locală cu frecvenţă înaltă provoacă reacţii degenerative – patomorfoză de gradul II în 72 % cazuri, duce la scăderea incidenţei recidivelor şi metastazelor, favorizează durata supravieţuirii bolnavilor la 3-5 ani, aceasta constituind respectiv 72,2 şi 69%. Evidarea ganglionară cervicală profi lactică este o metodă sigură de profi laxie a metastazelor regionale nedepistate clinic

Treatment of high-grade intraepithelial lesions of the cervix

Introduction. According to GLOBOCAN in 2018, 527.600 new cases and 265.700 deaths from cervical cancer have been diagnosed worldwide. In the Republic of Moldova, the incidence of cervical cancer is 21.4 per 100,000 women. The risk factor for cervical cancer is persistent HR-HPV infection. HSIL is a squamous cell abnormality associated with HR-HPV. The current management of HSIL is based on surgical treatment, while drug therapy is adjuvant and includes: immunomodulatory, anti-proliferative and antiviral medication. Aim of study. Evaluation of surgical, antiviral and immunomodulatory treatment in patients with cervical HSIL. Methods and materials. 94 patients with HSIL of the cervix, treated surgically and with additional antiviral and immunomodulator treatment, were involved in a prospective study, at the IMSP Oncological Institute of the Republic of Moldova, between 2020-2022. Results. The age of the patients ranged from 25 to 53 years old, the average age was 37.5 years old. Patients with HSIL were treated surgically with LEETZ 94.7% (n = 89), and by total hysterectomy 5.3% (n = 5), adjuvant therapy included: antiviral and immunomodulatory medication. Postoperative histology determined: CIN II - 36.1% (n = 34), CIN III - 54.2% (n = 51) and CIS - 9.7% (n = 9). All patients received antiviral and immunomodulatory therapy after surgery. All patients were monitored by Babeș-Papanicolau test at 6 months and HPV genotyping at 12 months after finishing the treatment. The results of the examination showed that 100% of the respondents determined NILM. HPV was not detected in 96.8% (n = 91), and in 3.2% (n = 3) of respondents the virus was present, of which type 16 was incriminated in 66.6% (n = 2) of cases, and type 18 in 33.3% (n = 1) of cases. Conclusion. The study found that the treatment of high-grade epithelial lesions of the cervix is combined: surgical, antiviral and immunomodulatory. The Babeș-Papanicolau test detected NILM in 100% of the cases. The presence of HPV virus was determined in 3 cases, and accounted for 94.6% of patients. The types of HPV detected were 16 and 18