Perforated gastroduodenal ulcer – peculiarities of treatment and diagnosis in elderly pacients and those with associated diseases

Coordonator stiintific: Vladimir Iacub, dr.med., conf.univ. Catedra Chirurgie generală şi semiologie USMF „Nicolae Testemiţanu”The study of the clinical cases of 24 patients operated on with perforated gastroduodenal ulcer during 2006-2009 reveals some peculiarities of treatment and diagnosis in elderly patients and those with associated diseases which were determined by the tendency to present late, the efficiency of the X-ray examination, the discordance between the clinical state and the seriousness of the disease in cirrhotics and diabetics, a poor prognosis in large surgical interventions and a high mortality rate caused by the fast decompensation during the operation. Studiul fişelor de observaţie a 24 de pacienţi operaţi în perioada 2006-2009 cu ulcer perforat relevă particularităţi în diagnosticul şi tratamentul pacienţilor în vîrstă şi celor taraţi date de tendinţa de adresabilitate tardivă, eficienţa metodei radiologice în diagnosticul clinic, discordanţa dintre gravitatea maladiei şi tabloul clinic la cei cu patologii asociate ca diabetul zaharat şi ciroza, prognosticul rezervat în cazul intervenţiilor chirurgicale masive şi o rata înaltă a mortalităţii din cauza decompensării rapide în timpul operaţiei

Abordare endovasculară a pacienţilor cu picior diabetic

Spitalul Clinic Republican, Chișinău, Republica Moldova, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introducere: Angiopatia diabetică şi complicaţiile septice sunt factorii care influenţează rata amputaţiilor la pacienţii cu diabet zaharat. Amputaţiile majore (de coapsă şi gambă) influenţează rata mortaltităţii în rândul pacienţilor cu picior diabetic. Studiul a avut ca scop evaluarea rezultatelor de angioplastie transluminală percutană cu balon la pacienţii cu picior diabetic. Material şi metode: Au fost analizate retrospectiv 180 de cazuri de angioplastie a arterelor tibiale la pacienţii cu picior diabetic, efectuate în cadrul Spitalului Clinic Republican în perioada 2016-2017. Pacienţii au fost evaluaţi prin Duplex scanare, CT angiografie, angiografie cu substracţie digitală. Angioplastiei de out-flow au fost supuşi doar pacienţii cu gradul de ischemie III (ischemie de repaos) – 56 de pacienţi şi IV Fotain (prezenţa ulceraţiei sau gangrenei) – 104 pacienţi. Rezultate: Angioplastii cu restabilirea fluxului trivascular (artere tibiale şi peronee) au fost posibile în 25 de cazuri, bivascular – în 79 de cazuri, monovascular – în 66 de cazuri. În 10 cazuri revascularizarea a fost cu eşec din cauza calcinozei pronunţate şi trombozei acute intraoperatorii. La 12 pacienţi au survenit complicaţii majore, dintre care 4 pacienţi au decedat. Amputaţii majore au fost efectuate la 4 pacienţi. Concluzii: Datele demonstrează că angioplastia de artere tibiale la pacienţii cu picior diabetic, însoţită de prelucrarea corespunzătoare a focarului septic, permite scăderea ratei de amputaţii majore şi creşterea speranţei de viaţă la pacienţii cu picior diabetic

MODERN TREATMENT OF ATHEROSCLEROTIC AORTOILIAC OCCLUSIVE DISEASE

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Patologia aterosclerotică stenozant-ocluzivă în segmental aorto-iliac este o manifestare tardivă si avansată a patologie arteriale, iar tabloul clinic variază de la claudicație intermitentă până la ischemia amenințătoare. Scopul lucrării. Prezentarea comparativă a rezultatelor revascularizării pentru patologia stenozant-ocluzivă în segmentul aorto-iliac la IMSP SCR „Timofei Mosneaga” secția chirurgie vasculară pentru perioada 2017-2020. Materiale și metode. Studiu retrospectiv, pentru care au fost studiate fișele medicale ale pacienților internați în secția de chirurgie vasculară a IMSP SCR „Timofei Mosneaga” în perioada 2017-2020 Criteriile examinate au fost: vârsta, tipul intervenției, complicațiile, numărul de zile de spitalizare și de terapie intensive. Pacienții au fost divizați în 2 loturi. Rezultate. În total, în perioada anilor 2017-2020, în secția Chirurgie Vasculară au fost spitalizați și operați pentru o leziune stenozant-ocluzivă în segmentul aorto-iliac 586 pacienți, 327 au beneficiat de o intervenție chirurgicală clasică: BABF, BAF, BIF, Simpatectomii lombare și amputație primară, iar 259 de pacienți au beneficiat de o revascularizare endovasculară. Media de zile de spitalizare la pacienții din I lot este de 12,3, iar la cei revascularizați endovascular 4,5 zile. Cea mai frecventă complicație a fost hemoragia, 18 pacienți din I lot și la 6 din al II, 10 pacienți din I lot au suportat o amputație de coapsă. În 6 cazuri a fost înregistrată o tromboza de branșă la I lot și 3 tromboze de a. brahiala s-au înregistrat în lotul II. Concluzii. Tratamentul endovascular în segmentul aorto-iliac la pacienții aterosclerotici și-a demonstrat eficacitatea prin scăderea numărului de zile de spitalizare, dar si având o rată scăzută a complicațiilor. Totuși, chirurgia convențională rămâne o alternativă importantă în cazul leziunilor greu de recanalizat, accesului vascular dificil și la pacienții cu insuficiență renală.Background: Stenotic-occlusive atherosclerotic pathology in the aorto-iliac segment is a late and advanced manifestation of arterial pathology. The clinical manifestation ranging from claudication to limb-threatening ischemia. Objective of the study: Comparative presentation of revascularization results for stenotic-occlusive pathology in the aorto-iliac segment at Republican Clinical Hospital „Timofei Mosneaga” vascular surgery department for the period 2017-2020. Material and Methods: This is a retrospective study, for which were studied the medical records of patients admitted to in vascular surgery department of RCH „Timofei Mosneaga” in 2017-2020: The examined criteria were: age, type of intervention, complications, number of days of hospitalization and therapy intensive, and the patients were divided into 2 groups. Results: In total, during 2017-2020, in the Vascular Surgery Department, 586 patients were hospitalized and operated for a stenotic-occlusive lesion in the aorto-iliac segment, 327 have benefited from a classic surgery: ABFB, AFB, IFB, Lumbar Sympathectomies and primary amputations, and 259 patients were performed endovascular revascularization. The average number of days of hospitalization in patients in I group is 12.3, and in those revascularized endovascularly 4.5 days. The most common complication was bleeding, 18 patients in group I and 6 in group 2, 10 patients in group I suffered a thigh amputation. In 6 cases, a branch thrombosis was registered in I group and 3 thrombosis of the brachial artery were registered in the II group. Conclusion: Endovascular treatment in the aorto-iliac segment has been shown to be effective in reducing the number of days of hospitalization, but also with a low rate of complications. However, conventional surgery remains an important alternative for difficult-to-recanalize lesions, difficult vascular access, and at patients with renal insufficiency

Acute mesenteric ischemia. Practical guide based on international treatment protocols

Secția Chirurgie Vasculară cu Cabinet de Cardiologie Intervențională și Endochirurgie, IMSP SCR „T. Moșneaga”, Catedra Chirurgie nr.4, USMF „N.Testemițanu”, Cabinet de Cardiologie Intervențională și Endochirurgie, IMSP SCR „T.Moșneaga”Patologia mezenterică acută reprezintă o problemă gravă de sănătate care, în ciuda progreselor obţinute în materie de diagnostic și tratament, prezintă un nivel foarte înalt de mortalitate la nivel global. În scopul îmbunătăţirii rezultatelor tratamentului, au fost elaborate ghiduri clinice care vin cu recomandări privind metodele optime de diagnostic și tratament în vederea creșterii ratei de succes în rezolvarea acestor cazuri.Acute mesenteric pathology is a serious health problem that, despite advances in diagnosis and treatment, shows a very high level of global mortality. In order to im-prove treatment outcomes, clinical guidelines have been developed that come up with recommendations on optimal diagnostic and treatment methods to increase the success rate in solving these cases

Tratamentul modern al patologiei aterosclerotice stenozant-ocluzive în segmentul aorto-iliac

Background: Stenotic-occlusive atherosclerotic pathology in the aorto-iliac segment is a late and advanced manifestation of arterial pathology. The clinical manifestation ranging from claudication to limb-threatening ischemia. Objective of the study: Comparative presentation of revascularization results for stenotic-occlusive pathology in the aorto-iliac segment at Republican Clinical Hospital „Timofei Mosneaga” vascular surgery department for the period 2017-2020. Material and Methods: This is a retrospective study, for which were studied the medical records of patients admitted to in vascular surgery department of RCH „Timofei Mosneaga” in 2017-2020: The examined criteria were: age, type of intervention, complications, number of days of hospitalization and therapy intensive, and the patients were divided into 2 groups. Results: In total, during 2017-2020, in the Vascular Surgery Department, 586 patients were hospitalized and operated for a stenotic-occlusive lesion in the aorto-iliac segment, 327 have benefited from a classic surgery: ABFB, AFB, IFB, Lumbar Sympathectomies and primary amputations, and 259 patients were performed endovascular revascularization. The average number of days of hospitalization in patients in I group is 12.3, and in those revascularized endovascularly 4.5 days. The most common complication was bleeding, 18 patients in group I and 6 in group 2, 10 patients in group I suffered a thigh amputation. In 6 cases, a branch thrombosis was registered in I group and 3 thrombosis of the brachial artery were registered in the II group. Conclusion: Endovascular treatment in the aorto-iliac segment has been shown to be effective in reducing the number of days of hospitalization, but also with a low rate of complications. However, conventional surgery remains an important alternative for difficult-to-recanalize lesions, difficult vascular access, and at patients with renal insufficiency.Introducere. Patologia aterosclerotică stenozant-ocluzivă în segmental aorto-iliac este o manifestare tardivă si avansată a patologie arteriale, iar tabloul clinic variază de la claudicație intermitentă până la ischemia amenințătoare. Scopul lucrării. Prezentarea comparativă a rezultatelor revascularizării pentru patologia stenozant-ocluzivă în segmentul aorto-iliac la IMSP SCR „Timofei Mosneaga” secția chirurgie vasculară pentru perioada 2017-2020. Materiale și metode. Studiu retrospectiv, pentru care au fost studiate fișele medicale ale pacienților internați în secția de chirurgie vasculară a IMSP SCR „Timofei Mosneaga” în perioada 2017-2020 Criteriile examinate au fost: vârsta, tipul intervenției, complicațiile, numărul de zile de spitalizare și de terapie intensive. Pacienții au fost divizați în 2 loturi. Rezultate. În total, în perioada anilor 2017-2020, în secția Chirurgie Vasculară au fost spitalizați și operați pentru o leziune stenozant-ocluzivă în segmentul aorto-iliac 586 pacienți, 327 au beneficiat de o intervenție chirurgicală clasică: BABF, BAF, BIF, Simpatectomii lombare și amputație primară, iar 259 de pacienți au beneficiat de o revascularizare endovasculară. Media de zile de spitalizare la pacienții din I lot este de 12,3, iar la cei revascularizați endovascular 4,5 zile. Cea mai frecventă complicație a fost hemoragia, 18 pacienți din I lot și la 6 din al II, 10 pacienți din I lot au suportat o amputație de coapsă. În 6 cazuri a fost înregistrată o tromboza de branșă la I lot și 3 tromboze de a. brahiala s-au înregistrat în lotul II. Concluzii. Tratamentul endovascular în segmentul aorto-iliac la pacienții aterosclerotici și-a demonstrat eficacitatea prin scăderea numărului de zile de spitalizare, dar si având o rată scăzută a complicațiilor. Totuși, chirurgia convențională rămâne o alternativă importantă în cazul leziunilor greu de recanalizat, accesului vascular dificil și la pacienții cu insuficiență renală

Novel Route to Produce Hydrocarbons from Woody Biomass Using Molten Salts

[Image: see text] The thermochemical decomposition of woody biomass has been widely identified as a promising route to produce renewable biofuels. More recently, the use of molten salts in combination with pyrolysis has gathered increased interest. The molten salts may act as a solvent, a heat transfer medium, and possibly also a catalyst. In this study, we report experimental studies on a process to convert woody biomass to a liquid hydrocarbon product with a very low oxygen content using molten salt pyrolysis (350–450 °C and atmospheric pressure) followed by subsequent catalytic conversions of the liquids obtained by pyrolysis. Pyrolysis of woody biomass in molten salt (ZnCl(2)/NaCl/KCl with a molar composition of 60:20:20) resulted in a liquid yield of 46 wt % at a temperature of 450 °C and a molten salt/biomass ratio of 10:1 (mass). The liquids are highly enriched in furfural (13 wt %) and acetic acid (14 wt %). To reduce complexity and experimental issues related to the production of sufficient amounts of pyrolysis oils for further catalytic upgrading, model studies were performed to convert both compounds to hydrocarbons using a three-step catalytic approach, viz., (i) ketonization of acetic acid to acetone, (ii) cross-aldol condensation between acetone and furfural to C(8)–C(13) products, followed by (iii) a two-stage catalytic hydrotreatment of the latter to liquid hydrocarbons. Ketonization of acetic acid to acetone was studied in a continuous setup over a ceria–zirconia-based catalyst at 250 °C. The catalyst showed no signs of deactivation over a period of 230 h while also achieving high selectivity toward acetone. Furfural was shown to have a negative effect on the catalyst performance, and as such, a separation step is required after pyrolysis to obtain an acetic-acid-enriched fraction. The cross-aldol condensation reaction between acetone and furfural was studied in a batch using a commercial Mg/Al hydrotalcite as the catalyst. Furfural was quantitatively converted with over 90% molar selectivity toward condensed products with a carbon number between C(8) and C(13). The two-stage hydrotreatment of the condensed product consisted of a stabilization step using a Ni-based Picula catalyst and a further deep hydrotreatment over a NiMo catalyst, in both batch setups. The final product with a residual 1.5 wt % O is rich in (cyclo)alkanes and aromatic hydrocarbons. The overall carbon yield for the four-step approach, from pinewood biomass to middle distillates, is 21%, assuming that separation of furfural and acetic acid after the pyrolysis step can be performed without losses

Clinic’s experience in endovascular treatment of peripheral arterial disease

Republican Clinical Hospital, Chișinău, Republic of Moldov

Novel Route to Produce Hydrocarbons from Woody Biomass Using Molten Salts

The thermochemical decomposition of woody biomass has been widely identified as a promising route to produce renewable biofuels. More recently, the use of molten salts in combination with pyrolysis has gathered increased interest. The molten salts may act as a solvent, a heat transfer medium, and possibly also a catalyst. In this study, we report experimental studies on a process to convert woody biomass to a liquid hydrocarbon product with a very low oxygen content using molten salt pyrolysis (350-450 °C and atmospheric pressure) followed by subsequent catalytic conversions of the liquids obtained by pyrolysis. Pyrolysis of woody biomass in molten salt (ZnCl2/NaCl/KCl with a molar composition of 60:20:20) resulted in a liquid yield of 46 wt % at a temperature of 450 °C and a molten salt/biomass ratio of 10:1 (mass). The liquids are highly enriched in furfural (13 wt %) and acetic acid (14 wt %). To reduce complexity and experimental issues related to the production of sufficient amounts of pyrolysis oils for further catalytic upgrading, model studies were performed to convert both compounds to hydrocarbons using a three-step catalytic approach, viz., (i) ketonization of acetic acid to acetone, (ii) cross-aldol condensation between acetone and furfural to C8-C13products, followed by (iii) a two-stage catalytic hydrotreatment of the latter to liquid hydrocarbons. Ketonization of acetic acid to acetone was studied in a continuous setup over a ceria-zirconia-based catalyst at 250 °C. The catalyst showed no signs of deactivation over a period of 230 h while also achieving high selectivity toward acetone. Furfural was shown to have a negative effect on the catalyst performance, and as such, a separation step is required after pyrolysis to obtain an acetic-acid-enriched fraction. The cross-aldol condensation reaction between acetone and furfural was studied in a batch using a commercial Mg/Al hydrotalcite as the catalyst. Furfural was quantitatively converted with over 90% molar selectivity toward condensed products with a carbon number between C8and C13. The two-stage hydrotreatment of the condensed product consisted of a stabilization step using a Ni-based Picula catalyst and a further deep hydrotreatment over a NiMo catalyst, in both batch setups. The final product with a residual 1.5 wt % O is rich in (cyclo)alkanes and aromatic hydrocarbons. The overall carbon yield for the four-step approach, from pinewood biomass to middle distillates, is 21%, assuming that separation of furfural and acetic acid after the pyrolysis step can be performed without losses