Curative tactic in the dehiscence of colorectal anastomosis

Catedra Chirurgie nr.2, Universitatea de Stat de Medicină și Farmacie ”Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Dehiscenţele anastomotice apărute dupa rezecţiile colorectale pot conduce la complicaţii septico-purulente severe, constituind o cauză importantă a letalității postoperatorii. Scopul lucrării: Optimizarea particularităţilor diagnostico-curative în conduita pacienţilor cu fistule intestinale, apărute in rezultatul rezecțiilor colorectale. Material și metode: În studiu dat au fost incluşi 776 de pacienți internați în clinică pe parcursul anilor 2011-2018, la care au fost aplicate anastomoze colorectale. Fistule postoperatorii au fost fixate în 7,98%(n=62) de cazuri.Anastomoze termino-terminale s-au aplicat în 93,54%(n=58) cazuri, anastomoze mecanice 3,22%(n=2) cazuri. În dependența de timpul apariției fistulei pacienții au fost divizați în 3 grupuri. În primul grup au intrat 5(8,06%) pacienți cu un interval mai mic de 6 zile, grupul doi l-au constituit 41(66,1%) pacienți cu un interval de 6-10 zile. Grupul trei -16(25.80%) pacienți cu un interval mai mare de 10 zile. Toți pacienții primului grup au necesitat relaparatomia cu drenarea si sanarea focarului septic, în grupul doi relaparatomie au necesitat 8(19,51%) pacienți. Concluzii: Tactica curativăîn dehiscenţa parţiala de anastomoză diferă semnificativ în dependenţă de perioada apariţiei acesteia. Cele mai grave sunt cazurile cu fistule apărute la scurt timp după intervenția chirurgicală (<6 zile), acești pacienți necesită relaparatomie cu sanarea focarului septic și montarea stomei.Introduction: Anastomotic dehiscence occurring after colorectal resection can lead to severe septic-purulent complications, constituting an important cause of postoperative lethality. Study purpose: Optimization of diagnostic and curative particularities in patients with intestinal fistula, resulting from colorectal resection. Materials and methods: In the clinical study, 776 patients were admittedto the clinic during the years 2011-2018, with colorectal anastomoses. Postoperative fistulas were found in 7.98%(n=62) cases. Endo-terminal anastomoses were applied in 93.54% (n=58) cases, mechanical anastomoses 3.22%(n=2) cases. Depending on the time of occurrence of the fistula, the patients were divided into 3 groups. In the first group 5(8.06%) patients were included with an interval of less than 6 days, the second group constituted 41(66.1%) patients with an interval between 6-10 days. Group three -16(25.80%) patients with a duration greater than 10 days. All patients in the first group required relaparatomy with drainage and septic healing, in group two - relaparatomy was required in 8(19.51%) patients. Conclusions: The curative tactic in the partial anastomosis dehiscence differs significantly and depends on the period of its occurrence. The worst are fistulas occurring shortly after surgery (<6 days), these patients will require relaparatomy with septic healing and stoma creation

Modern views in the diagnosis and surgical treatment of inflammatory bowel disease

Catedra de Chirurgie nr.2, USMF “Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Diagnosticul precoce corect și implicațiile chirurgicale oportune constituie premizele succesului în tratamentul bolilor inflamatorii ale intestinului. Scopul lucrării: Îmbunătățirea diagnosticului și rezultatelor postoperatorii în colita ulceroasă nespecifică (CUN) și boala Crohn (BC). Material și metode: Au fost asistați 285 pacienți cu CUN și 83 pacienți cu BC. S-au operat 79 bolnavi de CUN: urgență – 31 (39,2%), programat – 48 (60,8%) cazuri, respectiv. Operațiile primare realizate: colectomie subtotală proximală (33) sau distală (25), colectomie totală cu ileoplastie (7), colproctectomie (14). Operații reconstructive realizate (timpul II): ileorectoanastomoză (21), ascendostomie transanală (15), IAA Dumitriu-Ravich (7), IPAA în „J” (5), IPAA în „S” (2), sigmoproctectomie (8). S-au operat și 38 (45,7%) bolnavi cu BC: forma intestinală – 20 (52,6%), forma perianală – 18 (47,4%) cazuri, respectiv. Operațiile realizate: rezecția segmentară a intestinului subțire (6) sau gros (4) cu anastomoză, hemicolectomie (5), colectomie subtotală (2), stricturoplastie (3), rezecția rectului cu anastomoză (3), deschiderea și drenarea abcesului perianal (3), drenajul fistulei cu seton (5), stricturotomie anală cu stricturoplastie (3), plastia fistulei cu petic vaginal (2), ileostomie (2). Rezultate: După reconstrucții (în CUN): rezultate bune – 23 (58,9%), satisfăcătoare – 11 (28,2%), nesatisfăcătoare – 5 (12,9%) bolnavi. Analiza comparativă a rezultatelor postoperatorii în BC (intestinală și perianală) a evidențiat frecvența mai înaltă a recidivelor bolii (15% vs 33,3%), operațiilor repetate pentru acestea (10% vs 22,2%) și a complicațiilor postoperatorii (20% vs 27,7%) în forma perianală. Concluzii: În baza datelor clinice, radiologice, endoscopice și histologice diagnosticul cert dintre CUN și BC a fost posibil în ≈70% cazuri. Atitudinea medico-chirurgicală, individualizată la fiecare caz, a redus letalitatea postoperatorie la 12,8% (CUN) și 5,0% (BC).Introduction: Correct early diagnosis and opportune surgical implications are the keypoints of successful treatment of inflammatory bowel disease (IBD). The aim of study: Improvement of the diagnosis and postoperative results in ulcerative colitis (UC) and Crohn’s disease (CD). Material and methods: Were assisted 285 patients with UC and 83 patients with CD. From 79 patients with UC – 31 (39.2%) were operated on emergency and 48 (60.8%) – programmed. Performed primary operations: proximal (33) or distal (25) subtotal colectomia, total colectomia with ileoplastia (7), colproctectomia (14). Performed reconstructive intervences (II stage): ileorectoanasthomosis (21), transanal ascendostomia (15), IAA Dumitriu-Ravich (7), IPAA in ”J” (5) or IPAA in ”S” (2), sigmoproctectomy (8). Were operated 38 (45.7%) from 83 assisted patients with CD, with intestinal – 20 (52.6%) or perianal – 18 (47.4%) location. Types of surgical intervences: segmentary resection of small (6) or large intestine (4) with anasthomosis, hemicolectomia (5), subtotal colectomia (2), stricturoplastia (3), rectal resection with anasthomosis (3), opening and drainage of perianal abscess (3), fistula draining with seton (5), anal stricturotomia/stricturoplastia (3), fistula covering by vaginal path (2), ileostomia (2). Results: Tardive postoperative results after reconstructive intervences: good – 23 (58.9%), satisfactory – 11 (28.2%), unsatisfactory – 5 (12.9%) cases. Comparative analysis of obtained postoperative results în CD was showed increased frequency of recurences (15% vs 33.3%), repeated intervences (10% vs 22.2%) and postoperative complications (20% vs 27.7%) in perianal CD. Conclusions: In 70% of cases the clinic, radiologic, endoscopic and histologic exams assured relevant differentiation between UC and CD. The individualized therapeutic and surgical tactics was dimished the postoperative lethality till 12.8% (UC) and 5.0% (CD)

Parasites of domestic and wild pigeons in the south of Ukraine

Pigeons are closely related to human life and are both a source of food and object for hobbies and sports. Parasitic diseases of birds are the main reason for their growth retardation, reduced productivity and viability. The article presents the results of studying the prevalence of trichomonosis, cestodes and nematodes among the population of wild and domestic pigeons in the south of Ukraine. According to the results of the conducted researches it is established that in the south of Ukraine endoparasitoses of domestic and wild pigeons are quite widespread, and all species of this bird are carriers of Trichomonas gallinae. At the same time, the highest rate of Trichomonas infection was recorded in Columba palambus and C. livia domestica, and the overall infestation of males is higher by 4.4% compared to females. It was determined that domestic pigeons C. livia domestica were infested with trichomonosis (27.5%) and nematodes (Ascaridia columbae, 57.1%), C. palambus – trichomonosis (32.1%) and cestodes (Raillietina spp., 82.4%), Streptopelia turtur – cestodes (Raillietina spp., 12.5%) and S. decaocto – cestodes (Raillietina spp., 71.4%) and nematodes (Heterakis gallinarum, A. columbae – 33.3% and 44.4% respectively). The overall rate of infestation of pigeons with cestodes was 28.4% and the incidence in males was higher by 3.9% compared to females. It was found that the most common species among pigeon cestodes is Raillietina spp. In addition, 22.9% of pigeons are carriers of nematodes (H. gallinarum, A. columbae and Capillaria spp.). Continuous monitoring of pigeon parasites is necessary because they, in most cases, come into contact with other species of poultry and are a source of general invasion. In terms of further research, it would be promising to study the prevalence of helminthic infestation among wild migratory birds

Diagnosis and surgical treatment of perianal Crohn’s disease

Surgical Department 2, State University of Medicine and Pharmaceutics «Nicolae Testemitanu», Chisinau, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Perianal Crohn's disease (pCD) is a chronic inflammation of anal region, manifested by fissures, fistulas, abscesses or strictures. It is a marker of severe CD, associating with multiple relapses and operations. Can evolve in isolation (25%) or strike intestinal CD (75%). Correct early diagnosis, timed surgical implications constitute preconditions for success in the treatment of pCD. Purpose. Improvement of the diagnosis, of the early and late postoperative results in Perianal Crohn's disease (pCD). Material and methods. Retrospective study (2000-2019), based on the analysis of clinical observation files, results of paraclinical explorations and treatment of 52 patients with pCD. The investigation program was included: examination under anesthesia; endoscopy; imaging modalities (MRI, CT, fistulography, endorectal USG); histological explorations (biopsy, specimens). Conservative treatment was according to ECCO Protocol(2012). Results. Based on clinical, radiological, endoscopic and histological data, the definite diagnosis of pCD was possible in 72.7% of cases. Were operated 21 patients with pCD – drainage of perianal abscess (2), closure of the transphincterian fistula on Seton (6), fistulotomy (2), fistulectomy (3), closure of the recto-vaginal (2) or extrasphincterian (3) fistula with "advancement mucous flap", ileostomy (1), rectal resection with anastomosis (1), procectomy (1). Conclusions. The surgical attitude, individualized in each case, associated with biological therapy (infliximab), allows the essential reduction of relapses (23.8%), postoperative complications (14.3%) and lethality (4.8%)

Diagnosis and surgical treatment of intestinal and perineal Crohn’s disease

Catedra de Chirurgie nr 2, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu” Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Diagnosticul corect timpuriu, implicațile chirurgicale oportune constituie premizele succesului în tratamentul bolii Crohn. Scopul: Îmbunătățirea diagnosticului, rezultatelor postoperatorii precoce și tardive în boala Crohn (BC) cu localizare intestinală și perineală. Material și metode: În perioada 2000-2019 în Clinica 1 a Catedrei 2 Chirurgie au fost asistați 314 pacienţi cu boli inflamatorii intestinale, dintre care 108 (34.4%) pacienți cu BC. Au fost operați 67 (62.1%) bolnavi cu BC: forma intestinală – 38 (56.7%), forma perineală – 29 (43.3%) cazuri respectiv. Operațiile realizate: rezecția segmentară a intestinului subțire (10) sau gros (7) cu anastomoză, hemicolectomie (9), colectomie subtotală (5), stricturoplastie intestinală (4), rezecția rectului cu anastomoză (3), drenajul abcesului perianal (5), excizia fistulei anorectale (4), tratamentul fistulei anorectale cu seton (6), stricturotomie cu stricturoplastie anală (4), excizia fistulei recto-vaginale și închiderea defectului cu petic mucosal «la întâmpinare» (5), excizia fistulei recto-vezicale (3), ileostomie (2). Rezultate: Analiza comparativă a rezultatelor postoperatorii în BC (intestinală și perineală) a evidențiat frecvența mai înaltă a recidivelor bolii în primii 5 ani (28.9% vs 41.4%), complicațiilor postoperatorii (21.1% vs 34.5%) și operațiilor repetate pentru ele (13.2% vs 27.6%) în forma perianală. Concluzii: În baza datelor clinice, radiologice, endoscopice și histologice, diagnosticul cert al bolii Crohn a fost posibil în 72.7% cazuri. Atitudinea medico-chirurgicală, individualizată la fiecare caz, a redus letalitatea postoperatorie până la 7.9% (forma intestinală) și 3.4% (forma perineală).Introduction: Early correct diagnosis, timed surgical implications constitute preconditions for success in the treatment of Crohn's disease. The aim: Improvement of the diagnosis, early and late postoperative results in CD with intestinal and perineal localization. Material and methods: During 2000-2019 period, in Surgical Department №2 were assisted 314 patients with IBD, of which 108 (34.4%) patients with CD. There were 67 (62.1%) operated patients with CD: intestinal form – 38 (56.7%), perineal form – 29 (43.3%) cases respectively. Performed operations: segmental resection of small (10) or large bowel (7) with anastomosis, right/left hemicolectomy (9), subtotal colectomy (5), liquidation of intestinal stricture (4), rectal resection with anastomosis (3), drainage of perianal abscess (5), excision of anorectal fistula (4), treatment of anorectal fistula with long-term setons (6), incision of anal stricture (4), excision of recto-vesical (3) and recto-vaginal fistulas (5), ileostomy (2). Results: Comparative analysis of postoperative results showed a higher frequency of relapses of the disease during the first 5 years (28.9% vs 41.4%), postoperative complications (21.1% vs 34.5%) and repeated operations for them (27.6% vs 13.2%) in the perineal form. Conclusions: Based on clinical, radiological, endoscopic and histological data, the diagnosis of CD has been possible in 72.7% cases. Therapeutic and surgical attitude, individualized to each case, reduced postoperative lethality up to 7.9% (intestinal form) and 3.4% (perineal form)

Distribution, bioecological peculiarities of staphylinids (Coleoptera, Staphylinidae) in livestock biocenoses of forest-steppe and steppe Ukraine

As a result of research in the territory of livestock farms, 103 species of predatory Coleoptera were found, including Staphylinidae accounting for 51.4%, Histeridae – 27.3%, Carabidae – 21.3%. A total of 39 species of the Staphylinidae family were identified, belonging to 5 subfamilies: Oxytelinae, Steninae, Staphylininae, Tachyporinae, Aleocharinae. Species composition of staphylinids varied in relation to the types of animal rearing premises. In cowsheds and calf pens species diversity was higher (35 species). To study the peculiarities of feeding in laboratory conditions, we monitored 9 species of Staphylinidae: Philonthus addendus Sharp, Ph. cruentatus (Gmel.), Ph. rectangulus Sharp, Ph. varians (Payk.), Ph. spinipes Sharp, Ph. nitidus F., Creophilus maxillosus (L.), Ontholestes murinus (L.), Oxytelus sp. Feeding specialization of imagoes and larvae of different ages was studied. We determined that the mass of food consumed per day is higher than the weight of the beetles. Large species of staphylinids prefer feeding on average-aged larvae of flies and can eat puparia. Peculiarities of the development of coprophilous staphylinids were studied on the example of Ph. spinipes Sharp. During 24 h a female laid 1–3 eggs (in +28°С). Duration of the egg phase depends on the temperature regime (in +20 °С – 4–5, +28 °С – 3–4 days). Cessation of egg laying was observed with decrease in the temperature to +14 °С. The development takes part in three larval stages. Duration of the larva phase at +28 °С was 8–10 days, at +20 °С – 13–14 days. The first moulting was observed on the 2–3th days (in +28 °С) after the larvae emerged from the eggs. At +28 °С the pupa phase lasted 8–10 days. Decrease in temperature prolonged the rate of the development. At +24 °С it practically did not change (9–10 days), at +18 °С – increased to 13–15 days

Ecology of zoophilic flies in livestock biocenoses of Ukraine

In modern animal husbandry of Ukraine, there are still some unresolved issues related to the high number of zoophilic flies in the territories of facilities and the spread of animal infectious and parasitic diseases. A detailed study of bioecological peculiarities of the dominant zoophilic fly species contributes to improving the effectiveness of measures to control ectoparasites. 27 zoophilic fly species have been found in animal breeding complexes. The maximum number of parasitic Diptera species was recorded on cattle-keeping premises. The biological properties of Neomyia cornicina (Fabricius, 1781) (size, shape, colour, duration of preimaginal phase development) were studied. Also, we studied the dynamics of the number and daily activity of dominant fly species (Musca domestica Linnaeus, 1758, M. autumnalis De Geer, 1776, Stomoxys calcitrans (Linnaeus, 1758)). When studying the intraspecies competition, a high-degree survival of M. domestica and M. autumnalis was determined in the conditions of critical nutritional deficiency (0.5 g of nutrient medium per larva) and increased density of individuals (the imago emergence was 38.6% and 34.0%, respectively). In similar maintenance conditions, the emergence of N. cornicina imago was low (14.6%). With a two-fold increase in the insectarium volume and in the amount of nutrient medium (1 g per larva), the imago emergence of M.&nbsp;domestica, M. autumnalis and N. cornicina increased to 64.0%, 39.2%, and 24.0%, respectively. With an even greater increase in the amount of nutrient medium (2 g per larva), the maximum emergence of imagoes of all the studied fly species was observed (M. domestica, M. autumnalis, and N. cornicina: 96.6%, 91.2% and 72.6%, respectively). In the conditions of interspecific competition, M. autumnalis suppressed N. cornicina even in conditions of a sufficient amount of nutrient substrate. In the competition between M. domestica and M. autumnalis, house fly dominated. Increasing the nutrient medium volume narrowed the gap between the competing species

Minisatelite instability of hMLH1, hMSH2 genes in hereditary colorectal adenomas (Lynch Sindrome)

State University of Medicine and Pharmacy "Nicolae Testemitanu“, Department of Surgery nr2, Institute of Genetics, Academy of Sciences of Republic of Moldova, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. In the light of the progress achieved in the area of improving the methods of recombined DNA technology, today it has become possible to diagnose a genetic disease, including the Lynch Syndrome as a form of epithelial colorectal neoplasia (ECRN) at the level of genes (hMLH1, hMSH2). Purpose. Analysis of the results of genetic research, at the molecular level of the hMLH1, hMSH2 genes involved in triggering the mechanism of tumorogenesis. Material and methods. During the years 2012-2019, a group of 55 patients were observed and treated, of which 19 patients were diagnosed with IMS. In the identification of the genetic associations between the polymorphic DNA spectra and the clinical manifestations of the studied precancerous (tumorogenic) diseases, the PCR technique of the isolated DNA samples from the investigated patients was used. Results. Following the RT-PCR reaction based on RNA isolated from the biological material, 30 cases (54.5%) with negative expression were found, a positive result of grade I (+) was determined in 14 cases (26, 2%) and grade II (++) in 10 cases (19%). The molecular-genetic origin of NECR was confirmed and the value of the polymorphic appearance of the hMLH1, hMSH2 genes, their level and frequency of expression in tumor tissues was determined. Conclusions. The RT-PCR technique used in the experimental study contributes to increasing the efficiency of the medical-genetic consultation and to the eradication of colorectal cancer already at the early stages of development

The molecular genetic diagnosis of familial adenomatous polyposis (FAP)

Catedra Chirurgie nr.2, Universitatea de Stat de Medicină și Farmacie ”Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Depistarea precoce a pacienţilor cu PAF este una din problemele nesoluţionate ale chirurgiei colorectale. Dificultatea rezolvării acesteea este legată de evoluţia îndelungată şi asimptomatică a PAF. Expertiza genetico-moleculară deschide noi căi în diagnosticarea precoce a polipozei adenomatoase, prevenind apariţia manifestărilor protruzive la nivel de mucoasă colorectală. Scopul: Detectarea pacienţilor cu PAF în faza precoce a bolii. Material si metode: În studiul bazat pe utilizarea tehnicii PCR şi RT- PCR, pe parcursul anilor 2009-2018 au fost examinaţi 35 pacienţi cu neoplazie epitelială colorectală. Vârsta pacienţilor a variat de la 10 la 70 de ani. Rezultate: Analiza moleculară a materialului biologic a demonstrat atât expresia diferenţiată a genei APC în sânge, cât şi nivelul neomogen în ţesuturile tumorale. A fost apreciat riscul de apariţie al PAF la probanzii familiilor cercetate, prin efectuarea analizei moleculare a ADN şi ARN. Concluzie: Valoarea aspectului polimorf şi nivelul de expresie al genei APC prezintă markeri genetici informaţionali în diagnosticul precoce al PAF.Introduction: Early detection of FAP patients remains still one of the unsolved problems in coloproctology. Difficulty of its solving is a result of the long and asymptomatic evolution of FAP. The aim of the study was early detection of FAP patients. Materials and methods: The material was derived from 35 patients with colorectal epithelial neoplasia in 2009-2018 period. The age of the patients varied from 10 to 70 years old. The biomaterial (blood, polyps), based on PCR and RT- PCR techniques , was micro dissected and used to identify APC gene. Results: The DNA and RNA molecular analysis of the biomaterial shows a various expression of the APC-gene inside of the blood and tumoral tissue, as well. The risk of FAP appearance has been appreciated in proband’s families. Conclusion: The polymorphism and the level of expression of APC gene are an important informational markers in early detection of the patients with familial adenomatous polyposis