The usage of efferent methods in the complex treatment of acute pyelonephritis of patients with diabetes mellitus

Catedra Urologie şi nefrologie chirurgicală USMF „Nicolae Testemiţanu”The clinical evolution of acute pyelonephritis in patients with diabetes mellitus is studied in this article, it is regarded depending on the applied treatment. The collected results demonstrate that using plasmaferesis in the etiotropic treatment of acute pyelonephritis associated with diabetes mellitus considerably improves the patients condition decreasing the period of time almost by a half. The symptoms of intoxication were reduced considerably in these patients after the first application of plasmaferesis. The general condition improved, the fever persisted less time ranging within low figures. The modern medical achievements, the improvement of the surgical methods, the use of the efferent methods of treatment such as plasmoferesis have enabled the improvement of the actual and perspective results in the treatment of acute pyelonephritis. The use of these methods reduces the quantity of medicines and treatment period which is extremely important for the patients with diabetes mellitus. The risk of pathology aggravation and appearance of severe complications particularly in patients with diabetes mellitus is considerably reduced. In această lucrare este studiată evoluţia clinică a pielonefritei acute la pacienţii cu diabet zaharat în dependenţă de tratamentul aplicat. Rezultatele primite ne demonsterază că includerea plasmaferezei în tratamentul etiotrop a pielonefritei acute pe fundalul diabetului zaharat considerabil ameliorează starea bolnavului, micşorînd durata tratamentului în jumătate. La aceşti bolnavi după prima şedinţă de plasmafereză simptoamele de intoxicaţie sau micşorat considerabil, sa ameliorat starea generală, febra sa menţinut timp mai scurt şi cu cifre mai joase. Realizările moderne în medicină, perfecţiunea metodelor chirurgicale, utilizarea metodelor eferente de tratament ca plasmafereza au permis ameliorarea rezultatelor actuale şi de perspectivă în tratamentul pielonefritei acute pe fundalul diabetului zaharat. Folosirea acestor metode minimizează cantitatea medicamentelor şi durata tratamentului, ce este important pentru pacienţii cu diabet zaharat. Riscul agravării patologiei şi apariţiei complicaţiilor severe mai ales la pacienţii cu diabet zaharat, se micşorează considerabil

Microalbuminuria şi proteinuria în evaluarea pacienţilor cu diabet zaharat complicat cu pielonefrită acută

USMF „Nicolae Testemiţanu”Rezumat A fost efectuat un studiu prospectiv pe un lot din 90 de pacienţi cu diabetul zaharat de tipurile 1 şi 2, complicat cu pielonefrită acută, spitalizaţi în IMSP Spitalul clinic municipal „Sfântă Treime”. Pacienţii examinaţi au fost supuşi evaluării clinico-paraclinice complexe, repetate în dinamică la distanţă de 1-2-3 săptămâni. Evaluarea corelaţională prin metoda Spearman a determinat rolul predictiv al nivelului de microalbuminurie vizavi de gravitatea infl ama- ţiei generale şi riscul sporit de dezvoltare a complicaţiilor locale purulente la pacienţi cu nivel sporit de proteinurie. Suplimentar, nivelul proteinuriei a corelat cu severitatea insufi cienţei renale cronice. Summary There were performed a prospective study of 90 patients with type 1 and 2 diabetus mellitus complicated by acute pyelonephritis and admitted to the PMSI Clinical Municipal Hospital nr. 3. The enrolled patients were examined thoroughly by different clinical and paraclinical methods, repeated after 1-2-3 weeks. Correlation evaluation by Spearman method has determined the predictive role of microalbuminuria regarding the severity of general infl ammation and the high risk of the local purulent complications’ development in patients with high proteinuria level. Supplementary, the high level of proteinuria correlated with the reduction of the kidney function. Резюме Было проведено проспективное исследование группы из 90 пациентов с сахарным диабетом 1-го и 2-го типа, госпитализированных в ОМСУ Городскую клиническую больницу № 3. Данные пациенты были комплексно обследованы при помощи различных кли- нических и параклинических исследовваний, повто- рённых через 1-2-3 недели. Исследование корреляций по методу Спирмана определило прогностическую роль микроальбуминурии при оценке тяжести син- дрома общего воспаления, а также повышенный риск развития местных гнойных осложнений у пациентов с повышенным уровнем протеинурии. Уровень протеи- нурии дополнительно коррелировал с тяжестью хрони- ческой почечной недостаточности

The peculiarities of clinical evolution and diagnosis of acute pyelonephritis in patients with diabetes mellitus

Catedra Urologie şi Nefrologie Chirurgicală USMF „Nicolae Testemiţanu”Kidney involvement in diabetes mellitus represents a serious problem both in therapy, endocrinology and urology. It is due to the fact that inflammatory renal and urinary diseases in patients with diabetes mellitus are four times more freguent that in patients without diabetes mellitus. It is characteriyed by severe evolution associated with complication of renal failure and urosepsis being conditioned by postoperative lethality. Development of the severe forms of acute pyelonephritis is causedby late hospital admission, inexact clinical picture, late diagnosis and inappropriate treatment in this group of patients. The combination of these two severe diseases endanger patients life. This has made us carry aut a retrospective analysis of the collected data and give practical recommendations. The algorithm of the emergent examinations comprises the ultrasound scan, radiologic and radionuclear methods. Ultrasound scan accompanied by use of doplerography and computed tomography has an essential role. Nowadays the most effective method of examination used in diagnosis of acute pyelonephritis in patients with diabetes mellitus is considered to be computed tomography. Afectarea rinichiului în cazul DZ constituie o problemă serioasă atît în terapie şi endocrinologie, cît şi în urologie, deoarece maladiile inflamatorii ale rinichiului şi ale căilor urinare la bolnavii cu DZ este de 4 ori mai freceventă, decît la persoanele fără diabet şi se caracterizează prin evoluţie gravă, deseori complicată de insuficienţă renală şi urosepsis, condiţionată de letalitate postoperatorie. Dezvoltarea formelor grave ale PA este, condiţionată de internarea tardivă, tabloul clinic neclar, diagnosticării tardive şi tratării neadecvate a acestui contingent de bolnavi. Combinaţia acestot două maladii grave, crează un pericol potenţial pentru viaţa acestor bolnavi. Aceasta ne-a determinat de a realiza analiza retrospectivă de material acumulat şi de a da recomendaţii în practică. Algoritmul investigaţiilor urgente prevede, scanarea ultrasonografică, metodele radiologice şi radionucleare, dar locul de frunte îl ocupă scanarea ultrasonografică cu folosirea doplerografiei şi tomografia computerizată. La moment din metodele de investigaţie folosite în diagnosticul pielonefritei acute la pacienţii cu diabet zaharat tomografia computerizată este cea mai eficientă metodă

Microalbuminuria şi proteinuria în evaluarea pacienţilor cu diabet zaharat complicat cu pielonefrită acută

A fost efectuat un studiu prospectiv pe un lot din 90 de pacienţi cu diabetul zaharat de tipurile 1 şi 2, complicat cu pielonefrită acută, spitalizaţi în IMSP Spitalul clinic municipal „Sfântă Treime”. Pacienţii examinaţi au fost supuşi evaluării clinico-paraclinice complexe, repetate în dinamică la distanţă de 1-2-3 săptămâni. Evaluarea corelaţională prin metoda Spearman a determinat rolul predictiv al nivelului de microalbuminurie vizavi de gravitatea infl amaţiei generale şi riscul sporit de dezvoltare a complicaţiilor locale purulente la pacienţi cu nivel sporit de proteinurie. Suplimentar, nivelul proteinuriei a corelat cu severitatea insuficienţei renale cronice

The peculiarities of the acute pyelonephritis treatement with ceftriaxone in diabetic patients

Catedra Urologie şi Nefrologie Chirurgicală USMF „N. Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. Pyelonephritis in patients with diabetes mellitus is a serious disease both from the endocrinological and urological aspects, because the inflammatory diseases of the kidney and urinary pathways in patients with diabetes mellitus is four times more frequent than in non-diabetics and it is characterized by a severe development , usually complicated by renal failure and urosepsis, being a leading cause of death. The late hospitalization, the unclear clinical picture, the late diagnostics and the inadequate treatment of these patients determine the development of severe forms of AP. The association of these two severe diseases endangers the patients’ life. This determined us to make a retrospective evaluation of the obtained data and to give treatment indications of AP with ceftriaxone. Cephalosporins of third generation, differ greatly from penicillin and cephalosporins of the preceding generations by their increased efficiency from the majority of enterobacteria, by their stability to the beta-lactamose action of gram-negative bacteria. In conclusion we can say that ceftriaxone has a specific action in the therapy of acute pyelonephritis

The terapeutic plasmaferesis in the complex treatment of acute pyelonephritis in patients with diabetes mellitus

Catedra Urologie şi Nefrologie Chirurgicală USMF „Nicolae Testemiţanu”The clinical evolution of acute pyelonephritis in patients with diabetes mellitus is studied in this article, it is regarded depending on the applied treatment. The collected results demonstrate that using plasmaferesis in the etiotropic treatment of acute pyelonephritis associated with diabetes mellitus considerably improves the patientis condition decreasing the period of time almost by a half. The symptoms of intoxication were reduced considerably in these patients after the first application of plasmaferesis. The general condition improved, the fever persisted less time ranging within low figures. The modern medical achievements, the improvement of the surgical methods, the use of the efferent methods of treatment such as plasmoferesis have enabled the improvement of the actual and perspective results in the treatment of acute pyelonephritus. The use of these methods reduces the guantity of medicines and treatment period which is extremely important for the patients with diabetes mellitus. The risk of pathology aggravation and appearance of severe complications particularly in patients with diabetes mellitus is considerably reduced. În această lucrare este studiată evoluţia clinică a pielonefritei acute la pacienţii cu diabet zaharat în dependenţă de tratamentul aplicat. Rezultatele primite ne demonsterază că includerea plasmaferezei în tratamentul etiotrop a pielonefritei acute pe fundalul diabetului zaharat considerabil ameliorează starea bolnavului, micşorînd durata tratamentului în jumătate. La aceşti bolnavi după prima şedinţă de plasmafereză simptoamele de intoxicaţie sau micşorat considerabil, sa ameliorat starea generală, febra sa menţinut timp mai scurt şi cu cifre mai joase. Realizările moderne în medicină, perfecţiunea metodelor chirurgicale, utilizarea metodelor eferente de tratament ca plasmafereza au permis ameliorarea rezultatelor actuale şi de perspectivă în tratamentul pielonefritei acute pe fundalul diabetului zaharat. Folosirea acestor metode minimizează cantitatea medicamentelor şi durata tratamentului, ce este important pentru pacienţii cu diabet zaharat. Riscul agravării patologiei şi apariţiei complicaţiilor severe mai ales la pacienţii cu diabet zaharat, se micşorează considerabil

Antibacterial and immunomodulating limphotrop treatment of chlamydial chronic prostatitis

Catedra Urologie şi Nefrologie Chirurgicală, USMF „N.Testemiţanu”, Secţia Urologie IMSP Spitalul Clinic Republican, Profilactoriul „Constructorul”, Secţia Urologie IMSP Spitalul Clinic Municipal „Sfînta Treime”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. Treatment of chlamydial chronic prostatitis is an actual and very difficult problem. Standard antibiotic regimens don’t bring expected results. 46 patients with the diagnosis of chronic prostatitis caused by chlamydia undergone treatment. The studied group was divided into two lots, lot 1 - treated with clindamycin by regional – local method, lot 2 – by introducing clindamycin intramuscularly. Positive effect in group 1 was present in 96%, associated with regression of clinical symptoms of chronic prostatitis, in group number two - 88% without a full clinical normalization. Our results assert that endolymphatic administration of clindamycin is effective in the treatment of chlamydial chronic prostatitis, with a higher success rate than standard method of intramuscular input

Clinical case: Mayer-Rokitansky-Kuster-Hauser syndrome, atypic form

Secţia Urologie IMSP SCM „Sf. Treime”, Catedra Urologie şi Nefrologie Chirurgicală, USMF „N. Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary The Mayer-Rokitansky-kuster-Hauser (MRkH) syndrome is a rare anomaly in the prenatal development of the female genital tract. In this paper we report a clinical case of this syndrome observed in its atypical form with affected urogenital system, as well as uterine and renal agenesia. This case is interesting, as the patient did not receive any specific treatment associated with the syndrome until the age of 29. We provide a detailed description of the clinical case, its specifics and anamnesis. A literature review on the prenatal development of the female genital tract, urogenital system and the renal agenesia is also given

Особенности активности лизосомальных энзимов в сыворотке крови при аденоме простаты и их уровень в ложе после черезпузырной аденомэктомии при трансуретральном дренировании ложе

USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaThe mechanisms by which lysosomal disorders affecting prostate functions in prostate adenoma News. The mechanisms by which lysosomal disorders affecting prostate functions in prostate adenoma bulky (APV), including the Lodge of adenomectomy are poorly understood, and the effectiveness of current therapeutic measures are limited and uncertain. The research is based on two study groups: Lb – patients with a mean age of 68.6±1.05 and bulky AP definite diagnosis (≥ 80 cm3) repair surgery using drainage endouretralnye and Lm – 20 men of the same age, basically healthy. Lysosomal enzyme activity determination (Cat G rnd CatD; FA; NAG; β -gal, β-gul, and β-glucuronidase, arylsulfatase A and B, total protein was performed by standard techniques, adapted for application to multi-modal hybrid rider microplate Synergy H1 (Reader Hydride). As a result it was determined that AP ≥ 80 m3 bulky significantly induce the growth of all lysosomal enzymes studied, reaching values of 2-3 times higher compared with controls, with the prevalence of high values of 4-6 times, β –gal, ß-gluc and CatG fact catgut as coexistent inflammatory process caused by the presence of biological membranes and destabilization celulare. Sa direct interdependencies found the presence of liposomal enzymes in their blood serum and deletions to the lodge postoperative which can serve as a biomarker of evolution postoperative period, with predictive role in assessing the effectiveness of the treatment strategy and local general medical and surgical, monitoring and optimization of rehabilitation of patients with AP and adenomectomy.Механизмы расстройств лизосомальных энзимов, влияющие на функции простаты при аденоме предстательной железы (АПЖ), в том числе в ложе после аденомэктомии недостаточно изучены, а эффективность лечебных мероприятий ограничены и неопределенны. Исследование проводилось в двух группах: основная группа – 49 пациентов возрастом в среднем 68,6±1,05, оперированные по поводу АП с дренированием ложе [3], и контрольная – 20 мужчин того же возраста, в основном здоровые. Определение активности лизосомальных энзим (Cat G rnd CatD; FA; NAG; β -gal, β-gul, и β-glucuronidase, arylsulfatase A и B), общего белка проводили с помощью стандартных методов используя микропланшеты Synergy H1 (гидрид Reader). В результате было установлено, что при АПЖ происходит значительный рост всех лизосомальных энзимов, включенных в исследование, достигая цифры в 2-3 раза выше по сравнению с контрольной группой и в 4-6 раз значений β-галактозидазы (β-gal), бетаглюкозидазы (β-glu) и катепсина (Cat) G, обусловленные воспалительными существующими процессами приводящие к дестабилизации биологических клеточных мембран. Установлено наличие прямой зависимости между активностью лизосомных энзимов в сыворотке и послеоперационной ложе, что может служить биомаркером эволюции послеоперационного периода, с предсказательной ролью в оценке эффективности медицинской и хирургической тактики лечения, общего и локального мониторинга и оптимизации реабилитации больных с АПЖ до и после аденомэктомии