The role of stress echocardiography in the evaluation of myocardial viability

Department of Cardiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Stress echocardiography represents the combination of 2D echocardiography with a physical, pharmacological or electrical stress. The diagnostic end point for the detection of myocardial ischemia is the induction of transient worsening in regional function during stress. The presence (or absence) of inducible wall motion abnormalities specifies patients with different prognosis. This article represents an analysis and a short synthesis of recent information about stress echocardiography and its role in clinical practice for the determination of myocardial viability and the assessment of prognosis of patients with coronary artery disease. The data were structured in several aspects: the features of viable myocardium, the importance of the identification of hibernating myocardium for the management of patients with coronary artery disease and the role of stress echocardiography in this management. Dobutamine stress echocardiography is by far the most widely used method for assessing viable myocardium. This is mandatory in patients with left ventricle disfunction who may benefit from coronary revascularization. Conclusions: Stress echocardiography plays one of the main roles in management of patients with coronary artery disease, especially in the assessment of prognosis before revascularization and the long-term prognosis. The decision is based on the identification of viable myocardium that is hibernating. By far, the widest experience is available with dobutamine stress echocardiography, the preferred stressor for assessing myocardial viability

The renal artery resistive index as an integral marker of target organ damage in hypertensive patients

Department of Cardiology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: In the past few years, there has been growing attention to markers of subclinical organ damage because they are able to provide an accurate prediction of global cardiovascular outcome. The renal resistive index (RRI) measured using Doppler ultrasonography has been used as a diagnostic tool in the daily work-up of cardiovascular diseases. A better understanding of its relationship with preclinical organ damage may help in determining overall cardiovascular risk in hypertensive patients. The variability of RRI in hypertensive patients and the usefulness of the marker and interpretational difficulties of the index are an important matter of concern, which should not be underestimated in the course of diagnosis and management of cardiovascular diseases. This review summarizes current concepts in RRI interpretation against the cardiovascular pathologies, focusing on the vascular damage association with regard to the complex nature of RRI value variability. Currently, RRI measured in intrarenal segmental arteries is a well-known marker of renal vascular and interstitial damage, corresponding to an increased total cardiovascular risk. Conclusions: RRI has been shown to be a marker of renal and extrarenal organ damage in arterial hypertension. Several studies indicate that this index may in part reflect systemic vascular stiffness and entail a worse cardiovascular prognosis. On the basis of these results, the evaluation of RRI should be used to complement other signs of target organ damage in the assessment and management of hypertensive patients. Therefore under specific conditions, RRI could be considered as a renal vascular damage index

Синдром хронической сердечной недостаточности вторичной Тетраде Фалло: клинические и диагностические аспекты на основе одного случая

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe authors present a clinical case of a 17 year old boy, which in his clinical and paraclinical data highlighted the following diagnostic: Congenital heart failure; Tetralogy of Fallot; AV Block gr. III; Mitral valve insufficiency gr. IV; Tricuspid valve insufficiency gr. IV; Heart failure NYHA functional class gr. III-IV. The case focuses on complications that may occur in late cardio surgeries and the development of AV block gr. III disorders. If complications arose during the evolution of the disease, there would have been performed multiple pacemaker reimplantations. The article insists on the way how cardiovascular complications start as much as on the importance of prompt medical supervision to ensure the patient’s quality of life.В данной статье описан клинический случай ребёнка в возрасте 17 лет, у которого по клинико-инструментальным данным был установлен клинический диагноз – врожденный порок сердца, Tетрада Фалло, aтриовентрикулярная блокада III-ей степени. Имплантация исскуственного кардиостимулятора ритма сердца (1998, 2002, 2007). Недостаточность митрального клапана IV-ой степени. Недостаточность трикуспидального клапана IV-ой степени. НК IV NYHA

Факторы риска и особенности клинического течения и диагностики инфекций мочевыводящих путей у детей первого года жизни

USMF „Nicolae Testemiţanu“, Departamentul PediatrieBackground. Urinary tract infection (UTI) is one of the most common bacterial infections in children; the diagnosis is difficult particularly in young children and infants, because in this age group the clinical presentation of urine infection is often with non-specific clinical signs. UTI among other infant diseases have a special place because of the increased risk for sequels and renal scarring. Aim: To estimate risk factors for urinary tract infections in children and to evaluate clinical and diagnosis features of these in infants. Material and methods. The retrospective study included 44 children under 1 year of age diagnosed with UTI, who were hospitalized to the Nephrology Department of the Institute of Maternal and Child Healthcare in the period December 2007 to 2010. The studied children were 25 females and 19 males. The following methods were used for the examination of patients and experimental data processing: clinical – history, onset and clinical symptoms; laboratory – urinalysis and examination of the urine by Necipurenko method; instrumental – renal ultrasound and scintigraphy; statistical processing of results. Results. This paper highlights the contributory factors for the development of ITU in children under 1 year of age. Of a great importance is the mother’s health, especially during the antenatal period when certain risk factors may affect the child: heredity, chronic pyelonephritis (50%), gestosis (95,2%), nephropathies (45,3%), risk of abortion (36,3%). In the postnatal period risk factors include background conditions (52,3%), infectious inflammatory processes (40,9%), acute respiratory viral infections (22,7%). Conclusions: Becomes obvious the need to estimate the contribution of risk factors in the development of UTI in infants in order to attribute the child to a “risk group” and also to bring real improvements to early diagnosis, treatment outcomes and prevention of this disease.Введение. Инфекция мочевыводящих путей (ИМП) является одной из самых распространенных бактериальных инфекций у детей. Диагностика этих сотсояний часто затруднена, особенно у маленьких детей и младенцев, так как в этой возрастной группе клинические проявления часто характеризуются неспецифическими признаками. Среди других заболеваний детского возраста ИМП занимают особое место в связи с повышенным риском развития рубцовых осложнений. Цель: оценить факторы риска развития инфекции мочевыводящих путей у детей на первом году жизни, а также оценить особенности клинического течения и диагноза у детей грудного возраста. Материалы и методы. Ретроспективное исследование включило 44 ребенка (25 девочек и 19 мальчиков) в возрасте до 1 года с диагнозом ИМП, которые были госпитализированы в отделение нефрологии Института Матери и Ребенка в период с декабря 2007 по 2010 год. Следующие методы были использованы для обследования пациентов и обработки экспериментальных данных: клинические – анамнез, развитие заболевания и клинические проявления; лабораторные методы – анализ мочи и исследование мочи по методу Нечипуренко; инструментальные методы – УЗИ почек и сцинтиграфия; статистическая обработка результатов. Результаты. Данное исследование раскрывает факторы, способствующие развитию ИМП у детей грудного возраста. Большое значение имеет здоровье матери, особенно в дородовой период, когда определенные факторы риска могут негативно влиять на развитие плода: наследственность, хронический пиелонефрит (50%), гестоз (95,2%), нефропатии (45,3%), риск преждевременных родов (36,3%). В послеродовом периоде факторы риска включают преморбидные состояния (52,3%), инфекционные воспалительные процессы (40,9%), острые респираторные вирусные инфекции (22,7%). Выводы: Становится очевидной необходимость оценки вклада факторов риска в развитии инфекции мочевыводящих путей у детей раннего возраста с целью выявления групп высокого риска, а также улучшения ранней диагностики, результатов лечения и профилактики данных заболеваний

Thrombembolic complications in the biliary lithiasis surgery in aged patients, the preventive measures

USMF „N.Testemițanu”, Chişinau, Republica Moldova, 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. Boala trombembolică este complicația severă ce poate interveni în chirurgie, necesitînd permanent perfecționarea diagnosticului şi tratamentului. Scopul. Analiza tratamentului pacienților vîrstici cu litiază biliară , evidențierea factorilor de risc şi exercitatea metodelor de profilacsie în boala tromboembolică (BTE) .Material şi metode. Din 1314 pacienți tratați chirurgical în 2005 - 2010 pentru litiază biliară, pacienții cu vârsta de peste 60 ani au fost în 562 cazuri (42,8%). Operați pentru colecistită cronică - 419, pentru colecistită acută - 143 bolnavi. Colecistectomii clasice - 436 , laporoscopice - 126 cazuri. Durata intervenției chirurgicale de la 45 min – 2 ore 30 min. Evaluați factorii de risc ai BTE. S-au determinat: indicele protrombinic, fibrionogenul, TTPA (timpul trombinei parțial active), TAR (timpul activ de recalcificare), proba cu etanol, timpul de sângerare şi coagulare, s-a efectuat examinarea ecografică periferică Doppler în caz de afecțiuni vasculare.Rezultate. S-a constatat nivelul înalt de risc la toți pacienții cu vârsta de peste 60 ani. . Necătând profilaxiei s-au constatat următoarele complicații trombembolice: embolia arterelor pulmonare de calibru mare – 1 caz, embolia arterelor pulmonare de calibru mediu şi mic – 3 cazuri, tromboza venelor profunde – 2 cazuri, tromboflebită a venelor profunde – 2 cazuri, tromboflebită a venelor superficiale – 3 cazuri, sindrom dolor in molet cu marcarea timpului de coagulare – 26 cazuri. Complicațiile au survenit în lotul de pacienți operați în urgență, la indicații vitale, atât clasic cât şi laparoscopic. Profilaxia s-a efectuat cu heparină şi cu fraxiparină 2850ME - 3-4 zile. În cazul emboliei ramurilor masive a a. pulmonare a survenit subit un deces, celelalte au fost rezolvate prin tratament cu anticoagulante şi externare la a 15 - 23 zi, cu evaluare dinamică timp de trei luni.Introduction. Thrombembolic disease is a severe complications in surgery and need permanent improuvment of diagnosis and treatment.. Purpose. Analysis of risk factors and the prevention measures in thrombembolic complications (TEC) in treatment experience of aged patients with biliary stones .Material and methods: Of 1314 patients treated in 2005 - 2010 for biliary lithiasis, the aged patients were in 562 cases (42,8%). The cronic cholecystitis was in 419 cases, the acute cholecystitis was in 143 cases. The classic cholecystectomy was been done in 436 cases, the laparoscopic cholecistectomy - in 126 cases. The operations time was from 45 min to 2 hour 30 min. The analysis of risk factors of thrombembolic complications was been done. The laboratory investigations included : blood prothrombin, blood coagulation, the test with ethanol, hemoconcentration, Doplerography.Results. It was noticed the high risk of TEC in all aged patients. But in post operation period we determined some complications: the pulmonary large artery thrombembolism -1case, the little bronchus of pulmonary artery thrombembolism –3 cases, the thrombosis of deep veins-2 cases, the thrombophlebitis of deep veins-2 cases, the thrombophlebitis of varicose veins-3 cases, the arching pain syndrome with the increasing of coagulation time in 26 cases. These complications had appeared in group with urgent surgical treatment and was in classic and laparoscopic cholecystectomy. We notice that these patients were administrated heparin, fragmin and fraxiparin for 3-4 days. One case of pulmonary embolism had a fatal outcomes.The treatment of thrombembolic complications was anticoagulant therapy. The patients were discharged from the hospital on the 15 – 23 days of the treatment. We follow-up of this patients for 3 months

Extended necrotizing fasciitis complicated with toxic-septic shock

Clinica 2 Chirurgie USMF „N. Testemițanu”, Chişinău, Republica Moldova, 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 2011Fasciita necrozantă (FN) se caracterizează prin necroza rapidă a fasciei superficiale și tesuturilor adiacente, corespunde gradului III conform clasificării anatomice D.U.Ahrenholz. Forma gravă, tipul II în etiologia și geneza FN aparține streptococilor grupei A, frecvent ce duc la apariția Streptococcal toxic shock syndrome. Autorii prezintă cazul unei paciente 21 ani, fără antecedente chirurgicale tratată în secția chirurgie septică abdominală a S.C.R. Evoluția clinică gravă a fost condiționată de dezvoltarea rapidă a fascitei necrozante cu termenul de boală de ordinul cîtorva ore de la debut, endotoxicozei progrediente și dinamica de dezvoltare a șocului toxico- septic, insuficienței multiorganice. Morfologic – supurațiile necrozante pe o arie extinsă au cointeresat peretele anterior abdominal, antero-lateral toraco-abdominal și regiunii lombare cu detașarea circulară a țesuturilor moi și tegumentare. Tratamentul susținut, de urgență, a constat în incizii multiple cu evacuarea puroiului, fasciotomie, debridarea și excizia țesuturilor sfacelate, concomitent cu tratamentul antibacterian (cefalosporine generatia IV, vancomicină si carbapeneme) și de echilibrare a funcțiilor vitale și metabolice. Evoluția lent favorabilă cu intervenții chirurgicale repetate dupa 12-24 ore și în final autodermoplastie dupa 22 zile de la debut subliniază necesitatea diagnosticului precoce și a unei strategii curative corecte.Necrotizing fasciitis (NF) is characterized by quick necrosis of superficial fascia and adjacent tissues, corresponding to grade III anatomical classification D.U.Ahrenholz. The severe form, type II in etiology and genesis of FN is due to group A streptococcus which frequently leads to Streptococcal toxic shock syndrome. The authors present the case of a 21 years old female patient, with no surgical history who was treated in the abdominal surgery department of RCH. The severe development was conditioned by speedy evolution of FN within several hours from the onset, progressive endotoxicosis, and the dynamics of toxic-septic shock, multiorgan failure. Morphologically – necrotized suppurations on an extended area which implied anterior abdominal, antero-lateral thoraco-abdominal walls, and the lumbar region with a circular detachment of soft tissues. The emergency treatment was multiple incisions with pus discharge, fasciotomy, debridement, and excision of damaged tissues together with antibiotic medication (IV generation cephalosporins, vancomycin, carbapenems) and vital function equilibrium. The slow favorable evolution with repeated surgeries after 12-24 hours and the autoderoplasty on the 22nd day from the onset underline the necessity of early diagnosis and a correct curative strategy

Disfuncția vezicii urinare în obstrucțiile tractului urinar pelvin. Stenoza congenitală uretrală posterioară la băieţi. Partea I

Stenoza congenitală a uretrei posterioare se întâlnește frecvent și duce la tulburarea întregului tract urinar - uretra suprastenotică, colul vezicii urinare, vezica urinară, ureterohidronefroză, mai frecvent bilateral. Având origine congenitală, această malformație rezultă din dezvoltarea incompletă a membranei urogenitale - limita pasajului uretral posterior și anterior și spasmul muscular al tractului urinar pelvin. Diagnosticul include ultrasonografie, urografie, cistouretrografie micțională, renoscintigrafie dinamică, cistometrie, urofluometrie radionuclidică, uretroscopie, calibrarea uretrei cu buj cu olivă, examen neurologic, miografie musculară perineală. A fost elaboratăt clasificarea clinico-radiologică a acestui tip de stenoze, fiind descrise diferite grade, care necesită un tratament diferențiat în funcție de fazele clinic-radiologice. Stenoza neurogenă se dezvoltă la copiii mai mici cu un tablou clinic mai sever comparativ cel forma congenitală. Rezecția transuretrală a peretelui anterior al uretrei stenotice este metoda de elecție în tratamentul stenozei uretrale.Congenital posterior urethral stenosis is common and leads to disorder of the entire urinary tract - suprastenotic urethra, bladder neck, bladder, ureterohydronephrosis, more often bilaterally. It can be congenital as a result of incomplete development of the urogenital membrane - the limit of the posterior and anterior urethral passage and the muscular spasm of the pelvic urinary tract. Diagnosis includes ultrasound, urography, micturating cystourethrography, dynamic renoscintigraphy, cystometry, radionuclide uroflowmetry, urethroscopy, calibration of the urethra with olivary bougies, neurological examination, perineal muscle myography. The clinical-radiological classification of stenosis was developed, which is more didactic. There are different degrees of stenosis as suprastenotic resonance that requires a differentiated treatment depending on the clinical radiological phases. Neurogenic stenosis develops in younger children with a more severe clinical picture than the congenital one. Transurethral resection of the anterior wall of the stenotic urethra is the method of choice in the treatment of stenosis

Влияние цитомегаловирусной инфекции на новорожденных с врожденным пороком Пьер-Робин

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe authors present a clinical case of a newborn child aged 2 months in which the basis of clinical and genetic screening established diagnosis of Pierre-Robin syndrome. The article shows clinical prognosis of disease date.В работе авторами представлен клинический случай ребенка 2 месяцев, у которого на основании клинических и генетических данных был выставлен диагноз синдрома Пьера-Робина. В статье излагаются некоторые особенности клинической и генетической диагностики, эволюции и прогноза заболевания

Наблюдение детей с низкой массой тела при рождении в практической деятельности семейного врача

Department of Pediatrics, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThis study focused on the monitoring and promoting the health of LBW – infants during their first year of life. The value and stumbling blocks for integrated management of LBW – babies were assessed based on the development and one – year outcomes of two groups of LBW – infants managed at one of polyclinic from Chişinău (full – term babies with intrauterine grow retardation and premature babies). The two groups were compared based on parent – related factors, the characteristics of the babies and the health promotion services provided by the polyclinic. the availability of various integrated health care services ensuring global management proved beneficial.Был сделан анализ 60 амбулаторных карточек детей, рожденных с низкой массой (недоношенных, доношенных, но с ЗВР (задержка внутриутробного развития) в течение 1 года жизни. У обеих групп детей были выявлены факторы риска в перинатальном и постнатальном периодах. Была сделана оценка качества наблюдения этих детей в условиях поликлиники

Cystoadaptometry in children with nephrolithiasis

In view of studying the function of the urinary bladder, at thirty nine children with ages between four and fifteen years old, diagnosed with urotiliasis, 39 (thirty nine) cystoadaptomerys were performed and in about 60% (sixty percent) of the cases bladder hypotony was found. In order to improve the treatment of the bladder hypotony, stimulant drugs of the urinary tract peristalsis, such as Neostigmina, Cerucal, Neiromedina, were added to the treatment, which showed satisfying results