The elevation of the maxillary sinus floor through chrestal aproach with simultanous insertion of endosseous dental implants

Rezumat. Am propus o metodă de elevare a sinusului maxilar prin creastă cu înserarea simultană a implantelor ondoosoase. La 104 pacienţi au fost insta‑ late 186 implante dentare (sistemul Alpha‑Bio, Adin, Miss). S‑a dovedit că formarea osului la nivelul sinusului maxilar în jurul segmentului implantului care nu este mai mare de 4mm, formarea sa nu se include în influenţa fragmentelor osoase dislocate prin osteostomă şi trombul sanguin. Metoda propusă perminte instalarea implantelor cu o lungime mai mare, este mai simplă şi mai uşor tolerată de către pacienţi.Summary. It was proposed a method of elevation of the maxillary sinus floor through chrestal aproach with simultanous insertion of endosseous dental implants. At 104 patients there were instaled 186 endosseos dental implants (sistems Alpha‑Bio, Adin, Miss). In all cases insertion of the implants was done through transgingival aproach, without decolation of mucoperiostal flap and without augumentation with osteoplastic materials. It was proved that formation of the bone at maxillary sinus floor, around implant segement, which is pentrated into the sinus, no more than 4 mm, is formed with out augumentation under the influience of bone fragments dislocated through osteotomy and sanguin tromb. The method wich was proposed permits insertion of implants with more lentgh, it is simple and it is easy supported by the patients

Healing of trophic ulcers with bioplastic collagen material COLLOST ТМ

Catedra chirurgie generală, USMF “Nicolae Testemiţanu”, Spitalul Clinic Municipal nr.1, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: COLLOSTтм reprezintă un material bioplastic steril din colagen care păstrează structura fibroasă şi activează regenerarea ţesuturilor afectate. Este bazat pe colagenul bovin de tip I şi este asemănător cu colagenul uman după compoziţie şi structură. Scopul studiului a fost de a testa eficacitatea COLLOSTтм în tratamentul ulcerelor trofice, refractare la alte modalităţi de tratament. Material şi metode: În studiul nostru au fost incluşi 9 pacienţi cu ulcere trofice la nivelul membrelor inferioare fără răspuns sau cu răspuns scăzut la tratamentul standard pe parcursul unei perioade lungi de timp: de la 1 lună – la 30 ani. Ca şi etiologie a ulcerelor trofice au fost diabetul zaharat (5 pacienţi), osteomielita (1) şi sindromul post-trombotic (3). La 5 pacienţi plăgile au fost complet acoperite cu COLLOSTтм în formă de membrană perforată. La 4 pacienţi tratamentul s-a realizat cu aplicarea atât a COLLOSTтм în formă de gel 7% cât şi membrană perforată. Rezultate: Toţi pacienţii au prezentat răspuns favorabil la tratament. După 2 zile de tratament pacienţii au raportat dispariţia durerii. Edemul şi dimensiunile plăgilor s-au micşorat pe parcursul a 7-14 zile. Eficienţa COLLOSTтм este determinată de următorii factori: penetrarea înaltă a celulelor; adeziune bună faţă de plagă; asigură regenerarea ţesuturilor; nu induce reacţii antigenice şi prezintă un risc scăzut de transmitere a infecţiilor virale şi microbiene. Concluzii: Experienţa primară de utilizare a COLLOSTтм în tratamentul local al ulcerelor trofice indică asupra perspectivelor aplicării acestuia.Introduction: COLLOSTтм is sterile bioplastic collagen material with preserved fibrous structure which activates regeneration of affected tissues. It is based on bovine collagen type I, which is close to human collagen by its composition and structure. The aim of the study was to assess the efficacy of COLLOSTтм in treatment of the trophic ulcers, which have been refractory to previous treatment modalities. Material and methods: In our study there were included 9 patients who had trophic ulcers in lower limbs with reduced or no response to standard treatment during a long time periods: from 1 month to 30 years. The etiology of trophic ulcer was diabetes mellitus (5 patients), osteomyelitis (1) and post-thrombotic syndrome (3). In 5 patients the wounds were closely covered by COLLOSTтм in form of perforated membranes. In 4 patients the treatment was performed using both COLLOSTтм 7% gel and perforated membrane. Results: All patients showed good response to the treatment. After the 2nd day of treatment the patients reported no pain. The edema and size of the wounds were reduced in the period from 7 to 14 days. The efficiency of COLLOSTтм is determined by the following factors: high penetration of the cells; good adhesion to the wound; providing of tissue regeneration; no inducing of antigenic reaction, and has low risk in transition of viral or microbial infections. Conclusions: Initial experience of using COLLOSTтм in local treatment of trophic ulcers indicates on perspectives of its application

Open infrainguinal revascularization for chronic arterial occlusions: techniques and short-time clinical results

Catedra de chirurgie generală semiologie nr. 3, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Spitalul Clinic Municipal nr.1, 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: În pofida implementării active a tehnicilor endovasculare intervențiile arteriale deschise adresate leziunilor ocluzive cronice infrainghinale își păstrează utilitatea, reprezentând uneori chiar unica opțiune de revascularizare a extremității ischemizate. Scopul studiului a fost evidențierea ratei de aplicare în practica cotidiană a diverselor tehnici chirurgicale deschise de revascularizare în caz de ocluzii arteriale cronice infrainghinale și evaluarea rezultatelor clinice precoce ale acestora. Material și metode: Datele medicale referitoare la un grup constituit din 190 de pacienți revascularizați pentru leziuni aterosclerotice infrainghinale în cadrul Clinicii Chirurgie Generală – Semiologie nr.3, IMSP SCM nr.1 (Chișinău), au fost extrase din registrul electronic și supuse analizei retrospective. Rezultate: Vârsta medie a bolnavilor – 67,3±9,8 ani; bărbați – 83,2%. Repartizarea observațiilor conform gradului de ischemie (clasificarea Fontaine): IIB – 59 (31%), III – 52 (27,3%) și IV – 79 (41,5%). Ultrasonografia duplex/TC-angiografia au pus în evidență localizarea preponderentă a leziunilor ocluzive la nivelul arterei femurale (50%). Sediul ocluziei în 10,5% cazuri a fost artera femurală comună, iar în alte 10% – axul distal (trunchiul tibio-peronier, aa.tibiale). Revascularizarea s-a realizat prin: bypass femuropopliteu (46,4%), -infrapopliteu (13,3%) sau -distal (6,3%); endarterectomie cu angioplastie (18,4%); angioplastie cu petic (10,8%); arterializarea sistemului venos (2,5%) sau protezare arterială (1,9%). Rata amputațiilor secundare realizate în termen precoce (30 zile) de la revascularizare – 3,7%. Concluzii: La momentul adresării pacientului leziunile arteriale cronice ocluzive infrainghinale frecvent au caracter extins. Intervențiile deschise cu utilizarea întregului arsenal de tehnici de revascularizare oferă rezultate precoce acceptabile, în special la pacienții fără comorbidități critice.Introduction: Despite the active implementation of endovascular techniques, open arterial reconstructions for infrainguinal chronic occlusive arterial lesions (ICOAL) retain their usefulness, sometimes representing the sole option for revascularization and salvage of the affected extremity. Aim of study was to evaluate the rate of use in routine clinical practice of various open surgical techniques for revascularization in case of ICOAL and to assess their short-term clinical results. Material and methods: Medical data related to a group of 190 patients revascularized for ICOAL at the Department of General Surgery-Semiotics nr.3, Municipal Clinical Hospital no.1 (Chisinau), were extracted from the electronic registry and subjected to retrospective analysis. Results: The mean age of patients – 67.3±9.8 years; males – 83.2%. Distribution of cases according to the grade of ischemia (Fontaine classification): IIB – 59 (31%), III – 52 (27.3%) and IV – 79 (41.5%). Duplex ultrasound/CT-angiography revealed the predominant localization of ICOAL at the level of femoral artery (50%). The occlusion site in 10.5% cases was the common femoral artery, while in another 10% – the leg arteries (tibioperoneal trunk, tibial arteries). Revascularization was achieved by: femoro-popliteal (46.4%), -infrapopliteal (13.3%) or -distal (6.3%) bypasses; endarterectomy with angioplasty (18.4%); patch angioplasty (10.8%); venous arterialization (2.5%) or graft interposition (1.9%). The rate of secondary amputation within 30 days after revascularization was 3.7%. Conclusion: At the moment of patient presentation ICOAL frequently have extensive character. Open surgical procedures with utilization of all spectrum of techniques of revascularization provide acceptable short-term results, especially in patients without critical comorbidities

Distal bypasses and venous arterialization for lower limb salvage in critical ischemia

Catedra chirurgie generală, USMF „Nicolae Testemiţanu”, Spitalul Clinic Municipal nr.1, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Bypass-urile arteriale cu anastomoza distală la nivelul arterei poplitee infrageniculare, arterelor gambei sau a plantei, precum şi arterializarea venoasă sunt utilizate pentru salvarea extremităţilor. Scopul studiului actual cuprinde evaluarea rezultatelor diferitor reconstrucţii distale pentru ischemia critică. Material şi metode: În perioada 2009-2014 au fost efectuate 64 revascularizări distale. În 20 (31,2%) cazuri drept indicaţie pentru operaţie a fost durerea în repaus, în 36 (56,2%) – necroza tisulară şi în 8 (12,5%) – ischemia acută. Au fost analizate: patenţa primară, patenţa secundară şi rata de salvare a extremităţilor. Resultate: Bărbaţi au fost 79,6%, vîrsta medie în grupul studiat fiind 66,1 ani (diapazon 32-88). Cu excepția a 2 bolnavi cu trombangeită obliterantă, cauza ischemiei a fost ateroscleroza. Şaisprezece bolnavi (25%) au fost diabetici. Bypass-ul spre artera poplitea distală a fost montat în 34 cazuri, spre arterele gambiene – în 15, spre artera tibială posterioară retromaleolară – în 9. Arterializarea venoasă a fost practicată la 6 pacienţi. Mortalitatea postoperatorie a constituit 7,8% (infarctul miocardic – 2 cazuri, ictus – 1, insuficienţa poliorganică – 2). Patenţa primară, patenţa secundară şi rata de salvare a extremităţilor la 30 zile postoperator a constituit 79,6%, 86,4% şi 89,8%, respectiv. Deşi la 2 ani postoperator patenţa bypass-urilor plantare (25%) şi a arterializărilor venoase (0%) a fost mai mică vs a bypass-urilor femuro-popliteale (71,8%) sau tibiale (40%), aceste intervenţii sau soldat cu salvarea extremităţilor în 37,5% şi 33,3% cazuri, respectiv. Concluzii: Rezultatele obţinute demonstrează că bypass-urile distale reprezintă o metodă efectivă de tratament a ischemiei critice. Ocluziile multiple ale arterelor gambiene nu trebuie să fie considerate “a priori” ca o contraindicaţie pentru tentativa de revascularizare.Introduction: Arterial bypasses with distal anastomosis to the popliteal artery below the knee, crural and plantar arteries as well as venous arterializations are used for limb salvage. Aim: Actual study was performed to examine the results of various distal reconstructions in critical ischemia. Material and methods: During 2009-2014, 64 distal revascularizations were performed. Indications for surgery were rest pain in 20 (31.2%) cases, tissue loss – 36 (56.2%), and acute ischemia – 8 (12.5%). Primary and secondary patency and limb salvage rates were analyzed. Results: The 79.6% patients were male, mean age in study cohort was 66.1 years (range 32-88). Atherosclerosis was a cause of ischemia in all patients out of 2 suffering with thrombangiitis obliterans. Sixteen patients (25%) were diabetics. Bypass to distal popliteal artery was constructed in 34 cases, to crural arteries – in 15, to retromaleolar posterior tibial artery – in 9. Venous arterialization was performed in 6 patients. Postoperative mortality was 7.8% (myocardial infarction – 2 cases, stroke – 1, multiorgan failure - 2). Overall postoperative primary patency, secondary patency, and limb salvage rates at 30 days were 79.6%, 86.4%, and 89.8%, respectively. Although 2-years patency rates of plantar bypasses (25%) and venous arterialization (0%) were inferior to those of the femoro-popliteal (71.8%) or crural bypasses (40%), these procedures were limb-salvaging in 37.5% and 33.3% of cases, respectively. Conclusions: These results show that distal bypasses are effective procedures in treatment of critical ischemia. Multiple occlusions of crural arteries should not be considered as an “a priori” contraindication for a revascularization attempt

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The paper presents innovative solutions on the construction si operation of spraying machines in the view of reducing drift in field crops: with innovative electrostatic spraying system, with special panels with static condenser, nozzle protection system, spraying devices provided with hoods, downward air curtain system and with shielded system with caps for controlling drop dispersion. The paper is important, on the one hand, for producers of spraying equipment for reducing drift and, on the other hand, for farmers in the view of efficiently applying treatments in field crops, but also for reducing environmental pollution

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