The role of inner border sign and ridge sign in detecting high-grade cervical intraepithelial neoplasia

Background: The objectives of the study were to evaluate the role of two pathognomonic colposcopic signs (inner border sign and ridge sign) in detecting high-grade cervical lesions.Methods: A total of 122 patients with abnormal Pap smear who had colposcopy and biopsy or loop electrosurgical excision procedure were included. The correlations between the two signs pathognomonic signs (inner border, ridge sign) and pathological results were established. We also compared the two signs with Reid colposcopic index (RCI) in detecting high-grade cervical lesions.Results: Both pathognomonic signs proved to have a good accuracy in detecting high-grade lesions of the cervix. The sensitivity, specificity, PPV and NPV for the inner border sign and ridge sign were: 15%, 98%, 92%, 44%, respectively, and 30%, 94%, 88%, 47%, respectively. RCI has a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for predicting high-grade cervical intraepithelial lesions as follows: 86.3%, 83.6%, 88.7%, and 80.3%, respectively. The simultaneous presence of both signs increased the specificity and PPV to 100%, while sensitivity and NPV were 4% and 55%.Conclusions: Pathognomonic signs - inner sign and ridge sign- have a good specificity in predicting high-grade cervical intraepithelial lesions, but they are present in only 9.8%, respectively 20.5% of cases with high-grade cervical intraepithelial lesions

Дисфункция печени у пациентов с тетрадой Фалло после хирургической коррекции

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, Spitalul Clinic Republican, Conferința naţională de gastroenterologie şi hepatologie cu participare internaţională ”Actualităţi în gastroenterologie şi hepatologie” 16 iunie 2016 Chișinău, Republica MoldovaA reduction in liver function is common after cardiac operations, particularly in children with preexisting cardiac failure. The etiology is multifactorial, but the redistribution of organ blood flow that occurs during cardiopulmonary bypass implicates ischemia as one of the principal causes of injury. Tetralogy of Fallot is the most common cyanotic congenital heart disease, with an incidence of three per 10,000 live births, and represents about 5-7% of all congenital heart disease [4]. Objective: incidence of development, identifying trigger factors and characteristic of hepatic dysfunction in patients undergoing surgical correction of TF in conditions of extracorporeal circulation. Subjects and methods. Retrospectively we reviewed all patients who have undergone surgical correction TOF at our institution from June 2010 to December 2015. Were analyzed demographic and morphological data during preoperative, intraoperative and postoperative periods. Liver dysfunction criteria were considered total bilirubinemia level ≥ 25 micromol/L, prothrombin index ≤80% and ALT levels ≥ 40 IU/l. Results. During the study were subjected to surgical correction 45 patients diagnosed with TOF. The average age of the group was 38.2±5.3 months, average weight 13.4±1.7 kg. The duration of extracorporeal circulation was 142.6±13.02 minutes. Hypoprothrombinemia was detected in 41 (91.1%), hyperbilirubinemia 21 (46.6%) and transaminasemia 24 (53.3%) patients. Conclusion: hepatic dysfunction is frequently encountered in patients undergoing extracorporeal circulation, the main factors are increased during surgery, ino-vasotrop support in the perioperative period.Снижение функции печени частое явление после сердечно-сосудистой хирургии, особенно у детей с ранее существовавшей сердечной недостаточностью. Этиология дисфункций многофакторно, но перераспределение кровотока в органах во время искусственного кровообращения остается одной из основных ее причин. Тетрада Фалло является наиболее распространенным синюшным врожденным пороком сердца, с частотой три на 10000 родившихся живыми, и составляет около 5-7% от всех врожденных пороков сердца. Цель: частота развития и признаки нарушения функции печени у пациентов, подвергающихся хирургической коррекции тетрады Фалло с искусственным кровообращением. Выявление предикторных факторов в возникновении дисфункции печени. Материалы и методы: ретроспективный обзор всех пациентов, которые подверглись хирургической коррекции ТФ в нашем учреждении с июня 2010 года по декабрь 2015 года. Были проанализированы демографические и морфологические данные во время предоперационного, интраоперационного и в послеоперационного периодах. В качестве критерия дисфункции печени рассматривались общий уровень билирубина ≥ 25 мкмоль/л, протромбиновый индекс ≤80% и АЛТ уровенъ ≥ 40 МЕ/л. Результаты. В ходе исследования подверглись хирургической коррекции 45 больных с диагнозом ТФ. Средний возраст группы составил 38,2±5,3 мес., средний вес – 13,4±1,7 кг. Продолжительность искусственного кровообращения была 142,6±13,02 минуты. Гипопротромбинемия была обнаружена у 41 (91,1%) больных, гипербилирубинемия – у 21 (46,6%), высокий трансаминаз – у 24 (53,3%) пациентов. Вывод: печеночная дисфункция часто встречается у пациентов, перенесших искусственное кровообращение. Основными факторами развития явлаются продолжительное время операции, необходнимостъ использования вазоактивных препаратов в периоперационном периоде

Analgezia epidurală postoperatorie prelungită potenţiată cu raviten la pacienţii supuşi intervenţiei chirurgicale pe motiv de cancer al vezicii urinare

În anestezia peridurală, adiţionarea Ravitenului la anestezicul local creează posibilităţi de micşorare a dozelor de anestezic introdus în spaţiul epidural şi a volumului de infuzii necesare . Astfel, schema folosită de noi (Lidocain Raviten) poate fi caracterizată ca o metodă analgezică foarte efectivă, sigură şi puţin toxică. Efectul clinic constă în prevenirea progresării sindromului algic şi a intensităţii acestuia. Iată de ce, această metodă de analgezie merită implementarea în practică la pacientii operaţi pe motiv de cancer al vezicii urinare

Sindromul hepato-renal (Caz clinic)

Sindromul hepatorenal (HRS) este o complicaţie comună de ciroză avansată, caracterizată prin insufi cienţă renală şi tulburări majore în funcţia circulatorie. Transplantul hepatic este cea mai bună opţiune la pacienţii fără contraindicaţii la procedură, dar nu este întotdeauna posibilă datorită speranţei de supravieţuire scurtă. Terapiile introduse în ultimii ani, cum ar fi drogurile vasoconstrictoare (analogi de vasopresină, agonişti α-adrenergici) sau şunt transjugular intrahepatic portosistemic, sunt efi ciente în îmbunătăţirea funcţiei renale

Managementul anestezic şi reanimatologic perioperator al bolnavilor cu transplant hepatic

În Republica Moldova, pe parcursul anilor 2013–2014 au fost efectuate 6 intervenţii chirurgicale de transplant hepatic ortotopic de la donatori vii/moarte cerebrală, cu suportul metodologic şi participarea anesteziştilor de la Institutul Clinic Fundeni, Bucureşti. Evoluţia perianestezică la donatori: (persoane sănătoase) fără particularităţi; transferaţi în secţia de profi l a 4-a zi postoperator. Toţi recipienţii sunt suferinzi de ciroză hepatică, etiologie virală – HBV sau/şi HCV; un recipient – ciroză biliară. Scorul Child-Pugh – un pacient A, doi pacienţi – B, trei pacienţi – C. La toţi a fost stabilit hipertensiunea portală gr. IIB, hipersplenism gr. II, ascită. Investigaţiile şi monitorizarea perianestetică conform standardelor adoptate în centrele de transplant hepatic. Anestezia la donatori şi recipienţi: Midazolam, Propofol, Fentanil, Tracrium, Sevofl uran. Evoluţia fazelor preanhepatică şi anhepatică fără particularităţi la cinci recipienţi, o pacientă a dezvoltat şoc hemoragic grav. În faza neohepatică, la cinci pacienţi s-a înregistrat depresie hemodinamică relativă (hipotensiune, bradicardie), iar o pacientă – 2 pusee de fi brilaţie atrială, ambele corijate farmacologic. Pierderile sanguine intraoperatorii au variat, în medie constituind 5500 ml. În postoperator, la un recipient s-a depistat revărsat pleural minor pe dreapta, rezolvat conservativ. O pacientă a prezentat convulsii – reacţie adversă la Tacrolimus (s-a micşorat doza administrată), ulterior la această pacientă au apărut semne de rejet acut de organ, contracarat prin majorarea dozei de imunosupresor. La alt pacient s-a înregistrat sindrom febril persistent care a necesitat revizuirea antibioterapiei. Un pacient dezvoltă insufi cienţă renală acută. Pacienţii în stare satisfăcătoare au fost externaţi la domiciliu, cu exepţia unui recipient, care a decedat în urma instalării s-au MODS

Epidural anesthesia in thrombocytopenic pregnant: prost and cons? (Review of the literature)

Catedra Anesteziologie şi Reanimatologie nr. 1 “Valeriu Ghereg” Catedra Anesteziologie şi reanimatologie nr. 2 , FPMRegional anesthesia is a popular form of pain relief for the management of labor and delivery. Thrombocytopenia is considered a relative contraindication to the administration of regional anesthesia. Some authorities have recommended that an epidural anesthetic be withheld if the platelet count is <l00.000 mm³. We presented a review of the literature concerning the problem of regional anesthesia in thrombocytopenic parturient. There were analyzed eight large retrospective studies which included almost three hundred parturiente with thrombocytopenia and regional anesthesia performed, among them about 70 patient had platelet count <l00.000 mm³. No neurological complications were documented. Were registered two cases of hemorrhagic complications in patients with preexisting conditions (LES with hypertension and ependymoma). Anestezia peridurală la pacientele cu trombocitopenie este o contraindicaţie din cauza riscului de dezvoltare a complicaţiilor hemoragice (hematom epi sau subdural). Problema data este controversată şi larg discutată în literatura de specialitate. Au fost studiate şi analizate datele literaturii moderne în vederea elucidării parerilor referitor la utilizarea tehnicii de A.E. la gravide cu trombocitopenie, bazele de date Medline si PubMed pe perioada anilor 1980-2009 Au fost găsite si analizate articole ce relatează rezultatele a 8 studii mari referitor la efectuarea A.E. la gravidele cu trombocitopenie, la 321 de parturiente s-a efectuat bloc epidural. Din acestea apr 70 de parturiente au avut numărul de trombocite mai mic de 100.000 mm³,fară complicaţii neurologice. Din toată literatura au fost relatate 2 cazuri cu complicaţii hemoragice (o pacientă avea hipertensiune gestaţională şi LES , altă pacientă avea ependimomă) conform studiilor lui Beilini rata complicaţiilor nu depăşeşte 1,8%. Problema rămîne controversată, necesită studii largi, randomizate, prospective cu urmărirea în dinamică a pacientelor

Green's function of a finite chain and the discrete Fourier transform

A new expression for the Green's function of a finite one-dimensional lattice with nearest neighbor interaction is derived via discrete Fourier transform. Solution of the Heisenberg spin chain with periodic and open boundary conditions is considered as an example. Comparison to Bethe ansatz clarifies the relation between the two approaches.Comment: preprint of the paper published in Int. J. Modern Physics B Vol. 20, No. 5 (2006) 593-60

Патофизиология синдрома MODS после трансплантации печени

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, IMSP Spitalul Clinic Republican, Conferința naţională de gastroenterologie şi hepatologie cu participare internaţională ”Actualităţi în gastroenterologie şi hepatologie” 16 iunie 2016 Chișinău, Republica MoldovaMODS (multiple organ dysfunction syndrome) can develop in the postoperative period in patients with liver transplantation and drastically reduces the survival rate of recipients. Triggers involved in the occurrence of MODS (sepsis, shock of various etiologies, extracorporeal circulation, multiply transfused, large surgery, etc.) elicits a humoral and cell reply from the body. The clinical consequence of this humoral and cellular answer is a continuous process, constantly changing, including SIRS, CARS and MARS, which endangers the patient’s life. During the years 2013–2016 in Moldova were performed 19 surgeries for liver transplantation, which were included in the study, divided into two groups: the fi rst group – 7 patients who met criteria MODS, lot 2 – 12 without MODS criteria. Among the primary pathological aggression that could cause severe development in MODS were recorded: a) the preoperative porto-pulmonary syndrome in 2 patients, CID syndrome – 3 patients, cholestatic syndrome and severe hepatodepressive – 7 patients; b) intraoperative – massive haemorrhage in one patient; c) postoperative – massive hemorrhage 4, relaparatomie – 2, CID syndrome – 4, acute rejection – three recipient. In conclusion, the survival of recipients is largely influenced by the development of MODS syndrome in the postoperative period of liver transplantation.Синдром MODS, который может развиваться в послеоперационном периоде у больных с трансплантацией печени, является опасным осложнением, потому что резко может снижать выживаемость реципиентов. Триггеры возникновения MODS (сепсис, шок различной этиологии, искусственное кровообращение, многократные переливания, большая хирургия и т.д.) вызывают гуморальный и клеточный ответ организма. Этот гуморальный и клеточный ответ образуют непрерывный процесс, постоянно меняющийся, в том числе СИРС, КАРС и МАРС, которые ставят под угрозу жизнь пациента. За 2013-2016 годы в Молдове были проведены 19 операций по пересадке печени, которые были включены в исследование и разделены на две группы: первая группа – 7 больных, которые соответствовали критериям MODS, вторая группа – 12 пациентов без критериев MODS. Среди первичных патологических агрессий, которые могут привести к серьезному развитию MODS, были записаны: а) предоперационное – порто-легочный синдром у 2 больных, синдром ДВС – 3 пациента, холестатический синдром – 7; b) интраоперационной – массивное кровоизлияние у одного пациента; c) послеоперационной – массивное 1086кровоизлияние – 4, реоперация – 2, синдром ДВС – 4, острое отторжение – у трех реципиента. В заключение отметим, что выживание получателей во многом зависит от развития синдрома MODS в послеоперационном периоде после трансплантации печени

Multilayered Knowledge Base for Triage Task in Mass Casualty Situations

Use of portable ultrasound becomes common practice in mass casualty situations. The obtained information helps emergency crews to make decisions regarding on-site triage, helping in determination of adequate diagnostics in proper time for saving lives of patients. In this article a design of multilayered knowledge base in domain of the abdominal region ultrasound examination for the case of mass casualty situations is described. Layers 1-2 correspond to casualty's severity state, and layer 3 -- to pathologies when the free fluid is present in the abdominal cavity, that is not the consequence of an abdominal injury