Deviații axiale ale gambei la copii

Catedra de chirurgie, ortopedie şi anesteziologie pediatrică „Natalia Gheorghiu” Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu” or. Chișinău, Republica 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 dezvoltareActualitatea temei. Deformațiile membrului inferior continuă a fi o mare provocare în practica ortopedică. Deformațiile membrului inferior dețin I loc în deformațiilor scheletului. Din cauza meticulozității părinților, societății, și a individului față de sine, deviațiile axiale ale gambei la copil devine o problema care tot mai mult crește adresabilitate părinților. Sporirea nivelului de informarea și educație printre părinți face ca aceasta patologie (sau o perioada fiziologica de dezvoltare) să fie o cauză frecventă de prezentare la doctor. Această problemă devine diagnosticată tot mai precoce. Orice factori intrinseci ori extrinseci pot avea influență asupra dezvoltarii a membrului inferior a copilului. Din aceasta cauză consultul ortopedului este indispensabil mai ales dacă există o deviere de ax a membrelor inferioare. De asemenea medicul ortoped este competent pentru a diferenția starea patologică de cea fiziologică. Concretizînd că la naștere este un varus fiziologic de 15o asociat cu o torsiune medială a gambei. Treptat pe măsura creșterii, unghiul diafozo-diafizafemuro-tibial ajunge la 0 o la vârsta de 18-24 luni. Apoi unghiul deviază în valgus ajungându-se la +10o la vârsta de 3 ani (la fete) sau 4 ani (la băieți), ulterior valgusul genunchiului evoluează lent, ajungând la +5 o la vârsta de 8 ani. Scopul. Efectuarea unui studiu complex cu referință la etiopatogenia, diagnosticul clinic și imagistic, tratamentul conservator și chirurgical al deviațiilor axiale ale gambei la copii. Materiale și metode. Pe parcursul anilor 2018-2020 în clinica de ortopedie și traumatologie pediatrică a Centrul Național Științific practic de chirurgie pediatrică „Academician Natalia Gheorghiu” au fost tratați chirurgical 33 copii cu deformitate de varus a gambei (41 gambe). Patologia prezentată a fost apreciată la 18 fetițe și 15 băieți. Deformitatea unilaterală s-a constatat la 21 copii, cea bilaterală la 10 copii. Concluzii. 1. La maladia Blount metoda propusă de P.Moroz permite evaluarea gradului schimbărilor primare și secundare, care are o mare importanță în tactica și tehnica tratamentului. 2. Tratamentul chirurgical pentru corecția deformităților displastice este indicat după vârsta de 3 ani. La deformități posttraumatice corecția poate fi efectuată după restabilirea mișcărilor în articulațiile megieșe. Copiii cu consecințele osteomielitei pot fi supuși tratamentului chirurgical după 8-10 luni la lichidarea procesului inflamator. Deformitatea posttumorală se recomandă pentru corecție peste 5 ani după rezecția focarului patologic. 3. Recuperarea cu respectarea strictă a regimului ortopedic are o mare importanță în obținerea rezultatelor bune la distanță, în profilaxia recidivelor, pe tot parcursul perioadei de creștere a copiilor

Abordarea pacienților cu insuficiență mitrală ischemică (IMI)

Background. Mitral regurgitation is the second most common heart valve disease, of which 25% - suffer from IMI, thus being a current problem. Objective of the study. Study of therapeutic and surgical methods of patients with ischemic mitral insufficiency and determination of priority management Material and Methods. We conducted a study during the years 2018-2020, on a group of 56 patients (17 women and 39 men), the average age - 57 years (34-75 years), of which 30.4% had MI, and 23, 2%-VS aneurysm was detected. In 50 patients, v. Mitral annuloplasty (with 3 sutures) + coronary bypass was performed, and 6 needed valve prosthesis and coronary bypass (CABG). Results. The immediately postoperative period characterized by the following morbid features: postoperative hemorrhage 1 patient (1.8%), transient stroke 2 patients (3.6%), paroxysmal rhythm disorders 4 patients (7.1%). Assessment of functional capacity and assessment of symptoms in patients with IMI revealed that the first and essential charges are: palpitations (100%), retrosternal pain (94.6%), dyspnea (91.1%), fatigue (87.5%) , peripheral edema (44.6%). Predominantly, in patients with ischemic mitral regurgitation, the following comorbidities are recorded: coronary artery atherosclerosis (76.8%), diabetes mellitus (66.1%), hypertension (26.8%) and chronic renal failure (23.2%). Conclusion. IMI requires a therapeutic approach according to the national protocol, but the surgical approach remains the "gold standard". Elective are the reconstructive surgical techniques (papillary m. approximation, mitral annuloplasty "3 sutures") which combined with CABG generate valvular restoration. Introducere. Insuficiența mitrală reprezintă a 2-a cea mai întâlnită maladie valvulară cardiacă, dintre care 25% - suferă de IMI, astfel constituind o problemă actuală. Scopul lucrării. Studierea metodelor terapeutice și chirurgicale ale pacienților cu insuficiență mitrală ischemică și determinarea managementului prioritar. Material și Metode. Am realizat un studiu pe parcursul anilor 2018-2020, pe un lot de 56 de pacienți (17 femei și 39 bărbați), vârsta medie – 57 de ani (34-75 ani), dintre care 30,4% au suportat IM, iar la 23,2% s-a depistat anevrism al VS. La 50 de pacienți a fost realizată anuloplastia v. mitrale (cu 3 suturi)+ by-pass coronarian, iar 6 au avut nevoie de protezare valvulară și by-pass coronarian (CABG). Rezultate. Perioada imediat postoperatorie a fost caracterizată prin următoarele particularități morbide: hemoragie postoperatorie 1 pacient (1,8%), AVC tranzitor 2 pacienți (3,6%), dereglări paroxistice de ritm 4 pacienți (7,1%). Evaluarea capacității funcționale și aprecierea simptomatologiei la pacienții cu IMI a relevat faptul că primele și esențialele acuze sunt: palpitații (100%), dureri retrosternale (94,6%), dispnee (91,1%), fatigabilitate (87,5%), edeme periferice (44,6%). Predominant, la pacienții cu IMI, se înregistrează următoarele comorbidități: ateroscleroza a. coronare (76,8%), diabet zaharat (66,1%), hipertensiune arterială (26,8%) și insuficiență renală cronică (23,2%). Concluzii. În IMI se necesită o abordare terapeutică conform protocolului național, însă abordarea chirurgicală rămâne „standardul de aur”. De elecție sunt tehnicile chirurgicale reconstructive (aproximarea m. papilari, anuloplastia mitrală „3 suturi”) care, combinate cu CABG, generează restabilirea valvulară

Abordarea pacienților cu insuficiență mitrală ischemică (IMI)

Spitalul Internațional Medpark, State University of Medicine and Pharmacy "Nicolae Testemiteanu" Chișinău, 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 dezvoltareIntroducere: Insuficiența mitrală reprezintă a 2-a cea mai întâlnită maladie valvulară cardiacă, dintre care 25% - suferă de IMI, astfel constituind o problemă actuală. Scopul lucrării: Studierea metodelor terapeutice și chirurgicale ale pacienților cu insuficiență mitrală ischemică și determinarea managementului prioritar. Material și Metode: La 50 de pacienți a fost realizată anuloplastia v. mitrale (cu 3 suturi ) + by-pass coronarian (fig. 1), iar la 6protezare valvulară și by-pass coronarian (CABG) (fig. 2). Rezultate: Perioada imediat postoperatorie caracterizată prin următoarele particularități morbide: hemoragie postoperatorie 1 pacient (1,8%), AVC tranzitor 2 pacienți (3,6%), dereglări paroxistice de ritm 4 pacienți (7,1%). Concluzii: În IMI se necesită o abordare terapeutică conform protocolului national, însă abordarea chirurgicală rămîne ”standardul de aur”. De elecție sunt tehnicile chirurgicale reconstructive(aproximarea m. papilari, anuloplastia mitrală ”3 suturi”) care combinate cu CABG generează restabilirea valvulară

Multimodal treatment for local recurrent malignant gliomas: resurgery and/or reirradiation followed by chemotherapy

The therapeutic management of recurrent malignant gliomas (MGs) is not determined. Therefore, the efficacy of a multimodal approach and a combination systemic therapy was investigated. A retrospective analysis of 26 MGs patients at first relapse treated with multimodal therapy (chemotherapy plus surgery and/or reirradiation) or chemotherapy alone was performed. Second-line chemotherapy consisted of fotemustine (FTM) in combination with bevacizumab (BEV) (cFTM/BEV) or followed by third-line BEV (sFTM/BEV). Subgroup analyses were performed. Multimodal therapy provided a higher overall response rate (ORR) (73 vs. 47%), disease control rate (DCR) (82 vs. 67%), median progression-free survival (mPFS) (11 vs. 7 months; P=0.08) and median overall survival (mOS) (13 vs. 8 months; P=0.04) compared with chemotherapy. Concomitant FTM/BEV resulted in higher ORR (84 vs. 36%), DCR (92 vs. 57%), mPFS (10 vs. 5 months; P=0.22) and mOS (11 vs. 5.2 months; P=0.15) compared with sFTM/BEV. Methylated patients did not experience additional survival benefits with multimodality treatment but had higher mPFS (10 vs 7.1 months; P=0.33) and mOS (11 vs. 8 months; P=0.33) with cFTM/BEV. Unmethylated patients experienced the greatest survival benefit with the multimodal approach (mPFS: 10 vs. 5 months; mOS 11 vs 6 months; both P=0.02) and cFTM/BEV (mPFS: 5 vs. 2 months; mOS 6 vs. 3.2 months; both P=0.01). In conclusion, in recurrent MGs, multimodal therapy and cFTM/BEV provide survival and response benefits. Methylated patients benefit from a cFTM/BEV but not from a multimodal approach. Notably, unmethylated patients had the highest survival benefit with the two strategies

Fears and perception of the impact of COVID-19 on patients with lung cancer. A mono-institutional survey

In February 2020, Italy became one of the first countries to be plagued by the SARS-CoV-2 pandemic, COVID-19. In March 2020, the Italian government decreed a lockdown for the whole country, which overturned communication systems, hospital organization, and access to patients and their relatives and carers. This issue had a particular regard for cancer patients. Our Thoracic Oncology Division therefore reorganized patient access in order to reduce the risk of contagion and, at the same time, encourage the continuation of treatment. Our staff contacted all patients to inform them of any changes in treatment planning, check that they were taking safety measures, and ascertain their feelings and whether they had any COVID-19 symptoms. To better understand patients’ fears and expectations of during the pandemic period, we created a nine-question interview, administered from April to May 2020 to 156 patients with lung cancer. Patients were classified by age, sex, comorbidity, disease stage, prior treatment, and treatment type. The survey showed that during the pandemic period some patients experienced fear of COVID-19, in particular: women (55% vs. 33%), patients with comorbidities (24% vs. 9%), and patients who had already received prior insult (radiotherapy or surgery) on the lung (30% vs. 11%). In addition, the patients who received oral treatment at home or for whom intravenous treatment was delayed, experienced a sense of relief (90% and 72% respectively). However, only 21% of the patients were more afraid of COVID-19 than of their cancer, in particular patients with long-term (> 12 months) vs. short-term cancer diagnosis (28% vs. 12.5%, respectively). Furthermore, the quarantine period or even just the lockdown period alone, worsened the quality of life of some patients (40%), especially those in oral treatment (47%). Our data demonstrate how lung cancer patients are more afraid of their disease than of a world pandemic. Also this interview indirectly highlights the clinician’s major guiding principle in correctly and appropriately managing not just the patient’s expectations of their illness and its treatment, but also and especially of the patient’s fears

Predictive Role of Serum Thyroglobulin after Surgery and before Radioactive Iodine Therapy in Patients with Thyroid Carcinoma

Introduction: Thyroidectomy followed by radioactive iodine therapy (RAI) is the treatment of choice for differentiated thyroid carcinoma (DTC). Serum thyroglobulin (Tg) measurement has proved to be useful for predicting persistent and/or recurrent disease during follow-up of DTC patients. In our study, we evaluated the risk of disease recurrence in patients with papillary thyroid carcinoma (PTC), who were treated with thyroidectomy and RAI, by measuring serum Tg at different time-points: at least 40 days after surgery, in euthyroidism with TSH < 1.5 and usually 30 days before RAI (Tg−30), on the day of RAI (Tg0), and seven days after RAI (Tg+7). Methods: One hundred and twenty-nine patients with PTC were enrolled in this retrospective study. All patients were treated with 131I for thyroid remnant ablation. Disease relapse (nodal disease or distant disease) during at least 36 months follow-up was evaluated by serum measurements of Tg, TSH, AbTg at different time points and by imaging techniques (neck ultrasonography, 131I-whole body scan (WBS) after Thyrogen® stimulation). Typically, patients were assessed at 3, 6, 12, 18, 24, and 36 months after RAI. We classified patients in five groups: (i) those who developed nodal disease (ND), (ii) those who developed distant disease (DD), (iii) those with biochemical indeterminate response and minimal residual thyroid tissue (R), (iv) those with no evidence of structural or biochemical disease + intermediate ATA risk (NED-I), and (v) those with no evidence of structural or biochemical disease + low ATA risk (NED-L). ROC curves for Tg were generated to find potential discriminating cutoffs of Tg values in all patients’ groups. Results: A total of 15 out of 129 patients (11.63%) developed nodal disease and 5 (3.88%) distant metastases, during the follow-up. We found that Tg−30 (with suppressed TSH) has the same sensitivity and specificity than Tg0 (with stimulated TSH), and it is slightly better than Tg+7, which can be influenced by the size of the residual thyroid tissue. Conclusion: Serum Tg−30 value, measured in euthyroidism 30 days before RAI, is a reliable prognostic factor to predict future nodal or distant disease, thus allowing to plan the most appropriate therapy and follow-up

Factors influencing choice of chemotherapy in metastatic colorectal cancer (mCRC)

Management of metastatic colorectal cancer requires a multimodal approach and must be performed by an experienced, multidisciplinary expert team. The optimal choice of the individual treatment modality, according to disease localization and extent, tumor biology, and patient clinical characteristics, will be one that can maintain quality of life and long-term survival, and even cure selected patients. This review is an overview of the different therapeutic approaches available in metastatic colorectal cancer, for the purpose of defining personalized therapeutic algorithms according to tumor biology and patient clinical features

Correlation among different KRAS alterations, genetic co-mutations and PD-L1 expression in patients treated with immunotherapy in metastatic NSCLC

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Early Progression in Non-Small Cell Lung Cancer (NSCLC) with High PD-L1 Treated with Pembrolizumab in First-Line Setting: A Prognostic Scoring System Based on Clinical Features

Background: Pembrolizumab is approved in monotherapy for the first-line (1L) of advanced or metastatic NSCLC patients with high PD-L1 (≥50%). Despite a proportion of patients achieve long-term survival, about one-third of patients experience detrimental survival outcomes, including early death, hyperprogression, and fast progression. The impact of clinical factors on early progression (EP) development has not been widely explored. Methods: We designed a retrospective, multicenter study involving five Italian centers, in patients with metastatic NSCLC with PD-L1 ≥ 50%, treated with Pembrolizumab in a 1L setting. EP was defined as a progressive disease within three months from pembrolizumab initiation. Baseline clinical factors of patients with and without EP were collected and analyzed. Logistic regression was performed to identify clinical factors associated with EP and an EP prognostic score was developed based on the logistic model. Results: Overall, 321 out of 336 NSCLC patients treated with 1L pembrolizumab provided all the data for the analysis. EP occurred in 137 (42.7%) patients; the median PFS was 3.8 months (95% CI: 2.9–4.7), and median OS was not reached in the entire study population. Sex, Eastern Cooperative Oncology Group (ECOG) performance status (PS), steroids, metastatic sites ≥2, and the presence of liver/pleural metastasis were confirmed as independent factors for EP by multivariate analysis. By combining these factors, we developed an EP prognostic score ranging from 0–13, with three-risk group stratification: 0–2 (good prognosis), 3–6 (intermediate prognosis), and 7–13 (poor prognosis). The area under the curve (AUC) of the model was 0.76 (95% CI: 0.70–0.81). Conclusions: We identified six clinical factors independently associated with EP. We developed a prognostic score model for EP-risk to potentially improve clinical practice and patient selection for 1L pembrolizumab in NSCLC with high PD-L1, in the real-world clinical setting