Surgical treatment of abdominal aortic aneurisms

Secția Chirurgie Vasculară IMSP SCR, 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 2011În secția chirurgie vasculară a IMSP SCR, pe parcursul anilor 1988-2010 au fost operați 224 pacienți cu anevrisme ale aortei abdominale. SCa criteriu diagnostic pentru anevrism s-a considerat dilatarea aortei abdominale cu două diametre şi mai mult. Vârsta pacienților a fost cuprinsă între 15 şi 89 ani. Din totalul de pacienți 79,5%(178) au fost bărbați şi 20,5%(46) femei. La 18,75%(42) pacienți anevrismele au fost complicate prin ruptură completă sau incompletă, fiind operați în regim de urgență imediată. Etiologia a fost: ateroscleroza - 94,65% (212), aortoarteriita nespecifică - 3,57% (8), sindromul Marfan - 1,78% (4). Diagnosticul a fost stabilit clinic, ultrasonografic, prin Duplex vascular, angio-CT, aortografie, RMN. În 3 cazuri (1,34%) anevrismul implica şi arterele renale. Doi pacienți, neincluşi în studiu, au decedat preoperator prin hemoragie masivă cauzată de ruptura spontană a anevrismului în duoden şi cavitatea abdominală liberă. Toți pacienții au fost supuşi rezecției anevrismului aortal cu protezare aorto-distală (aortală, biiliacă, ilio-femurală, bifemurală), iar în 3 cazuri cu replantarea arterelor renale şi viscerale. Mortalitatea în anevrismele rupte a fost 57% (24), iar în cele complicate - 8% (18). Concluzii: pe parcursul ultimilor 5 ani a crescut ponderea pacienților cu anevrisme simptomatice sau deja complicate prin ruptură, astfel că toți pacienții cu factori de risc trecuți de 50 ani trebuie supuşi screening-ului prin USG sau Dopplerografie. Mortalitatea postoperatorie în anevrismele rupte s-a micşorat cu 13 %, iar în cele operate programat cu 7,55%. Implimentarea metodei endovasculare ar permite reducerea substanțială a acestui indice, mai ales în cazul anevrismelor complicate prin ruptură.During the period of 1988 - 2010, 224 patients underwent surgery for abdominal aortic aneurisms. The main diagnostic criteria was dilatation of the abdominal aorta by two diameters and more. All patients were aged between 15 and 89. Of all patients 79,5% (178) were males and 20,5% (46) were female. In 18,75% (42) cases, a complete or incomplete rupture of the aneurisms occurred. These patients underwent urgent surgery. Etiology: atherosclerosis – 94,65% (212), nonspecific aortoarteritis – 3,57% (8), Marfan syndrome – 1,78% (4). The diagnosis was made by clinical findings, vascular Duplex scanning, angio-CT and MRI. In 3(1,34%) cases the aneurism involved the renal arteries. There were two lethal outcomes, one caused by spontaneous rupture of the aneurism in the duodenum and the second caused by rupture into the peritoneal cavity. These cases were not included in the study. All patients underwent aneurism resection with aortal –distal (aortic, biiliac, ilio-femural, bifemural) allografting, while in three cases reimplantation of the renal arteries was necessary. The mortality in cases of ruptured aneurisms consisted 57% (24), and in cases of uncomplicated aneurisms – 8% (18).Conclusions: During the last 5 years we observed a raise in the rate of symptomatic aneurisms, including those complicated with rupture. Aortic ultrasonography or dopplerography should be used as screening methods in all patients, with risk factors, that are aged 50 and more. Postoperative mortality in cases of ruptured aneurisms has decreased by 13%, while in cases of planned aneurism surgery by 7,55%. Implementation of endovascular techniques would reduce substantially these indices

Перекисное окисление липидов и ферментные антиоксиданты при неспецифическом язвенном колите

Increased oxidative stress has been previously demonstrated in patients with inflammatory bowel disease. But this phenomenon has not been analyzed in the course of ulcerative colitis (UC). In this study we evaluated levels of malondialdehyde (the main product of lipid peroxidation), superoxide dismutase and catalase erythrocyte activities in 62 patients with active UC, in 22 patients after achievement of complete, endoscopic remission and in 52 control subjects. Significant increase of malondialdehyde in patients with active disease in comparison with control subjects, demonstrated in this study, suggests the presence of enhanced oxidative stress in active UC. Activation of enzymatic antioxidant system is characteristic of active UC, which is confirmed by an increase in superoxide dismutase and catalase erythrocyte activities in patients with active disease in comparison with control group. There is no significant difference in malondialdehyde and catalase erythrocyte activity between patients in remission of UC and the control subjects. The increase of conditional adaptive index in patients with active UC confirms large adaptive possibilities of enzymatic antioxidant system. The normal levels of malondialdehyde and catalase can be proposed as markers of complete disease remission in UC.В ряде научных исследований доказано наличие оксидативного стресса при неспецифическом язвенном колите (НЯК). Однако, этот феномен не был изучен в динамике заболевания. В настоящей работе оцениваются уровни малонового диальдегида (основного продукта перекисного окисления липидов), супероксиддисмутазной и каталазной активности эритроцитов у 62-х больных в период обострения НЯК, у 22-х больных после достижения полной, эндоскопической ремиссии и у 52-х человек из группы контроля. Существенное увеличение концентрации малонового диальдегида у пациентов в период обострения заболевания по сравнению с контрольной группой, выявленное в данном исследовании, указывает на наличие выраженного оксидативного стресса при активном НЯК. Для обострения НЯК характерна активация ферментной антиоксидантной системы, что подтверждается значительным увеличением супероксиддисмутазной и каталазной активности эритроцитов у пациентов с активными формами заболевания по сравнению с контрольной группой. Статистически значимых различий уровней малонового диальдегида и каталазной активности не было выявлено между группой контроля и пациентами в период ремиссии. В период обострения заболевания установлено увеличение условного адаптационного индекса, что свидетельствует о широких адаптивных возможностях ферментной антиоксидантной системы. Нормальные уровни малонового диальдегида и каталазы могут быть рекомендованы как маркеры полной ремиссии заболевания при НЯК

Optimizing surgical techniques in extra-anatomical ilio-femoral bypasses

Scopul lucrării. Bypass-ul extraanatomic ilio-femural crossover este o procedura chirurgicala utilizată pentru revascularizarea segmentului aorto-femural, când intervențiile endovasculare nu sunt posibile, iar aplicarea unui bypass aorto sau ilio-femural este dificilă sau chiar imposibilă din cauza condițiilor tehnice sau a stării pacientului. Scopul este studierea rezultatelor precoce și tardive pentru favorizarea unor schimbări și implementarea unor gesturi tehnice în aplicarea bypass-urilor crossover ilio-femural, pentru a crea o geometrie cât mai fiziologică ce poate oferi o soluție durabilă pe termen lung. Materiale și metode. Pe parcursul anilor 2001-2022 au fost efectuate 142 bypass-uri crossover ilio-femurale. Rezultate. În perioada postoperatorie a fost un singur deces și s-au efectuat 3 amputații. Au fost analizate duplex scanările și CT angiografiile în primele 12 luni postoperatorii, pentru aprecierea altor leziuni aterosclerotice, care ar necesita revascularizare deschisă s-au endovasculară atît in bazinul recipient cât și cel donator. Totodată, a fost apreciata poziția și forma bypass-ului ce a dus la folosirea ulterioară a unor noi procedee tehnice ce diferă de cele descrise anterior. Concluzii. Optimizarea tehnicilor chirurgicale creând o geometrie cât mai fiziologică, excluderea maximală a angulărilor stenozante ale grefei poate oferi bypass-ului extraanatomic crossover ilio-femural o durabilitate îndelungată. Acest lucru poate favoriza creșterea frecvenței indicațiilor la folosirea bypass-urilor crossover ilio-femural.Aim of study. The extra-anatomic ilio-femoral crossover bypass is a surgical procedure used for revascularizing the aorto-femoral segment when endovascular interventions are not possible, and when applying an aorto- or ilio-femoral bypass is difficult or even impossible due to technical conditions or the patient's condition. The aim was to study the early and late outcomes to promote changes and implement technical gestures in the application of ilio-femoral crossover bypasses, aiming to create a more physiological geometry that can provide a durable long-term solution. Materials and methods. Between 2001 and 2022, a total of 142 ilio-femoral crossover bypasses were performed. Results. There was one death and three amputations in the postoperative period. Duplex scans and CT angiography were analyzed in the first 12 months postoperatively to assess other atherosclerotic lesions that would require open or endovascular revascularization in both the recipient and donor areas. Additionally, the position and shape of the bypass were evaluated, leading to the subsequent use of new technical procedures that differ from those previously described. Conclusions. Optimizing surgical techniques by creating a more physiological geometry and minimizing stenotic angles of the graft can provide the extra-anatomic ilio-femoral crossover bypass with long-lasting durability. This may increase the frequency of indications for using ilio-femoral crossover bypasses

ÇOCUKLARIN RESİMLERİNDEKİ AİLEYİ TANILAMA DURUMLARININ DEĞERLENDİRİLMESİ

Çocuklar resim yoluyla bize duygularınıyansıtabilirler ve olaylar hakkındaki his ve düşüncelerini ifade edebilirler. Çocuğun yaptığıresimler onun iç dünyasının aynasıolarak kabul edilmektedir. Bu düşüncelerden yola çıkarak çocuk resmi konusunda pek çok araştırma yapılmıştır. Bu çalışmada; çocuk resminde aile kavramıdeğerlendirilmeye çalışılmıştır. Çalışmaya Türkiye’den Konya İli Meram ve Selçuklu İlçelerinden ilköğretim okullarına devam eden 8-14 yaşarası66 öğrenci ve Almanya’nın Berlin Şehrinde 8-14 yaşarası58 öğrenci olmak üzere toplam 124 öğrenci alınmıştır. Öğrencilere zihinsel boyutu değerlendirmek amacıile Goodenough Harris Adam Çizme Testi uygulanmıştır. Ayrıca öğrencilerden aile kavramınıdeğerlendirmek amacıile birer aile resmi çizmeleri istenmiştir. Çalışmanın sonucunda her iki ülkede yaşayan çocukların cinsiyetine göre resim çizme ve aileyi tanıma durumlarıarasında kızların erkeklerden daha başarılıolduklarıve yaşilerledikçe aileyi tanıma düzeyinin yükseldiği gözlenmiştir. Ayrıca kardeşsayısına göre aileyi tanıma puanlarıfarklılaşmaktadır, okul başarısıyüksek olan öğrencilerin goodenhough harris testinden aldılarıpuan daha yüksek bulunmuştur

The importance of the principles of good laboratory practice in quality assurance of preclinical studies

Scientific Center of Drug Research, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: The institution, which studies the safety of chemicals, biotechnological substances and nanotechnology products, should conduct researches in accordance with the principles and rules of GLP (Good Laboratory Practice). This standard establishes principles of good laboratory practice for application in non-clinical studies of substances contained in the medicines, pesticides, cosmetic products, veterinary drugs, food and feed additives, and industrial chemicals. GLP rules is a concept of research management, including the organization, preparation and conduct of the study, activity monitoring, obtaining and documenting data, concluding the report. Compliance with GLP principles in the conduct of studies is a mandatory requirement imposed by national regulatory agencies to determine the safety of chemical compounds and other substances related to the protection of human health and the environment. The issue of quality assurance of drug substances is particularly relevant during the authorization process of drugs. Application of standards is an important issue not only in the production of drug substances, but also in preclinical research and clinical studies. Application of GLP rules in research institution is guaranteed by a center quality assurance program, as well as by the institution’s management control and independent audit. Conclusions: GLP implementation in biomedical research centers of the university in the country will lead to proper management of preclinical laboratories and therefore will increase the credibility of scientific results at international level

Review of experience of family medicine in Europe and Central Asia : Executive summary

This report summarizes the findings of four case studies that review the experience of family medicine in Europe and Central Asia (ECA) Region. It is part of a study comprising five volumes that review the experience of family medicine in four countries in ECA--Armenia, Bosnia and Herzegovina, Kyrgyz Republic and Moldova. The report reviews the experience, draws lessons, and establishes an evidence base for detailed analysis. The study presents best practices for policy dialogue and future investments by the World Bank and other financial institutions. The detailed case studies compare these countries and draw common themes and issues. Comparisons are made with best-developed or existing models in the OECD and other countries in the Europe and Central Asia Region that have already undertaken family medicine reform

A compendium and functional characterization of mammalian genes involved in adaptation to Arctic or Antarctic environments

Many mammals are well adapted to surviving in extremely cold environments. These species have likely accumulated genetic changes that help them efficiently cope with low temperatures. It is not known whether the same genes related to cold adaptation in one species would be under selection in another species. The aims of this study therefore were: to create a compendium of mammalian genes related to adaptations to a low temperature environment; to identify genes related to cold tolerance that have been subjected to independent positive selection in several species; to determine promising candidate genes/pathways/organs for further empirical research on cold adaptation in mammals

Three flavor neutrino oscillation analysis of atmospheric neutrinos in Super-Kamiokande

We report on the results of a three-flavor oscillation analysis using Super-Kamiokande~I atmospheric neutrino data, with the assumption of one mass scale dominance ($\Delta m_{12}^2$$=$0). No significant flux change due to matter effect, which occurs when neutrinos propagate inside the Earth for $\theta_{13}$$\neq$0, has been seen either in a multi-GeV $\nu_e$-rich sample or in a $\nu_\mu$-rich sample. Both normal and inverted mass hierarchy hypotheses are tested and both are consistent with observation. Using Super-Kamiokande data only, 2-dimensional 90 % confidence allowed regions are obtained: mixing angles are constrained to $\sin^2\theta_{13} < 0.14$ and $0.37 < \sin^2\theta_{23} < 0.65$ for the normal mass hierarchy. Weaker constraints, $\sin^2\theta_{13} < 0.27$ and $0.37 < \sin^2\theta_{23} < 0.69$, are obtained for the inverted mass hierarchy case.Comment: 7 figures, 3 table

Solar neutrino measurements in Super-Kamiokande-I

The details of Super--Kamiokande--I's solar neutrino analysis are given. Solar neutrino measurement in Super--Kamiokande is a high statistics collection of $^8$B solar neutrinos via neutrino-electron scattering. The analysis method and results of the 1496 day data sample are presented. The final oscillation results for the data are also presented.Comment: 32pages, 57figures, submitted to Physical Review