Epidural anesthesia. Realities and Perspectives

(Coducător ştiinţific: Sergiu Vişnevschi, doctorand) Catedra Anatomie Topografică şi Chirurgie Operatorie USMF “Nicolae Testemiţanu”Anatomic and clinical description of the epidural anesthesia, to elucidate the anatomical structures that serve as barriers to physician anesthetist and can lead to a failure of this procedure. Vascular elements, bone ligaments, stratigraphic features that give this region have a great practical importance. Descrierea anatomo-clinică a anesteziei epidurale, pentru elucidare structurilor anatomice care servesc ca obstacole în calea medicului anaestezist şi care pot duce la o nereuşită a acestei proceduri. Elementele vasculare, osoase ligamentare, stratigrafice conferă acestei regiuni numeroase particularităţi care au o deosebită importanţă practică

Acupunture as a method of analgesia

Department of Topographical Anatomy and Operative Surgery, Medical Student Association “AStudMed” of State Medical and Pharmaceutical University “Nicolae Testemitanu", Chisinau, Republic of MoldovaIntroduction: Acupuncture as a therapeutic method of treatment comes from China and is becoming more widespread in Europe nowadays. It is based on the meridian theory and assumed mechanisms of action: autonomic, neuroendocrine and bioenergetical. The needles are pierced at specific points of the body, placed along the meridian line of movement which on the body of energy. If at their path appears an exciting form of stinging or pressure, then it can reduce pain and improve body condition that was affected. Purpose and Objectives: The effectiveness of acupuncture in postoperative analgesia, which was conducted in the National Scientific and Practical Center for Emergency Medicine (IMSP CNSPM U) Microsurgery Department. Material and Methods: We selected 20 patients between 20 and 50 years, suffer from skin trauma, soft tissue and vascular structures in the mining regions, which underwent a microsurgical intervention. They were divided into two groups of 10 patients each. Patients of the first group received 3 sessions of acupuncture and analgesic medication. The second group had only two analgesic drugs. All patients were analyzed according to subjective criterias: Visual-Analogue Scale (VAS), personal comfort and the objective criterias: blood pressure, temperature, respiratory rate, heart rate. The materials used were: set of individualized acupuncture needles, Visual- Analogue Scale, tensometer, thermometer, assessment questionnaire for postoperative pain management, patient satisfaction questionnaire for assessing the management of acute postoperative pain, patient informed consent about participating at the study. Results: The study showed that the first group which received minor analgesics, like sol. baralgin in combination with acupuncture by demand, a value of 5-6 points at VAS and objective indexes in the normal range. In the control group were administered major analgesics, like promedol, schematically, and VAS score was 8-9 points and clues major objective, as was observed in 4 patients dyspeptic side effects. Conclusion: We can say that acupuncture is a non-invasive method, followed by a stable postanestesic period with persistent analgesia and postoperative evolving remarkably good, due to the absence of adverse effects such as nausea and vomiting, which include early enteral feeding, early mobilization and less adverse effects

Utilizing paramedics in pre hospital and patient care

Department of Topographical Anatomy and Operative Surgery, Medical superviser of Medical Student Association “AStudMed” State Medical and Pharmaceutical University “Nicolae Testemițanu”, Chisinau, Republic of MoldovaIntroduction: The EMS system is a very known modality that rapidly evolved from 2nd half of 20th century, the rapid development was due to changes in drift of population to urbanized areas, usage of more motor vehicles and rapid growth in population. Nowadays exist two approaches toward administration of EMS one is by physicians while another is given by paramedics. To clarify paramedics are best defined as medical professionals who provide medical care at an advanced life support level in the pre-hospital environment, usually in an acute phase of illness or injury. Purpose and Objectives: Highlightning the importance of transition of Emergency Medical Services in Moldova from physicians based system to paramedic based system in order to improve the quality of response to the emergency medical cases, decrease expenses in healthcare system in Moldova and to solve physician deficiency issue. Materials and Methods: Our analysis of EMS systems worldwide has led us to an important conclusion that even though paramedics' education period and training courses are shorter (2-4 years) than that of physicians (approximately 12 years), their skills don't fall from that of physicians in pre hospital emergency care modality. As profession of paramedics developed and has become an university based training for theoretic knowledge and practical part on ambulances and medical simulation centers. Same EMS systems that provide pre hospital care by university educated paramedics exist in developed countries like, Ben-Gurion University of Negev in Israel, University of Washington Medical Center in USA, University of Greenwich in UK, and University of Tasmania in Australia. Systems that use physicians in providing pre hospital care are France, Germany, Russian Federation, and Republic of Moldova. Results: In order to make a quality comparison of both professionals that work in those two different systems we analyzed 2 profound researches that evaluated their diagnostic and treatment skills. First research of American Heart Association (AHA) compared diagnostic abilities of paramedics and physicians in stroke patients and revealed that recognition of neurological deficits by ambulance paramedics using FAST shows good agreement with physician assessment. Second research of American journal of Emergency medicine showed that highly trained paramedics in an urban emergency medical services system can identify patients with STEMI as accurately as blinded physician reviewers. Conclusion: In conclusion and in scope of current health problems and ongoing burden and load in financing and medical personnel quota deficiencies in many healthcare systems a transition to EMS system that is administered by paramedics can be very beneficial to healthcare system problems and simultaneously keep provision of professional pre hospital medical treatment in underdeveloped countries A transition to such system requires cooperation of many "players" and effort to bring this change in EMS provision, but in the long run it will bring a cure to ongoing problems in healthcare systems

Biochemical and immune status in patients with sepsis

Sepsis is considered one of the leading causes of death worldwide. It is a complex pathophysiological disorder arising from systemic inflammatory response to infection. The defense in sepsis consists of innate and adaptive immune system responses. White blood cells (WBC) participate actively in this response. Their mediators and enzymes fight with the infection, but they also injure the endothelium and other structures, producing multi-organ failure syndrome with sequels in the biochemical analysis. The aim of this study was the evaluation of immunological and biochemical status of patients diagnosed with sepsis syndrome. Sepsisul este considerat una din cauzele principale ale mortalităţii în lume. Acest sindrom este o tulburare fiziopatologică complexă ce rezultă din răspunsul inflamator sistemic la o infecţie. Apărarea în sepsis constă din răspunsul imunităţii înnăscute şi dobîndite. La aceasta participă activ leucocitele. Mediatorii şi enzimele lor luptă cu infecţia, dar, deasemenea, lezează endoteliul şi alte structuri, ducînd la sindromul insuficienţei multiple de organe cu repercusiuni în analizele biochimice. Scopul acestui studiu a fost evaluarea statutului imunologic şi biochimic la pacienţii diagnosticaţi cu sepsis

Role of the risk factors in clinical complications and types of acute myocardial infarction

Department of Cardiology, Medical superviser of Medical Student Association “AStudMed” State Medical and Pharmaceutical University “Nicolae Testemitanu”, Chisinau, Republic of MoldovaIntroduction: Acute Myocardial Infarction (AMI) is a major cause of death and disability worldwide. The diagnosis of acute MI is a clinical diagnosis based on patient symptoms, ECG changes, and highly sensitive biochemical markers, as well as information gleaned from various imaging techniques. It is important to characterize the type of MI as well as the extent of the infarct, residual LV function, and the severity of CAD and other risk factors, rather than merely making a diagnosis of MI. The ideal management of ST-segment-elevation Myocardial Infarction (STEMI) and Non- STEMI involves early diagnosis followed by rapid reperfusion therapy (PCI). Purpose and Objectives: Highlighting of importance correlation factors between, type of AMI, factors of risk and complication in patients without reperfusion therapy (PCI). Materials and methods: The retrospective research was based on the archive data of the Municipal Hospital Clinic "Sfânta Treime". Patients (N=71) had a mean age of 64,3 years, diagnosis of different type of MI and history of hospitalization in “Intensive Care Unit”. There were 2 periods of analysis (01.09.2012 to 31.10.2012 and 01.10.2013 to 31.12.2013). For data analyzes SPSS version 17 was used, p< 0,05 considered statistically significant. Results: From 71 patients that were examined, were identified common risk factor for type 2 of AMI in 56 patients which are: Arterial Hypertension (HT) 2-3rd in 85.7%, diabetes type 2 in 35.7%, dyslipidemia in 28,6%, Chronic Heart Failure NYHA 2-3 in 23.2%, anemia in 7.1% and ischemic cardiomyopathy in 7.1%. For type 3 of AMI in 10 patients HT in 70%, diabetes type 2 in 40%, dyslipidemia in 10%, and type 1 of AMI 5 patients without known risk factors. Also were identified complication for type 1 of AMI 5 patients: discirculatory encephalopathy in 40%, Killip 2, 3 and 4 each 20%. For type 2 of AMI 56 patients: Killip 2 in 50%, Killip 3 in 19.6%, Killip 4 in 10,8% other complications in 19,6%. For type 3 of AMI 10 patient: Killip 4 has 100%. The most common encountered complication for type 2 of AMI is Killip 2-findings of mild to moderate heart failure in 50%, and in type 3 are Killip 4 - cardiogenic shock in 100%. Conclusion: HT is a common risk factor in more than 50% in type 2 and 3 of AMI in Intensive Care Unit. HT is a prevalent risk factor in type 2 and 3 of AMI. Therefore patients in Intensive Care Unit with HT 2-3rd degree must be treated as patients with high risk for developing type 3 of AMI and Killip 4. According to data we can assume that patients with advanced metabolic syndrome (characterized by dyslipidemia, hypertension and diabetes mellitus) mainly develop type 2 AMI

Management of pacients with single ventricle: classic and contemporary aproaches

Disciplina Cardiologie USMF “Nicolae Testemiţanu”, Departamentul cardiochirurgie IMSP Spitalul Clinic Republican, Dispensarul IMSP Institutul de Cardiologie, Asociaţia Studenţilor Medici AO “AStudMed”This article represents a work of synthesis, based on the literature reviews, and includes the classification principles of congenital cardiac malformation – single ventricle, treatment techniques presented according to international protocols and clinical studies. Our research is dedicated to the problem of finding the most optimal support in order to obtain the lowest risk of complications and the best results possible in the improvement of the life’s quality. Lucrarea dată reprezintă un articol de sinteză bazat pe reviul literaturii, care include principiile după care se clasifică malformaţia congenitală de tip ventricul unic, tehnici de tratament prezentate conform protocoalelor internaţionale, studii clinice. Problema pe care o abordăm în studiul nostru este suportul optim necesar cu scop de a obţine risc de complicaţii minim şi a ameliora calitatea vieţii la maxim posibil

Cardiovascular complications and prognosis of the outcome of infective endocarditis

Disciplina Cardiologie, Clinica Medicală nr.3 Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”Infective endocarditis (IE) is a severe septic disease in which the microbial graft affects the intact, native or prosthetic heart valves and other cardiac structures, causing structural damage and systemic embolism. The annual incidence ranges from 3 to 10 IE cases per 100000 persons/year, with an increasing tendency in some new clinical variants. High lethality is caused by serious disease complications, cardiovascular being the most dangerous for patients. Heart failure is the most common complication in IE, valvular damage caused by rupture of prosthetic or native valve cusps, infected chordae tendineae rupture, fistulas or prosthetic dehiscence, myocardial absces, myocardial muscle rupture. The high degree of cardiac failure by NYNA, embolisms and high percentage of negative blood cultures were the predictors of lethal outcome. Endocardita infecţioasă (EI) este o maladie septică gravă, cu localizarea grefei microbiene pe valve intacte, native sau protezate şi pe alte structuri cardiace, ce determină deteriorari structurale şi embolii sistemice. Incidenţa anuală a EI variază între 3-10 cazuri la 100000 persoane/an, cu tendinţa de creştere la pacienții cu variante clinice noi ale maladiei. Mortalitatea înaltă a EI este cauzată de complicații grave, îndeosebi cele cardiovasculare. Insuficienţa cardiacă (IC) congestivă este complicaţia cea mai frecventă în EI, cauzată de deteriorările valvulare: perforarea cuspelor valvulare native sau protezate, ruptura cordajelor infectate, fistule sau dehiscenţe protetice, abcese miocardice, miocardită cu ruptura muschilor. Gradul înalt a IC după NYHA, embolismul și rata mare a hemoculturii negative sunt predictorii pronosticului nefavorabil a maladiei

Acupunture as a method of analgesia

Catedra Anatomie topografică şi Chirurgie operatorie, USMF Nicolae TestemiţanuAcupuncture and acupressure are a controversial topic in medicine, considered by some pseudoscience. Method comes from China and is becoming more widespread in Europe. It is based on meridian theory. If their path in view of the pathogen appears puncture or pressing, it can reduce the pain or make improvements to a wounded body. This method is becoming more and more applied by experts in the field of anesthesia and intenssive care, it is effective of minimal side effects and maximum results in relieving the pain of various origins and intensity. Acupunctura şi presopuctura este un subiect controversat în medicină, considerat de unii pseudoştiinţă. Metoda vine din China şi devine tot mai răspândită în Europa. Ea este bazată pe teoria meridianelor. Această metodă a obţinut tot mai multe aplicaţii de către experţii din domeniul anesteziei şi terapiei intensive, fiind eficientă şi cu efecte secundare minime, dar cu rezultate maxime în ameliorarea durerii de intensitate şi origine difertă

Association of CT-Derived Extracardiac Features and Aortic Annulus Size in Patients Planned for TAVI

Introduction: Transcatheter aortic valve implantation (TAVI) is commonly used to treat patients with stenosed aortic valves. CT is one of the crucial steps in planning TAVI to obtain measurements of the aortic annulus to choose an appropriately sized prosthesis. Incorrect measurements can lead to patient-prosthesis mismatch and other complications. However, some patients cannot undergo ECG-gated CT with radiocontrast because of the presence of radiopaque objects in the thorax, arrhythmia, renal failure, etc. Aim: To explore supplementary methods to improve aortic annulus sizing for TAVI by extracardiac measurements. Methods: We included all patients who underwent CT as part of TAVI planning. Measurements of femoral and iliac arteries and the femoral head cross-sectional area were performed. Results: CT scans of 139 patients were included in this study. Sixty-three patients (45%) were males. Mean age of the female patients was 79.6 &plusmn; 7.1 years and of the male patients was 81.3 &plusmn; 6.1 years. Mean aortic annulus perimeter among female patients was 74.3 &plusmn; 6 mm (range 61.9&ndash;88.2) and 83 &plusmn; 7.9 mm among male patients (range 70.1&ndash;74.3 mm). Mean diameters of common iliac, external iliac, and common femoral arteries were 9.2 &plusmn; 1.8, 7.6 &plusmn; 1, 7.6 &plusmn; 1 mm, respectively, for females and 10.2 &plusmn; 1.8, 8.5 &plusmn; 1.3, and 8.6 &plusmn; 1.4 mm for males. Mean perimeter of the femoral head (average value of right and left femoral heads) among the female patients was 137.8 &plusmn; 6.3 mm, and among male patients was 155 &plusmn; 9.6 mm. A significant correlation was observed between the perimeter of the aortic annulus and the perimeter of the femoral head (Pearson&rsquo;s R2 = 0.224). The correlation between the aortic annulus perimeter and the femoral head perimeter was stronger among men than among women (Pearson&rsquo;s R2 = 0.66 and 0.19, respectively). Conclusion: Femoral head diameter is associated with annulus size. This may help size the appropriate prosthesis in cases where the measurements by CT are in the border zone if corroborated by clinically driven data