Duodenal traumatism and intraabdominal lesional structure in polytrauma

Catedra de chirurgie nr.1 ”Nicolae Anestiadi”, Laboratorul Chirurgie Hepato-Pancreato-Biliară, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemitanu”, Chișinău, 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: Actualitatea problemei este inevitabilă prin prizma particularităților managementului, fiind determinate de complexitatea lezională- factor de risc major. Componența abdominală în politraumatisme (PT) cu implicarea duodenului conduce la creșterea mortalității, morbidității, invalidității. Erorile de diagnostic variază între 6,9-23,5%. În politraumatisme, organele intraabdominale sunt lezate în 25-35% cazuri. Scopul: Studierea frecvenței leziunilor organelor intraabdominale și duodenului în PT și influența asupra rezultatelor finale. Material și metode: Lotul de studiu include 73 pacienți politraumatizați cu componentă abdominală inclusiv și duodenul. Politraumatism: închis n=58(79,45%), deschis n=15(20,54%). Bărbați n=58(79,45%), femei n=15(20,54%). Raport b:f=3,86:1,vârsta între 18-70 ani. Mecanismul traumei accidente rutiere n=30(41,09%),catatraumă n=13(17,8%), agresiune fizică n=13(17,8%), sport n=2(2,73%), armă albă n=7(9,58%), armă de foc n=5(6,84%), explozie, jet apă n=2(2,73%). Spitalizați<12 ore n=57(78,08%), șoc n=49(67,12%), ebrietate n=17(23,28%). Intraoperator s-a stabilit: hemoperitoneum n=59(80,82%), hematom retroperitoneal n=46(63,01%), flegmon retroperitoneal n=9(12,32%), peritonită n=15(20,54%). Segmente lezate: D1n=26(35,61%), D2n=43(58,9%), D3n=19(26,02% ), D4n=2(2,73%). În 17 cazuri- leziuni asociate de segmente ale duodenului. Rezultate: În mecanismul traumei a predominat: accidentele rutiere, catatrauma, agresiunea fizică în 56(76,71%) cazuri. Mai des au fost lezate D1, D2. Frecvența organelor lezate: stomac-10, intestin subțire-8, intestin gros-23, ficat-38, vezica biliară-4, căile biliare-1, pancreas-46, Wirsung-5, splina-14, rinichi-12, vezica urinară-2, vase centrale-4. Cazuri cu numărul de organe lezate: 1-n=8(10,95%), 2-n=10(13,69%), 3-n=21(28,76%), >4-n=34(46,57%). Letalitatea generală n=39(53.42%). Concluzii: În lotul de studiu s-a constatat că frecvența leziunilor organelor intraabdominale prin complexitatea și severitatea lor lezională influențează direct rezultatul final. Relația între numărul de organe lezate și mortalitate este direct proporțională.Background: The actuality of the problem is inevitable due to the particularities of management, being determined by the lesion complexity -the major risk factor. The abdominal composition in polytrauma (PT) with duodenal involvement leads to increased mortality, morbidity, disability. Diagnostic errors vary between 6.9-23.5%. In polytrauma intraabdominal organs are injured in 25-35% of cases. Aim of the study: Study of the frequency of injuries of the intraabdominal organs and duodenum in PT and its influence on the final results. Methods and materials: The study group included 73 patients with polytraumatism with abdominal component including duodenum. Polytrauma: closed n= 58(79.45%), open n=15(20.54%). Men-58(79.45%), woman-15(20.54%). Male/Female=3.86:1, age 18-70 years. Mechanism of trauma: road accidents-30(41.09%), catatrauma-13(17.8%), physical aggression-13(17.8%), sport-2(2.73%), knife injuries-7(9.58%), fire weapon-5 (6.84%), explosion, water jet 2(2.73%). Intraoperative was established: hemoperitoneum 59(80.82%), retroperitoneal hematoma-46(63.01%), retroperitoneal phlegmon-9(12.32%), and peritonitis-15 (20.54%). Damaged segments: D1-26(35.61%), D2-43(58.9%),D3-19(26.02%),D4-2(2.73%). In 17 cases-associated lesions of duodenal segments. Results: In the mechanism of trauma predominated: road accidents, catatrauma, physical aggression in 56 (76.71%) cases. More often D1, D2 were injured. Frequency of injured organs: stomach-10, small intestine-8, large intestine-23, liver-38, biliary bladder-4, biliary tract-1, pancreas-46, Wirsung-5, spleen-14, kidney-12, urinary bladder-2, central vessels-4. Cases with number of injured organs: I-8(10,95%), II-10(13,69%), III-21(28,76%),>IV -34(46.57%).Overall lethality n=39(53.42%). Conclusion: In the study group it was found that the frequency of lesions of the intraabdominal organs through their lesion complexity and severity directly influences the final result. The relationship between the number of injured organs and mortality is directly proportional

Surgical treatment in wrist instabilities

Department of Traumatology and Orthopedics, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova Clinical Hospital of Orthopedics and TraumatologyIntroduction. Wrist joint instabilities are ligament injuries associated with subluxations, luxations, fractures, nonunions or osteoarticular diseases of carpal bones. There are type of surgery to resolve these problems. Materials and methods. Our experience is based on the treatment of 129 patients with wrist instabilities of different etiology aged between 17 and 68 years who underwent various selective arthrodesis. The average duration of disease was 3 years and 2 months. Kienbock disease was diagnosed in 41 patients, in various stages, pseudoarthrosis of the scaphoid complicated by deforming osteoarthritis - in 71 cases, rotational subluxation of the scaphoid - in 9 cases, trapezium-trapezoid-scaphoid osteoarthritis – in 4 patients and malunion of the distal radius fracture – in 4 cases. Results. Arthrodesis directed to obtain an ankylosis of the carpal bones by losing the amplitude of movements, but allows to achieve a stable joint, without pain and to restore gripping power. In 71 patients with scaphoid pseudoarthrosis, complicated with deforming osteoarthritis, arthrodesis of 4 carpal bones with scaphoidectomy in different variants was performed in 49 cases, total wrist arthrodesis in 8 cases, scaphocapitate arthrodesis in 4 cases, removing the first row of carpal bones in 3 cases, scaphoidectomy in 5 cases, radial-scaphoid arthrodesis – in 1 case, and 1 other in scapho-trapezium-trapezoid arthrodesis. In 41 patients with Kienbock disease, Graner operation was performed in 16 cases, arthrodesis of 3 carpal bones in 10 cases, capitate-scaphoid arthrodesis – in 8 cases, radial-semilunar – in 4 cases, radial-scaphoid arthrodesis – in 1 case, removing the first row of carpal bones – in 2 cases. Arthrodesis of 3 carpal bones (scaphotrapezium- trapezoid), was performed in 4 cases of deforming arthritis. Also triple scaphoid arthrodesis was done successfully in 9 patients with rotational subluxation of the scaphoid. Total wrist arthrodesis was performed in 4 cases of the intraarticular radial fracture malunion. Longterm results were followed up in 46 patients: good (18), satisfactory (23). Unsatisfactory outcomes were in 5 cases because of absence of the ankylosis and presence of the pain. Conclusions. Selective wrist arthrodesis is indicated in deforming arthritis grade II or III of diverse etiology, when outstanding amplitude movements are up to 50% of normal range. Each case of selective wrist arthrodesis is chosen individually according to disease, the spreading grade of deforming osteoarthritis and patient profession

Association of the IL-10 gene family locus on chromosome 1 with juvenile idiopathic arthritis (JIA)

The cytokine IL-10 and its family members have been implicated in autoimmune diseases and we have previously reported that genetic variants in IL-10 were associated with a rare group of diseases called juvenile idiopathic arthritis (JIA). The aim of this study was to fine map genetic variants within the IL-10 cytokine family cluster on chromosome 1 using linkage disequilibrium (LD)-tagging single nucleotide polymorphisms (tSNPs) approach with imputation and conditional analysis to test for disease associations

Low CD73 expression on synovial lymphocytes correlates with reduced adenosine generation and higher disease severity in juvenile idiopathic arthritis

Objective To investigate the expression and the adenosine-generating activity of the ecto-5'-nucleotidase CD73 on synovial fluid mononuclear cells (SFMC) and peripheral blood mononuclear cells (PBMC) from children with arthritis. Methods Given the role of CD73 protein in the production of anti-inflammatory adenosine which intersects with inflammatory biology, its expression on lymphocytes was determined by flow cytometry. The CD73 AMPase activity of PBMC and SFMC was measured by HPLC. The effects of cell activation on CD73 expression were examined by in vitro culture of PBMC. Results CD8+ and CD19+ synovial lymphocytes from patients with juvenile idiopathic arthritis (JIA) expressed decreased levels of CD73 compared to both paired JIA PBMC and those from healthy controls. When comparing percentages of CD73+ synovial fluid lymphocytes in the two clinical forms of oligoarthritis, those with extended oligoarthritis showed lower CD73 expression compared to patients with the milder form of disease. Synovial CD8+ T cells had a lower ability to produce adenosine from Etheno-AMP compared to CD8+ PBMC. T cell activation through the TCR of CD8+CD73+ cells and B cell activation through TLR9 resulted in reduced expression of CD73. This downregulation occurred on dividing cells. Conclusion These data show that low CD73 expression on T and B cells in the inflammatory site is related to cell proliferation and is correlated with the clinical severity of oligoarticular JIA. The decreased CD73 expression on SFMC in turn results in reduced adenosine production, which would lead to decreased potential for anti-inflammatory activity

The surgical treatment of the carpal tunnel syndrom

Catedra Ortopedie, traumatologie şi chirurgie în campanie, "USMF „N. Testemiţanu”, Conferinţa Naţională în cadrul Asociaţiei Ortopezilor – Traumatologi din Republica Moldova ”Actualităţi în microchirurgia reconstructivă”, Chișinău, Republica MoldovaOur experience are based on the treatment of the 36 patients with carpal tunnel syndrome during 2005-2009 years. The age of patients was between 18 and 65 years, men – 15 women – 21 persons. The right hand traumatized in 22 cases, left – 12 and bilateral at 2 patients. After fractures of the distal radius tunnel carpal syndrome beginning in 21 patients and after contusion of the radio-carpal join in 7 cases. The disorders at 5 patients have idiomatic origins. The III degree was confirmed in 29 cases, IV degree – in 4 and II degree – only 3 patients. Surgical treatment: in 15 cases was performed osteosinthesis of radial bone and excision of the carpal ligament. The excision of carpal ligament and decompression of medianus nerve execute at 21 patients. The good results confirmed at 33 patients, satisfactory in 3 cases.Experienţa noastră 2005-2009 se bazează pe tratamentul a 36 de bolnavi cu sindromul de canal carpian, cu vârsta cuprinsă între 18 şi 65 de ani. Au fost 15 bărbaţi şi 21 femei. În 22 cazuri a fost leziunea mâinii drepte, 12 – mâna stângă şi în 2 cazuri leziunea bilaterală. Sindromul de canal carpian s-a dezvoltat la 21 de bolnavi după fractura de radius şi în 7 cazuri după o contuzie a articulaţiei pumnului, la 5 – s-a dezvoltat o formă idiopatică. După materialul nostru 3 bolnavi cu sindromul de canal carpian au fost în stadiul –II, 29 de pacienţi au fost cu maladia în stadiul – III şi 4 în stadia a IV. Dintre intervenţiile chirurgicale: la 15 bolnavi paralel cu osteosinteza fragmentelor extremităţii distale a osului radial s-a efectuat excizia ligamentului carpian cu decompresia nervului median, la 21 pacienţi s-a efectuat excizia ligamentului carpian cu decompresia şi neuroliza nervului median. Rezultatele la distanţă s-au înregistrat ca bune la 33 bolnavi, satisfăcătoare la 3 pacienţi

Căile aeriene dificile în chirurgia maxilo-facială (Caz clinic)

Catedra Anesteziologie şi Reanimatologie Nr 1 „Valeriu Ghereg”, USMF „Nicolae Testemiţanu”, Centrul Naţional Ştiinţifico-Practic de Medicină de Urgenţă, Chişinău, Moldova, Catedra Chirurgie Orală şi Maxilo-Facială, USMF „Nicolae Testemiţanu”, Congresul II Internaţional al Societăţii Anesteziologie Reanimatologie din Republica Moldova 27-30 august 2009Confruntarea cu un pacient neventilat şi neintubat reprezintă o încercare serioasă pentru anestezist. Identificarea pacienţilor cu risc de intubare dificilă este un pas esenţial în examenul preanestezic ce poate reduce morbiditatea şi mortalitatea legată de căile aeriene dificile. Aplicarea anesteziei generale, a sedării intravenoase induce depresie respiratorie, care necesită asistenţă respiratorie cu protejarea căilor aeriene. Intubarea dificilă este definită ca necesitatea de a efectua mai mult de 3 încercări de intubare, sau mai mult de 10 minute, utilizând laringoscopie clasică. Laringoscopia dificilă este atunci, când nu este posibil de a vedea nici o porţiune a corzilor vocale prin laringoscopie clasică. În prezicerea căilor aeriene dificile sunt importante următoarele: anamnesticul, examinarea, măsurările, sistemele de scoruri, eşecurile