Moldovan Medical Journal

5-10

Authors: Pavel Banov, Andrei Galescu, Ilie Ceban, Emil Ceban

Background: Percutaneous nephrolithotomy (PNL) is the minimally invasive treatment elected for large kidney calculi (>2cm), staghorn calculi, inferior calyceal lithiasis, hard consistency calculi (calcium oxalate monohydrate or cystine) and lithiasis at the level of a malformed kidney. The aim was to analyse the results, which were obtained in the clinic for one year from the implementation of the method in patients with urolithiasis treated by PNL. Material and methods: The transversal descriptive study was performed in the group of 43 patients with urolithiasis, subjected to PNL treatment, throughout 2019. Results: The mean age of kidney stone patients treated by PNL was 55±7 years, among them 29 (67.5%) women and 14 (32.5%) men. The anatomical distribution of nephrolithiasis was: right kidney – 21(48.9%) patients, left kidney –22 (51.1%) patients. The post-operative period in most cases was 5 days. Most of the operated calculi had the following dimensions: 2-2.5 cm in 18 (41.86%) patients, 2.6-4 cm in 16 (37.2%) patients and over 4.5 cm in 9 (20.93%) patients. Postoperative complications were detected and distributed according to Clavien-Dindo scale (CDS). The majority of detected complications were minor (CDS grade 1) in 31 (72%) patients, CDS 2 in 7 (14%) patients and CDS 3b in 6 (14%) patients. Patients with CDS complications grade 4 and 5 were not detected. In 3 (7%) patients the procedure was of “tube-less” type and in 1 (2.3%) patient with double-pointed canal. Conclusions: The success of PNL intervention depends on multiple factors, such as calculus composition, dimension and location in the urinary tract, the patient’s body mass index, as well as collecting system anatomy. PNL is a safe and effective procedure with a 90-100% stone-free rate and minor complications.

16-21

Authors: Cornelia Fursenco, Tatiana Calalb, Livia Uncu

Background: Genus Solidago is represented in the Republic of Moldova flora by two species: S. virgaurea – spontaneous and S. canadensis – cultivated, known as medicinal plants in the world, also being studied in our country. The objective of this paper was the comparative microscopic study of Solidago species from the Republic of Moldova flora. Material and methods: Superficial preparations and sections were made from vegetal products of S. virgaurea and S. canadensis species and studied in the Micros microscope coupled with digital camera. Results: The main specific structural indicators with diagnostic role in the identification of g. Solidago species from the flora of the Republic of Moldova were highlighted: the presence of secretory channels in rhizome and stem (both species); the contour of stem in cross-section (polygonal outline – S. virgaurea, circular outline – S. canadensis); the mesophyll structure of leaf (dorsoventral mesophyll – S. virgaurea, equifacial mesophyll – S. canadensis); anomocytic type of stomata (both species); multicellular protective conical trichomes and flabelliform ones (both species); secretory trichomes (with unicellular foot – S. virgaurea, and with multicellular one – S. canadensis); abundant pappus composed of multiseriate bristles and spherical pollen grains (both species). Conclusions: S. virgaurea and S. canadensis species from the Republic of the Moldova flora could be identified by specific structural indices that have an important diagnostic role.

26-31

Authors: Anastasia Bendelic, Ilia Catereniuc

Background: Vena saphena magna (VSM) – one of the two superficial venous collectors of the lower limb, the longest vein of the human body, is often accompanied by parallel veins, of which clinical significance may be different. The objective of the study was to investigate the individual anatomical variability of the VSM, on macroscopic aspect, in cadavers, of which variability is important for the vascular surgeon and / or for the cardiac surgeon. Material and methods: This study was conducted on 22 formolized lower limbs using classical dissection methods. The observed anatomical variants were recorded and photographed. Results: The dorsal venous arch of the foot, the origin of the VSM, was double in 2 cases (9.1%), and it was absent in one case (4.55%), thus two dorsal metatarsal veins continued proximally with two medial marginal veins. In the leg, VSM was double in one case (4.55%), and in other 14 cases (63.63%) it was accompanied by accessory saphenous veins. In the thigh, it was double in 3 cases (13.6%), and in 10 cases (45.5%) it was accompanied by accessory saphenous veins. The saphenofemoral junction was located at 4.23±0.64 cm distance from the pubic tubercle; at 12.25±1.1 cm away from the anterior superior iliac spine and at 4.3±0.65 cm below the middle of the inguinal ligament. Conclusions. The anatomical variability of the VSM includes its duplicity and/or presence of the accessory saphenous veins. The dorsal venous arch may be double or absent. The saphenofemoral junction is relatively fixed in relation to the neighboring bone landmarks.

38-42

Authors: Oleg Arnaut, Ion Grabovschi

Background: Assessing the traumatic injuries severity, as well as estimating the severe trauma patient’s prognosis are the key moments in their management. Predictive models for severe trauma outcome need improvement. Material and methods: In the clinical study (65 severe trauma patients), proteases, antiproteases and treatment outcome (survival/non-survival) were considered. There were used two statistical instruments – dimension reduction analysis (principal component analysis) to prepare the data for modeling and modeling itself through multivariate logistic regression. Results: Principal component analysis evidenced 12 “latent” factors grouped in four models. The survival predictive model had the following characteristics: calibration χ²=1.547, df=7, р=.981; determination – 0.759; discrimination, sensitivity – 90.7%, specificity – 81.8 %, area under RОС curve – 0.95 (95%CI 0.912, 1.000). The model enrolled four “latent” factors (three destructive and one protective), male gender and ARDS development. Conclusions: In our research, the survival predictive model for severe trauma patients on base of proteases/antiproteases system components after dimension reduction procedure was elaborated. The model showed good characteristics and needs validation to be implemented in daily clinical practice.

51-57

Authors: Ala Istratenco

Background: Nasal polyposis (NP) is a multifactorial pathology with negative impact on quality of life. The pathogenesis of NP has not been fully elucidated. This limits the pathogenic treatment. Recent studies suggest that nitric oxide (NO) and its metabolites are involved in pathophysiological events of NP. Purpose of the study: to evaluate the tissue NO and nitrite/nitrate (NO2 - /NO3 - ) levels in patients with and without NP and to establish the relationship between NO levels and some clinical features. Material and methods: 86 recruited patients were divided into a case group (N1 =43), patients with NP and a control group (N2 =43), patients with septal deviations and turbinate hypertrophies. Visual Analog Scale (VAS) was used to evaluate the severity of nasal obstruction and olfactory disturbances. NO and NO2 - +NO3 - concentrations in tissue specimens were measured by spectrometric method. Results: Case group had significantly lower NO (U=173.5, p<0.001) and NO2 - +NO3 - levels (U=123.5, p<0.001). A negative correlation was found between VAS for nasal obstruction and NO levels (rs = -0.379, p<0.05), between VAS for olfactory disturbances and NO levels (rs = -0.531, p<0.001), and between endoscopic score and NO levels (rs = -0.758, p<0.05). Conclusions: Our results corroborate the previous findings. This underlines that NO levels depend on the patency of sinus ostium and the state of osteomeatal complex. Further studies, which take into account the role of NO in different rhinosinusitis endotypes, are needed to be performed in order to improve the NP management.

66-69

Authors: Vladimir Kusturov, Gheorghe Ghidirim, Anna Kusturova, Irina Paladii

Background: Parturition-induced pelvic injuries after spontaneous vaginal delivery sometimes happen causing deformation of the pelvic ring. The frequency of these lesions is from 1:300 to 1:30000 births, creating many problems for young women in postpartum life. Material and methods: Under our follow-up there were 14 patients with disruption to the pelvic ring II-III degree during labor. Special bed position was recommended for the patients (n=4) with rupture of the pubic symphysis II degree. Sacroiliac joint subluxation was reduced by manual traction in multiparous patients (n=3) with disruption of III degree. Closed pelvis osteosynthesis by external device was performed. Results: Osteosynthesis was performed in trauma clinic, taking into account that patients had breast-fed children. The maximum anesthesia time was up to 30 minutes. Closed reposition of the pelvic bones and stabilization by an external device without additional blood loss were performed. Reposition of damaged bone surfaces was achieved in all cases. In 3-4 hours after surgery, the patients were returned to their children. From the second day they were able to get up, move around the room, take care of the children. Long-term results of treatment were evaluated from 1.5 to 14 years and rated as good. Conclusions: Rupture of the pelvic ring in women during childbirth requires qualified diagnostics and appropriate treatment. Conservative treatment does not give stable clinical result in multiparous women with disruption of II degree.