Moldovan Medical Journal

10-14

Authors: Adrian Cociug, Olga Macagonova, Valeriu Cusnir Jr, Vitalie Procopciuc, Valeriu Cusnir Sr, Viorel Nacu

Background: The complexity of cryopreservation and its potential to damage the endothelium make it so that it is rarely used in routine eye banking, except for occasional, clinically urgent transplants, where the main objective is to save the eye. The culture medium was the method of choice in the Eye Bank. Material and methods: The study group was divided into 3 subgroups. For penetrating keratoplasty and anterior lamellar keratoplasty, corneas taken up to 24 hours, with a number greater than 2000 endothelial cells per mm2 , are preferably used. Results: In the first group we found: weakly edematous epithelium; thin, transparent stroma; thin Descemet’s membrane; transparent endothelial layer, endothelial cell density greater than 2800 cells/mm2. The corneas of the second group presented: edematous, but with uncompromised integrity epithelium; slightly edematous, transparent stroma; slightly folded Descemet’s membrane; intact endothelial layer and an average of 2600 cells/mm2. Corneas of the third group: evidently edematous epithelium, with exfoliations in some areas and Bowman’s membrane detachment; considerable edema of stroma in all layers; pronounced folds of Descemet’s membrane; interrupted endothelial layer along the outline of the folds. Conclusions: The age of the donor and the preservation time are important factors that influence corneas in culture media and determine the state of endothelial cells. Although the number of endothelial cells usually decreases with age, there are still many corneas from donors over 80 years of age who meet the minimum criteria for transplantation.

18-20

Authors: Oleksandr Slobodian, Anna Prodanchuk

Background: This investigation is important to reveal hard palate ontogenetic transformations in fetal and early neonatal periods, which is important for the facial surgery in fetuses, newborns. Material and methods: Investigations have been performed in 53 cadavers of fetuses from 4 to 10 months of development, and in 9 cadavers of newborn children of both genders, who died of the reasons not connected with digestive system diseases or anomalies, and were without external signs of anatomic deviations or abnormalities, and were without evident macroscopic deviations of skull structure. Adequate anatomic methods have been used for investigation: macropreparations, topographic anatomical sections, morphometry, and statistical analysis. Results: Variants of the hard palate shapes during fetal and early neonatal periods of ontogenesis are the following: trapezium (15%), square (10%), and ellipse (7%) shapes. The shapes of the trapezium were detected in most cases in 6-7-month fetuses (20%), and in equal percentage proportion in early and late fetuses (12%). The square form is a characteristic variant form in early fetuses (17%), with fetuses age increase this form was detected in less cases, in 6-7-month fetuses – in 10%, in late (8-10 month) fetuses – in 8%, and within the newborn period the square form was not observed. The form of the ellipse was observed in larger percentage proportion in late fetuses and in newborns (12%), in less proportion (5%) – in 6-7-month fetuses, in early fetuses this form was not detected at all. Forms of the ellipse and of the trapezium were observed in equal number of cases in 8-10-month fetuses and newborns. With fetuses development the hard palate form in sagittal and frontal planes changed from arcuate to flat one. Conclusions: An ascertainment of typical and variant anatomy of hard palate forms and types would promote implementation of the new methods of major and reconstructive surgical invasions in face and skull.

25-28

Authors: Liliana Profire

Background: Infection of the pregnant women in advanced period of pregnancy with any of the virus serotypes represents a danger not only for the developing fetus (e.g. fetal intrauterine retardation, fetal distress, oligoamniosis, etc.) but also for the pregnant woman who may develop respiratory and cardiovascular deficiency. We are interested to determine the peculiarities of the clinical evolution, of the flu diagnosis in pregnant women. Material and methods: The general study group consisted of 189 pregnant women which was divided into 2 clinical subgroups: L1, which included pregnant women with confirmed flu (n1 =42) A(H1N1) and subgroup L2 of pregnant women with seasonal flu (n2 =147). Results: The results of the examination of pregnant women for the flu virus’s DNK confirmed high frequency of pandemic flu in 2009, P0.05. The study of laboratory investigations of women with the flu demonstrates the presence of similar changes in the both groups: iron deficiency anemia 93 (49.2%); leukopenia 84 (44.4%); leukocytosis with neutrophilia 4 (2.1%); lymphocytosis 42 (22.2%), P>0.05. The most frequent complications of the pregnancy in pregnant women with the flu were premature delivery (early/late periods of pregnancy) – 15 (33.3±7.27) in L1 and in L2 – 35 (17.7±3.15), p<0.05, followed by intrauterine fetal infestation syndrome (fetal hypoxia, intrauterine fetal development retardation, oligoamniosis, placental dysfunction) – 33 (17.4%), p<0.05. Conclusions: Molecular methods of diagnosis to determine the virus serotype underlie the establishment of the definitive diagnosis of the flu. The risk of pregnancy disruption at various terms, premature birth, intrauterine fetus infestation syndrome are the most common complications in pregnant women with the flu in the study.

36-41

Authors: Оlga Yepanchintseva, Оleg Zharinov, Elena Onishchenko, Borys Тоdurov

Background: Diabetes mellitus (DM) is one of the most crucial risk factors for morbidity and mortality from coronary heart disease (CAD) in the contemporary world. The prevalence and rapid progression of atherosclerotic lesions leading to worse survival is a defining feature of the course of CAD in patients with DM. Clinical manifestations of CAD often call for revascularization in patients with DM. The contemporary data regarding efficacy of the coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with CAD and concomitant DM are summarized in the review. Conclusions: Worse survival prognosis in case of CAD with concomitant DM is associated with systemic atherosclerosis, presence of a number of concomitant risk factors, as well as masked clinical manifestations of ischemia and myocardial infarction common for the patients with DM. The combination of CAD and DM once again proves the benefit of the long-term use of drugs for the secondary prevention of cardiovascular events. From the standpoint of evidence-based medicine the optimal method of revascularization in CAD patients with multivessel coronary artery disease and concomitant DM is CABG surgery. In FREEDOM study surgical myocardial revascularization reduced the number of endpoints compared to PCI. In the case of PCI it is advisable that eluting stents reducing the likelihood of restenosis and the need for repeated revascularization be used.

46-51

Authors: Oleg Cobileanschi, Elena Condratiuc, Ion Cazacu, Diana Popusoi

Background: Pharmacological management of patients with epilepsy is still a very challenging approach for the best outcome of these patients. When considering the appropriate treatment choice for patients it is necessary to take into account several factors that can influence the effectiveness and quality of life. Cancelling or changing treatment suddenly can lead to uncontrolled seizures. After a short period without seizures, many patients are tempted to abandon treatment. Cessation of treatment can be discussed after a seizure-free period for at least two years. Treatment should be discontinued gradually by reducing the dosage and constant supervision of the physician. This paper analyses briefly the general pharmacological and treatment methods in several forms of adult epilepsy. Conclusions: Management of epilepsy means more than observing the medication prescribed by the specialist. It is also important for the patient to maintain his general health status, monitor the symptoms of epilepsy and response to treatment and take care of his safety. Involvement in the management of one’s own affection can help the patient to control his condition and to continue his routine in usual manner. The objective of antiepileptic treatment is to reduce epileptic seizures to zero without intolerable side effects. New treatments should focus not only on reducing the frequency and intensity of seizures but also improving the quality of life of patients.