Institutional Repository in Medical Sciences of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
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Capsular phimosis: clinical challenges and difficulties in postoperative management
Get PDFIntroducere. Fimoza capsulară reprezintă o complicaţie postoperatorie oftalmologică, care se manifestă prin contracţia progresivă sau fibrozarea capsulei, în special a capsulei anterioare a cristalinului, după chirurgia cataractei şi implantarea unei lentile intraoculare (LIO), afectând poziţia şi funcţia acesteia. Scop. Prezentarea cazuri de fimoză capsulară, cu sau fără dislocare a IOL si tactica de conduita. Incidenţa acestei complicaţii după operaţia de cataractă este, între 0,5% şi 3%. Material şi metode. Datele anamnestice, clinice şi paraclinice au fost obţinute în cadrul consultului oftalmologic de specialitate. Examinarea a inclus biomi-croscopia, documentarea fotografică a polului anterior, precum şi efectuarea capsulotomiei cu laser YAG în cazurile fimozei capsulare cu dislocare IOL. UBM a fost utilizat atunci când a fost indicat. Rezultate. Au fost analizaţi pacienţi cu fimoză capsulară apărută după operaţia de cataractă cu implantare de lentilă intraoculară (LIO). Unii au prezentat contracţie moderată a capsulei anterioare, fără afectarea poziţiei IOL şi cu acuitate vizuală menţinută, necesitând doar monitorizarea periodică a pacienţilor în cadrul controalelor de rutină. În cazurile severe, s-au observat complicaţii: într-un caz, ruptura zonulei şi decentrarea IOL cu scăderea acuităţii vizuale, necesitând intervenţie chirurgicală; în altele, dislocare parţială a IOL, tratată cu capsulotomie laser YAG, care a stabilizat lentila şi a îmbunătăţit vederea. Concluzii. Fimoza capsulară este o complicaţie postoperatorie ce poate afecta funcţia vizuală după implantarea lentilei intraoculare (LIO). Formele uşoare evoluează favorabil sub supraveghere, iar cele severe pot necesita capsulotomie laser YAG pentru stabilizarea lentilei şi ameliorarea vederii.Introduction. Capsular phimosis is a significant postoperative ophthalmologic complication characterized by progressive contraction or fibrosis of the capsule, especially the anterior lens capsule, following cataract surgery with intraocular lens (IOL) implantation, affecting its position and function. Objective. To present cases of capsular phimosis, with or without IOL dislocation, and to discuss the management approach. The incidence of this complication after cataract surgery ranges between 0.5% and 3%. Material and methods. Anamnestic, clinical, and paraclinical data were obtained during the specialist ophthalmologic consultation. The examination included biomicroscopy, photographic documentation of the anterior segment, and YAG laser cap-sulotomy in cases of capsular phimosis associated with IOL dislocation. UBM was also used when indicated. Results. Patients with capsular phimosis occurring after cataract surgery with intraocular lens implantation were analyzed. Some patients presented moderate anterior capsule contraction, without affecting the intraocular lens position and with maintained visual acuity, requiring only regular monitoring during follow-up visits. In severe cases, complications were noted: in one patient, zonular rupture and IOL decentration occurred, with decreased visual acuity, requiring surgical intervention; in other cases, partial IOL dislocation was treated with YAG laser capsulotomy, which stabilized the lens and improved visual function. Conclusion. Capsular phimosis is a postoperative complication that can impair visual function following intraocular lens (IOL) implantation. Mild forms evolve favorably under observation, while severe forms may require YAG laser capsulotomy to stabilize the lens and improve vision
Comparative analysis of clinical, biochemical, and genomic profiles in mitochondrial and non-mitochondrial genetic groups
Get PDFMulțumiri.
Acest studiu a fost susținut de proiectul instituțional de cercetare
„Diagnosticul şi monitoringul bolilor genetice în profilaxia sAcknowledgement.
This study was supported by the institutional research project „Diagnosis and Monitoring of Genetic Diseases in the PrevenIntroducere. Bolile mitocondriale constituie un grup de afecţiuni multisistemice relativ frecvente, determinate de defecte ale fosforilării oxidative, cu o incidenţă estimată de 1 la 4.300 indivizi. Suprapunerea fenotipică cu alte tulburări genetice complică diagnosticul şi impune o evaluare mul-tidisciplinară integrată. Scop. Compararea caracteristicilor clinice, biochimice şi genetice ale afecţiunilor cu implicare mitocondrială şi ale altor tulburări ereditare, în vederea optimizării strategiilor de diagnostic. Material şi metode. Pacienţii cu un scor Nijmegen >3 au fost repartizaţi în Grupul 1 (implicare mitocondrială, n = 37) sau Grupul 2 (alte tulburări ereditare, n = 44). S-au efectuat evaluarea clinică, profilarea biochimică (lactat, aminoacizi), investigaţii instrumentale şi diagnostic molecular (qPCR-HRM, secvenţiere Sanger), cu analiză prin statistica descriptivă. Rezultate. Grupul 1 a prezentat rate semnificativ mai mari de afectare neuromusculară severă, regres de dezvoltare şi afectare oculară. Profilul biochimic a evidenţiat lactat şi alanină crescute, iar neuroimagistica a relevat afectarea ganglionilor bazali şi atrofie cerebrală şi cerebelară. Analiza moleculară a identificat mutaţii nucleare la 5 pacienţi; qPCR-HRM a confirmat 8 variante mitocondriale patogene; iar secvenţierea Sanger a evidenţiat mutaţii la alţi 24 de pacienţi, predominant în subunităţile Complexelor I şi V, frecvent cu afectare multiplă a lanţului respirator. Grupul 2 a inclus un spectru eterogen de afecţiuni genetice non-mito-condriale. Concluzii. Evaluarea integrată clinică, biochimică şi genetică diferenţiază eficient afecţiunile mitocondriale de cele non-mitocondriale, evidenţiind valoarea diagnostică critică a testării moleculare complete şi a evaluării multidi-sciplinare pentru îmbunătăţirea semnificativă a acurateţei diagnostice.Introduction. Mitochondrial diseases represent a prevalent group of multisystem disorders caused by defects in oxidative phosphorylation, with an estimated incidence of 1 in 4,300 individuals. The phenotypic overlap with other genetic disorders complicates diagnosis and requires integrated multidisciplinary evaluation. Objective. The aim of this study is to compare clinical, biochemical, and genetic features of mitochondrial involvement and other inherited disorders, in order to refine diagnostic approaches. Material and methods. Patients with a Nijmegen Score >3 were allocated to Group 1 (mitochondrial involvement, n = 37) or Group 2 (other inherited disorders, n = 44). Clinical assessment, biochemical profiling (lactate, amino acids), instrumental evaluations, and molecular diagnostics (qPCR-HRM, Sanger sequencing) were performed, with analyses via descriptive statistics. Results. Group 1 showed significantly higher rates of severe neuromuscular defects, developmental regression, and ocular abnormalities. Biochemical profiling detected elevated lactate and alanine, while neuroimaging revealed basal ganglia abnormalities and cerebral-cerebellar atrophy. Molecular analysis revealed nuclear gene mutations in 5 patients; qPCR-HRM confirmed 8 pathogenic mitochondrial variants; and Sanger sequencing identified 24 additional patients with mutations, mainly in Complex I, V subunits, often involving multiple respiratory chain complexes. Conversely, Group 2 comprised a heterogeneous array of non-mitochondrial genetic disorders. Conclusion. Integrated clinical, biochemical, and genetic evaluation effectively distinguishes mitochondrial from non-mitochondrial disorders, highlighting the critical diagnostic value of comprehensive molecular testing and multidisciplinary assessment to significantly improve diagnostic accuracy
Morphological characteristics of upper limb superficial veins in adults
Get PDFBackground
Anatomical variability of the superficial veins of the upper limb is an important and clinically significant topic in
contemporary anatomy. Despite well-established basic schemes of venous drainage, numerous studies demonstrate
a high frequency of individual and population-specific variations in vein course, calibre, branching patterns, and the
structure of anastomoses.
These variations have direct clinical relevance, influencing the outcome of venepuncture, catheterization, vascular
access placement, as well as reconstructive and microsurgical procedures. Particular attention is given to variations
in the cubital fossa and the presence of atypical venous connections, which are important for planning venous
grafts, arteriovenous fistulas, and complex surgical interventions.
Modern investigative methods, including anatomical, ultrasonographic, and angiographic studies, demonstrate a
broad spectrum of variations, often influenced by demographic and population-specific factors. Studying these variations
is also essential for medical education, as standard anatomical textbooks often fail to reflect the true diversity
of the venous system.
Systematic documentation of such data improves training of healthcare professionals and enhances the safety
and effectiveness of clinical and surgical procedures. The aim of the study was to identify morphological variations
of the superficial veins of the upper limb in adults for their application in clinical practice.
Material and methods
A study was conducted on 75 healthy young adults (36 females, 39 males, aged 18–23) for visualization of the
superficial veins of the upper limb. A sphygmomanometer cuff was applied to the upper arm (130-140 mmHg) while
participants repeatedly clenched and unclenched their fists, allowing the veins to fill and become visible through the
skin. The veins were recorded using a digital camera. Macroscopic examination and statistical analysis were performed.
Results
The study identified multiple anatomical variants of the superficial veins of the anterior upper limb (SVASUL),
differing in prominence, connectivity, symmetry, and morphology.
Among 75 upper limbs, 87% were asymmetrical. Well-developed veins were observed in 60% of cases, with the
most common variant (24%) showing all major veins prominent, whereas in 40% the veins were poorly developed
or absent. Specific patterns included a well-developed median cubital vein (10%), well-developed lateral and medial
superficial veins of the arm (14%), and combinations with the median forearm vein (6%).
The prominence and continuity of venous anastomoses were classified into continuous networks (77%) with
large anastomosing veins, and discontinuous networks (23%) linked by smaller veins and microcirculatory vessels.
Venous anastomoses were further classified by shape, with the V-shaped type being the most frequent (29%), followed
by N-, M-, H-, W-, U-, Y-, O-, X-shaped, network-like forms, and mixed types. This classification provides a
comprehensive framework for describing SVASUL variability, which has clinical relevance for venous access procedures
and surgical interventions.
Conclusions
SVASUL are characterized by bilateral asymmetry in 87% of cases, continuous venous networks in 77% of cases,
and well-developed veins in 60% of cases.
Among the well-developed veins, the most common variant includes prominent lateral and medial superficial
veins of the arm together with the median cubital vein (24% of cases), while the most frequent shape of the venous
anastomosis is the V-shaped type (29% of cases)
The value of general anesthesia in bronchoscopy in children with foreign bodies
Get PDFUniversitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu”, Chișinău, Republica MoldovaIntroducere. În bronhoscopie anestezia generală joacă un rol crucial în explorarea arborelui traheobronşic la copii, când se suspectează un corp străin în căile respiratorii inferioare. Aceasta necesită o abordare atentă, având în vedere vârsta mică a copilului, riscurile anesteziei şi a bron-hoscopiei. Scop. Această lucrare are ca scop evidenţierea rolului anesteziei generale în bronhoscopie la copii cu corpuri străine în căile respiratorii inferioare pentru o intervenţie promptă şi eficientă. Material şi metode. Lucrarea se bazează pe o analiză narativă a literaturii ştiinţifice internaţionale privind anestezia generală în bronhoscopia pediatrică pentru corpi străini. Au fost consultate baze de date medicale recunoscute, selectându-se articole relevante publicate în ultimii ani, inclusiv studii clinice, meta-analize şi ghiduri. Rezultate. Anestezia generală are un rol esenţial în bronhoscopia pediatrică, asigurând imobilizarea copilului şi prevenind complicaţiile. Permite controlul respiraţiei şi menţinerea oxigenării. Prin eliminarea durerii, facilitează o intervenţie sigură şi eficientă, reducând reflexele nedorite (tusea, voma). De asemenea, oferă condiţii optime pentru vizualizare şi manipulare, menţinând stabilitatea hemodinamică. Cu toate acestea, anestezia generală nu este lipsită de riscuri, precum reacţiile adverse la medicamente sau complicaţiile respiratorii. Prin urmare, este necesară o evaluare preoperatorie atentă şi o planificare riguroasă a intervenţiei. Concluzii. În bronhoscopia pediatrică pentru extragerea corpurilor străine, anestezia generală asigură condiţii optime de siguranţă, confort şi eficienţă. Deşi implică anumite riscuri, acestea pot fi minimizate la o evaluare atentă şi o abordare multidisciplinară, esenţială succesului.Introduction. In bronchoscopy, general anesthesia plays a crucial role in the exploration of the tracheobronchial tree in children, when a foreign body is suspected in the lower airways. This requires a careful approach, considering the young age of the child, the risks of anesthesia and bronchoscopy procedure. Objective. This paper aims to highlight the role of general anesthesia in bronchoscopy in children with foreign bodies in the lower respiratory tract for prompt and effective intervention. Material and methods. This study is based on a narrative review from the recent years of the international scientific literature about general anesthesia in pediatric bronchoscopy for foreign bodies. Recognised medical databases were consulted, selecting relevant articles published in recent years, including clinical trials, meta-analyses and guidelines. Results. General anesthesia plays an essential role in pediatric bronchoscopy, ensuring the immobilization of the child and preventing complications. It allows for breathing control and maintaining oxygenation. By eliminating pain, it facilitates a safe and effective intervention, reducing unwanted reflexes (cough, vomiting). It also provides optimal conditions for visualization and manipulation, maintaining hemodynamic stability. However, general anesthesia is not without risks, such as adverse drug reactions or respiratory complications. Therefore, careful preoperative evaluation and rigorous intervention planning are necessary. Conclusion. In pediatric bronchoscopy for foreign body extraction, general anesthesia provides optimal conditions of safety, comfort, and efficiency. Although it involves certain risks, these can be minimized with careful evaluation and a multidisciplinary approach, essential for success
Advances in ovarian cancer diagnosis: from biomarkers to imaging innovation
Get PDFIntroducere. În ciuda progreselor în oncologie, cancerul ovarian rămâne cea mai letală malignitate ginecologică, din cauza diagnosticului tardiv. Supravieţuirea la 5 ani este de 93% în stadiul I vs. 20% în stadiul IV, evidenţiind nevoia unor metode de diagnostic mai timpurii, eficiente, accesibile şi standardizate. Scop. Acest studiu evaluează metode actuale şi emergente de diagnostic al cancerului ovarian, concentrându-se pe imagistică avansată şi bio-markeri moleculari promiţători pentru detectare precoce. Material şi metode. Am efectuat un review sistematic al literaturii ştiinţifice recenzate publicate între 2016 şi 2025, utilizând baze de date academice majore precum PubMed, ScienceDirect, Elsevier şi ResearchGate. Strategia de căutare a inclus criterii predefinite de selecţie şi s-a concentrat pe studii care abordează progresele în diagnosticul cancerului ovarian. Rezultate. Ecografia transvaginală combinată cu CA-125 oferă o sensibilitate de 84,9% şi o specificitate de 98,2%. RMN-ul caracterizează superior masele anexiale, cu o sensibilitate de 98% şi o specificitate de 91%, iar PET/CT detectează eficient recurenţa şi ghidează tratamentul. Mi-croARN-urile circulante şi autoanticorpii specifici tumorii au demonstrat sensibilităţi de până la 85,7% şi specificităţi de 100%, depăşind CA-125. Instrumentele emergente, precum imagistica asistată de inteligenţă artificială, panourile multi-analitice şi biopsiile lichide cu ADN tumoral circulant (ctDNA), oferă promisiuni importante pentru detectarea ne-invazivă, precoce. Concluzii. Integrarea imagisticii avansate cu biomarkeri noi îmbunătăţeşte diagnosticul precoce al cancerului ovarian. Strategiile viitoare cu ctADN, microARN şi autoanticorpi pot creşte sensibilitatea şi specificitatea, facilitând intervenţii timpurii şi rezultate clinice şi calitatea vieţii pacienţilor.Introduction. Despite ongoing progress in oncology, ovarian cancer remains the most lethal gynecologic malignancy, often diagnosed late due to vague symptoms and limited early detection tools. 5-year survival rates drop from 93% (stage I) to 20% (stage IV), highlighting the need for more accurate diagnostic methods. Objective. This study evaluates current and emerging diagnostic methods for ovarian cancer, focusing on advanced imaging techniques and promising molecular biomarkers for early detection. Material and methods. A comprehensive systematic review of peer-reviewed literature published between 2016 and 2025 was conducted, utilizing major academic databases including PubMed, ScienceDirect, Elsevier, and ResearchGate. The search strategy incorporated predefined inclusion criteria and focused on studies addressing diagnostic advancements in ovarian cancer. Results. Transvaginal ultrasound (TVUS) combined with CA-125 offers a sensitivity of 84.9% and specificity of 98.2%. MRI demonstrates superior characterization of adnexal masses, with 98% sensitivity and 91% specificity, while PET/CT effectively detects recurrence and guides treatment planning. Circulating microRNAs and tumor-specific autoantibodies have shown diagnostic sensitivities up to 85.7% and specificities of 100%, outperforming CA-125 alone. Emerging tools such as AI-assisted imaging, multi-analyte panels, and liquid biopsies using circulating tumor DNA (ctDNA) hold substantial promise for non-invasive, early-stage detection. Conclusion. Combining advanced imaging with novel biomarker panels significantly improves ovarian cancer early detection. Future approaches using ctDNA, microRNAs, and autoantibodies may enhance both sensitivity and specificity, enabling earlier intervention and better patient outcomes
Proportional structure of chronic digestive diseases in children
Get PDFIntroducere. Bolile digestive cronice la copii sunt o problemă majoră de sănătate la nivel global, fiind reprezentate de tulburări gastrointestinale funcţionale, boli inflamatorii intestinale, afecţiuni biliare, boala celiacă şi hepatite cronice, care presupun provocări diagnostice şi terapeutice importante. Scop. Ne-am propus să analizăm structura ponderală a bolilor digestive la copii, pe baza raportului anual de activitate al subdiviziunii municipale de Gastroenterologie pentru anii 2023-2024. Material şi metode. Studiul a inclus datele anuale raportate în 2023 şi 2024, preluate din fişele medicale de spitalizare ale pacienţilor externaţi din subdiviziunea Pediatrie 1 Gastroenterologie a SCMC „V. Ignatenco”, diagnosticaţi cu patologii digestive. Diagnosticul a fost stabilit în conformitate cu criteriile prevăzute de ghidurile naţionale şi internaţionale. Rezultate. În 2023 şi 2024, tratament specializat gastroenterologic au primit, respectiv, 1.334 şi 1.375 copii cu vârsta între 3 şi 18 ani, majoritatea provenind din municipiul Chişinău. Toţi copiii au fost examinaţi clinic şi paraclinic, inclusiv endoscopic, utilizând testul rapid ureazic Pronto Dry (Italia). În 2024, 63% dintre copii au fost diagnosticaţi cu gastrită şi duodenită cronică cu predominanţa infecţiei cu Helicobacter pylori (31%), urmaţi de dispepsia funcţională (33%) şi pancreatita cronică (1,9%). În 2023, au predominat dispepsiile funcţionale (28,5%), urmate de gastritele şi duodenitele cronice (23%) şi pancreatitele cronice (4,4%). Concluzii. Studiul efectuat relevă o supradiagnosticare a gastritelor şi duodenitelor cronice la copii în 2024 şi o subestimare a tulburărilor funcţionale digestive în 2023. Pe locul 3 se află patologia cronică pancreatică 4,4% (2023) şi 1,9% (2024), bolilor cronice ale vezicii biliare fiind subestimate.Introduction. Chronic digestive diseases in children constitute a significant global health issue, encompassing functional gastrointestinal disorders, inflammatory bowel diseases, biliary tract conditions, celiac disease, and chronic hepatitis-each presenting distinct diagnostic and therapeutic challenges. Objective. We aimed to examine the proportional structure of chronic digestive diseases in children, based on the 2023-2024 annual report of the municipal Gastroenterology department. Material and methods. The study included annual data reported for 2023 and 2024, extracted from the hospitalization records of patients discharged from the Pediatrics 1 Gastroenterology subdivision of Valentin Ignatenco CCMH, diagnosed with digestive diseases. Diagnoses were established in accordance with the criteria set forth in national and international guidelines. Results. In 2023 and 2024, specialized gastroenterological treatment was provided to 1,334 and 1,375 children aged 3 to 18 years, mostly from Chisinau. All patients underwent clinical and paraclinical evaluations, including endoscopy, using the Pronto Dry rapid urease test (Italy). In 2024, 63% of children were diagnosed with chronic gastritis and duodenitis, predominantly associated with Helicobacter pylori infection (31%), followed by functional dyspepsia (33%) and chronic pancreatitis (1.9%). In 2023, functional dyspepsia was the predominant diagnosis (28.5%), followed by chronic gastritis and duodenitis (23%) and chronic pancreatitis (4.4%). Conclusion. The study shows overdiagnosis of chronic gastritis and duodenitis in children in 2024, alongside underestimation of functional gastrointestinal disorders in 2023. Chronic pancreatic disease ranked third in 2023 (4.4%) and 2024 (1.9%), with underrecognition of chronic gallbladder diseases
Sensorineural hearing loss: global health burden and contemporary therapeutic approaches
Get PDFIntroducere. Hipoacuzia neurosenzorială (HNS) este cea mai frecventă formă de pierdere de auz, rezultând din afectarea ireversibilă a celulelor ciliate din cohlee sau a căilor nervului auditiv. In acest context, dezvoltarea unor noi metode de tratament al hipoacuziei rămâne o prioritate la nivel global. Scop. Explorarea şi sintetizarea celor mai recente progrese în terapiile celulare aplicabile în hipoacuzia neurosenzorială, în vederea eficientizării tratamentului patologiei date. Material şi metode. Au fost selectate articole din ultimii 10 ani din cele mai recente publicaţii ştiinţifice indexate în baze de date medicale majore precum PubMed, Scopus şi Web of Science, utilizând termeni-cheie relevanţi: “sensorineural hearing loss”, “hair cell regeneration”, “stem cell therapy”, “inner ear regeneration” şi “cell reprogramming”. Rezultate. În ultimul deceniu, terapiile celulare au devenit un domeniu promiţător de cercetare în tratamentul hipoacuziei neurosenzoriale (HNS), urmărind restaurarea funcţiei auditive prin regenerarea celulelor ciliate şi a neuronilor auditivi, realizându-se următoarele direcţii de cercetare: terapia cu celule stem pluripotente induse (iPSC), terapia cu celule stem mezenchimale (MSC), biomateriale de susţinere (hydrogels, nanoscaffolduri). Aceste tehnologii cresc rata de supravieţuire celulară şi potenţialul de regenerare. Majoritatea acestor terapii sunt în fază preclinică sau în trialuri clinice de fază I/II, cu rezultate preliminare încurajatoare. Concluzii. Terapia celulară oferă o perspectivă revoluţionară, vizând restaurarea funcţională a cohleei prin regenerarea celulelor ciliate şi a structurilor neuronale. Viitorul tratamentului hipoacuziei neurosenzoriale se conturează din ce în ce mai clar ca fiind unul biologic şi personalizat.Introduction. Sensorineural hearing loss is the most common form of hearing impairment resulting from irreversible damage to the cochlear hair cells or auditory nerve pathways. This condition affects millions of individuals regardless of age, and has a significant impact on quality of life and mental health. Objective. This work aims to highlight the biological mechanisms involved in hearing loss, current experimental strategies, and the challenges in translating these therapies into clinical practice. Material and methods. A narrative review of the scientific literature was conducted, focusing on emerging therapeutic approaches for sensorineural hearing loss, with particular emphasis on cellular and molecular strategies. Relevant studies were identified through comprehensive searches of major medical research databases including PubMed, Scopus, and Web of Science. Results. In recent years, cell-based therapies have emerged as a promising research direction in the treatment of sensorineural hearing loss (SNHL), aiming to restore auditory function through regeneration of cohlear hair cells and auditory neurons. Some of these therapies are induced pluripotent cell therapy, mesenchymal stem cells, biocompatible scaffold proteins (hydrogels, nanofiber matrices). These therapies remain in preclinical or early-phase clinical trials (Phase I/II). While preliminary results are promising, further research is needed to establish safety, reproducibility, and clinical applicability at large scale. Conclusion. Sensorineural hearing loss remains a major global health burden, significantly affecting cognition and the quality of life. Current rehabilitative strategies provide functional benefits, they do not address the underlying biological and specific damage within the cochlea
Renovascular hypertension associated with fibromuscular dysplasia in a young patient treated by angioplasty - Case study
Get PDFIntroducere. Hipertensiunea renovasculară (HRV), o formă de hipertensiune arterială secundară, este asociată în 7080% cu displazia fibromusculară (DFM) la tineri. Diagnosticul precoce prin metode imagistice şi de laborator, cât şi corecţia intervenţională timpurie previn complicaţiile cardiovasculare şi renale. Scop. Prezentarea cazului clinic a unui tânăr cu HRV, cu evaluarea stabilirii diagnosticului şi eficienţa angioplastiei periferice cu balon în controlul tensiunii arteriale (TA). Material şi metode. Bărbat, 18 ani, a fost investigat prin examen clinic, anamneză, analizele de laborator (hemogramă, ionogramă, renină plasmatică, aldo-sterona, metanefrinele, TSH, T3), monitorizare ambulatorie a tensiunii arteriale (MATA), ecografie Doppler renală, eco-cardiografie transtoracică, şi tomografie computerizată prin angiografie (angio-CT). Rezultate. Acuze: cefalee occipitală şi astenie; TA 165/90 mmHg. Renina serică 7,8 ng/mL/h. MATA a evidenţiat un profil non-dipper, TA medie diurnă -147/95 mmHg, nocturnă - 138/91 mmHg. La Angio-CT s-a identificat stenoză de 70% a arterei renale stângi cu aspect „mărgele pe fir”. Sub tratament iniţial (amlodipina, lisinopril) TA a scăzut la 130/85 mmHg. Angioplastia cu balon non-farmacologic a stenozei arterei renale stângi, realizată după 2 săptămâni, a restabilit fluxul arterial (stenoză reziduală). Concluzii. HRV cauzată de DFM trebuie suspectată la tinerii cu hipertensiune refractară la tratament. Renina serică crescută şi angio-CT a arterelor renale sunt investigaţii cheie, iar angioplastia precoce normalizează TA, reduce necesarul de medicaţie, şi îmbunătăţeşte calitatea vieţii pacientului.Introduction. Renovascular hypertension (RVH), a form of secondary arterial hypertension, is associated in 70-80% of young patients with fibromuscular dysplasia (FMD). Early diagnosis through imaging and laboratory methods, along with timely interventional correction, prevents cardiovascular and renal complications. Objective. Clinical case presentation of a young patient with RVH, including diagnostic evaluation and the effectiveness of peripheral balloon angioplasty in blood pressure (BP) control. Material and methods. Man, 18 years old, was investigated through clinical examination, medical history, laboratory tests (complete blood count, electrolyte panel, plasma renin, aldosterone, metanephrines, TSH, T3), ambulatory blood pressure monitoring (ABPM), renal Doppler ultrasound, transthoracic echocardiography, and computed tomography angiography (angio-CT). Results. Complaints: occipital headache and asthenia; BP 165/90 mmHg. Serum renin: 7.8 ng/mL/h. ABPM revealed a non-dipper profile, with an average daytime BP of 147/95 mmHg and nighttime BP of 138/91 mmHg. Angio-CT identified a 70% stenosis of the left renal artery with a “string-of-beads” appearance. Under initial treatment (amlodipine, lisinopril) BP decreased to 130/85 mmHg. Non-drug balloon angioplasty of the left renal artery stenosis, performed after 2 weeks, restored arterial flow (residual stenosis). Conclusion. RVH caused by FMD should be suspected in young patients with treatment-resistant hypertension. Elevated serum renin and renal artery angio-CT are key investigations, while early angioplasty normalizes blood pressure, reduces the need for medication, and improves the patient's quality of life
Surse de inervație ale venei cave superioare
Get PDFIntroducere
Morfologia patului vascular și autentificarea mecanismelor reglării nervoase a hemodinamicii venelor sistemice,
în special a venei cave superioare joacă un rol semnificativ în dezvoltarea maladiilor cardiovasculare.
Cunoașterea complexității morfologice a venei cave superioare poate avea un impact major în prevenirea și
tratamentul acestor maladii.
Scopul lucrării
Identificarea surselor de inervație ale venei cave superioare și rolul acestora în dezvoltarea patologiei cardiovasculare.
Material și metode
Sursele de inervație ale venei cave superioare au fost investigate prin metoda disecției anatomice fine pe 8 cadavre de adulți, din fondul Catedrei de anatomie și anatomie cinică, a USMF „Nicolae Testemițanu”.
Rezultate
Inervația venei cave superioare este asigurată de variate ramuri nervoase cu proveniență de la ganglionii cervicali ai trunchiului simpatic, nervul vag, ansele cervicală și subclaviculară.
Concluzii
Inervația complexă a venei cave superioare denotă rolul funcțional și semnificația clinică a acesteia în circulația
sistemică.Introduction
The morphology of the vascular bed and the authentication of the mechanisms by which the nervous system
regulates the hemodynamics of the systemic veins, especially of the superior vena cava, has a significant role in the
development of cardiovascular diseases.
Knowledge of the morphological complexity of the superior vena cava can have a major impact in the prevention
and treatment of those diseases.
Aim of study
Identification of the innervation sources of the superior vena cava and their role in the development of cardiovascular pathology.
Material and methods
The innervation sources of the superior vena cava were investigated by fine anatomical dissection on 8 adult
cadavers, from the Department of Anatomy and Clinical Anatomy of Nicolae Testemitanu SUMPh.
Results
The innervation of the superior vena cava is provided by various nervous branches originating from the cervical
ganglia of the sympathetic trunk, the vagus nerve, the cervical and subclavian loops.
Conclusions
The complex innervation of the superior vena cava denotes its functional role and clinical significance in the
systemic circulation
Anatomy of the coronary sinus of the adult human heart
Get PDFBackground.
Anatomy of the coronary sinus (CS) is important for radiofrequency ablation and implantation of intracardiac
electrodes. The objective was to explore structure and topography of the CS in the adult heart.
Material and methods
We studied 50 specimens of the heart by dissection, corrosion, and histotopographic method.
Morphometry was performed with a caliper; histotopograms were studied by means Olympus stereomicroscope.
Results
The CS length was 34.3 mm, varied from 13.7 to 50 mm in dissected specimens, and 31.8 mm (23.8–44.8 mm) in
corrosion casts. The circumference of the CS in its middle (Rs=.85) and at the confluence (Rs=.7; p<.005) increased
with the thickening of the left ventricular myocardium but didn’t depend on the heart weight.
On histotopograms, the thickness of the CS wall was 1.27 mm (.15 to 3.73 mm).
Despite the differences in the thickness of certain walls in the distal, middle, and proximal parts of the CS, the
average values of the CS wall thickness increased in the direction of blood flow, which was primarily due to the
presence of the myocardial “sheath” around the CS.
We analyzed the correspondence of coronary dominance and variants of the adjacent anatomy of CS and neighboring arteries.
Conclusion
CS is revealed to be anatomical variability, which is exhibited by certain shape variants, size ratios, thickness
parameters and histotopographic features of the walls, and various relationships of CS with the atrial myocardium
and arteries in the coronary sulcus