http://repository.usmf.md:80/handle/20.500.12710/10713 2026-07-03T17:26:12Z http://repository.usmf.md:80/handle/20.500.12710/29004 Title: Assessment of the cases of postpartum hemorrhage in multiparous women Authors: Cemortan, Maria; Bubulici, Cristina; Vicol, Maria-Magdalena; Grajdean, Elena; Scripnic, Gabriela; Manic, Milena Abstract: Introduction. Postpartum hemorrhage (PPH) is one of the leading obstetric complications, affecting 5-15% births. Being a major factor in maternal mortality and morbidity, PPH causes about 25% of maternal deaths worldwide. Aim of study. The aim of the study was to assess the cases of PPH in multiparous women, admitted to the Tertiary Perinatal Center. Methods and materials. The retrospective study was performed by assessing 81 clinical cases of PPH in multiparous women. Total blood loss in labor or C-section was performed by using graduated vessels, and all the sterile material used was weighted. For continuous variables, the mean values and standard deviation of the mean were calculated; the median (Me) as well as the interquartile range (Q1;Q3) in the case of a distribution of characteristics that differs from the normal. Results. The average age of women was 31.6±5.5 years (Me 32 (28;35.5)), varying in the limits of 20-42 years. The majority of participants delivered for the second time - 38 cases (46.9% (95% CI 33.3-59.9)), however, 30 women (37.0% (95% CI 25.9-48.2)) gave birth for the third time, and 13 women (16.1% (95% CI 8.5-27.4)) had 4th – 9th delivery. In 41 cases (50.6% (95% CI 40.7- 61.7)) a c-section was performed. The mean blood loss in vaginal delivery was 850±308 (Me 800 (600;1050)) mL, varying in the limits of 500– 1600 mL. Compared to the mean blood loss in Csection – 1752±1093 (Me 1500 (1100;1850)) mL, varying in the limits of 1000 – 5250 mL. In the structure of PPH there were assessed 26 cases (32.1% (95% CI 20.9-47.0)) of the placental defect or placenta adherens, 15 cases (18.5% (95% CI 10.3-30.5)) of lacerations of the birth canal, 11 cases (13.6% (95% CI 7.4-23.4)) of uterine atonia, and 2 cases (2.5% (95% CI 0-7.3)) of uterine rupture. Hence, in 46 women (56.8% (95% CI 44.6-69.1)) it was applied conservative management of the cases. However, in 20 cases (24.6% (95% CI 15.0-38.1)) an operative management was applied, from which 7 cases (8.6% (95% CI 3.7-14.7)) hemostatic sutures were applied. In 13 cases (16.0% (95% CI 8.5-27.4)) hysterectomy was performed, from which 9 cases (69.2% (95% CI 31.6-100)) subtotal hysterectomy without annexes was the elective method for definitive hemostasis. Conclusion. PPH is a major obstetric complication, which occurs more frequently in multiparous women, in association with placental pathology and birth canal trauma, explained by overextension of the uterus and coagulation disorders, requiring extensive surgical management. 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28447 Title: Biochemical aspects of malabsorption syndromes Authors: Burdeniuc, Ion Abstract: Introduction. Malabsorption affects millions of people worldwide. Prevalence of coeliac disease in the general population ranges from 0,5% to 2%, with an average of about 1%. At present over 100,000 people suffer from cystic fibrosis worldwide. Malabsorption can be caused by many different diseases and may lead to a wide spectrum of clinical signs, symptoms and biochemical findings including vitamin, mineral and macronutrient deficiency syndromes. Aim of study. Malabsorption is a clinical term that refers to the impaired absorption of nutrients. It encompasses defects that occur during the digestion and absorption of food nutrients by, and infections of, the gastrointestinal tract. Methods and materials. In the Pubmed and Google Scholar databases, we selected and analyzed 30 articles with embedded keywords: “Malabsorption syndromes”, “Coeliac Disease”, “Cystic Fibrosis”, etc. Results. The absorption of nutrients occurs in three distinct stages: luminal, mucosal, and postabsorptive. Malabsorption syndromes can be classified depending on which of these three stages is affected. There are numerous causes of malabsorption, including lactose intolerance, inflammatory bowel diseases, cystic fibrosis, short bowel syndrome, and others. Therefore, it is important to thoroughly examine the family history. From a biochemical perspective, malabsorption syndromes can be classified based on which nutrients are not assimilated: proteins, fats, carbohydrates, or micronutrients. Malabsorption syndromes are manifested by both biochemical abnormalities (anemia, hypoalbuminemia, dyslipidemia, vitamin deficiencies, etc.) and a clinical triad, including chronic diarrhea, abdominal distension, and developmental and/or growth delay. Celiac disease should be considered a primary food-related condition with lifelong consequences for affected individuals. The specific role of HLA-DQA1 and HLA-DQB1 genes in presenting gluten peptides as antigens makes the MHC-HLA locus a crucial genetic factor in the development of celiac disease. Nutrition is closely linked to the disease outcome, and malnutrition in cystic fibrosis typically results in a chronic negative energy balance, leading to malabsorption due to pancreatic enzyme insufficiency. Conclusion. Nutrient absorption can be disrupted by numerous pathophysiological conditions, including genetic disorders, such as those seen in celiac disease. Understanding the biochemical mechanisms of malabsorption syndromes is crucial for the diagnosis and management of these pathologies. in the general population ranges from 0,5% to 2%, with an a verage of about 1%. At present over 100,000 people suffer from cystic fibrosis worldwide. Malabsorptio n can be caused by many different diseases and may lead to a wide spectrum of clinic al signs, symptoms and biochemical findings including vitamin, mineral and macronutrient deficie ncy syndromes. Aim of study. Malabsorption is a clinical term that refers to the i mpaired absorption of nutrients. It encompasses defects that occur during the digestion and a bsorption of food nutrients by, and infections of, the gastrointestinal tract. Methods and materials. In the Pubmed and Google Scholar databases, we selected and analyzed 30 articles with embedded keywords: “Malabsorption syndromes”, “Coeliac Disease”, “Cystic Fibrosis”, etc. Results. The absorption of nutrients occurs in three distinct s tages: luminal, mucosal, and postabsorptive. Malabsorption syndromes can be classified de pending on which of these three stages is affected. There are numerous causes of malabso rption, including lactose intolerance, inflammatory bowel diseases, cystic fibrosis, short bo wel syndrome, and others. Therefore, it is important to thoroughly examine the family history. From a bioch emical perspective, malabsorption syndromes can be classified based on which n utrients are not assimilated: proteins, fats, carbohydrates, or micronutrients. Malabsorption syndromes are manifested by both biochemical abnormalities (anemia, hypoalbuminemia, dyslipide mia, vitamin deficiencies, etc.) and a clinical triad, including chronic diarrhea, abdominal distension, and developmental and/or growth delay. Celiac disease should be considered a prim ary food-related condition with lifelong consequences for affected individuals. The specific role o f HLA-DQA1 and HLA-DQB1 genes in presenting gluten peptides as antigens makes the MHC-HLA locus a crucial genetic factor in the development of celiac disease. Nutrition is closely linke d to the disease outcome, and malnutrition in cystic fibrosis typically results in a chronic neg ative energy balance, leading to malabsorption due to pancreatic enzyme insufficiency. Conclusion. Nutrient absorption can be disrupted by numerous pathophysiol ogical conditions, including genetic disorders, such as those seen in celiac disease. Understanding the biochemical mechanisms of malabsorption syndromes is crucial for th e diagnosis and management of these pathologies. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28443 Title: The anatomical variability of the last three pairs of the intercostal arteries Authors: Croitoru, Dan; Coșciug, Stanislav Abstract: Introduction. The intercostal arteries are of vital significance in the vascularisation of the intercostal musculature, fascia and the ribs. The last three pairs are involved in the blood supply of the antero-lateral abdominal wall and may be considered during the surgical intervention in this region. These may also play a vital role in the neurosurgical approaches to the intervertebral disks because of the possibility of a dramatical protrusion of the disk during the surgical intervention. Aim of study. To determine the particularities of the number, origin, trajectory and branching of the last three pairs of the intercostal arteries Methods and materials. We have studied 20 sections of the Magnetic Resonance Imaging in contrast regime of the arterial window in order to identify the anatomical variability patterns. Overall there have been 14 female patients and 6 male patients. The statistically processed data has been acquired. Results. The mean age of the patients in the study poll was 58.55±13.24 years. In the available literature reports the posterior intercostal arteries have branching patterns with the adjacent arterial systems. We have identified 14 cases that had collateral branches (70%) and 6 cases that did not have such branches (30%). The anatomical trajectory of the arteries is usually straight but in an advanced age they may become sinuous in some portions or in their whole trajectory. We have identified completely straight arteries in 2 cases (10%), partially straight and partially sinuous in 6 cases (30%) and completely sinuous in 12 cases (60%). Their length was not measured because in imagistic studies this is a relative limitation and it is already proven in numerous studies in different countries with different ethnic composition that there are no statistical significant factors which may influence it. Conclusion. The last three intercostal arteries are of comparable anatomical variability with other countries. The most prevalent group is the one which has collateral branches and sinuous trajectory (particularly because of an advanced age in our study poll). intercostal musculature, fascia and the ribs. The last three pairs are involved in the blood supply of the antero-lateral abdominal wall and may be consider ed during the surgical intervention in this region. These may also play a vital role in the neuros urgical approaches to the intervertebral disks because of the possibility of a dramatical protrusion of th e disk during the surgical intervention. Aim of study. To determine the particularities of the number, origin, tr ajectory and branching of the last three pairs of the intercostal arteries Methods and materials. We have studied 20 sections of the Magnetic Resonance Imaging in contrast regime of the arterial window in order to identify the anatomical variability patterns. Overall there have been 14 female patients and 6 male patien ts. The statistically processed data has been acquired. Results. The mean age of the patients in the study poll was 58.55±13.24 year s. In the available literature reports the posterior intercostal arteries h ave branching patterns with the adjacent arterial systems. We have identified 14 cases that had collateral br anches (70%) and 6 cases that did not have such branches (30%). The anatomical trajectory o f the arteries is usually straight but in an advanced age they may become sinuous in some portions or in their whole trajectory. We have identified completely straight arteries in 2 cases (10% ), partially straight and partially sinuous in 6 cases (30%) and completely sinuous in 12 cases (60%). Their length was not measured because in imagistic studies this is a relative limitation and it is already proven in numerous studies in different countries with different ethnic composition that there are no statistical significant factors which may influence it. Conclusion. The last three intercostal arteries are of comparable anatomical variability with other countries. The most prevalent group is the one which has collateral branches and sinuous trajectory (particularly because of an advanced age in our study poll). Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28445 Title: Variational aspects of the deep femoral artery Authors: Nacu, Zinaida Abstract: Introduction. The deep femoral artery (DFA), also known as the deep artery of the thigh, classically, originates from the lateral semi-circumference of the femoral artery (FA), in the distal direction, at a distance of about 4 cm from the inguinal ligament. It is of huge interest both for the angiographic diagnostic procedures and for the vascular and endovascular surgeons, due to the role it has in the collateral circulation between the blood vessels in the pelvis and those ones in the popliteal-tibial area. Aim of study. Studying the specialized references that describe the variational morphological peculiarities of the deep femoral artery. Methods and materials. There have been studied 25 reference sources, 6 national and 19 international references. Aiming to achieve this goal, we have carried on a study, by examining and processing the information on this topic of study, from various sources. Results. 22 sources provided the variants of origin of the deep femoral artery, as found with the frequency from 30 to 45%. In 80-85% of cases, the DFA originates from the FA. However, there are known variations of branching. In 48-60% of cases, the medial circumflex femoral artery (MCFA) and the lateral circumflex femoral artery (LCFA) originate from the DFA. In 25-34% of cases, the MCFA originates from the FA, while the LCFA originates from the DFA. In 9-12% of cases, the LCFA originates from the FA, and the MCFA originates from the DFA. There are also rare cases (1- 2%), when the DFA, MCFA and LCFA originate from the FA trifurcation. 20 reference sources have identified a range of anatomical variations of the DFA pathway, namely: in the majority of cases (from 40% to 55% of cases), the deep femoral artery goes in the posterolateral direction. It may also have the strictly posterior direction (from 20% to 40% of cases). It may also have the posteromedial pathway (from 5% to 14% of cases), or the strictly medial pathway (from 1.5% to 3.1% of cases). There are two extremely rare variations: DFA doubling, and DFA origin from the bifurcation of the external iliac artery, laterally to the femoral artery, with branching into the MCFA, LCFA, and two perforating arteries. Knowing the morphological variations of the deep femoral artery is essential for avoiding the arteriovenous femoral iatrogenic fistulas, which are caused by the femoral artery punction. Conclusion. Knowing the variations of origin and the pathway of the deep femoral artery and its branches, is very important for the successful results, both in the course of interventional and surgical procedures. Defining the vascular pattern before any and all invasive procedures will allow the surgeons to avoid iatrogenic injuries. classically, originates from the lateral semi-circumfer ence of the femoral artery (FA), in the distal direction, at a distance of about 4 cm from the inguinal ligament. It is of huge interest both for the angiographic diagnostic procedures and for the vascular a nd endovascular surgeons, due to the role it has in the collateral circulation between th e blood vessels in the pelvis and those ones in the popliteal-tibial area. Aim of study. Studying the specialized references that describe the variati onal morphological peculiarities of the deep femoral artery. Methods and materials. There have been studied 25 reference sources, 6 nationa l and 19 international references. Aiming to achieve this goal, we have carried on a study, by examining and processing the information on this topic of study, from various sources. Results. 22 sources provided the variants of origin of the deep fe moral artery, as found with the frequency from 30 to 45%. In 80-85% of cases, the DFA origina tes from the FA. However, there are known variations of branching. In 48-60% of cases, the me dial circumflex femoral artery (MCFA) and the lateral circumflex femoral artery (LC FA) originate from the DFA. In 25-34% of cases, the MCFA originates from the FA, while the LCFA originates from the DFA. In 9-12% of cases, the LCFA originates from the FA, and the MCFA originates from the DFA. There are also rare cases (1- 2%), when the DFA, MCFA and LCFA origina te from the FA trifurcation. 20 reference sources have identified a range of anatomical va riations of the DFA pathway, namely: in the majority of cases (from 40% to 55% of cases), the deep femoral artery goes in the posterolateral direction. It may also have the strict ly posterior direction (from 20% to 40% of cases). It may also have the posteromedial pathway (f rom 5% to 14% of cases), or the strictly medial pathway (from 1.5% to 3.1% of cases). There are two extremely rare variations: DFA doubling, and DFA origin from the bifurcation of the external iliac artery, laterally to the femoral artery, with branching into the MCFA, LCFA, and two perfo rating arteries. Knowing the morphological variations of the deep femoral artery i s essential for avoiding the arteriovenous femoral iatrogenic fistulas, which are caused by the femora l artery punction. Conclusion. Knowing the variations of origin and the pathway of the deep femoral artery and its branches, is very important for the successful results, both in the course of interventional and surgical procedures. Defining the vascular pattern before any and all invasive procedures will allow the surgeons to avoid iatrogenic injuries. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z