Treatment of end-stage peripheral artery disease by neuromodulation.

BACKGROUND: Neuromodulation is a therapeutic option to improve limb salvage in end-stage peripheral arterial disease (PAD), but there is no consensus on its indication for spinal cord stimulation (SCS) in PAD patients. OBJECTIVE: The aim of this study was to present the outcome of end-stage PAD patients treated with SCS. METHODS: This study is a retrospective analysis based on a local prospective registry. Neuromodulation was performed if there was: 1) no revascularisation option, 2) no septicemia, 3) and Rutherford stage 4-6. The primary endpoint of the study was limb salvage. Secondary endpoints were reduction in pain or simply pain reduction pain (assessed using a visual anlog scale/VAS) and improvement in walking distance. RESULTS: Limb salvage was reached in 30/34 patients (88%). Patients reported a significant reduction in pain on the 10-point VAS scale from baseline (median = 7.5, IQR = 7-8) to follow-up at 2 years (median = 0, IQR 0-2.75), p < 0.001. Walking distance also improved from preoperative (median = 50 m, IQR = 20-50 m) to follow-up at 2 years (median = 150 m, IQR 50-272 m), p < 0.001. RESULTS: SCS implantation in patients with end-stage PAD can enable limb salvage in a high percentage of cases and increase mobility due to pain reduction. The role of microcirculation in these improvements needs to be investigated in further studies.

[The management of acute pancreatitis according to the modern guidelines]. / Managementul pancreatitei acute conform ghidurilor terapeutice actuale.

Severe acute pancreatitis is a critical illness as the organism that produces a significant mortality despite diagnostic and therapeutic acquisitions. While new mechanisms have been identified for production and were crystallized management principles, a number of controversies remain awaiting resolution in the near future. Aim is to establish, based on their experience and literature data, place the current means of diagnosis and treatment in close correlation with the pathophysiological events of acute pancreatitis.

Mesenteric venous thrombosis: clinical and therapeutical approach.

Mesenteric venous thrombosis (MVT), an unusual location of deep venous thrombosis, occurs especially on a predisposing terrain. Recently, hyperhomocysteinemia has been shown to be associated with venous thrombosis, often recurrent and located in an uncommon site. Hyperhomocysteinemia is mainly due to genetic causes (mutations 677C>T and 1298A>C of methylenetetrahydrofolate reductase) and vitamins B deficiencies. MVT may present as acute, subacute or chronic form. The clinical supposition of mesenteric thrombosis is based on the discrepancy between the abdominal pain and the physical examination. The nonspecific character of the pain, mimicking peptic ulceration in some cases, and the possibility of an initial normal clinical examination may delay the diagnosis. The occurrence of the fever, rebound tenderness and guarding suggests progression to bowel infarction. MVT leads to peritonitis in 1/3 to 2/3 of cases. Laboratory blood tests are not helpful in confirming the diagnosis of venous thrombosis. Leukocytosis and metabolic acidosis are considered to be the most specific laboratory findings in patients with mesenteric ischemia. Abdominal computed tomography is the test of choice for the diagnosis. However, most of the cases are diagnosed during laparotomy or autopsy. Anticoagulant therapy administrated early increases the survival rate. Surgery is indicated in cases with bowel infarction or peritonitis.

[Clinico-histopathological correlations of venous wall modifications in chronic venous insufficiency]. / Corelatii clinico-histopatologice ale modificarilor parietale venoase in insuficienta venoasa cronica.

The interest manifested for the conjunctive tissue pathology leaded to the study of the structural disorder that appears in the varicose veins walls. The study is a prospective one initiated in March 2007 made on 11 patients with varicose disease hospitalized at Cluj-Napoca within Surgery Clinic no. II. The purpose of this study is to point out the histopathological modifications in the varicose venous wall (great saphenous vein cross, communicating veins, perforating veins), as well as the correlation of histopathological results with the evolutive stage of chronic vein insufficiency (CEAP classification) and with the clinical score at these patients. The histopathological (HP) results for 2 of the patients revealed hypertrophy of the media, intimal hyperplasia (stage II) corresponding to a CEAP 3. Six patients were integrated in HP stage III due to the partial intimal fibrosis corresponding to a CEAP 6 for one case, CEAP 4 one case, CEAP 3 four cases. One patient had HP stage I with CEAP 3 and two patients had HP stage IV corresponding to CEAP 5, respectively CEAP 6.

[Surgical treatment of aorto-iliac atherosclerosis]. / Tratamentul chirurgical al bolii aterosclerotice aorto-iliace.

The occlusive aorto-iliac disease is the consequence of a diffuse atherosclerotic process aggravated by risk factors and existing co-morbidity. The treatment aims at correcting the risk factors, balancing and compensating the associated diseases, the surgical re-vascularization of the lower limbs (by pass, particular techniques for the aortic aneurysms, necessity interventions). Aortic and peripheral angiographic exploration is required for the establishment of surgical strategy. The lot studied includes 77 patients hospitalized in the period between 2000-2006 in the Surgery Clinic no. II, Cluj-Napoca. 33 cases had an obstruction of a single iliac artery. The bilateral affection has been present in 27 cases, while that of the terminal trunk of the aorta and of its bifurcation has been present in 17 cases. The most frequent intervention has been the aorto-bifemoral prosthesis, the prosthesis used being: Terom, Dacron and PTFE. The thrombendarterectomy was used as an independent method or associated with the by-pass. At the same time, the aortoiliac interventions were associated with aorto-inguinal bypass, crossover as well as disarticulations and amputations of toes. 26% of the 77 patients, had early post-surgery complications (hemorrhage, infection, the thrombosis of the graft). The re-vascularization failed in 3.8% of cases, a major amputation of the limb being necessary. 11 deaths (14.3%) were recorded which occurred as a result of systemic complications.

[The experimental heterotopic transplantation of an isolated segment of colon]. / Transplantarea heterotopica experimentala a segmentului izolat de colon.

The heterotopic transplantation of isolated colon segment was achieved in the cervical region, for to study the behaviour of the colon in this new situation. The study included 20 dogs from which there were taken segments of 10 cm length from, the left colon. Then was prepared the common carotid artery, superficial jugular vein and their branches. In 5 dogs the cervical esophagus was resected. Then was performed the transplant using micro-surgical techniques. In 15 dogs the colon was exteriorized at the skin and in 5 dogs the colon was placed between the ends of the esophagus. In 76% of cases the postoperative evolution was good. From the viable colon transplants were taken fragments for histologic examinations after 1, 2 respectively 4 weeks postoperative. The results obtained, recommend the colic transplant as a possible graft for repairing the cervical esophagus defects.