Deep venous thrombosis during pregnancy and the postpartum period: clinical and evolutional features

Catedra de chirurgie general semiologie nr. 3, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Tromboza venelor profunde (TVP) a membrelor inferioare dezvoltată pe parcursul sarcinii sau postpartum are o incidență de 0,5-1 cazuri la 1000 nașteri; reprezentând un factor important ce sporește morbiditatea și mortalitatea maternă. Scopul: Studierea particularităților clinice, imagistice şi evolutive ale TVP survenite pe parcursul sarcinii sau lăuziei. Material şi metode: Studiul a cuprins 21 paciente cu TVP confirmată prin duplex scanare. În toate observațiile a fost iniţiată medicaţia anticoagulantă în asociere cu compresia elastică. În cazurile dificultăților de vizualizare la examenul imagistic primar sau progresării manifestărilor clinice pe fundalul tratamentului duplex scanarea a fost repetată peste 3-5 zile. Rezultate: Vârsta medie a pacientelor – 30,7 ani. TVP a fost depistată la primipare – 7 cazuri, pe durata celei de-a doua sarcini – 9, la gravidele cu a treia sarcină – 4 şi, într-un caz, pe durata celei de-a patra sarcini. TVP în antecedente au indicat 3 (14,2%) paciente. Tromboza a survenit în trimestrul I al gestației la 4 (19%) paciente, al II-lea – 4 (19%), al III-lea – 8 (38%) şi postpartum – 5 (23,8%). Afectarea extremității stângi s-a înregistrat în 16 (76,2%) cazuri. Localizarea TVP: vv.tibiale – 4 cazuri, v.poplitee – 2, v.femurală – 2, v.femurală comună – 2, vv.iliace – 9, v.cavă inferioară – 2. Duplex scanarea repetată a evidențiat progresarea trombozei spre segmentul anatomic venos proximal (n=2; 9,5%) sau extinderea în sens descendent (n=2; 9,5%). Concluzii: TVP se poate dezvolta în orice trimestru al sarcinii, precum şi postpartum; având sediul inițial mai frecvent în regiunea iliacă sau tibială și potențial de progresare chiar și pe fundalul anticoagulării inițiale adecvate.Background: Deep vein thrombosis (DVT) of lower extremities developed during pregnancy or postpartum period has an incidence of 0.5-1 cases per 1.000 births and represents an important factor which increases maternal morbidity and mortality. Aim of study: To highlight clinical, imaging and evolutional peculiarities of DVT occurring during pregnancy or postpartum period. Methods and materials: The study included 21 female patients with DVT confirmed by duplex scanning. Anticoagulants in association with elastic compression were initiated in all cases. In the event of difficult viewing during primary imaging exam or worsening of clinical manifestations despite treatment, duplex scanning was repeated after 3-5 days. Results: Average age of patients was 30.7 years. DVT was identified in primiparous women – 7 cases, during the second pregnancy – 9, in women with a third pregnancy – 4, and, in one case – during the fourth pregnancy. Previous history of DVT was indicated by 3 (14.2%) patients. Thrombosis occurred during the first trimester of gestation in 4 (19%) patients, II-nd – 4 (19%), III-rd – 8 (38%), and postpartum – 5 (23.8%). Involvement of the left limb was registered in 16 (76.2%) cases. Localization of DVT: tibial vv. – 4 cases, popliteal v. – 2, femoral v. – 2, common femoral v. – 2, iliac vv. – 9, inferior vena cava – 2. Repeat duplex scanning pointed out the progression of thrombosis to proximal venous segment (n=2; 9.5%) or downward extension (n=2; 9.5%). Conclusion: DVT can develop during any trimester of pregnancy as well as postpartum; being initially localized more frequently in iliac or tibial veins and having potential to progress even despite of appropriate initial anticoagulation

Distal forearm fractures at children

SCMC „V. Ignatenco”, Chișinău, Republic of Moldova, Clinic „Medicort”, Orhei, Republic of Moldova, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016The presentation elucidates the topicality, statistics, the tactics of treatment of distal forearm fractures at children. A high frequency of fractures, difficulties in choosing the treatment strategy, issues of recovery and possible complications (premature closure of the growth plate, posttraumatic deformity such as Madelung, joint stiffness etc.) make the distal forearm fractures at children a current topic which deserves attention. At S.C.M.C "V. Ignatenco " was made a statistics over a period of two years on a group of 488 children. From total number of traumatisms, the ones of hands occupy ~ 52%. From hands fractures they constitute 38,92 %. The average age of children is 11,2 years, more frequently at boys ~ 70%. Up to 10 years metaphyseal fractures prevail, but at 12-15 year childrenfractures at the growth plate.In 32% of cases both bones were fractured. There were 5 cases of open fractures 1-st degree after G-A and 3 cases of Volkmann syndrome all resolved without fasciotomies. The peak of the traumatisms is from June to August. The diagnosis doesn’t display great difficulties. An important value has the conservative treatment with osteoclasis if needed. An absolutely neccesary indication for a open reposition at children are fractures with neuro-vascular disorders, advanced degree open fractures, the failure of closed reposition. In our clinic the surgical treatment prevails, in particular closed reposition and osteosynthesis with wires under general anesthesia and are not used specific grown-up patient methods of osteosynthesis. We are guided by the principle that any angled displacement should be reduced. As a rule, when both bones of a distal forearm are fractured, the fixation with wires to the radial bone is performed. In case of a remaining displacement at the distal ulna, this doesn’t create functional and recovery problems, it can just remain a cosmetic defect, which can be well reshaped in the long run. At the next stage, under local anesthesia, wires are removed, their ends are left above the skin, but further care and aseptic dressings are needed.The subsequent results of up to 2 years are rated as satisfactory and good, but they require a continuous assessment. The basic objectives of the treatment are to restore bone alignment and clinical appearance, minimum soft tissue adjacent damage, preventing complications, pain relief, restore a functional forearm rotation, patient satisfaction and a good result afterwards