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Some prophylactic methods of hemorrhages from esophageal varices in patients with portal hypertensione


Author: Cazacu Lilian
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2010
Scientific adviser: Alin Bour
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 6 October, 2010
Approved by NCAA on the 23 December, 2010

Abstract

Adobe PDF document – 0.30 Mb / in romanian

Keywords

hepatic cirrhosis, portal hypertension, endoscopic sclerosation, esophageal varices, porto-caval anastomoses, Aethoxysklerol, Trombovar

Summary

Structure of the thesis:introduction, 4 chapters, synthesis of the obtained data, conclusions and practical recommendations, bibliography consisting of 283 surses, 121 pages of fundamental text, 24 charts, 45 figures. Results of the research were published in 11 scientific papers.

Area of research: surgery

Goal of research: is to improve esophageal varices hemorrhage prophylaxis in patients with portal hypertension by making a clinico-experimental study of different endoscopical sclerosation methods in patients with intrahepatic PH and of a surgical intervention in patients with extrahepatic PH.

Research objectives:
1. To study the efficacy of endoscopic sclerosation of esophageal varices with 1% Aethoxysklerol and with 0,5% Aethoxysklerol in combination with beta adrenal blokers.
2. The analysis of clinico-paraclinical results of ES with 1% Aethoxysklerol in comparison with ES 0,5% Aethoxysklerol.
3. To select the optimal concentration of sclerosal substance Aethoxysklerol for paravasal medication of EV through an experimental study.
4. To evaluate the sclerosal endoscopic intravasal results with 3% Trombovar in patients with HC.
5. To study the results of surgical treatment in patients with extrahepatic PH.
6. To elaborate an algorithm of diagnosis and prophylaxis of EV in patients with PH.

Methodology: Research of prospective and retrospective cases, experimental and clinical research.

Scientific novelty: For the first time in the clinical practice in Moldova was made a clinico-morphological study of both precocious results and distance of ES with 1% Aethoxysklerol solution and ES with 0,5% Aethoxysklerol solution. Proving the efficacy of intravasal ES medication with 3% Trombovar in combination with beta blockers in order to eradicate EV d~7-10 mm, the role of new radiovascular techniques, of porto-caval anastomoses in the radical treatment of extrahepatic PH and in EV hemorrhage prophylaxis.

Theoretical significance: The given research has allowed to make analysis of different forms of PH, to elaborate an algorithm of diagnosis of this category of patients, importance of ES in depending on the location and diameter of EV, combination ES with beta blockers and also a utilization of various methods of treatment in patients with extrahepatic PH.

Scientific value and clinical applicability: The results of the study made, basic postulates and practical recommendations were implemented in the didactic process for the students of the 3rd -4th years at the stomatology faculty SMPU „Nicolae Testemitanu”, in the day by day practice in the surgery departments and endoscopic wards in the SCMCC and in the SCC from Chisinau.