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Pathogenetic, clinical and morphological argumentation of the medical and surgical treatment of pulmonary hydatidosis in children


Author: Stanislav Babuci
Degree:doctor habilitat of medicine
Speciality: 14.00.35 - Infantine Surgery
Year:2005
Scientific consultant: Eva Gudumac
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 12 October, 2005
Approved by NCAA on the 22 December, 2005

Abstract

Adobe PDF document0.43 Mb / in romanian

Thesis

CZU 616.24–002.951.21–089–053.2

Adobe PDF document 7.92 Mb / in romanian
173 pages


Keywords

hydatidosis, lung, children, diagnosis, morphogenesis, treatment

Summary

Present work contains the results of study of 150 children aged from 2 to 17 years with pulmonary hydatidosis, surgically treated in the National Scientific and Practical Center of Pediatric Surgery “Natalia Gheorghiu” during 1997-2004 period of time

For definitive diagnosis establishment besides the routine methods of exploration, a some special paraclinic investigations were utilized, including haptoglobine, ceruloplasmine plasmatic concentrations assessment, evaluation of speed of releasing of nitric oxide. For nonspecific resistance evaluation the plasmatic concentrations of B-properdine factor and C3, C4 complement factors were investigated. The dynamic analysis of proteins of acute phase of inflammation and nitric oxide allowed not only to assess the inflammatory process activity in children with hydatidosis, but may be utilized as a special criteria for determination of disease severity, clinical and evolutional aspects of pathology, associated complications, evaluation of the applied treatment efficiency and disease outcome.

Dynamic analysis of the humoral immunity factors concentrations, IL-1β, IL-2, IL-8 allowed to establish a correlation between their concentrations and local inflammatory reaction intensity, and defensive processes in the pleural cavity – phenomenons that take important roles in the lung functional activity maintenance, that’s why these indices can be used as a specific markers of the local inflammatory response.

Morphologic investigations results proved to have a great importance in the clinical and evolutional disease peculiarities establishment permitted to determine the polymorphism of morphogenesis of the pulmonary hydatic cyst. Our study forced us to revise the morphologic control value in the determination of the pericystic parenchyma modifications. On the base of obtained results and taking into consideration clinical and evolutional stage of disease, parasitic vital cycle phase, hydatid cyst localization, associated complication, the early diagnostic algorithm and medical and surgical tactic were elaborated.

The utilization of the elaborated diagnostic algorithm and differential medical and surgical tactic in diverse clinical and evolutional forms of hydatid cyst in children, taking into consideration the pathogenetic and clinical, and morphologic disease aspects permitted to obtain good results in 98,7% of cases, in 1,3% the outcome was unfavorable.