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The optimization of the medical and surgical methods of correction of the diaphragmatic hernias and eventrations in children


Author: Bîrsan Aliona
Degree:doctor of medicine
Speciality: 14.00.35 - Infantine Surgery
Year:2011
Scientific adviser: Stanislav Babuci
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Anatol Ciubotaru
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council: DH 50-14.00.35-26.02.04
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 26 October, 2011
Approved by NCAA on the 22 December, 2011

Abstract

Adobe PDF document – 1.61 Mb / in romanian

Keywords

diaphragmatic hernia and eventration, pulmonary hypoplasia, pulmonary hypertension

Summary

The work is expressed on 148 pages and includes introduction, 4 chapters, conclusions, practical recommendations, references with 222 literature sources, 15 tables, 92 figures, 4 annexes. The obtained results are published in 15 scientific articles.

Field of research: pediatric surgery

Study aim: to improve the results of surgical treatment in children with congenital diaphragmatic hernias on the base of clinical, evolutional, structural, morphological and functional disease peculiarities analyses, as well as of the associated malformations and concomitant pathologies. Study goals: to determine the clinical and morphopathologic peculiarities of the vicious developed diaphragm and other vital organ, that are installed in diaphragmatic hernias and eventrations in children; to evaluate the morphologic modifications in placenta and annexes and their impact on the postnatal evolution.

Scientific novelty and originality: The role of clinical and paraclinical modifications in the assessment of the severity of the pulmonary hypoplasia and pulmonary hypertension in diaphragmatic hernias and eventrations in children of different ages was estimated and specified. The clinical efficacy of the pre- and postoperative treatment tactics as well as of the surgical methods in these patients was proved.

Theoretical value:Disturbances in feto-placentar blood supply results in chronic hypoxemia of the fetus and academia which have a great impact on the postnatal condition of newborns with congenital diaphragmatic hernias and eventrations. Local and systemic inflammatory processes are mainly responsible for the evolution and forecast of this congenital malformation.

Applied value: Depending on the severity of the malformation, biologic alterations and associated complications, the algorithm of diagnosis and selective treatment of the congenital diaphragmatic hernias and eventrations in children was elaborated, this, in turn, will improve the results and decrease the mortality.

Scientific results implementation:The scientific value of the study results was approved and the results were implemented in the current activity of the National Scientific and Practical Center of Pediatric Surgery „Natalia Gheorghiu”, as well as in training activities at the Department of Pediatric Surgery, Orthopedics and Anesthesiology of the State Medical and Pharmaceutical University „Nicolae Testemiţanu”.