Beruflich Dokumente
Kultur Dokumente
BALKAN
Military Medical
REVIEW
ISSN: 1107-6275
Congress abstracts
Workshops
Workshop 1
Defining features and perspectives of the Romanian military medicine
The role of Braov Military Hospital during the
Sarmis 15 Military Multinational Exercise
D. Derioiu
In the context of collective efforts of NATO allies to
improve the medical care during times of crisis, from
the point of injury to the highest level of medical care,
a Romanian military hospital responded to the
challenge of being a ROLE 3 hospital in the chain of
medical evacuation during a complex multinational
military exercise. From the planning process to the
execution phase, the military and the civilian medical
personnel involved were able to show the level of
readiness and interoperability of a segment of the
Romanian operational medicine.
In the exercise, the medical situation requiring
immediate treatment originated at Cincu Training Area,
where the casualties were air-lifted by helicopters to
Brasov. At the landing zone, the casualties were
transported to Brasov Military Hospital by ambulance,
implementing valuable assets on both land and air to
expedite the quickest transport and care possible. At the
hospital, the casualties entered the triage, evaluation
and resuscitation areas, then in the operating rooms for
complete trauma care.
A life may depend on the fast, cohesive care of all
allies, even if the members of the team hail from
differing countries. The procedures regarding the
setting of the hospital and the role of each team
member, as well as the specific medical procedures,
should be compatible and efficient in order to get the
best medical outcome in austere conditions, for both
co-nationals and allied partners. This paper presents the
stages and the results of this process, as a starting point
for further development.
"Bio-Chem" threats at the beginning of the 21st century and the response of military
medicine
C. tefani, M.S. Tudosie, V. Ordeanu, B. Patrinichi,
M. Neculescu, Gina Caragea, Cristina A. Secar
The current complex international situation, with the
declared and undeclared wars, mass migrations,
terrorism and other threats to Nations and democracy
requires consistent measures for an adequate response.
The army, as a guarantor of stability, has an essential
role in defense and national security. The immediate
objective of the fight being live enemy force
annihilation, military medicine is the main factor in
maintaining and regaining of the capability of the
military.
The primary mission of military medicine is to
maintain and to increase the fighting capability of the
workforce live in both peace and war, by providing
specific
medical
servicemen,
military-medical
scientific research carried out for the purpose of
identifying CBRN attack (especially bio-chem.),
elaboration of methods of early diagnosis and rapid,
complex therapeutic schemes and specific prophylaxis
required medical protection of military personnel and
the civilian population as a result of exposure to
military aggression or terrorism.
Deriving from the objectives of national defense
strategy on emergency management, medical protection
of military personnel and the civilian population
against chemical weapons, terrorism and natural
disasters and technological component toxicological a
priority military medical experience embodied by:
developing techniques and highlighting specific
methods for chemical warfare agent toxicity and
methodologies for obtaining and testing of specific
antidotes.
In the future, priorities in the field of military medicine
will result in optimization of medical countermeasures
Anti-Chemical Protection and development of
innovative methodologies and analytical clinical
diagnostic chemical warfare agents.
Workshop 3
Shared medical decision
Risk communication
C. Bicu
For the making of evidence-based decisions, the
comparison of two or more options is necessary. In
order to decide, the patient needs to understand
numeric estimates which describe the effects of these
options, therefore we must know which are the best
methods for risk communication.
There are eleven key components of risk
communication, among which we mention the
presentation of the chance that an event will occur, the
outcome estimates for test and screening decisions, the
expression of uncertainty, the visual formats best
suitable for risk communication etc.
The principles of risk communication are that the
formats should reflect tha task required of the user, they
shoul always define a reference class (denominator),
they should use a consistent format, they should avoid
Workshop 4
AB Dental devices hands on course
Digital solutions in implantology
A.M. Nistor, G. Lazarescu, A. Diaconeasa-Maier
Aim and purpose:
In the modern implantology, prosthetic driven implant
placement has become the routine. Implant supported
over denture need appropriate retention quite similar to
the natural teeth. Despite the difference between
biological support and prosthetic appliance the
planning must be highly accurate. In order to confirm
virtual position of needed implants the authors had
created a check list for every clinical situation.
Materials and method:
In order to compare decision protocol between implant
retained and tooth supported dentures, a number of 15
cases have been selected according to biomechanical
principles which have been individualized and applied.
Also, the modification of biological support has been
Workshop 5
Up-to-date in urology-gynecology
Female urinary incontinence The value and
challenges of randomized controlled trials
State of the art
V. Jinga
lateral trocars.
The tunnels are dissected under the control of
transillumination. Through these tunnels is the free end
of the mesh passed bilaterally and pulled out of the
abdominal wall to elevate the uterus. The mesh is left
tension free.
This mesh is based on the principle of a transverse
hammock for the vaginal vault and the uterus.
This procedure can be performed with preservation of
the uterus or together with laparoscopic subtotal (SLH)
or total hysterectomy (TLH), depending on the
gynecological situation of the patient.
ureterohydronephrosis): 4 cases
Conclusions:
In the pelvic surgery, the ureteral lesion is more
frequent to occur in the oncological surgery of the
uterine cervix, as well as in the vaginal surgery of the
advanced utero-vaginal prolapsed.
It is important the intraoperative recognition (of a
certain situation) and the uro-gynecological
colaboration.
Keywords: ureteral lesions, uterine cervix cancer,
uroperitoneum
Workshop 6
CCUBCVA Round Tables
Vasile Cndea Emergency Clinical Centre for
Cardiovascular Diseases: 5 years in Romanian
national programme for interventional therapy
in ST-elevation myocardial infarction
Alice Munteanu, S. Dumitrescu, L. Chiriac, D. Nita,
R. Rosulescu, Nicoleta Avram, Irina Florescu
Cardiovascular diseases (CVDs) represent the main
cause of death globally, being responsible for 1/3 of all
deaths, more than cancer, chronic respiratory failure or
diabetes mellitus. CVDs are a major cause of disability
requiring high costs for monitoring, treatment and longterm care at home. Almost 17 millions people die
annually from CVDs. The total number of deaths from
CVDs is estimated to reach 25 million by 2020. Every
five seconds a death occurs as a result of a myocardial
infarction.
Acute ST-elevation myocardial infarction (STEMI) is
characterized by prolonged (15-20 minutes), severe
chest
pain
nonresponsive
to
nitroglycerin
administration. ECG shows ST-segment elevation 0.2
mV in V2-V3 and/or 0.1 mV in other derivations or
new onset left bundle branch bloc. Biochimy shows:
increasing of cardiac enzymes (troponin, CK / CK-MB)
showing myocardial necrosis.
A national programme called RO-STEMI started in
Romania in 2010 in 12 centres organised in a 24/7
system in five regional networks. The implementation
of the programme had significantly reduced the number
of patients treated conservatively (32%). 63% of
patients with STEMI were referred to myocardial
primary angioplasty, facilitated or delayed, and only
5% received thrombolysis (RO-STEMI register). The
number of patients with primary PCI was 10 times
higher in 2011 compared to 2007 (SD Kristensen et al
Eur. Heart. J 2014 August 1 35 29 1957-1970). AMI
mortality rate decreased significantly, from 13% to
7.55% (RO-STEMI register). The mortality rate was
approximately 4.4% in patients admitted for primary
PCI, 8.3% in patients receiving thrombolysis and
17.1% in those treated conservatively. (Kristensen SD
et al Eur Heart J 2014 August 1 35 29 1957-1970).
Vasile Cndea Emergency Clinical Centre for
Cardiovascular Diseases is part of the national program
RO-STEMI for 5 years. During this period 3453
patients were admitted with STEMI. 2952 patients
received primary PCI. 33.1% of the patients were
brought to the ER directly by ambulance, 31.1% were
transferred from other hospitals in Bucharest, 8.4%
were transferred from hospitals at a distance <50 km,
10.2 % from a distance <100 km, 4.9% <150 km, 4.7%
<200 km and 7.6% > 200 km. The average time from
the onset of pain until calling to the emergency medical
system was 3 hours, with a median of 2,5 ore. Only
21% of patients called the emergency medical system
within 60 min from the onset of chest pain. The time
from first medical contact to balloon inflation was less
than 90 min in 29% of patients.
The results regarding procedures performed were:
14.5% were not admitted to angiography, 4.4%
received only PCI without stent, 52.6% of patients
received one stent, 21.5% 2 stents, 6.4% 3 stents and
0.6% 5 stents. The vessel responsible for STMI was in
57% of cases LAD, in 30.2% was RCA, in 11% was
CXA and in 1.7% was not specified. 43.6% of patients
had single-vessel lesion, 38.1% had two-vessel lesions,
10.8% had three-vessel lesions/multivessel, 5.8% had
non-obstructive coronary artery disease and 1.7% had
permeable coronary arteries.
The rate of early complications after angiography was
9.3%: 3.5% of patients suffered acute stent thrombosis,
3.2% of patients had pseudoaneurysm, 1.7% of patients
had procedural failure and 0.9% had coronary
dissection. At discharge 71.5% of patients had not had
simptoms of heart failure. 25% of patients showed
signs of left heart failure and 3.5% of patient admitted
in programme died.
Workshop 7
Interventional endoscopy
ERCP role in choledocholithiasis treatment
G. Constantinescu, . Vasile, C. Balahura, I.C.
Nedelcu, S. Ummar
Bile duct stones represent a frequent condition
encountered in hospitals with large departments of
digestive surgery and gastroenterology. Between 10
and 17% of the patients with gallbladder stones have
also choledocholithiasis. The endoscopic approach of
bile duct seems to have permanently gained ground in
front of open or laparascopic surgery, in spite of the
Workshop 8
Up-to-date in gastroenterology
Hepatocellular carcinoma Current treatment
and evidence-based medicine
Introduction:
We are presenting an update about hepatocellular
carcinoma (HCC), and our department recent
diagnosed cases.
Materials and methods:
Hepatocellular carcinoma (HCC) is a primary tumor of
the liver that usually develops in the setting of chronic
liver disease, particularly in patients with chronic
hepatitis B, C or cirrhosis. It is typically diagnosed late
in its course, because of the absence of pathognomonic
symptoms, and often requires the use of one or more
imaging modalities.
Suspicion for HCC should be heightened in patients
with previously compensated cirrhosis who develop
decompensation such as ascites, encephalopathy,
jaundice, or variceal bleeding.
These complications are often associated with
extension of the tumor into the hepatic or portal veins
or arteriovenous shunting induced by the tumor. The
median survival following diagnosis is approximately 6
to 20 months.
The pathogenesis of HCC is a multistep and complex
process, wherein angiogenesis plays an important role.
Multiple treatment options are available for HCC
including
curative
surgical
resection,
liver
transplantation, radiofrequency ablation (RFA) and
microwave ablation, percutaneous ethanol ablation,
trans-arterial chemoembolization, and systemic
targeted agent like sorafenib.
The treatment of HCC depends on the tumor stage,
liver function reserve, and patient performance status
(BCLC stage), and requires a multidisciplinary
approach. Liver transplant and hepatic resection are the
only curative options in early stage of disease.
Results and conclusion:
Despite effective surveillance and treatment strategies
available in HCC, the proportions of patients receiving
these interventions are suboptimal.
Measures to increase access to surveillance, early
diagnosis and effective treatment should be
implemented.
Workshop 9
Diagnosis of left ventricular dysfunction Role of echocardiography
Right ventricle function and failure
Echocardiographic evaluation
S.I. Dumitrescu
Right ventricular function was and largely still is
regarded as having a minor role in normal
hemodynamics, but is widely recognized as important
in all pathological conditions which are accompanied
by changes of pressure and / or volume in right
circulation. Normally, the right ventricle (RV) ejection
ensure systemic venous circulation of blood in the
pulmonary vascular bed maintaining adequate
conditions of reduced pressure in both downstream and
upstream.
Morphologically, RV forms the largest part of the front
face and the lower 3/5 of the heart surrounding the left
ventricle in the form of a "U", one arm being formed by
the inflow path, and the other by the outflow path;
between their long axes there is a 120 shaft, this
architecture cannot be equated with any simple
geometric shapes. The special structure of RV makes
the ratio of its inner surface and intracavitary volume to
be much higher than it is in the left ventricle (LV);
ejection is perfectly suited for large amounts of blood
with a minimum but complex contractile effort.
This is achieved through three mechanisms: (1)
contraction of spiral muscle fibers which reduces the
long axis of RV, moving the tricuspid annulus to the
Workshop 10
Emergency medicine
Emergency Department triage and POCT
devices
C.B. Teudea, M. Toma
Medical triage of the patients admitted into the ED is
made on the basis of specific criteria established by the
national laws taking into account their clinical
condition, stability of vital functions, aggravating
potential of their status, the necessity of starting a
treatment or to carry out some investigations etc.
setting up the priorities of the medical care. There are 5
triage categories/ levels that establish patients waiting
time, from zero minutes - code red to maximum 120
minutes the white code.
If we want to treat correct the patient, we need the
point of care testing - POCT devices that provides
blood tests needed for a rapid and correct diagnosis.
More than those blood tests results arrived in maximum
15-20 minutes can change the assignment of the patient
in a triage category, increasing or decreasing his
medical care.
In our experience a patient with anterior thoracic pain,
level 3-4 on the pain scale, which usually is assigned
with level III - green code, after obtaining the cardiac
markers results, he can keep the same level (negative
cardiac markers) or he can be introduced in the superior
level level II (yellow code).
Workshop 11
Up-to-date in rheumatology
Is biological therapy always the answer?
L.M. Ciobc, Daniela Anghel, G.D. Stoicescu, Ioana
Rdu, Iolanda Srbu, Ana M. Dumitru, Mihaela
Iordache, Ancua Coca, Aida A. Fnica
Although biological therapy has revolutionized the
treatment of rheumatic diseases in the past decade, we
still encounter some particular cases which, although
early diagnosed and treated, have an aggressive
evolution and are non-responsive to treatment.
We would like to bring to your attention the case of a
28 year old male, diagnosed at age 13 with juvenile
Workshop 12
Quality standards
Vasoactive treatment in variceal bleeding
Raluca S. Costache, Florentina Ioni Radu,
Mariana Jinga, P. Nu, Sndica Bucuric, B.
Macadon, M. Ptrescu, Andrada Popescu,
Ctlina Diaconu, Laura Voicu, D.O. Costache
The natural evolution of chronic liver disease is to
compensated cirrhosis, decompensated cirrhosis and
death.
www.bmmc-bmmr.org
BALKAN
Military Medical
REVIEW
Congress abstracts
Oral presentations
MD 1
Oral communications medical 1
Modern management of Helicobacter pylori
infection
Florentina Ioni-Radu, Andrada L. Popescu, I.P.
Nu, Raluca S. Costache, Mariana Jinga, Sndica
Bucuric, B. Macadon, M. Ptrescu, A.I. Gavril
Introduction:
Our objective is to review current international
guidelines for Helicobacter Pylori treatment and our
department`s experience in this field.
Materials and methods:
Helicobacter
pylori
is
a
Gram-negative,
microaerophilic bacterium that can be found mainly in
the gastric mucus or on the inner surface of the gastric
epithelium, infecting up to 50% of the population.
Colonization with this bacterium is not a disease in
itself, but can cause chronic gastritis, peptic ulcer,
gastric cancer and MALToma. Because of this,
infection with H. pylori continues to be a major
healthcare burden, especially in less-developed
countries.
A multitude of non-invasive tests are available for the
diagnosis of Helicobacter pylori infection (blood
antibody, stool antigen or urea breath test), but the most
reliable method of diagnosis is histological examination
from two sites after endoscopic biopsy, combined with
either a microbial culture or rapid urease test.
Treatment of Helicobacter pylori infection is becoming
a challenge, as eradication following standard triple
therapie is decreasing worldwide due to increased
bacterial resistance against antibiotics, which has led to
the developement of newer therapies such as the
sequential treatment in which a PPI and amoxicillin is
given for 5 days followed by a PPI, clarithromycin and
metronidazole for another 5 days, or the quadruple
therapy based on a PPI, bismuth subcitrate,
metronidazole and tetracycline for 10 days.
MD 2
Oral communications medical 2
The most popular medium frequency therapies.
Innovation and evidence in new therapies
Anca Slceanu, G. Teodoru
What we aim through this paper is the comparison of
the classical interferential current with the new medium
frequency therapies, the interferential stereodynamic
current and the High Tone Power Therapy. We also
focus on underlining relevant evidence in the new
therapies, accompanied by technological evolution in
the continuously changing, extremely dynamic field of
evidence based medical practice.
The classical interferential current was first
documented in 1948 by Hans Nemec. Later on, an
interesting fact drew new developments of the medium
frequency therapies: if ions can move easily in all three
dimensions, how can we generate a three dimensional
movement through an electric current? Therefore, the
other.
Method and material: Actual status of DSME and
ongoing diabetes support as outpatient was assessed
using a local questionnaire, using some aspects that are
discussed during our local educational program. 97
patients were kindly asked to respond to this
questionnaire. In the same time, patients were
evaluated using anthropometric and biochemical
parameters.
Results: The evaluated patients were distributed in two
lots after a first question considering the selfassessment
of
adherence
to
the
medical
recommendation (Lot A 73 patients that consider they
respect the medical recommendations, Lot B 24
patients that consider that they are not able to follow
the medical recommendations). Most of the patients
dont have basic elements about daily nutrition and
medical therapeutics recommendations considering
their disease.
Conclusions: The assessment of diabetes selfmanagement education program and ongoing diabetes
support as outpatient should be improved. The
educational level of patient could be appreciated as
poor or medium and a lot of educational materials
could be helpful in this action.
Rosai-Dorfman disease
Anca Ghiau, Romelia Sfetcu, Lavinia Brsan,
D.A. Chiri, E. Dnil, M. otcan
Introduction: Histiocytosis defines a series of diseases
of the reticulo-endothelial system- cells with the origin
in promonocytes which the mononuclear phagocytic
system. The proliferation of Langerhans cells (which
have the role of defense in the skin) means
histiocytosis. The symptoms are variable depending on
the affected organs- the osteo-articular system is
affected in 80% of cases, skin, lymphatic system are a
frequent target. There are cases of localized
histiocytosis (just skin/ mono or poliostotic lesions) or
an extensive form with visceral implication with or
without organ dysfunction. The positive diagnosis is
made on biopsy of the skin lesions or curettage of the
bone lesions.
Material and method: We present the case of a young
man -27 years who was admitted on Dermatology for a
series of subcutaneous, erythematous skin nodules on
the torso.
Results: A skin biopsy was performed by surgically
removing a cutaneous flap which histologically and
imuno- histochemically resembled Rosai Dorfman
disease. We continued investigating the systemic
implication by performing a cerebral and thoracoabdomino-pelvic tomography which
identified
numerous
peripheral
and
hepatic
hilar
lymphadenopathies thus contouring the diagnosis of
multisystem histiocytosis.
Conclusion: Multisystem histiocytosis without lung,
lymphatic system, cerebral parenchyma, liver
involvement has low mortality and a good prognosis
but left untreated can lead to disease extension. With
parenteral treatment with Vinblastine and SoluMedrol
the evolution was favorable the skin lesions and
lymphadenopathy disappeared.
MD 3
Oral communications medical 3
Preparing for Ebola The experience of the
infectious diseases ward of the Carol Davila
Central Military Hospital
B. Crciumaru, I. tefan, C. Bnic, O. Dunreanu,
Simona Ionescu, Ioana Pandrea, V. Gheorghi
Introduction:
The 2104-2015 West African Ebola outbreaks
produced a generalized panic. The international
response although delayed, was finally successful, as it
contained the disease. The Romanian Ministry of
Health coordinated the chain of response for our
country, with an important role for the military medical
services.
Material:
The staff of our ward was actively implicated into the
preparedness for possible Ebola cases; for quick
diagnosis and treatment into a dedicated military field
hospital.
Methods:
Many teams were instituted: doctors and nurses from
our ward, as well as from the Matei Bal National
Institute of Infectious Diseases, having a weekly
training with the Personal Protective Equipment (PPE),
within the Institute and in the field hospital.
Results:
We practiced the safely and fastest methods for the
PPE use; we constantly improved our capabilities,
being aware of our limits. We became familiar with the
field hospital, where we constantly improved the
patient`s management networks.
Discussions:
The human staff is well trained and equipped, but a
proper infrastructure-negative pressure rooms and level
4 high security labs-is necessary. The actual strategy
provides an acceptable degree of protection for the
medical staff, and a proper management of the patients.
bowel obstruction.
Introduction:
Neurologic paraneoplastic syndromes result from an
indirect or remote effect of a primary systemic
malignancy on the central or peripheral nervous system
or other organs. The neurologic syndrome may begin
years before there are symptoms of the tumor or may
follow treatment.
Materials and methods:
Electrodiagnostic evaluation reveals an abnormally low
amplitude compound muscle action potential (CMAP),
increasing in amplitude after voluntary muscle
contraction or repetitive stimulation at rapid rates
(>10Hz) (potentiation or increment) which may exceed
4700%.
Single-fiber EMG reveals abnormal filter and blocking
in all cases which is also seen MG.
Results:
Generally, these syndromes showed to be a diagnosis
of exclusion. Other causes such as metabolic or
endocrine effects of tumor, vascular or infections
disorders, complications of chemotherapy or
radiotherapy, and direct spread or metastasis of the
tumor to the CNS are far more common, CT and MRI
exclude parenchymal metastasis, MRI or mielography
excludes spinal metastasis, CSF examination excludes
possible carcinomatose meningitis.
Conclusions:
The electrophysiologic abnormalities still define the
syndromes, examination by CT, MRI, mielography
confirm the diagnostic.
MD 4
Oral communications medical 4
Behcets disease A challenge of diagnosis and
treatment
L.M. Ciobc, Daniela Anghel, G.D. Stoicescu, Ioana
Rdu, Iolanda Srbu, Ana M. Dumitru, Mihaela
Iordache, Ancua Coca, Andreea F. Aida
Bechet's disease is a rare and poorly understood
condition with multiple systemic manifestations. The
disease causes inflammation in blood vessels
throughout the body which leads to numerous
symptoms that may initially seem unrelated. The signs
death.
SG 1
Oral communications surgery 1
Presentation of robotic surgery platform
daVinci
F. Svulescu, C. Crlan, Mdlina Petrescu
Minimally invasive surgery is the surgery performed
through small incisions or surgical ports, resulting in a
quicker recovery, fewer complications, lower hospital
costs and fewer traumas to the patient. While
minimally invasive surgery has become the standard
for certain interventions, it has not been widely adopted
for more delicate or complex interventions. Some of
the major benefits of using the da Vinci system to
traditional techniques are greater surgical precision,
greater range of motion, improved dexterity, better
picture and better access. Patient benefits include a
shorter hospital stay, less pain, lower risk of infection,
less blood loss, decreases the need for transfusions, less
scarring, faster recovery and a faster return to day to
day activities. None of these advantages can be
guaranteed, the results depend both on the patient and
the intervention.
In the following presentation we will shorttly descrive
the surgical sistem daVinci, the indications of the
robotic minimal invasive treatment and the way of
using it. We will add the robotic sistem in the surgical
intruments cathegory, throwing down the ideea that it is
a part of the surgical team.
Keywords: robotic surgery platform daVinci, minimal
invasive surgery
SG 2
Oral communications surgery 2
Degloving injury of the ring finger Case
report
Andreea Benga, B. Marinescu
A 34 years old male patient, smoker, living in the rural
area, fire man, presents at the ER with a ring avulsion
injury to the fourth left digital ray. After clinical and
paraclinical evaluation, the defect was covered with an
Italian plasty, the pedicle being released at 23 days.
The particularity of the case consists in modifying the
classical technique by placing the suture line on the
ulnar border, thus providing a long lasting, scar free
prehension surface.
Case presentations
We present a series of cases with pigmented tumours of
the head that were diagnosed and treated in our clinic.
The patients were evaluated clinically and with
dermoscopy. While in some cases the diagnosis was
established clinically, in other cases dermoscopy
proved to be a valuable tool for reaching the correct
diagnosis.
Discussion and conclusions
There are some benign pigmented tumours (e.g.
compound naevi, pigmented seborrheic keratosis) that
can be treated with minimal surgical interventions (e.g.
tangential biopsy with electrocauterisation of the
tumour base, surgical excision with 1-2mm margins).
Some malignant tumours such as pigmented basal cell
carcinoma are better treated by surgical excision with
3mm margins. However other malignant tumours like
pigmented cutaneous melanoma require extensive
surgery with 0.5 to 2 cm margins. A solid clinical
diagnosis, aided by dermoscopy, can help a surgeon to
better manage these tumours and as such to deliver a
disease free, functional and aesthetical result.
Keywords: pigmented basal cell carcinoma, pigmented
cutaneous melanoma, pigmented seborrheic keratosis,
dermoscopy
Note
This paper was co-financed from the European Social
Fund, through the Sectorial Operational Programme
Human Resources Development 2007-2013, contract
POSDRU/159/1.5/S/155463 "Supporting excellence in
scientific interdisciplinary doctoral research in the
economic, medical and social fields", coordinator The
Bucharest University of Economic Studies.
SG 3
Oral communications surgery 3
Minimally invasive repair for pectus
excavatum A single institution experience
C. Grozavu, M. Ilia, D. Marin, D. Pantile, T.
Augustin
Introduction:
Pectus excavatum is the most frequent anterior thoracic
wall congenital malformation. This malformation
becomes more evident with the aging process and has
its peak incidence during teenage, when the clinical
symptoms become more acute and psychological
effects are real important. Over time many treatment
techniques have been proposed, conservative or
surgical. The minimally invasive repair of pectus
excavatum, Nuss technique, developed after 1987, is
the most used technique worldwide.
Material and Method:
This presentation analyzes 85 patients, admitted on
University Emergency Military Hospital Carol
Davila - Thoracic Surgery Department, over an 8-year
timeframe (2007 2015), diagnosed, investigated and
surgically treated according to Nuss procedure.
Therapeutic and diagnostic protocols will be presented
and analyzed: clinical and paraclinical evaluation,
indications and contraindications of Nuss procedure, as
well as possible intraoperative and postoperative
complications.
Results:
Nuss procedures esthetical benefits will be presented,
as well as improvements of lung functional parameters.
Patients degree of satisfaction is presented according
to the 2-step Nuss questionnaire.
Conclusions:
YD 1
Oral communications young doctors 1
Clostridium difficile-associated diarrhea. Case
presentation
Anamaria R. Alexandru, Alina M. Benescu, B.
Crciumaru, C.G. Apostolescu
Background: The frequency of Clostridium difficile
infections (CDI) has dramatically increased in recent
years all around the world. In addition it seems their
severity has also increased with the discovery of the
hypervirulent strains. For these cases a new therapy,
fecal microbiota transplantation (FMT), was
introduced.
Methods: A 63-year-old woman presented to the
emergency room with a 4-day history of explosive
watery diarrhea, abdominal pain and nausea. She was
diagnosed with CDI, ribotype 027 and treated with
vancomycine and tigecycline but her condition
remained serious. Therefore FMT was performed. The
patient recovered immediately but the symptomatology
recurred after a month. Knowing her medical history,
another FMT was performed. The evolution was
favorable, without recurrent infection.
Results: Some of the most severe cases of Clostridium
difficile-associated diarrhea are produced by ribotype
027. This hypervirulent strain frequently develops
antibiotic resistance. The association with an
underlying illness favors the recurrence. Restoring the
normal, functional intestinal microbiota seems to
become the most effective therapy.
Conclusions: Fecal microbiota transplantation (FMT)
by nasogastric tube is an effective and reproducible
option for patients with recurrent CDI, severe infection
and antibiotic-resistant strains infection.
Keywords: Clostridium difficile, fecal microbiota
transplantation
Aphasia
S.G. Lungu, Emilia Furdu-Lungu, I. Furdu,
Carmen A. Srbu
Introduction: Disturbances in speech and language are
usually caused by lesions bordering the silvian fissure
of the dominant hemisphere. The further from this
zone, the less the lesion disturbes speech and language.
Matherials and methods: Case presentation.
Results: Clinical examination, CT, MRI, the special
testing demonstrates where is the lesion.
Conclusions: The precocious diagnostic and the
immediate institution of the usefull treatment grow the
chances of total recovery.
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Oral communications young doctors 2
Vaginal myomectomy for subserosal and
intramural uterine fibroids
M. Nicodin, B.P. Panaite, Ioana Niculescu, N.
Niculescu, O. Nicodin
Objective. Our aim was to explore the feasibility and
safety of vaginal myomectomy in patients with
subserosal and intramural uterine fibroids.
Methods. 36 year old patient, diagnosed with uterine
fibroid and no associated pathology was offered
vaginal myomectomy. The size of the fibroid measured
at echo was 60 mm. The operation was possible due to
the fibroids size, the favorable uterine mobility, the
adequate vaginal access, lack of cavity involvement
and adnexal pathology. We analyzed the indications,
operative performance, postoperative complications,
recovery and fertility follow-up (24 months) of the
patient.
Results. Vaginal myomectomy was successful. The
mean operative time was 40 min; the intraoperative
blood loss was 150-180 ml and none of the patients
required transfusions. Hospitalization was 48 hours.
The patient delivered 27 months after the intervention
(3.200 g baby-C section). There are no clinical or
ultrasound signs of recurrence to the day.
Conclusions. Vaginal myomectomy, a minimally
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Young women and metastatic breast cancer
Maria L. Berbece, Florentina Ciocan
General aspects
Breast cancer is a disease in which malignant cells
develop in the breast tissue.
Risk factors
Menstrual reproductive factors
Exposure to radiation
Exogenous hormones
Factors that lower the risk of breast cancer
- young age at first birth
- extended lactation
- sports
- artificial menopause under 35 year
- dietary fish oil,fiber,phytoestrogens
Statistics
Natural history
Common histological types of breast carcinoma.
-invasive ductal carcinoma
-invasive lobular carcinoma
-medullary carcinoma
Metastatic breast cancer
Recurrent breast cancer
The psychological impact of breast cancer diagnosis
Results
Conclusion
Nursing process
Stela Platon, Florentina Aviana
In the modern world, ever-changing, the problems of
individual tend increasingly to become problems of
society.
At the same time the company by its major problems is
a factor for each individual modeler.
In this context the care process must be adapted to both
the individual and the demands of society but keeping
its main goal: a good health for the individual, family
and community.
The main objective of health care is patient, but not
perceived as a simple individual but holistically as a
person with the physical, mental, emotional, social, and
spiritual.
The care process is an organized and systematic
manner, allowing for individualized care.
Care approach is centered on the particular reactions of
each individual (or group of individuals) to an actual or
potential health update.
The approach can be defined as: an intellectual process
consists of various stages logically sequenced, aimed at
reaching a better state of the patient.
After Genevieve Dechanoz, the care process is the
application of scientific way of solving problems, the
analysis of the situation, to care, in order to respond the
physical, psychosocial the person.
Virginia Henderson's conceptual framework is based
on the existence of physiological needs and aspirations
of human beings - called basic needs
This definition is based on the 14 basic needs,
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Issues in caring for patients with pancreatitis
Iuliana Ghinea, Georgiana Mic, Nicoleta Berbec
On Gastroenterology Department many patients with
acute and chronic pancreatitis are frequently
hospitalized. Acute pancreatitis, also called "the great
abdominal drama", is the acute inflammation of the
pancreas caused by different causes such as gallstones,
alcohol, viral infections, digestive enzymes,
autoimmune diseases and other.
Traditionally many nations have holidays based
specially on food and beverages; such is Christmas,
Easter, Ramadan or birthdays and anniversaries.
Unfortunately, even Romanians sometimes surpass
measure and go from dance to the hospital." Whether
they have eaten sour cream, mayonnaise, cabbage rolls,
or sausages and are suffering from gallstones, or want
to empty the keg to make room for the new wine,
because the grapes ripen, finally they reach ICU with
persistent pain in the upper abdomen, vomiting,
diarrhea, sweating, abdominal distension or worse,
hypertensive shock, reduced urine output, jaundice.
This is where professional nursing team get involved,
and besides specific interventions (abdominal CT scan,
abdominal ultrasound, blood tests, fluid and
electrolytes rebalancing treatment, fluid diet, analgesic
and antispasmodic medication) they make efforts to
prevent similar episodes by advice on maintaining
proper body weight, regular medical tests, avoiding
food and alcohol abuse, proper hydration.
Because it affects one of the organs with essential role
in body function (the pancreas), the disease can lead to
exitus if not treated early and correctly. Therefore
prevention and treatment promptly set can avoid
serious complications of pancreatitis.
Oxygen therapy
Luminia Atudori, Simona Bran, Mdlina Preda,
Adriana Chiru
Oxygen therapy is a treatment that provides you with
extra oxygen, a gas that your body needs to work well.
Normally, your lungs absorb oxygen from the air.
However, some diseases and conditions can prevent
you from getting enough oxygen.
Oxygen therapy may help you function better and be
more active. Oxygen is supplied in a metal cylinder or
other container. It flows through a tube and is delivered
to your lungs in one of the following ways:
Through a nasal cannula, which consists of two
small plastic tubes, or prongs, that are placed in both
nostrils?
Through a face mask, which fits over your nose and
mouth?
Through a small tube inserted into your windpipe
through the front of your neck. Your doctor will use a
needle or small incision (cut) to place the tube. Oxygen
delivered this way is called transtracheal oxygen
therapy.
Oxygen therapy helps many people function better and
be more active. It also may help:
Decrease shortness of breath and fatigue (tiredness)
Improve sleep in some people who have sleeprelated breathing disorders
Increase the lifespan of some people who have
COPD
Although you may need oxygen therapy long term, it
doesn't have to limit your daily routine. Portable
Arthrodesis
Ctlina G. Vlad
Ankle arthrodesis is a classic surgical procedure aiming
to block the tibio-talar joint, in order to obtain a
painless and stable gait. It has been described multiple
methods to obtain bone fusion of the ankle using
screws, plates, external fixators etc.
Retrograde intramedullary nail, usually called
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Guillain-Barre syndrome
Olga Preda Carsote
Guillain-Barr syndrome (GBS) is an acute, immunemediated,
postinfectious
polyneuropathy
with
symmetrical ascending weakness, diminished deep
tendon reflexes, and nonspecific sensory symptoms.
CSF protein is raised with normal or only slightly
elevated cell count. Based on electrophysiological and
pathological findings, a demyelinating variant (acute
inflammatory demyelinating polyneuropathy, AIDP)
and an axonal variant (acute motor axonal neuropathy,
AMAN) can be differentiated. Molecular mimicry with
common epitopes between infective agents and
peripheral nerves is discussed as an important
pathophysiological principle.
The symptoms progress for a mean of 10 days (up to 4
weeks) and after a plateau of 1-2 weeks remit
spontaneously. At the height of the disease 60% of
children are unable to walk and 10-15% need artificial
ventilation.
Treatment with plasmapheresis and intravenous
immunoglobulins (IVIG) has been proven in placebocontrolled studies in adults with severe disease to speed
up recovery significantly. In children, mostly open
studies have shown similar treatment effects, although
their spontaneous course is frequently less severe.
Children with GBS should be treated with IVIG when
they have lost the ability to walk, or when they are still
deteriorating significantly and are expected to lose the
ability to walk. The long-term prognosis is more
favorable than that in adults. Whereas 25% of patients
maintain mild neurological symptoms and signs,
disability in the long term is very rare and usually due
to complications such as myelitic involvement or
chronic inflammatory demyelinating polyneuropathy
(CIDP).
Future research needs to be focused on developing
accurate diagnostic methods as well as protocols to
Intracerebral hemorrhage
Carmen Slniceanu
Intracerebral hemorrhage usually has a sudden start,
being able to cause rapid brain damage, and also being
a very life-threatening injury. Intracerebral haemorhage
is a bleeding that occurs within the brain tissue. The
bleeding which is caused by bursting blood vessels is
also known as hemorrhagic stroke.
The cerebral hemorrhage mechanism includes high
blood pressure less than 2/3 of cases. In other cases it
may find the following causes: arteriovenous
malformations, blood dyscrasias, small vessel diseases,
cerebral angiopathy, chronic treatment with blood
thinners and patients treated for fibrinolysis in case of
heart attack.
The risk causes for intracerebral hemorrhage are as
following: high blood preassure, age, male are more
often affected as an average,cocaine abuse, drug and
alcohol addiction, smoking and obesity.
The symptoms of intracerebral hemorrhage are:
headache, nausea, and vomiting; lethargy or confusion;
sudden weakness or numbness of the face; arm or leg,
usually on one side; loss of consciousness; temporary
loss of vision and seizures.
The cerebral hemorrhage treatment depends on
location, cause and bleeding extension.
In order to prevent intracerebral hemorrhage are
recommended the following advices: treatment and
monitoring of risk factors, including high blood
preassure and surgery treatment in case of aneurysm.
Electroencephalogram
Nicoleta Munteanu, Dana Constantin, Ana Dinu
Definition
Elecroencephalogram is an exploration method of brain
electrical potentials.
The graphic obtained by recording electric fields along
the scalp is called elecroencephalogram (EEG ) and it
is represented by the variable number of derivatives depending on the number of amplifier channels of
recording equipment.
Importance
EEG is one of the commonly used as a diagnostic
investigations in neurology, neurosurgery, psychiatry,
intensive care unit- to determine the depth of coma,
anesthesia, in neurophysiology, psychology etc.
Advantages
- Non invasive procedure that does not cause any pain
- Simple in use
- The possibility of serially repeated or continuous
display depending on the purpose, conditions: wakeful
state or sleep
- Monitoring the therapeutic efficacy of a drug that
affects the brain elecrtic activity
Correct EEG ecquisition
- Preparing the patient
- Preparing device
- The correct positioning of the electrodes
- Recording
Renal scintigraphy
Veronica Nicolau, Eugenia Rusu, Mariana
Ciauescu, Raluca Mititelu
Introduction
Renal scintigraphy involves intravenous administration
of a radio-pharmaceutical that is extracted form the
blood by the kidneys and tracking the distribution of a
radio-pharmaceutical activity in time and space with
the scintillation camera and a computer attached to it.
Materials and methods
Renal scintigraphy is a technique that helps the
physician detect anatomic or functional abnormalities
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Bedsores
Mirela Lupu, Alina Serban, Ana-Maria Lamba
Bedsores are injuries of the skin; they are named
pressure sore or decubitus sore and represent the
complication of some conditions that involve prolonged
immobilization of the pacient.
For example:
- Paralysis
- Fractures
- Neurological diseases
- Spinal cord injuries
Frequently, they appear in different areas: cubitus,
knee, heel or sacral area.
The signs of infection are: pus, unpleasant smell, the
area is hot and red. Fever and weakness indicate the
spread of infection.
Erythrocyte
D. Svoiu, Virginica Svoiu, C. Coman
Transesofageal echocardiography
Camelia Barbulescu, Liliana Predescu
Transesofagian ecocardiografy is a semi-invasive
diagnostic tool wich is based on the same principles as
transthoracic ecocardiograf, only it uses a tranducer
similar to the gastroscope.
The advantages over transthoracic ecocardiografyare
the absence of thoracic wall image distortion (the
transducer is placed in the esophagus wich less tissue
interposing between it and the hart) and use of higher
imaging frequency swich produce better image quatly.
Indications:
Transthoracic ecocardiografy is being used to obtain
clearer images of the hart, offering informations
regarding:
-the evalution of mitral and aortic valves, valvular
prosthesis and the presence of endocarditis vegetations
-intracardiac shunts
-cardioembolicsources; the evalution of the left atrium
and auriculum
-aortic dissection
-further and more detailed evalution of intracardiac
thumors diagnosed wich thoracic ecocardiografy
-evalution during different procedures: percutan ASD
closure, balloon mitral valvuloplasty, electrophysiology
and pacing procedures
-poor transthoracic imaging quality
Rheumatoid Factor
Ionela Pandilic, Matilda Marinache, Lili Petea
The rheumatoid factor belongs to the M.
immunoglobulins and it is likely gamma globulin.
The presence of immunoglobulin confers to the serum
of patients with rheumatoid arthritis, the ownership to
behave as if it contains an antibody to human and
animals immunoglobulin G.
The Rheumatoid factor is such a protein complex, that
can act as a izoantibodies or a heteroantibodies.
The detection of the Rheumatoid factor is making by
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To value ones experience gain and its utility in
theatre of operations
Gina A. Ciuc
Introduction: During the period of July 2007 -
observation chart.
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Communication in nursing process
Daniela M. Dobeanu, Magdalena Negru, Margareta
I. Popa
... in the begining there was the word
The profesion of medical assistant is not just a tehnique
but a process that incorporate elements of the soul,
mind and imagination. The essence is in the
imagination of the creator, sensibil soul, and inteligent
reaction that represent the fondation of eficient
assistance.
Objective
Comunication is the most important thing in a doctorpacient relationship and other members of the medical
team.
To know how to listen is the first thing in a dialog.
Materials and methodes
- Verbal,
- Language,
- Paraverbal language,
- Non-verbal language.
Verbal language represents 7% of paraverbal language
and how we say it 38% and non-verbal language 55%.
Results: Even tho there is a desire for comunication, it
is strong to realise it so difficult and hard. One of the
motives is that same people raise the barier of
comunication. It is estimated that over 90% of the time
is used on the comunication barier especialy when
satisfying a need.
Conclusion: No matter the type of relation, patientasistent, asistent-rest of medical team, there needs to be
authority, not politeness, good will, not weakness.
Suicide
Meningitis
Roxana Vasilescu
Meningitis is an inflammation of the tissue that covers
the brain and spinal cord. Viral meningitis is the most
common type of meningitis. It is often less severe than
bacterial meningitis. Streptococcus pneumoniae - is the
most common cause of bacterial meningitis. Chronic
forms of meningitis occur when slow-growing
organisms invade the membranes and fluid surrounding
your brain. Delaying treatment for bacterial meningitis
increases the risk of permanent brain damage or death.
Appropriate antibiotic treatment of the most common
types of bacterial meningitis should reduce the risk of
dying from meningitis to below 15%.
In Romania, bacterial meningitis has a mortality rate of
over 30%, the most affected are children aged up to 5
years, with an incidence of 15 cases per 100,000
inhabitants a year.
15-20 cases are reported each year in Military Hospital.
Almost all of the cases occur as single, isolated events.
Approximately half of the cases are due to common
enteroviruses. 10% of hospital episodes were for viral
infections. 78% of hospital consultations for viral
infections of the central nervous system required
hospital admission. Meningitis can be diagnosed by
doing specific lab tests on specimens from the sick
person. If meningitis is suspected, cerebrospinal fluid,
blood, and serum are collected and sent to the
laboratory for testing. Lumbar puncture is the most
important lab test for meningitis. However, people with
meningitis caused by certain viruses such as
herpesvirus and influenza, may benefit from treatment
with an antiviral medication. The first step in treating
viral meningitis is preventing its occurrence and spread.
Depressive disorders
Elena Tolea, Alina Popa, D. Vasilache
Depressive disorders are a set of mental illnesses
characterised by a serious alteration of disposition
(usual emotional status of the individual external
behaviour of the individual) and also of congitive
functioning, affecting the human body as a whole.
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Hearing aids, present and future
Ileana M. Mate
In human life, hearing aids came later, being somewhat
Recklinghausen neurofibromatosis
Petronela andru, Mirela Tatu, Mihaela I. Arghir
Neurofibromatosis most frequent phakomatoses is not a
single entity comprising at least 2 NF1 and NF2
distinct disorders whose genes have been sighted in the
chromosome 17 and 22.
Clinical manifestations are:
Acoustic neuromas;
Meningiomas (70%) are generally small fronto-basal
localized;
Other events include a few spots urine, painful
subcutaneous neurofibromas cutaneous pressure.
Case study
MC patient, age 34, female, urban teacher, hospitalized
in our clinic.
The patient is dealing with a tumor occurrence of a pre
and retroauricular US, at the CAE pavilion extension,
aural fullness and US hearing loss.
Symptoms started about seven years ago, insidious,
slow-growing, and asymptomatic.
ENT
examination:
occipital
lymph
nodes,
submandibular laterocervical predominantly stg.
mobile versus superficial and deep plans.
Laboratory findings:
- Rx c-p, EKG- within normal limits.
- ESR 29 mm | h; Fb. = 425000 u | m.
- Liminal tonal audiometry.
- NMR.
The course of treatment proposed: Surgical treatment.
Evolution
Vital prognosis is good.
There is a risk of malignant transformation of
neurofibromas in sarcomas.
The risk of cancer diseases is increased compared to
the general population, 50% of cases brain tumors;
pheochromocytoma leukemia.
Life expectancy is lower than the general population.
neighboring skin.
Several factors are involved in the etiology of basal cell
carcinoma, such as: actinic aggression, ionizing
radiation exposure and genetic factors.
We present the key role of nursing in the pre and
postoperative management of patients with basal cell
carcinomas.
- Psychic comfort
- Shortening hospitalization
Prognosis:
The outlook depends on the person's overall health and
how bad the fistula is.
People who are otherwise healthy have a very good
chance of recovery.
Possible Complications:
Fistulas may result in malnutrition and dehydration,
depending on their location in the intestine.
They may also cause skin problems and infection.