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Balkan Military Medical Review 2015; 18(Suppl):i-lxxv

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.

New trends in causalities estimation process


An essential factor in the efficient planning of
resources needed for medical support in
operations
B. Savu, D. Cuzino
In the context of the current military conflicts,
especially those asymmetric, and use of improvised
explosive devices, complete and correct planning of
resources needed to provide an efficient and sufficient
medical support, put enough problems to specialists.
This fact is due in particular by the classical casualties
estimation method which use the average, and which
cannot be good in mass casualties situations. The
medical resources are either undersized, or if taking
into account the above situations, oversized. This
presentation tries to review new methods for casualties
estimation, using other methods than average, and
concludes that the best of these is the percentile
calculation, that allows more accurate to plan the
needed medical resources.

Do soldiers have the right to choose their own


doctor?
D. Aron
The goal of this material is to analyze two medical
situations from Romanian mission in Afghanistan,
situations with significant relevance in the right of the
soldiers to choose their doctor. There is a important
dilemma for all military systems, and Romania, being
in the middle of the transformation process of the
medical system, to find the best way to solve this. Is a
matter of interest how our partners have solved this
issue.
Institution and individual interests should be not

divergent, on the contrary, should be in synergy and


complementary position.
A well-organized medical system in the military should
be able to provide in the same time both, the best
medical care for all the soldiers and the best medical
protection for the troops.
Permanently monitoring individual health status should
be a goal to achieve.
Medical decisions should serve the best interest of all
the patients, in the meantime, the force medical
protection measures should be well grounded and
argument.

"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

variable denominators and shoud take into account the


numeracy of the audience.

Patient decision aids IPDAS (International


Patient Decision Aids Standards) criteria
Alina Dima
Patients Decision Aids (PtDAs) are evidenced-based
tools proposed to facilitate the Shared Decision Making
(SDM) process, approach by which the patient
participates together with the practitioner in the
diagnosis and treatment management. The International
Patient
Decision
Aids
Standards
(IPDAS)
Collaboration, world-wide group of researches and
practitioners, was created in 2003 for the developing
and quality control of PtDAs.
Several aspects are to consider when making a SDM:
ethical (meaning especially the patients informed
choice), quality-of-care (patient-centered medical care)

and scientific (evidence-based medical data). And so,


the PtDAs should be actually evidence-based tools,
proposal of the relevant options on the base of best
available research evidence.
PtDAs utility is reflected by two dimensions, the
improvement of the decision making process quality, as
well as of the quality of the choice that is made
(decision quality).
In this regard, five constructs important in SDM
implementation by PtDAs are proposed: the recognition
of the decision made the feeling of being informed
about options as well as by outcomes, the discussion of
goals and preferences with the health care provider,
respectively the involvement in taking the decision.
The PtDAs use reduces the decisional conflict and the
feeling uninformed. Furthermore, PtDAs increase
patients knowledge on available options and
awareness on both treatments risks and benefits
(Cochrane Collaborations review showed that the
PtDAs improves knowledge by about 14%, while the
realistic expectations are improved with as much as
74%).

Shared decision making in breast and prostate


cancer screening
Camelia Badea
Shared decision-making is relevant in decisions about
whether to do screening and diagnostic tests. There is a
common misconception that screening and early
diagnosis is always beneficial, but it can involve risk of
harm just like any other medical intervention.
For testing a prostate specific antigen (PSA) for
prostate cancer men need to understand the risk. These
include the risk of a false positive result, or correct
diagnosis of a slow-developing cancer that would not
have caused harm. (Evans et al 2010).
The New England Journal of Medicine recently
published two studies looking at the effects of prostate
cancer screening, with conflicting results. The first
found that such screening didnt decrease deaths. The
second study showed that for every death prevented, 50
men would suffer from over-diagnosis, which can
range from a prostate biopsy to removing the prostate
entirely.
People might choose to do screening tests for a number
of reasons, including: have an increased risk (genetic or
otherwise) above the population risk of developing a
specific condition (eg, women who have a family
history of breast cancer might choose to do regular
breast screening)

A 2006 analysis by the Nordic Cochrane Center


collaborative, found that for every 2,000 women age 50
to 70 who are screened for 10 years, one woman will be
saved from dying of breast cancer, while 10 will have
their lives disrupted unnecessarily by overtreatment.
Mammograms detect a number of slow-growing tumors
that will never be harmful. But because doctors cannot
be sure of which cancers are dangerous, every woman
with a suspicious finding is subjected to a biopsy or
breast surgery. For every life saved from breast cancer,
10 more lives will be affected by the ensuing
procedures.

Shared decision making in inflammatory bowel


disease and colorectal cancer screening
Raluca S. Costache, D.O. Costache
Inflammatory bowel diseases are chronic diseases of
unknown etiology with long term evolution, with flares
and remission periods, with no spontaneous healing.
All the available treatment use to ameliorated rather
than cure the disease.
Most of the patients are used to take long-term drug
treatment to control their disease. There are many
treatment options with different adverse effects, special
indications and a lot of clinical trials demonstrating the
effectiveness of these pills.
Management guidelines indicates that the patient
should be provided with information on treatment
options and it should be implicated in decisions about
treatment
A better shared decision making should improve the
understanding of the risks and benefits of the various
treatment options, the adherence to treatment, and ad a
beneficial outcome for both patient and health service.
Colorectal cancer is the most frequent digestive
malignancies and represents the second neoplasia
mortality risk in both sexes (after lung cancer in men
and breast cancer in women). The mortality rate is
almost 500000 cases per year.
It was demonstrated by randomized trials that screening
for colorectal cancer reduce the its incidence and
mortality and the European and US guidelines
recommend the screening for adults over 50 years. It
can become a real problem the absence of presentations
for age-eligible patients to gastroenterologist for the
screening because of lack of information.
Good decision making in this case includes information
about this issue, the benefits and adverse reactions of
screening, the possibility to choose between different
tests.

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

taken under clinical observation. Using regular implant


planning software Blue Sky Bio (free usage) the virtual
position of future implants is considered for each case.
Therefore, a complete prediction has been compiled for
each clinical case and then used for the creation of
virtual prosthetic appliance.
Results:
For the confirmation on virtual implant planning in
implant-retained over dentures has been created the
checklist.
Conclusions:
Dental implants placement using virtual planning of is
more accurate and reliable if anatomical and
biomechanical considerations are taken into account.
Using various principles and digital methods is a
common method useful while planning the future
position of the implants.
Keywords: overdenture, virtual planning, retention

Workshop 5
Up-to-date in urology-gynecology
Female urinary incontinence The value and
challenges of randomized controlled trials
State of the art

Urethral Slings) and ValUE (Value of Urodynamic


Evaluation).

V. Jinga

Laparoscopic lateral hysteropexy for pop


(Dubuisson procedure)

I will present the design and findings of several


randomized controlled trials in female urinary
incontinence developed and performed by the major
multiinstitutional/multispecialty cooperative networks
in the United States.
The UITN (Urinary Incontinence Treatment Network),
established in 1999, was a consortium of urologists and
urogynecologists from 9 clinical centers and a
biostatistical coordinating center, supported by a
cooperative agreement between the NIDDK (National
Institute of Diabetes and Digestive and Kidney
Diseases) and the NICHD (National Institute of Child
Health and Human Development).
The primary focus of the UITN was to conduct longterm clinical trials on the evaluation and management
of common forms of urinary incontinence in women.
The 4 major studies undertaken in the last 15 years are
SISTEr (Stress Incontinence Surgical Treatment
Efficacy trial), BeDri (Behavior Enhances Drug
Reduction of Incontinence), TOMUS (Trial Of Mid

I. Chira, M. Botea, M. Dumitrache, D. Bdescu, V.


Jinga
There has been increasing interest in recent years in the
preservation of the uterus in patients with POP (pelvic
organ prolapse). The laparoscopic lateral suspension
technique originates in the open procedure and it was
first described by Dubuisson in 1998. This uterineconserving surgical technique was performed on our
patients since 2012.
Multiple variations of this technique are described in
literature, with little to no modification of the basic
principle. After the peritoneum is incised and dissected
of the bladder below the cystocele, a long, narrow mesh
with a flap in the middle is fixed in the midpoint to the
anterior wall of the cervix.
Afterwards properitoneal tunnels are made bilaterally
using blunt dissection, through additional small
incisions, lateral and above the anterior superior iliac
spine or through the incisions left after withdrawing

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.

TVT versus TOT A retrospective comparison


M. Dumitrache, D. Bdescu, R. Petca, S. Racu, V.
Jinga
The gold standard for the treatment of female patients
with stress-urinary incontinence is the mid-urethral
slings, whether the approach is transobturatory or
retropubic. The purpose of our study was to evaluate
the complication and pad-free rates in women treated
with either of the two procedures.
For this, we evaluated retrospectively 100 female
patients with SUI which we separated in 2 equal
groups.
The first group had a TVT sling procedure performed
between May 2009 and August 2010. The second
group had a TOT sling procedure performed between
January 2013 and December 2013 with at least 1 year
follow-up. The patients were evaluated at 1 week, 1
month, 3 months and 1 year. The mean BMI was 31+3
Kg/m2 in the TVT group and 30+3 Kg/m2 in the TOT
group. At the 1 year follow-up the pad-free rate was
80% in the TVT group and 84% in the TOT group.
Conclusion
Both tapes have similar efficacy regarding cure of
incontinence. TOT is more effective, albeit
insignificantly, with regard to the cure of urinary
incontinence. The TOT procedure should be the first
choice in patients with previous retropubic SUI
surgery.

Mesh surgical treatment in stress urinary


incontinence
O. Bratu, M. Dinu, D. Spnu, A. Rdulescu, R.
Popescu, D. Marcu, I. Oprea, B. Petre, D. Mischianu
Introduction
Stress urinary incontinence affects a large number of
women causing dramatic reduction of life quality.
Several therapeutic approaches have been tried.
Nowadays vaginal sling procedures are becoming more
and more important.
Materials and Methods

This review deals with our experience at the Urology


Clinic of the Central Military Emergency University
Hospital Dr. Carol Davila regarding the treatment of
stress urinary incontinence with polypropylene meshes.
Several variables are analyzed: the age of the patient,
the number of vaginal births, if hysterectomy is
recorded, body mass index. We present our cases and
experience regarding perioperative complications and
their management.
Results
47 female patients diagnosed with stress urinary
incontinence undergone vaginal mesh procedures in our
Clinic, in 34 patients we have performed TOT and in
13 patients TVT. The results were favorable with very
few perioperative and postoperative complications. In
all patients with TVT we have performed
intraoperatory cystoscopy.
Conclusions
Vaginal slings become more and more attractive
treatment option both for the patient and the surgeon
due to the reduced risk of complications and operating
time, for good postoperative results and the last but not
the least brief patient inbound.

Mesh surgical treatment in advanced genital


prolapse
O. Bratu, M. Dinu, D. Spnu, A. Rdulescu, R.
Popescu, D. Marcu, I. Oprea, B. Petre, D. Mischianu
Objective
Genital prolapse represents a frequent pathology in
women and is the source of numerous urogynecological complications.
Multiple births, menopause, obesity are known risk
factors.
The aim of this article is to evaluate the surgical results
of this particular pathology.
Material and method
We have analysed in a retrospective study a batch of 15
women with advanced genital prolapse (grade III and
IV). They all underwent mesh surgical procedures. For
the anterior prolapse (cystocele) we have used a
transobturatory four arms polypropilene mesh and for
the posterior prolapse (rectocele) another mesh was
anchored to the sacrospinous ligament.
Results
Operating time was brief and no major intraoperatory
complications occured. The patients were discharched
2-3 days after surgery and they were periodically
evaluated. Two relapses occured in which we have
performed vaginal hysterectomy and colpocleysis.
Conclusions
Genital prolapse represents a serious health condition,
disturbing normal social activities.
Surgical treatment with polypropilene mesh represents
the standard for advanced genital prolapse. Classical

surgical techniques such as posterior or anterior


perineoraphy are now becoming obsolete.

Conclusion: Infiltrating endometriosis is a surgical


affliction that requires interdisciplinary surgery or
gynecological surgery.

Ureteral risk in pelvic surgery


O. Nicodin, N. Niculescu, B. Panaite
Purpose: Recording of the ureteral lesions and their
type in the gynecological surgery of the prolapsed.
Materials and method: During the period 2008-2015
have been analized retrospectively the intraoperative
ureteral lesions.
Results:
Open surgery benign pathology: 7 cases
Oncological surgery (uterine cervix cancer): 8 cases
Vaginal surgery: 2 cases
Types of lesions:
- sectioning: 12 cases
- ligature: 5 cases
Moment of identification:
- intraoperative: 13 cases
postoperative
(uroperitoneum

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

Deep infiltrating endometriosis


O. Nicodin, N. Niculescu, B. Panaite
Purpose: Presentation of a complex deep infiltrating
endometriosis case.
Materials and Method: Patient is 30 years old. The
diagnose before surgery was: nephritic right ureter.
During the surgery: infiltrating endometriosis stage IV
with ureter hydro nephritis. The procedure: cystectomy
of the endomembrane of the ovaries. Replantation of
the ureters, gall bladder on the right side.

Complications of prosthetic surgery in pelvic


floor disorders
O. Nicodin, N. Niculescu, B. Panaite
Introduction
In 2008, the Food and Drug Administration (FDA)
warned of potentially serious complications associated
with surgical mesh placed through the vagina to treat
POP and SUI. Then, in 2011, the FDA stated that
serious complications associated with surgical mesh for
transvaginal repair of POP are not rare.
The U.S. Food and Drug Administration today issued
two proposed orders. If finalized, the orders would
reclassify surgical mesh for transvaginal POP from a
moderate-risk device (class II) to a high-risk device
(class III) and require manufacturers to submit a
premarket approval (PMA) application for the agency
to evaluate safety and effectiveness The American
Urogynecologic Society (AUGS) disagrees that mesh
should be banned.
Material and methods:
Mesh surgery in our clinic: between ian 2010 - ian
2015 was performed 208 TOT and 30 TVT anterior
procedures for Stress Urinary Incontinence and 105
intervention for Genital Prolapse (71 anterior wall
repair and 23 posterior wall repair. 11 intervention for
repair of central compartiment - colposacropexy)
The complications that appear were:
-mesh erosion - 5 cases for TOT and 3 cases for TVT
anterior,0 cases for treatment of POP (all procedures)
-pain and dispareunia 19 cases for treatment of SUI and
7 cases for treatment of POP
-vesical perforation 15 cases for treatment of SUI and
3cases for teatment of POP
Conclusions
Currently, it is the surgeons duty to fully inform the
patient and discuss the risks vs benefits of such
procedures.Just as important, the surgeon must also
reflect on and judge their surgical competency, being
allowed to decide what is best for individual patients.

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.

Effect of algisyl ventriculoplasty on right heart


S. I. Dumitrescu, I. Droc, G. Neagoe, V. Murgu, D.
Svoiu, I. Mocanu, S. Rurac, C. Buzil, D.
Dragomir, S. Stamate, G. Cristian
Introduction: To evaluate the changes in right
ventricular (RV) systolic function and right ventricularright atrial pressure gradients after implantation of
novel device in the first 8 patients from our center,
randomized to the surgical group in AUGMENT-HF
clinical trial and evaluated after three months.
Methods: AUGMENT-HF clinical trial is a
randomized, controlled study to evaluate the safety and
cardiovascular effects of Algisyl-LVR as a method
of LV augmentation in patients with chronic heart
failure due to ischemic or non-ischemic dilated
cardiomyopathy. Algisyl-LVR is a biopolymer
classified as medical device by regulatory authorities
that is implanted in free wall of the left ventricle aiming
to alleviate LV dysfunction by reducing the wall stress
through the modification of the ratio between LV
radius and wall thickness. The technique of
implantation is a surgical procedure consisting of a left
thoracotomy, afterwards the biopolymer being

delivered by the cardiac surgeon through a series of 10


to 19 implants that are placed circumferential at the
mid-ventricular level. We report the available
echocardiographic data on 3 months follow-up,
obtained for the first 8 patients randomized in the
surgical group in our center.

Dangerous liaisons: subclinical cardiovascular


disease and periodontal disease
S. I. Dumitrescu, L. Chiriac, Maria M. Gurzun, D.
Svoiu, Ileana Hantulie, R. Boingiu, Alexandra
Grleanu, Mariana Vicol, R. Oroan, I.M. Geru, H.
Barbu
Introduction:
There is a universally recognized need to explore
additional cardiovascular risk factors and risk markers
and to attain an enhanced correlation between statistical
risk assessment and the presence of subclinical
cardiovascular disease.
Purpose:
We intended to examine the relationship between
subclinical cardiovascular disease evaluated by cardiac
and vascular ultrasound examination and the
periodontal disease (PD) status, assessed through a
simple clinical exam.
Methods:
We screened 190 individuals during a cardiovascular
primary prevention program. Data on risk factors were
collected using an individual evaluation sheet and
through determination of laboratory parameters (lipid
profile, glucose) in a period of +/- 3 days from the
baseline clinical and ultrasonography evaluation.
Ultrasound data was collected on three examinations
made in same day: echocardiography, brachial artery
flow mediated dilatation and carotid artery intima

media thickness. Data on PD status were collected


through a simple clinical exam performed in a period of
+/- 7 days from the baseline clinical and
ultrasonography evaluation and categorized the study
group in a subgroup of normal periodontal status (N =
69 persons; 36.3%) and periodontal disease subgroup
(N=121; 63.7%).
Results:
After data collection we divided the study group
according to PD status and compared the mean values
for ultrasound measurements. There are significant
variances between the groups, regarding both the
structural and functional cardiovascular parameters, the
only parameters that have not been different being LV
systolic and diastolic diameter dimensions, LV
shortening fraction and LV ejection fraction.
There is widespread presence of subclinical
cardiovascular disease in the subgroup of persons with
abnormal PD status, 110 (91%) persons out of 121
having at least one type of subclinical injury. The
presence of PD is associated with a relative risk RR =
2.98 (CI 2.08 4.28) for any type of subclinical
cardiovascular damage. Oppositely, a normal
periodontal status is highly indicative for a reduced
occurrence of subclinical lesions. We calculated
concordance coefficient for group classification based
on subclinical cardiovascular impairment status
compared with classification based on PD status and
we found Kappa = 0.624, p< 0,001 (high concordance).
Conclusions:
A normal periodontal status is indicative of low
probability for the presence of subclinical
cardiovascular disease and an abnormal periodontal
status is highly indicative for the occurrence of
subclinical cardiovascular disease.

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

fact that recent statistics studies depict them with equal


medical performance. ERCP (Endoscopic retrograde
cholangiopancreatography) seems to be faster and
cheaper than the surgical methods used for the same
pathology, even if the efficiency is quoted the same.
There are many situations in which the bile duct stones
removal is really difficult: bile stones larger than 2 cm,
bile stones larger than the distal bile duct, stones
located above biliary stenosis, stone impaction of
common bile duct, Mirizzis syndrome.
Failure of bile duct stones extraction is frustrating for
the endoscopist. Using just the common devices, basket

or extraction balloon, bile duct stone removal has also


an important rate of failure (6-8%). If the endoscopist
doctor uses effectively in the common practice the
dilation balloons and the lithotripters, the success rate
achieves 98-99%.
The retrospective analysis of the Emergency Hospital
Floreasca-Endoscopy Center, comparing the year 2010
with 2014, shows that the systematic use of the two
devices has significantly improved the results and we
recommend them in the therapeutic routine use of
interventional endoscopy. About 7-10% of the patients
with bile duct stones require special extraction devices.
Although the choledocholithiasis is considered the most
accessible for the interventional endoscopist doctors,
there is a significant percentage of patients in whom the
procedure has a higher degree of complexity, requiring
either a special endoscopic technique or forwarding the
case to the surgeon.

Gastrointestinal bleeding event in patients


anticoagulated with Dabigatran
Ruxandra Opria, A. Kostov, A. Ragea
Background: According to 2010 RELY trial, pacients
who take dabigatran (150 mg bid), were 1.5 times more
likely to have a major gastrointestinal bleeding event.
The risk of major gastrointestinal bleeding is even
greater in some categories of pacients (pacients older
than 65 years, pacients who receive 150mg vs 110 mg,
cronic kidney disease etc). The antidote for dabigatran
is under development. As a matter of fact, the absence
of specific reversal agent highlights the significance of
considering
an interventional approach when
managing a patient with dabigatran associated
bleeding.
Methods: A prospective stude, that lasted 12 months
(March, 2013 March, 2014). We admitted 25
anticoagulated with dabigatran pacients, that presented
for massive GI bleeding. All the patiens underwent
upper or lower endoscopy within 24 h from admission,
followed by endoscopic hemostasis. We used combined
hemostasis methods (local adrenaline injection and
thermal/energy based coagulation) and some pacients
benefited from mechanical hemostatic devices metal
clips.
Results: From 25 pacients, 17 pacients were older then
65 years. Higher prevalence was reported in females
(11 males/ 14 females). Upper GI bleeding was
identified in 15 pacients (60%), most frequently
gastric/duodenal ulcers, angiodysplasia (3 cases, 12%)
and 1 gastic polyp. Most common cause for lower GI
bleeding
(10 pacients) were: colon polyps,
diverticulosis (2 pacients), angyodisplasia and one
pacient with rectal ulcer. Standard endoscopic therapy
(for all 25 pacients) consisted of adrenaline injection
endoscopic hemostasis and thermal coagulation with

Golde Probe 10F. 12 pacients received additional


hemostatic therapy mechanical hemostasis. The
phenomena of rebleeding was more frequent in the
double hemostasis group (4 pacients rebleeded)
compared to the triple hemostasis group (1 pacient,
with CrClearence of 20 mL/min).
Conclusion:
Dabigatran pacients have higher risk for developing
massive GI bleeding.
Endoscopic therapy for this pacients is compex, and we
strongly recommend mandatory association of double
hemostasis (adrenaline injection/coagulation) with
mechanical hemostasis (metal clips).

Expandable stents in digestive pathology


present use in an emergency hospital
Mdlina Ilie, V. andru, I.C. Nedelcu, S. Ummar,
I. Dora, G. Constantinescu
Introduction:
Self expandable metal stents(SEMS) are developed
lately, as an effective and safe, less invasive alternative
of surgery for the treatment of malignant
intestinal/biliary obstruction. Recently, SEMS are also
introduced in benign pathology.
Aim:
The aim of this presentation is to report a retrospective
analysis of the total number of SEMS placed for
esophageal, enteral, colorectal and biliary obstruction
during the last 3 years in Clinical Emergency Hospital
Bucharest, as well to review the literature published on
this issue.
Methods:
Between 2013-2015 in Clinical Emergency Hospital
Bucharest, we have placed: 232 esophageal stents, 23
enteral stents, 5 colonic stents and 60 biliary stents
under radiologic guidance. The main parameters
followed were represented by: sex, age, grades of
obstruction, stent diameter and type, immediate and
late complications and survival rate.
Results:
Regarding the esophageal stenting, most of the
indications were malignant obstruction (155 cases of
esophageal cancer and 30 cases of extrinsic
compression), but also for esophageal fistula, peptic
stenosis and even traumatic esophageal rupture. The
majority of the enteral and colonic stents were inserted
for malignant obstructions, having only 2 cases with
benign obstructions. This is also the case for biliary
stenting, were most of the indications were represented
by pancreatic cancer. Technical and clinical success
rates were approximately 92% and 80%, respectively.
There were no major complications of perforation,
bleeding, or death.
Conclusions:
SEMS insertion can be performed safely, with minimal

complications and hospitalization allowing the restart


of oral feeding and improvement of nutritional status
for the digestive obstruction or jaundice disappearance
in case of biliary obstruction. It represents the first
option for unresectable digestive/ biliary malignant
obstruction.

Pancreatic cysts New insights


Mariana Jinga, Raluca S. Costache, M. Ptrescu,
P. Nu, Sndica Bucuric, B. Macadon, Andrada
Popescu, Florentina Ioni Radu, Georgiana Robu,
Alice Farca, V. Balaban
With the increasing use of advanced imaging
techniques for various indications, incidental cystic
pancreatic lesions are being found more and more.
Most of the pancreatic cysts are benign, and their
management consists of surveillance. A small
proportion of cystic pancreatic lesions can however
show neoplastic changes or morphological risk features
(size 3 cm, dilated main pancreatic duct, inner solid
nodule) which can predict the malignant potential.
Offering the possibility of cyst fluid and tissue
sampling by fine needle aspiration (FNA), endoscopic
ultrasound (EUS) has developed as a very useful tool in
evaluation of high-risk pancreatic cysts, which benefit
from surgery; due to the its high morbidity and
mortality, pancreatic surgery should be provided by
centers with expertise. On the other hand, absence of
concerning features on EUS-FNA can be reassuring
and patients can undergo careful surveillance.
EUS thus plays a central role in the management of
pancreatic cysts, selecting patients with high-risk
lesions who benefit from surgery and those who only
need surveillance.

Actual standards in gastroenterology Focus


on endoscopy
Sndica Bucuric, R. Mateescu, Raluca S. Costache,
P. Nu, B. Macadon, Andrada Popescu, M.
Ptrescu, Mariana Jinga, Florentina Ioni Radu
The politics of implementing standards in medical
practice could lead to an improved medical act,
protection of the patients and doctors. Although there
are protocols and guidelines at various level (European,
academic), there is an option to choose the one that is
applied at unit level. The efficiency of this is better
when it is applicable in a organized and coordinated
way.
Regarding endoscopy there are auditable factors that,
when are accomplished, raise the quality of medical
act. In endoscopy the some of the auditable factors are:
the retrieval of informed consent less than 5% during
the procedure day and less than 1% during the

procedure, good bowel preparation and cleansing >


90%, less than 1% of the patient with hypoxia
(SaO2<85% for more than 3 minutes) during sedation,
cecal intubation >90%, adenoma detection rate around
10%, minimum 6 minutes retrieval of colonoscope
time, sterilization of the endoscopes with
microbiological testing at least at 3 months. There is
necessary to introduces standards of quality in Romania
and to follow the auditable factors in endoscopy units.

Diagnostic yield of endoscopic markers for


celiac disease
V.D. Balaban, Georgiana Robu, Adriana Miric, M.
Ptrescu, B. Macadon, Sndica Bucuric, Raluca
S. Costache, P. Nu, Florentina Ioni-Radu,
Mariana Jinga
Introduction:
Several endoscopic markers have been described in
celiac disease (CD). The aim of this study was to
evaluate the diagnostic accuracy of these markers for
CD in an adult population undergoing upper
gastrointestinal endoscopy.
Methods:
Over a period of 3 years, between June 2012 and 2015,
all patients who underwent upper GI endoscopy and
presented one or more of the following endoscopic
features were included: atrophy, fissures, mosaic or
nodular pattern in the bulb/second duodenum,
scalloped folds, reduced or absent folds in the second
duodenum. A total of 222 patients met the criteria, but
40 were excluded from analysis because duodenal
biopsy or CD serology was either not done or not
available.
Results:
Among the 182 patients, 56.04% were female, with a
mean age of 47.6 13.9 years. 20/182 (10.99%) had a
final diagnosis of CD. Presence of any endoscopic
marker had high sensitivity (95%) and negative
predictive value (98.41%), but low specificity and
positive predictive value; a similar diagnostic
performance was obtained if only duodenal endoscopic
markers were considered. Bulb atrophy and reduced
folds in the descending duodenum had a low diagnostic
accuracy, while mosaic pattern and scalloping were
highly specific for CD (98.77% and 99.38%
respectively).
Conclusions:
Detection of endoscopic markers by careful
examination of the duodenum during endoscopy allows
for an accurate selection of patients who warrant
duodenal biopsy for CD confirmation.

Percutaneous endoscopic gastrostomy Long


and short time solution for impossible eating
Sndica Bucuric, R. Mateescu, Raluca S. Costache,
P. Nu, Mdlina Prun, V. tefnescu, M. Tnase,
B. Macadon, M. Ptrescu, Ctlina Diaconu,
Andrada Popescu, V. Balaban, Florentina Ioni
Radu, Mariana Jinga
Introduction:
Percutaneous endoscopic gastrostomy (PEG) tubes
have more indications into the practical use of
gastroenterologists. PEG has shown that mortality and
morbidity is lower comparing with surgical
gastrostomy if the indications and evaluation is well
done. There are various indications in different range of
pathologies and the outcome is favorable.The objective
of our study is to underline the influence of PEG in
adult patients quality of life, but also to describe
functional status and possible complications.
Aims & Methods:
One year period of time a total of 29 patients with
indication for PEG (21 men, 8 women, mean age
56.85) were included in our study. The tube was placed
using the pull technique (Ponsky). Most of the patients
underwent sedation using Midazolam, except for two
cases where Propofol sedation was indicated,
associated with topical Lidocaine at incision site, and
injection of large spectrum antibiotherapy prior to
intervention.
Results:
Most of the patients suffered from neurological
conditions such as: cerebrovascular accident (8 cases),
traumatic subdural hemorrhage (2 case), dementia and
Gerhardt syndrome (1 case), vascular progressive
leukoencephalopathy (1 case), polyradiculoneuritis
Guillan Barre (1 case), coma (1 case), lateral sclerosis
amyotrophy (1 case). Other indications for PEG
included: partial mechanical obstruction of pharynx (3
cases) or esophagus (5 cases), tongue malignancy (3
cases) and 2 cases of facial polytrauma including
fracture of the mandible. In 12 % cases from our study
group was achieved clinical improvement that leaded to
the removal of the gastrostomy kit, mean time to the
removal of the gastrostomy tubes being about 14
weeks. 8.7 % of the study lot suffered complications
such as: tube migration leading to gastric perforation,
peristomal infection and PEG-site leakage.
Conclusion:
PEG tubes are associated with low complications,
morbidity and mortality rates. Our descriptive study
highlights the utility and prognosis of PEG tube feeding

in comparison to alternative methods of treatment for


adults with impossibility of oral feeding, either
temporary or permanent.
Keywords: PEG, Percutaneous endoscopic gastrostomy

Case report Postgastrectomy esophagitis


resistant to medical therapy revealing local
cancer recurrence
Andrada L. Popescu, A.I. Gavril, I.P. Nu, Raluca
S. Costache, Mariana Jinga, Sndica Bucuric, B.
Macadon, M. Ptrescu, Florentina Ioni-Radu
Objective:
We are presenting a case of severe postgastrectomy
esophagitis, resistant to medical treatment in a patient
operated for gastric cancer two year ago, followed by
adjuvant chemotherapy, the latest endoscopy report
suggesting
tumor
recurrence,
confirmed
by
histopathological result.
Case report:
A 70-year-old male with severe esophagitis
postgastrectomy, was admitted to our hospital for
control. For the last year he had three upper
gastrointestinal endoscopy because of reflux symptoms,
with severe refractory esophagitis to medical treatment.
The annual CT scan recommended by oncologist
revealed four weeks before a circumferential thickening
of preanastomotic esophagus wall of 10 mm length,
who
needed
additional
EUS
(endoscopic
ultrasonography).
The physical exam was unremarkable and his
laboratory data were normal.
Esophagogastroduodenoscopy
(EGD)
revealed
irregular mucosa with large erosions and a vegetant
mass in the inferior esophagus, not described at the
endoscopy made three months ago. Histological
examination of the endoscopic biopsy specimen
demonstrates adenocarcinoma with signet ring cell.
After tumoral staging the patient needs surgical and
oncological treatment. The signet ring cell (SRC)
carcinoma respond less well to therapy and have
decreased overall survival compared with patients with
non-SRC histology.
Discussion and conclusion:
Reflux esophagitis is a common postgastrectomy
complication and it seems to be caused by nocturnal
exposure to trypsin and conjugated bile acids.
Refractory symptoms to medical treatment should lead
to careful surveillance of patients for early detection of
tumor recurrence.

Workshop 8
Up-to-date in gastroenterology
Hepatocellular carcinoma Current treatment
and evidence-based medicine

Management of spontaneous bacterial


peritonitis in cirrhosis patients

Andrada L. Popescu, A.I. Gavril, I.P. Nu, Raluca


S. Costache, Mariana Jinga, Sndica Bucuric, B.
Macadon, M. Ptrescu, Florentina Ioni-Radu

Sndica Bucuric, R. Mateescu, Andrada Popescu,


Raluca S. Costache, P. Nu, B. Macadon, M.
Ptrescu, Mariana Jinga, V. Balaban, Florentina
Ioni Radu

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.

Spontaneous bacterial peritonitis remains one of


cirrhosis ascites complication, although it is a lower
incidence due to prophylaxis attitude. Diagnosis is
important and it should not be made only by clinical
impression, paracentesis still remains a good diagnostic
tool. The use of dipstick tests and automated cell count
allow a quick diagnostic. Also the cause of the
infection should be reevaluated at patient with no
response to treatment, and fungal infection should be
considered. The identification of situations with high
risk for spontaneous peritonitis like low albumin in
ascetic fluid (< 1g/dl), variceal hemorrhage and
recurrent episodes of peritonitis should be made. It was
found an association between the use of proton pump
inhibitors and a raised rate of spontaneous bacterial
peritonitis. This is why the diagnostic, treatment and
prevention of this complication should be an integrant
part in global management of a patient with cirrhosis
and ascitis.

Chronic liver disease evaluation through


noninvasive methods
Raluca S. Costache, I.P. Nu, Sndica Bucuric, B.
Macadon, Florentina Ioni Radu, Mariana Jinga,
M. Ptrescu, Andrada Popescu, V. Balaban,
Ctlina Diaconu, Laura Voicu, D.O. Costache
Chronic liver disease is one of the most comprehensive
patology with a wide variety of ethiologic aspects and
is associated with the evolutions to end stage liver
disease one of the most important factors for evaluation
of chronic liver disease is the amount of fibrosis
correlated with the risk of developing cirrhosis and its
complications. Up to now the reference method for
evaluation of hepatic fibrosis was liver biopsy, but
more and more the non invasive methods for
assessment of liver fibrosis are being used. Non
invasive methods rely on two different methods of
evaluation: the evaluations of biomarkers in serum
samples the biological method, and the evaluations of
liver stiffness - the physical method.
Although these methods are widely used, non invasive
and cost efficient they do not abolish the need for liver
biopsy.

They must be used as an integrated system with liver


biosy according to the specific situations.

Diabetes mellitus type II An important risk


factor for colorectal cancer
M. Ptrescu, P. Nu, Raluca S. Costache, Sndica
Bucuric, B. Macadon, Andrada Popescu, Mariana
Jinga, Florentina Ioni Radu
Colorectal cancer (CCR) is a major heath problem
considering the increasing prevalence and mortality all
over the world.
Recent data points to an incresed incidence rates in
under 50 years age group and a slight decreased
incidence rates in older age groups. CRC is a third
cause of cancer in men and a second cause of cancer in
women. In Romania the anual incidence rates are about
23/100,000.
The modifiable risk factors (diet, physical effort,

smoking, obesity) are responsible of about of


incidence rates differences between underdeveloped
and developed countries.
Diabetes mellitus type II is also an ailment facing an
increased prevalence and morbidity in close relation to
life style and diet issues.
PREDATORR Study, closed at the end of 2014,
showed that the prevalence of DM II in Romania is as
high as 11.6%.
DM increases by 1.5 fold the risk of several cancers:
colorectal, urinary bladder, cervix. In 2010 American
Cancer Society and American Diabetes Association
issued a common statement recommending a proactive
diagnosis workup attitude concering the relation
between DM and colorectal cancer.
In spite of all the relevant epidemiological data in
Europe and Romania a similar recommendation has not
yet been issued.

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

apex, (2) the movement of the free wall towards the


inter-ventricular septum and (3) traction of right
ventricular free wall edges in the areas of continuity
with LV, performed by the LV contraction. All these
elements, correlated with the retrosternal position of the
right ventricle, turn the echocardiographic assessment
of RV into a challenge that calls for an increasingly
more detailed response, using both qualitative and
quantitative approaches.
Given the numerous studies that have shown that right
ventricular dysfunction is one of the major independent
prognostic factors, the need to integrate its
quantification in the diagnostic and therapeutic
management, we propose an overview of the steps that
we must go through in echocardiographic evaluation of
the RV. There is no section covering the entire RV, so
its assessment requires to integrate the information
obtained by viewing its various segments in standard
sections parasternal long axis (Plax), parasternal short
axis (PSAx), apical 4 chambers (A4c), apical subcostal
and in the two RV sections one for the inflow and one
for the outflow tract. Instead of conclusions, we
propose an algorithm for examination of RV that meets
the goal of being easy to put into practice, enriching
qualitative and quantitative information of an
echocardiographic report.
Also, we review situations where the uncommon
encountered
pathology
requires
additional
measurements or echocardiographic techniques.

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).

Medical triage in chemical mass casualty


incidents
C.B. Teudea
Weapons of mass destruction were used from the
ancient history, but nowadays their use is less probable,
excepting the terrorist acts. A great importance has the
medical system preparedness so that it can cope with
that kind of situations. The chemical substances that
can be used as weapons of mass destruction are very
accessible being used in industry as at home. The
chemical agents that are used can be lethal or unlethal
and can action at different levels of the human
organism. Medical management of the chemical mass
casualty incidents (MCI) is influenced by several
factors related to the chemical agent used (type,
toxicity, half-life, persistence, antidote), to the type of
exposure (liquid, vapors or both), the route of exposure
(inhalation or transcutaneous), the presence or absence
of clinical signs, the time from exposure, and also by
the number of victims and the resources available.
Triage in MCI is done using the classical principles of

military triage with 4 color codes (red, yellow, green


and expectant / black), but adapted to the chemical risk
situation. The initial triage shall be done in the DECON
area by a special triage team wearing a complete PPE,
which will establish the triage categories. In the same
time an emergency care squad will be ready to
intervene every time the patient /victim are in danger.
Key words: chemical incidents, medical triage, triage
categories.

Usefulness of point of care testing in the


emergency department Our experience
C.B. Teudea, M. Toma, S. Dogaru, Luminia M.
Popa
Point of care testing (POCT) in the Emergency
Department (ED) is becoming more common. The
implementation and maintenance of POC testing in the
ED, however, is a complex issue. POCT instruments
vary widely and can be categorized as transportable,
portable, or handheld, based on the format. For
emergency medicine, 60-70% of the decisions made by
the physicians on admission, discharge and medication
are based on lab results. In this presentation we discuss
the benefits that point-of-care testing bring for
Emergency medicine: improved turnaround time,
decreasing the time in the ED, cost benefit, reducing
emergency department overcrowding, increasing
patient satisfaction, improved ED efficiency; better
patient outcomes.
POCT instruments are used every day in our ED for
biomarkers determination, such as cardiac biomarkers,
sepsis biomarkers (presepsin), and also for blood tests
blood count, biochemistry and urine tests (toxicology).
We made a comparison between the blood test results
obtained on POCT instruments (complete blood count,
biochemistry) and the blood tests obtained in the
Central Laboratory of the hospital. The final result was
a little difference between the 2 lab tests, but with no
statistically significance.
Keywords: Emergency, Point of care testing,
Emergency Department.

Medevac evacuation for a femur fracture in a


paratrooper
D. Negoi, C.B. Teudea
We present the case of a 46 yrs. old male paratrooper
who had an accident while jumping with the parachute

during a contest, falling from about 4 meters. He got a


fractured femur. Because of the terrain, his evacuation
by conventional ground ambulance was not feasible.
The SMMU (Medical Military Emergency System) was
activated for a fractured femur and a suspicion of
pelvic and/or lumbar spine fracture. We were made
aware of the case at 16:40. In less than 2 hours from the
emergency call, we arrived at the SUUMC
(Universitary Emergency Central Military Hospital)
with the patient.
The patient was admitted into a trauma ward and he
suffered a surgical intervention the next day, with good
results.
Conclusion: this is a not too complex case which shows
that the MEDEVAC helicopter can be used to evacuate
trauma patients from places where the ground
ambulance cant get and/or the ambulance must be
driven on bumpy roads which can worsen the patients
status. Also, the time length was 2 to 3 times shorter
with the MEDEVAC than it would have been with the
ambulance.
Key words: trauma, parachuting accident, rapid
medical intervention, MEDEVAC.

Peripheral catheter embolism Case


presentation
C.B. Teudea, M. Slceanu
The first case of catheter embolism was published over
60 years ago. Catheter embolism is defined as a part or
the whole central or peripheral catheter migration in the
venous system, heart and/or pulmonary circulation.
The complications that may arise shortly or after a long
period of time from the event are: cardiac arrhythmias,
acute
myocardial
infarction,
phlebitis,
thrombophlebitis, vascular perforation with secondary
bleeding, pulmonary embolism, myocarditis and even
death.
In this paper we present a case of a patient admitted to
our Emergency Department. During the procedure of
intravenous peripheral catheter introducing an incident
has occurred: detaching the plastic tip (the intravenous
part) of the peripheral catheter from the fixed part and
migrated into the venous system.
Our goal is to describe the immediate measures (local
compression, tourniquet), investigations (Doppler and
cardiac ultrasound, chest X-Ray, CAT scan,
angiography, perfusion scintigraphy), treatment
(phlebotomy, intravascular exploration and foreign
body extraction), prophylactic measures (pain killers,
antibiotics and antithrombotic medication) and patient
evolution throughout hospitalization.
The case presentation will be followed by a literature
review of related cases and the description of The
guide of catheter embolism management implemented
at the Universitary Central Emergency Military

Hospital Carol Davila Bucharest.


Keywords: peripheral catheter, catheter embolism,
immediate measures, clinical guide.

Emergency Medical Military Service 5 years


L.M. Lupu, C.B. Teudea
Introduction and Objectives:
Emergency Medical Military Service, founded in 2010,
deals with first aid, transport and emergency care for
staff of the Ministry of National Defense, on mission
inside the country. The service is linked to the national
emergency medical system; including the call can be
alerted single emergency number 112.
Methods:
There are presented missions executed this time
focusing on difficulties in the planning and execution
of these missions.
Results: The analysis showed continuing improvement
in the response time from the onset of a mission
information system EMMS. Chronic underfunding,
lack an integrated vision regarding this concept creates
the potential difficulties in the execution of these
missions.
Conclusion:
Increasing interoperability between the structures of
Air Force Staff and medical units of the Medical
Directorate, and finding ways to integrate in this
system other forces and medical means in the army,
along with organizing a training center in medicine at
Universitary Emergency Central Military Hospital in
Bucharest, may be a solution to increase the
performance of this system.
Key words: emergency, medical military system,
interoperability.

Flight surgeon towards a new necessary asset


of the air force
L.M. Lupu
Introduction and Objectives: The practice of aviation
medicine has developed largely around the military use
of high performance aircrafts and the need for the flight
surgeons to address the many physiological and
psychological challenges that military flight poses.
Methods: Will present a framework of the operational
role of the flight surgeon in the Romanian Air Force.
The flight surgeon role encompasses the traditional
operational medicine roles with additional tasks such as
flight incidents investigation, aeromedical evacuation,
physiological support, aeromedical expertise, making it
one of the more complex military specialities.
Results: The analysis shows the current state of medical
flight support and the basis towards the flight surgeon
program. The current capabilities and the expected

challenges to be overcome are presented.


Conclusion:
The
flight
surgeon
program
implementation is crucial towards a better flight
medical assistance. The role of a flight surgeon will be
of major importance, as will be his responsibility. A
close cooperation with other institutions will be the key
of a successful implementation.

The National Institute of Aerospace Medicine


and the experience in training flying doctors
A. Macovei, D. Vlad
Introduction and Objectives: The National Institute of
Aerospace Medicine has an established experience in
aeromedical training, and we want to show in what
measure these capabilities can help the new Air Force
program towards implementing the flight surgeon in
Romania.

Methods: A brief history of the institute capabilities in


the aeromedical field will be presented, along of a more
detailed description of its technical capabilities.
Results: The analysis shows the capability of the
institute to take over a large amount of the required
flight surgeon training according to the international
similar programs. Unfortunately some of the critical
capabilities we miss, like the human centrifuge will
take its toll on a state of the art implementation and it
will be the Air Force responsibility to find external
partners for the program.
Conclusion: The need for the flight surgeon program
implementation is vital for a better flight medical
assistance. The National Institute of Aerospace
Medicine is ready to take care of the whole theoretical
curricula and of a major part of the practical training. A
close cooperation with other institutions will be the key
of a successful implementation.

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

arthritis (HLAB 27+). 3 years after the onset of the


disease he is started on Infliximab and he stays on the
treatment until 2006, when he is admitted to the
hospital sepsis. So far the patient had 4 switches of
biological therapy due to inefficiency, infections,
anaphylactic reactions, with an extremely aggressive
progression of the disease. Due to an inadequate
response to DMARD and biological therapy, our
patient has suffered, by the year 2009 a double hip and
knee replacement. The patient is currently on
adalimumab, leflunomid and prednisone, and has a
slightly improved disease control.

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.

50% patients with compensated hepatic cirrhosis have


esophageal varices. The rate of first variceal bleeding is
around 7-8%/year; up to 30% mortality from variceal
bleeding at 6 weeks remains higher.
The standard treatment for variceal bleeding include
the administration of vasoactive substances
vasopresina (and analogues) and somatostatin (and
analogues).
The advantages of vasoactive substances includes:

administration as soon as we suspect variceal


hemorrhage (prior to endoscopic confirmation), does
not require specialized equipment or advanced training
of medical staff, it is well tolerated by patients, rapid
and effective hemostasis.

Portal vein thrombosis and anticoagulation


therapy
Raluca S. Costache, P. Nu, Mariana Jinga,
Sndica Bucuric, B. Macadon, M. Ptrescu,
Andrada Popescu, Ctlina Diaconu, Laura Voicu,
Florentina Ioni Radu, D.O. Costache
Portal vein thrombosis (PVT) is one of the major
complications in cirrhotic patients. PVT is
independently associated with risk of failure to control
acute variceal bleeding and rebleeding, may worsen
liver function increasing parenchimal extinction.
PVT increases morbidity and mortality during liver
transplantation and extension to superior mesenteric
vein leads to the need of difficult vascular
reconstruction in liver transplant recipients.
In order to have a better management of these patients
it is important to Screen for PVT cirrhotics who are
potential candidates for liver transplantation, treat
potential LT candidates with thrombosis of the main
portal vein or progressive thrombosis and mantain the
anticoagulation until transplant due to the high risk of
recurrence, in non transplant candidates anticoagulation
in selected cases (strong prothrombotic conditions or
extension to SMV), patients with PLT count less than
50000/uL are at greater risk of bleeding during
anticoagulation therapy, therefore they require more
caution.

Treatment of chronic hepatitis C Old and


new in 2015
Raluca S. Costache, Mariana Jinga, P. Nu, B.
Macadon, Sndica Bucuric, M. Ptrescu,
Ctlina Diaconu, Laura Voicu, Andrada Popescu,
Florentina Ioni Radu, D.O. Costache
In 2015 in Romania we face some realities: the patients
are infected with Genotype 1b HCV, it is an easy to
treat population: nave or experienced only to

PegIFN+RIBA, few patients are non-responders to


protease inhibitors.
The goal of antiviral therapy is to eradicate HCV
infection to prevent hepatic cirrhosis, decompensation
of cirrhosis, HCC and death. In patient with F3 and
cirrhosis, HCV eradication reduces the rate of
decompensation and will reduce, albeit not abolish the
risk of HCC. The treatment endpoint is undetectable
HCV RNA in a sensitive assay (<15IU/ml) 12 weeks
(SVR12) and 24 weeks (SVR24) after the end of the
treatment.
Beginning with September 2015 the dreamed interferon
free therapy is available also in Romania addressed to
special patients. Together with the old IFN and Riba
therapy the new interferon free regimens will ad a
higher rate of sustained virological response

Methotrexate, an old drug eternally young


D.O. Costache, Raluca S. Costache
We present an update on methotrexate, a drug that has
been used in therapeutics for decades. The use of this
drug from 1962 to nowadays remains mainly empirical,
only few well documented studies being available
despite large utilization due to favorable benefit to risk
ratio and low costs.
In dermatology, the prescription of MTX was feared
for a long time, probably because lack of training and
information.
The biologic therapies mainly in psoriasis patients
boosted the attention of dermatologist on this drug, the
last few years being probably a new youth for MTX.

Dermatology in art A historical perspective


D.O. Costache, Raluca S. Costache
We present a brief foray into the way in which artists
have understood for centuries to describe skin
pathology and strengthen certain aspects to promote
their desired messages.
Since ancient Greek or Egyptian peculiarities of normal
or pathological skin attracted the attention of artists
more important than any other branch of medicine
dermatology is part mainstay.

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.

Results and conclusion:


H. pylori infection remains one of the most challenging
infectious diseases, causing high morbidity and
mortality, mainly because none of the actual antibiotic
therapies can provide successful eradication.

A rare case of mesenteric venous ischemia in a


patient with hepatocytolytic syndrome
Andrada L. Popescu, A.I. Gavril, I.P. Nu, Raluca
S. Costache, Mariana Jinga, Sndica Bucuric, B.
Macadon, M. Ptrescu, Florentina Ioni-Radu
Introduction:
We are presenting a rare case of mesenteric venous
ischemia, in a hospitalized patient for hepatocytolysis acute hepatitis C infection.
Case report:
A 70-year-old male with abdominal aortic aneurism
operated six years ago with reimplantation of both renal
artery after aortic graft, was referred to our
gastroenterology unit for investigating an acute
hepatocytolytic syndrome (AST = 297 UI/ml, ALT =
616 UI/ml). A control angiogram and Doppler
ultrasound was performed six months ago, with no
evidence of occlusion or blockage of the mesenteric
arteries.
Viral markers were taken (Ac anti-HCV positive with
low viral load - 115 UI/ml) and supportive hepatic
treatment was immediate conducted. After a few days
the patient accused upper abdominal pain, nausea,
vomiting and constipation. The CT scan did not
confirm arterial mesenteric ischemia suspicion. The
laboratory tests showed rapid increase of urea- 270
mg/dl and creatinine - 4.88 mg/dl needing temporary
hemodialysis in ICU. The abdominal pain persisted,
with signs of peritoneal irritation, and we performed

another CT scan revealing terminal ileum wall oedema,


suggestive for acute mesenteric vein ischaemia, plus
entero-enteral fistula localized in the right inguinal
fossa. The treatment included both surgical and antithrombotic therapy, the postoperative evolution was
favorable, and the patient was released with normal
liver and renal function, with protective ileostomy. At
three months the patient came in good clinical status,
and ileostomy reversal was made.
Results and conclusion:
Acute superior mesenteric vein thrombosis is one of the
less common causes of intestinal ischaemia, but can
lead to life-threatening complications without prompt
treatment.

Gut microbiota Its revealed role in health and


disease
M. Ptrescu, P. Nu, Raluca S. Costache, Sndica
Bucuric, B. Macadon, Andrada Popescu, Mariana
Jinga, Florentina Ioni Radu
Colonization of the gastrointestinal (GI) tract starts at
birth and evolves and changes over a lifetime, such that
the adult human GI tract is home to a unique ecosystem
of several billion bacteria.
The density of gut microbiota reaches its maximum in
distal colon with an estimated concentration of 1011
bacteria per gram of gut content. The microbial
community of the human gut plays a critical role in
functions that sustain health.
In recent years, our understanding of this so called
human super organism has advanced, following
characterization of fecal metagenomes which identified
three core bacterial enterotypes. Basic and clinical
research progressively revealed the impact and
consequences of microbiota
biodiversity on
gastrointestinal disorders and diseases.
The composition of gut microbiota is amenable to
change by diet, this observation providing a reasonable
explanation for the link between certain unhealthy diet
habits and several diseases like: obesity, diabetes,
nonalcoholic fatty liver disease, colorectal cancer,
psychiatric disorders.
The role of pro- and prebiotics in health and disease by
means of changing the microbiota is becoming more
and more obvious.

Medical intelligence, utility for


civilians/international operations
V. Pun, D. Costache, Raluca S. Costache
There have been many examples where personnel
losses caused by diseases and poor medical force
protection have affected military operations. Many of
these could have been prevented by using accurate,

timely medical intelligence.


As a branch of Military Intelligence, Medical
Intelligence (MEDINT) can assesses medical risks and
implement appropriate preventive measures in the
preparatory phase prior the deployment.
Medical Intelligence comes from medical, bioscientific, epidemiological, environmental and other
information related to human or animal health and it
requires medical expertise.
Medical staff is responsible for ensuring a
comprehensive medical force protection program, to be
implemented by the commander.
MEDINT consists of:
- Assessment of environmental and health risks that
forces may be exposed to.
- Analysis of medical capabilities and capacities in the
areas of interest.
- Development of medical threat analysis and its
integration into the overall threat assessment.
In order to assess risks fully and implement appropriate
preventive measures in the preparatory phase(prior the
deployment), the first step is the international medical
cooperation and efforts coordination. An up to date
medical threats assessment should be performed.
Even we discussed about civilian international
operations, especially in areas like Africa, Asia, South
America, we can face many risks that can jeopardize
the business of a company by affecting peoples health.
We can fully compare the military and civilian
operations, considering also the risk of death by guns,
e.g.
The aim of the presentation is to emphasize the role of
medical intelligence for achieving better medical
operational interoperability during missions abroad.
As a result, medical intelligence could be defined as a
tool for multinational cooperation solving the
requirement for sharing medical information between
medical staff in the multinational operations.
Keywords: Medint, assessment, analysis, civilian
operations, multinational cooperation

Ten years laboratory experiment in the


investigation of mustard toxicity
A. Korkmaz, F. Kalkan, T. Topal, O. Aykutlug, S.
Oter
Introduction
Sulfur Mustard (SM), also known as mustard gas, has
been most widely used chemical weapon. The toxicity
of SM as an incapacitating agent is much greater
importance than its ability to cause lethality. After
several decades of studies, the acute toxicity of SM has
been revealed as nitro-oxidative stress, DNA
alkylation, energy depletion and a consequent robust
inflammation with in the affected tissues. Therefore,
several antioxidant compounds and anti-inflammatory

drugs have been shown beneficial effects on acute


toxicity. The delayed toxicity of SM however, has still
no mechanistic explanation.
Materials and Methods
Mustard group of agents known as alkylating agents
due to the addition of alkyl groups to DNA chains.
Furthermore it is demonstrated that the mechanism
which cause acute toxicity also lead oxidative and
nitrosative stress. In light of these data we realized that
acute and chronic toxic mechanism of mustards is
different. We have made a variety of experimental
studies using rats, mice along with several chemicals
including nitrogen mustard, mechlorethamine and half
mustard.
Results and Conclusion
For years, scientific studies related to mustard gas
derivatives in our research laboratories have led us to
the hypothesis that apart from oxidative and nitrosative
stress driven acute toxicity, the toxicity of chronic
period may be due to epigenetic changes. In this
presentation, we try to give an overview on all these
pathophysiological mechanisms obtained from our
laboratories from 2001 to present.

Romanian medical doctors members of


Romanian Academy
F. Tuc, C. Constantin, A. Ciuche

country. This scientific forum was founded nearly 150


years ago, in the last year of the reign of Romanian
Prince Alexandru Ioan Cuza (1859-1866). Moreover,
Prince Cuza is considered the founder for this
Romanian high level scientific institution.
Materials and Methods: Participation of medicine
trained figures to the activities and principles of
Romanian Academy was studied and documented. The
book is structured into two chapters: Romanian medical
doctors - members of the Romanian Academy and
Romanian military doctors - members of the Romanian
Academy.
Results: For nearly 150 years of existence of the
Romanian Academy, more than 1,000 scientists and
cultural representatives in all areas have been elected as
members, either with corresponding status, titular or
honorary members, or members elected posthumously.
Among them will there are more than 100 Romanian
doctors, veterinarians and pharmacists. In this paper we
will refer to all the Romanian doctors who had been
elected in the Romanian Academy till present,
highlighting this among many other aspects of their
biographies.
Conclusions: We inform the readers that both the title
and the content of his work represent, to our
knowledge, a novelty in the Romanian medical
literature. May this writers initiative be auspicious and
a starting point for other and other approaches on the
subject!

Background: The Romanian Academy is the highest


and most representative scientific institution in our

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

first breakthrough was to generate an interferential


current that was variable only in the fields parallel to
the field initially generated by its direction. Further
improvement of the technology introduced a third extra
current, creating a three dimensional flow of ions
through the tissues.
By increasing the frequency of the current we can
increase the amount of energy in the entire body, thus
improving the energetic potential of cells and the
overall regulation of cellular metabolism. That is why
the new therapies introduce a range of frequencies
between 4096 and 32768 Hz, a higher local and
systemic tolerance and optimized therapeutic depth.
Extended research show the superiority of functional
status and safety in practice of the new therapies, along
with an overall helpful holistic effect.

Experimental treatment of medical conditions


for models of Diabetes in Wistar Rat
C Constantin, Georgiana Constantin, Andra Tubac,
A. Bor, A. Ranetti, C. Serafinceanu
Background: Using a model of streptozotocined Wistar
rat, we showed kidney diabetic damage even if model
of type 2 diabetes is with a good metabolic control.
Objectives: To prove that using NPH insulin or glargin
(analog insulin) in initial treatment of streptozotocined
Wistar rat we will obtain the similar model of diabetes
mellitus.
Material and Methods: 70 streptozotocined Wistar Rats
are randomly distributed in lots, which are used to
obtain a classical model of diabetes and used to
compare the characteristic of diabetes mellitus obtained
after injection of streptozotocin.
In order to quantify the kidney changes, skin lesions or
to study the possible beneficial effect of some
compounds we created dedicated animal Groups that
were matched for sex, weight, and metabolic control.
Each of them war treated with glargin insulin or with
human NPH insulin, dedicated in the same quantity,
after an initial algorithm. We compared the model
obtained using NPH and glargin. At the end of the
study period all rats were sacrificed.
Conclusions: 1.Our data show that studied compound
(thiamine, or dedicated skin cream) could be used for
prevention of kidney disease or in treatment of induced
skin lesions, in this model of diabetes mellitus. 2. Even
in a pretty well controlled model of diabetes, the
affection of kidney could be present. 3. Our experience
is the first step in studied some derivates in order to
prevent a secondary complication of diabetes mellitus
(skin lesions or induced chronic complications).

The assessment of Diabetes Self-Management


Education and Ongoing Diabetes Support at
Type 2 Diabetes Patients
C. Constantin, Elena Tolo, Marinela Sirbu, A.
Ranetti
Background: Diabetes self-management education
(DSME) and ongoing diabetes support should be
integral components of the management plan. Various
strategies (considering the presence of psychological
support) should be used to enable patients to selfmanage their diabetes, including: first evaluation,
providing education on problem-solving skills for all
aspects of diabetes management, a second step
evaluating the level of education etc. In developing
each educational plan, consideration should be given
to: diagnostic and presence of complications, the
patients age, school/work schedule and conditions,
presence of physical activity, personal patterns and

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.

Myo-inositol and womens health Current


concepts
Anca-Pati Cucu, A.E. Ranetti
Aim: In the past years myo-inositol, a novel insulin
sensitizer, was marketed for use in infertility associated
with PCOS, one of the most common endocrine
disorders that occur in about 7% of women of
reproductive age. Recent studies have shown MIs
utility in various other conditions along womens
lifespan.
Material-method: Myo-inositol is one of nine isomeric
forms of inositol. MI is produced by the human body
from D-glucose and is a component of cell membrane,
an essential nutrient for cells growth and survival. It is
synthesized predominantly in the kidneys, but testes,
the prostate, the epididymis and seminal vesicles
contain also a large amount of MI. In women ovarian
fluid is rich in MI. We reviewed and summarized the
most important functions of MI on female reproductive
system along with current regimens and associations
used in clinical practice.
Results: Studies have shown that MI supplementation
reestablishes spontaneous ovarian activity and fertility
in many women with PCOS, it reduced the incidence of
GDM in pregnancy in women at high risk of this
disorder. Also, MI with diet was shown to improve
systolic and diastolic blood pressure, HOMA index,
cholesterol, and triglyceride serum levels in
postmenopausal women with metabolic syndrome.

Conclusions: Scientific evidence strongly supports the


therapeutic efficiency of myo-inositol in selected cases,
their supplementation being highly recommended.

Adhesion to MNT (medical nutrition therapy)


and nutritional status in people with metabolic
syndrome
Doina Ene
Diet is the determining factor of nutritional status.
MNT is the first step that is required over the entire
lifetime of people with metabolic syndrome.
Purpose: MNT adherence and nutritional status
evolution.
Methods: A retrospective study on 100 patients, aged
35-60 years old (61.3% female; 38.7% male) with
metabolic syndrome monitored quarterly in the first
year and twice/year in the next 2 years; for 3 years
using:
anthropometric
assessment,
individual
application of Dietary Quality Score (DQS)
questionnaire and laboratory tests: serum albumin,
sideremia, serum: total Ca; Mg; electrolytes; uric acid.
Results:
Adhesion to MNT is maximum first 6 month (35.6%
female; 29.8% men); medium in the third year (31.4%
women; 28.5% men), lower in the second year (27.1%
women; 19.8% men).
Using information from the media and alimentary
supplements: 58.9% and 18.7% in women in men.
Efficiency MNT: 1. weight loss and favorable
development of biological parameters to 45, 7% of
women and 32.6% of men in the first half, 38.6%
women and 29.7% men after 3 three years. 2. Adverse
changes: in nutritional status: 65. 5% of those who use
diuretics, laxatives and / or various dietary
supplements, 45% of dieters d of ads
Conclusions: implementation of MNT is a difficult
change after eating behavior has long been inadequate.
Using recommendations from non-medical sources
diets and food supplements can affect nutritional status.

Anemia A chameleon in medicine


Anca Ghiau, Romelia Sfetcu, Lavinia Brsan,
Elena tefan, E. Dnil, M. otcan
Introduction: We present the case of a 65 years- old
woman who was admitted with a severe macrocytic
anemia Hb= 5.7g/dl and diffuse bone pain. Biologically
she has moderate thrombocytopenia 35,000/l, a
hepatic cytolysis and colestatic syndrome.
Material and method: The patient was extensively
evaluated before presentation for a mild iron deficiency anemia for which she underwent endoscopic
examination of the upper and lower gastrointestinal
tract- normal. The bone marrow aspiration on

admission revealed a marked hyperplasia of the


erythroblastic line with ~50% basophilic erythroblasts
suggesting a regenerative erythroid hyperplasia. These
changes along with the marked reticulocytosis on the
peripheral blood smear oriented us towards a hemolytic
anemia; Folic acid, vitamin B12, autoimmune tests and
hemolytic tests were all normal. We continued the
investigations with a thoraco-abdomino-pelvic
computed tomography which identified diffuse
demineralization, vertebral compactation and pelvic
stress fractures. The breast examination revealed a right
breast nodule, but the breast ultrasonography pleaded
for benignity. Lacking a clear definitive diagnosis we
decided to perform an osteomedullary biopsy.
Results: The osteomedullary biopsy pointed towards a
medullar invasion from a lobular mammary carcinoma;
In this circumstances we performed an ultrasound
guided biopsy of the right mammary placard thus
histologically confirming a tumoral invasion of the
bone marrow with subsequent anemia. The patient
started chemotherapy in the Oncology ward.
Conclusion: The particularity of this case consists in
the pattern of anemia, which initially seemed iron
deficient and afterwards macrocytic apparently
hemolytic and was actually due to the tumoral medullar
invasion and also the nonspecific ultrasonographic
appearance of the breast tumor.

Occams razor versus Saints Triad


Anca Ghiau, M. otcan, C. Jurcu, I. Copaci
Introduction: We present the case of a 41 year old man
who performed extensive investigations a year before
admission in our clinic for mild pancytopenia and
prehepatic jaundice which excluded catalytic deficit,
autoimmune hemolytic anemia, paroxysmal nocturnal
hemoglobinuria, B12/folic acid deficit, hepatic viral
infections. Osteomedullary biopsy- march 2012
suggests
erythroblastic
hyperplasia
with
diserythropoiesis. Given the fact the the total bilirubin
was moderately elevated <5mg/dl it was initially
considered a viral infection who could have been the
cause for both pathologies- jaundice and pancytopenia.
Material and methods: First admission in our clinicfebruary 2013 he presented with progressive jaundice
without pruritus, pancytopenia and a marked elevated
bilirubin= 13mg/dl. We repeted the osteomedullary
biopsy- without changes and we performed a liver
biopsy- chronic inflammatory infiltrate in the portal
spaces, abdomino-pelvic tomography which didt clear
out the diagnosis. He followed treatment with low dose
corticosteroid 15 mg/dl, then phenobarbital, with no
impact on bilirubin levels.
After 1 year during which he was lost for follow upSeptember 2014 he was admitted in Dermatology for
pruritic erythematous placards on the torso, superior

and inferior limbs. The skin biopsy suggests lupic


panicullitis but the imunologic tests are negative. The
persistance of pancytopenia imposes a repeted
osteomedullary biopsy which sustains a diagnosis of
hyperfibrotic myelodysplastic syndrome.
Conclusion: A year after the diagnosis, the cutaneous
lesions of our pacient are significantly better under
treatment with corticoid and hidroxiclorochine and
hemoglobin levels are greater than 9mg/dl with
erythropoietin.. The particularity of our case resided in
the difficulty of forming a diagnosis, thus rendering us
to discuss which approach is better: plurality of
diagnosis (Saints triad) or a single diagnosis for all
symptoms (Occams razor)?

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.

Solitary pulmonary nodule A diagnostic


challenge
I. Jascu, Ioana tefnescu, M. eu, C. Ioni, E.
Firoiu, Claudia Popovici, Gabriela Andra
Introduction. A solitary pulmonary nodule (SPN) is an
imagistic entity (radiological or tomographic), that has
long challenged the clinician. A SPN is defined as a
single pulmonary opacity, of 3 cm diameter or less,
surrounded by normal lung tissue, that is not associated
with adenopathy or atelectasis. The frequency with
which SPN is identified on chest radiography is on the
order of 1 to 2 per thousand chest radiographs. The
diagnostic and the management of SPN are not yet very
well standardized. A significant percentage of SPN are
the malignant.
Material and method. In the Pulmonology Department
of the "Dr. Carol Davila" Emergency Military Hospital
Bucharest we investigated in 2015 a total of 30 patients
with SPN, discovered during routine imaging
evaluations. For all patients was applied a rigorous
diagnostic management, including noninvasive
(tomography) and low invasive (bronchoscopy)
procedures and those with suspected malignancy were
referred to the Thoracic Surgery Department. We
conducted a thorough retrospective analysis of cases
investigated, assessing the role of the clinician in
diagnosing approach of SPN.
Results. Of the 30 patients investigated 5 were
diagnosed with lung cancer, 3 with tuberculomas, 13
had SPN with tomographical characters of benignancy,
being further monitored, in 2 cases SPN disappeared in
three months, and 7 patients were lost from evidence.
Conclusions. The first objective of SPN management is
identifying the nature of benign or malignant by
noninvasive methods, which will guide the subsequent
conduct of diagnosis and treatment, and the ultimate
goal is to ensure an early and complete surgical
treatment of lung cancer while avoiding thoracotomy in
patients with benign nodules.

Sarcoidosis and tuberculosis association


E. Firoiu, Ioana tefnescu, M. eu, C. Ioni, I.
Jascu, Claudia Popovici, Gabriela Andra
Sarcoidosis is a systemic disease of unknown cause that
affects more frequently young people. The most
commonly affected organs are lymph nodes, lungs, skin
and eyes. The histopathologic appearance is similar to
tuberculosis; the differential diagnosis between them is
based on presence or absence of cazeum.
We present you the case of a 23 years old male, who
had cough and fever since June with no improvement
after antibiotic and NSAID, subsequently he develops
arthralgia and erythema nodosum, which is why he

comes to the emergency room. He is hospitalized in the


Internal Disease Department. Chest radiography is
performed, that shows suspicion of sarcoidosis.
The BAL performed during a bronchoscopy showed
lymphocitic alveolitis, that sustained the diagnosis and
the doctor decides monitoring and pulmonology
evaluation after 30 days. The routine bacteriological
examination for tuberculosis collected during
bronchoscopy was positive.
The association of sarcoidosis and tuberculosis occurs
in 3% of sarcoidosis pacients and it can complicate
their evolution.

observational study on 64 patients during TB treatment


between January to August 2015.
In our department was the same trend of increasing
number of cases resistant to first-line TB treatment.
It is possible that the Isoniazid resistance to be given by
the prophilactic treatment with this drug, that led to the
selection of resistant germs. Given the increasing
number of cases resistant to first-line TB treatment, it
requires new methods of diagnosis, such as GeneXpert
and VersaTREK, that can detect in time the pacients
with resistant TB treatment, and thus decrease of TB
incidence in our country.

Tuberculosis, still a public health problem in


Romania

The benefits of early recovery post nucleoplasty


Simona Ionescu

E. Firoiu, Ioana tefnescu, M. eu, C. Ioni, I.


Jascu, Claudia Popovici, Gabriela Andra
Although the incidence of TB in Romania is decreasing
from 142.2 cases per hundred thousand inhabitants in
2002 (when The National TB Control Program was
implemented), to 72.9 cases per hundred thousand
inhabitants in 2013, our country has the highest
incidence of tuberculosis in the EU and it is in 6th
place in the WHO European Region. Both globally and
in our country a growing number of TB cases resistant
to first-line chemotherapy are registered.
In the Pulmonology Department of Military Hospital
from Bucharest, we conducted a descriptive-

Ive chosen these subjects out of two simple reasons:


- Discopathy lumbar intervertebral disc is a disease
very common in all age categories for all people and
quite varied (it may meet this condition and among us
especially those presents inn certain medical fields,
because of the position during the medical practice).
Because of advantages such us. Nucleoplastic
percutaneuos interventions is a minimally invasive
alternative to drug terapy of a herniated disc or the
classic surgery. Post nucleoplasty medical recovery can
begin very early and has very good results.

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.

Prolonged febrile syndrome in HCV infection


I. tefan, Simona Ionescu, Ioana Pandrea, C.
Banic, B. Crciumaru, O. Dunreanu, V.
Gheorghi
This is a presentation of the case of a 66 yo female
patient diagnosed in 2014 with Chronic Hepatitis C, for
which the patient undergone treatment with Pegasys
and Ribavirin, starting September 2014, discontinued
after a period of 9 months due to major adverse effects
such as severe pancitopenia and persistent fever.
In June 2015, the patient was transfered to the
Infectious Diseases ward with fever, chills, fatigue,
excessive sweating and productive cough, symptoms
that appearead after a two week period of treatment
with Targocid (400 mg bid) and Invanz (1g daily) for
positive blood culture with MRSA. Sputum culture
detected Candida albicans and thorax CT revealed
mediastinal lymphadenopathy. Following a period of
two weeks of therapy with antibiotic and antifungal
medication, the patient was discharged afebrile,
asymptomatic.
After 3 weeks, the patient is re-admitted presenting
fever, chills, productive cough, erythema nodosum,
sweating, myalgia, and arthralgia. Chest radiography
and repetead thorax CT revealed bilateral
bronchopneumonia
and
persistant
mediastinal
lymphadenopathy.
Bronchoscopy revealed lymphocytyc alveolitis and
angiotensin converting enzyme blood level was over
normal value. The hystopathological findings after
performing mediastinoscopy and lymph node biopsy
led to the diagnosis of sarcoidosis. Being an early
stage, it was decided not to initiate cortisone therapy
and the patient received antibiotic and symptomatic
treatment for another 10 days, with complete recover.
The particularity of this case consists of the ethiological
variety of prolonged febrile syndrome and the
multitude of pathological aspects, possibly deriving
from the Viral Hepatitis C Infection.
Keywords: chronic hepatitis C, sarcoidosis, angiotensin
converting enzyme

Plurimicrobian sepsis in a patient


immunocompromised
Simona Ionescu, M. eu, Ioana Bdicu, I. tefan,
Ioana Pandrea, C. Bnic, O. Dunreanu, B.
Crciumaru
Background: Imunocompromised patients are very
responsive to infections, sometimes, with severe
evolution that cause problems in diagnosis and therapy.
These patients may develop infections with
opportunistic germs, such as Fussarium spp.,
Burkholderia spp. or Acinetobacter.

Fusarium spp.is a large genus of filamentous


fungi.Only some species may cause a range of
opportunistic infectious to the human body.
Burkholderia spp. is a gram negative bacteria with a
relative poor virulence, but can often cause pneumonia
in immunocompromised individuals.
Acinetobacter is a gram negative opportunistic
pathogen, which can cause life threatening infectious in
immunocompromised individuals.
Case report: A 34 year-old patient reffered to Central
Military Hospital, from another territory tertiary-care
hospital in Bucharest, with prolonged fever and
dispneea.
He has unbalanced Diabetus mellitus, and morbid
obesity. Two months prior to being reffered to us, he
had received antibiotic treatment: Amoxicillin with
Clavulanic Acid, followed by Ciprofloxacin.
Upon admission we diagnosed fungal and
pluribacterian sepsis. Relevant laboratory tests included
positive procalcitonine, bloodstream culture positive
for Acinetobacter spp., bronchial aspirates culture
positive for Fusarium spp. and Burkholderia seminalis.
IRM suggestive for bronchopneumonia, pleuresia,
pericarditis and splenic abcess.
He
received
treatement
with
Meropenem,
Levofloxacin, Metronidazole, plus Voriconazole for 60
days, with favorable evolutions.
Conclusions: The medical care of sepsis in
immunocompromised patients is very complicated,
needs ultra-high specialized tests, and expensive
medications.

Current issues in radiotherapy after breast


conserving surgery for early breast cancer
L. Stoleru, . Vlad, G. Blaa, O. Florea, M. Matei,
Alina Tnase, M. Dumitrache
Breast conservation treatment (BCT) is an appropriate
method of primary therapy for most women with stage
I or II breast cancer, because it provides similar
survival to that of total mastectomy and axillary
dissection, while preserving the breast.
The purpose of the irradiation after breast conservative
surgery is to minimize the risk of local failure and
improve specific survival without causing side effects
to the heart or lungs or impede cosmetics.
Standard (conventional) adjuvant radiotherapy includes
irradiation of the mammary gland + regional lymph
nodes, with doses around 50 Gy in 25 fractions given in
5 weeks. A boost to the tumor bed is recommended in
patients at high risk for local failure (age < 50 years,
positive margins).
Two major randomized trials, one in the United
Kingdom and one in Canada have shown that
hypofractionation (HF) shorter courses of irradiation
given in large daily fraction sizes during 3 to 4 weeks

period resulted in comparable disease control rates


and overall survival as conventional fractionation.
Accelerated partial breast irradiation (APBI) where
only a limited volume of the mammary gland is
irradiated with a high dose in 1-10 fractions is currently
under investigation and might be an alternative to the
whole breast irradiation.
Concerns are related to the appropriate volume to be
irradiated in APBI, still unknown, and to the tumor bed
delineation which remains a challenge with a high rate
of interobserver variability.

HDR brachytherapy planning protocols for


gynecological cancers
Maria Vlsceanu, Alina Tnase, M. Dumitrache, .
Vlad
Introduction: High dose radte (HDR) brachytherapy is
a multidisciplinary clinical specialy that uses complex
equipments and procedures for dose prescription,
treatment planning and management of oncological
diseases. The main objective of HDR brachytherapy is
treatment of gynecologic cancer, by placing a
radioactive source close to tumor tissue.
Materials: Our radiotherapy department has new,
dedicated equipment, used for brachytherapy treatment
administration, as follows: a GammaMedplus iX
afterloader system, that utilizes a high-activity Iridium192 source, a mobile x-ray C-arm, used for image
acquisition and for intracavitarry applicators
reconstruction. A computerized planning system is also
available, by using the BrachyVision Varian software.
Methods: Brachytherapy clinical procedures involves a
series of complex steps, requiring a team of physician,
medical physicist, radiation technologist and nurses,
each with clearly defined tasks and responsibilities,
acording available clinical protocols.
Conclusion: According to HDR brachytherapy
procedures and to the clinical guide in practice, our
department offers to all patients the possibility of being
properly treated. The HDR brachytherapy technique
can be used in addition to the external 3D radiotherapy,
or exclusively, all of our patients received customized
treatment plans.

The role of radiotherapy in soft tissue sarcomas


. Vlad, L. Stoleru, M. Matei, O. Florea, G. Blaa,
A. Tnase, M. Dumitrache, M. Vlsceanu, V.
Blbneanu
Introduction: Management approaches for newly
diagnosed soft tissue sarcomas include surgery,
combined with pre- or postoperative radiotherapy.
Material and method: We use in our Radiotherapy
Department modern equipment for 3D Conformal

external beam radiotherapy (Unique Power Linear


Accelerator, Varian, USA) and for HDR Brachytherapy
(GammaMed Plus iX model, Varian, USA).
The presentation describes the indication for
radiotherapy in soft tissue sarcomas, part of the limb
preservation management of this cases. We discuss also
our radiotherapy technique and our protocol in defining
the treatment targets: GTV, CTV and PTV.
Conclusion: The primary local therapy for soft-tissue
sarcomas is resection plus radiotherapy. The sequence
surgery radiotherapy depends on tumour stage, site of
the tumour and patient preferences, with relative
advantages and disadvantages of delivering
radiotherapy before or after surgery.
Keywords: soft tissue sarcomas, radiotherapy, HDR
brachytherapy

The tumor in ultrasound diagnosis of giant


abdominal cyst
Carmen Tipar, Valerica Voicu, C. Mazilu, Raluca
Mititelu
Objectives:
The aim of this paper is to highlight the contribution of
ultrasonography to accurately identify abdominal cystic
lumps that help differential diagnosis in patients who
come in with an abdominal volume increase.
Materials and Methods:
15 years young female without significant pathological
personal history shows the increase in volume of the
abdomen, accompanied by fatigue complaints. On
examination, abdomen stands increased in volume and
asymmetric and on percussion procedure timpanism is
found. Given that the ultrasound is a cheap and
noninvasive way, it was chosen as the first
investigation.
Results:
Ultrasound revealed a predominant transonic image,
large, localized to the abdominal-pelvic which
determines the dislocation of parenchymal organs,
possibly of ovarian origin. Blood tests showed an
inflammatory syndrome with elevated ESR. Tumoral
markers were within normal limits. It was decided to
carry an MRI that confirmed the diagnosis of large
cystic pelvic-abdominal tumor formation with an
ovarian right side origin.
Conclusions:
Abdominal ultrasound is an accessible method, which
is both fast and non-invasive and represented the basis
in the differential diagnosis of ovarian cystic tumor
formation, pregnancy and other types of abdominal
tumors in a patient of a very young age and with mild
symptoms.

The contribution of imaging techniques in the


diagnosis of primary hyperparathyroidism
Valerica Voicu, C. Mazilu, Raluca Mititelu, Carmen
Tipar, I.A. Chiriac, Adina Mazilu, O. Niculescu, E.
Rusu, V. Nicolau, M. Ciauescu
Introduction
The diagnosis of primary hyperparathyroidism is
sometimes difficult. Symptoms may be nonspecific,
and routine laboratory investigations can direct the
management of such patients in the wrong direction.
Whole body" bone scintigraphy, metabolic radiotracer
investigations and cervical ultrasound are simple,
handy techniques, which can have a role in the initial
diagnosis,
staging
and
follow-up
of
hyperparathyroidism.
Material and Methods
The paper shows two cases from the departments of
Endocrinology and Nuclear Medicine of SUUMC
Carol Davila Hospital recorded in 2013-2014. The
patients had whole body" scintigraphy with Tc-99mMDP and with Tc-99m-MIBI. The scintigraphic
images were correlated with ultrasound and other
imaging techniques.
Results
The "superscan" aspect on the whole body" bone scan
may suggest - although very rare - the presence of a
metabolic bone disorder, sometimes related to
hyperparathyroidism. Focal uptake of the radiotracer
suggests the presence of bone replacement formations
(brown tumors).
Conclusions
Hyperparathyroidism is sometimes difficult to
diagnose. Symptoms can be determined, as in these
cases, by the existence of bone tumors (pain, swelling,
fracture). Whole body" bone scintigraphy provides an
overview of the skeleton, demonstrating the location of
the tumor lesions and the characteristic superscan"
image. It can refocus the diagnosis and management of
these patients in the right direction, if a proper
integration of the information is done with other
imaging techniques and laboratory results.

Ultrasonography in the diagnosis of biliary


stones
Valerica Voicu, Carmen Tipar, Raluca Mititelu, C.
Mazilu
Objectives: Aim of the study is to highlight the
contribution of abdominal ultrasonography in
highlighting the migration of stones from the
gallbladder into the bile ducts.
Materials and Methods: A study was conducted on
patients coming to the emergency room or hospitalized
in surgical wards with the diagnosis of colic, jaundice

and increased bilirubin. These patients were examined


by ultrasound service within the Department of
Ultrasonography. The study included 10 patients, 4 of
which were referred to ERSP.
Results: Of the total number of patients: 4 patients had
changes in the pancreatic cephalic extremity edema; 2
patients had developed formations cephalic extremity
of the pancreas; 4 patients had calculi in the bile with
diameters between 3mm and 8mm being guided by
ERSP for their discharge.
After carrying ERSP the presence of calculi has been
confirmed in the coledoc duct.
Conclusions: Ultrasonography is an imaging technique,
an useful way to evaluate the presence of calculi in the
biliar duct. It is a noninvasive, inexpensive and fast
method.
Ultrasound allows differential diagnosis of biliary
pathology, quickly selecting medical versus surgical
cases or cancer.

The importance of modern medical imagistics


Anca Manolache, V. Duescu, Elena Busuioc, I.
Copaci
We are presenting the case of a 47 years old patient,
which was treated for positive helicobacter pylori
gastritis one year ago. The patient came to our hospital
with tumefaction, pain on the right lateral-cervical and
with low fever, symptoms which started about two
weeks back. The initial diagnostic was torticollis, the
patient receiving symptomatic treatment without
showing visible improvements.
The medical exam performed at the moment she was
hospitalized, was completed with an ultrasound of the
right lateral cervical region which showed internal
jugular vein thrombosis with 2 lymphnodes of approx.
2.5 cm. Additionally, the medical exam shows also
polyserositis.
Biologically we found a slight normochromic and
normocytic anemia with normal test results for
infectious autoimmune or thrombophilic etiology of
jugular vein thrombosis. The result of the ascites test
confirms the presence of rare neoplasic cells of
adenocarcinoma. Then we proceeded in making the
following investigations: CT scan (chest, abdomen,
pelvic) with contrast substance, pelvic MRI, upper and
lower gastro endoscopy, which did not help us to set a
concrete diagnostic. Subsequently, we took the decision
to make a diagnostic laparoscopy.
The histopathological exam of the multiple biopsy
samples was negative for neoplastic cells.
Due to the fact that all the investigations performed up
to this moment did not point us into the direction of
final diagnostic, we decided to perform a PET CT. This
shows modifications at esogastric junction level. The
next step was to repeat the upper gastro endoscopy by

taking multiple biopsy samples. The result was positive


for gastric adenocarcinoma which triggered the
initiation of the chemotherapy treatment.

bowel obstruction.

Neurologic paraneoplastic syndromes


Emilia Furdu-Lungu, E. Dnil, I. Furdu,
Carmen A. Srbu, Cristina F. Plea

Small bowel obstruction in the adult The


importance of CT imaging in diagnosis and
patient assessment
Elena Ghia, R. Meirou, C. Beianu
Small-bowel obstruction represents one of the most
common and most important clinical conditions, where
early diagnosis is critical for the management of these
emergency cases.
This review is hoping to familiarize radiology
physicians with up-to-date knowledge of the CT
imaging findings, and also to help recognizing the
severity and associated complications.
Intestinal obstruction remains an important cause of
morbidity and mortality, representing 20% of surgical
admissions for acute abdominal pain. The correct
approach includes clinical integration, patient history,
and initial plain abdominal radiographic examination,
but often this is not sufficient for the clinician to
conceive a treatment plan.
Investigation of patients has come a long way from the
old paradigm never let the sun set or rise on and
obstructed abdomen. Nowadays, multidetector CT
scan with multiplanar reconstruction is the method of
choice, with the highest specificity and sensitivity for
the evaluation of an obstruction, tissue damage, or the
indications of immediate surgery.
A methodology can be used for the analysis of the
imaging study: confirm the diagnosis, identify the
transition point, the etiology, determine its severity
degree, and assess the presence of strangulation.
Therefore, radiologists provide significant information
that affects the management of patients with small

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

and symptoms of Behcet's disease may vary from


person to person and may come and go on their own.
Due to the lack of specific guidelines for the diagnosis
and treatment, the therapeutic approach for Behcet is
mainly based on the clinical experience of the attending
physician.
A 33 year old woman, with no significant medical
history is admitted to our clinic. Her family medical
history reveals multiple strokes (father) and
autoimmune thyroiditis (sister).
The onset of her symptomatology is in 2013 and it

consists in fever (39-40 Celsius degrees) sicca


syndrome and persistent headaches. As the disease
progresses, our patient presents oral ulcerations,
odynophagia, muscle weakness and blindness of the
left eye.
The lab tests showed: C3 hypocomplementemia, Anticentromere antibodies (-), anti-b2gp1 antibody (+)
lupus anticoagulant (+), U1RNP (-).
We started the patient on cyclophosphamide and started
to see an improvement after the 4th dose.
An important event is important to mention -the
patients suffer an episode of upper gastrointestinal
bleeding (hemoglobin drops to 2,5g/dl which leads to
cardiac arrest- resuscitated).
In order to be able to talk about evidence based
medicine for the management of Bechets disease, a
large number of clinical trials is required to provide to
physicians the necessary data for diagnosis and
treatment.

Febrile polyarthritis in a young male patient


L.M. Ciobc, Daniela Anghel, G.D. Stoicescu, Ioana
Rdu, Iolanda Srbu, Ana M. Dumitru, Mihaela
Iordache, Ancua Coca, Andreea F. Aida
Although autoimmune diseases usually affect women,
often men are affected, sometimes with atypical
clinical, biological and immune findings.
We would like to bring to your atention the case of a 51
year old man, admitted to our clinic with assimetrical
large joints arthritis of the lower limbs (coxofemural,
knee and tibiotarsian arthritis) and systemic
manifestations like intermittent fever, weight loss and
constant fatigue.
Biological findings: Marked inflamatory syndrome, RF
slightly positive, negative anti CCP antibodies, anti
double stranded dna antibodies slightly positive,
negative c-Anca p-Anca, positive Hbs Ag, HLA B27
negative.
The case was initially considered to be rheumatoid
atrhritis; therefore we started the patient on
sulfasalazyne. At the follow up (2 months later) the
patient presents with significant pancytopenia, high
fever (39-40 degrees C) and a slightly positive
cacitonin test.
Due to these facts, the patient underwent complex
cardiac, pulmonary and hematologic investigations, so
we were able to exclude differential diagnosis.
Finally the case has been diagnosed as a possible Still
disease; the patient s condition improved with fever
remission under NSAIDs, and completes hematological
resolution after discontinuation of sulfasalazyne
administration and follic acid treatment.

Alternative medicine, to be or not to be?


V. Ordeanu, Diana M. Popescu
Medicine is the art of healing; it is based on the
methods and results of any other arts and sciences,
which it uses for the benefit of humans and other
animals. Through prevention, diagnosis and treatment,
it helps to the maintenance and recovery of physical
health, psychological and intellectual or social welfare
biopsychosocial.
Modern medicine, like the ancient and traditional
eastern is essentially integrative, holistic, man she
regards as a whole, psycho-somatic, and influenced by
social and surroundings environment.
The methods and techniques, diagnosis and treatment
are not limitative the purpose being the good of the
individual and the community, so apply Hippocrates
adage, father of medicine: primum non nocere. But we
must consider that there are no diseases but patients, so
it should be and personalized medicine.
From the scientific point of view, there is an
alternative: we can only distinguish a scientific
medicine based on evidence and observations of a
traditional medicine based on empirical observation
and imagination.
Doctors should not be limited to a particular medical
system; they must apply the art of using the knowledge
of all health related sciences for the benefit of the
patient. Therapeutic methods and techniques must be
scientifically assessed, adapting procedures for drugs,
to apply only what is effective and risk free.
Although the term alternative medicine, it doesn't
actually exist. Integrative medicine must integrate the
various medical schools and current, as well as various
therapies, scientific or empirical, to assess them on the
basis of medical evidence and keep what is effective
therapeutic and risk free. Integrative medicine
evidence-based medicine will contribute to the progress
and welfare of humanity.
Keywords: alternative medicine, integrative medicine,
evidence based medicine, therapeuticl

Rare cause of cardiac insufficiency


Nicoleta A. Dobrete, L. Ciobc, G. Stoicescu,
Daniela Anghel, Ioana Rdu, A. Anghel, B. Olan,
S. Stanciu
Extrinsic compression of the heart is a rare cause of
cardiac insufficiency, usually encountered in patients
with intrathoracic tumors (pulmonary cancer,
lymphomas), intraabdominal tumors or other causes
such as diaphragmatic and oesophageal hernias, aortic
aneurysm, etc.
We present the case of a mid 40s male patient, with a
history of smoking and alchool consumption, from a
rural area, who sought medical assistance for weight

loss, fatigue and worsening shortness of breath, which


set in 6 months earlier.
The clinical examination revealed tachycardia, signs of
right cardiac insufficiency (hepatojugular reflux, lower
limb edema) and a firm tumor mass which occupied the
epigastric area.
The abdominal CT exam showed a massive
intraabdominal
tumor.
On
the transthoracic
echocardiography severe compression of the right
cardiac cavities was discovered.
The left ventricle presented concentric hypertrophy, but
its ejection fraction was preserved.
There was no tumor infiltration of the pericardium.
The inferior vena cava couldnt be visualised so the
patient underwent a venography and later surgery for
tumor resection.
Intraadominal tumors are a rare cause of cardiac
insufficiency due to extrinsic compression.
Key words: cardiac insufficiency, tumor, extrinsic
compression

The efficiency of low doses corticotherapy in


association with a fond therapy in patients with
rheumatoid arthritis Clinical and ultrasound
evaluation
Daniela Anghel, M.L. Ciobc, M.M. Murean, N.C.
Anghel, Ancua Coca
Introduction:
The association of a background therapy (DMARDS)
with low doses of cortisone at patients with rheumatoid
arthritis can cause a better control of the disease
symptoms. In this situation the ultrasound can have an
important contribution by assessing synovial
inflammation under treatment.
Objectives:
I studied the biological and clinical response measured
by markers of inflammation (CRP, VSH), VAS, DAS
28 and quantifiable ultrasound evolution synovitis in
patients with rheumatoid arthritis treated with
DMARDs
compared
with
DMARDs
and
corticosteroids.
Methods:
The patients from the study were diagnosed with
rheumatoid arthritis using the criteria EULAR/ACR
2010. They have received treatments with DMARDs in
combination or not, with a corticosteroid in low doses
(prednisone < 10 mg/day) and they were under
observation for 1 year. The clinical and laboratory
parameters of the disease were evaluated at the
beginning of the illness with the visual analogue scale
for pain (VAS), DAS 28, VSH and CRP.
Ultrasonographic assessment of meta-carp-phalanges
and radio-carpals joints watched in gray scale and
Doppler power has appreciated synovitis degree. The

evaluation of these parameters was done at 0, 6 months


and 12 months. Disease remission was defined by DAS
28 <2.6.
Results:
20 patients received corticosteroid treatment and
DMARDs and 25 patients received only DMARD
therapy (Leflunomide / Methotrexate / Sulphasalazine).
At the initial evaluation of the patients, DAS 28, VAS,
CRP, VSH and ultrasound, changes were relatively
similar in the 2 groups. At 6 and 12 months through
VAS pain assessment showed a significant decrease
quite similar in both groups while joint swelling was
quickly controlled with DMARDs and corticosteroids
(p < 0.001). Inflammatory markers (VSH, CRP) have
showed a more rapid reduction in the corticosteroid
group (p < 0.001). Glasgow score and power Doppler
appreciated at the ultrasound examination showed a
reduction of inflammation at the sinovitis more
important in the group treated with DMARDs and
corticosteroids. DAS 28 score also had a more
significant fall in the group treated with corticosteroids
(p < 0.04).
Conclusions:
At the patients with rheumatoid arthritis the
combination between DMARDs and corticotherapy has
improved the clinical and paraclinical parameters.
The ultrasound changes also showed a favorable trend
in synovial inflammation, more evident in the group
where were associated and corticosteroids.

The efficacy of SSRIs on improving depressive


symptomatology in patients with major
depressive disorder (MDD)
A.M. Badic, C. Cndea
Objectives: The primary objective was to examine the
efficacy of SSRI-selective serotonin reuptake inhibitors
(escitalopram, sertraline, paroxetine) in major
depressive disorder (MDD) (1) after one month of
treatment. The secondary objective was improving the
quality of patients life.
Methods: Criteria - Major depressive disorder MDD
patients over 18 years age, the first episode or who
have not been previously treated with SSRIs.
The SSRIs have been included was escitalopram 10mg, sertraline- 100 mg, paroxetine-30 mg. The
number of patients monitored at one month was 30 (21
women and 9 men). MADRAS scale was used (2) both
at admission and after one month of treatment.
To quantify secondary endpoint in these patients,were
used SDS scales (3) and Q-LES-Q scale (4).
Results: After one month of treatment with SSRIs
MADRS score was improved by 54.32% and in terms
of improving the quality of life scale SDS was 53.21%,
and days lost fell with 67.07%, the scale of Q-LES- Q
improvement was 66.65%. Only after the first month of

treatment you can see the benefits of treatment with


SSRIs in patients with MDD.
Keywords: Depressed Symptoms, Quality of life, SSRI,
MADRS, SDS, Q-LES-Q

Delirium and depression: relationship and


clinical overlap in elderly people
D. Vasile, B.M. Petrescu, O. Vasiliu, A. Mangalagiu,
C. Cndea
Delirium and depression are complex psychiatric
syndromes common in elderly and are associated with
poor health care outcomes. Accurate and immediate
diagnosis is essential for individuals with these
conditions but is a challenge due clinically overlap and
multiple morbidities.
A careful assessment of patients symptoms including
context and time course is the key for accurate
diagnosis.
Previous depression is common in patients with
delirium and depressive illness is recognized sequelae
of delirium. The two syndromes seem to be caused by
similar pathophysiological mechanism.
Improved methods to assess delirium and depression in
old age population are the key target to achieve good
health outcomes for elderly patients.

The efficiency of anti-TNF therapy in patients


with rheumatoid arthritis and positive anti Ro
Daniela Anghel, Ancua Coca, M.L. Ciobc, N.C.
Anghel, G.D. Stoicescu
Introduction:
Rheumatoid arthritis is a chronic inflammatory disease
that presents a vast panel of antibodies including anti
Ro. These antibodies are associated with Sjogren's
syndrome quite often, poor prognostic factor in the
evolution of this disease. The efficiency anti-TNF alpha
therapy in patients with rheumatoid arthritis and anti
Ro presents is lower comparative to those that do not
have this type of antibodies.
Objectives:
Our study watched the answer to anti TNF therapy
(Etanercept, Adalimumab and Infliximab) of the
patients with rheumatoid arthritis and positive anti Ro
antibodies.
Methods:
The study group included 52 patients diagnosed with
rheumatoid arthritis using the criteria of EULAR / ACR
2010. The determination of anti Ro and anti CCP
antibodies was performed with the help of ELISA
method. Clinical response was evaluated with DAS 28
and inflammatory markers (CRP, VSH) at 0, 6 and 12
months. The factors of poor response to anti TNF alpha
therapy were represented by the presence of anti Ro

antibodies, raised titers of anti CCP antibodies,


increased 28 DAS and the presence of Sjogren's
syndrome was evaluated at the beginning of the study,
then at 6 and 12 months.
Results:
Patients with rheumatoid arthritis in the study group
were treated with Etanercept (25), Adalimumab (20)
and Infliximab (7) as the first biologic therapy. Ro
antibodies were detected in 18 pacients (34 %) and at 7
patients (13%) the Sjogrens syndrome was present.
The frequency of Ro antibodies was comparable in the
3 groups (11% Etanercept, 9% Adalimumab and 13%
Infliximab). CCP antibodies were present in 48 (92%)
of the patients in the study, in the group with positive
Ro antibodies being present in 100%. Patients with
positive anti Ro antibodies that were treated with
Adalimumab and Infliximab had an efficiency of the
therapy appreciated DAS 28 CRP, VSH lower
compared with patients receiving Etanercept.
Conclusions:
Anti Ro antibodies being in patients with rheumatoid
arthritis is associated with a lower efficiency of anti
TNF alpha biologic therapy.
From all the anti TNF alpha biological agents,
apparently, Etanercept is associated with greater
efficacy in patients with rheumatoid arthritis and anti
Ro antibodies and which can associate or not Sjogrens
syndrome.

Innovative approaches therapies in acute heart


failure
Ioana Rdu, A. Anghel, S. Stanciu, G. Stoicescu,
Daniela Anghel, l. Ciobc
Acute heart failure (AHF) is a major public health
problem with high prevalence associated with poor
prognosis. It is the leading medical cause of
hospitalization among patients over 65 years in the
USA and European countries, with a significant cost
burden for the health care systems.
The therapeutic approach of AHF has remained the
same for decades, being the use of the most acute
treatments empirical. Conventional treatment for AHF
consist of loop diuretics to reduce fluid overload plus
de addition of nitrates (oral, sublingual or IV) where
required to ease vasoconstriction.
None of the currently available treatments can
demonstrate positive outcome benefits from the
randomized clinical trials and, according to the latest
ESC-ESH guidelines, treatment in AHF remains
largely opinion based with little good evidence to guide
therapy.
Among the innovative therapies in AHF is Serelaxin
which is a recombinant form of human relaxin 2, a
naturally occurring peptide hormone which is present
in both men and women and rises to pharmacologic

levels during pregnancy, being associated with many


hemodynamic and reno-vascular responses such as
increased cardiac output, increased renal blood flow
and arterial compliance.
Its efficacy and safety in AHF patients has been
demonstrated in two studies: the phase II PRERELAX-AHF and the phase III pivotal study RELAXAHF.
Our department is taking part of a multinational,
multicenter, randomized, open label study to confirm
and expand the efficacy, safety and tolerability
evidence of intravenous infusion of serelaxin when
added to Standard of Care in patients admitted to
hospital for AHF.
Serelaxin seems to represent a new treatment option in
AHF in addition to standard therapy, maybe the first
evidence- based therapy to substantially improve
patients symptoms and clinical outcomes, including

death.

The role of neuroplasticity in


neurorehabilitation
D. Nedelescu
Neurorehabilitation, by combining neuroscience with
clinical application and rehabilitation medical, benefits
both cerebral emergencies, such as stroke, traumatic
brain injury, and neurodegenerative chronic diseases.
Functional improvement after permanent brain damage
depends on adaptive plasticity of free nerve tissue and
can be stimulated by pharmacological interventions,
physical activity and cognitive electromagnetic
stimulation, psychological support by adapting the
environment and any combination of these factors.

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

Communications skills in surgical team


C. Duu, L. Alexandru, Elena Starcu, F. Svulescu
Introduction
The surgical team has the duty to ensure and promote a
positive working environment that enhances the
performance of the team and results in good outcomes
for the patients safety.
The most important attributes which are critical to the
development of a high- performance team are:
membership and leadership.
In order of importance of features, team members are
likely to feel committed and involved in the team and
experience mutual trust and respect.
In a safe interpersonal environment surgical team
members feel free to express their views, challenge one
another and formulate concerns. They also feel
comfortable to discuss slips and mistakes.
A simple way of reviewing and reflecting on
performance is to ask:
- What did we do well?
- What could we have done better?
- What should we stop doing?
- What should we continue doing?
Conclusion
Communication skills are a key component of the
surgery practice that can be taught, learned and
upgraded, thus improving the performance and
enjoyment in clinical practice.
Inter-professional miscommunication is the root cause
of many medical errors.

Structured communication protocols, such as SBAR,


are designed for efficient and complete communication.

Simultaneous colon and hepatic resection for


synchronous colorectal liver metastases
L.P. Mosoia, T. Artenie, P. Oprea, R. Petrescu, M.
Tnase, Mdlina Prun, V. tefnescu, F. Mcu,
A. Dima, D. Florea, T. Calu, C. Drgan, C. Mitru, S.
Amza, V. Dumitracu, Florina Bold
Background: The surgical strategy for treatment of
synchronous colorectal liver metastases remains
controversial. The early postoperative outcome of
combined resection of colorectal cancer and liver
metastases treated by simultaneous resection were
retrospectively evaluated.
Methods: From 2015 to 2010, 63 patients presented
with synchronous colorectal liver metastases, of whom
27 (43 %) underwent a simultaneous resection. For
combined procedure were considered only patients with
fewer than four unilobar metastases.
Results: The perioperative data, morbidity, and survival
of the patient were assessed, according with different
types of hepatic tumors and treatment complexity. The
location of the primary tumor and extent of liver
resection did not influence the morbidity rate
significantly.
Conclusion: In selected patients, simultaneous resection
of the colorectal primary tumor and liver metastases
does not increase mortality or morbidity rates even if a
left colectomy and/or a major hepatectomy are
required.

Radical surgery in breast cancer


R. Nica, C. Muat, Alexandra Mihai, C. Plea,
Florentina Vasilescu, F. Svulescu
The patients were women with ages between 40 and 65
years, with a history of breast cancer from their mother/
sister, showing a nodule usually located in the outer
upper quadrant of one of the breasts. Have been
performed Madden type mastectomies with good
postoperative evolution, which did not involve
complications or deaths.
The breast represents the most common localization
(after skin cancer) of malignant tumors in women
between the ages of 40-60 years. The risk factors are
represented by external factors (exposure to x-ray,
breasts distress), a personal or family history of cancer,
genetic factors (mutations of genes BRCA1 or
BRCA2). Early detection of breast cancer is supported
by the importance of screening: prior to the extension
to the axillar lymph nodes, the life expectancy is 85 %
at 5 years.
Auto examination must be performed every month for

all the women over 20 years, mammography being


recommended annually for women over 50 years.
Signs and symptoms: in 70% of the cases the main sign
is a nodule in the breast, edema, erythema or distant
metastasis (axillary, pulmonary). The sonoelastography
is a procedure that measures the elasticity of the lesion
in relation to nearby healthy breast tissue.
Surgical treatment has triple function: diagnostic,
prognostic and therapeutic purposes. Radical surgery
aims at complete removal of the neoplastic tissue.
Madden type modified mastectomy: this technique
involves both pectoral muscles conservation, being less
mutilating. It can be applied especially on patients
whose pectoral muscles are less developed.
The sentinel lymph node is the first lymph node on the
drainage path toward the axilla, therefore the first that
can be invaded neoplastic.
Axillary lymph surgery: the procedure involves an
extended dissection around some important nerve
structures, dissection that has actually dual-purpose:
curative
and
diagnostic.
Complete
axillary
lymphadenectomy involves complete dissection of
axillary contents to the top of the axillary line with or
without the resection of small pectoral muscle.
In conclusion: radical surgical treatment is the first
intention and the most effective in breast cancer.

Minimally invasive treatment of recurrent


hiatal hernia
F. Svulescu, C. Crlan, Mdlina Petrescu
Minimally invasive surgery has become the first
indication of the diaphragmatic defects pathology
achieving thus an increased quality of life by reducing
the period of convalescence, by reducing the risk of
postoperative complications, improvement of video
control and, not least, the degree of comfort of the
surgical team is increased. One of the most sensitive
issues in terms of minimally invasive surgical resources
is represented by the recurrent hiatal hernia. The
technical difficulty of this pathology is represented by
the adherent process formed near the hiatus esophageal
area, the changing of the local anatomy due to various
technical processes used previously, which may include
the use of alloplastic materials. Such issues were most
often tackled resorting to thoracic approach in case of
reintervention. Now, recurrent hiatal hernias can be
treated using minimally invasive technologies such as
the da Vinci robotic surgical system.
We will present the case of a man, 56 years old, who
was operated for hiatal hernia three years ago, and is
currently diagnosed with recurrent hiatal hernia. The
difficult choice of therapeutic method was caused by
the lack of medical documents regarding the process
used previously. We mention that the process we used
was minimally invasive with the help of the daVinci

robotic surgical system.

Peritoneal ovarian carcinomatosis End of the


way?
O. Albia, T. Rogin, V. Vrjoghe, A. Zaciu, F.
Svulescu
Introduction: Peritoneal ovarian carcinomatosis is
usually considered to be the final stage of the ovarian
neoplasia evolution. The surgical approach represents a
stage in the multidisciplinary treatment and varies from
abstention to hyper aggressive surgery.
Materials and methods: We present a few patients with
peritoneal ovarian carcinomatosis where the hyper
aggressive surgery is combined with intraperitoneal
hyperthermical
chemotherapy
and
adjuvant
chemotherapy.
Intraperinoneal hyperthermical chemotherapy seems to
improve the destruction rate of tumoral cells.
Results: Despite surgical risks and outcomes, we
confirm and emphasize the correlation between
minimal tumoral tissue and long term evolution.
Subsequent scheduled laparatomies or on-demand
procedures intend to evaluate the lesions, to revert
temporary stomas or to re-resect new tumors. Long
term survival depends of the aggressive approach and
the 5-year survival can be achieved.
Discussion: Although at first sight, hyper-aggressive
surgery seems to be too much for some patients, multi
visceral resection combined with intraperitoneal
hyperthermical chemotherapy, adjuvant chemotherapy
and scheduled or on-demand surgery are the only
solutions to obtain sometime surprisingly long term
survival.

In the present work we will make a review of the


personal experience of the surgical team led by doctor
Savulescu Florin who works in the Second Surgical
Department of the SUUMC "Carol Davila" on a total of
106 patients, these being the first patients that were
operated for laparoscopic inguinal hernia by the team
mentioned above.
Keywords: inguinal hernia, laparoscopic surgery

Multiple cerebral lesions; hazard or genetic


determinism
C. Nstase, E. Zeinali, M. Mitric
Introduction: Due to improvements in diagnosis and
treatment for numerous benign and malignant tumors,
we are currently facing patients that develop over time
multiple malignant tumors or multiple cerebral lesions.
Methods: We conducted a retrospective analysis of
patients diagnosed with at least two synchronous
cerebral lesions, admitted and treated in Carol Davila
Central Military Emergency Clinical Hospital
Bucharest. The study followed patients over a period of
5 years (2010 2015).
Results: In this study, we included 17 patients (4.33%)
with two or more cerebral lesions out of 73 cases
diagnosed with cerebral tumors. The most frequent
multiple tumors were multicenter primitive cerebral
gliomas, synchronous and metachronous cerebral
metastases, other multiple cerebral lesions etc.
Conclusions: We must always take into account the
possibility of synchronous tumors occurring and we
have to acknowledge the fact that a therapeutic success
over a cancerous disease wont protect the patient from
a new primitive tumor.

Surgical treatment of laparoscopic inguinal


hernia Personal experience

Ethical and legal aspects of physical restraints


of patients in ICU

F. Svulescu, C. Crlan, Mdlina Petrescu

S.B. Petre, L. Ene

Inguinal hernia represents the pathology of the


abdominal wall with the highest incidence.
Epidemiological data are very difficult to obtain,
however, in an arbitrary manner, it is estimated that
approximately 3% of the population shows a form of
inguinal hernia. This disease can affect both sexes at
any age, but a higher incidence was observed among
men (ratio of male:female 9:1) aged between 40 and 59
years. The high number of people diagnosed as well as
the fact that the only curative treatment is the surgical
treatment, inguinal hernia becomes a very important
disease, both in medical and socioeconomic terms. The
only method by which the effect of this condition can
be diminishing (by decreasing the number of days of
hospitalization, minimal risk of relapse, low cost) is the
continuous improvement of the surgical technique.

Being in respiratory distress is a reason to be anxious.


Being
mechanically ventilated
is extremely
uncomfortable. Attempts weaning in chronic
respiratory insufficiency are also generating anxiety.
Permanent noise, sleep deprivation and bustle feature
enhances ICU patient anxiety causes that are
responsible assessment of patients fell agitation is
essential and must be managed accordingly. Delirium,
a common basis for agitation cannot be managed or
resolved entirely by anxiolytics agents. Basically, it is
much easier to settle the case than to treat and manage
a patient psychomotor agitation. Already appeared in
the evolution of patients admitted to the intensive care
unit, anxiety should be immediately removed it and
kept it under control. An agitated patient is a patient
aggressive and dangerous to himself (first - accidental

extubation, avulsion of IV line or arterial line...) so we


should take measures of restraint / immobilization. We
have chemical reassurance with multiple disadvantages
(to extend the period of mechanical ventilation to
increase the risk of nosocomial infections.) and
physical restraint, viewed by the media, either
misinformed, as a barbarian measure derived from the
middle Ages
There are situations where physical restraints with
special textile items which do not generate secondary
lesions are indicated in the treatment of patients. This
should be indicated primarily by currant physician,
under the close supervision of patient status,
accompanied by a close communication with the
patient and the family, following a protocol approved
in the hospital unit.
In Romania the situation was legally regulated by Law
487/2002 art. 5 and 39 and republished in 2012.It
remains a controversial method, hard admitted by
population so that communication with patient, music
therapy, acupuncture and administration of melatonin
in order to increase sleep quality are modern
approaches, alternative psychomotor agitated patient.

Volatile induction and maintenance anesthesia


S.B. Petre, N. Guu, D. Corneci, L. Ene
VIMA is an acronym for Induction and Maintenance of
Volatile Anesthetsia. Maintaining of volatile anesthetic
is common practice among the anesthetic techniques,
but volatile induction is less used. However, there are
clear cases in which volatile induction (sevoflurane
using in general) bring multiple benefits.
VIMA has real advantages. When it is used in
ambulatory surgery, volatile anesthetic (VA) with
Sevolfurane is fastest ( 51 vs. 81 4 seconds 12
seconds) and has the same side effects, recovery time
and patient satisfaction level compared with
intravenous induction (VI ) with Propofol. In
conclusion VA cost less than VI.
In this report I presented a case of difficult intubations
in which I obtained enough relaxation using inhaled
technique without using succinylcholine and in this
way I was protected from the possible stress of
unsuccessful maneuvers (reversibility of volatility is
superior to any curara).
Another indication of this technique outside the
suspicion of difficult intubations, could be anesthesia
for children, especially in patients with difficult venous
access (although the latest data in the literature show a
higher growth of levels of stress hormones, of agitation
and cough in patients with VIMA, compared to those
with TIVA).
In case of multiallergic patients VIMA has high level
indication in case of surgery requiring general
anesthesia. Older adults also benefit from multiple

advantages of induction volatile in slow flux of


volatiles to feature hemodynamic stability. VIMA
brings real benefits in case of upper airway obstruction
(epiglottis) or lower (foreign body).
With all its advantages and limitations, VIMA is
appreciated among anesthesiologists but not widely
used (in Romania is estimated to represent 1-5% of the
total general anesthesia). For further method regularly
organizes workshops aimed at increasing skill and
technique learning VIMA.

Management of medical treatment in glaucoma


Current research
C. tefan, G. Anghel, M. Burcea, Daniela elaru,
Cristina M. Timaru, Daniela A. Iliescu, O. Muat,
M. Zemba, H. Manole, Laura Macovei, Liliana
Pulbere, Monica Armegioiu
Introduction: Glaucoma refers to a group of related eye
disorders that have in common an optic neuropathy
associated with visual function loss. It is one of the
leading causes of irreversible blindness worldwide.
Glaucoma can damage vision gradually so it may not
be noticed until the disease is at an advanced stage.
Material and methods: This study is a review of current
medical treatment and research of alternatives for
patients with glaucoma.
Results and discussions: There are numerous
antiglaucoma drugs currently available on the market
and research continues in developing new methods for
treatment of this disease.
Early diagnosis and treatment can minimize or prevent
optic nerve damage and limit glaucoma-related vision
loss. Nowadays, research continues for improving
current medical treatment.
Keywords: glaucoma, preservative-free, medical
treatment, drug delivery, gene therapy, stem cells

Penetrating ocular trauma with intraocular


foreign body retention Surgical approach
O. Muat, G. Anghel, C. tefan, H. Manole, M.
Zemba, Laura Macovei, Liliana Pulbere, Corina
Cernat, Daniela elaru, Monica Armegioiu
We present the case of a patient with penetrating ocular
trauma with intraocular magnetic foreign body
retention.
Emergency surgical intervention is decided in this case,
and we practice pars plana vitrectomy, endolaser,
internal tamponade with silicone oil and the foreign
body extraction.
Intra and postoperative results were favorable.
We also present the long term evolution case and some
opinions about possible forensic complications.

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.

Surgical approach of Marjolins ulcer


developed on postcombustional scar Case
presentation
B. Marinescu, Ioana Nedelcu, Andreea Benga
Introduction: Marjolins ulcer is a rare and often
aggressive cutaneous malignant lesion which develops
in previously traumatized or chronically inflamed skin,
particularly in old burn scar, ulcer or chronic fistula.
Subject: The aim of the paper is to report a study case,
of soft tissue reconstruction, after a large Marjolins
ulcer tumor resection.
Material and method: Male patient, 60-year old had
been severely burned - third and fourth degree thermal
burns, 15% (B.S.A.), on the inferior abdomen and
thighs - 55 years earlier. The lesion healed with
conservative treatment. The patient remained invalid
since there, due to postcombustional sequels of the
inferior abdomen and thighs he can't stand or walk
straight up.
After clinic and paraclinic investigations, we decide to
performe a wide and complete resection of the tumoral
block, histopathologicaly verified.
The entire post excisional defect was covered with
meshed skin autograft at 3:1 expansion, harvested on
the anterior bilateral thighs.
Result: Two weeks after grafting, complete
revascularization of the skin graft was observed.
Histopathology of excised tissue showed well
differentiated squamous cell carcinoma. The deep
resection limits and surrounding areas were free of
tumor infiltration.
The patient is leaving the hospital, walking in normal
straight up position.
He was stable and free from local recurrence and
metastasis, 6 month after surgery.

Conclusions: Marjolins ulcer is a rare but aggressive


malignancy with a higher rate of regional metastases.
When local condition are changing: excessively ulcer
drain, bleeding, increasing in size, local or regional
pain - prompt management of the lesion is imperative
(extensive surgery).
Usually, multidisciplinary approach is necessary. After
surgery, long time follow up is recommended.
Prognostic is related to:
1. histopathological type of tumor lesion
2. tumor size and anatomical location
3. presence or absence of metastasis

Skin grafts in dermatology A review and


update on full and split skin grafts and free
cartilage grafts
V. Trifu, Monica Drmnescu, Mihaela Georgescu,
Marcela Poenaru, A.M. ilea
Skin
grafting
represents
a
well-established
reconstruction technique, implemented to restore
structure, function and cosmesis to different surgical
wounds.
We present an overview of the general principles of
skin grafting useful for the dermatologic surgeon,
taking into account the old and the up to date
techniques. We illustrate in a series of cases the
different applications and techniques of full and splitthickness and free cartilage grafts.
We discuss in detail the practical issues concerning the
preoperative and postoperative care. As such the proper
wound care, correct surgical preparation of the defect
and the type and timing of the graft procedure are all
important considerations in maximising the final result.
Skin grafting represents a versatile method of
cutaneous reconstruction. A thorough understanding of
the indications, advantages, disadvantages, techniques
and complications, is necessary for successful aestethic
and functional results.

Pigmented tumors of the cephalic region


Clinical and dermoscopical aspects
A.M. ilea, Mihaela Georgescu, M.A. Badea,
Monica Drmnescu, V. Trifu
Introduction
Tumours of the cephalic region can bring significant
distress to the patients considering the functional and
aesthetical aspects that are implied when performing
surgery at this level.

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.

Indications for surgical treatment of laryngeal


trauma

News in ENT multidisciplinary cancer therapy


C. Romanian, R. Costin, G. Ganea, A. Ioni
Laryngeal cancer represents a major area of interest in
ENT cancer pathology, diagnostic methods and
treatment being in continuous improvement. Special
attention should be paid to the location of the tumor
and accurate establishing of TNM staging.
This paper tries to highlight the current role of surgery
in laryngeal cancer therapy.

Large vesical haemangioma in KlippelTrenaunay syndrome


O. Bratu, M. Dinu, D. Spnu, A. Rdulescu, R.
Popescu, D. Marcu, C. Farca, D. Mischianu
Introduction
Klippel-Trenaunay syndrome is a rarely met syndrome
which can associate visceral haemangiomas, bladder
localisation being present in 3-8% of cases.
Material and method
Pacient C.V., age 32, was reffered to our clinic for
intermitent
macroscopic
hematuria.
Paraclinic
investigations, cystoscopic examination and related
pathology established diagnosis of large vesical
haemangioma associated to Klippel-Trenaunay
syndrome. Partial cystectomy was performed by
hypogastric incision.
Results
The postoperative evolution was uneventful, no
complications occured. Patient was discharched 8 days
post-procedure.
Conclusions
Although surgical approach is endoscopic in most cases
of vesical haemangiomas, tumor size may impose open
surgery.

C. Romanian, R. Costin, G. Ganea, A. Ioni


Although laryngeal trauma have declined in incidence
in the context of traffic accidents due to seat belt use, if
not properly assessed and treated, can lead to serious
sequelae of vocal cords or airways and the patient's
death in severe cases.
This paper attempts to summarize the ways of solving
laryngeal surgical trauma.

Laryngeal cancer Rare histological types


C. Romanian, R. Costin, G. Ganea, A. Ioni
The majority (95 %) malignant laryngeal tumor
processes are of epithelial origin.
This work captures two types of rare histopathological
laryngeal cancer: Malignant fibrous histiocytoma and
Chondrosarcoma, cases diagnosed and surgically
treated at the ENT Clinic of SUUMC.

Paraneoplastic syndrome in primitive


retroperitoneal tumors
O. Bratu, M. Dinu, D. Spnu, A. Iliescu, R. Popescu,
D. Marcu, I. Oprea, B. Petre, F. Rusu, C. Farca, D.
Mischianu
Introduction
Retroperitoneal tumors represent a particular
oncological pathology. No other human pathology is so
deceiving and scarce in specific clinical symptoms as
these tumors. Usually borrowing the symptoms of
nearby organs they are discovered in advanced or
incurable stages.
Material and method
We are presenting you the challenge of diagnosing
some retroperitoneal tumors. One of the rarest signs
was by far the paraneoplastic syndrome or the secretion
of active biological substances.

The study group is composed of histopatological


diagnosed patients. They were enrolled from many
surgical specialties because of their pleomorphic
clinical signs. The vast majority were selected from
urology and general surgery wards but there were cases
from gynecology, neurosurgery and even from
endocrinology and gastroenterology.
Results
Paraneoplastic syndrome represents the secretion of
various substances by the tumor, substances that make
changes at bioumoral level. Hormones, cytokines,
interleukins, antibodies, complement system are a few
examples of these biologic active substances.
In our study we found 3 cases of 44 patients (6.82%)
with paraneoplastic syndrome. What it is to be noticed
is that because of this syndrome the diagnosis was
more difficult and was indirectly referred to a
retroperitoneal tumor. We would like to present you
these cases and their particularities.
Conclusions
Every case was a surgical and diagnosis challenge.
Biologic active substance secretion or the
paraneoplastic syndrome makes the clinical picture
even more complicated for primitive retroperitoneal
tumors.

Posttraumatic arterial priapism


O. Bratu, M. Dinu, D. Spnu, C. Farca, R. Popescu,
D. Marcu, I. Oprea, S. Botezatu, D. Mischianu
Introduction
Either venous or arterial priapism it represents an
important urological problem. Venous priapism is one
of the major urological emergencies and arterial
priapism could lead to permanent erectile dysfunction.
Material and Method
We would like to present a case of a 32 years old male
patient with erectile dysfunction caused by an arterial
fistula due to a penile trauma.
Results
Ultraselective embolisation was performed at the level
of penile arterial branches emerging from internal
pudental and obturatory arteries, closing the arterial
fistula.
The patient was discharged few hours after procedure.
Erectile function was greatly improved altough the
patient still needed 5-PDE inhibitors treatment.
Conclusion
Selective embolisation represents the gold standard
treatment in arterial priapism avoiding open surgery
complications.
This case shows the perfect cooperation between
urologist and interventional radiologist.

Prognosis markers in primitive retroperitoneal


tumors
O. Bratu, M. Dinu, D. Spnu, A. Rdulescu, R.
Popescu, D. Marcu, I. Oprea, B. Petre, C. Farca, F.
Rusu, D. Mischianu
Introduction
Because of their late diagnosis, unfavourable evolution,
anatomo-pathological and clinical diversity primitive
retroperitoneal tumors represent a complex neoplasia
which we analyzed by means of prognosis markers.
Material and Methods
44 patients with anatomo-pathological diagnosis of
different histological types of primitive retroperitoneal
tumors were included in the study. Any retroperitoneal
neoplasia related to a secondary lesion or to any
retroperitoneal organ was excluded from the group.
The histo-pathological material was obtained through
biopsy, exploratory laparotomy or surgical exeresis and
was immunologically and genetically evaluated. Some
particular oncogenes, chromosome alterations and
lymphocytes dynamics in the immune tumoral process
were followed.
Results
Overall immune response decreased although some
particular lymphocytes types responded.
The oncogenes which were analyzed responded
accordingly to our present knowledge, being
independent of the tumor type. It was found a
correspondence between oncogenes and tumor
aggressiveness and metastasis.
Conclusions
The prognosis for this type of neoplasms is not
favourable. An early diagnosis is mandatory because
surgery still remains the only method of prolonging the
life expectancy for these patients.
Early detection of specific oncogenes can lead to a
more effective surgery or can better guide the adjuvant
therapy. This is actually a wider aim applicable in all
human neoplasia.
With the discovery of new oncogenic mechanisms, new
therapies will be developed, capable of stopping or why
not, cure the neoplasm.

Surgical treatment for urinary incontinence in


men
O. Bratu, M. Dinu, D. Spnu, A. Rdulescu, R.
Popescu, D. Marcu, I. Oprea, B. Petre, D. Mischianu
Introduction
We are presenting a possible surgical approach for
urinary incontinence in men using a polypropylene
mesh placed under the bulbar urethra. This procedure is
similar with TOT procedure for stress urinary
incontinence in women.

Material and Method


This surgical approach was used for 5 patients
presenting urinary incontinence after radical
prostatectomy and trans-urethral-resection of prostate.
This method could also be used for neurological
urinary incontinence
like
spina
bifida
or
mielomeningocele. Obviously urinary incontinence due
to chronic retention of urine was an exclusion criteria.
We used polypropylene mesh placed similar to that
used in TOT for women or special model made for
men. The surgical technique consisted in dissection of
the bulbous urethra through the perineum and placing
the mesh under the urethra, trans-obturatory, in outin mannner.
Results
Post-operatory outcome is simple, in 24 hours the

urinary catheter is removed and in 48-72 hours the


patient is discharged.
The follow-up showed the overall success of this
procedure, the absence of post-mictional residue. Few
or no operatory complications occurred.
Conclusions
The surgical technique we used proved to be effective.
The procedure is less invasive, not complicated and
takes little operating time.
Intraoperatory complications include vascular and
urethral lesions which can be avoided by experienced
surgeons. Post-operatory complications do not usually
occur.
This procedure is a real alternative in the cure of
iatrogenic, neurological or post prostatectomy urinary
incontinence, greatly increasing the quality of life.

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:

Nuss procedure has a series of advantages: minimally


invasive surgical procedure reduced operative time,
minimal blood loss and fast socio-professional
reinstatement.

Solitary fibrous tumors of the pleura A 5 year


experience
C. Grozavu, M. Ilia, D. Marin, D. Pantile, T.
Augustin
Introduction:
Primary pleural tumors are either localized or diffuse
pleural lesions. Tumors with a diffuse pattern
mesotheliomas arise from the mesothelial pleural
cells and have a high degree of malignancy. Localized
tumors solitary fibrous tumors of the pleura arise
from the mesenchymal cells of the mesotheliums
subjacent areolar tissue.
Material and method:
We analyze the patients admitted with this condition in
the Thoracic Surgery Department of the Carol Davila
Military Emergency University Hospital over a
timeframe of 5 years (2010 2015). Clinical and
Paraclinical findings are summarized. We also analyze
the indications and contraindications of the surgical
intervention, as well as possible intraoperative and
postoperative complications.
Results:
Usually, patients have a positive postoperative
outcome, with low postoperative morbidity and
mortality rates. 5-year survival rate is over 95%,
complete surgical resection representing the curative

treatment. Several factors which seem to influence


patients survival are also summarized, as well as the
postoperative morbidity rate.
Discussion:
Although the postoperative outcome is usually positive,
recurrence may occur even after 15-20 years
postoperative. A high cellularity and a high density of
micro-vessels, hyper expression of Ki67 and CD31,
and negativity of CD34 are considered negative
prognostic factors.
Conclusion:
Although histological benign, these tumors can grow
rapidly and occasionally they can become malignant.
The treatment of choice is complete surgical resection.
Long-term surveillance is mandatory, even after the
complete resection of a benign pleural tumor. Serial CT
scans are recommended to monitor reoccurrence.

Therapeutical options for iatrogenic lesions of


the trachea
C. Nistor, C. Grozavu, M. eu, A. Ciuche, D.
Marin, Aurora Fera, M. Ilia, D. Pantile, A. Tudose
Introduction:
Iatrogenic tracheal lesions usually are found after
difficult oro-tracheal intubation. Tracheal lesions
represent a rare, but serious complication of any
maneuver at this level, no matter the experience of the
medical personnel performing the maneuver.
Material and method:
During the last 5 years (20112015), four patients with
post oro-tracheal intubation tracheal lesions were
admitted in our service. Three of them required a
surgical intervention, while one patient benefited from
conservative treatment.
Results:
All patients had a favorable outcome. The surgical
intervention was performed either through a cervical or
through a lateral thoracic approach.
Discussions and conclusions:
Iatrogenic tracheal lesions usually represent a surgical
emergency. The acknowledgment of the lesion in due
time is of the essence. Fiber-bronchoscopic
investigation of the trachea is mandatory in order to
both identify the level at which the lesion occurred, and
to establish the best surgical approach. These cases
may have legal implications. The complications of
iatrogenic tracheal lesions are serious and may lead to
patients death. The surgical approach is essential for
the lesions surgical cure.
Every anesthesiologist should have a thoracic surgeon
friend!

Horseshoe kidney pathology A constant


challenge
D. Marcu, D. Spnu, O. Bratu, A. Aungurenci, C.
Farca, A. Ciuc, M. Dinu, D. Mischianu
Introduction: Horseshoe kidney is defined by the
joining of the two kidneys, most frequently at the
inferior poles level, by fibrous or parenchymatous
tissue called isthmus, with variable vascularization.
A condition such as, increases the risk of developing
complications like: urinary infections, urinary lithiasis,
hydronephrosis and neoplasia.
The purpose of this case-report is to emphasize the
particularities of the management of horseshoe kidney
associated pathology.
Material and methods: We present the cases of two
pacients, who were addmited in our clinic accusing
only diffuse lombar pain. The horseshoe kidney
suspicion was raised after the abdominopelvic
ultrasonography and later confirmed by CT-scan.
Before deciding the surgical treatment, we took into
acount the vascularization particularities.
Results and conclusions:
Horseshoe kidney is usually an accidental discovery,
following investigations for unrelated illnesses or
secondary to its complications.
Neoplasia affecting horseshoe kidney is relatively rare,
the incidence in such cases being 3 or 4 times higher
than in the normal population.
The high insertion point of the ureters into the renal
pelvis, their abnornal course and the orientation of the
calyces emphasize the risk of urinary stasis,
hydronephrosis, urinary infections and kidney stones.
For us, surgery is divided into regulated and
nonregulated interventions. In this particular case, we
are talking about the latter.
The imaging tehniques (CT, MRI, and angiography)
have proven to be invaluable in establishing the optimal
surgical treatment (minimal invasive or classical
surgery) in regards to kidney topography and especially
to the vascularization, taking into account the higher
intraoperatory risks associated whith the latter.

Predictive factors of uroperitoneum following


gynecologic surgery
V. Mdan, A. Aungurenci, A. Rdulescu, V. Botea,
M. Dinu, D. Mischianu
Introduction and objectives: Gynaecologic disorders
may frequently have an aggressive evolution, which
can create multiple complications after surgery. One of
these complications is the uroperitoneum that
distinguishes by insidious emergence of symptoms,
difficulties in diagnosis and rapid deterioration of
general condition, sometimes leading to exitus. The

purpose of this study is to evaluate the factors that led


to uroperitoneum after gynecologic surgery.
Material and method: We have made a retrospective
study which included 11 patients admitted to our clinic
in the last 5 years, diagnosed with uroperitoneum after
gynecologycal surgery. We have included in our
analysis the primary surgery, the disease stage at
diagnosis time, the surgical history, the mechanism of
emergence and other comorbidities.
Results: The mean age in our study was 51.3 years (42
to 58 years). Uroperitoneum was encountered mainly in
patients diagnosed with cervical cancer 82% (n=9stages I B1 II B), followed by patients with uterine
fibroid 18% (n=2). Two patients included in our study
benefited of preoperative radiotherapy for tumor down
staging, and 5 of them had previous surgical history.
The most frequent gynecological surgery encountered
was Wertheim hysterectomy with pelvic lymph node
dissection 82% (n=9), followed by total hysterectomy
with adnexectomy 18% (n=2). The main mechanism of
uroperitoneum emergence was by ureteral fistula 91%
(n=10), followed by bladder fistula 9% (n=1).
Conclusions: The most common gynecological disease
encountered in our group was cervical cancer. The
most important factors for ureteral and bladder lesions
were: tumor stage (I B2, II A, II B), preoperative
external radiotherapy and abdominal surgical history.
Other complementary factors were represented by the
type of gynecological surgery practiced (Wertheim
hysterectomy), technical difficulties encountered in
relation to local anatomy and postoperative follow up.

Pregnancy associated urological conditions


V. Mdan, A. Rdulescu, A. Aungurenci, C. Farca,
M. Dinu, D. Mischianu
Introduction: Urinary and genital apparatus have
common embryological origin and share close
anatomical relations. Pregnancy is often associated
with hydronephrosis which is considered physiological
unless UTI, lithiasis or severe pain occur.
Method and material: Between January 2014 and July
2015 20 pregnant women with hidronephrosis or
pyelonephritis were admitted in our Clinic. We have
analyzed the degree of urinary tract dilatation, presence
or absence of UTI and treatment option.
Results: As treatment option we decided for ureteric
stent placement for 10 patients, 3 patients benefited of
percutaneous nephrostomy and 7 patients were treated
conservatively with antispastic, antalgic and
intravenous cephalosporines. All pregnancies were not
affected by the urological acute episode and progressed
without incidents.
Conclusions: The association between pregnancy and
urological condition is not very common.
The urologist must be aware of the counter indications,

side effects and the special care needed by the pregnant


patient. Conservative treatment should always be the
first choice when it is feasible.

Late oropharengeal functional outcomes of


suicidal maxillofacial gunshot wounds
F. Zor, A. Aykan, U. Coskun, M. Aksu, S. Ozturk
Purpose: The aim of this study was to evaluate the long
term aesthetic and functional results of suicidal gunshot
injuries with objective methods to identify the residual
problems following one-stage reconstruction.
Methods: Twenty male patients with gunshot injuries
resulting from suicide attempts that were treated in the
Department of Plastic and Reconstructive Surgery at
Gulhane Military Medical Academy were included in
the study. The control group was composed of 10 male
volunteers. The reconstructions of all involved
structures were performed within 1-3 days of the
injury. The patients were evaluated both aesthetically
and functionally. The Body Satisfaction Scale was used
for evaluation of aesthetic appearances of the facial
structures. To evaluate swallowing, videofluoroscopy,
cine-MRI, submental EMG, Functional Endoscopic
Evaluation of Swallowing and submental ultrasound
were performed. The perceptual speech analysis was
used for speech evaluation.
Results: In the control group, the Body Satisfaction
Scale score was statistically higher than patients with
both ongoing and completed reconstructions (p<0.05).
The swallowing disturbances and their frequency in the
study group were higher than the control group. The
most frequently observed swallowing disturbance was
found to be stasis in the sinuses. The laryngeal
elevation and geometric angle of the epiglottis in the
study group were statistically lower than the control
group (p<0.05). The mean amplitude of contraction of
submental muscles was lower in the study group than
in the control group (p<0.05). The Multidimensional
Voice Program showed statistically significant
differences between the treatment and control groups
(p< 0.01).
Conclusion: The objective assessment methods were
enabled us to retrospectively evaluate the treatment and
identify the specific problem causing functional and
aesthetic morbidities.

Total hemiface allotransplantation model in


rats
Y. Kulahci, S.H. Altunta, F. Zor, H. Karagz,
Maria Siemionow
Introduction: Facial defects following high-energy
trauma or gunshot wounds may include all parts of the
face. Autologous reconstruction of these defects results

in suboptimal results in terms of function and


aesthetics. Vascularized composite allotransplantation
(VCA) is a new option for these patients. Although
there are several clinical cases of facial VCA, each case
includes different facial parts and we still do not know
how different facial structures respond to
allotransplantation. The aim of this study was to
describe a total hemiface VCA model including all
types of tissues in face, in order to evaluate effect of
allotransplantation on these various tissue types.
Material and Methods: Total hemiface allograft was
harvested based on common carotid artery and external
jugular vein. Total 10 transplantations were performed
in two groups. Allografts included all tissue types in
face, namely, premaxillar bone, nose, external ear,
mystacial pad, upper and lower palpebral. In isograft
group (n=5) transplantations was performed between
Lewis rats. In allograft group (n=5) transplantations
were performed between LBN donors and Lewis
recipients. All transplantations were performed to the
inguinal region of the recipient rats and femoral vessels
were used as recipient vessels. CsA monotherapy was
used in allograft group in order to prevent rejection.
Results: All flaps survived indefinitely. Meal surgical
time was about 3 hours with a warm ischemia time of
45 minutes. No rejection was seen during the 100 days
of follow up. Histologic sections of different tissue
types showed normal histology, including bone,
cartilage (ear and nose), conjunctiva, palpebral,
eyelashes and etc.
Conclusion: As a conclusion, total hemiface
allotransplantation model including all types of tissues
in face is described and post-transplant changes were
evaluated.

Microvascular reconstruction of mandible


defects due to gunshot injuries
F. Zor, Y. Bayram, K. Yapici, M. Eski, S. Ozturk
Introduction:
Mandibular reconstruction has been presenting a
significant challenge for reconstructive surgeons.
However, the advance of microvascular and
maxillofacial surgical principles has brought a new
dimension to overcome the difficulties in this era.
Material and Methods:
114 patients with mandibular gunshot injuries were
treated in the Department of Plastic and Reconstructive
Surgery at Glhane Military Medical Academy. In 84
cases, the bony defects were treated with free flap
transfers, which 21 were osseous and the remaining
flaps were in osteocutaneous fashion. Of these 84
patients, 23 were treated with a free fibula flap transfer
in the early period. Vascularized fibula flap was used
for definitive treatment of bone defects. Bone grafts
were used if the mandibular defect was less than 4 cm.

Other cases were treated either by bone graft or


distraction osteogenesis. In six patients, vertical
distraction osteogenesis of the osteocutaneous fibula
flap was performed for implant placement. Dental
prosthetics were routinely employed.
Results:
The average bony defect was 6.7 cm (range, 4-9 cm).
The definitive treatment was preferred to be performed
in the early period but it was possible only in 23 cases.
A near-normal occlusion was obtained in all cases.
Postoperative complications included loss of free fibula
flap (2 cases), loosening of plate (9 cases), nonunion (2
case) and plate fracture (1 case). A second free fibular
flap was performed to those with free flap loss.
Conclusion:
We recommend reconstructing large bone defects by
vascularized bone flaps in the early periods. Early
reconstruction of the mandibular gunshot injuries has
several advantages such as better functional and
cosmetic outcome, decreased hospitalization and cost.
Defect should be bridged by use of a reconstruction
plate if early definitive treatment is not possible.

Between benign or malign A rare cause of


neoplasm of the pancreas: serous cystadenoma
(ICD-O: 8441/0) Case report
L.G. Eftimie, M. Curea, M. Dumitrescu, Florina
Vasilescu, Liana Toma, Rodica Bulata
Introduction: Most serous cystic neoplasms of the
pancreas are benign (serous cystadenomas), accounting
for 1-2% of all pancreatic neoplasms and only rare
cases metastasize (serous cystadenocarcinomas). These
tumors usually arise in the body or tail of the pancreas
and malignancy is defined only by the presence of
distant metastases, although, macroscopically and
microscopically are almost similar and approximately
40% present as an incidental finding at routine physical
examination.
Materials and methods: We present the case of a 66
years old female who came with abdominal pain,
weight loss and a palpable upper abdominal mass,
nausea and vomiting. Imaging techniques and the
macroscopy reveal a well-circumscribed, multilocular
mass with evident central stellate scar, which doesnt
communicate with the pancreatic duct system. Its
important to say that serum CEA and CA19-9 levels
are usually normal or slightly increased. The neoplastic
cells are uniform and most serous cystadenocarcinomas
do not have an increased mitotic rate.
Results and Conclusion: We report for the first time
this case because it is very rarely encountered and the
resection of this slowly growing neoplasm is helpful,
even
at
an
advanced
stage
of
serous
cystadenocarcinoma or serous cystadenomas with
locally aggressive features.

Radical retropubic prostatectomy in treatment


of prostate cancer
O. Bratu, M. Dinu, D. Spinu, A. Rdulescu, R.
Popescu, D. Marcu, I. Oprea, B. Petre, C. Farca, D.
Mischianu
Introduction
Prostate cancer is a serious public health issue affecting
more and more men. Using PSA and periodic urologic
exams more and patients are diagnosed in an early
stage and may benefit from a curative treatment.
Retropubic radical prostatectomy, external beam
radiation therapy and brachytherapy are the curative
options.
Method and materials
The experience of Clinic of Urology from Central
Military Hospital representing 100 cases was analyzed
in terms of PSA level at diagnose moment,
preoperative and postoperative staging, preoperative
and postoperative Gleason score, intraoperative
complications and also precocious and late
postoperative complications and oncologic outcomes.
Besides those aspects, we have analysed surgery related
parameters.
Results
Favorable outcomes were obtained in most cases with
mild to moderate intraoperative complications (blood
loss), early postoperative complications (hematuria,
urinary tract infection, lymph drainage) or late
postoperative complications (erectile dysfunction and
urinary incontinence).
Conclusions
Radical prostatectomy remains the gold standard
treatment for patient with localized prostate cancer and
in some cases for local advanced prostate cancer. It
provides good oncological outcome with manageable
complications.

Hemodynamic monitoring in trauma patients


I. Oprea, B. Petre, L. Ene, N. Tnase, D. Ghinescu
Introduction
The purpose of this presentation is to show the
advantages and disadvantages of hemodynamic
monitoring in trauma patients. We would also like to
use an advanced information system to predict
outcomes and to evaluate the relative effectiveness of
various instant feedback informations during acute
emergency conditions.

Traumatic lesions are complex and have a rapid


evolution. The management of a wounded patient has
specific evaluation particularities; therefore it was
created a teaching system based upon international
standards and protocols.
Materials and methods
We will try to present the hemodynamic monitoring
techniques, starting from the primary evaluation of the
patient regarding arterial pressure, cardiac frequency,
urine output, following more advanced methods like
Flotrac, Picco, Lidco, Swan Ganz catether monitoring.
The purpose of hemodynamic monitoring in trauma
patients is to evaluate the cardiovascular system and its
oxygen and fluid necessities.
Results
We found the advantage of a correct resuscitation
regarding the traumatic and hypovolemic shock, and
also the disadvantage of using invasive maneuvers in
an already wounded patient.
Conclusion
The functional hemodynamic monitoring is a relatively
new concept and it helps guiding the resuscitation in
order to improve the patient's prognosis.

The posterior polar cataract A challenge for


the eye surgeon
Gh. Anghel, O. Musat, M. Zemba, H. Manole,
Laura Macovei, Liliana Pulbere, Daniela Selaru,
Maria Monica Armegioiu, C. Stefan, Alina
Cristiana Anghel
We present two cases of posterior polar cataract with
different intra operative evolutions. In both cases
intraocular lenses (one standard mono focal, one
refractive multifocal) were implanted after the
phacoemulsification of the cataract. In both cases the
achieved postoperative visual acuity was 1 without
correction.
The posterior polar cataract represents a challenge for
the eye surgeon because it is associated with an
increased incidence of intra operative rupture of the
posterior capsule due to the cataracts adherence to or
the associated weakness of the posterior capsule. Intra
operative rupture of the posterior capsule may prevent
the implantation of the IOL in the capsular bag.
Adequate surgical management even when this incident
takes place increases the likelihood of a capsular bag
IOL implantation.

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

Prosthetic valve endocarditis. Case


presentation
Alina M. Benescu, Anamaria R. Alexandru, B.
Crciumaru
Background: Infectious endocarditis is an inflammatory
and proliferative disease of the endocardium that
mainly affects valvular structures.
Methods: A 63-year-old man is sent to the Central
Military Emergency University Hospital for fever
during 4 month, suspected of infective endocarditis.
The patient has a prosthetic aortic valve since 2006.
The transthoracic echocardiography was inconclusive,
but the transesophageal echocardiography revealed 2
mobile structures with medium echogenity on the aortic

valve, of 12 and 9 mm. The patient arrived to National


Institute of Infectious Diseases Prof. Dr. Matei Bals
and the cultures became positive for Streptococcus
gallolyticus. After 10 days, the vegetations are smaller
(3-4 mm) and a lesion suggesting an abscess appears on
the anterior leaflet mitral valve. After 1 month, the
aortic valve is clean and the abscess is in regression.
Results: The treatment with meropenemum was
efficient. This case will be monitored whole life
because a new episode of infective endocarditis is
expected. The risk was that the prosthetic valve became
inoperative and the patient required a new surgery.
Conclusions: The patient with prosthetic aortic valve
has his first episode of infective endocarditis after 9
years. The problems were about the ambiguous
transthoracic echocardiography and the blood cultures
which were negative.
Keywords: Streptococcus gallolyticus, infective
endocarditis, prosthetic aortic valve

Considerations on First Aid in the Tactical


Field (Care under fire)
Iulia M. Staicu, B. Savu
The development of the weapons systems used during
military operations, the transition from classical to
asymmetrical conflicts, employing during the latter
improvised explosive devices (IED), as well as aiming
to minimize the number of causalities during combat,
have led to researches in the field of improving the
survival rate of the wounded troops during battle. If in
WWII the rate of causalities among all wounded had
been of 19.1%, while during the Vietnam war of
15.8%, this percentage has dropped to 9.4% during the
Iraq conflict (OIF/OEF), in spite of all the warfare
development and the use of IED. This fact is due to the
improvement of tactical combat casualty care
techniques (TCCC). This represents a new standard of
medical aid for the management of the wounded in the
tactical field.
The first phase of TCCC bears the name care under fire
(CUF). The current paper presents CUF, the most
controversial phase of TCCC and aims to prove the
necessity of introducing a similar provision within the
Romanian Armed Forces, first of all in order to serve
the personal that is going to participate in missions in
operation theaters.

Diagnostic pitfalls in subarachnoid hemorrhage


Case report
Florina Stoian, Oana D. Damian, Cristina F. Plea,
Emilia Furdu-Lungu, Carmen A. Srbu
Background: Subarachnoid hemorrhage (SAH) is an
acute cerebrovascular disease with an incidence of 222.5 cases per 100,000 individuals. SAH is
misdiagnosed in approximately 12% of cases. As a
result, this leads to delayed treatment with increasing
risk of neurological deterioration.
Case study:
A 74-years-old male, known with ileofemoral venous
thrombosis, who had pursued oral anticoagulant
treatment for many years, has a symptomatic debut of
epigastralgia, vomiting and intense occipital headache.
The pacient is first diagnosed with meningeal
syndrome in etiological observation. Both cerebral CT
and lumbar puncture puts us in difficulty because the
CT scan was normal and CSF is intensely hemorrhagic
with a suggestive biochemistry for hemorrhagic
bacterial meningitis.
Because angio-MRI ruled out meningitis, SAH is being
confirmed. In addition to the clinical examination and
the anamnesis (nonfebrile status, recent non-infectious
history, ACO treatment with INR= 3.5 and antiinflammatory self-medication,), SAH remains the most
valid diagnosis.
Conclusion:
Over 20% of subarachnoid hemorrhages are
nonaneurysmal and therefore, a significant risk factor
for developing this pathology is ACO treatment.This
complication could have been avoided only if the
pacient had gone to the medical specialist to stop his
ACO treatment after nine months from the debut. The
pacient should have been receiving proper counselling
towards INR monitoring and the interactions between
ACO and drugs or food. For this matter, we elaborated
a synopsis regarding ACO treatment, which is attached
to the hospital discharge documents.

The role of the medical student in


cardiopulmonary resuscitation
Anca Arsene, Teodora Cuzuban, Ilinca Ilie,
Andreea Tudose, F. Costea, Jaqueline Costea, C.B.
Teudea
Many medical specialties have seen the need for CPR
training of their personnel, this approach is logic and
natural given the fact that cardiac arrest can occur in
any area of the hospital as well as outside its premises.
Cardiopulmonary resuscitation guides are probably
among the most read medical guides by the average
layman. The tendency in the past decade has been to
educate as many people as possible to perform basic

CPR and efforts have been made in this direction in


many countries.
It seems however that an effort to make CPR common
knowledge is needed in the hospital as well, amongst
medical personnel outside the E.R and Intensive Care
units, given the fact that in many countries, Roumania
included, CPR when needed is many times performed
by staff from the E.R or I.C.U and not by the medical
staff in the hospital department it occurred in. And lack
of knowledge is easy to explain when one takes into
consideration that BLS and CPR are not a common
course in the curriculum of medical schools across the
globe.
Implementation of BLS classes in medical schools
would make today's med students and tomorrows
medical doctors better prepared to handle cardiac arrest
and would make transition to ALS courses easier.
Keywords: medical student, cardiac arrest, CPR

Thoracic pain Approaching it in the E.R.


Anca Arsene, Maria Elisei, Raluca Greceanu, S.
Vultur, F. Costea, Gabriela Andra, C.B. Teudea
Chest pain is accountable for a large number of visits to
the Emergency Room. Given the fact that it can be the
presenting complaint of various disorders from mild
ones such as muscle pain to life threatening conditions
such as acute myocardial infarction it is of utmost
importance to establish the cause of chest pain.
A large number of patients that present with unstable
angina will infarct within 14 days without the
appropriate diagnostic and treatment.
Acute myocardial infarction death rate is currently 45%
with 70% of the deaths occurring before patients reach
the hospital.
It's worth noting misdiagnosed acute myocardial
infarction accounts for 20% of the money paid in
malpractice lawsuits in the U.S.A alone.
Although it is very important to establish if the cause of
chest pain is cardiac or not it's also important not to
subject patients to unnecessary investigations and the
stress that comes with them.
The E.R medical staff should make sure that adequate
medical history is taken as this can be extremely
helpful in establishing a diagnostic and limiting the
number of invasive procedures.
Keywords: emergency, thoracic pain, differential
diagnosis

Subacute erythematous lupus Annular type


lesions mimicking a chronic erythema annulare
centrifugum Darier
Mihaela Georgescu, Viorica Marinescu, C. Jurcu,
Daniela Anghel, D.A. Chiri
Introduction: Subacute cutaneous lupus erythematosus
(SCLE) is a nonscarring, nonatrophy-producing,
photosensitive dermatosis which typically manifests in
1 of 2 forms: annular/polycyclic or psoriasiform/
papulosquamous lesions.
Case report: A 64 years old female was admitted in
June 2015 with an eruption formed of annular and
polycyclic plaques and placards, with a tendency to
extend through the periphery, 0.2-0.5 cm/day, and
central hyperpigmentation, erythematous-edematous
margins, with discrete desquamation, diameters of 2/2
and 30/30 cm, intensely itching, localized on the arms
and legs, trunk.
The lab results showed a false positive VDRL, elevated
CRP, consumption of C4, hypokalemia, elevated LD-P,
neutrophilic leukocytosis, elevated ANAs and antidsDNA antibodies. The histopathology exam was
nonspecific. IFD negative.
The internal medicine consult suggested a collagenous
disease.
Correlating the clinical aspects with the immunology
results we established the diagnosis of subacute
cutaneous lupus erythematous.
For the differential diagnosis we excluded chronic
erythema annulare centrifugum Darrier, but also LE
tumidus, annular erythema from Sjogren syndrome etc.
The patient was treated with 0.5 mg/kg of
metilprednisolonum. She had favorable evolution under
treatment, but with a recurrence when the patient
decided to stop the treatment.
Discussion: Subacute lupus erythematous is a clinical
form of cutaneous lupus which clinically has annular
lesions and positive immunology tests.
Conclusion: The rapid tendency of the lesions to extend
through the periphery raised many differential
diagnostic problems, but the correlation between the
clinical with the laboratory results helped to establish
the positive diagnosis and the correct therapeutic
conduit.

Miastenia gravis Case report


Crina Diaconu, G. Teodoru
We examined patient aged 22 years, a student who was
admitted to our clinic for: Back pain intensity increased
outlined progressively, requiring bed rest; weakness
and muscle fatigue, predominantly of the belt; severe
shortage of locomotives and self-care. APP:
Myasthenia gravis diagnosed 5 years ago, drug-induced

Cushing, mixed dyslipidemia, impaired glucose


tolerance, secondary amenorrhea (hypogonadotropic
hypogonadism induced cortisol), and pituitary tumor.
Disease history: In 2010, the patient describes the
sudden onset of symptoms: bilateral ptosis, diplopia
transient, fatigue, and difficulty in chewing solid food,
motor deficit proximal upper and lower limbs
(difficulty combing, climbing stairs)
Myasthenia gravis is diagnosed based on the following
investigations: EMG- myasthenic block postsynaptic
type, Ac antiAchR Dosage, Test to miostin; Initiating
therapy with prednisone cp5mg progressively
increasing dose is reached 60mg / day, Mestinon cp
120mg / day and calcium VitD3, gastric protection with
delay due to thymectomy MG big scores. It tried
reducing the dose of prednisone, but emphasizing
return of symptoms, caused re dosage with 35mg / day.
MRI toracolombar show uncharacteristic changes. The
patient was reassessed because Mydocalm and
Indomethacin treatment did not induce any
improvement in back pain. Attempts pulse therapy with
250mg Solumedrol, 1FL / day, 2 days, the patient does
not respond. Enter therapy Lyrica 150mg / day with
minimal improvement in symptomatology. CT was
performed with dye i.v. - Thymus 26 / 17mmm without
mediastinal lymph nodes; It mentioned that antibiotics
for a UTI carried asymptomatic, discovered
incidentally, led to the temporary relief of back pain.
Later the Institute C.I. Parhon diagnosed the pacient
with Cushing drug-induced suppression syndrome of
endogenous cortisol secretion; hypogonadotropic
hypogonadism secondary amenorrhea induced by
prolonged corticosteroid therapy. The hypothalamicpituitary region performed CT: pituitary micronode left
lateroselar that needs to be reassessed periodic.
Treatment objectives are: Improvement of symptoms
pain relief, improved static and dynamic spinal
disorders, increased exercise tolerance, increased
muscle strength level belts and limbs, and gait
improvement,
MG
control,
management
of
osteoporosis; Watching: breaking the vicious circle
pain-restraining-increasing
bone
resorptionemphasizing back-pain, increased BMD reduce the risk
of falls and fracture risk, increase quality of life,
control side effects of corticosteroid (amenorrhea,
dyslipidemia, impaired glucose tolerance). Methods:
hygienic and dietary regime, medication; physical
therapy, kinesiology program;
Evolution: it was favorable. The particularity of the
case: Until the advent of low back pain, the patient
lived a relatively normal life, myasthenia being under
therapeutic control. Sudden onset of back pain caused
deterioration of functional status and decreased quality
of life. The consequences of prolonged bed rest (6
months) are important in this case because the patient
has already generalized muscle hypotrophy and

hypotonia, fatigue, metabolic disorders, osteoporosis,


cortisone myopathy.

Paraparesis post polyradiculoneuritis Event


overview
Crina Diaconu, G. Teodoru
We examined a 45 years old patient that was admitted
to our department for spastic paraparesis and important
limitation of mobility bilateral hip joints.
Retained from previous medical history: Inflammatory
polyneuropathy (februarie2015), Difficulties in
administering nutrition, Status post tracheostomy,
Osteochondroma right hip, multiple trauma by falls
from height 12 years ago.
History: The patient installs a distal paresthesia
syndrome at MI and MS level bilateral subsequently
installed motor deficit at this level with progressive gait
disturbance, and the impossibility of maintaining
orthostatism;he is hospitalized in neurology clinic
where based on clinical and paraclinical exam
(cerebrospinal fluid, EMG, brain CT) he is diagnosed
with Acute Polyradiculoneuritis. It installs acute
respiratory failure with mechanical support that needs
for tracheostomy practice and the patient was
transferred at the ICU.
After treatment with immunoglobulin IV, neurotrophic,
vitamins, the evolution was favorable and he is
transferred to our clinic for specialized treatment in
order to recover the outstanding motor deficit and
sensory disturbance.
The objectives are: -improving nerve trophicity,
reducing motor deficit, training balance and training
coordination, proprioception reeducation, improving
static and dynamic spinal disorders, gait improvement
scheme for increasing levels of independence and
socio-professional reintegration.
Methods:
medicine
(treatment
indicated
by
neurologist):
Vitamin B therapy- B1, B6, B12 with tropism for
peripheral nerves: Milgamma 1cpx2 / day, Thiogamma
1cp 600mg / day, Piracetam400mg 2cp / day trophicity
nerve growth. Antiplatelet agents: Aspenter 1cp / day.
Adjuvant- increased use of oxygen: Aspacardin 1cpx2 /
day.
Physical therapy aims: increase muscle strength,
coordination, balance, gait scheme, proprioception, and
aerobic workout. Exercises: passive, passive-active
throughout the range of movement, active exercises
without resistance, anti-gravity and then with
progressive resistance, reaching a moderate level of
resistance. Sets of exercises with a small number of
repetitions and pauses.
Toning Massage MS and MI and lumbar massage
sedate and relaxing of paravertebral muscles.
Occupational therapy.

Electrotherapy: four cell galvanic bath, downflow


current, the threshold intensity to mild tingling
sensation 20 minutes to trophic effects on the
peripheral nervous system.
Electrostimulation on the anterior tibial;
-Manual Lumbar pv CIF 35Hz 10min, 10min spectrum
= 0-100Hz painkiller effect, decontracturant and
muscle relaxant.
Short term evolution was slow favorable: limited by the
hips heterotopic ossification, the pacient is walking
short distances with fixed frame support and foot
orthotics.
In the long term: evolution can be good if the pacient
will continue Physical Therapy programs, but depends
on both the natural evolution of the disease (recurrence
5-8 %) and the evolution of existing hips heterotopic
ossification.

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.

Guillain-Barre syndrome and variants


S.G. Lungu, Emilia Furdu-Lungu, I. Furdu,
Carmen A. Srbu
Introduction:
The Guillain-Barre syndrome (acute inflammatory
demyelinating neuropathy) is characterized by acute
onset of peripheral and cranial nerve disfunction. Viral
respiratory or gastro intestinal infection, immunization
or surgery often precedes neurologic symptoms by 5
days to 3 weeks.
Matherials and methods:
Case presentation.
Results:
The characteristic history of subacute development of
symmetric motor or sensorimotor neuropathy after a
viral illness, delivery or surgery toghether with slowing
of conduction and the high CSF protein content with
normal CSF cell count define the Guillaume Barre
syndrome.
Conclusions:
The Guillaume Barre syndrome is the most frequent

acquired demyelinating neuropathy, with an incidence


of 0.6 to 1.9 cases per 100.000.
The incidence increases gradually with age, but disease
may occur at any age.
Early plasmapheresys or intravenous infusion of human
gamma globulins accelerates recovery ad diminishes
the incidence of long term neurologic disability.

Importance of genetic testing in miotonic


dystrophy Case report
M. Matei, Carmen A. Srbu
Introduction: Myotonic dystrophy (DM) is a
multisystemic disease characterized by skeletal muscle
weakness and myotonia. There are two major forms of
DM: DM type 1 (Steinerts disease) and DM type 2.
DM 1 is the most common hereditary myopathy.
Objective: Highlighting the importance of genetic
testing to determine the type and the prognosis of DM
disease.
Case report: A 41-year-old man, at the age of 18,
observed locomotor difficulty at initiating movements.

Later, he noticed difficulties in vowel pronunciation


and recently, he noticed a slowed relaxation following
a normal muscle contraction.
Neurological examination: conscious and cooperative
patient, hypertonic hands and feet muscle, atrophy in
the masseter muscles, temporalis muscles, bilateral
sternocleidomastoid muscles and distal legs muscles,
early balding, triangular facies, distal motor deficit in
wrist extension, walk without support, normal usual
analysis. The pattern is characteristic for muscular
dystrophy but to establish the type, the gold standard is
genetic testing. Specific genetic testing showed the
presence of an expanded CTG repeat in the DMPK
gene, the gold standard for the diagnosis of DM1.
Analyzed patient has on a chromosome (allele) 51
CTG repeats and on the other chromosome (allele)
>300 CTG repeats.
Conclusion: Specific genetic testing revealed that the
patient has classic DM 1, heterozygous form (>300
CTG repeats on a single chromosome). Genetic testing
is recommended for his children (the risk of inheriting
the disease is 50%).

YD 2
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

invasive technique with minimal tissue injury, is a


feasible, safe and well tolerated alternative to
abdominal myomectomy for well selected cases.
Keywords: vaginal, myomectomy, minimally invasive
surgery, subserosal, intramural, fibroids

Orthostatic hypotension Symptom or disease


Georgiana Radu, Cristina F. Plea, Emilia FurduLungu, Carmen A. Srbu
Orthostatic hypotension (OH) is a common symptom
affecting older patients. It is defined as the
cardiovascular systems incapacity to adapt to an
orthostatic position soon enough, so the patient feels
dizzy, tired and has a blurry vision. Sometimes the
patient can experience an altering in the consciousness
level.
We present the case of a 74 year-old patient who was
diagnosed with Parkinsons disease 13 years ago. He is
admitted because of multiple episodes of consciousness
alteration, motor seizures, tonic seizures with
sphincteric relaxations both while sitting and in an
orthostatic position, faints and fallings. He was never
diagnosed with OH nor investigated for this problem
even though he presents a cardiovascular risk. The

clinical management of this case implied both the


neurological treatment of Parkinsons and other current
diseases and the investigation of these new symptoms,
which finally led to the conclusion that he was indeed
suffering from OH and being severely undertreated.
Because of all the clinical manifestations that OH has
on so many levels as a group of symptoms that
sometimes can manifest alone, and also its association
with other diseases like Parkinsons, we couldnt help
but wonder: can it be considered a separate disease or
should it still remain a symptom?

Macules and tumors Progressing


Neurofibromatosis type 1 Case report
Anca Irina Toma, Cristina F. Plea, Emilia FurduLungu, Carmen A. Srbu
Background:
Neurofibromatosis is a genetic condition with
autosomal-dominant inheritance characterized by
neuroectodermal tumors arising within multiple organs.
Neurofibromatosis type 1 (NF-1), also known as
Recklinghausens disease, accounts for 90% of the
cases and is represented by multiple cutaneous
neurofibromas, frequently benign, caf-au-lait spots,
axillary and inguinal freckling, iris Lisch nodules and
in 50% of the cases its accompanied by learning
disabilities.
Case study:
We present a case of a 20 year-old female with NF-1 in
the context of clinical examination. The patient was
admitted to the hospital for left half-body paresthesia,
motor deficiency in the left lower limb and left-knee
joint pain; the symptoms appeared a year ago and got
progressively worse. The disease started in childhood,
around the age of seven, with the appearance of
multiple hyperpigmented skin macules and cutaneous
tumors all over the body surface which started to
increase in size. The growth of a group of fibromas in
the left lateral cervical region caused significant motor
difficulties, which made the patient seek care.
Conclusion:
The neurological examination revealed quadriparesis
mostly with left hemiparesis, ankle clonus with
spontaneous plantar extension and external rotation,
pyramidal syndrome, proprioceptive sensitivity
dysfunction in the lower limbs, hypoesthesia in the T8T9 area; the patient has neither learning disabilities nor
attention deficit hyperactivity disorder which occur
frequently in affected individuals. The ophthalmic
examination showed the absence of Lisch nodules. The
oncologist concluded that the patient does not present
malignant peripheral nerve sheath tumors. The
recommendation is C1-C4 surgical decompression. The
patient underwent the surgical procedure and the results
are pending.

Noninvasive assessment of sever portal


hypertension Screening and monitoring
algorithm
Oana Stancu, Sabina Zurac, Daniela Ion
Introduction: Regardless of etiology, liver cirrhosis
remains a nationally and globally major healthcare
topic, both through the increased incidence on active
socio-economic categories, and the cost of care given
to these patients. In recent years, the literature
emphasized the proper use of serological markers, with
the advantage of better accessibility and increased
possibility of a screening program for patients with
liver cirrhosis.
Material and Methods:
The research design involved the investigation of noninvasive serological markers in a prospective,
observational and analytical study that will take place
over a period of 6 months. The parameters analyzed
are: age, no. of platelets, coagulation, transaminase,
ultrasound parameters (diameter spleen, VP diameter,
velocity in VP, VP congestive index, diam. VS and
pulsatility index VS). Based on well-established
criteria, the study group includes a total of 60 patients
with viral etiology CH / alcohol. The instruments used
were the patient's clinical record with clinical and
laboratory data obtained on admission, biological
samples and upper endoscopy performed by the
gastroenterology department.
Discussion / Conclusion: The partial results, part of a
vast research project, revealed the severity HP based
both on serological markers and liver and spleen
ultrasound parameters. The scientifically and medical
relevance of the study could conduct to the
implementation of a national screening base.
Note:
The work has been funded by the Sectorial Operational
Programme Human Resources Development 20072013 of the Ministry of European Funds through the
Financial Agreement POSDRU 187/1.5/S/155420.

Rare cause of acute abdominal pain in young


adults
Oana Stancu, I. Copaci, C. Jurcu
Introduction: Evaluation of abdominal pain in adults
requires understanding the multitude of triggering
mechanisms and recognizing typical patterns and forms
of clinical presentation.
Methods: We present a 40 years old patient without
significant history which came in our department for
clinical and biological examination in order to establish
the etiology of recurrent episodes of acute abdominal
pain associated with signs of peritoneal irritation and
febrile syndrome. The whole symptoms began 10 years

ago, during which time he conducted numerous


laboratory exams without being able to clarify the
cause of these periodic attacks of pain. We performed a
complex examination, using different clinical and
laboratory methods, to try to exclude, the whole range
of possible etiologies of acute abdominal pain in a
young adult. We excluded life-threatening pathologies
(e.g. ischaemia) as well as all classic cases of acute
abdominal pain. After seven days, the patient returned
in our department presenting a classical acute
abdominal pain crisis with peritonitis, F = 38.7 to 40
degrees Celsius and aches in the joints. At this point we
decided to exclude some uncommon cause of recurrent
abdominal pain taking into account the diagnosis of
Familial Mediterranean Fever based on the clinical
picture and the exclusion of other common diseases. In
this regard, we have done the genetic testing for MEVF
gene, which have showed the presence of two
heterozygous mutations pathological: M694V and
V726A, confirming the diagnosis. We established longterm treatment with colchicine, without recurrence of
febrile syndrome or painful attacks in the last 6 months.
Discussion / Conclusion: FMF is a relatively rare
pathology in Romania. It is the most common
autoinflammatory disease, with a high prevalence in
certain ethnic groups, but small in our country. The
mutations that we mentioned are part of the classic
mutations reported in the literature as clear signs for
FMF.

Type 1 diabetes and other autoimmune


disorders
Nicoleta Huidiu, I. Copaci
Introduction
A 43 years old patient, female, smoker, known with
type 1 diabetes, came for fatiguability, dizziness,
arthralgia of the shoulders, weakness of the upper limb,
numbness of the limbs, started 4 months ago and
progressively worsen.
Clinical examination: bilateral retromaleolar swelling,
dorsal kyphosis, pain on mobilization of shoulders and
hands, BP 100/50mmHg, HR 78bpm, nocturia (4-5),
exaggerated reflexes symmetrical bilateral, bilateral
Babinski.
Material and method
Interdisciplinary examinations, laboratory and imaging
investigations revealed:
- Bipyramidal syndrome, uterus fibroids, secondary
amenorrhea, amblyopia forte, positive uroculture for E.
coli, mild iron deficiency anemia, fasting
hyperglycemia, HbA1c 8.9%, biologic inflammatory
syndrome, anti-tissue transglutaminase antibodies,
decreased TSH and VDRL, TPHA, HIV, SLE and
vasculitis serology negative, normal thyroid peroxidase
antibodies, FT3, FT4 increased.

- Abdominal ultrasound - thickening and stasis of the


small intestine. SDE - nodular duodenum, biopsies.
Cervical MRI - spondylosis, discopathy, small
demyelinating lesions, nonspecific.
Antibiotic treatment led to remission of urinary
symptoms. Under NSAID + PPI and Gabapentin,
musculoskeletal discomfort was alleviated. Iron
supplementation has normalized hemoglobin.
At discharge - insulin, alpha-lipoic acid, amitriptyline,
synthetic antithyroid drug, NSAID.
Results
Diagnosis: type 1 diabetes (LADA) unbalanced,
complicated with polyneuropathy, celiac disease,
hyperthyroidism
with
secondary
amenorrhea,
bipyramidal syndrome with demyelination under
investigation, severe cervical spondylosis, discopathy
cervical brahialgii, uterus fibroids, urinary infection,
amblyopia forte.
Conclusion
For the right evaluation of the pacient, we are waiting
for the brain MRI (possible multiple sclerosis). This
patient currently has multiple autoimmune diseases
with an intricated clinical and paraclinical picture.

Ventriculoperitoneal shunt complications


C. Peneoau, A. Chirte, M. Mitric
Ventriculoperitoneal shunt is the election treatment for
posttraumatic
hydrocephalus.
This
term
(hydrocephalus) is formed from the Greek words
hydro meaning water and cephalus meaning
encephalon. As you can see, it is obvious even by its
name that hydrocephalus is a condition in which there
is an excessive amount of liquid near the encephalon.
In the past it was perceived that this liquid is water but
now it is stated that it is cerebrospinal fluid.
Posttraumatic hydrocephalus is an active process which
develops progressively starting from a disorder in the
dynamics of the cerebrospinal fluid. The most frequent
cause of this disorder is represented by a head trauma.
The ventriculoperitoneal shunt is the most used surgical
technique
as
treatment
for
posttraumatic
hydrocephalus. An usual shunt system is made from
four basic components: ventricular catheter, collector, a
valve and a distal catheter. All these parts come in
various sizes so they can be adjusted depending on our
patient (age, stature). A very important step of the
shunting is the positioning of the unidirectional valve
which opens only when the intraventricular pressure
reaches a maximum level. In this way we avoid the
continuous drainage of cerebrospinal liquid by which
we could induce a too low intraventricular pressure or
even a ventricular collapse syndrome.
Ventriculoperitoneal shunt complications are various
and they can be classified in four big groups:
- Mechanical complications represented by

obstruction, disconnection and breaking of the shunt


system
- Infectious complications
- Complications caused by the excessive drainage of
the cerebrospinal fluid
- Particular complications, depending on the shunt
system used for the case.

Modern technologies in laparoscopic surgery


Ioana Niculescu, C. Prvulescu, Alis Alexandru, B.
Panaite, N. Niculescu, O. Nicodin
Objective: Presentation of operating principles and
advantages of modern technologies in laparoscopic
surgery - our experience.

Abstract: For dissection and hemostasis were used two


innovative technologies: laser and ultrasonic surgery.
The laser has been mainly used in treatment of
endometriosis and infertility and the following
surgeries
where
made
using
ultrasound:
laparoscopically assisted vaginal hysterectomy in 82
cases; laparoscopic pelvic lymphadenectomy in 23
cases; laparoscopic omentectomy in one case; ovarian
cystectomy in 41 cases; myomectomy in 3 cases;
adhesiolysis in 64 cases; Retzius space dissection in 8
cases; laparoscopic hormonsuppression in 38 cases and
uterosacral ligament resection (LUNA) in 2 cases.
Conclusions: The technologies analyzed intraoperative
coagulation performs and simultaneous comfort and
reduced bleeding and surgical accuracy through precise
cutting and safe dissection of vital structures.
Keywords: laparoscopic, laser, ultrasonic surgery

NS 1
Oral communications nurses 1
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

General medical intervention in prevention and


treatment of osteoporosis
Daniela Buzatu, Nicoleta Mavri, Aglaia Nedelcu,
Viorica Bogza
Bone strength, as a result of bone quality and bone
mineral density, is the target for the prevention and
treatment of osteoporosis. Compromised bone strength
increases fracture risk. Osteoporosis treatment
objectives are the increase of bone mass, the
improvement of bone quality and prevention of falls.
Lifestyle changes like adequate calcium and vitamin D
intake, quitting smoking, physical exercise and healthy
diet, correction of secondary factors like medication
and co-morbidities and general measures to prevent
falls are important fracture prevention tools.

Calcium and vitamin D in osteoporosis


Carmen Miron, Tatiana Onofrei, Nicoleta Vale,
Constana Bandulea, Ancua Istrate
Calcium and vitamin D are included in any
osteoporosis treatment protocol. Adequate calcium
intake increases bone mineral density and reduces
vertebral and non-vertebral fracture risk in postmenopausal women. Calcium absorption is influenced
by the chemical composition of calcium supplement,
alimentary factors (lactose, oxalates, phosphates,
phytates)
and
hormonal
factors
(estrogens,
parathormone, D hormone). Calcium requirements are
age dependent; postmenoapusal women need 1500mg

calcium daily. Vitamin D is essential for calcium


intestinal absorption and bone mineral density. Vitamin
D deficiency leads to muscle weakness and falls, which
increases the fracture risk.
Dietary sources of vitamin D are few and poor; the
main source is the synthesis in the skin in the presence
of ultraviolet light. Vitamin D insufficiency is common
in postmenopausal women. The recommended daily
dose of vitamin D is 600-2000IU. Vitamin D
supplementation prevents osteoporosis and osteoporotic
fractures.

Placing an urethral double J stent A simple


or a complex intervention
Mihaela Marin, Claudia Dumitru, Adriana Ursu,
Gina Popescu, Angelica Mlescu
Placing an urethral stent may a lifesaving intervention
in many urological conditions like lithiasis, tumors,
gynecological pathology or iatrogenic.
During our practice we have encountered several
patients who had ureteric stents placed in territorial
urology clinics for well-founded reasons. This simple
procedure that may last as least as 5 minutes and may
be performed even without anesthesia is well known to
all urologists.
All patients that affirmed placement of an ureteric stent
in another clinic had a reno-vesical radiography
performed. This is how we achieved a very interesting
collection of radiologic images. The paper refers
strictly to complications that may occur when placing
an urethral stent.
Even if it may seem hilarious complications when
placing a stent may occur to anyone. Urethra stent
pathology may develop into serious medical problems
and an endless series of complications. As simple is to
place an ureteric stent as difficult it may be to remove
it.

Modern brachytherapy technique for


gynecological cancers The role of radiation
technologist
N. Bocnial, L. Iancu, A. Toma
Introduction
Brachytherapy
(internal
radiation
therapy,
curietherapy) is a method of radiotherapy in which
radioactive source is placed inside or near the tumor.
Modern techniques of brachytherapy are called "afterloading" and involves placing of special applicators
inside the patient, within which a radioactive source
will be later introduced, under computer guidance.
Material and method
We use in our Radiotherapy Department modern
equipment for HDR Brachytherapy (GammaMed Plus

iX model, manufactured by Varian, USA). The


presentation describes our endocavitary brachytherapy
technique for cervical and endometrial carcinomas, the
types of endocavitary applicators we use and the role of
radiation technologist in patient positioning, equipment
protocols, radiation safety and specific patient care.
Conclusion
Endocavitary Brachytherapy is a modern method of
radiotherapy in the treatment of gynecologic cancers.
Radiation technologist has a very important role,
requiring special training, both in terms of theoretical
and practical specific procedures needed for
brachytherapy procedure.

Management of ectopic pregnancy patient in


the operative room
Claudia Plateev-Serban, Nicoleta Bue, Mariana
Dinu, N. Niculescu, C. Prvulescu
Introduction
Ectopic pregnancy is a surgical emergency it is a
consequence of the implantation of ovum outside the
uterine cavity because of previous pelvic inflamatory
disease.
Treatment
The management of ectopic pregnancy patients
supouses admitance to a OG unit. The treatment can be
either conservative (using adequate chemeotherapics)
or surgical (laparoscopy being the gold standard).
Conclusions
A precocious diagnosis of the ectopic pregnancy is
increasing the chances of a conservative approach.

Inflammatory pelvic disease Symptomes,


diagnostic, treatment
Ioana M. Pasca, Marieta Iszkovits, Adela Argseal
Inflamatory pelvic disease is a term utilised to describe
a infection of eny pelvic organ, uther, ovarise, uterin
tromps.
Cause
Some women with Inflamatory pelvic disease close not
show eny symptomes, but find out about the infection
when they try to get pregnant and find out they are
steril.
Causes of inflamatory pelvic disease are diseases that
are sexualy transmited that infect uterin cervix. Once
infected, it allows other bacteria in the vaginal cervity
to infect the uther and the trompes.
Materials and methodes
Inflamatory pelvic disease can be:
- Acute: has a sharp start and is more severe.
- Cronic: is an infection with a small intensity that can
cause pain on in the lomba region.
Diagnostic of inflamatory pelvic disease is descovered

after a digital vaginal exam. If there are sighns of


infection, take a sample of secretion from the vaginal
cavity.
The sample will be analysed to determine the
microorganisme responsible for the infection.
Sometimes to diagnose precise, a laparoscopic exame
a surgical procedure with a special instrument to
visualise is introduced in the abdominal cavity.
Results
For a better imunitary sistem and the acceleration of
organ recovery after infection, suppliment vitamines.
Vitamine A (1000 UI daily), Vitamine C (500-200 mg
daily) and vitamine B complex (50 mg three times a
day).

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,

components bio-psycho-social, cultural and spiritual


aspects of the individual
Stages of care process
The care process involves five steps:
1. Data collection
2. Analysis and interpretation (problems, diagnostic
care)
3. Care Plan (goals)
4. Making interventions (their application)
5. Evaluation

The role of nurses in palliative care


B. Silvean, Ani Ivan
The current nurse is a key figure of collaborative
medical practice.
Perhaps the most comprehensive definition of the
professional activities of the nurse, known as nursing,
is that of Virginia Henderson: "... to assist people, sick
or healthy, in making those activities that contribute to
promoting health or regaining it, activities that they
could perform by themselves if they had the power,
will and knowledge".
The hope is the result of the concept that all significant
needs and problems of the human being can be
resolved.
Most people expect that they and their families be
healthy and had a long life, while a serious illness puts
them in a situation of vulnerability and uncertainty
about the future.
The situation is more complex when the perspective is
not only a severe loss of function and skills but the
death itself.
The nurse, in collaboration with the patient and family,
has the task of restoring hope by providing help to the
patients, encouraging them to continue fighting.
In the case of diseases that do not involve a fatal
outcome, leaving the patient to foresee "the light at the
end of the tunnel", will mobilize his resources to obtain
the best possible functionality.
Even if the prospect of losing his life, the nurse finds
ways to give hope for easing suffering and motivate the
patient to live for the tine being.
To be successful in such a difficult situation, the nurse
herself must foresee the hope; otherwise the patient and
his entourage will become troubled, angry and griefstricken.

NS 2
Oral communications nurses 2
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.

Mechanical heart assists with IACB in cardiac


surgery
Marinela Bosincianu, Elena Iftode, Mihaela
Apostol, Coca Mocanu, Roxana Tudor, Roxana
Constantin
Evolution and development of cardiac surgery have
made it possible to treat many diseases and developing
the concept of quality in the field. IABC is one of the
devices currently available and used for circulatory
assistance in the field of cardiac surgery and
interventional cardiology.IABC has become a standard
in the treatment of patients with cardiogen shock or
severe left heart failure who do not respond quickly to
the administration of fluids, vasodilators and inotropic

support, positive, significant mitral regurgitation or


ventricular septal broken, hemodynamic stabilization
investigations necessary to complete diagnosis and
treatment. It also is indicated in severe myocardial
ischemia in preparation angiography and myocardial
revascularization. Unlike other mechanical circulatory
assist devices, IABC is an invasive maneuver and
consists of inserting the femoral artery via a balloon
catheter positioned in the descending thoracic aorta, left
subclavian artery immediately after emergence and its
positive impact resistance reduced ejection LV, DC
increasing by 40% and thus increasing coronary flow.
IABC is a temporary solution, applied with positive
inotropic substances and techniques of myocardial
revascularization, contributing to a marked reduction in
mortality by 40% after recently studies. Nurses
involvement in care management IABC is very
important both in preventing and treat complications
that may occur in the process of inserting IABC
(peripheral pulse assessment, the occurrence of
bleeding at the puncture site, an infectious process or
peripheral thrombosis, maintaining limb in the correct
position to prevent catheter intrrupted, initiation or
continuation of anticoagulants, make a dressing
correctly arterial sheath removal, and if compartment
syndrome is suspected, the patient should be prepared
for surgery.

The role of healthcare in treating anaphylactic


shock
Elena Zamfir, Maria Bogriceanu, Liliana Bulat
Anaphylaxis is a severe allergic reaction that can
endanger a person's life. This can occur within seconds
or minutes of exposure to an allergen, such as venom
resulting from bee sting or peanut consumption. The
large amount of chemicals released by the immune
system during anaphylactic shock can cause blood
pressure to drop suddenly, airways to narrow and
breathing to stop.
Signs and symptoms of anaphylaxis include rapid
heartbeat, weak heartbeat, rash, nausea and vomiting.
A person suffering from anaphylaxis requires
emergency medical care and epinephrine injection.
If anaphylaxis is not treated immediately, it can lead to
unconsciousness or even death.
Triggers: the factors that can trigger anaphylaxis
include food - especially eggs, seafood, nuts, grains,
milk, but also medicine.

Aspects of meningeal tuberculosis in patients


infected with HIV
Doina Andrei, Mariana Tnsescu, Vasilica Ionescu
Tuberculous meningoencephalitis is one of the most
severe forms of extrapulmonary tuberculosis,
severeness given by the difficulty of an early diagnosis,
of the lethality still important and debilitating sequelae
of the disease in case of late diagnosis and treatment.
In recent years there is an increase of tuberculosis
worldwide, it being given by the demographic
explosion and the spread of HIV/AIDS the most
important contributing factor of tuberculosis ever
known.
Tuberculosis is often the first manifestation of HIV
infection in patients who show no signs of AIDS. The
strongest feature of tuberculosis in patients with HIV
(+) is highly frequency of extrapulmonary involvement
evaluating at the same time with pulmonary TB or
sometimes concomitanly with other opportunist
infections. The extrapulmonary TB frequency is
inversely proportional to the number of T4
lymphocytes. Thus in patients with more than 200
lymphocytes T/mm, the extrapulmonary TB
proportion was 37%,while for those with less than 100
cells T/mm, the freaqency was 62%.
The frequency of tuberculous meningoencephailitis in
patients with HIV (+) is 5 times higher than in the
population with HIV are similar with HIV (-). The
symptoms and signs of TB meningitis in patients
infected with HIV are similar to those of TB meningitis
in HIV (-). Tracking the clinical milestones of medical
evolution include meningeal syndrome; Intracranial
hypertension syndrome, the encephalitic syndrome and
the neurologic syndrome.
Tuberculous meningitis treatment is established in case
of:
- Clinical suspicion and after laboratory tyests;
- There is no need for the diagnosis to be confirmed by
cultures;
- The treatment must be early administrated for long,
uninterrupted periods of time.
Treatment of TB in patients infected with HIV shows
some specific aspects: the germ multidrug resistance,
the issue of chemoprophylaxis, compliance of patients
with HIV to the anti-TB treatment is difficult to
achieve.
Adequately diagnosis the complete treatment of
active people with tuberculosis, investigation of
contacts and prophylaxis treatment are the classical
principles of TB control policies.

Self fluorescence bronchoscopy technique


Iuliana Radu, Mariana Lazurca, Marinela Matei
Self fluorescence bronchoscopy is a minimally invasive
method used to diagnose the bronchopulmonary cancer
at an early stage. It is an endoscopic procedure that
uses blue light. Self fluorescence phenomenon is due in
the tissues of fluorophores (NAD/ NADH, Flavin,
Tryptophan). These substances may be present in small
quantity in the abnormal tissue, that combined with the
increase in thickness of the tissue and with the increase
of the blood flow, change the self fluorescence. The
difference between self fluorescence issued by normal
endobronchial mucosa and the one issued in case of
dysplasia and carcinoma lesions underlies the self
fluorescence bronchoscopy technique development.
Self fluorescence bronchoscopy technique utility
provides return results in: bronchopulmonary cancer
suspicion, screening of the high risk of
bronchopulmonary cancer patients, post surgery
surveillance of bronchopulmonary cancer patients,
synchronous lung cancer diagnosis and relapse, rating
the return on the treatment of preneoplasic lesions.

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

oxygen units can make it easier for you to move around


and do many daily activities.
In conclusion, the oxygen therapy is important for
healing the patients with breathe diseases, in acute
situations and in the chronically ones too.

Early ventilatory disorders at patients with


pulmonary tuberculosis
Gabriela Drilea, Mirela Barbu, Tatiana Lazr
Chronic Obstructive Pulmonary Disease (COPD) and
pulmonary tuberculosis (TB) are two of the most
common lung disease with complex interaction. They
are representative of major public health problem
worldwide, resulting in a huge burden on public health
and health resources. The two diseases are widespread
in Romania, covering a great deal of practice and
concerns pneumologists in our country.
TB is a risk factor for COPD. GOLD report in 2013
recorded that a history of TB may be associated with
bronchial obstruction in adults over 40 years. The
development of bronchial obstruction and respiratory
signs may be preceded by one or more episodes of TB
and, apparently, the severity of infection depends on
the severity of airflow limitation and expansion
radiological TB lesions.
The primary objective of the study is to identify early
changes that occur in lung function in patients with
pulmonary TB.
They were included in the study 84 patients with
pulmonary TB considered in our department between
January 2013 and March 2014.
Lung function assessment was done before discharge,
at one month of treatment for patients BK negative
microscopic examination and sputum conversion (after
2-3 months of treatment) in patients with positive BK
of baseline TB.
Pulmonary TB has important functional consequences
present even in the early stages of the disease. In this
study, 58.33% of patients showed ventilatory function
abnormalities.
Early identification of patients with functional sequelae
after TB can help an active attitude towards them,
surveillance and prompt treatment, including smoking
cessation programs and pulmonary rehabilitation.

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

retronail is in use from some years in our clinic both


for supracondilar femoral fractures and to obtain ankle
fusion in pacients with significant posttraumatic
arthrosis and bone loss and other complications after
complex trauma at this level.
Currently, ankle arthrodesis is still considered the
treatment of choice in advanced stages of ankle
osteoarthritis. Harvesting a bone graft from the distal
tibia and sliding and fixing it in the talus leads to a
strong stabilization without the need for osteosynthesis
material.

Endoscopic ultrasound fine needle aspiration in


digestive disease
Monica F. Nicolescu, Mariana Moldoveanu, Aura
Avram, Daniela Tanasov
Endoscopic ultrasound (EUS) is an advanced technique
that combines ultrasound and endoscopy to examine
parietal structures and extraparietal ones in the vicinity
of the gastrointestinal (GI) tract. EUS is indicated for
locoregional staging of GI tract neoplasms, biliopancreatic pathology, GI submucosal and mediastinal
tumors. The linear probes, which allow the introduction
of the puncture needle guided by ultrasound in real
time, offer the possibility of cytological and
histological diagnosis of the examined tumors.
Increasing the number of passes, using the fanning and
cell-block techniques, presence of the cytopathologist
on-site and optimizing the needle size all these
increase the diagnostic accuracy of EUS fine needle
aspiration (EUS-FNA). Besides tissue diagnosis,
additional
imaging
techniques
such
as
sonoelastography and contrast-enhanced EUS can
better characterize the lesions. In this paper we present
our experience with EUS-FNA in gastrointestinal
pathology.

Ultrasonography a useful diagnostic method


Daniela Zavragiu, Paula Sima
Medical ultrasonography is a medical diagnostic
imaging method based on ultrasound, used to visualize
different structures (like muscles, tendons, organs).
Ultrasound allows measurements of dimensions, the
evaluation of the internal structure of organs and the
highlighting of some injuries, based on the images
obtained in real time. Ultrasound images of internal
organs allow gastroenterologists and internists the
diagnosis of liver (cirrhosis, steatosis, liver cancer),
pancreatic (cysts, chronic pancreatitis, tumors), bile
(gallstones, cholecystitis, cholangiocarcinoma), kidney
(stones, tumors) or spleen diseases. In gynecology,
ultrasound allows for the vizualization and evaluation
of the uterus and ovaries and their associated diseases

(polycystic ovary, uterine fibroids); in obstetrics it


allows for the monitoring of the normal development of
the fetus and the detection of congenital malformations.
Urologists can diagnose conditions such as enlarged
prostate on ultrasound and neuroscientists can evaluate
blood flow in the arteries of major importance in
patients with a high cardiovascular risk.
The transducer is a device that converts one type of
energy to another. The transducer is connected to a
computer (central processing unit) that performs all

calculations and contains the electrical power; there are


buttons that control the transducer pulse (which adjusts
the amplitude, frequency and duration of pulses), a
screen for displaying images, an information storage
device, keyboard or cursor and a printer. Ultrasound
has limits: it cannot penetrate bone structures, the depth
of penetration of ultrasound is smaller in obese patients
and therefore lower accuracy and image resolution
limit is 3 mm (cannot detect structures smaller than this
size).

NS 3
Oral communications nurses 3
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

identify at-risk patients. The role of immunotherapy in


patients with GBS needs to be fully established, and
effective therapies are yet to be developed. Other areas
of research include investigating ventilator support
measures and management of fatigue.

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.

Chronic back pain (dorsalgia)


Daniela Iuga, C. Ene, Natasa Corpodeanu
Chronic back pain (dorsalgia): Pain felt in the back that
usually originates from the muscles, nerves, bones,
joints or other structures in the spine.
Symptoms of dorsalgia (chronic back pain). Some of
the symptoms of Dorsalgia incude:
The pain can often be divided into neck pain, upper
back pain, lower back pain or tailbone pain. It may
have a sudden onset or can be a chronic pain
It can be constant or intermittent, stay in one place or
radiate to other areas. It may be a dull ache, or a sharp
or piercing or burning sensation. The pain may be felt
in the neck (and might radiate into the arm and hand),
in the upper back, or in the low back, (and might
radiate into the leg or foot), and may include symptoms
other than pain, such as weakness, numbness or
tingling.
Causes of chronic back pain
Possibly cause Chronic Back pain includes: Spinal disc
herniation; Degenerative disc disease or isthmic
spondylolisthesis; Osteoarthritis (degenerative joint
disease). Spinal stenosis; Trauma; Cancer; Infection;
Fractures; Inflammatory disease
Back pain treatments: include
Pharmacologic treatment options include NSAIDS,
acetaminophen, as well as muscle relaxants and
tricyclic antidepressants (amitriptyline).
Nonmedicinal pharmaceutical therapies include:
physical therapy, massage, transcutaneous nerve
stimulation-or even surgery.
Physical therapy and massage are especially useful in
improving short-term treatment. It seems like the
pressure points massage is more useful than classic
(Swedish) massage.
Applying cold compresses is considered effective in
some cases, while in others the patients respond better
to therapy with warm compresses and wet (or
permanent heated so as to maintain at a constant
temperature for 4-6 hours).
Exercise, especially those that focus on paravertebral
muscles performed by specialised personnel can induce
a patient's comfort and relaxation.

Diarrhea after antibiotics and infection with


Clostridium difficile
Ecaterina Dane, Georgeta Matei
Clostridium edificial is a bacteria that is usually located
to the intestine, causing inflammation manifested by its
prolonged diarrhea.
Clostridium edificial is found most commonly in
people taking antibiotics and/or with a deficiency of the
immune status. Clostridium edificial is dangerous

because it secretes two toxins (A and B) that cause


inflammation of the lining mucous of the colon.
There are the following types of infection
- Healthy carrier state (asymptomatic) not treated;
- The disease with moderate diarrhea, which can be
solved with some diet;
- Pseudomembranous colitis (the most common and
popular form of the disease);
- Fulminant colitis, high risk of death.
Symptoms of intestinal infection: 3-15 watery diarrhea
stools daily, abdominal cramps, fever, and blood in the
stool, nausea, symptoms of dehydration, decreased
appetite, and weight loss.
To diagnose the disease or complications we need:
- Microbiological examination from stool;
- Determination of the two secreted toxins A and B in
stool;
- Blood ionograma;
- Serum albumina;
- Blood- leukocytes;
- Occult bleeding and leukocytes in the stool.
Clostridium difficile infection complications:
- Dehydration;
- Deficient kidney;
- Toxic megacolon;
- Intestinal perforation.
Treatment of Clostridium difficile infection:
-in the first place should stop the treatement with those
antibiotics that caused the colonization of the intestine;
- The substitution of substances lost through diarrhea
seats;
- Therapy antibiotica target.
Diet oral or parenteral fluid in the patient's condition
while avoiding some foods that can aggravate digestive
functional status.

Multiple sclerosis: side effects during injectable


treatment Case presentation
Ana Dinu, Diana Simona Simion
Multiple sclerosis is also called degenerative disorder,
disseminated
sclerosis
or
disseminated
encephalomyelitis, is a disease in which the insulating
sheaths of nerve cells in the brain and spinal cord are
damaged. This damage affects the nervous system's
ability to communicate, producing a wide range of
signs and symptoms including physical and psyhical
disability, mental ilness. SM problems sometimes take
different forms, new symptoms occurring either
sporadic attacks (relapsing forms) or to deepen the over
time (progressive forms). Between episodes, the
symptoms may disappear completely; however, often
result permanent neurological problems, especially in
the more advanced stages of the disease. While the
cause is not clear yet, it is believed that the mechanism
would be an autoimmune disease or a malfunction of

the cells which produce myelin. Some suggested causes


include genetic and environmental factors such as
infections. SM is usually diagnosed based on signs and
symptoms and the presence of adequate medical test
results.

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

The role of nurse in chronic liver disease


management
Maria M. Chiriac, Elena Opreanu, Petrica
Gheorghe
Introduction:
Improving care for individuals with chronic liver
disease is perhaps the greatest challenge facing our
health care system. In this paper we want to focus on
the nurse role in the management and health-care of
patients suffering from liver disease.
Materials and methods:
Chronic alcoholism, hepatitis B or C virus infection,
autoimmune hepatitis, inherited or genetic disorder
(cystic fibrosis, alpha-1 antitrypsin deficiency,
hemochromatosis, Wilson disease, galactosemia, and
glycogen storage diseases) can lead to chronic liver
disease and cirrhosis. Cirrhosis is a chronic disease
characterized by replacement of normal liver tissue

with diffuse fibrosis that disrupts the structure and


function of the liver. Non-invasive biomarkers
FibroMax, as well as transient elastography (TE) Fibroscan are used to asses the liver fibrosis, while
liver biopsy is less used in clinical practice.
People with liver disease eventually develop many
symptoms and complications that can be life
threatening. The nurse is close to the patient and can
offer psychological support and encouragement, advise
him that rest and good nutrition conserve energy and
decrease metabolic demands on the liver, monitor vital
signs, assess fluid retention, administer diuretics and
specific treatment, observe and document for bleeding
and degree of sclera/skin jaundice, observe closely for
signs of developing encephalopathy.
Results and conclusion:
Nursing includes the promotion of health, prevention of
illness, and the care of ill, disabled and dying people.
Advocacy, promotion of a safe environment, research,
participation in shaping health policy and in patient and
health systems management, and education are also key
nursing roles.

Nursing at admission in upper gastrointestinal


bleeding and preparation for diagnostic and
therapeutic evaluation
Liliana Bulat, Veronica Niculi, Ana Munteanu
Upper gastrointestinal bleeding is one of the most
frequent medical issues for physicians and nurses in the
field of gastroenterology and surgery.
Patients with upper gastrointestinal bleeding rarely
address gastroenterologists first. They tend to address
especially family doctors or the emergency room, after
which they will be redirected to gastroenterologists or
to surgeons.
It is therefore necessary that doctors and nurses in
primary and secondary echelon can assess patients with
digestive hemorrhage. Medical staff should know how
to quickly evaluate disease severity, whether it is
required in the consulting rooms or hospital so that they
can take suitable decisions quickly. Before the
gastroenterologist`s intervention, initial assessment of
the case must take place and the medical team must
decide where, how and with what means the patient
will be transported.
The main causes of upper gastrointestinal bleeding are
peptic ulcer, which is the most common cause, even
after the introduction of H2 antagonists, proton pump
inhibitors (PPI) and anti-HP antibiotic therapies.
Frequent use of aspirin and other nonsteroidal antiinflammatory drugs (NSAID) is a major cause of
perforation and hemorrhage due to peptic ulcer.
Esophageal
varices
and
gastropathy
portalhypertensive, Mallory-Weiss syndrome (manifested
through cracks in the esogastric jonction mucosae that

may cause upper gastrointestinal bleeding, but rarely as


severe as ulcers or esophageal varices), aortoenteric
fistula, Barrett`s ulcer,eso-gastro-duodenl cancer,
hemobilia and "hemosuccus pancreaticus" are rarer
causes of upper gastrointestinal bleeding. Esophagitis,
gastritis and duodenitis can cause gastrointestinal
bleeding with a frequency, magnitude and
hemodynamic impact less severe.
Upper gastrointestinal endoscopy can assess lesion site,
if the bleeding is persistent or not and prognosis. It also
allows therapy of esophageal varices and sometimes
ulcers. It should be performed in all cases. Early
training is a benefit.

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

of the kidneys and urinary tract by interpretation of the


scintigraphic images and/or the data acquired from a
computer. If done correctly, this is a sensitive method
to asses and evaluates many pathological conditions.
The main indications of renal scintigraphy (static or
dynamic) are:
Evaluation of renal parenchyma
Assessing obstructive uropathies
Renovascular hypertension
Renal transplant assessment
Renal scintigraphy is a non invasive and non
nephrotoxic technique that can be performed even in
the presence of kidney injury and can offer information
about:
Renal perfus
Ion: an accurate renal angiography
Global renal function and for each kidney,
separately
Urinary tract permeability
Radio-pharmaceuticals used for this technique are:
99mTc DTPA
99mTc DMSA
99mTc GH
99mTc MAG3
A fully informed and reasoned patient is the basis for a
successful investigation technique as well as a trained
medical staff.

NS 4
Oral communications nurses 4
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.

A nurses role in LASER assisted refractive


surgery
Florentina Mihai, Livia Aluchenesei
Introduction: Refractive surgery is one of the most
rapidly evolving fields in ophthalmology. It is used to
correct refractive errors such as myopia, hyperopia,
astigmatism and presbyopia.
This field of surgery evolved rapidly with the
development of excimer laser assisted procedures, the
most commonly used being LASIK.
Systematic review methodology: This study is a review
on laser assisted refractive surgery, emphasizing the
role of the nurse in patients care.
Results: A critical part of this procedure is the
perioperative care of the patient and, as such, the nurse.
Nursing involves deep
human interpersonal
relationships between nurses and patients and it is an
essential part of the patients care.
Conclusions: The nurse is a critical part of the
perioperative care of the patient.

If a patient decides, after careful consideration, to do


this procedure, he must meet some criteria, carefully
selected to limit the postoperative complications.
Even if patients satisfaction after this type of
procedure is usually high, there are various
complications that may occur, depending on the type of
procedure used.
Key words: excimer laser, PRK, LASEK, LASIK,
nurse, perioperative care, complications

Rhinitis Symptoms, diagnosis and treatment


Mariana Sorescu, Bunea Maria, Negre Florina
The inflammation that occurs in the eyes, nose and
throat due to exaggerated response of the body on
contact with air irritants (allergens) and release of
histamine (amine found in living tissues), called rhinitis
Causes rhinitis
Infectious rhinitis is caused by a viral or bacterial
infection
Allergic Rhinitis non - splits itself in noninflammatory
and inflammatory rhinitis.
Allergic rhinitis is caused by pollen, mold, animal fur,
dust and other allergens like.
Signs and symptoms of rhinitis
Infectious rhinitis shows: runny nose, burning in the
throat, cough, nasal congestion and headache
Allergic rhinitis is non - symptoms sneezing, nasal
congestion, rhinorrhea, itchy nose, throat, eyes and
ears.
Allergic rhinitis is inflammation of the connective
tissue symptoms, swollen eyelids, lower eyelid venous
stasis, creating creases on the sides of the nose,
inflammation of the nasal turbinates and middle ear
effusion.
Stuffy nose, sneezing frequently, itching and runny
nose are all symptoms of allergic rhinitis. The immune
system reacts in an exaggerated manner to airborne
particles, perceiving dust, pollen and other allergens as
some intruders that can harm the body, so alienate.
The diagnosis of rhinitis
Rhinitis is diagnosed based on a discussion with the
doctor. Based on specific tests that are performed to
determine an allergic rhinitis, can confirm or exclude
the diagnosis. It is also conducting a local examination
of the nose, throat, eyes and ears to rule out other
diseases with similar symptoms and blood tests taken
from secretions of affected organs.
Rhinitis Treatment
Treatment for allergic rhinitis involves an oral
medication, one based inhalants, controlling allergy
immunotherapy injections. Allergic rhinitis is treated
with non - saline nasal spray or containing
corticosteroids, antihistamines and oral or nasal
decongestant.
Rhinitis, especially because of the fever is not a very

serious condition, but symptoms can be quite irritating


and affects quality of life. Any form of affection is very
important to be diagnosed and diagosticata since early
stage thus more easily kept under control and treated.

Nursing patients in Intensive Care Unit


Gabriela Amoaei
In the IUC, people are constantly looked after and
monitored by a right specializes team, which includes
consultants, psychotherapists, dieticians and nurses,
each of them with specialist knowledge and skills.
Specially trained nurses provide round the clock care
and monitoring.
ICU nurses play a vital role in the particulars care,
including the following:
- Take regular blood tests
- Giving the patient the drugs and fluids that the
doctors had prescript
- Recording the patients blood pressure heart rate and
oxygen levels
- Turning the patients every few hours to present sores
on the skin
- Cleaning the patients month cavity
Changing a patients surgical stockings which help
circulation when he/she is inactive for a long time.

Gastric sleeve in treatment of morbid obesity


Florina Aslan, Mihaela Arisanu, Anisoara Graure
Through this study I want to make a presentation about
the surgery and its indications for morbid obesity.
Longitudinal gastrectomy laparoscopic (gastric sleeve)
is the treatment of choice of morbid obesity, considered
one of the leading causes of death and is the main
etiological factor in the occurrence of type II diabetes,
hypercholesterolemia, hypertension, heart disease and
sleep apnea. In addition, morbid obesity favors the
appearance of various types of cancer: breast,
endometrial, pancreatic, gallbladder.
With the decrease in weight, after surgery, can achieve
improvement of related conditions comorbidities.
Comorbidities are positively and significantly
influenced by bariatric surgery:
Heart disease and hypertension;
Respiratory diseases: sleep apnea, snoring, obesity
hypoventilation syndrome;
Menstrual disorders, infertility and sterility;
Back pain or knee pain;
Urinary incontinence in women;
Psychological status.
The study includes a short review about morbid obesity
classification of obesity and the benefits of bariatric
surgery to treat morbid obesity, describing the surgical
procedure, its indications, surgical technique, incidents,

complications, results, conclusions.

Erythrocyte
D. Svoiu, Virginica Svoiu, C. Coman

Rectal neoplasm Minimally invasive


approach
tefania Aldea, Daniela Buzrnescu, Claudia
Buzatu
Robotic surgery is spearheading regarding minimally
invasive surgery. Surgical robotic platforms enable
image magnification revealing more details of the
operator field, rendering images in three-dimensional
format, more degrees of freedom in forceps
maneuverability, qualities which finally allow
minimally invasive approach to oncologic pathology
hardly accessible in terms of location, without putting
in specific radicalism threatening or postoperative
prognosis, while providing a minimal comfort to the
surgical team.
In this paper we make a brief presentation of daVinci
Robotic Surgical Platform and present a case of lower
rectal cancer surgically treated using daVinci platform.
Key words: robotic surgery, daVinci platform, rectal
neoplasm

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

The erythrocyte is a discoid and biconcave cell;


intensive pink colored at panoptic coloration, with the
center of the cell is less colored.
It is a cell without nucleus, and the cytoplasm contains
a high concentration of hemoglobin.
The maturation speed of the erythroid series cells is
fast: the transition from basophil erythroblast to
erythrocyte lasts 25 hours. Normally, the erythroblast is
a backup cell that divides only under strong
hematopoietic stimuli. Erythropoiesis is provided by
the division of the basophil and chromatophilic
erythroblasts.
Normal erythrocytes are shaped like biconcave discs
with a medium diameter of about 7,8m and an average
thickness that reaches a peak in 2.5 m, but it can
measure 1m or less in the center. The average volume
of the erythrocyte is 90-95m3.
The shape of erythrocyte can change greatly, when the
cell enters in the capillaries, and it deforms.
The concentration of red cells in the blood
Normally, the number of erythrocytes per mm3 is 5
200.000 for men, respectively 4,700,000 for women.
The persons that are living at high altitudes have an
increased number of red blood cells.
The main stimulus for the formation of erythrocytes,
in conditions characterized by a decreased availability
of oxygen, is the circulating hormone: erythropoietin.
In its absence, the effect of hypoxia that stimulates red
blood cell formation is reduced or absent.
After the red blood cells witch are formed in the bone
marrow get into the circulatory system, they remain in
the blood, normally, about for 120 days, before being
destroyed.
The erythrocytes present different anomalies:
- Waist anomalies: macrocytes, megalocytes,
microcytes, schistocytes
- Shape anomalies: spherocytes, leptocytes, target cells,
crescent bodies, drepanocytes
- Color anomalies: hypochromic erythrocytes,
hyperchromic erythrocytes, anulocytes

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

passive agglutination and is done by various reactions


that differ by nature of the support for immunoglobulin
G or antigen source.
The Rheumatoid factor can be detected through the
following reactions:
a) The reaction Waller Rose - classic positive
b) Reaction Waller Rose - updated
c) Reaction Heller
d) Reaction Singer - Platz
e) Reaction Blach - Bunim.
The statistical studies have shown that, when Rose
Waller reaction is positive, the other types of tests for
the presence of rheumatoid factor are mandatory
positive. The tests are considered positive reactions for
values over 1/32 to 1/40 Waller Rose and over who
have underlying reactions to latex particles-polistiren.
Reactions for rheumatoid factor are negative to less
than 1/16. The main diseases in human pathology
associated with the presence of rheumatoid factor are:
1. Collagenoses,
2. Malignant tumors,
3. Disglobulinemia,
4. Infectious diseases,
5. Respiratory diseases.
The highest incidence of positivity determination
reactions for rheumatoid factor is rheumatoid arthritis
which is situated at 16-18 months after onset
(percentage 95%).

Nurse responsibilities for mechanical


ventilation in Emergency Department
M. Fleican, Petrua Mitrea, Liliana Mocanu, M.
Stanciu, C.B. Teudea
Mechanical ventilation is indicated for numerous
clinical and physiological reasons. The nursing
management of the mechanically ventilated patient in
Emergency Department (ED) involves acquisition of
highly technical skills, expert knowledge on invasive
monitoring, and implementation of interventions to
care for the patient.
Regarding the nurse responsibilities in management of
such patients are two direction patient safety and

patient comfort. This presentation is an overview of the


very important role of emergency nurse in the initial
management of the mechanically ventilated patient in
the ED, multiple traumas or other type of patient with
respiratory failure.

Epidemic parotidis (mumps)


Roxana Vasilescu
Parotitis is an infectious and contagious disease caused
by mumps virus which affects the salivary glandsknown as the parotid glands, the pancreas, nervous
system and genitals organs. The signs and symptoms of
parotitis can vary among individuals Nonspecific
prodromal symptoms may precede parotitis, including
low-grade fever which may last three to four days,
myalgia, anorexia, malaise, and headache. Fever may
persist for 3 to 4 days. Parotitis can be treated
successfully with antibioics and by practicing good oral
hygiene, drinking of fluids, washing hands, and
receiving the MMR vaccine to prevent mumps.
Mumps is a viral illness caused by a paramyxovirus, a
member of the Rubulavirus family. The average
incubation period is 16 to 18 days. Mumps usually
involves pain, tenderness, and swelling in one or both
parotid salivary glands. Swelling is first visible in front
of the lower part of the ear. Mumps is no longer very
common in Romania, but outbreaks continue to occur
in places where people have had prolonged, close
contact with a person who has mumps, such as
attending the same class or living in the same
dormitory. Peak incidence is schoolchildren between 6
and 12 years.
Some complications of mumps are known to occur
more frequently among adults than children. Other rare
complications of mumps that include pancreatitis,
deafness, meningitis, and encephalitis, which has
occurred in less than 1% of cases.
Vaccination is the best way to prevent mumps. This
vaccine is included in the combination measlesmumps-rubella (MMR) and measles-mumps-rubellavaricella (MMRV) vaccines.

NS 5
Oral communications nurses 5
To value ones experience gain and its utility in
theatre of operations
Gina A. Ciuc
Introduction: During the period of July 2007 -

December 2007 the healthcare in the war zone Iraq was


provided by the American Campaign Hospital - CASH,
from Camp Cropper under the tutelage of TF115 where
Romania was the only coalition country - Operation
Iraq Freedom commanded by Multinational Command

Force Iraq attended a medical detachment composed of


20 health professionals from which I took part, divided
in two locations Camp Cropper and Camp Buca.
Material and method: American Campaign Hospital
provided troops, prisoners and the civilian population
healthcare in the city and in the Baghdad international
airport.
The activity which was carried out in the conflict area
with a large numbers of victims included surgical
emergency (gunshot wounds, blast wounds and burns)
besides this primary healthcare, preventive measures
and monitoring detainees.
After a brief training period near American colleagues,
Romanian medical team was part of all hospital
medical team.
Results: To achieve the best results against the high
number of daily arrived emergencies, due the war, was
very important the collaboration between medical staff,
the many hours spent in hospital and professionalism,
all this things together with effort saved many military
and civilians lives.
Conclusions: In the American Campaign Hospital in
which we operate, all my patients received the same
care and the same treatment regardless of social status,
religion, nationality or sex. The mission of the
Romanian military detachment was carried out in
dangerous situations, health professionals wearing
bulletproof vest and weaponry even in operating rooms,
these efforts were rewarded with medals and
decorations received from the American partner and
great personal satisfaction for the work done and for
the results obtained.

Battlefield medical capabilities for the 21st


century
Tudora Braru
Romania has joined North Atlantic Treat (NATO) since
2004 and from then our soldiers were involved in
Theatre of Operations as Iraq and Afghanistan.
Health care support - as a main component of logistics
that makes difference between life and death for front
line soldiers.
The NATO Treat has proved during all these conflicts
that its possesses powerful logistic capabilities.
Witnesses are our seriously wounded warriors who
benefited from medical treatment in their Health Care
centers (ex. Ramstain- Germany, Burnt Healthcare
Sandiego- United States).
This material is concerned with an overview on
medical assistance in Theater of Operation full
spectrum- and the, front line,, NCOs role.
Before to lunching into an analysis of current state of
battlefield care it is important to fully understand its
current state. The modern medical care across
battlefield will be described special at the maneuver

battalion level. The medical treatment plan for the


modern conventional battlefield has five numbers
levels of care through which injured patience flows.
The Levels I, II and III are the closest to the front line.
Goal of Level I care is to perform immediate lifesaving
measure enable patient to be evacuated to a level
capable of definitive care capabilities.
Level I fileservers are: combat NCOs- nurse- and
soldiers themselves (self and buddy aid). Since patience
are stabilized for transport are rapidly evacuated from
Level I (front line) to level II (miniature mobile
hospital) or Level III.
Level III echelon has approximately 255 personnel
with complete range of specialists, services, surgical
capabilities.
Level IV and Level V echelons Health care Centers are
located out of area of operation (ex. from U.S.A.,
Germany, U.K.). The front line medical serviceman is
Noncommissioned Officers, nurse, trained to
recognize shock by aspersing pulses and mental status
rather than with blood pressure cuff and stethoscope
which have little use on the battlefield.
The NCOs nurse learned to quickly triage causalities
first, first than going throu the actual speps involved in
their treatment.
STATISTICS:
1. The most important in intervention death are:
- To quick evacuation of causalities (CASEVAC) air
evacuations- helicopters soldiers need to be rapidly
evacuated by the ground;
- The ballistic west;
- The army combats NCOs nurse.
2. The most important intervention in preventing deaths
were:
- Hemorrhage control (particular of extremity wounds;
- Pneumothorax and air obstructions.
The modern medical care across battlefields is not
recently studied in our country, the Army was involved
in conflicts that have been starting in the last years or
because lock of interest, will be a challenge for the next
generation.

Military hospital Romanian nurses duties on


war zone
Daniela Sorica
On August 21, 1862 by Royal Law, signed by
Alexandru Ioan Cuza, were established Army Corps of
Medical Officers and Romanian General Directorate of
Health Services, attesting the military medicine as a
specialized element for the health workforce army.
From then until now, military medicine has been an
integral part in all missions undertaken by the
Romanian Army.
Operational Medicine is in charge of providing medical
assistance during peacetime military operations for the

Romanian Army and Alliance partners.


For the first time in Romania and USA history a
Romanian Medical Unit, officers (doctors) and NCOs
(nurses) began their mission in Abu Ghraib common
mission in November 2004 working together inTask
Force Hospital. It was given emergency care for
soldiers wounded in the forefront of theater and
prisoners alike were cared Abu Ghraib prison. A
second location, Camp Bucca, was used as a base
prolonged hospitalization for soldiers who need more
time to recover.
Romanian Nurses provided medical care in all the
departments that have been assigned in: triage,
emergency room, ward medical-surgical, ICU,
operating room, laboratory, radiology (including CT),
pharmacy, dental department and fulfillingsuccessfully
all nursing duties requested by each department.
The biggest challenge was to use English in
communication with American partners and patients
cared. ForIraqis patients were used local translators.
Despite the difficulties in communication, collaboration
in medical care was excellent, according to the ratings
received from all 9 series of Romanian Medical Unit.

In these situations we try to define the most appropriate


therapeutic approach in our clinic of Maxillofacial
Surgery.
Injuries to the face, by their very nature, impart a high
degree of emotional, as well as physical trauma to
patients. The science and art of treating these injuries
requires special training involving a hands on
experience and an understanding of how the treatment
provided will influence the patients long term function
and appearance.
There are a number of possible causes of facial trauma.
Motor vehicle accidents, accidental falls, sports
injuries, interpersonal violence and work related
injuries account for many. Types of facial injuries can
range from injuries of teeth to extremely severe injuries
of the skin and bones of the face. Typically, facial
injuries are classified as either soft tissue injuries (skin
and gums), bony injuries (fractures), or injuries to
special regions (such as the eyes, facial nerves or the
salivary glands).
To avoid major postoperative complications as well as
therapeutic for obtaining better results, it is necessary
that the injuries in polytrauma patients to be as early as
possible.

Wounds War wound


Ruxandra Samoila, Ana-Maria Lamba
Definition: A wound is a tipe of injury which happens
relatively quickly in which skin is torn, cut or
punctured (an open second), or where blunt force
trauma causes a contusion.
Clasification:
According to level of contamination a wound can be
classified as:
- Open wound:
o Incisions or incised wounds, caused by a clean,
sharp edged object such as a knife, razor, etc.
o Lacerations, irregular tear like wounds caused by
some blunt trauma
o Abrasions
o Avulsions
o Puncture wounds
o Penetration wounds
o Gunshot wounds caused by a bullet or similar
projectile driving into or through the body.
- Closed wounds:
o Hematomas
Crush injury

Therapeutic approach in facial trauma


Veta Nstase
Polytrauma involving craniocerebral component is an
important cause of mortality and morbidity in young
adult population during the current geopolitical context.

The rehabilitation of the foreign soldiers with


face traumas
Mihaela Stnic
A country cannot stand isolated from the rest of the
world. In order to survive politically, economically and
in all the other aspects, that country must join an
alliance.
Romania joined NATO and as member country of this
organisation, it benefits of support from the other
countries, but, at the same time, it has the chitty to
provide assistance of any kind for the other countries,
when required. This includes logistic and medical
support.
Romanian soldiers participated succesfully in military
missions in Afganistan and their role was to appeace
the eventual conflicts. As in any war, there were
casualties among the Romanian military detachements
on the operation field. Some of the wounded presented
shotgun lesios in the face and neck areas and after
receiving emergency care, they were treated by
specialised medical personnel from the Facial Surgery
and Dentistry Unit in the Central Military Hospital.
At the same time, Facial Surgery and Dentistry Unit
hosted and treated on NATO regulation basis, foreign
soldiers with various face traumas acquaired during the
military conflicts in Ukraine.
Our units primary goal was the rehabilitation of the
patients in order to restore (as much as possible) their
health status.

Heart failure patient management A team


project
Daniela Nae, Magdalena Petrea, Maria M. Guzun
Heart failure incidence is increasing continuously in the
modern era and the understanding of medial team in the
appropriate management of this patient is essential for
an optimal therapeutically result.
This paper has the scope to underline the importance of
nurses regarding the heart failure patient in every day
clinical practice, in Romanian hospitals.
Although the nurses importance is neglected, several
trials had proven the decreasing of heart failure rehospitalisation by outpatient clinic visits, involving a
trained nurse. The patient compliance to treatment is
superior in this situation. Moreover, the communication
between the in- and outpatient medical care is
mandatory. The nurses involvement in heart failure
patient care had shortened the hospitalisation time and
improved the quality of life.
The life style advices are very important for heart
failure patient. The early mobilisation and respiratory
movements are an important step for inpatients. The
dietary restrictions include low salt intake (max 2
g/day) and sometimes water restriction (1.5 l/day).
Blood pressure, heart rate, blood oxygen saturation, in
vs out fluids, weight monitorisation every day is
mandatory. For outpatients every day weight control
may be very helpful, suggesting diuretic dosage
increasing when the weight gain is more than 3 kg in 2
days. Moreover the betablockers and IEC need
gradually dosage increasing related to blood pressure,
heart rate and sericionogram.
In any patient care, lack of links determined a
suboptimal result and training and involvement of
health professionals is mandatory.

Nurses role in triage in the Emergency


Department
Liliana Mocanu, M. Stanciu, M. Fleican; E.
Frcanu, M. Toma; C.B. Teudea
Triage in emergency care is a process of collecting
pertinent patient information and initiating a decisionmaking process that categorizes and prioritizes the
needs of patients seeking care. Thats why in Roumania
exists a national law National Protocol for triage in
Emergency Receiving Unit - for medical triage in ED,
which establishes the role of nurses in these continuous
medical procedures.
Emergency rooms in hospitals provide rapid care to
patients who suffer injuries or develop sudden, serious
symptoms of illness or disease. Triage nurses form an
important part of the emergency room team.
Based upon the triage nurse's decision regarding the

urgency of a patient's condition, the emergency room


staff develops the order that waiting patients will be
seen. Because of this, the role of the triage nurse
directly effects how quickly patients receive care.
To fulfill their role, triage nurses must have the ability
to make quick decisions, a high level of listening and
communication skills and extensive knowledge of
warning signs and symptoms. In most cases, nurses
work in the field of emergency medicine for several
years before becoming triage nurses in order to gain
experience with many different conditions.
Keywords: Emergency Department, nurse, triage,
national protocol for triage

Tactical combat casualities care


A. Grigore
Tactical combat AID into a special situation is done by
civilians personnel under pressure, sometimes,
frustrated. The language barriers, cultural difference
and level of education are example of difficulties with
have to face up when personnel are teaching by.
The final result of this kind of course is finally affected
by the way its given by instructors. The courses aim
isnt made for all personnel to understand the entire
pathology and psychology reasons for which certain
medical treatment care are given.
The final objectives of this course are to provide
participants whom are able to identify wounded man
with increasing chance of survival/treatment. Because
of number of unprepared personnel regarding this kind
of FIRST AID during the combat crisis power-point
presentations are the most efficient instrument visualize
different types of wounded warriors.
The most beneficent way to approach is more
explanation of using KITs in power-point presentation.

Taking care of patients with ankle fractures


Ana M. Enache, Ramona M. Iosif
- The ankle is part of the leg, that contains the portion
of the joint between the tibia and the tarsus
- The muscles, tendons and ligaments that form the
ankle joint, and function together to propel the body.
- The ankle fracture includes the fracture of one or
more bones that make up the ankle joint.
- Also, it is possible that among these fractures, tears of
ligaments can be associated.
- The more bones are fractured at the ankle joint, the
joint instability is bigger and the fracture is more
complicated.
- In joint fractures, the nurses role is to prevent
complication and subsequent injuries, to diminish pain
and prevent the area swelling.
- To evaluate the patients physical and mental state.

- To ensure bed rest in dorsal decubitus position, on the

observation chart.

bed plan, to monitor vital signs and write in the

- To create a clean environment in the hospital ward.

NS 6
Oral communications nurses 6
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.

Delirium intensive care


Mirela Bidilic, Dorina Braru, Giorgeta Grosu, L.
Ene
Over de past years theres an increasing interest in
delirium which affects patients in intensive care (ICU)
and other health department. Delirium represents quite
an issue for health care services being defined as a
disorder of the conscious state and cognitive function
which develops within a short period of time (hoursdays) and fluctuates in time.
Prevalence in terms of author, disease seriousness and
diagnosis method is from 20% to 80%. Its associated

with various complications and unfavorable evolution


which leads to longer hospitalization, increase in cost,
increase in death rate and it is predicts the cognitive
function state in the long term.
Delirium means a degradable health care state for man
by loss on control over self, and by loss of abilities and
personality.
Among the determining factors there are age over 65,
preexisting cognitive disorders hip join fracture and
sever illnesses. It appears at approximately half the
patients after surgery in particular after hip join fracture
surgery and vascular surgery. Apriority diagnoses and
appropriate treatment are to be desired by all doctors.

Slimming products A myth or reality


Mihaela Andreev, Gabriela Georgescu
The slimming products are almost the most requested
"drugs". Usually, these are dietary supplements or teas,
for which the marketing restrictions are less strict
compared to the restrictions for drugs. Most times, the
"myth" precedes and exceeds reality. Advertising is
essential to achieving potential customers: the "fast
universal panacea' suggestion delights. Often, it is
overlooked that adverse effects are more important than
they appear to be. The disordering of metabolism may
require long period to be corrected.
The doctor's advice, be it diabetologist, nutritionist,
endocrinologist, internist and so on, is essential.
However the multitude of "cool nutritionists" is more
attractive and easier to approache. It is important to
remind the patients that the long time diet and physical
practice are essential in order to achieve and maintain
"the perfect silhouette".
What is happening in practice? How many of us have,
at least once in lifetime, tried a cure that worked in case
of a celebrity or a friend?

Psychosocial risk prevention in healthcare


Stela M. Dinu, Roxana E. Darnu, Cristina Guu
Healthcare is one of the sectors most affected by stress
at work. According to Eurostat (1999), for healthcare
workers, psychological problems are a cause of
absenteeism over 14 days almost as frequent as osteo-

musculo-skeletal disorders. Typical psychosocial risk


factors for the healthcare sector include: high
expectations combined with time, skills and insufficient
social support, emergencies, exposure to traumatic
events, complaints and disputes, shift work, working
improperly, violence and harassment.
Psychosocial risks require careful consideration at any
health institutions, to elaborate institutional level
programs to prevent situations that can cause adverse
effects on the mental health of workers.

The illness may often be undiagnosed because the


symptoms are hardly noticeable and because affected
individuals are not willing to ask for help fearing that
they would be stigmatised and considered to be
crazy.
The respect towards human dignity in psychiatric
patients is one of the main keys in winning the trust of
the patient who, in many cases, could open up more
towards the nurse than towards the doctor.

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.

Manuela Chera, Nicoleta M. Ene


Suicide is any case which results in death as a direct or
indirect consequence of a positive or negative act
committed by the victim himself/herself who has the
intention of committing it with this purpose.
Suicide represents a human act which leads to the
cessation of living and which is willingly committed on
self.
This behavior is triggered not just by one factor; it is a
highly specialized human behavior like any other
human attitude and is triggered by multiple factors.
Suicide appears in situations of acute crisis,
unemployment, bankruptcy.
The overstressing and excessive competition in social
relationships may cause an anxiety state that can lead to
suicide. Social exclusion may be a factor that increases
the risk of suicide.
Every suicide and attempt of suicide affects both
directly and indirectly other persons as well.

The role of psychiatric nurses in the


management of patients with alcohol use
disorders
A. Meliaca, Cecilia Bizon, Nicoleta Ene, Valentina
Dinoiu
Alcohol is one of the most well-known and highly used
addictive substances.
Alcohol use disorders cause progressive changes in
personality, will-power, familial and social situation
and lead to physical and intellectual collapse of the
individuals.
The number of individuals who use alcohol in an
abusive way is gradually rising and the age limit of the
persons using it is progressively decreasing, young
people being more and more numerous among patients
with this type of disorder.
If an alcohol consumer suddenly diminishes the
quantity of alcohol consumed or stops using it he/she
will experience withdrawl symptoms: psychomotor
agitation, anxiety, trembling, sweating, anorexia,
insomnia.
The care management in these cases should always

start with what is generally known as detoxification,


term which is not properly used, and which is a process
of re-balancing metabolic and other specific functions
that were affected by the chronic and abusive use of
alcohol.
This process of detoxification is initiated along with
other specific interventions that address other
symptoms that might also be present: delirium,
hallucinose, paranoid syndrome, alcoholic epilepsy.

The influence of disease on patient behavior


A. Meliaca, S.C. Glc, Zoica S. Frcanu,
Manuela Chera
In order to reduce the stres and complaints of patients
and in order to change the way patients see nurses, we
have to first change the way we think and behave
towards them.
Patients decisions and behaviours are not based on
scientific theories, but rather on empirical ones that are
less known by healthcare providers.
Before reacting to situations and events that affect their
health, patients mentally display the information on
disease and medication as personal beliefs with a
specific content that is called a mental representation
of the disease.
Studies of mental representation on treatment show that
most frequently individuals taking some sort of
medication tend to asign any distressing symptoms that
appear during treatment to the medication and not to
aging, the disease itself or other factors.

Asepsis and antisepsis in dental office


Anca Panait, tefnia Ciobanu, Georgiana
Zgorobete
Particularities regarding the fight against infections in
dental office: The particularities are given
by:\treatments in the oral cavity where frequently there
are infectious agents that can get in contact with
doctors or nurses hands and to which we can add the
instruments we use in dental offices such as: units,
hand pieces. The oral cavity is considered to be the

most contaminated natural cavity of the organism in


proximity of which we find also skeptical cavities of
the head and neck region like maxillary sinuses or the
pharynx. Acute and chronic lesions: most often patients
come to the dental office for nonspecific infectious
agents like periodontal abcess, stomatites, for specific
infectious agents like tuberculosis, syphilis or even
carrying viruses such as hepatitis B, C, D or HIV.
Contaminating doctors or nurseshands with blood,
pus, saliva, contaminated tissues. Dental units with
polyethylene tubing can ease the contamination and
growing of the microorganisms that can pass from one
patient to another but they can be easily destroyed by
general sterilization and disinfection of dental offices.

The mantaining of implants through


hygienization, the key of long term success of
dental implants
Maria Niescu, Elena Dogrescu, Cristina Tincea
The success of a dental implant depends on the surgical
technique used, the quantity and quality of the support
bone and the hygiene and healthiness of the patient.
When the patient attends periodic checks and assures a
proper care of the implant, this can last for a life time.
If the oral hygiene is not correct, the risk of affection
may appear which can lead to the infection of the tissue
that surrounds the implant called peri implantitis.
Periodic checks can be scheduled regarding to the
necessities of the patient, according to the quantity of
the soft and hard deposits on the implant, the aspect of
the peri implantitis tissues, the healthiness of the
pacient and the aspect of the prosthetic on the implant.
The check will include the evaluation of the index of
bacterial plaque, the healthiness of the peri implantitis
tissues, the verification of the gum-implant
relationship, the peri implatitis bleeding, taking a
panoramic or periapical radiography, also removing the
tartar using plastic made tools that will not scratch the
surface of the implant.
Using those methods, the prosthetic reconstruction
from the dental implant can be maintained for a long
period of time.

NS 7
Oral communications nurses 7
Hearing aids, present and future
Ileana M. Mate
In human life, hearing aids came later, being somewhat

an invention of modern times. The first electric hearing


aids began to configure in the same time with the
invention of the telephone. Only in the twentieth
century digital hearing aidswere invented, those we
enjoy today.

The purpose of this paper is to present hearing aids,


following thesteps:
Initially a briefpresentation of sound perception and
auditory organ is made. Then a description of hearing
and an overview of all types of hearing aids are
presented. The main components of a hearing aid isalso
presented.
Being a specific economic problem, an analysis of
the hearing aids market in recent years is made and to
the latest technologies in this marketare presented.
Finally, conclusions about hearing aids and future
marketsare drawn, enhancingthe importance of
developing hearing aids.

Basal cell carcinoma


Elena Zaim, Alina Ispas, Florinela Stancu
Basal cell carcinoma is the most common form of skin
cancer. It arises from basal cells, underlying the
epithelium
Causes:
- Long duration of sun exposure (predilection areas are:
the neck, ears, face, shoulders and back)
- Other favorable factors: contact with arsenic;
radiation exposure; wounds that do not heal chronic
skin inflammation; also burns complications, scars,
skin infections, vaccinations and even the tattoos.
Case report
Patient CM, aged 47, male, rural police officer, is
hospitalized through a referral in the ENT clinic on 14
February due to the occurrence of necrotic ulcerative
lesions US, ear pain with intermittent US.
Symptoms started about 4 years ago, insidious.
Based on personal history, clinical examination
apparatuses and systems, clinical examination ENT
diagnosis probability lineup ulcerative necrotic flag
auricular extension at CAE US and periauricular (root
helix), with no signs of relapse locoregional
(lymphadenopathy) and distant was filed.
To confirm the diagnosis the HP examination was
needed.
Based on historical data, clinical examination devices
and systems, clinical examination and laboratory ENT
examination and samples HP an accurate diagnosis of
basal cell carcinoma US, with no signs of locoregional
relapse (lymphadenopathy) and remote has been made.

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.

Chronic leg ulcers Modern treatments


Ioana Badea, Liliana La, F. Pieptea, Lucua Tea
Chronic leg ulcer is a substance loss including dermal
layer, located on the legs, with various etiology,
characterized by the absence of spontaneous healing.
It persists for a long time, and
allows
series
of
complications both general and local. Though its
resilience and resistance to treatment, long evolution,
frecquent relapses and complications, chronic leg ulcer
is a social medical problem, being one of the most
troublesome aspects of modern medicine.

Pre and postoperative nursing of skin tumors


patients
Ioana Badea, Ioana L. Moisei, Irina Vaciu, Andreea
Mihai, Daniela M. Papa
Basal cell carcinoma is a tumor originated in basal cells
of the skin and appendages; is one of the less
aggressive tumors, seldom metastasing. Malignant
character is underlined by its capacity of local
destruction. Basal cell carcinoma does not primarily
affect mucosa, but is known to be able to spread from

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.

Non-specific suppurated pleural effusions


Jenica Trifu, Violeta Jarca, Camelia Militaru,
Ionela Zanfir, Daniela Copceac, Monica E. Nicula
Pleural empyema is suppurated pleural effusions
caused by pyogenic germs, often having as starting
point a lung infection: bronchopneumonia, lung
abscess, etc.
Bacteriological characteristics of suppurated pleural
effusions have modified over time.
Usual signs and symptoms of pleural empyema are:
dyspnea, thoracic pain, cough and fever.
The diagnosis of pleural empyema is established by the
doctor, after diagnostic thoracentesis, depending the
stage of the disease.
The treatment consists of: antibiotics, symptomatic
medication, and high caloric hygienic-dietary regimen
and, of course, surgical treatment (aimed to evacuate
the pleural effusion).
The prognosis and evolution for non-specific pleural
empyema are favorable in most of the cases.
Depending on the patients age, diseases evolutionary
stage, and on the promptitude of the medical and
surgical treatment, the prognosis can be affected in a
negative or positive way.

The operation room nursing implied in hepatic


resection
Maria Stoian, Cornelia Niu, Adriana Oprea,
Tudoria Vasile, Mihaela Muat, Voichia Militaru
The present paper intends to present an anesthetic and
surgical protocol used in Surgery 1 Department.
The hepatic resections are an important activity in
Surgery 1 Department and nurses are well-trained in
anesthetical and surgical preparation. We consider
important to define the role of the nurse in such an
activity.
The particular aspects of the preparation protocol are:
1) Special patient preparation:
- Preparation of the transfusion needs(autologous,
heterologous blood)
- Preparation of the nutritional needs, pre-operatively.
2) The right choice for the anesthetic technique which
would confer surgical, anesthetic and patient comfort.
3) Diminishing blood-losses intra-operatively:
- Anesthetic considerations (controlled hypotension,

euvolemic acue hemodilution),


- Surgical considerations (clamping the hepatic
pedicle centrally or laterally, technical considerations
bipolar diathermy, ultrascision, argon coagulation, cell
saver use, the use of special suture and hemostasis
materials,
- Special monitoring of the patient in order to reveal
and treat hemodynamic instability (invasive blood
pressure determination, cardiac output and central
venous pressure).
Our experience began 20 years ago and summons 250
hepatic resections, among which 45% are major(more
then 2 hepatic segments) with very good results.
Keywords: preparation, protocol, monitoring, comfort

Benefits of aspiration technique in caring for


patients with digestive fistula
Liliana Badea, Mihaela Moscaliuc, Carmen Florea,
Georgeta Ionescu
Definition:
A gastrointestinal fistula is an abnormal opening in the
stomach or intestines that allows the contents to leak.
Causes:
Most gastrointestinal fistulas occur after surgery.
Symptoms:
Depending on where the leak is, gastrointestinal fistulas
may cause:
- Diarrhea,
- Malabsorption of nutrients,
- Dehydration.
Entero-enteral fistulas may have no symptoms.
Enterocutaneous fistulas cause intestinal contents to
leak through an opening in the skin.
Exams and Test
Barium swallows to look for a gastrointestinal fistula
Barium enema to look for a fistula involving the colon
CT scan of the abdomen to look for fistulas between
loops of the intestines or areas of infection
Fistulogram, in which contrast dye is injected into the
opening of the skin of an enterocutaneous fistula and xrays are taken
Treatment
Treatments may include:
- Antibiotics
- Immune suppressing medicines if the fistula is a result
of Crohn's disease
- Surgery to remove the fistula and part of the intestines
if the fistula is not healing
- Nutrition through a vein while the fistula heals (in
some cases)
- Some fistulas close on their own after a few weeks to
months
Benefits of aspiration technique:
- The skin is less affected
- Costs reduced

- 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.

Preventive education for diabetic foot


Daniela Buzatu, Nedelcu Aglaia, Viorica Bogza,
Nicoleta Mavri, C. Constantin
Background: Involvement of therapeutic education to
prevent diabetic foot is important in desire to decrease
the incidence and prevalence of such cases in pathology
diagnosed either as peripheral arterial disease, or as
diabetic neuropathy sensitive symmetric or as a
complex of both diagnosis, at the level of lower limbs.
Material and Methods: The medical treatment of
diabetic foot complex is an intervention described as by
reducing cardiovascular risk and this is completed by a
series of measures: therapeutic education during
hospitalization (which is important) considering the
time spent in the presence of health professionals,
investigation guided by medical doctor.
This lecture tries to highlight the role of simple
measures in an attempt to decrease the incidence and
prevalence of neuronal and arterial complications of
lower limbs.

The messages sent to the patient are: 1) wash your feet


daily with soap and water; 2) use a clean towel and
clean them especially between the toes; 3) apply
moisturizing lotion, but not between the toes; 4) check
if there are inflamed regions, bedsores, wounds and
consult your doctor immediately; 5) clean nails every
day, cut them right; 6) change socks daily; 7) never go
out of their shoes or in surfaces; 8)casual check to
prevent injury legs, etc.
Anyone with a foot injury or open sore should be
restricted to nonweight-bearing activities.
Conclusions: These simple measures complement
medical intervention and can contribute to preventing
mutilating surgery for diabetic foot pathology. For all
patients with diabetes, should be performed an annual
comprehensive foot examination to identify risk factors
predictive of ulcers and amputations. The foot
examination should include inspection and assessment
of foot pulses.

Overdose with Sintrom


Mirela Vintilescu, Mihaela Stoa
Anticoagulation is prescribed in case of diseases which
can lead to thrombus formation. The danger arises from
thrombus dislocation and mobilisation in the blood
stream.
The most frequent anticoagulated diseases are: atrial
fibrilation, ischemic stroke, deep venous thrombosis,
cardiac prosthetic valves.
Ambulatory patients are advised to carry with them a
warning regarding anticoagulation in case something
happens to them as they are found inconscient.