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 75 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. insertion can be performed safely, with minimal complications and Conclusions: SEMS 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.
Epidermoid squamous-cell carcinoma is by far the most common malignant tumor of larynx (95-96%), representing 1.6-2% of cancers in men and 0.2-0.4% of malignancies in females, with a world growing incidence and a slight dominance in urban areas. By exposing cells and tissues to UV in part by non-radiative light, the excitation of naturally occurring chromophores occurs deactivations, in part via fluorescence emission. Using laser induced autofluorescence (LIAF) in natural tissues not impregnated with photosensitizers as a noninvasive autofluorescence technique for both diagnosis and intraoperative assessments of laryngeal cancer we can improve the tumor malign identification in vivo. A total of three laryngeal biopsies (i.e. three pairs of tissues, each pair containing a healthy and a tumor tissue sample extracted from the same patient) were considered in this study. The samples were collected from patients previously diagnosed with stage T3 laryngeal carcinoma. Immediately after the surgery fragments of normal tissue and neoplastic tissue were collected, fragments of which later, after freezing, were sectioned in 25-30 μm thickness slices and stretched to quartz slides. All samples were subjected to controlled laser irradiation using a pulsed diode laser (λ=375nm, pulse width=87ps, frequency 31MHz) and the autofluorescence and its lifetime were collected using two optical fibers (inner diameter 400µm and 1500µm, respectively) positioned in a 45o geometry. The signals were recorded using a spectrograph and a photo-sensor module, the output of which was fed to a digital oscilloscope. lifetime We assessed the measurements in order to identify the differences between healthy and tumoral laryngeal tissue and outlining them, in terms of differences between the laser autoinduced fluorescence averaged intensity. The results determined the usefulness of laser induced spectroscopy in the diagnosis of laryngeal squamous cell carcinoma, discriminating between the malignant and normal tissue by analyzing the differences in spectral autofluorescence intensity and autofluorescence lifetime. Acknowledgements: This work has been financed by the National Authority for Research and Innovation in the frame of Nucleus programme - contract 4N/2016 and the project number PN-II-ID- PCE-2011-3-0922. The authors thank Prof. M. L. Pascu for permanent support in performing this research. induced autofluorescence and autofluorescence impact of laser
A finite element simulation of the mechanical static features for a modified short hip endoprosthesis was performed. The corkscrew-like femoral stem was modified introducing more turns of the thread. By such an approach it is expected that for some cases the mechanical fixation of the prosthesis to the bone will be improved or the use of the cement for bonding is not necessary. Our scenario was estimated for titanium and stainless steel, and both materials show good safety factors. Mechanical stress is expected to be distributed more uniform in the bone for the new design with more turns of thread.
Introduction: Starting September 2010 in Romania was created the Military Emergency Medical Service (SMMU) by the Ministry of National Defense, which has as main mission to provide first aid and save the lives of military personnel during military operations using special equipped MEDEAVC aircraft. Nationwide exist the national emergency system which operates thru 112- SMURD acting in support of the civilian population. In case of accidents with multiple victims the experience has shown the need for collaboration between the two systems, in order to save lives. In the last 5 years there has been an increasing Airlift missions (MEDEVAC) with multiple victims executed by joint civil-military medical teams using military aircraft. Material and methods. This paper provides a review of the most important aspects of particularities, advantages and disadvantages of this type of medical transport using the MEDEVAC missions based study carried out by the Air Force in recent years. Results and conclusions. Performing these tasks presents challenges to mission planning, use of medical equipment and procedures, command-control system, exercise programs jointly joint medical teams and, of course, managing a large number of patients in flight. The large number of patients transported safely and in the shortest time, regardless of weather conditions recommends this type of medical intervention. Given the Romanian military presence in various theaters and that NATO strategic medical evacuation is a national responsibility, the capacity of air transport in case multiple casualties is a priority.
The tracheoesophageal fistula which occurred during oro-tracheal intubation of a patient in intensive care unit is a true challenge both in diagnostic and in therapeutic approach. The best treatment is prevention, by identifying risk factors but especially is important which the mechanism in the occurrence of tracheoesophageal fistula was. The occurrence of this complication in the evolution of hospitalized patients in ICU is accompanied by significant increase in mortality, contributing to negative prognostic. We have started a large multicentric study in April 2016 regarding all patients who required intubation longer than 7 days. The study will finish at the end of 2020. We are looking for a definite conclusion, in this moment we do not have enough data for a conclusion.[1, 2] INTRODUCTION fistula tracheoesophageal The is an abnormal communication between the esophagus and trachea. It can be congenital or acquired. Most of them are congenital with a frequency of 1 to 3500/ 6000 births. In this case usually are associated, or appear within, with other birth defects (trisomy 13, 18 or 21, tetralogy of Fallot, other digestive problems or muscle skeletal VACTERL Syndrome (Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula and/or Esophageal atresia, Renal & Radial anomalies and Limb defects.). Then, there are the malignant ones which appear in the posterior infiltrating tracheal wall or the anterior wall of the esophagus. The last ones are those acquired, non- malignant [1, 3, 4]. maneuver, in the operating room but especially in ICU. The first fistula appeared after a prolonged period of intubation and was initially described in 1956 by d’Avignon [2, 4]. in involved factors are Several these serious complications during a prolonged period of intubation. The most important and most discussed about in recent years is represented by the cuff pressure of orotracheal tube. If the cuff is overinflated, it leads to compression on the rear wall membranous trachea, which in time leads to ischemia and necrosis, basically forming an abnormal communication between the trachea and esophagus. Other possible complication of a hyper-inflated cuff is tracheal stenosis or bleeding erosion of a significant blood vessel. Often, both The situations simultaneously. occur can They occur particularly after a prolonged period of intubation with or without mechanical ventilation. intubation Fistula can result from incidents of 1 Carol Davila Central University Emergency Military Hospital, Bucharest 2 Carol Davila University of Medicine and Pharmacy, Bucharest 3 University Emergency Hospital, Bucharest 35
Aim. To identify the main facial features associated to facial attractiveness in women nowadays. Method. A descriptive study was conducted on a sample of 20 female public figures, very famous and successful women, most frequently actresses, singers or models, considered very beautiful nowadays. Their selection followed the analysis of several recent tops that aimed identifying most beautiful women, in which raters were lay persons. Data was collected by analyzing photos from frontal and lateral view, during rest position and smiling. Results. The persons analyzed registered diverse facial traits. Most obvious trends, encountered in more than 75% of them, included: Caucasian race; straight and long hair; average nasal tip protrusion; maxillary dental midline concordant to facial midline; a thicker lower lip compared to the upper lip; exposure of only maxillary incisors during smile; decreased or absent buccal corridor; maxillary central incisors of oval/rectangular shape; absence of maxillary teeth crowding. Other frequently encountered features were: American nationality; brown hair; eyes with medium size, almond shape, wide set, of green color; nose with an average width; face with a decreased lower third and a slightly convex profile; a thick lower lip and an average upper lip; exposure during smiling till the first molar, with a normal smile line. Conclusions. The public beautiful women nowadays register features that are generally associated to an increased facial attractiveness. Knowledge of trends in facial beauty is useful in dental practice, in order to understand better patient’s need in terms of esthetic expectations.
Introduction: The hallux rigidus is a term that signifies a mobility limitation of the metatarsophalangeal joint of the big toe due to osteoarthritic degeneration. Several factors are incriminated in the appearance of this pathology but without being able to establish the cause. The cartilaginous erosion of the metatarsal head and / or the base of the phalange, the dorsal osteophyte of the head of the first metatarsal were found during cadaveric studies. The main reason for consultation is pain and limitation of the dorsiflexion of the big toe during the step. Hypothesis: Arthroscopic debridement of the first metatarsophalangeal joint improves the early postoperative clinical score compared to isolated percutaneous treatment. Material and method: 11 patients divided into 2 groups were assessed clinically at 3 months postoperatively. All patients were hospitalized on an outpatient basis. Results: There was a gain in mobility at 3 months compared to the preoperative assessment in both groups, as well as an improvement in pain without being able to demonstrate the superiority of the additional arthroscopy to the percutaneous debridement. Hypothesis reversed..
Public health is the most important power factor of a nation, from which all other factors derive. Infectious diseases are the most important cause of morbidity and mortality in humans. Vaccination is the most important method of prophylaxis of infectious-contagious diseases. Mass implementation of vaccination prevents the occurrence of epidemics, epizootic diseases or homonymous pandemics, and at the individual level ensures the specific active immunity (total or partial). So the vaccination of the population and/or the risk groups is of strategic importance to the nation, both in peacetime and in time of war. The national antidote production along with anti-infectives (vaccines, therapeutic serums, immunomodulators, antimicrobial chemotherapies and pesticides) has a strategic importance for the health of the population and of the troops. Biological crisis situations are cases of force majeure, where the Medicines Law provides the exception for manufacturing and use, even without a "marketing authorization". The military scientific research could make micro-production of specific drugs (antidotes, antiinfectives) for the needs of the army and the risk groups of the population. An example would be the preparation of vaccines for the prophylaxis of diseases caused by BWA and bioterrorism as niche products. Nothing hinders the preparation of any medication, such as magistral and galenical preparations, or pilot batch, provided there is adequate space, equipment, staff and procedures according to the law or the exception.
Objective: The goal of this paper is to present the management of cases of deep endometriosis that affects the bladder, the ureters and the kidney. Materials and method: In this review we analyzed the sensitivity and specificity of imaging techniques for diagnosing deep infiltrating endometriosis, the optimal surgical technique and the surgical approach. Results: In patients with pelvic endometriosis in advanced stages the urinary tract is frequently involved. Preoperative work-up of patients with deep infiltrating endometriosis is aimed at evaluating the extension of the lesions in order to assess the complexity of the intervention and to choose the optimal approach. Conclusions: Laparoscopic and robotic management of these cases are good therapeutic alternatives. Ultrasound, sonovaginography with gel and MRI are useful imaging techniques for evaluating patients with deep infiltrating endometriois. The surgical management of patients with deep infiltrating endometriosis that involves the urinary tract consists of partial bladder resections, ureterolysis, ureteral resection and anastomosis and ureteral reimplantation..
