Showing papers by "Clinical Emergency Hospital Bucharest published in 2011"

Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging.

Abstract: This paper briefly describes the POP–Q system, by comparison with other staging systems, analyzing its main features and the concept behind it

Traumatic brain injury in infants and toddlers, 0-3 years old.

Abstract: OBJECT: Children 0-3 years old present a completely different neurotraumatic pathology. The growing and the development processes in this age group imply specific anatomical and pathophysiological features of the skull, subarachnoid space, CSF flow, and brain. Most common specific neurotraumatic entities in children 0-3 years old are cephalhematoma, subaponeurotic (subgaleal) hematoma, diastatic skull fracture, grow skull fracture, depressed ('ping-pong') skull fracture, and extradural hematoma. METHODS: We present our 10 years experience in neuropediatric traumatic brain injuries, between 1999 and 2009, in the First Department of Neurosurgery and Pediatric Intensive Care Unit. Including criteria were children, 0-3 years old, presenting only traumatic brain injury. We excluded patients with politrauma, who require a different management. RESULTS: We present the incidence of these specific head injuries, clinical and imagistic features, treatment, and outcome. We found 72 children with diastatic skull fracture, 61 cases with depressed ('ping-pong') skull fracture, 22 cases with grow skull fracture, 11 children harboring intrusive skull fracture, 58 cephalhematomas, 26 extradural hematomas, and 7 children with severe brain injury and major posttraumatic diffuse ischemia ('black-brain'). Usually, infants and toddlers present with seizures, pallor, and rapid loss of consciousness. First choice examination, in all children was cerebral CT-scan, and for follow-up, we performed cerebral MRI. We emphasize on the importance of seizure prevention in this age group. Children presenting with extensive diffuse ischemia ('black-brain') had a poor outcome, death occurring in all 7 cases. CONCLUSION: Children 0-3 years old, present with a total distinctive pathology than adults. Children with head injury must be addressed to a pediatric department of neurosurgery and pediatric intensive care unit. Prophylaxis pays the most important role in improving the outcome. Language: en

In vitro biocompatibility testing of some synthetic polymers used for the achievement of nervous conduits.

Abstract: Biocompatible synthetic polymers are largely used in the bio–medical domain, tissue engineering and in controlled release of medicines. Polymers can be used in the achievement of cardiac and vascular devices, mammary implants, eye lenses, surgical threads, nervous conduits, adhesives, blood substitutes, etc. Our study was axed on the development of cytotoxicity tests for 3 synthetic polymers, namely polyvinyl alcohol, polyethylene glycol and polyvinyl chloride. These tests targeted to determine the viability and morphology of cells (fibroblasts) that were in indirect contact with the studied polymers. Cell viability achieved for all the studied synthetic polymers allowed their frame in biocompatible material category. Cell morphology did not significantly change, thus accomplishing a new biocompatibility criterion. The degree of biocompatibility of the studied polymers varied. Polyvinyl alcohol presented the highest grade of biocompatibility and polyvinyl chloride placed itself at the lowest limit of biocompatibility. The results achieved allowed the selection of those polymers that (by enhancing their degrees of biocompatibility due to the association with various biopolymers) will be used in the development of new biocompatible materials, useful in nervous conduits manufacture.

Present and future tense in operable rectal cancer.

Abstract: In the last three decades it has been repeatedly insisted on the total mesorectal excision (TME), as being the key for pelvic recurrence. The authors have focused upon issues still "questionable", that invite reflection, having as a starting point now become the classic precepts of RJ Heald. The authors stop mainly on defining points that justify the complex therapeutical approach of rectal cancer. There are discussed some issues still subject to controversy: the extent of regional extirpation, critical points of surgical risk, the attitude towards the protection of genito-urinary innervation. In this purpose surgical considerations are presented on: the anatomy of the rectum and mesorectum, TME and its limits, on dissemination issues and pathology tumor grading, pelvic relapse and the place of adjuvant therapy. Complication rate is also analyzed and the quality of life of patients undergoing TME. Finally conclusions are advanced, some of them having the capacity to provide topics for future study and debate.

New application of diffusion tensor imaging in neurosurgery.

Abstract: Diffusion tensor imaging is a MRI technique that enables the measurement of the diffusion of water in tissue in order to produce neural tract images. Advanced methods such as color coding and tractography (fiber tracking) have been used to investigate the directionality. The localization of tumors in relation to the white matter tracts (infiltration, deflection), has been one the most important initial applications. A non invasive technique for assessing tumor tissue characteristics, like tumor cell density, is required to assist preoperative surgical planning for malignant brain tumors and help better define the target for tumor biopsy, resulting in more accurate diagnosis and grading of malignant brain tumors. One possible source of this information is diffusion tensor imaging. Date studies have focused on its ability to delineate white matter fiber tracks by fiber tracking and to detect tumor infiltration around the tumor and normal white matter interface. Relationships between cell density and the two key values that diffusion tensor imaging provides, fractional anisotropy and mean diffusivity, still need to be investigated. Mean diffusivity has a good negative correlation and fractional anisotropy has a good positive correlation with tumor cell density within the tumor core. Similar correlation was observed between the Ki–67, on the one hand and fractional anisotropy and mean diffusivity, on the other hand. Thus, measurement of both fractional anisotropy and mean diffusivity within the tumor core has a potential to provide detailed information on tumor cell density within the tumor. Abbreviations: DTI - diffusion tensor imaging, FA - fractional anisotropy, MD - mean diffusivity, WM - white matter

Idiopathic venous thromboembolism and thrombophilia.

Abstract: During the past decade idiopathic venous thromboembolism has become a separate entity, a chronic illness which has required prolonged anticoagulation and other prevention strategies to avoid recurrences. This article reviews recent developments regarding unprovoked venous thromboembolism and its relation with thrombophilia. In the beginning, the latest definition of idiopathic venous thromboembolism is presented. The article continues with statistics about thrombophilia, related venous thromboembolism, and a classification of major thrombophilic factors according to their intrinsic risk of thrombosis and of thrombotic recurrences. Great interest is given to the predictors of recurrence and the importance of prolonged anticoagulation is underlined. The antiphospholipid antibody syndrome, the most common acquired thrombophilia, is presented separately. The revised diagnosis criteria are discussed. Some characteristics of the antiphospholipid syndrome are worth presenting: the risk of both venous and arterial thrombosis, the high risk of thrombotic recurrence and the diversity of antiphospholipid antibodies. Patients experiencing idiopathic venous thromboembolic event have a great risk of recurrence, and highly benefit from long time anticoagulation. Natural coagulation inhibitors deficiencies, homozygous factor V Leiden and prothrombin G20210A and the antiphospholipid syndrome, increase the risk of first venous thrombosis and their recurrences and require adequate prevention. Abbreviations: VTE–venous thromboembolism, HRT–hormone replacement therapy, AVK–antivitamin K, FVL–factor V Leiden, PT G20210A–prothrombin G20210A, TAFI–thrombin activatable fibrinolysis inhibitor, PAI–1–plasminogen activator inhibitor 1, T–PA–tissue plasminogen activator, APS–antiphospholipid syndrome, LA–lupus anticoagulant, Abeta2GP1–anti beta2 glycoprotein 1.

Multidisciplinary management and outcome in subdural empyema--a case report.

Abstract: Cranial subdural empyema (SDE), a localized septic intracranial collection, occurs mostly as a complication of sinusitis, otitis or mastoiditis. Although relatively rare, SDE requires an increased attention for early recognition, cerebral imagery being mandatory in any suspected case. Any delay in treatment can lead to coma with a fatal outcome. The authors report the case of a young boy, who developed a severe, important cerebral edema, thin subdural collection with minimal displacement of the median line. Repeated cerebral MRI showed an enlarged subdural collection with higher median line shift and imposed rapid surgical intervention. The collection proved to be empyema. Other findings on MRI are pansinusitis, mild mastoiditis and transverse sinus thromboflebitis. The recovery was accompanied by the need for long course of antibiotherapy, secondary epilepsy treatment and kinetotherapy for hemiparesis. The patient also developed intracerebral cysts expanding the brain through the postoperative cranial defect which later needed surgical intervention, for both neurological and esthetic improvement. The management of the case implied strong interdisciplinary collaboration between infectionist, neurologist, neurosurgeon, microbiologist and imagist.

Three-dimensional imaging of anomalous origin of the right coronary artery in a young athlete

Abstract: We present a case of a 14-year-old male athlete to demonstrate the potential usefulness of three-dimensional echocardiography in supplementing magnetic resonance angiography in the assessment of actual anatomy in patients with anomalous origin of right coronary artery. Anomalous origin of the right coronary artery (RCA) from the left Valsalva sinus with an inter-arterial course between the great arteries is a …

Safety of drotrecogin alfa (activated) treatment in patients with severe sepsis on renal replacement therapy without additional anticoagulation

Abstract: Patients with sepsis-induced acute renal failure on continuous renal replacement therapy (CRRT), who receive heparin, may be at higher risk of bleeding when drotrecogin alfa activated (DAA) is administered in addition to standard anticoagulation, especially surgical patients. There are some previous observations that no additional anticoagulation is necessary during simultaneous DAA infusion and CRRT. The aim of this study was to evaluate the safety of CRRT during DAA infusion without additional anticoagulant therapy.