IUNIE 2017
BUCURESTI
Lucrari inscrise - Simpozion "Victor Babes"
Lucrari inscrise pentru Simpozionul "Victor Babes" cu tema Medicina multidisciplinara, un concept mereu de actualitate. 18 ani de experienta in CDT "Victor Babes".
- Conferenţiar Universitar Doctor Laurenţiu Beluşică, Medic primar Chirurgie generala, Doctor in stiinte medicale
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucuresti
Comunicare orală
Chirurgia de zi între dorinţe, posibilităţi şi limite !
- Lector universitar Vladică Simona Maria, Doctor în Psihologie
Facultatea de Psihologie - Universitatea Ecologică Bucureşti
Comunicare orală
Consilierea psihologică pre şi post operator, componentă esenţială în reuşita actului medical.
- Dr. Adrian Istrate, Medic specialist Chirurgie Toracică
Profesor Doctor Mircea Emil Pătruţ, Medic primar Chirurgie generală, medic primar Chirurgie cardiovasculară, doctor în ştiinţe medicale
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Abordul chirurgical al pneumotoraxului spontan – aspecte particulare.
Pneumotoraxul spontan reprezintă o urgenţă chirurgicală, care constă în acumularea de aer în cavitatea pleurală, fiind însoţit de tulburări respiratorii şi circulatorii. Abordarea acestei patologii necesită decizii rapide şi cu impact de durată, cunoscându-se tendinţa la recidivă, în special la pacienţii care prezintă factori favorizanţi (efort intens, fumat, etc.).
Prezentăm cazul unui pacient de 15 ani, căpitan al unei echipe de fotbal juniori, care prezintă episoade succesive bilateral de pneumotorax spontan (la interval de 2 luni). În acest caz, abordarea planului de investigaţii şi conduită terapeutică au avut caracter de urgenţă, de fiecare dată, necesitând o colaborare interdisciplinară şi centrându-se pe rolul curativ (rezecţie blebs-uri pulmonare segmente apicale ale lobilor superiori prin chirurgie toracică video-asistată), dar mai ales preventiv (pleurodeza chimică cu betadină, electrică şi mecanică).
În cazuri particulare, algoritmul clasic de investigaţii şi tratament poate suferi modificări, în funcţie de situaţia impusă, fiind necesare investigaţii imediate şi un abord chirurgical adecvat (disponibile în Centrul de Diagnostic şi Tratament "Victor Babeş" Bucureşti, pentru o reintegrare socio-profesională rapidă a pacienţilor.
- Dott. Marco La Torre, MD, PhD, Specialista in chirurgia generale miniinvasiva presso
Ospedale San Carlo di Nancy Roma
Dott. Carlo Farina, MD, Specialista in chirurgia generale miniinvasiva presso
Ospedale San Carlo di Nancy Roma
Dott. Kenneth Zeri, MD, Specialista in chirugia generale e colonprocrologia presso
Ospedale San Carlo di Nancy Roma
Sapienza Università di Roma, Policlinico Umberto I, Dipartimento di Chirurgia Valdoni, Roma
Comunicare orală
Endoscopic Pilonidal Sinus Treatment (EPSiT) in Recurrent Pilonidal Disease.
Background. Pilonidal disease (PD) is a common inflammatory disease of the gluteal fold, resulting in recurrent acute/chronic infection at the level of the natal cleft. Persistence of PD or recurrence after surgical treatment is frequent event for the 25-30% of cases. EPSiT (endoscopic pilonidal sinus treatment) is a new endoscopic minimally-invasive procedure, has been studied in recurrent and multi-recurrent PD.
Methods: 21 consecutive prospective patients with recurrent PD were enrolled in a prospective study. The primary focus of this study was to evaluate healing, and the short/long-term outcomes such as healing time, morbidity rate, and re-recurrence rate were analytically studied in this respect. The secondary focus of this study was the patient’s quality of life (QoL).
Results. The complete wound healing rate was 90.5%, and the mean complete wound healing time was 29 ± 12 days. The incomplete healing rate (9.5%) was significantly related to the number of external openings (p = 0.008). Recurrence occurred in 2 cases (9.5%). Normal daily activity was re-established on the first post-operative day, and the mean duration before patients returned to work was 3 ± 1 days. QoL significantly increased between the pre-operative stage and 30 days after the EPSiT procedure (45.3 vs. 7.9; p < 0.0001).
Conclusions. EPSiT is a mini-invasive outpatient procedure, which is associated with a quick recovery and an attractive QoL outcome. The EPSiT procedure seems to be a safe and effective technique in treating even complex recurrent PD. It enables excellent short- and long-term outcomes than various other techniques that are more invasive.
- Dott. Edoardo Nanni, Primario del reparto di chirurgia generale presso
L'ospedale San Carlo di Nancy Roma
Comunicare orală
Transverse colon cancer. Mininvasive surgical approach.
Introduzione : The transverse colon cancer has a low incidence about 6% compared to the other site colon cancer. Mininvasive approach has been considered as a challenge for the laparoscopic surgery so much that was excluded from prior randomized controlled trials. L’ampiezza dell’exeresi del mesocolon e del colon, la preparazione del tronco di Henle e la sede dell’anastomosi , hanno reso difficoltoso l’approccio mininvasivo.
Materiali e metodi : Dal 2006 al 2016 sono stati sottoposti a trattamento chirurgico laparoscopico per neoplasia del colon trasverso circa 30 pazienti su 522 pari al 6%. Tutti i pazienti hanno effettuato : Computed tomografy, barium enema, colonscopy per l’esatta localizzazione del tumore ed una corretta stadiazione. La procedure usata per il cancro del colon trasverso era scelta in base alla sede del tumore (Right extended colectomy - Left extended colectomy - transverse colectomy). Nella nostra esperienza abbiamo eseguito 10 extended right colectomy, 5 transverse colectomy e 15 left extended colectomy.
Risultati : I dati della nostra esperienza evidenziano come pazienti trattati con chirurgia mininvasiva per neoplasia del colon trasverso abbiano risultati similari a quelli operati per altre localizzazioni di carcinoma colico. Tali dati sovrapponibili riguardano : l’estensione della linfectomia (numero dei linfonodi) la conversione e la morbilita’e mortalita’ postoperatoria.
Conclusioni :Dal nostro studio la laparoscopia del colon trasverso e’ risultata tecnicamente fattibile nonostante le difficolta’ anatomiche. La scarsa frequenza di tale lesione tumorale non permette di avere casistiche tali da poter formulare linee guida sia per quanto concerne l’estensione dell’exeresi sia per i risultati oncologici a distanza.
Keywords : colorectal cancer, surgery, transverse colectomy.
- Dott. Kenneth Zeri, MD, Specialista in chirugia generale e colonprocrologia presso
Ospedale San Carlo di Nancy Roma
Sapienza Università di Roma, Policlinico Umberto I, Dipartimento di Chirurgia Valdoni, Roma
Dott. Carlo Farina, MD, Specialista in chirurgia generale miniinvasiva presso
Ospedale San Carlo di Nancy Roma
Dott. Edoardo Nanni, Primario del reparto di chirurgia generale presso
L'ospedale San Carlo di Nancy Roma
Comunicare orală
Stapled haemorrhoidopexy or haemorrhoidectomy : which technique in which case. Personal experience and litterature review.
Purpouse : Chose the correct surgical procedure for haemorrhoidal disease comparing the outcome of patients operated in the last 5 years with stapled haemorrhoidopexy with those of patients that underwent haemorrhoidectomy with milligan morgan technique using traditional diathermy or ligasure. This study evaluates and compares short and long term results and complication rates such as bleeding, infection, anal discharge, urinary retention of patients treated with different surgical techniques.
Methods : 350 patients that underwent surgery from jan 2012 to december 2016 for second to fourth degree haemorrhoidal disease were studied analizing the necessity for post op analgesic treatment, antibiotics, laxatives. number of days in the hospital and time of return to work. The two groups (haemorrhoidopexy and haemorrhoidectomy) matched for sex age and general conditions. patients with concomitant anal fissure were included with comparable relevance in the two groups those with abscess and fistula were excluded. Results : The outcome for patients in the haemorrhoidopexy group was better in means of post op pain , necessity for analgesics, hospital stay, and return to work. the group of patients that underwent haemorrhoidectomy had better results in terms of recurrence rates especially for fourth degree haemorrhoids. operating time was shorter for the stapled technique (29 min) if compared to the diathermic milligan morgan technique 39 but similar to that of patients treated with ligasure (30).
Conclusions : Based on the results we consider hemorrhoidopexy a better choice for second and third degree haemorrhoids. fibrotic irreducible fourth degree haemorrhoidal tissue and thrombosed haemorrhoides should be removed with exscissional technique for better results. Stapled haemorrhoidopexy should be used to cure circumferential mucosal prolapse. therefore the surgeon must be able to perform all these techniques to tailor the correct surgery for the different haemorrhoidal disease.
- Profesor Doctor Mircea Emil Pătruţ, Medic primar Chirurgie generală, medic primar Chirurgie cardiovasculară, doctor în ştiinţe medicale
Doctor Adrian Istrate, Medic specialist Chirurgie Toracică
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Cura chirurgicală a insuficienţei venoase cronice superficiale şi varicelor hidrostatice cu sistemul de radiofrecvenţă VNUS în sistemul medical privat.
Autorii prezintă un studiu clinic asupra 345 pacienţi cu IVCS operaţi în 4 clinici private, în ultimii 5 ani. Lotul luat în studiu este omogen, cu predominanta sexului feminin, cu diverse stadii evolutive ale bolii, cu frecvenţa dominantă în fazele de complicaţii (tulburări trofice cutanate, tromboze, infecţii, ulcere trofice, etc).
Cura chirurgicală cu radiofrecvenţă realizează cele mai bune rezultate clinice postoperatorii, care se pretează la chirurgia de zi ("one day surgery"), cu incidente, accidente şi complicaţii precoce minime, iar rata de recidivă la 2 ani este sub 0,5 %.
- Dott. Alberto Costantini, MD
Dott. Carlo Farina, MD, Specialista in chirurgia generale miniinvasiva presso
Ospedale San Carlo di Nancy Roma
Dott. Attilio Di Donato, MD
Concordia Hospital for Special Surgery, Roma, Italia
Comunicare orală
Osteoarthritis of the hip : hip arthroscopy as joint preserving surgery tool.
ABSTRACT The prevalence and incidence of osteoarthritis (OA) continue to accelerate as life expectancy of the general population increases. Hip osteoarthritis in people under 50 years is caused in most cases by anatomical deformities such as femoroacetabular impingement (FAI) or dysplasia. They cause a space conflict in certain ranges of motion leading to a progressive damage to the acetabular labrum and the adjacent chondral surface, which may progress to advanced hip osteoarthritis. These insights have offered the chance to understand and treat hip osteoarthritis earlier, thus preventing the arthritic degeneration of the hip joint. PATHOPHYSIOLOGY Femoroacetabular impingement is due to bony morphologic abnormalities of the hip joint that cause abnormal contact during motion. There are 2 main types of FAI: Cam-type FAI is caused by an irregular osseous prominence of the head-neck junction Pincer-type FAI is caused by excessive acetabular coverage of the femoral head which can occur owing to several morphologic variants. Most patients have both deformities, resulting in mixed FAI pathology.
PHYSICAL EXAMINATION It is important to conduct a full hip, low back, and abdominal examination to assess for alternate causes of anterior groin pain. Physical examination of the hip joint includes inspection, gait observation, palpation, determination of active and passive range of motion, and specialized tests. IMAGING Plain film radiography Is the gold standard imaging method. Commonly used views include the anteroposterior pelvis view, the Dunn view, the cross-table lateral view, and the frog-leg lateral view. Computed tomography and MRI or magnetic resonance arthrography Computed tomography and MRI or MR arthrography might assist in further detailing subtle deformities and aid in preoperative planning. CT is not part of the routine workup for FAI owing to concern about radiation exposure in young patients.
MANAGEMENT Conservative options It is not currently recommended to treat asymptomatic patients, although patient education and periodic reassessment is advised. Surgery Arthroscopic tools are used to repair damage to the hip and prevent osteoarthritis progressing. Therefore, surgery for FAI aims to correct the areas of excess acetabular coverage or bony femoral head-neck protrusion to restore the normal clearance within the hip joint. Operative management of FAI has been shown to be effective in providing symptomatic relief and improving function, and it is substantially better than non-surgical management. It is currently unknown if any treatments of FAI will alter the natural history of the disease progression of OA or future need for hip replacement. Data from randomized controlled trials are lacking. Arthroscopic surgery has an advantage over open surgery, with faster rehabilitation and lower rates of complications.
CONCLUSION Femoroacetabular impingement is an important cause of anterior groin pain and might be an important cause of hip OA in the adult population. Patients with persistent hip pain for whom conservative management failed might be referred to an orthopedic surgeon experienced in this area for further evaluation. Prevention of OA and resultant total hip arthroplasty might be possible; therefore, early recognition and intervention make the role of the primary care provider critical.
Keywords: Osteoarthrosis - Hip - Arthroscopy.
- Dott. Carlo Farina, MD, Specialista in chirurgia generale miniinvasiva presso
Ospedale San Carlo di Nancy Roma
Dott. Edoardo Nanni, MD, Chief of the deparment of General and Miniivasive Surgery
San Carlo di Nancy Hospital in Rome
Dott. Kenneth Zeri, MD, General and Proctologic Surgery
Ospedale San Carlo di Nancy Roma
Dott. Marco La Torre, MD, PhD, General and Proctologic Surgery
Department of Surgery, Policlinico Umberto I in Rome
Comunicare orală
The role of Laparoscopy for complicated diverticulitis. Personal Experience.
Introduction : Diverticular disease is common in western countries and its prevalence is close linked to age. With the increasing median age is becaming an important challenging disease not only for Surgeons. Over the last decades the treatment of diverticulitis has changed and the Surgeon is not longer alone... General medicine practioners, Radiologist, Infectivologist, Gastroenterologist anestesiologist work togheter. Even if percutaneous drainage, antibiotics and expectant policies lowered the need for more invasive treatment there is still an important role for Surgery. According with International guideline, Laparoscopic drainage or colon resection for uncomplicated diverticulitis should be the preferred treatment in experienced hands. Controversy exist for Laparoscopic treatment for stable patients with Hinkley III-IV complicated or perforated diverticulitis. Nevertheless, despite its potential advantages, laparoscopic management of diverticular disease it's currentl y performed by a minority of surgeons. Our aim is to demonstrate that laparoscopy treatment is possible even in complicated diverticular disease.
Material and Methods : Over a total of 156 patient treated laparoscopically for diverticolitis in the last ten years we selected 38 patients with complicated disease : 23 with perforation, 12 with fistula, 3 patients with ureteral involvement. - Results: We had no operative mortality nor intraoperative complications. Two cases of perforation were converted in Laparotomy.
Conclusions : Laparoscopic treatment of complicated diverticular disease in experienced well trained Center has to be attempted . As our experience grows, it can be expected that the complication and conversion rates will continue to decline even if conversion in laparotomy never is to be considered a surgical failure.
Keywords: Complicated Diverticular Disease, Diverticulitis, guideline, Laparoscopy.
- Dott. Marco La Torre, MD, PhD
Dott. Carlo Farina, MD, Specialista in chirurgia generale miniinvasiva presso
Ospedale San Carlo di Nancy Roma
Sapienza University of Rome, Valdoni Department of Surgery
Comunicare orală
Video Assisted Anal Fistula Treatment (VAAFT). Personal Preliminary Experience.
Aim. Video-Assisted Anal Fistula Treatment (VAAFT) is a novel minimally invasive and sphincter-saving technique for anal fistulas. Aim of this report is to describe the outcomes of VAAFT in recurrent complex anal fistulas.
Methods. A prospective study from 2014 to 2016 on 38 patients was performed. VAAFT was performed by using the Karl Storz Video equipment. Each patient underwent to: 1) diagnostic exploration through the endoscopic VAAFT fistuloscope (main/secondary tracts and internal opening detection), 2) fistula endoscopic video-assisted treatment by fulguration of fistula tract and closure of the internal opening using a stapler or cutaneous-mucosal flap. A 4,6,12 months follow-up was performed.
Results. 8 patients (21.1 %) presented a persistence of the disease at the 6 months follow-up. 6 Patients (15.7 %) after an initial healing of the external orifice presented a recurrence within the 6 - 12 sixth months follow-up. The definitive success rate, at the 6 months follow-up, was 63.2 %. No major complications occurred. 2 patients (10.5%) presented an anal abscess within the 6 weeks after surgery. In 76.5 % cases short-term and long-term postoperative pain was minimal and acceptable. No deterioration of continence was documented.
Conclusions. VAAFT is a new promising minimally invasive technique. In very complex recurrent anal fistulas VAAFT can allow encouraging healing rate, with the clear advantage to not compromise continence status and even offering high post-operative quality of life comparing to standard/traditional techniques.
Keywords. Complex anal fistula, Fistuloscopy, VAAFT.
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Dr. Cristina Ene, Medic specialist Endocrinologie
Dr. Irina Ungureanu, Medic primar Medicină internă, Medic specialist Gastroenterologie
Dr. Marilena Constantin, Medic primar Medicină generală, Medic specialist Diabet, nutriţie & boli metabolice
Dr. Elena Călinescu, Medic specialist Psihiatrie, Doctor în ştiinţe medicale
Dr. Mihaly Enyedi, Medic primar Radiologie - Imagistică medicală, Şef lucrări Disciplina Anatomie
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Empty Sella - de la incidental la insuficienta hipofizara severa.
"Empty sella" este definita drept o entitate determinata de hernierea diafragmei sellare cu extinderea spatiului subarahnoidian in seaua turcica, aceasta fiind partial umpluta cu LCR. Acest proces duce la remodelarea si marirea seii tucice, pe de o parte, si diminuarea tesutului hipofizar, pe de alta parte.
Empty sella primara rezulta dintr-o incompetenta congenitala a membranei sellare. Este destul de comuna, avand o incidenta in seriile de autopsii de pana la 25 % si reprezinta cauza cea mai frecventa pentru aspectul radiologic de "sa turceasca largita".
Empty sella apare secundar dupa chirurgia hipofizara, radioterapie in aceasta sfera sau secundar infarctizarii pituitare postpartum (Sd Sheehan). Infarctizare hemoragica subclinica poate aparea de asemenea in adenoame hipofizare secretante de GH sau PRL, prezenta empty sella neputand exclude astfel un adenom hipofizar.
Diagnosticul este imagistic – RMN / CT – descriind hernierea diafragmei sellare si prezenta LCR la nivelul seii turcice.
Desi, cel mai frecvent, probele hormonale sunt normale, iar ocazional asociaza hiperprolactinemie, testarea functiei hipofizare anterioare este obligatorie pentru a exclude insuficienta hipofizara sau microadenoamele secretante.
Deficitul hormonal se poate prezenta sub orice forma – de la deficite izolate, asocieri si pana la deficit sever pe toate liniile hipofizare (panhipopituitarism). Vom exemplifica prezenta acestor deficite printr-o serie de cazuri diagnosticate datorita abordarii multidisciplinare in cadrul CDT "Victor Babes".
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Dr. Ramona Bică, Medic specialist Cardiologie
Dr. Cristina Ene, Medic specialist Endocrinologie
Dr. Magdalena Zidu, Medic primar Medicina interna, Medic specialist Reumatologie
Dr. Liliana Ştefan, Medic primar Cardiologie
Dr. Adrian Istrate, Medic specialist Chirurgie Toracică
Dr. Sorin Constantinescu, Medic specialist Radiologie - Imagistică medicală
Dr. Mihaly Enyedi, Medic primar Radiologie - Imagistică medicală, Şef lucrări Disciplina Anatomie
Dr. Aida Mihailovici, Medic specialist Radiologie - Imagistică medicală
Dr. Ana Maria Tănase, Medic primar Chirurgie generala
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
De la pericardita la chimioterapie - abordare multidisciplinara.
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Dr. Cristina Ene, Medic specialist Endocrinologie
Dr. Ramona Bică, Medic specialist Cardiologie
Dr. Liliana Ştefan, Medic primar Cardiologie
Dr. Eliza Acatrinei, Medic primar Medicină internă, Medic specialist Cardiologie, Doctor in stiinte medicale
Dr. Angelica Nour-Dincă, Medic primar Medicină internă, Medic specialist Cardiologie, Doctor în ştiinţe medicale
Dr. Irina Ungureanu, Medic primar Medicină internă, Medic specialist Gastroenterologie
Dr. Magdalena Zidu, Medic primar Medicina interna, Medic specialist Reumatologie
Dr. Marilena Constantin, Medic primar Medicină generală, Medic specialist Diabet, nutriţie & boli metabolice
Dr. Mihaly Enyedi, Medic primar Radiologie - Imagistică medicală, Şef lucrări Disciplina Anatomie
Dr. Sorin Constantinescu, Medic specialist Radiologie - Imagistică medicală
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
H.T.A. secundara - Cand ? Pe cine ? Cum testam ?
Hipertensiunea arteriala, definita de cresterea presiunii arteriale sistolice ≥140 mmHg si diastolice ≥90 mmHg, are o prevalenta in polulatia generala de 30 - 45 %, procentul fiind mai mare la varstnici. Cele mai multe cazuri prezinta HTA primara (esentiala sau idiopatica), dar un subgrup de pana la 15 % prezinta HTA secundara – renovasculara sau endocrina.
A fost raportata o relatie stransa intre prevalenta hipertensiunii arteriale si mortalitatea datorata accidentului vascular. Daca in ultimii ani in vestul Europei, conform ultimilor raportari OMS, se inregistreaza o scadere a mortaliltatii prin AVC, in Estul Europei, incluzand tara noastra, incidenta HTA si a AVC sunt in crestere.
Un diagnostic corect si precoce al HTA secundare ne ofera posbilitatea unui tratament adecvat (medicamentos sau chirurgical) cu scaderea mortalitatii de cauza cardio-vasculara.
Este dificila si costisitoare testarea pentru toate formele de HTA secundara.
Avand in vedere Ghidul Societatii Europene de Cardiologe pentru HTA si ultimul review endocrinologic (publicat in Endocrine Reviews 01.04.2017) am sintetizat principalele forme de HTA secundara, insistand pe prevalenta, clinica, pe momentul oportun al testarii si probele necesare.
Vom incheia cu prezentarea unor cazuri clinice diagnosticate cu HTA secundara datorita eforturilor sustinute ale echipei mutidisciplinare din CDT "Victor Babes".
- Dr. Rodica Cristina Dogaru, Medic primar Psihiatrie
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Urgente psihiatrice in practica ambulatorie
- Dr. Marilena Constantin, Medic primar Medicină generală, Medic specialist Diabet, nutriţie & boli metabolice
Dr. Gabriel Zamfirescu, Medic specialist Pneumologie
Dr. Cristina Voinea, Medic primar Medicina de Laborator, Doctor in stiinte medicale
Dr. Sorin Constantinescu, Medic specialist Radiologie - Imagistică medicală
Centrul de Diagnostic şi Tratament "Dr. Victor Babeş"
Comunicare orală
Eozinofilia - factor trigger pentru tromboza venoasa profunda si embolia pulmonara.
BACKGROUND. Infiltratul pulmonar si eozinofilia reprezinta un grup heterogen de boli.Rpaortam cazul unui pacient de 53 ani , sex masculin cu infiltrat pulmonar si eozinofilie secundara infectiei cu Toxocara Cannis diagnosticat cu tromboza venoasa profunda si embolie pulmonara la 30 zile dupa tratamentul pentru Toxocara.Investigatiile ulterioare au demonstrt status procoagulant.
PREZENTARE CAZ. Pacient de 35 ani se prezinta la consultasie pentru durere intensa la nivelul toracelui posterior accentuata la inspir profund. Examenul fizic a fost in limite normale, dar tomografia computerizata efectuata in urgenta infiltrat pulmonar la baza plamanului stang cu rectie pleurala. Analizele de sange au aratat eozinofilie si sindrom inflamator. Investigatiile pentru eozinofilie au identificat test Western Blot pozitiv pentru Toxocara canis. Pacientul a urmat tratament cu Albendazol 3 saptamani cu raspuns pozitiv la tratament. La o luna de la tratament pacientul se prezinta pentru durere la nivelul gambei drepte. Ecografia Doppler vene si testul Ddimeri intens pozitiv au confirmat diagnosticul de tromboza venoasa profunda. Se efectueaza tomografie computerizata cu substanta de contrast care descrie embolie pulmonara dreapta. Se initiaza trataent anticoagulant. Analizele de trombofilie au fost pozitive pentru mutatia MTHFR tsi PAI 1 675.
DISCUTII. Infectiile cu helminti se asociaza cu eozinofilie. Intrebarea noastra a fost daca eozinofilia a indus tromboza venoasa sau a fost doar factorul trigger. Intrucat doua teste genetice (MTHFR, PAI 1 675) au fost pozitive am considerat tromboza venoasa profunda si embolia pulmonara in contextul statusului procoagulant.
CONCLUZIE. Cazul prezentat demonstreaza ca eozinofilia este factor trigger pentru tromboza venoasa si embolie pulmonara la un pacient cu status procoagulant.
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Eosinophilia as trigger factor for vein thromboses and pulmonary embolia
BACKGROUND & AIM. Pulmonary infiltrate and eosinophilia represent a heterogenous group of diseases. We report the case of a 53 years old, male patient with pulmonary infiltrate and eosinophilia secondary to Toxocara infection who was diagnosed with deep vein thrombosis and pulmonary embolia one month later from the treatment for Toxocariasis. The futher investigations demonstrated a hypercoagulable status.
CASE PRESENTATION. A 53 years old male came to my office for very intensive pain on the left posterior thorax which was increased by deeply breath in Physical exame was in normal range, but chest computer tomography without contrast done in emergency showed pulmonary infiltrate at the base of the left lung with pleuritic reaction. Blood tests showed eosinophilia and inflamtory syndrome. Investigation for eosinophilia showed a positive Western blot test for Toxocara canis so the pacient began the treatment with Albendazole for three weeks with positive response. One month later pacient visited us for a pain on the right calf. The ultrasound vein Doppler confirmed the diagnosis of deep vein thrombosis and the chest computer tomography with contrast substance described mild right pulmonary embolia. The pacient started the anticoagulation treatment. The thrombophilia tests were done with positive reaction for MTHFR gene and PAI1 675.
DISCUSSIONS. Helmintic infections are associated with eosinophilia. Our questions was is eosinophilia responsible for the patient thrombosis or was it only the trigger factor ? As two genetic tests for trombophilia (MTHFR, PAI 1 675) were positive we considered deep vein thrombosis and pulmonary embolia in the context of hypercoagulable states.
CONCLUSION. This case highlights the implication of eosinophilia as trigger factor for vein thromboses and pulmonary embolia.
- Profesor Universitar Doctor Adam Danil, Medic primar Neurochirurgie
Spitalul Clinic de Urgenta "Sfantul Pantelimon", Bucuresti, Sectia de Neurochirurgie
Universitatea de Medicina si Farmacie "Carol Davila", Bucureşti
Doctor Dragos-George Iftimie, Medic rezident Neurochirurgie
Doctor Gina Burdusa, Medic rezident Neurochirurgie
Doctor Cristiana Moisescu, Medic rezident Neurochirurgie
Spitalul Clinic de Urgenta "Sfantul Pantelimon", Bucuresti, Sectia de Neurochirurgie
Poster
"Fish vertebra" la multiple nivele in cazul unui pacient cu osteomalacie indusa tumoral.
Introducere. "Fish vertebra" reprezinta o anomalie rara a corpului vertebral ce consta in depresia ariei centrale a suprafetelor vertebrale superioare si inferioare. Acest aspect particular a fost asociat cu numeroase afectiuni, precum : osteoporoza, osteomalacie, hiperparatiroidism, boala Paget, anemie falciforma, mielom multiplu sau lupus eritematos sistemic.
Prezentare de caz. Un pacient de sex masculin in varsta de 29 de ani, anterior tratat pentru spondilita anchilozanta (cu AINS si inhibitor de TNFα), fara ameliorarea simptomatologiei, a fost internat in sectia noastra. Acesta acuza mers dificil, posibil doar cu sprijin in baston, lombalgii si dureri la nivelul soldului bilateral, cu absenta radiculopatiei. Pacientul neaga traumatisme recente. Examenul neurologic a fost in limite normale. Radiografiile de coloana vertebrala lombara si toracala au evidentiat aspectul de "fish vertebra" la multiple nivele. IRM-ul de coloana vertebrala lombara si CT-ul toraco-abdomino-pelvin cu contrast au detectat numeroase fracturi : pedicul stang L4, lamina si pars interarticularis L4 dreapta, arcuri costale II-VII dreapta, arcuri costale I-V stanga si de aripi sacrate bilateral. Numeroasele analize de laborator efectuate au evidentiat nivele scazute de fosfor seric si PTH, cu cresterea fosfatazei alcaline, acestea sugerand o afectiune endocrinologica. Ulterior, pacientul a fost transferat pe o Sectie de Endocrinologie, stabilindu-se diagnosticul de osteomalacie hipofosfatemica. Determinarea ulterioara de nivele crescute de FGF23 a sugerat diagnosticul de osteomalacie indusa tumoral. IRM-ul "whole body" nu a localizat o tumora primara, insa PET/CT-ul Galiu-68 DOTATATE a decelat o formatiune mica (Ø = 15 mm), hiperfixanta in capul femurului drept. Pacientul a fost tratat cu fosfati si calcitriol oral, cu ameliorarea simptomatologiei. S-a recomandat ablatia chirurgicala a tumorii, insa pacientul a decis temporizarea interventiei.
Concluzie: Testele biochimice si investigatiile imagistice moderne au facut saltul de la simpla constatare a biconcavitatilor vertebrale, la stabilirea etiologiei si, in consecinta, la aplicarea tratamentului adecvat pentru cauzele rare de "fish vertebra", cum ar fi osteomalacia indusa tumoral.
Cuvinte cheie: "fish vertebra", osteomalacie hipofosfatemica, osteomalacie indusa tumoral, fracturi multiple, FGF23, PET/CT Gallium-68 DOTATATE.
- Doctor George GherlanMedic primar Boli infectioase, Doctor in stiinte medicale, Asistent universitar
Profesor Doctor Calistru Petre, Medic primar Boli infecţioase, Doctor în ştiinţe medicale
Doctor Neaţă Mădălina, Medic spacialist Boli infecţioase
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Monitorizarea prin metode neinvazive a evolutiei pacientilor cu ciroza hepatica cu VHC tratati cu medicamente cu actiune directa antivirala.
Liver fibrosis monitoring by noninvasive methods in patients with chronic C hepatitis treated with direct acting antivirals.Background and objectives. In 2015 / 2016, in Romania, treatment with ombitasvir/paritaprevir/dasabuvir/ritonavir was available for patients with Hepatitis C compensated cirrhosis. We monitored 43 patients with noninvasive methods (imaging and biochemical) for the evaluation of the liver fibrosis, aiming to demonstrate that liver fibrosis is reversible even in cirrhotic patients.
Material and methods. 43 patients (27 females) were included in the study. Fibroscan, APRI FIB4, CBC and liver function tests were performed at the beginning of the treatment, one month later, 3 months later (end of treatment (EOT)) and 6 months after EOT. At the first visit, liver ultrasound with ARFI and Fibrotest were also available.Patients ages were between 36 and 79, with a mean of 64.6 +/- 8.2 years.
Results. Noninvasive tests agreement at first visit : Fibroscan was strongly correlated (p<0.01) with spleen length and ARFI and had a good correlation (0.01<p<0.05) with Fibrotest, FIB4, platelets and prothrombin index. Fibrotest was strongly correlated (p<0.01) with FIB4 and prothrombin index and had a good correlation (0.01<p<0.05) with Fibroscan, APRI and platelet count. Parameters evolution in time : There was a decrease of liver stiffness value from the first visit to the end of treatment of 7.45 (STDEV = 6.88, p<0.01) and of 8.8 (STDEV = 8.37, p<0.01) from the first visit until 6 months after EOT. APRI showed a similar evolution, with a decrease of 1.04 (STDEV = 0.97, p<0.01) at the EOT and of 0.8 (STDEV=0.5, p=0.024) at 6 months from the first visit.
Conclusions. There is an improvement in the noninvasive tests for liver fibrosis at the end of treatment and 6 months later in patients with liver cirrhosis, in some cases showing even reduction of the stage of fibrosis below Metavir 4. The agreement of the imaging methods with the biochemical ones was satisfactory in this study in staging liver fibrosis.
Keywords : Liver fibrosis, Hepatitis C, Elastography, Fibroscan, ARFI
- Dott. Lucian Lior Marcovici, Orthopaedic Surgeon, Expert in Hand and Wrist Surgery, Expert in Wrist Arthroscopy, Head of The Wrist Arthroscopy Subunit in the Hand and Microsurgery Unit of the Jewish Hospital of Rome - Ospedale Isreaelitico
Dott. Alessia Pagnotta, Orthopaedic and Plastic Surgeon, Expert in Hand and Wrist Surgery, Expert in Microsurgery, Head of the Hand and Microsurgery Unit of the Jewish Hospital of Rome - Ospedale Isreaelitico
Dott. Carlo Farina, MD, Specialista in chirurgia generale miniinvasiva presso, Ospedale San Carlo di Nancy Roma
Comunicare orală
Wrist Osteoarthritis from Arthroscopy to Salvage Surgery.
Key Words : 1. Advanced Carpal Collapse 2. Wrist Arthroscopy 3. Osteochondral Resurfacing 4. Proximal Row Carpectomy 5. Wrist Osteoarthritis.
Purpose : Degenerative changes of the capitate or the lunate fossa historically have been a contraindication to proximal row carpec¬tomy (PRC). The goal of our study was to evaluate the results with a novel technique of PRC combined with autologous osteochondral grafting taken from one of the carpal bones of the first row and transplanted on a chondral defect of the capitate head or the lunate fossa.
Methods : Between 2010 and 2014, 11 patients underwent a PRC surgery associated with osteochondral resurfacing of the capitate o lunate fossa in our unit. All cases were first evaluated and treated by a wrist arthroscopy. Location, grade and diameter of chondrosis were recorded, as well as, the graft harvest origin. Preoperative and postoperative examinations included: Visual Analog Scale for pain, Range of Motion, and a Quick Disability of the Arm, Shoulder and Hand questionnaire. All patients underwent an MRI or CT control of graft at 1 year after surgery.
Results : The results of our study at a mean of 55.5 months of follow up (26 - 74 months) are very satisfying. Patients showed statistically significant reduction in pain and in QDASH scores with return to work of manual workers and to sportive activity like swimming and tennis in 3 cases. ROM after surgery is 111.2° in flexion-extension and 37° in radial- ulnar deviation. Graft at 12 months after surgery showed complete integration in all cases.
Conclusions : Our study confirms that chondrosis of capitate head and lunate fossa are not contraindications for a PRC procedure in pathological conditions of the carpus. The technique represents an alternative to total wrist arthrodesis in chondrosis of the lunate fossa, as to S+4CF when the capitate head is involved. We believe that this procedure represents a safer and a more biological solution for the treatment of carpal advance collapse conditions.
Level of evidence - IV. Type of study : Therapeutic study.
- Doctor Marin Ioan Tudor, Medic primar Chirurgie generală, Doctor în ştiiţe medicale
Clinica Neolife, Bucureşti
Doctor Zaharia Roxana, Medic specialist Chirurgie generală
Spitalul Clinic "Dr. I. Cantacuzino"
Doctor Lupu LeonardMedic specialist Chirurgie generală
Institutul National de Diabet, Nutriţie şi Boli Metabolice "Prof. Dr. N. C. Paulescu"
Spitalul Clinic "Dr. I. Cantacuzino"
Poster
Tratamentul chirurgical al herniei hiatale-deschis sau laparoscopic.
O data cu evolutia tehnicilor minim invazive tratamentul celioscopic a devenit "gold standard" pentru hernia gastrica transhiatala. Lucrarea de fata isi propune sa compare abordul chirurgical al acestei patologii si rezultatele, pe un lot de 91 cazuri 1995 - 2002 comparativ cu un altul de 62 cazuri din perioada 2005 - 2016. Varsta inaintata nu mai constituie contraindicatie pentru abordul minim invaziv, iar pentru pacientul obez abordul celioscopic este de preferat. Rata de complicatii postoperatorii (hemoragie, supuratie plaga) si recidivele sunt mai reduse in ultima decada datorita abordului predominant celioscopic, constatandu-se scaderea duratei de spitalizare si a duratei interventiei prin ameliorarea curbei de invatare.
- Cercetator stiintific III, Asistent universitar UMF "Carol Davila" Doctor Stroescu Cezar, Medic primar Chirurgie generală şi oncologică
Institutul Clinic Fundeni, Spitalul Clinic "Sf. Maria"
Doctor Aida Mihailovici, Medic specialist Radiologie - Imagistică medicală
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Interactiunea radiolog - chirurg in cancerul de san.
- Doctor Ana-Luminita Banacu, Medic Primar Chirurgie Plastică şi Estetică, Doctor în ştiinţe medicale
Spitalul Clinic de Urgenţă Chirurgie Plastică, Reconstructivă şi Arsuri
Fundaţia "Dr. Victor Babeş", Centrul de Diagnostic şi Tratament, Bucureşti
Doctor Patrick Semionov, Medic Specialist Chirurgie Plastică şi Estetică
Fundaţia "Dr. Victor Babeş", Centrul de Diagnostic şi Tratament, Bucureşti
Doctor Preda Maria, Medic Rezident Chirurgie Plastică şi Estetică
S pitalul Clinic de Urgenţă Chirurgie Plastică, Reconstructivă şi Arsuri
Comunicare orală
Gigantomastia, Estetic vs Functional.
- Doctor Ungureanu Irina, Medic primar Medicină internă, Medic specialist Gastroenterologie
Doctor Dr. Horaţiu Teodorescu, Medic primar Gastroenterologie, Doctor în ştiinţe medicale
Doctor Răzvan Capşa, Medic primar Radiologie - Imagistică medicală, Şef lucrari Disciplina Radiologie
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Bolile inflamatorii intestinale - capcane de diagnostic (prezentare de caz).
- Doctor Constantinescu Sorin, Medic specialist Radiologie - Imagistică medicală
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Poster
Particularitati IRM in Leziunea Meniscala de Tip "Bucket Handle".
- Doctor Mihaly Enyedi, Medic primar Radiologie - Imagistică medicală, Şef lucrări Disciplina Anatomie
Doctor Eugen Tarţa-Arsene, Medic primar Radiologie - Imagistică medicală
Doctor Constantinescu Sorin, Medic specialist Radiologie - Imagistică medicală
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Consideraţii imagistice în schizencefalie.
Schizencefalia reprezintă o anomalie în dezvoltarea telencefalului constând într-o soluţie de continuitate între sistemul ventricular si spaţiul subarahnoidian, ce este bordata de cortex cerebral.
Etiologia este plurifactorială şi include: cauză genetică (gena EMX2, ce prezintă mutaţii în cazuri de schizencefalie familială) sauleziuni in utero ce afectează zona germinală înainte de migrarea neuronală – infecţii(CMV), afecţiuni vasculare, traumatisme, toxine, trombocitopenie alloimună.
Schizencefalia poate asocia displazie septo-optică, displazie de lob frontal sau anomalii în dezvoltarea hipocampului sau a corpului calos.
În studiu am cuprinds cele mai frecvente variante de schizencefalie, cu detalierea aspectului atât pe investigaţiile de tomografie computerizată cât şi pe cele de rezonanţă magnetică.
Cuvinte cheie : schizencefalie, tomografie computerizată, rezonanţă magnetică.
- Doctor Stoian Mircea, Medic rezident Radiologie - Imagistică medicală, Doctorand
Spitalul Universitar de Urgenţă Militar Central "Dr. Carol Davila"
Profesor Doctor Calistru Petre, Medic primar Boli infecţioase, Doctor în ştiinţe medicale
Doctor Mihaly Enyedi, Medic primar Radiologie - Imagistică medicală, Şef lucrări Disciplina Anatomie
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Doctor Erşcoiu Simona, Medic primar Boli infecţioase, Şef lucrari UMF "Carol Davila"
Spitalul Clinic de Boli infecţioase şi Tropicale "Dr. Victor Babeş"
Comunicare orală
Toxoplasmoză cerebrală la un pacient infectat cu HIV - Studiu de caz.
Prezentăm cazul unui pacient în vârstă de 30 de ani cunoscut ca purtator al virsului HIV (depistat în anul 2013),cunoscut în antecedente cu proces expansiv intracranian parietal stâng cu epilepsie secundară cu asociere de crize parţiale de partea dreaptă şi generalizare secundară (iunie 2016), virus hepatic C, herpes-zoster inghinal şi anemie cu trombocitopenie, se internează pentru convulsii tonico-clonice de hemicorp drept cu generalizare secundară dar şi mioclonii de partea dreaptă, cefalee, vertij, greţuri şi alterarea stării generale cu aproximativ 3 zile în urmă.
S-a luat decizia efectuării unui examen RMN care a descris urmatoarele modificări faţă de ultima examinare când pacientul a fost externat în stare stabilă. Astfel se remarcă progresia dimensională semnificativă a leziunii expansive prezente la explorarea anterioară, la nivel cortico-subcortical parietal paramedian stang, ce prezintă actual diametre axiale maxime de aproximativ 14 / 12 mm, întindere cranio-caudală pe 22 mm, are structură neomogenă în hiposemnal T1, hipersemnal T2/FLAIR şi prezintă priză intensă, preponderent periferică de substanţă de contrast. Leziunea determină apariţia la nivelul substanţei albe adiacente a unei plaje întinse de edem, în progresie dimensională semnificativă faţă de examenul anterior. În concluzie pacientul prezintă o leziune cu aspect compatibil tumoral localizată cortico-subcortical parietal paramedian stâng ce apare în progresie dimensională semnificativă, cu edem asociat ce are de asemenea arie de proiecţie în progresie importantă care în contextul antecedentelor patologice ale pacientului poate sugera o reactivare toxoplasmozică.
În urma examenului RMN şi a rezultatelor serologiei IgG s-a luat decizia de a se administra Biseptol în doză de 3 tablete la 6 ore zilnic, iar la externare pacientul se afla într-o stare stabilă, afebril, compensat hemodinamic şi respirator, însa cu recomandarea de a se prezenta la o lună la control clinico-neurologic şi imagistic.
La controlul efectuat la o lună după episod, pacientul se prezintă având o evoluţie favorabilă, iar examenul RMN descrie un aspect net ameliorat, cu regresia marcată dimensională a leziunilor gadofile confluente situate la nivel cortico-subcortical parietal paramedian stâng, masurând actualmente aprox. 15 mm diametru maxim cranio-caudal, cca. 7 mm diametru transvers si antero-posterior aproximativ 9 mm. Gadofilia leziunii apare net redusă faţă de explorarea precedentă. Limitare marcată a edemului perilezional, din care persistă doar o mică plajă parietală paramediană stângă de cca. 18 mm diametru transvers maxim, fără efect de masă restant asupra ventriculului lateral stâng. Regresie importantă a plajei cu restricţie de difuzie a apei de la nivel parietal stâng, actualmente evidenţiindu-se o mică arie predominant corticală cu discretă extensie subcorticală în hipersemnal DWI, hipersemnal pe harta ADC, cu aspect edematos, de aprox. 18 mm diametru axial maxim.
În concluzie, leziunile cerebrale apărute la pacienţii imunocompromişi pot avea un patern asemănător, iar diagnosticul diferenţial este dificil şi întârzie tratamentul. Biopsiile se efectuază greu şi prezintă riscuri importante, uneori periclitând viaţa. Astfel imagistica modernă prin RMN şi spectro-RM împreuna cu probele biologice pot orienta diagnosticul şi astfel pacientul poate primi un tratament corespunzător care să vindece sau să stopeze progresia bolii.
- Doctor Acatrinei Eliza, Medic primar Medicină internă, Medic specialist Cardiologie, Doctor în ştiinţe medicale
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Afectarea cardiacă în infecţia cu virusul hepatitei C.
- Doctor Ungureanu Ramona, Medic specialist O.R.L., Doctor în ştiinţe medicale
Doctor Boacă Larisa, Medic prima O.R.L.
Doctor Feţeanu Cătălina, Medic prima O.R.L.
Doctor Petcu Ana-Alexandra, Medic specialist O.R.L.
Fundaţia "Dr. Victor Babeş", Bucureşti
Comunicare orală
Managementul actual al rinitei cronice hipertrofice.
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Dr. Magdalena Zidu, Medic primar Medicina interna, Medic specialist Reumatologie
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Dr. Oprea Anca Cristiana, Medic primar Boli infecţioase
Spitalul Clinic de Boli infecţioase şi Tropicale "Dr. Victor Babeş"
Profesor Doctor Calistru Petre, Medic primar Boli infecţioase, Doctor în ştiinţe medicale
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Infecţie HIV, prezentare atipică - Prezentare de caz.
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Dr. Andreea Ruxandra Cazan, Medic specialist Gastroenterologie, Doctorand
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Boala celiacă - o descoperire surprinzătoare ? - Prezentare de caz.
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Prof. Dr. Radu Iftimovici
Comunicare orală
Un stralucit elev al lui Victor Babes : Constantin Levaditi. Drumul sau in patologia infectioasa.
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Dr. Elena Mădălan, Medic specialist Alergologie si Imunologie clinica
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Poster
Angioedemul indus de IECA - Prezentare de caz.
- Conferenţiar Universitar Doctor Laurenţiu Beluşică, Medic primar Chirurgie generala, Doctor in stiinte medicale
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucuresti
Comunicare orală
Echipa multidisciplinara. Elemente de bune practici in medicina moderna.
- Doctor Aida Mihailovici, Medic specialist Radiologie - Imagistică medicală
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Cercetator stiintific III, Asistent universitar UMF "Carol Davila" Doctor Stroescu Cezar, Medic primar Chirurgie generală şi oncologică
Institutul Clinic Fundeni, Spitalul Clinic "Sf. Maria"
Comunicare orală
Imagistica sanului. Diagnostic la limita - Prezentare de cazuri.
Dupa o scurta introducere privind avantajele si limitele metodelor imagistice de investigatie a sanului, lucrarea prezinta cateva cazuri de neoplazii mamare greu diagnosticate, prezentari la debut sau cazuri atipice si un caz de comunicare ineficienta.
Fara a fi relevanta din punct de vedere statistic, lucrarea isi propune sa aduca in lumina cateva cazuri mai rare, dificultati de diagnostic intalnite in practica curenta si managementul acestor situatii, rolul urmaririi atente, la intervale scurte de timp, in situatiile unor modificari minimale, precum si aspecte privind rolul radiologului, claritatea rezultatului si buna comunicare cu clinicianul, in scopul stabilirii cat mai rapid si corect a indicatiei chirurgicale.
- Şef Lucrări Catedra Microbiologie UMF "Carol Davila" Doctor Maria Nica, Medic primar Medicină de Laborator
Spitalul Clinic de Boli Infecţioase şi Tropicale "Dr. Victor Babeş"
Fundaţia "Dr. Victor Babeş", Bucureşti
Universitatea de Medicină şi Farmacie "Carol Davila"
Comunicare orală
Dinamica antibiorezistentei speciilor bacteriene izolate de la pacientii din ambulatoriu versus pacientii spitalizati.
- Doctor Nica Maria Alexandra, Medic rezident anul IV Oftalmologie
Spitalul Universitar de Urgenţă Militar Central "Dr. Carol Davila"
Comunicare orală
Retinopatia diabetică : diagnostic şi management.
- Dr. Angelica Nour-Dincă, Medic primar Medicină internă, Medic specialist Cardiologie, Doctor în ştiinţe medicale
Dr. Cristina Voinea, Medic primar Medicina de Laborator, Doctor in stiinte medicale
Doctor George GherlanMedic primar Boli infectioase, Doctor in stiinte medicale, Asistent universitar
Dr. Cristina Ene, Medic specialist Endocrinologie
Dr. Anca Aparu, Medic specialist Hematologie
Profesor Doctor Calistru Petre, Medic primar Boli infecţioase, Doctor în ştiinţe medicale
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Abordarea multidisciplinară în infecţia cu virusul hepatitic C - experienţa CDT "Victor Babeş".
- Rocco Lapenta
Departement of Gastroenterology, Regina Elena Hospital (Rome-Italy)
Comunicare orală
Timely evolution of indications, findings, technical success and outcomes of Endoscopic retrograde cholangiopancreatography (ERCP): past and present.
Keywords : ERCP, complications, success, indications.
BACKGROUND AND AIMS : Since its introduction, the diagnostic and therapeutic utility of ERCP has been well demonstrated for several disorders. During the last decades, its evolution led to improvement of the diagnostic properties (but in competition with MRCP and EUS), extension of the therapeutic role and greater safety. A good and updated today knowledge of lights and shadows of ERCP is very relevant to find its right position in the diagnostic-therapeutic algorithm of each patient but data in the literature vary widely. We aimed to review the timely evolution of indications, findings, technical success and outcomes of ERCP in a single third-referral centre.
Patients and methods : We included all consecutive ERCP performed in the last 12 years in our unit. All procedures were performed by the same operators. ERCP indications, details of procedures and complications were reviewed. We performed a time-dependent analysis individuating 3 periods : 2005 - 2008 (1), 2009 - 2013 (2) and 2014 - 2017 (3). Since 2014, as suggested in European guidelines, we provided a routine rectal administration of FANS immediately after ERCP.
Results : A total of 5000 ERCP have been performed (56% males, age 54.3±14.2years). A successful biliary cannulation was achieved in 92% in period 1, 93% in 2 and 96% in 3. Main indications were suspected stones and jaundice due to malignancies (mainly pancreatic neoplasia, lymphonode and liver metastasis from gastro-intestinal neoplasia) in all 3 periods. The concordance between suspected indications and effective diagnosis was increasing from period 1 to 3 with a decrease rate of "not-diagnostic" exams from 10% to 3%. Common-bile-duct stones were more frequently retrieved with balloon extraction in all 3 periods with an excellent rate of success (91%), anyway in period 1 a Dormia basket was used in 20% of cases leading to success in a lower rate of patients (75%). A mechanical lithotripsy was used for difficult stones. As concerns neoplastic indications, stents for bile drainage were inserted in 95%of cases (70% plastic) obtaining a resolution of jaundice of 90% similar in the 3 periods while the rate of cholangitis (with need of change of biliary drainage) progressively decreased from period 1 to 3 (from 7 to 1%). The other more frequent complications were acute pancreatitis significantly decreased (particularly acute pancreatitis after the introduction of use of FANS). Mortality was reported in 0.3% of patients.
Conclusion : Today ERCP is safe and only rarely useless. In diagnostic-therapeutic algorithms of different disorders its role would be better enhanced and all hospitals would be equipped to performed these procedures.
- A. Di Donato
M. Mazzuca
F. Chiazzolla
A. Greco
S.P.I.N.E. Spine Pain Italian NeurOrthopedic Surgery Concordia Hospital for Special Surgery, Roma
Comunicare orală
Epiduroscopy in treatment of degenerative chronic low back pain : A prospective analysis and follow-up at 60 months.
- Doctor Andreea Vlad, Medic specialist Pneumologie
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Pleurezia : elemente de orientare diagnostica. Elemente de diagnostic pentru o pleurezie cu debut aparent acut la un pacient fara factori de risc respirator.
Comunicare orală
Pneumoniile interstitiale difuze. Orientarea si evaluarea diagnostica in functie de caracteristicile imagistice,clinice si paraclinice.
- Dr. Voinea Cristina Aura, Medic primar Medicină de laborator, Doctor în ştiinţe medicale
Dr. Szabo Cristian, Medic specialist Medicina de Laborator
Bioch. Popescu Sergiu
Biol. Ghiţă Camelia
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Dozarea 25 OH vitaminei D - analiza determinarilor efectuate in ultimii 5 ani.
- Dr. Marilena Constantin, Medic primar Medicină generală, Medic specialist Diabet, nutriţie & boli metabolice
Dr. Vişan Raluca, Medic primar Diabet, nutriţie & boli metabolice
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Comunicare orală
Abordarea multidisciplinara a pacientului cu diabet zaharat.
- Psihanalist - psiholog Boancă-Pătraşcu N. Camelia, Psihanalist, Doctorand
I.A.A.P. Zurich
Prof. Dr. Petre Calistru
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucuresti
Comunicare orală
Schimbarea persistenta a personalitatii dupa o boala somatica severa. Trasaturi psihologice si psihopatologice activate la pacientii cu infectie cu virus hepatitic C.
- Doctor Andreea Vlad, Medic specialist Pneumologie
Centrul de Diagnostic şi Tratament "Victor Babeş", Bucureşti
Poster
Nodulul pulmonar solitar : evaluare imagistica.
- Dott. Alberto Costantini, MD, Concordia Hospital, Roma, Italy
Dott. Andrea De Vita, MD, Concordia Hospital, Roma, Italy
Dott. Giovanni Di Giacomo, MD, Concordia Hospital, Roma, Italy
Dott. Nicola De Gasperis, MD, Concordia Hospital, Roma, Italy
Dott. Paolo Scarso, MD, Concordia Hospital, Roma, Italy
Comunicare orală
A new tecnique for rotator cuff repair: "Single row suture-cross technique".
Background : Double-row repair is suggested to have superior biomechanical properties in rotator cuff reconstruction compared with single-row repair. However, double-row rotator cuff repair is frequently compared with simple suture repair and not with modified suture configurations. We introduce a new technique of suture configuration to achieve a good cuff repair with improvement of tensile strength and the foot print reconstruction.
Hypothesis : Starting from clinical observation that patient treated with single row suture cross technique had less pain of those treated with standard single-row and double-row rotator cuff repairs, we hypnotized that the modified suture configurations (cross technique) create a good foot print reconstruction, improve the strength of the repair following a non in line tension with the tendon fibres during rotator cuff movement thus to create the bases for tendon healing.
Methods :
In vivo: We evaluate two groups of patients with cuff repair (same features of the lesion: sovraspinatus / infraspinatus tendons lesions- minimum two suture anchor repair). We comparate 10 patients with standard single-row repair and 10 patients with single-row suture cross technique repair and 10 patient with double-row repair, with Constant and Rowe score before and after surgery (follow-up average 28 months) . In laboratory: We compare on 4 specimens the strength of the single row suture cross technique with Cyclic Loading Test (test machine type Instron 5543. Test Parameter: Cyclic Loading Test: Pre Load: 5N,Cyclic Load: 30N,Frequenz: approx. 0,25Hz, Total Cycles: 200.) to the similar test that is possible to found in literature.
Results :
In vivo: In laboratory: Following the cyclic loading a pull to failure test was performed. A maximum of 309 N was achieved until the bone broke within the vice fixture. Suture fixation was still intact. In literature we founded that in the load-to-failure test, double-row fixation had the highest mean ultimate tensile load (287 ± 24 N), two-simple sutures (191 ± 18 N), arthroscopic Mason-Allen (212 ± 21N), and massive cuff (250 ± 21 N) repairs (Ma C.B, Comerford L, Wilson J, Puttlitz C: Biomechanical Evaluation Of Arthroscopic Rotator Cuff Repairs: Double-Row Compared With Single-Row Fixation. JBJS Am 2006;88: 403-410.
Conclusion : The results of this study demonstrate that suture-cross technique is similar to the double-row fixation and may provide significantly higher ultimate tensile load to failure than single-row fixation methods. The ultimate tensile load for double-row fixation was higher respect to any other stiches configurations, which may result in lower failure rates for the same level of postoperative activity compared with single-row fixation.
Suture cross is a single row configuration technique and from clinical and biomechanical point of view we have obtained very good results respect to a standard single row technique, and a little inferior to double row construct. Our idea is to incorporate the suture cross tech. in normal practice during shoulder arthroscopy using it as better single row configuration when compared to the others.