Raluca M. Tat, Adela Golea, Ştefan C. Vesa and Daniela Ionescu
Despite fifty years of research, cardiac arrest (CA) and complications resulting from hypoxic organ injury, remains one of the most significant challenges faced by physicians, knowing that the vast majority of patients with CA have an unfavourable prognosis with a higher chance of death and severe neurological disabilities [ 1 , 2 , 3 ]. In the last few years, efforts have been focused on the best way to detect those patients who have a chance to survive and to recover.
In an attempt to identify patients who survived after resuscitated CA
A. Bădilă, R. Manolescu, I. Japie, E. Bădilă, A. Papuc, C. Popovici, M. Tihulcă, A. Bujdei, D. Rădulescu, C. Cîrstoiu and R. Rădulescu
Aim: To assess the clinical results after osteosynthesis with locked intramedullary nail in metastasis of the long bones. Material and methods. We designed a prospective study in which we included all the patients with metastasis of the long bones admitted and surgically treated in our department between 2013 and 2015. Data for 64 were available at the final check-up. Our cohort totalized a number of 69 fractures (2 long bones required surgical treatment in 5 patients). The mean follow-up for survivors was 37 months (limits: 18-49 months). The primary tumor was known in 51 patients (79,69%). For the remaining 13 cases (20,31%), the primary tumor was not known and the pathological fracture was the first sign of the malignant disease. In the last group, the tumor could be identified by imagistic methods in 6 cases, while in other 3 cases, a biopsy and histological examination (which were performed in all the remaining 7 cases) determined the source organ. Clinical and radiological check-ups were performed at every 3 months in the first year and at every 6 months after that. Results. Pain amelioration and mobilization of the involved limb were achieved in all the cases. In 3 patients, the osteosynthesis could not compensate the progressive bone loss and the permanent use of an external orthosis was mandatory. The survival rate was 82,81% at 6 months and 67,19% at 12 months. Conclusions. All patients could be mobilized. Two thirds of the patients will survive more than a year. The goals of osteosynthesis are the same, regardless the location of the fracture and implant used: pain amelioration, stability for immediate full weight bearing, durability for patient’s life expectancy.
Oana Antal, Elena Ștefănescu, Monica Mleșnițe, Andrei Mihai Bălan and Natalia Hagău
, informed consent was obtained from each patient or their next of kin, if the patient was unable to give consent.
Seventy-one patients with severe sepsis and septic shock, initially defined according to the Surviving Sepsis Campaign Definitions [ 6 ] and subsequently redefined according to the new Sepsis-3 definitions in sepsis and septic shock [ 7 ], were included in the study.
Patients were recruited either in the emergency department (ED) or the hospital ward.
Patients were excluded if they were >80 years old, had severe cardiac disease as
O. Bodean, T. Georgescu, L. Arsene, D. Voicu, O. Munteanu, C. Berceanu, M. Sajin and M.M. Cîrstoiu
Ovarian carcinoma is a deadly disease, with one of the highest case-to-fatality ratio amongst all gynecological malignancies. The high mortality of these tumors can be explained by the fact that most patients present at an advanced stage, with widely spread metastatic disease, especially within the peritoneal cavity. Extraperitoneal, occult metastases are usually rare in cancer surviving patients. Bone metastases are not a common finding, but their incidence seems to be higher than expected, as proven by autopsy studies. Because most clinicians are not very familiar with bone metastases of ovarian carcinoma, in this article we intended to discuss the most controversial aspects concerning the diagnosis of this type of disease.
M. Popa, Z. Panti, M. Nica, M. Pleniceanu, B. Şerban, R. Ene and C. Cîrstoiu
Introduction. Giant cell tumors of soft tissue (GCTs) have a relatively low incidence and their low prognosis is reserved to local relapses and distant metastases. This type of pathology usually affects adults and the elderly and it is localized in the extremities, most frequently in the thigh. Materials and methods. GCT is a relatively low aggressive tumor; approximately 85% of the patients survive at least 5 years after diagnosis. The risk factors for low prognosis are old age, metastases at the time of diagnosis, local relapse. We conducted this study in the University Emergency Hospital, Bucharest for a period of 3 years, between 01.01.2015 and 01.01.2018, which included 20 patients with ages between 22 and 83 years, of whom 9 were women and 11 were men. Results. Excision with safety margins was performed for all patients. During surgery, tissue samples from 6 different areas were sent for extemporaneous examination. After excision, the histopathological examination was performed and the diagnosis of GCT was established. Localized forms were described in 16 cases; diffuse forms were identified in 4 cases and loco-regional recurrences in 3 cases. Pre or postoperative adjuvant treatment was not applied in any of the cases. Conclusions. GCT is a rare, potentially malignant pathology, in which case evolution is unfavorable. From the clinical and imaging point of view, it is difficult to establish this diagnosis due to the large variety of pathologies it can be mistaken for, making biopsy an essential step within the diagnostic algorithm. Election treatment is represented by local excision with safety margins.
Adina N. Hadade, Caius M. Breazu, Iulian V. Ilie and Calin I. Mitre
1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801-810.
2. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):762-774.
3. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016
Janos Szederjesi, Emoke Almasy, Alexandra Lazar, Adina Huțanu, Iudita Badea and Anca Georgescu
/ Society of Critical Care Medicine”. Chest. 1992;101: 1644-55.
4. Linde-Zwirble WT, Angus DC. Severe sepsis epidemiology: Sampling, selection, and society. Crit Care. 2004;8:222-6.
5. Hervald H, Egesten A. Sepsis. Pro-Inflammatory and Anti- Inflammatory Responses. Controb Microbiol. Basel, Krager, 2011, vol 17, pp 1-11.
6. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsisand septic shock: 2012. Crit Care Med. 2013;41:580-637.
Arthur A. Keresztesi, Gabriela Asofie and Harald Jung
In posttraumatic coronary dissection, a small intimal tear occurs due to the sudden compression of the thoracic wall during the chest trauma, this being sometimes fatal. We present the case of a 56-year-old truck driver with chest trauma after a car crash. The 12-lead ECG showed signs suggestive of an acute anterior myocardial infarction, and the coronary angiography confirmed an arterial dissection of the left anterior descending coronary artery. A stent was inserted the same day, and the patient was treated accordingly. He survived for a total of three days. The autopsy and histological examination confirmed the MI and the coronary dissection. The chest trauma was linked to the patient’s death. The literature review reveals 46 cases in which the most frequent cause of chest trauma was a car or motorcycle accident; also, young male subjects were more frequently involved. Stent placement was the main course of treatment, and a delay in the onset of symptoms was also frequent.
Thomas-Michael Schneider, Friederike Klenner and Franz Brettner
Background: Newly approved immunotherapeutic agents, like CTLA-4 inhibitors and antibodies against PD-1, are a promising therapeutic option in cancer therapy.
Case presentation: A 74-year-old man, with a history of advanced stage melanoma and treatment with ipilimumab, pembrolizumab and nivolumab, was admitted to the hospital due to respiratory failure with hypoxemia and dyspnoea. He rapidly developed severe acute respiratory distress syndrome (ARDS), which required treatment in the intensive care unit which included mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Computed tomographic imaging (CT) showed signs of a pneumonitis, with an ARDS pattern related to the use of PD-1 antibodies. Treating the patient with high-dose immunosuppressive steroids led to an overall improvement. He was transferred to a rehabilitation hospital and subsequently to his home.
Discussion and conclusion: This is a unique case report of a patient suffering a grade 4 adverse event under nivolumab who survived having been treated with ECMO. It highlights the possibility of associated adverse reactions as well as the use of ECMO in palliative care patients. ECMO can be of great success even in patients with malignancies, but careful decision making should be done on a case by case basis.
Janos Szederjesi, Emoke Almasy, Alexandra Lazar, Adina HuȚanu and Anca Georgescu
1. Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup; Dellinger, RP; Levy, MM; Rhodes, A et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsisand septic shock: 2012. Critical Care Medicine. 2013;41:580-637.
2. Russel, JA. The current management of septic shock. Minerva Medica. 2008;99:431-58.
3. Deutschman, CS; Tracey, KJ. Sepsis: Current dogma andnewperspectives. Immunity. 2014;40:463-75.
4. Jui J. Septic Shock. In Tintinalli JE, Stapczynski JS, Ma OJ et al. Tintinalli