`
Official Journal of
Balkan Military Medical Committee
EDITOR – IN – CHIEF
Commander Christos BISSIAS, Greece
ASSOCIATE EDITORS
Lt Colonel Alexandra KARVOUNIARI, Greece
Lt Colonel Miltiadis ZIOGAS, Greece
Lt Commander Vasiliki ROKA, Greece
NATIONAL BOARDS
Albania
Bulgaria
Greece
Romania
Serbia
Turkey
LTC Hekuran Braho
COL Assen Petkov
CDR Christos Bissias
MAJ Bogdan Marinescu
COL Djoko Maksic
COL Sait Sirin
LT Bledar Kruja
LTC Kalin Kanev
LTC Alexandra Karvouniari
MAJ Rares Zamfir
LTC Boban Djordjevic
COL Nuri Arslan
ADVISORY BOARD
M. Levhi Akin
Turkey
Krum Katsarov
Bulgaria
Assen Petkov
Bulgaria
Mustafa Turan
Turkey
Fikret Arpaci
Turkey
Christos Grigoreas
Greece
Konstantin Ramshev
Bulgaria
M. Tahir Unal
Turkey
Zeki Bayraktar
Turkey
Mustafa Kutlu
Turkey
Corneliu Romanitan
Romania
Krasimir Vasilev
Bulgaria
Evgeni Belokonski
Bulgaria
Marian Macri
Romania
Deniz Sagdic
Turkey
Victor Volcu
Romania
Mirela Bidilicã
Romania
Apostolos Mantides
Greece
Georgios Sakarikos
Greece
Stefanos Fourlemadis
Greece
Hayati Bilgic
Turkey
Krasimir Mekushinov
Bulgaria
Ivan Samnaliev
Bulgaria
Aimilios Christias
Greece
Selcuk Isik
Turkey
Ali Sehirlioglu
Turkey
F. Sevgi Hatipoglu
Turkey
Okan Ozcan
Turkey
Ioan Sirbu
Romania
Ersoy Isik
Turkey
M.Ali Ozguven
Turkey
C. Turgut Tufan
Turkey
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Official Journal of
Balkan Military Medical Committee
Volume 15, Number 3, 2012
CONTENTS
17th CONGRESS OF BALKAN MILITARY MEDICAL COMMITTEE
BELGRADE, SERBIA
29th MAY – 1st JUNE 2012
Abstracts
96
Editorial
97
Oral Presentations (OP)
171 Poster Presentations (PP)
Balkan Military Medical Review
Jul -Sep 2012; 15(3): 96
Editorial
Dear colleagues, dear friends
The July-September 2012 issue of our Journal comprises the abstracts of all the papers, both oral and
poster ones, presented during the 17th Balkan Military Medical Committee Congress hosted by the
beautiful City of Belgrade.
We all enjoyed the Serbian hospitality and exchanged medical knowledge between 29 May and 01
June 2012.
The presented abstracts touch on a vast variety of specialised Military Medicine issues as well as
other, less ‘glamorous’ but no-less-important “bread-and-butter” topics of our daily routines at our
clinics and hospitals.
A significant fact was that young colleagues, students of Military Medical and Nursing Academies,
got together in a special scientific session, got acquainted with one another, had the chance to
familiarize with other countries’ training systems and presented oral papers: this, in our mind at least,
is of utmost importance and, along with other initiatives, can pave the way for wider and long-lasting
scientific cooperation between our countries.
The following pages will allow us all a taste of the scientific debate that materialised during the
Congress.
Best regards
Editor-in Chief
Commander Christos BISSIAS (Navy)
Associate Editors
Lt Colonel Alexandra KARVOUNIARI (Air Force)
Lt Colonel Miltiadis ZIOGAS (Army)
Lt Commander Vasiliki ROKA (Navy)
Balkan Military Medical Review
Jul-Sep 2012; 15(3): 97 - 170
ORAL PRESENTATIONS
OP001
PATHOGENESIS OF ATHEROSCLEROSIS
Author:
Commander (Navy) Dr. Georgios
Katsimagklis, M.D.
Institution: Associate Director, Cardiology clinic
& Catheterisation Laboratory, Naval Hospital of
Athens, GREECE
Atherosclerosis -basically a word derived from two
Greek words, “athero” (porridge) and “sclerosis”
(hardening)- is a progressive multifactorial disease
process that generally begins in childhood and has
clinical manifestations in middle to late adulthood.
The form and content of the advanced lesions of
atherosclerosis demonstrate the results of three
fundamental biological processes:
1) Accumulations of intimal smooth muscle cells,
together with variable number of accumulated
macrophages and T-Lymphocytes.
2) Formation by the proliferated smooth muscle
cells of large amounts of connective tissue matrix,
including
collagen,
elastic
fibers
and
proteoglycanes.
3) Accumulation of lipids principally as cholesteryl
esters and free cholesterol within the cells as well
as in the surrounding connective tissues.
There is a great variability in the relative amount of
tissue formed by each of these processes in the
lesions. Several studies demonstrated a consistent
association among certain characteristics, observed
at one point in time in apparently healthy
individuals with the subsequent incidence of
different forms of atherosclerosis. These
characteristics have been termed as “risk factors”
and may be a causative agent or a causative
condition. There are at least 7 main risk factors:
cholesterol,
smoking,
diabetes,
arterial
hypertension, obesity, age and gender. Knowledge
in the field of atherosclerosis is changing rapidly.
Cell and molecular biology has increased our
understanding of how risk factors are related to
inflammation through the different cellular
interactions with macrophages, monocytes and Tlymphocytes. Perhaps the most critical aspect is the
need to understand the basis of the genetic
susceptibility to these risk factors and thus to
circumstances that can lead to these increased
cellular interactions.
OP002
IMMUNOLOGICAL
ATHEROSCLEROSIS
ASPECTS
OF
Authors: Assoc. Prof. Dragana Vucević1,2, Brig.
Gen., Academician Miodrag Čolić2
Institutions:
1. The Institute of Medical Research, Military
Medical Academy, Belgrade; SERBIA
2. The MMA’s Medical Faculty, University of
Defense, Belgrade; SERBIA
Atherosclerosis, a chronic inflammatory disease of
blood vessels, is the most common pathological
process that leads to cardiovascular diseases.
Inflammation is recognized as a major contributor
of atherosclerotic lesion development. The
inflammatory response in atherosclerosis involves
cross talk between cells and molecules of innate
(phagocytic leukocytes, complement, cytokines)
and acquired immunity (T-cells, antibodies,
cytokines). The most prominent cells that invade in
evolving
lesions
are
monocyte-derived
macrophages and T-lymphocytes. Macrophages
express receptors that connect the innate and
adaptive immune response during atherosclerosis.
Most of the T-cells of the atherosclerotic plaque are
CD4+ cells with an activated phenotype. The clonal
expansion of T-cells and their clustering in close
proximity to dendritic cells and macrophages point
to a local immune response in the atherosclerotic
plaque. Autoantigens (oxidized LDL and heat
shock proteins) as well as pathogens have been
linked to these immune mechanisms. Immune cells
detected within atherosclerosis-prone vessels
produce a wide array cytokines and chemokines.
Th1 responses generally amplify proinflammatory
pathways and appear to aggravate atherosclerosis.
A more recently recognized T-cell subset, Th17
cells, may also exert proinflammatory actions. The
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
role of Th2 in atherosclerosis is controversial, with
some
experimental
studies
showing
proatherosclerotic effects and others showing
protective effects. Regulatory T-cells appear to
have anti-inflammatory activity and impaired
function of these cells is likely one of the reasons
for the local inflammation in atherosclerosis.
Regarding B-cells and antibodies, several lines of
experimental evidence suggest that humoral
immunity can attenuate rather than promote
atherogenesis, performing protective functions.
OP003
HDL-C AND ATHEROSCLEROSIS:
98
understanding these mechanisms, new prophylactic
and therapeutic strategies to combat atherosclerosis
and thrombotic disorders, can be provided.
OP004
PENETRATING NECK INJURY
Authors:
Kledia Pollo, MD, MBA, MPH;
Hekuran Braho, MD
Institutions: Department of Otorhinolaryngology,
Military Central University Hospital, Tirana,
ALBANIA
ATHEROGENIC AND ATHEROPROTECTIVE
MECHANISMS
Author: Col. Assoc. Prof, Dragan Dinčić
Institution: Military Medical Academy, Belgrade,
Medical Faculty, University of Defense, Belgrade;
SERBIA
Several prospective epidemiological studies
provided overwhelming evidence that a low plasma
HDL-C is a major, continues, independent risk
factor for the development of atherosclerosis and
plaque rupture. Lipoprotein HDL has two important
roles: first, it promotes reverse cholesterol transport
(RCT), the mechanism by which excess cellular
cholesterol is returned to the liver for excretion in
the bile. Second, HDLs also have different
pleiotropic effects: they decrease inflammation,
prevent low-density lipoprotein oxidation, vascular
endothelial cell apoptosis and thrombosis, and
improve vascular endothelial function. Acting on
the coagulation system, platelet function can be
improved, and HDL has a complex interaction with
the protein C and S system. The main component of
HDL is apolipoprotein A1 (apoAl), which is largely
responsible for RCT through the macrophage ATP
binding cassette transporter ABCA1. Infusion of
lipid free apoAl reduces neutrophil recruitment into
the vessel wall and MPO expression, as well as
endothelial expression of VCAM 1 and ICAM 1.
On the other hand, APO A1 can be damaged by
oxidative mechanisms, which render the protein
less able to promote cholesterol efflux. HDL also,
contains a number of other proteins that are affected
by the oxidative environment of the acute phase
response. Modification of the protein components
of HDL can convert it from an antiinflammatory to
a proinflammatory particle. Multiple clinical
studies have indetified individuals with a
significant atherosclerotic burden despite normal or
elevated levels of HDL-C. With further
investigation and resulting greater depth of
Introduction: Greater urban violence has resulted
in an increased incidence of penetrating neck
trauma. Penetrating neck wounds can present
difficult diagnostic and therapeutic dilemmas. The
evaluation and management of such injuries,
however,
remains
controversial.
Factors
contributing to these problems are complex
anatomy, proximity of vital structures and potential
for rapid deterioration of airway, vascular, or
neurologic injuries. Other contributing factors are
the lack of consensus in the literature regarding
appropriate evaluation and management of
penetrating neck injuries, and insufficient resources
or experienced personnel at some institutions.
Case description: A 16-year-old male was
presented to the emergency unit of the Military
Central Hospital in Tirana, Albania with a
penetrating neck wound. He had stridor, tacypnea,
subcutaneous emphysema, no active bleeding,
significant crepitations in the anterior region of the
neck and superior thoracic region. Physical
examination was remarkable for the wound in the
left anterior region of the neck, the subcutaneous
emphysema on the right part of the neck and the
right armpit, the light edema in the right part of the
neck. The wound was 3-4 cm long and sutured. He
was conscious; cardiovascular, respiratory and
renal systems were normal. Laboratory findings
were normal. Radiologic findings consisted of the
CT reports, which confirmed the perforation of the
trachea, pneumomediastin, pneumothorax, and
subcutaneous emphysema. He was admitted with a
diagnosis of penetrating neck wound and injury of
the trachea. Medical management consisted of
intravenous antibiotics, analgesics and bed rest.
During hospital stay the patient improved. He was
discharged on day eight.
Discussion: This case illustrates that an equal
willingness for both conservative and surgical
intervention as dictated by serial bedside evaluation
99
with adequate radiological support can provide the
clinician a safe and effective means of managing a
potentially complex and lethal problem.
OP005
STRUCTURE AND TRENDS IN INFECTIOUS
DISEASES SPREADING IN BULGARIAN
ARMED FORCES IN THE PERIOD 1997-2010
Authors: Maj. Popivanov I., MD1; Shalamanov
D., MD, PhD2; Bogdanov N., MD1; Col. Petkov A.,
MD, MSc1; LtCol. Kanev K., MD1
Institutions:
1. Military Medical Academy – Sofia, BULGARIA
2. Medical University – Pleven, BULGARIA
Objectives: This paper aims to make a
retrospective analysis of structure and trends in
infectious diseases spreading in Bulgarian armed
forces (BAF) during the period 1997-2010. The
period presents considerable changes in purpose,
development and tasks of BAF and significant
personnel reduction as well.
Materials and Methods: This survey is based on
data from the periodic reports of the officially
recorded infectious diseases and outbreaks in BAF
during analyzing period. Some data from scientific
studies are used as well. Regression analysis and
the least squares approach are conducted to
determine trends in infectious diseases incidence.
Results: The analyzed data shows an upward trend
in infectious diseases incidence, along with the
BAF personnel downsize. The infectious diseases
structure represents the leading role of Influenza
and Acute Respiratory Infections (ARI) – 38.3 % of
all patients, followed by Gastroenteritis (19.06 %),
Hepatitis A (9.04 %), Helminth diseases (5.98 %),
Mumps (5.01 %), Hepatitis B (3.45 %),
Chickenpox (3.16 %), Rubella (2.65 %),
Echinococcosis and Toxoplasmosis (1.84 %),
Shigellosis (1.62 %), Hepatitis C (1.54 %), Foodborne illness (1.51 %), Lyme borreliosis (1.0 %)
etc. Upward trends in diseases incidence are
ascertained for Influenza and ARI, Gastroenteritis,
Mumps, Chickenpox and Lyme borreliosis.
Downward trends are found for all types of viral
hepatitis, Rubella, Shigellosis and Food-borne
illness.
Conclusion: Infectious diseases continue to be
topical for the medical service of BAF. On one
hand, the ascertained trends in spreading of
infectious diseases resulted from the conducted
changes in structure and personnel of BAF. On the
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
other hand, they correspond with the introduction
and implementation in epidemiological practice of
certain vaccines and diagnostic tests with proven
effectiveness.
Correspondence:
OF-3 Popivanov Ivan, MD
Military Medical Academy, Georgy Sofiisky Str. 3,
1606, Sofia, BULGARIA
Fax: + 359 2 952 6536
Phone: + 359 2 922 5756
E-mail: drpopivanov@abv.bg
OP006
OCCUPATIONAL
ACCIDENTS
AND
MUSCULOSKELETAL DISORDERS IN THE
GREEK ARMED FORCES IN EVROS
COUNTY
Authors: MAJ Malliarou Maria RN, MSc, PhD1;
MAJ Karathanasi Konstantinia RN, MSc, PhD(c)1;
MAJ Moustaka Heleni, RN, MSc, PhD(c)2; MAJ
Sotiriadou Kiriaki RN, MSc, PhD(c)3; Sarafis
Pavlos4; Constantinidis Theodoros5
Institutions:
1. 404 General Military Hospital, Larisa, GREECE
2. Non-Commissioned Officers School, Trikala,
GREECE
3. 2nd Brigade/ DYG, Kozani, GREECE
4. Lecturer, Technological Institution of Lamia,
Nursing Faculty, GREECE
5. Associate Professor, Medical School,
Democritus University of Thrace, GREECE
Purpose: The purpose of this study was to
investigate musculoskeletal disorders in Greece in
relation to occupational accidents of army
personnel in Evros County.
Material and methods: A case-control study was
conducted in military personnel in Evros County in
Greece. Cases (n=250) were defined as enlisted
personnel having had an accident at work and the
control series (n=300) comprised of a simple
random sample, stratified by age from the army
population. Standardized Nordic Questionnaire for
the analysis of Musculoskeletal Symptoms (NMQ)
was used. The analysis was made with SPSS 19.
Results: Conscripted soldiers (OR=3.8, 2.21 to
6.58, p<0.001) and professional soldiers (OR=2.2,
1.28-3.75, p=0.004) had higher frequency of
occurrence of accidents in comparison to army
officers. Neck discomfort was present in 37.7% of
army personnel in the last 12 months and 23.6% of
participants could not complete their work because
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
of neck complaints. A 22.0% of participants had
knee discomfort in the last year and 15.3% could
not complete their work because of their knee
complaints. Finally, 24.4% of participants had
ankle discomfort in the last year and 11.8% of
participants could not complete their work because
of their ankle joint complaints. There was no
statistical
correlation
with
demographic
characteristics of the sample.
Conclusion: The Greek Armed Forces personnel
work in an environment with specific
characteristics and operate under difficult
conditions. Appropriate security measures, staff
training in hygiene and safety, mentoring of new
staff and conscripted soldiers will help in
occupational accident prevention.
OP007
MODELLING
LIPOPHILIC
COMPOUNDS
POWDERS
OF
TRANSFER
OF
ORGANOPHOSFOROUS
BY
DECONTAMINANT
Authors: Col. (ret) Prof. C.Mircioiu1,2, PhD;
Mihaela Ionescu1, PhD; Lavinia G. Hinescu1;
Lt.Col. PhD Maria C. Ranetti1,; Elena Ionica1
Institutions:
1. Army Center for Medical Research, C.A.Rosetti,
no.37; sect. 2,
2. University of Medicine and Pharmacy “Carol
Davila”, Faculty of Pharmacy, ROMANIA
The large spread use of solvents or surfactant
solutions for washing skin has the disadvantage that
apolar solvents and surfactants come to modify the
cornified layer, the main skin barrier face to skin
penetration of all xenobiotic compounds.
Adsorptive powders as non-specific antidotes
represent an alternative with fewer risks of later
undesired effects.
Aim of the study: The objectives of the present
paper were to estimate of the absorption,
decontamination and desorption of lipophilic
organophosforous compounds (LOPC) at skin level
using in vitro experimental models and to estimate
the antidote efficacy of adsorptive powders.
Material and method: The in vitro transfer across
synthetic membranes and skin of chlorpyriphos,
soman and malathione was studied using a static
Franz diffusion cell battery and a flow through cell
system. Cuprophane, cellulose acetate, methyl-ethyl
cellulose and polysulphone were used as
hydrophilic
membranes.
Acetophane
and
100
polyamide were used hydrophobic membranes.
Bentonite, magnesium trisilicate and a mixture
cellulose acetate – bentonite were tested as
adsorptive powders. The concentrations of the toxic
compounds in receptor compartment were
quantified using validated HPLC methods.
Results: The transfer of chlorpyriphos was
dependent on the membrane hydrofilicity: less
hydrophilic the membrane, less the chlopyriphos
transferred. The transfer of malathion across the
hydrophilic membrane cuprophane was less than
half of the transfer across the Acetophane
hydrophobic membrane.
Conclusion: The transfer across synthetic
membranes is strongly dependent on the affinity
between toxicants and membranes. The tested
powders significantly reduce the amount of
transferred toxicants across synthetic membranes –
at least for some hours.
Correspondence:
Telephone number: 004213156453
Fax number: 004213101410 8
OP008
SERUM ENZYME CHANGES IN SOLDIERS
DURING EXERTIONAL HEAT STRESS
Authors: Assoc. Prof. Sonja Radakovic1, Prof.
Maja Surbatovic1, Assist. Prof. Elizabeta
Ristanovic1, Col. Assist. Prof. Srdjan Lazic, Assist.
Prof. Slavica Radjen1, Vesic Zoran, MD2
Institutions:
1. The Medical Faculty of the University of
Defence;
2. Ministry of Defence, Republic of Serbia;
Belgrade, SERBIA
Background/Aim: Exertional heat stress is a
common problem in military services. The aim was
to examine changes in serum concentrations of
some enzymes in soldiers during exceptional heat
stress test (EHST) as well as the effects of a 10-day
passive or active acclimation in climatic chamber.
Methods: 40 male soldiers with high aerobic
capacity performed EHST either in cool (20ºC,
16ºC WBGT) or hot (40 ºC, 25 ºC WBGT) environ
ment, unacclimatized, or after 10 days of passive or
active acclimation. Physiological strain was
measured by tympanic temperatures (Tty) and heart
rates (HR). Concentrations of alanine- and
aspartate-aminotransferase (ALT, AST), lactatedehydrogenase (LDH), and creatine-kinase (CK)
101
were measured in blood samples collected before
and immediately after EHST.
Results: EHST in hot conditions induced
physiological heat stress (increase in Tty and HR),
with significant increase in concentrations of all
enzymes in unacclimatized group: ALT (42,5±4,2
before vs. 48,1±3,75 U/l after EHST, p<0,01), AST
(24,9±5,1 vs. 33,4±4,48 U/l, p<0,01), LDH
(160,6±20,2 vs. 195,7±22,6 U/l, p<0,001) and CK
(215,5±91,2 vs. 279,1±117,5, p<0,05). In
acclimatized soldiers there were no significant
changes in concentrations of ALT and AST, while
concentration of CK was significantly higher.
Concentrations of LDH were significantly higher in
all investigated groups, regardless of temperature
conditions.
Conclusion: In trained soldiers, a 10-day passive or
active acclimation in climatic chamber can prevent
increase in serum concentrations of ALT and AST
induced by exceptional heat stress. Increase in
serum concentrations of LDH was induced by
physical strain itself, with no additional effect of
heat stress.
Correspondence:
Assoc. Prof. Sonja Radakovic, M.D., PhD, Military
Medical Academy, Sector of Preventive Medicine
Crnotravska 17, 11 000 Belgrade, Serbia
OP009
PROTECTIVE EFFECTS OF MELATONIN
AND
S-METHYLISOTHIOUREA
ON
MECHLORETHAMINE
INDUCED
NEPHROTOXICITY
Authors: MAJ KUNAK Zeki Ilker, MD, PhD1;
CPT MACIT Enis, Pharm, PhD2; CDR YAREN
Hakan, MD, PhD1; CDR YAMAN Halil, MD3;
CAPT CAKIR Erdinc, MD3; CPT AYDIN Ibrahim,
MD3; MAJ TURKER Turker, MD4; CPT KURT
Yasemin Gulcan, MD3; COL OZCAN Ayhan,
MD5; MAJ UYSAL Bulent, MD6; MAJ ISBILIR
Salim, MD7; LCDR AKGUL Emin Ozgur, MD3;
MAJ CAYCI Tuncer, MD3; COL KORKMAZ
Ahmet, MD6; COL KENAR Levent, MD, PhD1.
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Medical CBRN Defense, Ankara, TURKEY.
2. Gulhane Military Medical Academy, Dept. of
Analytical Toxicology, Ankara, TURKEY.
3. Gulhane Military Medical Academy, Dept. of
Medical and Clinical Biochemistry, Ankara,
TURKEY
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
4. Gulhane Military Medical Academy, Dept. of
Epidemiology, Ankara, TURKEY
5. Gulhane Military Medical Academy, Dept. of
Pathology, Ankara, TURKEY
6. Gulhane Military Medical Academy, Dept. of
Physiology, Ankara, TURKEY
7. Beytepe Military Hospital, Dept. of Medical and
Clinical Biochemistry, Ankara, TURKEY
Objective: In this study, we aimed to investigate
the protective effects of melatonin (MEL) and Smethylisothiourea (SMT) on mechlorethamine
(MEC) induced nephrotoxicity.
Material and method: A total of 36 male SpraqueDawley rats were divided into four groups: control,
MEC, MEC+MEL and MEC+SMT. Three groups
received single dose of MEC (3.5 mg/kg) via
transdermal route. Control animals were given
saline only via transdermal route. MEL (100
mg/kg) was administered intraperitoneally 30 min
after the application of MEC, and after the same
dose of MEL was given every 12 h for a total of six
doses. SMT (50 mg/kg) was also given
intraperitoneally 30 min after the application of
MEC.
Results: The tissue TNF-α IL-1β and NOx levels
were found significantly different for all groups
(p<0.001). MEC application resulted in severe
histopathological changes. Melatonin showed
meaningful protection against kidney damage. But
protection by SMT was weaker. TNF-α and IL-1β
levels increased significantly with MEC application
and, MEL and SMT ameliorated these increases in
kidney tissue. MEC also elevated NOx levels in
kidney tissue.
Conclusion: Both inflammation and oxidative
stress may have an important role in the MEC
induced nephrotoxicity. MEL and SMT may also
have anti-inflammatory properties, as well as antioxidant properties.
Correspondence:
Zeki Ilker KUNAK GATA KBRN BD. Etlik
06018, Ankara, TURKEY
Tel: + 90 312 304 3331 GSM: + 90 533 646 5599
e-mail: zikunak@gata.edu.tr
UNAK GATA KBRN BD. Etlik 06018, Ankara
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
OP010
THE INFLUENCE OF PROFESSIONAL
FACTORS IN HEARING IMPAIRMENTS AT
MILITARY EMPLOYEES IN A TRANS
MISSION UNIT
Authors: Lt. col. Dr. Chelcea D1; dr. Carmen
Popentiu1; Mr. dr. Barna A. 2
Institutions:
1. Spitalul Militar de Urgenta, Sibiu, ROMANIA
2. Scoala Militara de Transmisiuni, Sibiu,
ROMANIA
One of the most important pathogenic factors in
military professions is the exposure to intense
noise. The traumatic hearing impairment represents
one of the most frequent pathology, either due to
acute exposure (firings, explosions), or caused by
chronic exposure to high intensity noise. Acute
exposure to intense noises in military transmission
units are rare and accidental, but chronic
impairment of internal ear is significantly increased
comparing with other types of military units. Based
on these observations, the present paper is a
retrospective study of 3 years, analyzing 30 persons
by annual audiometric testing and measuring the
hearing impairment after long exposure to high
intensity noises. Conclusions: the present study
confirms initial hypothesis – chronic exposure to
high intensity noises represents an important risk
factor for traumatic hearing impairment, and
professionals working in military transmission units
are more exposed to neurosensorial impairment
than other types of military workers.
Correspondence:
Lt. col. Dr. Chelcea D.
Emergency Military Hospital B-dul Victoriei 44-46
Sibiu, Romania
Tel +40269.211.209
OP011
SERBIAN WAR EXPERIENCES (1991-1999)
IN THE THORACIC
WAR INJURY
TREATMENT
Author: Col.Vlado Cvijanović M.D., Ph.D.
Institution: The MMA’s Clinic for Thoracic
Surgery, Medical Faculty, University of Defence,
Belgrade, SERBIA
Objective: The aim of this review was to present
our experiences in the thoracic war trauma and
septic complications treatment. We wanted to
emphasize the importance of the proper thoracic
102
drainage and advantages of the limited lung
resection in lung trauma treatment and early
decortication in the empyema treatment.
Methods: The review is a retrospective study of
1,303 injured soldiers who were treated in the
Military Medical Academy in the period of
September 1991 to June 1999, with statistical
significances were they have found out.
Results: We encountered 1,117 (86%) penetrating
and 186 (16%) non-penetrating thoracic injuries.
There were 703 (54%) shrapnel injuries, 535
(45.5%) gunshot injuries and 65 (0.5%) patients
with lung blast injury. In 675 (60%) lung injuries
were isolated and in 442 (40%) cases as
concomitant injury. The treatment was by stage,
from field hospital in the war zones in Bosnia and
Croatia through regional medical centers to our
hospital. Thoracic drainage was performed in 950
(85%) patients and 167 (15%) underwent
thoracotomy. Urgent thoracotomy was performed
in 49 injured soldiers (29% of thoracotomy
number) due to hemorrhagic shock and severe lung
damages. In 60 % of cases, heart and great vessels
injuries were successfully treated in field hospitals.
Mortality rate for this kind of injury was 29% .We
used to perform autotransfusion in 36 patients with
a large hemothorax. Overall complication rate was
11%. Most frequent causes were posttraumatic
empyema (59) and postoperative bleeding. We
found that limited lung resection has statistical
significantly fewer complications comparing with
suture method as well as early versus late
decortication. Overall mortality rate for isolated
injuries was 3% and for concomitant injuries 8%.
Conclusion: Thoracic drainage is the main surgical
procedure in the thoracic war trauma treatment.
Limited lung resection and early decortication are
operation of choice in the lung injury and empyema
pleurae treatment.
OP012
ISOLATED SHARP LACERATION OF THE
AXILLARY REGION. AN UNUSUAL CASE:
IMMEDIATE REPAIR OF THE BRACHIAL
PLEXUS AND BRACHIAL ARTERY AND
LONG-TERM FOLLOW-UP RESULTS
Authors:
CPT OKSUZ Sinan, MD; MAJ
KARAGOZ Huseyin, MD; LTC KULAHCI
Yalcin, MD; COL ULKUR Ersin, MD; 2LT USLU
Asim, MD.
103
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Institutions:
Gulhane Military Medical Academy, Haydarpasa
Training Hospital, Dept. of Plastic, Reconstructive
and Aesthetic Surgery and Burn Unit, Istanbul,
TURKEY
OP013
THE FIREARM TRAUMAS OF THE PENIS:
OUR 7-YEAR EXPERIENCE
Introduction: Sharp laceration injuries of the
brachial plexus are not common and long term
follow up results after repair are rarely reported.
Functional recovery results after the nerve repair
are closely related with the age and the level of the
injury. As the nerve injury shifts to proximal the
functional outcomes deteriorate.
Institutions:
Department of Urology, Central Military University
Hospital, Tirana, ALBANIA
Material and method: A five-year old child with a
skin laceration at the axillary region presented to
the emergency service 10 hours after injury.
Although the radial and ulnar artery pulses could
hardly be palpated the pinprick test did not
represent a major circulation problem. Surgical
exploration exhibited that the biceps brachii muscle
was totally lacerated at its humeral incertion and
the brachial artery, median, ulnar, radial and
musculocutaneous nerve branches of the brachial
plexus were also lacerated at the same level. All of
the lacerated nerves were repaired with epineural
sutures following the brachial artery anastomosis.
Results: Significant functional recovery was
determined at the injured extremity even three
months after the repair. Electromyography (EMG)
test results also supported the clinically observed
recovery. Postoperative first year follow-up results
revealed almost total functional recovery.
Negligible neuronal morbidity was determined with
EMG test at the postoperative first year visit.
Conclusion: The circulation deprivation of an
extremity even owing to the total brachial artery
laceration of the childhood patients can be tolerated
for longer periods than the adults. Successful
functional recovery results can be observed among
the younger patients even for the higher levels of
nerve injury.
Correspondence:
Gulhane Askeri Tip Akademsi Haydarpasa Egitim
Hastanesi,
Plastik ve Rekonstruktif Cerrahi Servisi, Selimiye
Mah. Tibbiye Cad. Uskudar 34668, Istanbul
TURKEY
Tel: + 90 216 542 20 20 – 4173
Fax: + 90 216 348 78 80 GSM: + 90 533 322 90 12
e-mail: sinanoksuz@gmail.com
Authors: Hodo A, Mustafa A, Mihaj B.
Objective: The firearm traumas of the penis are
rare. Starting from the first appearance and penile
hematoma following trauma most times these cases
ends up with penile exploration. In some cases
scrotal exploration is also necessary. Here we
introduce our 7-year experience in traumas of penis
with firearms.
Material and method: In this study we have
included cases of penile trauma with firearms in the
period 2004-2011. There are six cases of firearm
traumas of the penis. Two of these cases had the
scrotum explored and in 4 of them a penile
exploration was done. Due to edema of the skin of
the penis, the exploration included circumcision
and associated lacunar incision. This helps to exit
the penis completely disconnected from the skin.
Corpus cavernous damage at entry and exit of the
bullet as well as those of the corpus spongiosis are
regulated by making the debridement of the edge
lips of the wound and primary suturing with
prolene and vicryl. In both cases the testes were
explored; in one case the damaged testis could not
be preserved.
Results: In both cases where the firearm was in the
vicinity of > 10 cm, erosion of penile skin in the
dorsal part (entrance) was seen, resulting from the
burning of gunpowder or blast action. Erectile
dysfunction is not seen in any of the cases. Urethra
has been damaged tangentially in 3 cases and after
primary suturing there was no stricture of urethra in
follow-ups.
Conclusion: Penetrating trauma of the penis caused
by small caliber firearms in most cases damages are
much smaller than what can be expected. Methods
followed by our staff have optimistic results.
OP014
VOLUME REDUCTIVE TECHNIQUES IN
VAGINAL HYSTERECTOMY
Authors: Col. O. Nicodin MD, PhD; Cpt. Panaite
Bogdan MD; Col. Nicolae Niculescu MD; Mariana
Serban MD, PhD; Anca Cucu MD
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Institutions:
Central University Military Hospital, Bucharest,
ROMANIA
Introduction: The uterine size is a major criterion
in establishing the surgical route for hysterectomy.
The preoperative pelvic examination will give you
a good idea of the size and mobility of the uterus
but it is impossible to know whether a large uterus
can be removed through the vagina until the actual
attempt is made. Volume reductive techniques can
be used for overcoming intraoperative challenges in
such cases and they include: uterine bivalving/
bisection, myomectomy, intramiometrial coring,
morcellation and amputation of the cervix.
Objective: This study aims to evaluate the
relationship between each reductive volume
technique and morbidity and failure rate of vaginal
hysterectomy.
Study design: We compared the outcome of 545
case patients (out of a total of 1600 cases over a 2year count) for whom we used different volume
reductive techniques while performing vaginal
hysterectomy.
Results: Volume reductive techniques required a
longer operative time than simple hysterectomy, but
it did not affect hemorrhage or postoperative
complications. None of the cases needed
conversion to a laparotomy/ laparoscopy.
Conclusions:
Volume
reductive
vaginal
hysterectomy is a serious alternative to abdominal
approach for large uteri, affording patients less
morbidity and faster recovery. The main advantage
of this technique is represented by minimising
perioperative complications.
Correspondence:
Anca Cucu
Tel: +40726.380.039
e-mail: ancuta_pati@yahoo.com
OP015
OBSTRUCTIVE
SLEEP
APNEA
IMPLICATIONS FOR THE PERIOPERATIVE
SETTING
Authors: Diana Toma MD, Col. D. Stefanescu
MD, G-ral. Br. Prof. M. Macri M.D.
Institutions:
National Institute of
Bucharest, ROMANIA
Aerospatial
Medicine,
104
OSA – general implications. Obstructive sleep
apnea (OSA) syndrome is a common, yet
underestimated, chronic disorder with a major
impact on morbidity and mortality in the general
population. Hypertension, coronary artery disease,
arrhythmia, atherosclerosis, stroke, diabetes and
heart failure have all been linked to this syndrome.
Patients with sleep apnea suffer haemodynamic
disturbances caused by the decreases in
intrathoracic pressure during the periods of apnea,
and also biochemical derangements caused by
hypoxemia and CO2 retention, leading to
myocardial ischaemia, vasoconstriction and
inflammatory responses.
OSA – perioperative implications. An increased
risk for perioperative complications (including
cardiac ischemia and respiratory failure) has been
found in patients with OSA, because of the comorbidities associated with OSA, and because both
anesthesia and surgery affect the architecture of
sleep. Screening for OSA prior to surgery is
recommended to identify patients at risk for
postoperative complications.
OSA – our perioperative management. In order
to identify the patients with OSA, we first look for
physical characteristics reveal potential risks for
OSA (obesity, large neck circumference, HBP, etc),
we asked about snoring and waking habits, we use
preoperative screening tools (STOP-BANG
questionnaire). If moderate to severe OSA is
suspected, polysomnography can provide a more
complete diagnosis. In addition, to these patients
we perform an endoscopy or drug-induced sleep
endoscopy of the upper airway to locate the place
and identify the cause of the obstruction, in order to
find appropriate therapeutic solution. The presence
of moderate or severe OSA calls for modified
strategies of perioperative anesthesia, pain
management, and postoperative monitoring to
reduce OSA-associated complications.
OP016
COMBAT INJURIES OF THE HEART AND
CHEST MAJOR BLOOD VESSELS
Authors: Col. Profesor. Ilić Radoje. , Lt Col Dr.
Trifunović Zoran, Asst Prof Dr. Pavlović P., Dr
Mandarić Vladimir., Dr. Tišma Svetislav., Dr.
Marković Zoran
Institutions:
The MMA’s Clinic for Cardiac Surgery, Medical
Faculty of the University of Defence, Belgrade,
SERBIA
105
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Aim: To present the results of surgical treatment of
combat injuries of the heart and major blood
vessels in the chest.
Institutions:
The MMA’s Clinic for ORL, Medical Faculty of
the University of Defence, Belgrade, SERBIA
Material and method: We analyzed the results of
surgical treatment of combat injuries of the heart
and major blood vessels in the chest that occured
during war engagements in the territory of exYugoslavia from 1991 to 1995, as well as during air
bombing during March to June 1999. During this
period we treated 1303 wounded patients with
combat injuries of the chest; 1117 (84%) due to
penetrating injury and 186 (16%) due to
nonpenetrating wounds. Most frequent injuries
were explosive injuries (54%), injuries caused by
infantry gun arms (45.5%) and blast injuries
(0.5%). Incidence of thoracic trauma within total
number of injuries was around 12%.
The authors presented results of reposition of the
blast eardrum ruptures in 93 soldiers who
experienced war blast trauma.
All wounded soldiers were hospitalized within 72
hours after blast trauma. Unilateral rupture had 67,
and bilateral 25 of them. Otomicroscopic evaluation
and audiometry were done before surgical
intervention. Intervention was done in the general
anesthesia. Mean time of the hospitalization was
13.2 days. Control examinations were done
monthly, and definitive results were evaluated six
months after the reposition of the eardrum. On
indicated cases, reposition was done within 72
hours after the injury, others were treated
expectantly.
Results: During mentioned period there were 39
(4.69%) combat injuries of the heart and major
blood vessels of the chest. Combat wounds of the
heart were identified in 27 (3.25%) pts and major
blood vessels of the chest were treated in 12
(1.44%) of the wounded. There were 35 male
(89.18%) and four females (10.82%). The age of
the wounded ranged from 17 to 52 yrs (mean 29
yrs). Most frequent injuries were of right ventricle
and right atrium (16 pts), left ventricle injury had 4
pts, pericardium in 7 pts, aortic arch in 2 pts,
thoracic aorta in 3 pts, brachocephalic truncus in 2
pts, v. anonima in 3 pts, upper vena cava in 1 pt and
left a. Mammaria interna in 1 pt. Four wounded
died (two left ventricle injuries, one injury of the
aortic arch and one due to injury of upper v, cava).
In MASH Units 22 (59.46%) of injured were
initially surgically treated and 17 (40.54%) were
treated in Military Medical Academy. The most
frequent of vital damages in these kind of injuries
were bleeding and tamponade. It was clearly
analyzed that early CPR and prompt surgery create
a much better chance of survival.
Conclusion: Despite the fact that heart injuries
were taken as lethal in the front line, in a certain
percentage of the cases early CPR at the very site as
well as in MASH Units, including prompt surgical
intervention, contributes to increased percentage of
survival in these, often fatal wounds.
OP017
REPOSITION OF THE EARDRUM WAR
BLAST RUPTURES
Authors: Lt. Colonel Bozidar Jakovljevic, Colonel
Dusan Bijelic, Lt. Colonel Nenad Baletic
Results: Completely healing of the ruptures found
in 85.8%, minimal defect in 8.6%, and unchanged
status in 5.9%. Six months after the reposition
51.1% had regular hearing, uncompleted improved
hearing had 40% and unchanged hearing results
8.9% of the patients.
OP018
SENSORY IMPAIRMENTS IN REFLEX
SYMPATHETIC
DYSTROPHY
SYNDROME
Authors: Maj BAKLACI Korhan, MD
Institution:
Isparta Military Hospital, Physical Medicine and
Rehabilitation Service, TURKEY
Objective: The aim of this study is to assess
sensory impairments in reflex sympathetic
dystrophy syndrome (RSDS) and to search whether
these impairments are related with central
mechanisms and motor functional abilities.
Material and method: 24 patients with type 1
RSDS on upper extremity were included in the
study. 20 subjects, who had normal neurological
examination and did not have the diagnosis of
RSDS or any chronic pain syndrome, attended as
control group. 1999 modified IASP criteria were
used to diagnose as RSDS. Pinprick, temprature,
monofilament, vibration and two-point discrimi
nation tests were performed to evaluate sensory
assessments; DASH, FHS, Keitel index, gross and
fine grip force, Jebsen and Perdue Pegboard tests
had been performed to assess functional abilities.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Results: Scores of dominant or affected limb were
compared with scores of contralateral normal limb
also with scores of control group. Pressure
component of monofilament test and two point
discrimination test revealed that there was positive,
powerful, statistically significant correlation
between ipsilateral upper and lower extremity
scores (r=0.72, p=0.00), (r=0.66, p=0.000). There
was a mild-powerful correlation between affected
extremity functional assessment scores and sensory
assessment parameters. Consequently ipsilateral,
hemisensorial type sensory deficit were generally
observed in patients with upper limb RSDS.
Conclusion:
We concluded that sensory
impairments might affect motor functions and
sensorial assessment results of the ipsilateral lower
limb by central mechanisms.The most reliable data
could be obtained with monofilament and two-point
discrimination tests.
Correspondence:
Isparta Military Hospital, Physical Medicine and
Rehabilitation Service, 32100, Isparta, TURKEY
Tel: +90 246 224 11 65 Fax: +90 246 224 13 14
GSM: +90 532 335 83 31
e-mail: kbaklaci@yahoo.com
OP019
DYSLIPOPROTEINEMIA AND ISCHEMIC
BRAIN DISEASE
Authors:
Veljančić Dragana, Toplica Lepić,
Krsmanović Zeljko, Raičević Ranko
Institutions:
The MMA’s Neurology Clinic, Medical Faculty of
the University of Defence, Belgrade, SERBIA
Introduction: Dyslipoproteinemia is a major risk
factor for development of cerebral atherosclerosis
and ischemic brain disease (IBD). Normolipidemic
dyslipoproteinemia (ND) comprises quantitative
and/or qualitative changes of certain lipoprotein
components, with normal levels of total blood
cholesterol and triglycerides. : Oxidative modified
low-density (oxLDL) lipoprotein particles are
considered to have a major role in atherogenesis by
inducing the formation of foam cells and the
process of inflamation and thrombogenesis. The
aim of this study was to evaluate the significance of
different
lipoprotein
particles
and
their
modifications as well as apolipoproteins in cerebral
atherosclerosis and IBD.
Methods and results: The investigation included
150 patients of both gender with IBD of various
severity All patients were divided in subgroups
106
according to the severity of color-duplex
ultrasonography of carotid arteries, using a standard
five-graded scale. The patients with metabolic
disorders were not included There were 60 subjects
in the control group. The patients with metabolic
disorders were not included The serum levels of
HDL, LDL, oxLDL and total blood cholesterol,
TG, apoprotein A1, B and E, as well as total
antioxidative serum status were determined. Their
relative relations were also analysed. The results
showed that the most prominent lipid status
disorder in patients with cerebral atherosclerosis
and IBD was the increase of apoprotein B and the
decrease of apoA1/apoB index, while the level of
oxLDL particles was in positive correlation with
the severity of IBD. Decreased relation of total
LDL paticles ant total antioxidative serum status
was also significantly related to the severity of
cerebral atherosclerosis.
Conclusion: Disorders of apoprotein levels and
relations can suggest an increased risk of
atherosclerosis and IBD in individuals who were
considered as normolipidemic after routine lipid
status analysis (total cholesterol and TG level) were
done. OxLDL particles have important pathogenic
role not only in the process of atherogenesis, but
also in the pathogenesis of ischemic cerebral lesion
and reperfusional cerebral lesion.
OP020
VENOUS DRAINAGE IN NEUROLOGICAL
DISEASES
Author: Željko KRSMANOVIĆ
Institution:
The MMA’s Neurology Clinic, Medical Faculty of
the University of Defence, Belgrade, SERBIA
Background: Owing to the fact that 50-70% of
brain blood is represented by venous blood, venous
drainage is undeservedly neglected. There are
contradictory opinions on role of chronic
cerebrospinal venous insufficiency (CCSVI) in
ethiopathogenesis of Multiple Sclerosis (MS)
Methods: Using ultrasound we are able to examine
internal jugular, vertebral veins and their capacity
in the blood drainage. Emphasis will be on
pathophysiological findings in the field of venous
drainage in patients with:Transient global amnesia;
Venous thrombosis; Raised intracranial pressure;
Cephalalgia; Primary Pulmonary Hypertension;
Leukoaraiosis ; Chronic obstructive pulmonary
disease. We will show our results regarding to
venous drainage of CNS in different forms of
107
subjects with Multiple Sclerosis. Our study
included 58 MS patients (37 relapsing remittinmg
and 21 secondary progressive). There were 20
examinees in the control group. Duration of disease
and expanded disability status scale (EDSS) score
were determined.
Results: Out of 58 patients 13.79% was positive for
CCSVI and none of controls (p=0.08). We found
significantly higher presence of small internal
jugular vein (IJV) in patients with high functional
disability (EDSS ≥6,n=21) compared to other
patients (EDSS<6,n=37) (OR =13.4,CI 3.3–53.9,
p=0.0002) and controls (61.9 % vs. 10.8% vs.25%,
respectively;p<0.01).Also the high disability group
had OR = 7.0 CI 1.2 – 40.2, p<0.05, for CCSVI
compared to other patients.
Conclusion: Our results suggest that small IJV is
associated with more progressive MS. Impaired
venous drainage and its impact on the brain
function is neglected view on neurological diseases.
OP021
EVALUATION OF THE ANXIETY LEVEL
AMONG H.A.F. FLIGHT PERSONNEL
GROUPS AT A DIFFERENT TRAINING
PHASE
Authors: Lt Moutevelis Vasileios MD, FS; 2nd Lt
Kontotasios Alexandros, Psychologist; Capt
Alevetsovitis Georgios MD, FS
Institutions:
Aviation Medicine Office, 120 Flight Training
Wing, Hellenic Air Force, GREECE
Aim: To map two fundamental training screening
phases’ anxiety levels, compare anxiety scores
between them and depict internal trends.
Ultimately, detect probable pathology and evaluate
the efficiency of the current screening systems
suggesting alternative modifications.
Material and Method: Beck’s Anxiety Inventory
was used and 123 anonymous questionnaires were
distributed (Cronbach a = 0.81). We divided them
into four groups and compared them. Group A (61
trainees) was the personnel undergoing the first
screening phase and Group B (45 trainees) the
personnel of the second screening phase. We subdivided Group B into Group C (qualified and
continued to the last training phase: 17 trainees)
and Group D (discontinuation: 28 trainees).
Results: Group A did not exhibit higher anxiety
levels than Group B (p=0.971) despite the
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
participation of the extreme values of ‘’High-Very
High’’ at a significant percentage. Group B consists
of different trends: Group C shows increased
percentages of the values ‘’Medium-High’’,
contrary to the 82% of Low anxiety levels of Group
D; still, no statistical significance was confirmed
(p>0.05). After qualification Group C demonstrates
a significant decrease of those rates. High anxiety
levels were noticed to trainees of lower seniority in
Group A, whereas higher anxiety levels are noticed
to trainees of higher seniority in Group B. Another
important issue was the observation that in Group B
a moderate correlation exists (R=0.491) between
seniority and anxiety level of high significance (p=
0.001) Anxiety = 1.79-0.021xSeniority.
Conclusions: It seems that there exists a correlation
between anxiety and screening phase as well as
seniority, probably related to motivational factors.
Questions concerning the efficiency of the current
screening efficacy emerge as far as the initial
exclusion sufficiency is concerned and the
accordance between the guidance direction and the
cadets’ threshold of the selection screening phase.
From the perspective of Human Dynamics and
Human Resource Management we propose further
research in order to conform operational needs to
current screening procedures that will provide the
strategic advantage of maximizing Operational
capability and Safety.
OP022
SUICIDE IN THE
FORCES 2001-2010
SERBIAN
ARMED
Authors: Prof. DEDIC Gordana. M.D., Ph.D.;
Col. PANIC Milivoj. M.D.; Col. Asst. Prof.
SAMARDŽIĆ Radomir M.D., Ph.D.; Maj. ŽIVIC
B. M.D.
Institutions:
The MMA’s Psychiatry Clinic, Medical Faculty of
the University of Defence, Belgrade, SERBIA
Introduction: Analyses of suicide risk factors is
important in taking some suicide preventive
measures within the Suicide Prevention Program in
Military Environment, which was fully applied in
2003 in the Serbian Armed Forces.
Aim: to establish the suicide risk factors of military
personnel in the Serbian Armed Forces within the
period 2001 to 2010.
Material and Method: Analysis of the suicide risk
factors for military personnel was carried out on the
basis of data obtained by psychological suicide
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
autopsy, Pierce Suicide Intent Scale (SIS1- subscale
Circumstances of suicide) and Life Event Stress
Scale (Paykel). Descriptive statistics method was
used for the risk factors analysis.
Results: 61 military personnel of Serbian Armed
Forces committed suicide within the period 2001 to
2010: 11.48% officers, 27.86% noncommissioned
officers, 11.48% contract soldiers and 49.18%
soldiers during military service. A graphics
representation of completed suicides within the
period from 2001 to 2010 is given. Distal and
proximal suicide risk factors and characteristics of
suicide are described, for each category of military
personnel.
Conclusion: According to the presence of multiple
suicide risk factors, Suicide Prevention Program of
military personnel in the Serbian Armed Forces is
directed to prevention of proximal and distal
suicide risk factors.
OP023
ALCOHOL AS RISK FACTOR FOR
PSYCHOLOGICAL
AND
PHYSICAL
TRAUMA AMONG MILITARY PERSONNEL
DURING WAR AND PEACETIME
Authors: Professor MANDIĆ-GAJIĆ Gordana
M.D., Ph.D.; Professor ŠPIRIĆ Željko MD, PhD;
Col. Asst. Prof. SAMARDŽIĆ Radomir M.D.,
Ph.D
Institutions:
The MMA’s Psychiatry Clinic, Medical Faculty of
the University of Defence, Belgrade, SERBIA
Background: Both during the war and in the
peacetime alcohol intoxication and abuse play a
major role in the morbidity and mortality associated
with accidents, negative mood states, homicide,
suicide, and medical conditions among military
personal.
Objective: To investigate the differences in pattern
of alcohol use, depressiveness, life events, and
suicide attempts between alcoholics and healthy
military personal.
Material and Method: After detoxication, 100
inpatient primary alcoholics were investigated and
were compared with 30 healthy military persons in
the post-war period. All participants were males,
aged from 20 to 60 years, without prominent
medical illness. The pattern of use of alcohol was
retrospectively analyzed. The data from medical
records and structured interviews were obtained, as
108
well as BDI scale (Beck, 1960) for depression
screening. The differences between groups were
tested by Student t-test.
Results: Ninety percent of healthy persons
consumed alcohol on social occasions. Stress life
events, physical injures alcohol amount and
frequency of drinking were significantly more
frequent among alcoholics. There was no
depression among healthy personal, but alcoholics
had mild depression. Suicide attempts existed in
6% of alcoholics.
Conclusion: Recurrent alcohol use is hazardous,
especially in the army, and is related to life
stressors, physical injures, depression and suicide
attempts. It is necessary to improve prevention and
early detection of alcohol misuse in the army units.
OP024
PSYCHIATRIC CONSEQUENCES OF
HEAD AND BRAIN TRAUMA INJURY
A
Authors: Col. Asst. Prof. SAMARDŽIĆ Radomir
M.D., Ph.D.; Professor ŠPIRIĆ Zeljko M.D., Ph.D.;
Maj. KRSTIĆ Dragan. M.D.; Professor MANDIĆGAJIĆ Gordana M.D., Ph.D
Institutions:
The MMA’s Psychiatry Clinic, Medical Faculty of
the University of Defence, Belgrade, SERBIA
Background: Over the past decades, a growing
attention has been paid to the interplay between
physical and psychological injuries; that is, to the
psychological consequences of a physical injury
caused by a traumatic event. At present, there is a
growing body of literature indicating that, apart
from the posttraumatic stress disorder (PTSD),
other mental disorders may result from a traumatic
event, and that the probability of suffering from
more than one mental disorder simultaneously is
the rule and not the exception.
Objective: Our aim was to determine the
relationship between a physical injury, especially
the one involving the head and brain, and its mental
health consequences.
Material and Method: We conducted a crosssectional clinic-based study of the war veterans
evaluated for their degree of disability at the
MMA’s Psychiatry Clinic. Our group included 237
veterans with a disability confirmed by the Civilian
Medical Boards. Data on the degree of physical
injuries and documented medical diagnoses were
109
extracted from their medical records. The main
mental health outcome measures used in our survey
included Clinical Interview, Impact of Event Scale
(IES-R) and Clinician-Administered PTSD Scale
(CAPS). The statistical analysis was performed
using descriptive and analytical non-parametric
methods.
Results: Among 121 (51.1%) wounded veterans,
there were 71 (30%) with body injuries, 19 (8%)
with head injuries, and 31 (13.1%) with associated
head and body injuries. The PTSD was diagnosed
in 72 (30.4%) veterans, of which 31 (43.1%) were
wounded, 11 were from a group of veterans with
associated injuries, and 7 were head-injured
veterans. Out of 18 veterans with the lifetime
PTSD, 6 had associated body and head injuries.
There were only eight wounded veterans diagnosed
with other mental disorders apart from PTSD.
Conclusion: Most of the veterans in our study
group were wounded. High PTSD rates were found
among wounded veterans. These findings have
inidicated that the head and brain trauma should be
incorporated into early screening for PTSD risk.
OP025
THE ROLE OF MANIPULATION UNDER
ANAESTHETIC IN A STIFF KNEE JOINT
AFTER ANTERIOR CRUCIATE LIGAMENT
RECONSTRUCTION:
METHOD
AND
TIMING
Authors:
LT COL I. Bisbinas1; MAJ D. Georgiannos1; LT
COL M. Savvidis1; CDR C. Bissias2; LT I.
Theodoroudis1; LT COL M. Hatzopoulos3; COL G.
Gouvas1
Institutions:
1. Orthopaedic Dept, 424 Military General
Hospital, Thessaloniki, GREECE
2. Orthopaedic Dept, Naval Hospital of Athens,
Athens, GREECE
3. Anaesthesiology Dept, 424 Military General
Hospital, Thessaloniki, GREECE
Introduction: Anterior cruciate reconstruction
(ACL-R) is nowadays almost routinely performed
following traumatic rupture of the anterior cruciate
ligament (ACL). However, postoperative rehabili
tation and recovery could occasionally prove tricky
and eventful.
Objectives: Aim of the study is the evaluation of
the outcome of a postoperative rehabilitation
protocol used after ACL reconstruction surgery.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Methods: We retrospectively evaluated 150
patients who underwent ACL reconstruction with
the use of autologous hamstrings graft. Values that
were checked were: knee range of motion (ROM),
quadriceps muscle atrophy, knee stability, time to
return to previous athletic activities. All patients
were examined at 6 weeks, 3 months and 6 months
postoperatively.
Results: All patients had ROM 0-90º at discharge.
At 6 weeks, 9 (6.5%) had ROM<70º and 80 (60%)
quadriceps muscle atrophy of 2 cm. At 3 months,
only 5 (3%) had ROM<100º and 2 (0.75%)
quadriceps muscle atrophy of 2 cm. In 2 patients,
stiffness was dramatically improved following
Manipulation Under Anaesthetic (MUA) with
femoral nerve block infusion. At 6 months all
patients had ROM 0-120º and returned to moderate
athletic activities.
Conclusion: In cases of stiffness after ACL
reconstruction surgery, early management with
MUA and physiotherapy improves the ROM and
speeds up the time of return to athletic activities.
OP026
THE
ROLE
AND
TIMING
OF
MANIPULATION UNDER ANAESTHETIC IN
A STIFF TOTAL KNEE REPLACEMENT
Authors:
LT COL I. Bisbinas1; MAJ D. Georgiannos1; LT
COL M. Savvidis1; CDR C. Bissias2; T. Mihail1;
LT COL M. Hatzopoulos3; COL G. Gouvas1
Institutions:
1. Orthopaedic Dept, 424 Military General
Hospital, Thessaloniki, GREECE
2. Orthopaedic Dept, Naval Hospital of Athens,
Athens, GREECE
3. Anaesthesiology Dept, 424 Military General
Hospital, Thessaloniki, GREECE
Introduction: Stiffness in the knee joint after a
Total Knee Replacement (TKR) is not uncommonly
seen in Orthopaedic clinics. It can lead to unhappy
patients with limping and low level of daily living
activities (DLAs).
Objectives: To evaluate the outcome of
postoperative rehabilitation following Total Knee
Replacement surgery as regards to the knee range
of motion (ROM).
Material-Method: We retrospectively investigated
the clinical notes and radiographs of all our patients
with TKRs performed in our department during the
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
last 2.5 years. Their rehabilitation progress was
recorded during their follow-up at 6 weeks, 12
weeks, 6 months and one year.
Results: We collected and examined the notes of
131 patients who had an otherwise uncomplicated
TKR. There were 112 females - 19 males with a
mean age of 54.7 years. All of them had a range of
movement (ROM) of 90° before their discharge
from the hospital. At 6 weeks postoperatively, 38
patients and at 12 weeks 17 patients had a ROM
below 90°. Of these, 6 patients had MUA followed
by physiotherapy, and 11 patients only received
physiotherapy management. The MUA patients had
an average of 26.2° improvement and 4 reached
knee flexion of 90° at the 6-month appointment.
Those without the MUA had only 11.4°
improvement and only 3 patients reached the 90°
mark at the 6-month appointment. At one year
postoperatively, the patients had minimal additional
improvement (average 3.2°).
Conclusions: Early management of the stiff TKR is
imperative and it should be done between 6-12
weeks postoperatively. The combination of MUA
with physiotherapy (in the beginning under femoral
nerve block) is extremely helpful for the patient.
Early management of the stiff TKR using the
combination of MUA and physiotherapy leads to
substantial improvement of ROM in the knee joint.
OP027
AVASCULAR NECROSIS OF FEMORAL
AND TIBIAL CONDYLES IN THE KNEE
JOINT: FOUR-YEAR EXPERIENCE AT A
MILITARY HOSPITAL
Authors:
LT COL I. Bisbinas1; MAJ D. Georgiannos1; LT
COL M. Savvidis1; LT I. Theodoroudis1; CDR C.
Bissias2; T. Mihail1; COL G. Gouvas1
Institutions:
1. Orthopaedic Dept, 424 Military General
Hospital, Thessaloniki, GREECE
2. Orthopaedic Dept, Naval Hospital of Athens,
Athens, GREECE
Introduction: Avascular necrosis (AVN) in the
bones around the knee joint is not a particularly
common occurence. It can be treated either
conservatively or operatively and it often leads to
knee osteoarthritis.
Objectives: To investigate the outcome of
conservative treatment in cases of AVN in the
bones around the knee joint.
110
Methods: We investigated the clinical notes of all
our patients with AVN around the knee joint during
the last four years. Radiological investigations were
also examined and our patients were followed up
with a phone interview.
Results: We collected data regarding 32 AVN
patients with atraumatic bone oedema, 26 in the
femoral condyles and 6 in the tibial condyles with a
mean age of 54.7 years. Further to history, clinical
examination and laboratory investigations, the
diagnosis was based on plain radiographs and MRI
scans. All patients were treated conservatively with
physiotherapy which was coupled with partial- or
non-weight bearing (PWB/NWB) mobilisation,
salmon calcitonin (nasally), calcium and D3
vitamin (orally) for a total of 4 months. All of them
had clinical improvement and revealed a 60-80%
bone oedema improvement without chondral
lesions in the 3-month follow-up MRI scan. None
had operative management to date. Clinically, they
returned back to their previous job within 3.8
months and sports activities in 4.8 months.
Conclusion: Early diagnosis of AVN in the bones
around the knee joint is based on MRI scan. The
disease can be successfully managed conservatively
in the majority of patients if diagnosed early. PWB
or NWB in combination with anti-osteoporotic
treatment and physiotherapy may lead the disease
to settle. However, progressive disease will require
operative treatment in the form of either
arthroscopy and bone drilling or Total Knee
Replacement (TKR).
OP028
COMPUTER NAVIGATED TOTAL KNEE
ARTHOPLASTY
Authors:
Col. Professor Zoran. Popović, M.D., Ph.D.; Maj.
Dragan. Radoičić, M.D.; Lt.Col. Milan. Luković,
M.D.; Lt Aleksandar Jevtić, M.D
Institutions:
The MMA’s Clinic for Orthopaedic Surgery and
Traumatology, Medical Faculty of the University of
Defence, Belgrade, SERBIA
Background: Navigated total knee arthroplasty
(TKA) has a great potential to increase the
precision of component placement. Primary goal of
computer navigated TKA is to reduce the revision
rate of TKAs by improving the alignment of
components.
111
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Material and methods: Navigated TKA at the
Military Medical Academy was introduced
26.12.2006. So far we have performed 108
navigated TKAs. Sixty four unilateral, and 22
bilateral TKAs (in the same procedure). The
average age of patients was 66.2 years; 82 of the
108 total knee arthroplasties implanted with a
navigation system were investigated. Elements
specifically related to navigation difficulties were
studied. The series was composed of 46 women and
36 men. All patients were reviewed by the operator
using a standard X-ray protocol. Mean follow-up
was six months. Primary or post-traumatic
osteoarthritis were the main reason for surgery.
Navigated TKA series was compared with one
series of 96 TKA (same total knee implant type),
implanted without a navigation system. The two
series were compared in terms of operative time
and precision (comparison of postoperative
alignment and implant position). We also focused
on difficulties encountered when using the new
system, on intra- and postoperative complications
and on assessment of implant position.
Results: All procedures were performed with the
same navigation system (Zimmer-Orthosoft
Navitrack), and with the same type of total knee
prosthesis. Operative time was lengthened by an
average of 19 min (range, 8 to 48 min). We noted
no complications specifically related to the
navigation system. The position of the implants was
assessed in the frontal and sagittal plane on the
plain X-rays (of whole leg) and with a goniometer.
Computed tomography was used to assess femoral
component rotation (in 17 cases). In the computer
navigated series the overall alignment of the lower
limb was within the "ideal" range of +/-3 degrees in
91.4%. Implant accuracy in not navigated series
was within ideal range of +/- 3 degrees in only
81.2% of cases.
Conclusion: In our series of computer navigated
TKAs we did not have any of major problems with
the new technology. The length of the learning
curve was acceptable. The potential for improving
the alignment of prosthesis and eliminating human
error are the strongest arguments for using a
navigation system, while the prolonged operative
time and risk of infection still remain as valid
reasons, for some surgeons, against the introduction
of computer navigation.
OP029
HEAD AND NECK
RECONSTRUCTION
Authors:
MICROVASCULAR
Col. Prof. Jefta Kozarski, Brig. Gen. Prof. Marijan
Novaković, Ltc. Asst. Prof. Boban Djordjević,
Nikola Ostojić M.D.
Institutions:
The MMA’s Clinic for Plastic Surgery and Burns,
Medical Faculty of the University of Defence,
Belgrade, SERBIA
The head and neck region’s defects present a great
challenge for reconstructive surgeons. We report
our experience in the treatment of 54 patients with
head and neck microvascular flap reconstruction
after war wounds with burns, with postburn
contracture and after tumor resection (36 war
wounded patients, 2 with burns, one with postburn
neck contracture and 15 tumor resection). We
applied six fibular, four scapular, three radial
forearm, one dorsalis pedis and one latissimus dorsi
free flap. Fibular and radial forearm flap were used
for reconstruction of the mandibular bone, while
scapular, dorsalis pedis and latissimus dorsi flaps
were used for filling the defects of the mouth floor,
orbital or maxilar region. We used scapular free
flap for covering the burn of the face, scapular and
parascapular flap for the covering of the neck and
exposed mandibular bone and preexpanded
scapular and parascapular flap for correction of the
neck’s postburn contracture. We treated extensive
wartime tissue defects of the lower third of the face
with composite free flaps: seven scapular, nine
radial forearm and twenty fibular flaps. Length of
the mandibular defects varied from 5-16 cm. The
bones were fixed by wire, miniplates or external
fixation. The skin parts of the flaps were used in
reconstruction of lower lip, chin and/or cheek,
respectively. Vascular pedicles of the flaps were
microsutured to either the superior thyroid, facial or
external maxillary and carotid vessels. Our
experience
and
results
in
microvascular
reconstruction in the head and neck region support
the use of this reconstructive method.
OP030
OUR EXPERIENCE IN THE TREATMENT
OF CHEMICAL BURNS
Authors:
Ltc. Asst. Prof. Boban Djordjević; Col. Prof. Jefta
Kozarski; Brig. Gen. Prof. Marijan Novaković; Ltc.
Milomir Gačević, MSc, M.D; Maj. Saša Miličević
MSc, M.D.
Institutions:
The MMA’s Clinic for Plastic Surgery and Burns,
Medical Faculty of the University of Defence,
Belgrade, SERBIA
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
A chemical burn is a special type of burn injury,
caused by a chemical agent. It occurs when of
living the tissue is exposed to a corrosive chemical
compound, most commonly a base or an acid and
hydrocarbons. The severity of burns associated with
chemicals depends on the concentration of a
substance, the length of exposure, and the type of
chemical causing the damage. These burns don't
need a source of heat and can be extremely painful,
as they evolve very quickly.
Most acids produce a coagulation necrosis by
denaturing proteins, and form a coagulum (eg,
eschar) that limits the penetration of the acid. Bases
typically produce more severe injuries known as
liquefaction necrosis. This involves denaturing of
proteins as well as saponification of fats, not
limiting tissue penetration. Hydrofluoric acid is
somewhat different from other acids in that it
produces a liquefaction necrosis. Chemical in a
gaseous form can cause direct injury to the lungs
and respiratory system. In case if the agent causes
only external skin damage, it may be accompanied
by respiratory complications because they may
trigger the release of histamine which can cause
swelling or bronchospasm. Sometimes chemicals
may be absorbed into the tissue thus causing
secondary injuries. A patient’s history should
include the following:
− Offending agent, concentration, physical form,
pH;
− Route of exposure;
− Time of exposure;
− Volume of exposure;
− Possibility of coexisting injury and
− The timing and extent of irrigation
First aid should consist of neutralizing of the
chemical agent if possible. This should be
performed with great care, because some
neutralizing reactions are exotermal or produce
poisonous substances, which may cause even more
damage. Irrigation of the affected area with cool,
clean water is also an option, but it should also be
handled with care because some substances react
violently with water and can cause further damage.
The treatment involves removal of the agent and, in
most cases, a high-density water shower. Surgical
intervention may be required, especially if the
burns are deep and require skin grafting.
OP031
LOWER EXTREMITY RECONSTRUCTION
WITH FIBULA FLAP
112
Authors:
MAJ KARAGOZ Huseyin, MD1, COL ULKUR
Ersin, MD1, LTC KULAHCI Yalcin, MD1, CPT
OKSUZ Sinan, MD1, LCDR CAKMAK Selami,
MD2, COL RODOP Osman, MD2, COL
MAHIROGULLARI Mahir, MD2
Institutions:
1. Gulhane Military Medical Academy, Haydarpasa
Training Hospital, Dept. of Plastic and
Reconstructive Surgery, Istanbul, TURKEY
2. Gulhane Military Medical Academy, Haydarpasa
Training Hospital, Dept. of Orthopedic Surgery,
Istanbul, TURKEY
Objective: The aim of this study is to present our
results and experiences about lower extremity
reconstruction with fibula flap.
Material and method: We used the fibula flap for
lower extremity reconstruction in three cases. In the
first case, the free fibula flap was used to repair of
pathological femoral neck fracture. This patient had
already been operated on twice by the orthopedic
surgeon because of the non-healing fracture and we
used free fibula flap to support the neck of the
femur. Free fibula flap was used to repair the
proximal femur defect that had occurred as a result
of tumor excision in the second case. In the last
case, fibula flap was used as pedicled to repair the
ipsilateral tibia defect. The patients were followed
up at least 6 months.
Results: All of the flaps survived. We didn’t
observe any serious complication. The patients can
walk with assistance. Time has not been enough yet
to walk without assistance.
Conclusion: The fibula flap which can be elevated
with considerable big size is a versatile and also
very useful when used to repair lower extremity
bone defects as well as of the head and neck region.
Especially, it may be primarily preferred to
reconstruct large size load-bearing bone defects
which have poor blood supply.
Correspondence: Gulhane Askeri Tip Akademisi,
Haydarpasa Egitim Hastanesi, Plastik Cerrahi
Servisi, Uskudar 34668, Istanbul, TURKEY
Tel: +90 216 5422020 (4204)
Fax: +90 216 GSM: +90 532 5169957
e-mail: hkaragozmd@hotmail.com
OP032
FOOT ARC RECONSTRUCTION WITH
FREE OSTEOCUTANEOUS FIBULA FLAP
IN GUNSHOT WOUNDS
113
Authors:
MAJ SAHIN Ismail, MD, MAJ ZOR Fatih, MD,
COL OZTURK Serdar, MD, COL NISANCI
MUSTAFA, MD, COL ESKI Muhitdin, MD, COL
ISIK Selcuk, MD
Institution:
Gulhane Military Medical Academy, Dept. of
Plastic and Reconstructive Surgery, Ankara,
TURKEY
Objective: The skeletal integrity of the foot is as
important as the soft tissue coverage of the foot. In
this article, we present reconstruction of arches of
foot with free osteocutaneous fibula flap.
Material and method: Five patients with
composite foot defects underwent reconstruction a
with free osteocutaneous fibula flap. Free fibula
flap was used to reconstruct the transverse arch in
two cases, longitudinal arch in two cases and lateral
longitudinal
and
anterior
transverse
arc
simultaneously in one case. Functional outcome
was evaluated with three dimensional motion
analyses. The follow-up period was 3.2 years.
Results: No early or late complications were
encountered and all patients were satisfied with
both cosmetic appearance and functional aspects of
their foot. Fibular bone showed a very healthy
course without any fracture, resorption, extrusion,
or migration. Three dimensional motion analyses
revealed a successful restoration of the arch
structures.
Conclusion: As a conclusion, free osteocutaneous
fibula flap was found to be a good alternative for
reconstruction of longitudinal and transverse arches
of the foot.
Correspondence:
Gülhane Askeri Tip Akademisi, Plastik ve
Rekonstrüftif Cerrahi AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 304 5409
Fax: +90 312 304 5404 GSM: +90 532 664 9285
e-mail: drismailsahin@yahoo.com
OP033
IN THE ICU SETTING ULTRASONO
GRAPHY IS AN IDEAL FIRST LINE
DIAGNOSTIC INTERVENTION
Authors:
LT COL Karellas J, LT COL Aloizos S, LT COL
Gourgiotis S, MAJ Tsakalakis Chr, .MAJ
Arsenoglou A, MAJ Sourlas S, LT COL Liapis G
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Institution:
401 General Military Hospital, Athens, GREECE
Purpose: To evaluate the usefulness of
ultrasonography in a general intensive care unit
(ICU).
Materials and methods: In a one-year study, 247
patients that were admitted in a general ICU were
evaluated sonographically both on admission and
after indications. The initial evaluation consisted of
abdominal, cardiac and/or transcranial ultrasound
scan (TCD). Multiple ultrasound scans in each
patient were performed by properly trained
intensivists.
Results: A total of 2019 ultrasound examinations
were performed (850 TCDs, 293 Cardiac, 588
Abdominal and 288 Large Vein). Findings that led
to a change in diagnosis or treatment were
documented. In patients with traumatic brain injury,
TCD was able to demonstrate a decrease in cerebral
perfusion pressure (CPP) in 80% of the patients
(n=35). TCD was able to demonstrate brain death
(BD) many days before clinical tests became
eligible (n=17, 7±3). In 12 of 35 TBI patients TCD
was used to direct therapy. Transthoracic cardiac
ultrasound was able to reveal cardiac dysfunction in
40% of the patients who were hemodynamically
unstable (n=80). Abdominal ultrasound showed
abnormal findings in 20% of the cases (n=195).
Large veins were found thrombosed in 3% of the
febrile patients (n=140). Vein thrombosis was
revealed in all patients that presented with massive
pulmonary emboli (n=3).
Conclusion: Ultrasonography justifies its use as a
first line evaluation tool in ICU giving solutions in
a variety of clinical problems. All the intensivists
should be familiar of the multiple ways ultrasounds
can be used in ICU as this will raise confidence and
increase accuracy in any clinical decision.
OP034
DIASTOLIC FUNCTIONS OF THE LEFT
VENTRICLE
IN
PATIENTS
WITH
HYPERTROPHIC
CARDIOMYOPATHY:
PRELIMINARY REPORT
Authors:
MAJ
ALAGOZ
Engin,
MD,
COL
KARACALIOGLU A. Ozgur, MD, 1st LT INCE
Semra, MD, MAJ EMER Ozdes, MD, GUNALP
Bengul, MD, COL ARSLAN Nuri, MD, RDML
OZGUVEN M. Ali, MD.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Institution:
Gulhane Military Medical Academy, Dept. of
Nuclear Medicine, Ankara, TURKEY
Objective: Hypertrophic cardiomyopathy (HCM)
is a genetically transmitted cardiac disease in
majority of cases which usually involves the apex
and interventricular septum asymmetrically. It is an
important cause of morbidity, arrhythmias and
sudden cardiac death especially in young people.
The aim of this study was to evaluate the diastolic
functions derived by planar multigated analysis
(MUGA) in patients with HCM diagnosed by
echocardiography.
Material and method: 6 patients (1 woman, 5
men; 45±9 years) with HCM and randomly chosen
6 patients (1 women, 5 men; 47±6 years) without
HCM diagnosed by echocardiography for
comparison were included in the study. The
diastolic functions of the left ventricle were derived
from planar multigated analysis study in all
patients. The results were compared by using the
independent samples t-test.
Results: Although the difference between the
parameters of PFR and EF of the diastolic functions
of the left ventricle of both groups was statistically
significant (p=0.020, and p=0.047 respectively), the
difference between the parameters of PER, TTPF,
and TTPE of the diastolic functions of the left
ventricle were not significant (p=0.325, p=0.900,
p=0.287, respectively).
Conclusion: According to our results, the presence
of HCM seems to reduce the diastolic functions of
the left ventricle and the early results of this study
seems to be helpful in the management of these
patients. Since depressed diastolic functions of the
left ventricle can lead to reduced diastolic filling of
the left ventricle, increased congestion in the lungs
and finally heart failure.
Correspondence:
Gulhane Askeri Tıp Akademisi, Nükleer Tıp AD,
Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 4820 (w)
Fax: + 90 312 304 4800 (w) GSM: + 90 542 577
9101
e-mail: enalamed@yahoo.com
OP035
DIASTOLIC DISFUNCTION IN CORONARY
ARTERY DISEASE
114
Authors:
1st LT INCE Semra, MD, COL KARACALIOGLU
A. Ozgur, MD, MAJ EMER Ozdes, MD, MAJ
ALAGOZ Engin, MD, GUNALP Bengul, MD,
COL ARSLAN Nuri, MD, and RDML OZGUVEN
M. Ali, MD.
Institution:
Gulhane Military Medical Academy, Dept. of
Nuclear Medicine, Ankara, TURKEY
Objective: A heartbeat is a two-part pumping
action that takes about a second. If the diastole part
of this action is abnormal, this is called diastolic
dysfunction. This can lead to pulmonary congestion
or systemic congestion. The aim of this study was
to evaluate the diastolic dysfunction in coronary
artery disease diagnosed by gated myocardial
perfusion imaging (gMPI).
Material and method: 101 patients (40 women,
61men; 65±9 years) were included in the study.
gMPI was performed with Tc-99m MIBI in all
patients and exercise test was performed with
treadmill exercise stress test according to Bruce
protocol in a gamma camera (Discovery 530 NC,
GE, USA). According to gMPI results, patients
were categorized as normal, ischemia and infarct.
The relationship between measurements was
evaluated by one-way ANOVA test.
Results: The parameters of systolic and diastolic
functions of the left ventricle were significantly
different among study groups. While the endsystolic and end-diastolic volumes of the left
ventricle were increasing in the ischemia and the
infarct groups, ejection fraction and parameters of
diastolic functions significantly decreased in the
ischemia and infarct groups. This difference was
more prominent in the infarct group (p<0.001).
Conclusion: The diastolic parameters are important
as much as the systolic parameters of the left
ventricle and these both parameters can easily be
calculated in the new generation gamma cameras.
As in our study, both systolic and diastolic
functions of the left ventricle depressed in the
presence of the coronary artery disease and this
depression is more prominent in the myocardium
after infarct.
Correspondence:
Gulhane Askeri Tıp Akademisi, Nükleer Tıp AD,
Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 4807 (w)
Fax: + 90 312 304 4800 (w) GSM: + 90 505 710
4320
115
e-mail: since@gata.edu.tr
OP036
RIGHT VENTRICULAR INFARCTION AND
GENDER
Authors:
Col. Gligić Branko, Capt. Džudović B, Capt. Djurić
I, Capt. Sipcic M, Lt.Col. Obradovic S, Djenic N,
Maj. Jovic. Z, Ristic A, Col. Ratkovic N, Col.
Dincic D, Rafajlovski S.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Conclusion: According to the criteria we used for
diagnosis of RVI, women have more often RVI
than men.
OP037
MULTISLICE CT OF THE CORONARY
ARTERY DISEASE
Authors:
Col. Dr. D. Cuzino Assoc. Professor of Radiology1,
Mr. Dr. S. Stanciu2, Dr. Oana. Baston2, Dr.C. Blaj2
Institutions:
The MMA’s Clinic for Emergency Medicine,
Medical Faculty of the University of Defence,
Belgrade, SERBIA
Institutions:
1. Medical Military Institute-Bucharest ROMANIA
2. Central University Emergency Military Hospital
– Bucharest ROMANIA
Background: Differences between men and
women with acute myocardial infarction regarding
age, risk factors and clinical presentations are well
known. However, difference in localization of
myocardial infarction among genders is still
questionable.
Purpose: Coronary calcification detected by
multislice CT (MSCT) is a marker for
atherosclerotic disease with prognostic significance.
The unstable plaque with clinical consequences is
characterized by a high lipid content rather than
calcification, which may make detection using only
the calcium score difficult. To assess the prevalence
and severity of atherosclerotic disease in patients
without coronary calcification, we also evaluated
findings in patients with a normal calcium score.
Objectives: To estimate the frequency of the right
ventricle infarction (RVI) in women and men and
to compare the clinical features of this complicated
infarction among genders.
Methods: In the period from January 2005 to
January 2012, 368 consecutive patients with STsegment elevation myocardial infarction (STEMI)
who underwent primary or urgent percutaneous
coronary intervention (PCI), were enrolled in this
study. Criteria for inferior STEMI with RVI were
presence of ST-segment elevation for ≥1mm in
minimum two inferior leads and in the right
precordial lead V4R in extended baseline
electrocardiogram. Using the same criteria for the
diagnosis of RVI, searching PubMed and Cohrane
databases, 9 more relevant studies of RVI were
identified and included in meta-analysis.
Results: Among 368 patients with STEMI,
presence of RVI between women and men was:
28% vs. 9.5% respectively, OR = 3.701 (95%CI
2.017-6.791), p<0.001. With right coronary artery
as an infarction related artery, presence of RVI in
women and men were 72.2% vs. 28.9%
respectively, OR=6.392 (95%CI 2.678-15.258),
p<0.001. From a total of 3868 patients with inferior
STEMI included in meta-analysis, 417 of 905
women (46%) and 1155 of 2963 men (39%) had
RVI, OR=1.338 (95%CI 1.151 - 1.554) p < 0.001.
Methods and Materials: Clinical and MSCT data
were analyzed in consecutive high-risk patients
with suspected Coronary Artery Disease (CAD)
who were scheduled for 64-slice MSCT coronary
angiography. For the calcified plaques we used
Agatston score. MSCT angiograms were assessed
for their presence, luminal stenosis severity,
location, and type (non-calcified, mixed or
calcified) of coronary atherosclerotic plaques. The
pacients were followed-up. Cardiac events (cardiac
death, nonfatal myocardial infarction (MI) and
revascularization were related to clinical and
MSCT data.
Results: Coronary plaques were found in the
majority of patients. We assessed the potential
cardiac events.
Conclusion: MSCT coronary angiography provides
prognostic information in high-risk patients with
suspected CAD. It may also identify those who
despite high SCORE value are at very low risk for
future adverse cardiac events or can be followed by
a potential interventional radiology procedure.
Correspondence:
Col. Dr. D. Cuzino, Associate Professor of
Radiology
Tel: +40722.657.456
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
e-mail: dragos_cuzino@yahoo.com
OP038
ROLE OF CORONARY CALCIUM SCORE IN
STRATIFICATION OF PATIENTS WITH
HIGH
AND
INTERMEDIATE
FRAMINGHAM RISK PATIENTS
Authors:
S.
STANCIU1,
Magda
IRICIUC1,
F.
NAFTANAILA, S. DUMITRESCU, D. CUZINO2
Institutions:
1. Bucharest University Military Hospital “Carol
Davila”
2. Bucharest Cardiovascular Army Center
“Constantin ZAMFIR”, ROMANIA
Background: The majority of patients with
metabolic syndrome (MS) have a Framingham high
risk score but there are a lot of patients with
intermediate risk Framingham score. The aim of
this study is to determine the amount of coronary
calcium and distribution of the plaques in untreated
metabolic syndrome patients with Framingham
high risk score compared to a group of metabolic
syndrome patients with intermediate Framingham
risk score using 64-multislice detector computed
tomography (MDCT).
Methods: We prospectively included 53 untreated
asymptomatic patients with high risk score (HRS)
MS (male 69%, 54 ± 7 years, mean Framingham
score 24) and 39 untreated asymptomatic patients
with intermediate risk score (IRS) MS (male 59%,
56 ± 6 years, mean Framingham score 15). All
patients underwent both MDCT calcium scoring
and coronary angiography. Agatston score and
coronary plaque burden were calculated.
Results: There was no difference regarding calcium
score and coronary plaque burden in patients with
HRS-MS compared to patients with IRS-MS
(Agatston= 47 vs 38). Moreover the prevalence of
significant obstructive CAD was similar in both
groups (22 % vs 21%).
Conclusions: The patients with HRS-MS have the
same anatomical coronary profile like patients with
IRS-MS highlighting the problem of limited power
of imaging risk score versus low predictability of
the traditional risk prediction models in this
population. The patients with MS represent a
heterogenic group where the limit between high and
intermediate risk score is flu.
116
Correspondence:
S. STANCIU, Bucharest University Military
Hospital “Carol Davila”
E.mail: silviu.stanciu@yahoo.com
OP039
INVASIVE ASSESSMENT OF CORONARY
RESERVE-FRACTIONAL FLOW RESERVE
(FFR)
Authors:
Maj. Zoran Jović, M.D, Nemanja Đenić MD2,
Radoslav Romanović2, Predrag Đurić M.D1,
Marijan Spasić MD1, Zorica Mladenović MD,
MSc1, Prof. Dragan Tavčiovski
Institutions:
1. The MMA’s Clinic for Cardiology
2. The Medical Faculty of the University of Defence
Belgrade, SERBIA
Background: Clinical significance of coronary
artery stenosis of moderate severity is sometimes
difficult to determine. Myocardial fractional flow
reserve (FFR) is a new index of the functional
significance of coronary stenosis, which is
calculated by measuring the pressure during
coronary arteriography. Defining the hemodynamic
significance of stenosis by visual estimation of the
angiogram is difficult. Often it seems that we cure
the stenosis which is not clearly associated with
symptoms, even when ischemia can be attributed to
the lesion when the stenosis is mild or moderate.
One way to define the pathophysiological
significance of border stenosis (diameter stenosis of
50 to 70%) is to determine the fractional flow
reserve (FFR). FFR is defined as the ratio of the
maximum achievable blood flow in the narrowed
coronary arteries in relation to the maximum flow
of blood through the artery when the same would
not be narrowed. Its normal value is 1.0 and values
<0.75 identify lesions that are associated with
ischemia, with high diagnostic accuracy of 90%.
Many studies have demonstrated the safety of
disposal of revascularization in patients with
moderate coronary stenosis on the basis of FFR ≥
0.75.
Methods: To determine the value of FFR is used
the wire diameter of 0.36 mm (0.014 inches), which
measures the pressure in the coronary artery via a
sensor that is located 3 cm proximal to the top of
the wire. Managing wire and its flexibility is very
similar to conventional wires that are used during
percutaneous coronary intervention. 6 or 7 French
(Fr) catheters, that is placed through the femoral
vein, most commonly recommended for the
117
assessment of FFR-a. Before inserting the wire,
which is sensitive to pressure changes, we
administered the nitroglycerin and heparin
according to standard protocol. Then the wire is
extremely null and inserted into the distal portion of
catheter. After equalizing the pressure, they are
confirmed at the site and the wire is introduced and
positioned at least 2 cm below the stenosis. In order
to properly determine the value of FFR, it requires
a maximal hyperemia of coronary artery that is
achieved with an intracoronary bolus or continuous
infusion of vasodilators (adenosine, adenosine 5'triphosphate (ATP), papaverine and dobutamine),
and then we determines the FFR. Taking everything
into account, when measuring FFR, is usually used
intracoronary adenosine or ATP. Vasodilator agents
(adenosine or ATP) is given in doses of 20-40 mg
intracoronary.
Conclusion: FFR is a simple and reliable index of
functional severity of coronary artery disease.
Making decisions on the basis of physiological
criteria for evaluation is certainly. If the lesion is
not hemodynamically significant, patients do not
benefit from revascularization, and medication
treatment may be used instead, which is safer and
results in better outcome. Thanks to many recent
studies, FFR method is entered in the recent
recommendations for the diagnosis of lesions
caused by ischemia.
OP040
CORONARY FLOW RESERVE (CFR)
Authors:
Zorica Mladenovic1 MD, MSc; Ana Djordjevic Dikic2, MD, PhDa; Prof. Dragan Tavciovski1; Maj
Zoran Jovic, MD1; Predrag Djuric, MD, MSc1
Institutions:
1. The MMA’s Clinic for Cardiology, The Medical
Faculty of the University of Defence Belgrade,
SERBIA
2. University of Belgrade, School of Medicine,
CCS, Institute for Cardiovascular Diseases,
Belgrade, SERBIA
Coronary flow reserve (CFR) is defined as a ratio
of maximal (stimulated) to baseline coronary
bloodflow. CFR evaluation is important for the
understanding of the pathophysiology of coronary
circulation. CFRmeasurement is used both to assess
epicardial coronary stenoses and to examine the
integrity
of
microvascular
circulation.An
appreciation of coronary physiology is an integral
part
of
clinical
decision-making
for
cardiologiststreating patients with coronary artery
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
disease. Transthoracic Doppler echocardiography
(TDE), to measure coronary flow and CFR, is noninvasive, easily available at bedside, not expensive,
and without radiation exposure, with multiple
potential clinical applications. Recently the
usefulness
of
transthoracic
Doppler
echocardiography to assess CFR has been reported
in various clinical settings in a large general referral
population. The measurements of TDE-CFR are
closely correlated with invasive measurements
using a Doppler flow wire. The method provides
reliable measurements of CFR in the distal or
middle segment of left anterior descending
coronary artery (LAD), in the circumflex
coronaryartery (ACX) and in the right coronary
artery (RCA) using pulsed wave Doppler
echocardiography under the guidance of color
Doppler flow mapping. The most commonly used
vasodilator to assess TDE-CFR is adenosine.
Coronary angiography provides a limited insight
into the physiological significance of coronary
stenoses. Therefore, the CFR is a useful parameter
in several important clinical settings like functional
assessment of intermediate stenosis, detection of
critical stenosis, combined assessment of coronary
flow and wall motion, monitoring the changes of
CFR in the post PCI period to detect artery
occlusion, microvascular stunning or to predict
restenosis and assessment of coronary graft
patency. In the absence of stenosis in the epicardial
coronary artery, decreased CFR enable to detect
impairedmicrovascular vasodilatation in: reperfused
myocardial infarct, arterial hypertension with or
without left ventricular hypertrophy, diabetes
mellitus, hypercholesterolemia, syndrome X,
hypertrophic cardiomyopathy. In these diseases,
noninvasive transthoracic Doppler echocardio
graphy allows for serial CFR evaluations to explore
the effect of various pharmacological therapies.
Correspondence:
Zorica T. Mladenovic, MD, MSc
Vojislava Ilica 22, Belgrade 11000, Serbia
Tel.: +381 65 808 6 148
E mail: zoz3377@gmail.com
OP041
CONCEPT OF MEDICAL MANAGEMENT
OF CHEMICAL ACCIDENT – ROLE AND
TASKS OF SERBIA NATIONAL POISON
CONTROL CENTRE
Authors:
Prof. Jasmina Jovic-Stosic, M.D., Ph.D.; Prof.
Slavica Vucinic M.D., Ph.D
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Institutions:
The MMA’s National Poison Control Centre, The
Medical Faculty of the University of Defence,
Belgrade, SERBIA
The possibility of mass chemical injuries due to
industrial accidents or terrorist attack is every day
reality. The most probable scenario includes
surgical trauma and toxic effect of gasses. Medical
management of mass injuries is a public health
concern in coordination with other governmental
and local authorities and services. It includes
activities on education and prevention, response
planning and coordination and finally medical care.
Treatment of victims may need complex measures
including activities on the site, transportation, and
hospital care. Analysis of the chemical accidents
worldwide reveals some important general lessons
for health service and the authorities. Dissemination
of the information to the involved services could be
of great assistance. The toxicology information
system should be able to evaluate, summarize and
proceed information on poisonous substances. It
should facilitate determination of a possible cause
based
on
symptoms,
physical
findings,
biochemistry and simple qualitative analysis for
poisonous substances. It also should be able to
manage antidote distribution as quickly as possible.
Consequently, Serbian National Poison Control
Centre is consisted of informational, analytical,
treatment and experimental departments. It is
located in Military Medical Academy (MMA) in
Belgrade, medical institution of tertiary level with a
capacity of 1214 beds. Being a part of MMA,
Centre benefits from all advantages of central type
hospital. Except for the capacity of Centre (24
beds), there is a reserve of 10-15% unoccupied beds
within the hospital, kept for emergency admissions.
The capability of the hospital to fulfill the tasks
concerning management of chemical accident
victims also involves adequate communication,
access and decontamination facilities. In case of
mass chemical trauma coordination team may
activate Mobile Toxicological - Chemical Squad,
which includes clinical toxicologists and specialists
of toxicological chemistry. Its main activities are:
detection, identification and quantification of
chemicals in environment and biological material
on site; organization of the management and
medical treatment of poisoned persons; first aid and
emergency treatment on site along with local
medical staff; supportive and symptomatic care
during transport of poisoned subjects. Clinical
toxicologists and poison centres should play a
major role in preparing for the case of chemical
accident or terrorist attack. The prior detailed
response planning is essential. An adequate supply
118
of protective equipment is required for the rescuers.
Plans for decontamination should take into account
not only hospitals, but also public facilities in the
area. Emergency organizations must cooperate and
must be trained to response effectively.
OP042
TRIAGE TAG PROPOSAL FOR MOBILE
MEDICAL FACILITIES
Authors:
Assist.prof. col. Caius Bogdan Teuşdea MD, PhD,
EMDM
Institutions:
Emergency Receiving Unit, Central Universitary
Emergency Military Hospital „Dr. Carol Davila”,
Bucharest; ROMANIA
Summary: War is a disaster and from the medical
point of view a disaster is characterized by the
disproportion between the demand for medical aid
and medical response capacity. Triage is a medical
management approach to identify cases, placing
them in categories of triage increasing the chances
of survival. Proposed triage card is to improve the
identification, marking the victims, but also to link
the various stages of the chain of medical help to
ease the tracking of victims and not least forensic
matter.
Correspondence:
Assist.prof. col. Caius Bogdan Teuşdea Emergency
Receiving Unit, Central Universitary Emergency
Military Hospital „Dr. Carol Davila”
e.mail: teusdea_bogdan@yahoo.com
OP043
DU IN SERBIA - PAST, PRESENT AND
FUTURE ACTIVITIES
Author:
Assoc. Prof. Djurovic B, M.D., PhD
Institution:
The Radiological Protection Department, Military
Medical Academy, University of Defence,
Belgrade, SERBIA
In 1999, during the NATO attacks on Kosovo over
50000 30-mm projectiles have been shot from AT10 aircrafts against the tanks and armoured
vechicles of Serbian Army on 112 locations in
Kosovo, 7 locations in the South of Serbia and one
location in Montenegro. These projectiles contained
aproximately 15 tones of DU. Besides DU,
projectiles contained products of DU radioactive
119
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
decay as well as americium, neptunium, plutonium
and technetium. After the strikes these locations
were heavily contaminated. NRBC and Medical
Services performed numerous activities before,
during and after the strikes. In this paper these
activities are presented, as well as our limitations
and plans of future activities. Immediately after the
strikes, all the locations were defined, marked, coordinates, isolated and the residents informed. In
order to prevent further spread of contamination
and possible harmful health effects and wide
contamination of the environment, decontamination
plan was created and performed on the south of
Serbia in a few subsequent years after the strikes.
Health surveillance programme for exposed
military personnel, included educational material,
criteria for the selection of the personnel, medical
protocol, radiation protection measurements and
biodosimetry were performed. Knowing that DU
can cause genetic and teratogenic hamful effects in
the embrios/foetus our pediatric service organized
follow-up study of the heritable effects, congenital
malformations and malignant diseases, endocrine
and immune disorders in the offspring of military
personnel employed in DU contaminated regions.
Monitoring of the environment, including water
supplies and milk was organized. Besides the fact
that most of contaminated locations in Kosovo are
under international supervision, our main limitation
was the lack of adequate equipment, especially
ICP-MS. Controversial results of international
teams sent to explore environmental conditions in
Serbia, as well as long-term contamination and
possible harmful effects, imply the need for the
further activities. We belive that objective
international teams constituted of the experts from
all sides involved in the problem under the
supervision of UN and WHO, should examine
environmental conditions, as well as health
consequences in residences of contaminated regions
and help in decontaminations.
3. University Emergency
Bucharest, ROMANIA
Contact: E-mail: djurovic.branka@gmail.com
OP045
CIVIL-MILITARY COOPERATION IN THE
MEDICAL UNIVERSE
OP044
NEW DRUG-ABUSE PSYCHOTOMIMETICS
SUBSTANCES
Authors:
CS III. Mărgărita Forje1; Acad. Prof. Dr. V.
Voicu12; Prof. Dr. R. Macovei12,3; Dr. Ilenuţa
Dănescu2; Dr. Daniela Burlacu Ph.D.2; Eng.
M.Ionică1
Institutions:
1. Military Medical Research Centre
2. UMF “Carol Davila”
Military
Hospital
In the last period, new drug-abuse substances
“psychotomimetics” have appeared, designed as
products with other uses and benefits apparently
harmless, such as: traditional and medicinal plants,
plant fertilizer, bath salts and all. FPIA techniques
which
can
determinate
barbiturics,
benzodiazepines,
opiates,
antidepressants,
phencyclidines, cocaine, amphetamines and
methamphetamines, give a negative response, in
case there are analyzed the urine samples from
those
subjects,
because
for
the
new
psychotomimetics do not exist monoclonal
antibodies that are a part of FPIA kits. The
consumers can be associated this substance with
traditional abuse substances, such as: opiates,
antipsychotic, anticonvulsivantes, antidepressants,
THC. This association can result in very severe
clinical symptoms that can be in some cases fatal.
The authors present a GC-MS method to be used in
the identification of psychotomimetics substances.
The urine samples have been collected from the
patients presented in the ER and other medical
facilities in Bucharest. Those samples have been
analyzed on a FPIA-COBAS Integra 400 Plus, and
also on a GC-MS Saturn 2000 Varian. For the
identification of the substances found in the pieces
that have been analyzed, we used the PMW, NIST
and Wiley libraries. Some of those substances
could not have been identified in the spectrum
libraries. Analyzing the vectors taken from the
market, these substances were also identified and
some of these substances are named with the
commercial name of the vector.
Correspondence:
Mărgărita Forje
Tel: 0724384941
E-mail: m_forje@yahoo.co.uk
Authors:
Col (ret) Professor Kanev Kamen, Col Kostadinov
Rostislav, Col Parashkevov, Col (ret) Aleksandar
Dimitrov
Institution:
Military Medical Academy, Sofia, BULGARIA
Introduction: Throughout the history medical care
providers have broaden medical art objectives and
capabilities in such an extent that it became a
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Universe. There are many examples of interactions
and cooperation between the civilian and military
medicine resulting in great medical breakthroughs.
The changing in the military objectives with
increasing role of military involvement in disaster
relief, humanitarian and stabilization and
reconstruction operations combined with the
immense medical science and technologies
development are just a few of the contemporary
world’s demands for enhancing the Civil-Military
Medical Cooperation.
Aim: The aim of study is to present the areas where
civil-military medical cooperation could be
intensified. The means for achieving it are also
discussed. Descriptive method along with heuristic
analysis is applied for depicting the areas where the
coordination between civil and military medicine
could be strengthen. By means of the cluster
analysis in the conclusions means for improvement
of the coordination into depicted areas are
proposed.
Correspondence:
Dr Rostislav Kostadinov, MD, PhD Colonel, BGR
A
Email: r.kostadinov@jfcna.nato.int
rostikosti@abv.bg
OP046
COMPARATIVE
EFFECTS
OF
ANTIOXIDANTS ON CHRONIC ETHANOLINDUCED OXIDATIVE STRESS IN RAT
HIPPOCAMPUS
Authors:
CPT MACIT Enis, Pharm, PhD1; MAJ KUNAK
Zeki Ilker, MD, PhD2; MAJ ULUSOY Gokhan,
MD1; COL CELIK Turgay, MD1; MAJ KAYIR
Hakan, MD1; COL UZBAY Tayfun, Pharm., PhD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Pharmacology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Medical CBRN Defense, Ankara, TURKEY
Objective: The aim of the study was to investigate
the effects of antioxidant agents such as melatonin,
vitamin E, vitamin C, ebselen and proanthocyanidin
(PAC) on chronic ethanol-induced oxidative stress
in rat brain.
Material and methods: Seventy adult male Wistar
rats were used in experiments. Ethanol was given to
rats by a liquid diet for 28 days. Control rats were
pair fed an isocaloric liquid diet containing sucrose
120
as a caloric substitute to ethanol. Melatonin (4 mg),
ebselen (20 mg), PAC (100 mg), vitamin E and
vitamin C (100 mg/kg/ day) were applied to rats by
oral route with a help of gavages for 7 days from
22nd day of ethanol administration. Blood alcohol
levels were measured by gas chromatography
technique. MDA, SOD and GSH-Px levels were
measured in hippocampal tissue.
Results: While chronic exposure to ethanol caused
a significant increase in MDA level, it significantly
decreased both SOD and GSH-Px levels in
hippocampal tissue. All antioxidants used in the
study significantly reversed both the decrease in
SOD and the increase in MDA levels. Vitamin E
and vitamin C were found to be ineffective on
decreased GSH-Px level in ethanol administered
rats.
Conclusion: Our results suggest that chronic
ethanol exposition causes oxidative stress responses
that can be reversed by melatonin, ebselen, PAC,
vitamin E and vitamin C treatments in hippocampal
area of rat brain. In addition, melatonin, ebselen
and proanthocyanidin were more effective than
vitamin E and vitamin C.
Correspondence:
Enis MACIT GATA Analitik Toksikoloji BD.
06018, Ankara, TURKEY
Tel: + 90 312 304 4784
GSM: + 90 530 426 4379
e-mail: enis@gata.edu.tr
OP047
DRUG ABUSE TESTING PROGRAM IN THE
SERBIAN ARMED FORCES
Authors:
Professor Kilibarda Vesna, Ph.D., Djordjević
Snežana, Ph.D.
Institutions:
MMA’s National Poison Control Centre, The
Medical Faculty of the University of Defence,
Belgrade, SERBIA
Abusing of psychoactive substances in recent years
has been increased, with alcohol as the most
frequently agent, especially in young population.
The results of recruits and professional soldiers of
Serbian Army testing, which has been carried out
from 2006, show that there was abusing of different
psychoactive substances. Cannabinoids and opiates
also were detected in small percent of soldiers. For
the purpose of testing of psychophysical ability of
Serbian candidates for peace keeping missions we
121
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
performed testing of psychoactive substances abuse
(alcohol and drugs abuse). For determination of
ethyl alcohol, blood is the sample of choice.
Analysis of alcohol in blood is performed by gas
chromatography with flame ionization detection
(GC-FID). Detection of drugs abuse from five
groups (opiates, cannabinoids, metamphetamines,
cocaine and benzodiazepines) is performed from
urine samples, because of its fast metabolism and
low concentration in blood. The first step in
analysis of these compounds is immunochorma
tographic test. Every positive result has to be
confirmed by analyzing of samples with some of
chromatographic technique. Application of mass
spectrometric method is very important because of
possibility of false positive results after screening
immunochromatographic testing, especially in the
cases of heroine abusing. Described analytical
techniques has important role in reliable testing of
those substances abuse. This is the way to avoid the
publishing of false positive results obtained after
performing of immunochromatographic tests.
Furthermore, these results together with other
biochemical tests and physical examination can
obtain a complete image of psycho-physical
condition of Serbian Army candidates for Peace
keeping mission.
(courses) related to scientific work: Basic
Principles of Scientific Work, Evidence-based
Medicine, Scientific Thought and Research. The
cadets are able to learn the methodology of
scientific work through small research projects in
different area such as immunology, biochemistry,
histology and molecular medicine. Three to four
cadets work in a group together with their mentor.
The work begins with several theoretical lectures
about scientific problem, hypothesis, aim of the
study and methodology. This is followed by
practical work in the laboratory. In addition to
acquiring the practical skills, the cadets are
encouraged to discuss and interpret the obtained
results, thus developing the scientific way of
thinking. The final part of the research project is
related to oral or poster presentation of the results.
Moreover, the cadets learn how to publish the
results as a second step of their education. The best
results will be presented at congresses and meetings
organized by students of medicine.
OP048
THE ROLE OF SCIENTIFIC WORK IN THE
CURRICULUM OF MEDICAL STUDIES AT
THE MEDICAL FACULTY OF THE
MILITARY
MEDICAL
ACADEMY,
UNIVERSITY OF DEFENSE
Authors:
Gencheva, D; Nikolova, M
Author:
Miodrag Čolić, Brigadier General
Background: The rupture of an intracranial
aneurysm is a severe and usually life-threatening
condition. Endovascular treatment allows aneurysm
exclusion from circulation thus avoiding
craniotomy.
Institutions:
Academician Medical Faculty of the Military
Medical Academy, University of Defense in
Belgrade, SERBIA
The Medical Faculty of the Military Medical
Academy (MMA-MF) was established in 2009 and
together with the Military Academy constitutes the
University of Defense. The integrative studies of
medicine at MMA-MF, which lasts 6 years, are
based on three key principles. One of them is a
core, consisting of 35 courses, that is common to all
medical studies. The other principle is based on a
great number of various electives, especially those
based on scientific work. The third part consists of
knowledge and skills necessary for specific duties
of military doctors, including the treatment of
people affected by natural disasters or mass
casualty accidents. There are several subjects
OP049
ENDOVASCULAR
TREATMENT
INTRACRANIAL
ANEURYSMS
PREPARATION AND MONITORING
THE PATIENTS
OF
–
OF
Institutions:
Department of Neurosurgery, Military Medical
Academy, Sofia, BULGARIA
Aim: To assess the effectiveness of a perioperative
preparation and monitoring protocol for patients
with intracranial aneurysms treated by means of
endovascular embolization.
Materials and Methods: During an 18-month
period (Jan 2010-July 2011) we studied 106
patients with intracranial aneurysms treated
endovascularly in the Department of Neurosurgery,
Military Medical Academy, Sofia. All patients
underwent brain vessel angiography and were
treated accordingly either by coil and/or stent
application. We employed a perioperative
preparation protocol which comprised of a 5-day
course of anti-coagulation, i.v. infusion of 1,500 ml
saline prior to the procedure, low-molecular weight
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
heparin 4 hours post-procedure and ‘triple H’. We
continuously monitored blood pressure, heart rate,
oxygen saturation and GCS score. Strict visual
surveillance of the femoral artery puncture site was
performed.
Results: Introducing our perioperative preparation
protocol to patients with endovascular treatment of
intracranial aneurisms prevented complications
among studied patients. We did not record a single
lethal outcome or a case of newly presented
neurological finding. All patients were ambulatory
on the 30th hour post-procedure and discharged
from the Department on the 48th hour.
Conclusion: Our perioperative preparation protocol
for patients treated endovascularly for intracranial
aneurysms allows reduction of post-procedure
complications.
OP050
ENDOVASCULAR
TREATMENT
OF
CAROTID-CAVERNOUS
AND
DURAL
ARTERIOVENOUS FISTULAE
Authors:
M. Lilov1, Col. T. Eftimov2, Lieut I. Todorov2, I.
Hadzhiangelov2, N. Neichev3, D. Zidarova3
Institutions:
1. Department of Image Diagnostics
2. Department of Neurosurgery
3. Department of Anesthesiology and Critical Care,
Military Medical Academy, Sofia, BULGARIA
Aim: To present the etiology, classification and
current options for endovascular treatment of the
carotid-cavernous and dural arteriovenous fistulae
and to analyze in this respect the outcome of
patients treated in MMA - Sofia.
Material and methods: A retrospective analysis of
selected cases from the clinical practice of our
departments is provided, along with a short
literature review, so as to illustrate the current state
of the diagnosis and the endovascular methods for
treatment of the intracranial arteriovenous fistulae.
Results: Both the endovascular coil-embolisation
of the fistulae and the parent artery reconstruction
using flow-diverter devices resulted in occlusion of
the arteriovenous communication with no
procedure-related complications.
Conclusions: The CT and the MRI provide
valuable initial information, but are not always
conclusive about the diagnosis and the particular
type of the fistulae. The Digital Subtraction
122
Angiography (DSA) remains the “golden standard”
for imaging and can be used for subsequent
endovascular treatment of these diseases. Because
of their minimal invasiveness and low complication
rates, the endovascular interventions become a
method of choice for the management of the
intracranial arteriovenous fistulae.
Correspondence:
Military Medical Academy Department of
Neurosurgery 3, Georgi Sofiyski blvd. 1606 Sofia
Tel: +359 88 981 15 43
e-mail: ivantd13@abv.bg
OP051
SENSORY RE-EDUCATION OF THE HAND
AFTER COMPLETE MEDIAN NERVE
TRANSACTION AND MICROSURGICAL
REPAIR
Authors:
LT COL Dimitrios K. Antonopoulos, MD1,3;
Andreas F. Mavrogenis, MD2; Dimitrios Korres
MD2; Nikolaos Efstathopoylos MD2; Sarantis G.
Spyridonos, MD3
Institutions:
1. Hellenic Police, Medical Service
2. Department of Orthopaedics, Athens University
Medical School
3. Department of Hand and Upper Extremity
Surgery and Microsurgery, KAT Hospital, Athens,
GREECE
Objective: To evaluate the functional outcome
after complete median nerve transaction and repair,
and sensory re-education.
Methods: We studied 37 patients, aged 22 to 45
years, with median nerve neurotmesis at the wrist.
Primary epineural microsurgical repair using 8-0
single-strand sutures was done in all patients, and a
hand and wrist cast was applied for 4 weeks. After
cast removal all patients went through physical
therapy for 1 month to restore motion and reduce
stiffness of the injured hand. After re-innervation
was completed, the patients were randomly
allocated into 2 equal groups: Group A (19)
patients were instructed to a sensory re-education
program; Group B (18) patients had no further
treatment. Clinical evaluation was done at 18
months postoperatively including the localization
test (locognosia), the static and the moving 2-point
discrimination tests, the Moberg’s pick-up test
(stereognosia) and the hand grip and the opposition
strength tests.
123
Results: All patients were included in the
postoperative evaluation. Hand grip and opposition
strength, static and moving 2-point discrimination
were not statistically significant between the two
groups. The localization test was statistically
significant in group A and a trend to statistical
significance was observed regarding the Moberg’s
pick-up test in group A.
Conclusions: Sensory re-education is essential for
patients with median nerve neurotmesis and repair,
as it significantly re-educates localization and
stereognosia in the shortest time following
peripheral nerve injury and repair.
OP052
TRANSCRANIAL DOPPLER ULTRASOUND
(TCD) CAN ACCURATELY DETERMINE
BRAIN DEATH LONG BEFORE CLINICAL
TESTS BECOME ELIGIBLE
Authors:
LT COL Karellas J, LT COL Aloizos S, LT COL
Gourgiotis S, MAJ Tsakalakis Chr, MAJ
Arsenoglou A, MAJ Sourlas S, LT COL Liapis G
Institution:
401 Military Hospital, Athens, GREECE
Purpose: To compare the efficacy of Transcranial
Doppler Ultrasound (TCD) in defining brain death
(BD) in comparison with clinical trials,
computerized tomography (CT) and cerebral
angiography.
Materials and methods: Seventeen (17) ICU
patients were studied, 12 suffering from close head
injury (TBI), 3 from subarachnoid hemorrhage
(SAH) and 2 from CNS infections. A transtemporal
window was used and middle cerebral arteries
(ΜCAs) were insonated, bilaterally. TCD
indications of BD were a systolic forward flow or
systolic spikes and diastolic reversed flow, a brief
systolic forward flow or systolic spikes and no
diastolic flow or no flow at all in a patient who had
a normal previous examination. CT scan and
cerebral angiography were performed in all patients
who had indications of BD in TCD.
Results: In 5 patients TCD was able to demonstrate
preliminary signs of raised ICP compliant with CT
findings of diffuse cerebral edema, 3 days (3±2)
before TCD indications of BD were evident. TCD
signs of BD were found approximately 7 days (7±3)
before clinical tests became eligible while cerebral
angiography demonstrated lack of cerebral
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
perfusion and CT scan signs of descending
transtentorial herniation.
Conclusion: Impairment of cerebral flow can
accurately be demonstrated by TCD in patients who
have intact skull. In all patients at risk for
developing cerebral edema without continuous ICP
monitoring, frequent TCD scans are very important
for the early diagnosis and treatment of raised ICP.
In this study TCD was able to confirm BD as early
and accurately as cerebral angiography.
OP053
COMPARING PATIENTS WITH APERT AND
CROUZON
SYNDROMES:
CLINICAL
FEATURES
AND
CRANIOFACIAL
SURGICAL RECONSTRUCTION
Authors:
LIEUTENANT
(NAVY)
DIMITRIOS
STAVROPOULOS HN1, BENGT MOHLIN2,
KARL-ERIK
KAHNBERG2,
CATHARINA
2
HAGBERG
Institutions:
1. Dept of Orthodontics, Athens Naval Hospital,
Athens, GREECE
2. Dept of Orthodontics, Institute of Odontology at
Gothenburg University, Gothenburg, SWEDEN
Purpose: The aims of this study were to describe
and compare the main facial and intraoral features
of patients with Apert and Crouzon syndromes, the
clinical manifestations that may be present
additionally to the main syndromic traits as well as
the craniofacial surgical treatment protocols
followed.
Material and Methods: Twenty three patients with
Apert syndrome (6 males, 17 females) and 28
patients with Crouzon syndrome (20 males, 8
females) were evaluated for general medical
aspects, craniofacial aspects, dentoalveolar traits
before and after the final orthognathic surgery,
types and timing of craniofacial surgical operations.
Results: Mental retardation, associated additional
malformations, cleft palate, extensive lateral palatal
swellings and dental midline deviations were more
common in children with Apert syndrome. In both
syndromes, the clinical findings included concave
profile, negative overjet, posterior crossbites and
anterior openbite, which were corrected in almost
all instances after the final orthognathic surgical
operation, with the exception of the lateral
crossbites which persisted in about half of the
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
cases. Cranial vault decompression and/or
reshaping, midfacial and orbital advancement
procedures, often in conjunction with a mandibular
set-back were the most frequent craniofacial
operations performed.
Conclusion: Apert syndrome is more asymmetric
in nature and a more severe clinical entity than
Crouzon syndrome. The syndromic dentoalveolar
features of both conditions could be corrected after
a series of surgical procedures in almost all cases
with the exception of the posterior crossbites which
were found to be persisting after the final
orthognathic operation in about half of the cases in
both syndromes.
OP054
ALGORITHM IN TREATMENT OF THE
MAXILLOFACIAL WAR INJURIES
Authors:
Col. Professor Jović Nebojša MD, PhD; Kozomara
R MD, PhD; Broćić M MD, PhD; Jović S MD
Institutions:
Clinic for Maxillofacial Surgery, The Medical
Faculty of the University of Defence, Belgrade,
SERBIA
During the Civil War in Yugoslavia, 7.2% of the
total number of causalties were wounded in the
maxillofacial region and treated in Clinic for
maxillofacial surgery of the Military Medical
Academy. The first aid was given to causalties at
Forward Casualty Surgical Stations near the front
line by physicians with different levels of
proffesional education. For definitive treatment all
casualties were transported in our Clinic by
helicopter or by car. Algorithm of treatment of the
maxillofacial war injuries was: Antibiotic therapy
(in case of extensive wound – cephalosporins,
metronithasol,
amicacin),
primary
surgical
treatment in first 36 to 72 hours, minimal
debridement of soft and bony tissues, primary
neurosuture (n. facialis) in first 72 hours and second
one after 3-4 weeks and reconstruction of defects
with vascularised flaps. We will represent the data
of the types of wounds and their locations, as well
as modality, result, durations of complications of
treatment aspecially in regard to reconstruction of
mandibulary defects.
OP055
PAIN SYNDROMES IN MISSILE-CAUSED
PERIPHERAL NERVE INJURIES
124
Authors:
Col. Professor Roganović Zoran., M.D., Ph.D1,
Professor. Gordana Mandić - Gajić M.D., Ph.D2
Institutions:
1. The MMA’s Clinic for Neurosurgery, The
Medical Faculty of the University of Defence,
Belgrade, SERBIA
2. The MMA’s Clinic for Psychiatry, The Medical
Faculty of the University of Defence, Belgrade,
SERBIA
Background: An accredited therapeutic algorithm
for painful peripheral nerve injuries does not exist
and literature data dealing with this topic are scanty
and controversial. The aim of this study is to
analyze the clinical characteristics and treatemnt
outcome of pain syndromes following missilecaused peripheral nerve injuries.
Methods: A retrospective study on 326 patients
with „causalgia“ (CRPS II), deafferentation pain,
reinnervation pain, and neuralgic pain. Therapeutic
procedures included drug treatment, nerve surgery,
sympatholysis, DREZ-otomy or combination of
these procedures. Pain intensity was measured
according to visual analogue scale (VAS) and the
treatment outcome was defined as excellent
(reduction of pain > 70%), fair (reduction of pain
50 - 69%) or poor (reduction of pain < 50%). The
outcomes were compared between different types
of pain syndromes and different treatment
procedures.
Results: Excellent outcome was obtained in 28.6%
of patients with deafferentation pain, in 76.9% of
patients with CRPS II, and in the range of 87.9% to
100% of patients with other types of pain
(P=0.002). Each of pain types required specific
therapeutic algorithm, but average pain reduction
was statistically similar for different manners of
treatment (81 - 88 %; P>0.05). Thirteen factors
influenced significantly on the outcome, but only
two of them were found to be independent
predictors of excellent outcome: absence of
neuropathic pain (P<0.001) and absence of pain
paroxysms (P=0.003).
Conclusions: Final treatment outcome for painful
missile-caused nerve injuries depends on several
factors, but the type of pain syndrome is the most
important. Drug therapy may be recommended for
patients with reinnervation pain, deafferentation
pain, and CRPS II, whereas nerve surgery is a
treatment of choice for patients with posttraumatic
neuralgia.
125
OP056
ISOLATED SHARP LACERATION OF THE
AXILLARY REGION AN UNUSUAL CASE:
IMMEDIATE REPAIR OF THE BRACHIAL
PLEXUS AND BRACHIAL ARTERY AND
LONG TERM FOLLOW UP RESULTS
Authors:
CPT OKSUZ Sinan, MD;; MAJ KARAGOZ
Huseyin, MD; LTC KULAHCI Yalcin, MD; COL
ULKUR Ersin, MD; 2LT USLU Asim, MD.
Institutions:
Gulhane Military Medical Academy Haydarpasa
Training Hospital, Dept. of Plastic Reconstructive
and Aesthetic Surgery and Burn Unit, Istanbul,
TURKEY
Introduction: Sharp laceration injuries of the
brachial plexus are not common and long term
follow up results after repair are rarely reported.
Functional recovery results after the nerve repair
are closely related with the age and the level of the
injury. As the nerve injury shifts to proximal the
functional outcomes deteriorates.
Material and methods: A five-year-old child with
a skin laceration at the axillary region presented to
the emergency service 10 hours after injury.
Although the radial and ulnar artery pulses could
hardly be palpated the pinprick test did not
represent a major circulation problem. Surgical
exploration exhibited that the biceps brachii muscle
was totally lacerated at its humeral incertion and
the brachial artery, median, ulnar, radial and
musculocutaneous nerve branches of the brachial
plexus were also lacerated at the same level. All of
the lacerated nerves were repaired with epineural
sutures following the brachial artery anastomosis.
Results: Significant functional recovery was
determined at the injured extremity even three
months after the repair. Electromyography (EMG)
test results also supported the clinically observed
recovery. Postoperative first year follow up results
revealed almost total functional recovery.
Negligible neuronal morbidity was determined with
EMG test at the postoperative first year visit.
Conclusion: The circulation deprivation of an
extremity even owing to the total brachial artery
laceration of the childhood patients can be tolerated
for longer periods than the adults. Successful
functional recovery results can be observed among
the younger patients even for the higher levels of
nerve injury.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Correspondence:
Gulhane Askeri Tip Akademsi Haydarpasa Egitim
Hastanesi, Plastik ve Rekonstruktif Cerrahi Servisi,
Selimiye Mah. Tibbiye Cad. Uskudar 34668,
Istanbul TURKEY
Tel: + 90 216 542 20 20 – 4173
Fax: + 90 216 348 78 80
GSM: + 90 533 322 90 12
e-mail: sinanoksuz@gmail.com
OP057
SURGICAL
SAFETY
GREEK HOSPITALS
CHECKLIST
IN
Authors:
Μajor RN Karathanasi Konstantina MSc, PhDc1;
Μajor RN Malliarou Maria, PhD1; Lecturer Sarafis
P2; Assistant Professor Prezerakos Panagiotis3
Institutions:
1. 404 General Army Hospital of Larisa
2. Technological Institution of Lamia, Nursing
Faculty, Greece
3. Nursing Department, University of Peloponnese
Purpose: The purpose of this study was to evaluate
the knowledge and applicability of the surgical
safety checklist in Greek operating rooms.
Material and Methods: The survey was conducted
through the use of a questionnaire and included 125
nurses and 27 surgeons. The questionnaire included
questions referring to the 19-point surgical
checklist which was based on World Health
Organization guidelines and identified practices
that helped to ensure the safety of surgical patients
worldwide. Statistical analysis was carried out with
SPSS 19 statistical package.
Results: 105 women and 47 men participated with
a mean age of 35.10 years. In 58.2% of cases there
were no forms for recording the surgical
complications and more than half of nurses (55.3%)
were unaware of surgical safety checklist as defined
by the WHO. Seventy five respondents knew about
the surgical list but only 42.7% of them were using
it. There was statistically significant correlation of
knowledge of the checklist between nurses and
doctors (p = 0.013) and between nurses educational
background (p = 0.012).
Conclusion: Although the introduction of surgical
safety checklist is not yet adopted worldwide and
requires a considerable change in attitudes and
behavior within operating room teams, there was a
neglect of Greek nurses in knowledge of protocols
such as surgical safety checklist as a quality
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
126
indicator. The new reality requires from operating
room teams across the world and also the Greek
surgical family to use quality indicators in order to
measure and, therefore, improve quality care.
cardiopulmonary complications and may be safely
performed on young individuals with no known
heart and pulmonary diseases, without need for
monitoring.
OP058
COMPLICATIONS AND ADVERSE EFFECTS
OF
DIAGNOSTIC
ESOPHAGOGASTRO
DUODENOSCOPY IN YOUNG MILITARY
MEN WITH NO KNOWN DISEASES
OP059
PREVALENCE
OF
NON-ALCOHOLIC
FATTY
LIVER
DISEASE
WITH
COEXISTING TRANSAMINASAEMIA IN
PHENOMENALLY HEALTHY ADULTS: A
TWO-YEAR STUDY OF A MILITARY
POPULATION
Authors:
Col. VAZHAROV Ivaylo MD, PhD; GEORGIEV
Milen MD; Maj. SHOPOV Nikolay MD
Institutions:
Multiprofile Hospital for Active Treatment - Varna
(Naval Hospital), Military Medical Academy,
BULGARIA
Background: Undesired side-effects and complica
tions of esophagogastroduodenoscopy (EGD) and
premedication are rare events. The complication
rate of upper gastrointestinal endoscopy is about
0.1%, predominantly with cardiopulmonary events.
Methods: The study group comprised 50 patients
in the age between 18 and 33 years (medium age:
25 years, 45 males, 5 females), free of signs and
symptoms of any heart and pulmonary diseases
according to their history, physical examination,
ECG and determination of oxygen saturation
(SaO2) by pulse oximeter. Holter recordings were
started one hour prior the endoscopic procedure and
continued until the end of the first hour after the
manipulation. Blood pressures and O2 saturations
were obtained before, during, and after the
procedure. Endoscopies were performed without
any premedication or sedation.
Results:
The
frequencies
of
premature
supraventricular beats were higher and the
maximum heart rate, when compared to the
recordings before the endoscopic procedure, was
higher. During the endoscopic examination 12
patients (24%) showed rhythm disorders. In 9 cases
(18%) sinus tachycardia was induced and 3 cases
(6%) of supraventricular premature complexes were
observed. No ST-T changes was detected. The
highest blood pressures was measured immediately
before and during endoscopy, but the level is not
higher than 150/100. Two patients (2%) had shortlasting episodes of oxygen desaturation (SaO2
92%-94%).
Conclusions:
Our
result
suggests
that
gastroduodenoendoscopy does not cause serious
Authors:
MAJ Sfikas G, LT COL Pehlivanidis A, MAJ
Psallas M, MAJ Gkiourtzis T, LT Grezios T, COL
Iosifidis M
Institutions:
1ST Department of Internal Medicine, 424 General
Military Hospital of Thressaloniki, GREECE
Purpose: The non-alcoholic fatty liver disease
(NAFLD) is a relatively frequent clinical entity
with potentially dangerous complications. The
purpose of this study is to record the prevalence of
NAFLD in phenomenally healthy military
personnel subjected to the standard annual medical
screening.
Material and methods: The initial material of our
study was the 4211 annual medical tests of military
personnel during the years 2009 and 2010. After the
initial evaluation, abnormal levels of liver enzymes
were found in 172 (4.08%) subjects (ALT>40
IU/L). These people were reevaluated after one
month
and
the
ones
with
persistent
transaminasaemia were further examined with
virological screening and liver ultrasound.
Results:
Out
of
172
subjects
with
transaminasaemia (mean value of AST: 55.3±10.9
and ALT: 71.9±12.7 IU/L) during the initial
evaluation (4.1%), the ones who presented for
reevaluation were 111 (106 males, 5 females with
mean age of 37.2 years) who became the final
material of the study. None mentioned use of
alcohol >40 gr/day; 52 of them (46.38%) presented
with persistent transaminasaemia four weeks after
initial evaluation. The screening for viruses was
positive in two cases (hepatitis C and EBV
infection) . The remaining 50 subjects underwent
liver ultrasound which confirmed the diagnosis of
NAFLD in 41 of them. No specific cause of
transaminasaemia was identified in 9 patients.
127
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Conclusions: Our findings demonstrate that
NAFLD with coexisting transaminasaemia was
found in 78.8% of cases with persistent
transaminasaemia, 36.9% of the total number of
cases with transaminasaemia and 0.97% of
phenomenally healthy adults, with a high
percentage of temporary transaminasaemia most
likely due to subclinical liver infections.
OP060
IN
ADDITION
TO
GRANULOMAS,
MORPHOLOGICAL
FEATURES
OF
TERMINAL ILEAL INFLAMMATION MAY
BE
SUFFICIENT
TO
DISTUNGUISH
CROHN’S DISEASE FROM NONSPECIFIC
ILEITIS
Authors:
COL UMUDUM Haldun1, MAJ
Muammer2, COL ÇERMİK Hakan1
KARA
Institutions:
1. Etimesgut Military Hospital, Pathology, Ankara,
TURKEY
2. Etimesgut Military Hospital, Gastroenterology,
Ankara, TURKEY
Objective: Crohn’s disease (CD) may involve any
part of the gastrointestinal tract. The skip lesions,
transmural inflammation and specific type of
granulomas are hallmarks of CD. The differential
diagnosis of CD rests on clinicopathological and
endoscopic correlations. Current study compare the
morphological and immunohistochemical features
of terminal ileum involvement of CD and
nonspecific ileitis (NI) in order to identify
histological features that distunguish these two
entities.
Material and methods: Biopsy materials of twenty
one cases were evaluated retrospectively. Final
diagnoses were reached with clinicopathological
and endoscopic correlation. For each case, neuronal
hypertrophy, lymphoid aggregates, ulceration of
lymphoid aggregates, presence of intraepithelial
lymphocytes, presence of vasculitis, cript abscess
formation, submucosal fibrosis, presence of ectatic
vessels in submucosal areas were recorded. In
addition, CD68 stained immunohistochemistry
slides that were available, have also been evaluated.
Each parameter was evaluated with logistical
regression and nonparametric tests.
Results: There are seven CD and 14 NI patients.
Ulcerated lymphoid aggregates, presence of
vasculitis, intraepithelial lymphocytosis, neuronal
hypertrophy and cript abscess were significantly
correlated with CD diagnosis. CD68 expressing cell
count was not significantly different between the
two diagnostic categories.
Conclusion: Granulomas that are characteristic
feature of CD can be found only in 40% of cases. In
endoscopic specimens, observation of transmural
inflammation which is common feature of CD is
not straightforward. Our results showed that
presence of certain histological features (lymphoid
aggregates with ulcerated surfaces, neuronal
hypertrophy, intraepithelial lymphocytosis and
vasculitis) are helpful for distinguishing the CD
from NI.
Correspondence:
Etimesgut Asker Hastanesi, Patoloji Laboratuarı,
06770, Etimesgut Ankara, TURKİYE
Tel : +90 312 249101 ext:3716
Fax: +90 312 2444977
GSM: 90505 9355814
e mail: humudum@yahoo.com
OP061
WHAT IS THE OPTIMAL TREATMENT
ALGORITHM
FOR
METASTATIC
COLORECTAL CANCER?
Author:
COL Nebojsa Manojlovic MD, PhD
Institution:
Clinic for Gastroenterology and Hepatology,
Military Medical Academy, Belgrade, SERBIA
Background/Aims: Twenty percent of patients
with colorectal cancer have metastatic disease at the
first presentation, and an additional 25-50% will
develop metastatic disease. Fifty percent of patients
with metastatic disease have disease limited to the
liver at the time of diagnosis and 80-90% of them
are considered to have unresectable disease. Several
guidelines and expert recommendation are
available. We review guidelines in order to find
optimal treatment guideline for metastatic CRC.
Methodology: We analyzed all actual guidelines
and expert recommendation for treatment of
metastatic colorectal cancer published in the last
years.
Results: There have been recognized three different
situations in metastatic colorectal cancer: resectable
disease, potentially resectable disease and
unresectable disease. Criteria for differentiation of
the three clinical situations are: the free interval
between surgery for primary tumor and occurrence
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
128
of metastatic disease, number of metastasis, number
of involved liver lobes, size of metastasis, vascular
involvement. The therapeutic approach should be
multidisciplinary. For the group of patients with
resectable disease perioperative chemotherapy and
surgery could be the treatment of choice, for
potentially
resectable
disease
neoadjuvant
chemotherapy and surgery represents reasonable
approach while in patients who have unresectable
disease palliative systemic chemotherapy represent
the treatment of choice. In the last group, there are
patients who demand aggressive treatment and
those who are candidate for less toxic
chemotherapy regimens.
applications made in the last year in our
department.
Conclusion: The optimal treatment algorithm for
metastatic colorectal cancer is based on the
presence of resectable, potentially respectable of
definitely
unresectable
disease,
predictive
molecular markers (K-Ras) and demand for
aggressive chemotherapy regimens.
Institutions:
Department of Internal Medicine, Central Clinical
Emergency Military Hospital “Dr. Carol Davila”,
88, Mircea Vulcanescu Street, Bucharest, Sector 1,
ROMANIA
OP062
CONTRAST ENHANCED ULTRASOUND –
CLINICAL APPLICATIONS
Authors:
A.Anghel, S. Stanciu, L.Ciobica, D. Stoicescu,
M.Muresan
Institutions:
1st Internal Medicine Department, Central Military
Universitary Emergency Hospital Bucharest,
ROMANIA
Ultrasound contrast agents are used to improve the
conventional and Doppler ultrasound, especially in
the evaluation of the microvascularization. With a
structure made of gas-filled microbubbles stabilized
by a lipophilic layer (phospholipidics or albumin)
the ultrasound contrast agents have only an
intravascular distribution offering information
about the blood flow in the interest area.
Modification of the echogenicity using an
ultrasound contrast agent has a specific dynamics
described by the vascular times: arterial phase of 20
seconds followed by the portal phase between 60
and 180 seconds and the tardive phase. By
following the vascular times and the specific
dynamics of the contrast agent it will allow a more
complete evaluation of the suspect lesion enhancing
the sensibility and the specificity of the ultrasound
exploration. The ultrasound contrast agents are
safety with a low incidence of the adverse
reactions, without any kidney toxicity and thyroid
interactions. In our work, we will present a caseseries study of the most frecvent clinical
Correspondence:
Tel: +40722653778
mihaelaiordache2005@yahoo.com
OP063
ONE
CASE
OF
NEUROENDOCRIN
PANCREATIC TUMOR WITH MULTIPLE
LIVER METASTASES
Authors:
Lt.Col.Dr. M. L. Ciobîcã; Mihaela Iordache
We present the case of a female patient admitted in
our clinic for nonspecific digestive symptoms,
corresponding to carcinoid syndrome: upper
abdominal pain aggravated after meals and
associated with diarrhea, asthenia and weight loss,
symptoms lasting for many years, but agravated in
the last one. Abdominal ultrasonography (US)
detected the presence of multiple large hypoechoic
nodules, suggesting liver metastases; this was
confirmed using contrast-enhanced ultrasonography
(CEUS) which demonstrate the hypervascular
pattern of these nodules, leading to the suspicion
for a neuroendocrine tumor with liver metastasis.
The pancreatic area couldn’t be viewed at US due
to the improper preparation. Colonoscopy and
gastroscopy did not reveal a primary digestive
tumor. Abdominal CT scan confirmed the presence
of the liver metastases and detected the presence of
a tumoral mass in the tail of the pancreas. We have
decided to perform a laparoscopy exploratory for
the liver biopsy puncture. The postoperative
histopathologic exam established the diagnosis of
metastases of a neuroendocrine carcinoma.
Frequently, patients with neuroendocrine tumors
are asymptomatic or initial symptoms are
nonspecific, leading to long delays in diagnosis.
Patients with symptoms of chronic diarrhea or
abdominal pain are often misdiagnosed and treated
empirically for many years until a correct diagnosis
is made. In the presence of large hypoechoic liver
metastases a neuroendocrine tumor should be
suspected. Contrast-enhanced ultrasonography
(CEUS) may represent a convenient alternative to
contrast CT for selected cases.
129
Correspondence:
Tel: +40722653778
mihaelaiordache2005@yahoo.com
OP064
RAPIDLY PROGRESSIVE GOODPASTURE
SYNDROME LEADING TO FATAL EXIT
ONE MONTH AFTER DIAGNOSIS
Authors:
Jordanov Hristo MD; Assoc.Profesor Draganov
V.MD PhD; Lt.Colonel Vasilev V MD; Lilov M
MD; Assoc.Prof. Petrov N MD, PhD
Institutions:
Military Medical Academy, Department of
Pneumonology, Department of Nephrology
Department of ICU&CCU, Sofia, BULGARIA
Goodpasture Syndrome or anti-GBM disease is an
eponym used to describe the triad of diffuse
pulmonary hemorrhage, glomerulonephritis and
circulating anti-glomerular basement membrane
(anti-GBM) antibodies. Anti-GBM disease is an
uncommon disorder,approximately 0.5 cases per
million people per year occurring over a 4-year
period in England.This disorder, compared to
Wegener granulomatosis, which has an incidence of
approximately 0.5 cases per 100 000 people, is rare.
In the past, the disease was almost universally fatal.
Currently, the mortality rate is approximately 10%.
Incidence shows a male predominance with the
male-to female ratio reported as 2.9:1. Distribution
is bimodal. Young men present with pulmonaryrenal syndrome at ages 20 and 30 years and elderly
women (ie, aged 60-70 years) present primarily
with glomerulonephritis. We reported the case of
rapidly progressive Goodpasture Syndrome in a 56year-old white female, started with pulmonary
disorders led to fatal exit due to acute hemorrhage
from intestinal tract which is uncommon.
Correspondence:
Military Medical Academy,
3 G.Sofiiski str.1606, Sofia, Bulgaria
Fax:+359 2 952 6536
Tel.:+359 2 922 5763
Mobile:+359 885018175
E-mail:dr.hristojordanov@gmail.com
OP065
HYPERBARIC
OXYGEN
THERAPY
CENTERS
AND
REGULATIONS
FOR
AUTHORIZATION OF THESE CENTERS IN
TURKEY
Authors:
CAPT YILDIZ Senol, MD1, LCDR UZUN Gunalp
MD2, LT MUTLUOGLU Mesut, MD2
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Undersea and Hyperbaric Medicine, Ankara;
TURKEY,
2.Gulhane Military Medical Academy, Haydarpasa
Teaching Hospital, Dept. of Undersea and
Hyperbaric Medicine, Istanbul, TURKEY
Objective: Hyperbaric oxygen therapy (HBOT)
centers were first established almost 4 decades ago
in Turkey. In the 1980s, there were only two HBOT
centers, which were at İstanbul University Medical
School and Gulhane Military Medical Academy.
Private centers started to emerge in 1996 and
authorization of private HBOT centers was
necessitated after this time. Ministry of Health
published first legal regulations for authorization of
private HBOT centers in 2001. Three factors are
considered while planning to open a new HBOT
center. These factors are population of the area,
number of patients with acute and elective
indications of HBOT in the region and presence of
dive tourism. In this paper, we will review
historical development of regulations pertaining to
medical and technical personal, hyperbaric chamber
and environment in HBOT centers.
Material and method: Managers of private and
state-owned HBOT centers were reached via email
or phone and information including hyperbaric
chamber type and specifications, date of
establishment, medical and technical personals was
gathered. Authorization procedures were examined
by investigating legal regulations published in
2001.
Results: At the time of this study, there were 30
HBOT centers in Turkey. There are 4 HBOT
centers in University Hospitals, 6 in State Hospitals
and 20 private HBOT centers. Twenty eight (93%)
of HBOT centers were established in or after 1997.
Current regulations require one underwater and
hyperbaric medicine specialist or aviation and
space medicine specialist to run a HBOT center.
Other personnel to be present is the hyperbaric
chamber operator. Other then these, HBOT centers
can hire nurses as inside attendants.
Conclusion: New regulation requires nurses who
finished a special certification course to be a
hyperbaric nurse, to attend all hyperbaric treatments
in multiplace chambers. State-owned centers also
require authorization according to the new
regulation. The aim of the new regulation is to
increase the safety of HBOT centers.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Correspondence:
Doc.Dz.Tbp.Alb. Senol YILDIZ Gulhane Askeri
Tip Akademisi, Sualtı hekimligi ve Hiperbarik Tip
AD, Ankara, TURKEY
Tel: +90 312 3044791
Fax: +90 312 3042700
GSM: +90 536 6553855
e-mail: seyildiz@gata.edu.tr
130
OP067
HYPERBARIC OXYGENATION AS AN
ADJUNCTIVE
MODALITY
IN
THE
TREATMENT OF SEVERE LOWER LIMB
TRAUMA
OP066
ADJUNCTIVE
HYPERBARIC
OXYGEN
TREATMENT FOR CARPAL SCAPHOID
FRACTURES
Authors:
Commander Christos Bissias HN1, LT CDR
Vasileios Kalentzos HN2, LT CDR Pavlos Vavasis
HN2, LT CDR Konstantinos Bougoulias HN1, LT
Nikolaos Natsioulas HN1, LT Konstantinos
Papoutsis HN1, Eleftherios Nikas1, LT CDR Ioannis
Kontolatis HN1, LT Georgios Gr. Sidiras HN2 .
Authors:
LT Georgios Gr. Sidiras HN1, LT CDR Pavlos
Vavasis HN1, LT CDR Vasileios Kalentzos HN1,
LT CDR Ioannis Kontolatis HN2, LT Konstantinos
Papoutsis HN2, CDR Christos Bissias HN2
Institutions:
1. 1st Orthopaedic Department, Athens Naval
Hospital, Athens, GREECE
2. Diving & Hyperbaric Medicine Unit, Athens
Naval Hospital, Athens, GREECE
Institutions:
1. Diving & Hyperbaric Medicine Unit, Athens
Naval Hospital, Athens, GREECE;
2. 1st Orthopaedic Department, Athens Naval
Hospital, Athens, GREECE
Purpose: To demonstrate the use of hyperbaric
oxygenation (HBO) as an adjunctive therapeutic
modality in the treatment of open lower limb
fractures complicated with soft tissue defect,
compartment syndrome and crush injury.
Purpose: To evaluate the effectiveness of
adjunctive hyperbaric oxygen treatment on
avoiding complications of carpal scaphoid fractures
(CSFs) at the Diving & Hyperbaric Medicine Unit
(DHMU) of the Athens Naval Hospital between
2003-2011.
Material: We present 2 cases of severe lower limb
trauma following motorcycle accidents, which
combined open tibial Gustillo 3B fracture, crush
injury and compartment syndrome. Patient 9008,
aged 26, had fractures of the tibia, fibula, femoral
neck and shaft as well as jejunal and mesenterial
ruptures. He was referred for HBO treatment 3
weeks post-injury, during ICU stay, for leg
compartment syndrome, achieving 17 sessions
(discontinued due to intolerance). Patient 9110, 24year-old male, had fractures of the tibia and
maxilla. HBO treatment commenced 4 weeks postinjury due to a compromised tibial skin graft,
achieving 21 sessions. Five months later, there were
20+9 additional sessions due to tibial
pseudarthrosis and suspected osteomyelitis.
Treatment was complimented with 20 follow-up
sessions after 6 months. HBO was administered via
face mask at a pressure of 180-200 kPa in a
multiplace hyperbaric chamber.
Material & Methods: Five men aged 28-39 with 6
CSFs (3 middle, 3 proximal pole) were referred to
DHMU 2-10 days after their initial injury. One had
bilateral fractures, two were smokers, one was
under corticosteroids for dermatomyositis, and one
had simultaneous dorsal perilunate wrist dislocation
with palmar cutaneous necrosis of the wrist.
Treatment was conservative using wrist cast. The
patients underwent 7-33 hyperbaric oxygen
sessions (mean 16.8±9.76) in a multiplace chamber,
breathing oxygen through face mask at a pressure
of 200 kPa.
Results: All CSFs showed callus formation on xrays after 6/52. No avascular necrosis or other
complication occurred for the next 2 years (one
patient pending).
Conclusion: Hyperbaric oxygen treatment had a
positive impact on avoiding complications of the
CSFs for our small patient sample. Larger studies
are expected to produce safer conclusions.
Results: In both cases, HBO assisted in infection
control and reduced the risk for late amputation.
Patient 9008’s exit from the ICU was facilitated.
The benefit for patient 9110 was graft rescue and an
optimally perfused field for final operations.
Conclusions: Adjunctive HBO treatment has
significantly facilitated our positive response to
problems or complications related to the severity of
lower limb injuries. Early application, similar to the
131
HOLLT Study protocol, should be considered for
selected multitrauma cases.
OP068
THE
2011
HYPERBARIC
OXYGEN
EXPERIENCE FOR THE TREATMENT OF
ASEPTIC
OSTEONECROSIS
AT
THE
ATHENS NAVAL HOSPITAL
Authors:
Lt Georgios Gr. Sidiras HN1, Lt Cdr Pavlos Vavasis
HN1, Lt Cdr Vasileios Kalentzos HN1, Lt Cdr
Konstantinos Bougoulias HN2, Lt Nikolaos
Natsioulas HN2, Cdr Christos Bissias HN2.
Institutions:
1. Diving & Hyperbaric Medicine Unit, Athens
Naval Hospital, Athens, GREECE
2. 1st Orthopaedic Department, Athens Naval
Hospital, Athens, GREECE
Purpose: To study the use of Hyperbaric Oxygen
Treatment (HBOT) in patients with aseptic
osteonecrosis at the Diving & Hyperbaric Medicine
Unit of the Athens Naval Hospital during 2011.
Material: We treated 4 female and 8 male patients,
aged 16-58, with aseptic osteonecrosis stage I-II. Of
the lesions, 9 were localised in the femoral head, 2
in the femoral condyles and 1 in the talus. Six cases
were post-traumatic and five had a co-existing
systemic disease; two of the latter were under
chronic prednisolone use. Non-steroids were being
taken by six patients. HBOT consisted of oxygen
administration via face mask for 90 min, 5
days/week, in a multiplace hyperbaric chamber at a
pressure of 180-200 kPa. The patients followed a
mean of 25.5 sessions.
Results: Most patients (7) demonstrated clinical
and radiological (MRI) improvement. Four
discontinued treatment after 1-7 sessions. No
improvement or relapse presented in the talus case,
which was operated on elsewhere.
Conclusions: Aseptic osteonecrosis appears to
respond favourably to HBOT. Greater patient
samples will provide safer conclusions.
OP069
THE EVALUATION OF CARDIOVASCULAR
DISEASES
IN
TURKISH
MILITARY
AIRCREW
Authors:
COL OZTURK Cengiz MD1, CPT METIN
Suleyman MD2, MAJ CAKMAK Tolga MD2, COL
AKIN Ahmet MD2, LTC DULKADIR Zeki MD2
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Institutions:
1. Eskisehir Military Hospital, Dept. of Cardiology,
Eskisehir, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
Objective: Cardiovascular system healthiness is
very essential for the aircrew. Cardiovascular
Diseases (CVD) detected in military aircrew may
cause an incapacitation during flight, jeopardizing
flight safety and leading mishaps.
Material and methods: In this study we
retrospectively evaluated the records of aircrew
applying for periodic aeromedical examinations to
our center in 2011. In addition to physical
examination and biochemical tests, the diagnoses of
CVD were made by using sphygmomanometer,
electrocardiogram, echocardiogram and Holter
monitoring. The diagnoses, demographic features,
biochemical test results, and the approval decisions
for flight fitness were recorded. The results were
assessed as percentage (%) and numbers (n).
Results: Of the 3346 aircrew, 163 (4.9%) were
diagnosed with CVD. The mean age was 32.4±7
(20 – 50). 78 (47.9%) of them were pilot, 56
(34.4%) other aircrew and 29 (17.8%) cadet. Most
common CVD were valvular diseases (64.2%),
predominantly mitral insufficiency (36.8%). Mitral
valve prolapse (12.4%), dysrhythmia (10.9%),
aortic insufficiency (9.3%), ascending aortic
dilatation (6.7%), tricuspid insufficiency (5.7%),
atrial septal aneurysm (5.2%) and others were seen
consequently. There were 22 temporary and 24
permanent groundings.
Conclusion: We have figured out that CVD are
responsible for 25% of all the temporary or
permanent grounding reasons. Detecting and
treating the CVD at the very beginning will make
useful contributions to the flight safety. Given the
high rates of valve diseases, echocardiogram is very
useful for the periodic aeromedical examinations.
Correspondence:
Doc.Hv.Tbp.Alb.Ahmet AKIN
Gulhane Askeri Tip Akademisi, Hava-Uzay
Hekimligi AD, 26020, Eskisehir, TURKEY
Tel: + 90 222 230 0191
Fax: + 90 222 230 34 33
GSM: + 90 532 221 4051
e-mail: ahmetakin45@gmail.com
OP070
ABDOMINAL
ULTRASONOGRAPHY
RESULTS OF MILITARY AIRCREW
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Authors:
CPT ATA Nazim, MD1, LTC OKUR AKTAS
Gokcan, MD2, COL EMEKSIZ Servet, MD3
Institutions:
1. Aircrew’s Health, Research and Training Center,
Eskisehir, TURKEY
2. Etimesgut Military Hospital, Radiology Clinic,
Ankara, TURKEY
3. Eskisehir Military Hospital, Aeromedical Center,
Eskisehir, TURKEY
Objective: The military aircrew’s periodical
medical examination is carried out once a year after
the initial medical examination. The imaging
techniques used in these medical examinations are
performed according to Turkish Armed Forces
Health Regulations. Abdominal ultrasonography is
one of them. The purpose of this study is to
determine the prevalence of abdominal pathologies
and abnormalities in military aircrews.
Material and methods: Military aircrews who
came for periodical medical examination between
January 2011 and May 2011 were retrospectively
evaluated. Abdominal ultrasonographic findings
and their duty were analyzed.
Results: 1139 military aircrews (666 pilots and 473
flight attendants) were included in the study group.
Abdominal abnormalities and pathologies were
detected in 374 (32.84%) aircrews by
ultrasonographic screening. In 56 aircrews, more
than one pathology were detected. 281 (24.67%)
aircrews had liver pathologies. The most frequently
detected liver pathology was fatty liver disease. 174
aircrews had grade-I, 62 had grade-II and 19 had
grade-III fatty liver disease. 91 (7.99%) aircrews
had renal pathologies. The most frequently detected
renal pathology was nephrolithiasis. 33 aircrews
had unilateral, 10 had bilateral nephrolithiasis. 54
(4.74%) aircrews had biliary pathology. The most
frequently detected biliary pathology was
gallbladder polyp or chollesterolosis. 33 aircrews
had gallbladder polyps or chollesterolosis. 14
(1.23%) aircrews had splenic pathology. Size
enlargement was the most usual pathology in the
spleen.
Conclusion: Abdominal ultrasonography helps to
identify diseases that may cause in-flight
incapacitation in advance. Therefore, it should be
considered as an important tool to detect the
diseases in early stages for aircrew who have longterm careers.
132
Correspondence:
Hv.Tbp.Yb. Gokcan OKUR AKTAS Etimesgut
Asker Hastanesi, Radyoloji Klinigi, Etimesgut,
ANKARA, TURKEY
Tel: + 90 312 249 1011
Fax: + 90 312 249 1011
GSM:
+
90
543
765
3020
e-mail:
okur_g@yahoo.com
OP071
AEROMEDICAL
EVACUATION
ROMANIAN AIR FORCE
IN
Author:
Major Lupu I. Leonard-Marin
Institution:
Romanian Air Force Headquarters, ROMANIA
On March 18, 1906, in Montesson, near Paris, took
place the first European flight by a fully selfpropelled, fixed-wing aircraft using an internal
combustion engine and a single tractor propeller,
which was built by the Romanian engineer Traian
Vuia. The second medic in the world who became a
pilot was Victor Anastasiu, MD, medic in aviation
from 1913, then pilot in training in 1914 and
licensed as a pilot in March 1916. He created in
1920 the Aeromedical Center in Bucharest – the 4th
center in Europe which was transformed in 2001 in
NIASM – National Institute of Aeronautical and
Space Medicine. During WW II, Romania was the
first country in the world having a fixed-wing
MEDEVAC squadron with female pilots. On 14
November 1946 “AVIASAN” was created, as the
first system of air ambulance in Romania, which
lasted 35 years; it was closed in 1981 by the
communist regime. Since 2004, concepts like
operational aviation medicine, flight surgeon, inflight care are being implemented in Romania as
part of NATO integration. In 2012 Romania has 2
national aeromedical evacuation systems: a civilian
one and a military one. We developed cross-border
aeromedical evacuation with Hungary and in the
near future with Bulgaria. Improving training in
aeromedicine and emergency medicine, increasing
the level of interoperability regarding the
aeromedical crews are the most important issues for
our armed forces.
Correspondence:
Tel: +40213194000/int. 583, +40723577452
Email: lupu.leonard@hotmail.com
OP072
HEART RATE AND R-R INTERVAL
RESPONSE OF STUDENTS – PILOTS ON
133
CORIOLES
REACTION
ACCELERATION
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
AND
+
Gz
Authors:
M.Pavlovic, P.Stepanic, A. Krošnjar, S. Đurđević,
S. Međedovic, D.Ranđelovic
Institution:
Institute of Aviation Medicine, Institute LOLA,
SERBIA
Introduction: Baroreflex response in young and
health people during physical effort was considered
an individual characteristic. We hypothesize that it
could be repeated in conditions of extreme physical
effort of + Gz load and coriolos reaction in
students-pilots.
Methods: A group of 11 students – pilots, same
age of 22 years, with 30 hours of flying experience,
eight male and three female, was exposed to
coriolis reaction and + Gz load on human
centrifuge run. The test was repeated after three
months. The test on centrifuge lasted for 9 minutes.
All students-pilots performed active coriolis
reaction (active head movements) on +2Gz load.
Head tilt was performed: down, neutral position,
right shoulder, neutral position, left shoulder,
neutral position, staying for 30 seconds in each
position. After the last movement, acceleration
profile for gradual onset run (GOR), onset rate of
0.1 G/s was performed, achieving +5.5Gz peak.
Deceleration of same rate to +2Gz was achieved,
and all head movements were performed again.
Before, during and after experiment ECG, heart
rate, respiration, R-R interval were monitored.
Results: R-R interval as more sensitive measure
revealed statistically significant difference for all
students, between first and second test and between
male and female for both test. Heart rate for three
male students did not show statistically significant
difference between first and second test.
Conclusion: R-R interval as accurate indicator of
baroreflex sensitivity did not show same response
of students-pilots for both tests, but heart rate did
show that, in case of three male students. For first
time female and male were compared and
statistically difference was significant. The
experimental sample was small and problem
demands further research efforts.
OP073
RADIOLOGICAL IMAGING FEATURES OF
INVASIVE MICROPAPILLARY CARCINO
MA OF THE BREAST
Authors:
MAJ GUVENC Inanc MD1, LT COL YILDIZ
Ramazan MD2, MAJ ILICA A.Turan MD1, COL
OZTURK Erkan MD, COL SAFALI Mükerrem
MD3, COL GORGULU Semih MD2, COL
UGUREL M.Sahin MD1
Institutions:
1. Gulhane Military Medical Academy, Department
of Radiology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Department
of General Surgery, Ankara, TURKEY
3. Gulhane Military Medical Academy, Department
of Pathology, Ankara, TURKEY
Objective: The aim of this study was to investigate
the imaging features of invasive micropapillary
carcinoma of the breast, which is a recently
described, rare variant of infiltrating ductal
carcinoma.
Material and method: Our surgical pathology
database was searched to identify the cases of
patients who received a diagnosis of invasive
micropapillary carcinoma from January 1996 to
January 2011. The study sample included 44
patients: 43 women and one man. Two radiologists
who are specialists in breast imaging
retrospectively reviewed all mammographic
findings in consensus. The MRI and sonographic
prints and records of each patient were reviewed
after the mammograms during the same evaluation
session.
Results: The mean patient age was 48.2 years
(range 34-72). The mean size of breast masses was
18.3 mm (range 11-57). Mammography and
sonography were performed on all cases, and only 5
cases had preoperative breast MRI. The most
common mammographic finding is high density
space occupying lesion, and second one is isolated
microcalcifications. In sonography all masses were
hypoechoic. While 2/3 of lesions showed posterior
acoustic shadowing, 1/3 of lesions had normal
sound transmission. In MRI four enhancing masses
with washout kinetics were present in four patients,
and non-masslike enhancement was found in one
patient.
Conclusion: Invasive micropapillary carcinoma of
the breast usually manifests on mammography as a
high-density irregular mass, often associated with
microcalcifications.
Common
findings
on
sonography are hypoechoic mass, irregular shape
with indistinct margins and posterior acoustic
shadowing. The MRI characteristics of invasive
micropapillary carcinoma are irregular margins and
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
rapid initial enhancement after washout kinetics.
Although these findings are not specific, radiologic
findings may help in the histopathologic
differentiation of cases that are difficult to
diagnose.
Correspondence:
Gulhane Askeri Tıp Akademisi, Radyoloji AD,
Etlik, 06018, Ankara, TURKEY
Tel.:+90 312 304 47 09
Fax:+90 312 304 47 00
GSM:+90 530 464 99 07
E-mail: inancguvenc@yahoo.com
OP074
THE ROLE OF PRIMARY TRACHEOTOMY
IN PATIENTS WITH SEVERE HEAD
TRAUMA
Authors:
Lt. Col Bardhyl Kurti MD, Assoc. Prof Mihal
Kerci, Vera Kurti MD, Fitim Marku MD
Institutions:
Military Medical Academy, Tirana, ALBANIA
Purpose: Assesment of the superiority of early
tracheostomy over the later one in the reduction of
time of Mechanical Ventilation and its
complication in patients with head trauma GCS
greater than 8 points.
Material and methods: Patients hospitalized in the
Military Hospital of Tirana are divided into 2
groups.The first group with 51 subjects was submit
to early tracheostomiy and the second group with
43 patient was submit to late tracheostomy.
Results: Early tracheostomy has advantages in
comparison to late tracheostomy, because the time
of mechanical ventilation and doses of sedation is
reduced Reduction of the incidence of nasocomial
pneumonia. Reduction of the time in intensive care.
Better comfort of patient and medical staff
Reduction of cost. Low mortality.
OP075
THE EFFECT OF INTRAOPERATIVE
CLONIDIN ON POSTOPERATIVE PERIOD
IN CHILDREN OF PRESCHOOL AGE
AFTER ANAESTHESIA FOR ADENOTONSI
LECTOMY
Authors:
Col. Karjin E., Zidarova D., Martinova H., Col.
Petrov N.** Assoc.Prof.
134
Institution:
Military Medical Academy, Sofia, BULGARIA
Nowadays sevorane is widely used for anesthesia in
children. The fast recovery is known to be
accompanied by a high rate of postoperative
anxiety. The use of clonidin attenuates these
reactions. This study compares the postoperative
period in children after sevorane anesthesia with
and without intraop application of clonidin.
Methods: 56 children ASA I-II in preschool age
were divided into 2 groups: gr K-controls and gr Cclonidine group. In gr C with the beginning of the
operation clonidine 2mcg/kg/10min was infused.
Intraoperatively heart rate, NIBP, ECG,
capnometry and pulse oxymetry were monitored.
The following parameters were monitored: time to
extubation, postoperative pain, anxiety and
ambulation times. Results: statistically significant
differences between the 2 groups were observed
concerning: time to extubation, ambulation times
and frequency and degree of anxiety. Concerning
the rest of variables no statistical differences
between groups was noted.
OP076
TREATMENT OF A 15-YEAR-OLD PATIENT
AFTER HEAVY CAR ACCIDENT
Authors:
S. Mitov, MD; Col. Prof. N. Petrov; M. Doncheva,
MD; D. Alexandrov, MD
Institution:
Military Medical Academy – Sofia, BULGARIA
G.V.V., a-15-year-old had passed heavy car
accident with motorcicle on 29.05.12. Right after
he was hospitalized in the city hospital in Kurjali
There after the primary exam he was intubated.
Because there was nasal haemorrhage, frontal and
rear nasal tamponade were performed. On the next
day the patient was transported to the Military
medical Academy in Sofia whewe he was
hospitalized in the Intensive care unit. EKG and CT
scans of the head, thoracic and abdominal area were
done. The following traumatic lesions were found:
cerebral oedema, traumatical subarachnoidal
haemorhagia, transversal fractura of the maxilla Le Fort 2 on the left and Le Fort 1 on the right,
mandibular fracture in the right, fracture of the ribs
VIII-X, fracture of the VIII metatarsal bone,
contusion of the pulmon and the liver and renal
contusion.
On
2.06.2011
we
performed
tracheostomy, and on 7.06.11 the patient was
started nutrition trough percutaneal gastrostomy.
The same day he was operated in the department of
135
Oral and Maxilofacial surgery where the jaws were
fixed with cranio-facial fixation on the left and
suspensive intermaxillary fixation on the right.
(Mectubjian), the lower first mollar was extracted,
because of fractured and standard archbars were
placed on both jaws. After all, a normal occlusion
was achieved. The whole reposition and fixation
reconstruction can be seen on the picture. At this
stage the operation on the leg which was also
fracture was performed. The following medication
weas given: Tavanic, Quamatel, Fraxiparin,
Dexamethazone, Nimotop, Antialerzin, Dormicum,
Diprivan, Hes steril, Ringer, Glucosa, Perfalgan.
The patient was nutrified through percutaneous
gastrostomy. During the days after the cerebral
oedema was reduced and the general status of the
patient was normalized. On 7.07.12 the craniofacial
fixation was removed, as well as the suspensive
intermaxillary fixation and the ligatures between
the archbars of the both jaws. The mouth was
opened, the movement was normalized and the
gastrostomy was removed as well. On 10.07.12 the
patient was discharged in good general condition.
On the following control exam (25.07.12.) the
standard archbars were removed from both jaws
and the threatment was fiinished with optimal
result.
OP077
ABC-VED ANALYZE OF DRUGS USED IN
ANAESTHESIOLOGY
AND
INTENSIVE
CARE DEPARTMENT
Authors:
V. Vaseva; Col. Petrov N., MD, DSc; Col. Petkov
Ass., MD, DSc
Institutions:
Scientific
and
Education
Department,
Anaesthesiology and Intensive Care Department
Military Medical Academy – Sofia, BULGARIA
Introduction: About one-third of the annual
hospital budget is spent on buying material and
supplies, including medicines. A study from
Anaesthesiology and Intensive Care Department of
MMA – Sofia has claimed that review and control
measures for expensive drugs brought about 20%
savings. It has been suggested that with six months
of data, the performance and functioning of a
current inventory system can be estimated.
Objective: To conduct the economic analysis of
drug expenditure in the Anaesthesiology and
Intensive Care Department, MMA-Sofia and to
identify the categories of drugs needing stringent
management control.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Material and Methods: A matrix based on the
coupling
of
cost
(ABC)
analysis
and
vital/essential/desirable (VED) criticality analysis
was formulated for prioritization, to narrow down
the group of drugs requiring greater management
monitoring. The difference between actual
expenditure and the inflation factor-derived
expenditure was found.
Results: The percentage cost of each drug helped
in determining the economic order quantity and the
schedule of placing the purchase orders for drugs of
high value but low criticality. Using the cost
inflation index, it was observed that the overtly
seen increase in annual drug expenditure was just
2.84% when the inflation factor-based expenditure
was derived.
Conclusion: Categorization of drugs by the ABCVED coupling matrix model helps to narrow down
on fewer drugs. The application of the cost inflation
index justified the increased annual budget.
OP078
COST-EFFECTIVE
ANAESTHESIA
CHOICE
IN
Authors:
V.Vaseva; Col. N. Petrov, MD, DSc
Institutions:
Scientific
and
Education
Department,
Anaesthesiology and Intensive Care Department
Military Medical Academy – Sofia, BULGARIA
Introduction: The ongoing global economic crisis
led to a significant reduction in financing costs of
budgetary hospitals that initiated the problem of
providing quality medical care in times of shortage
of funds.Providing anaesthesia requires specialized
medical care in presence of certain drugs and
medical equipment. In this situation it is necessary
to conduct pharmacoeconomic studies of used
drugs in providing anaesthesia. Goals: The three
goals of this research are as follows:
1. To explain the language of health care
economics, particularly as applied to anesthesia
PHARMACOECONOMICS.
2. To summarize those studies concerned with cost
benefit and cost-effective analysis in the field of
anesthesia—PROCESS ANALYSIS.
3. To identify the problems, omissions and
misinterpretations of pharmacoeconomic studies in
anesthesia practice—COMMON PROBLEMS.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Materials and methods:
1. Comparison of drug therapy with other treatment
modalities.
2. Cost effectiveness of alternative drugs.
3. Methods and procedures to improve cost
effectiveness.
Conclusion: At a time of severe cost reduction in
medical care, anesthetic practice is threatened. Less
progress has been made in the application of
pharmacoeconomic
analysis
to
anesthetic
procedures. Comparison of the acquisition costs of
alternative drugs is too simplistic because the data
need careful interpretation. Also, the impact that is
likely to be made by minor modifications in the
anesthetic drug budget is too small to produce any
real change in health care financing. There is a need
to develop a comprehensive pharmacoeconomic
approach to anesthesia so that evaluation of the
total cost of anesthesia care to the hospital, patient
and payer can be performed to determine whether
pharmaceutical switching is effective and safe.
OP079
DILATATIONAL AND NOT OPEN IS THE
WAY TRACHEOSTOMIES SHOULD BE
PERFORMED IN THE ICU
Authors:
LT COL Karellas J, LT COL Aloizos S, LT COL
Gourgiotis S, MAJ Tsakalakis Chr, MAJ
Arsenoglou A, MAJ Sourlas S, LT COL Liapis G
Institution:
401 Military Hospital, Athens, GREECE
Purpose: To evaluate the safety and efficacy of
percutaneous dilatational tracheostomy in the
intensive care unit (ICU). Open tracheostomy takes
time, is more traumatic, considerably more
expensive than dilatational, often prohibited by
bleeding diathesis or by the use of anticoagulants
and usually not performed in the ICU.
Materials and methods: Fifty five dilatational
tracheostomies that were performed in ICU in a 2year period were studied. Time needed and
intraoperative and postoperative complications
were recorded. All dilatational tracheostomies were
performed by the patient’s bed, by intensivists
without bronchoscopy. All ICU patients that needed
a tracheostomy, regardless of the reason of
admission to ICU, underwent a dilatational
tracheostomy during this specific period of time.
136
Results: Percutaneous dilatational tracheostomy
was completed successfully in all patients in whom
it was attempted, regardless of airway anatomy,
gender, age, body condition, comorbidities, existing
bleeding diathesis or low platelets and lung
mechanics. All the procedures were performed in
the ICU with a mean duration of 10.5 minutes (95%
confidence interval, 8.5-12.5 minutes). Minor
intraoperative technical difficulties occurred in 10
patients (18%). Postoperative complications
occurred in 8 patients (14%), consisting of 2
premature decannulations, 5 acute obstructions of
tracheostoma and one episode of endotracheal
bleeding but none led to serious morbidity or death.
Long-term airway complications after percutaneous
dilatational tracheostomy were not reported after
discharge from ICU.
Conclusion:
Percutaneous
dilatational
tracheostomy is a safe, rapid and effective
procedure that can replace open tracheostomy in the
ICU environment. It can be performed at the
bedside, independently of the patient condition,
without the need to transport the critically ill
patients to other hospital departments.
OP080
DAMAGE CONTROL RESUSCITATION
Authors:
Veljović Milić, Udovičić Ivo, Damjanović Nebojša
Institutions:
Department of Anesthesiology and Intensive care,
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
Damage Control Resuscitation (DCR) is a
systematic approach to major exsanguinating
trauma incorporating strategies of permissive
hypotension, haemostatic resuscitation and damage
control surgery. DCR is a novel concept that draws
together a series of technical and organizational
advances in combat casualty care. DCR, a concept
that has been popularized by the military, is now
being evaluated for its applicability in the civilian
setting. It is consistent with and encapsulates the
established concept of damage control surgery. In
this lecture we review current literature regarding
the pathophysiology of massive hemorrhage: the
“lethal triad” of coagulopathy, acidosis and
hypothermia, and integrates this with an
introduction to the components of DCR. Traditional
management centered upon correction of acidosis
and hypotension with crystalloids. Today, however,
early use of red blood cells, fresh frozen plasma
and platelets is recommended and as well as, using
137
TEG (thromboelastograph) as a guide for the
administration of blood products.
OP081
CORRELATION OF BONE TURNOVER
MARKERS, VITAMIN-D LEVELS AND
STEROIDAL HORMONES WITH BONE
DENSITY IN HEALTHY MALE MILITARY
PERSONNEL
Authors:
Lt. Colonel Panagiotis Kokkoris, Captain
Athanasios Papatheodorou, Brigadier Georgios
Toloumis
Institution:
Department of Endocrinology, 251 Hellenic Air
Force General Hospital, Athens, GREECE
Aim: The aim of the study is to reveal factors
which may influence bone density in otherwise
healthy Air Force male personnel. Specifically, to
examine if there is any correlation between bone
turnover markers, vitamin D levels and steroidal
hormones with bone mineral density (BMD)
measured by DXA scan.
Materials-Methods: We examined 300 men,
Hellenic Air Force personnel, during their
annual/bi-annual scheduled medical examination.
They all had a DXA scan in both the lumbar spine
and the femoral neck. Blood samples were
measured for bone turnover markers (osteocalcin,
alkaline phosphatase and P1NP for bone formation;
CTX for bone resorption), 25(OH) Vitamin D
levels, steroidal hormones (testosterone and
estradiol) and calcium and phosphorus levels. The
SPSS statistical program was used to evaluate any
correlation between all the above measurements
with bone density.
Results: The mean age of the study sample was
33.9±7.7 years, mean weight 84.1±10.8 kg and
mean body mass index 26.1±4.2 kg/m². The mean
bone mineral density was 1.26±0.15 g/cm² for the
lumbar spine and 1.08±0.14 g/cm² for the femoral
neck. The mean values for the markers described
above were: Osteocalcin 18.3±7 ng/ml, alkaline
phosphatase 63±17.2 IU/l, P1NP 51.7±25 ng/ml,
CTX 0.36±0.18 ng/ml, 25(OH) Vitamin D 21.7±9.2
ng/ml, testosterone 5.5±2.3 ng/ml, estradiol
43.6±17.3 pg/ml, calcium 9.5±0.6 mg/dl and
phosphorus 3.2±0.5 mg/dl. Positive correlation was
found between BMD and osteocalcin, P1NP and
CTX respectively (p<0.05); negative correlation
between BMD and alkaline phosphatase (p<0.05).
There was no correlation, either positive or
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
negative, between BMD and 25(OH) Vitamin,
testosterone, estradiol, calcium and phosphorus.
Additionally, mineral density (BMD) (p<0.05) and
negative correlation between BMI and 25(OH)
Vitamin and testosterone, while we found no
correlation between BMI and estradiol.
Conclusion: In relatively young healthy Air Force
personnel bone turnover markers (apart from the
alkaline phosphatase) are positively correlated with
bone mineral density, while in that age steroidal
hormones, Vitamin D and calcium and phosphorus
are not correlated with BMD. Additionally, body
weight is positively correlated with BMD and
negatively correlated with Vitamin D and
testosterone.
OP082
RISK FACTORS FROM DEVELOPMENT OF
ZOLEDRONATE – INDUCED ACUTE PHASE
REACTION
IN
POSTMENOPAUSAL
WOMEN WITH LOW BONE MASS
Authors:
LT COL Athanasios D. Anastasilakis1, Stergios A.
Polyzos2, LT COL Polyzois Makras3, MAJ
Grigorios T. Sakellariou4, MAJ Athina Gkiomisi5,
LT COL Sideris Delaroudis1, CDR Christos
Bissias6, Spyridon Gerou7, LT COL Dimitrios
Oikonomou8, LT COL Ilias Bisbinas9
Institutions:
1. Department of Endocrinology, 424 General
Military Hospital, Thessaloniki, Greece
2. 2nd Department of Internal Medicine, Aristotle
University of Thessaloniki, Ippokration General
Hospital, Thessaloniki, Greece
3. Department of Endocrinology and Diabetes, 251
Hellenic Air Force & VA General Hospital, Athens,
Greece
4. Department of Rheumatology, 424 General
Military Hospital, Thessaloniki, Greece
5. Department of Obstetrics and Gynaecology, 424
General Military Hospital, Thessaloniki, Greece
6. 1st Department of Orthopaedics, Naval Hospital,
Athens, Greece
7. Laboratories “Analysis”, Thessaloniki, Greece
8. Department of Biochemistry, 424 General
Military Hospital, Thessaloniki, Greece
9. 1st Department of Orthopaedics, 424 General
Military Hospital, Thessaloniki, Greece
Purpose: Patients treated with intravenous (i.v.)
zoledronate (ZOL) frequently experience an acute
phase reaction (APR) characterized by flu-like
symptoms and increased levels of inflammatory
cytokines. We aimed to define the role of various
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
cytokines/adipocytokines in ZOL-induced APR and
develop a prognostic model for its prediction.
Patients-Methods: Fifty-one postmenopausal
women with low bone mass were subjected to ZOL
i.v. infusion. Patients were divided into those
experiencing APR (APR+) or not (APR-). APR was
clinically defined by body temperature and the
visual analog pain scale (VAS) for musculoskeletal
symptoms. White blood cell count (WBC),
leucocytic subpopulations, C-reactive protein
(CRP), interleukin (IL)-6, tumor necrosis factor
(TNF)α, visfatin, resistin and leptin were measured
before and 48 hours (h) following the infusion. The
quantitative insulin sensitivity check index
(QUICKI) and homeostasis model of assessment –
insulin resistance (HOMA-IR) were calculated to
assess insulin sensitivity and resistance,
respectively.
Results: APR+ patients were younger and had
lower baseline visfatin and higher baseline
lymphocytes and phosphate compared to APRpatients. QUICKI decreased and HOMA-IR
increased in APR+ patients while remained
unchanged in APR- patients. In binary logistic
regression analysis a model containing previous
bisphosphonate treatment, age, BMI, lymphocytes
and visfatin, which predicted ZOL-induced APR
with 85.7% sensitivity and 73.9% specificity, was
selected. In this model, lymphocytes (p=0.010) and
visfatin (p=0.029) at baseline could independently
predict APR.
Conclusions: Higher lymphocytes and lower
visfatin at baseline independently predict the risk
for ZOL-induced APR. Insulin resistance is
increased after ZOL infusion in APR+ but not in
APR- patients.
OP083
HEART
RATE
VARIABILITY
ALTERATIONS IN CHILDREN WITH
EUTHYROID HASHIMOTO THYROIDITIS
Authors:
COL KILIC Ayhan, MD1; MAJ GULGUN
Mustafa1, MD; COL TASCILAR Emre2, MD; MAJ
SARI Erkan2, MD; COL YOKUSOGLU Mehmet,
MD3
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Pediatric Cardiology
2. Gulhane Military Medical Academy, Dept. of
Pediatric Endocrinology
3. Gulhane Military Medical Academy, Dept. of
Cardiology, Ankara, TURKEY
138
Objective:
Hashimoto
thyroiditis
(chronic
autoimmune thyroiditis) is the most common form
of thyroiditis in childhood. Previous studies have
found autonomic dysfunction of varying magnitude
in patients with autoimmune diseases, which in turn
is a considered a cardiovascular risk factor. The aim
of the present study was to evaluate the heart rate
variability (HRV), a measure of cardiac autonomic
modulation, in children with euthyroid Hashimoto
thyroiditis (eHT).
Material and methods: The study included 32
patients with eHT (27 girls and 5 boys; mean age
11±4.1 years, range 8-16; body mass index
0.47±0.69 kg/m2), as judged by normal or
minimally elevated serum TSH levels (normal
range: 0.34-5.6 mIU/L) and normal levels of free
thyroid hormones (FT4 and FT3) and 38 euthyroid
healthy controls. Subjects with cardiac, metabolic,
neurological disease or any other systemic disease
that could affect autonomic activity were excluded
from the study. Patients with eHT and control
subjects underwent a full history, physical
examination and 24-hour ambulatory ECG
monitoring. Time-domain parameters of HRV were
evaluated for cardiac autonomic functions.
Results: Children with eHT displayed statistically
significantly lower values of time-domain
parameters of SDANN, RMSSD, NN50 counts and
pNN50 for each 5-min interval (p<0.05) as
compared to healthy controls (p<0.05). Only the
SDNN in children with eHT did not significantly
differ from those in controls (p>0.05).
Conclusion: These results demonstrate that eHT is
associated
with
decreased
sympathovagal
modulation of the heart rate. Hashimoto thyroiditis
may increase cardiovascular risks in children even
when they are in the euthyroid state.
Correspondence:
Gülhane Askeri Tıp Akademisi, Pediatrik
Kardiyoloji BD, 06018, Ankara, TURKEY
Tel: +90 312 304 4370 (w)
Fax: +90 312 304 4381 (w)
GSM: +90 532 333 4011
e-mail: akilic@gata.edu.tr
OP084
ASVS AND DIAGNOSIS OF PANCREATIC
GASTRINOMA – OUR EXPERIENCE WITH
TWO PATIENTS
139
Authors:
Ristic P.1, Tavcar I.1, Rusovic S.2, Cizmic M.1,
Kuzmic-Jankovic S.1, Dragovic T.1, Djuran Z.1,
Karajovic J.1, Kikovic S.1, Hajdukovic Z.1
Institutions:
1. Endocrinology Clinic, MMA, Belgrade, SERBIA
2.Center for interventional vascular radiology,
MMA, Belgrade, SERBIA
Background: Pancreatic endocrine tumors
evaluation is diagnostically challenging due to their
small size. Neuroendocrine tumors are sensitive to
Ca stimulation unlike normal tissue. Arterial
stimulation with Ca and following venous sampling
of gastrin -ASVS is morphologic and functional test
that could provide necessary help with pancreatic
gastrinoma diagnosis. This test is particularly useful
when we need to connect suspicious morphological
finding with functional tumor response. Following
its
functional
evaluation
pathological
vascularisation of tumor can be seen during
angiography.
Material and methods: Recently we had two
female patients with suspicious gastrinoma.After
usual laboratory and morphological examination we
performed stimulation with Ca gluconate directly
into a. gastroduodenalis, a. mesenterica superior,
a.linenalis both in distal and proximal part and
a.hepatica. Blood samples for gastrin were
collected from v. hepatica dex. prior to stimulation
and on every 30 seconds till 2 min margin. Results
were compared as relative numbers, rise from
initial value, for each artery.
Results: In both cases there was significant
response to Ca stimulation in arteries that irrigate
pancreatic head. In the first case a.gastroduodenalis
and in the second a.mesenterica superior.After
surgery diagnosis and tumor localization was
confirmed. In our experience among all
morphological examinations performed only
endoscopic ultrasound visualized these tumors.
Conclusion: ASVS is powerful and useful
functional and morphological test, from our
experience preferably combined with endoscopic
ultrasound.
OP085
MONITORING RISK FACTORS FOR EARLY
ATHEROSCLEROSIS
IN
PATIENTS
DIAGNOSED WITH SYSTEMIC LUPUS
ERYTHEMATOSUS
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Authors:
Assistant Professor Dr.Monica Copotoiu; Second
Lieutenant Oparlescu Roxana-Maria
Institution:
ROMANIA
Objectives: To assess the changes in carotid
intima-media thickness (IMT) and the associated
risks factors in patients with low severity systemic
lupus erythematosus (SLE).
Methods: A prospective, observational study was
performed in the Rheumatology Department of
Targu Mures in order to assess the atherosclerotic
risk factors in patients diagnosed with lupus
erythematosus. 20 patients meet the inclusion
criteria and were submitted to ultrasound
measurements on an 8-month period, in order to
obtain their carotid intima-media thickness. The
cardiovascular risk factors, the accumulated
damage, the disease activity severity index (the
Katz index) and immunological parameters
(antinuclear antibodies, antiDNA double-stranded
antibodies,
anticardiolipin
antibodies),
the
corticotherapy treatment, the cholesterol and the
glycemia were also assessed. The statistical
software used was Graph Pad Prism5 and SPSS and
the data were assessed using the Pearson correlation
and the multiple linear regression.
Results: Gender was not a variable to be count on
(all the patients were females). The mean age of the
group was 46.13+/-9.479 with the mean onset of
the disease of 5.250 years. The group was divised
according with the treatment a first group on
hidroxicloroquine and a second one on
cortticotherapy. The IMT was measured on both
sides (right and left). Similar results were found
(IMTr: 0.09469+/-0.04559; IMTl: 0.09625+/0.03115). We couldn’t find a positive statistical
correlation between the variables in the main group
(all patients regardeless the treatment) and the
antimalarics group (p>0.05). The group on
corticotherapy showed statistically a positive
correlation between the IMT and the levels of
glicemia (p=0.049).
Conclusions: The patients receiving corticotherapy
associate modified IMT measurements and an
increased risk on developing associated comorbidities. We cannot draw a strong remark on the
early atherosclerotic risk due to the low number of
the patients.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Correspondence:
Assistant Professor Dr.Monica Copotoiu, Second
Lieutenant Oparlescu Roxana-Maria
Tel: +40.756.974.866
E.mail: mar_rias@yahoo.com
OP086
PECULIARITIES
IN
EPIDEMIOLOGY,
CLINICAL
MANIFESTATION
AND
TREATMENT OF TUBERCULOSIS IN THE
BULGARIAN ARMY
Authors:
Yanev1, N. Yanev2
Institutions:
1. Military Medical Academy – Clinic for
Pneumonology and Phthisiatry – Sofia, Bulgaria
2.Univrsity Medical Hospital for Active Treatment
- Clinic for Pneumonology and Phthisiatry, –
Pleven, BULGARIA
Authors:
Tuberculosis is social problem in the whole world.
It advances in region as Balkan penisula –
crossroad between Europe, Asia and Africa (the last
two with high morbidity rate). The threat for the
army devisions is higher because of the closed
nature of the community and there is a real danger
of development an outbreak. The danger comes
from the residence of troop contingents in areas of
contamination during peacekeeping missions.
Aims and objectives: In this survey there are
discussed, contemporary trends in epidemiology of
tuberculosis, our experience in specific way of
transmission in the army and prevention. Get
acquainted with peculiarity in manifestation of
disease in the recent years and the developments in
treatment and prophylaxis of tuberculosis.
Conclusion: Good knowledge of the epidemiology,
clinical course specifics, new diagnostic methods
and supervised treatment led to good results in our
practice to reduce morbidity and mortality of
tuberculosis.
Correspondence:
Military Medical Academy, Georgy Sofiisky Str. 3,
1606, Sofia, BULGARIA
Tel: +359 2 922 5930
GSM: +359 887 437 677
E –mail: atanas61@yahoo.com
www.pulmolog.dir.bg
140
OP087
OF NON-SMALL CELL LUNG CANCER BY
4-D RADIOTHERAPY WITH ACTIVE
BREATHING CONTROL
Authors:
COL BEYZADEOGLU Murat, MD; CPT SAGER
Omer, MD; CPT DINCOGLAN Ferrat, MD; CPT
GAMSIZ Hakan, MD; CPT UYSAL Bora, MD;
CPT DEMIRAL Selcuk, MD; ELCIM KAHYA
Yelda, MSc; COL OYSUL Kaan, MD; COL
SURENKOK Serdar, MD
Institutions:
Gulhane Military Medical Academy, Dept. of
Radiation Oncology, Ankara, TURKEY
Objective: The aim of this study is to evaluate the
effect of 4-D radiotherapeutic management of nonsmall cell lung cancer (NSCLC) using Active
Breathing Control-moderate deep inspiration
breath-hold (ABC-mDIBH) in terms of normal
tissue sparing with maximized precision cancer
therapy.
Material and methods: Forty-one patients with
locally advanced NSCLC treated between January
2010 and January 2012 at Gulhane Military
Medical Academy Radiation Oncology Department
were included in the study. All patients were
scanned at free breathing and ABC-mDIBH for
radiation treatment planning. 2 separate treatment
plans were generated for each patient with and
without ABC-mDIBH. Critical organ dose-volumes
and physical lung parameters were comparatively
evaluated on 2 separate dose-volume histograms of
each patient acquired from planning software.
Individual tumor motion of each patient with and
without ABC-mDIBH was documented and
compared. All patients were treated using 4-D
radiotherapeutic
management
with
Active
Breathing Control-moderate deep inspiration
breath-hold (ABC-mDIBH). Image Guided
Radiation Therapy (IGRT) technology including
Cone Beam Computed Tomography (CBCT) and
X-ray Volume Imaging (XVI, Elekta, UK) was
used to improve treatment precision.
Results: Forty-one patients with locally advanced
NSCLC were treated using 4-D radiotherapeutic
management with ABC-mDIBH. The use of ABCmDIBH resulted in statistically significant
improvement in physical lung parameters of V20
(lung volume receiving ≥ 20 Gy) and mean lung
dose (MLD) which are predictors of radiation
pneumonitis (p<0.001). Reduction in spinal cord
141
dose and tumor motion with ABC-mDIBH was also
statistically significant (p<0.001).
Conlusion: In the management of NSCLC, 4-D
radiotherapy using ABC-mDIBH increases normal
lung tissue sparing by improving physical lung
parameters along with spinal cord dose reduction
through excellent tumor immobilization. The
incorporation of ABC-mDIBH into NSCLC
radiotherapy may have implications for potential
margin reduction and dose escalation to improve
treatment outcomes.
Correspondence:
Gulhane Askeri Tıp Akademisi, Radyasyon
Onkolojisi AD, Etlik 06018, Ankara, TURKEY
Tel: +90 312 304 4681
Fax: +90 312 304 4680
GSM: +90 535 942 2726
E-mail: mbeyzadeoglu@yahoo.com
OP088
LEVEL OF PARATHYROID HORMONE IN
ACUTE PHASE OF ST ELEVATION
MYOCARDIAL INFARCTION PREDICTS
EARLY DEATH AND ACUTE HEART
FAILURE
Authors:
Gligic B1, Obradovic S1, Banovic M2, Vukotic S1,
Ostojic M2
Institutions:
1Clinic of emergency medicine, The Medical
Faculty of the University of Defence, Belgrade
2Institute for cardiovascular diseases, Clinical
centre of Serbia, Belgrade, SERBIA
Background: Several biomarkers are useful for the
early prediction of outcome in ST elevation
myocardial infarction (STEMI) patients. It is
unknown whether the level of parathyroid hormone
can predict the early outcome in STEMI patients.
Methods: Levels of parathyroid hormone (PTH),
creatinine-kinaze
MB
(CKMB),
lactate
dehydrogenase (LDH) and C-reactive protein
(CRP) were measured at least once a day for the
first three days from the STEMI patients treated
with reperfusion therapy. The end points of the
study were death and acute heart failure at 90 days.
Results: One hundred and five consecutive STEMI
patients who received reperfusion therapy were
enrolled. The majority of patients were treated with
either primary (62.0%) or urgent PCI after
fibrinolysis (31.4%) and only 6.7% of patients were
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
treated with fibrinolysis alone. Nine patients (8.6%)
have died and 13 patients (12.4%) experienced non
fatal acute heart failure during the 90 days.
According to quartiles of maximum PTH levels
patients were divided into 4 groups (Q1-Q4). There
was no death or acute heart failure in Q1 and Q2.
However mortality was 3.8% in Q3 and 33.3% in
Q4, and non fatal acute heart failure was 23.1% in
Q3 and 22.2% in Q4, respectively. In the Cox
regression analysis including quartiles of all
biomarkers, quartiles of PTH were an independent
predictor of composite end point of death and acute
heart failure (p<0.001). Area under the ROC for
composite end point of death and acute heart failure
was the greatest for the PTH 0.894 (95% CI 0.810.98) compared to LDH 0.822 (0.69-0.95), CRP
0.793 (0.66-0.92) and CKMB 0.731 (0.58-0.88),
respectively.
Conclusion: The level of parathyroid hormone is
an excellent predictor of death and acute heart
failure during the early days after STEMI.
OP089
RENAL LESION IN EXPERIMENTAL
ACUTE HEMORRHAGIC NECROTIZING
CANINE PANCREATITIS
Authors:
Ljiljana Ignjatović†, Dragan Ignjatović‡, Darko
Mirković‡, Jovan Dimitrijević‼, Vujadin Tatić‼,
Đoko Maksić†, Dubravko Bokunjić§ and Jovan
Savić
Institutions:
†Clinic of Nephrology, ‡Clinic of General Surgery,
‼Institute for Pathology and Forensic Medicine,
§Center for Poison Control and ¶Institute for
Medical Investigations in Medical Military
Academy, Belgrade, SERBIA
Aim/Background: To explore the influence of
spreading ways blockade for mediators of systemic
inflammation and pancreatic enzymes on renal
lesion in experimental hemorrhagic necrotizing
dog’s pancreatitis.
Method: 25 mongrel dogs, BW 20-25 kilos, were
divided in five groups. Every dog had cannula in
femoral artery, vein and thoracic duct. First group
of dogs was control – without pancreatitis. In dogs
from groups II-V hemorrhagic necrotizing
pancreatitis was induced by modified Mayer –
Blomqvist model. Second and third group returned
lymph to systemic circulation, and third group
retained peripancreatic exudates. Groups four and
five drained lymph and fifth group retained
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
peripancreatic exudate. In the period 0, 1, 3, 6 and
24 hours from serum, lymph and peripancreatic
exudates were measured concentrations of
pancreatic amylases, lipases and phospholipase A2
– as a marker of pancreas necrosis. Renal function
was evaluated through creatinine and urea in serum.
In arterial and venous blood PH, pO2 i pCO2 were
measured. After 24 hours dogs were sacrificed and
prepared for histology analysis of pancreas and
kidneys. Renal lesion was expressed through
glomerular, tubulointerstitial, vascular inex and
total score. In statistic analysis were used T test,
ANOVA 1, nonparametric Wilcoxon test and
Spearmen coefficient of correlation.
Results: Pancreatic enzymes were significantly
lower in groups IV and V, marking a favorable
clinical course. Renal lesion evaluated through
specific indexes and total score was significantly
higher in groups II and III, without lymph drainage
and in groups II and IV without retaining of
peripancreatic exudates.
Conclusion: Important route for systemic
mediators of inflammation and pancreatic enzymes
in the course of s hemorrhagic necrotizing
pancreatitis is lymph. Lymph drainage before
systemic inflammatory response could change
clinical course of serious pancreatitis and minimize
renal lesion.
OP090
“GEORGE N. PAPANICOLAOU (1883-1962):
THE MAN, THE SCIENTIST AND THE
HUMANITARIAN. A 50-YEAR COMMEMO
RATIVE”
Authors:
Captain (Navy) Aristidis G. Diamantis, M.D.,
Ph.D., H.N.1; Commander Christos Bissias, M.D.,
M.Sc., H.N. 2
Institutions:
1. Head, Cytopathology Dept. and Laboratory
Division, Naval Hospital of Athens, Hellas;
Honorary Member, BMMC
2. Consultant Orthopaedic Surgeon, Naval Hospital
of Athens, GREECE
Fifty years have passed since the death of the
renowned George Papanicolaou, the man who
“gave life to the women of the whole world”,
saving them from cervical cancer, as is quite
distinctly commemorated on the inscriptive stone
outside the Cancer Research Institute in Miami,
Florida (USA), which is named after him, in his
honour. His philosophical approach to life and
142
science is epitomized in the following words: “My
ideal is not to become a rich man, neither to lead a
happy life, but to work, to act, to make something
worthy of a morally strong man”. Fifty years after
his death the name of George Papanicolaou -as
man, scientist, teacher and humanitarian- recurs
constantly in worldwide publications relating to the
modern history of medicine. “Doctor Pap” and the
“Pap Smear” are the regular subjects of world
medical literature and still hold the spotlight in
international medical circles. Countless individuals
and our global society at large have reason to be
grateful to him for his research efforts.
OP091
THE HERO-CULT OF
FOUNDER OF NAVAL
ANCIENT GREECE
AMPHIARAUS:
MEDICINE IN
Authors:
Emmanouil Magiorkinis, BSc, MD, PhD;
Commander Christos Bissias, MD, MSc, HN;
Captain Aristidis Diamantis, MD, PhD, HN
Institutions:
Office for the Study of History of Hellenic Naval
Medicine, Naval Hospital of Athens and Veterans,
GREECE
Purpose: The purpose of this study was to trace
back the origin of Naval Medicine and to highlight
the figure of Amphiaraus as the first naval doctor in
history of Medicine.
Material and Methods: Historical archives and
reports were researched as well as extensive
research in available literature was also conducted.
Results: Amphiaraus, in Greek Mythology, son of
Oecles from the line of Melampus, a great seerhealer and Hypermnestra. He was honored in his
time as a seer, since Zeus and Apollo gave him his
oracular talent. According to Apollodorus, he was
enlisted as one of the Argonauts, although
Apollonius, Hyginus and Valerius Flaccus did not
mention him. He died in the tragic battle of Seven
against Thebes; according to the myth, Amphiaraus
tried to flee from Periclymenus, the famous son of
Poseidon who wanted to kill him, but Zeus threw a
thunderbolt and the earth opened to swallow
Amphiaraus along with his chariot. After his death,
Amphiaraus was worshipped as a chthonic cult and
as a god-healer; in the sanctuary of Amphiareion of
Oropos, the petitioner, after making a small
sacrifice of a few coins, slept and received a dream
detailing the solution to his problem.
143
Conclusion: Amphiaraus, a semi-god and healer, is
to be considered the first naval doctor.
OP092
83 YEARS MILITARY HOSPITAL IN
ALBANIA (September 26, 1929- September 26,
2012)
Authors:
Colonel PhD Luan NIKOLLARI, LTC Dr.Edlira
KUKEL
Institution:
Military Medical Academy, Tirana, ALBANIA
The Central University Military Hospital (CUMH)
was founded 83 years ago, on September 26, 1929.
It is one of the most important medical institutions
in our country for tradition, experience created
during many years, contributing to the development
of Albanian military and civilian medicine. The
location of CUMH is in Ǿ 41020’34” dhe
Л19047’41” j 56.801, occupies an area of 77.405
sq.m and plenty of green. CUMH is reference
institution of military medicine in the Albanian
Armed Forces (AAF). At the memory of military
generations the military hospital has particular
importance. After the 1990 structural changes,
adapting the developments in the Albanian army
with the assistance of NATO, CUMH was
composed to fulfill the mission in support of AAF
taking on another mission: polytrauma management
at national level and assisting the civilian
population in disaster and misfortunes.
OP093
THE WAR AGAINST CHOLERA: THE
EXCITING STORY OF THE DISCOVERY OF
VIBRIO CHOLERAE BY ROBERT KOCH IN
THE GREEK HOSPITAL OF ALEXANDRIA
IN EGYPT
Authors:
Emmanouil Magiorkinis, BSc, MD, PhD;
Commander Christos Bissias, MD, MSc, HN;
Captain Aristidis Diamantis, MD, PhD, HN
Institutions:
Office for the Study of History of Hellenic Naval
Medicine, Naval Hospital of Athens and Veterans,
GREECE
Purpose: The purpose of this study was to
highlight the important events that took place at the
Greek Hospital of Alexandria, which led to the
discovery of Vibrio cholera as the causative agent
of cholera by Robert Koch.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Material and Methods: Historical archives and
reports were researched as well as extensive
research in available literature was also conducted.
Results: The German team under Robert’s Koch
supervision managed to assemble a complete
travelling bacteriological laboratory, which was
transported to Egypt. Koch and its co-workers,
Georg Gaffky, Berhnard Fischer and Dr. Treskow,
left Berlin on 16 August 1883 and reached
Alexandria a week later. Seeking a location with
many cholera cases, the German team established
themselves in the Greek Hospital of Saint
Sophronios which was established by the Greek
community in the 19th century, where they laid out
their laboratory and began their pathological
examinations. There was also a German Hospital in
Alexandria, but it was not suitable since it had very
few cholera cases. Robert Koch collaborated with
two eminent Alexandrian Greek physicians
Stefanos Kartoulis and Valassopoulos. The French
commission under the supervision of Louis Pasteur
established themselves in the “Hôpital Européen”.
In Egypt, Koch managed to identify the same
organism from 10 cho-lera victims, but failed to
culture the organism. He also carried out important
epidemiological studies with the goal to describe
the conditions that propagate the cholera epidemic.
The final identification of the causative agent took
place in India in Calcutta.
Conclusions: The establishment of the German
mission in the Greek Hospital of Alexandria was an
important hallmark in the discovery of the causative
agent of cholera.
OP094
SOME ELEMENTS OF THE MEDICOSOCIAL
PROFILE
OF
BULGARIAN
FEMALE SOLDIERS
Authors:
А. Nacheva, N. Vasilev, S. Kovachev.
Institutions:
Military Medical Academy, Multiprofile Hospital
for Active Treatment, Department of General and
Oncologic Gynaecology – Sofia, BULGARIA
The author presents part of the results of a survey
conducted in 2009-2011 among two groups of
respondents:
1. 646 female soldiers;
2. 178 civilian women whose occupations require
wearing of a uniform.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
The average age of female soldiers is 32 years. The
average age of civilian women is 41 years (P <
0.0001). The majority of both military (81%) and
civilian (82%) women are either married or “de
facto” wives. One third of female soldiers (32%)
explain their professional choice with financial
and/or social reasons. Among civilian women the
respective proportion is significantly lower – 24%
(P < 0.0001). No statistically significant difference
exists between female soldiers and civilian women
as far as the reason “Thrill” is concerned. Women
involved in civilian professions are more satisfied
with the “acceptance of their performance by third
parties” than female soldiers – 55% vs. 21% (P <
0.0001). Female soldiers who assess their physical
strain as higher than the physical strain of their
male counterparts are a minority (4%). Much more
(23 %) of civilians assess their physical strain as
higher than that of males (P < 0.0001). Most
civilian women (66%) are convinced that physical
strain of both genders is symmetrical. As far as
psycho-emotional strain is concerned, the two
groups of respondents display considerable
differences. Psycho-emotional strain is assessed as:
− higher in females by 18% of military and 39% of
civilian respondents;
− lower in females by 14% of military and 6% of
civilian respondents;
− symmetrical in both genders by 68% of military
and 55% of civilian respondents.
All the above differences are statistically significant
(P < 0.0001). Women without clinically important
menstrual disorders prevail in both groups (83% of
female soldiers and 79% of civilians). Absenteeism
due to gynaecological ailments rank as follows: 2%
of female soldiers and 1 % of civilians are absent
“often”, 23% of female soldiers and 8% of civilians
– “seldom”, 75% of female soldiers and 91% of
civilians – “never”. The proportion of answers
“seldom” and “never” collected in the two groups
differ significantly (P < 0.0001). There are good
reasons to assume that absenteeism due to
gynaecological ailments is more common among
female soldiers than among civilians. The vast
majority of female soldiers:
− consider they lack enough information on how to
cope with gynaecological disorders during field
operations (76%);
− believe that their uniforms must take into
consideration the specifics of female anatomy
(88%).
Over 50% of female soldiers (opposed to 13% of
civilian women) assess facilities for intimate
hygiene at the workplace as “poor”.
144
OP095
MEASURING THE EFFECT OF TYRE
PRESSURE ON THE POWER, ENERGY AND
EFFICIENCY OF PROPULSION OF AN
ULTRA LIGHT WHEELCHAIR: A SPORTS
DISABILITY STUDY
Author:
Lt Commander Konstantinos Bougoulias MD,
MSc.
Institutions:
Orthopaedic Dept, Naval Hospital of Athens,
Greece & Royal National Orthopaedic Hospital
London, U.K.
GREECE.
Purpose: The aim was to prove that tyre pressure
significantly affects the amount of energy required
to propel a wheelchair.
Materials and methods: One no paraplegic, no
wheelchair permanent user, right-handed, 35-yearold male took part in the study. One ultra lightweight wheelchair was used. The tests took place at
the Royal National Orthopaedic Hospital, London,
UK. The length that was run by the individual was
the same for all tests, 80m. A plastic bag with bag
valve, one-way breathing valve mouthpiece, gas
analyser and a spirometer were used for
measurement
of
oxygen
consumption.
Measurement of wheelchair acceleration and
velocity were done by a three-axis [x, y and z]
accelerometer [Crossbow CXL 04M3] connected to
a remote data logger [TT8]. The individual
propelled the wheelchair 3 times per condition
(tyres normally inflated vs deflated) at constant
velocity 4Km/h or 1.11m/s. Drag force and tyre
pressure were measured for each condition.
Results: All measurements are shown in Tables 16. The results were based on the measurement of
the external power [Po], internal power [En] and
gross mechanical efficiency [ME%=Po/En%] after
a six-times-repeated test run. There was a
statistically significant difference between the two
measured conditions.
Conclusions: The energy required for wheelchair
propulsion is elevated when the tyres are deflated.
That simple detail can significantly influence the
outcome in sports competitions, although many
other parameters, such as the kind of wheelchair,
biomechanics and physical condition of the user are
also extremely important. On the other hand, an
individual who is not careful about tyre pressure
along with a potential wrong choice of type of
145
wheelchair may risk suffering overuse injuries.
Therefore, tyre pressure should be checked
regularly [weekly] with a tyre pressure gauge as
indispensable equipment.
OP096
HOW COST-WORTHY IS THE HELLENIC
AIR-FORCE’S INVESTMENT ON HEALTH
DISORDERS
PREVENTION?
POLICY
COMPARISON BETWEEN FLYING vs NONFLYING PERSONNEL
Authors:
CPT George Alevetsovitis MD,FS1; LT Vasileios
Moutevelis MD, FS1; CPT Panagiotis Kousoulis
MD, FS1; 2nd LT Alexandros Kontotasios,
Psychologist1; Panagiotis Prezerakos, Asst. Prof.,
Msc, PhD2
Institutions:
1. Aviation Medicine Office, 120 Flight Training
Wing.
2. University of Peloponnese, Nursing Department,
GREECE
Aim: Statistical analysis of cross-correlation
between health status and the degree of prevention
(by the means of health services consumption) in a
specimen of the Hellenic Air Force personnel.
Material – Method: Calculation of cardiovascular
risk score (Hellenic Score) and Body Mass Index in
a specimen of 190 individuals (92 pilots and 98
individuals from technical/maintenance – air traffic
control sectors) chosen using the method of simple
random sampling from the ‘120 Flight Training
Wing’ and statistical analysis (SPSS 18.0 significance level 95%) of the level of correlation
between health status (by the means of CVR Score
and BMI) and the intensenity of medical prevention
policy (by the means of cost-effective health
services consumption).
Results: The level of cardiovascular risk depends
positively upon the value of BMI (p value=0,009).
The BMI value is in statistically significant relation
to the type of profession (flying vs non flying
personnel) (pilots/ground personnel, p= 0.004;
pilots/air traffic control, p= 0.016). However, the
cardiovascular risk score does not seem to depend
strongly upon the type of profession with the
borderline rejection of p= 0.057 between pilots and
ground personnel. There is a linear model which
defines the relation between cardiovascular risk and
BMI, CVR= 0.820+0.092x BMI. This model
presents a weak correlation (R=0.198) but it is
statistically important (p=0.006)
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Conclusions: In general, Hellenic Air Force pilots
seem to keep a higher level of quality Health status
and the interpretation of this result lies upon the
policy of Health Prevention measures which
demands an annual medical examination for pilots,
whereas the ground personnel undergo medical
evaluation every two years. We can, therefore,
clearly justify the choice of annual medical
evaluation which seems to be cost effective.
However, there is still need for further examination
of the importance of imposing this policy to the
whole air force personnel by means of Health
Economy.
OP097
HYDATID DISEASE, A REALITY IN AND
AROUND MODERN-DAY BATTLEFIELD
Authors:
Maj. A.Popentiu¹, Maj. D. Moga¹, Col. I. Barb², A.
Sabau³, Prof. D. Sabau³
Institutions:
1. Department of Surgery, Emergency Military
Hospital Sibiu, ROMANIA
2. Department of Internal Medicine, Emergency
Military Hospital Sibiu, ROMANIA
3. First Surgical Clinic, “Victor Papilian” Faculty
of Medicine, Sibiu, ROMANIA
Human echinococcosis is a zoonotic infection
caused by the tapeworm of the genus
Echinococcus, which is endemic to Balkan area,
Mediterranean, Middle and Far East, and South
America. The present day conflicts involve contact
with the endemic areas, during deployments, with a
subsequent danger of infestation. The hydatid cyst,
either hepatic or pulmonary, as an extremely
serious disease, with great social and economic
expenses, is also treatable by using modern
techniques. The surgery addressed to the hepatic
hydatid cysts benefits heavily from the appearance
of the laparoscopy, with all its advantages. The
laparoscopic treatment is made possible with the
use of special patented devices, which leaded to
better results than the classic, open interventions.
Our paper is reviewing the data concerning the
patophysiology, epidemiology of the parasite, and
the medical treatment. We present the case-report
of a hepatic hydatid cyst treated in a war-zone, and
also the modern-day devices and surgical methods
used for the laparoscopic approach.
Correspondence:
Maj. Adrian Popentiu, MD, PhD, Department of
Surgery, Emergency Military Hospital B-dul
Victoriei 44-46 Sibiu, Romania
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
146
Tel +40269.211.209 / 132, +40.742.074.094
E-mail: adipopentiu@yahoo.com
stenosis and can also be used to predict the severity
of stenosis.
OP098
ULTRASONOGRAPHIC
CHARACTERI
STICS IN OCULAR ISCHEMIC SYNDROME
OP0099
THE VITREO-RETINEAL SURGERY ON 23G
Authors:
Silviana Nina Jianu1, D.C. Jianu2
Institutions:
1. MD, PhD, Senior Ophthalmologist, Military
Emergency
Hospital,
Department
of
Ophthalmology, Timisoara, ROMANIA
2. MD, PhD, Senior Neurologist, Associate
Professor of Neurology, University of Medicine
and Pharmacy “Victor Babes”, First Dept of
Neurology,
County
Emergency
Hospital,
ROMANIA
Authors:
The internal carotid artery (ICA) is the main route
by which the blood is supplied from the heart to the
brain and other areas of the head. The ocular and
orbital circulation is supplied by the ophthalmic
artery, which is the main collateral branch of the
ICA. Severe atherosclerosis of the ICA (due to an
atherosclerotic plaque which is more than 75% of
the arterial lumen`s diameter) may lead to transient
or permanent symptoms of retinal ischemia and to
an increased risk of stroke.
Purpose:
To
define
orbital
circulation
abnormalities identified by color Doppler imaging
(CDI) of retrobulbar vessels in patients with carotid
occlusive disease.
Material and methods: We used a Loqic 500
sonographer with 9 MHz linear probe for Doppler
investigation of retrobulbar vessels and an
ultrasound equipment (MyLab 50 Esaote) with a
7.5-10 MHZ linear array transducer for extracranial
Duplex sonography.
Results: We presented 5 patients with severe ICA
stenosis that developed or not an ocular ischemic
syndrome. We discussed the hemodynamic status
(orbital and cerebral) in order to elucidate the
contribution to the ischemic symptoms. Cerebral
and retinal perfusion is dependent not only on the
degree of stenosis but also on the presence of
unilateral or bilateral lesions and on the patency of
collateral pathways.
Conclusion: The presentation of ocular ischemic
symptoms may be the initial sign of carotid artery
Authors:
BĂLĂ R., BĂLĂ A.
Institution:
Department of Ophtalmology, Emergency Military
Hospital Sibiu, ROMANIA
For more than 5 years, the 23G vitreo-retinal
surgery accounted as the first and only “sutureless”
surgery for the vitreous and retina affections.
"Reserved" originally to a small number of
pathological conditions-especially on the posterior
pole and only in early stages, the 23G access can be
used now on any surgical pathology of the vitreous,
due to advances in technology for surgical, optical
and other devices. The benefits of the technique, its
indications, and some intra-operative aspects are
presented in our paper. The results are annalised
through the vast experience of our surgical team.
Correspondence:
BĂLĂ R., Department of Ophtalmology,
Emergency Military Hospital Sibiu, Romania B-dul
Victoriei 44-46 Sibiu, Romania
Tel +40269.211.209
OP100
TWO
CASES
WITH
CORNEAL
PERFORATION TREATED WITH THE
APPLICATION
OF
CYANOACRYLATE
GLUE ON WOUND LEAK
Authors:
Cap Bledar Kruja MD, ,Maj Elvis Veliu MD
Institution:
Military Medical Academy, Tirana, ALBANIA
Material and methods: the 2 patients suffered
corneal abscess caused by an agricultural trauma.
After about 1.5 months they developed corneal
perforation at the center of the abscess and
shallowing of the anterior chamber. On both
patients we used cyanoacrylicate glue on the
perforation and contact lens upon it.
Results: The next day both patients had formed
anterior chamber and no leakage at all. We continue
the therapy for the corneal abscess for a long time.
The effective early application of a cyanoacrylate
glue corneal patch can aid in the management of
147
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
small corneal perforations, corneal melts and
wound leaks. Their use gives improved visual
outcomes with reduced enucleation rates (6% vs
19%). It may also avoid the need for tectonic
penetrating keratoplasty. Cyanoacrylate glue
prevents re-epithelialization into the zone of
damaged and naked stroma and prevents the
development of the critical setting for collagenase
production that leads to stromal melting.
Cyanoacrylates also have significant bacteriostatic
activity against gram-positive organisms. We
describe a simple and easily reproducible method of
cyanoacrylate corneal patch application, with
neglible risk of inadvertent glue complications. It
has the further advantage of a smooth corneal
surface rather than an irregular surface as often
occurs with direct application methods. With
corneal application, the major concern is toxicity of
cyanoacrylates through direct contact with the
corneal endothelium and lens. Fibrin glues may be
less toxic; however, they are not as readily
available. The longer alkyl chains of currently
available cyanoacrylate glues (e.g. Histoacryl) slow
degradation significantly, limiting accumulation of
histotoxic by-products to amounts that can be
effectively eliminated by tissues. Vigilance in
monitoring for infection/corneal infiltrate is
necessary at all times, especially when the glue has
been present for more than 6 weeks.
Conclusions: Corneal patching with cyanoacrylate
glue is a temporizing procedure only, buying time
to allow healing secondary to medical treatment of
the underlying condition, or allowing surgery to be
elective and under more optimal conditions once
inflammation has been reduced and the integrity of
the globe restored.
OP101
DIABETIC MACULAR EDEMA- TYPES, OCT
CHARACTERISTICS, FOLLOW UP
Authors:
VIDINOVA Christina MD, PhD; Col. VOINOV
Latcezar MD, PhD
Institution:
Clinic of Ophthalmology, Military
Academy - Sofia, BULGARIA
Medical
Introduction: Diabetic macular edema (DME) is
one of the severest complications of non
proliferative diabetic retinopathy, leading to major
reduction of the visual acuity.
Aim: The aim of our survey is to demonstrate the
diagnostic abilities of OCT RTVue for precise
evaluation of diabetic macular edema morphology,
as well as the progression of the disease.
Material and methods: 15 patients with diabetic
macular edema were enrolled in the study. They
were all examined every three months in a period of
one year for visual acuity, fundus photography,
fluorescein angiography and OCT. We used the
following programmes- HD line, Cross line, EMM5
and EMM5 progression to detect any changes in the
course of the disease.
Results: There was a significant correlation
between the fundus photographs and fluorescein
agiography. OCT imaging gave us additional
information about the DME morphology, its size,
cystoids or not cystoid type, as well as the presence
of vitreo-retinal tractions or serous retinal
detachment. The most frequent finding in our
patients was the diffuse DME. With the help of
ЕММ5 map we were able to calculate the size of
the lesion. Less common was cystoid macular
edema. Most rare was DME with serous retinal
detachment. ЕММ5 progression helped us follow
the changes in the size of the retinal edema in time
and after treatment.
Conclusion: Our results come in support of the fact
that fundus photography and fluorescein
angiography may detect the presence of DME, but
only OCT techniques give us information about the
morphology of the edema and the existence of
vitreoretinal tractions. A significant advantage of
OCT RTVue is the programme ЕММ5 progression
with the possibility of following the dynamics of
the disease and the effect of treatment.
Correspondence:
Clinic of Ophthalmology, Military Medical
Academy, “Georgy Sofiisky” Str.3, 1606 Sofia,
BULGARIA
Tel: 00359 2 922 53 21
Fax: 003592 952 65 36
Mobile: 00359 888 38 75 29.
E-mail: christinavidinova@yahoo.com
OP102
RISK FACTORS FOR THE DEVELOPMENT
OF CONSECUTIVE EXOTROPIA AFTER
BIMEDIAL RECTUS RECESSION SURGERY
Authors:
COL MUTLU Fatih Mehmet Mutlu MD1, MAJ
CEYLAN Osman Melih MD1, BG ALTINSOY
Halil Ibrahim MD1 , TURK Adem MD2, CPT
GOKCE Gokcen MD3
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
148
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Ophthalmology, Ankara, TURKEY
2. Karadeniz Technical University, Dept. of
Ophthalmology, Ankara, TURKEY
3. Sarıkamıs Military Hospital, Eye Service, Kars,
TURKEY
Correspondence:
Gulhane Askeri Tip Akademisi, Goz AD, Etlik,
06018, Ankara, TURKEY.
Tel: +90 312 3045858
Fax: +90 312 4182880
GSM: +90 533 3581157
E-mail: fmmutlu@gata.edu.tr
Objective: To determine the the rate and risk
factors impacting on the development of
consecutive exotropia (XT) following bimedial
rectus recession (BMR) surgery for the treatment of
childhood esotropia (ET).
OP103
IMPACT OF INTRAOCULAR FOREIGN
BODIES IN EXPLOSIVE-RELATED OPENGLOBE INJURIES BY TERRORIST ACT
Material and methods: Ninety-eight cases with
ET, aged 1-12, who underwent only BMR surgery
between 1996 and 2006, were included in this
study. Data relating preoperative angle of deviation,
refraction and presence of inferior oblique over
action, age at surgery, prematurity, accompanying
neurologic problems, amount of medial rectus
recession, postoperative adduction limitation and
follow-up time were determined and compared
between cases with (group 1) and without (group 2)
consecutive XT. The association between the
development of consecutive XT and risk factors
related with the development of consecutive XT
were also evaluated.
Results: Mean follow-up time after BMR surgery
was 7.23±3.62 years. The rate of consecutive XT
was 30.61%. There was not any significant
difference between the groups in terms of age,
preoperative angle of near deviation, follow-up
time and spherical equivalent values for both eyes
(p>0.05 for all). The differences regarding
preoperative angle of distance deviation (p=0.009),
IOOA (p= 0.023), amount of the bimedial rectus
recession (p=0.028) and postoperative adduction
limitation (p< 0.0001) between the groups were
statistically significant. However, only preoperative
angle of distance deviation (p=0.043) and presence
of postoperative adduction limitation were
independent risk factors for the development of
consecutive exotropia (p=0.007).
Conclusion: It seems to be important to determine
the amount of bimedial rectus recession considering
the preoperative distance angle of deviation for
surgical planning of childhood esotropia. Presence
of postoperative adduction limitation should also
alert physcians to be more suspicious in long-term
follow-ups of these cases for increased risk of
developing consecutive XT.
Authors:
COL SOBACI
Abdullah, MD
Gungor,
MD;
1LT
ILHAN
Institutions:
Gulhane Military Medical Academy, Dept of
Ophtalmology, Ankara, TURKEY
Objective: To determine the role of intraocular
foreign body (IOFB) on visual outcomes of ocular
injuries caused by terrorist attacks with landmines
and improvised explosive devices.
Material and methods: Chart review of 154 eyes
of 126 patients who had open-globe injuries by
terrorist act, and treated at Gulhane Medical School
Hospital over the past ten year period were
included. Size of IOFB was divided into small
(≤5mm) and large (>5mm). Only those who had
complete data of OTCS (Ocular Trauma
Classification System) criteria were considered.
Results: Eighty-six (68.2%) patients had IOFB
(OTCS Type C) injury. Totally 350 operations were
performed. Forty-five (29.2%) eyes were
enucleated/eviscerated, 75 (68.8%) eyes underwent
secondary surgical procedures, 72 (50%) eyes had
PVR and 10 (6.4%) eyes were phitisical at the final
exam (≥4months) None of the patients was wearing
protective eyewear when terrorist event occurred.
Type A (rupture), grade V, zone-III, and RAPDpositive injuries were associated with unfavorable
visual outcome. Vitrectomy was associated with
lower rate of enucleation; 9 eyes (8.2%) developed
culture-proven endophthalmitis. Mine (Blast)
injuries had the worse outcome (Less than
ambulatory vision of 5/200). No significant
difference in performing comprehensive surgery
within the first 24 hours. Unfavorable outcome in
eyes w large IOFB (group 2) was unrelated to other
OTCS variables. Injuries with IOFBs less than
10mm (group1) had significantly higher (p<0.01)
superficial corneal laceration and anterior segment
problems.
149
Conclusion: In addition to blast effect, size and the
nature of the IOFB may be of prognostic value in
terror-related ocular injuries.
Correspondence:
COL. Gungor SOBACI, MD, Gulhane Askeri Tıp
Akademisi, Göz AD, Etlik 06018, ANKARA,
TURKEY
Tel: 90.3123045856
Fax: 90 3123045850
Email: gsobaci@gata.edu.tr
OP104
MINIMUM
STANDARDS
FOR
LABORATORY UNITS OF IN THEATRE
MILITARY
MEDICAL
TREATMENT
FACILITIES (MTFs): A STORY OF NATO
STANDARDIZATION AGREEMENT
Authors:
COL. BAKIR Bilal, MD1; MAJ YILDIRAN Nuri,
MD2; LTCOL YAMAN Halil3; BG OZTOSUN
Muzaffer4
Institutions:
1Gulhane Military Medical Academy Public Health
Department, Ankara, Turkey
2 Gulhane Military Medical Academy Dept. of
Military Health Services, Ankara, Turkey
3 Gulhane Military Medical Academy, Dept. of
Biochemistry, Ankara, Turkey
4 Turkish Health Command, Ankara, Turkey
Objective: NATO has too many operations in
different geographic areas. NATO health providers
should be able to work together in a multinational
environment to provide best medical care to its
deployed forces at different Military Treatment
Facilities (MTFs) including laboratory units. This
study aims to determine the minimum lists of
laboratory tests required for deployment of
different Role levels.
Material and methods: The idea was first
presented as a STANAG Proposal to the Military
Medical Steering group in April 2009 by Turkish
National Delegate titled as “Laboratory Standards
for Theatre MTFs”. Following silence procedure, it
was endorsed and tasked to Military Health Care
Working Group (MHCWG) as study 2571 “MTF
Laboratory capabilities”. An inquiry form was sent
to all nations in September 2009 and revised
inquiry form with STANAG draft was sent again in
March 2010 to collect their existing lists. The
results were presented and discussed at September
2010 Meeting of MHCWG. It was decided to liaise
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
with some other COMEDS groups in order to
obtain their contribution. In March 2011 MHCWG
meeting, it was accepted to prepare a new and
different list based on the national responses and
send this new product with STANAG draft to
member countries.
Results: Eleven (11) nations sent their responses.
No comment was received for STANAG Draft for
main text from the member countries. Results based
on responses have indicated that the list of tests for
Role 1 is very limited and the lists of tests for Role
2LM and Role 2E are almost identical, thus the list
of tests for Role 3 are very similar to these two test
lists. The latest version of lists was endorsed by
nations following a silence procedure.
Conclusion: Preparing a NATO medical document
takes considerably long time and too many efforts.
Creating an effective document requires well
coordination along with contribution of all member
countries.
Correspondence:
Bilal BAKIR, GATA Halk Sagligi Etlik 06018
Ankara, TURKEY
Tel and Fax: 90 312 3044664
Mobile: 90 532 5899128
E.mail: bakirbilal@hotmail.com
bbakir@gata.edu.tr
OP105
REGENERATIVE MEDICINE
Authors:
Cadet DURAN Rıza
Institutions:
3rd Grade, Gulhane Military Medical Faculty,
Gulhane Military Medical Academy, Ankara,
TURKEY
Regenerative medicine includes stem cell research
and treatment methods to fix the tissue and organ
damages and to restore the functions of cells. In
organism, stem cells still undifferentiated cellsare
remained unspecialized in their special natural
environment which is called niche. They need to
have some features to be a stem cell. These are:
proliferation, differentiation and self-renewal.
In such cases, the cell renewal and tissue repair,
stem cells can turn into the cells which belong to
the same tissue. They can also turn into the other
cells which are already different phenotypically
from their own precursor cell with the help of some
specific biological signals. According to in vitro
studies, they can be used in some areas such as
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
producing new cells and tissue for using on cellderived treatments, investigating new drugs and
determining their toxicity, gene treatments, learning
mechanisms of formation of malignancy. By using
stem cell therapy, diseases can be treated such as
Alzheimer's, Parkinson's disease,type 1diabetes
mellitus, multiplesclerosis, spinal cord injury,
ischemic heart disease and cancer. Today stem cell
research is one of the topics that are largely studied
on. Stem cells have been thought as an important
alternative treatment especially for tissue
degeneration diseases which the current medicine is
less effective. Today successful results have been
obtained and reported from a lot of studies and the
importance of cell therapy has been demonstrated
by the clinical practices carried out in a lot of areas.
Correspondence:
Cadet Rıza DURAN, Gulhane Askeri Tip
Akademisi, Askeri Tıp Fakültesi, Ankara,
TURKEY.
GSM: + 90 543 3651797
OP106
ANALYSIS
OF
RISK
FACTORS
ASSOCIATED
WITH
TRANSMISION
AMONG SOLDIERS WITH CHRONIC
HEPATITIS C
Authors:
COL MERT Gurkan, MD1; 1LT FIDAN Gonca,
MD1; CPT YILMAZ Soner, MD2; MAJ TURKER
Turker, MD3; COL AVCI Ismaıl Yasar, MD1; BG
EYIGUN Can Polat, MD1
Institutions:
1Gulhane Military Medical Academy, Dept. of
Infectious Diseases and Clinical Microbiology,
Ankara, TURKEY.
2Gulhane Military Medical Academy, Dept. of
Medical
Microbiology
Ankara,
TURKEY.
3Gulhane Military Medical Academy, Dept. of
Public Health, Ankara, TURKEY
Objective: Hepatitis C has a potential of being
chronic hepatitis such as hepatitis B is a health
problem among soldiers. Because of it is
transfusion transmissible and not possible to have a
protection by vaccination. In this study the risk
factors were analyzed related transmission among
younger age group patients and statistical results
were obtained.
Material and methods: Our study included 54
soldiers diagnosed chronic hepatitis C those applied
in 2011, were Anti-HCV and HCV-RNA positive,
had a result more than 2/18 in Knodell score at liver
fine-needle biopsy and untreated. For the control
150
group, 60 healthy voluntary blood donors were
involved. Their mean age were (22.28, 21.48)
respectively. The potential risk factors those were
drug addiction, tattoos, self mutilation, unsafe sex
habits, history of surgery, dental treatment, blood
transfusion, history of being abroad were searched.
Results: All factors found significant which were
analyzed as a result of the analysis of the potential
risk factors for the presence of chronic hepatitis C
(p<0.25). Then, regression analysis was performed
to evaluate independently by comparing all these
factors with each other. Model was created.
Eventually it was found that dental treatment, self
mutilation and blood transfusion had a high
relationship with hepatitis C, p-values were
(<0.001, <0.001, 0.013) respectively.
Conclusion: In our study showed that selfmutilation, dental treatment and blood transfusion
are independent risk factors for HCV. The results of
transmission analysis have to be reached by people
with education programs. This study made
according to our society. Because of every society
live differently; this study’s results may differ.
Making comparative studies about this subject and
expanding patient groups will help to the solution
of this problem.
Correspondence:
Gulhane Askeri Tip Akademisi, Enfeksiyon Hast.
ve Kl. Mikrobiyoloji AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 3044315
Fax: +90 312 3044300
GSM: +90 5335142711
E-mail: gmert@gata.edu.tr
OP107
STRUCTURE AND TRENDS IN INFECTIOUS
DISEASES SPREADING IN BULGARIAN
ARMED FORCES IN THE PERIOD 1997-2010
Authors:
Maj. Popivanov I., MD1; Shalamanov D., MD,
PhD2; Bogdanov N., MD1; Col. Petkov A., MD,
MSc1; LtCol. Kanev K., MD1
Institutions:
1. Military Medical Academy – Sofia, Bulgaria
2. Medical University – Pleven, BULGARIA
Objectives: This paper aims to make a
retrospective analysis of structure and trends in
infectious diseases spreading in Bulgarian armed
forces (BAF) during the period 1997-2010. The
151
period presents considerable changes in purpose,
development and tasks of BAF and significant
personnel reduction as well.
Materials and Methods: This survey is based on
data from the periodic reports of the officially
recorded infectious diseases and outbreaks in BAF
during analyzing period. Some data from scientific
studies are used as well. Regression analysis and
the least squares approach are conducted to
determine trends in infectious diseases incidence.
Results: The analyzed data shows an upward trend
in infectious diseases incidence, along with the
BAF personnel downsize. The infectious diseases
structure represents the leading role of Influenza
and Acute Respiratory Infections (ARI) – 38.3 % of
all patients, followed by Gastroenteritis (19.06 %),
Hepatitis A (9.04 %), Helminth diseases (5.98 %),
Mumps (5.01 %), Hepatitis B (3.45%), Chickenpox
(3.16%), Rubella (2.65%), Echinoco ccosis and
Toxoplasmosis (1,84 %), Shigellosis (1,62 %),
Hepatitis C (1.54 %), Food-borne illness (1.51 %),
Lyme borreliosis (1.0%) etc. Upward trends in
diseases incidence are ascertained for Influenza and
ARI, Gastroenteritis, Mumps, Chickenpox and
Lyme borreliosis. Downward trends are found for
all types of viral hepatitis, Rubella, Shigellosis and
Food-borne illness.
Conclusion: Infectious diseases continue to be
topical for the medical service of BAF. On the one
hand, the ascertained trends in spreading of
infectious diseases resulted from the conducted
changes in structure and personnel of BAF. On the
other hand, they correspond with the introduction
and implementation in epidemiological practice of
certain vaccines and diagnostic tests with proven
effectiveness.
Correspondence:
OF-3 Popivanov Ivan, MD Military Medical
Academy, Georgy Sofiisky Str. 3, 1606, Sofia,
BULGARIA
Fax: + 359 2 952 6536
Phone: + 359 2 922 5756
E-mail: drpopivanov@abv.bg
OP108
INFECTIOUS
DISEASE
MORBIDITY
MANAGEMENT IN MILITARY MISSIONS
ABROAD
Authors:
LTC Dr Georgi Popov, MD, PhD; COL Dr
Rostislav Kostadinov, MD, PhD
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Institution:
Military Medical Academy, Sofia, BULGARIA
Introduction: A lot of recorded data presents the
significance of infectious diseases for the success of
military campaigns throughout history. Great
military leaders were defeated not on the battlefield
by their opponents, but were forced to quit their
wining campaigns because of the infectious
diseases morbidity and mortality among the ranks.
The development of medicine knowledge and the
implementation of preventive medicine measures
have significantly reduced the infectious disease
mortality in the last 150 years. The data about
servicemen morbidity during recent and on-going
military operations continues to describe the
infectious diseases as a major cause for service-day
lost.
Aim: The aim of this publication is to present the
Bulgarian armed forces medical service infectious
disease management in military missions abroad.
Methods: By means of descriptive and
comparative methods the data regarding infectious
disease morbidity during Bulgarian mission in
support of operation Althea is presented. The
deductive and cluster analyses are applied for
describing the measures implemented in order to
minimize the infectious diseases impact on
deployed troops health and combat readiness.
Conclusion: As a conclusion the authors proposed
a simplified approach to managing the infectious
disease morbidity in military missions abroad.
Correspondence:
Military Medical Academy 3, Georgi Sofiisky str,
1606 Sofia, Bulgaria LTC Dr Georgi Popov, MD,
PhD
Fax: +359 2 9526536
Tel: +359 2 9216098
Cell phone: +359888517529
E-mail: popovg@abv.bg
OP109
VISCERAL
LEISHMANIASIS
Authors:
Rajic-Dimitrijevic
Nozic D, Mikic D
OR
R,
KALA-AZAR
Begovic-Kupresanin
V,
Institution:
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Leishmaniasis is a parasitic disease transmited by
the bite of the send fly. Visceral leishmaniasis is the
most severe form of the disease and affects the
internal organs. Untreated, this form of
leishmaniasis is fatal within two years.
Manifestations
are
elevated
temperature,
splenomegaly, hepatomegaly and policlonal
hypergamaglobulinaemia.
For
diagnosis
is
important epidemiologycal data of residence in
endemic areas, positive serologycal analisis and
finding of parasites in bone marrow. In our Clinic
in period for last 20 years, we treated 28 patients
with visceral leishmaniasis, 27 of them were
healed, one died. The diagnosis was made in 1-9
months after onset of first symptoms. Almost
everyone had fever, hepatosplenomegaly and
policlonal hypergamaglobulinaemia. Three of our
patients had negativ epidemiologycal servay, so we
had a lot of dilemas, given the entrenched attitude
endemic leishmaniasis is related to the southern
areas of the country. All our patients came to Clinic
with diagnosis of fever of unknown origine. Most
of them, although they had caracteristical
presentation and positive epidemiology were
treated by physicians of other specialties, with
various antibiotics, even with chemotherapy. In our
Academy we used for detection TIHA test for
Leishmaniasis. Eight of our patients had only
positive serology for Leishmaniasis, and in only
eight patients our pathologysts find parasits in bone
merrow. Two of our patients had negative serology
and parasitic finding of parasites. All of our patients
were treated with pentivalent antimonals, for one
month, and in one patient we had complication such
as myocarditis. In one patient we had relapse of the
illness 10 years after treatment. In our country
visceral leishmaniasis is still a diagnostic problem,
because of lack of diagnostic tests and adequate
pathologyc findings.
152
2. 251 Air Force Hospital, Athens, GREECE
Purpose: Sexually transmitted diseases (STDs) are
a major health problem not only in developing but
also in developed countries. We conducted this
survey to determine awareness and knowledge of
navy personnel about STDs and if possible, how
they perceive their own risk of contracting a STD.
Results of this survey can help point out areas
where health education and promotion for Navy
personnel need to be improved.
Material and Methods: To achieve this purpose a
special questionnaire was prepared which, in
addition to demographic data, contained questions
about the degree of knowledge. The index of
knowledge was estimated from a total of 63
questions (237 questionnaires) during the period
November 2011 – March 2012. Descriptive
statistics and multivariable logistic regression were
used for analysis for potential differences due to
specific characteristics through PASW Statistics 18.
Results: Data were collected from 237 participants
aged between 19 to 34 years. Approximately 50%
had their sexual debut at 18-19 years and 39.2%
had had more than one partner in their life. About
8.5% had been infected by a sexually transmitted
disease (10 genital warts, 3 herpes, 2 chlamydia, 2
trichomonas, 5 other). Although 68.7% knew about
HPV and 87.7% about cervical cancer, only 50.8%
knew of their specific association. Only 8.1% of the
women had been vaccinated for HPV.
Multivariable analysis revealed that gender,
education and religious beliefs were associated with
sexual knowledge and attitude.
Correspondence:
Rajic Dimitrijevic Radmila, MD
E.mail: parama@eunet.rs
Conclusions: While the majority showed high
levels of knowledge and relatively positive attitudes
and beliefs about sexually transmitted infections,
some inconsistencies in attitudes were discernible.
Talks and seminars focusing on education on STDs
prevention are needed to improve awareness.
OP110
SEXUALLY
TRANSMITTED
DISEASES
(STDs): KNOWLEDGE, ATTITUDES AND
BEHAVIORS AMONG NAVY PERSONNEL,
EMPHASIS ON HPV
OP111
THE EVALUATION OF NEPHROTOXICITY
OF COMBINATION OF LAMIVUDIN AND
TENOFOVIR ON THE PATIENTS WITH
CHRONIC HEPATITIS B
Authors:
LTJG Kalogeropoulos Athanasios MD1, ENS
Kalogeropoulou Maria RN1, LT Loutas Theodoros
RN1, 2nd LT Yfanti Basiliki RN2
Authors:
BG EYIGUN Can Polat MD1, MAJ GUNAL
Emine MD1, Cadet KAYA Ilker2
Institutions:
1. Naval Hospital of Salamis, Salamis, GREECE
153
Institutions:
1. Infectious Disease and Clinical Microbiology,
Gulhane Military Medical Academy, Ankara,
TURKEY
2. 5th Grade, Gulhane Military Medical Faculty,
Gulhane Military Medical Academy, Ankara,
TURKEY
Objective: Tenofovir dysoproxyl fumarate (TDF)
is one of the antivirals which have been used for the
treatment of chronic hepatitis B (CHB). Although
TDF is very safe and has few adverse effects, it was
reported that TDF has minimal nephrotoxicity.
Therefore we think that the nephrotoxicity may
increase if another antiviral is combined with TDF.
In this study, we aimed to analyze the effect on
renal functions after adding TDF to the treatment
with Lamivudin (LMD) on the patients with CHB
who have resistance to LMD.
Material and methods: The study was performed
retrospectively by analyzing the files of the patients
who have been being treated in the Clinic of
Infectious Disease in GATF (Gülhane Military
Medical Faculty) Education and Search Hospital.
TDF was added to the treatment of 25 patients who
had been taking LMD because they had resistance
to LMD. Glomerular filtration rate (GFR) was
calculated with Modification of Diet in Renal
Disease (MDRD) by analyzing the levels of
creatinine of the patients before adding TDF and
after 1 year GFR was checked again and compared
with before. RESULTS: 21 of the patients were
male (84%) and 4 of the patients were female
(16%). The mean age was 44.5±10.4 years. At the
beginning 7 of patients (%28) were Hbe Ag (+).
The mean follow-up was 16.6±7.6 months. The last
mean level of serum creatinine of the patients
before TDF was found 0.98±0.23 (minimum 0,8
and maximum 1,86) mg/dl. The mean GFR was
found 87.98±16.46 (minimum 37 and maximum
130) ml/min. The mean level of serum creatinine
was found 1.22±0.24 (minimum 0.76 and
maximum 1.96) mg/dl and the mean GFR was
found 85.6±16.8 ml/min, 1 year after TDF had been
added. The difference between GFR and the level
of serum creatinine of the patients before TDF and
after 1 year was not significant statistically
(p>0,005).
Discussion: No change on renal functions was
found 1 year after treatment with the combination
of LMD and TDF. We believe that more reliable
results can be obtained with long-term and largescale studies.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Correspondence:
Cadet, Ilker KAYA
Gulhane Askeri Tip Akademisi, Askeri Tıp
Fakültesi, Ankara, TURKEY
GSM: + 90 539 5885606
OP112
DETERMINATION OF THE SIGNIFICANT
RISK FACTORS AMONG HIV POSITIVE
SOLDIERS IN THE TURKISH ARMY
Authors:
COL MERT Gurkan, MD1, 1LT FIDAN Gonca,
MD1, CPT YILMAZ Soner, MD2, MAJ TURKER
Turker, MD3, COL BESIRBELLIOGLU Bulent,
MD1, BG EYIGUN Can Polat, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Infectious Disease and Clinical Microbiology,
Ankara,
2. Gulhane Military Medical Academy, Dept. of
Medical Microbiology, Ankara,
3. Gulhane Military Medical Academy, Dept. of
Public Health, Ankara, TURKEY
Objective: With this study we made among the
soldiers, we statistically evaluated possible risk
factors of HIV infection which has not been
possible to prevent by vaccination yet and can be
transmitted by blood.
Material and methods: The study consists of 30
soldiers that were HIV positive verified with
Western Blot between 2009 and 2011. For the
control group 60 healthy blood donor soldiers at the
same age were included to the study. The evaluated
risk factors were drug addiction, tattoos, unsafe
sexual habits, self mutilation, being abroad, history
of surgery, dental treatment, blood transfusion.
Results: For HIV the mean age was calculated as
23.03 (22.00±3.113), for the control group mean
age was 21.48 (21.00±1.384). Because of the pvalue of evaluated risk factors except for drug
addiction and history of surgery was smaller than
0.25, it was subjected to regression analysis. Model
was formed. It was revealed that self mutilation,
unsafe sex habits, dental treatment were statistically
significant among the HIV positive soldiers. Pvalues were 0.001, <0.001, 0.022 respectively.
Conclusion: We think that forming models by the
identification of high collaborative risk factors is
important for education of younger age groups who
do not have enough knowledge about sexually
transmitted diseases, also important for touristic
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
countries and countries with a young population. In
the light of formed models it will be suitable for
making early screening tests and providing to reach
anti-retroviral therapy (ART) earlier.
Correspondence:
Gulhane Askeri Tip Akademisi, Enfeksiyon Hast.
Ve Kl. Mikrobiyoloji AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 3044306
Fax: +90 312 3044300
GSM: +90 5054870334
E-mail: gmert@gata.edu.tr
OP113
DETERMINATION OF THE EFFICACY OF
QUADRIVALENT
POLYSACCHARIDE
MENINGOCOCCAL VACCINE (A, C, Y,
W135); TWO YEARS EXAMINATION
Authors:
COL MERT Gurkan, MD1, C YILMAZ Soner,
MD2, 1LT FIDAN Gonca, MD1, BG EYIGUN Can
Polat, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Infectious Disease and Clinical Microbiology,
Ankara,
2. Gulhane Military Medical Academy, Dept. of
Medica, Microbiology Ankara, TURKEY
Objective: Meningococcal disease is a major cause
of preventable death and disability in both
industrialized
and
developing
countries.
Meningococcal menengitidis usually occurs in
epidemic waves among military recruits, children
attending day-care centers or people travelling to
endemic region. The most effective way to prevent
and control meningococcal disease is through the
use of a vaccine that offers protection against as
many bacteria groups possible. In this study it was
aimed to display whether Turkish recruits
vaccinated by quadrivalent polysaccharide vaccine
is effective in lowering the incidence of
meningococcal meningitis or not.
Material and methods: This research was made by
examining the retrospective records of patients
diagnosed with meningococcal menengitidis
between January 2007 and December 2011 in
Gulhane Military Medical Academy (GMMA),
Infectious Disease and Clinical Microbiology
Department.
Results:
Before
using
the
quadrivalent
polysaccharide vaccine there were 15 bacterial
154
meningitis patients in a 36-month period (2007 and
2008 and until June 2009). After using this vaccine
a total of 10 patients (one patient was in after June
2009, four patients were in 2010 and 5 patients in
2011) were diagnosed as meningococcal
menengitidis in GMMA, Infectious Disease and
Clinical Microbiology Department.
Conclusion: As seen from the results after
quadrivalent
polysaccharide
meningococcal
vaccination in soldiers there is one and half fold
reduction in the number at purulent meningococcal
meningitis by two years. In the future it needs to be
searched with furthermore studies and have results
of increased number of cases. It is convenient that
making phylogenetic studies by determining the
types of cases.
Correspondence:
Gulhane Askeri Tip Akademisi, Enfeksiyon Hast.
ve Kl. Mikrobiyoloji AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 3044306
Fax: +90 312 3044300
GSM: +90 5054870334
E-mail: gmert@gata.edu.tr
OP114
NASOPHARYNGEAL CARRIAGE RATE
AND
SEROGROUPS
OF
NEİISERIA
MENİNGITIDIS IN TURKISH RECRUITS
UPON ENTRY TO THE MILITARY
Authors:
COL BASUSTAOGLU Ahmet MD1, LTC BEDIR
Orhan MD1, MAJ GUMRAL Ramazan MD1, LTC
KILIC Abdullah MD1, COL MERT Gurkan MD2,
C YILMAZ Soner MD1, COL BESIRBELLIOGLU
Bulent MD2
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Medical Microbiology Ankara,
2. Gulhane Military Medical Academy, Dept. of
Infectious Disease and Clinical Microbiology,
Ankara, TURKEY
Objective: The aim of this study was to determine
nasopharyngeal carriage rate and serogroup of
Neisseria meningitidis strains isolated from Turkish
recruits upon entry to the military.
Material and methods: Nasopharyngeal swab
samples were obtained from 1995 soldiers and were
inoculated immediately on BBL-modified ThayerMartin medium plates. The plates were examined
for the presence of colonies showing the typical
155
morphology of N. meningitidis. Suspect colonies
were screened for oxidase reactivity, and positive
colonies were Gram stained. If Gram-negative
diplococci were present, a biochemical profile by
the API NH system was used for confirmation.
Serogrouping of the meningococcal isolates was
performed by a slide agglutination technique.
Results: The nasopharyngeal carriage rate of N.
meningitidis was found to be 4.2% (n=83). Of these
meningococci, 15.6% (n=13) were serogroup Y,
10.8% (n=9) were serogroup W-135, 9.6% (n=8)
were serogroup C, 6.1% (n=5) were serogroup B,
2.4% (n=2) were serogroup A. The 46 isolates
(55.4%) were detected as nonserogroupable.
Conclusions: Since serogroup Y and W-135 are
predominant in this study population, it was
suggested that Turkish recruits should be
vaccinated by quadrivalent vaccine (A,C,Y, and W135) upon the military instead of A+C
polysaccharide vaccine and now quadrivalent
vaccine has been carried out.
Correspondence:
Gulhane Askeri Tip Akademisi, Enfeksiyon Hast.
ve Kl. Mikrobiyoloji AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 3044306
Fax: +90 312 3044300
GSM: +90 5054870334
E-mail: gmert@gata.edu.tr
OP115
PREVENTION AND CONTROL OF HIV/AIDS
IN ARMED FORCES OF SERBIA
Authors:
Šuljagić Vesna, Jadranin Željko, Rajić-Dimitrijević
Radmila.
Institution:
The Medical Faculty of the University of Defence,
Belgrade; SERBIA
During 2006-2011 the Armed Forces of Serbia
(AFS) submitted the five proposals to Department
of Defense of United States HIV/AIDS Prevention
Program (DHAPP) for fiscal years 2006 - 2011. All
proposals were accepted and DHAPP funded these
programs under the name “Prevention and Control
of HIV/AIDS in AFS”. a) Goals of Programs: - To
increase awareness of HIV/AIDS among members
of unifomed services. - To incourage behavioural
change among members of the uniformed services.
b) Objectives of Programs: - To increase quality
and access to HIV/AIDS prevention in AFS. - To
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
provide mass awareness campaigns in AFS - To
provide voluntary testing and counseling, HIVscreening in AFS. - To provide HIV-diagnostics.
The initial phase of DHAPP initiative to support
HIV prevention in the AFS has focused on the
development of laboratory and infrastructure for
HIV testing and diagnosis, as well as equipment
and supplies for primary prevention activities.
Knowledge that HIV is preventable infection is one
of the most important fact influence us to make
plan to educate our military personnel. So,
continuing medical education is the basic activity of
our HIV/AIDS prevention strategy plan. We
provide trainings for: master trainers, peer
educators, physicians, nurses, laboratory personnel,
social workers, uniformed personnel, peacekeeping
personnel. During the realization of our programs.
four main types of activities are organized: 1.
Activities in mass awareness campaigns
“Prevention is primary! Low the risk”. 2. Activities
in HIV screening. 3. Activities in prevention. 4.
Activities to protect uniformed personnel living
with HIV/AIDS.
OP116
ANTIMICROBIAL SUSCEPTIBILITY OF 55
TURKISH BACILLUS ANTHRACIS STRAINS
Authors:
LTC ORTATATLI Mesut, MD, PhD1; KARAGOZ
Alper, Vet, PhD2; PERCIN Duygu, MD3; COL
KENAR Levent, MD, PhD1; KILIC Selcuk, MD4;
DURMAZ Rıza, MD2
Institutions:
1. Gulhane Military Medical Academy, Dept. of
CBRN, Ankara, TURKEY
2. Refik Saydam National Public Health Agency,
Dept. of Molecular Microbiology Research and
Application Laboratory, Ankara, TURKEY
3. Erciyes University Faculty of Medicine, Dept. of
Clinical Microbiology, Kayseri, TURKEY
4. Refik Saydam National Public Health Agency,
Dept. Of Communicable Diseases Research,
Ankara, TURKEY.
Objective: The aim of this study was to
determinate the antimicrobial susceptibility pattern
of 55 Bacillus anthracis isolates from Turkey, the
majority of which were cultured from various
animals.
Material and methods: A total of 55 B. anthracis
isolates were used in this study. The antimicrobial
susceptibility of the isolates was investigated using
the agar dilution method.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Results: All of the Turkish B. anthracis isolates
were susceptible to ciprofloxacin, levofloxacin,
tigecycline, linezolid, and vancomycin. Using the
breakpoints for B. anthracis, only one isolate was
resistant to penicillin (MIC=1 μg/mL) and to
doxycycline (MIC=4 μg/mL) (Table 4). Using the
staphylococcal susceptibility breakpoint for
erythromycin (≤0.5 μg/mL), 61.8% of the isolates
(n=34) were susceptible, 36.4% (n=20) were
intermediate, and one isolate was resistant. None of
the isolates exhibited susceptibility to cefotaxime;
38.2% of the isolates (21/55) were categorized as
intermediate (MIC=32 μg/mL) and the other 34
isolates as resistant (MICs of 64, 128 or 256
μg/mL). Out of the 55 isolates, 53 were susceptible
to gentamicin (MIC ≤2 μg/mL), and two were
classified as resistant (MICs, 16 or 32 μg/mL).
Conclusion: The previous studies and our
susceptibility
data
support
current
recommendations for the use of ciprofloxacin or
doxycycline as empirical antimicrobial agents for
the treatment or prophylaxis of anthrax, particularly
in suspected inhalational cases. it is crucial to
perform sensitivity tests for all antibiotics,
particularly penicillin and erythromycin, when they
are recommended for children and pregnant
women.
Correspondence:
Gulhane Askeri Tip Akademisi, KBRN BD, Etlik
06018, Ankara, TURKEY
Tel: + 90 312 304 3329 (w)
GSM: + 90 532 282 6759
E-mail: lkenar@gata.edu.tr
OP117
ROLE CONFLICT, ROLE AMBIGUITY AND
QUIT
INTENTIONS
OF
MEDICAL
NONCOMISSIONED OFFICERS
Authors:
CPT OZTURK Gultekin, MD1; MAJ YILDIRAN
Nuri, MD, PhD2; COL OZER Mustafa, MD, PhD1;
COL CETIN Mehmet, MD, PhD1; MAJ TURK
Yusuf Ziya, MD, PhD1; COL FEDAI Turan, PhD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Military Health Services, Ankara, TURKEY
2. Turkish Armed Forces Medical Command,
Ankara, TURKEY.
Objective: We aimed to determine the relation
among the role conflict, role ambiguity levels and
‘intend to quit’ of the ten-year medical NCOs.
156
Material and methods: Role conflict, role
ambiguity and intend to quit questionnaires were
composed by reviewing the literature. The
questionnaire is applied to 63 medical NCOs served
ten years in the army. 49 (77.8%) of them were
married, 38 (60.3%) had children, 40 (63.5%) were
graduated at military school, 36 (57.1%) were
serving at corps. The five likert scale scored
between 1 and 5 point.
Results: We found mean scores as 4.18±0.68 (so
high from median) at role conflict, 3.19±0.62 at
role ambiguity and 3.37±0.84 at intention of quit.
Interestingly, being married and having children
presented higher intentions to quit (3.44±0.83 and
3.48±0.88). The medical NCOs graduated from
civilian schools have significant high points at role
conflict (3.38±0.66) and intend to quit (3.72±0.73).
The NCOs serving at corps had high role conflict
(4.23±0.62) and intend to quit points (3.45±0.83)
compared with serving at hospitals and
headquarters. The relationship between the
graduated school and intention of quit (p=0.017)
was statistically significant.
Conclusion: Role conflict, role ambiguity and
intention of quit mean scores were all considerably
high from the median. The intention of quit
dimension was high at NCOs serving at corps and
graduated from civilian schools as expected. But
unlike similar studies being married and having
children and also serving for ten years at the army
are not the restrictive issues to remain at the same
job.
Correspondence:
Gultekin OZTURK Gulhane Askeri Tip Akademisi,
Askeri Saglik Hizmetleri AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 3043359
GSM: +90 532 7001822
E-mail: gozturk4@yahoo.com
OP118
ASSESSMENT
OF
COMBAT
MEDIC
TRAINING IN TURKISH ARMED FORCES
(TAF): WHAT SHOULD A COMBAT MEDIC
KNOW AND PRACTICE?
Authors:
CPT TOSUN Ugur, MD, PhD1; COL OZER
Mustafa, MD, PhD2; CPT YAVAS Umit, MD2
Institutions:
1. Turkish Armed Forces Medical Command,
Ankara, TURKEY
157
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
2. Gulhane Military Medical Academy, Dept. of
Military Health Services, Ankara, TURKEY.
Authors:
Col. Daskalov Vl., Col. Belokonski E, Todorov P.
Objective: Combat medics have a crucial role in
delivery of health service support both at peace and
war time. Aim of this paper is to determine how a
combat should be trained and what should he know
and practice.
Institution:
Clinic of Abdominal Surgery, Military Medical
Academy, Sofia, BULGARIA
Material and methods: In this descriptive study, a
150 person expert panel comprising of specialist
physicians, general practitioners and medical NCOs
from different services were questioned using
Delphi technique, utilizing repetitive question
naires. While the first Delphi questionnaire
involved open ended questions, second and third
Delphi questionnaires consisted of structured items
and a 5-point Likert scale.
Results: Majority of experts in the panel (77.6%)
were serving in TAF for more than 10 years while
half of them (51.5%) were serving in the field for 39 years and mean age was 38.1±6.4 years. The most
frequent statements in first Delphi round were
“principles of first aid and basic life support”
(68.4%), “monitoring vital signs” (61.2%), “wound
care and dressings” (56.1%), “hemorrhage control
and tourniquets” (54.1%) and “initiating IV
cannulation and fluid replacement” (54.1%). The
items having the highest mean scores in second and
third Delphi rounds were “hemorrhage control and
tourniquets” (respectively; 4.94±0.40, 4.97±0.31),
“principles of first aid and basic life support”
(respectively; 4.93±0.42, 4.95±0.34), “monitoring
vital signs” (respectively; 4.93±0.26, 4.96±0.20),
“securing airway and artificial ventilation”
(respectively; 4.87±0.47, 4.95±0.34).
Conclusion: Current certification of combat medics
should be enriched so that they could initiate IV
cannulation, perform minor stitches and apply
oxygen to enhance the combat medical health
support in Turkish Armed Forces.
Correspondence:
TSK Sağlık Komutanlığı, Bakanlıklar, Ankara,
TURKEY
Tel: + 90 312 402 6100-4036 (w)
Fax: + 90 312 417 7951 (w)
GSM: + 90 555 458 2859
E-mail: tosun2002@hotmail.com
OP113
DOPPLER-GUIDED
HEMORRHOIDAL
ARTERY LIGATION: AN ALTERNATIVE
TO HEMORRHOIDECTOMY
Objective: The aim of this study is to prove
clinically the effectiveness of Doppler-guided
hemorrhoidal artery ligation (HAL) for patients
having symptomatic and prolapsing hemorrhoids
and accompanying pathology of the anal canal.
Materials and methods: 169 patients (29 females)
complaining of symptoms of hemorrhoids were
included in the study. The hemorrhoid arteries were
ligated with an absorbable suture material under
Doppler-control as modification Meintjes D.
Operating time, postoperative complications,
postoperative pain syndrome and outcome of the
procedure were analyzed. Follow-up was planned
following to discharge after one month, three
months and after eight months.
Results: The mean procedure time was in range of
19–35 minutes, and the admission period after
procedure was from 30 about 40 minutes. Bleeding
from the stitched region, perianal edemas and sub
mucous hematoma were the commonest postoperative complications. The painful syndrome did
not exceed 5 points with a scale of VAS, on the
average made (Mean = 2.30±0,778). The
postoperative follow-up revealed therapeutic
success in 147 patients (87%), who presented with
hemorrhoidal bleeding. In 13% patients mostly with
III and IV stages of disease were found
symptomatic and treated again.
Conclusion: Doppler-guided hemorrhoidal artery
ligation is a pathogenesis targeting, effectiveproved technique that is well accepted by patients.
HAL-procedure has good results in treatment of
hemorrhoids, and could be combined, with
fissurectomy and fistulotomy.
OP114
SURGICAL TREATMENT OF ABDOMINAL
COMPARTMENT SYNDROME IN SEVERE
ACUTE PANCREATITIS
Authors:
Bezmarevic M MD, Mirkovic D MD PhD, Col.
Stankovic N MD PhD, Trifunovic B MD PhD, Col.
Kostic Z MD, Ignjatovic M MD PhD
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Institutions:
Clinic for General Surgery, Military Medical
Academy; Belgrade, SERBIA
Aims/Objectives:
Abdominal
compartment
sydrome (ACS) was detected in 10-30% of patients
with severe acute pancreatitis (SAP), with mortality
rate up to 50%. Increased intra-abdominal pressure
(IAP) impairs functioning of the already affected
organ systems in SAP. This study was undertaken
to compare effects of decompresive laparotomy
with temporary abdominal closure using “Ethizip”
and percutaneous puncture with placement of
abdominal catheter (peritofix) in patients with ACS
during SAP.
Patients and Methods: Prospective study included
15 patients divided into two groups (8 with
decompresive laparotomy, 7 with peritofix).
APACHE II score, IAP and presence of sepsis were
evaluated before and after procedures in all patients
and comparison between two groups were assessed
with ANOVA test.
Results: In the first group APACHE II score was
19.5±2.7 before and 15.7±3.1 after procedure, and
IAP was 22±1.4 mm Hg before and 10±2.1 mm Hg
after procedure. In the second group APACHE II
score was 19.7±3.9 before and 17.3±5.7 after
procedure, and IAP was 23±2.2 mm Hg before and
14±3.2 after procedure. There was significant
difference in APACHE II scores (F=16.964;
p=0.001) and IAP (F=137.932; p<0.001) before and
after procedures, but no significant difference in
APACHE II scores (F=0.776; p=0.394) and IAP
(F=2.423; p=0.144) changes between groups. In the
first group sepsis was noted in one patient before
and in 4 after procedure. Before procedure there
weren’t patients with sespis and sepsis was noted in
3 patients after procedure in the second group.
Overall mortality was 53% (8 patients), 63% (5
patients) in the first group and 43% (3 patients) in
the second group. There was no significant
difference in mortality between groups (p=0.619).
Conclusion: Patients with ACS in SAP requires
decompression procedure. Impact of procedures in
reducing the systemic complications is similar, but
lower incidence of sepsis and lower mortality rate
is associated in patients with peritofix.
Correspondence:
Mihailo Bezmarevic, Military Medical Academy,
Clinic for General Surgery, Crnotravska 17, 11 000
Belgrade, Serbia.
Fax: +381113608550
Cell: +381641994288;
158
E-mail: bezmarevicm@gmail.com
mihailobezmarevic@gmail.com
OP115
TREATMENT OF HEMORRHOID DISEASE
GRADE III-IV WITH DOPPLER-GUIDED
LIGATION OF THE HEMORRHOIDAL
ARTERIES (HAL) WITH RAR (RECTO
ANAL REPAIR)
Authors:
Col. Daskalov Vl., Col. Belokonski E, Todorov P.
Institution:
Clinic of Abdominal Surgery, Military Medical
Academy, Sofia, BULGARIA
Abstract: Postoperative pain is the main adverse
effect of formal hemorrhoidectomy. RAR (Recto
Anal Repair) - a new technique based on DGHAL Doppler-guided Hemorrhoidal Artery Ligation of
the terminal branches of the superior hemorrhoidal
artery is presented as an alternative to
hemorrhoidectomy.
Methods: This non-controlled, prospective study
includes 85 patients (male: 57, female: 28, mean
age: 44 years) treated for Grade III-IV hemorrhoids.
By means of a special new modified proctoscope,
the arteries leading to the hemorrhoidal cushions
had located in the pain-free area of the rectum
above the dentate line and were ligated under
Doppler guidance. A transanal rectal mucopexy
was then performed to lift and secure the
hemorrhoidal prolapse back in place.
Results: Time of procedure is ranged from 24 to 45
minutes (32±5.21). Postoperative discomfort has
been measured with a visual analog scale (1-10)
distributed in 100mm graphical scale of notation
and has resulted in a mean score of 33.2 ± 0.52 mm
(range: 2.1-4.8 mm) on the first day, and a mean
score of 16.5 ± 0.10 mm (range: 0-4.0 mm) over
five days. The patients have been examined at
intervals of 6, 8 and 12 months thereafter. The
mean follow-up was 10 months (range: 6-12).
Bleeding has been resolved in 82 patients (96.5
percent), prolapse in 78 patients (91.8 percent). The
complication rate is relatively low.
Conclusion: Doppler-guided ligation of the
hemorrhoidal arteries (HAL) with RAR (Recto
Anal Repair) is a safe and effective alternative to
hemorrhoidectomy and is associated with minimal
discomfort and a low risk of complications.
159
OP116
DUODENUM PRESERVING PANCREATIC
HEAD RESECTION IN THE TREATMENT
OF CHRONIC PANCREATITIS
Authors:
Mihaylov V, Col. Mutafchiyski V, Takorov I,
Vasselevski I, Sergeev S, Vladov N, Col.
Belokonsky E.
Institutions:
Hepato-biliary, Pancreatic and Transplant Surgery,
Military Medical Academy – Sofia, BULGARIA
Introduction: Chronic pancreatitis is an
inflammatory disease which is characterized by a
progressive conversion of pancreatic parenchyma
into fibrous tissue.Indications for surgical treatment
are intractable pain and complications such as
stenosis of the common bile duct or pancreatic duct,
gastrointestinal obstruction due to the pancreatic
head tumor.The primary goals of surgery for
chronic pancreatitis are long-term pain control, and
control of pancreatitis-associated complications of
adherent tissues and organs.
Material and Method: We studied 82 consecutive
patients operated for chronic pancreatitis during a
period of 8 years, men 59 (71.9%) and women 23
(28.1%). The mean age of the patients is 49.2 years.
We have performed 47 resections of the pancreas
(Beger procedures - 11 cases, PPPD – 10 cases,
Frey procedure – 14 cases, Izbicki procedure – 2
cases, Whipple procedure – 5 cases, distal
pancreatectomy – 5 cases) and 35 drainage
procedures.
Results: The mean hospital stay for the patients
with resection of the pancreas and drainage
procedure is 9 and 6 days respectively. The pain
score decreased by 94% after resection and by 60%
after drainage procedure. Global quality of life
improved by 71% in the first group and by 43% in
the second group.
Conclusions: Simple drainage procedures are not
sufficient to treatpatients with chronic pancreatitis.
Surgical intervention in patients with intractable
pain should involve resection of the inflammatory
mass in the pancreatic head, if possible with
minimal loss of intact pancreatic parenchyma
andwithout collateral damage to neighboring
organs.
OP117
LAPAROSCOPIC TREATMENT OF SMALL
BOWEL OBSTRUCTION
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Authors:
Col. Mutafchiyski V, Takorov I, Sergeev S,
Mihaylov V, N.Vladov, Col. Belokonsky E.
Institution:
Department of Hepato-biliary Surgery and
Transplantation, Military Medical Academy, Sofia,
BULGARIA
Background: Acute small bowel obstruction is
arelatively common cause of emergency hospital
admission and is most frequently due to
postoperative adhesions. According to the
European Association for Endoscopic Surgery’s
consensus statement in the case of clinical and
radiological evidence of small bowel obstruction
non-responding to conservative management,
laparoscopy may be performed using an open
access technique. If adhesions are found at
laparoscopy, cautious laparoscopic adhesiolysis can
beattempted.
Methods: From April 2010 to April 2011, 5
patients underwent laparoscopy for definitive
diagnosis and treatment of intestinal obstruction.
Average patient age was 43 years (range, 32-64).
The site of obstruction in all cases was small bowel
and the reason - postoperative adhesions in 3 cases,
migration of a gastric band in one and
intussusception in one. We present a compilation of
two video clips: the first case is with an adhesive
small bowel obstruction in a 32-years old man,
treated successfully by means of laparoscopic
adhesiolisis and desobstruction; the second one
presents laparoscopic management of a migrated
gastric band.
Results: Laparoscopy successfully diagnosed the
site of obstruction in all patients. All of them were
successfully treated laparoscopically without
conversion to laparotomy. There were neither
intraoperative nor postoperative complications.
Mean postoperative stay was 3 days (range, 2-4).
Conclusions: We have found that in experienced
hands, laparoscopy is a safe and effective technique
for the management of acute small bowel
obstruction.
OP118
SEVERE BLUNT LIVER
SURGICAL MANAGEMENT
TRAUMA
-
Authors:
Col. Mutafchiyski V, Takorov I, Mihaylov V,
Vladov N, Col. Belokonsky E.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
160
Institution:
HPB and Transplant Surgery, Military Medical
Academy – Sofia, BULGARIA
Institution:
HPB and Transplant Surgery, Military Medical
Academy – Sofia, BULGARIA
The liver is the largest solid abdominal organ with
arelatively fixed position, which makes it prone to
injury. Liver trauma is the second most frequent
event during an abdominal trauma and is the
leading cause of death in these cases.These patients
require close attention, rapid evaluation, accurate
classification and well-structured action protocol.
Although the nonoperative treatment of liver
trauma patients has become a gold standard it is not
always possible. In cases with severe (high-grade)
liver trauma it is successful in no more than 20% of
cases. We present eight cases, managed in our
department during the last two years. Five men and
three women, with a median age 41.3 years. All
patients were classified according to AAST
classification of liver trauma. One of them was with
IIIrd grade liver trauma, 4 were with IVth grade and
3 – with Vth grade. Surgery was used in seven
cases. The following protocol was applied: 1.
Damage control (DC) laparotomy with packing
and/or suture of bleeding vessels; 2. DC
resuscitation using massive haemotornas fusion
protocol; 3. Definitive hemostasis and repair: right
hepatectomy in 2 cases, bisegmentectomy in 3 and
repacking in 1 case. High rate of postoperative
complications was observed – abdominal abscess in
3 cases, late hemorrhage in one, bile leak in one
and wound disruption in one case. The median
hospital stay was 28.5 days. Two of the presented
patients died despite of the treatment applied.
Operative approach in cases of blunt liver injury is
mandatory when hemodynamic instability is
present. The increased transfusion requirement is
the other important factor precluding the operative
treatment. The application of DCS increased the
survival after severe liver trauma, despite of the
high complications rate. The definitive treatment of
patients with severe liver trauma must be performed
in high-volume centers where there are possibilities
for adequate image diagnostic, highly experienced
surgical and intensive care teams and
multidisciplinary approach.
Introduction: Since its introduction the vacuum
assisted closure (V.A.C.) therapy has changed the
way wounds are healed and has been selected as the
treatment of choice worldwide. The main
indications including traumatic and complicated
wounds as well as vacuum assisted closure of open
abdomen.
OP119
VACUUM ASSISTED CLOSURE THERAPY
IN GENERAL SURGERY
Authors:
Col. Mutafchiyski V, Mihaylov V,Takorov I,
Stoyanova R, Vladov N, Col. Belokonsky E.
Material and Methods: For a period of 3 years we
present 40 patients treated with V.A.C. therapy.
The patients are divided into two main groups –
vacuum assisted closure of open abdomen and
complicated wounds.
Results: The use of negative pressure treatment for
complicated wounds and in the management of
open abdomen reduces the bacterial colonization
and edema, stimulate blood flow and granulations
with excellent short and long term results.
Complications occurring with the vacuum-pack in
place appear to be associated with the underlying
pathology and not the vacuum-pack dressing.
Conclusion: Vacuum-pack closure technique for
management of the open abdominal wound is a
reliable technique that can be used in trauma and
general surgical patients. The vacuum-pack
dressing meets the needs for temporary abdominal
wound
coverage
during
open
abdomen
management in a variety of surgical conditions with
diverse predisposing factors, such as trauma,
infection,
contamination,
hemorrhage,
and
ischemia.
OP120
WAR INJURIES OF RECTUM AND
PERINEUM IN THE CONDITIONS OF WAR
HOSPITAL IN FORMER YUGOSLAVIA
Authors:
Col. Nebojša Stanković, PhD, MD; Maj. Milan
Jovanović, MD; Maj. Miroslav Mitrović, MD;
Mihailo Bezmarević, MD
Institution:
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
The treatment results of 35 wounded with rectal
and perineal lesion, treated in the period from 1991
to 1993 were analyzed retrospectively. In military
hospitals, 82% of wounded were primarily
surgically managed. The majority (65.8%) was with
161
injury of intraperitoneal rectal segment, 10 patients
(28.5%) were with the lesion of extraperitoneal
segment and 2 patients (5.7%) were with the injury
of anal tract and perineum. The injuries were
mostly inflected by the bullets of various calibers
(42.6%). Multiple or combined injuries were found
in 91.6% of wounded with rectal injury and 38.2%
of them were managed within 6 hours after injury.
Different surgical procedures, most frequently the
lesion suture and proximal colostomy (n=14) were
primarily used.Postoperative complications occured
in 10 wounded (28.6%). In 3 wounded it was
reintervened by Hartmann’s procedure. Mortality
rate was 8.5% (n=3). Anorectal war injuries are the
most severe of all colonic injuries. To our
experience and unique war surgical doctrine in the
primary treatment of rectum injury, the most
important is to perform terminal colostomy, injury
suture (always intraperitoneal, and extraperitoneal
if posible, including the sphincter muscles
approximation) and presacral drainage. This
approach was performed just before the
inauguration of the current damage control surgery
doctrine.
OP121
MISSION – HEART, AFGHANISTAN – 39th
SURGICAL TEAM
Authors:
Lieutenant-colonel Dr. Svetlin Nikolov, Colonel
Dr. Alexander Parashkevov, Prof. Dr. Borimir
Vassilev, Associate Prof. Dr. Evgeni Belokonski
Institution:
Military Medical Academy, Experimental Surgery
Department, Sofia
Introduction: The Bulgarian medical /surgical/
teams remain as an irrepealable part of the structure
of hospital Role 2 situated in the base CAMP
ARENA in Herat, Afghanistan. They have an
essential role not only with regard to the structural
composition and functioning of the hospital but also
in relation to the accurate provision with medical
support within the crucial moments of NATO’s
mission in this extremely important region of
Afghanistan. The presence of the Bulgarian
military, medical and surgical science and
experience in this mission is substantial with
respect to the lasting recognition of Bulgaria within
the realization of the peacekeeping politics
worldwide.
Aim: To make an analysis of the activities of the
39th Bulgarian surgical team from point of view of
the Military surgery and in relation with the
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
conceptual development
peacekeeping politics.
of
the
NATO’s
Material and methods: For the period of 102 days
spent in the hospital, numerous medical
examinations and different surgeries took place,
following and respecting all approved international
military surgical principles for required volume of
surgical help for Role 2. A detailed analysis for the
traumatism has been made. The number of the
explosive traumas keeps increasing. The level of
the academic diagnostics of the patients rises. The
Bulgarian surgical team participated in the
scientific activities of the mission – two lectures
were held by the Bulgarian specialists about the
following subjects: 1. Control of the traumas and
damages caused by fire and explosive injuries and
2. Traumatic and terminal ballistics. Explosive
traumas.
Results: Observation of the work and activities of
the Bulgarian surgical team for the period of the
mission. The great role of the supporting
administrative institution has to be underlined. The
chronology and the analysis of the achieved results
show that 100 % of all urgent fire, explosive and
other military traumas were successfully held,
taking into consideration the for required volume of
surgical help for Role 2. Certain mistakes with
regard to the organization and effectuation of the
urgent surgical help as well as some problems in
the management were detected. Some important
comparisons with the great experience of the
leading centers for military traumas were made.
Conclusions:
1. The role of the Bulgarian surgical team in
hospital Role 2 situated in the base CAMP ARENA
in Herat, Afghanistan is daily and essential.
2. The military surgery is a clinical speciality with
concrete specific contents and essence.
3. The Bulgarian surgical team responds to the
requirements and the principles of NATO’s military
surgical doctrine.
4. The academic level of the Bulgarian military
surgery is highly evaluated by its international
partners and it progresses in accordance with the
new dynamic tendencies in the conceptual
development of the science “Military surgery”.
5. The Bulgarian military surgical examinations
with regard to the traumatic and termination
ballistics as well as with regard to the explosive
traumas, don’t have an analogue in the military
surgery of the other countries members of NATO.
6. A brand new conceptual revaluation with regard
to the training of the medics is required and needed,
taking into consideration the tendencies of the
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
world politics and the contemporary development
of the Military medicine and Military surgery.
7. Reconsideration of the decision for termination
of the Bulgarian mission in Heart, Afghanistan is
suggested.
OP122
MODELLING OF INJURY BY PORTABLE
FIREARM
WITH
DAMPER
IN
EXPERIMENT IN VITRO
Authors:
Sv. Nikolov, B. Vasilev, E. Belokonsky, R.
Lazarov, B.Aminkov, G. Kesov, Al. Parashkevov
Institutions:
Military Medical Academy, Experimental Surgical
Ward, Thoracic Surgical Clinic, Centre for
Professional Education – MVR Academy, Faculty
of Veterinary Medicine – University of Forestry –
Sofia
Introduction:
In the last few decades in army in almost every
country get into equipped guns with aids for
decreasing the sound and fire in gunshot. The
damper are used in this cases, when one of psychological factors of gunfight – sound effect does not
contribute for successful resolution of shooting task
by the fact that expose the actions of gun man. The
main reason for the sound in shot is detonation,
arising by fast enlargement of gunpowder gas, after
throwing out the bullet by barrel. The second main
reason for sound effect in gunshot is ballistic wave,
comprised in result of the meeting of the bullet with
air and acted with sound with high frequency.
IT IS TYPICAL A FREQUENT USE OF WAR
SUPPLIES WITH REDUCED /TILL SOUND/
START SPEED OF THE BULLET. These are the
so called bullet “Subsonic”, which have reduced
gunpowder blast and heavy bullet. It is obvious that
more patients with gunfire injuries by gun with
dumpers and war supplies with till sound start
speed will be subject of military surgery. The
damages and marks, which are generate into struck
stroma /barrier / after gunfight with damper
considerably are different from the damages in
gunfight with the same gun without damper. Till
now in Bulgaria have not been organize scientific –
experimental research of the marks by gunshot with
damper. The dumper is essential factor for
beginning a specific injury profile with change of
classic parameters. In documents there have no
description of injury profile in simulation ambient
or biological object, caused by bullet with
specification, enable shooting the bullet by damper.
162
Material and methods: There have been executed
20 gunfights by shooting training specialist into
special standard simulator of human commissure –
ITCH by different destinations.
Results: There is analysis of injury profile of
damages in view of injury ballistics.
Discussion: Improve the knowledge for damages in
use of present day portable firearm with dumper in
military action and terroristic acts, as well as
criminal accidents. Detailed is studying terminal
and injury ballistics in damages of till sound
bullets. Injury profile, with their 4 components /
injury channel, temporary pulsing flaw, permanent
flaw, bullet disconnection / is essentially
distinguishing in use of till sound bullet. There have
no description of detailed profile into block – target
by portable firearm with dumper. There have been
resolutions regarding possible damages in different
anatomic parts and organs in accordance to the
distance of experimental gunshot. There have been
announcing to continue the scientific –
experimental research in vitro into appropriate
experimental animals, according to the principal of
ICLAS/FELASA and in order to human behavior of
experimental animal.
OP123
AUTOMATED INFORMATION SYSTEM
FOR ASSESSMENT OF MEDICAL RISK FOR
BULGARIAN
TROOPS
IN
THEIR
PARTICIPATION
IN
MISSIONS
AND
OPERATIONS ABROAD
Authors:
HRISTOVA KR., Col. A.PARASHKEVOV
Institution:
Medical Academy, Sofia, BULGARIA
Introduction: The revolution of the computer and
information technologies is an important feature of
the modern information society. Its results are
established information and communication
technologies. One of the trends in today's global
information infrastructure / GII / is the free
exchange of information and access to information.
Automated Information Systems / AIS / have been
developed as an instrument for thematic screening.
They contain different types and volumes of
information and use computer technology to
perform as many operations on input and output
processing of information.
Purpose: The aim of the study is to answer the
needs of the Military Medical Intelligence /MMI/
163
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
and to developed an automated information system
for the medical risk assessment for the needs of the
Bulgarian troops - AIS-MMI in their participations
in missions and operations abroad.
Material and methods:
1. Information for new events changing medical
environment, preparing twice a week in a science
research laboratory of MMI.
2. Analysis, evaluation and interpretation of the
collected current medical reference information.
3. Analysis, evaluation and interpretation of
medical information gathered in records produced
by Nile creation of science research laboratory
before.
Expected results of the development: The system
will provide a final product as "The overall risk
assessment" and "Risk Assessment for the health
and lives of troops" in their participation in
missions and operations abroad.
Contributions: The contributions from the
development of this system would be for the
practical scientific purpose. The establishment of
the AIS-MMI allows efficient use of Military
Intelligence Model in a form comprehensible to the
commanders and will directly affect the speed of
decision making, considering all the most important
features of the Military Medical Intelligence.
OP124
COMPREHENSIVE APPROACH IMPACT
ON MEDICAL SUPPORT TO NATO
OPERATIONS
Authors:
Col Kostadinov Rostislav; Col
Alexander; Col Angelov Grudi
Comprehensive approach in NATO operations’
planning and execution.
Aim: To present the NATO Comprehensive
Approach impact on medical support planning and
execution.
Materials and Methods: Descriptive and
comparative methods are applied in order to
analyze the new requirements to medical support
related
to
NATO’s
contribution
to
a
“Comprehensive Approach”.
Conclusions: We summarize the changes that have
to be implemented in the medical support
organization in order to respond to the
Comprehensive Approach demands.
Correspondence:
Col Rostislav Kostadinov, MD, PhD
Email: r.kostadinov@jfcna.nato.int
rostikosti@abv.bg
OP125
THE
EXPERIENCE
OF
THE
HUMANITARIAN MISSION IN HAITI - A
BASIS
FOR
OPTIMIZING
THE
PREPARATION OF MILITARY MEDICAL
TEAMS
Authors:
Col. Alexander Parashkevov, MD; Col. Rostislav
Kostadinov, MD, PhD; Assoc. Prof. Nikolay
Chobanov, MD, PhD.
Institution:
Military Medical Academy, Sofia, BULGARIA
Parashkevov
Institutions:
NATO AJFC HQ Naples, Italy; Military Medical
Academy, Sofia, BULGARIA
Introduction: In an increasingly complex
contemporary world peace, security and
development are more interconnected than ever. All
Allied countries unanimously accepted that the
crisis in the contemporary world cannot be solved
with the political will and military means by one
actor only, the need of close cooperation and
coordination between international organizations is
a prerequisite for effective crisis prevention and
management. On NATO summits from 2006 to
2010 the Heads of State and Government of
Alliance have discussed the implementation of the
Introduction: On January 22, 2010, the tenth day
after the devastating earthquake in Haiti a Military
surgical team from the Military Medical
Detachment for Emergency Response of MMA
departed from the airport Sofia, to provide surgical
care to victims of the earthquake.
Aim: This publication aims to present changes in
the plan for training of military medics to be
imposed in connection with the experience gained
from the Military surgical team during the mission
in Haiti.
Material and methods: To achieve the goal the
authors through the possibilities of documentary
and reference methods and deductive analysis,
systematized experience gained from the Military
surgical team in Haiti. Comparative method and
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
cluster analysis are used to group the proposals for
increasing the effectiveness of training.
Results and discussion: Based on thorough
analysis, the authors draw conclusions, classified in
several groups about the difficulties in the
organization and conducting of the mission. They
are discussed various options to overcome these
difficulties. The authors summarize concrete
proposals aimed at increasing the effectiveness of
the training of military doctors for medical support
during humanitarian mission.
Conclusions:
1. It is necessary to increase the role of the Military
Intelligence in the training of military medics;
2. Military medical teams should be provided with
a standard, easily portable with land and air
resources medical kit, which ensures the autonomy
of the team within 10-14 days;
3. It is expedient to provide theoretical and practical
training of military medical professionals for
admission and treatment of victims with injuries in
different body areas, multiple traumas as well as
stabilization and treatment of children;
4. It is necessary the passing of psychological
training for overcoming the stress of emergency
situations;
5. It is necessary to undergo training in basic skills
necessary for effective communication with the
public and the media during emergency situations
and crise
OP126
INFECTIOUS
DISEASE
MORBIDITY
MANAGEMENT IN MILITARY MISSIONS
ABROAD
Authors:
LTC Dr Georgi Popov MD, PhD; COL Dr
Rostislav Kostadinov, MD, PhD.
Institution:
Military Medical Academy, Sofia, BULGARIA
Introduction: A lot of recorded data presents the
significance of infectious diseases for the success of
military campaigns throughout history. Great
military leaders were defeated not on the battlefield
by their opponents, but were forced to quit their
wining campaigns because of the infectious
diseases morbidity and mortality among the ranks.
The development of medicine knowledge and the
implementation of preventive medicine measures
have significantly reduced the infectious disease
mortality in the last 150 years. The data about
servicemen morbidity during recent and on-going
164
military operations continues to describe the
infectious diseases as a major cause for service-day
lost.
Aim: The aim of this publication is to present the
Bulgarian armed forces medical service infectious
disease management in military missions abroad.
Methods: By means of descriptive and
comparative methods the data regarding infectious
disease morbidity during Bulgarian mission in
support of operation Althea is presented. The
deductive and cluster analyses are applied for
describing the measures implemented in order to
minimize the infectious diseases impact on
deployed troops health and combat readiness.
Conclusion: The authors propose a simplified
approach to managing the infectious disease
morbidity in military missions abroad.
Correspondence:
Military Medical Academy 3, Georgi Sofiisky str,
1606 Sofia, Bulgaria LTC Dr Georgi Popov, MD,
PhD
Fax: +359 2 9526536
Tel: +359 2 9216098
Cell phone: +359888517529
E-mail: popovg@abv.bg
OP127
AFGHANISTAN HEALTH ASSISTANCE
SERVICES FROM TURKISH MILITARY
FORCE AS A NATO ISAF IN 2009
Authors:
MAJ DURUSU Murat, MD¹, COL ERYILMAZ
Mehmet, MD¹, LT ARZIMAN Ibrahim, MD¹, 1LT
ARDIC Sukru, MD¹, CPT EYI Yusuf Emrah, MD²,
COL AKYILDIZ Ramazan, MD3
Institutions:
1. Gulhane Military Medical Academy, Dept. Of
Emergency Medicine, Ankara, TURKEY
2. Hakkari Military Hospital, Hakkari, TURKEY
3. Ministry of Defense, Health Branch, Ankara,
TURKEY
Objective: Turkish military medical forces have
executed assistance service in Afghanistan since
2002 as a part of NATO ISAF. We aimed to share
our one year experiences about these activities in
Kabul province in 2009. Assistance activities were
composed of two parts that treatment and training
activities. Otherwise these activities have executed
civilian and military components separately.
165
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
TRAININGS Afghan military medical staffs have
referred to Turkey for education since 2003. 44
medical staff have been educated by Gulhane
Military Medical Academy/Turkey in 2009-2010
education period. “Medical technician course” was
executed for 14 Afghan medical personnel in 2431th March 2009. “Emergency Care For Trauma
course” was executed for 25 Afghan medical
personnel in 14-15th April 2010. A medical team in
OMLT (Operating Mentor and Liaison Team) has
been working with Afghan medical personnel since
Sept 2009 as on-the-job training.
Objective: We aimed to determine the effects of
military doctors’ occupational commitments and
quality of work lives on their organizational
commitments.
Treatments: Approximately 60 military patient are
referred to Turkey for further treatment in a year,
totally 378 patients have been referred since 2003.
Approximately 3000 Afghan patients have been
treated monthly in Kabul Ataturk Military Hospital
in 2009. All of civilian and military Afghan patients
were treated and given medicine free of charge.
Nine Medcap (medical civic action programme)
activities were executed in 2009 and approximately
2000 patients were treated in these activities. These
are some examples of our activities in Afghanistan:
vaccinations, circumcision activities, hadj activities,
Afghan Military Academy Health screening
activities etc.
Results: The total mean score of occupational
commitment was 2.3±0.8, quality of work life was
3.2±0.6 and organizational commitment was
2.6±0.8. Regression model was statistically
significant (F=287.633; p<0.001). The regression
model explains 71% of organizational commitment
level alteration (R2=0.71). In this model, we found
that the effects of affective occupational
commitment (β=0.409), normative occupational
commitment (β=0.264) and accumulated costs
(β=0.176) on organizational commitment are
statistically significant (p<0.001). Also quality of
work life dimensions (social integration to
organization (β=0.075), opportunity of skill
development and usage (β=0.061) and materialpersonnel support (β=0.049) effects are found
statistically significant.
Conclusion: Training and treatment activities are
two main parts of ISAF medical force assistance
missions. These activities must continue frequently.
Correspondence:
Gulhane Askeri Tıp Akademisi, Acil Tıp AD, Etlik
06010, Ankara, TURKEY.
Tel: +90 312 304 3007 (w)
Fax: +90 312 304 3019 (w)
GSM: +90 533 7479093
E-mail: iarziman@gata.edu.tr
OP128
THE EFFECTIVE FACTORS ON MILITARY
DOCTORS’ ORGANIZATIONAL COMMIT
MENT
Material and methods: At this study five-likert
questions about occupational commitment, quality
of work life and organizational commitment asked
to 1060 military doctors from 41 different
specialties. To determine the relationship among
variables stepwise linear regression analysis was
applied.
Conclusion: Of all variables, affective occupational
commitment has the most positive effect on
organizational commitment. The other dimensions
of occupational commitment and quality of work
life are also effective positively on organizational
commitment.
Correspondence:
Nuri YILDIRAN TSK Saglik Komutanligi, NSA
Subayi. Bakanliklar 06100, Ankara, TURKEY.
Tel: + 90 312 402 4078
GSM: + 90 505 798 5475
E-mail: yildirannuri@yahoo.com.tr
Authors:
MAJ YILDIRAN Nuri, MD, PhD¹, COL OZER
Mustafa, MD, PhD2, CPT OZTURK Gultekin,
MD2, COL CETIN Mehmet, MD, PhD2, MAJ
TURK Yusuf Ziya, MD, PhD2, COL FEDAI Turan,
PhD2
OP129
PEACE KEEPING MISSION MINURCAT II
REPUBLIC OF CHAD
Institutions:
1Turkish Armed Forces Medical Command,
Ankara, TURKEY.
2Gulhane Military Medical Academy, Dept. of
Military Health Services, Ankara, TURKEY.
Institution:
Center of Interventional Cardiovascular Pathology,
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
Author:
Danijela Ivković
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Introduction: The Republic of Chad is a
landlocked country in central Africa, where desert
climate prevails, known as a “Dead heart of
Africa”. Chad borders to the east with Sudan
(Darfur region), and in this part of the country live
about 400 000 refugees and displaced, as the state
is in constant conflict with rebel groups from
Sudan. Population is divided into three major tribes
that each other in the struggle for supermacy. I am
startled by the fact that rebel groups recruit children
who have no food, water and basic living
conditions, but get “Kalashnikov” and bombs
together with food and shelter. There are a lot of
hazards, from various armed paramilitary groups
and mines to extreme weather conditions, sand
storms and poisonoussnakes, scorpions, lizards and
spiders. Due to inadequate living conditions and
poverty, numerous diseases are spread such as
malaria, dysentery, meningitis, yellow fever,
tetanus, tuberculosis and AIDS. We knew we were
going to uncertainty and challenge, to the poorest,
war-torn country in the world. It is a country
without electricity, water supply, and where people
live in tribes, like thousand years ago. These
conditions demanded our psychological and
physical preparations before entering the mission.
That included pre-deployment in the garrnison in
Sessvollmoen, Norway, where we took part in one
month lasting military training. We were trained to
protect ourselves against infectious diseases and
bites of poisonous and contagious animals. We
practiced behavior in unpredictable situations such
as kidnapping, attacks of terrorist groups or
individuals and entering the minefield. In addition,
we had training pistol shooting on fixed and
moving targets.
The objective of the mission MINURCAT II was to
estabilish peace in the region and to facilitate
conditions for deliveries of humanitarian aid. The
objective of the hospital with in MINURCAT was
to provide health care for 7 500 members of the
mission, other UN organizations and civil
population. That often meant going twice a week to
the local civilian hospital under full military
equipment and with armor in order of selfprotection. We were engaged as surgical team with
six members. Hospital was a container-tent type,
equipped and organized to the highest level. It met
all the standards for “field deployment hospitals “
Military medical preparation: Within the military
medical preparation, nurse gets used to wear
military uniform, is trained to use weapons in selfdefanse, drive a military ambulance and render first
aid on the field and in specific circumstances.
166
Preparing medical supplies for the transport:
The nurse, together with army and other health
members, was involved in the preoparation of
material for the transport as a coordinator and
adviser in order to protect equipment from being
damaged and to control the list of all supllies
interventions depending on where the team was
involved. After the transport of medical supplies to
the destination, the task of nurses was to organize
the workspace, provide aseptic conditions, keep
records and perform specific interventions
depending on where the team was involved. Our
surgical team was the very first day after arrival
engaged in a life-saving operation. In the field
hospital, which was placed in the middle of the
chad*s desert, our medical care was already waiting
little Hassan (7 years) and Sara (15 years). Hassan
was wounded in his innocent game, falling into a
campfire when he suffered third-degree burns to
45% of his skin mostly on the arms and back. Sara
is the girl whose sin was that she refused to marry
the one who was promised in a neighboring tribe,
and she paid her sin with thired-degree burns also
on 45% of the body, mostly on the gluteal area and
the back of her legs. Little Hassan and Sara were
only two cases among many who were treated by
our surgical team in Chad. During the four months
spent in the mission, the result of our medical team
was: 240 surgical procedures, 150 patients in the
surgical intensive care unit, and thousands of
patients who were medically consulded and treated
The pathology was various: surgical cases,
infectious diseases, congenital anomalies, injuries,
fractures, gunshots, baby drowning with swallowed
foreign body, etc. The role of nurse in
peacekeeping missions is manifold. Must be trained
in the care and treatment of patients with different
pathologies. In addition, at any time she must give
the best to represent her country with dignity. In
turn, thanks to her selfless effort, she will get the
smiling face of patients of all ages who have got the
chance for a new life and hope for better future.
And at last, she gets the honors from mission state
participants. 200
OP130
CURRENT ORGANIZATION STRUCTURE
AND ACTIVITIES OF THE MEDICAL
SERVICE TRAINING CENTER.
Authors:
Maj Đukić Igor; Col Dimović Zoran MD. PhD;
Zukić Snežana Rn;
Institution:
Military Medical Academy, Belgrade, SERBIA
167
Medical Service Training Center (MSTC) is a
constituent unit of the Department for Education
and Scientific Research of the Military Medical
Academy (MMA). Historical background General
Military Hospital Student Company - the
forerunner of Medical Service Reserve Officer
School in 1935. Medical Officer School - formed at
the General Military Hospital in October 1945.
Since then the Center has trained over 38,000
cadets. Medical Service Training Center was the
first in the Serbian Armed Forces to carry out
exercises in accordance with protocols of UN and
PfP member countries. Tasks of Medical Service
Training Center are: Organization and delivering of
courses, seminars and other forms of training for
officers, Medical Service candidates for officers
and candidates for peacekeeping missions,
preparation of medical staff teams of all profiles for
emergency situations, organization and delivering
of training courses in civil protection, organization
and delivering of courses for medical officers
within the framework of international military
cooperation. Visions of the development prospects
Project of The Regional Medical Service Training
Center restructuring includes: New way of
organization,Increase in personnel and medical
equipment, The role and tasks in accordance with
the
International
Humanitarian
Law
Activities:Development of MSTC, Development of
the MSTC new formation. Education of the existing
personnel, Development of training programs and
courses, Training of medical personnel abroad
(DIMO, ...), License obtaining for ATLS courses
and DIMO, Renovation and equipping the KN-3
facility Banjica barracks, Procurement of medical
equipment and ambulances. Activities of the MSTC
in the area of UN operations. Since 2003 MSTC
has executed preparation training of MEDEVAC
teams for UN AMET mission in the African region.
18 teams, overall 108 SAF members of all profiles
of medical staff, passed the training and
successfully executed 6-month rotation.
OP131
FACTORS
FOR
ESTABLISHING
A
SUCCESSFUL NURSE TEAM IN HOSPITAL
INPATIENT
Authors:
R. Doynovska, V. Vaseva
Institutions:
Clinic of Pneumology and Phthisiatrics, Scientific
and education department, Military Medical
Academy – Sofia, BULGARIA
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Summary: The objectives of each organization are
achieved through a certain number of tasks, as for
this goal employees are separated into groups. For
greater efficiency of work performance is necessary
to analyze the activity of groups - to achieve
organizational goals and personal satisfaction of
individuals. The working groups/teams shall be
approved as the most effective in medical practice.
The aim is to explore and analyze the status and
working atmosphere in the group as part of the
factors that influence the development of effective
nursing team in the hospital ward. We used
anonymous sociological survey of 247 nurses from
military hospitals. The results are described using
graphs and numerical values. Respondents give
high marks to the atmosphere in the team (73%)
with significant differences, according to age,
education level and profile, and no differences in
service. Due to team principle at work in the
hospital ward atmosphere in the team has a heavy
burden also in the choice of work place in the frame
of hospital and place to achieve professional
successes, through proof of the position in the team.
The work is one that is essential for professional
status. The close rates in respondents’ answers
indicate relatively uniform beliefs about the status
of the employee in the team and the importance of
work behavior. Most of nurses believe that the
employee is they are responsible for their positions
in the team (63.1) and others think there are side
factors for the attitude to it (13.8%).
OP132
TIME AS A BASIC RESOURCE IN NURSE
MANAGEMENT
Authors:
V. Vaseva, R. Doynovska, M. Ilieva.
Institution:
Military Medical Academy – Sofia, BULGARIA
Introduction: Time itself cannot be managed
because it is constant. Therefore, attention should
be focused on how individuals use time. This is
accomplished
by applying
personal
and
professional means to ensure its effective use.
Objective: To study how nurses in MMA organize
and use time in their daily activities and to analyze
the obstacles to effective time management.
Methods: The survey was conducted among
nursing staff of MMA for self-analyze of attitude
toward time.The results were analyzed and we
compared priorities of each nurse. Based on survey
results and analyze we suggested approaches and
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
168
strategies for effective time management by the
nurse manager.
boundaries and general condition of the ulcer
served as evaluation criteria.
Conclusion: Proper and effective time management
is a key to the success of any nurse manager. It
should be flexible in planning workflow and make
sure that its efforts to improve time management
will not be in conflict with thw plans of other
persons associated with the healing process. It
should be explained the plan to colleagues,
subordinates and the manager and to draw their
cooperation and support.
Results: Throughout the healing process, in
medical terms, the patient was treated in the same
way. As regards his compliance with nursing
instructions, he presented two types of behaviour
(positive/negative) in several evaluations.
OP133
THE
CONTRIBUTION
OF
NURSING
COUNSELING IN THE HEALING PROCESS
OF THE DIABETIC FOOT – A CASE STUDY
Authors:
Apostolidou Eleni1, Kravvari Christina-Maria1,
Gylari Eirini1, Maragiannis Konstantinos2, Dr Roka
Vasiliki3, Mpourlidis Panagiotis4, GREECE
Institutions:
1. Student, Military Nursing Academy, Athens,
Greece;
2. MD, Health Center, Kalivia, Greece;
3. Lieutenant Commander, Department of
Education, Military Nursing Academy, Athens,
Greece,
4. MD, National Health Operation Center, Ministry
of Health, Athens, Greece
Introduction: There is an increasing prevalence of
Diabetes Mellitus and its complications. The
complication with the highest incidence is that of
the “diabetic foot” in which diabetics have reduced
sensation, susceptibility to infections and
obstructive lesions in small arteries. Foot care is
extremely important for these patients in order to
prevent severe problems such as damage to the
integrity of the skin, soft tissues and bone. The
damage of lower limbs appears in such frequency
that it is referred to as a distinct pathology and is
called “diabetic foot”. Therefore, early detection
and treatment of ulcers, trauma and cellulitis helps
to reduce the risk of osteomyelitis, dry gangrene
and amputation.
Material–Method: In the emergency department
of a Health Center in 2011, a patient with a history
of diabetes mellitus type II, presented with a foot
ulcer. The outcome of the patient’s compliance and
deviation from the instructions of the health care
team was evaluated by comparing his clinical status
during all consultations within a 6-month period.
The presence or absence of infection as well as the
Conclusions: The “diabetic foot” constitutes a
significant pathology whose treatment requires a
multidisciplinary approach. Nursing intervention is
of critical importance for a positive outcome.
Counseling as well as support in the effective
implementation of clinical protocols can lead in an
improvement of the quality of life avoiding severe,
occasionally fatal complications.
OP134
NURSING
FAILURE
IN
CHRONIC
RESPIRATORY
Author:
Cristina-Maria Radu.
Institution:
Emergency Central Military Hospital-Pneumology,
ROMANIA
The chronic respiratory failure represents a severe
deficiency of respiratory functions. The nursing of
the patient with CRF implicates two aspects:
nursing during exacerbation in hospital and during
the stabile period of the disease at home. The
correct and prompt nursing applied to the patient
during exacerbation could be fundamental in the
further favorable evolution. The efficient nursing at
home during the stable period may reduce the
numbers of the admittances and the costs of
medical assistance.
Correspondence:
Tel: 0723910074; 0217457322
E. mail: raducristinamaria@yahoo.com
OP135
DETERMINATION OF THE IMPORTANCE
THAT NURSING STUDENTS GIVE TO
ERGONOMIC RULES IN CLINICS
Authors:
CDR COSKUN HaliseRN, PhD; MAJ UNVER
Vesile RN, PhD; COL IYIGUN Emine RN, PhD
Institutions:
Gulhane Military Medical Academy, School of
Nursing, Ankara, TURKEY
169
Objective: The concept of ergonomics is not new
to healthcare. All health professionals come face to
face with biological, chemical, physical,
environmental, psycho-social and biomechanic
risks in hospital environment.This study was made
to determine the importance that nursing students
give to ergonomic rules in clinics.
Material and methods: This study is a descriptive
study. The universe of the study is the students at
fourth grade in nursing school.The study examples
are composed of total 80 nursing students accepted
to participate in this study.The data of the study
were acquired using the information form prepared
according to literature information.SPSS package
program was used to analyse the data.
Results: The most important ergonomic rules for
nursing students are related to prevention of
infections. It was generally determined that
importance given to the other ergonomic rules was
middle level.
Conclusion: It was considered that continuing
education about this subject after graduation would
be useful. Nursing students still need to understand
how important ergonomic rules and how some
behaviors increase risk of injury.
Correspondence:
Gülhane Askeri Tıp Akademisi, Hemşirelik
Yüksekokulu, Etlik 06018, Ankara, TURKEY
Tel: +90 312 3043942
Fax: +90 312 3043900
GSM:+90 539 4531898
E,mail: hcoskun@gata.edu.tr
OP136
NURSING STUDENTS’ BEHAVIOURS AND
ATTITUDES TOWARD SMOKING
Authors:
MAJ GUVENC Gulten, RN, PhD1, COL
HATIPOGLU Sevgi RN, PhD2, CIRIK Burcu,
Senior Nursing Student3, TURK Asuman, Senior
Nursing Student3
Institutions:
1. Gulhane Military Medical Academy, School of
Nursing, Department of Obstetrics and Gynecology
Nursing, Ankara, TURKEY
2. Gulhane Military Medical Academy, Director of
School of Nursing, Ankara, TURKEY
3. Gulhane Military Medical Academy, School of
Nursing, Ankara, TURKEY
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Objective: The aim of this study was to determine
nursing students’ behaviors and attitudes toward
smoking.
Material and methods: This descriptive study was
carried out as in a School of Nursing. The study
population was consisted of 404 nursing students
studying in the 1th, 2nd, 3th and 4th classes. The
study sample was consisted of 364 volunteer
students. Data were collected using a data
collection form developed by researchers and the
Smoking Scale. Obtained data were analyzed using
SPSS version 15.0. Smokers were classified
according to the stages of change of
Transtheoretical Model. Smokers were defined as
being in the stage of precontemplation (not thinking
of quitting within the next 6 months),
contemplation (thinking of quitting within the next
6 months) or preparation (thinking of quitting
within the next 30 days, having managed to quit for
at least 24 h within the last 12 months).
Results: The mean age of participants was 20.36
±1.2. A total of 27(7.4%) participants were
smokers: 13 (48.1%) were in the precontemplation
stage, 11 (40.7%) in the contemplation stage and 3
(11.1%) in the preparation stage. The mean first
smoking age was 17.07 ±1.60. The mean total
smoking questionnaire score was 78.09±7.52. The
mean total smoking questionnaire score was
78.95±6.33 in non smoker students, and the mean
total smoking questionnaire score was 67.37±11.92
in smoker students. Higher scores indicate the
beliefs and attitudes that support smoking cessation.
Conclusion: The findings of this research showed
that nursing students have attitudes support in
smoking cessation. Nursing students will be role
models for the public; hence, it is important to give
special attention to this significant health problem.
Correspondence:
Gulhane Askeri Tıp Akademisi, Hemsirelik
Yuksekokulu, Etlik, 06018, Ankara, TURKEY.
Tel.:+90 312 304 39 47
Fax:+90 312 304 39 00
GSM:+90 536 670 03 21
E-mail: guvencgulden@yahoo.com
OP137
NURSING ROLES IN
BOWEL DISEASE CARE
Author:
Svetlana Rakicevic
INFLLAMATORY
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Institution:
Clinic of Gastroenterology, Military Medical
Academy, Belgrade, SERBIA
Ulcerative colitis and Crohn's disease are incurable
chronic diseases of the intestinal tract. The two
diseases are often grouped together as
inflammatory bowel disease (IBD) because of their
similar symptoms. Individuals with IBD have
unpredictable health care needs and come into
contact with care services in many difrent settings
throughout their lifetime. Nurses are in a strong
position to be able to support our patients wherever
they might be within the healthcare setting at any
one time. Understanding IBD as a condition and
having insight into how we might support our
patients at different times within their pathways can
help to improve the experience for our patients.
Working as part of a multidisciplinary care team
focused on prviding high quality care for
individuals with IBD can improve disease
manament and outcomes. Crohn's and Colitis
special interest group for nurses recognises the need
for futher development work araund competencies
and standards for practice. The remit o the role may
include:
− telephone advice line
170
− follow-up clinics
− rapid acceSs clinics
− in patient support
− mAnaging an immunosupression service
−administration and monitoring of anti TNF therapy
Balkan Military Medical Review
Jul-Sep 2012; 15(3): 171 - 273
POSTER PRESENTATIONS
PPOO1
DIAGNOSIS DIFFICULTIES IN DIGESTIVE
SUBEPITHELIAL MASSES
Authors:
Mariana Jinga1,2, Gabriela Costiana Cherana1,2,
Andrada Loredana Popescu1,2, Vasile Daniel
Balaban1,2 , Florina Vasilescu1
Institutions:
1. “Dr. Carol Davila”, Central University
Emergency Military Hospital,
2. “Carol Davila”, University of Medicine and
Pharmacy, Carol Davila, Bucharest, ROMANIA
We are presenting the case of a 57-year-old female
patient, who was admitted to the clinic for
abdominal pain with maximum intensity in the left
iliac fossa and hypogastrium. Upper digestive
endoscopy revealed a gastric subepithelial mass; at
EUS this lesion corresponds to a solid tumor 20/20
mm in size, hard on sonoelastrography, with a
transonic content, which is most likely originated in
the muscular layer of the gastric wall. The
colonoscopy revealed at about 18 cm from the anus
a subepithelial mass, witch at EUS corresponds to
an approximately 23/18 mm tumor with a structure
as the one in the gastric wall. Gynecological
examination raised suspicion of a tumor that might
have the origin in the uterus wall. The patient
refused biopsy puncture and aspiration and the
bioptic curettage and she was being discharged at
her will. She was admitted afterwards for
metrorrhagia in a gynecology clinic, where it was
performed a complete hysterectomy, with
abdominal approach, without adnexectomy. The
histophatological and immunohistochemical tests of
the intraoperative piece revealed the diagnosis of
small cell neuroendocrine carcinoma (atypical
carcinoid) at the uterus body, with cacinomatous
invasion in both annexes. The patient was
diagnosed with a rare type of neuroendocrine
tumor, having the origin located in the uterus body
with metastases to the wall of the digestive tract.
Correspondence:
E.mail: mariana_jinga@yahoo.com
POO2
DIAGNOSTIC
DIFFICULTIES
PANCREATIC TUBERCULOSIS
IN
Authors:
Mariana Jinga1,2, Bogdan Macadon1,, Gabriela
Costiana Cherana1,2, Andrada Loredana Popescu1,2,
Vasile Daniel Balaban1,2
Institutions:
1. “Dr. Carol Davila” Central University
Emergency
Military
Hospital,
Bucharest,
ROMANIA
2. “Carol Davila” University of Medicine and
Pharmacy, Bucharest, ROMANIA
Extrapulmonary locations are seen in 15% of all
tuberculosis cases, the digestive involvement being
mostly found in abdominal lymph nodes,
peritoneum and ileocecal junction. Tuberculosis of
the pancreas is a rare clinical condition that can
mimic pancreatic cancer clinically and on imaging,
and should be considered as a differential diagnosis
of pancreatic masses, especially in an area where
tuberculosis is endemic. We present 2 cases of
pancreatic
tuberculosis
in
nonimmunocompromised patients (HIV-negative,
normal serum immunogram) and without evidence
of active pulmonary tuberculosis. The first one is a
male patient aged 39, with unremarkable medical
history, who presented with anorexia and fatigue
and in whom abdominal imagery revealed a
pancreatic isthmus tumor of 30/20 mm, with cystic
appearance, accompanied by mild biliary dilatation;
because the EUS-FNA result was inconclusive,
exploratory laparotomy with biopsy was done and
bacillary etiology was confirmed. The second case
is the one of a 28 years old female, with a history of
pulmonary tuberculosis, who presented for
epigastric pain and weight loss and in whom
imaging detected a well-defined cephalopancreatic
mass of 50/30 mm, with microcystic appearance,
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
and enlarged abdominal lymph nodes. Exploratory
laparotomy
with
biopsy
of
the
retrocephalopancreatic lymph nodes confirmed the
diagnosis of tuberculosis. The two patients received
tuberculostatic treatment and had a favorable
outcome.
Correspondence:
E.mail: mariana_jinga@yahoo.com
Tel: +40722232530
PPOO3
ROLE
OF
CONTRAST-ENHANCED
ULTRASOUND IN THE FOLLOW-UP OF
ENDO-VASCULAR AORTIC ANEURYSM
REPAIR
Authors:
S. STANCIU1, I. DROC2, L.CIOBICA1, Mihaela
IORDACHE1, D. NITA2
Institutions:
1. Bucharest University Military Hospital “Carol
Davila” ROMANIA
2. Bucharest Cardiology Army Center “Constantin
Zamfir” ROMANIA
Endo Vascular Aortic Repair [EVAR] is accepted
technique of treatment of abdominal aortic
aneurysms that has changed the surgical approach
to abdominal aortic aneurysms, conferring a low
perioperative morbility and mortality rate and
shorter hospital stay. Endoleaks after endovascular
aneurysm repair (EVAR) are commonly
encountered and present a diagnostic challenge in
the follow-up after EVAR. Contrast-enhanced
computed tomography (CT) has become the 'goldstandard' imaging modality for surveillance
following EVAR. However repeated CT carrries
cumulative radiation exposure and causes contrast
related renal injury. In the last ten years several
studies have been published on the role of Contrast
Enhanced UltraSound [CEUS] in EVAR follow-up
asserting high accuracy of this evaluation technique
with absence of renal impairment, without radiation
risk and at low costs. The extension of CEUS
investigations by using new generation of contrast
medium represents an important step in the EVAR
surveillance and could help us into our practice in
evaluation of endovascular aortic procedures
gaining a fundamental role in EVAR follow-up.
Contrast-enhanced ultrasound (CEUS) is a new
promising method in the diagnosis and follow-up of
endoleaks.
172
Correspondence:
S. STANCIU Bucharest University
Hospital “Carol Davila”
E.mail: silviu.stanciu@yahoo.com
Military
PPOO4
ABDOMINAL COMPARTMENT SYNDROME
- THE PERSPECTIVE IN THE EMERGENCY
DEPARTMENT
Authors:
Cpt. Mihai TOMA, MD;J Cpt. Alexandru BUTOI,
MD; Lt.Col. Florea COSTEA, MD; Mihaiela
COMAN, MD; Liliana POTERASU, MD; Nicoleta
RUS, MD; Col Bogdan TEUSDEA, MD.
Institution:
Universitary Emergency Central Military Hospital
Bucharest, Emergency Department, ROMANIA
Compartment syndromes can occur in many body
regions. Abdominal compartment syndrome,
initially described many years ago, has become
increasingly recognized in critical care patients.
Abdominal compartment syndrome is defined as an
intra-abdominal pressure >20 mm Hg with
evidence of organ dysfunction. At risk patients
should be identified in the emergency department
and early monitoring of intra-abdominal pressure
instituted. In the emergency department and
intensive care unit, abdominal compartment
syndrome is recognized with growing frequency as
the cause of morbidity such as metabolic acidosis,
decreased urine output, and decreased cardiac
output. In this presentation we will note the
principal direction regarding its definition,
pathophysiology, etiology and treatment in the
emergency department.
Correspondence:
Email: iahim_t@yahoo.com
PPOO5
MASSIVE FACIAL DAMAGE CAUSED BY
FIREARMS ASSOCIATED WITH EYE LOSS
Author:
Dr.Lozana Binjaku
Institution:
Military Medical Academy, Tirana, ALBANIA
Purpose: Identification of maxillary-facial injuries
caused by firearms, in order to present the difficulty
of eliminating the defects in the first phase and to
point out the importance of treatment of these
defects in two or more stages.
173
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Material and methods: a 12-year-old patient
presented in the Emergency Department of Central
Military Hospital, in Tirana after an accident (shot
with a firearm by his brother) with soft tissue
injuries to the face, loss of maxillary bone, left
orbital bone, damage to the frontal bone, with loss
of both eyes, with nasal bleeding. Urgent was made
tracheostomy and in the first moment was made the
left-eye exclusion and closure of the bucal defect,
frontal and orbital with sliding plastic surrounding
tissue. The patient was subjected to plain Xrays,
head CT, CT-thorax, Ro mandible. The patient in
the first week was fed by gastric drill. Bone defects
will be treated in a second stage.
Conclusions: Firearms cause major damage, with
loss of tissue in two or more organs. Their
treatment is a difficult stage, because the correction
of two or more defects requires several stages. To
provide respiratory, stopping bleeding and soft
tissue plastic is the first stage is realized in an
emergency. Replacement of bone defects with
plastic material constitutes later stages.
PPOO6
CLINICAL CASE OF SOLITARY FIBROUS
TUMOR OF THE PLEURA
Authors:
DRANDARSKA Ivanka MD, MIHOVA Anna MD
PhD
Institutions:
Military Medical Academy,
Pathology, Sofia, BULGARIA
Department
Authors:
Stefan Mitov, MD
Institution:
Military Medical Academy-Sofia, BULGARIA
At the beginning of the year, a late evening at the
emergency unit anxious parrents came to me withe
their son. The 18-month-old M. who had fallen on
the coffee table covered with glass and was injured
in the auricular area. During the exam we found
still bleeding wound, there was a defect with
missing part of the auricle (see pic.1). We imme
diately placed the missing part that the parents were
carrying in a plastic cup in sterile saline solution.
We found also and lacerocontusion wound in the
temporal area on the same saide of the head, which
was about 5cm. long. To overcome the
haemorrhage primary a compressive dressing was
placed over the wound. After that the necessary Xray exams were done for exclusion of cranial
fracture. There were no fractures found. The patient
was prepared for operation with common
anesthesia. The missing part of the auricule was
sutured at place with 6-0 Pemilen. The adaptation
of the margins was good. (pic. 2). On the fourth day
after the operation the wound was in goog
condition. (pic.3). The postoperative period was
smooh. The dressings were changed daily, and on
the seventh day the stiches were removed. This is
the patient on th e eighth day after the operation.
(pics. 4 and 5). Here you can see the happy father
with his son.
of
Solitary fibrous tumour of the pleura /SFTP/is a
rare tumour. In most cases, the case of a
asymptomatic
tumour
mass,
discovered
accidentally in the review, which is often larger.
Over 70% of cases it is a benign disease. Malignant
cases of SFTP are rare, where occurrence of relapse
is over 60%. We present a clinical case of 63 year
old woman with SFTP. The tumour is accidentally
discovered in X-ray and subsequently performed
resection of the tumour with the adjacent
pulmonary
parenchyma.
Pathohistological
diagnosis
was
with
the
help
of
immunohistochemical study with abroad spectrum
of antibodies.
PPOO7
TREATMENT OF A LACEROCONTUSION
WOUND WITH PARTIAL AMPUTATION OF
THE AURICULE IN AN 18-MONTH-OLD
CHILD
PPOO8
ONCOCYTOMA (OXYPHIL ADENOMA) OF
THE PAROTID GLAND ACCOMPANIED BY
NODULAR ONCOCYTIC HYPERPLASIA ONCOCYTOCIS
Authors:
Lieutenant Ν. Chaleplidis, Lieutenant Ζ. Almpanis,
Captain Κ. Avraam, Captain Μ. Tsantopoulos,
Lieutenant Colonel Κ. Revelos
Institutions:
Pathology Department, 251 Hellenic Air Force
Hospital, GREECE
Purpose: We present a rare oncocyticparotid
neoplasm which poses a differential diagnosis
problem from other parotid neoplasms with an
oncocytic component.
Material & Methods: 70-year-old female with
painless mass of the left parotid gland for 2 years.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
174
We received a segment of salivary gland
d:3,8x2.6x1,5
cms.
After
sectioning
a
circumscribed brown nodule d:1,2 cm and a lymph
node d:0,6 cm were found.
Results: Microscopically a circumscribed, solid
lesion was recognized, surrounded by a thin fibrous
capsule, composed of polygonal cell groups with
slight pleomorphism and abundant eosinophilic
cytoplasm (oncocytes) separated by fibrous septa.
The cells had central nucleus with prominent
nucleoli. No mitoses or perivascular - perineural
invasion were recognized. The rest of the
parenchyma showed nodular aggregates of
oncocytes, without fibrous capsule. Inside the
coalescent lymph node some tubular epithelial
formations were found with the presence of oxyphil
cells without atypia.
Conclusion: Parotid oncocytoma, accompanied by
nodular oncocytic hyperplasia and ectopic parotid
tissue in coalescent lymph node.
Discussion: Oncocytic neoplasms are rare (<1%),
usually benign neoplasms of the salivary glands
which consist of oncocytes and develop in elderly
patients. The presence of the capsule and the
absence of atypia, mitoses, perivascular - perineural
invasion or metastases favor the benign nature of
the lesion. Sometimes they may develop in
combination with oncocytic hyperplasia and these
two conditions may represent two different stages
of the same pathology. Differential diagnosis
includes other neoplasms which may have an
oncocytic component (Warthin tumor, pleomorphic
adenoma, mucoepidermoid carcinoma, acinic cell
carcinoma).
PPOO9
A
CASE
OF
THROMBOSIS
SUBCLAVIAN
Authors:
Lieutenant Konstantinos Geronatsios,
Lieutenant Georgios Karagiorgis, MD2,
VEIN
Materials and Methods: We describe the findings
of a case of subclavian vein thrombosis in a 22year-old soldier of Plati army camp, basketball
player, non – smoker, with no medical history of
other thromboses, hematologic disorders, clavicle
fracture or other health problems.
Results: The patient presented to our clinic
complaining of pain in his left arm. At initial
presentation there were no other findings in clinical
examination. He was treated for the pain with a
non-steroid anti-inflammatory drug. A few hours
later, he came back with worsening pain. There
were also whole left arm edema, discoloration
(cyanosis), numbness and he was not able to lift his
arm above the level of his shoulder because of the
pain. His blood pressure was 132/82 mmHg in both
arms and pulses were normal, 86 per minute.
Capillary refill time was normal. The patient was
ordered to place his arm above the level of his body
and after two hours he was transferred to the
nearest military hospital, where a triplex
ultrasonograph showed subclavian vein thrombosis.
Treatment with enoxaparin sodium was initiated
and the patient was transferred in a central Military
Hospital for further evaluation.
Conclusion: Subclavian vein thrombosis can be
found in adults without other obvious disorders.
The patient was in better clinical condition after a
few days, without persistent damage left.
PPO10
IMPORTANCE
OF
THE
REGULAR
OPHTHALMOLOGICAL
SYSTEMATIC
REVIEW OF MILITARY AIR FORCE
PILOTS
Authors:
D. Randjelovic1, M. Pavlovic1, S. Djurdjevic1,
B.Kostic1, S. Medjedovic1, J. Lazarevic-Misic2, T.
Mraović3, V. Tepsic-Ostojic4
MD1,
Institutions:
1. Plati Army Camp Clinic, GREECE
2. Koufovouno Army Camp Clinic, GREECE
Objective: Subclavian vein thrombosis (Paget –
Schroetter syndrome) is a rare disorder of multiple
etiology. It accounts for around 4 per cent of all
deep vein thromboses. Previous studies show that
one-quarter of cases are primary and three-quarters
secondary. Our aim is to present a case of this rare
condition in our clinic.
Institutions:
1. Institute of Aviation Medicine, Belgrade,
SERBIA
2. Military Medical Centre Karaburma, Belgrade,
SERBIA
3. Military Medical Academy, Institute of Hygiene,
Belgrade, SERBIA
4. Military Medical Academy, Clinic for the
psychiatry, Belgrade, SERBIA
Introduction: Regular systematic reviews of pilots
are performed because of the establishing of state
of visible functions what make possible safe the
performance services.
175
Methods and materials: Regular reviews are
subject to:
- pilots of the supersonic combat aircraft - every
year
- pilots of the all other categories air force to 35
year of age every two years and more than 35 years
annually.
Results: Evaluation and thinking about the ability
of pilot of military air force gives the military
medical commission on the basis of reports doctor
ophthalmologist after the detailed ophthalmological
review.
Conclusion: Reviews must establish that do not
exist deviations in visible functions from normal
and book of regulations of the established which
could that limit the pilot in the doing of flying
activities.
PPO11
CONSERVATIVE
TREATMENT
OF
ABDOMINAL COMPARTMENT SYNDROME
AFTER LARGE VENTRAL HERNIA REPAIR
Authors:
Bezmarevic M MD; Col. Stankovic N MD, PhD;
Slavkovic D MD; Mirkovic D MD, PhD;
Trifunovic B MD, PhD; Cap. Mickovic S MD;
Ignjatovic M MD, PhD
Institution:
Clinic for General Surgery, The Medical Faculty of
the University of Defence, Belgrade, SERBIA
Introduction: Large ventral hernias reduce the
patient’s physical capacity and quality of life.
Surgical repair of these hernias has become feasible
after the introduction of synthetic meshes and
developments in intensive-care treatment. In
addition to the operative challenges, the
postoperative
disorders
incurred
as
the
consequences of increased intra-abdominal pressure
still expose the patient to severe risks.
Case report: A 44–year-old man was admitted in
our institution for the operative treatment of large
ventral hernia. Despite a large ventral hernia with
the thickened subcutaneous tissue above hernia sac,
a relatively small primary defect that was easy to
repair has been found on abdominal computed
tomography. Intraoperatively, the primary defect
was 10 cm in diameter with preserved and
macroscopically normal abdominal front wall
layers around it. The hernia sac was resected and
the defect was repaired with an onlay Prolene®
mesh. The intraabdominal pressure measured
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
intraoperatively was normal. On the 2nd
postoperative day the patient was intubated due to
respiratory failure in the developement of
abdominal compartment syndrome. This condition
has been treated conservatively and the patient was
extubated on the 6th postoperative day. The
subsequent course was uneventful and the patient
was discharged 14 days after surgery with the
significant improvement in his mobility.
Conclusion: Relatively small abdominal wall
defect and hypertrophic subcutaneous tissue of
large ventral hernia made the surgery less
complicated than assumed on the first presentation.
Serious postoperative complications, such as the
abdominal compartment syndrome, have proven to
be able to be solved conservatively without further
surgery.
PPO12
TOTAL PARENTERAL NUTRITION IN THE
MILITARY
MEDICAL
ACADEMY
–
PHARMACEUTICAL ASPECTS
Authors:
M. Antunovic1, M.Panisic2, D. Tarabar3
Institutions:
1. Sector for Pharmacy,
2. Clinic for Abdominal and Endocrine Surgery,
3.Gastroenterology and Hepatology Clinic,
Medical Faculty of the University of Defence,
Belgrade, SERBIA
A high level of malnutrition has been reported in
hospitals and is linked to poor clinical outcome.
Oral, enteral or parenteral nutrition support, alone
or in combination, should be considered for all
patients who are either malnourished or at risk of
malnutrition. Nutritional support which include
lipid, dextrose with amino acids, with minerals,
vitamins, trace elements and water, applied by iv.
route is known as total parenteral nutrition (TPN) .
The most significant development in the field of
TPN was replacement of ward operated bottles with
“All in One” bag, which are made in the Military
Medical Academy hospital pharmacy since 1990.
The continuous developments in aseptic facilities,
with new design of computer controlled
compounding machines contributed to greater
quality and safety of TPN admixtures. The fact is
that there are possibilities of destabilization of
admixture during mixing procidures, such as
chemical degradation of amino acids and vitamins,
absorption of some components to the bag,
calcium-phosphate
precipitation
and
fat
destabilization. But with validated standard
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
operative procedures in mixing, appropriate
equipment and qualified pharmacists, it is possible
to produce effective and safe TPN admixtures of
high quality, in the hospital pharmacy.
PPO13
ELECTRICAL BURNS
Authors:
Ltc Asst. Prof. Boban Djordjevic, Col. Prof. Jevta
Kozarski, Brig. Gen. Prof.Marijan Novakovic, Maj.
Sasa Milicevic MD
Institutions:
The MMA’s Clinic for Plastic Surgery and Burns,
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
Introduction: Electrical burn is thermal injury of
skin, tissue and organs, which develops after
conversion of electrical in heat energy upon
connection human body in the flow of electric
current or when human body was in contact with
flame of Volt arc. Due to advances in resuscitation
of patients with electrical injuries, new challenges
in reconstruction and rehabilitation have emerged.
Material and Methods: Sixty-four patients with
electrical burns were admitted to the Department of
Burns in Clinic for Plastic Surgery and Burns of
Military Medical Academy during the past 6 years.
A trauma registry was used to identify patients with
electrical injuries. Procedures needed, their timing,
final impairment ratings, and return to work were
recorded.
Results: There were 1050 admissions during this
period, the incidence of electricalburns being 5.2
per cent. The youngest patient was 9 years old and
the oldest patient was 69 years old. Sixty per cent
(33) of the patients sustained injury from direct
contact with live electrical wire, the remaining forty
per cent sustained flash burns. The incidence of low
voltage injury was much higher as compared to
high voltage. Forty-four per cent of these injuries
were not work related. Less than 10 per cent of the
body surface area was involved in about 85 per cent
of the patients. In group of surgically treated
patients average number of surgical operation was
five. Both upper limbs were amputated in four
patients and left or right wrist was amputated in six
patients. One lower limb was amputated in two
patients.
Conclusion: Electrical burns can produce
significant morbidity despite relatively small burn
sizes. Patients require early operative procedures
176
for prevention of further injury. Timely
reconstructive surgery may improve final function
and return to productivity. Finally, continued
reconstruction may ensure improved late outcomes.
The plastic surgeon is essential to patients with
electrical injuries through all phases of their care.
PPO14
EXPLOSIVE WAR WOUNDS OF THE UPPER
EXTREMITES –
CHARACTERISTICS AND TREATMENT
Authors:
Ltc Dragomir Pavlović, Brig. Gen. Prof.Marijan
Novaković, Maj. Vladislav Krstić M.D., V.
Stojiljković M.D.
Institutions:
The MMA’s Clinic for Plastic Surgery and Burns,
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
Introduction: Explosive wounds are characterized
as injuries of anatomic and functional structures
caused by explosive devices. This type of wounds
was frequently seen in war operations.
Cause of injury:
Of 981 wounded: 592 (60.3%) explosive devices;
321 (32.7%) infantry weapon; 68 (6.9%) blast +
other.
Injuries caused by explosive devices are:
- Ussually accompanied by tissue defects
- Most often affecting more organs and systems
(polytraumatism)
- Often associated with blast injuries
- Might be penetrating
Injury localization: (from the patients treated at
the mma): head and neck (7.24%); extremities
(72.36%) - upper (35.17%) - lower (37.19%); trunk
(6.47%); uro-genital region(0.77%); multilocular
(0.77%).
Characteristics of explosive wounds: Excessive
tissue destruction. Necrosis progression due to blast
effect. Contamination with powder charge,
radioactive substances, foreign particles and
microorganisms. Final outcome: - reduced function
and lower or higher grade of disability.
Surgical tretment includes: Primary excision,
Surgical treatment of the tissue defects with nonexposed deep structures and with exposed deep
structures.(Local flaps, Local flaps + skin grafting,
177
Local composit flaps, Regional flaps, Distant flaps,
Free flaps).
Conclusion:
Contemporary
warfare
is
characterized by a higher rate of occurrence of
explosive injuries caused by various types of
weapons. Due to their vulnerability and exposure,
extremities are most often affected. Limited
possibilities of primary reconstruction. Due to the
complexity of the wound, multidisciplinary surgical
approach is essential for the final outcome.
PPO15
SURGICAL
REPAIR
OF
ACUTE
QUADRICEPS OR PATELLAR TENDON
RUPTURE WITH SUTURE ANCHORS
TECHNIQUE IN MILITARY PERSONNEL
(PATIENTS
WITHOUT
UNDERLUYING
SYSTEMIC DISEASES)
Authors:
Major dr Radoičić Dragan, Colonel Prof dr Zoran
Popović,
Lieutenant
Colonel
Radoslav
Barjaktarović, Major dr Jugoslav Marinković
Institution:
SERBIA
Background: For complete ruptures/sections of the
quadriceps or patellar tendon in patients without
underluying sistemic diseases the predisposing
factors, treatment guidelines, as well as
rehabilitation protocols and recovery expectations
are not yet well established. The questions of the
appropriate operative technique, the timing of
weight bearing and mobilisation provoke most
contraversies.
Setting: Level I Trauma Center (University
Hospital). Study Design: Case series; Level of
evidence 4.
Methods: We report case series of five acute
patellar tendon ruptures/sections and six quadriceps
tendon ruptures in patients without underluying
sistemic diseases that were immediatly treated
operatively. We noted three cases of patellar
ligament rupture during sports activities, and two
cases of selfinflicted section of patellar ligament
with chainsaw, one of them had concomitant
section of peroneal nerve and fibular head. Three
quadriceps tendon ruptures occurred during sposrt
and three during military activities. All patients
were males and all of them underwent primary
repair with transpatellar suture fixation. For all
patients same postoperative rehabilitation protocol
with immediate weight bearing and early knee
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
controlled mobilisation was aplied. Postoperatively
hinged knee brace was used in all cases, and
discontinued after 10 to 12 weeks. Average followup was 23 months. There were no failures of repair.
All patients had excellent knee range of motion and
strength, and they regained their preoperative level
of activities after an average of 18.3 weeks after
injury.
Conclusion: Quadriceps and patellar tendon
ruptures are relatively infrequent, but they can be a
disabling injury in the active patient if not
diagnosed and treated properly. Immediate surgical
repair is the treatment of choice. If reliable fixation
is achieved during surgical repair, surgeons should
not hesitate to allow immediate weight bearing and
early controlled knee mobilisation. This approach
produces good functional results and allows return
to preinjury level of activities.
PPO16
CASUISTRY
HOSPITALIZED
PROFES
SIONAL MEMBERS OF THE SERBIAN
ARMY
IN
THE
DEPARTMENT
OF
OPHTHALMOLOGY, MILITARY HOSPITAL
NIS
Authors:
T. Mladenovic, LJ. Radosavljevic, M. Mladenovic,
N. Paunovic
Institution:
Department of Ophthalmology, Military Hospital
Nis, SERBIA
Objective: The aim of this study is to present the
most commonly ophthalmic diseases and injuries
which require stationary treatment of professional
members of the Serbian Army.
Material and Methods: In retrospective study
were included professional members of the Serbian
Army
(officer,
noncommissioned
officer,
professional soldiers, soldiers on regular military
service) who were treated in Millitary Hospital
from 2007 to 2011. Data were statistically
analyzed, conclusions were made and issued
guidelines for future work.
Results: In the period from 2007 to 2011 the
Department of Ophthalmology, Military Hospital in
Nis treated 498 professional members of the
Serbian Army. The structure of treated members
was: officers and noncommissioned officers were
34%, professional soldiers were 19% and 47% of
soldiers on regular military service. The total
number of operated patients was 17%. The most
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
commonly causes of operations were tumefacts on
the eyelid and conjunctive (chalasion and atheroma
12%). Only 4 cataract operations were done in
treated group. The largest number of soldiers on
regular military service were treated because of
inflammatory diseases on the eyelids and
conjunctiva (21%), surgical managements on the
eyelids and surface injuries (10%), refractive
disorders (6%). Officers and noncommissioned
officers were tested in terms of glaucoma (17%).
Conclusion: The soldiers on regular millitary
service were about the half of the stationary treated
patients. The most commonly reason for
hospitalization were inflammatory diseases on the
eyelid and conjunctiva. Serious injuries of eyes
were not noticed.
PPO17
OUR EXPERIENCE IN THE TREATMENT
OF THE SY LYELL
Authors:
Maj Sasa Milicevic Msc M.D., Ltc Assis. Prof.
Boban Djordjevic, Col. Prof. Jevta Kozarski, Brig.
Gen. Prof. Marijan Novakovic, Ltc Milomir
Gacevic Msc M.D.
Institutions:
The MMA’s Clinic for Plastic Surgery and Burns,
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
Clinically,
Lyell's
syndrome
and
the
StevensJohnson syndrome or toxic epidermal
necrolysis are a severe form of exfoliative dennatitis accompanied by systemic changes that share
certain clinical and anatomo-pathological aspects
with the disorders caused by intermediate seconddegree burns. Its pathophysiology is not yet well
determined, although the presence of an
immunological basis is almost consensual. In its
severest forms, the cutaneous affection covers
100% of the body surface. Characteristically the
palms and soles are affected. The oral, ophthalmic,
urogenital and rectal mucosae are typically
affected. Perioral crusting may impair oral
nutritional support. Oropharyngeal involvement
causes a troublesome cough. Haernaternesis and
melaeria are occasionally seen secondary to intraoral, oesophageal, gastric or intestinal mucosal
haemorrhages. The gastrointestinal tract mucosa
may be affected at any level, with manifestations
such as rectal bleeding and proctalgia occasionally
being present. Urogenital mucosa involvement
causes dysuria and itching. Ophthalmic mucosa
involvement
may
produce
photophobia,
178
conjunctivitis and synechia, which compromise the
integrity of visual function. The syndrome is
characteristically accompanied by fever and severe
pain. Six cases of severe toxic epidermal necrolysis
or Lyell's syndrome are described that have been
managed in the Department of Burns in the Clinic
for Plastic Surgery and Burns in the last five years.
The main treatment is the immediate suspension of
the inducing drug and early admission of the patient
to a hospital facility which is capable of providing
intensive support care and minimizing the risk of
infection and which also offers conditions for the
performance of surgical traetment of the affected
areas, i.e. a burns unit. Treatment of the condition
has three primary goals: haemodynarnic stability,
pain management and infection control policy.
Several therapeutic measures designed to lower the
morbidity and mortality of this syndrome are in the
course of study, including the use of
plasmapheresis, the administration of high doses of
corticosteroids,
immunosuppression,
and
hyperbaric oxygen. It usually appears as a response
to the taking of a drug and, in spite of being selflimited in the absence of complications, it is
associated if not well managed, with high morbidity
and high mortality due in most cases to the
development of sepsis.
PPO18
TREATMENT OF
TERTIARY LEVEL
POLYTRAUMA
AT
Authors:
Popadić Ana, Veljović Milić, Rondović Goran
Institutions:
Department of Anesthesiology and Intensive Care,
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
Polytrauma is a violation of at least two organ
systems with at least one life - threatening injury. It
usually occurs as a result of traffic accidents and is
one of three leading causes of death. Treatment of
polytraumatized patients is expensive and very
complex task. It requires timely and adequate
response, complex diagnostic procedures, along
with highly specialized treatment procedures.
Tertiary institutions with their facilities provide
reevaluation of injuries and possible complications,
treatment in specialized intensive care units, team
work of different specialists and definitive surgical
treatment of such patients. These institutions
provide treatment from the moment of injury until
full rehabilitation. The course of treatment of
polytraumatized patients is often complicated by
infection, sepsis, acute respiratory distress
179
syndrome (ARDS), myoglobinuria, acute renal
insufficiency and other severe clinical conditions.
This paper will demonstrate successful treatment of
polytraumatized patient which was complicated by
ARDS,
myoglobinuria
and
acute
renal
insufficiency.
PPO19
INNOMINATE ARTERY WAR INJURY
Authors:
Col. Dr. Ilić R., Col Lt Dr. Trifunović Z., Dr.
Marković Z., Dr. Tišma S., Dr Mandarić V.
Institutions:
Clinic for Cardiac surgery, The Medical Faculty of
the University of Defence, Belgrade, SERBIA
Aim: A case is reported of successfully surgically
treated explosive war injury to the innominate
artery.
Case report: A 26-year-old soldier was injured in
combat by a fragment of mortar shell. In the field
hospital, the wound gauze packing was applied,
followed by orotracheal intubation and thoracic
drainage. The soldier was admitted to MMA six
hours later. Physical examination, on admission,
revealed huge swelling of the neck, the absence of
pulse in the right arm and the right common carotid
artery. Chest x-ray revealed hemopneumothorax of
the right side and the foreign metal body in the
projection of the right sternoclavicular joint. Due to
the suspicion of large vessel injury, a median
sternotomy was immediately performed. Surgery
revealed disrupted bifurcation of the right
innominate artery, so the ligation was performed.
Aortography was performed postoperatively,
followed by the reconstruction of innominate
bifurcation with synthetic grafts. Control
aortography showed good graft patency, and the
patient was discharged from the hospital in good
general condition with palpable pulses and mild
anisocoria as a sole neurological sequela.
Conclusion: A rare and life-threatening injury was
successfully managed, mainly due to the rational
treatment carried out in the field hospital that
helped the injured to survive and arrive to the
institution capable of performing the most
sophisticated diagnostic and therapeutic procedures.
PPO20
EFFECT OF OPHTHALMIC MORBIDITY IN
ADOLESCENTS CAREERS
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Authors:
LJ. Radosavljevic, T. Mladenovic, M. Mladenovic,
N. Paunovic
Institutions:
Department of Ophthalmology, Military Hospital
Nis, SERBIA
Aim of study: Adolescence is a period when we
make a decision on the future vocation. The
military profession is in the sphere of interest in this
age group. Changes in normal vision form have
influence on the professional orientation.
Materials and Methods: A retrospective study of
ophthalmologic treated youths processed in the
systematic treatment for the Secondary Military
School. All the youths were subjected to basic
ophthalmologic examination (adapted to the
darkness, color recognition, determination of the
mobility of the eyeball and visual acuity,
ophthalmoscopy examination). After that, the
indications were carried out additional surveys
(measuring the angle of strabismus, fusion,
stereoscopic vision, the determination of refraction,
IOP measurement, the measurement of wide field
of view, the quantitative determination of
disturbances in color vision, gonioscopy).
Assessment of state of the eye was based on an
objective review considering to the Regulations for
the assessment of suitability of candidates for
education.
Results: Between 2007 and of 2011 in the
Department of Ophthalmology, Military Hospital
Nis ophthalmology treated 1272 candidates for the
Military high school (boys 15 years old). 17% of
them were found some disoredsrs on the eye. The
majority (9%) were refractive disorders, 6% were
disturbances in color vision, 1.5% was walleye and
low vision, there were other changes that were
present in small percentages ( ptosis, pseudophakia,
macular hole).
Conclusion: Refractive disorders and disturbances
in color vision have the greatest impact on the
careers of adolescents. Representation of hyperopic
and myopic refractive disorders is practically equal,
while in color vision the number of deuteranomaly
is significantly higher percentage.
PPO21
RECONSTRUCTIVE METHODS IN THE
TREATMENT OF THE LOWER LEG TISSUE
DEFECTS
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Authors:
Col Prof. Jefta Kozarski, Ltc. Assis. Prof. Boban
Djordjevic, Maj. Nikola Ostojic M.D., Ltc Goran
Stankovic M.D.
Institutions:
The MMA’s Clinic for Plastic Surgery and Burns,
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
The specificity of the lower leg is in sparse
collateral blood flow of the skin cover in the middle
and distal part, reduced subcutaneous tissue and
prominence of the front side of tibia immediately
under skin. These characteristics of the lower leg
make the application of standard plastic
reconstructive principles to a certain degree
impossible. The progress in anatomical knowledge
of vascularization of the tissue territories,
application of surgical microscope, new suture
materials provides reconstructive surgeon modern
methods of reconstruction – micro vascular
transplantation
of
tissue
and
reverse
fasciocutaneous flaps. The aim of this study is to
show available methods in the treatment of lower
leg injuries. On the basis of our experiences in the
management of the war wounds we would like to
point on the existence of the clear indications for
the applications of certain reconstructive methods
depending on size, localization and tissue defect
structure, as well as the advantages and
disadvantages of the available reconstructive
procedures.
PPO22
VASCULARISATION FIELD
ASCENDENS
ARTERIAE
PERFORANS
OF RAMUS
PERONEAE
Authors:
Ltc Milomir Gačević Msc M.D., Brig. Gen. Prof.
Marijan Novaković, Prof. Danilo Vojvodić, Ltc
Asst. Prof. Boban Đorđević, Žarko Borović M.D,
Maj. Nikola Ostojić M.D., Maj. Saša Milićević Msc
M.D.
180
of the distal flap on the antero-lateral aspect of the
distal third of the lower leg.
Methods: Direct genciana-violet injection of the
interosseal perforator of ten fresh cadaveric lower
legs with subsequent corrosive acrylic preparation
was performed to reveal vascularization filed of
ascending branch of ramus perforans. The height,
length, diameter and communication of perforating
branch and its subsequent smaller ascending and
descending branches were determined. The
CAMIA image analyzer software was used. All
results were statistically analyzed and presented in
figures and tables.
Results: Our results show that ramus perforans of
peroneal artery is always present. The origin of
ramus perforans from peroneal artery is at the
medial height of 66mm when measured from the
inferior border of the lateral malleolus. Medium
length of ramus perforans is 51.7mm. After
transition through the inter-osseal membrane,
ramus perforans divides into ascending and
descending branches. The diameter proximal to the
level of bifurcation is 1.37mm (variation 1.01.8mm), and the diameter of the ascending branch
distal to the level of bifurcation is 1mm. Using
CAMIA image analyzer software, the medium
length of the vascularization filed labeled with the
genciana violet was calculated to be 164mm
(variation 125-210mm), medium width was 66mm
(57-77 mm) and medium area was 10305mm (6385
mm2-14341 mm2).
Conclusion: Our results support the use of
fasciocutaneous distal flap, vascularized by
ascending branch of ramus perforans of peroneal
artery for reconstruction of soft tissue defects in the
distal third of the lower limb, malleolar regions and
dorsum of the foot.
PPO23
DR. MIHAILO PETROVIC - GENERAL,
SURGEON, PROFESSOR AND FOUNDER OF
SURGERY IN SERBIA
Institutions:
The Medical Faculty of the University of Defence,
Belgrade, SERBIA
Authors:
Colonel Asst. Prof. Nebojša Đenić, Major Saša
Dragović M.D.
Introduction/ Aim: Soft tissue defects in the distal
third of the lower leg are persistent and constitute a
big problem in the reconstructive surgery. This
study presents an analysis of the anatomical
vascularization filed of ascending branch of the
perforating artery. The goal was to assess reliability
Institution:
The Military Hospital in Nish, SERBIA
Aim: The Balkan nations were often in conflict
with each other throughout their history, but
military surgeons – no matter which side they are
on in war – always have the same humane duty.
181
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
This paper introduces one of the most distinguished
military surgeons in the Balkans, the greatest talent
that the Serbian wartime surgery ever had. At the
start of the Balkan War, he stuck by the rule: “Do
not touch the wound” in relation to all small calibre
wounds. However, as the artillery wounds
multipled, Dr. Petrovic was no longer content with
the conservative approach in surgery, so he
changed to a more radical approach to wounds,
applying debridement.
Conclusion: In Dr. Petrovich two different streams
of military surgery are reflected and mixed: the
conservative-aseptic approach and the radical
surgical approach. He is the last representative of
the former and the first representative of the latter
approach in war surgery.
PPO24
THE
INCREASING
TENDENCY
PILONIDAL SINUS IN ADOLESCENTS
OF
Authors:
LCDR CALISKAN Bahadir, MD; MAJ ATABEK
Cuneyt, MD; LTJG ALTAN Bilal, MD; LTC
GUVEN Ahmet, MD; COL DEMIRBAG Suzi,
MD; COL SURER İlhami, MD
Institution:
Gulhane Askeri Tip Akademisi, Ankara, TURKEY
Aim: Pilonidal sinus disease (PSD) is a painful
condition that mostly occurs in the intergluteal
region and is commoly seen in young adults. PSD
in pediatric patients is not a rare occurrence. It is
predicted that, asymptomatic pilonidal disease
remains undiagnosed in children and they are never
infected. Many operative and conservative
treatments have been described for the management
of PSD.
Material and Method: Between 2010 January and
2012 January, 9 adolescents with pilonidal sinus
were treated in our pediatric surgery department; 6
girls and 3 boys with a mean age of 14 (10-17)
years. 4 of them was infected and presented with
painful swelling in the gluteal region. Abscesses
were incised and drained then treated with oral
antibiotics. Body mass index (BMI) was measured
for all patients. General anesthesia was used in all
surgeries. The operative position used was prone.
Palpation and methylene blue injection are always
used to estimate the borders of diseased tissue. We
performed total excision of the sinus and primary
midline closure in all patients.
Results: Among the 6 female patients, 1 was obese
(BMI > 30 kg/m2), 3 were overweight (BMI > 25
but < 30 kg/m2) and 2 had a healthy weight (BMI <
25 kg/m2). Among the 3 male patients, 1 were
obese (BMI > 30 kg/m2), 2 were overweight (BMI
> 25 but < 30 kg/m2). All patients were given
intravenous antibiotics and stayed in bed for 3 days
after operation. The sutures were removed on day
14. Shaving the natal cleft and area twice monthly
after surgery for 1 year was strongly recommended.
4 patients recovered uneventfully but 2 girls had
abscess and swelling in the operation region and
treated daily with local antibiotics for 2 weeks.
Conclusion: Obesity, sitting for a long time and
tight wearing especially in girls are risk factors for
PSD. The borders of the surgical wound would
depend on the size of the pilonidal sinus cavity and
associated sinus tract and should not be extended
beyond methylene blue stained tissue.
Correspondence:
Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi
AD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 5487
Fax: + 90 312 304 5900
GSM: + 90 505 806 4996
e-mail: mbcaliskan@gata.edu.tr
PPO25
THE CLINICAL OUTCOME OF STAPLED
HEMORRHOIDOPEXY
Authors:
MAJ DUMAN Kazım MD1, CPT OZDEMIR
Yavuz MD2, LTC YUCEL Ergun MD2, COL
YIGITLER Cengizhan MD2, BG AKIN Mehmet
Levhi MD2
Institutions:
1. Gumussuyu Military Hospital, Dept. of General
Surgery, Istanbul, TURKEY
2. Gulhane Military Medical Academy, Department
of General Surgery, Haydarpasa Teaching Hospital,
Istanbul, TURKEY
Introduction: This study was carried out to present
our experiences with the patients undergoing
stapled hemorrhoidopexy, their postoperative
morbidity, the rate of recurrence, analgesic
requirements and in-patient hospital stay.
Materials
and
methods:
Patients
with
symptomatic third and fourth degree hemorrhoids
and having received stapled hemorrhoidopexy were
retrospectively analyzed. Fourth and seventh
postoperative days, first, third, sixth and twelfth
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
postoperative months, follow-up examinations were
performed. The demographic data of patients, the
postoperative analgesic requirements, the date of
the operation, the duration of hospital stay, the data
of complications, frequency of recurrence and type
of anesthesia were investigated.
Results: This study included totally 56 patients; of
these patients, there were 6 women and 50 men.
The average age was 31. The average operating
time was 38 minutes. Besides, the average length of
hospital stay was recorded as 1.8 day. Of the
patients who were followed up for one year, four of
them were observed to have urinary retention. Also,
a mucosal prolapsed was seen in two patients, a
thrombus was observed in two patients, anal
bleeding was again seen in two patients and one
patient had a recurrence.
Conclusion: Compared with the conventional
techniques, stapled hemorrhoidopexy is a good
alternative method in treatment of hemorrhoids.
This method has the advantages of a minimal
analgesic use, shorter hospital stay, a speedier
return to normal activities; on the other hand, to be
able to determine the disadvantages of stapled
hemorrhoidopexy, there is a need of more
experience and a longer follow up.
Correspondence:
Gumussuyu Military Hospital, Dept. of General
Surgery, Istanbul, TURKEY Tel: +90 212 251 8500
Fax: +90 212 251 9597 GSM: +90 538 385 9511 EMail: drkduman@gmail.com
PPO26
THE
CLINICAL
OUTCOME
OF
TRADITIONAL
LAPAROSCOPIC
CHOLECYSTECTO MY
Authors:
MAJ DUMAN Kazım MD1, CPT SEZER Koray
Halil MD2, COL YILMAZ Fahri MD3, BG AKIN
Mehmet Levhi MD4
Institutions:
1. Gumussuyu Military Hospital, Dept. of General
Surgery, Istanbul, TURKEY
2. Balıkesir Military Hospital, Dept. of General
Surgery, Balıkesir, TURKEY
3. Gölcük Military Hospital, Dept. of General
Surgery, Kocaeli, TURKEY
4. Gulhane Military Medical Academy, Department
of General Surgery, Haydarpasa Teaching Hospital,
Istanbul, TURKEY
182
Intraduction: Laparoscopic cholecystectomy is a
safe, efficient, established method for the treatment
of symptomatic gallstone disease. Complication
rate and morbidity rate are decreased compare to
the open cholecystectomy.We aim to share
traditional laparoscopic cholesistectomy experience
and complications that treated with experienced
surgeons in low-volume hospitals.
Material and method: This study performed
during the period of 2009- 20011 in three hospitals.
We analyzed retrospectively 260 patients, who
operated elective by three surgeons whose
experiences were close. We compared demographic
data, patients age, gender, number of ports,
operation time, lenght of hospital stay, whether or
not previous abdominal surgery, whether or not
systemic disease, whether or not has been
performed ERCP, reason of converted from
laparoscopic to open cholecystectomy and
complications.
Results: 266 [165 (72.6%) female and 101 (27.4%)
male] patients eveluated retrospectively. The
avaerage age was 42.6 (range 27-42). Of all patients
46 (17.3%) had hypertension, 38 (14.3%) had
diabetes mellitus, 13 (4%) had hiperkollesterolemi,
5 (1.8%) had heart failure, 4(1.5%) had COPD. The
average duration of operation was 45 minutes
(range 35-72). The operation was performed by
using four ports in 195 (73.3%) patients and by
using three ports in 71 (26.7%) patients. 25 (9.4%)
patients had intra-abdominal drainage. ERCP was
performed preoperatively in 5 (9.4%) patients, and
6 (2.3%) patients had the upper abdomen surgery,
31 (11.7%) patients had a lower abdominal
surgery.We convert open cholecystectomy in6
(2.3%) patients, due to bleeding, in 4 patients
(1.5%) due to anatomical mismatch, 3 patients
(1.1%) due to adhesions and difficult technical
conditions
Conclusion: Laparoscopic cholecystectomy can be
performed seamlessly with appropriate patient
selection in low-volume hospitals. We believe that
multidisciplinary approach was a priority in case
with complications, it will be useful in terms of
patient morbidity and mortality.
Correspondence:
Gumussuyu Military Hospital, Department of
General Surgery, Istanbul, TURKEY
Tel: +90 212 251 8500
Fax: +90 212 251 9597
GSM: +90 538 385 9511
E-Mail: drkduman@gmail.com
183
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
PPO27
TREATMENT
OF
SEVERE
HAND
CONTRACTURES WITH COMBINED USE
OF MULTIPLE LOCAL HAND FLAPS
Authors:
MAJ EREN Fikret, MD1, CPT OKSUZ Sinan,
MD1, 1LT AYSAL Bilge Kagan, MD1, COL
ULKUR Ersin, MD1, 2LT MELIKOGLU Cenk,
MD2
Correspondence:
Gulhane Askeri Tip Akademsi Haydarpasa Egitim
Hastanesi, Plastik ve Rekonstruktif Cerrahi Servisi,
Selimiye Mah. Tibbiye Cad. Uskudar 34668,
Istanbul TURKEY
Tel: + 90 216 542 20 20 – 4173
Fax: + 90 216 348 78 80
GSM: + 90 533 322 90 12
E-mail: sinanoksuz@gmail.com
Institutions:
1. Gulhane Military Medical Academy Haydarpasa
Training Hospital, Dept. of Plastic Reconstructive
and Aesthetic Surgery and Burn Unit, Istanbul,
TURKEY
2. Etimesgut Asker Hastanesi, Dept. of Plastic and
Reconstructive Surgery, Ankara, TURKEY
PPO28
ANESTHESIA
MANAGEMENT
OF
A
PARTURIENT
WITH
PULMONARY
HYPERTENSION – A CASE REPORT
Objective: Burn and crush injuries usually results
in severe hand contractures. Due to the professional
risk factors military staff can always be subjected to
such kind of injuries. The function of the hand is
affected by the contractures. The aim of treatment
is releasing the contracture and covering the
exposed deep structures such as tendons, joints and
neurovascular structures with the flaps. The flap
choices are versatile. Side finger, cross finger,
heterodigital and rhomboid flaps can be used to
repair the contracture for the cases in which local
hand flaps are sufficient to cover the defects.
Combined use of local hand flaps enables the repair
of larger defects at different regions of the hand.
Material and method: 24 patients with palmar
contractures were treated with combined use of at
least two of the local hand flaps. The contractures
were developed either due to the burn injury or
crush injuries.
Results: The repair of contracture deformities with
combined use of local hand flaps including side
finger flap, heterodigital flap, cross finger flap and
rhomboid flaps were successful. All of the
contractures were released and treated uneventfully.
Hand functions were well established.
Conclusion: Tissue defects caused by the release of
palmar contractures such as finger contracture, web
contracture and various combinations of these
contractures can be covered with combined use of
local hand flaps. Combined application of the
multiple local hand flaps for the repair of the
contracture usually enables adequate restoration of
the hand functions with minimal donor site
morbidity.
Authors:
LT ESKİN Burak MD, MAJ PURTULOGLU Tarik
MD, LTJG INCE M. Emin MD, COL YILDIRIM
Vedat MD
Institutions:
Gülhane Military Medical Academy, Dept. of
Anesthesiology
and
Reanimation,
Ankara,
TURKEY
Objective: Pulmonary hypertension (PH) is a rare,
progressive, and fatal illness defined as pulmonary
artery pressure (PAP) greater than 25 mmHg while
pulmonary capillary pressure is below 12 mmHg at
rest. Cardiovascular and pulmonary physiologic
changes during pregnancy adversely affect
pulmonary hypertension and right ventricular
dysfunction.
Case Report: Cardio-version under sedation with
propofol and midazolam was performed to a 31
years old pregnant with 31 weeks gestation who
had heart failure, atrial fibrillation and PH (PAP: 80
mmHg). After ensuring sinus rhythm, beta-blocker
and diuretics were initiated. At 36 weeks of
gestation, general anesthesia was planned. ECG,
SpO2, heart rate, invasive arterial and pulmonary
artery monitoring was provided. PAP was 35
mmHg, ejection fraction 40% and biochemical
parameters were normal. Nitroglycerin infusion
(0.2mg/kg/dk), ketamine (0.75mg/kg), etomidate
(0.5mg/kg), and succinylcholine (1mg/kg) IV were
administered during induction of anesthesia. Three
minutes after intubation, the child was delivered
healthy and umbilical cord was clamped. Then,
alfentanyl 0.05 mg and vecuronium bromide 0.1
mg/kg, furosemide 20 mg was administered IV.
PAP was 34 mmHg. Low molecular weight
heparine was injected subcutaneously. PAP
measurements were identified respectively 50, 30,
21 mmHg in the postoperative three hours. The
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
184
patient was discharged on the third postoperative
day without any complications.
and the drop foot gait was totally improved at the
postoperative third month.
Discussion: Mortality in pregnant patients with
severe PH is 36%. Medical therapy should be
started as soon as possible for parturient with
idiopathic PH. Preanesthetic assessment should be
started in early period. Mode of delivery and
anesthetic management of patients should be
determined with a multidisciplinary approach.
Conclusion: Primary purpose of the treatment for a
Gustillo type IIIB tibial open fracture should be
devoted to immediate stabilization and repair of the
bone and soft tissue. The definitive treatment of a
functional deficit such as a drop foot deformity can
be ameliorated just after complete infectious free
bone repair. Although the tensor fasciae latae free
flap was used at a secondary reconstruction stage in
this case it can also be used during the primary
repair of the acute composite tissue defect for the
tibia fracture by including a greater portion of the
muscle.
Correspondence:
Gulhane Askeri Tip Akademisi, Anesteziyoloji ve
Rean. AD., Etlik 06018, Ankara, TURKEY
Tel: +90 312 3045907
Fax: +90 312 3045900
GSM: +905436305711
E-mail: burakeskin@hotmail.com
PPO29
THE DEFINITIVE SECONDARY REPAIR OF
A GUNSHOT INJURY RELATED DROP
FOOT DEFORMITY WITH A TENSOR
FASCIAE LATAE FREE FLAP
Authors:
MAJ KARAGOZ Huseyin, MD1, COL ULKUR
Ersin, MD1, CPT OKSUZ Sinan, MD1, CPT
SAHIN Cihan, MD2, MAJ SEVER Celalettin1, MD,
LTC KULAHCI Yalcin, MD1
Institutions:
1. Gulhane Military Medical Academy, Haydarpasa
Training Hospital, Dept. of Plastic and
Reconstructive Surgery, Istanbul, TURKEY
2. Kasimpasa Military Hospital, Dept. of Plastic
and Reconstructive Surgery, Istanbul, TURKEY
Objective: In this case report immediate
reconstruction of an open tibia fracture due to a
high velocity gunshot injury and the final delayed
total repair of the lower extremity is presented.
Case report: A patient sustained a close-range high
velocity gunshot injury to his left leg, which
resulted in extensive soft tissue damage with
Gustillo type IIIB segmental fracture of the tibia. A
composite soft tissue defect including anterior tibial
tendon and extansor hallucis longus tendon was
determined. The soft tissue defect was
reconstructed with a reverse flow sural flap in first
operation and the open fracture and soft tissue
defect healed uneventfully. A second operation to
repair the tendon defects was planned. Tensor
fasciae latae free flap was tailored to repair the
defect of the anterior tibial tendon and extensor
hallucis longus tendon. The repair was successful
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim
Hastanesi, Plastik Cerrahi Servisi, Uskudar 34668,
Istanbul, TURKEY
Tel: +90 216 5422020 (4204)
Fax: +90 216
GSM: +90 532 5169957
E-mail: hkaragozmd@hotmail.com
PPO30
CAN SONOGRAPHIC CHARACTERISTICS
OF LYMPH NODES IN BREAST CANCER
PATIENTS HELP IN DETERMINING THE
AXILLARY STATUS?
Authors:
MAJ KILBAS Zafer, MD1, MAJ ILICA Turan,
MD2, LTC YILDIZ Ramazan, MD1, COL
OZTURK Erkan, MD1, LTC MENTES Oner, MD1,
COL GORGULU Semih, MD1, BG PEKER Yusuf,
MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
General Surgery, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Radiology, Ankara, TURKEY
Objectives: Preoperative knowledge of axillary
lymph node (ALN) status is important in the initial
staging of breast cancer because it affects the
selection of the type of treatment and surgery. In
this prospective study, the role of ultrasonography
on the preoperative axillary staging of clinically
node negative patients with breast cancer was
investigated.
Material and methods: In the present study,
clinical node negative 63 patients with the
185
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
diagnosis of breast cancer were included. All
patients
were re-evaluated
with detailed
preoperative
axillary
ultrasonography.
The
following criteria were used to identify positive
lymph nodes: asymmetric cortical thickening, focal
cortical mass and/or thickening, and effacement or
replacement of the fatty hilum and increased
peripheral blood flow. The results of the
ultrasonography were compared with the
histopathologic examinations of the lymph nodes.
Results: Among these 63 patients, 29 (47 %) had
axillary lymph node metastasis proved by final
histopathologic
examination.
Axillary
ultrasonography could detect 24 of 29 patients in
the preoperative period. In terms of detecting
metastatic lymh nodes, the sensitivity, specificity,
positive predictive value and negative predictive
value of axillary ultrasonography were 86%, 79%,
82% and 83% respectively.
Conclusion: In conclusion, nodal sonographic
characteristics of patients at high risk for metastases
are useful predictors of tumour burden in the axilla.
When a patient is identified as having a high
probability of ALN metastatic disease, the surgeon
can eliminate the sentinel node biopsy procedure
and advance directly to ALN dissection.
Correspondence:
Gulhane Askeri Tip Akademisi, Genel Cerrahi AD,
Etlik 06018, Ankara, TURKEY
Tel : +90 312 3045112
Fax : +90 312 3045002
GSM : +90 505 4754095
E-mail : zkilbas@yahoo.com
PPO31
LATE PRESENTATION
PERFORATION
DUE
ABDOMINAL TRAUMA
CASE REPORT
OF JEJUNAL
TO
BLUNT
(COW BUMP):
Authors:
MAJ KILBAS Zafer, MD, COL DEMIRBAS
Sezai, MD, MAJ COSKUN Kagan, MD, COL
KOZAK Orhan, MD, RDML TUFAN Turgut, MD.
Institution:
Gulhane Military Medical Academy, Dept. of
General Surgery, Ankara, TURKEY
Objective: Isolated jejunal perforation after blunt
abdominal trauma is an uncommon entity and
delayed diagnosis can cause increased morbidity
and mortality. We aimed to highlight this rare but
lifethreatening condition by presenting a case.
Material and method: We describe an intestinal
perforation in an old man who had been hit by
acow in the abdomen.
Case: A 77-year-old man was admitted to the
emergency department with the complaint of
abdominal pain and nausea. At admission, his
general condition was down and he was in septic
shock. On physical examination, musculary rigidity
and rebound tenderness was detected in the whole
abdomen. Computed tomography revealed the
diagnosis of intestinal perforation by showing free
air and free fluid. At exploration, 2-cm perforation
zone in the antimesenteric side of jejunum, 110 cm
distal to the treitz ligament, was seen and the small
bowel were ischemic and eudomateus. The patient
underwent two-staged surgery; in the first step, the
abdomen was irrigated, aspirated and jejunostomy
was performed. In the second step, 72 hours later,
to avoid the complications of proximal
jejunostomy, stoma closure was performed. His
postoperative course was uneventful and he was
discharged at postoperative seventh day.
Conclusion: Perforation of the small bowel,
following blunt abdominal trauma, is relatively
rare. Computed tomography is the most commonly
utilized diagnostic test in the evaluation of the
stable blunt abdominal trauma patient. Repeated
abdominal examinations and dynamic follow-up are
essential enteric perforation.
Correspondence:
Gulhane Askeri Tip Akademisi, Genel Cerrahi AD,
Etlik 06018, Ankara, TURKEY
Tel : +90 312 3045112
Fax : +90 312 3045002
GSM : +90 505 4754095
E-mail : zkilbas@yahoo.com
PPO32
WHICH OF THE BREAST CANCER
PATIENTS SHOULD BE SCANNED FOR
DISTANT METASTASIS?
Authors:
MAJ KILBAS Zafer MD, LTC YILDIZ Ramazan
MD, COL OZTURK Erkan MD, LTC MENTES
Oner MD, COL GORGULU Semih MD, BALKAN
Mujdat MD, BG PEKER Yusuf MD.
Institution:
Gulhane Military Medical Academy, Dept. of
General Surgery, Ankara, TURKEY
Objective: Accurate staging of patients diagnosed
with breast cancer is essential for effective
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
treatment planning. The aim of the present study is
to investigate theeffect of staging tests (bone
scintigraphy and liver ultrasonography)on the
management of patients with breast cancer and to
determine the patient population having increased
risk for distant metastasis.
Material and method: Data of 304 patients, who
were operated for breast cancer between 2002 and
2010 were retrospectively collected. As staging
procedures, liver ultrasonography and scintigraphy
were assessed. Patients were staged according to
the histopathologic results (TNM) and the results of
the staging procedures were interpreted stage by
stage and in terms of primary tumor size, lymph
node status and histopathologic grade.
Results: Of these 304 patients, 234 patients were
planned for scintigraphy. Bone metastasis were
detected in 4% (10) of the 234 patients. 29 patients
(9.5%) revealed questionable findings for distant
metastasis and had to be examined with further
investigations to ascertain. Additional bone
metastasis were detected in 8 of these 29 patients.
Although bone metastasis was not found in patients
with stage I breast cancer, the metastasis rate were
3, 10 percent for stage II, III patients, respectively.
Conclusion: As a conclusion, preoperative staging
procedures such as scintigraphy, ultrasonography
are not routinely recommended for early stage
breast cancer but they may alter the management of
patients with local-advanced disease who are at
increased risk for distant metastasis.
Correspondence:
Gulhane Askeri Tip Akademisi, Genel Cerrahi AD,
Etlik 06018, Ankara, TURKEY
Tel : +90 312 3045112
Fax : +90 312 3045002
GSM : +90 505 4754095
E-mail : zkilbas@yahoo.com
PPO33
OPHTHALMOLOGICAL ASSESSMENT IN
CIVIL AVIATION
Authors:
CPT METIN Suleyman, MD1, CPT GOKCE
Gokcen, MD2, MAJ CAKMAK Tolga, MD1, LTC
DULKADIR Zeki, MD1, COL AKIN Ahmet, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
2. Sarikamis Military Hospital, Dept. of
Ophthalmology, Kars, TURKEY
186
Objective: The aim of this epidemiological study
was to present the results of ophthalmological
assessment performed during periodic aeromedical
examinations.
Material and method: We conducted a
retrospective chart review according to ICAO
(International Civil Aviation Organization) Annex
1 - JAR-FCL 3 (Joint Aviation Requirements-Flight
Crew Licensing 3) Ophthalmology Examination
Report Form of 73 Turkish civilian pilots (age
37.62±9.53 and 68 male; 5 female) admitted to our
center from January 2011 through September 2011.
Results: All pilots except one had 20/20 best
corrected visual acuity (VA) in both eyes according
to Snellen VA chart. No color deficiency was
observed by performing Ishiara isochromatic plates.
Cover testing showed orthophoria with no tropia
and Hirschberg's test showed orthophoria equally in
each eye. Mean near point of accommodation was
2.48±1.37
centimeters
and
the
mean
accommodation amplitude was 1.82±0.94 diopters
(Dpt). Nine pilots were myopic, while two were
hypermetropic. Ten pilots were presbyopic. The
average spherical refractive error was -0.15±0.50
Dpt. for the right eye and -0.15±0.46 Dpt. for the
left one. The average cylinder power was -0.7±0.38
Dpt. for the right eye and -0.7±0.29 Dpt. for the left
one. Intraocular pressure (IOP) ranged between 13
and 20 mm Hg with a mean of 17.63±1.94 mmHg
in the right eye; 13 and 22 mmHg with a mean of
18.16±2.14 mmHg in the left. Biomicroscopic and
fundoscopic examinations revealed no abnormality
in all subjects.
Conclusion: Ophthalmological disorders in civilian
pilots seem to be happened secondary to senile and
structural factors rather than flight environment.
Correspondence:
Hv.Tbp.Yzb. Suleyman METIN
Gulhane Askeri Tip Akademisi, Hava-Uzay
Hekimligi AD, 26020, Eskisehir, TURKEY
Tel: + 90 222 230 0191
Fax: + 90 222 230 34 33
GSM: + 90 506 589 74 95
E-mail: drsmetin@gmail.com
PPO34
COMBINED USE OF THORACODORSAL
ARTERY
PERFORATOR
FLAP
AND
STAGED SKIN GRAFTING AFTER EXCISIN
OF AN UPPER EXTREMITY GIANT HAIRY
NEVUS
187
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Authors:
CPT OKSUZ Sinan, MD, COL ULKUR Ersin,
MD, MAJ SEVER Celalettin, MD, MAJ
KARAGOZ Huseyin, MD, 2LT TUNCER Serhan,
MD
PPO35
LINEAR ACCELERATOR-BASED STEREO
TACTIC RADIOSURGERY IN RECURRENT
GLIOBLASTOMA: A SINGLE CENTER
EXPERIENCE
Institution:
Gulhane Military Medical Academy Haydarpasa
Training Hospital, Dept. of Plastic, Reconstructive
and Aesthetic Surgery and Burn Unit, Istanbul,
TURKEY
Authors:
COL OYSUL Kaan, MD1, CPT DINCOGLAN
Ferrat, MD1, CPT SAGER Omer, MD1, COL
SIRIN Sait, MD2, DIRICAN Bahar, PhD1, COL
BEYZADEOGLU Murat, MD1, COL SURENKOK
Serdar, MD1
Introdution: The standard treatment for giant hairy
nevi is complete resection of the lesion. The elbow
is a weight bearing area of the body. Elbow defects
require durable soft tissue coverage and the tissue
cover must possess excellent elastic properties to
re-establish elbow mobility. In this case, treatment
of a giant hairy nevus on the upper extremity with
serial excision and reconstruction using split
thickness skin graft combined with pedicled
thoracodorsal artery perforator (TDAP) flap
coverage of the elbow is presented.
Material and method: A 21-year-old man
presented with a congenital giant hairy nevus on the
left upper extremity. The nevus was excised in two
stages and resulting raw surface after the excision
was covered with a split-thickness skin graft except
for the elbow region. The elbow was covered with
ipsilateral 24 cm long pedicled thoracodorsal artery
perforatory flap.
Results: The follow-up examination 6 months after
total reconstruction, demonstrated durable elbow
support provided by the TDAP flap. The patient
revealed no complaint considering pain or
sensitivity particularly when exposed to mechanical
stress.
Conclusion: Skin grafting can cause unstable scar
and recurrent ulcers on the elbow. Pedicled
thoracodorsal artery perforator flap represents a
safe and reliable treatment option to achieve
adequate, durable closure for elbow defects.
Correspondence:
Gulhane Askeri Tip Akademsi Haydarpasa Egitim
Hastanesi, Plastik ve Rekonstruktif Cerrahi Servisi,
Selimiye Mah. Tibbiye Cad. Uskudar 34668,
Istanbul TURKEY
Tel: + 90 216 542 20 20 – 4173
Fax: + 90 216 348 78 80
GSM: + 90 533 322 90 12
e-mail: sinanoksuz@gmail.com
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Radiation Oncology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Neurosurgery, Ankara, TURKEY
Objective: The management of patients with
recurrent glioblastoma (GB) comprises a
formidable challenge in neurooncology owing to
the aggressive nature of the disease with poor local
control despite combined modality treatment. The
majority of cases recur within the high-dose
radiotherapy field limiting the use of conventional
techniques for re-irradiation due to potential
toxicity. Stereotactic radiosurgery (SRS) offers a
viable non-invasive therapeutic option in palliative
treatment of recurrent GB as a sophisticated
modality with improved set-up accuracy allowing
the
administration of
high-dose,
precise
radiotherapy. The aim of the study is to report our
experience with single-dose linear accelerator
(LINAC) based SRS in the management of patients
with recurrent glioblastoma.
Material and method: Between 1998 and 2010 a
total of 19 patients with recurrent GB were treated
using single-dose LINAC-based SRS at Gulhane
Military Medical Academy Radiation Oncology
Department. The median age was 47 (23-65) years
at primary diagnosis. Karnofsky Performance Score
was > or = 70 for all the patients. The median
planning target volume (PTV) was 13 (7-19) cc.
The median marginal dose was 16 (10-19) Gy
prescribed to the 80%-95% isodose line
encompassing the planning target volume. The
median follow-up time was 13 (2-59) months.
Results: The median survival was 21 months and
9.3 months from the initial GB diagnosis and from
SRS, respectively. The median progression-free
survival from SRS was 5.7 months. All the patients
tolerated radiosurgical treatment well without any
Common Toxicity Criteria (CTC) grade > 2 acute
side effects.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
188
Conclusion: Single-dose LINAC-based SRS is a
safe and well- tolerated palliative therapeutic option
in the management of patients with recurrent GB.
Conclusion: Treatment of pituitary adenomas using
LINAC-based single dose SRS is safe and effective
in improving local tumor and biochemical control.
Correspondence:
Gulhane Askeri Tıp Akademisi, Radyasyon
Onkolojisi AD, Etlik 06018, Ankara, TURKEY
Tel: +90 312 304 4683
Fax: +90 312 304 4680
GSM: +90 532 426 2388
E-mail: kaan@oysul.com
Correspondence:
Gulhane Askeri Tıp Akademisi, Radyasyon
Onkolojisi AD, Etlik 06018, Ankara, TURKEY
Tel: +90 312 304 4683
Fax: +90 312 304 4680
GSM: +90 532 426 2388
E-mail: kaan@oysul.com
PPO36
STEREOTACTIC
RADIOSURGERY
IN
PITUITARY
ADENOMAS:
A
SINGLE
CENTER EXPERIENCE
Authors:
COL OYSUL Kaan, MD1, CPT DINCOGLAN
Ferrat, MD1, CPT SAGER Omer, MD1, CPT
GAMSIZ Hakan, MD1, CPT UYSAL Bora, MD1,
CPT DEMIRAL Selcuk, MD1, COL SIRIN Sait,
MD2, COL SURENKOK Serdar, MD1, COL
BEYZADEOGLU Murat, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Radiation Oncology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Neurosurgery, Ankara, TURKEY
Objective: The aim of this study is to evaluate the
efficiency of stereotactic radiosurgery (SRS) in the
management of pituitary adenomas.
Material and methods: Between June 1998 and
July 2011, 57 patients with pituitary adenomas
were treated using SRS at Gulhane Military
Medical
Academy
Radiation
Oncology
Department. All patients underwent high-precision
single dose SRS using a linear accelerator with 6MV photons.
Results: Median follow-up time was 31.5 (3-92)
months. Median age was 40 years (range;19-57
years). Radiological tumor growth control was
achieved in 48 patients (84.2%) (a decrease in
tumor size in 25 patients and no change in tumor
size in 23 patients). 13 patients with functioning
adenomas had available biochemical follow-up and
biochemical complete response was achieved in 8
(61.5%) of these 13 patients.
PPO37
OSTEOCUTANEOUS FIBULAR FLAP FOR
RECONSTRUCTION
OF
COMPOSITE
METACARPAL
DEFECTS
DUE
TO
GUNSHOT WOUNDS
Authors:
MAJ. SAHIN Ismail MD, COL. NISANCI Mustafa
MD, MAJ. ZOR Fatih MD, COL. OZTURK
Serdar MD, CPT ALHAN Dogan MD, ISIK
Selcuk MD
Institution:
Gulhane Military Medical Academy, Dept. of
Plastic reconstructive Surgery, Ankara, TURKEY
Objective: Gunshot wounds of the hand pose a
challenge to the reconstructive surgeon, since these
injuries include bones, tendons and soft tissue. It is
known that, osteocutaneous fibula flap is an
excellent option for treating the composite defects.
In this study, reconstruction of gunshot injuries of
the metacarpal bones with fibular flap is presented.
Material and method: Six patients with upper
extremity gunshot injuries were treated with free
osteocutabeous fibular flap. All patients had
composite
defects
reconstructed
with
osteocutaneous fibula flap. Because of the size
mismatch between fibula and metacarpal bone,
longitudinally split fibula was used in two patients.
In one patient, the flap was used in a double barrel
fashion to reconstruct two metacarpal bone losses.
Tendon repairs were performed either primarily or
free tendon graft. Hand function was evaluated by
grip and pinch strength tests and Jebsen Hand
Function test.
Result. All flaps survived and no postoperative
explorations were needed. The mean follow-up
period was 16 months. Web releasing and
arthrodesis procedure was performed to one patient
and tenolysis was performed in two. All flaps
adapted well to the recipient area. With respect to
189
routine daily activities, overall hand function was
considered satisfactory in all patients.
Conclusion: As a conclusion, the fibular flap is a
good alternative for reconstruction of the injured
hand with composite defects, includingmetacarpal
bone and soft tissue. It can be used longitudinally
or transversly. Osteotomies can be performed in
order to obtain split fibular flap or double barrel
fibular flap according to the bone defect.
Correspondence:
Gülhane
Askeri
Tıp
Akademisi,
Plastik
Rekonstrüktif Ve Estetik Cerrahi AD, Etlik 06018,
Ankara, TURKEY
Tel : +90 312 304 5409
Fax : +90 312 304 5404
GSM : +90 532 664 9285
E-mail : drismailsahin@yahoo.com
PPO38
AN UNUSUAL THYROID PAPILLARY
CARCINOMA CASE: A CASE REPORT
Authors:
MAJ SALIHOGLU Murat, MD; CPT CESMECİ
Enver, MD; CDR CEKIN I.Engin; MAJ CAKMAK
Adem, MD; CPT ERKUL B.Evren; COL
GUNGOR Atila, MD.
Institution:
Gulhane Military Medical Academy, Haydarpasa
Training Hospital, Department of ENT, Istanbul,
TURKEY
Objective: We want to present a rare welldifferentiatedthyroidcarcinoma case which initial
findings were hemoptysis and tracheal mass in
endoscopic laryngeal examination withoutaneck
mass.
Case
report:
Well-differentiated
thyroid
carcinomas rarely invade upper respiratory tractand
digestive system. If the invasion occurs, laryngeal
nerve, larynx, trachea, pharynx and esophagus are
invaded usually by the way of neighborhood.
Invasion of these structures causes some symptoms
such as hemoptysis, dysphagia, and airway
deficiencies. A 68-year-old female patient was
admitted to our clinic with complaints of
hemoptysis lasting for about 1 month. Head and
neck examination was normal. In endoscopic
laryngeal examination a subglottic mass narrowing
the trachea was seen. Computed tomography (CT)
of the neck and ultrasonography guided fine needle
aspiration biopsy (FNAB) were done. Neck CT
revealed us that subglottic mass narrowing trachea
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
was originated from the thyroid gland. FNAB was
reported as thyroidpapillary carcinoma. Bilateral
total thyroidectomy and partial excision of invaded
trachea was applied. Since cutaneous and
mediastinalemphysema developed after surgery; a
second operation was performed. Approximately
1.5cm of segmental resection including defective
first and second tracheal rings and end-to-end
anastomosis of the trachea were performed.
Thyroid papillary carcinoma is a common
histologic type of thyroid cancers. These tumors are
usually not aggressive and are treated easily.
However, some cases have progressive course and
poor prognosis. Since trachea is just behind the
thyroid gland, thyroid papillary carcinoma may
invade trachea. According to some authors tracheal
invasion also indicates a poor prognosis. In these
cases aggressive surgical techniques are
recommended such as tracheal fenestration or
tracheal resection with end to end anastomosis.
Conclusion: It is important to know that an unusual
symptom like hemoptysis may be the first finding
of thyroid papillary carcinoma.
Correspondence:
Murat SALIHOGLU GATA HaydarpasaEgitim
Hastanesi, Kulak Burun Boğaz Servisi, 34668,
Istanbul, TURKEY
Tel: +90 0216 542 2020- 4356
Fax:+90 216 348 7880
GSM : +90 534 9457644
Email : drmuratsali@gmail.com
PPO39
PEDIATRIC
LITHIASIS
TESTICULAR
MICRO
Authors:
COL SURER İlhami, MD; LCDR CALISKAN
Bahadir, MD; MAJ ATABEK Cuneyt, MD; LTJG
ALTAN Bilal, MD; LTC GUVEN Ahmet, MD;
COL DEMIRBAG Suzi, MD
Institution:
Gulhane Military Medical Academy, Department of
Pediatric Surgery, Ankara, TURKEY
Introduction: Testicular microlithiasis is a rare
disease and its frequency detected by
ultrasonography has been reported 0.6%-9%. But
relatively small number of cases has been reported
for the pediatric age group. Severe calcification of
the seminiferous tubules has been detected at this
entity. Testicular germ cell neoplasies and
infertility have clinical importance in this group.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Material and method: A total of 18 testicles in 10
children diagnosed with typical microlith
formations were diagnosed and followed up in our
clinic between 2001-2011. All charts were
evaluated etrospectively and undescended testicle
(4 cases), varicocele (2), acute scrotum (2), trauma
(1) and developmental delay (1) were the
complaints in this group of patients.
Results: Mean age was 8.4 (3-17) years. Follow up
period was changing between 1-10 years under
ultrasonographic surveillance in every 6 mo. or 12
mo. basis. No malignancy was detected in this
period.
Conclusion: Testicular microlithiasis is more
common in undescended testicle which should be
investigated by scrotal ultrasonography. Frequency
of examinations can be diminshed in pediatric age
group and the parents should be informed about the
long term follow up necessity,possible malignancy
and infertility problems.
Correspondence:
Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi
AD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 5487
Fax: + 90 312 304 5900
GSM: + 90 505 806 4996
E-mail: mbcaliskan@gata.edu.tr
PPO40
SURGICAL TREATMENT RESULTS IN 18
CASES WITH BRACHIAL PLEXUS LESION
CAUSED BY TRAUMA
Authors:
CDR TOPUZ Ali Kıvanç, MD, CPT EROĞLU
Ahmet, MD, MAJ ATABEY Cem, MD, MAJ
GÖÇMEN Selçuk, MD, 1LT ZORLU Emre MD,
COL DEMİRCAN Mehmet Nusret MD
Institution:
GATA Haydarpaşa Training Hospital, Dept. of
Neurosurgery İstanbul, TURKEY
Aim: Brachial plexus is generally caused by sharp
object wounding and isolated brachial plexus
wounding is rarely encountered. These are more
complex than peripheral nerve wounding due to
their complex structure containing cervical nerve
roots, truncus and fasciculus. In this retrospective
study, during the period covering 5 years at our
clinic, surgical treatment we applied to 18 traumatic
patients with brachial plexus nerve lesions by
wounding by gunshot and the results are presented.
190
Material and method: Patients that applied to our
clinic between January 2005 – February 2010 with
brachial plexus lesion caused after trauma were
included. In the preoperative period, Brachial
plexus Magnetic Resonance Imaging (MRI) studies
and preoperative and postoperative period
electromyography (EMG), and motor power
grading were applied to all patients. Surgical
treatment was applied to all cases. Cases were
called for control in the 1st, 6th, and 12th months
after the operation.
Results: 15 of our cases were male and 3 of them
were female, average age was 32,7 years (21-49
years). Most common reason in etiology was
motorcycle accidents with 11 cases (61.1%), and in
4 cases (22,2%), it was caused by wounding by
gunshot and in 3 cases (16,6%) it was caused by
sharp object wounding. In Brachial plexus EMG of
7 of the cases, root avulsion was encountered. As
surgical treatment, decompression was performed
to 8 cases as infraclavicular approach, to 6 cases as
supra clavicular approach, and to 4 cases as supra
and infraclavicular with combined approach. After
surgical operation, it was detected that MRI results
and the improvement in motor functions were the
best in cases without root avulsion.
Conclusion: Detail information on surgical
anatomy of Brachial Plexus and its response to
wounding are required for optimal planning in
nerve repair and reconstruction. Prognosis of
wounding with root avulsion is bad and the
efficiency of surgical treatment is unsatisfactory.
Correspondence:
EROĞLU Ahmet, M.D. GATA Haydarpaşa
Training Hospital, Neurosurgery Clinic, 34668
Üsküdar, İstanbul, TURKEY
Tel: + 90 216 542 2815
Fax: + 90 216 348 7880
GSM: + 90 506 203 6231
E-mail: drahmeteroglu@gmail.com
PPO41
FUNCTIONAL NERVE TRANSFERS IN
HIGH LEVEL NERVE INJURIES OF THE
UPPER EXTREMITY
Authors:
MAJ ZOR Fatih, MD, COL OZTURK Serdar, MD,
CPT AYKAN Andac, MD, MAJ SAHIN Ismail,
MD1, COL ESKI Muhitdin, MD, CPT ALHAN
Dogan, MD, MAJ SAFAZ Ismail, MD, COL ISIK
Selcuk, MD
191
Institution:
Gulhane Military Medical Academy, Dept. of
Plastic and Reconstructive Surgery, Ankara,
TURKEY
Objective: The functional results of high nerve
injuries in the upper extremity are not satisfying
even in the case of ideal repair, thus research on
new techniques in this field continues. We present
nerve transfer procedures in patients with high
nerve injuries of the upper extremities.
Material and method: Nine cases with high level
nerve injury in the proximal forearm treated with
nerve transfers between the years 2009-2011 have
been included. Ulnar nerve injury only have been
repaired in 6 patients and ulnar and median nerve in
three patients. Only motor repair has been
performed in all patients.
Results: All nerve coaptations were functional in
the EMG findings in all the cases. Noticeable
enhancement was observed in thelateral pinch, pulp
pinch, grip force and Jebsen hand function results.
Conclusion: Nerve transfers are candidate to be
first choice in high level injuries of the peripheral
nerves of the upper extremity.
Correspondence:
Gülhane Askeri Tip Akademisi, Plastik ve
Rekonstrüftif Cerrahi AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 304 5406
Fax: +90 312 304 5404
GSM: +90 532 664 9285
E-mail: fatihzor@yahoo.com
PPO42
COMPUTERIZED
NUCLEAR
MORPHO
METRY OF PRIMARY MELANOMA OF THE
SKIN:
CORRELATION
WITH
THE
IMMUNOEXPRESSION OF P53 AND P16
PROTEINS AND TUMOR THICKNESS
Authors:
LIEUT. Milos KOSTOV, MD, PhD1, Snezana
CEROVIC, MD, PhD2, Zaklina MIJOVIC, MD
PhD3, Dragan Mihailovic, MD, PhD3
Institutions:
1. Department of Pathology, Military hospital of
Nis, Serbia
2. Center for Pathology and Forensic Medicine,
Military Medical Academy of Belgrade, Serbia
3. Institute of Pathology, Faculty of Medicine,
University of Nis, Nis, SERBIA
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Objective: The purpose of the study was to
determine the correlation of nuclear morphometry
with the degree of expression of p53 and p16INK4a
proteins and thickness of primary melanoma of the
skin.
Material and methods: Using image analysis and
computerized nuclear morphometry on a series of
53 primary cutaneous melanomata. Measured
morphometric nuclear features included size, shape
and optical density. In each case, 100 nuclei were
measured and the mean nuclear morphometric
features were calculated and compared with the
degree of expression of p53 and p16INK4a proteins
and tumor thickness. The tumor thickness was
determined according to Breslow using an ocular
micrometer. Invasion depth was classified
according to Clark.
Results: There was a significant correlation
between optical density and of melanoma level of
invasion according to Clark (p<0.05), while the
Breslow thickness of melanoma was not
significantly correlated with nuclear morphometric
variables. Also, a statistically significant negative
correlation were found between nuclear optical
density and p53 positive cells, while a statistically
significant positive correlation was found between
the nuclear circularity and p53 positive cells. There
was no statistically significant correlation between
the expression of p16INK4a protein and tested
nuclear morphometric variables. Melanoma with
higher values of optical density and lower
circularity of nuclei have a lower level of invasion
according to Clark.
Conclusions: Nuclear morphometric variables may
determine the melanoma aggressive phenotype and
indicate the immunoprofile of the tumor.
Correspondence:
LIEUT. MILOS KOSTOV, MD, PhD
Military Hospital of Nis,
Department of Pathology
Bul. Zorana Djindjica bb
Tel. +381 63 77 82 091
Fax: +381 18 238 191
E-mail: kostov.milos@gmail.com
PPO43
MEDICAL
INFORMATION
FLOW
MANAGEMENT TOOL FOR MEDICAL
SUPPORT TO NATO-LED OPERATIONS
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
192
Authors:
Col Kostadinov Rostislav; Col As. Prof. Evgeni
Belokonski
Institution:
Military Medical Academy, Sofia, BULGARIA
Introduction: NATO-led military operations are
multinational in their nature. While the medical
care to the deployed troops remains a sending
nation responsibility, the NATO Operational
Commander is sharing the responsibility for
provision of medical support to the deployed troops
equating to best medical practice. Consequently,
Commander needs to be fully aware of the
operational medical situation development and
advised by medical staff on his/her decision
possible impact on servicemen health. Therefore,
the efficient management of medical information is
of utmost importance for appropriate medical
support.
Aim: The aim of publication is to present a medical
information flow management tool that improves
the medical information management during NATO
operation
Materials and Methods: By the means of the
descriptive and comparative methods the medial
information sharing challenges are depicted. The
deductive and cluster analyses were implemented in
order to describe how the new tool addresses these
challenges.
Conclusions: As a conclusion the user-friendly
interface of the tool is presented.
Correspondence:
Dr Rostislav Kostadinov, MD, PhD Colonel, BGR
A
Email: r.kostadinov@jfcna.nato.int
rostikosti@abv.bg
PPO44
OPERATION UNIFIED PROTECTOR
MEDICAL LESSONS IDENTIFIED
–
Authors:
Col Kostadinov Rostislav
Institution:
Military Medical Academy, Sofia, BULGARIA
Introduction: In response to UN Security Council
resolutions 1970 and 1973 North Atlantic Council
approved NATO Operation Unified Protector
(OUP) in order to protect civilians and civilianpopulated areas under threat of attack from the
Gaddafi regime. The NATO mission comprised of
three elements: an arms embargo, a no-fly-zone and
actions to protect civilians from attack or the threat
of attack.
Aim: The aim of this publication is to present the
medical support to OUP challenges and applied
strategies to manage the highly demanding medical
situation.
Materials and Methods: By the means of the
descriptive and comparative methods the challenges
during the planning and executing phases are
depicted. The deductive and cluster analyses were
implemented in order to describe the activities
performed by medical planners and medical
executive officers on operational level in order to
respond to the operational demands.
Conclusions: In the conclusions the author
highlights the significance of the mitigations
strategies and newly created tools and procedures,
implemented for the success of medical support.
Correspondence:
Dr Rostislav Kostadinov, MD, PhD, Colonel
Email: r.kostadinov@jfcna.nato.int
rostikosti@abv.bg
PPO45
PARTICIPATION
OF
BULGARIAN
MEDICAL PERSONNEL IN THE SERBOTURKISH WAR OF 1876
Authors:
Prof. K. Kanev, MD, DSc, Assoc. Prof. N.
Chobanov, MD, PhD, G. Varbanov, M. Stoeva,
MD
Institution:
Military Medical Academy – Sofia, BULGARIA
The Serbian-Turkish war in 1876 is part of the
enacted crisis in Eastern Europe that ended with the
signing of the Treaty of Berlin in 1878. Our study
includes the activity of the Bulgarian medical
personnel who participated in the composition of
sanitary missions sent to help the Serbian military
medical service. They were able to give medical
assistance to 7,000 wounded and sick Serbian
soldiers and Bulgarian volunteers. Our review of
the events during the Eastern crisis, which began in
Europe in 1875 shows that cooperation between
military medics in the Balkans dates far back into
the past and continues for more than 135 years.
193
PPO46
THE
HUMAN
OPERATIONS
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
ASPECTS
IN
NATO
Authors:
Col Kostadinov Rostislav; Col Alexandar
Parashkevov, Col (ret) Aleksandar Dimitrov
Institution:
Military Medical Academy, Sofia, BULGARIA
Introduction: To the challenges of complex,
global, interconnected and constantly changing
contemporary world NATO is responding by
transformation process. While assuring the allied
countries security and integrity (Article 5) remains
the main NATO objective, more frequently the
Alliance is participating in crisis response missions
aimed at stabilization, reconstruction, humanitarian
relief, thus contributing to human security. The
success in these missions could be achieved only
when the human aspects are understood, mastered
and influenced. The aim of study is to present the
main human aspects in operations with impact on
public acceptance of military activities. The role of
military medical community is noted.
Materials and Methods: Descriptive and
comparative methods are applied in order to
describe the human aspects of the military
operations in the contemporary world and the new
social reality. The cluster analysis is used for
highlighting the role of medical support. As
conclusions
the
authors
are
proposing
transformation measures in medical support
structure and planning process in order to better
address the human aspects in NATO-led operations.
Correspondence:
Dr Rostislav Kostadinov, MD, PhD Colonel, BGR
A
Email: r.kostadinov@jfcna.nato.int
rostikosti@abv.bg
PPO47
NATO
MEDICAL
STAFF
OFFICERS
ASSIGNMENTS
TRAINING
AND
KNOWLEDGE REQUIREMENTS
Authors:
Col Kostadinov Rostislav; Col As. Prof. Krum
Katzarov; Col Parashkevov Alexander
Institution:
Military Medical Academy, Sofia, BULGARIA
Introduction: Medical support to NATO deployed
troops relays on national commitments. Allied
nations provide physicians and medical staff for
executing medical support activities into theatre
deployed medical instillations (Roles 1-3), as well
as medical specialists for NATO Command
structures. All medical officers in NATO
environment have to perform staff duties in
addition to the pure medical one. The level of staff
work competency of the medical officers has a
direct impact on the medical support efficiency and
effectiveness. The revision of NATO medical staff
officers’
training
requirements
is
under
consideration in NATO medical community that
could have an impact on the national educational
and training procedures.
Aim: The aim of the publication is to present the
results of the study conducted on the required
medical officers’ staff skills and knowledge in
NATO environment. By the means of comparative
method and deductive analyzes the required by the
NATO medical support doctrine and policy staff
skills and knowledge are summarized.
Conclusion: As a conclusion the authors propose
establishment of NATO Medical Staff Officer
Course. Its objectives and program are presented.
Correspondence:
Dr Rostislav Kostadinov, MD, PhD, Colonel
Email: r.kostadinov@jfcna.nato.int
rostikosti@abv.bg
PPO48
DEVELOPING
STANDARDS
AND
PERFORMANCE MEASUREMENT IN THE
HOSPITAL
Authors:
COL CANKUL H.Ibrahim, PhD1; COL TEKE
Abdulkadir, PhD1; COL CIHANGIROGLU
Necmettin, PhD1
Institution:
Gulhane Military Medical Academy, Dept. of
Health Services Management, Ankara, TURKEY
Objective: Hospital performance may be defined
according to the achievement of specified targets,
either clinical or administrative. Targets may relate
to traditional hospital functions, such as diagnosis,
treatment, care and rehabilitation as well as to
teaching and research. Hospital performance may
thus be expected to include elements of community
care and public health, as well as social and
employment functions.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Material and method: Performance measurement
is a simple concept without a simple definition.
Essentially, performance measurement analyzes the
success of a work group, program, or organization's
efforts by comparing data on what actually
happened to what was planned or intended.
Measurement is central to the concept of hospital
quality improvement; it provides a means to define
what hospitals actually do, and to compare that with
the original targets in order to identify opportunities
for improvement. The principal methods of
measuring hospital performance are regulatory
inspection, public satisfaction surveys, and
statistical indicators, most of which have never
been tested rigorously. Statistical indicators can
suggest issues for performance management,
quality improvement and further scrutiny; however,
they need to be interpreted with caution. Much of
the current evidence on the effectiveness of
performance indicators is based on observational or
experimental data.
Conculusion: Today's health care world demands
both quality and cost-effective performance,
measured by programs based on clear, realistic, and
challenging standards. Quality and cost-effective
performance are not incompatible, or even at odds;
they are parts of the same whole.
Correspondence:
Gulhane Askeri Tip Akademisi, Saglık Hizmetleri
Yonetimi BD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 6003
Fax: + 90 312 304 2900
GSM: + 90 536 461 3597
E-mail: icankul@yahoo.com
PPO49
JOB
COMMITMENT
MILITARY DOCTORS
OF
TRAINEE
Authors:
CPT OZTURK Gultekin, MD1, MAJ YILDIRAN
Nuri, MD, PhD2, COL OZER Mustafa, MD, PhD1,
COL CETIN Mehmet, MD, PhD1, MAJ TURK
Yusuf Ziya, MD, PhD1, COL FEDAI Turan, PhD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Military Health Services, Ankara, TURKEY
2. Turkish Armed Forces Medical Command,
Ankara, TURKEY
Objective: One of the most important issues about
employee motivation is job commitment. At this
194
study we aimed to assess the job commitment level
of the new graduate military physicians.
Material and method: “Job Commitment Scale”
(Blau) is used with four dimensions (affective,
normative, accumulated costs, and limited
alternatives). The scale is applied to 62 trainee
military doctors. 5 are female, 4 are married and 12
are graduates of civilian medical schools.
Results: The five likert scale scored between 1 and
5 point. Job commitment mean scores were
3.52±1.05 at affective, 2.96±1.04 at normative,
2.96±0.82 at accumulated costs, 2.53±0.61 at
limited alternatives and 2.99±0.69 at total. There is
no clear difference among the army, navy, air force
personnel. Females have high scores at each
dimensions and at total (3.21±0.73) compared to
males (2.96±0.69). Married personnel have higher
scores (3.56±0.52 at total). The physicians
graduated from civilian medical schools have
significant high total score (3.54±0.37) compared to
graduated
from
military
medical
school
(2.85±0.68). The relation of accumulated costs and
gender (p<0.05) was statistically significant. Also
there is a significance among the graduated medical
school, limited alternatives (p=0.015), affective
commitment (p=0.003), normative commitment
(p<0.001) and total score (p=0.02).
Conclusion: The total commitment (2.99±0.69)
was a little high from the median and limited
alternatives (2.53±0.61) had the lowest score. These
findings mean that the physicians have to continue
to stay in their job since there are no more
alternatives. Some measures must be taken to
motivate the doctors and increase the commitment
level.
Correspondence:
Gultekin OZTURK Gulhane Askeri Tip Akademisi,
Askeri Saglik Hizmetleri AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 3043359
GSM: +90 532 7001822
E-mail: gozturk4@yahoo.com
PPO50
ANTECEDENTS OF CUSTOMER (PATIENT)
COMPLAINT BEHAVIOURS IN HEALTH
SERVICES
Authors:
COL TEKE Abdulkadir, PhD1, CENGIZ Ekrem,
PhD2
195
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Health Services Management, Ankara, TURKEY
2. Gümüşhane University, Faculty of Economics
and Administrative Sciences, Department of
Marketing, Gümüşhane, TURKEY
Objective: The objective of this research is to
determine the factors that affect the patients’
complaining behaviours and analyzing these factors
in a model.
Material and method: A survey was conducted
with the method of face to face interviews between
10 December 2008 -30 December 2008. Data was
collected from 727 patients by simple random
sampling method from three hospitals in the North
Part of Turkey.
Results: The consequence of model analysis, 19 of
hypothesis were accepted from 55 hypothesis
which were suggested.
Conclusion: The patients show their displeasure
while taking health services in different ways.
These are: voice company, silence, negative wordof-mouth, exit and voice third party
Correspondence:
Gulhane Askeri Tip Akademisi, Saglık Hizmetleri
Yonetimi BD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 6002
Fax: + 90 312 304 2900
GSM: + 90 533 348 2138
E-mail: ateke@gata.edu.tr
PPO51
SECONDARY TRAUMATISM IN MEDICAL
STAFF ENGAGED IN MANAGEMENT OF
WAR INJURED PATIENTS
Authors:
Dragana Blagojevic, High Nurse1, Col. Zvonko
Sundric2
Institutions:
1. The MMA’s Neurology Clinic, Militari Medical
Acamemy, Belgrade, SERBIA
2. Institute for Air Space Medicine, SERBIA
Secondary traumatism represents a consequence of
observation of catastrophic events, their
consequences, or hearing about them, the term that
refers to the impact of exposure to traumatic
experiences of others. The symptoms of secondary
traumatism are parallel symptoms of posttraumatic
stress disorder and include reliving the trauma,
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
avoidance and emotional numbness and extreme
anxiety. Secondary traumatims, which is
developing in the workplace, in response to "job
stressors" has an important role in the development
of „burning out syndrome“, thus reducing the work
satisfaction and ultimately affect professional
performance, which is from the perspective of
"human resource management" , must be wrapped
into account when planning the layout of engaging
employees. The aim of our study is the importance
of line identification with war-traumatised as a
stressor for professional medical staff. Study
sample include 38 nurses or physical therapists who
are participating in the treatment of war-traumatised
persons during the period of civil war (mid-90's).
Two questionnaires, Trauma History Screen and
Life Stressors Checklist were used regarding the
presence of symptoms of traumatization during two
periods, previous one related to engagement of wartraumatized persons and during present time. Our
results show that working with war-traumatized
may lead to secondary traumatization, or represents
a significant professional stressor.
PPO52
TURNOVER
AND
PROFESSIONAL
SATISFACTION AMONG GREEK NURSING
STAFF
Authors:
Sereti Ourania, Lieutenant Colonel, RN, MSc;
George Koulierakis, Health Pscycologist, Ph.D
Institution:
401 General Military Hospital of Athens,
Department of Sociology, National School of
Public Health, GREECE
Introduction: The lack of nursing staff in Greece
combined with an increased demand for qualitative
health services urgently calls for exploring nurses’
turnover and its determinants.
Purpose: a) to record registered nurses’ job
satisfaction, intention to leave the organization, the
profession and the clinical practice, b) to explore
the relationship between turnover intentions and job
satisfaction.
Material and Methods: A cross-sectional,
correlation
survey
using
self-administered
questionnaires, including Turnover Intentions
scales and the Index of Work Satisfaction was used
to collect data. Higher scores in scales represent
higher turnover intention and job satisfaction
respectively. The sample consisted of 405
registered nurses (13% males) employed in clinical
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
practice in two public hospitals (one military).
Response rate: 67.27%. Pearson’s r statistical test
was used to examine the correlation between
variables.
Results: The study showed that the level of job
satisfaction was low to moderate while there was
recorded nursing turnover intention which was
significantly related with job satisfaction: lower
levels of satisfaction were correlated with nurses’
intention to leave clinical practice (r= -0.35,
p<0.0001), Organization (r= -0.14, p<0.005) and
profession (r= -0.43, p<0.0001).
Conclusion: Turnover was recorded for the first
time among Greek nursing staff. Findings were
close to those of international research indicating
that in every health system work satisfaction affects
nurses’ turnover. This calls for immediate
interventions towards the direction of increasing
nurses’ satisfaction for safe and quality provision of
health care.
PPO53
COMPARISON OF THE EFFECTS OF
COOPERATIVE
LEARNING
AND
TRADITIONAL LEARNING METHODS ON
DRUG-DOSE CALCULATION SKILLS OF
INTERN NURSING STUDENTS
Authors:
BASAK Tulay, RN, PhD, LTC YILDIZ Dilek, RN,
PhD
Institutions:
Gulhane Military Medical Academy, School of
Nursing, Ankara, TURKEY
Objective. The aim of this study was to compare
the efficacy of cooperative learning method and
traditional learning method in training of nursing
interns’ drug dose calculation skills.
Material and method. The population of this study
was composed of nursing students (n= 85) studying
in last semester in a nursing college in Turkey.
Students were divided into two groups: an
experimental group and a control group. The
cooperative learning method was applied to the
experimental group (n=32) and traditional learning
method was applied to the control group (n=40).
Pre test and post test scores of drug dose calculation
skills were compared. Data were obtained from
using data collection form which were developed
by researchers. T-test and Wilcoxon's signed rank
test with Bonferroni correction were used for
comparison of drug dose calculation skill scores
196
between groups and within groups before and after
training.
Results. The mean age of intern nursing students
was 22.5 ± 0.5 and all were female students. There
was not found a statistically significant difference
between drug dose calculation pretest scores of
both groups (p= 0.144). After training, while post
test mean score of the control group was 92.00 ±
7.90, this score was 87.03 ± 9.98 in the
experimental group and the difference was
statistically significant (p= 0.021).
Conclusions. After training, drug dose calculation
skills of students were increased in both groups.
But the traditional learning method was found more
effective than cooperative learning method in the
development of drug dose calculation skills.
Correspondence:
Gulhane Askeri Tip Akademisi, Hemsirelik
Yuksekokulu, Etlik 06018, Ankara, TURKEY.
Tel: + 90 3123033943 Fax: + 90 3123043900
GSM: + 90 5322284622
e-mail: tbasak@gata.edu.tr
PPO54
AN OVERVIEW OF THE TRAINING ON
NURSING
SKILLS
AT
GULHANE
MILITARY MEDICAL ACADEMY SCHOOL
OF NURSING
Authors:
GUNAYDIN Sinem, 2nd Grade Nursing Student1,
CULHA Meltem, 3rd Grade Nursing Student1,
TURHAN Nazlı, 3rd Grade Nursing Student 1,
TURK Asuman, Senior Nursing Student1,
CAGLAR Merve, Senior Nursing Student1, CDR
ASLAN Ozlem, RN, PhD2, COL HATIPOGLU
Sevgi, RN, PhD3, COL AKBAYRAK Nalan, RN,
PhD4
Institutions:
1.Gulhane Military Medical Academy, School of
Nursing, Ankara, TURKEY
2.Gulhane Military Medical Academy, School of
Nursing, Department of Fundamentals of Nursing,
Ankara, TURKEY
3.Gulhane Military Medical Academy, Director of
School of Nursing, Ankara, TURKEY
4.Gulhane Military Medical Academy, School of
Nursing, Department of Internal Medicine Nursing,
Ankara, TURKEY
Objective. The aim of this article was to describe
the training on nursing skills (TONS) performed at
Gulhane Military Medical Academy (GMMA)
School of Nursing.
197
Conclusion. TONS is an important part of nursing
education. At GMMA School of Nursing TONS are
carried out as theoretical education, laboratory
practice and implementation in clinical settings.
According to the integrated education system at
GMMA School of Nursing, classes are conducted
on a committee basis. Each committee covers
specific nursing skills. For example, “The
Committee of Human Need for Movement”
includes preventive-therapeutic positioning and
patient transfer techniques, nonparenteral and
intramuscular drug administrations, oral care,
patient hygiene; “The Committee of Heart and
Circulation System” contains blood pressure
measurement, IV catheter insertion, catheter care,
IV drug-fluid administration, blood sample drawing
and blood transfusion; “The Committee of
Digestion includes tube feeding, stoma care and
total parenteral nutrition. For each committee,
firstly TONS is given at theoretical basis. Then
laboratory practice is performed on manikins. At
last clinical practice on patients is carried out under
the supervision of clinical educators. All of the
committees include classes on physical examination
skills and students gain the ability of data collection
on the basis of nursing care plan. GMMA School of
Nursing has two well-equipped and sufficient-sized
laboratories for skill training. In the intern program,
senior students gain proficiency on all nursing skills
that they learn from previous classes in medical,
surgical, intensive care units and emergency
department in GMMA Hospital.
Correspondence: Gulhane Askeri Tıp Akademisi,
Hemsirelik Yuksekokulu, Etlik, 06018, Ankara,
TURKEY
Tel.:+90 312 304 39 53
Fax:+90 312 304 39 00
GSM:+90 537 492 11 71
E-mail: oaslan@gata.edu.tr
PPO55
MUSCULOSKELETAL DISORDERS AMONG
NURSES WORKING IN A REHABILITA
TION HOSPITAL
Authors:
CPT YAVAS Umit, MD1, CPT OZTURK
Gultekin, MD1, CPT TOSUN Ugur, MD, PhD2,
MAJ TURK Yusuf Ziya, MD, PhD1, COL CETIN
Mehmet, MD, PhD1, COL OZER Mustafa, MD,
PhD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Military Health Services, Ankara, TURKEY.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
2. Turkish Armed Forces Medical Command,
Ankara, TURKEY
Objective. The aim of this study was to determine
the prevelance of Musculoskeletal disorders (MSD)
among nurses working in a rehabilitation hospital.
Material and method. This is a cross-sectional
study which was conducted in 53 nurses working in
a rehabilitation hospital. Data were collected by the
Nordic Musculoskeletal Questionnaire.
Results. From a total of 64 female nurses, 53 (82%)
completed
questionnaire
were
obtained.
Participitants’ mean age was 31.2 years (SD 3.9),
average height was 163.5cm (SD 4.2), average
weight was 62.3 kg (SD 6.3) and Body Mass Index
was 23.2 kg/m2 (SD 2.5). The nuses’ average
duration of employment was 10.8 years (SD 4.4).
The 12-month period-prevalence of MSD at any
site among nurses was 90.5% (n=48). Lower back
pain was the most reported MSD, 64.2%. This was
followed by neck (52.8%) and upper back (45.3%)
region. The weekly prevelance of MSD at neck was
39.6% and lower back pain has followed this body
region with a weekly prevelance of 34%.
Symptoms associated with the lower back (47.2%),
neck (35.8%) and upper back (18.9) were the
common MSD, preventing normal activities.
Conclusion. MSD prevelance among nurses in a
rehabilitation hospital seems to be higher than
previous studies conducted in different countries.
Our methodology was similar with the others so it
is possible to say that the nurses of the
rehabilitation hospital did not use correct body
posture or body mechanics.
Correspondence:
CAPT. Umit YAVAS Gulhane Askeri Tip
Akademisi, Askeri Sağlik Hizmetleri AD, Etlik
06018, Ankara, TURKEY
Tel: +90 312 3043359 (w)
GSM: +90 505 6462956
E-mail: uyavas@gata.edu.tr
PPO56
PROPHYLAXIS
OF
DIABETIC
POLYNEUROPATHY
AS
PREVENTION
DEVELOPMENТ DIABETIC FOOT
Authors:
Hristo LESSIDRENSKY M.D., Col. Krasimir
GENOV M.D., PhD
Institutions:
Clinic of neurological diseases - Military Medical
Academy, Sofia, BULGARIA
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
198
International Organization for Diabetes predicts
that one in ten adult residents of the planet will
suffer from diabetes in 2030. According to World
Health Organization / WHO / diabetes sufferers
worldwide are now about 346 million people. The
epidemic of diabetes poses a greater risk for
economic systems of European countries,
especially Eastern Europe. Over the next two
decades, about 522 million people will fall prey to
disease. In Bulgaria we have no precise studies on
the incidence and frequency of diabetic neuropathy.
The more accurate data available are related to
some of its complications and consequences - and
diabetic foot amputations. The estimated number of
diabetics in the country is 175,000 people, of whom
25,000 are in Sofia. 10% of them suffer from
diabetic foot and 1.9% of had at least one
amputation. Data from the National Center for
surgery for 4 years in our country have made 2169
amputations. Of them - 1559 / 73.77% / were nontraumatic. And 92.4 percent of non-traumatic because Hank and diabetic foot. The disease is
among the top places in the structure of morbidity
and mortality in our country, and around 75% of
diagnosed diabetics with poor metabolic control,
leading to the development of complications. More
than 10 years at the clinic of nervous diseases is
carried out drug prevention of complications of
diabetes. Over 100 people a month go to the clinic
for treatment. After treatment in patients a
significant improvement in overall condition, with
patients of working age are able to re-engage with
their duties. Greater frequency and duration of
prevention activities lead to significant reductions
in clinical symptoms of diabetic polyneuropathy
and respectively reduce the patients at risk for the
formation of diabetic foot.
Correspondence:
3”Georgy Sofiisky” str., Military
Academy, Sofia 1606, BULGARIA
Telephone: +359 2 922 54 47
E-mail : hr_lessidrensky@yahoo.com
Medical
Department of Neurosurgery,
Cardiology, Belgrade, SERBIA
Department
of
Introduction. Several clinical entity are included in
intracranial hemorrhage syndrome.The aim of this
study was to confirmed and to determined role,
significance and place of risk factors and associated
disorders due to results and prognosis of
intracranial hemorrhage.
Methods. We observed 150 patients with ICH that
have been treated conservatively in our hospital. To
all patients were determined grade of neurological
and functional deficit as well as a level of
consciousness. Canadian neurologic scale, Bartel
functional ability index, and Glasgow soma score
were used for this purpose. As a conferment of
hypertension
existence
an
ophtalmological
examination were performed, and for conferment of
glycoregulation glycemic day profile were done.
Consumed amount of alcohol per day we
multiplicand with years of abuse to gain a grade of
alcohol dependence.Confirmed of SAH and ICH
were done by using CT inside first 48 hours since
the first clinical manifestations have shown out.
Results: Hypertension is the most readily
recognized factors in the genesis oh ICH.On the
other hand alcohol abuse represent unfavorable
predictive indicates of un expectable results of this
syndrome.Association of the several risk factors
represent multiple and non-linear increasing
liability to the most difficult results of ICH.
Conclusion:On the basis of such observations it
was clearly determined pathogenic connection
between risk factors and ICH on one side and
knowledge of the key pathoppsychology process
that are taking place in this syndrome on the other
side can implicate new facts for the
multidisciplinary preventive therapeutic program of
this seriously clinical entity.
PPO57
THE
INTRACRANIAL
HEMORRHAGESIGNIFICANCE OF RISK FACTORS
PPO58
NEURONAL
ALUMINIUM
APPLICATION
Authors:
RAICEVIC Ranko, KOSTIC Dejan, DINCIC
Evica, MINIC Ljubodrag, LEPIC Toplica,
TAVCIOVSKI Dragan, VELJANCIC Dragana.
Authors:
STEVANOVIC Ivana, JOVANOVIC Marina,
JELENKOVIC Ankica, MIHAJLOVIC Rosa,
NINKOVIC Milica, COLIC Miodrag
Institutions:
Military Medical Academy, Department
Neurology, Department of Radiology,
of
INJURY
FOLLOWING
INTRACEREBRAL
Institutions:
1. Military Medical Academy, Institute for Medical
Research, Belgrade, SERBIA
199
2. Institute for Biological Research, Belgrade,
SERBIA
3. Institute for Rehabilitation, Belgrade, SERBIA
Aim: Aluminium (Al) compounds are neurotoxic
and have been shown to induce experimental
neurodegeneration. Also, Al has been implicated as
a destabilizer of cell membranes. Mitochondria are
essential to the cell for maintaining the normal
voltage gradient across the cell membrane as well
as a number of processes that controlling
intracellular Ca2+. Complex IV, cytochrome C
oxidase (CO), is the last component of
mitochondrial electron-transport chain. In the
present study we investigated the CO activity after
intrahippocampal AlCl3 application in selective
vulnerable brain regions.
Methods. A single dose of AlCl3 was applied in
the CA1 sector of rats hippocampus. The animals
were decapitated three hours and 30 days after the
treatment and crude mitochondrial fraction
preparations of basal forebrain and forebrain cortex
were used for the biochemical analyses.
Results. Activity of CO (mg cyt. c/mg protein) was
decreased bilaterally in both basal forebrain and
forebrain cortex after AlCl3 application compared
to control animals (p<0.01), at all times tested
(three hours, 30 days).
Conclusion. Bilateral decrease in CO activity in
different neural areas post AlCl3 application
suggest that Al neurotoxicity involves a specific
impairment of CO activity. Our data revealed that
AlCl3 application in the CA1 hippocampal sector,
resulting in both temporal and spatial spreading of
damage to the selective vulnerable brain structures.
Also, the decreased activity of CO indicates a
defficiency in reducing equivalents with consequent
diminishing of proton gradient i.e. reentering of
protons to the mitochondria, followed with
insufficient ATP synthesis.
PPO59
ASYMPTOMATIC PANCREATIC TUMOUR
IN A PATIENT SUFFERING OF DYSPEPSIA
Authors:
Col. Ionita Radu Florentina MD, Maj. Patrasescu
M. MD, Lt. Smedescu V. MD, Maj. Sotcan M. MD,
Plt. P Giorgeta Grosu Reg.
Institutions:
Nurse Department of Gastroenterology, Emergency
University
Military
Hospital,
Bucharest,
ROMANIA
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
We present the case of a 56-year-old patient
admitted in our clinic for heartburn , epigastric pain
referred to the back and astenia. The patient was
previously diagnosed with high blood pressure,
nodular gout with hypothyroidism, morbid obesity
(BMI 38kg/sqm). Physical exam was unremarkable.
Labs were also unremarkable (including pancreatic
panel, CA 19.9, carcinoembryonic antigen, alpha
fetoprotein).We performed
upper digestive
endoscopy which concluded the diagnosis of
eritematous gastritis and duodenitis. Abdominal
ultrasound shows an ovalar well demarcated lesion
(27mm) located in subcapsular III-rd hepatic
segment, unomogenous and with strong Doppler
signal; at the level of pancreatic body we noticed a
poor demarcated lesion (25/20mm) unomogenous
which leaves an impression on spleno-portal
confluent. MRI exam confirms the pancreatic lesion
and notices supplemental hepatic lesions with late
wash-out characteristics. Ultrasound guided liver
biopsy
of
the
subcapsular
lesion
and
immunohistochemical exam yield the diagnosis of
metastasis of a neuroendocrine pancreatic tumour.
In conclusion a rare pancreatic tumour may
masquerade itself as a dyspeptic syndrom and,
thereafter, a high index of suspicion may be
mandatory in order to yield a proper diagnosis of a
life threatening disease. An aggressive diagnostic
approach may be necessary in the context of strong
known risk factors such as obesity and smoking.
Correspondence:
E.mail: Mihai_patrasescu@yahoo.co.uk
Tel.: 0740151100
PPO60
CORRELATION
BETWEEN
DIALYSIS
SOLUTION TYPE AND CARDIOVASCULAR
MORBIDITY
RATE
IN
PATIENTS
UNDERGOING CONTINUOUS AMBULATO
RY PERITONEAL DIALYSIS
Authors:
Col.Prof. Đoko Maksić, M.D,PhD, Verica PopovicStankovic, M.D, PhD, Prof Žarko Vučinić, M.D,
PhD, Col. Toplica Lepić M.D, PhD.
Institutions:
Clinic of Nephrology
Clinic of Cardiology
Clinic of Neurology, The Medical Faculty of the
University of Defence, Belgrade, SERBIA
Aim. Peritoneal dialysis (PD) patients have an
increased risk for cardiovascular diseases. The aim
of the study was to evaluate the cardiovascular
changes in patients undergoing chronic PD and the
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
eventual existing differences depending
biocompatibility of dialysis solutions.
200
on
Methods. After 3±2 years of starting PD, 21 PD
patients on the treatment with bioincompatible
dialysis solutions (conventional glucose- based
solutions: PDP-1), average age 47.43±12.87 years,
and 21 PD patients on the treatment with
biocompatible dialysis solutions (neutral solutions
with lower level of glucose degradation products,
lower concentration of Ca2+ an neutral pH: PDP2), average age 68.62±13.98 years, participated in
the longitudinal study. The average number of
episodes of peritonitis was similare in both groups:
1 episode per 36 months of the treatment. The
control group included 21 patients with preterminal
phase of chronic renal failure (Glomerular
Filtration Rate: 22.19±10.73 ml/min), average age
65.29± 13.74 years. All the patients underwent
transthoracal echocardiography (in order to detect:
eject fraction (EF), left ventricular hypertrophy
(LVH), and valvular calcification (VC) and B-mode
ultrasonography of common carotid artery (CCA):
IMT, lumen narrowing, and plaque detection.
Results. The values of EF were: in PDP-1 group
62.05±5.65%, in PDP-2 group 53.43±7.47%, and in
the control group 56.71±8.12% (Bonferroni test, p
= 0.001). The recorded LVH was: in PDP-1 group
in 47.6% of the patients; in PDP-2 group in 61.9%
of the patients; and in control the group in 52.4%
(χ2 test; p = 0.639). The detected VC as: in PDP-1
in 52.4% of the patients, in PDP-2 group in 42.9%
of the patients, and in the control group in 23.8% of
the patients (χ2 test; p = 0.776). The IMT was: in
PDP-1 group 1.26±0.54 mm, in PDP-2 group
1.23±0.32, and in the control group 1.25±0.27 mm
(Bonferroni test; p = 0.981). An average lumen
narrowing was: in PDP-1 group 13.78±18.26%, in
PDP-2 group 18.57±22.98%, and in the control
group 25.00±28.02% (Kruskal Wallis test; p =
0.413). Calcified plaques of CCA were detected in
PDP-1 group in 61.9% of the patients, in PDP-2
group in 85.7%, of the patients and in the control
group in 81% of the patients (χ2 test; p = 0.159).
Conclusion. Generally, PD had a significant
influence on cardiovascular morbidity in the treated
patients, especially on the left ventricular function
and peripherial atherosclerosis. The age of the
patients had more influence on acceleration of
atherosclerosis than the length of dialysis or
biocompatibility of dialysis solutions.
PPO61
APICAL BALLOONING SYNDROM
Authors:
Colonel Themistoklis Iliopoulos, MD1, Major
Christina Nella, RN, MSN1, Pefanis Aggelos, MD1,
Kotsas
Dimitrios2,
MD,
Lampropoulos
Konstantinos, MD, PhD2.
Institutions:
1. Cardiology Department, 251 General Air Force
Hospital, Athens GREECE
2. Cardiology Department, Polyclinic General
Hospital of Athens, GREECE
Aim: Takotsubo cardiomyopathy (TCM), also
known as transient apical ballooning syndrome,
mimics acute coronary syndromes and is
accompanied by reversible left ventricular apical
ballooning in the absence of angiographically
significant coronary artery stenosis. It is important
for physicians to recognize this type of nonischemic cardiomyopathy.
Case presentation: A 68-year-old male patient
presented at the emergency department (ED)
complaining of severe chest pain, an elevated
troponin I and Nt-proBNP. The patient’s 12-lead
electrocardiogram showed ST-segment elevation in
the precordial leads with maximal ST-elevation in
leads V2-V3. Cardiac transthoracic echocardiogram
was revealed transient hypokinesis of the left
ventricular midsegments, with apical involvement
and ejection fraction about 40%. Coronary
angiography was performed. In the catheterization
laboratory normal atherosclerotic vessels are
demonstrated. Left ventriculography confirmed the
typically diagnosis of apical ballooning syndrome.
Conclusion: Physicians should be aware of the
presentation of TCM, and the chest pain after a
recent stressor should not readily be attributed to
anxiety. It is also important to keep in mind that
patients with TCM do not usually have cardiac risk
factors, but still their pain should be taken
seriously.
PPO62
DISTRIBUTION
OF
CORONARY
ATHEROSCLEROSIS IN RELATION TO
PERIPHERAL VASCULAR CHANGES IN
PATIENTS
WITH
ERECTILE
DYSFUNCTION
Authors:
Maragiannis Dimitrios, MD, Ioakimidis Nikolaos,
MD, Vlachopoulos Charalampos, MD, Stefanadis
Christodoulos, MD
201
Institutions:
First Cardiology Department, School of Medicine,
University of Athens, Hippokration Hospital,
GREECE
Purpose: Erectile dysfunction (ED) and coronary
artery disease (CAD) are overlapping in terms of
risk factors, pathophysiologic mechanisms and the
clinical context. However, there is limited data
about the relation between peripheral vascular
parameters
and
distribution
of
coronary
atherosclerotic lesions.
Methods: A total of 68 men in whom a
comprehensive assessment with non-invasive tests
(exercise stress test and stress echocardiography)
and coronary angiography revealed single vessel
disease (>70% luminal narrowing) were enrolled in
this study. The participants were divided into two
groups according to distribution of stenotic lesion;
21 (31%) men who had left main coronary artery
(LMCA) or proximal or mid-left anterior
descending artery (LAD) lesions (Group 1) and 47
(69%) with lesions at remaining coronary segments
(Group 2). Intima media thickness of carotid
arteries (cIMT), carotid-femoral pulse wave
velocity
(PWVc-f)
and
pharmacologically
stimulated peak systolic velocity (PSV) of
cavernous arteries were used to assess peripheral
vascular damage. Lower PSV values indicate penile
vascular disease and increased peripheral
atherosclerotic burden.
Results: The clinical characteristics and peripheral
vascular parameters of the two study groups are
presented in Table. PWVc-f and cIMT values did
not differ between the two groups, however, mean
PSV of penile arteries was significantly lower in
group 1 compared to group 2 (p<0.001). ROC
curve analysis revealed that a cut-off value of 23.2
cm/s for PSV had a sensitivity of 77%, a specificity
of 64%, a positive predictive value of 85.3 % and a
negative predictive value of 62 % for presence of
LMCA or proximal or mid-LAD lesions.
Interestingly, the prevalence of patients who
reported ED prior to CAD onset was significantly
higher among men in group 1 (81 vs 52 %,
P=0.004).
Conclusions: Evaluation of penile arterial inflow
has an incremental value in ED patients because it
may provide important information about coronary
lesion distribution.
PPO63
LIPOMATOUS HYPERTROPHY OF THE
INTERATRIAL SEPTUM
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Authors:
Colonel Themistoklis Iliopoulos, MD1, Major
Christina Nella, RN, MSN1, Potsios Dimitrios,
MD1, Kotsas Dimitrios, MD2, Lampropoulos
Konstantinos, MD, PhD2.
Institutions:
1. Cardiology Department, 251 General Air Force
Hospital, Athens, GREECE;
2. Cardiology Department, Polyclinic General
Hospital of Athens, GREECE.
Aim: Lipomatous hypertrophy (LHIS) of the
interatrial septum is a rare, but increasingly
recognized, cardiac lesion that can cause right atrial
obstruction,
intractable
supraventricular
arrhythmias, or sudden unexpected cardiac death.
Its etiology is still unknown and the diagnosis can
be made by the use of imaging techniques.
Case presentation: A 60-year-old male patient
presented at the emergency department (ED)
complaining of palpitations. He had a history of
acute myocardial infarction 7 years ago and
paroxysmal atrial fibrillation for which he has been
on standard oral anticoagulation. Electrocardiogram
revealed atrial fibrillation with heart rate ranging
from 70 to 100 beats/min. At the initial evaluation
at the ED a cardiac transthoracic echocardiogram
was ordered that revealed the presence of a right
atrial mass, attached to the interatrial septum.
Transesophageal echocardiogram also revealed in
the left atrium an echogenic hypertrophy of the
interatrial septum (about 2 cm), sparing the
foramen ovale. Diagnosis was confirmed by cardiac
magnetic resonance imaging.
Conclusion: LHIS is an easy to diagnose disease
that could be the culprit for a number of seemingly
“lone” conditions, like atrial fibrillation.
Transthoracic and transesophageal echocardio
graphy being the first techniques to provide
evidence of the disease and then multislice CT or
MRI delineating further the preliminary findings.
Clinical vigilance is warranted if we want to
provide the best medical practice for our patients.
PPO64
EFFECTS
OF
AMLODIPIN
AND
VALSARTAN ON LIPID PROFILE IN
PATIENTS WITH HYPERTENSION
Authors:
1LT AY S.Ahmet, MD1, 1LT KARAMAN Murat,
MD1, COL CELİK Turgay, MD2, 1LT BALTA
Sevket, MD2, MAJ ARSLAN Erol, MD1, 1LT
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
202
CAKAR Mustafa, MD1, CDR YAMAN Halil,
MD3, CPT KOCAK Necmettin, MD4, LTC
DEMİRBAS Seref, MD1, COL SAGLAM Kenan,
MD1
PPO65
HYPEREOSINOPHILIC
PRESENTING WITH
FAILURE
Institutions:
1. Gulhane Military Medical Academy, Dept.
Internal Medicine, Ankara/TURKEY.
2. Gulhane Military Medical Academy,Dept.
Cardiology, Ankara/TURKEY.
3. Gulhane Military Medical Academy, Dept.
Biochemistry, Ankara/TURKEY.
4. Gulhane Military Medical Academy, Dept.
Public Health, Ankara/TURKEY.
Authors:
1LT AY S.Ahmet, MD1, 1LT KARAMAN Murat,
MD1, 1LT ACAR RAMAZAN, MD1, 1LT BALTA
Sevket, MD2, MAJ ARSLAN Erol, MD1, COL
CELİK Turgay, MD2
of
of
SYNDROME
ACUTE HEART
of
of
Objective. The aim of the present study was to
investigate the effects of valsartan as an angiotensin
II receptor antagonist and amlodipine as a calcium
channel blocker on the lipid profile in patients with
essential hypertension.
Material and method. Patients applying to the
internal medicine and cardiology outpatient clinics
who had a newly diagnosed essential hypertension
were recruited in the study. Patients were
randomized to one of the following intervention
protocols: An (A) angiotensine II receptor blocker
(valsartan, 80-320 mg/day) or (B) calcium channel
blocker (amlodipine, 5-10 mg/day), for 12 weeks
immediately after baseline measurements. Serum
lipid profile levels of the patient groups were
measured before treatment and on the 12nd week.
RESULTS This study was performed on 50 patients
with newly diagnosed essential hypertension (group
A; n=28 and group B; n=22). In the amlodipine
group, there was a significant decrease in levels of
LDL-C (median LDL-C/ before-after: 136,4/125;
p<0.05) in comparison with valsartan. No
significant changes were observed in the levels of
TG, T-C, HDL-C after both drug arms.
CONCLUSION In this study, we observed a
beneficial effect of amlodipine on lipid profile with
a significant reduction of LDL-C in comparison to
valsartan. As a result, in the treatment of
hypertension, prior knowledge of the levels of
plasma cholesterol could be important in
antihypertensive drug choice.
Correspondence:
Gulhane Askeri Tıp Akademisi, İç hastalıkları
BD.Etlik 06080, Ankara/TURKEY.
Tel:+90 312 304 4007
GSM:+90 543 482 45 51
E-mail: drsahmet42@hotmail.com
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Internal Medicine, Ankara/TURKEY.
2. Gulhane Military Medical Academy, Dept. of
Cardiology, Ankara/TURKEY.
Objective. We report involvement of the heart in
patient with hypereosinophilic syndrome (HES).
Case. A 43-year-old female patient had chest pain,
progressing for a month and increasing exertional,
shortness of breath, fatigue, and a history of 10 kg
weight loss. Because of these complaints patient
admitted to the cardiology outpatient clinic.In
echocardiography, pericardial effusion, left
ventricular ejection fraction 38% and stage 3
diastolic dysfunction was detected. In coronary
angiography for the etiology of cardiomyopathy,
vascular pathology was not seen. In complete blood
count, white blood cell count were 11100/mm³ and
eosinophil were 30%. And also in peripheral blood
smear cells 22% eosinophils were seen. In the bone
marrow aspiration-biopsy examination eosinophils
were 20% of the myeloid progenitor cells. No
significant findings were observed for leukemic
infiltration. Cardiac examination for Advanced
Magnetic Resonance Imaging was performed. In
the delayed enhancement MRI all subendocardial
surface and surface of the interatrial septum facing
left atrium had late enhancement areas. Also late
enhancement areas was seen at the mid cardiac
section of inter ventricular septum. The patient with
Hipereosinophilia ongoing, the other causes of
height eosinophils were ruling out and cardiac MRI
findings as non-ischemic heart involvement was
evaluated as cardiac involvement in HES.
Conclusion. As a result, when patient who has
acute heart failure with eosinophilia as in our case
report, the cardiac involvement in HES should be
considered in the differential diagnosis.
Correspondence:
Gulhane Askeri Tıp Akademisi, İç hastalıkları
BD.Etlik 06080, Ankara/TURKEY.
Tel:+90 312 304 4007
203
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
GSM:+90 543 482 45 51
E-mail: drsahmet42@hotmail.com
together the relation between CAE and total
bilirubin at the least denominator of atherosclerosis.
PPO66
ASSESSMENT OF THE ASSOCIATION
BETWEEN
TOTAL
BILIRUBIN
AND
CORONARY ARTERY ECTASIA
Correspondence:
Gulhane Askeri Tip Akademisi, Iç Hastalıkları BD,
Etlik 06018, Ankara, TURKEY
Tel:+90 312 304 4015
Fax:+90 312 304 4001
GSM:+90 554 525 2246
e-mail: drmustafacakar@gmail.com
Authors:
MAJ DEMIRKOL Sait, MD1, 1LT BALTA Sevket,
MD1, COL BARCIN Cem, MD1, 1LT KUCUK
Ugur, MD1, 1LT CAKAR Mustafa, MD2, 1LT
AKHAN Muharrem, MD2, MAJ ARSLAN Erol,
MD2,
1LT
AY
S.Ahmet,
MD2,
COL
1
YOKUSOGLU Mehmet, MD
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Cardiology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Internal Medicine, Ankara, TURKEY
Objective. Coronary artery ectasia (CAE) has been
established as a localized or diffuse non-obstructive
lesion of the epicardial coronary arteries with a
luminal dilation exceeding 1.5-fold the normal
adjacent segment or vessel diameter. It is
accompanied by atherosclerotic coronary disease in
85% of the cases. The contact between CAE and
total bilirubin as an inflammatory marker has not
been investigated so far. We aimed to evaluate
levels of total bilirubin in patients with CAE.
Material and method. The study population
consisted of the patients who underwent coronary
angiography with suspected coronary artery disease
(CAD). We enrolled 115 consecutive patients with
CAD, normal coronary arteries (NCA) and CAE.
Total bilirubin was measured related with increased
vascular risk and events were investigated in the
groups determined by the presence or absence of
CAE and CAD. We studied total bilirubin in 37
individuals with CAE, 38 with CAD, and 40
controls with normal coronary arteries whose mean
ages were 53.2 ± 5.6, 51.4 ± 7.8, and 49.6 ± 8.6
years, respectively. RESULTS: There was no
significant difference in total bilirubin between
CAE and CAD groups. Total bilirubin was
significantly decreased in patients of both CAE and
CAD groups, compared to control group (P <
0.005, P < 0.005, respectively).
Conclusion. We have shown for the first time that
patients with CAE have lower total bilirubin
compared to controls with normal coronary
angiograms. The results of the present study bring
PPO67
ASSESSMENT OF THE ASSOCIATION
BETWEEN NEUTROPHYL/LYMPHOCYTE
RATIO AND CARDIAC SYNDROME X
Authors:
MAJ DEMIRKOL Sait, MD1, 1LT BALTA Sevket,
MD1, MAJ ARSLAN Zekeriya, MD1, MAJ UNLU
Murat, MD1, 1LT CAKAR Mustafa, MD2, 1LT
SARLAK Hakan, MD2, 1LT KARAMAN Murat,
MD2, LTC DEMIRBAS Seref, MD2, MAJ
ARSLAN Erol, MD2
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Cardiology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Internal Medicine, Ankara, TURKEY
Objective. Angina-like chest pain, a positive result
from a stress test, and normal coronary arteries are
characteristics of patients with cardiac syndrome X
(CSX). The ratio between neutrophils and
lymphocytes ratio (NLR) count has been studied as
a new predictor for cardiovascular risk. We aimed
to investigate NLR level in patients with CSX
compared to patients with CAD and normal
subjects.
Material and method. 288 subjects (92 patients
with CSX, 97 with coronary artery disease (CAD),
and 99 control subjects) were enrolled in the study.
Coronary arteries were evaluated by coronary
angiography. The study population consisted of 92
enrolled consecutive patients (37 men and 45
women, mean age=49.4 ± 9.5 years) with diagnosis
of CSX group having anginal chest pain with
ischemia on noninvasive stress test but normal
coronary angiographies. The CAD group consisted
of 85 subjects (41 men and 44 women, mean age=
50.3± 8.9 years) with CAD (at least stenotic lesions
≥ 50%). The control group consisted of 90 age- and
sex-matched individuals (42 men and 48 women,
mean age=47.2 ± 9.0 years) with atypical anginal
symptoms but normal myocardial perfusion
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
scintigraphy or nomal treadmill exercise test. N/L
ratios was compared among the 3 groups.
Results. There were no statistically significant
differences in N/L ratio levels between CSX and
CAD groups (p=0.17). N/L ratio was found
significantly increased in patients in both CSX and
CAD groups, compared to controls (p<0.01).
Conclusion. Our findings show that patients with
CSX have significantly increased N/L ratio levels.
Correspondence:
Gulhane Askeri Tip Akademisi, Iç Hastalıkları BD,
Etlik 06018, Ankara, TURKEY.
Tel:+90 312 304 4015
Fax:+90 312 304 4001
GSM:+90 554 525 2246
E-mail: drmustafacakar@gmail.com
PPO68
RIGHT
SIDED
COMPLEX
PARTIAL
ANOMALOUS
PULMONARY
VENOUS
RETURN ASSOCİATED WITH SINUS
VENOSUS ATRIAL SEPTAL DEFECT
Authors:
CPT AKAY Sinan, MD1, MAJ KARAMAN
Bulent, MD2, MAJ BATTAL Bilal, MD2, LTC
BOZLAR Ugur, MD2
Institutions:
1. Ankara Military Hospital, Anittepe Polyclinic,
Department of Radiology, 06580, Ankara,
TURKEY
2. Gulhane Military Medical Academy, Department
of Radiology, 06018, Ankara, TURKEY
Objective. Partial anomalous pulmonary venous
return (PAPVR) is a rare congenital anomaly
affects one or more right- or left-sided pulmonary
veins. Sinus venosus atrial septal defect (SVASD)
association of this anomaly may be also seen. In
this report, we have described unique, complex
PAPVR case that was not reported before in
medical literature shows segmental drainage
difference in the same lobe associated with
SVASD.
Materials and methods. A 30-year-old male
visited the cardiology department of our hospital
due to dyspnea and palpitation. 2/6 systolic murmur
at the pulmonary focus and fixed split S2 were
detected on auscultation. Right branch bundle block
was observed in electrocardiography. In
transthoracic echocardiography examination the
right heart cavities were dilated. SVASD was
204
detected in transesophageal echocardiography. In
the same examination, anomalous pulmonary
venous return to superior vena cava (SVC) was also
suspected and the patient was referred to radiology
department for pulmonary venous computed
tomography angiography (CTA) examination.
Results. Pulmonary venous CTA examination
demonstrated that combining apical and posterior
segment pulmonary veins of right upper lobe drain
into SVC via one ostium. Anterior segment of right
upper lobe and middle lobe pulmonary vein were
also draining into SVC-right atrium junction
separately at the level of SVASD. The atrial septal
defect size at the location of cavoatrial junction was
12 mm. Right lower lobe and left lung pulmonary
veins were draining into the left atrium as usual.
Right atrium and ventricle were mildly large.
CONCLUSION: In this report, we have described a
unique, complex PAPVR case that associates with
SVASD and its detailed CTA findings. We think
that CTA studies improve detection and detailed
characterization of PAPVR for diagnosis and/or
pre-surgical or interventional evaluation.
Correspondence:
Gulhane Military Medical Academy, Department of
Radiology, 06018, Ankara, Turkey
Tel: + 90 312 3044701
Fax: + 90 312 3044700
GSM: + 90 533 4330667
E-mail: bilbat_23@yahoo.com
PPO69
COMPARISON
OF
THE
DIASTOLIC
FUNCTIONS OF THE LEFT VENTRICLE
COMPUTED
BY
TWO
DIFFERENT
ACQUISITION MODALITIES
Authors:
MAJ
EMER
Ozdes,
MD¹,
KARACALIOGLU
A.Ozgur,
MD¹,
ALAGOZ Engin, MD¹, 1st LT INCE Semra,
GUNALP Bengul, MD¹, COL ARSLAN
MD¹, RDML OZGUVEN M.Ali, MD¹
COL
MAJ
MD¹,
Nuri,
Institution:
Gulhane Military Medical Academy, Ankara,
TURKEY
Objective. There is growing recognition that
congestive heart failure caused by a predominant
abnormality in diastolic function. Diastolic
dysfunction refers to a condition in which
abnormalities in mechanical function are present
during diastole. The aim of this study was to
compare the parameters of the diastolic function of
205
the left ventricle that were derived from planar
multigated analysis (MUGA) and gated blood pool
single photon emission tomography (gBPSPECT)
Material and method. 7 patients (all men; 52±8
years) were included in the study. After in vivo
labeling of red blood cells, patients underwent
MUGA and gBPSPECT analysis consecutively in
the same day. The parameters of the diastolic
functions were analyzed paired samples t-test.
Results: The results of the EF, PFR and PER
calculated by MUGA analysis were 36.71±9.16,
1.63±0.67, and 2.14±0.57, respectively. The results
of the EF, PFR and PER calculated by gBPSPECT
analysis were 41.57±14.62, 1.42±0.51 and
1.7±0.71, respectively. There were not statistically
significant difference between the parameters of
EF, PFR and PER that they were computed by
MUGA and gBPSPECT (p=0.215, p=0.379,
p=0.082, respectively). The correlations between
the same parameters calculated by two different
modalities were also good (r(EF):0.789,
r(PFR):0.536, and r(PER):0.621).
Conclusion. Although the modalites of planar
MUGA and gBPSPECT are completely different,
the results of the diastolic function parameters such
as EF, PFR and PER are found to be similar and
there seems to be good correlation between these
two different modalities.
Correspondence. Gulhane Askeri Tıp Akademisi,
Nükleer Tıp AD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 4807 (w)
Fax: + 90 312 304 4800 (w)
GSM: + 90 535 621 3077
E-mail: moemer@gata.edu.tr
PPO70
DOES
VALSARTAN
IMPROVE
ENDOTHELIAL
DYSFUNCTION
AND
VASCULAR MİCROINFLAMMATION?
Authors:
1LT KARAMAN Murat, MD1, 1LT AY S.Ahmet,
MD1, 1LT KURT Omer, MD1, COL CELİK
Turgay, MD2, CDR YAMAN Halil, MD3, CPT
HONCA Tevfik, MD3, COL YİLMAZ M.Ilker,
MD4, MAJ ARSLAN Erol, MD1, LTC
DEMİRBAS
Seref,MD1,
COL
SAGLAM
1
Kenan,MD
Institutions:
1. Gulhane Military Medical Academy,Dept. Of
İnternal Medicine Ankara/TURKEY
2. Gulhane Military Medical Academy,Dept. Of
Cardiology Ankara/TURKEY
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
3. Gulhane Military Medical Academy,Dept. Of
Biochemistry Ankara/TURKEY
4. Gulhane Military Medical Academy,Dept. Of
Nephrology Ankara/TURKEY
Objective. In this study, we aimed to investigate
the effects of valsartan molecule as one of
angiotensin receptor blockers (ARB), on vascular
endothelial dysfunction and microinflammation in
patients with essential hypertension.
Material and method. 34 patients who are newly
diagnosed with essential hypertension and valsartan
treatment was started in internal medicine and
cardiology outpatient clinics, were included in the
study. VWF as a marker of endothelial dysfunction
and hscrp, pentraxin 3(Ptx3) for vascular
microinflammation were studied.
Results. After twelve-week follow-up, a total of 28
patients (M:6, F:22)(stage-1:13 patient, stage-2: 15)
who were received only valsartan, were evaluated.
Marked improvement in the level of vWF was
observed in all patients (change: 69% reduction, p =
0.000). Ptx3 and hscrp levels were decreased. But,
while the fall in the value of ptx3 was significantly,
hsCRP fall was not (respectively of change: 53%, p
= 0.000 and change: 4%, p = 0.738).
Conclusion. Endothelial dysfunction is an effective
marker for detection of cardiovascular disease. In
our study; the improving effects of valsartan
treatment on endothelial dysfunction and
microinflammation was detected. A reduction of
69% was found in VWF values compared to
pretreatment, that was significantly. Also, a
reduction of 53% compared to pretreatment value
of ptx3 and a reduction of 4% in hsCRP were
observed. Considering the positive results; it can be
said that the therapies aimed this blokage are more
rational.
Correspondence:
Gulhane Askeri Tıp Akademisi, İç hastalıkları
BD.Etlik 06080, Ankara/TURKEY. Tel:+90 312
304 4007
GSM:+90 555 489 53 94
E-mail: drmuratkaraman@gmail.com
PPO71
THE EFFECTS OF AMLODİPİNE ON
ENDOTHELİAL
DYSFUNCTİON
AND
VASCULAR MİCROİNFLAMMATİON
Authors:
1LT KARAMAN Murat, MD1, 1LT AY S.Ahmet,
MD1, 1LT KURT Omer, MD1, COL CELİK
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Turgay, MD2, CDR YAMAN Halil, MD3, 1LT
AGILLI Mehmet, MD3, COL YILMAZ M.Ilker,
MD4, MAJ ARSLAN Erol, MD1, LTC
DEMİRBAS
Seref,MD1,
COL
SAGLAM
1
Kenan,MD
Institutions:
1. Gulhane Military Medical Academy,
İnternal Medicine, Ankara/TURKEY
2. Gulhane Military Medical Academy,
Cardiology, Ankara/TURKEY
3. Gulhane Military Medical Academy,
Biochemistry, Ankara/TURKEY
4. Gulhane Military Medical Academy,
Nephrology, Ankara/TURKEY
Dept. Of
Dept. Of
206
E-mail: drmuratkaraman@gmail.com
PPO72
INCIDENTALLY DIAGNOSED ASYMPTO
MATIC ATRIAL SEPTAL DEFECTS IN
AIRCREW
Authors:
COL OZTURK Cengiz, MD1, LTC SEN Ahmet,
MD2, COL AKIN Ahmet, MD2, MAJ CAKMAK
Tolga, MD2, CPT METIN Suleyman, MD2
Dept. Of
Dept. Of
Objective. In this study, we aimed to evaluate the
effects of amlodipine in patients with essential
hypertension, endothelial dysfunction and microinflammation.
Material and method. 27 patients that are newly
diagnosed with essential hypertension and given
amlodipine treatment in internal medicine and
cardiology outpatient clinics, were included in the
study.After 3 months, the patients were called for
control. Endothelial dysfunction and systemic
inflammation were evaluated with VWF, PTX3 and
hsCRP.
Results. At the end of 3rd month, 22 patients (M: 9,
K: 13) (stage1:12, stage2:10 patients) were
evaluated. Regulation of ABP were provided for all
patients. A very significant reduction was observed
at VWF levels and it was interpreted as in favour of
the effectiveness of the therapy (ranges: - 72%, p =
0.000). PTX3 and hsCRP levels that are assessed as
a marker for vascular microinflammation, were
decreased significantly (change: - 43%, P = 0.006,
change:- 24%, p = 0.041).
Conclusion. Micro-inflammation and endothelial
dysfunction in hypertensive patients is listed among
the causes of cardiovascular morbidity and
mortality. In our study, compared with pretreatment
values; there was a reduction of 72% at VWF
levels; PTX and hsCRP levels were decreased when
compared to baseline levels respectively by 43%
and 24%. In this study,it is shown that when a
sufficient dose of amlodipine therapy was used
effectively, endothelial dysfunction and microinflammation was reduced.(p <0.05)
Correspondence: Gulhane Askeri Tıp Akademisi,
İç hastalıkları BD.Etlik 06080, Ankara/TURKEY
Tel:+90 312 304 4007
GSM:+90 555 489 53 94
Institutions:
1. Eskisehir Military Hospital, Dept. of Cardiology,
Eskisehir, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
Objective. We present two asymptomatic cases of
atrial septal defect (ASD) diagnosed at 5 yearly
aeromedical exam.
Material and method. 32-year-old male
maintenance technician and 37-year-old male
helicopter technician visited our center to have 5
yearly aeromedical exam which consists of physical
exam, chest x-ray, electrocardiography and
biochemical analysis.
Results. Case 1: The electrocardiogram of 32-yearold male maintenance technician revealed complete
right bundle branch block along with a regular
sinus rhythm. Physical exam showed paradoxical
splitting of S2. Biochemical analysis was normal.
Chest x-ray showed mild increase in pulmonary
conus.
Transthoracic
echocardiography
demonstrated enlargement in right heart volumes,
mild tricuspid insufficiency, pulmonary artery
pressure of 27mmHg and 3.6cm defect in interatrial
septum with left-right shunt, no Eisenmenger
development yet (QP/QS:2,3). Left ventricule
systolic and diastolic functions were normal. Pt was
referred to cardiac surgery center and ASD repair
was performed with an open heart operation. Case
2: The electrocardiogram of 37-year-old male
helicopter technician revealed complete right
bundle branch block along with a regular sinus
rhythm. Physical examination, chest x-ray and
biochemical analysis were normal. Transthoracic
echocardiography showed no enlargement in right
heart volumes, but mild tricuspid insufficiency,
pulmonary artery pressure of 27 mmHg; 3 mm and
5 mm defects, in interatrial septum, both with left to
right shunt, but no Eisenmenger development yet
(QP/QS:1,5). Left ventricule systolic and diastolic
functions were normal. Pt was treated with ASD
repair via percutaneous Amplatz occluder.
207
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Conclusion.
Transthoracic
echocardiography
performed in 5 yearly aeromedical examinations is
quite useful in diagnosing unnoticed conditions.
both pilots were allowed to return to flight duties.
They have been flying for one year without having
any health problem.
Correspondence:
Doc.Hv.Tbp.Alb. Cengiz OZTURK Eskisehir
Military Hospital, Dept. of Cardiology, 26035,
Eskisehir, TURKEY
Tel: + 90 222 220 45 30
Fax: + 90 222 220 34 33
E-mail: drcengizozturk@yahoo.com.tr
Conclusion. An electrical conduction system
abnormality detected in surface electrocardiography
may reveal a conduction disease as an underlying
cause or it can be seen in a totally healthy
individual. EPS can be performed on aircrew as an
effective and dependable method in order to decide
whether they are fit to fly.
PPO73
THE RESULTS OF ELECTROPHYSIO
LOGICAL STUDY OF TWO JET PILOTS
WITH
ELECTRICAL
CONDUCTION
SYSTEM ABNORMALITIES DETECTED IN
SURFACE ELECTROCARDIOGRAPHY
Correspondence:
Doc.Hv.Tbp.Alb. Cengiz OZTURK Eskisehir
Military Hospital, Dept. of Cardiology, 26035,
Eskisehir, TURKEY
Tel: + 90 222 220 45 30
Fax: + 90 222 220 34 33
E-mail: drcengizozturk@yahoo.com.tr
Authors:
COL OZTURK Cengiz, MD1, CPT METIN
Suleyman, MD2, MAJ CAKMAK Tolga, MD2,
COL AKIN Ahmet, MD2, LTC SEN Ahmet, MD2
Institutions:
1. Eskisehir Military Hospital, Dept. of Cardiology,
Eskisehir, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
Objective. We present the electrophysiological
study results showing electrical conduction system
abnormalities including junctional rhythm and
extrasystole that are incidentally detected in two jet
pilots applying for periodic aeromedical
examination.
Material and method. Both cases were 24-yearold male F-5 jet pilot. The first pilot had frequent
atrial extrasystoles in his electrocardiography
(ECG). Atrial extrasystoles originated from the
right atrial appendage were seen by performing
incremental atrial pacing and was treated with
radiofrequency ablation. The second pilot had
normal sinus rhythm and also short duration
junctional rhythm observed in his ECG.
Results. Both pilots applied to our department with
electrical conduction system abnormality. They had
no
significant
medical
history.
Physical
examination and biochemical tests revealed no
abnormality.
Transthoracic
echocardiography
showed no structural heart disease. 24-hour rhythm
Holter monitoring records showed frequent atrial
extrasystoles in the first case and rare junctional
rhythms in the second case. The EPS showed
normal sinus and AV Node functions for both. So
PPO74
BIOMARKERS IN PREDICTION OF SIXMONTH LEFT VENTRICULAR SYSTOLIC
FUNCTION IN PATIENTS WITH STSEGMENT MYOCARDIAL INFARCTION
TREATED WITH PRIMARY PERCUTA
NEOUS CORONARY INTERVENTION
Authors:
Col. Prof. Gligic B1, Lt Col Romanovic R1, Lt Col.
Assoc. Prof. Obradovic S1, Djenic N1, Cap
Dzudovic B1, Maj Jovic Z2, Col Markovic M1,
Ristic A1, Col Assoc. Prof. Dincic D, Prof.
Rafajlovski S1,
Institutions:
1. The MMA’s Clinic for Emergency Medicine
2. The MMA’s Clinic for Cardiology, The Medical
Faculty of the University of Defence, Belgrade,
SERBIA
Background. Few hours upon ST-elevation
myocardial infarction (STEMI), creatine kinaseMB fraction (CK-MB), lactate dehydrogenase
(LDH) and C-reactive peptide (CRP) progressively
arise in a bloodstream.
Objective: To estimate the prognostic character of
maximal measured values of CK-MB, LDH and
CRP on a six-month left ventricular (LV) systolic
function in patients with STEMI treated with
primary percutaneous intervention (PCI).
Methods: 88 consecutive patients with STEMI
treated with primary PCI were enrolled in this
study. CK-MB, LDH and CRP were measured on
admission and on every 6 hours on the first day
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
(CK-MB and LDH), and once on the second and
third day after admission. Transthoracic ultrasound
was used to estimate the six-month LV systolic
function
through
ejection
fraction
(EF)
measurement.
Results: The six-month median EF in a group of
patients within 2nd (210-374.4 u/L) vs. 3rd (>374.4
u/L) tercile of maximal measured CK-MB was 49%
vs. 40%, respectively; p=0.03 and in 1st (<210 u/L)
vs. 3rd tercile: 51% vs. 40%, respectively; p <
0.001. After logarithmic adjustment of maximal
CRP values there was no significant difference in
the six-month EF. The six-month median EF in 1st
(<1270,7u/L) vs. 2nd (1270,7-1740,3u/L) vs. 3rd
(>1740,3u/L) tercile of maximal measured LDH
was: 54% vs. 45% vs. 37%, p=0.002 and p=0.005
respectively, and 1st vs. 3rd tercile (p<0.001). In a
multiple regression analysis maximal concentration
of LDH was the strongest independent predictor of
the six-month EF (p<0.001).
Conclusion: Maximal value of LDH after STEMI
treated with primary PCI is better predictor of the
six-month LV systolic function than CK-MB and
CRP.
PPO75
THE
METABOLIC
SYNDROME
CARDIOVASCULAR DISEASE
AND
Author:
Đurić dr Predrag
Institution:
Military Medical Academy – Clinic for Cardiology,
Belgrade, SERBIA
Introduction. The metabolic syndrome (MetS) is a
complex disorder, a term used to describe a
clustering of metabolic and physiologic risk factors
for both type 2 diabetes mellitus and atherosclerotic
cardiovascular diseases (ASCVD). The new IDF
criteria recommends that at least 3 of the following
5 elements should be present: increased waist
circumference (≥ 94 cm in men and ≥ 80 cm in
women), hypertriglyceridemia (≥ 1,7 mmol/l or on
drug treatment), low HDL cholesterol (< 1,03
mmol/l in men and < 1,29 mmol/l in women or on
drug treatment), hypertension (≥ 130 mmHg
systolic and ≥ 85 mmHg diastolic or on drug
treatment), and a fasting glucose ≥ 5,6 mmol/l or
diagnosed diabetes mellitus on drug treatment.
Other conditions that may promote the metabolic
syndrome include sedentary lifestyle, aging,
hormonal imbalance, and genetic or ethnic
predisposition. Prospective population studies
208
suggest that the metabolic syndrome is associated
with approximately a twofold increase in relative
risk for atherosclerotic cardiovascular disease, and
a fivefold increase in risk for developing diabetes.
Methods. Insulin resistance is a generalized
metabolic disorder, in which the body can’t use
insulin efficiently, and some people are genetically
predisposed to insulin resistance, who has a
negative effect on lipid production, increasing
VLDL (very low-density lipoprotein), LDL (lowdensity lipoprotein), and triglyceride levels in the
bloodstream and decreasing HDL (high-density
lipoprotein). This can lead to fatty plaque deposits
in the arteries which, over time, can lead to
cardiovascular disease and strokes. Lifestyle
interventions deserve prime consideration for risk
reduction across a lifetime; these interventions
include weight control, increased physical activity,
and a diet designed to reduce the risk for ASCVD.
Goals for lifestyle intervention for abdominal
obesity are to reduce body weight by 7% to 10%
during the first year of treatment and continued
weight loss thereafter to achieve desirable weight
(body mass index, < 25 kg/m 2) and waist
circumference of less than 94 cm for men and less
than 80 cm for women. Recommended physical
activity is of moderate intensity for 30 to 60
minutes five to seven days a week. Diet should
reduce intakes of saturated fat (< 7% of total
calories), trans fat, cholesterol levels (< 200
mg/day), and total fat (25% - 35% of total calories).
In people for whom lifestyle change is not enough
and who are considered to be at high risk for CVD,
drug therapy may be required to treat the metabolic
syndrome.
Several clinical studies have confirmed the benefits
of statin therapy and fibrates. Hypertension (BP ≥
140/≥ 90 mm Hg) should be treated according to
the JNC 7 recommendations: in patients with
established diabetes, antihypertensive therapy
should be introduced at BP ≥ 130/≥ 80 mm Hg.
Angiotensin converting enzyme inhibitors and
angiotensin receptor blockers are useful
antihypertensive drugs, with clinical trials
suggesting they carry advantages over other drugs
in patients with diabetes. There is growing interest
in the possibility that drugs that reduce insulin
resistance will delay the onset of type 2 diabetes
and will reduce CVD risk when metabolic
syndrome is present. The Diabetes Prevention
Program (DPP) showed that metformin therapy in
patients with prediabetes will prevent or delay the
development
of
diabetes
and
recent
thiazolidinedione studies have also demonstrated
efficacy in delaying or preventing type 2 diabetes in
209
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
patients with impaired glucose tolerance (IGT) and
insulin resistance.
− Other coronary anatomy not amenable to
percutaneous intervention
Conclusion. The metabolic syndrome (MetS) is a
prothrombotic state (e.g., high fibrinogen or
plasminogen activator inhibitor–1 in the blood) and
proinflammatory state (e.g., elevated C-reactive
protein in the blood). Metabolic syndrome is
associated with a twofold increase in relative risk
for ASCVD, and a fivefold increase in risk for
developing diabetes. The primary goal of clinical
management of the metabolic syndrome is to
reduce the risk for cardiovascular disease and type
2 diabetes.
Methods. Acute myocardial infarction (STEMI).
Intracoronary thrombosis is the primary mechanism
of vessel occlusion in acute myocardial infarction
and prompt restoration of vessel patency provides
significant clinical benefit. Thrombolytic therapies
open approximately 80% of infarct-related vessels
within 90 minutes, but only 50% will have normal
(TIMI grade 3) flow. In addition, 10% of vessels
opened by thrombolysis either reocclude or are the
source for recurrent symptoms of angina. Because
of these limitations to thrombolytic therapy, PCI
has severel advantages in the setting of acute
myocardial infarction. An analysis of 23 trials
confirms the superiority of primary angioplasty
over fibrinolytic therapy in terms of adverse events
and mortality reduction both in the short and long
term. Improvements in catheter technique and the
development of new devices, wires, stents, drugeluting stents, and medications (dual antiplatelet
therapy with ticagrelol or prasugrel or clopidogrel
and aspirin reduces major CV events in patients
with established ischemic heart disease) have
occurred parallel to advances in the understanding
of cardiovascular physiology, the pathogenesis of
atherosclerosis, and the body's response to vascular
injury. The management of patients with non ST
elevation myocardial infarction (NSTEMI) has
changed considerably over the past 5 years. Clinical
indications to pPCI are: recurrent resting pain,
dynamic ST segment changes, eleveted Troponin I,
CK-MB levels, haemodynamic instability, major
arrhythmias, early post infarction unstable angina
and diabetes mellitus. In the situation where
patients are transferred from outside hospitals,
primary angioplasty is often preferred to onsite
fibrinolytic therapy for patients with the following:
expected door-to-balloon time less than 90 minutes
and symptom duration less than 3 hours, symptom
duration more than 3 hours, cardiogenic shock,
contraindications to fibrinolytic therapy, and age
older than 75 years.
Conclusion: PCI has transformed the practice of
revascularization for coronary artery disease
(CAD), evolving into an effective nonsurgical
modality for treating patients. Acording to recent
studies primary PCI was associated with significant
reductions in death , recurrent myocardial
infarction, reinfarction, and the combined end point
of death, myocardial infarction, and stroke. The
time is essentiale for effective primary PCI.
PPO76
PERCUTANEOUS CORONARY INTERVEN
TION
IN
ACUTE
MYOCARDIAL
INFARCTION
Authors:
Đurić dr Predrag
Institution:
Military Medical Academy – Clinic for Cardiology,
Belgrade, SERBIA
Introduction: The use of percutaneous coronary
intervention (PCI) has increased dramatically
during the last decade, becoming one of the most
common medical interventions performed. Initially
used in the treatment of patients with stable angina
with single lesions in coronary arteries, PCI has
multiple indications today: unstable angina, acute
myocardial infarction (MI), and multivessel
coronary artery disease. Other key factors include
sophisticated equipment, experienced operators,
and modern adjunctive drug therapy. Clinical
indications to PCI: acute ST elevation myocardial
infarction (STEMI), non ST elevation myocardial
infarction (NSTEMI), stable angina, anginal
equivalent
(eg,
dyspnea,
arrhythmia,
dizziness/syncope), asymptomatic or mildly
symptomatic patients with objective evidence of a
moderate to large area of viable myocardium or
moderate to severe ischemia on noninvasive testing.
Clinical contraindications to PCI include significant
comorbidities
(relative
contraindication).
Angiographic
indications
to
PCI
are
hemodynamically significant lesion in a vessel
serving viable myocardium (vessel diameter >1.5
mm), and angiographic contraindications are:
− Left main stenosis in a patient who is a surgical
candidate (however, this area is rapidly evolving
toward safe and feasible PCI options.)
− Diffusely diseased small-caliber artery or vein
graft
PPO77
ACUTE RENAL FAILURE ASSOCIATED TO
NIGELLA SATIVA IN A DIABETIC PATIENT
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Authors:
MAJ ARSLAN Erol, MD1, CPT SAYIN Selim,
MD1, LTC DEMIRBAS Seref, MD1, 1LT CAKAR
Mustafa, MD1, 1LT SOMAK N.Gokce, MD1, MAJ
YESILKAYA Sirzat, MD2, COL SAGLAM Kenan,
MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Internal Medicine, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Family Medicine, Ankara, TURKEY
Objective. The antidiabetic effect of Nigella sativa
(N. Sativa) is known to occur by reducing hepatic
glucose output. Though it is known with
antioxidant effects, here we present a case of acute
renal failure after use of N. sativa.
Case. A 62-year-old female patient had diabetes
mellitus for 12 years, coronary artery disease and
hypertension for 1 year. She was hospitalized due
to deterioration of her glycemic control. Laboratory
evaluation of the patient was normal. Her insulin
doses were adjusted for the regulation of glycemia.
On the third day of admission, urea was 65 mg / dl,
creatinine: 1.39 mg/dl, and on the sixth day; urea:
1.85 mg/dl, creatinine: 89 mg/dl. On urinary
ultrasound examination, there was no pathology to
cause acute renal failure. Urinary Na was 95
mmol/L. With continuing use of her same previous
drugs and no addition of any new one, the patient
was questioned again in detail in terms of any other
toxic drug intake. Thus, a fact emerged that she
used approximately 2000-2500 mg / day N. sativa
capsules. Following the cease of the agent, urea
declined to 42 mg / dl, and creatinine was 1.17 mg /
dl. The patient's mentioned acute renal failure was
thought to be due to the use of N. Sativa.
210
Authors:
DRANDARSKA Ivanka MD, MIHOVA Anna MD
PhD
Institution:
Military Medical Academy,
Pathology, Sofia, BULGARIA
Department
of
Solitary fibrous tumour of the pleura /SFTP/is a
rare tumour. In most cases, the case of a
asymptomatic
tumour
mass,
discovered
accidentally in the review, which is often larger.
Over 70% of cases it is a benign disease. Malignant
cases of SFTP are rare, where occurrence of relapse
is over 60%. We present a clinical case of 63 year
old woman with SFTP. The tumour is accidentally
discovered in X-ray and subsequently performed
resection of the tumour with the adjacent
pulmonary
parenchyma.
Pathohistological
diagnosis
was
with
the
help
of
immunohistochemical study with abroad spectrum
of antibodies.
PPO79
THE ROLE OF INTEGRATED [18F]FLUORO-2-DEOXY-D-GLUCOSE POSITRON
EMISSION
TOMOGRAPHY
(PET)/
COMPUTED TOMOGRAPHY (CT) IMAGING
IN
STAGING
AND
RADIOTHERAPY
TREATMENT VOLUME DEFINITION OF
NON-SMALL
CELL
LUNG
CANCER
(NSCLC)
Authors:
COL BEYZADEOGLU Murat, MD1, CPT
DINCOGLAN Ferrat, MD1, CPT SAGER Omer,
MD1, DIRICAN Bahar, PhD1, COL ARSLAN
Nuri, MD2, COL OYSUL Kaan, MD1, COL
SURENKOK Serdar, MD1
Conclusion. In diabetic patients, we think that the
use of N. Sativa 2000-2500 mg/day may be
nephrotoxic. In diabetic patients with acute renal
failure, the use of herbal medicine and especially N.
Sativa should be questioned.
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Radiation Oncology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Nuclear Medicine, Ankara, TURKEY
Correspondence: Gulhane Askeri Tip Akademisi,
Iç Hastalıkları BD, Etlik 06018, Ankara, TURKEY
Tel:+90 312 304 4015
Fax:+90 312 304 4001
GSM:+90 505 828 2624
E-mail: earslan89@yahoo.com
Objective. The aim of this study is to evaluate the
impact of integrated Positron emission tomography
(PET)/Computed tomography (CT) imaging on
staging and radiotherapy treatment volume
definition of non-small cell lung cancer (NSCLC).
PPO78
CLINICAL CASE OF SOLITARY FIBROUS
TUMOR OF THE PLEURA
Material and method. Thirty-nine patients with
NSCLC referred to our department for radical
radiotherapy between June 2011 and December
2011 were enrolled in this study. All patients
211
underwent integrated PET/CT imaging in treatment
position for initial assessment. For patients deemed
suitable for radical radiotherapy, CT-based and
integrated PET/CT imaging based radiotherapy
treatment plans were generated to comparatively
evaluate dose-volume parameters of both plans.
Results. Out of the 39 patients initially assessed
with integrated PET/CT imaging, 29 patients
(74.4%) were deemed suitable for radical
radiotherapy with curative intent. Fifteen patients
(38.5%) were upstaged after integrated PET/CT
staging. Of the 29 patients treated with radical
radiotherapy at our department using integrated
PET/CT imaging based radiation treatment
planning (RTP), gross tumor volume was decreased
in 16 patients (55.2%) and increased in 13 patients
(44.8%) by incorporating PET/CT into RTP.
Conclusion. Integrated PET/CT imaging allows
selection of patients eligible for radical
radiotherapy along with tailoring of radiotherapy
target volumes to prevent overtreatment and
undertreatment.
Correspondence: Gulhane Askeri Tıp Akademisi,
Radyasyon Onkolojisi AD, Etlik 06018, Ankara,
TURKEY, Tel: +90 312 304 4681 Fax: +90 312
304 4680 GSM: +90 535 942 2726
e-mail: mbeyzadeoglu@yahoo.com
PPO80
3-DIMENTIONAL – “RADIOBIOLOGIC”
DOSIMETRY (3D-RD) IN PATIENTS WITH
METASTATIC FOCI OF DIFFERENTIATED
THYROID CANCER
Author:
Lt Col Daniel Chatzifotiadis, MD
Institution:
Director of Nuclear Medicine Division of 251
Hellenic Air Force Hospital, Athens, GREECE
Purpose: To investigate the use of a new way of
calculation of the appropriate estimated dose of
radioactive Iodine-131(131I) in patients with
differentiated thyroid cancer and with brain and
lung metastases after surgery in thyroid bed.
Material: A DS7 –Sophy γ-camera and a 3000
Captus Thyroid Uptake and Well -type system had
used in the current study, in order to obtain the
Whole Body Scans and the measurements of the
radioactivity of the blood samples. The patients
were administered 2.5 mCi 131I after withdrawal of
their T3 therapy. Blood was collected at 4,24,48
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
and 72 hours after the administered 131I and the
WB scans(with SPECT images) followed
immediately after .CT was taken place one day
before the whole procedure. Two (2) patients were
selected for the 3D Imaging based Dosimetry, the
first was 46 year old with neck and disseminated
lung metastases and the second was 70 year old
with all the previously mentioned plus brain and
pleura.
Results: With the estimated clearance rate from
time activity curve of the consecutive four (4) scans
and the activity (SPECT) and density (CT) maps
we had estimated the recommended administered
dose activity in order to deliver the lower dose to
the normal tissue and the maximum tolerated to the
malignant tissue wherever it was.
Conclusion: The patient-specific 3D dosimetry
method is the most exact method to calculate the
administered therapeutic dose of 131I in patients
with lung and brain metastases of differentiated
thyroid cancer.
PPO81
A CASE OF PULMONARY INFLAMMA
TORY
PSEUDOTUMOR
INVASED
MEDIASTINUM AND ENCOUNTERED AS
FEVER OF UNKNOWN ORIGIN
Authors:
MAJ GUNAL Emine, COL BESIRBELLIOGLU
Ahmet Bulent, COL AVCI Ismail Yasar, BG
EYIGUN Can Polat
Institutions:
Infectious Disease and Clinical Microbiology,
Gulhane Military Medical Academy, Ankara,
TURKEY
Objective. Inflammatory myofibroblastic tumor
(IMT) is a proliferative lesion which is rarely seen,
not having a precisely known etiology, showing
reactive pseudoneoplastic characteristics. Its
radiographic appearance is nonspecific and it is
diagnosed based on histopathology. Excisional
biopsy is usually required for diagnosis. It is seen
predominantly in lungs. Surgical excision, steroids,
radiotherapy and/or chemotherapy are sufficient in
treatment. The aim of this case is to emphasize the
importance in differential diagnosis of fever of
unknown origin and chronic lung infections by
infection specialists.
Case. The patient is a 65-year-old female with
fatigue, anorexia, fever, sweating, cough, sputum,
chest pain for 3 months. She had subfebril fever,
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
212
tachypnea (50/dk), mild leukocytosis, elevated
transaminase, sedim (120mm / H) and CRP (++++)
levels. When Hiller fullness were seen on lung
radiography, thorax computed tomography was
performed and soft tissue masses between 1 and 3
cm. on both lung paranchyma, pleural thickening,
many hiller mediastinal lymphadenopathies and
mass in azygo-esophageal recess were detected.
Positron Emission Tomography was thought as
malignant character due to the increased metabolic
activity and to be spread to the lymph nodes.
Patology of the bronchoscopic transbronchial
needle aspiration was consistent with chronic
bronchitis. Transthoracic needle aspiration smears
were hypocellular with reactive pneumocytes. At
last, the diagnostic thoracotomy was performed and
pathology of excisional biopsy was active chronic
inflammation, fibrosis, organized pneumonia. Then
empirical rifampicin, doxycycline, TMP-SMX
treatment was given for one month. The control
tomography showed persistency and progresion and
so lesions were re- evaluated by pathology.
Pulmonary IMT was diagnosed this time and she
was refered to Oncology.
Conclusion. As it can be seen, if pathologists aren’t
directed well by clinicians, diagnosis can be missed
easly for pulmonary-mediastinal IMF so it’s very
rare. Pulmonary IFM should be known well by
clinicians so serious invasive procedures are needed
to diagnose and it can be easly confused with
chronical lung infections.
Correspondence:
Emine Gunal Gulhane Military Medical Academy,
Ankara, TURKEY
GSM : + 90 5052335296
e-mail : egunal@gata.edu.tr
PPO82
EFFECTS
OF
THE
ALTITUDE
PULMONARY FUNCTIONS
ON
Authors:
CPT YILDIZ Safak, MD¹, CPT ATA Nazim, MD²,
CPT ERCAN Erdinc, MD²
Institutions:
1. Eskisehir Military Hospital, Dept. Of Pulmonary
Medicine, Eskisehir, TURKEY
2. Aircrew's Health, Research and Training Center,
Eskisehir, TURKEY
Objective. As the altitude increases the air pressure
and partial oxygen pressure decrease. If precautions
aren’t taken against the decrease of the oxygen
pressure, hypoxia influences the pilots. In our
study, we examined the affects of the altitude on
pulmonary functions.
Material and method. 40 pilot candidates were
included. Their FEV1 and PEF values were
measured before they entered high altitude
chamber. The values also measured in the high
altitude chamber at 8000 feet altitude and after the
training.
Results. Mean values of all subjects were before
training PEF(BTP):537.45±100.94; at 8000 feet
PEF(8000FP):517.02±116.77;
after
training
PEF(ATP):548.08±102.82;
before
training
FEV1(BTF):3.56±0.68;
8000
feet
FEV1(8000FF):3.22±0.71;
after
training
FEV1(ATF): 3.42±0.70. Analysis of all subjects
showed that the mean of 8000FF group was lower
than BFF mean value and the differences between
groups were statically significant (p<0.05).
Differences between PEF groups were not statically
significant (p>0.05). When we grouped all subjects
according to their smoking habits, in smokers group
mean of 8000FF was lower than BFF mean value
and the differences between groups were statically
significant(p<0.05). And also in smokers group,
mean of ATF was higher than 8000FF mean value
and the differences between groups were statically
significant (p<0.05).
Conclusion. In our study, changes in FEV 1 values
between two altitudes were statistically significant.
When the effect of smoking on FEV1 decline
examined; in smoker group there was statistically
significant difference, but this difference was not
observed in non-smokers. This result showed that
the adverse effects of high altitude on the values of
FEV1 may increase with smoking.
Correspondence: Hv.Tbp.Yzb. Safak Yildiz
Eskisehir Military Hospital, Dept. of Pulmonary
Medicine, Eskisehir, TURKEY
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
GSM: + 90 532 462 19 81
E-mail: safakmd@yahoo.com
PPO83
BULLOUS DISEASE OF LUNG IN FLIGHT
PERSONNEL: TWO CASES
Authors:
CPT YILDIZ Safak, MD¹, CPT ATA Nazim, MD²,
CPT ERCAN Erdinc, MD², CPT METIN
Suleyman, MD3
213
Institutions:
1. Eskisehir Military Hospital, Dept. of Pulmonary
Medicine, Eskisehir, TURKEY
2. Aircrew's Health, Research and Training Center,
Eskisehir, TURKEY.
3. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
Objective. A bulla is a large, air-containing space
within the lung parenchyma resulting from
destruction, dilatation, and confluence of airspaces
bronchioles. Bullae are larger than 1 cm in diameter
and are composed of attenuated and compressed
parenchyma. Bullae may be asymptomatic or give
rise to progressive dyspnea or chest pain.
Material and method. We analyzed two aircrews
who had pulmonary bullae which were diagnosed
while periodical medical examination.
Results. Our fist case was a 42-year-old, male
helicopter pilot. He had no complaints. On
auscultation, prolonged expiratory phase was noted.
In the pulmonary function test; restriction and small
airway obstruction detected. Multiple bullae were
detected in upper lobes of the lungs on high
resolution computerized tomography of the chest
(HRCT). Our second case was a 29-year-old, male
helicopter technician. He had no complaints and his
physical examination was normal. After a suspected
lesion had been seen in chest radiograph, HRCT
was taken. Atelectasis with fibrotic opacity in right
lower lobe and 1 cm diameter bulla was seen in the
left lower lobe on HRCT. As a final decision, two
aircrews were permanently restricted from flying.
Conclusion. Small air cysts/bullae usually do not
influence the gas exchange but large ones may
cause atelectasis by compressing surrounding
tissue. In aviation, as altitude increases, the bullae
expand and may cause spontaneous pneumothorax.
Ascending an altitude of 5000 feet causes 20% rise
in the volume of the bullae. Pulmonary bullae
which are generally asymptomatic at sea level may
cause serious problems in aviation.
Correspondence:
Hv.Tbp.Yzb. Safak Yildiz Eskisehir Military
Hospital, Dept. of Pulmonary Medicine, Eskisehir,
TURKEY
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
GSM: + 90 532 462 19 81
E-mail: safakmd@yahoo.com
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
PPO84
RUSSELL BODY GASTRITIS ASSOCIATED
WITH
HELICOBACTER
PYLORI
INFECTION
Authors:
Lieutenant Ν. Chaleplidis, Lieutenant Ζ. Almpanis,
Captain Κ. Avraam, Captain Μ. Tsantopoulos,
Lieutenant Colonel Κ. Revelos
Institution:
Pathology Department, 251 Hellenic Air Force
Hospital, GREECE
Purpose: We present a rare lesion of the gastric
mucosa which usually develops in association with
Helicobacter pylori (HP) gastritis, characterized by
the accumulation of plasma cells with cytoplasmic
eosinophilic inclusions (Russell bodies) in lamina
propria.
Material & Methods: A 76-year-old female
underwent gastroendoscopic examination and we
received three biopsy specimens measuring up to
0.3 cm.
Results: The microscopic examination showed bits
of gastric mucosa with heavy active chronic
gastritis. Within lamina propria many eosinophilic
globules were recognized, some of which were
found in the cytoplasm of plasma cells (Russell
bodies). The globules were positive for PAS and
PAS-D, while the cells with the inclusions stained
for CD138, CD79α, and for κ and λ light chains.
The accompanying lymphocytes stained for both
CD3 and CD20, while cytokeratin staining showed
no atypical epithelial cells in lamina propria.
Numerous HP organisms were found.
Discussion: Russell bodies are thought to be
aggregations of immunoglobulins inside the rough
endoplasmic reticulum of plasma cells, as a result
of a blockage in their normal secretion. This occurs
usually in neoplasms of plasma cell origin, but
rarely may also present in reactive lesions (e.g.
chronic gastritis). The density and uniformity of the
Russell body-containing plasma cells in standard
H/E sections, although a reactive lesion, can pose a
differential diagnostic problem from neoplastic
processes, such as plasmacytoma, monoclonal
gammopathy of undetermined significance, MALT
lymphoma, or ever signet-ring carcinoma.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
PPO85
AN ATYPICAL PRESENTATION OF COLON
CANCER WITH AN ATYPICAL PRESENTA
TION PATTERN DISSEMINATED SKIN
METASTASES
Authors:
COL ATAERGIN A Selmin MD1, LTC ERDEM
Gokhan MD1, MAJ KARADURMUS Nuri MD1,
COL ARSLAN Nuri MD2
1. Gulhane Military Medical Academy, Dept. of
Medical Oncology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Nuclear Medicine, Ankara, TURKEY
Introduction. Very few cases of colon cancer’s
atypical metastases are found in the literature.
Case: A 28-year-old male patient was diagnosed
poorly differentiated colon adeno carcinoma and
underwent a surgery. He was staged as T4N0M0
tumor and received two courses of FOLFOX-6
chemotherapy. Nodular skin lesions appeared and
were confirmed to be colon cancer metastasis.
Then, IFL-Bevacizumab was given for 5
chemotherapy cycles which resulted to achieve a
stable disease. Therefore Cetuximab was given for
8 weeks on a weekly schedule. However, this
treatment was discontinued after 1.5 months due to
intolerance to Cetuximab. During this wait and
watch period multinodular metastatic involvements
on whole body areas.
Fourth-line
chemotherapy
consisting
of
capecitabine and also paliative radiotherapy and
surgery were applied for metastatic lesions. Three
months later, under the treatment a PET/CT scan
demonstrated multiple metastatic large new lesions
on right axilla, right surrenal, abdomen skin and
pelvic fossa. Oxaliplatin together with capecitabine
was then started. Two months later, he was detected
a left palmar large ulserative painfull mass.
Chemotherapy together with local radiotherapy lead
to a partial remission. After 4 months, he
experienced motor and sensorial neuropathy in left
leg due to metastases in iliac and thoracolombar
vertebral bones. Oxaliplatin was then stopped and
paliative radiotherapy was applied on painfull bony
structures. Capecitabine and zoledronic acid
treatments were continued for two months but were
stopped when he presented with acute renal failure.
Under palliative care and oral chemotherapy, he
maintained his metastatic stage for up to six
months, until his death due to progression.
Conclusion. Colon cancer may be a long-term
cancer with current therapy modalities even in
214
metastatic stages. Multi-institutional collaborations
may provide to obtain larger data collection to
clarify best treatment options.
Correspondence: Gulhane Askeri Tip Akademisi,
Tıbbi Onkoloji BD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 4164
Fax: + 90 312 304 4150
GSM: + 90 536 640 10 20
E-mail: sataergin@gata.edu.tr
PPO86
COULD IT BE POSSIBLE TO ACHIEVE A
LONG-TERM SURVIVAL PERIOD IN
PATIENTS WITH RECTUM CANCER WITH
LIVER
METASTASES
WITH
MULTIMODALITY TREATMENTS?
Authors:
COL ATAERGIN A Selmin MD1, COL ARSLAN
Nuri MD2
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Medical Oncology, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Nuclear Medicine, Ankara, TURKEY
Introduction. Survival rate is low in cases with
colorectal cancer with liver metastases.
Material and method. A 55-year-old female was
diagnosed local-advanced rectum carcinoma and
underwent
surgery
after
neo-adjuvant
chemotherapy. Soon after, multiple liver metastases
were detected, therefore, 6 cycles of chemotherapy
with monoclonal antibody (MoAb) were applied
(irinotecan,
5-FU,
leucoverin
(IFL)
+
bevacizumab). A partial remission was achieved
and the patient refused further parenteral
chemotherapy. Therefore, capecitabine was given
for 8 months. Afterwards, progression was
developped in liver metastases, and 2nd
chemotherapy together with MoAb (5-FU,
lecoverin, oxaliplatin + bevacizumab) was given for
6 courses. Treatment was discontinued due to
oxaliplatin-induced neurotoxicity. Capecitabine
maintanance therapy was continued until she was
assessed as very good partial remission on her 1st
year and metastasectomy was performed. However,
two months later, new metastases were developped
in liver. Therefore, a 3rd line chemotherapy and
MoAb (capecitabine, irinotecan and bevacizumab)
was initiated. Chemotherapy was stopped earlier
due to acute pulmonary embolism and ileus, until
she was recovered after intensive care unit
medications. A control lung perfusion scintigraphy
215
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
was normal, thus, IFL + bevacizumab was restarted
together with low molecular weight heparin
prophylaxis. A control PET/CT after 2nd course
showed four metastatic lesions in liver. Oral
capecitabine + bevacizumab re-initiated due to
irinotecan intolerance. Two months after, a new
PET/CT showed just small abnormal FDG-uptakes
in liver. Then, a radioembolization using Ytrium-90
microsphres was performed. Necrosis in tumor sites
was observed on imaging studies. The patient is
still under the same maintenance therapy and good
performance score on her 30th month of follow-up.
Conclusion. Rectum cancer cases with limited
number of liver metastasis may be effectively
treated with multimodality and maintenance
therapy strategies.
Correspondence: Gulhane Askeri Tip Akademisi,
Tıbbi Onkoloji BD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 41 64
Fax: + 90 312 304 41 50
GSM: + 90 536 640 10 20
e-mail: sataergin@gata.edu.tr
PPO87
DISSEMINATED
COAGULABILITY IN
GASTRIC CANCER
INTRAVASCULAR
A METASTATIC
was initiated immediately a chemotherapy regimen
consisting of docetaxel, cisplatin and 5-FU together
with supports of fresh frozen plasma and
thrombocytes transfusions. After 4 courses of
chemotherapy the patient showed a partial
remission in clinical and laboratory settings.
However, he progressed fast and has died due to
massive gastrointestinal system bleeding after 5
months of the diagnosis.
Conclusion. DIC altough rare in gastric cancer may
result in death in 1 to 3 weeks, if not treated.
Palliative chemotherapy prolongs survival when
compared with best supportive care. Therefore,
chemotherapy
together
with
supportive
measurements,
without
hesitation
of
myelosuppression should be initiated as soon as
possible.
Correspondence: Gulhane Askeri Tip Akademisi,
Tıbbi Onkoloji BD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 4154
Fax: + 90 312 304 41 50
GSM: + 90 536 640 10 20
E-mail: gokhanerdem@gata.edu.tr
PPO88
MAGNETIC RESONANCE CHOLANGIO
PANCREATOGRAPHY (MRCP) FINDINGS
OF BILIARY HAMARTOMA
Authors:
LTC ERDEM Gokhan MD, COL ATAERGIN A
Selmin MD, MAJ KARADURMUS Nuri MD,
COL OZTURK Mustafa MD, BG ARPACI Fikret
MD
Authors:
CPT OZCAN Emrah, MD, MAJ KARAMAN
Bulent, MD, MAJ BATTAL Bilal, MD, 1st LT
BOZKURT Yalcin, MD
Institution:
Gulhane Military Medical Academy, Dept. of
Medical Oncology, ANKARA, TURKEY
Institution:
Gulhane Military Medical Academy, Department of
Radiology, 06018, Ankara, TURKEY
Introduction.
Disseminated
intravascular
coagulability (DIC) cases are fewly reported in the
literature. Fresh frozen plasma, trombocyte
transfusions as well as heparin treatments, altough
are among classical therapeutic approaches, do
usually not achieve good results.
Objective. Biliary hamartoma also known as van
Meyenburg disease is rare ductal plate anomaly
usually seen in adults with multiple cystic lesions
not communicating to biliary tree. Magnetic
resonance cholangiopancreatography (MRCP) has
been considered to highly sensitive in evaluating
intra- and extra-hepatic bile duct disease recently.
The cystic lesions seen in biliary hamartoma has no
communications with biliary tree and MRCP
images with thick slice can show this with great
quality. The aim of this case report is to present
MRCP imaging findings of biliary hamartoma.
Case. A 21-year-old male patient was diagnosed
metastatic gastric cancer and presented few time
later with anemia, thrombocytopenia, icterus and
gingival bleedings. Whole blood count showed Hb:
5.7 g/dl, Plt: 22.000 /mm3, LDH: 3273 U/L, direct
bilirubin: 5.1 mg/dl, indirect bilirubin: 6.2 mg/dl,
ALP: 259 U/L, ALT: 751 U/L, AST: 147 U/L.
Protrombin time was 1.7 second, fibrinogen and Ddimer levels were 36 mg/dl and <500 ng/ml,
respectively. Which lead to a diagnosis of DIC. He
Material and method. A 49-year-old male patient
with right upper abdominal pain underwent
abdominal ultrasonography. In ultrasonography, we
found multiple cystic lesions with variable diameter
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
in liver. In order to evaluate these lesions with
biliary tree we apply to MRCP imaging protocol.
Three-dimensional and thick slice MRCP images
processed and Maximum Intensity Projection (MIP)
images were constituted. RESULTS: Two- and
three-dimensional MRCP, and axial T2-weighted
images demonstrated multiple thin walled cystic
lesions in both hepatic lobes with diameter ranging
between 5 mm to 25 mm without communicating
biliary tree. We also saw normal appearances of
intra- and extra-hepatic bile ducts.
Conclusion. MRCP is useful imaging technique in
the diagnosis and differential diagnosis of biliary
hamartoma in which we seen multiple tiny cystic
lesions and normal biliary tract.
Correspondence:
Gulhane Military Medical Academy, Department of
Radiology, 06018, Ankara, Turkey
Tel: + 90 312 3044701
Fax: + 90 312 3260551
GSM: + 90 536 5287891
E-mail: drrd066@hotmail.com
PPO89
ASYMPTOMATIC PANCREATIC TUMOUR
IN DYSPEPSIA SUFFERING
Authors:
Col. Ionita Radu Florentina MD, Maj. Patrasescu
M. MD, Lt. Smedescu V. MD, Maj. Sotcan M. MD,
Plt. P Giorgeta Grosu Reg.
Institution:
Nurse Department of Gastroenterology, Emergency
University
Military
Hospital,
Bucharest,
ROMANIA
We present the case of a 56-year-old patient
admitted in our clinic for heartburn, epigastric pain
referred to the back and astenia. The patient was
previously diagnosed with high blood pressure,
nodular gout with hypothyroidism, morbid obesity
(BMI 38kg/sqm). Physical exam was unremarkable.
Labs were also unremarkable (including pancreatic
panel, CA 19.9, carcinoembryonic antigen, alpha
fetoprotein).We performed
upper digestive
endoscopy which concluded the diagnosis of
eritematous gastritis and duodenitis. Abdominal
ultrasound shows an ovalar well demarcated lesion
(27mm ) located in subcapsular III-rd hepatic
segment, unomogenous and with strong Doppler
signal; at the level of pancreatic body we noticed a
poor demarcated lesion (25/20mm) unomogenous
which leaves an impression on spleno-portal
confluent. MRI exam confirms the pancreatic lesion
216
and notices supplemental hepatic lesions with late
wash-out characteristics. Ultrasound guided liver
biopsy
of
the
subcapsular
lesion
and
immunohistochemical exam yield the diagnosis of
metastasis of a neuroendocrine pancreatic tumour.
In conclusion a rare pancreatic tumour may
masquerade itself as a dyspeptic syndrom and,
thereafter, a high index of suspicion may be
mandatory in order to yield a proper diagnosis of a
life threatening disease. An aggressive diagnostic
approach may be necessary in the context of strong
known risk factors such as obesity and smoking.
Correspondence:
Tel: 0740151100
E.mail: Mihai_patrasescu@yahoo.co.uk
PPO90
CARDIAC IMAGE
EXPERIENCE
FUSION:
CLINICAL
Authors:
Silviu STANCIU1, Christian GOETZ2, Andre
CONSTANTINESCO2,
L.
CIOBICA1,
M.
1
MURESAN
Institutions:
1. University Emergency Military Hospital “Carol
Davila” Bucharest, ROMANIA
2. Strasbourg Civil University Hospital
Introduction: Myocardial perfusion scintigraphy
by SPECT and angiography by computertomografie
(CTA) are noninvasive techniques validated in the
evaluation of ischemic coronary disease.
Tridimensional fusion images obtained by SPECT
and CTA can provide useful additional information
to accurately detect myocardial ischemia and culprit
coronary artery.
Methods: The images obtained from a series of
nine consecutive patients in whom SPECT
(acquisition of stress and rest 99mTc-tetrofosmin)
and 64 slice CTA were performed were merged
using a software compatible to recognize and
generate three-dimensional images were compared
with results obtained by analyzing individual sideby-side the two methods.
Results: SPECT/CTA images fusion has additional
information regarding the pathophysiology of
coronary lesions in 24% of coronary stenosis
explored. Notably, the majority of additional
information (65%) was brought to the coronary side
branches (diagonal and marginal arteries) where
analysis of individual side-by-side has certain
limitations.
217
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
E.mail: mariana_jinga@yahoo.com
Conclusions: Three-dimensional fusion of SPECT
and CTA images can provide additional
information
regarding
the
hemodynamic
significance of coronary stenosis and morphologic
appearance of the plaque involved in the genesis of
ischemia, with a potential role in the choice of
revascularization modality and evaluating its
effectiveness.
Correspondence:
S. STANCIU Bucharest University
Hospital “Carol Davila”
E. mail: silviu.stanciu@yahoo.com
–
Authors:
Vasile Daniel Balaban1,2, Florina Vasilescu1,
Gabriela Costiana Cherana1,2, Raluca Costache1,2,
Florentina Ionita-Radu1, Petrut Nuta1, Sandica
Bucurica1, Mariana Jinga1,2
Military
PPO91
DIAGNOSTIC DIFFICULTIES OF CELIAC
DISEASE
Authors:
Mariana Jinga1,2, Ciprian Jurcut1, Florina
Vasilescu1, Andrada Loredana Popescu1, Vasile
Daniel Balaban1,2, Alina Stanescu-Popp2
Institutions:
1. “Dr. Carol Davila” Central University
Emergency
Military
Hospital,
Bucharest,
ROMANIA
2. “Carol Davila” University of Medicine and
Pharmacy, Bucharest, ROMANIA
We present the case-report of a 56-year-old woman,
recently diagnosed in our department with
hypothyroidism and autoimmune thyroiditis
(TSH=22.7; ATPO=546.7). The family history was
positive for celiac disease in her daughter (with
positive serology and histopathology). In this
context, we performed the serological screening for
celiac disease in our patient which was highly
positive, reflecting an important activity of the
disease. Consequently, an upper digestive
endoscopy was done (which was without any
specific findings) and biopsy specimens were
obtained.
The
standard
histopathological
examination was unremarkable for a definite celiac
disease.
However,
the
results
of
immunohistological techniques were compatible
with a subclinical celiac disease. The patient was
completely
asymptomatic
regarding
the
gastrointestinal tract. In patients with family history
of celiac disease, even without any suggestive
symptoms, the screening for celiac disease is
important, especially in those associating other
autoimmune disease.
Correspondence:
Tel: +40722232530
PPO92
EOSINOPHILIC
ESOPHAGITIS
DIAGNOSTIC CLUES
Institutions:
1. “Dr. Carol Davila”, Central University
Emergency Military Hospital,
2. “Carol Davila”, University of Medicine and
Pharmacy, Carol Davila, Bucharest, ROMANIA
Eosinophilic esophagitis is an increasingly
recognized cause of esophageal symptoms, due to a
rising prevalence and awareness of the disease by
GI endoscopists and pathologists. The diagnosis is
frequently missed because up to 20% of patients
have normal endoscopic appearance, esophageal
biopsies are not routinely done during upper GI
endoscopy, multiple biopsies are frequently needed
and the disease can be a great mimicker of GERD.
We report the case of a 49-year-old male who
presented with intermittent dysphagia for the last
couple of months. He denied odynophagia, food
impaction, heartburn, nausea or vomiting. The
patient had a history of atopic illness since
childhood (allergic rhinitis and asthma, treated with
salmeterol/fluticasone), chronic HCV infection
(successfully
treated
with
pegylated
interferon+ribavirin, with sustained virological
response at 3 years after completion of treatment).
Physical exam was remarkable only for mild
bilateral expiratory wheezes on lung auscultation.
Blood tests showed eosinophilia and high IgE.
Upper GI endoscopy revealed numerous small
white deposits on the entire circumference of the
esophagus starting at 25cm from the incisors, which
were biopsied and sent for histological
examination. We considered mycotic esophagitis as
a complication of inhaled steroid therapy, but the
histopathology report documented significant
eosinophilic infiltration (over 20 eosinophils/hpf)
and a diagnosis of eosinophilic esophagitis was
made. We referred the patient to an allergologist,
who identified egg allergy and recommended
dietary exclusion of egg-based foods. After one
month of allergen avoidance and treatment with
topical corticosteroid and a proton pump inhibitor,
the patient is symptom-free.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Correspondence:
Tel: +40722232530
E.mail: mariana_jinga@yahoo.com
PPO94
UNUSUAL CASE OF A FOLLICULAR
LYMPHOMA WITH BCL-2 NEGATIVE
EXPRESSION
PPO93
IL28B POLYMORPHISM -- PREDICTIVE
FACTOR OF HCV INFECTED GENOTYPE 1
INDIVIDUALS TO TREATMENT RESPONSE
AND MANAGEMENT OF THERAPY
Authors:
Col. Ionita Radu Florentina MD, PhD, Aida
Rascanu MD, Bianca Cheaib MD, Giorgeta Grosu
Institutions:
Department of Gastroenterology,
University
Military
Hospital,
ROMANIA
218
Authors:
Lieutenant Ζannis Almpanis, MD; Lieutenant Ν.
Chaleplidis, MD ; Captain Κ. Avraam, MD ;
Captain Μ. Tsantopoulos, MD ; Lieutenant Colonel
Κ. Revelos, MD
Institution:
Pathology Department,
251 Hellenic Air Force Hospital, GREECE
Emergency
Bucharest,
Purpose: We present a case of follicular (nodular)
lymphoma with negative expression of the bcl2
protein.
It is estimated that approximately 3% of the world
population are chronically infected with HCV.
Despite all efforts made to eradicate the HCV
infection, after the standard therapy (PegIFN and
ribavirin for 48 weeks) only 40-50% of the HCV
infected individuals with genotype 1 achieve
sustained virological response (SVR). Since our
goal today is the eradication of HCV infection, our
prior concern has become the identification of
predictor factors concerning treatment response.
Recently all interest has been turned towards the
demonstration of the host polymorphism located
upstream of the IL-28B gene and which is
associated with sustained virological response to
treatment with pegylated interferon Alfa in
combination with ribavirin. Although 2011 comes
with the FDA approval of the new triple therapy
associating telaprevir/ boceprevir to the standard
therapy, a new ethical concern regarding the high
costs of this treatment raises the problem of who is
the first in line? Determination of the IL-28
polymorphisms may be used together with clinical
assessment in order to evaluate patients and to
personalize their treatment. The purpose of this
paper is to underline the main concerns regarding
the goal and endpoints of the HCV therapy, and the
relationship of IL-28 in achieving sustained
virological response, as well as in pointing out the
importance to determine prior to initiating
treatment the polymorphism of IL-28 since it is a
strong predictor. This is important because it will
increase the chances to achieve SVR, it will be
cost-effective and reduces adverse effects.
Material & Methods: a 54-year-old male with a
history of rheumatoid arthritis of the right hip joint.
We received 2 lymph nodes d. 2 – 2.2 cm.
Correspondence:
Tel: +40722232606
E.mail: fionita04@yahoo.com
Results: Microscopically two lymph nodes were
recognized with almost complete destruction of
their architecture, with the accompanying presence
of nodular neoplastic formations. The latter
consisted of small and medium-sized lymphocytes
resembling centrocytes, as well as larger cells with
distinct nucleoli, resembling centroblasts. ReedSternberg, lacunar or Hodgkin cells were not
identified in our case. Mitoses were rarely
recognized.
Immunohistochemical
findings:
CD20(+), CD79a(+), CD10(+), BCL2(-), CD23 (-),
CD5(-), CD3(-), CD15(-), CD30(-), Pankeratin(-),
cyclinD1(-).
Conclusion: Non-Hodgkin lymphoma of B-cell
origin with nodular architectural pattern, most
compatible with nodular lymphoma.
Discussion: About 10% of globally reported
nodular lymphomas do not express bcl-2, causing a
differential diagnostic problem from reactive
nodular hyperplasia.The differential diagnosis of
lymphomas with nodular pattern also involves i) the
nodular type of Hodgkin lymphoma and ii) the
nodular sclerosis subtype of the classic type of
Hodgkin lymphoma. The negative expression of
CD15 and CD30 immunohistochemical markers in
our case with the combination of CD10 positivity in
the interfollicular area (despite the negativity of
BCL-2) suggested the diagnosis of follicular
lymphoma.
219
PPO95
INCIDENCE AND PRESENTATION OF
OSTEONECROSIS OF THE JAWS IN
MULTIPLE
MYELOMA
PATIENTS
TREATED WITH BISPHOSPHONATES
Authors:
Lieutenant Kyriakos Karypidis1,2, M. Iskas1,
Lieutenant JG G. Christopoulos2, V. Douka1, A.
Marvaki1, M. Papathanasiou1, R. Saloum1, A.
Anagnostopoulos1, C. Lalayanni1
Institutions:
1. Hematology Department & HCT Unit, “G.
Papanicolaou Hospital”, Thessaloniki, GREECE
2. Northern Greece Naval Administration (NDBE)
GREECE
Aim: The administration of bisphosphonates
currently represents a mainstay in the management
of hypercalcemia and bone absorption due to
malignancies such as multiple myeloma (MM) or
solid tumors. Osteonecrosis of the jaws (ONJ) is a
relatively rare complication of bisphosphonate use.
We report 13 MM patients, 9 men and 4 women,
median age 68 (range 49-80) years, with
bisphosphonate-associated ONJ.
Material – Method: Initial treatment was
melphalan-prednisolone (7/11) and vincristineadriamycin-dexamethasone (6/11). Three patients
received bortezomib and two thalidomide as
second-line treatment. Four out of thirteen affected
patients were treated long-term (from 29 to 46
months) with either pamidronate or zoledronic acid
at monthly intervals. However, two patients
received zoledronic acid for 9 and 12 months only,
before ONJ appearence.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Extensive dental procedures should be avoided and
good oral hygiene should be maintained in patients
treated with bisphosphonates.
PPO96
ACUTE HYPEROSMOLAR HYPERGLYCE
MIC STATE ASSOCIATED WITH USE OF
NEW
GENERATION
ANTIPSYCHOTIC
DRUG: A CASE REPORT
Authors:
1LT CAKAR Mustafa, MD1, MAJ ARSLAN Erol,
MD1, LTC DEMIRBAS Seref, MD1, 1LT KILINC
Ali, MD1, MAJ YESILKAYA Sirzat, MD2, COL
SAGLAM Kenan, MD1
Institutions:
1. Gulhane Military Medical Academy, Department
of Internal Medicine, Ankara, TURKEY
2. Gulhane Military Medical Academy, Department
of Family Medicine, Ankara, TURKEY
Objective. Diabetes mellitus is more common in
schizophrenia patients than the general population,
due to antipsychotic drugs or a variety of
mechanisms. Hyperosmolar hyperglycemic state is
an acute complication of diabetes. Here we present
a case of hyperosmolar hyperglycemic state due to
a new generation antipsychotic drug usage.
Results: A total of 235 patients with MM were
treated with bisphosphonates in our center, thus
accounting for an ONJ incidence of 5.5%. The
typical presentation of ONJ was a painful exposed
necrotic bone at the site of previous dental
extraction or injury. Biopsies showed no evidence
of malignancy and cultures revealed normal oral
flora. The lesions were not easily treatable and most
patients required surgical procedures despite
antibiotic
therapy
and
bisphosphonate
discontinuation. One patient responded well to
hyperbaric oxygen therapy. Both patients being on
bisphosphonate treatment for less than a year, were
more responsive to therapy.
Case. A 59-year-old male had schizophrenia for 30
years and he was using antipsychotic drugs of
risperidone (25 mg im/2 times a month) and
quetiapine (1x100 mg). The patient had a new
speech disorder and difficulty on face movements.
Physical examination revealed a peripheral facial
paralysia. Arterial blood pressure (ABP) was
140/80mmHg, pulse rate 84/min, fever: 36.4‘C,
respiratory rate: 20/min, tongue and oral mucosa
were dry. Leukocytes were 10900/mm3, Hb: 16.6
g/dl, glucose: 609 mg / dl, urea: 20 mg / dl,
creatinine: 1.0 mg / dl, uric acid: 2.63 mg/dl, Na:
132 mmol/l, C: 3.84 mmol/l; urine density: 1024,
glucose: +++, ketone (-), on sediment:1-2
leukocytes was detected. Arterial blood gas analysis
was pH: 7.415, pCO2: 28.1, HCO3: 18.2. Serum
osmolarity was 305 mOsm/kg. The patient had no
diabetes history, and was in remission of the
psychotic illness. High blood glucose, normal pH,
ketone negativity and hyperosmolar hyperglycemic
state was found associated with a new-onset
diabetes and patient and hospitalized for fluid and
insulin therapy.
Conclusions: At conclusion, ONJ is a serious
complication of bisphosphonate administration
which needs to be timely recognized and treated.
Conclusion. Schizophrenia and the drugs used to
treat it may worsen the diabetes disease course.
Diabetic schizophrenia patients using new
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
generation antipsychotic medication should be
monitored closely for possible acute diabetic
complications.
Correspondence:
Gulhane Askeri Tip Akademisi, Iç Hastalıkları BD,
Etlik 06018, Ankara, TURKEY
Tel:+90 312 304 4015 Fax:+90 312 304 4001
GSM:+90 554 525 2246
E-mail: drmustafacakar@gmail.com
PPO97
PANCYTOPENIA
AND
DELIRIUM
ASSOCIATED WITH THE USE OF LOWDOSE ORAL METHOTREXATE: A CASE
REPORT
Authors:
MAJ ARSLAN Erol, MD1, COL OZCELIK Fatih,
MD2, 1LT CAKAR Mustafa, MD1, BG OZTOSUN
Muzaffer, MD3, LTC DEMIRBAS Seref, MD1,
COL SAGLAM Kenan, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Internal Medicine, Ankara, TURKEY
2. Gumussuyu Military Hospital, Laboratory of
Medical Chemistry, Istanbul
3. Turkish Army Forces Health Command, Health
Services Commandership, Ankara, TURKEY
Objective. Although it is generally well tolerated,
methotrexate
(MTX)-related
pancytopenia,
hepatotoxicity, pulmonary toxicity, fever, skin
rashes and gastrointestinal side effects can be seen.
Low dose MTX-related side effects are less
frequent. Here we present a case using low dose
oral MTX with a diagnosis of psoriatic arthritis
suffering pancytopenia and delirium.
Case. A 59-year-old female patient had complaints
of weakness, fatigue, confusion, and hallucinations
continueing for five days. 9 months ago, she had
diagnosis of psoriatic arthritis and 15 mg/week
MTX, and 5 mg/day prednisolone was started.
Orientation and cooperation of the patient was
disturbed, she had pale skin, fever of 38.5 °C, and a
large number of aphthous and bleeding ulcers in the
mouth. Hemoglobin was 9.7 g/dl, WBC: 1 x
103/mm3, platelets: 9 x 103/mm3, and ESR:130
mm/h. A peripheral blood smear, bone marrow
aspiration biopsy, brain CT, hematology, psychiatry
and neurology consultations were included. MTX
was blamed to cause toxicity of pancytopenia,
gastrointestinal side effects, fever and delirium and
was stopped. We treated the patient with folinic
acid rescue therapy. Two days later, the patient's
220
peripheral blood count, and after the third day fever
and delirium recovered.
Conclusion. Although evidence of neurotoxicity
due to high-dose MTX is present, neurotoxicity due
to low-dose oral usage is less encountered. There is
not enough information for delirium. Possible cause
of pancytopenia and delirium reversible after
cessation of the drug should be low-dose oral MTX.
Close monitoring of patients using MTX is
necessary as it may cause pancytopenia as well as
delirium.
Correspondence:
Gulhane Askeri Tip Akademisi, Iç Hastalıkları BD,
Etlik 06018, Ankara, TURKEY
Tel:+90 312 304 4015
Fax:+90 312 304 4001
GSM:+90 505 828 2624
E-mail: earslan89@yahoo.com
PPO98
POST TRAUMATIC STRESS
AND THYROID FUNCTIONS
DISORDER
Authors:
1LT BOLU Abdullah, MD1, LTJG AKARSU
Suleyman, 1LT AYDEMİR Emre MD1, MAJ
ÖZNUR Taner MD2, MAJ ERDEM Murat, MAJ
OZDEMIR Barbaros, MD1, CAPT OZMENLER
Kamil Nahit, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Psychiatry, Dept of Military Psychology and War
Psychiatry, Ankara, TURKEY
Objective. The relationship between thyroid
hormones and post traumatic stres disorder (PTSD)
contiunes to be a subject of debate for a long time.
İn this study we aimed to examine the relationship
between the severity of PTSD symtoms and thyroid
hormones levels.
Material and method. Impact of Event Scale (IESR) and the Clinician Administered PTSD Scale
(CAPS) were administered to 56 patients with a
diagnosis of PTSD according to DSM-IV
diagnostic criteria; thyroid hormones levels (T3,
T4, TSH) of patients and control group were
determined. The correlation between CAPS, IES-R
subscale scores and T3, T4, TSH levels were
assessed by Pearson correlation test. RESULTS
The mean T3, T4, TSH values were 3.29±0.56,
1.24±0.32, 1.94±0.23. When thyroid function tests
221
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
of patients with PTSD compared to halthy subjects;
T3, T4 levels did not differ, but there was
difference in TSH values (p<0.05). A negative
correlation between T4 levels in patients with
PTSD and IES avoidance score (r=0.40), and a
positive correlation between free T3 levels and
CAPS total scores (0.46), intruziv CAPS scores
(0.42), hyperarousal CAPS scores (0.41), CAPS
avoidance scores (0.38) were determined.
Conclusion. İn the studies negative (1) or positive
(2-4) correlation between clinical symptoms and
free, total T3 in PTSD patients than control group
have been reported. The results of this study
support the positive correlation between two
variables. Studies with more participation need to
be done on this issue.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 506 5089652
E-mail: abdullah_bolu@yahoo.com
PPO99
A RARE PRESENTATION OF FOLLICULAR
LYMPHOMA: CEREBELLAR METASTASIS,
SUCCESSFULLY
TREATED
WITH
A
COMBINATION OF RADIOTHERAPY AND
CHEMOTHERAPY
Authors:
MAJ KARADURMUS Nuri MD1, COL
ATAERGIN A Selmin MD1, LTC ERDEM
Gokhan MD1, 1LT CAKAR Mustafa MD2, MAJ
EMER Ozdes MD3, CPT OZAYDIN Sukru MD1,
COL OZTURK Mustafa MD1, COL SAFALI
Mukerrem MD4, BG ARPACI Fikret MD1
Institutions:
1. Gulhane Military Medical Academy,
Medical Oncology, ANKARA, TURKEY
2. Gulhane Military Medical Academy,
Internal Medicine, ANKARA, TURKEY
3. Gulhane Military Medical Academy,
Nuclear Medicine, ANKARA, TURKEY
4. Gulhane Military Medical Academy,
Pathology, ANKARA, TURKEY
thoracentesis fluid represented chylothorax The
computed tomography of thorax, abdomen and
pelvic areas showed supra and infra diaphragmatic
bilaterally enlarged multiple conglomerated lymph
nodes. The lymph node and bone marrow biopsy
results revealed grade 2 follicular lymphoma,
therefore was staged IV -B disease. Thereafter,
after receiving 6 courses of R-CHOP chemo
therapy, the patient went on a regular check-up
every 3 months for one year, until he applied again
with complaints of cervical lymphadenopaties and
disequilibrium. PET/ CT revealed a right cerebellar
diffuse intensity and left supraclavicular lymph
nodes with high SUV max uptake levels of 11.3
and 12.3 respectively. The nodal excisional biopsy
showed the same histopathology, as described
previously The brain magnetic resonance imaging
showed a homogen-contrasted lesion, on a 2x1.5
cm dimension, involving dural surface totally of the
right cerebellum. Therefore, a second line
chemotherapy regimen (rituximab 350 mg/m2 day
1, fludarabine 20 mg/m2 days 1 to 3 and
cyclophosphamide 240 mg/m2 days 1 to 3) was
started. Whole brain sequential radiotherapy was
scheduled for 10x30 cGy. In the follow up period,
his symptoms and complaints were completly
resolved.
Conclusion. The Lymphoma experts including
Oncologists, internists, neuroradiologists, and
pathologists should always be in cooperation and
remind the different patterns of CNS involvement
to make a correct diagnosis and management
schedules of lymphoma.
Correspondence:
Gulhane Askeri Tip Akademisi, Tıbbi Onkoloji
BD, Etlik 06018, Ankara, TURKEY
Tel: + 90 312 304 4159
Fax: + 90 312 304 4150
GSM: + 90 536 640 10 20
E-mail: nkaradurmus@gata.edu.tr
Dept. of
Dept. of
PP100
AN UNUSUAL THYROID PAPILLARY
CARCINOMA CASE: A CASE REPORT
Dept. of
Dept. of
Introduction. Although follicular lymphoma
represents a low-grade histology, it may rarely
present with CNS involvement. CASE: A 57-years
old male patient was referred with complaints of
dizziness and dyspnea. A plain chest radiography
revealed massive bilateral pleural effusion and the
Authors:
MAJ SALIHOGLU Murat, MD , CPT CESMECİ
Enver, MD, CDR CEKIN I. Engin, MAJ
CAKMAK Adem, MD, CPT ERKUL B.Evren,
COL GUNGOR Atila, MD.
Institution:
Gulhane Military Medical Academy, Haydarpasa
Training Hospital, Department of ENT, Istanbul,
TURKEY
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Objective. We want to present a rare welldifferentiated thyroidcarcinoma case which initial
findings were hemoptysis and tracheal mass in
endoscopic laryngeal examination withoutaneck
mass.
Case report. Well-differentiated thyroid carcino
mas rarely invade upper respiratory tractand
digestive system. If the invasion occurs, laryngeal
nerve, larynx, trachea, pharynx and esophagus are
invaded usually by the way of neighborhood.
Invasion of these structures causes some symptoms
such as hemoptysis, dysphagia, and airway
deficiencies. A 68-year-old female patient was
admitted to our clinic with complaints of
hemoptysis lastingfor about 1month. Head and neck
examination was normal. In endoscopic laryngeal
examination a subglottic mass narrowing the
trachea was seen. Computed tomography (CT) of
the neck and ultrasonography guided fine needle
aspiration biopsy (FNAB) were done. Neck CT
revealed us that subglottic mass narrowing trachea
was originated from the thyroid gland. FNAB was
reported as thyroidpapillary carcinoma. Bilateral
total thyroidectomy and partial excision of invaded
trachea was applied. Since cutaneous and
mediastinalemphysema developed after surgery; a
second operation was performed. Approximately
1.5cm of segmental resection including defective
first and second tracheal ringsand end to end
anastomosis of the trachea was performed. Thyroid
papillary carcinoma is a common histologic type of
thyroid cancers. These tumors are usually not
aggressive and are treated easily. However, some
cases have progressive course and poor prognosis.
Since trachea is just behind the thyroid gland,
thyroid papillary carcinoma may invade trachea.
According to some authors tracheal invasion also
indicates a poor prognosis. In these cases
aggressive surgical techniques are recommended
such as tracheal fenestration or tracheal resection
with end to end anastomosis.
Conclusion. It is important to know that an unusual
symptom like hemoptysis may be the first finding
of thyroid papillary carcinoma.
Correspondence:
Murat SALIHOGLU GATA HaydarpasaEgitim
Hastanesi,
Kulak
Burun
Boğaz
Servisi,
34668,Istanbul, TURKEY
Tel: +90 0216 542 2020- 4356
Fax:+90 216 348 7880
GSM : +90 534 9457644
Email : drmuratsali@gmail.com
222
PP101
RELATIONSHIP
BETWEEN
BLOOD
PRESSURE, INSULINEMIA AND C-PEPTIDE
Authors:
Emilia Rusu, Jinga Mariana, Simona Ateia, F.Rusu,
Gabriela Radulian
Institutions:
National Institute of Diabetes, Nutrition and
Metabolic Diseases, Bucharest, ROMANIA,
Dr. Carol Davila” Clinical Central Military
Emergency Hospital, Bucharest, ROMANIA,
University of Medicine Carol Davila, Bucharest,
ROMANIA
Beckground and aims: The association between
hyperinsulinemia and higher blood pressure (BP)
was described in numerous publications, and has
addressed the relationship between insulin
resistance, obesity, abnormal lipid profile, diabetes
mellitus, and cardiovascular diseases. We examined
the association between insulin and C-peptide
levels and BP among in diabetic and non-diabetic
patients. We hypothesized that there would be a
positive association between insulin levels and BP
after controlling for the potential confounding
elements (age, sex, and BMI level).
Material and methods: We selected 276 patients
that were divided in 2 groups: group A - 213
patients without diabetes and group B - 63 patients
with diabetes. Body weight, BMI, serum glucose
levels,
HbA1c,
lipid
profile,
alanin
aminotransferase,
aspartat
aminotransferase,
gamma glutamil transpeptidase, proinflammatory
state and adipocyokines were measured. Diabetes
status was confirmed by a 75-g oral glucose
tolerance test conducted and interpreted according
to ADA criteria. Subjects with diabetes mellitus,
impaired glucose tolerance, or those taking insulin,
oral hypoglycemic, or antihypertensive medication
were analyzed separately. IR was determined using
Homeostasis model assessment (HOMA-IR)
(fasting insulin level (mUI/l) x fasting glucose level
(mg/dl)/405; a HOMA-IR index value of more than
2.0 was considered as the criteria of insulin
resistance, and that higher than 4.0 as a prediabetic
state. Multiple linear regression analysis was used
to examine relationships between fasting insulin
and C-peptide levels and blood pressure.
Results: A total of 276 subjects were included in
the analysis. Among all subjects, diastolic blood
pressure was found to significantly increase with
increasing levels of both hormones (for insulin r =
0.32, P=0.01; for C-peptide, r=0.2, p=0.002),
223
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
whereas systolic blood pressure was significantly
related to fasting C-peptide level (r= 0.0295,
p=0.050). Mean fasting insulin and C-peptide levels
increased with increasing dBP or sBP categories
among men but not women. Mean hormone levels
among nonobese males increased with each
increase in either dBP or sBP category.
Conclusion: Our findings are consistent with
previous epidemiological and clinical studies that
showed a significant association between and
hypertension.
Correspondence:
E.mail: emiliarusumd@yahoo.com
PP102
PROINSULIN
SYNDROME
AND
METABOLIC
Authors:
Simona Ateia, Emilia Rusu, Mariana Jinga, Florin
Rusu, Gabriela Radulian
Institutions:
Medas Clinic, Bucharest, ROMANIA
University of Medicine “Carol Davila”, Bucharest,
ROMANIA
Institute of Diabetes, Nutrition and Metabolic
Diseases, Prof. N. Paulescu”, Bucharest,
ROMANIA 4. Dr. Carol Davila” Clinical Central
Military
Emergency
Hospital,
Bucharest,
ROMANIA
Introduction: The metabolic syndrome is a
complex of interrelated risk factors for
cardiovascular disease (CVD) and diabetes. These
factors include dysglycemia, raised blood pressure,
elevated triglyceride levels, low high-density
lipoprotein cholesterol levels, and obesity
(particularly central adiposity).
Participants were recruited over 3 medical centers
in Romania. Waist circumference, fasting glucose,
proinsulin, insulin, high-density lipoprotein
cholesterol and triglyceride concentrations, and
blood pressure were the main outcome measures.
Baseline data presented include demographics,
clinical/medical
history,
biochemical
measurements, and clinical and biochemical
abnormalities.
Results: The prevalence of MetS, using IDF
criteria, was 57.9% (41.3% in men and 58.7% in
women, p=0.28), 27.6% in patients without
diabetes and 72.4% in patients with diabetes. Serum
proinsulin, proinsulin/insulin ratio, HOMA-IR in
metabolic syndrome group were higher than that in
the non-metabolic syndrome group (p<0.001). The
serum proinsulin and HOMA-IR but not
proinsulin/insulin ratio were positively related with
the prevalence of overweight/obesity.
The highest fasting quartiles presented higher mean
age (p < 0.0001), BMI (p < 0.0001), SBP, DBP (p <
0.0001), TG (p < 0.01), eGFR (p < 0.001) and
lower mean HDL-c (p < 0.0001). The group with
the highest FP quartiles showed higher prevalence
of overwieght/obesity and MetS (p < 0.0001).
Conclusion: MetS represents a cluster of risk
factors and is associated with an increased risk of
cardiovascular morbidity and mortality. The
prevalence of MetS is high and continuously
increasing in the modern world. Our study has
demonstrated a close association between obesity
and
elevated
proinsulin
but
not
with
proinsulin/insulin ratio. In the present study, fasting
proinsulin, insulin, and HOMA-IR were
significantly associated with MetS for both genders.
Correspondence:
E.mail: emiliarusumd@yahoo.com
Objective: The aim of this study was to assess the
prevalence of MetS in general population (i.e.
patients who presented after an advertising
campaign) using IDF criteria (2009). Secondary
objectives were to evaluate the correlation of
proinsulin with MetS and MetS components in
adult population.
PP103
RELATION OF RESISTIN LEVELS WITH
CARDIOVASCULAR RISK FACTORS AND
INSULIN RESISTANCE IN PATIENTS WITH
HEPATITIS C
Ramona Toma, Jinga Mariana, Emilia Rusu, Irina
Sima, Gabriela Radulian
Material and methods: Observational study,
multicenter study which included a random
population-based sample (n=656) of Romanians
(35–80 years). The study contains an assessment of
cross (the baseline) by measuring the prevalence of
metabolic syndrome in adult population and
measurement of association, and other pathological
entities such as obesity, diabetes, hypertension.
Dr. Carol Davila” Clinical Central Military
Emergency Hospital, Bucharest, Romania
National Institute of Diabetes, Nutrition and
Metabolic Diseases, Bucharest, Romania
Healthy Nutrition Foundation, Bucharest, Romania
4. University of Medicine Carol Davila, Bucharest,
ROMANIA
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
224
Objective: The aim of the current study is to
determine the circulating resistin levels obtained
from patients with CHC and to correlate them with
insulin resistance and hepatic histological features.
study was to check how plasma levels of MMP-9,
sFas, TNFα and IL-8, determined at the time of
diagnosis, correlate with severity and outcome of
sepsis in our patients.
Methods: We selected 69 patients with hepatitis C.
There were followed anthropometric indicators
(weight, height, waist circumference, BMI (body
mass index) (ratio of actual weight expressed in
kilograms and the square of height - BMI =
kg/m2)). Biochemical parameters followed were
blood glucose, glycosylated hemoglobin, lipid
profile (cholesterol, trigiceride, HDL-cholesterol),
liver profile (ALT, AST, GGT, bilirubin, albumin,
total protein), blood count. The WHO definition of
obesity was used. IR was determined using
Homeostasis model assessment (HOMA-IR).
Methods. A total of 58, non-surgical, septic
patients were included in the study. Diagnosis of
sepsis and its complications was made according to
consensus guidelines ACCP/SCCM. The severity
of illness was scored by an APACHE II score.
Patients were subdivided into different groups.
Results: Resistin levels were higher in CHC
patients with obesity, with metabolic syndrome,
diabetes, fibrosis (Forns index over 6.9), and
steatosis (all p<0.001). Serum resistin levels
increased parallel with increasing body mass index.
Resistin correlated positively, but not very strong
with BMI (r=0.273, p=0.023), HOMA-IR (r=0.37,
p=0.002), UKPDS-CHD (r=0.21, p=0.036) but not
with cholesterol, tryglicerides, HDL-colesterol, and
fatal CHD (UKPDS).
Conclusions: This study demonstrated the
relationship between resistin and IR. Resistin levels
are related with different cardiovascular risk and
anthropometric parameters, without relation with
insulin resistance.
PP104
RELATIONSHIP
BETWEEN
PLASMA
LEVELS OF MMP-9, SFAS, TNFα AND IL-8
AND CLINICAL CHARACTERISTICS OF
SEPTIC PATIENTS
Authors:
D. Mikic2, M. Colic1, M. Cucuz1, S. Vasilijic1, V.
Begovic-Kupresanin2, and R. Rajic-Dimitrijevic2
Institutions:
1. Institute of Medical Research, The Medical
Faculty of the University of Defence, Belgrade,
SERBIA
2. Clinic for Infectious and Tropical Diseases and
Introduction. The prognostic value as well as
relationship
between
concentrations
of
matrixmetalloproteinase-9 (MMP-9), soluble form
of apoptotic signal receptor Fas (sFas), TNFα and
IL-8 and the development of septic complications
are not fully elucidated. Therefore, the aim of this
Results. The plasma level of MMP-9 (206.1±258.6
ng/ml, 0-1313.7 ng/ml) was elevated in 98.3% of
patients, sFas level (9.7±10.1 U/ml, 0-44.2 U/ml) in
54.4%, TNFα level (27.3±18.5 pg/ml, 2.5-94.0
pg/ml) in 76.4% and IL-8 level (198.8±499.3
pg/ml, 4.0-3392.0 pg/ml) in 80.0% of patients. We
found the differences in the mean levels of the
examined mediators between patients with sepsis,
severe sepsis and septic shock, patients with and
without MODS, and patients who survived or died.
There were positive correlations between APACHE
II score and plasma levels of MMP-9 (r = 0.3209, p
< 0.05), sFas (r = 0.6046, p < 0.001), TNFα (r =
0.4845, p < 0.001) and IL-8 (r = 0.4813, p < 0.001).
Conclusions. Among examined mediators, in our
study, initial plasmatic levels of TNFα were shown
the best relationship with outcome and levels of IL8 with the development of septic shock and MODS.
Concentrations of sFas were shown to correlate
very well with clinical course and outcome of
sepsis. All examined mediators correlated with
APACHE II score.
PP105
POSITIVE PREDICTIVE FACTORS FOR
SUSTAINED VIROLOGICAL RESPONSE IN
TREATMENT OF CHRONIC HEPATITIS C
PATIENTS
Authors:
Assist. Prof. Raluca S. Costache MD PhD,
Florentina Ioniţă Radu MD PhD, P. Nuţă MD, B
Macadon MD, Florin Lungana MD, Andrada
Popescu MD, Assoc. Prof Mariana Jinga MD PhD
Institutions:
Gastroenterology Clinic, Central
Universitary
Military
Hospital,
ROMANIA
Emergency
Bucharest,
Aim. Hepatitis C virus chronic infection is one of
the most widespread, with major health impact
disease. In the last years the standard of care
treatment with high rate sustained virological
225
response (SVR) is represented by association of
peginterferon and ribavirin.
Material and Method. We evaluated 327 patients
with chronic hepatitis C infection during 20062010. The inclusion criteria were those
recommended by national health authority for the
antiviral treatment. The protocol included:
evaluation of fibrosis, ALAT level, evaluation of
viral response at 12 weeks, 48 weeks and 72 weeks,
and the evaluation of metabolic status (BMI, total
cholesterol level, steatosis).
Results. In our study 52.29% patients obtained
sustained virological response. 26.31% of obese
patients obtained SVR; 48.43% of patients with
steatosis obtained SVR versus 61.93% patient with
no steatosis; 59.15% of young patients (age under
40) obtained SVR, 61.94% of patients with low
viral load (< 600.000 UI/ml) obtained SVR. Using
the Cox multivariate analysis we obtained high
significant statistic values for viral load at week 0
(p = 0.002, OR = 1) and less significant for BMI (p
= 0.045, OR = 0,644), cholesterol (p = 0.005, p =
0.953), and steatosis (p = 0 01, OR = 0 94) and no
statistical significance for age and fibrosis.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Material and methods: This observational,
transversal, epidemiological study was held at the
National Institute of Diabetes, Nutrition and
Metabolic Diseases "NC Paulescu ". We evaluated
cardiovascular risk using UKPDS software in 70
patients with hepatitis C. There were followed
anthropometric indicators (weight, height, waist
circumference, BMI (body mass index) (ratio of
actual weight expressed in kilograms and the square
of height - BMI = kg/m2). Biochemical parameters
followed were blood glucose, glycosylated
hemoglobin, lipid profile (cholesterol, trigiceride,
HDL-cholesterol), liver profile (ALT, AST, GGT,
bilirubin, albumin, total protein), blood count.
Results: The average age of the evaluated patients
was 60±8.4 years, 56.5% men (n=134), 44.9% with
metabolic syndrome, 29% with obesity. Using the
UKPDS score 36.7% of MetS patients and 10.4%
of the patients without MetS presented an increased
risk of CVD. UKPDS- CHD score was strongly
correlated with age (r=0.734, p=0.001), HOMA-IR
(r=0.401, p=0.01), systolic blood pressure (r=0.42,
p=0.01), cholesterol (r=0.329, p=0.006), gender
(r=0.351, p=0.003), BMI (r=0.4, p=0.001),
trygliecerides
(r=0.569,
p=0.005),
waist
circumferance (r=0.483, p=0.001).
Comments. The standard of care treatment for
chronic hepatitis C viral infection in our patients
with genotype 1 virus proved to be efficient with
SVR at 52.29% patients. The positive predictive
factors for SVR were low viral load at week 0,
BMI, cholesterol and steatosis.
Conclusions: In these patients UKPDS score
identifies more patients at high cardiovascular risk.
Finding people with diabetes and increased
cardiovascular risk and control the cardiovascular
risk factors is very important in medical practice.
Correspondence:
ralu_alf@yahoo.com
Correspondence:
E.mail: emiliarusumd@yahoo.com
PP106
METABOLIC
SYNDROME
AND
CARDIOVASCULAR RISK IN PATIENTS
WITH HEPATITIS C
PP107
COMPARISON OF THREE METHODS OF
AUTOLOGOUS BONE-MARROW STEM
CELL DELIVERY FOR THE TREATMENT
OF LARGE MYOCARDIAL INFARCTION
Authors:
Jinga Mariana, Emilia Rusu, Ramona Toma, Irina
Sima, Gabriela Radulian
Institutions:
“Dr. Carol Davila” Clinical Central Military
Emergency Hospital, Bucharest, Romania,
National Institute of Diabetes, Nutrition and
Metabolic Diseases, Bucharest, Romania,
University of Medicine Carol Davila, Bucharest,
ROMANIA
Aim: Goals of the study were to evaluate the
cardiovascular risk factors and to estimate the
cardiovascular risk in patients with hepatitis C.
Authors:
Branko Gligic1, Slobodan Obradovic1, Zoran
Trifunovic2, Bela Balint3
Institutions:
1. Clinic of Emergency Medicine,
2. Clinic of Cardiac Surgery,
3. Institute of Transfusiology, The Medical Faculty
of the University of Defence, Belgrade, SERBIA
Background. The optimal method and proper
timing for autologous bone-marrow derived stem
cells delivery in the treatment of systolic left
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
ventricle dysfunction after ST elevation myocardial
infarction (STEMI) is still not known.
Methods. We have compared the influence of three
methods (intracoronary stem cell transfer during
subacute STEMI, intramyocardial stem cell
injections with CABG in chronic STEMI and
intracoronary stem cell transfer during chronic
STEMI) of autologous bone-marrow mononuclear
cell delivery on the left ventricle ejection function
change (ΔLVEF) and infarction size reduction
(ISR-perfusion scintigraphy measurement) in
patients with large STEMI (LVEF<41%) 6 months
after stem cell therapy. We also compared the
frequency of patients among groups who achieved
target therapy goal of 5% LVEF increase and 5%
ISR after 6 months.
Results. Nineteen patients received cells
intracoronary during second week from MI (group
I), 14 received cells by intramyocardial injections
during CABG (group II) at least 2 months after
STEMI, and in 9 cells were given intracoronary,
also at least two months after MI (group III).
Baseline characteristics of patients except for the
timing of cell therapy were very similar. Difference
between 6 months and baseline LVEF were 5% (1.0-12.0%), 5% (2.75-8.5%) and 0% (-1.5-2.5%),
and difference between baseline and 6 months ISR
were 5% (2.0-8.0%), 7% (2.0-9.0) and 1% (-0.51.0%), for group I, II and III, respectively. ISR
were significantly higher in group I and II
compared to group III (p<0.05, for both
comparison), and the change of LVEF were also
significantly higher in group II compared to group
III (p<0.05). Frequencies of patients who had 5% of
LVEF increase were 9/19, 8/14 and 1/9 and the
frequencies of 5% ISR increase were 10/19, 10/14
and 0/9 in three groups, respectively.
Conclusion. Autologous bone-marrow derived
mononuclear cells are capable to improve
significantly LVEF and reduce IS in approximately
50% of patients, with intracoronary cell delivery in
the early stage of STEMI and in patients with
intramyocardial cell delivery in chronic stage of
STEMI. Intracoronary bone-marrow derived stem
cell therapy doesn’t improve either LVEF or
decrease IS in patients with chronic STEMI.
PP108
CESSATION
OF
LONG-TERM
CLOPIDOGREL THERAPY CAUSES WORSE
RESPONSE TO ASPIRIN AND THE
INCREASE
OF
SOLUBLE
CD40L
DEPENDENT ON GLYCAEMIA AND HDL
LEVELS
226
Authors:
Gligic B, Obradovic S, Nina Dj, Todorovic Z,
Prostran M, Zamaklar-Trifunovic D, Markovic I,
Njegomirovic S, Ostojic M
Institution:
Clinic of Emergency Medicine, The Medical
Faculty of the University of Defence, Belgrade,
SERBIA
Background. It is unknown is there a rebound
effect on platelet function after cessation of longterm therapy of clopidogrel, how it can be
measured and what is its clinical significance.
Methodology. Platelet function was measured by
multiplate (ASPI test, ADP test and TRAP test) on
the last day of one-year clopidogrel therapy and
after 10, 45 and 90 days after cessation the drug in
200 hundred patients who were on dual antiplatelet
therapy after coronary stenting. All patients stayed
on 100 mg of aspirin. Basic laboratory tests
(glycaemia, lipid parameters, high sensitive CRP)
and serum level of soluble CD40L were determined
at the last day of clopidogrel therapy and 45 days
after.
Results. Platelet activation by arachidonic acid
(ASPI test) significantly increased after cessation of
clopidogrel (p<0.001 for comparison to baseline
level for all measurements after cessation of
clopidogrel). The same result was found with ADP
test, however with constantly significant increase of
platelet reactivity to ADP during the study period
(p<0.001 for comparison of all further
measurements to the previous ones). Soluble
CD40L slightly but significantly raised after
stopping clopidogrel (p=0.004) and the levels of
hsCRP and TRAP was unchanged. Maximum
platelet reactivity to arachidonic acid and ADP
measured at 90 days strongly correlate to the level
of sCD40L at 45 days after clopidogrel treatment.
Patients
with
poor
metabolic
control
(glycamia/HDL≥7.0) at baseline had the greatest
increase of sCD40L (2.4 vs 0.4 pmol/L, p=0.003).
Conclusion. Platelet reactivity to arachidonic acid
and ADP increase for the 3 months after cessation
of clopidogrel and raise of sCD40L well correlated
to the platelet reactivity to arachidonic acid and
depended on the level of baseline glycaemia and
HDL.
PP109
DIAGNOSTIC
AND
THERAPEUTIC
APPROACH IN PATIENTS WITH FREE-
227
FLOATING THROMBUS IN THE RIGHT
HEART
Authors:
Gligic Branko1, Dzudovic Boris1, Obradovic
Slobodan1, Rusovic Sinisa2, Rafajlovski Saso1,
Romanovic Radoslav1, Ratkovic Nenad1, Dincic
Dragan1
Institutions:
1. Clinic of Emergency Medicine,
2. Institute of Radiology, The Medical Faculty of
the University of Defence, Belgrade, SERBIA
Free-floating thrombi in the right heart are rare but
life treatening condition and have important
diagnostic and therapeutic significance. We present
three patients with free-floating thrombus in the
right heart and pulmonary thromboembolism. Two
of them had thrombus in the right atrium and one
had trombus entrapped within the patent foramen
ovale with one part of the thrombus prolapsing into
the left atrium. Patients with free-floating thrombus
in the right atrium were treated with fibrinolytic
therapy with excellent outcome: the complete
resolution of thrombus in the right heart
immediatelly after finishing the therapy. Since we
were afraid of systemic embolisation in the patient
with thrombus struggled in open foramen ovale we
decided to perform surgical removal of the
thrombus. While waiting the cardiac surgery, the
patient has been treated with continuous infusion of
heparin without thrombus resolution and he has
developed spontaneous ischemic-embolic stroke at
the 5th day of hospitalization, just a day before
planned cardiac surgery. These 3 cases present
importance of urgent but different approach to the
patients with free floating thrombus in the right
atrium depends on presence of thrombus entrapped
within the patent foramen ovale or not.
Conclusion. Free-floating thrombus in the right
heart usually discovered itself after appearance of
PTE. On other hand, PTE has many different
clinical faces. Using a different diagnostic
laboratory and imaging procedures is helpful in
revealing existence and determining severity of
PTE. Aggressive therapy approach in patients with
free-floating thrombus in the right heart could be
lifesaving due to high rate of massive PTE cause of
death. Thrombolysis is advisable in treating patients
with free floating thrombus in the right heart, but
only if not entrapped into PFO with prolapsing into
left atrium, where, despite inconclusive data,
surgical removal is preferred.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
PP110
A CASE OF SPONDYLODISCITIS CAUSED
BY SERRATIA MARCESCENS IN A
FEMALE PATIENT WITH DIABETES
MELLITUS, MYASTHENIA GRAVIS AND
HYPOTHYROIDISM
Authors:
M. DIMITROVA, Col. Kr. GENOV
Institution:
Clinic of Neurological Diseases, Military Medical
Academy, Sofia, BULGARIA
Objectives: Spondylodiscitis is an inflammatory
disease affecting the intervertebral disc and
vertebral bodies with frequency that varies between
0.4 and 2.4 per 100000. The aim of this report is to
present a rare spinal infection which occurs in
patient with compromised immune status due to
concomitant diseases: diabetes mellitus, myasthenia
gravis, thymoma and postoperative hypothyroidism
due thyroidectomy for thyroid cancer.
Methods: A 57-year-old female patient presented
with severe back pain irradiating to the chest and
fever with onset several days before the
hospitalization. The patient had had diabetes
mellitus for five years, myasthenia gravis with
onset the previous year, thymoma that had been
been surgically removed, as well as thyroidectomy
due to thyroid cancer 18 years ago resulting in
postoperative hypothyroidism. MRT examination
was performed with a finding of spondylodiscitis
affecting Th7-Th8 vertebrae. Blood cultures
showed Serratia marcescens.
Results: Clinical examination, laboratory blood
work, microbiological examination of CSF,
Quantiferon TB gold test and TB spot test,
computed tomography of mediastinum, MRT of
thoracic spine, blood and urine cultures were
performed. Intravenous antibiotics effective against
Serratia marcescens was applied.
Conclusion: Serratia marcescens is an aerobic
Gram- negative bacillus. The most susceptible
patients are those with nosocomial infections,
diabetes mellitus, renal failure, compromised
immune status, open wounds, eldery patients or
drug addicts. In these cases the infection is
associated with high mortality (25-50%).
PP111
STUDY ON THE DEPENDENCE OF
COGNITIVE
ABERRATIONS
ON
DIFFERENT EXTENTS OF NEUROLOGIC
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
DEFICIENCY ACCORDING TO J. F.
KURTZKE (EDSS) IN PATIENTS WITH
MULTIPLE SCLEROSIS
Authors:
Col. K. GENOV, M. DIMITROVA
Institutions:
Clinic of Neurology, Military Medical Academy,
Sofia, BULGARIA
Aim: The aim of this study is to investigate a
possible dependency of changes in the cognitive
functions in patients with MS and different rate of
neurological deficiency after the Kurtzke scale. 25
patients have been involved in the study /11 women
and 14 men at average age 25.2 +/- 5.3 years/ with
clinically confirmed diagnosis of MS. The patients
have been divided into two groups: Ist group:
Neurological deficiency up to 5th level after
Kurtzke – 17 patients /68%/; IInd group:
Neurological deficiency above 5th level after
Kurtzke – 8 patients 32%/. A control group with 10
clinically healthy persons has been used /5 women
and 5 men at an average age of 24.6 +/- 7.3 years/
with educational degree, analogical to that of the
patients. The cognitive capacity, nonverbal intellect
and distribution of attention have been assessed.
The verbal memory abilities, nonverbal memory
and personality structure of the patients have been
used.
Results: The comparison between the results from
the investigation of attention unveils significant
differences in the two groups. The same results
apply to the investigation of the memory functions,
nonverbal intellect and cognitive capacity. A
deterioration of the cognitive disturbances has been
found in the patients from the IInd group with
neurological deficiency above 5th level.
Conclusions: In accordance with other studies the
cognitive and neurological deficiencies do not
develop in parallel. However, it has been proved
that the cognitive function appears to be precedent
for the difficulties, arising in the every-day routine,
even in patients at the initial stage of the disease.
Correspondence:
Assoc. Prof. Krasimir Genov, M.D., Ph.D
Clinic of neurological diseases, Military Medical
Academy 3, “G. Sofiiski” Blvd. 1606 Sofia
BULGARIA
PP112
MEASUREMENT OF QUALITY OF LIFE IN
STROKE PATIENTS
228
Authors:
Second Lieutenant YFANTI Vasiliki, RN1; ENS
Kalogeropoulou
Maria
RN2;
LTJG
KALOGEROPOULOS Athanasios MD2; LTJG
LOUTAS Theodoros RN2
Institutions:
1. 251 General Air Force Hospital, Athens,
GREECE
2. Naval Hospital of Salamis, Salamis, GREECE
Aim: The objective of this review was to evaluate
the quality of life in stroke patients as far as their
physical, psychological, social, and functional
aspects of living are concerned. It is generally
based on the patients' subjective perception of
his/her general health and well-being.
Material - Method: The population of this review
consisted of 40 patients with stroke who had been
hospitalized in Red Cross Hospital during JanuaryFebruary 2010. The data were collected using the
SF-36 internationally recognized questionnaire
which was completed anonymously.
Results: It was observed that 70% of stroke
patients had much worse health than a year ago.
After the stroke, the 40% of patients referred that
their moderate activities such as moving a table
were limited a lot. Moreover, the 55% of patients
mentioned that the ability of walking several blocks
was limited a lot. Bathing or dressing oneself was
also affected a lot at the 40% of patients.
Furthermore, the 70% of patients felt bodily pain
and the 45% of patients did not have a lot of energy
during the past 4 weeks. Finally, the 25% of
patients expected their health to get worse.
Conclusions: It is of vital importance to encourage
self-care and the participation of family members in
care plan during all stages of rehabilitation. Taking
into consideration the fact that the disease affects
each patient differently, it is a necessity for nurses
and family background to provide individualized
care.
PP113
CLOSED HEAD INJURY-FREQUENCY AND
CHARACTER LESION OF BRAIN
Authors:
LABOVIC Boban, JOVANOVSKI Aleksandar,
KRSMANOVIC Zeljko, BOSKOVIC Zeljko,
LEPIC Toplica, RAICEVIC Ranko.
229
Institutions:
Department of Neurology, Department of
Radiology. Military Medical Academy.Belgrade,
SERBIA
Introduction: Neurotrauma syndrome by its
complexity but also by its frequency represents one
of the leading problems of modern medicine. In
closed head injuries syndrome usually is lacking
connection between clinical phenomenology and
objectiv conferment of brain tissue lesions.
Material and methods: According to that, the
major outcome or goal of those studies was to
determinate frequency and characeristics of brain
tissue lesions using MRI and CT. As well as
conferming connections between those demages
with clinical parameters such as neurologic deficit
and consciousness deficit disorders evaluating
sensitivity and specificity of neororadiologic
procedures. 40 patiens with closed head injuries
were investigated by the same neurologist. Grade of
neurological deficit (Canadian neurological scale)
and consciousness deficit disorders (Glasgow coma
scale) were determined to all patients. All patiens
were investigated by MRI and CT.
Results: In this study the MRI presented significant
higer specifity and sensitivity especially determing
smaller ishemic and contusion lesions with
significant correlation related to CT. A technique
called MRI has helped improve diagnosis and
treatment of closed head injuries patiens.
Conclusion: This is method that might be useful to
plan further evaluation and possible treatment in
significant number of cases.
PP114
THE CORRELATION OF CHANGES IN
HEMOSTATIC PARAMETERS AND THE
DEGREE OF CEREBRAL ATHEROSCLE
ROSIS (CA) IN PATIENTS WITH ISCHEMIC
STROKE (IS)
Authors:
RAICEVIC Ranko, LEPIC Toplica, TAVCIOVSKI
Dragan, LABOVIC Boban, KRSMANOVIC
Zeljko, VELJANCIC Dragana.
Institutions:
Dpt of Neurology, Dpt. Of Cardiology, The
Medical Faculty of the University of Defence,
Belgrade SERBIA
Introduction. Blood coagulation and fibrinolytic
process are involved in thrombotic vessel
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
obstruction.It is accepted that are association
among dysfunction of vascular endothelium and
changes of coagulation proteins. Considering these
facts, it was established the hypothesis that in
patients with AIS existed changes in hemostatic
system, which were were in positive correlation
with the degree of CA.
Methods and Results. The study was performed in
99 patients (74 males and 24 females), average 66
years (range 44-82) with AIS confirmed by
standard clinical and radiological criteriaa. The
citrate blood was taken within 24-72 hours after
acute event. The activities of protein C(PC),
antithrombin III (ATIII), protein S(PS), α2
antiplasmin(AP),and
plasminogen
activator
inhibitor(PAI1) were measured by commercial
reagents (Behring, Marburg and Instrumentation
Labaratory, Milan).The results were compared with
the values of 41 matched (31 males and 10 females)
nonvascular neurological patients and compared.to
the degree of CA (ultrasonographically). There was
positive correlation of degree of CA cervical
arteries and PAI 1 concentrations (p<0.05). For Ddimer it had boreder-line value (p=0.064).
Significant negative correlation existed between
ultrasonographic findings CA and antithrombin III
and platelet aggregation (p<0.05).
Conclusions. It is concluded that essential
anticoagulants and inhibitors are important in
regulation of hemostasis in patients with AIS,
and.there is a significant increase in concentration
of procoagulant factors in patients with AIS, which
is in positive correlation with degree of CA.
PP115
MUTUAL DETERIORATION SYNDROME IN
CASES OF COMBINED CRANIOCEREBRAL
INJURIES OF PERIPHERAL TISSUES:
EXPERIMENTAL ASPECT
Authors:
SELAKOVIC Vesna, RAICEVIC Ranko, PERISIC
Olja
Institutions:
Military Medical Academy, Institute of Medical
Research, Clinic of Neurology, Belgrade, SERBIA
Purpose. Intact functional and morphological
integrity of central nervous system (CNS) is the
clue for maintenance of homeostasis and regulation
of general response to trauma. It is assumed that
changes in brain functions, without regard to be the
sequelae of direct CNS injury, or they occurred
indirectly, as the result of peripheral tissue injury,
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
basically modify complex interaction (homeostasis)
in the response of each organ and organic system to
injury. The specificity of combined injury includes
the changes in severity, duration or patterns of
general response induced by basic injury, due to the
simultaneous reaction of the organism to the
associated injury.
Material and methods. General reaction of
organism (survival, body temperature, haematocrit
and glycemia) was followed in Mongolian gerbils
subjected to isolated head injury (ligation of the
both common carotid arteries), to peripheral injury
(ligation of both hind limbs), and to combined
injury. In the acute period after the injury,
parameters of oxidative stress (superoxide anion,
index of lipid peroxidation, activity of superoxide
dismutase and glutathione reductase) were followed
in the brain cortex and striatum.
Results - conclusions. Obtained results indicate
that the combined peripheral and craniocerebral
injury of low lethality lead to worsening of general
response of the organism with high lethality of
experimental animals. Also, the increased cortical
and striatal production of superoxide anion and
index of lipid peroxidation, as well as disturbances
of antioxidative enzymes activity suggest on an
important role of brain oxidative stress in the
development of the syndrome of mutual
aggravation in animals subjected to combined
injury.
PP116
NEUROLOGICAL
COMPLICATIONS
FOLLOWING CARDIO-THORACIC SURGE
RY: VALUE OF ELECTROENCEPHALO
GRAPHY
Authors:
SUNDRIC Zvonko, RAICEVIC Ranko, STANIĆ
Vojkan.
Institutions:
Dpt.of Neurology, Dpt. of thoracic surgery. The
Medical Faculty of the University of Defence,
Belgrade, SERBIA
Introduction. Administration of general anestesia
is seldom accompanied with neurological
complications postoperativly.
Material and methods. We analysed postoperative
complications following cardio-thoracic surgery in
patients who after general anestesia developed
neurological complications. We included 60
patients. The same neurologist performed
230
neurological examination, electroencephalography
and according to need, computerised tomography.
Results. In 48 (80%) patients we did not detect
focal stimulative or destructive phenomenons such
as epi-seizures or neurological deficit based on
neurological examination. In 3 (5%) patients we
detected concience crisis with no change in EEG
activity. Three patients (5%) we registered right
extremities weakness with motor dysphasia which
couped in first 24 hours. In these cases EEG
pointed to activity in teta frequency above
frontoparietal regions bilateraly. In 3 (5%) patients
we detected neurological deficit of hemiparesis of
semi-severe degree with development of ischemic
lesion proved by computerised tomography. In 6
(10%) patients CT pointed to mild brain
oedema.Also, we found positive correlation
between duration of anestesia, age and presence of
metabolic disorders (especially diabetes mellitus).
Conclusions. These results suggest significance
value of electroencephalography in detection
neurological complications in patients following the
cardio-thoracic surgery in general anesthesia.
PP117
SEIZURE
INDUCTION
PROCEDURE
DURING EEG RECORDING - HOT WATER
EPILEPSY
Authors:
LABOVIC Boban, RAICEVIC Ranko, LEPIC
Toplica, VELJANCIC Dragana
Institutions:
Clinic of Nurology, The Medical Faculty of the
University of Defence, Belgrade. SERBIA
Introduction. Hot water epilepsy (HWE)
represents a rare clinical entity, classified in a group
of “reflex epilepsy” in which seizures are
precipitated by hot water during bathing.
MethodWe report a HWE in a 21-year-old male,
with symptoms have appeared at age of seven years
old. After initial provocative procedure when we
have applied a tea-pot filled with warm water of
38C and wrapped up with warm towel was pressed
against the back skin, with no effect, we have used
the shower of wider surface of his shoulders and
back with hot water of the same temperature of 38 o
C -that has been effective. Alongside with this, long
term EEG monitoring was proceeded.
Results. It is possible that stimulation of broad skin
areas was involves hypersynchronisation of the
parietal and fronotemporal regions that is critical to
231
elict seizure, not the temperature alone. As complex
partial seizure was induced, the EEG has shown
high voltage slow waves of 2.5 to 3.5/s over the left
side, maximal over Fp1 and C3, followed by well
developed spike and wave complexes over
Fp1C3F3 and F7. The patient experienced a
secondary generalized seizure in the next 70
seconds, feeling sleepy, confused and recovered
gradually after cessation of the ceizure over the
following 15 minutes.
Conclusion. We found special interest to present
the case because of the novel method for seizure
induction, which we have applied. The importance
of this observation is related to the feasibility of
seizure induction, in HWE cases, under the
conditions of EEG recordings.
PP118
REDUCTION OF CEREBRAL BLOOD FLOW
IN THE CHRONIC HEART FAILURE
PATIENTS
Authors:
LEPIC Toplica, LONCAR G, BOZIC B,
VELJANCIC D, LABOVIC B, KRSMANOVIC
Zeljko, Raicevic Ranko.
Institutions:
Military Medical Academy, Neurology department;
Clinical Medical Center Zvezdara, Cardiology
Department; Institute for Physiology and
Biochemistry, University of Belgrade, SERBIA
Background: Global cerebral blood flow (CBF), as
a measure of cerebral perfusion, can be noninvasive studied using Doppler sonography.
Chronic heart failure (CHF) increases the risk of
stroke and dementia. One of the possible causes
may be cerebral hypoperfusion in CHF patients.
Therefore, we aimed to investigate the relationship
between CBF and CHF severity.
Methods: Study was performed in 76 ischemic or
idiopathic dilatative cardiomyopathy patients, left
ventricular ejection fraction (LVEF) <40%, with no
clinical evidence of decompensation and 20 healthy
volunteers. Each CHF patient was categorized
according to the New NYHA criteria. All patients
underwent Doppler echocardiography examination
(GE Vivid 7). The LVEF was quantified using the
Simpson method. CBF was estimated by a 7.0-MHz
linear transducer of a computed sonography system
(Toshiba Power vision 6000). CBF volume was
determined as the sum of the flow volumes of the
ICA and the VA of both sides.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Results: Atrial fibrillation was noted in 30%, l
eft bundle branch block in 26%, while pacemaker
was implanted in 9% of patients with CHF. History
of myocardial infraction was presented in 64% of
patients. No differences in age, waist/hip ratio,
body mass index and lipid profile were found
between CHF patients and healthy subjects. CBF
was calculated in 71 of 76 patients. Three patients
had occlusion of ICA, while VA was ocluded in
another two patients. Others did not have
hemodynamicaly significant ICA and VA stenosis.
CBF volume was decreased in CHF patients, (677 ±
170) according to control (783 ± 128).
Conclusion:
Our results
of noninvasive
sonographic measurement of CBF according to
LVEF and NYHA criteria, suggest on significantly
reduced CBF in CHF patients.
PP119
CLINICAL
AND
POLYSOMNOGRAFIC
FEATURES OF SIX CASES WHO WERE
DIAGNOSED
WITH
KLEINE-LEVIN
SYNDROME
Authors:
MAJ ERDEM Murat MD1, 1LT BOLU Abdullah
MD1, 1LT GARIP Beyazıt MD1, MAJ
KARAMAN Dursun MD2, COL YETKIN Sinan
MD1
Institutions:
1 Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara, TURKEY.
2 Gulhane Military Medical Academy, Dept. of
Chil and Adolesan Psychiatry, Ankara, TURKEY
Introduction. Kleine-Levin Syndrom is a rare
disease which is characterized by intermittent
hypersomnia,
hyperphagia,
hypersexsuelty,
abnormal behaviors and confusion but patient is
generraly healthy between the interval. The aim of
this trail is to determine clinical features in KLS
patients compared the PSG results while
symptomatic and asymptomatic period.
Material and methods. PSG results of 6 KLS
patients have been compared while symptomatic
and asynmptomatic period that was diagnosed by
Gulhane Military Medical School Sleep Center.
Results.The onset of KLS is aproximmately 18
years old and making a diagnosis might be 2.67
years late, hypersomnia attack continues 11.5 days,
Until the correct diagnosis, patient had experinced
5 attacks. Total sleep time of KLS patients in
symptomatic period and STAGE 2 sleep pecent
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
ratio is higher than asymptomatic period. REM
latans in asymptomatic period was short, Stage 3 ve
REM percent of their sleep time was lower when
compare the asymptomatic period.
Conlucion. Initial of disease and period of sleeping
time was in a correlation with litrature. The sleep
architecture of symptomatic period was different
from asymptomatic period. When PSG was
performed early (before the end of the first half of
the symptomatic period), an important reduction in
slow wave sleep (SWS) was always present with
progressive return to normal during the second half
(with percentages very similar to those monitored
during the asymptomatic period) despite persistence
of clinical symptoms. The limit our study was not
eveluated the sleep architecture as first and second
episode.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 506 5361351
E-mail: drmerdem@yahoo.com
PP120
INFLUENCE OF CEFTRIAXONE AND LNAME ON CONVULSIONS INDUCED BY
PENTYLENETERAZOLE
Authors:
Prof. Jelenković A1, Prof. Jovanović M2, Prof.
Bokonjić D2, Prof. Bošković B2
Institutions:
1. Institute for Biological Research „Siniša
Stanković“, Belgrade, University of Belgrade,
Serbia
2. Military Medical Academy, Institute for Medical
Research, Belgrade, SERBIA
Successful control of epilepsy is hindered by its
complex pathogenesis in which are involved
excitatory
amino
acids,
GABA,
other
neurochemicals, nitric oxide, etc. Ceftriaxone
enhances expression and function of glutamate
GLT1 transporter and may be anticonvulsant under
some conditions in pentylenetetrazole (PTZ)evoked convulsions. Therefore it was of interest to
investigate interaction between ceftriaxone and
inhibition of NO synthesis evoked by NG-nitro-Larginine-methyl ester (L-NAME). Research was
performed in six groups of C57Bl strain of mice,
three groups of four and three of 12 weeks old
animals at the beginning of the experiments. The
232
first group received saline (control group) and the
second ceftriaxone once daily for six consecutive
days before PTZ, and the third was treated with LNAME after ceftriaxone and before PTZ. All
substances were administered intraperitoneally.
Within 30 minutes after PTZ treatment it was
monitored incidency and latent time of generalized
clonic and clonic-tonic convulsions, and death of
mice. Ceftriaxone did not prevent PTZ effects in
four weeks, opposite to 12 weeks old mice.
However, in one month old mice L-NAME
pretreatment demonstrated statistically significant
anticonvulant effects, prevented death and
prolonged latent time of all three clinical
parameters, compared to both, PTZ and
Ceftriaxone+PTZ treated groups. In 12 weeks old
mice L-NAME pretreatment did not influence
anticonvulsant effects of ceftriaxone. Obtained
results suggested that interaction of ceftriaxone and
NO in PTZ-evoked convulsions exists and depends
on the age of treated C57Bl mice.
PP121
SOCIAL SKILLS TRAINING RESULTS IN
CLUSTER C PERSONALITY DISORDERS
Authors:
Prof. Assoc. Col. VASILE Daniel MD, PhD, Mr.
VASILIU Octavian MD, PhD, UNGUREANU
Daniela MD, Capt. MANGALAGIU Andrei
Gabriel MD, Lt. PETRESCU Bogdan Mircea MD,
BANICA Anisoara MD, BLANDU Maria MD, Plt.
Adj. Princ. GROSU Georgeta LPN, MELIACA
Alexandru LPN
Institutions:
Military University Emergency Central Hospital
“Dr. Carol Davila”, Department of Psychiatry,
Bucharest, ROMANIA
Background: Cluster C personality disorders are
usually associated with a maladaptive pattern of
social skills. The assessment of these skills and
their training are needed in order to improve the
quality of these patients life and to reduce the risk
of axis II co-morbidities.
Objective: To assess the impact of social skills
training in cluster C personality disorders on
medium term, using a structured cognitive
behavioral approach.
Methods: A group of 15 subjects, 10 male and 5
female, mean age 28.6, diagnosed- according to the
DSM IV TR criteria- with avoidant personality
disorder (n=4), dependent personality disorder
(n=4), obsessive-compulsive personality disorder
233
(n=3) or mixed personality disorder, with cluster C
features (n=4) were referred to our department for
evaluation and treatment. These subjects were
evaluated using a structured, social skills oriented
interview, Clinical Global Impressions (CGI) and
Global Assessment of Functioning (GAF) every 4
weeks, for 3 months. Patients received either
structured, 2 sessions a week, cognitive behavior
therapy, focused on social skills training (n=8), or
supportive, non-specific, therapy (n=7).
Results: Patients diagnosed with cluster C
personality disorder presented at 3 months a higher
rate of global improvement (CGI -2.2 vs. -1.4,
p<0.05) and global functioning (GAF +15.3 vs.
+10.2, p<0.05) in the cognitive-behavioral, social
skills oriented approach group. The structured
interview showed also an increase in the ability of
patients to cope with social stressful situation, as
well as an increase in the response to social
everyday demands.
Conclusion: Patients with cluster C personality
disorder could benefit from the social skills training
and this fact is reflected in the improvement of
global functioning and social interactions quality of
these patients.
Correspondence:
E.mail: octavvasiliu@yahoo.com
PP122
REPETITIVE TRANSCRANIAL MAGNETIC
STIMULATION
(RTMS)
IN
THE
TREATMENT
OF
OBSESSIVECOMPULSIVE DISORDER (OCD) - CASE
REPORT
Authors:
Cpt. DOLIC Mirko. MD; STOJANOVIC Zvedana,
MD; Cpt. JOKOVIC Danilo, MD
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
serotonin and dopamine) in patients. A possible
genetic mutation may contribute to OCD. A
mutation has been found in the human serotonin
transporter gene, hSERT, in unrelated families with
OCD. There is evidence that motor and premotor
cortex are hyperexcitable in obsessive-compulsive
disorder (OCD). In treatment refractory OCD an
important place is reserved for Transcranial
magnetic stimulation (TMS). This technique was
first introduced in 1985 by Baker, and is the least
invasive of all physical OCD treatments. It involves
a magnetic field being inducted over the scalp by
passing an electrical current through a coil.
Method: Patient, 33-year-old, who had refractory
OCD was treated with active rTMS to the
supplementary motor area (SMA) with 10 daily
sessions (two week) at 1 Hz, 100% of motor
threshold, 1200 stimuli/day. At the second week of
treatment, statistically significant reductions were
seen in the severity of simptoms (confirmed by
psychometric instruments YBOCS, CGI, MOS-6
HDRS, BDI-II, SCL-90)
Conclusion: The data suggest abnormal cortical
excitability in obsessive–compulsive disorder, with
overlapping dysfunction in corticobasal circuits.
Because of encouraging results of TMS and fewer
side effects compared to other more invasive
physical procedures, more research in the future
appears most likely.
PP123
STRESS AND COPING TEHNIQUES IN UN
PEACEKEEPING OPERATIONS-SERBIAN
EXPERIENCE
IN
MONUSCO,
THE
DEMOCRATIC REPUBLIC OF CONGO
Institution:
Department of Psychiatry, The Medical Faculty of
the University of Defence, Belgrade, SERBIA
Authors:
Capt. JOKOVIC Danilo. MD, Ass. Prof. Col.
SAMARDZIC Radomir. MD, PhD, Capt. DOLIC
Mirko. MD
Institution:
Department of Psychiatry, The Medical Faculty of
the University of Defence, Belgrade, SERBIA
Background: Obsessive-compulsive disorder is an
anxiety disorder in which people have unwanted
and repeated thoughts, feelings, ideas, sensations
(obsessions), or behaviors that make them feel
driven to do something (compulsions). It’s more
common than it was once thought. There are
several theories about the cause of OCD, but none
have been confirmed. Some reports have linked
OCD to head injury and infections. Several studies
have shown that there are brain abnormalities (an
imbalance of brain neurotransmitters, especially
Background: UN Mission in the DRC-MONUC
and later MONUSCO was establihed by UN
Security Council Resolution 1279 from 30/09/1999.
Serbian participation in this mission dates back
from April 2003 till present with military
contingent consisting of six members as part of Air
medical evacuation team with primary task:
medical escort, monitoring of vital signs,
diagnostics and therapy during medical evacuation,
casualty evacuation and medical repatriation by air
and by land.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Method: Observational analisys of Serbian
participation in MONUSCO with emphasis on
stress
and
coping
tehniques.
Observed
stressogenous factors in the DRC were before
arrival to the mission area and in the mission area.
Before arrrival to the mission area soldiers had to
face with: reactions of surroundings; insufficient
length and inadequate structure and focus of
preparations; long period between completion of
training and departure; unresolved issues of
payment of compensations; delayed and incomplete
supply and performing regular duties up to the
moment of departure. In the misssion area most
important stressogenous factors were: mutual
relationships; culture shock; accommodation,
climate, health threats, security risks; difficulties in
communication with family and superior command;
delays in payment of compensations in Serbia and
in the DRC and imprecisely defined obligations and
rights. Numerous stress reactions occured:
fluctuations in energy level and mood; disturbances
of sleep and appetite; polymorphic somatic
complaints, fear of diseases, multiple repeating
infectious diseases tests; disturbed interpersonal
relations; violations of Code of conduct; excessive
use of alcohol, nicotine and occasional use of
psychoactive substances; lack of social inhibitions,
promiscuity, use of sex workers’ services.
Conclusion: Productive ways of overwhelming
stress used in this mission were: honesty and
openness in interpersonal communications;
dedication to work; maintaining discipline and
order; strict following of appropriate regime of
work, diet, rest and recreation; regular
communication with family and organizing and
participation in various social, cultural and sports
manifestations. Most important is appropriate
selection of personnel which have to be mentally
stable,
mature
personality,
intelligent,
broadminded, without prejudice, communicative,
resourceful, wise, brave, courageous, interested and
motivated, persistent, competent and skilled.
PP124
FOLATE, FERRITIN AND VITAMIN B12
LEVELS IN POST TRAUMATIC STRESS
DISORDER
Authors:
LTJG AKARSU Suleyman, MD1, 1Lt BOLU
Abdullah, MD1, LTJG OZSELEK Suleyman, MD1,
1Lt GARIP Beyazıt, MD1, Maj ÖZNUR Taner,
MD2, Maj AK Mehmet, MD1 , Maj OZDEMIR
Barbaros, MD1, Capt OZMENLER Kamil Nahit,
MD1
234
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara
2. Gulhane Military Medical Academy, Dept. of
Psychiatry, Dept of Military Psychology and War
Psychiatry, Ankara, TURKEY
Objective. Posttraumatic stress disorder (PTSD) is
an incapacitating clinical syndrome characterized
by intrusive recollections, emotional numbing and
withdrawal,
cue-related
responses,
and
psychological and physiological hyperarousal.
Patients often suffer from anxiety or depressive
symptoms. İn this study we aimed to examine the
relationship between anxiety, depressive symptoms
and serum folate, ferritin, vitamin B12 levels.
Material and methods. Hamilton anxiety scale,
Hamilton depression scale, Impact of Event Scale
(IES-R) and the Clinician administered PTSD scale
(CAPS) were administered to 53 patients with a
diagnosis of PTSD according to DSM-IV
diagnostic criteria; serum folate, ferritin, vitamin
B12 levels of patients and control group were
determined. The correlation between Hamilton
anxiety scale, Hamilton depression scale, Impact of
Event Scale (IES-R), CAPS scores and serum
folate, ferritin, vitamin B12 levels were assessed by
Pearson correlation test.
Results. The mean serum folate, ferritin, vitamin
B12 values were .49±5.07, 58.33±46.29,
319.30±96.07. When serum folate, ferritin, vitamin
B12 values of patients with PTSD compared to
healthy subjects; the difference between two groups
were evaluated as statistically significant. A
positive correlation (r=0.37) between vitamin B12
levels and IES intruziv scores were determined.
There was no correlation between serum folate,
ferritin, vitamin B12 values and Hamilton anxiety,
Hamilton depression scores.
Conclusion. İt is known that the addition of folate,
ferritin and vitamin B12 to the treatment of patients
with depressive and anxiety disorder increases the
response to treatment(1). Similary the addition of
folate, ferritin and vitamin B12 to the treatment of
PTSD patients should be useful in controlling
symptoms.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY.
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 538 3283032
235
E-mail: drakarsus@hotmail.com
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
PP125
ACUTE HYPEROSMOLAR HYPERGLYCE
MIC STATE ASSOCIATED WITH USE OF
NEW
GENERATION
ANTIPSYCHOTIC
DRUG: A CASE REPORT
Correspondence:
Gulhane Askeri Tip Akademisi, Iç Hastalıkları BD,
Etlik 06018, Ankara, TURKEY.
Tel:+90 312 304 4015
Fax:+90 312 304 4001
GSM:+90 554 525 2246
E-mail: drmustafacakar@gmail.com
Authors:
1Lt CAKAR Mustafa, MD1, Maj ARSLAN Erol,
MD1, Ltc DEMIRBAS Seref, MD1, 1Lt KILINC
Ali, MD1, Maj YESILKAYA Sirzat, MD2, Col
SAGLAM Kenan, MD1
PP126
SELF
MUTILATING
BEHAVIOUR,
DISSOCIATIVE
EXPERIENCES
AND
COPING IN SOLDIERS DIAGNOSED AS
ANTISOCIAL PERSONALITY DISORDER
Institutions:
1. Gulhane Military Medical Academy, Department
of Internal Medicine, Ankara, TURKEY
2. Gulhane Military Medical Academy, Department
of Family Medicine, Ankara, TURKEY
Authors:
Capt BALIKCI Adem, MD, 1LT BOLU Abdullah,
MD, LTJG AKARSU Suleyman, MD, Maj
ERDEM Murat MD, Maj OZDEMIR Barbaros,
MD , Col UZUN Ozcan, MD
Objective. Diabetes mellitus is more common in
schizophrenia patients than the general population,
due to antipsychotic drugs or a variety of
mechanisms. Hyperosmolar hyperglycemic state is
an acute complication of diabetes. Here we present
a case of hyperosmolar hyperglycemic state due to
a new generation antipsychotic drug usage. CASE:
A 59-years old male had schizophrenia for 30 years
and he was using antipsychotic drugs of risperidone
(25 mg im/2 times a month) and quetiapine (1x100
mg). The patient had a new speech disorder and
difficulty on face movements. Physical examination
revealed a peripheral facial paralysia. Arterial blood
pressure (ABP) was 140/80mmHg, pulse rate
84/min, fever: 36.4‘C, respiratory rate: 20/min,
tongue and oral mucosa were dry. Leukocytes were
10900/mm3, Hb: 16.6 g/dl, glucose: 609 mg / dl,
urea: 20 mg / dl, creatinine: 1.0 mg / dl, uric acid:
2.63 mg/dl, Na: 132 mmol/l, C: 3.84 mmol/l; urine
density: 1024, glucose: +++, ketone (-), on
sediment:1-2 leukocytes was detected. Arterial
blood gas analysis was pH: 7.415, pCO2: 28.1,
HCO3: 18.2. Serum osmolarity was 305 mOsm/kg.
The patient had no diabetes history, and was in
remission of the psychotic illness. High blood
glucose, normal pH, ketone negativity and
hyperosmolar hyperglycemic state was found
associated with a new-onset diabetes and patient
and hospitalized for fluid and insulin therapy.
Institution:
Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara, TURKEY
Conclusion. Schizophrenia and the drugs used to
treat it may worsen the diabetes disease course.
Diabetic schizophrenia patients using new
generation antipsychotic medication should be
monitored closely for possible acute diabetic
complications.
Objective. We aimed to investigate self mutilating
behaviour, which is a frequent behaviour at military
psychiatry settings, at a homogenous group that
consists of antisocial individuals and to study the
correlations of this behaviour with dissociative
experiences and coping attitudes within that group.
Material and methods. The study consists of 130
male cases that have antisocial personality disorder
diagnosis. These individiuals have been divided
into two groups according to their self mutilation
status. A semi structured questionnare was
applicated to patients in order to determine
sociodemographic and clinical features. Coping
mechanisms was evaluated with COPE and
dissociative experiences was evaluated with DES
(Dissociative Experiences Scale).
Results. In this study, self mutilating individiuals
had significantly higher scores than non self
mutilating individuals at DES measures and at
disfunctional coping and drug use subscales of
COPE. It was shown that there is a correlation
between coping attitudes, dissociative experiences
and self mutilating behavior. We found that self
mutilating individuals are using some maladaptive
coping strategies more than non self mutilating
group and have more dissociative experiences.
Conclusion. İn our study, we found a positive
correlation between DES scores and restraint
coping, problem focused coping, laugh of, emotion
focused coping, denial, behavioral disengagement
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
and dysfunctional coping in non-selfmutilating
group. It could be said that dissociative experiences
are more common at antisocial personality disorder
(APD) patients who had shown self mutilating
behaviour and they use disfunctional coping
mechanisms more frequently. It was suggested that
further evaluation of this psychopathology of APD
patients is required in restrictive environments such
as military service.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY.
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 533 8178544
E-mail: balikciadem@yahoo.com
PP127
POST TRAUMATIC STRESS
AND THYROID FUNCTIONS
DISORDER
Authors:
1Lt BOLU Abdullah, MD1, LTJG AKARSU
Suleyman, 1Lt AYDEMİR Emre MD1, Maj
ÖZNUR Taner MD2, Maj ERDEM Murat, Maj
OZDEMIR Barbaros, MD1, Capt OZMENLER
Kamil Nahit, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara
2. Gulhane Military Medical Academy, Dept. of
Psychiatry, Dept of Military Psychology and War
Psychiatry, Ankara, TURKEY
Objective. The relationship between thyroid
hormones and post traumatic stres disorder (PTSD)
contiunes to be a subject of debate for a long time.
İn this study we aimed to examine the relationship
between the severity of PTSD symtoms and thyroid
hormones levels.
Material and method. Impact of Event Scale (IESR) and the Clinician Administered PTSD Scale
(CAPS) were administered to 56 patients with a
diagnosis of PTSD according to DSM-IV
diagnostic criteria; thyroid hormones levels (T3,
T4, TSH) of patients and control group were
determined. The correlation between CAPS, IES-R
subscale scores and T3, T4, TSH levels were
assessed by Pearson correlation test.
Results. The mean T3, T4, TSH values were
3.29±0.56, 1.24±0.32, 1.94±0.23. When thyroid
function tests of patients with PTSD compared to
halthy subjects; T3, T4 levels did not differ, but
there was difference in TSH values (p<0.05). A
236
negative correlation between T4 levels in patients
with PTSD and IES avoidance score (r=0.40), and a
positive correlation between free T3 levels and
CAPS total scores (0.46), intruziv CAPS scores
(0.42), hyperarousal CAPS scores (0.41), CAPS
avoidance scores (0.38) were determined.
Conclusion. İn the studies negative (1) or pozitive
(2-4) correlation between clinical symptoms and
free, total T3 in PTSD patients than control group
have been reported. The results of this study
support the positive correlation between two
variables. Studies with more participation needs to
be done in this issue.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY.
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 506 5089652
E-mail: abdullah_bolu@yahoo.com
PP128
POST TRAUMATİC STRESS DISORDERPSYCHOTIC
DISORDER;
EFFECTIVE
TREATMENT OF TWO CASES WİTH
ELECTROCONVULSIVE THERAPY
Authors:
1LT BOLU Abdullah, MD1, LTJG AKARSU
Suleyman, MD1, Maj ERDEM Murat MD1 , Maj
ÖZNUR Taner MD2, Maj OZDEMIR Barbaros,
MD1, Capt OZMENLER Kamil Nahit, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Psychiatry, Dept of Military Psychology and War
Psychiatry, Ankara, TURKEY
Objective. The prevalence of comorbidity with
schizophrenia and post-traumatic stres disorder
(PTSD) patient is reported between 0-17% (1,2).
ECT (electroconvulsive therapy) is used since 1930
as a somatic treatment in psychiatry (3) for the
treatment of mood disorders, schizophrenia and
other psychiatric disorders (4). Despite the lack of
adeqate studies, ECT is being used more common
for the treatment of PTSD comorbid depressive
symptoms (5). In this study we aimed to share the
results of two PTSD comorbid psychotic disorder
patients’ ECT treatment.
First Case: A 48 years old male. He had multipl
combat reaction 15 years ago and then his
complaints have been started as hyper arousal,
237
insomnia, flashbacks and nightmares. He had
received treatment with a diagnosis of PTSD. 8
years after trauma recession, loss of pleasure and
interest, auditory and visual hallucinations,
paranoid thoughts, behavioral pathologies had been
emerged and he had received antipsychotic
treatment with a diagnosis of psychotic disorder.
He admitted to the psychiatric clinic because of
development
of
suisidal
ideation,
drug
incompatibility, increased symptoms of hyper
arousal and behavioral pathologies. CAPS 2, HamD, Ham-A, PANNS, BPRS and CGI scores were
49, 19, 29, 63, 39, 5. 10 sessions of ECT were
administered . He was treated for 35 days in
hospital. Psychometric examination of the patient’s
output scores were 29, 13, 18, 41,18, 2 respectively.
His suicidal thoughts and pathologies related to
behavior and thought content had been significantly
reduced.
Second Case: A 43 years old male. He had
traumatic event 18 years ago and then his
complaints have been started as excessive
irritability, insomnia, flashbacks and nightmares.
He had received treatment with a diagnosis of
PTSD. 2 years after trauma emational limitations,
auditory and visual hallucinations, reference
thoughts had been emerged and he had received
antipsychotic treatment with a diagnosis of
psychotic disorder. He admitted to the psychiatric
clinic because of development of homosidal and
paranoid thoughts, agitation and behavioral
pathologies. CAPS 2, Ham-D, Ham-A, PANNS,
BPRS and CGI scores were 45, 20, 27, 62, 41, 5. 10
sessions of ECT were administered He was treated
for 45 days in hospital. Psychometric examination
of the patient’s output scores were 28, 12, 17, 39,
19, 2 respectively. The patient's symptoms
improved.
Conclusion. Margoob et al. investigated the impact
of ECT in 20 patients with PTSD comorbid with
depression and improvement in CAPS and
depression scores was %40 and % 57 (5). ECT is
useful in the treatment of both PTSD and psychotic
symptoms, So that ECT should be used in tratment
resistant PTSD with comorbid psychotic disorder as
augmentation therapy.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY.
Tel: + 90 312 3044501
Fax: + 90 312 3044507 EGSM: + 90 506 5089652
e-mail: abdullah_bolu@yahoo.com
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
PP129
THE
RELATIONSHIP
BETWEEN
AGRESSION
STATE
AND
SERUM
TRYPTHOFAN AND LARGE NEUTRAL
AMINOACID LEVELS IN ANTISOCIAL
PERSONALITY DISORDER
Authors:
MAJ ERDEM Murat MD1, 1LT GARIP Beyazıt,
MD1, LTJG ZINCIR Serkan, MD1, Maj GULCAN
KURT Yasemin MD2, MAJ YAMAN Halil, MD2,
MAJ AKGUL Ozgur Emin MD2
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Biochemistry, Ankara, TURKEY
Introduction. Serotonin is produced from an
essential aminoasit which is called as thyriptofan.
Serotonin is always in a competation with the
others LNAA (valin, lösin, izolosin, fenilalnin,
tirozin) to pass the blood /brain barrier. Some of the
studies show that antisocial personality disorder
(APD) cases reveal some sort of the discrepancy
about the level of the seratonin level when
compared with control group. The aim of this study
is to determine the relationship between serum
triptofan and triptofan /LNAA ratio or correlation
between serum triptofan and agression state.
Material and methods. 52 male patients with a
diagnosis of APD according to DSM-IV diagnostic
criteria and control group including 20
particitipants matched with sex and age were
enrolled to the study. The agression state was
assesed with Buss-Perry scale. The serum
aminoacid levels were measured by using HPLC
method. Student t test was used to compare both of
two groups serum aminoacid levels. The correlation
between serum aminoacid levels and agression state
was eveluated with pearson correlation test.
Results. There was no significant difference
between patients’ serum triptophan (t= 0.49, p=
0.63) and triptophan/LNAA (t= 1.24, p= 0.22)
levels with control group. Buss-Pery agresyon scale
or subscale scores of ASD have no significant
correlation between serum trypthophan levels.
Conclusion. Virkkunen et al indicated that APD
patients’ total triptophan /LNAA and free
trypthophan /LNAA ratios were higher than the
control group.( Acta Psychiatr Scand 2003: 108:
244–247). We didn’t find any significant
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
correlation between not only agression and
tripthofan but also TT and LNAA
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY.
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 506 5361351
E-mail: drmerdem@yahoo.com
PP130
PSYCHIATRIC SYMPTOMS AND QUALITY
OF LIFE IN THE MILITARY PERSONNEL
WHO WORK ABROAD
Authors:
Maj ÖZNUR Taner MD2, Maj ERDEM Murat
MD1, LTJG AKARSU Suleyman, Maj DURUSU
Murat MD3, Maj TOYGAR Mehmet MD 4, Col
ERYILMAZ Mehmet MD3, Capt OZMENLER
Kamil Nahit, MD1
Institutions:
1. Gulhane Military Medical Academy,
Psychiatry, Ankara, TURKEY
2. Gulhane Military Medical Academy,
Psychiatry, Dept of Military Psychology
Psychiatry, Ankara, TURKEY
3. Gulhane Military Medical Academy,
Emergency, Ankara, TURKEY
4. Gulhane Military Medical Academy,
Forcenic Medical, Ankara, TURKEY
Dept. of
Dept. of
and War
Dept. of
Dept. of
Introduction. In this study we aimed to examine
psychiatric symptoms and quality of life in the
Turkish Armed Forces personnel working in
Afghanistan.
Material and methods. 289 Turkish military
personnel working under the command of ISAF in
Afghanistan, were enrolled to the study. The Brief
symptom inventory (BSI), quality of life
questionnaire- short form (SF-36) and data form
containing questions about sociodemographic
characteristics administered to the participants.
Data from 258 participants who filled the forms
properly were evaluated.
Results. Level of somatization was found to have
negative effects on the SF-36 subscales of physical
function, physical role limitations and pain score;
level of depression was found to have negative
effects on pain, vitality and mental health score.
Age, tenure, education level and BSI subscales of
anxiety, negative self, hostility were found to have
no effect on the quality of life subscale scores.
238
Conclusion. Psychological morbidity of the study
sample were similar with the general population (926%). This showed that personnel adapted to the
work despite the many difficulties of working
abroad. Findings suggest that having a high level of
psychiatric symptoms in the staff who work abroad,
has a negative impact on quality of life. To
contribute to the reduction of problems, personnel
who will work abroad should be informed about the
possible conditions and individual support should
be provided as needed.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY.
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 506 5361351
E-mail: drmerdem@yahoo.com
PP131
TRAUMA AND EMDR: 2 CASE REPORTS
Authors:
Maj ÖZNUR Taner MD2, 1LT BOLU Abdullah,
MD1, LTJG AKARSU Suleyman, MD1, Maj
OZDEMIR Barbaros, MD1, Capt OZMENLER
Kamil Nahit, MD1
Institutions:
1 Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara, 2 Gulhane Military Medical
Academy, Dept. of Psychiatry, Dept of Military
Psychology and War Psychiatry, Ankara, TURKEY
Objective. EMDR (Eye movement desensitization
and reprocessing), is a psychologic procedure used
in treatment of affectivity disorders. In this study
we aimed to share the results of two PTSD patients’
EMDR treatment.
First Case: A 32 years old male. He had an combat
reaction and since then his complaints had been
started as insomnia and flashbacks. Five sessions of
EMDR were applied. Negative and positive
cognition were determined as ‘’I’m in danger’’ and
‘’that is over, now safe here’’. His subjective unit
of disturbance (SUDS) was 10 and validity of
cognition (VOC) was 1, Impact of Event Scale
(IES-R) , Beck Depression Inventory (BDI) , Beck
Anxiety Inventory (BAI) scores were 70, 47, 39 .
After the therapy SUDS, VOC, IES-R , BDI , BAI
scores were determined 0, 6, 47, 25,19 respectively.
Second Case: A 44-year-old male. He had an
earthquake and since then re-experiencing the
earthquake, inability to sleep had been emerged.
One session of EMDR were applied. Negative and
positive cognition were determined as ‘’I have lost
239
loved ones’’ and ‘’Now I have options’’. His SUDS
was 10 and VOC was 5. IES-R, BDI, BAI scores
were 56, 36, 38. After the therapy SUDS, VOC,
IES-R , BDI , BAI scores were determined 1, 7, 29,
22, 24 respectively.
Conclusion. In our study measurements of SUDS
values between the initial and final were very clear.
The results of this study are compatible with other
EMDR researches in the literature.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY.
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 533 7081036
E-mail: abdullah_bolu@yahoo.com
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
REM percent of their sleep time was lower when
compare the asymptomatic period.
Conlucion. Initial of disease and period of sleeping
time was in a correlation with litrature. The sleep
architecture of symptomatic period was different
from asymptomatic period. When PSG was
performed early (before the end of the first half of
the symptomatic period), an important reduction in
slow wave sleep (SWS) was always present with
progressive return to normal during the second half
(with percentages very similar to those monitored
during the asymptomatic period) despite persistence
of clinical symptoms. The limitted our study was
not eveluated the sleep architecture as first and
second episode.
PP132
CLINICAL
AND
POLYSOMNOGRAFIC
FEATURES OF SIX CASES WHO WERE
DIAGNOSED
WITH
KLEINE-LEVIN
SYNDROME
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD,
Etlik 06018, Ankara, TURKEY.
Tel: + 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 506 5361351
E-mail: drmerdem@yahoo.com
Authors:
Maj ERDEM Murat MD1, 1LT BOLU Abdullah
MD1, 1LT GARIP Beyazıt MD1, Maj KARAMAN
Dursun MD2, Col YETKIN Sinan MD1
PP133
BURNOUT AND JOB SATISFACTION
LEVELS OF PHYSICIANS ENGAGED IN
MILITARY SERVICE
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Psychiatry, Ankara, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Chil and Adolesan Psychiatry, Ankara, TURKEY
Authors:
Capt OZTURK Gultekin, MD1, Capt YAVAS
Umit, MD1, Maj YILDIRAN Nuri, MD, PhD2, Col
OZER Mustafa, MD, PhD1, Col CETIN Mehmet,
MD, PhD1, Maj TURK Yusuf Ziya, MD, PhD1
Introduction. Kleine-Levin Syndrom is a rare
disease which is caracterized intermittant
hypersomnia,
hyperphagia,
hypersexsuelty,
abnormal behaviors and confusion but patient is
generaly healthy between the interval. The aim of
this trail is to determine clinical features in KLS
patients compared the PSG results while
symptomatic and asymptomatic period.
Material and methods. PSG results of 6 KLS
patients have been compared while symptomatic
and asynmptomatic period that was diagnosed by
Gulhane Military Medical School Sleep Center.
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Military Health Services, Ankara, TURKEY
2. Turkish Armed Forces Medical Command,
Ankara, TURKEY
Results. The onset of KLS is aproximetly 18 years
old and making a diagnosis might be 2.67 yaers
late, hypersomnia attack continues 11.5 days. Until
the correct diagnosis, patient had experinced 5
attacs. Total sleep time of KLS patients in
symptomatic period and STAGE 2 sleep pecent
ratio is higher than asymptomatic period. REM
latans in asymptomatic period was short, Stage 3 ve
Material and methods. “Maslach Burnout
Inventory (MBI)” with emotional exhaustion,
depersonalization and personal accomplishment
dimensions and “Job Satisfaction Inventory” were
used. The questionnaires are applied to 145
physicians. 95 (65,5%) of them were specialist. 86
(59,3%) physicians were in 24-30 ages, 59 (40,7%)
were in 31-40 ages. Married, single and divorced
Objective. Burnout manifests itself with
depersonalization, emotional exhaustion, and
reduced feelings of personal achievement and
adequacy. This study’s objective was to determine
burnout and job satisfaction levels in physicians
engaged in military service.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
physicians’ frequencies were 79 (54,5%), 59
(40,7%) and 7 (4,8%) respectively. 105 (72,4%)
physicians don’t have child. 91 (62,8%) of them
were working less than 5 years.
Results. MBI mean scores were 21,2±4,9 at
emotional exhaustion (highest at married
(21,6±4,6)), 9,3±3,0 at depersonalization (highest at
physicians without children (9,75±3,0)) and
31,1±3,4 at personal accomplishment (lowest at
single (30,5±3,9)). Physicians without children
have high depersonalization level (p=0,003).
Physicians worked less than 5 years have low
personal achievement (p=0,043). JSI mean scores
were between 52 and 148 (32 items over 5 points).
The highest scores were at divorced (100,29±20,9)
and single physicians (97,8±17,6). Physicians with
child (92,07±22,3) and married (92,93±21,6) have
lowest scores. Single physicians and physicians
without child were more satisfied at payment
dimension (p=0,028 and p=0,018 respectively).
Conclusion. This study indicates having no child
and lack of experience at the job (working less than
5 years) and also being single is related with the
physicians’ high burnout and low satisfaction
levels.
Correspondance:
Gultekin OZTURK Gulhane Askeri Tip Akademisi,
Askeri Saglik Hizmetleri AD, Etlik 06018, Ankara,
TURKEY
Tel: +90 312 3043359
GSM: +90 532 7001822
E-mail: gozturk4@yahoo.com
PP134
INTEGRATED PLATFORM FOR RESEARCH
AND EXPERTISE FOR BIOLOGICAL
AGENTS
Authors:
Colonel (r.) medic Dr. Viorel Ordeanu C.S.gr.I,
Dr.vet. Marius Necsulescu C.S.gr.I, Colonel medic
dr. Cristian Radut, General-maior (r.) medic
Academician Prof.univ.Dr. Victor A. Voicu
C.S.gr.I
Institution:
Military Medical Research Center Bucharest,
ROMANIA
International context of threats and bioterrorism
attacks brings to attention the current risks of
biological warfare, biological and toxin weapons,
terrorism "bio-chem" and connection with
epidemiological issues (pandemics, panzootics),
240
which may culminate in a biological crisis.
Considering the fact that Romania is the Eastern
border of NATO and the EU, considered as
"spearheading the alliance eastward" biological
risks are taken into account. Military Medical
Department should monitor and be able to intervene
for medical protection against biological agents,
primarily for force protection but also for protecting
the public from the affected area. Our institution
has a part of research for medical protection against
biological weapons and toxins, with facilities (some
modernized national projects NASR / PNCDI /
capabilities) that are complementary to work as an
integrated platform for scientific research and
medical expertise for protection from biological
agents: highly secure microbiology laboratory
(under construction), secured biobase, toxinological
laboratory, point of checking suspicious mail,
biological decontamination micropoligon for
testing in simulated conditions, minipoligon testing
and training for field decontamination laboratory,
etc. For effective medical protection against
biological weapons, it is necessary that existing
facilities to be completed, upgraded, combined in
one integrated platform, to be licensed, accredited
and recognized as a national reference laboratory
for biological agents. This is useful as an
interdepartmental entity, with regional and national
importance and to meet EU requirements BSL4 full
functional network of laboratories.
Correspondence:
CCSMM 0213156453,
E.mail: ordeanu_viorel@yahoo.com
PP135
RESEARCH
FOR
OBTAINING
BIOLOGICAL DECONTAMINATED
NEW
Authors:
General-maior(r.) medic Academician Prof.univ.Dr.
Victor A. Voicu C.S.gr.I1, Colonel (r.) medic Dr.
Viorel Ordeanu C.S.gr.I1, Colonel (r.) farmacist
Prof.univ. Dr. Adrian A. Andrieş2, Colonel (r.)
Dr.ing.chim. Nicolae Luţă C.S.gr.I3, Dr.ing.chim.
Emilia Bărbulescu4
Institutions:
1. Military Medical Research CenterBucharest
2. Universiy of Medicine and Pharmacy “Carol
Davila” Bucureşti,
3. ICECHIM,
4. ICTCM, ROMANIA
Medical protection against weapons of mass
destruction with chemical, biological, radiological
and nuclear agents (WMD / CBRN) nowadays has
241
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
special importance for defense in case of a war,
terrorism defense in warfare "asymmetric" attacks "
bio-chem "etc. This research was performed in a
national project, NASR / PNCDI / CEEX /
Aeronautics / PRODECON, in order to produce
"bio-chem" decontaminants and high performance
obtaining technologies and application procedures
in order to combat the effects of chemical and
biological
attacks.
Microbiological
and
toxicological testing of compounds to make the
recommendations made in "Methods and
techniques commonly used in clinical laboratory"
published by the Ministry of Health and Academy
of Medical Sciences and AFNOR rules
"Antiseptiques et desinfectants". Research has
several stages: screening, in vitro - in the
microbiologically secured laboratory, in vivo laboratory biobase, in micropoligon, minipoligon
and polygon specialized for training in CBRN
defense.
Decontamination-adsorbent
powder
disinfected by complete coverage the contaminated
area by wiping with swab (sponge) to remove the
biological agent, min. 10g/dmp. For liquid
decontaminas spraying aqueous solution was made
10% to complete coverage of the contaminated
area. Results were appropriate and I selected the
most effective substances. In experimental
researches the experimental model revealed the
following
products:
liquid
half
foaming
decontaminant organophosphorus (Alchifos) liquid
decontaminant, half foaming quaternary ammonium
(Amodec), liquid decontaminant salt quinolone
(Chinodec), half foaming formalin liquid
decontaminant (Fordec), half foaming liquid
decontaminant with glutaraldehyde (Glutadec),
clorigenic decontaminant powder (Clordec),
detergent-disinfectant filtroventilation (A / C
Cleaner), disinfectant-detergent filtroventilation (A
/ C Disinfecter)..
onset rate of 6 G/sec. It is designed to train the jet
pilots to reduce the G-induced loss of
consciousness (G-LOC) incidence. G-LOC is a
situation which comes out in case that blood is
taken away from the brain on account of G-forces.
Aircrew’s Health, Research and Training Center at
Eskisehir, Turkey has a G-LAB. The aim of this
study was to investigate the incidence of G-LOC
during high-G centrifuge training.
Correspondence:
CCSMM 0213156453
E.mail: ordeanu_viorel@yahoo.com
PP137
COMPARATED
EFFECTS
IONTOPHORETICAL
AND
PERORAL
APPLICATIONS NSAL FOR PILOTS AND
PARACHUTISTS
PP136
G-LOC
INCIDENCE
DURING
CENTRIFUGE TRAINING
Material and methods. High-G centrifuge training
results in the year of 2011 were retrospectively
analyzed. RESULTS There were 1003 jet pilots and
pilot aspirants subjected to high-G training at our
center during the year 2011. Out of the 1003
aircrews, 850 (84.75%) completed high-G training
on their first attempts. The reason of being not able
to complete the training for the rest was either GLOC or discomfort (stomach awareness or
vomiting). Of the 1003 trainees, 131 (13.06%) had
one or more G-LOC episodes. All aircrews who
experienced G-LOC were pilot aspirants. G-LOC
occurred at 3 trainees at relax G; 16 trainees at 4.5
G 30 sec; 105 trainees at 6 G 15 sec; 5 trainees at
7.5 G 15 sec; 2 trainees at 9 G 15 sec profiles.
Conclusion. In order to show that for protecting the
aircrew against the physiological effects of
sustained high-G forces and preventing losses of
aircraft/aircrew reasoned from GLOC; G-LAB is
the safest training device.
Correspondence:
Hv.Tbp.Yzb. Nazim ATA Ucucu Saglıgı
Arastirma ve Egitim Merkezi, Eskisehir, TURKEY.
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
GSM: + 90 505 251 07 49
E-mail: doktornazim@yahoo.com
THE
Author:
CPT ATA Nazim, MD
Institutions:
Aircrew’s Health, Research and Training Center,
Eskisehir, TURKEY.
Objective. G-LAB is a high-G trainer, generating
sustained G-forces up to 15 G with an approximate
Authors:
Slaviša Đurđević¹, Miroslav Pavlović¹,Dragan
Ivković¹, Stojan Stojanov¹, Slavica Kaličanin²,
Danijela Ranđelović¹, Svetlana Međedović¹,
Bratislav Kostić¹
Institutions:
1. Airforce Medical Institute, M May 2012
2. Belgrade Medical Center – Prokuplje, SERBIA
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
242
The goal of research was to overview
concentration of aceticisalic acid (ASK) applied
perorally using electrophoresis (EF) in knee article
for sport injuries of pilots end parachutes with
damaged meniscus along with determination of
knee width and angle of it’s movement.
Danijela Ranđelović¹,
Bratislav Kostić¹.
Research example included 10 pilots and s
parachutes male gender, age from 25-45, divided
into 2 groups of 5 examiners.For first group,it was
applied 0.5g ASK perorally during 5 days in tablet
form,and for second group including 5 patience
same amount of drug was applied by one-therm
electrophoresis. Afterwards, samples of meniscus
and sinovial liquid were taken during
meniscectomy by using biopsy.
The goal of research was to check functional
restitution
of
iatrogenic
subluxation
of
temporomandibles joint (LTMJ) with normalizing
of mastication post malextraction of mandibles
molar, after applying physical efficients as
shortwave diathermacy and sonophoretic.
Using methods of liquid-mass spectrometry
(HPCL) it was quantified concentration of medical
in micrograms of drug per gram of tissue,applied on
both ways,while by using meter and gravitational
angle-meter the difference was determined
according to width of healthy and injuried knee and
amplitude of movement.
Research results. They were tested by using
Student t-test for small pair of examples and it was
concluded high significant amount of drug
p<0,001,applicated per short time into EF in
meniskus compared to five day peroral application
of drug,so higher concentration in sinovial liquid
compared to meniscus.The difference was
compared between central weidth of healthy and
injured knee and amplitude of movement of
injuried article for both groups of examiners during
5 days according to EF. and it was concluded
statistically important improved movement and
lesser difference of width of healthy tissue
compared to injuried tissue of knee in group with
EF,with importance of p<0,005.
Conclusion: Iontophoretical aplication of drug in
knee article, significantly affects lowering of
inflamation and prevention of anatomical
remodeling of knee article,along with it’s higher
functionality compared to peroral application of
drug.
PP138
PHYSICAL THERAPY LUXATION OF
TEMPOROMANDIBLES JOINT OF PILOTS
AND PARACHUTIST ARMY SERBIEN
Authors:
Slaviša Đurđević¹, Dragan Ivković¹, Stojan
Stojanov¹, Miroslav Pavlović¹, Slavica Kaličanin²,
Svetlana
Međedović¹,
Institutions:
1. Airforce Medical Institute, M M y-Belgrade,
2. Medical Center – Prokuplje, SERBIA
The sample included 14 pilots and parachutist, age
22-52 with and clinical and ultrasonographic
approved subperiosteal odontogenic LTMJ within
malextraction of mandibles molars and premolars
divided in two groups of 7 examiners.
Using methods: For first group, it was applied
bipolar shortwave diathermacy technique (SWD) λ
= 12 m; ν = 27 Mhz with 3cm distance between
skin surface and electrode during 15min., then Gel
Deep Relief sonophoretic by sonde d = 2,5 cm long
6 W/cm² in 6min.Application of mechanical mouth
opener “heyster” in series of 12 days few times
daily was the next step in treatment. For second
group it was applied only mechanical mouth opener
“heyster” in series of 12 days and hot bandage on
TMJ.
Followed variables were mandibles opened angle,
measured by protractor in degrees and internal scale
of pain, graduated from 1-5.
Research results : were tested by using Student ttest for small pair of examples, and it was
concluded: significant increase in amplitude of
mandibles movement and decrease of painfully
sensations in group with applied SWD,
sonophoretic and mechanical mouth opener
“heyster” according to the group used only
mechanical mouth opener “heyster” and hot
bandage on TMJ.
Conclusion: physical efficients as SWD and
sonophoretic could influence on significant
restitution in function of LTMJ and could be
recommended as usable method in clinical praxis.
PP139
MODERN
ELECTROFORESTIC
TREATMENT
OF
SUBPERIOSTEAL
ODONTOGENIC INFECTIONS IN AIM TO
PREVENT APICOTHOMY AND TO SAVE
DENTAL ARCHITECTURE
243
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Authors:
Dragan Ivković¹, Slaviša Đurđević¹, Slavica
Kaličanin², Stojan Stojanov¹, Bojan Jovičić¹
Institutions:
Military Medical Academy-Belgrade¹Medical Center - Prokuplje² SERBIA
AMI¹,
The goal of research was to heal sub end
periapical odontogenic infections on mandibles
incisive by electrophoresis in aim to prevent apical
dental amputation. The sample, concluded 20
patients the both gender, age from 24-50 with
radiological and clinical approved subperiosteal
odontogenic infections on mandibles incisive,
divided in two groups of 10 examiners.
Using methods: For first group, it was applied 1ml
10% solution of KJ in the canal base of a tooth with
inserted endodontic needle as cathode and anode
soaking by isotonic solution of NaCl with
submandibles application dose of 100mg
metaciklin. Intesity of electric current by individual
sensitivity was in X caliber of 0,85mA during
12min. (biodose of 10,2mAmin) in 36 days, every
3th day by electrophoresis. For second group was
applied
every
3th
day
in
turn
iodophormiumchlumsky and Ca(OH)2 paste during
36 days.Final results were introspected radiological
and simptomatic by internal scale of pain,
graduated from 1-5.
Research results: Radiological lighting decreased
in range X±SD from 9,7mm to 3,5mm within t =
4,58 and p<0,005 but pain sharpness decreased in
range from X±SD=4,85 to X±SD=1,84 (internal
scale from 1-5) and t=3,45 and p<0,005 for the first
group of examiners. There was no significant
difference for biomedical researched appearance for
the second group of examiners. Conclusion:
Electrophoresis
application
of
drugs
in
subperiosteal odontogenic infections of mandibles
incisive significantly affects lowering of
inflammation and could be recommended as usable
method in clinical dental praxis.
PP140
SMOKING HABITS AMONG MILITARY
PILOTS
Authors:
1LT ILBASMIS Savas, MD1, CPT METIN
Suleyman, MD2, MAJ CAKMAK Tolga MD2,
MAJ KAHRAMAN Erkan, MD3
Institutions:
1. Aircrew's Health Research and Training Center,
Eskisehir, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
3. Eskisehir Military Hospital, Dept. of
Otolaryngology, Eskisehir, TURKEY
Objective. It is highly important to determine the
success rates of antismoking campaigns among
various groups of society. This research was
performed to detect smoking habits among military
pilots.
Material and methods. 95 military pilots who
have applied for aviator periodic medical
examinations in 3 months period were included in
this study. They were asked about their smoking
habits by using a questionnaire developed by our
center. After asking about their personal general
information the subjects were questioned whether
they smoke cigarettes, if yes how long and how
frequently. The data obtained was assessed with
descriptive statistics.
Results. Of the 95 participant pilots whose ages
vary from 27 to 51, 26 (27.3%) were smokers and
69 (72.7%) were nonsmokers. 20 (76.9%) of
smokers had smoking habits over ten years and 6
(23.1%) of smokers had less than ten years. 7
(26.9%) of the smokers cited that they smoke a few
in a day, 9 (34.6%) smokers cited that they smoke
5-10 cigarette per day, 9 (34.6%) smokers a packet
of cigarette per day and 1 (0.04%) smoker more
than 1 packet. Among the 26 smokers 16 (61.5%)
were high performance aircraft pilots and 10
(38.5%) smokers were transport and helicopter
pilots.
Conclusion. Since the military pilots are supposed
to have low rates of smoking due to requiring high
medical standards, it is needed to organize smoking
cessation campaigns to reduce the rate of pilots
which is slightly less than general Turkish
population smoking rate (31.2 %).
Correspondence:
Savas ILBASMIS
Aircrew Health Research and Training Center,
Eskisehir, TURKEY.
Tel: + 90 222 220 4530
Fax: + 90 222 230 3433
GSM: +90 5055733866
E-mail: msavasi@hotmail.com
PP141
MILITARY MEDICAL ASPECTS OF HARSH
ENVIRONMENTS
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Authors:
Assoc. Prof. Radakovic S. Sonja, MD, PhD. 1, Prof.
Surbatovic Maja, MD, PhD. 1, Vesic Zoran, MD2
Institutions:
1. Military Medical Academy;
2. Ministry of Defence, Republic of Serbia;
Belgrade, SERBIA
The planning and conducting military operations
are under significant influence of environmental
conditions, such as heat, cold, high altitude,
increased or decreased barometric pressure.
Although contemporary military operations
consider soldiers’ engagement in any possible
environment on the Earth (and even out of the
Earth!), some campaigns are impacted by extremely
harsh conditions that impose extreme physiological
exertion. In soldiers, mechanisms related to safe
behaviour in dangerous conditions are largely
suppressed, due to their determination to
accomplish the mission. In order to maintain
physiological homeostasis, the human organism
needs to perform serious adjustments. For example,
adaptation to heat considers cardiovascular strain
reflecting in increase in heart rate and profuse
sweating leading to dehydration. Prolonged
exposure to cold environment may involve complex
adaptation of endocrine, respiratory, renal and
immune system. Soldiers who deploy from sealevel bases for operations in the high altitudes, such
as mountains, are exposed to oxygen-deficient
atmosphere which leads to incapacity to sustain
physical exertion. In order to compensate the
reduction in ambient oxygen, a series of
physiological adjustments occur, such as increase in
ventilation, as well as hemodynamic and
hematologic changes. Underwater diving imposes
particular strain to almost every organ in human
body, because changes in barometric pressure
induce extreme adaptation either on descent or
ascent. Deficient adaptation, often as consequence
of neglecting the procedures, can lead to
barotrauma, or decompression sickness. Military
pilots during rapid ascent to altitude experience
physiological adaptations to hypoxia reflecting in
hyperventilation. Nevertheless, acceleration (Gforce) is the major physical stress associated with
combat flying, with loss of consciousness as
possible (and probably fatal) result. Adaptation to
such efforts requires wearing anti-G suit, together
with centrifuge training to ensure that fighter pilot
makes optimal use of straining maneuvers and
maintain vision and consciousness for extended
periods at acceleration levels of 9 G. Medical
aspects of contemporary military operations
emphasize the need for a preventive approach to
244
decrease attrition due to harsh environments, such
as predicting the likelihood of its occurrence and
enhancing the awareness of how specific factors
(eg. gender, nutritional status) are sometimes
important determinants of outcome.
Correspondence:
Assoc. Prof. Sonja Radakovic, M.D., PhD, Military
Medical Academy Sector of Preventive Medicine
Crnotravska 17, 11 000 Belgrade, SERBIA
PP142
PHYSIOLOGICAL
TOLERANCE
TO
UNCOMPENSABLE HEAT STRESS IN
SOLDIERS: EFFECTS OF BODY COOLING
VESTS
Authors:
Maj. Dalibor Jovanovic1, Sonja S. Radakovic2,
Leut. Col. Radovan Karkalic1, Zoran Vesic3
Institutions:
1. Technical Testing Centre, Army of Serbia;
2. Military Medical Academy;
3. Ministry of Defence, Republic of Serbia;
Belgrade, SERBIA
Background/Aim: Urgent situations that combine
nuclear, biological or chemical contamination with
high temperatures present great challenge to
soldiers' physiological performance, because
physical strain while wearing impermeable suit
induces uncompensable heat stress (UCHS). In
these specific conditions, usage of the personal
body cooling systems may be useful in reducing
heat stress. This study was conducted in order to
evaluate efficacy of 4 various types of the
contemporary personal body cooling systems based
on Phase Change Material and their effects on
soldiers' performance during exertional heat stress
in hot environment.
Methods: Ten male soldiers performed exertional
heat stress tests (EHST) in hot environment (40 ºC,
29 ºC WBGT) in climatic chamber, while wearing
NBC isolating non-permeable protective suit
without any cooling solution (NOCOOL), and with
4 different types of cooling systems (3 types of
cooling vests, and one type of cooling underwear).
Mean skin (Tsk) and tympanic (Tty) temperatures
and heart rates (HR) measured physiological strain,
while sweat rate (SWR) was calculated in order to
estimate changes in water and electrolyte status.
Results: In all cases EHST induced physiological
heat stress (increase in Tsk, Tty, HR and SWR).
However, all observed values were significantly
245
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
lower while wearing cooling vests based on PCM
under protective suit. When using cooling
underwear, the observed indicators of physiological
strain did not differ compared to NOCOOL.
mean value of the beginning time was 10.4 (1-30
days). The overall percentage of ears showing
improvement (more then 10 dB) was 52.5% (21
ears).
Conclusion: Body cooling vests based on PCM
worn under NBC protective suit alleviate heat stress
and consequent physiological strain reflected by
slower increase in Tty and HR and also extends the
duration of exposures.
Conclusion. The results of this study indicate the
necessity of performing additional controled studies
for the effects of hyperbaric oxygen therapy on
SHL.
Correspondence:
Assoc. Prof. Sonja Radakovic, M.D., PhD Military
Medical Academy Sector of Preventive Medicine
Crnotravska 17, 11 000 Belgrade, Serbia
PP143
THERAPEUTIC RESULTS OF HYPERBARIC
OXYGEN
THERAPY
IN
SUDDEN
SENSORINEURAL HEARING LOSS
Authors:
MAJ KAHRAMAN Erkan, MD1, CPT ATA
Nazim, MD2
Institutions:
1. Eskisehir Military Hospital, ENT Clinic,
Eskisehir, TURKEY
2. Aircrew’s Health, Research and Training Center,
Eskisehir, TURKEY
Objective. Sudden hearing loss (SHL) is an
emergency condition. It has been defined as greater
than 30 dB hearing reduction, over at least three
contiguous frequencies, occurring over 3 days or
less. Treatment for SHL usually depends on the
cause of the hearing loss. Different treatments such
as steroids, vasodilators, antiviral agents and
hyperbaric oxygen therapy have been suggested.
Hyperbaric oxygen therapy (HBOT) is breathing
100% oxygen while in a sealed chamber that has
been pressurized at 2.5 times normal atmospheric
pressure. The aim of this study was to evaluate the
effect of HBOT in the treatment of SHL.
Material and methods. We analyzed the patients
with SHL who received HBOT at Aircrew’s
Health, Research and Training Center at Eskisehir,
Turkey from 1 January 2009 to 31 December 2011.
Results. A total of 35 patients (40 ears) were
evaluated in a retrospective study. Patients received
100% oxygen in a multiplace hyperbaric chamber
at a pressure of 2.4 atmospheres absolute for 90
minutes 4 to 21 days (mean 10.7). The mean value
of patients’ age was 39.6 (13-83 years old). HBOT
was performed within 10 days on 22 patients. The
Correspondence:
Hv.Tbp.Bnb. Erkan KAHRAMAN Eskisehir Asker
Hastanesi, Kulak Burun Boğaz Klinigi, Eskisehir,
TURKEY
Tel: + 90 222 220 4530
Fax: + 90 222 220 4531
GSM: + 90 532 245 3467
E-mail: drerkan76@yahoo.com
PP144
OPHTHALMOLOGICAL ASSESSMENT IN
CIVIL AVIATION
Authors:
CPT METIN Suleyman, MD1, CPT GOKCE
Gokcen, MD2, MAJ CAKMAK Tolga, MD1, LTC
DULKADIR Zeki, MD1, COL AKIN Ahmet, MD1
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
2. Sarikamis Military Hospital, Dept. of
Ophthalmology, Kars, TURKEY.
Objective. The aim of this epidemiological study
was to present the results of ophthalmological
assessment performed during periodic aeromedical
examinations.
Material and methods. We conducted a
retrospective chart review according to ICAO
(International Civil Aviation Organization) Annex
1 - JAR-FCL 3 (Joint Aviation Requirements-Flight
Crew Licensing 3) Ophthalmology Examination
Report Form of 73 Turkish civilian pilots (age
37.62±9.53 and 68 male; 5 female) admitted to our
center from January 2011 through September 2011.
Results. All pilots except one had 20/20 best
corrected visual acuity (VA) in both eyes according
to Snellen VA chart. No color deficiency was
observed by performing Ishiara isochromatic plates.
Cover testing showed orthophoria with no tropia
and Hirschberg's test showed orthophoria equally in
each eye. Mean near point of accommodation was
2.48±1.37
centimeters
and
the
mean
accommodation amplitude was 1.82±0.94 diopters
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
(Dpt). Nine pilots were myopic, while two were
hypermetropic. Ten pilots were presbyopic. The
average spherical refractive error was -0.15±0.50
Dpt. for the right eye and -0.15±0.46 Dpt. for the
left one. The average cylinder power was -0.7±0.38
Dpt. for the right eye and -0.7±0.29 Dpt. for the left
one. Intraocular pressure (IOP) ranged between 13
and 20 mm Hg with a mean of 17.63±1.94 mmHg
in the right eye; 13 and 22 mmHg with a mean of
18.16±2.14 mmHg in the left. Biomicroscopic and
fundoscopic examinations revealed no abnormality
in all subjects.
Conclusion. Ophthalmological disorders in civilian
pilots seem to be happened secondary to senile and
structural factors rather than flight environment.
Correspondence:
Hv.Tbp.Yzb. Suleyman METIN
Gulhane Askeri Tip Akademisi, Hava-Uzay
Hekimligi AD, 26020, Eskisehir, TURKEY.
Tel: + 90 222 230 0191
Fax: + 90 222 230 34 33
GSM: + 90 506 589 74 95
E-mail: drsmetin@gmail.com
PP145
THE RESULTS OF ELECTROPHYSIO
LOGICAL STUDY OF TWO JET PILOTS
WITH
ELECTRICAL
CONDUCTION
SYSTEM ABNORMALITIES DETECTED IN
SURFACE ELECTROCARDIOGRAPHY
Authors:
COL OZTURK Cengiz, MD1, CPT METIN
Suleyman, MD1, MAJ CAKMAK Tolga, MD2,
COL AKIN Ahmet, MD2, LTC SEN Ahmet, MD2
Institutions:
1. Eskisehir Military Hospital, Dept. of Cardiology,
Eskisehir, TURKEY
2. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
Objective. We present the electrophysiological
study results showing electrical conduction system
abnormalities including junctional rhythm and
extrasystole that are incidentally detected in two jet
pilots applying for periodic aeromedical
examination.
Material and methods. Both cases were 24-yearold male F-5 jet pilots. The first pilot had frequent
atrial extrasystoles in his electrocardiography
(ECG). Atrial extrasystoles originated from the
right atrial appendage were seen by performing
incremental atrial pacing and was treated with
radiofrequency ablation. The second pilot had
246
normal sinus rhythm and also short duration
junctional rhythm observed in his ECG.
Results. Both pilots applied to our department with
electrical conduction system abnormality. They had
no
significant
medical
history.
Physical
examination and biochemical tests revealed no
abnormality.
Transthoracic
echocardiography
showed no structural heart disease. 24-hour rhythm
Holter monitoring records showed frequent atrial
extrasystoles in the first case and rare junctional
rhythms in the second case. The EPS showed
normal sinus and AV Node functions for both. So
both pilots were allowed to return to flight duties.
They have been flying for one year without having
any health problem.
Conclusion. An electrical conduction system
abnormality detected in surface electrocardiography
may reveal a conduction disease as an underlying
cause or it can be seen in a totally healthy
individual. EPS can be performed on aircrew as an
effective and dependable method in order to decide
whether they are fit to fly.
Correspondence:
Doc.Hv.Tbp.Alb. Cengiz OZTURK Eskisehir
Military Hospital, Dept. of Cardiology, 26035,
Eskisehir, TURKEY.
Tel: + 90 222 220 45 30
Fax: + 90 222 220 34 33
E-mail: drcengizozturk@yahoo.com.tr
PP146
VESTIBULAR ILLUSION TRAINING AND
MOTION SICKNESS
Authors:
M. Pavlovic, P.Stepanić, A. Krošnjar, S. Đurđević,
S. Međjedovic, D. Ranđjelovic.
Institutions:
Institute of Aviation Medicine, Institute LOLA,
Belgrade, SERBIA
Introduction: Spatial disorientation is main
problem in modern military aviation, especially
dangerous are vestibular illusions. Training of
students – pilots and adequate preparing for flying
duties is of primary importance. In achieving this
goal we trained our student – pilots on device for
demonstration of vestibular illusions and on human
centrifuge.
Methods: There were two groups of thirty students
– pilots, of same age and with 30 hours of flying
experience, one group performed vestibular
247
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
illusions (somatogiral, somatogravic, leans, pasiv
and active coriolis) on device for demonstration of
vestibular illusions, and another performed active
coriolis reaction (active head movements) on + 2
Gz load. Vestibular illusions lasting 22 min. and
training on centrifuge was 9 min. On centrifuge all
were exposed to centrifuge runs of +2Gz and
performed head tilt: down, neutral position, right
shoulder, neutral position, left shoulder, neutral
position, staying 30 sec. in position for each
movement. After last movement, centrifuge
acceleration profile for gradual onset run (GOR),
onset rate 0,1 G/s, was performed, achieving
+5,5Gz peak. Deceleration of same rate to+2Gz
was achieved and all head movements were
performed again. Before, during and after
experiment EKG, heart rate, respiration, horizontal
and vertical nistagmus, were monitoring for both of
groups.
Material and methods. Regular reviews are
subject to:
− pilots of the supersonic combat aircraft - every
year
− pilots of the all other categories air force to 35
year of age every two years and more than 35 years
annually.
Results: 10 % of students – pilots that were
performing vestibular illusions and 20% of students
on centrifuge demonstrated signs of motion
sickness (MS), points were graded on Graybiel –
Miller scale. All students with MS poorly withstand
+Gz load, and one of them lost peripheral vision on
+5Gz.
PP148
EFFECT OF HYPERBARIC OXYGEN
THERAPY ON SERUM MARKERS OF
ENDOTHELIAL DYSFUNCTION
Conclusion: Training of vestibular illusions is
necessary part of students training, but it is not
complete without active coriolis on centrifuge with
+Gz load.
PP147
IMPORTANCE
OF
THE
REGULAR
OPHTHALMOLOGICAL
SYSTEMATIC
REVIEW OF MILITARY AIR FORCE
PILOTS
Authors:
D. Randjelovic1, M. Pavlovic1, S. Djurdjevic1,
B.Kostic1, S. Medjedovic1, J. Lazarevic-Misic2, T.
Mraović3, V. Tepsic-Ostojic4
1. Institute of Aviation Medicine, Belgrade, Serbia
2. Military Medical Centre Karaburma, Belgrade,
Serbia
3. Military Medical Academy, Institute of Hygiene,
Belgrade, Serbia
4. Military Medical Academy, Clinic for the
psychiatry, Belgrade, SERBIA
Introduction: Regular systematic reviews of pilot
are performed because of the establishing of state
of visible functions what make possible safe the
performance services.
Results: Evaluation and thinking about the ability
of pilot of military air force gives the military
medical commission on the basis of reports doctor
ophthalmologist after the detailed ophthalmological
review.
Conclusion: Reviews must establish that do not
exist deviations in visible functions from normal
and book of regulations of the established which
could that limit the pilot in the doing of flying
activities.
Authors:
LTC TASLIPINAR Abdullah, MD1, LTC
DEMIRBAS Seref, MD2, CAPT YILDIZ Senol,
MD3, LTC YURTDAS Yuksel, MD4, LCDR
UZUN Gunalp, MD5, LTC KARAKAŞ Ahmet,
MD6, CAPT YAMAN Halil, MD7, CDR SIMSEK
Kemal, MD3
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Endocrinology and Metabolic disorders, AnkaraTURKEY
2. Gulhane Military Medical Academy, Dept. of
Internal Medicine, Ankara-TURKEY
3. Gulhane Military Medical Academy, Dept. of
Undersea and Hyperbaric Medicine, AnkaraTURKEY
4. Gulhane Military Medical Academy, Dept. of
Orthopedic Surgery and Traumatology, AnkaraTURKEY
5.Gulhane Military Medical Academy, Haydarpasa
Teaching Hospital, Dept. of Undersea and
Hyperbaric Medicine, Istanbul, TURKEY
6. Gulhane Military Medical Academy, Dept. of
Infectious Disease, Ankara-TURKEY
7. Gulhane Military Medical Academy, Dept. of
Biochemistry, Ankara, TURKEY
Objective. Endothelial dysfunction is characterized
by an imbalance between vasodilator and
vasoconstrictor substances. Endothelial dysfunction
plays a significant role in the pathogenesis of
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
248
vascular complications of diabetes. Hyperbaric
oxygen (HBO) therapy that increases the amount of
oxygen dissolved in blood and delivered to tissues
is used in the treatment of chronic wounds in
diabetic patients. In this study, we investigated the
alterations of serum markers of endothelial
dysfunction in diabetic patients receiving HBO
therapy.
Material and methods. Thirty diabetic patients
were included. Patients received daily hyperbaric
oxygen therapy sessions for 120 minutes at 2.5
atmospheres absolute. Blood samples were drawn
before the first HBO therapy session and after 15th
and 30th HBO therapy sessions. Serum levels of
following markers were measured: Von Willebrand
factor (vWf), soluble P selectin (sP-selectin),
soluble E selectin (sE-selectin), tissue factor (TF),
fibrinogen, plasminogen activator inhibitor (PAI) –
1, intercellular adhesion molecule (ICAM)-1,
vascular cell adhesion molecule (VCAM)-1,
nitrogen oxide (NOx), homocysteine, superoxide
dismutase (SOD), and asymmetric dimethyl
arginine (ADMA).
Results. There were 22 male and 8 female patients
in the study group. Mean age of the patients was
62,16. None of the markers were changed with
HBO therapy.
Conclusion. HBO therapy does not affect serum
levels vWf, sP-selectin, sE-selectin, TF, fibrinogen,
PAI –1, ICAM 1, VCAM 1, NOx, homocysteine,
SOD, and ADMA in diabetic patients.
Correspondence:
Doc.Dz.Tbp.Alb. Senol YILDIZ Gulhane Askeri
Tip Akademisi, Sualtı hekimligi ve Hiperbarik Tip
AD, Ankara, TURKEY.
Tel: +90 312 3044791
Fax: +90 312 3042700
GSM: +90 536 6553855
E-mail: seyildiz@gata.edu.tr
PP149
EFFECTS
OF
THE
ALTITUDE
PULMONARY FUNCTIONS
ON
Authors:
CPT YILDIZ Safak, MD¹, CPT ATA Nazim, MD²,
CPT ERCAN Erdinc, MD²
Institutions:
1. Eskisehir Military Hospital, Dept. Of Pulmonary
Medicine, Eskisehir, TURKEY
2. Aircrew's Health, Research and Training Center,
Eskisehir, TURKEY
Objective. As the altitude increases the air pressure
and partial oxygen pressure decrease. If precautions
aren’t taken against the decrease of the oxygen
pressure, hypoxia influences the pilots. In our
study, we examined the affects of the altitude on
pulmonary functions.
Material and methods. 40 pilot candidates were
included. Their FEV1 and PEF values were
measured before they entered high altitude
chamber. The values also measured in the high
altitude chamber at 8000 feet altitude and after the
training.
Results. Mean values of all subjects were before
training PEF(BTP):537.45±100.94; at 8000 feet
PEF(8000FP):517.02±116.77;
after
training
PEF(ATP):548.08±102.82;
before
training
FEV1(BTF):3.56±0.68;
8000
feet
FEV1(8000FF):3.22±0.71;
after
training
FEV1(ATF): 3.42±0.70. Analysis of all subjects
showed that the mean of 8000FF group was lower
than BFF mean value and the differences between
groups were statically significant (p<0.05).
Differences between PEF groups were not statically
significant (p>0.05). When we grouped all subjects
according to their smoking habits, in smokers group
mean of 8000FF was lower than BFF mean value
and the differences between groups were statically
significant(p<0.05). And also in smokers group,
mean of ATF was higher than 8000FF mean value
and the differences between groups were statically
significant (p<0.05).
Conclusion. In our study, changes in FEV 1 values
between two altitudes were statistically significant.
When the effect of smoking on FEV1 decline
examined; in smoker group there was statistically
significant difference, but this difference was not
observed in non-smokers. This result showed that
the adverse effects of high altitude on the values of
FEV1 may increase with smoking.
Correspondence:
Hv.Tbp.Yzb. Safak Yildiz Eskisehir Military
Hospital, Dept. of Pulmonary Medicine, Eskisehir,
TURKEY.
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
GSM: + 90 532 462 19 81
E-mail: safakmd@yahoo.com
PP150
BULLOUS DISEASE OF LUNG IN FLIGHT
PERSONNEL: TWO CASES
249
Authors:
CPT YILDIZ Safak, MD¹, CPT ATA Nazim, MD²,
CPT ERCAN Erdinc, MD², CPT METIN
Suleyman, MD3
Institutions:
1. Eskisehir Military Hospital, Dept. of Pulmonary
Medicine, Eskisehir, TURKEY
2. Aircrew's Health, Research and Training Center,
Eskisehir, TURKEY
3. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
Objective. A bulla is a large, air-containing space
within the lung parenchyma resulting from
destruction, dilatation, and confluence of airspaces
bronchioles. Bullae are larger than 1 cm in diameter
and are composed of attenuated and compressed
parenchyma. Bullae may be asymptomatic or give
rise to progressive dyspnea or chest pain.
Material and methods. We analyzed two aircrews
who have pulmonary bullae which were diagnosed
while periodical medical examination.
Results. Our fist case was a 42-year-old, male
helicopter pilot. He had no complaints. On
auscultation; prolonged expiratory phase was noted.
In the pulmonary function test; restriction and small
airway obstruction detected. Multiple bullae were
detected in upper lobes of the lungs on high
resolution computerized tomography of the chest
(HRCT). Our second case was a 29-year-old, male
helicopter technician. He had no complaints and his
physical examination was normal. After a suspected
lesion had been seen in chest radiograph, HRCT
was taken. Atelectasis with fibrotic opacity in right
lower lobe and 1 cm diameter bulla was seen in the
left lower lobe on HRCT. As a final decision, two
aircrews were permanently restricted from flying.
Conclusion. Small air cysts/bullae usually don’t
influence the gas exchange but large ones may
cause atelectasis by compressing surrounding
tissue. In aviation, as altitude increases, the bullae
expand and may cause spontaneous pneumothorax.
Ascending an altitude of 5000 feet causes 20% rise
in the volume of the bullae. Pulmonary bullae
which are generally asymptomatic at sea level may
cause serious problems in aviation.
Correspondence:
Hv.Tbp.Yzb. Safak Yildiz Eskisehir Military
Hospital, Dept. of Pulmonary Medicine, Eskisehir,
TURKEY.
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
GSM: + 90 532 462 19 81
E-mail: safakmd@yahoo.com
PP151
SMOKING RATES IN CIVIL AVIATION
PILOTS
Authors:
CPT YILDIZ Safak, MD¹, CPT ATA Nazim, MD²,
CPT ERCAN Erdinc, MD²
Institutions:
1. Eskisehir Military Hospital, Dept. of Pulmonary
Medicine, Eskisehir, TURKEY
2. Aircrew's Health, Research and Training Center,
Eskisehir, TURKEY
Objective. Smoking habit is a health problem
which concerns all the community. Smoking also
accepted by World Health Organization (WHO) as
an important mortality and morbidity reason which
can be prevent. According to Joint Aviation
Authorities Requirements for Flight Crew
Licensing (JAR-FCL) and International Civil
Aviation Organization (ICAO) rules, pilots are
examined by the flight surgeons in aeromedical
centers designated and authorized by Directorate
General of Civil Aviation (DGCA). In this study,
we aimed to determine smoking rates in civil
aviation pilots.
Material and methods. We evaluated the medical
records of 281 pilots and student pilots who got in
medical examination with the requirements of JARFCL and ICAO in our aeromedical center between
the years 2006-2010. Their smoking habits, ages,
sex and health problems were noted.
Results. 271 of the cases were male and 10 were
female. 213 cases have graduated from university
and 68 cases have graduated from high school. The
ratio of smoking cigarette was 24.2% (68/281). 26
of the cases declared they used to smoke but not
any more. 187 of the pilots declared they never
smoked. None of them had pulmonary health
problem history.
Conclusion. After the thoracic medicine
examination, all of them were assessed as fit for
flying duties. Training of the pilots is quite difficult
and very expensive. Pilots’ smoking-related health
problems influence not only their life but also the
life of other people and passengers. So smoking
history must be questioned and pilots must be
advised to quit smoking.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
250
Correspondence:
Hv.Tbp.Yzb. Safak Yildiz Eskisehir Military
Hospital, Dept. of Pulmonary Medicine, Eskisehir,
TURKEY
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
GSM: + 90 532 462 19 81
E-mail: safakmd@yahoo.com
PP153
THIAMINE HYDROCHLORIDE PREVENTS
COMPLICATIONS IN STREPTOZOTOCIN
DIABETIC RATS
PP152
UNUSUAL EPIDEMIC EVENTS: A NEW
METHOD OF EARLY ORIENTATION AND
DIFFERETIATION BETWEEN NATURAL
AND DELIBERATE EPIDEMICS
Institutions:
1."Carol Davila" University Emergency Central
Military Hospital, Bucharest, ROMANIA
2. Healthy Nutrition Foundation, Bucharest,
ROMANIA
Authors:
Radosavljevic V, Belojevic G.
Aim is to identify a new potential for thiamine
hydrocloride in tentative to prevent complications
of diabetes in streptozotocin (STZ) rats.
Institutions:
Medical Corps Headquarters, Armu of Serbia;
School of Medicine, University of Belgrade,
Belgrade, SERBIA
Objective: To develop a model for quick and
accurate evaluation of unusual epidemic events
(UEE), based on the original model of bioterrorism
risk assessment.
Methods: A new scoring system was developed for
quick differentiation between a biological attack
and other epidemics, using eight qualitative and six
quantitative indicators.
Results: A new scoring system was applied to three
UEEs: (1) a spontaneous outbreak of a new or reemerging disease ('swine flu'); (2) a spontaneous
outbreak following accidental release of a pathogen
(Sverdlovsk anthrax); and (3) a spontaneous natural
outbreak of a known endemic disease that may
mimic bioterrorism or biowarfare (Kosovo
tularaemia). The disease agent was found to be the
most important and the most informative UEE
component of the scoring system.
Conclusions: This new scoring system may be
useful for public health institutions and federal civil
and military officials responsible for bio-attack
investigations. Source: Radosavljević V, Belojević
G. Unusual epidemilogical event - new model for
early orientation and differentation between natural
and deliberate outbreak.
Public Health 2012; 126(1): 77-81.
Authors:
Maj. C. Constantin1, Georgiana Constantin2,
Nicoleta Mavris1, Associate Prof. Col. AE Ranetti 1
Materials and Methods: 60Wistar rats were
injected with STZ(60mg/kgc). Initially we used
insulin to reduce STZeffects, then for adequate
metabolic control. After 10 days of STZinjection a
model of diabetes was obtained and were made
three groups of rats as follows: a good glycemic
control 130-150mg/dl (20 rats-2groupsA,A'),
medium glycemic control 150-170mg/dl (10ratsgroupB), poor glycemic control 170-190mg/dl
(20rats-2lotsC,C'). These lots received thiamine
hydrochloride in drinking water in quantities of
2mg/L(lotsA,B,C) or 4mg/L(lots A',C') and were
monitored: clinical aspects, blood sugar, weight,
amount of drinking water and urinary albumin
elimination (UAE). Tail tissue was taken at the
beginning of the experiment. After six months of
the experiment all lots were sacrificed and some
parts from the liver, kidney and heart were
analyzed.
Results: Thiamine hydrochloride was no toxic in
given doses (2mg/L or 4mg/L) and no toxicity
effects were observed (clinical, kidney, liver or
heart). For rats with type 2 diabetes with poor
control receiving thiamine in large dose (C') the
rate of renal impairment was lower compared with
those who received a smaller dose of thiamine
hydrochloride (groupC vs. groupC',p <0.05).
Conclusions: Thiamine hydrochloride was no toxic
in given doses and its potential in prevention of
complications at STZ-induced diabetes rats was
confirmed. The association between this potential
and genetic background remains to be investigated.
Correspondence:
This
study
was
supported
by
2008STAFPREDIAB Research Grant
52164/
251
Dr Ciprian Constantin
Tel: +40722227839
Asist Nicoleta Mavris
Tel: +40724802745
PP154
HEALTH-RELATED QUALITY OF LIFE
CHANGE
IN
BIOLOGIC
THERAPY
TREATED PSORIASIS PATIENTS
Authors:
LTC Daniel O. Costache MD, PhD, MBA; Assist.
Prof. Maj. Raluca S. Costache MD, PhD
Institutions:
Central University Emergency Military Hospital,
Bucharest, ROMANIA
Psoriasis is a chronic, immune-mediated disease of
the skin and joints, with a strong genetic basis that
have a significant negative impact on the physical
and emotional wellbeing of affected patients. It can
present at any age, but is more commonly reported
in the adult; it does not influence survival
parameters, nevertheless is associated with major
co-morbidities such as cardiac, metabolic and
psychological anomalies. Patients with psoriasis
have a reduction in their quality of life similar to or
worse than patients with other chronic diseases,
such as ischemic heart disease and diabetes; they
tend to feel stigmatized by the condition and their
disability is leading to depression and suicidal
ideation in more than 5%. To have a maximal
quality of life, one need to be able to participate in
all aspects of life, including effective interaction
with others and carrying out physical
responsibilities, both at work and at home. That is
the reason for the development of various
assessment tools, such as DLQI (Dermatology Life
Quality Index), PDI, IPSQ, PLSI, DSQLI,
PSORIQoL, PQoL. Biologic treatments costs are
covered by National Health Insurance System and
closely monitored, DLQI being one of the
monitoring cornerstones. We present our
experience after 10 years of biologic treatment in
patients with moderate to severe psoriasis. In our
daily practice, DLQI seems to be a sufficient index
of health-related quality of life, nevertheless is not
tailored specifically for Romanian life ambiance
and so does not cover completely all the aspects
altered by the disease. Improvements are needed
and expected.
Correspondence:
E.mail: author: daniel_costache@yahoo.com
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
PP155
VESTIBULAR ILLUSION TRAINING AND
MOTION SICKNESS
Authors:
Stepanic P, Krisnjar S, Djurdjevic S, Medjedovic S,
Randjelovic D.
Institutions:
Institute of Aviation Medicine; Institute LOLA,
Belgrade, SERBIA
Introduction. Spatial disorientation is main
problem in modern military aviation, especially
danger are vestibular illusions. Training of students
– pilots and adequate preparing for flying duties is
of primary importance. In achieving this goal we
trained our student – pilots on device for
demonstration of vestibular illusions and on human
centrifuge.
Methods. There were two groups of thirty students
– pilots, of same age and with 30 hours of flying
experience, one group performed vestibular
illusions (somatogiral, somatogravic, leans, pasiv
and active coriolis) on device for demonstration of
vestibular illusions, and another performed active
coriolis reaction (active head movements) on + 2
Gz load. Vestibular illusions lasting 22 min. and
training on centrifuge was 9 min. On centrifuge all
were exposed to centrifuge runs of +2Gz and
performed head tilt: down, neutral position, right
shoulder, neutral position, left shoulder, neutral
position, staying 30 sec. in position for each
movement. After last movement, centrifuge
acceleration profile for gradual onset run (GOR),
onset rate 0,1 G/s, was performed, achieving
+5,5Gz peak. Deceleration of same rate to+2Gz
was achieved and all head movements were
performed again. Before, during and after
experiment EKG, heart rate, respiration, horizontal
and vertical nistagmus, were monitoring for both of
groups.
Results. 10 % of students – pilots that were
performing vestibular illusions and 20% of students
on centrifuge demonstrated signs of motion
sickness (MS), points were graded on Graybiel –
Miller scale. All students with MS poorly withstand
+Gz load, and one of them lost peripheral vision on
+5Gz.
Conclusion. Training of vestibular illusions is
necessary part of students training, but it is not
complete without active coriolis on centrifuge with
+Gz load.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
PP156
SERUM ENZYME CHANGES IN SOLDIERS
DURING EXERTIONAL HEAT STRESS
Authors:
Assoc. Prof. Sonja Radakovic1, Prof. Maja
Surbatovic1, Assist. Prof. Elizabeta Ristanovic1,
Col. Assist. Prof. Srdjan Lazic, Assist. Prof. Slavica
Radjen, Zoran Vesic2
Institutions:
1. Military Medical Academy;
2. Ministry of Defence, Republic of Serbia;
Belgrade, SERBIA
Background/Aim: Exertional heat stress is
common problem in military services. The aim was
to exemine changes in serum concentrations of
some enzymes in soldiers during exertional heat
stress test (EHST) as well as the effects of 10-days
passive or active acclimation in climatic chamber.
Methods: 40 male soldiers with high aerobic
capacity, performed EHST either in cool (20 ºC, 16
ºC WBGT), or hot (40 ºC, 25 ºC WBGT)
environment, unacclimatized, or after 10 days of
passive or active acclimation. Physiological strain
was measured by tympanic temperatures (Tty) and
heart rates (HR). Concentrations of alanine- and
aspartate-aminotransferase (ALT, AST), lactatedehydrogenase (LDH), and creatine-kinase (CK)
were measured in blood samples collected before
and immediately after EHST.
Results: EHST in hot conditions induced
physiological heat stress (increase in Tty and HR),
with significant increase in concentrations of all
enzymes in unacclimatized group: ALT (42,5±4,2
before vs. 48,1±3,75 U/l after EHST, p<0,01), AST
(24,9±5,1 vs. 33,4±4,48 U/l, p<0,01), LDH
(160,6±20,2 vs. 195,7±22,6 U/l, p<0,001) and CK
(215,5±91,2 vs. 279,1±117,5, p<0,05). In
acclimatized soldiers there were no significant
changes in concentrations of ALT and AST, while
concentration of CK was significantly higher.
Concentrations of LDH were significanlty higher in
all investigated groups, regardless of temperature
conditions.
Conclusion: In trained soldiers, 10-days passive or
active acclimation in climatic chamber can prevent
increase in serum concentrations of ALT and AST
induced by exertional heat stress. Increase in serum
concentrations of LDH was induced by physical
strain itself, with no additional effect of heat stress.
252
Correspondence:
Assoc. Prof. Sonja Radakovic, M.D., PhD Military
Medical Academy Sector of Preventive Medicine
Crnotravska 17, 11 000 Belgrade, SERBIA
PP157
COMPARATED EFFECTS IONTOPHORETI
CAL AND PERORAL APPLICATION NSAIL
FOR PILOTS AND PARACHUTISTS
Authors:
Djurdjevic S, Pavlovic M, Stojanov S, Kalicann S,
Randjelovic D, Medjedovic S, Kostic B.
Institution:
Institute of Aviation Medicine, Belgrade, SERBIA
The goal of research was to overview
concentration of aceticisalic acid (ASK) applied
perorally using electrophoresis (EF) in knee article
for sport injuries of pilots end parachutes with
damaged meniscus along with determination of
knee width and angle of it’s movement.
Research example included 10 pilots and s
parachutes male gender, age from 25-45, divided
into 2 groups of 5 examiners.For first group,it was
applied 0.5g ASK perorally during 5 days in tablet
form,and for second group including 5 patience
same amount of drug was applied by one-therm
electrophoresis .Afterwards sample of meniscus
and sinovial liquid was taken during meniscethomy
by using biopsy
Using methods of liquid-mass spectrometry
(HPCL) it was quantified concentration of medical
in micrograms of drug per gram of tissue,applied on
both ways,while by using meter and gravitational
angle-meter the difference was determined
according to width of healthy and injuried knee and
amplitude of movement.
Research results were tested by using Student ttest for small pair of examples and it was concluded
high significant amount of drug p<0,001,applicated
per short time into EF in meniskus compared to five
day peroral application of drug,so higher
concentration in sinovial liquid compared to
meniscus.The difference was compared between
central weidth of healthy and injured knee and
amplitude of movement of injuried article for both
groups of examiners during 5 days according to EF.
and it was concluded statistically important
improved movement and lesser difference of width
of healthy tissue compared to injuried tissue of
knee in group with EF,with importance of p<0,005.
253
Conclusion: Iontophoretical aplication of drug in
knee article, significantly affects lowering of
inflamation and prevention of anatomical
remodeling of knee article,along with it’s higher
functionality compared to peroral application of
drug.
PP158
PHYSICAL THERAPY OF LUXATION OF
TEMPOROMANDIBLES JOINT OF PILOTS
AND PARACHUTIST
Authors:
Djurdjevic S, Ivkovic D, Stojanov S, Pavlovic M,
Kalicanin S, Randjelovic D, Medjedovic S, Kostic
B.
Institution:
Institute of Aviation Medicine, Belgrade, SERBIA
The goal of research was to check functional
restitution
of
iatrogenic
subluxation
of
temporomandibles joint (LTMJ) with normalizing
of mastication post malextraction of mandibles
molar, after applying physical efficients as
shortwave diathermacy and sonophoretic.
The sample included 14 pilots end parachutist, age
22-52 with and clinical and ultrasonographic
approved subperiosteal odontogenic LTMJ within
malextraction of mandibles molars and premolars
divided in two groups of 7 examiners.
Using methods: For first group, it was applied
bipolar shortwave diathermacy technique (SWD) λ
= 12 m; ν = 27 Mhz with 3cm distance between
skin surface and electrode during 15min., then Gel
Deep Relief sonophoretic by sonde d = 2,5 cm long
6 W/cm² in 6min.Application of mechanical mouth
opener “heyster” in series of 12 days few times
daily was the next step in treatment. For second
group it was applied only mechanical mouth opener
“heyster” in series of 12 days and hot bandage on
TMJ.
Followed variables were mandibles opened angle,
measured by protractor in degrees and internal scale
of pain, graduated from 1-5.
Research results : were tested by using Student ttest for small pair of examples, and it was
concluded: significant increase in amplitude of
mandibles movement and decrease of painfully
sensations in group with applied SWD,
sonophoretic and mechanical mouth opener
“heyster” according to the group used only
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
mechanical mouth opener “heyster” and hot
bandage on TMJ.
Conclusion: physical efficients as SWD and
sonophoretic could influence on significant
restitution in function of LTMJ and could be
recommended as usable method in clinical praxis.
PP159
IMPORTANCE
OF
THE
REGULAR
OPHTAMOLOGICAL
SYSTEMATIC
REVIEW OF MILITARY AIR FORCE
PILOTS
Authors:
Randjelovic D, Pavlovic M, Djurdjevic S, Kostic B,
Medjedovic S, Layarevic-Misic J, Mraovic T,
Tepsic-Ostojic V.
Institutions:
Institute of Aviation Medicine; Military Medical
Centre Karaburma; The Medical Faculty of the
University of Defence, Belgrade, SERBIA
Introduction: Regular systematic reviews of pilots
are performed because of the establishing of state
of visible functions what make possible safe the
performance services.
Material and methods. Regular reviews are
subject to:
− pilots of the supersonic combat aircraft - every
year
− pilots of the all other categories air force to 35
year of age every two years and more than 35 years
annually.
Results: Evaluation and thinking about the ability
of pilot of military air force gives the military
medical commission on the basis of reports doctor
ophthalmologist after the detailed ophthalmological
review.
Conclusion: Reviews must establish that do not
exist deviations in visible functions from normal
and book of regulations of the established which
could that limit the pilot in the doing of flying
activities.
PP160
PREVALENCE OF TINEA CAPITIS AND
TINEA PEDIS IN SCHOOL CHILDREN IN
THE CENTRAL ANATOLIA OF TURKEY: A
POPULATION-BASED EPIDEMIOLOGICAL
STUDY
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Authors:
CPT GULGUN Mustafa, MD1, BALCI Elcin, MD2,
CPT KARAOGLU Abdulbaki, MD1, CPT KESIK
Vural, MD1, KOC Ayse Nedret, MD3
Institutions:
1. Gulhane Military Medical Academy, Department
of Pediatrics, Ankara, TURKEY
2. Erciyes University, Department of Public Health,
Kayseri, TURKEY
3. Kayseri Military Hospital, Department of
Microbiology, Kayseri, TURKEY
Objective. The aim of the present study was to
evaluate the predominant pathogens and risk factors
of tinea capitis and tinea pedis in several schools in
rural and urban areas of Central Anatolia in Turkey.
Material and methods. Our study included 8122
students from 24 schools in the rural and urban area
around Kayseri, Turkey. We asked every student
for their personal identification and also for their
sanitation in order to get an idea about
dermatophytosis. Samples taken from suspicious
lesions were collected and inoculated onto
Sabouraud dextrose agar slants. For identification
of fungi which were grown, macroscopic
appearance of colonies, microscopic examination
and biochemical tests were used.
Results. We found suspicious lesions in 41 (0,5%)
in feet and 31 (0,3%) in scalp and diagnosed tinea
pedis in 22 (0,2%) and tinea capitis in 9 (0,1%) of
the students. The predominant etiologic agents in
feet were Trichophyton rubrum 8 (36%),
Trichophyton mentagrophytes 1 (4%), Rhodotorula
8 (36%), Trichosporon 2 (9%), Candida glabrata 2
(9%), Candida albicans 1 (4%), while Trichophyton
verrucosum
8
(88%)
and
Trichophyton
mentagrophytes 1 (12%) were identified in scalp
samples. Age and school settlement were found as
risk factors on the frequency of tinea pedis while
gender and animal husbandry were found as risk
factors on the frequency of tinea capitis.
Conclusion. The results of this study demonstrate a
low prevalence of tinea capitis and tinea pedis in
school children of Central Anatolia of Turkey.
Correspondence:
Mustafa GULGUN Gulhane Military Medical
Academy, Department of Pediatrics, Ankara,
TURKEY
Tel: +90 312 3044393
Fax: +90 312 3044381
GSM: +90 539 9645480
E-mail: mustafagulgun@yahoo.com
254
PP161
NASOPHARYNGEAL CARRIAGE RATE
AND
SEROGROUPS
OF
NEİISERIA
MENİNGITIDIS IN TURKISH RECRUITS
UPON ENTRY TO THE MILITARY
Authors:
COL BASUSTAOGLU Ahmet MD1, MD, LTC
BEDIR Orhan MD1, MAJ GUMRAL Ramazan
MD1, LTC KILIC Abdullah MD1, COL MERT
Gurkan MD2, C YILMAZ Soner MD1, COL
BESIRBELLIOGLU Bulent MD2
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Medical Microbiology Ankara, TURKEY.
2. Gulhane Military Medical Academy, Dept. of
Infectious Disease and Clinical Microbiology,
Ankara, TURKEY
Objective. The aim of this study was to determine
nasopharyngeal carriage rate and serogroup of
Neisseria meningitidis strains isolated from Turkish
recruits upon entry to the military.
Material and methods. Nasopharyngeal swab
samples were obtained from 1995 soldiers and were
inoculated immediately on BBL-modified ThayerMartin medium plates. The plates were examined
for the presence of colonies showing the typical
morphology of N. meningitidis. Suspect colonies
were screened for oxidase reactivity, and positive
colonies were Gram stained. If Gram-negative
diplococci were present, a biochemical profile by
the API NH system was used for confirmation.
Serogrouping of the meningococcal isolates was
performed by a slide agglutination technique.
Results. The nasopharyngeal carriage rate of N.
meningitidis was found to be 4.2% (n=83). Of these
meningococci, 15.6% (n=13) were serogroup Y,
10.8% (n=9) were serogroup W-135, 9.6% (n=8)
were serogroup C, 6.1% (n=5) were serogroup B,
2.4% (n=2) were serogroup A. The 46 isolates
(55.4%) were detected as nonserogroupable.
Conclusion. Since serogroup Y and W-135 are
predominant in this study population, it was suggest
that Turkish recruits should be vaccinated by
quadrivalent vaccine (A,C,Y, and W-135) upon the
military instead of A+C polysaccharide vaccine and
now quadrivalent vaccine has been carried out.
255
Correspondence:
Gulhane Askeri Tip Akademisi, Enfeksiyon Hast.
ve Kl. Mikrobiyoloji AD, Etlik 06018, Ankara,
TURKEY.
Tel: +90 312 3044306
Fax: +90 312 3044300
GSM: +90 5054870334
E-mail: gmert@gata.edu.tr
PP162
METHICILLIN
RESISTANCE
OF
STAPHYLOCOCCUS AUREUS INFECTIONS
IN
GULHANE
MILITARY
FACULTY
HOSPITAL
Authors:
MAJ GUNAL Emine, COL BESIRBELLIOGLU
Ahmet Bulent, BG EYIGUN Can Polat
Institution:
Infectious Disease and Clinical Microbiology,
Gulhane Military Medical Academy, Ankara,
TURKEY.
Objective: The purpose of this study was to put
forward the epidemiology of S. aureus infections in
Gulhane Military Medical Faculty Hospital in
recent years by comparing the advanced infections
with MRSA (methicillin-resistant S. aureus) and
MSSA (methicillin-sensitive S. aureus) strains and
to make recommendations to reduce MRSA rates.
Material and methods. The study was designed as
a retrospective case-control study. All patients
developed S. aureus infection between 2003-2008
were studied and evaluated in two sub-groups as
MRSA and MSSA. Distribution of S. aureus
infections by years, clinics and intensive care units,
tables of infection, sources of infection and MRSA
rates were assesed by comparing of both groups.
Results. In our study, both MRSA and MSSA cases
were found most common in primary blood stream
and surgical site infections but burn infections and
pneumonia were observed more frequent in MRSA
cases versus MSSA (p <0.05). MRSA infections
were most common in surgical (32.5%) and internal
intensive care units (23.5%) when MSSA were
most common in internal clinics (47.1%). MRSA
rates were highest in Burn Center (97.5%), Neurosurgery (91.1%), General Surgery (88.9%) Clinics
when it was 82.6% in hospital-wide (p <0.05).
MRSA cases decreased since 2003 while MSSA
cases were increasing (p <0.05).
Conclusion. This reduction in MRSA rates (91.1%
in 2003, 65.9% in 2008) was connected to active
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
work of the Infection Control Committee since
2002 and the restriction of inappropriate antibiotic
use.
Correspondence:
Emine Gunal Gulhane Military Medical Academy,
Ankara, TURKEY
GSM : + 90 5052335296
E-mail : egunal@gata.edu.tr
PP163
DETERMINATION OF MERCURY IN FISH
TISSUE AND HUMAN BLOOD SAMPLES
Author:
Bratu MC.
Institution:
Medicine Preventive Center, Defense Ministry,
Bucharest, ROMANIA
A sensitive method was proposed and optimized for
the determination of total mercury in fish tissue and
human blood samples by using digestion followed
by cold vapor atomic absorption spectrometry
detection (CVAAS), at the main resonance line of
mercury (184.9 nm). A new type of a non
dispersive mercury minianalyser based on the
measurement of the mercury absorption line at
184.9 nm was developed. For validating the
developed method, this new instrument was linked
with
a
conventional
atomic
absorption
spectrometer, the measurements being performed
simultaneously at two different wavelengths: 184.9
nm and 253.7 nm. To check also the method,
standard addition procedure was applied and the
recoveries of mercury spiked to wet fish tissue and
to each blood analysed sample were > 90% .The
linear calibration ranges were in the domain 2 – 10
μg l-1 and the sensitivity limit for mercury was 0.04
μg l-1. The results showed a better sensitivity when
using the mercury absorption line at 184.9 nm
compared with the sensitivity obtained by
conventional CVAAS at 253.7 nm line. The method
was successfully applied in routine analysis for
determination of mercury in various types of fish
and also in human blood samples. Key words:
mercury analysis, cold vapor atomic absorption
spectrometry at 184.9 nm and 253.7 nm, mercury in
fish tissue, mercury in human blood samples.
PP164
INTERLINKS:
A
EUROPE-WIDE
RESOURCE THAT AIMS TO IMPROVE
LONG-TERM CARE FOR OLDER PEOPLE
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Authors:
Lieutenant Georgios Kagialaris RN, MSc, HN,
Mastroyannakis T, Triantafillou J.
Institution:
Naval Hospital of Athens, GREECE
Purpose: The interlinks project helps people in
Europe who work with and represent older people
in need of long-term care (LTC). It aims to inspire
health and social care professionals, policy makers,
people from administrative agencies, and people
working in non-governmental organisations
(NGOs) to: work towards integrated systems of
LTC; improve planning and delivery of services for
frail older people at the interfaces between formal
and informal care, and between social and health
care; integrate prevention, rehabilitation, quality
management, governance and finance in the
toolbox to develop LTC systems.
Material and methods. Interlinks project was
carried out by a consortium of 15 partners from
universities, as well as national and international
research institutes with international and
interdisciplinary expertise. The consortium
represents 12 EU member states – Austria,
Denmark, Finland, France, Germany, Greece, Italy,
Netherlands, Slovakia, Spain, Sweden, the United
Kingdom and Switzerland. Through a spiral
methodology national and conclusive reports were
produced, good practices on LTC were reported, a
web site was set up and finally a publication is
pending.
Results. A Framework for Long-term Care has
been developed to identify gaps in long-term care
and to highlight solutions that will help planners
and care providers assess and improve their
services,
Conclusion: Interlinks project deals with Health
systems and long-term care for older people in
Europe – Modelling the INTERfaces and LINKS
between prevention, rehabilitation, quality of
services and informal care.
PP165
THE FUKOSIMA LESSON: WHAT NEW IN
THE TREATMENT OF MEDICAL MASS
CASUALTIES IN THE NBC ENVIRONMENT
Authors:
Captain Degermetzoglou Nikolaos, MD, MSc,
Stamoulis S, Siafakis A, Mpountouris I, Perdikides
T.
256
Institutions:
Hellenic Air Force 113 CW/Staff, Thessaloniki;
251 Hellenic Air Force General Hospital, Athens,
GREECE
Purpose: To demonstrate the lessons learnt from
the Fukosima Nuclear Catastrophe after the tsunami
in Japan in March 2011.
Material and Method: Review of the literature
about the effects that the nuclear disaster had on
local and national population of the area incidents
took place. Analysis of the strategy that was
followed in the mass casualties’ management and
focus on the role of the Military Medical Corps in
the handling of the cases.
Results: During March 2011, after a 9,2R
earthquake, a tsunami stroke the banks of Japan,
causing many catastrophes and disasters in the
structures of the coastal country. The worst of them
was the disaster of the Fukosima nuclear electricity
power plant. Although medical casualties were
evacuated on the first hours after the disaster, the
continuous leak of radiation from the reactor via the
sea water caused many problems in the
management of new casualties. The Military
Medical Corps applied sophisticated plans for
handling this situation, but the unstable stasis of the
Company owned the plant complicated the
management. Lessons have been learn from this
story, that showed there is a great need for major
cooperation from both civilian and military
authorities for the total and safe management of
such incidents.
PP166
THEARAPEUTIC
RESULTS
OF
HYPERBARIC OXYGEN THERAPY IN
SUDDEN SENSORINEURAL HEARING LOSS
Authors:
MAJ KAHRAMAN Erkan, MD1, CPT ATA
Nazim, MD2
Institutions:
1 Eskisehir Military Hospital, ENT Clinic,
Eskisehir, TURKEY
2. Aircrew’s Health, Research and Training Center,
Eskisehir, TURKEY.
Objective. Sudden hearing loss (SHL) is an
emergency condition. It has been defined as greater
than 30 dB hearing reduction, over at least three
contiguous frequencies, occurring over 3 days or
less. Treatment for SHL usually depends on the
cause of the hearing loss. Different treatments such
257
as steroids, vasodilators, antiviral agents and
hyperbaric oxygen therapy have been suggested.
Hyperbaric oxygen therapy (HBOT) is breathing
100% oxygen while in a sealed chamber that has
been pressurized at 2.5 times normal atmospheric
pressure. The aim of this study was to evaluate the
effect of HBOT in the treatment of SHL.
Material and methods. We analyze the patients
with SHL who received HBOT at Aircrew’s
Health, Research and Training Center at Eskisehir,
Turkey from 1 January 2009 to 31 December 2011.
Results. A total of 35 patients (40 ears) were
evaluated in a retrospective study. Patients received
100% oxygen in a multiplace hyperbaric chamber
at a pressure of 2.4 atmospheres absolute for 90
minutes 4 to 21 days (mean 10.7). The mean value
of patients’ age was 39.6 (13-83 years old). HBOT
was performed within 10 days on 22 patients. The
mean value of the beginning time was 10.4 (1-30
days). The overall percentage of ears showing
improvement (more then 10 dB) was 52.5% (21
ears).
Conclusion. The results of this study indicate the
necessity of performing additional controled studies
for the effects of hyperbaric oxygen therapy on
SHL.
Correspondence:
Hv.Tbp.Bnb. Erkan KAHRAMAN Eskisehir Asker
Hastanesi, Kulak Burun Boğaz Klinigi, Eskisehir,
TURKEY.
Tel: + 90 222 220 4530
Fax: + 90 222 220 4531
GSM: + 90 532 245 3467
E-mail: drerkan76@yahoo.com
PP167
OPHTHALMOLOGICAL ASSESSMENT IN
CIVIL AVIATION
Authors:
CPT METIN Suleyman, MD1, CPT GOKCE
Gokcen, MD2, MAJ CAKMAK Tolga, MD1, LTC
DULKADIR Zeki, MD1, COL AKIN Ahmet, MD1
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
assessment performed during periodic aeromedical
examinations.
Material and methods. We conducted a
retrospective chart review according to ICAO
(International Civil Aviation Organization) Annex
1 - JAR-FCL 3 (Joint Aviation Requirements-Flight
Crew Licensing 3) Ophthalmology Examination
Report Form of 73 Turkish civilian pilots (age
37.62±9.53 and 68 male; 5 female) admitted to our
center from January 2011 through September 2011.
Results. All pilots except one had 20/20 best
corrected visual acuity (VA) in both eyes according
to Snellen VA chart. No color deficiency was
observed by performing Ishiara isochromatic plates.
Cover testing showed orthophoria with no tropia
and Hirschberg's test showed orthophoria equally in
each eye. Mean near point of accommodation was
2.48±1.37
centimeters
and
the
mean
accommodation amplitude was 1.82±0.94 diopters
(Dpt). Nine pilots were myopic, while two were
hypermetropic. Ten pilots were presbyopic. The
average spherical refractive error was -0.15±0.50
Dpt. for the right eye and -0.15±0.46 Dpt. for the
left one. The average cylinder power was -0.7±0.38
Dpt. for the right eye and -0.7±0.29 Dpt. for the left
one. Intraocular pressure (IOP) ranged between 13
and 20 mm Hg with a mean of 17.63±1.94 mmHg
in the right eye; 13 and 22 mmHg with a mean of
18.16±2.14 mmHg in the left. Biomicroscopic and
fundoscopic examinations revealed no abnormality
in all subjects.
Conclusion. Ophthalmological disorders in civilian
pilots seem to be happened secondary to senile and
structural factors rather than flight environment.
Correspondence:
Hv.Tbp.Yzb. Suleyman METIN
Gulhane Askeri Tip Akademisi, Hava-Uzay
Hekimligi AD, 26020, Eskisehir, TURKEY.
Tel: + 90 222 230 0191
Fax: + 90 222 230 34 33
GSM: + 90 506 589 74 95
E-mail: drsmetin@gmail.com
Institutions:
1. Gulhane Military Medical Academy, Dept. of
Aerospace Medicine, Eskisehir, TURKEY
2. Sarikamis Military Hospital, Dept. of
Ophthalmology, Kars, TURKEY
PP168
THE RESULTS OF ELECTROPHYSIOLO
GICAL STUDY OF TWO JET PILOTS WITH
ELECTRICAL
CONDUCTION
SYSTEM
ABNORMALITIES DETECTED IN SURFACE
ELECTROCARDIOGRAPHY
Objective. The aim of this epidemiological study
was to present the results of ophthalmological
Authors:
Ozturk C, Metin S, Cakmak T, Akin A, Sen A.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
258
Institutions:
Eskisehir Military Hospital; Gulhane Mlitary
Medical Academy, Eskisehir, TURKEY
Institutions:
Eskisehir Military Hospital; Aircrew’s Health,
Research and Training Centre, Eskisehir, TURKEY
Objective. We present the electrophysiological
study results showing electrical conduction system
abnormalities including junctional rhythm and
extrasystole that are incidentally detected in two jet
pilots applying for periodic aeromedical
examination.
Objective. As the altitude increases the air pressure
and partial oxygen pressure decrease. If precautions
aren’t taken against the decrease of the oxygen
pressure, hypoxia influences the pilots. In our
study, we examined the affects of the altitude on
pulmonary functions.
Material and methods. Both cases were 24-yearold male F-5 jet pilots. The first pilot had frequent
atrial extrasystoles in his electrocardiography
(ECG). Atrial extrasystoles originated from the
right atrial appendage were seen by performing
incremental atrial pacing and was treated with
radiofrequency ablation. The second pilot had
normal sinus rhythm and also short duration
junctional rhythm observed in his ECG.
Material and methods. 40 pilot candidates were
included. Their FEV1 and PEF values were
measured before they entered high altitude
chamber. The values also measured in the high
altitude chamber at 8000 feet altitude and after the
training.
Results. Both pilots applied to our department with
electrical conduction system abnormality. They had
no
significant
medical
history.
Physical
examination and biochemical tests revealed no
abnormality.
Transthoracic
echocardiography
showed no structural heart disease. 24-hour rhythm
Holter monitoring records showed frequent atrial
extrasystoles in the first case and rare junctional
rhythms in the second case. The EPS showed
normal sinus and AV Node functions for both. So
both pilots were allowed to return to flight duties.
They have been flying for one year without having
any health problem.
Conclusion. An electrical conduction system
abnormality detected in surface electrocardiography
may reveal a conduction disease as an underlying
cause or it can be seen in a totally healthy
individual. EPS can be performed on aircrew as an
effective and dependable method in order to decide
whether they are fit to fly.
Correspondence:
Doc.Hv.Tbp.Alb. Cengiz OZTURK Eskisehir
Military Hospital, Dept. of Cardiology, 26035,
Eskisehir, TURKEY.
Tel: + 90 222 220 45 30
Fax: + 90 222 220 34 33
E-mail: drcengizozturk@yahoo.com.tr
PP169
AFFECTS
OF
THE
ALTITUDE
PULMONARY FUNCTIONS
Authors:
Yildiz S, Ata N, Ercan E.
ON
Results. Mean values of all subjects were before
training PEF(BTP):537.45±100.94; at 8000 feet
PEF(8000FP):517.02±116.77;
after
training
PEF(ATP):548.08±102.82;
before
training
FEV1(BTF):3.56±0.68;
8000
feet
FEV1(8000FF):3.22±0.71;
after
training
FEV1(ATF): 3.42±0.70. Analysis of all subjects
showed that the mean of 8000FF group was lower
than BFF mean value and the differences between
groups were statically significant (p<0.05).
Differences between PEF groups were not statically
ignificant (p>0.05). When we grouped all subjects
according to their smoking habits, in smokers group
mean of 8000FF was lower than BFF mean value
and the differences between groups were statically
significant(p<0.05). And also in smokers group,
mean of ATF was higher than 8000FF mean value
and the differences between groups were statically
significant (p<0.05).
Conclusion. In our study, changes in FEV 1 values
between two altitudes were statistically significant.
When the effect of smoking on FEV1 decline
examined; in smoker group there was statistically
significant difference, but this difference was not
observed in non-smokers. This result showed that
the adverse effects of high altitude on the values of
FEV1 may increase with smoking.
Correspondence:
Hv.Tbp.Yzb. Safak Yildiz Eskisehir Military
Hospital, Dept. of Pulmonary Medicine, Eskisehir,
TURKEY.
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
GSM: + 90 532 462 19 81
E-mail: safakmd@yahoo.com
259
PP170
BULLOUS DISEASE OF LUNG IN FLIGHT
PERSONNEL: TWO CASES
Authors:
Yildiz S, Ata N, Ercan E, Metin S. Eskisehir
Institutions:
Military Hospital; Aircrew’s Health, Research and
Training Centre; Gulhane Military Medical
Academy, Eskisehir, TURKEY
Objective. A bulla is a large, air-containing space
within the lung parenchyma resulting from
destruction, dilatation, and confluence of airspaces
bronchioles. Bullae are larger than 1 cm in diameter
and are composed of attenuated and compressed
parenchyma. Bullae may be asymptomatic or give
rise to progressive dyspnea or chest pain.
Material and methods. We analyzed two aircrews
who have pulmonary bullae which were diagnosed
while periodical medical examination.
Results. Our fist case was a 42-year-old, male
helicopter pilot. He had no complaints. On
auscultation; prolonged expiratory phase was noted.
In the pulmonary function test; restriction and small
airway obstruction detected. Multiple bullae were
detected in upper lobes of the lungs on high
resolution computerized tomography of the chest
(HRCT). Our second case was a 29-year-old, male
helicopter technician. He had no complaints and his
physical examination was normal. After a suspected
lesion had been seen in chest radiograph, HRCT
was taken. Atelectasis with fibrotic opacity in right
lower lobe and 1 cm diameter bulla was seen in the
left lower lobe on HRCT. As a final decision, two
aircrews were permanently restricted from flying.
Conclusion. Small air cysts/bullae usually don’t
influence the gas exchange but large ones may
cause atelectasis by compressing surrounding
tissue. In aviation, as altitude increases, the bullae
expand and may cause spontaneous pneumothorax.
Ascending an altitude of 5000 feet causes 20% rise
in the volume of the bullae. Pulmonary bullae
which are generally asymptomatic at sea level may
cause serious problems in aviation.
Correspondence:
Hv.Tbp.Yzb. Safak Yildiz Eskisehir Military
Hospital, Dept. of Pulmonary Medicine, Eskisehir,
TURKEY.
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
GSM: + 90 532 462 19 81
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
E-mail: safakmd@yahoo.com
PP171
SMOKING RATES IN CIVIL AVIATION
PILOTS
Authors:
Yildiz S, Ata N, Ercan E. Eskisehir
Institutions:
Military Hospital; Aircrew’s Health, Research and
Training Centre, Eskisehir, TURKEY
Objective. Smoking habit is a health problem
which concerns all the community. Smoking also
accepted by World Health Organization (WHO) as
an important mortality and morbidity reason which
can be prevent. According to Joint Aviation
Authorities Requirements for Flight Crew
Licensing (JAR-FCL) and International Civil
Aviation Organization (ICAO) rules, pilots are
examined by the flight surgeons in aeromedical
centers designated and authorized by Directorate
General of Civil Aviation (DGCA). In this study,
we aimed to determine smoking rates in civil
aviation pilots.
Material and methods. We evaluated the medical
records of 281 pilots and student pilots who got in
medical examination with the requirements of JARFCL and ICAO in our aeromedical center between
the years 2006-2010. Their smoking habits, ages,
sex and health problems were noted.
Results. 271 of the cases were male and 10 were
female. 213 cases have graduated from university
and 68 cases have graduated from high school. The
ratio of smoking cigarette was 24.2% (68/281). 26
of the cases declared they used to smoke but not
any more. 187 of the pilots declared they never
smoked. None of them had pulmonary health
problem history.
Conclusion.
After the thoracic medicine
examination, all of them assessed as fit for flying
duties. Training of the pilots is quite difficult and
very expensive. Pilot’s smoking related health
problems influence not only their life but also the
life of other people and passengers. So smoking
history must be questioned and pilots must be
advised to quit smoking.
Correspondence:
Hv.Tbp.Yzb. Safak Yildiz Eskisehir Military
Hospital, Dept. of Pulmonary Medicine, Eskisehir,
TURKEY
Tel: + 90 222 220 45 30
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Fax: + 90 222 220 45 31
GSM: + 90 532 462
safakmd@yahoo.com
19
81
e-mail:
PP172
SMOKING HABITS AMONG MILITARY
PILOTS
Authors:
Ilbasmis S, Metin S, Cakmak T, Kahraman E.
Institutions:
Aircrew’s Health, Research and Training Centre;
Gulhane Military Medical Academy; Eskisehir
Military Hospital, Eskisehir, TURKEY
Objective. It is highly important to determine the
success rates of antismoking campaigns among
various groups of society. This research was
performed to detect smoking habits among military
pilots.
Material and methods. 95 military pilots who
have applied for aviator periodic medical
examinations in 3 months period were included in
this study. They were asked about their smoking
habits by using a questionnaire developed by our
center. After asking about their personal general
information the subjects were questioned whether
they smoke cigarettes, if yes how long and how
frequently. The data obtained was assessed with
descriptive statistics.
Results. Of the 95 participant pilots whose ages
vary from 27 to 51, 26 (27.3%) were smokers and
69 (72.7%) were nonsmokers. 20 (76.9%) of
smokers had smoking habits over ten years and 6
(23.1%) of smokers had less than ten years. 7
(26.9%) of the smokers cited that they smoke a few
in a day, 9 (34.6%) smokers cited that they smoke
5-10 cigarette per day, 9 (34.6%) smokers a packet
of cigarette per day and 1 (0.04%) smoker more
than 1 packet. Among the 26 smokers 16 (61.5%)
were high performance aircraft pilots and 10
(38.5%) smokers were transport and helicopter
pilots.
Conclusion. Since the military pilots are supposed
to have low rates of smoking due to requiring high
medical standards, it is needed to organize smoking
cessation campaigns to reduce the rate of pilots
which is slightly less than general Turkish
population smoking rate (31.2 %).
Correspondence:
Savas ILBASMIS
260
Aircrew Health Research and Training Center,
Eskisehir, TURKEY.
Tel: + 90 222 220 4530
Fax: + 90 222 230 3433
GSM: +90 5055733866
E-mail: msavasi@hotmail.com
PP173
G-LOC
INCIDENCE
DURING
CENTRIFUGE TRAINING
THE
Author:
CPT ATA Nazim, MD
Institutions:
Aircrew’s Health, Research and Training Centre,
Eskisehir, TURKEY
Objective. G-LAB is a high-G trainer, generating
sustained G-forces up to 15 G with an approximate
onset rate of 6 G/sec. It is designed to train the jet
pilots to reduce the G-induced loss of
consciousness (G-LOC) incidence. G-LOC is a
situation which comes out in case that blood is
taken away from the brain on account of G-forces.
Aircrew’s Health, Research and Training Center at
Eskisehir, Turkey has a G-LAB. The aim of this
study was to investigate the incidence of G-LOC
during high-G centrifuge training.
Material and methods. High-G centrifuge training
results in the year of 2011 were retrospectively
analyzed. RESULTS There were 1003 jet pilots and
pilot aspirants subjected to high-G training at our
center during the year 2011. Out of the 1003
aircrews, 850 (84.75%) completed high-G training
on their first attempts. The reason of being not able
to complete the training for the rest was either GLOC or discomfort (stomach awareness or
vomiting). Of the 1003 trainees, 131 (13.06%) had
one or more G-LOC episodes. All aircrews who
experienced G-LOC were pilot aspirants. G-LOC
occurred at 3 trainees at relax G; 16 trainees at 4.5
G 30 sec; 105 trainees at 6 G 15 sec; 5 trainees at
7.5 G 15 sec; 2 trainees at 9 G 15 sec profiles.
Conclusion. In order to show that for protecting
the aircrew against the physiological effects of
sustained high-G forces, and preventing losses of
aircraft/aircrew reasoned from GLOC; G-LAB is
the safest training device.
Correspondence:
Hv.Tbp.Yzb. Nazim ATA Ucucu Saglıgı Arastirma
ve Egitim Merkezi, Eskisehir, TURKEY.
Tel: + 90 222 220 45 30
Fax: + 90 222 220 45 31
261
GSM: + 90 505 251 07 49
E-mail: doktornazim@yahoo.com
PP174
BIOSAFETY
Authors:
Lazic S, Cekanac R, Krstic M, Stajkovic N,
Mladenovic J, Jadranin Z, Radakovic S, Radjen S,
Ristanovic E.
Institutions:
Medical Faculty MMA, University of Defense,
Belgrade, SERBIA
We are living in an era of uncertainty and change.
New infectious agents and diseases have emerged.
Work with infectious agents in public and private
research, public health, clinical and diagnostic
laboratories, and in animal care facilities has
expanded. Biosafety is the discipline addressing the
safe handling and containment of infectious
microorganisms and hazardous biological materials.
The main goal is the protection of laboratory
workers from dangerous pathogens, which is
critical for the safety of these skilled personnel as
well as the prevention of pathogen transmission to
surrounding populations. Recent world events have
demonstrated new threats of bioterrorism. For these
reasons organizations and laboratory directors are
compelled to evaluate and ensure the effectiveness
of their biosafety programs, the proficiency of their
workers, as well as the capability of equipment,
facilities, and management practices to provide
containment and security of microbiological agents.
Similarly, individual workers who handle
pathogenic microorganisms must understand the
containment conditions under which infectious
agents can be safely manipulated and secured.
Application of this knowledge and the use of
appropriate techniques and equipment will enable
the microbiological and biomedical community to
prevent personal, laboratory and environmental
exposure to potentially infectious agents or
biohazards. These pathogens and the intellectual
property surrounding them may be sought by
foreign or domestic adversaries with nefarious
intent. The principles of biosafety introduced in
1984 in the USA, are containment and risk
assessment. The fundamentals of containment
include the microbiological practices, safety
equipment, and facility safeguards that protect
laboratory workers, the environment, and the public
from exposure to infectious microorganisms that
are handled and stored in the laboratory. Risk
assessment is the process that enables the
appropriate selection of microbiological practices,
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
safety equipment, and facility safeguards that can
prevent laboratory-associated infections (LAI).
There is no doubt that the work on biosafety is an
continous everydays process and effort, which
include public health authorities as well as
laboratory managment and laboratory workers. The
aim is to avoid events such as anthrax incident in
Sverdlovsk, SARS incident in Singapore, Foot and
Mouth disease in the United Kingdom and
noumerous LAI all over the World. Corresponding
author: colonel assist. prof. Srđan Lazić, MD, PhD
PP175
EPIDEMIOLOGICAL CHARACTERISTICS
OF LYME DISEASE IN SERBIA
Authors:
Mladenovic J, Cekanac R, Lazic S.
Institutions:
Medical Faculty MMA, University of Defense,
Belgrade, SERBIA
Introduction. Lyme borreliosis is one of the most
frequent tick-borne diseases in North America,
Europe and Asia. There are a variety of symptoms
of Lyme disease including a skin rash around the
tick bite and various later general symptoms such
as fever, fatigue and many other possible
symptoms. Lyme disease can also affect the joints,
central nervous system and the heart.
Aim of this research is analysis of most important
epidemiological characteristic of Lyme borreliosis
in Serbia.
Methods. Source of data about morbidity was
annual reports from Public Health Institute of
Serbia from 1990 to 2009. Source of population
data is Statistical Office of the Republic of Serbia.
Incidence is displayed per 100000 inhabitants.
Results.In the observed period in Serbia annual
incidence of LB ranged from 3.11/100,000 in 1991
to 12.64/100,000 in 2009. Mean incidence in Serbia
during this period was 7.67/100000. During last
five years of observed period (2005-2009),
maximum values of average incidence were
recorded in regions Kolubarski (44.47/100000) and
Južno Bački (24.58/100,000). Incidence trend of
LB demonstrated increase for observed period. The
highest occurrence is during the summer months
with gradually increasing occurrence from May
with maximum in June and July and a decline till
October. Disease was more often registered among
female (11.08/100000) than male persons
(8.91/100000).
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Conclusion. In conclusion, Lyme borreliosis still
requires an increased attention, especially due to
the problems with prevention, complicated
diagnosis and treatment and also due to a possible
significant impact on the quality of life of these
patients.
Correspondence:
Jovan Mladenović Institut za epidemiologiju, SPM
VMA
Tel: +381113609332; +391641286959
Email: jovan.mladenovic@gmail.com
PP176
BIOTERRORISM
Authors:
Ristanovic E, Lazic S, Radakovic S.
Institutions:
Medical Faculty MMA, University of Defense,
Belgrade, SERBIA
Bioterrorism is an abuse of microorganismsbacteria, viruses, fungi, parasites and their
products-toxins for terrorist purposes. Although the
problem is as old as civilization as a whole, today's
era of great world contradictions, risks and threats,
as well science development especially in the field
of genetic engineering and and biotechnology,
make a bioterrorism a real challenge and a global
threat, and fight with him one of the priority
national objectives and international commitments
in which the medical profession has a special
responsibility and obligation. Within that,
continuous improvement of procedures for the
detection and identification of potential biological
warfare agents is very important. But the
construction and respect of biosafety and
biosecurity measures and standards is equally
important. Biosafety includes all measures to
protect staff coming into contact with dangerous
microorganisms. Biosecurity actually implies the
protection of of microorganisms, i.e. all measures
to control access and prevent unauthorized access
to potential biological agents, the protection of the
workflow as well professional staff from the people
with dangerous intentions. Biosecurity measures
relate to physical security, material control,
information security, personnel security as well the
control of transfers. The implementation of
biosecurity measures is joint responsibility of the
institution management, scientific staff, the human
resources and information technology managers as
well security services. Effective biosecurity
measures are not dependent on expensive high-tech
262
security systems, but from process of management,
which provides training, accountability, and
controlled access to high-risk pathogens and
working material in laboratories, archives of the
microorganisms, risk assessment as well the
response plans in case of emergency events.
Particular focus is the "insider" threat, so there is
great responsibility for the employees and experts.
The aim of this paper is to highlight the importance
of biosecurity measures as part of bioterrorism
combating strategy as well the efforts taken in that
respect.
PP177
THE
ROLE
OF
THE
GENERAL
PRACTITIONERS AS A RESPONDER IN A
MAJOR MEDICAL EMERGENCY
Authors:
KOLEV S MD MSs (Toxicology), PASKALEV K
MSc (Pharmacy) Chief Experts
Institutions:
Military Medical Intelligence Unit, Department of
Toxicology and Disaster Medicine. Military
Medical Academy, Sofia, BULGARIA
Background: General practitioners until now seem
overlooked medical resource for assistance in
disaster preparedness planning and relief operations
in many countries. In practice, however, they can
be of great value to support the medical personnel
in the disaster zone as well as in the nearby
hospitals, which are often short of staff in major
medical emergencies. Typically GP’s offices are
located in the community, outside the main
hospitals. Therefore, they could be the only
qualified medical personnel situated in close
proximity, or in the disaster zone. Most GPs
practice in one area for a significant period of time
and have a unique knowledge about the geography
of the region as well as the socio-economic
structure and the health status of the population
there. Generally they are available 24 hours and can
be quickly mobilized to participate in rescue
operations. According to Тolhust et al. 8.4% of the
GPs calls in remote areas are calcified as an
emergency or life threatening cases. Many GPs,
therefore believe they will cope when called upon
in a disaster, as they believe the skills required are
merely an extension of their everyday activities.
Although not very common in inner-city practices,
(on average two per fortnight for 2500 patients)
personal experience of the author shows that they
happen regularly. This fact lead to the introduction
of periodic obligatory basic life support courses for
all working in the health care system in many
263
countries. Australian Emergency Manual and other
guidelines define the role of the GPs in major
medical emergency in two directions:
1. to provide medical support
2. because of their unique knowledge about the
geography of the region as well as the socioeconomic structure and the health status of the
population, they can be involved in disaster
preparedness planning.
Objectives: The aim of this report is to increase
awareness and to encourage rethinking of the role
of the GPs as a responder in a major medical
emergency.
Material and methods. In this report, the role of
the GPs as a responder in a major medical
emergency has been reviewed in the literature.
Conclusion: Based on analysis of the literature and
personal experience of the authors, we see the role
of the GPs as a responder in a major medical
emergency in three directions: 1. as a volunteered
to participate in the rescue operations 2. to be
included as members of the rescue teams 3. to get
involved in disaster preparedness planning
Military Medical Academy 3 Georgi Sofiiski St
Sofia 1606 BULGARIA Telephone + 359 2/
9225878 Fax + 359 2 /9225878 E-mail
medkat@vma.bg
PP178
BUTYRYLCHOLINESTERASE
PHENOTYPING
AS
A
PREVENTIVE
APPROACH IN BULGARIAN SERVICEMEN
Authors:
LTC Dimov D., MD; prof. Kanev K., MD, DSc;
Assoc. Prof. Dragnev V., MD, PhD
Institutions:
Disaster Medicine Scientific Research Laboratory
Disaster Medicine and Toxicology Department
Military Medical Academy 3, St. G. Sofiisky Str.,
1606, Sofia, BULGARIA
Introduction: Butyrylcholinesterase (BCHE) is a
biological scavenger against organophosphorus and
carbamate compounds used as pesticides and nerve
agents. Also BCHE has an important role in the
hydrolysis of the muscle relaxant succinylcholine.
Mutations in BCHE gene may have a significant
impact on the response of military personnel to
pharmaceuticals and their sensitivity to chemical
warfare agents.
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Aim: The aim of the study is to evaluate the
Butyrylcholinesterase phenotyping as a preventive
approach in members of Bulgarian Armed Forces.
Material and Methods: We determined the BChE
phenotypes in 642 Bulgarian servicemen with the
mean age of 35 ± 15 years. Comparative analyze
was applied to define the individuals who may be
higher sensitive to certain drugs and chemical
compounds.
Results/Discussion: The results obtained from our
study for the distrubution of BChE phenotypes in
Bulgarian servicemen revealed that 0.57 % of
individuals carried hypersensitive variants (AA,
AS, AK). Also the data illustrate that in 1 of 18 was
detected heterozygote BChE genotype that
associated with moderate sensitivity to muscle
relaxant succinylcholine and organophosphorus
compounds. Our research show that biochemical
phenotyping of BChE variants is a reliable and
quick method for detection those risk individuals.
Conclusion: The genetic polymorphism determines
the clinical features and therapeutic response in
cases of organophosphorus intoxications or
application of succinylcholine. We suggest that
butyrylcholinesterase phenotyping may use as a
preventive approach in Bulgarian servicemen.
Correspondence:
Disaster Medicine Scientific Research Laboratory,
Disaster Medicine and Toxicology Department,
Military Medical Academy 3, St. G. Sofiisky Str.,
1606, Sofia, BULGARIA
Tel. +35929225929
Email: medkat@vma.bg
PP179
THE
ROLE
OF
GEOGRAPHICAL
INFORMATION
SYSTEMS
(GIS)
IN
CHEMICAL ACCIDENT RESPONSE
Authors:
Assist. GALABOVA Agnes; Prof. K. KANEV,
MD, DSc; Assoc. Prof. DRAGNEV Velichko, MD,
PhD; Ltc. KONOV Valentin, MD
Institutions:
Military Medical Academy, SRL Disaster
Medicine, Disaster Medicine and Toxicology
Department, BULGARIA
Introduction. Industrial accidents or terrorist acts
on chemical facilities pose the problem of quick
and effective emergency response in interorganizational way. The information about the
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
evolution of the situation, the occurred damages,
the material and human resources available and
needed to manage the emergency are necessary to
know. Nowadays GIS are used as an essential tool
for planning purposes in the resonse phase. The
AIM is to outline the possibilities of GIS and their
role in chemical accident response management.
Material and methods. Survey of the open
literature about the current trends of GIS use in
cases of accidents in chemical industry.
Results. GIS can establish spatial topological
relationships among geographical objects - roads,
buildings, etc. The integrated map is an important
source for information in order to apply protection
and/or mitigation measures for the exposed
population. The supplied software can model toxic
releases and urban dispersion from single and
several release points, blast and fire models, the
consequences of the accident are calculated, the
evolution of the current situation is observed. GIS
can provide an easy way of distributing information
from experts to first responders and operational
headquarters.
Conclusion. Our and international and experience
reveals that GIS can support emergency managers
in finding the appropriate information for acting
procedures to cope with chemical industrial
accidents.
Correspondence:
Disaster Medicine Scientific Research Laboratory
Disaster Medicine and Toxicology Department
Military Medical Academy 3, St. G. Sofiisky Str.
1606, Sofia BULGARIA
Tel. +35929225929
Email: medkat@vma.bg
PP180
WEAPONS OF MASS DESTRUCTION
(WMDs)
AND
BASIC
MEDICAL
MANAGEMENT IN THE GREEK MILITARY
Author:
CPT Katerina Stasini, RN, PN
Institution:
414 General Military Hospital,
Department, Athens, GREECE
Psychiatric
Purpose: To describe how the Greek Medical
Military Team may maintain safety at a scene with
WMDs.
264
Material and methods: An extensive literature
search was performed aiming to identify and review
studies that analyze every WMD and its effects on
humans. The research was accomplished in the
databases of MEDLINE, CINAHL and in the
National Documentation Center of Greece for the
period of the last ten years, using the keywords
‟chemical agents”, “nerve agents”, ‟biologicradiologic threats”.
Results: At this time the most common type of
terrorist attack throughout the world continues to be
conventional weapons, mainly explosions from
bombs and ballistic trauma from firearms.
However, the risk of chemical, biologic, radiologic
and nuclear attacks exist, so medical units must be
prepared to respond to both conventional and
unconventional threats. The Greek Medical
Military Team responds to CBRN incidents as they
are deliberate malicious acts intended to kill, sicken
and/or disrupt society. CBRN (chemical, biologic,
radiologic, and nuclear) threats have several
features in common: they are rare and sometimes
difficult to identify, require specialized training to
understand and mitigate and are frightening to the
population.
Conclusion: First of all, it is the threat of an actual
use of these agents that causes fear in the general
population, which is the larger goal of a terrorist
group. These agents may cause injuries and
illnesses that are unusual and difficult to treat
.Although the risk of CBRN threat is rare if utilized
in a well planned and coordinated fashion, CBRN
agents could potentially kill thousands of innocent
people and terrorize millions more. For that reason
the Greek Military Medical Team is perfectly
trained to provide effective measures to reduce or
even vanish every hazard.
PP181
THE USE OF BORIC ACID AND
HYPERTONIC NaCl 15% AS ANTISEPTIC
FACTORS IN THE TREATMENT OF
ULCERS IN DIABETIC FOOT
Authors:
Cpt Nikolaos Degermetzoglou, MD, MSc1,
Stavrides Kyriakos², Genios Ioannis², Janjic Milka²,
Lazarides Ioannis², Ktenides Kyriakos², Saratsis
Nikolaos², Kiskinis Dimitrios²
Institutions:
1. Captain, MD, MSc, Hellenic Air Force - 113
CW/Staff, Thessaloniki, GREECE
265
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
2. Aristotle University of Thessaloniki, 1st Surgery
Clinic,
Vascular
Surgery
Department,
Papageorgiou General Hospital
3. Etlik Training and Research Hospital,
Department of Radiology, 06018, Ankara,
TURKEY
Purpose: To demonstrate the value of boric acid
and NaCl 15% as local antiseptic factors in the
treatment of Diabetic foot ulcers and the necessity
of their use in the strategy of treatment.
Objective: Carbon monoxide (CO) is a highly toxic
gas affecting predominantly central nerve system.
Clinical features of poisoning are generally nonspecific and the severity ranges from mild headache
to death depending on the exposed gas
concentration and exposure duration. Brain MRI
performed in a patient suffering from CO poisoning
can show signal changes in globus pallidus,
putamen, caudate nucleus, thalamus, hippocampus,
cerebellum, periventricular and subcortical white
matter. Although we haven’t met any case reported
in literature yet, we identified an isolated cerebellar
damage caused by CO poisoning without any
supratentorial changes in brain MRI.
Material and Method: In the period between June
2011 and March 2012, 124 patients with diabetic
foot ulcers were hospitalized in our clinic. After
imaging control of the arteries of the limbs (U/S
triplex scan, CTA, MRA, DSA) and treatment of
critical artery stenosis , the patients underwent a
programme of ulcer care with application of NaCl
15% and boric acid on the ulcer wound during the
final dressing. The patients were followed-up at the
Vascular Outpatient Department every 15 days for
the first 3 months and every month for the rest of
the period.
Results: From the 124 patients, 113 are still alive
(92.7%). Peripheral or major amputation had to be
performed in 21 cases (18.3%). In the patients with
intact limbs, 68 had complete healing of the ulcer
after 9-14 weeks and 29 had a reduction of the ulcer
surface by more than 65%, while the final 6 had a
reduction of 20-35%. It seems that the use of both
agents helped the reduction of time for healing and
helped to keep the ulcer area sterile from
microorganisms such as E.coli, Enterococcus,
Strephotrophomonas, Proteus and Pseudomonas,
which are the germs most commonly isolated in
diabetic ulcers.
Conclusions: It seems that both agents constitute a
good and cheap method for the reduction of
diabetic ulcers; in combination with other measures
they can provide a good level of blood perfusion.
PP182
ISOLATED
CEREBELLAR
DAMAGE
CAUSED
BY
CARBON
MONOXIDE
INTOXICATION
Authors:
CPT HAMCAN Salih, MD1, YILMAZ Omer, MD2,
TURAN Aynur, MD3
Institutions:
1. Balıkesir Military Hospital, Department of
Radiology, 10020, Balıkesir, TURKEY
2, Suleyman Demirel University Faculty of
Medicine, Department of Radiology, 32100,
Ankara, TURKEY
Material and methods. A 5-year-old girl was
brought to emergency department by her family
members. On admission, the patient was
unconscious and had convulsions. Carbon
monoxide intoxication was presumed and she was
referred to our department for brain MRI. In
addition to conventional sequences, diffusion
weighted images (DWI) were performed in brain
MRI.
Results: Whereas there wasn’t any pathologic
signal change in supratentorial images, symmetrical
lesions in gray matter were observed in both
cerebellar hemispheres
Conclusion: In CO poisoning, as in other hypoxic
ischemic central nervous system events, relatively
poor vascularization and “watershed” areas are
more vulnerable and affected earlier. The most
sensitive brain regions to hypoxia are cerebral
cortex, white matter, basal ganglions and Purkinje
cells in cerebellum. Furthermore, the lesions
identified in MRI are commonly located in
supratentorial region and cerebellar lesions often
coincide with supratentorial ones. In our case, we
have detected isolated cerebellar lesions which have
not been reported in any case of CO poisoning in
literature. Also, in DWI, we observed that these
described lesions showed restricted diffusion
pattern as a consequence of cytotoxic edema.
Correspondence:
Balıkesir Military Hospital, Department
Radiology, 10020, Balıkesir, Turkey
Tel: + 90 266 2396000
Fax: + 90 266 2496739
GSM: + 90 533 3817205
E-mail: slhhmcn@hotmail.com
of
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
266
PP183
ESTIMATION OF ANTI-INFLAMMATORY
ACTIVITY
OF
NEW
SYNTHESIZED
CORTICOSTEROID PRODRUG ESTERS
Authors:
Bojan
Markovic1,
Vesna
Vladimirov1, Silva Dobrić2
Jaćević2,
Sote
Institutions:
1. Department of Pharmaceutical Chemistry,
University of Belgrade, Faculty of Pharmacy
2. National Poison Control Centre, The Medical
Faculty of the University of Defence, Belgrade,
SERBIA
PP184
ACUTE
HYPEROSMOLAR
HYPERGLYCEMIC STATE ASSOCIATED
WITH USE OF NEW GENERATION
ANTIPSYCHOTIC DRUG: A CASE REPORT
Authors:
1LT CAKAR Mustafa, MD, MAJ ARSLAN Erol,
MD, LTC DEMIRBAS Seref, MD, 1LT KILINC
Ali, MD, MAJ YESILKAYA Sirzat, MD, COL
SAGLAM Kenan, MD
Institutions:
Gulhane Military Medical Academy, Department of
Internal Medicine, Ankara, TURKEY
Corticosteroids are used in therapy for their antiinflammatory and immunosuppressive actions, but
their use is limited due to numerous systemic side
effects. Corticosteroid esters applied topically, due
to increased lipophilicity and better penetration
properties, show much stronger anti-inflammatory
effects. In order to achieve a better benefit/risk ratio
25 new C-21 esters of hydrocortisone (H),
dexamethasone (DEX), methylprednisolone (MP),
fluocinolone acetonide (FA) and triamcinolone
acetonide (TA) have been synthesized with 2alkoxyalkanoic
(2-methoxypropanoic,
2ethoxypropanoic, 2-methoxybutanoic and 2ethoxybutanoic) and
α-aryloxyalkanoic (2phenoxypropanoic)
acids.
Topical
antiinflammatory activities of new synthesized
corticosteroid prodrugs have been estimated in a
modification of the test inhibition of croton oil
induced ear edema in mice. Acetone solutions of all
test compounds have been prepared in
concentration which correspond to ED50 of FA
(27,51 μM). Croton oil solution in acetone (20 μl,
35 μg/ml) was applied in inner side of ear and 30
min later corticosteroid solution (20 μl). The mass
of edema were measured 4 hours after
corticosteroid application. Results were compared
with standard corticosteroids. All new synthesized
C-21
corticosteroid
esters
showed
antiinflammatory activities similar to standard
corticosteroid. The best activities have been
measured on DEX, FA and MP series of new
synthesized C-21 esters. The most uniform results
have been noted in seria of DEX esters (the
measured inhibition edema was in range from 29.32
to 46.34 %) and these compounds were selected for
further experiments.
Objective: Diabetes mellitus is more common in
schizophrenia patients than the general population,
due to antipsychotic drugs or a variety of
mechanisms. Hyperosmolar hyperglycemic state is
an acute complication of diabetes. Here we present
a case of hyperosmolar hyperglycemic state due to
a new generation antipsychotic drug usage. CASE:
A 59-years old male had schizophrenia for 30 years
and he was using antipsychotic drugs of risperidone
(25 mg im/2 times a month) and quetiapine (1x100
mg). The patient had a new speech disorder and
difficulty on face movements. Physical examination
revealed a peripheral facial paralysia. Arterial blood
pressure (ABP) was 140/80mmHg, pulse rate
84/min, fever: 36.4‘C, respiratory rate: 20/min,
tongue and oral mucosa were dry. Leukocytes were
10900/mm3, Hb: 16.6 g/dl, glucose: 609 mg / dl,
urea: 20 mg / dl, creatinine: 1.0 mg / dl, uric acid:
2.63 mg/dl, Na: 132 mmol/l, C: 3.84 mmol/l; urine
density: 1024, glucose: +++, ketone (-), on
sediment:1-2 leukocytes was detected. Arterial
blood gas analysis was pH: 7.415, pCO2: 28.1,
HCO3: 18.2. Serum osmolarity was 305 mOsm/kg.
The patient had no diabetes history, and was in
remission of the psychotic illness. High blood
glucose, normal pH, ketone negativity and
hyperosmolar hyperglycemic state was found
associated with a new-onset diabetes and patient
and hospitalized for fluid and insulin therapy.
This work was partially supported by the Ministry
of Education and Science, Belgrade, Serbia, as part
of Project No. 172041.
Correspondence:
Gulhane Askeri Tip Akademisi, Iç Hastalıkları BD,
Etlik 06018, Ankara, TURKEY. Tel:+90 312 304
Conclusion: Schizophrenia and the drugs used to
treat it may worsen the diabetes disease course.
Diabetic schizophrenia patients using new
generation antipsychotic medication should be
monitored closely for possible acute diabetic
complications.
267
4015 Fax:+90 312 304 4001 GSM:+90 554 525
2246 e-mail:drmustafacakar@gmail.com
PP185
CORRELATION
BETWEEN
ACHE
ACTIVITY
AND
EXPRESSION
OF
CEREBRAL
STRUCTURAL
PROTEINS
FOLLOWING GD INTOXICATION
Authors:
LTC. Hertzog RG, MD, PhD, Perieteanu Mihaela,
PhD, LTC. Patranichi B, MD, CAPT. Popa AC,
MD, Maj. Gen. Prof. Voicu VA, MD, PhD
Institution:
Army Center for Medical Research, Bucharest,
ROMANIA
Background: Soman or GD is potent inhibitor of
AChE activity among nerve gases leading to
cholinergic symptoms, seizures and death. The aim
of our study is to investigate the effect of soman on
structural proteins expression in few cerebral areas
with known AChE activity and a possible
correlation between degree of AChE inhibition and
cytoarchitecture changes.
Material and methods: Adult Wistar rats were
divided into groups: control and GD intoxicated
with LD50. We selected only rats which presented
cholinergic symptoms (seizures). AChE activity
was assessed by histochemistry. Protein expression
was determined by tissue indirect immunofluorescence.
Results: 24 h following GD intoxication, we found
AChE activity decreased in hippocampus, cerebral
and cerebellar cortex. In the same areas we noticed
a loss of microtubule-associated protein 2 (MAP-2)
immunoreactivity and moderate glial fibrillary
acidic protein (GFAP) overexpression.
Conclusion: Inhibition of AChE activity by soman
correlates with cerebral cytoarchitecture changes,
suggesting neurodegeneration and onset of
astrogliosis.
Correspondence:
Tel: +40213178495
E.mail: raduhg@yahoo.co.uk
PP186
THE
INFLUENCE
OF
SODIUM
BICARBONATE
AND
STANDARD
ANTIDOTES ON ACID-BASE STATUS IN
RATS
ACUTELY
POISONED
WITH
MALATHION
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
Authors:
Miroslav
Marković1,
Dubravko
Bokonjić1,
1
2
Tomislav Režić , Zoran Tambur , Slavica Vučinić1
Institutions:
1. National Poison Control Centre,
2. Institute of Hygiene, The Medical Faculty of the
University of Defence, Belgrade, SERBIA
The development of effective antidotes against
organophosphates has been a persistent challenge
during
the
past
decades.
Therapy
of
organophosphate poisoning is based mainly on the
administration of atropine and oxime as standard
antidotes. During the last several years the
introduction of sodium bicarbonate made further
improvement of the standard therapy. The present
study was undertaken to evaluate the ability of
sodium bicarbonate, to increase protective indices
of standard antidotes in rats poisoned with
malathion. In order to examine protective effect of
standard antidotes and their combinations, groups
of experimental animals were poisoned with
absolutely lethal dose of malathion (1.3 LD50)
given by intragastric probe. Immediately thereafter
rats were treated with atropine 10 mg/kg im, oxime
PAM-2 10 mg/kg im, diazepam 5 mg/kg im and
sodium bicarbonate 3 mmol/kg ip. These antidotes
were administered either as single regimens or in
combinations. The influence of malathion (1 LD50)
on acid-base status parameters in arterial blood of
the rats was studied also at several time points (10
min, 6 hrs and 24 hrs) after intoxication. The
possibility of various combination of antidotal
treatment (with or without sodium bicarbonate) to
improve the metabolic changes induced by 1.3
LD50 dose of malathion was examined at end point
(24 hrs) after their administration. When sodium
bicarbonate was added to standard antidotes, further
improvement of protection (24 hrs survival) was
found. Treatment with sodium bicarbonate
successfully prevented acidose caused by malathion
only in the early stage of malathion intoxication. In
conclusion, there are no clear relationship between
metabolic effect of sodium bicarbonate and its
influence on survival rate in rats acutely poisoned
with malathion.
PP187
TOXIC
MUSHROOMS
IN
POSSIBILITY OF POISONING
TERRAIN ACTIVITIES
Authors:
Babić G, Perković-Vukčević N.
SERBIADURING
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Institutions:
National Poison Control Centre, The Medical
Faculty of the University of Defence, Belgrade,
SERBIA
Of the about 1200 of mushroom species in Serbia,
almost 50 have been identified as containing
significant toxins. Poisonous mushrooms may grow
wherever non-poisonous mushrooms grow. The
most dangerous species are Amanita phalloides,
Amanita verna, Amanita virosa, Gyromitra
esculenta, and the Galerina species. The Amanita
species are reputed to be responsible for 90% of
fatal mushroom poisonings worldwide. Today,
most reports of deadly mushroom ingestion come
from Central and Eastern Europe. Mushrooms
poisoning (mycetismus) commonly is due to
amateur mushroom picking or accidental ingestions
by unsupervised children. Even experts can mistake
Amanita phalloides, also known as the death cap,
for similar-looking nontoxic mushrooms. Amanita
phalloides contains the heat-stable polypeptides
amanitin and phaloidin, which damage cells
throughout the body. Liver, kidneys, brain and
heart are especially affected. With current therapies,
mortality from A phalloides is 20-30%.
PP188
SORCES OF EXPOSURE TO LEAD AND
POSSIBILITY OF INTOXICATION DURING
TERRAIN ACTIVITIES
Authors:
Vuković-Ercegović Gordana, Perković-Vukčević
Nataša, Potrebić Olivera
Institutions:
National Poison Control Centre, The Medical
Faculty of the University of Defence, Belgrade,
SERBIA
Lead is one of the oldest known and one of the
widespread used metals. Although the hazard of
lead exposure has been recognized since classical
times, lead intoxication remains the most common
metal poisoning encountered today. It is due to
widespread presence and use of lead in number
industries
and
consequently presence
in
environment, in addition to nonspecific and
multisystemic findings that often characterize lead
toxicity. Numerous suorces of lead exposure exist,
which can be enviromental, occupational or
recreational exposures. Enviromental sources are
lead-base paint, soil, water, air and food that can
affect entire population. A number of additional
surces of lead exposure resulting in occasional
cases of lead poisoning are retained lead bullets,
268
illicit substance abuse, lead-glazed ceramic,
ingestion of lead foreign bodies. High risk group of
occupational exposures include any that involve
welding, cutting or burning of metallic lead or lead
coated materials as shipbreaking, metal welders,
cutters, construction workers, painters(sanding,
scraping, spraying of lead paint, demolition of lead
painted sites), firing range instructors, bullet
salvagers and many other. Lead is absorbed
primarily through inhalation (adults with
occupational exposures) and ingestion (children).
Following absorption, it is extensively bound to
circulating erytrocytes and is distributed to soft
tissues and bone. The primarily route of excretion is
via urine. Lead is not an essential element and
serves no useful purpose in the body. It is complex
toxin exerting numerous pathophysiologic effects in
many organ systems. Clinical manifestations of
lead poisoning involve CNS, peripheral nerve,
hematologic, renal, gastrointestinal, rheumatologic,
endocrine findings. Severe lead intoxication with
blood lead level over 100 μg/dl is manifested with
encephalopathy, abdominal colic and severe
anemia. First step of treatment is removal from
exposure to lead, but a mainstay of therapy in
symptomatic patients is chelation therapy.
PP189
REDUCED GLUTATHIONE IN THE BRAIN
OF ALCL3-INTOXICATED AND GLUCOSE6-PHOSPHATDEHYDROGENASE
PRETREATED WISTAR RATS
Authors:
Prof. Jovanović M. MD1, Prof. Jelenković A2,
Assoc. Prof. Stevanović ID1, Prof. Petronijević N3
Institutions:
1. Military Medical Academy, Institute for Medical
Research, Belgrade, SERBIA
2. Institute for Biological Research “Siniša
Stanković”, University of Belgrade, Belgrade,
SERBIA
3. Institute of Biochemistry, School of Medicine,
University of Belgrade, Belgrade, SERBIA
Aluminium causes brain neuronal and astroglial
cells damage in rats, as well as in humans, affecting
brain regions included in memory processes, seen
in Alzheimer’s disease. One group of Wistar rats
were injected unilaterally with a single dose of
AlCl3 (3.7 x 10–4 g/kg b.w.) into the CA1 sector of
the hippocampus. The other group of animals was
intrahippocampally pretreated before AlCl3 with
glucoso–6–phosphate dehydrogenase (G6PDH).
The control group received 0.9% saline in the same
manner. Animals were decapitated 12 days after
269
each treatment. Content of reduced glutathione
(GSH) were measured in the ipsi- and contralateral
forebrain cortex, hippocampus and basal forebrain
12 days after the treatments. There were no
significant ipsi-/contralateral differences in each
structure for this examined parameter. Content of
GSH were dramatically reduced with AlCl3 in all
three structures. In the group pretreated with
G6PDH, GSH increased more than ten times,
compared to AlCl3 group, and were nearby to
control values in all the examined structures.
Depletion of GSH content in the AlCl3 group
indicate operative oxidative stress and disturbed
cell redox state in aluminium neurotoxic effects.
Increased GSH level in all three structures with
G6PDH pretreatment suggests benefit effects of
this enzyme in the aluminium neurotoxicity.
G6PDH, an enzyme of the pentosophosphate
methabolic pathway of glucose, indicate a
regeneration of reducing equivalents necessary for
GSH generation activity, as a main antioxidative
compound, as well as its potentially neuroprotective
effects.
PP190
CLINICAL EFFECTS OF KETAMINE AND
ON BIOCHEMICAL AND PATHOHISTO
LOGICAL CHANGES IN RAT LIVER AFTER
CHEMICALLY INDUCED BRAIN TRAUMA
BY PENTYLENETETRAZOLE
Authors:
Colonel Assoc. Prof. Đurđević D1, Prof. Jelenković
A2, Prof. Jovanović M, MD1, Assoc. Prof.
Stevanović I.D. 1
Institutions:
1. Military Medical Academy, Institute for Medical
Research, Belgrade, SERBIA,
2. Institute for Biological Research “Siniša
Stanković”, University of Belgrade, Belgrade,
SERBIA
A great attention is directed towards protective
effects of general anesthetics in acute epileptic
seizure and status epilepticus. Data on changes
induced by convulsions in different organs, beside
the brain, are very poor. The aim of this study was
to investigate clinical and biochemical changes
induced by convulsant pentylenetetrazole (PTZ) in
adult male Wistar rats. Potentially protective effects
of, ketamine, a general anestheteics were
monitored. Control group of animals received
normal saline. All substances were administered
intraperitoneally. PTZ was administered in a dose
of 65 mg/kg b.w. The other group received
ketamine (50 mg/kg b.w.; subansthetic dose wich
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
induces only analgesia) five minutes before PTZ.
Animals were sacrificed by decapitation 24 hours
after each treatement. In the liver tissue it was
determined content of nitrite oxide (NO), which is
involved in pathogenesis of PTZ-evoked
convulsions.
Intraperitoneally
injection
of
proconvulsive chemical PTZ induced generalized
clonic-tonic convulsions that occurred within 2-20
minutes after PTZ application, as well as death of
rats as a consequence of convulsions. Application
of ketamine before PTZ showed anticonvulsant
effects and prevented rats death. Also, it was found
significantly increase of nitrate in of rats pretreated
with ketamine in comparison to control and PTZtreated groups. These results indicate protective
clinical effects of ketamine in PTZ induced
convulsion,
including
rat
mortality,
and
involvement of NO in these effects under such
experimental condition.
PP191
PROPERTIES AND DENDRITIC CELL
DIFFERENTIATION
POTENTIAL
OF
PERITONEAL
MACROPHAGES
FROM
PATIENTS ON PERITONEAL DIALYSIS
Authors:
Assist. Prof. Saša Vasilijić, PhD1; Col. Prof. Đoko
Maksić, MD, PhD2; Assoc. Prof. Dragana Vučević,
MD, PhD1; Assist. Prof. Verica Stankovic-Popovic,
MD, PhD3; Col. Assoc. Prof. Dragan Mikić, MD,
PhD4 and Brigadier General Prof. Miodrag Čolić,
MD, PhD, MSAAS5
Institutions:
1. Institute for Medical Research, Military Medical
Academy, Belgrade, SERBIA
2. Clinic for Nephrology, Military Medical
Academy, Belgrade, SERBIA
3. Clinical Department for Renal Diseases,
Zvezdara University Medical Center, Belgrade,
SERBIA
4. Clinic for Infectious and Tropic Diseases,
Military Medical Academy, Belgrade, SERBIA
5. Medical Faculty of the Military Medical
Academy, University of Defense, Belgrade,
SERBIA
Introduction: In patients on peritoneal dialysis
(PD), peritoneal macrophages (PMF) constitute the
first-line
host
defense
against
invading
microorganisms. Furthermore, peritoneal dendritic
cells (PDC) are crucial for initiation of T cell
response to peritoneal antigens. In this study we
tested the functional properties of PMF and their
capacity to generate DC (PMF-DC) in vitro.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
Methods: Ten patients in the early period of PD
were included in the study. PDC were generated by
cultivating PMF with GM-CSF and IL-4 for 7 days.
Maturation
of
PDC
was
induced
by
lipopolysaccharide.
Results: Almost all isolated PMF were
CD14+HLA-DR+CD1a- and significant number of
PMF were CD40+CD80+CD86+. They had ability
to stimulate a considerable proliferative response of
T cells. However, their endocytic capacity was still
preserved. Over 40% PMF were able to
differentiate into PDC. Unstimulated PMF-DC
showed characteristics of immature PDC (HLADRhi CD83low CD80lo CD86lo CD54+).
However, up to 40% of PMF-DC expressed CD14
molecule. Stimulated PMF-DC became more
mature and expressed higher levels of almost all
examined markers. Maturation of PMF-DC was
followed by increasing in alostimulatory activity,
better production of proinflamatory cytokines and
down-regulation of endocytic activity.
Conclusions: Most of PMF isolated form dialysis
effluent was presented in activated stage. A
significant part of them have capacity to
differentiate into PDC which display similar
characteristics to conventional DC. Such
preparation of autologous PDC can be starting point
for development of new strategies targeted
modulation of immune responses in PD patients.
PP192
ANALYSIS
OF
TUMOR
NECROSIS
FACTOR-ALPHA AND INTERLEUKIN-10
GENE POLYMORPHISMS IN CRITICALLY
ILL PATIENTS
Authors:
PhD Bojana Cikota-Aleksić1, professor, MD Maja
Šurbatović2, MSc Nataša Strelić1, PhD, MD
Krasimirka Grujić2, colonel, professor, MD,
Predrag Romić2, colonel, professor, MD, Nikola
Filipović2, professor, MD Zvonko Magić 1
Institutions:
1. Institute of medical research, Military Medical
Academy, Belgrade, SERBIA
2. Clinic for Anesthesiology and intensive therapy,
Military Medical Academy, Belgrade, SERBIA
Background:
The
inflammatory
response
contributes significantly to the morbidity and
mortality of critically ill patients and displays high
level of interindividual variations. These variations
are determined at genetic level. AIM: This study
was aimed to assess whether polymorphisms of
270
genes coding proinflammatory cytokine tumor
necrosis factor (TNF) – α and antiinflammatory
interleukin (IL) – 10 are associated with outcome,
underlying cause of sepsis (peritonitis, pancreatitis)
or the type of infecting microorganism (Gram
positive, Gram negative and mixed - Gram positive
and Gram negative).
Patients and methods: The study included 106
critically ill patients with severe trauma and/or
sepsis who were treated in Military Medical
Academy from October 2006 until November 2008.
Genotyping of TNF-α at position 308 and IL-10 at
position 1082 was performed by PCR-RFLP
method.
Results: All patients with TNF-α308AA genotype
survived. In patients with TNF-α308AG genotype
relative risk (RR) for death was 3.250 and in
patients with TNF-α308 GG it was 1.923 (p<0.01).
The majority of patients with Gram-positive sepsis
had IL-101082 AA and AG genotypes, while
patients with Gram-negative sepsis the most often
had IL-101082 GG genotype (Pearson χ2, p<0.01).
Patients suffering from sepsis associated with
pancreatitis the most often had IL-101082 AA
genotype while patients with sepsis associated with
peritonitis the most often had IL-101082 GG
genotype (Pearson χ2, p<0.01).
Conclusion:
TNF-α308
gene
polymer
phisms/genotypes are associated with outcome of
sepsis, while IL-101082 polymorphisms/genotypes
are associated with type of infecting microorganism
and underlying cause of sepsis.
PP193
SOCIO-DEMOGRAPHIC
CHARACTERISTICS AND STATUS
TEETH
IN
THE
POPULATION
MILITARY INSURED- PILOT STUDY
OF
OF
Authors:
Milosavljević
Marko1,
Daković
Dragana2,
2
Milosavljević Adrijana , Jovanović Jovana3, Rančić
Nemanja4
Institutions:
1. Department of Military health care, Pancevo,
SERBIA
2. Military Medical Academy, Belgrade, SERBIA
3. University of Belgrade, School of Dentistry,
Belgrade, SERBIA
4. The Medical Faculty University of Kragujevac,
Kragujevac, SERBIA
271
Introduction: Oral health is an important indicator
of general health status of people. General living
habits and the habits of oral hygiene are the main
factors in the development of dental caries. One of
the best indicators of quality oral health is decayed,
missing and filled teeth index (DMFT index). The
aim of this study is to determine the state of teeth
by using the DMFT index.
Material and methods. We have done a
prospective
cross-sectional
pilot
study
(Observational study) which contained 76
examinees (56 men and 20 women), mean age
40.03±12.20. We analyzed all categories of military
insured persons between the ages of 20-64 years.
They divided into three age groups: 20-34, 35-44
and 45-64 years. The study has done in the
Department of Military health care in Pancevo and
Belgrade.
Results: The total number of examinees was the
aged from 20 to 34 years (34; 44.7%). The most
examinees used the simple sugars in the nutrition
(90.8%), alcohol (59.2%) and fizzy drinks (67.1%)
at least once a week. The most examinees did not
use mouthwashes (72.4%), interproximal brushes
(80.3%) and dental floss (69.7%). The most
examinees had bad brushing technique (69.7%).
The average values of DMFT index in all
examinees were 14.91±4.81, and there were no
statistically significant difference between age
groups (F=1.365; p=0.262). However, there were
significant differences between age groups in caries
(F=6.718; p=0.002). The highest average value of
caries was in the group of 20-34 years (7.88±3.90).
Missing teeth were statistically the most common in
the age group 35-44 (F=9.097; p=0.000)
(5.35±3.32). The most examinees (57.9%) did not
rehabilitate of prosthodontics, even they had a need.
Conclusions: Although there is a high awareness
about the influence of oral health to general health
(98.68%), the most of them have bad status of teeth
as confirmed by the DMFT index.
PP194
PERIODONTAL STATUS AND STATUS OF
ORAL HYGIENE OF THE POPULATION OF
MILITARY INSURED- PILOT STUDY
Authors:
Milosavljević
Marko1,
Daković
Dragana2,
Milosavljević Adrijana2, Jovanović Jovana3,
Rančić Nemanja4
Institutions:
1. Department of Military health care, Pancevo,
SERBIA
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012
2. Military Medical Academy, Belgrade, SERBIA
3. University of Belgrade, School of Dentistry,
Belgrade, SERBIA
4. The Medical Faculty University of Kragujevac,
Kragujevac, SERBIA
Introduction: One of the important factors in the
development of periodontal disease is a condition
of oral hygiene. The aim of this study was to
determine the state of oral hygiene and periodontal
state.
Material and methods. We have done a
prospective
cross-sectional
pilot
study
(Observational study) which contained 76
examinees (56 men and 20 women), mean age
40.03±12.20. We analyzed all categories of military
insured persons between the ages of 20-64 years.
They divided into three age groups: 20-34, 35-44
and 45-64 years. The study has done in the
Department of Military health care in Pancevo and
Belgrade. Indices used to assess: Index of soft
debris by Silness-Löe (dental plaque index-PI), oral
hygiene index (OHI) and the periodontal index
(CPITN).
Results: The total number of the examinees (34;
44.7%) was ages 20 through 34 years old. The most
examinees did not use mouthwashes (72.4%),
interproximal brushes (80.3%) and dental floss
(69.7%). More than half of examinees had bleeding
gums during tooth brushing (39; 51.3%). The most
examinees had a bad brushing technique (69.7%).
The CPITN index showed that in the one third of
cases were present periodontal pockets deep 4-5
mm, while only in the 13-23 and 33-43 teeth had
dominated dental calculus. In all examinees, mean
values of these indices were for OHI- 1.19±0.63,
while for PI- 0.90±0.36. The mean values of PI
were significantly higher in examinees who did not
use dental floss (U=413.0; p=0.026) (0.97±0.35)
and interproximal brushes (U=300.0; p=0.039)
(0.95±0.31). The value of OHI was statistically
significantly higher in examinees who were
changing the brush once a year (C2=11.00;
p=0.027) (1.70±0.28) and the lowest in those who
were changing the brush 5 or more times
(0.92±0.45). The mean values of PI (1.01±0.32)
(U=296.5; p=0.000) and OHI (1.35±0.62)
(U=297.0; p=0.001) were significantly higher in
patients with improper technique brushing their
teeth.
Conclusions: Examinees have a need for health
education about oral hygiene and factors which
influence the development of periodontitis.
17th Congress of Balkan Military Medical Committee
Belgrade, Serbia
29th May – 1st June 2012
272
PP194
EPIDEMIOLOGICAL TYPING OF STRAINS
STREPTOCOCCUS PYOGENES, ISOLATED
FROM
PATIENTS
WITH
ACUTE
PHARYNGOTONSILLITIS
Conclusion. An epidemiological link is proven
between GAS strains isolated in individual cases by
the method of epidemiological typing. The method
can be utilized not only in research, but also for the
objectives of epidemiological study.
Authors:
T. Petkova1, S. Pachkova2, A. Decheva3, K. Kanev4,
N. Bogdanov4, I. Popivanov4, D. Shalamanov1
PP194
CONSULTATIVE
AND
LIAISON
PSYCHIATRY IN COMMON HOSPITAL
Institutions:
1. Department of Epidemiology, Parasitology and
Tropical Medicine, Medical University-Pleven,
Bulgaria
2. Department "Microbiology, Virology and
Medical Genetics," MU-Pleven
3. National reference laboratory "Streptococci and
diphtheria" NCIPD-Sofia
4. MMA-Sofia
Authors:
Lt-Col. Prof. T. Dontchev, Dr. K. Stoynov Dr. G.
Vandev, Dr. Stoyanova, Dr. M. Dimitrova, Cap. Dr.
D. Dilkov, Dr. M. Kaludieva
Introduction. Numerous studies have shown that
beta-hemolytic group A streptococci (Streptococcus
pyogenes, GAS) are the etiologic agents of 15 to
30% of acute tonsillopharyngitis. The use of
epidemiological
typing
method
allows
distinguishing individual GAS strains of different
origin. This method is important in determining the
genetic relationships between microorganisms,
which in turn makes it possible to track the
epidemic chain. This is particularly important for
organized groups with close contact and prolonged
stay as teaching classes, military units and others.
Purpose. To determine the proportion of betahemolytic streptococci in the etiology of acute
tonsillopharyngitis and to perform epidemiological
typing of isolated strains of GAS.
Material and methods. During the period October
2010 - October 2011 a prospective study in the
Diagnostic and Advisory Centre in Pleven was
conducted. 726 throat swabs from patients with
acute
tonsillopharyngitis
were
examined.
Lancefield group of the isolated streptococci in
pure culture was determined using the latex
agglutination test Slidex Strepto Plus Company Bio
Merieux. M and T serotype identification and
testing for production of serum opacity factor
(SOF) were carried out in the NRL "Streptococci
and diphtheria" to NCIPD.
Results. The relative proportion of the isolated
beta-hemolytic streptococci was 9.92%, from which
GAS - 9,09%, GCS - 0,55% and GGS - 0,28%.
Performed serotyping of GAS showed circulation
of 16 M serotypes in Pleven region, dominated by
the M6, M12 and M25.
Institutions:
Department of
Academy
Psychiatry,
Military
Medical
Introduction: The Psychiatry Clinic of Military
Medical Academy founded a Department of
Consultative and Liaison Therapy in 2001 as a unit
logically necessitated by the needs of the common
hospital. Patients have changed over the years in
terms of age according to the general demographic
trends of the Bulgarian population towards aging.
Therefore, the profile of psychiatric nosology
logically alters in marked preponderance of organic
disorders. The number of psychotic patients, not
covered by other mental health services, is also
significant. It turns out that they are hospitalised in
somatic clinics without receiving adequate or any
psychiatric treatment. Very often, these patients
terminate their psychiatric treatment after leaving
the hospital.
Materials and methods: 6-months sample of
consultations in somatic departments in the
common hospital is presented. The patients are are
divided by gender, age, psychiatric syndrome
diagnoses and somatic diseases. We also described
the most prescriped groups of medications.
Results: The study demonstrated: 1) The most
common requests for consultation come from the
treating team. Usually the patient are not informed
about the nature of the consultation; 2) In most
cases there is no real request for treatment from the
patient motivated by: 3) leading findings are
organic psychiatry disorders associated with
degenerative disorders or syndromes such as
Bonhoeffer reactions.
Conclusions:
1) Increased effectiveness of modern antipsychotic
and antidepressive treatment gives the opportunity
for effective treatment of psychiatric disorders
273
outside the specific hospitals. This factor, along
with the aging of the nation makes consultative and
liaison psychiatry a basic subspecialty into
contemporary health care model.
The major problem is cost effectiveness: the
beginnig of the psychiatric treatment in the
multispecialty hospital especially with atypical
antipsychotics and SSRI’s demands a longer
hospital stay to influence the psychiatric condition
rather than the usual somatic treatment. That
means: the hospital pays for psychiatry treatment
and in a certain percet of cases when the patients
are discharged from the hospital they terminate the
treatment – money for nothing!
Balkan Military Medical Review
Vol. 15, No 3, Jul - Sep 2012