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 Narcis Tanase

LTC Boban Djordjevic

COL Nuri Arslan

ADVISORY BOARD M. Levhi Akin Turkey

Krum Katsarov Bulgaria

M.Ali Ozguven Turkey

Ioan Sirbu Romania

Fikret Arpaci Turkey

Stavros Kavasakalis Greece

Assen Petkov Bulgaria

C. Turgut Tufan Turkey

Zeki Bayraktar Turkey

Mustafa Kutlu Turkey

Konstantin Ramshev Bulgaria

Mustafa Turan Turkey

Evgeni Belokonski Bulgaria

Marian Macri Romania

Corneliu Romanitan Romania

M.Tahir Unal Turkey

Mirela Bidilicã Romania

Apostolos Mantides Greece

Deniz Sagdic Turkey

Krasimir Vasilev Bulgaria

Hayati Bilgic Turkey

Krasimir Mekushinov Bulgaria

Georgios Sakarikos Greece

Victor Volcu Romania

F. Sevgi Hatipoglu Turkey

Selcuk Isik Turkey

Ivan Samnaliev Bulgaria

Ersoy Isik Turkey

Okan Ozcan Turkey

Ali Sehirlioglu Turkey

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Official Journal of Balkan Military Medical Committee

Volume 14, Number 2, 2011

CONTENTS th

16 CONGRESS OF BALKAN MILITARY MEDICAL COMMITTEE BUCHAREST, ROMANIA st

th

1 - 4 JUNE 2011

Abstracts

66.

Oral Presentations (OP)

128. Poster Presentations (PP) 194. Round Tables (RT) 198. Students’ Meeting (SM)

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ORAL PRESENTATIONS OP001 EXPERIENCES OF GREEK MILITARY DOCTORS AND NURSES FROM THEIR PARTICIPATION IN THE INTERNATIONAL SECURITY ASSISTANCE FORCE - ISAF 1

Authors: LTC Maria MITSIOU, RN, MSc , COL 2

Charalampos LALOUSIS, MSc, HAR , LTC Maria 1,

NTONTOGLOU,

RN

PTE

Konstantinos

1

CHATZIMICHAEL, Econ., PhD Institution: 1. Dept. of Human Resources Management, Ministry of National Defense, 2. Crisis Management Center, Hellenic National Defense General Staff, GREECE Purpose: To investigate Greek Military Doctors’ and Nurses’ experiences during and after their participation at ISAF. Material and Methods: A descriptive and correlational analysis was carried out using a case country approach. The quantitative results were based on primary data selected via a formal selfreport questionnaire. The sample consisted from all the 115 Officer Doctors and Nurses (MC, HN, HAF), participated at ISAF during 2006-2010. 34 questionnaires were returned (RR= 29.6%) Several hypotheses concerning both the distributional form and the correlation of the variables were examined

respondents was quite good (mean=3.8 in a 6-point Likert scale). The majority of the participants (74%) were ordered to participate in the mission. The marital status, age, length of stay and reason for participation at ISAF are strongly correlated with the participants’ emotions. Officers being married and ordered to participate at the mission expressed more negative feelings. In addition to this, increase in the length of stay, worsens emotional problems. On the other hand, age was found to be positively associated with good feelings whereas older officers were found to best address their feelings concerning the mission. Medical and Nursing Officers had good relationships with the other Greek Officers and extremely good with foreign Officers respectively. However they would never suggest anybody to participate in a similar mission because of the risk. The vast majority of the participants concluded that their participation at ISAF has helped them to ameliorate themselves as personalities and to value the small pleasures of the daily routine. Conclusion: Comprehensive, detailed and timely information about any upcoming mission, improves the participants’ level of adjustment as far as the environment and the mission requirements. Careful selection of the participants to any kind of mission abroad and provision of psychological preparation and support are strongly recommended. Correspondence: LTC Maria MITSIOU, RN, MSc +30 210-6598220

2

using a set of various tests (X test, Mann-Whitney U-test and Spearman’s test). The null hypothesis was rejected in all cases at p50,000cells/mm) with>90%

2

Authors: CPT BABAYIGIT Mustafa Alparslan, 1

1

MD , MAJ KARAKAS Ahmet, MD , MAJ 1

3

polymorphonuclear

neutrophils

(n=2), 3

inflammatory (3,000 to 50,000cells/mm) with>50% polymorphs(n=28), and non3

inflammatory(>3,000 cells/mm)(n=10) with a predominance of lymphocytes or monocytes. In active RA, reactive arthritis, psoriatic arthritis, and acute crystal-induced arthritis a preponderance of polymorphonuclear neutrophils was noted, although early RA fluids may have primarily monocytes. Monocytes and lymphocytes predominated in viral arthritis, lupus, and sarcoidosis. Interestingly, in a patient with sarcoidosis epitheloid and giants cells were observed. More than 10% cytophagocytic monocytes were characteristic of the spondyloarthritides. Monosodium urate crystals were diagnostic of gout. Many were intracellular, having been phagocytosed by leukocytes.Crystals of calcium pyrophosphate (CPPD) were consistent with pseudogout but also with non-inflammatory arthropathy and coincidental chondrocalcinosis.In a patient with monoarthritis, metastatic lung carcinoma cells were observed before the clinical diagnosis was made. Conclusions: Synovial fluid microscopy allows the rapid diagnosis of septic arthritis, distinguishes

2

Institutions: 1

Turkish Armed Forces Health Command, Dept. of Preventive Health Services, Ankara, TURKEY UN Interim Force in Lebanon, Engineering Construction Unit, Es LEBANON

Turkish Saatiye,

Objective: We aimed to determine the frequency of symptoms, diseases, medications, and results of medical examinations during a peacekeeping operation. Material and method: To determine disease type, 999 medical records from January 2007 to September 2010 were examined using a systematic sampling method between October 1–10, 2010 in the infirmary of Turkish Engineering Construction Unit, Lebanon. In this cross-sectional study, the International Classification of Disease (ICD-10) and SPSS were used to analyze the data. Results: The mean age of the staff was 28.1±8.8 years; 59.2% were in the 20–29 year age group. All were male, and 55.8% had the rank of private. The most frequent symptoms were sore throat (12.9%), toothache (11.4%), and ankle/wrist sprain (11.2%). According to disease records (n=869), the most common illnesses were related to the respiratory (26.9%), digestive (18.8%), and musculoskeletal systems (14.1%). The most frequent illnesses were acute upper respiratory tract infections, myalgia/low back pain, sprain/strain of

16th Congress of Balkan Military Medical Committee Bucharest, Romania 1st – 4th June 2011

joints/ligaments, and dental caries (23.1%, 13.5%, 11.6%, and 9.9%, respectively). Statistically significant differences were found in distributions of the diseases by age, rank, and season (p 0.05). Conclusion: Drug dose calculation skills of intern nursing students were found as inadequate. It wasn’t determined a relationship between drug dose calculation skills and academic achievement. It is suggested that internship education programs were arranged according this subject to improve drug dose calculation skills. Correspondence: Tulay BASAK Gulhane Askeri Tip Akademisi Hemsirelik Yuksek Okulu, Etlik 06018, Ankara, TURKEY e-mail: [email protected] Tel:+905323043943 GSM: +905322284622 Fax: 0 312 304 3900

PP005 TOXICOLOGICAL THREAT – MILITARY MEDICAL ACADEMY READINESS FOR MANAGEMENT Authors: Authors: BELOKONSKY Evgueni, KANEV Kamen; KOSTADINOV Rostislav Institutions: Chair Disaster Medicine and Toxicology, Military Medical Academy, Sofia, BULGARIA The recent chemical disaster in Hungary once again highlighted the imminent threat chemical installations are posing to the population in contemporary world. Aim: The aim of the article is to present the forced by imminent toxicological health threat, activities performed in MMA in order to prepare the military medics to confront chemical disaster. Material and Methods: In order to achieve the set goal thoroughly were analyzed activities performed in MMA. By means of descriptive analysis the established structures for toxicological aid

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provision are presented. Comparative, deductive and heuristic analyses were applied to describe the expected outcome of established toxicological units in MMA, in case of MASCAL event due to acute or chronic intoxications. Results: The industrialization has led to various processes with significant impact on population security. The observed increase in chemical installations number, urbanization and population density in industrial hubs is factor with direct impact on chemical health threat level for population nowadays. Since World War I end, Bulgarian Armed Force medical Service has started to prepare units for toxicological help in case of chemical (CWA) attack or major chemical incident. The result of this more than half century process of structures development is the present organization of toxicological help, part of the established Chair Disaster Medicine and toxicology. Conclusion: The observed trends for increase level of chemical risk to population has led to establishment of structures in MMA dedicated to urgent, adequate and prompt toxicological help provision for military personnel as well as for civilians in Republic of Bulgaria.

PP006 HEALTH MANAGEMENT PERFORMANCE: MEASURES AND INDICATORS 1

Authors: COL CANKUL H.İbrahim, PhD ; COL 1

TEKE Abdulkadir, PhD ; DEMİR Cesim, PhD

1

Institutions: 1

Gulhane Military Medical Academy, Dept. of Health Services Management, Ankara, TURKEY Objective: The aim of this article is to suggest such a way by offering a model of health performance indicators for the specific purpose of facilitating an informed choice between alternatives. The outcome of this study is an analysis of a wide range of health management performance measures within a skeletal framework which offers a theoretical explanation for what is -or what could be disclosed. Material and method: Performance measures generate criticism from those who claim that they may be used by powerful minorities to marginalize some interests and to construct false realities.

16th Congress of Balkan Military Medical Committee Bucharest, Romania 1st – 4th June 2011

Results: It should be made clear that measures are an indication of a situation which may call for further enquiry. Indicators do not provide answers, they inspire questions, and this should be made clear. Conclusion: There is even the suggestion that disclosing performance measures is dangerous because they may be used to define the content and goals for an organization in ways which are not seen as relevant from the point of view of those who are involved.. Keywords: Health management, Performance measurement, Measurement Indicators. 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: [email protected]

PP007 TURKISH SWORD IMAGE: A RARE CONGENITAL ANOMALY IN AN ADULT PATIENT 1

Authors: CPT CELIK Murat, MD ; LTC CELIK 2

2

Turgay, MD ; CAPT IYISOY Atila, MD ; CPT 3

AYTEN Omer, MD Institutions: 1

Van Army District Hospital, Department of Cardiology,Van 2

Gulhane Military Medical Academy, Department of Cardiology, Ankara 3

Van Army District Hospital, Department of Pulmonary Diseases and Tuberculosis, Van, TURKEY Objective: Total or partial anomalous pulmonary venous drainage of the right lung to the inferior vena cava (IVC), anomalous systemic arterial supply to the right lung and varying degrees of hypoplasia of the right lung with or without pulmonary sequestration is known as “Scimitar syndrome”. In this syndrome, descending anomalous pulmonary vein is visible as a curviliniear shadow along the right side of the heart on the posteroanterior chest x-ray, and resembles a Turkish sword or scimitar. Although, this syndrome is usually in association with congenital heart

131

defects, anomalous course of IVC such as azygous continuation of IVC is rarely associated with this syndrome. Case report: A 21-year old male patient without an evidence of previous cardiac disease and/or pulmonary disease was admitted to our hospital because of his exertional dyspnea. Physical examination revealed that the heart sounds were heard from the right anterior side of the chest without any murmur. Also, respiratory system examination revealed decreased intensity of breath sounds on the right side. The electrocardiographical findings were suggestive of dextrocardia with R/S > 1 in lead V1. Two-dimensional transthoracic echocardiography showed dextrocardia and mildly left ventricular enlargement (left ventricular enddiastolic diameter 58 mm) with ejection fraction of 50%. The pulmonary arterial pressures were normal Atrial and ventricular septum was intact, and there was no other abnormal echocardiographical findings related to any congenital heart diseases. The posteroanterior view of chest X-ray showed dextrocardia, small right hemithorax and a scimitar sign as a curvilnear density along the right side of the heart. For the further evaluation, a computed tomography (CT) scan of the thorax and abdomen was performed. The CT scan revealed dextrocardia, decreased right lung volume and an anomalous pulmonary venous drainage of the right upper pulmonary vein into the IVC just below the diaphragma (Figure 1). The CT scan also showed an arterial supply from the abdominal aorta, near the celiac trunk, through the right lung. In light of these findings, the patient was diagnosed as “Scimitar syndrome”. Interestingly, the diameter of the azygous vein was found enlarged, and an azygous continuation of IVC was diagnosed during CT s can. Discussion: The “Scimitar syndrome” is rare and can be accidentally discovered in adulthood when the patient is asymptomatic. The diagnosis is wellestablished by the development of non-invasive imaging techniques such as CT. Also, the azygous continuation of IVC was found at CT scan. The coincidental occurrence of these two unusual vascular malformations in the same patient has been rarely described. Physicians should be aware of this syndrome in cases of left-to-right shunt without evidence of obvious cardiac structural defects. Thus, unnecessary invasive imaging procedures and/or surgical treatment may be prevent. Keywords: scimitar syndrome, azygous continuation of inferior caval vein, non-invasive imaging technique.

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Correspondence: CPT CELIK Murat, MD Department of Cardiology, Van Army District Hospital, 65040, Van-Turkey Tel: +90-432 2220224 Fax: +90-432 2220245 E-mail: [email protected]

PP008 DETERMINATION OF STANDARD VALUES BELONGING TO HEALTH SERVICES INDICATORS OF MILITARY HOSPITALS UNDER TURKISH ARMED FORCES Authors:COL ERDOĞAN Endercan, PhD , ISIK Alev, MS Institutions: Command of Health Services, Ankara, TURKEY

Balkan Military Medical Review Vol. 14, No 2, April 2011

Conclusion: We think that statistical data should be widely used in strategic management of health institution and future plans by decision makers. Key Words : Standards, Healthcare Indicators Correspondence: COL ERDOGAN Endercan Command of Health Services, Ankara, TURKEY. Tel: + 90 312 2431190/4005 GSM: +90 532 3432909 e-mail: [email protected]

PP009 ANESTHETIC MANAGEMENT IN PATIENT WITH PFEIFFER SYNDROME

A

Authors: CPT ERTEN Ela MD, CPT EKSERT Sami MD, COL ORHAN M. Emin MD, COL KURT Ercan MD

Objective: Healthcare data of military hospitals which are connected to the Turkish Armed Forces Command of Health Services is recorded at regular intervals. The data collected from military hospitals is not only a concrete indicator of the organisational performance in the past but also is a source for decision makers in healthcare management. Healthcare indicators should be compared to the quantitative standard value in order to detect which level healthcare indicator is. In our study we try to determine standard value of healthcare indicators for military hospitals.

Institutions: Gülhane Military Medical Academy, Dept. of Anesthesiology, ANKARA, TURKEY

Material and method: For this purpose 21 important indicators such as the number of outpatient, inpatient, surgery, emergency patient, laboratory testing and patient referral are included in our data base. Descriptive statistics for the health indicators are examined for the years between 2005-2010 and the average values of health indicators are adopted as standard values. Standard values are firstly calculated on the basis of military hospitals, then, these numbers of hospitals belong to the Regional Command of Health Services are used to create standard values for Regional Command of Health Services and finally, Command of Health Services standard value was determined by considering all military hospitals.

Case report: A male infant (12months) was scheduled for the surgery. Physical examination revealed clover skull and craniosynostosis, severe axophthalmia, narrow oral structure, maxillary hypoplasia and low ear anomaly.All preparations for diffucult airway mangement were completed before the surgery. The aneshesia was induced with sevoflurane via a face mask. With the succesful ventilation, fentanyl and atracurium were given for endotracheal intubation. Direct laryngoscopy revealed a stenosis at subglottic region, and Cormack-lehane score was considered 2 and intubated with cuffed ETT(no3). A subclavian venous catheter, radial arter cannula, bladder catheter, an esophageal temperature probe were placed. Intraoperative bleeding and fluid therapy was managed with ABG analyses, CVP,urine output and vital signs.The surgery lasted 11 hours and the patient was transferred to PACU as intubated. ETT was removed after adequate respiration.Severe hydrocephalus was diagnosed after control cranial CT, and the patient was taken into urgent ventriculoperitoneal shunt operation.

Results: In the light of the standards which are obtained from different management levels, it is possible to evaluate the development trend of the activities of the health services as a numerical. In this way significant rise level or fall level can be detected among the military hospital indicators.

Indroductıon: Pfeiffer Syndrome (PS) is an autosomal dominant condition comprising bilateral coronal craniosynostosis, midface hypoplasia, broad and medially deviated thumbs, great toes and tracheal anomalies. These patients are candidates of difficult intubation. We report our anesthetic management in a patient with PS type II underwent frontal craniectomy.

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After the operation the paitent was extubated and follewed in the PACU four hours before sent to his clinic. Dıscussıon: The patients with PS require careful monitoring and prompt mangement for diffucult airway mangement with multiple airway interventions, massive blood loss and sudden hydrocephalus. We think that all prepatations should be completed before the surgery for a safe anesthetic plan. Correspondence: Ela ERTEN Gulhane Askeri Tıp Akademisi, Anestezi ve Reanimasyon AD, ETLİK 06018, ANKARA, TURKEY. Tel: +90 312 304 5934 Fax: +90 312 304 5900 GSM: +90 533 812 0365 E-mail: [email protected]

PP010 INVESTIGATION OF NASAL CARRIAGE RATES AND ANTIMICROBIAL SUSCEPTIBILITY OF STAPHYLOCOCCUS AUREUS IN HOSPITAL STAFF 1

Author(s):

CPT

GULGUN

Mustafa,

MD ,

performed in Muller-Hinton agar plates according to the quidelines of the Clinical and Laboratory Standard Institute (CLSI, 2005). Results: There were 17 (13.2%) doctors, 32 (24.6%) nurses, 12 (9.2%) supportive personnel, 1 (0.8%) pharmacist, 29 (22.3%) civilian personel, 34 (26.4%) soldier, 5 (3.8%) noncommissioned officer in the study group. Metisilin-resistant S. aureus carriage rate was 5.6%. No antibacterial resistance was found against clindamycin, vancomycin, gentamycin and mupirocin. Resistance rates against erythromycin, trimethoprim-sulphamethoxazol, fusidic acid, rifampycin and tetracycline was; 22.2%, 11.1%, 8.3%, 5.6%, 16.7%, respectively. Conclusion: Even in our study MRSA nasal colonization was not found we know it is significant to investigate MRSA carriage rates hospitals and community. Correspondence: Mustafa GULGUN Gulhane Military Medical Academy, Department of Pediatrics, Ankara, TURKEY Tel: +90 312 3044393Fax: +90 312 3044381GSM: +90 539 9645480 e-mail: [email protected]

2

OGUZKAYA-ARTAN Müge, Bio , BAYKAN 2

3

PP011 CONTEMPORARY TRENDS TOXICOLOGICAL THREAT

Zeynep, MD , LTC TOK Duran, MD Institutions:

IN

1

Gulhane Military Medical Academy, Department of Pediatrics, Ankara 2

Erciyes University, Halil Bayraktar Collage, Kayseri

Author(s): KATZAROV Krum, KOSTADINOV Rostislav; KANEV Kamen

of

Institutions: Chair Disaster Medicine and Toxicology, Military Medical Academy, Sofia, BULGARIA

Objective: The purpose of this study was to determine the prevalence of S. aureus and MRSA nasal carriage in Kayseri Military Hospital staff and also evaluate the antibiotic susceptibility patterns of the isolates.

The chemical disaster in Hungary is the most recent example for the existing chemical threat in contemporary world. The prerequisite for relevant population chemical protection is the proper identification of chemical hazards’ sources and risk level assessment.

3

Kayseri Military Hospital, Department Infection Disease, Kayseri, TURKEY

Material and method: This study is a croossectional study carried on Kayseri Military 100bedded hospital. The study was conducted on 136 staff. Specimens for culture were obtained with a cotton swab, circulated through both nostrils. The identification of S. aureus was confirmed by gram stain, catalase tests and tube coagulase test. Susceptibilities of all isolates of S. aureus against antibiotics with standardized disc-diffusion test was

Aim: The aim of the article is to present the observed in recent years trends in chemical health risk level for military men and civilian population. Material and Methods: In order to achieve the set goal thoroughly were analyzed activities performed by Medical Intelligence in MMA in order to identify chemical hazardous sites, to assess their

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vulnerability and severity of the possible consequences for the servicemen and civilians. Descriptive, comparative and heuristic analyses were applied for description of obtained results. Results: From performed analyses the industrialization is noted to be the leading factor for observed changing in the chemical threat trend. The increase of possible mass toxicology casualties’ event indisputably is related to the increase in chemical facilities number, the greater transfer of chemical substances and number employees in the chemicals production. On the other hand more widely implementation of chemicals in daily life is other source for toxicology patients. Terrorists, according some recent publication nowadays are more eager than ever to produce and use chemicals for their goals fulfilling. The criteria created for hazard identification, vulnerability, severity and risk levels assessment are presented. Conclusion: Based on obtained results authors conclude that trend for increase in level of chemical risk to population is present in contemporary world. From the analyses has to be noted that every single chemical installation has to be identified as toxicological hazard for the population.

PP012 ETIOLOGICAL DIAGNOSTICS OF ATYPICAL PNEUMONIAS IN THE BULGARIAN MILITARY MEDICAL ACADEMY CONTINGENT DURING 2009-10 Authors: ALEXANDROVA D. MD, PhD, TUNEVA L. MD, DARLEVA S, Major KUNCHEV M. MD, PhD, Assoc.prof. MEKOUCHINOV K., MD,PhD Institutions: Laboratory of Virology, Military Academy, Sofia, BULGARIA

Medical

Objective: To determine the viral etiologic agents causing atypical pneumonia in patients, contingent of Military Medical Academy. Methods: During 2 years we investigated 1970 persons with pneumonia: 1010 (2009) and 960 (2010). We used ELISA and IFA. Results: Generally 429 patients with pneumonia (220 – 2009 and 209 – 2010), are positive for the following viruses: Chlamydia pneumoniae- 33,5%,

Mycoplazma pneumoniae-31%, Adeno virus-17% Influenza virus-10,5%, Q-fever-8%. Conclusion: According to our investigations Chlamydia pneumoniae is the most important viral agent in the structure of atypical pneumonia during the epidemic period and all year, following by Mycoplazma pneumoniae and Adeno virus. Chlamydia pneumoniae and Mycoplazma pneumoniae are described as main agents causing “Community-acquired pneumonia“ spread during all seasons, among yang people, living in close military communities. The main role of Adeno virus in etiologic structure in our previous investigations decreases, probably connected with professional transformation of Bulgarian army and disappearing importance of Adeno virus as agent causing “Recruit disease”. Correspondence: Laboratory of Virology, Military medical Academy, No 3, Georgy Sofiisky Str.,1606, Sofia, Bulgaria Tel: (+359 2) 922 5441 Fax: (+359 2) 952 65 36 Mobile: 0889 50 88 38, Email: [email protected]

PP013 ARGON PLASMA COAGULATION IN THE MANAGEMENT OF GASTROINTESTINAL BLEEDING Authors: JINGA Mariana, CHERANA Gabriela, POPESCU Andrada, IONIȚĂ-RADU Florentina, COJOCARU Mihai, SIMA Irina Ioana, BUCURICA Sandica, CHECHERITA AlexandruIonel. Institutions: Central Universitary Emergency Military Hospital, Dr. Carol Davila, Bucharest, ROMANIA Aberrant blood vessels are frequently found in the gastrointestinal tract. Angiodysplasias, gastric antral vascular ectasias (GAVE or watermelon stomach), radiation-induced vascular ectasias and Dieulafoy's lesions are considered acquired and sporadic lesions and they can induce gastrointestinal bleeding. The most common vascular anomalies encountered in the gastrointestinal tract are angiodysplasias: the prevalence is higher in older populations and in patients with end-stage renal disease and possibly aortic stenosis.

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We are reporting three cases of upper gastrointestinal bleeding caused of angiodysplasias (two patients) and GAVE (one patient). All of them were referred from other hospitals. Angiodysplasias were diagnosed by upper digestive endoscopy, being done to investigate gastrointestinal bleeding. All three patients were old male with severe comorbidities: two with end stage renal failure (one was a dialysis patient) and one with cirrhosis. All three cases were successfully treated endoscopically with argon plasma coagulation (APC). APC is a noncontact, monopolar, electrocoagulation technique that works by applying high frequency current to the tissues through ionized argon. All three patients needed several sessions of APC. Endoscopic therapy was followed by treatment with iron substitution, proton pump inhibitors and sucralfate. All three patients had a favorable clinical evolution, with the rise in hemoglobin levels. APC is a safe and effective technique for the treatment of gastrointestinal angiodysplasias and GAVE. Key words: argon plasma coagulation (APC), gastrointestinal bleeding, angiodysplasias, gastric antral vascular ectasias (GAVE) Correspondence: Mariana Jinga [email protected] Tel: 0040722232530

PP014 A RARER CASE OF DIGESTIVE HEMORRHAGE IN AN ELDERLY PATIENT; DIAGNOSIS AND TREATMENT DIFFICULTIES 1

painful joints, diarrhea, rectal tenesmus and subtle skin rash. He has a history of peripheral artery disease and was taking clopidogrel. Clinically – the patient has moderate abdominal distension. Few days after admission he presented melena stools, peripheral edema and elements of palpable purpura involving the lower extremities. Endoscopy revealed petechiae, ecchymosis, erosions and ulcerations in the terminal ileum and in the proximal jejunum. Immunology tests were negative. Urinalysis showed microscopic hematuria with nephrotic range proteinuria. It was established the diagnosis of Henoch-Schonlein purpura and it was initiated parenteral corticosteroid therapy which led to a rapid improvement of the gastrointestinal symptoms. Because not improve of proteinuria, intravenous cyclophosphamide therapy was introduced. After first pulse of cyclophosphamide the patient presented intestinal perforation. Affected segment of the small bowel had intestinal infarction with a small solution of continuity (1 cm diameter) and it was rezected. Recovery was difficult, with evisceration and a new surgical intervention. After six month, following treatment with corticosteroids and pulses of cyclophosphamide, the patient had a good clinical condition, and improvement of renal disease. We concluded that the patient was a rare and severe case of Henoch-Schönlein purpura in an elderly patient. Key words: digestive proteinuria, intestinal Schönlein purpura

hemorrhage, infraction,

,nephritic Henoch-

Correspondence: Maria Jinga [email protected] Tel: 004072232530

1

Author(s): JINGA Mariana, DRAGAN Cristian, 1

1

1

CIOBICA Lucian,

VASILESCU Florina, 2

PP015 EVALUATION OF MEDICS’ FIRST AID SKILLS AND PRACTICES

MIRCESCU

Authors: CPT OZTURK Gultekin, MD , CPT

1

1

COSTACHE Raluca Simona, JURCUT Ciprian, 1

CHERANA Gabriela,

POPESCU Andrada, 2

STANCU Gabriel

Simona

Hildegard,

Institutions: 1

Central Universitary Emergency Military Hospital, Dr. Carol Davila 2 Internal Medicine and Nephrology Clinic, Carol Davila Hospital, University of Medicine and Pharmacy, Bucharest, ROMANIA We are presented a 65 years old man complaining for diffuse abdominal pain, nausea, vomiting,

1 2

YILDIRAN Nuri, MD, PhD , COL OZER Mustafa, 1

1

MD, PhD , LTC CETIN Mehmet, MD, PhD Institutions: 1

Gulhane Military Medical Academy, Dept. of Military Health Services 2

Turkish Armed Forces Medical Command, Ankara, TURKEY

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Objective: The purpose of this research is to determine first aid skills and practices of medics that were educated in different schools and serve in different military medical units. We also aimed to present the medics’ first aid competency perceptions in military operations. Materials and methods: The questionnaire developed by researchers is used to determine the medics’ training from their recruitment to the end of their serving. And some quesitons asked to establish first aid skills and practices that they used in daily life and medical situations during military serving. The questionnaire is applied to totally 72 medic that 80.6% of them (n=58) had medical training in their recruitment at field medical school and only 21% of them (n=15) were educated in a medical school in their civilian life. Results: After analysis the training about first aid skills is found efficient but after all a great number of medic did not perform first aid in a real situation (84.7%, n=61) and with this handicap they feel they are inefficient about performing these skills at field or operational status. Conclusion: A medic serving in any Unit is the first step of a wounded soldier’s survival and he must train just like in an operational situation and this must be repeated to decimate the casualty. 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: [email protected]

PP016 DETERMINATION OF THE GENETIC PREDISPOSITION IN DIABETES MELLITUS TYPE 2 1

2

Besides of proving the genetic predisposing of diabetes mellitus, the genes determination is important for the right choice of the therapeutic strategies for patients with diabetes mellitus type 2. CAPN10 ( the gene for calpain10) encodes the intracellular calcium-depended cistein protease, which is fully expressed. Basically connected haplotype with type 2 DM is SNP43 (single nucleotide polymorphism)-a mutation of intron 3 of CAPN10, as which is a change in the 43 position of A with G. There two amino acids polymorphisms with a high risk of the development of diabetes mellitus type 2 – Thr504Ala и Phe200Thr. The physiologic studies describe that the variations of the activity of calpain 10 change the insulin secretion and modified the intracellular insulin response and they are an independent predisposing for the raising of diabetes mellitus type 2. From the observed 60 patients with diabetes mellitus type 2 we concluded that the frequency of influence and genotype review of gene for calpain 10 is: 35% are homozygote of dominant allele, 45% are heterozygote and 20% are homozygote of recessive allele. The conclusion from these results is that the predominant part is the heterozygote patients with diabetes mellitus type 2. Correspondence: Military Medical Academy Bulgaria, Sofia 1606 3, Georgi Sofiiski Blvd. Fax: +35929225586 Phone: +35929226333 E-mail: [email protected]

PP017 TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) - A STATE OF THE ART METHOD WHICH SAVED A LIFE 1

2

Author(s): Mihai COJOCARU , Eliyahu ATAR , 1

1

Florentina RADU IONITA , Cristina SANDU , 3

Ionela DAMIAN

Authors: S.PASHKUNOVA , V. IVANOV , А. 3

SAVOV Institutions: 1

Clinic of endocrinology, 2

Department of Endocrinology and pulmonary diseases, 3

Genetic laboratory BULGARIA

for

DNA

analyses,

Institutions: 1. Department of Internal medicineGastroenterology, Central Military Hospital Bucharest, ROMANIA 2. Vascular and Interventional Radiology units Rabin Medical Center, Petach Tikva, ISRAEL 3. Department of Gastroenterology, County Emergency Hospital, Craiova, ROMANIA

16th Congress of Balkan Military Medical Committee Bucharest, Romania 1st – 4th June 2011

A 52-year-old patient with virus C liver cirrhosis was urgently admitted to the Central Military Hospital in Bucharest with life threatening massive upper GI bleeding from esophageal varices. After the initial endoscopic haemostasis by putting 9 rubber rings on the bleeding varices, the necessity of a TIPS was taken into account because the patient had high portal hypertension and this bleeding episode was the third within the last 8 months. The MRI revealed patent portal vein and large varices originating from the proximal splenic vein and multiple gallbladder stones and one stone located in the cystic duct. Based on the MRI images one can observe that an optimum access to make the shunt between the median hepatic vein and the portal vein is to aim the puncture needle in the space between the clustering calculi in the gall bladder and the stone in the cystic duct. Respecting this tip under fluoroscopy control aiming the needle tip between the radiopaque stones the TIPS was successfully created and the stent was perfectly positioned, followed by embolization of the large esophageal varices.

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Case Report: We report a case of facial diplegia – a mild Guillain – Barre Syndrome variant. Case Description: A 42-year-old patient presented with a clinical depressive onset. One day later, the patient developed a facial diplegia that regressed after a proper treatment according with a proper diagnosis. Conclusion: There are pathological situations in which these two conditions can occur as comorbidities. Correspondence: Col. E. Lungut, MD PhD, Phone: 0785202552 Col. I. Furdu, MD, Phone: 0785202551 email: [email protected]

PP019 USE OF NEUTROPHILS CD64 IN DIAGNOSIS OF INFECTION AND SEPSIS 1

Conclusion: sometimes a tip can do (or become) a TIPS which do save the life.

1

Author(s): Lt.Col. J. PEJOVIC , T. ANDJELIC , 1

1

V. SUBOTA , T. DJURASINOVIC

and M.

2

SURBATOVIC PP018 FACIAL DIPLEGIA AND DEPRESSIVE DISORDER – DIAGNOSIS INVOLVEMENTS FOCUS ON THE DIFFERENTIAL DIAGNOSIS

Institutions:

Authors: Authors: Col. E. LUNGUT, MD PhD*, Col. I. FURDU, MD**, C. CALCIU, MD***

Background: Infection is still a common health problem in hospitals, especially in intensive care unit (ICU). CD64 is a high affinity Fc-gamma receptor expressed by activated neutrophils. It is sensitive and specific laboratory indicator of infection and sepsis. The aim of the study is to verify this statement.

Institutions: *Central Military Hospital ‘Carol Davila’, Neurology Department; ** Clinical Cardiovascular Diseases Centre of the Army, Chef of Imagistic Department; *** Central Military Hospital ‘Carol Davila’, Neurology Department – resident doctor Central Military Hospital Bucharest, ROMANIA Key words: facial diplegia, depressive disorder, comorbidity, differential diagnosis Facial diplegia is an extremely rare clinical entity and occurs in 0.3 – 2 % of facial paralysis patients. The annual incidence is approximately 1 per 5 million. (Fellman, 1990) Depressed people are more likely to exhibit a negative bias and misjudge neutral facial cues. Perception errors can trigger negative feelings and depression.

1

Institute of Medical Biochemistry, 2

Department of Intensive Care Medicine, Military Medical Academy, Belgrade, SERBIA

Method: Peripheral blood samples were taken from 75 ICU patients, who were divided into three groups (Gr.1, Gr 2 and Gr 3). Gr 1: 34 patients with no signs of systemic inflammatory response syndrome (SIRS negative). Gr. 2: 22 SIRS positive patients. Gr. 3: 19 patients with clinical diagnosis of sepsis. Neutrophil CD64 was measured with Leuko64kit, on hematology analyzer CELL-DYN Sapphire using the flow cytometry method, and compared to interleukin 6, WBC count, neutrophils, left shift and immature granulocytes. Interleukin 6 was tested on Siemens Immulite 2000 and hematology parameters were determined on Siemens ADVIA 120.

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Results: There is a significant statistical difference among CD64 values from these three groups, with the lowest CD64 mean level in Gr.1 and the highest in Gr.3. CD64 and IL6 showed correlation in Gr. 3 ( r= 0.49, p 1 glass of beer, wine or ouzo/day) were 30 out of the 50 hypertensive patients (60%). On the other hand,

Authors: 2ndLT Maria-Angeliki GKINI, MD, F. MANTOPOULOU, MD, T. FATSEA MD, MAJ K. CHRISTODOULOPOULOS, MD, MAJ A. PRANTSIDIS,MD, COL M. PAPACONSTANTIS, MD Institution: Dermatology Dept., 401 General Army Hospital, Athens, GREECE Purpose: Impetigo is a common bacterial skin infection among children caused primarily by staphylococcus aureus and streptococcus pyogenes. It is usually treated with topical or systemic antibiotics. Purpose of this study is to present an interesting case of impetigo in an adult caused by an unusual pathogen, with underlying atopic dermatitis, resistant to conventional therapy. Material and Methods: A 23-year-old male, with no history of atopy, presented with red, pruritic and oozing erosions capped with golden, honey-like crusts. The lesions involved the right side of the face. He commenced on clarythromycin per os and then changed to fusidic acid due to poor response to medication after a week. Results: Despite that, lesions extended to the right hand and elbow. The culture of pus revealed infection from serratia sp. The patient commenced on ciprofloxacin per os, according to antibiogram, but lesions quickly progressed to involve whole

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Correspondence: 2ndLT Maria-Angeliki GKINI, MD Tel : +30 6939195772, +30 2108040152, [email protected]

Results: Mean age of the privates was 21.7±2.4 years, 67.3% were ≤21 year age group. The most common diseases were related with the respiratory system (30.1%), musculoskeletal system and connective tissue (16.4%), and the skin and subcutaneous tissue (12.9%) according to the ICD10. The most frequent ilnesses observed were acute upper respiratory tract infections, myalgia/low back pain, and dermatophytosis (22.4%, 10.8%, 6.1% respectively). Distribution of the diseases by age had no significant differance, however seasonal distribution had statistically significant differances (p