The laparoscopic approach to cholecysto-choledocholithiasis.The "rendez-vous " technique

A combined method of endoscopic sphincterotomy (ES) with common bile duct (CBD) stone extraction and laparoscopic cholecystectomy under general anesthesia for a single-session treatment of patients with colecysto-choledocholithiasis is described. The so called "rendez-vous" technique consists in: standard laparoscopic cholecystectomy with intraoperative cholangiography followed by ES if common bile duct stones are detected. The sphincterotome is driven across the papilla through a wire guide inserted by transcystic route. Nine patients were scheduled for "rendez-vous" approach. At intraoperative cholangiography 4 have had CBD stones. Endoscopic sphincterotomy and CBD clearance were successful in all patients. No complication was encountered. Mean postoperative hospital stay was 5 days. The laparo-endoscopic "rendez-vous" approach is feasible, it reduces the number of unnecessary ERCP examinations, it lowers the morbidity related with endoscopic sphincterotomy and shortens the hospital stay.     

Portal biliopathy--a lesser known complication of portal hypertension. Case report and review of the literature

Portal biliopathy is a newly introduced term, describing the changes observed in the biliary ducts of portal hypertension patients. We present here the case of a patient diagnosed with portal vein thrombosis secondary to a chronic pancreatitis; the abnormalities in the bile ducts were observed during the endoscopic retrograde cholangiopancreatography. We also review the existing information on this subject in the literature.     

Dying and Death in Some Roma Communities: Ethical Challenges

The Roma people have specific values, therefore their views and beliefs about illness, dying and death are important to be known for health care providers caring for members of this community. The aim of this qualitative study based on 48 semi-structured interviews with Roma patients and caregivers in communities in two regions of Romania was to examine their selfdescribed behaviors and practices, their experiences and perceptions of illness, dying and death. Five more important themes about the Roma people facing dying and death have been identified: (1) The perception of illness in the community as reason for shame and the isolation that results from this, as well as the tendency for Roma people to take this on in their self image; (2) The importance of the family as the major support for the ill/dying individual, including the social requirement that family gather when someone is ill/dying; (3) The belief that the patient should not be told his/her diagnosis for fear it will harm him/her and that the family should be informed of the diagnosis as the main decision maker regarding medical treatment; (4) The reluctance of the Roma to decide on stopping life prolonging treatment; (5) The view of death as ‘impure’. These results can be useful for health care providers working with members of the Roma community. By paying attention to and respecting the Roma patients’ values, spirituality, and relationship dynamics, the medical staff can provide the most suitable healthcare by respecting the patients’ wishes and expectations.     

Topical netilmicin compared with tobramycin in the treatment of external ocular infection.

In a pilot double-blind, randomized, prospective controlled study the effectiveness and safety of 0.3% netilmicin ophthalmic solution were compared with those of 0.3% tobramycin in treating external bacterial ocular infections in 45 eligible patients. The treatment with both study medications resulted in a significant (p < 0.001, Wilcoxon test) reduction in the mean cumulative score of the signs and symptoms. However, no statistically significant differences were observed between the two groups. The clinical improvement rate was almost complete with either antibiotics. There was a statistically positive trend in the netilmicin group with regard to the microbiological improvement that was achieved in (87% of the netilmicin patients) compared with 77% of the tobramycin patients (77%). Antibiotic sensitivity revealed that 84% of the organisms isolated were sensitive to netilmicin whereas only 64% of them were sensitive to tobramycin. Only minor adverse events occurred in patients treated with either netilmicin or tobramycin. In conclusion, this study demonstrates that netilmicin is a promising new antibiotic for treating external ocular infections.     

The burden of pediatric HIV/AIDS in Constanta, Romania: a cross-sectional study

Background

Plasmodium falciparum malaria, is a major health problem in forested tribal belt of central India. Rapid and accurate methods are needed for the diagnosis of P. falciparum. We performed a blinded evaluation of the recently introduced Determine? malaria pf test (Abbott, Laboratories, Japan) compared with microscopy and splenomegaly in children in epidemic prone areas of district Mandla to assess the impact of intervention measures.

Methods

Children aged 2–10 yrs with and without fever were examined for spleen enlargement by medical specialist by establishing a mobile field clinic. From these children thick blood smears were prepared from finger prick and read by a technician. Simultaneously, rapid tests were performed by a field lab attendant. The figures for specificity, sensitivity and predictive values were calculated using microscopy as gold standard.

Results

In all 349 children were examined. The sensitivity and specificity for Determine rapid diagnostic test were 91 and 80% respectively. The positive predictive values (PPV), negative predictive values (NPV) and accuracy of the test were respectively 79, 91 and 85%. On the contrary, the sensitivity and specificity of spleen in detecting malaria infection were 57 and 74 % respectively with PPV of 73%, NPV 59 % and an accuracy of 65%.

Conclusions

Determine? malaria rapid diagnostic test is easier and quicker to perform and has other advantages over microscopy in not requiring prior training of personnel or quality control. Thus, highlighting the usefulness of a rapid antigen test in assessing prevailing malaria situation in remote areas.     

Vasculitis in the very elderly

BACKGROUND: Whatever may be their clinical presentation, vasculitis syndromes (VS) have a bad prognosis in the very elderly. OBJECTIVE: The aim of this work was to study VS particularities in very old people. Most published studies on VS in elderly people concern patients older than 60 years; studies concerning very old patients are unusual. METHODS: We studied retrospectively subjects older than 75 years with a diagnosis of VS from the Departments of Geriatrics and Internal Medicine at Dijon University Hospital. These subjects were hospitalized between January 1995 and December 1999. Data were obtained from the medical files of these patients. Several aspects were considered: type of VS, associated diseases, treatment, complications, and outcome. RESULTS: Twelve patients, 5 men and 7 women aged 79-91 (mean age 82.3) years, were included. Primary VS was observed in half of the patients and secondary VS in the others. The initial clinical presentation was often polymorphous and unspecific; 8 of the patients died, 2 developed progressive severe functional impairment, 1 was stabilized under therapy, and 1 patient with VS secondary to infection recovered. Most patients either died quickly or progressively deteriorated from infections, malnutrition, or functional impairment. CONCLUSION: The health of the majority of patients (83%) deteriorated dramatically, leading to death or severe functional impairment.     

The influenza season 2016/17 in Bucharest,Romania – surveillance data and clinical characteristics of patients with influenza-like illness admitted to a tertiary infectious diseases hospital

Background

Influenza continues to drive seasonal morbidity, particularly in settings with low vaccine coverage.

Can Ultrasound Therapy Be an Environmental-Friendly Alternative to Non-Steroidal Anti-Inflammatory Drugs in Knee Osteoarthritis Treatment?

The non-steroidal anti-inflammatory drugs (NSAIDs) are the most used drugs in knee osteoarthritis (OA) treatment. Despite their efficiency in pain and inflammation alleviation, NSAIDs accumulate in the environment as chemical pollutants and have numerous genetic, morphologic, and functional negative effects on plants and animals. Ultrasound (US) therapy can improve pain, inflammation, and function in knee OA, without impact on environment, and with supplementary metabolic beneficial effects on cartilage compared to NSAIDs. These features recommend US therapy as alternative for NSAIDs use in knee OA treatment.