Personalized nuclear imaging protocol in cases with nodular goiter and parathyroid adenoma.

A 62 years old woman was diagnosed with multinodular toxic goiter and primary hyperparathyroidism/left parathyroid adenoma by hormonal assessment, ultrasound and nuclear thyroid/parathyroid scans. Cervical ultrasound illustrated a multinodular aspect of the thyroid with solid nodules and cystic-component nodules; the larger one represented a multinodular complex with necrosis areas in the left thyroid lobe, ACR TI-RADS score 4 (moderately suspicious). Functional nuclear imaging was performed for accurate differential diagnosis between thyroid vs. parathyroid localization, between cold vs. hot nodules, and eventually, for guiding the choice of a subsequent Fine-Needle Aspiration Biopsy (FNAB). Scans described an early intense 99mTc-sestaMIBI uptake with no 99mTc-pertechnetate uptake in the left thyroid lobe larger nodule. Due to the suspicion of malignancy for this nodule, we performed an additional scan (1 hour before the classical 2 hours parathyroid delayed scan). The intense uptake persists in both delayed scans suggesting no malignant phenotype and which was confirmed after surgery by benign histology. In conclusion, using a 99mTc-sestaMIBI personalized protocol, related to the radiotracer cellular uptake mechanisms: 1 hour scan (supplementary image, corresponding to the maximum uptake pattern of 99mTc-sestaMIBI for cancer cells) and 2 hours scan (for parathyroid washout evaluation) may avoid unnecessary extensive thyroid surgery.

Assessment of knowledge, attitudes and perceptions regarding Ebola disease in healthcare workers from a tertiary care hospital in Romania.

OBJECTIVES: The National Institute for Infectious Diseases 'Prof. Dr. Matei Balș' was the designated centre for managing Ebola alerts in Romania during the 2014 African outbreak. We surveyed Ebola knowledge, attitudes and perceptions (KAP) among the institute's healthcare workers. STUDY DESIGN: This was a cross-sectional survey. METHODS: The study consisted of a self-administered paper-based anonymous questionnaire that included 24 closed-item questions and two scales of personal concern. RESULTS: Respondents were generally well informed; compared to nurses, doctors recorded a 1.9-fold higher rate of correct responses regarding Ebola transmission (P < 0.001), but both nurses and doctors correctly identified Ebola's aetiological agent. Nurses perceived higher personal (P = 0.008) and family (P < 0.001) risk than doctors. Respondents reporting high perceived risks were more likely to be less informed about Ebola (P = 0.019) and its prevention options (P = 0.033). Males were 6.7-fold more likely to volunteer than females (P = 0.001) and so were graduates of higher rather than lower education (1.5-fold more likely, P = 0.017) and doctors than nurses (1.7-fold more likely, P = 0.018). The institute ranked first among sources of information on Ebola; respondents who had received Ebola training in the institute 2 years previously were 1.2-1.3 times more likely to correctly identify transmission routes. CONCLUSIONS: We have characterised KAP on Ebola disease among Romanian healthcare workers from a tertiary care hospital in Bucharest. Nurses, specialist physicians and laboratory personnel may need more frequent retraining than residents and senior physicians.

The experience of the rigid lockdown in the dental emergency room and urgency care during COVID-19 pandemic: a transnational multicenter observational study.

OBJECTIVE: The COVID-19 pandemic had a major impact on our lives all over the world. Changes have occurred in daily life as well as in all medical services. The aim of the present study was to evaluate the emergency accesses in four universities' emergency services during the lockdown period from March to June 2020 during the COVID-19 pandemic. SUBJECTS AND METHODS: A cross-sectional study was carried out on 44,787 patients to evaluate the emergency services of university centers. The medical data of Medical Emergency Service Data (MESD) were assessed by five independent operators considering the epidemiological findings for statistics methods. RESULTS: A lower level of emergency access was reported in March-July compared to the pre-COVID period. The epidemiological data confirmed that female pathologies were more frequent compared to male patients. A fluctuation for almost all urgent healthcare centers was detected, showing one/two peaks per year during the years 2017-2019. The COVID-19 pandemic period did not influence the variety of pathology detected. CONCLUSIONS: After the lockdown period, the emergency services slowly increased in cases. The pre-COVID period showed an overlapping of the most frequent pathologies compared to the post-COVID period: periodontitis (Bari and Tirana), dental fractures (Bari and Bucharest), odontogenic abscess (Bari, Cluj and Tirana).

Comparative absorption and distribution pharmacokinetics of intravenous and epidural sufentanil for major abdominal surgery.

The pharmacokinetics of absorption and distribution of a single bolus dose of sufentanil 150 micrograms for major abdominal surgery were compared in 20 patients after random intravenous or epidural administration. Samples of plasma and cerebrospinal fluid were taken at regular intervals from time zero to 180 min after injection and at the time of tracheal extubation (3.43 to 12.66h). Sufentanil was analysed by radioimmunoassay. The area under the concentration-time curve (AUC) from zero to 1h, 2h, 3h, tracheal extubation and infinity, the absorption and distribution half-lives, maximum plasma and CSF concentrations, time to the peak concentration of sufentanil, and the fraction of sufentanil that reached the central circulation after epidural administration were assessed. Except in the first sample, plasma concentrations of sufentanil were comparable between the 2 groups. The initial transfer of sufentanil from the epidural space to the systemic circulation appeared to be very rapid. Explanations for this phenomenon are given. In only 3 patients could an uptake of sufentanil from the systemic circulation into the CSF be demonstrated. The transfer of sufentanil from the epidural space into the CSF is slower than the transfer into the plasma and it varied interindividually.

The pharmacokinetics of intradural morphine in major abdominal surgery.

The pharmacokinetics of intradural morphine used for major abdominal surgery were evaluated. Lumbar spinal fluid and plasma concentrations were measured at intervals after morphine 0.05 mg/kg had been injected intradurally in 21 patients scheduled for elective abdominal aortic surgery. The CSF morphine concentrations were fitted by a biexponential function. A non-compartmental model based on statistical moment theory was used for calculating the intradural morphine disposition. Mean residence time was 137 +/- 54.9 minutes, mean initial volume of distribution 15 +/- 5.49 ml, mean volume of distribution at steady-state 42 +/- 18.25 ml and mean clearance 0.34 +/- 0.18 ml/min (0.02 +/- 0.01 L/h). The moments of the morphine concentration-time curves and the pharmacokinetic parameters varied between the patients. They were not significantly different with regard to morphine dosage, or patient sex or age. Free morphine could not be detected in plasma. Morphine-3-glucuronide appeared in plasma at 5 minutes, increased to a maximum at 240 minutes and fell below the detection limit at about 16 hours after morphine administration. Possible clinical causes of interindividual variations in the CSF morphine concentrations and the pharmacokinetics of intradural morphine are discussed.

Pharmacokinetic profile of epidurally injected bupivacaine in awake patients.

In order to investigate the influence of general anaesthesia on the pharmacokinetics of bupivacaine 0.5% after a single, epidurally injected dose of 20ml (= 100mg), 5 patients, scheduled for surgical procedures appropriate for epidural anaesthesia without the need for combination with general anaesthesia, were studied. In all patients an arterial, central venous and intrathecal catheter were inserted for sampling of, respectively, arterial and central venous blood and cerebrospinal fluid (CSF), at regular intervals up to 12 hours after administration. Bupivacaine was analysed by gas chromatography. The drug appeared after 2 minutes in the plasma and CSF samples, and was still detectable after 12 hours. There were no significant differences between the bupivacaine concentrations in the arterial and central venous plasma samples at all times. The same applied for the calculated plasma pharmacokinetic parameters at all intervals. The bupivacaine concentrations in the CSF were many dozen times higher than in the plasma samples at all times. There was no clear evidence of a pulmonary retention of bupivacaine in this study. From a pharmacokinetic point of view the epidural anaesthesia was largely spinal anaesthesia.

Epidural bupivacaine versus epidural sufentanil anesthesia: hemodynamic differences during induction of anesthesia and abdominal dissection in aortic surgery.

The present study was designed to compare the hemodynamic changes of epidural bupivacaine (EB) with epidural sufentanil (ES), supplemented by general anesthesia, in patients scheduled for abdominal aorto-iliac surgery. Twenty-eight ASA Grade 2 patients randomly received bupivacaine 0.5%, 1-1.5 mg kg-1 (n = 14) or sufentanil 150 micrograms (n = 14) epidurally at T12-L1, combined with light general anesthesia. Hemodynamics were measured before (T1) and after (T2) injection of EB or ES, after induction of general anesthesia (T3), and during the aortic dissection period (T4). EB or ES injection both produced a significant decrease in systolic, mean and diastolic blood pressure, left ventricular stroke work index (LVSWI) and coronary perfusion pressure (CPP). The induction of general anesthesia caused a significant fall in heart rate (HR) and cardiac index (CI) in the ES group. Abdominal dissection restored systemic pressure and cardiac index in the ES group. It was concluded that both ES and EB provided adequate analgesia and hemodynamics during tracheal intubation and abdominal dissection for aorto-iliac surgery.

A study of epidural morphine and sufentanil anesthesia for abdominal aortic surgery.

Thirty six comparable patients, ASA 2, without cardiac disease, underwent aortic disobliteration, 19 under epidural 100 micrograms/kg morphine (EM) and 17 under epidural 2 micrograms/kg sufentanil (ES), combined with general anesthesia. To compare the hemodynamics, measurements were taken pre-operatively, after induction of general anesthesia, during aortic dissection, aortic cross-clamping and 3-5 minutes after the first revascularisation. Plasma and CSF drug levels were measured at intervals in 6 patients in the EM end 5 patients in the ES group. Both drugs provided satisfactory analgesia which persisted for 10.4 hours in the EM and 6.3 hours in the ES group. The fall in systemic pressure and left ventricular work in both groups after induction of general anesthesia suggests that EM and ES must be used with caution in patients with hypovolemic or cardiovascular disease. There was a significant difference in SVR between the two groups during the aortic dissection, due to a rise in SBP in the ES group and a tendency for SVR to fall in the EM group. However significant differences in left ventricular work did not occur. Notable was the absence of significant changes in filling pressure, CI and left ventricular function during aortic cross-clamping. After revascularization a significant decrease in systolic blood pressure occurred in association with an increase in heart rate in the EM group. The influence of the plasma and CSF concentrations of morphine and sufentanil on the hemodynamic changes during surgery were evaluated.

[The surgical treatment of haemophilic arthropathy (author's transl)]. / Indications du traitement chirurgical dans l'arthropathie hémophilique.

The authors have operated on 13 haemophilic joints. The operation included 5 knee synovectomies of the knee, 2 corrective osteotomies, 4 soft tissue procedures on the knee or foot (tendon lengthening, capsulotomy), 1 arthrodesis of knee and 1 excision of heterotopic ossification. The type of operation needed varied with the degree of involvement. Indications for associated haematological treatment are given. The indications were both preventive and curative. The results were gratifying, although two cases of post-operative infection were seen.

Histopathological and ultrastructural modifications of the arthrosis articular cartilage.

Thirty samples of articular cartilage taken during the operation from patients with incipient arthrosis, arthrosis with radiological modifications and arthrosis under study for Rheumatoid Arthritis (RA) were investigated using histopathological (HE, VG, PAS-Alcian, Gömöri, Safranine O) and electronmicroscopic techniques. The control material was made of posttraumatic cartilage (Moore prosthesis). Histopathologically, the incipient arthrosis cartilage had superficial exfoliations associated with reduced saframinophilic tinctorial perichondrocytic activity. The arthrosic cartilage with typical radiological modifications was individualized at the synovia-cartilage junction by villous aspects of the synovia associated with perichondrocytic gaps, reduction of safraninophilia and modifications of reticuline-collagenic network. The arthrosic cartilage under study for RA revealed destructive fibrous modifications of the synovia and severe affection of the articular cartilage at synovia-cartilage junction. Electronmicroscopically, the ultrastructural affection was minimum in the incipient arthrosis cartilage developing to chondrocytic degeneration in arthrosis with radiological correspondent. Both histopathological and ultrastructural data emphasize the fact that arthrosis is associated with synovitis following a primitive degenerative process similar to rheumathoid synovitis in arthrosis under study for RA.

Pathogenesis aspects of arthrosis in histopathological and electronmicroscopical studies of articular cartilage, correlated to some immunological parameters.

Twenty-five biopsies of arthrosic cartilage with radiological correspondence, arthro, sic cartilage under study for Rheumatoid Arthritis (RA) and posttrauma cartilage as control-were examined using histopathological (HE, VG, PAS-Alcian, Gömöri, Safranine O) and electronmicroscopical techniques. The arthrosic cartilage with radiological correspondence shows superficial and deep fissures, perichondrocytic gaps and modified reticulino-collagenic network at the histopathological examination. At the level of synovia-cartilage junction, we found some villous aspects of the synovia desquamating in the proximity of the affected cartilage. The investigated arthroses for RA presented some destructive fibrous modifications of the synovia similar to rheumatoid synovitis and associated with some dystrophic chondrocytic alterations. The ultrastructural affection was severe leading to cellular degeneration. The immunologically-studied arthroses for RA had seric pathologic values regarding: circulating immune complexes (CIC) (mean = 67.08 +/- 1.45 U), Ig.M(mean = 358 +/- 3.02 UI/ml) and anti collagen antibodies (mean = 409.9 +/- 0.42 U). The synovial depletion of complementary fraction C3(mean = 42.3-1 mg%) as against the normal seric level (mean = 63.07 +/- 0.49 mg%) suggests an immune synovitis. Correlation of immunomorphopathological data emphasize that arthrosis coexists with a secondary synovitis following a primitive degenerative process and allows arthroses under study for RA to be separated from other degenerative rheumatism diseases.

Structure formation under steady-state isothermal planar elongational flow of n-eicosane: a comparison between simulation and experiment.

We use nonequilibrium molecular dynamics simulations to investigate the structural properties of an oriented melt of n-eicosane under steady-state planar elongational flow. The flow-induced structure was evaluated using the structure factor s(k) taken as the Fourier transform of the total pair correlation function g(r). We found that the equilibrium liquid structure factor is in excellent agreement with the one determined via x-ray diffraction. Moreover, a new x-ray diffraction experiment has been performed on a crystalline n-eicosane sample. The resulting intramolecular contribution to the structure factor was found to be in very good agreement with the simulated one at a high elongation rate, indicating the existence of a possible crystalline precursor structure.

[HB antigen in the family environment]. / Antigenul HB in mediul familial

HBs antigen was determined in 297 members of 91 families, former blood donors in whom the state of HBs antigen carrier lasted more than six months. The results emphasized the higher proportion of HBs antigen carriers in the family environment than in the general population (7.4% as against 4.9%) and the significantly higher frequency of the antigen among the members of consanguine families.

Data processing system for the Centre of Nutrition and Metabolic Diseases.

The paper is devoted to the functional specification and the architecture of a data processing system to database generation and management within the Centre of Nutrition and Metabolic Diseases in Bucharest. The main operations performed by the system refer to: --Patient admission. A patient file which is created for any new patient, contains all the details hitherto included in the patient registration form. --File update, carried out periodically or whenever required. Any new relevant detail is added to the existing file in a conversational manner. --Report generation. The reports are produced periodically or upon request. --Inventory and stock control concerning the drugs dispensed free of charge. --Data processing and classification. --Creation and retrieval of patient archives. --Display on request of the various details contained by the patient file. The described system can be implemented on an INDEPENDENT I-100 general purpose minicomputer, having a main memory of 96 kwords. The disc-based AMS operating system is used. The system operates in real time, although off-line background jobs can be run in order to assist the scientific work. A FORTRAN compiler is part of the operating system.

Data processing system for the centre of nutrition and metabolic diseases.

The paper is devoted to the functional specification and the architecture of a data processing system to database generation and management within the Centre of Nutrition and Metabolic Diseases in Bucharest. The main operations performed by the system refer to: -Patient admission. A patient file which is created for any new patient, contains all the details hitherto included in the patient registration form. -File update, carried out periodically or whenever required. Any new relevant detail is added to the existing file in a conversational manner. -Report generation. The reports are produced periodically or upon request. -Inventory and stock control concerning the drugs dispensed free of charge. -Data processing and classification. -Creation and retrieval of patient archives. -Display on request of the various details contained by the patient file. The described system can be implemented on an INDEPENDENT 1-100 general purpose minicomputer, having a main memory of 96 words. The disc-based AMS operating system is used. The system operates in real time, although off-line background jobs can be run in order to assist the scientific work. A FORTRAN compiler is part of the operating system.