Recipients' experience with information provision for electroconvulsive therapy (ECT).

BACKGROUND: Despite improvements, studies continue to report unsatisfactory provision of information before, during and after electroconvulsive treatment (ECT). AIMS: The study explores participants' experiences with information provision about ECT. METHODS: In-depth interviews with 21 participants (21- 65 year-old) were conducted. Thematic analysis resulted in identification of four themes: pre-treatment knowledge, experience of informed consent, the need for information depth and life after ECT. The study includes user involvement. RESULTS: Although some participants were satisfied with information provision, the majority experienced an education deficit throughout the treatment period. Their consent was based mostly on oral information, insufficient and unvaried information on official health websites and media. Further, patients reported a lack of follow-up services that can attend to (neuro) psychological concerns. CONCLUSIONS: Better access to updated factual and narrative information should support patient education and autonomy. Active use of diary writing, better follow-up and more varied representations of experience with ECT in media and health information sites are necessary to educate, improve consent processes and reduce stigma.

Characterisation of CIME, an experimental chamber for simulating interactions between materials of the cultural heritage and the environment.

An approach consisting in combining in situ and laboratory experiments is often favoured for investigating the mechanisms involved in the weathering of the materials of the cultural heritage. However, the realistic simulation in the laboratory of the environmental conditions ruling the interactions of atmospheric compounds with materials is a very complex task. The aim of this work is to characterise CIME, a new chamber specially built to simulate the interactions between materials of the cultural heritage and the environment. The originality of this instrument is that beside the usual climatic parameters (temperature, relative humidity, solar radiation) and gaseous pollutants, it also allows the controlled injection of different types of particulate matter such as terrigenous, marine and anthropogenic. Therefore, varied realistic atmospheric environments (marine or urban) can be easily simulated within CIME. In addition to the technical description of CIME, this paper shows the first results obtained by the impact of gaseous pollutants on non-durable glass, bronze and limestone. The first experiments for the deposition of different particles (calcite, clays, soot and halite) are also presented.

Laparoscopic treatment of perforated duodenal ulcer -- a multicenter study.

AIM: The aim of this study is to evaluate the results of the laparoscopic treatment of perforated duodenal ulcer performed in 6 Romanian surgical centres with experience in the field of laparoscopic surgery. MATERIAL AND METHOD: Between 1996 and 2005, 186 patients with perforated duodenal ulcer were operated on in the centers participating in this retrospective study, all patients being ASA I-II. Thirty-nine patients (20.0%) presented mild peritonitis, 120 (64.5%) medium peritonitis and 27 (15.5%) severe (20.0%) simple suture was performed, in 110 (59.1%) suture with epiplonoplasty, for 1 (0.5%) only epiplonoplasty and 1 (0.5%) underwent excision of the perforation and suture. RESULTS: The operative time was between 30-120 minutes, with an average of 75 minutes. No death was noted. Average hospitalization time was 6 days, with periods varying between 3 and 18 days. Postoperative complications included: 5 patients (2,6%) presented infections of the abdominal walls, 1 patient (0.5%) duodenal fistula, 1 patient (0.5%) intra-abdominal abscess, 1 patient (0.5%) a superior digestive hemorrhage by "mirrored ulcer" and 1 patient (0.5%) duodenal stenosis 6 months after operation. The patients were administered 50% less analgesics, used 70% less dressings, 30% less antibiotics and had 60% less complications in comparison with those operated by the classical approach. CONCLUSION: The laparoscopic approach of perforated duodenal ulcer constitutes the first choice for patients without important co-morbidities, allowing a quick recovery and a significant reduction in the consumption of analgesics, antibiotics and dressing materials.

[Thyroid cancer--the malignant lesions in the contralateral lobe]. / Cancerul tiroidian--leziunile maligne din lobul contralateral.

AIM: This study analysed the frequency of the malignant lesions in contralateral thyroidian lobe after completion thyroidectomy for malignant lesions in the ipsilateral lobe, in order to establish which patients have indication of total thyroidectomy. MATERIAL AND METHOD: There were studied retrospectively 228 patients which had completion thyroidectomy after histological confirmation of the thyroid cancer in the ipsilateral lobe. RESULTS: Thyroid cancer in contralateral lobe was found in 94(41.2%) patients. One (4.7%) of patients with cancer < 1 cm in ipsilateral lob had malignant lesions in the contralateral lobe. In patients with ipsilateral lobe cancer > 1 cm, the frequency of malignant lesions was between 42.8% and 47.6%. CONCLUSION: The very high frequency of malignant lesions in the patients with ipsilateral thyroid cancer > 1 cm impose total thyroidectomy in these cases.

Epithelial-myoepithelial carcinoma of the tongue base: a case for the case-report and review of the literature.

A 60 year old lady was referred to the Princess Alexandra Hospital (Brisbane, Queensland, Australia) tertiary Otolaryngology, Head and Neck Unit from a peripheral hospital for investigation and management of a tumour at the base of the tongue. Biopsy of the tumour revealed it to be an epithelial-myoepithelial carcinoma of the base of the tongue. This is an extremely rare tumour in this location with only 2 other case reports in the world literature: the patients were treated with chemo-radiotherapy and surgery respectively. Our patient was made aware of the world literature and was able to make a fully informed decision on her choice of treatment modality and was treated with radiotherapy. Increasingly journals are limiting publication of case reports to "world firsts" only. We present a case where such a policy would have denied patient choice and possibly led to detrimental treatment.We review the world literature of tongue base epithelial-myoepithelial carcinoma of the tongue.

[Laparoscopic surgery for hepatic hydatid cyst--possibilities and limitations]. / Chirurgia laparoscopica a chistului hidatic hepatic--performante si limite.

Laparoscopy in hydatid liver disease, is not addressing only to simple but to complicated cases, although the rate of complications registered a significant decrease because of the modem means (ultrasonography, TC) and the precocity of the diagnostic. We made a retrospective study on 76 patients with liver hydatid cysts admitted and operated in two Surgery Clinics of Sibiu and Braila, between January 2002 and January 2007. On 52 cases we performed laparoscopic interventions and 24 where operated in open surgery, decided by the option and the experience of the surgeon. Our laparoscopic technique is based on specific and original instruments, two patented inventions which increase the security of the primary approach of the liver hydatid cyst. This specific set of instruments, uses extraperitoneal work tunnels for treatment and exploration inside the cyst. The limits of laparoscopy are represented by the cases which presume difficulties and require the conversion. We had one patient who needed conversion to open surgery with a "mercedes" incision, because of the huges dimensions of the liver cyst (25 cm), which did not allowed the induction of a suitable work camera, and because of it's central position (IV-V-VI segments) and numerous adherences to adjacent organs. At three or our cases, the cyst position and the peri-cystic adherences, required the cysto-phrenic dissection, ended with diaphragm perforation, solved by laparoscopic suture without thoracic drainage, but with intra-operatory aspiration of the pneumothorax. The advantages of the laparoscopy are numerous, from the excellent visibility inside abdomen and inside the hydatid cyst cavity, the protection of the abdominal wall and peritoneal cavity, to a relevant shortening of hospitalisation period and convalescence.

[Metabolic effects of hypolipemic drugs on aged type 2 diabetes]. / Influenta terapiei hipolipemiante în reglarea metabolica a diabetului tip II la vârstnic.

There are multiple lipids anomalies on diabetes. IDDM has, because of insulin lack, increased levels of triglycerides and afferent lipoproteins. NIDDM, especially obese one, linked by insulinoresistance and hyperinsulinemia, has different and complex anomalies by quality and quantity. There is a specific shape for this anomalies named "B phenotype" with high cardiovascular risk: rise LDL-chol charged with TG and low level of HDL-chol. We searched lipoproteins levels and the effects of simvastatin on aged persons (after 60 years). We randomised 158 cases with obese type II diabetes on a case control study. We concluded that only 28% had high TG levels and 71.8% had low levels of HDL-chol. For HDL-chol this percent is higher over 60 years old group (88.75%) (p < 0.001). Cholesterol has no significant high levels (28.55%) (p < 0.5), and aged group has almost normal levels of cholesterol and triglycerides (p < 0.0001). We administered simvastatin (Zocor) on 86% cases, therapeutically doses, during a period of 6 months to one year. Making lipidograms initially, after 6 months and a year, we proved good effects of Zocor, on lipoproteins levels: rise levels of HDL-chol (p < 0.005), moderate effect on LDL-chol (p < 0.01). At the same time the treatment improving the glucose tolerability to both groups (p < 0.002).

Implications for HIV/AIDS of laws affecting men who have sex with men in Romania. ACCEPT (The Bucharest Acceptance Group).

In this article, the authors discuss the predicament, in Romanian society, of one group that is especially vulnerable to HIV infection and AIDS: men who have sex with men. Such men are driven to secrecy, and discouraged from disclosing themselves even to obtain the help and information they need, because Romanian law prohibits homosexual overtures, denies legal recognition to gay and lesbian organisations, often imposes strong disincentives in the way of those seeking diagnostic tests for HIV or for venereal disease, and still penalizes same sex relations themselves in many circumstances. Social and administrative circumstances in Romania have also aggravated such men's vulnerability. Drawing especially on the United Nations' International Guidelines on HIV/AIDS and Human Rights, the authors offer several recommendations for reform.

[Antilipemic therapy in dyslipidemias in obese non-insulin-dependent diabetics (ONIDDM)]. / Terapia hipolipemianta în dislipidemiile diabetului noninsulinodependent obez (DNIDO).

There are multiple lipids anomalies on diabetes. IDDM has, because of insulin lack, raised levels of triglycerides and afferent lipoproteins. NIDDM, especially the obese one, directly linked with insulin-resistance and hyperinsulinemia, has different and complex anomalies. There is a specific type named "B phenotype" with high cardiovascular risk: raised LDL chol charged with TG and low level of HDL chol. Our study on 58 cases with NIDDM obese concluded that only 28% had high TG levels but 71.8% had low levels of HDL chol. We administered fibrates, therapeutical doses, 3 months. We made lipidograms from the beginning and after one and three months. So we proved the good effect of fibrates on lipids: rise of HDL chol., moderate effect on LDL chol. for reduced cardio-vascular risk. There were good results on glucose tolerability (improving 65.8%, p < 0.01).

[Insulinemia and its evolution over time in obesity]. / Insulinemia si evolutia în timp a obezitatii.

There is a steady-state metabolism of adipose tissue ("adipose state") with a "metabolic signal" significance. It consists of: seric levels of glucose, insulin, free fatty acids. We studied 45 cases with uncomplicated obesity and we correlated seric level of insulin, basal and reactive, with DAM (mean adipocyte diameter), insulin receptor activity and obesity evolution length (age of obesity). Level of insulin has high influence on insulin receptor function (p < 0.01). Reactive insulin level are higher with obesity age (p < 0.0001). Hyperinsulinemia is a constant, continuous and early reference point of obesity.

[Apolipoproteins-a cardiovascular risk factor within the context of syndrome X]. / Apolipoproteinele--factor de risc cardiovascular în contextul sindromului X.

Apolipoprotein is now a new biochemical marker for evolution of atherosclerosis, even better than lipid fraction. We studied seric apolipoprotein A and B (Apo A, B) on 50 cases with complicated obesity, with ages between 37-52 years, and 15 males and 35 females. Selection criteria were: android constitution, obesity, essential hypertension (EHT). We also made statistical correlations on IBM PC compatible computer using chi-square test. We correlated glycoregulation abnormalities with body mass index (BMI > 25) with meaningfully value (p < 0.005) or with complicated EHT less meaningfully (p < 0.2). On this background, we appreciated the predictive value of seric levels of Apo A, B and Apo B/A ratio > 1. EHT correlates with low levels of seric Apo A very meaningfully (p < 0.0001) and this association is higher correlated when added ICD (P < 0.00001). There is no significant relationship between high levels of seric Apo B and EHT in our study, but it is significant for Apo B/A > 1 (p < 0.0001). EHT with seric cholesterol are not correlated (p:NS). Our conclusion is that seric Apo A and Apo B/A are statistical predictive risk factors for complicated EHT on android obese persons (X syndrome).