Open Chest Wounds and Missed Injuries - A Really Opened Pandora's Box.

The purpose of the study is to highlight the importance of systematic approach and investigation for identification of potential life threatening lesions to a serious injured patients with the presence of obvious other lesions. MATERIAL AND METHOD: A clinical case patient, with penetrating transfixing chest trauma, severe shock and respiratory distress. RESULTS: HEMS emergency evacuation under aggressive resuscitation, to a regional trauma center. Further clinical examination, imagistic and complex biomarkers revealed cardiac, lung, spleen and spinal cord contusions. Emergency intervention practiced foreign body extraction, extensive exploration, regulate and surgical treatment of the wound trajectory. Two weeks later, the patient has been discharged from hospital without complications. CONCLUSIONS: 1. Patient with opened, penetrating chest trauma should be considered and managed as a life threatening situation but the assessment plan and the investigation strategy required should be extensive in order to identify all visceral both thoracic and abdominal tissues injuries, not only the life-threatening one, as cardiac contusion and spinal cord injuries. 2. Cardiac contusion is not a rare event, but a rare confirmed diagnosis, in association with other sources of shock or hypoxia, the result of traumatic complex of lesions, which include cardiac contusion, could thus impact on survival chances. 3. Air evacuation is, the first intention to assist such a patient in the trauma center.

[Paradoxical kinesia in Parkinson's disease: theories and practical application].

This literature review addresses the phenomenon of paradoxical kinesia (PK) in patients with Parkinson's disease (PD). PK is the sudden ability of the patient wit hPD to perform movements that were previously disturbed. This ability can be caused by different internal or environmental stressors. Different theories explaining the mechanism of paradoxical kinesia were proposed. In recent years, in the context of a search for new effective methods of treatment of akinesia I PD, methods of correction of motor impairment based on the phenomenon of PK are being developed.

Prematurity and Sepsis - Features and Approach Difficulties During Neonatal Emergency Transfer.

Purpose - We aimed to identify conditions, means and methods of suspecting, certification and stratification of neonatal sepsis, to prioritize and define levels of management during evacuation, and to follow the neonatal sepsis succeeding the transfer. Material and method - An observational study was conducted between 1January 2011 - the 1 January 2015, that included 610 preterm newborns with suspected sepsis transferred by UTIM NN or HEMS Craiova. We statistically studied confirmation rate of suspected sepsis, the sepsis onset condition, severity stratification, and correlate with medical centers performance assisting newborns and planning transfers. A follow up performed two weeks after evacuation. Results - We detected low rate of detection and affirmed sepsis: n=38 (6.25%) - C.I. (95%): 4.454309335 and very high level of founded unsuspected sepsis: n=85 (13.98026316%) C.I. (95%): 4.982552268, 9of them being very low body weight newborns (1.480263158%). High rate of founded, unaffirmed respiratory distress 23.35526316% (n=142), C.I. (95%): 5.383960957, as sign of sepsis. High rate of accidental hypoglycemia/hypothermia founded by emergency evacuation team: n=131 (21.54605263%), especially to VLBW newborns, associate with sepsis, respiratory failure or confounding with. Conclusions - Newborns transfer its self generates multiple additional risks, including sepsis, but not neglected any stress generated by transport conditions, so that ,,in utero'' transfer has to be extended in current practice for high risk fetus, mother or special medical conditions to limit newborns transfers. Wider use of telemedicine would facilitate refining the transfer criteria.

Assessment of myocardial perfusion using contrast echocardiography - Case report.

Contrast echocardiography is a technique that improves endocardial demarcation and provides real-time data on blood circulation (blood flow, velocity). Left ventricle imaging study using contrast agents that cross the pulmonary circulation allows an improved visualization of endocardial tissue. This creates a more accurate ultrasound evaluation of left ventricular dimensions and its kinetics. Contrast echocardiography can improve Doppler mode evaluation and can provide information on myocardial perfusion precisely through this mechanism. Microbubble contrast agents are second-generation ultrasound contrast agents and are especially useful in endocardial demarcation. Second generation ultrasound contrast agents available now, include "Definity", "Optison" - available in almost all countries with an average medical system except for Europe and "SonoVue" - available in most European countries. Contrast agents are represented by microbubbles between 1-10µm in diameter, containing a gas surrounded by a phospholipid membrane (SonoVue) or protein (Optison). Because the microbubble ultrasound characteristics used are different from the characteristics of the surrounding tissue or blood elements and cardiac structures, their diffusion produce very strong acoustic signals, which are directly proportional to blood volume. Quantitative assessment of myocardial microcirculation is now possible due to the advancing techniques in contrast echocardiography, provided that the left ventricular cavity has an increased echogenicity compared with the surrounding myocardium (which has a lower blood volume).

Plurietiologyc Possibilities and Difficulties of Seizures Management in Pregnancy.

Background - Pre-existing pathology, the development of acute new one strictly dependent of the pregnancy or an independent acute or chronic medical problems generate a highly complex disease that requires a nuanced interpretation of the pregnant women in an attempt to identify the most favorable solutions for evaluation and treatment. Case report - 26-28 weeks pregnant women, 23 years old, known epilepsy, HIV encephalitis and pulmonary TB in inconsistent treatment with prolonged seizure status. Emergency air evacuation from a third degree medical center to regional center ( first level) under general anesthesia. After 24 hours, conscious, without focal signs. Favorable ongoing pregnancy. Conclusions - Considering the medical history, we analyzed several possibly triggering and maintenance of the crisis elements so that clarification of them constituted the main challenges. Finding an imaging examination solution with minimal harming effect on the fetus was a key decision points. Tocography and excluding eclampsia as the etiology were the main reasons to refrain from practicing cesarean section and magnesium sulphate administration. Paralytic agents use, in particular succinylcholine was a decisional key point, considering the variation in serum cholynesterase activity in peripartum period. The phenytoin administration was also a difficult choice because of the risk of bradycardia to the fetus. No any adverse event as effects of the crisis and medical intervention on the mother reported to the newborn during the first 8 months of life, but cerebral palsy continues to concern before 24 months.