.

Under the auspices of the:

Romanian Minister of National Defence

Mr. Gabriel OPREA
Chief of Medical Directorate and President of Congress
BRIGADIER GENERAL Mihai Marius MUREAN, MD
President of RNB / BMMC and Vice President of Congress
MAJ Assist. Prof. Bogdan MARINESCU, MD, PhD
Secretary General of RNB / BMMC
MAJ Narcis V. TANASE, MD

SCIENTIFIC PROGRAMME

2NDJUNE2011

09:00-17:30

ARRIVAL, REGISTRATION, ACCOMMODATION

INTERCONTINENTAL HOTEL, BUCHAREST

20:00-23:00

WELCOME RECEPTION
INTERCONTINENTAL HOTEL (FORTUNA BALLROOM)

2ndJUNE2011

09:00-10:30

OPENING CEREMONY

THE NATIONAL MILITARY CIRCLE (THE PERFORMANCE HALL)

10:30-10:40 GROUP PHOTO (IN FRONT OF THE NATIONAL MILITARY CIRCLE)
10:40-11:00 COFFEE BREAK (BYZANTINE ROOM)
ART PERFORMANCE
11:00-12:30 MEETING OF THE CHIEFS OF MILITARY SERVICES

(MARSHALS ROUND HALL & N. GRIGORESCU ROTONDA)

11:00-12:30

ORAL PRESENTATION I
(GOTHIC HALL)

Chairpersons: Professor Encho Zapryanov SAVOV, MD, DSc (BULGARIA)

LTC Maria MITSIOU, RN, MSc (GREECE)
OP001

EXPERIENCES OF GREEK MILITARY DOCTORS AND NURSES FROM THEIR

PARTICIPATION IN THE INTERNATIONAL SECURITY ASSISTANCE FORCE ISAF
Authors: LTC Maria MITSIOU, RN, MSc1, COL Charalampos LALOUSIS, MSc, HAR2,
LTC Maria NTONTOGLOU, RN1, PTE Konstantinos CHATZIMICHAEL, Econ., PhD1
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 self-report 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 using a set of
various tests (X2 test, Mann-Whitney U-test and Spearmans test). The null hypothesis
was rejected in all cases at p<0,05, confirming the initial suspicion about significant
trade-offs between the considered variables. The information obtained from the openended questions was presented through content analysis.
Results: 51 % of the respondents were married whereas 34% of them were parents
(mean age 35.6 years old). The living conditions as well as the available equipment
were considered moderate to good. Regarding the educational profile, 74% of the
respondents were graduates from the Military Medical Academy and the remaining
26% of the Military Nursing Academy. Approximately 50% of the doctors were junior
doctors. All but one individual were English spoken, while almost 60% were trilingual.
The economic status of the respondents was quite good (mean=3.8 in a 6 points Likert
4

2NDJUNE2011

scale). The majority of the participants (74%) were ordered to participate to the
mission. The marital status, the age, the length of stay and the 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,
OP002

CHIMICAL, BIOLOGICAL, RADIOLOGICAL AND NUCLEAR AND THE

EMERGENCY DEPARTMENT: DECONTAMINATION MEASURES IN THE
EMERGENCY DEPARTMENT
Authors: Maj. Florea COSTEA, MD,*; maj. Adrian EREMIA, MD,**,cpt. Mihai TOMA,
MD,*; maj. Leonard LUPU, MD***; lt.col Bogdan TEUSDEA, MD, EMDM, PhD *
Institution:
*Clinical Emergency Central Military Hospital Bucharest, Emergency Department ,
ROMANIA
** Medical Directorate of MOD, Public Health Compartment, ROMANIA
*** Romanian AIR FORCE,
ROMANIA
Key words: Bioterrorism, decontamination measures, emergency department.
Abstract: The intended use of biological agents as weapons and the deliberate employ
of these agents in terrorist actions on the civilian populations amplify the threat in
modern conflicts and enhance the vulnerability of people exposed to those agents.
Medical defence against biological warfare or terrorism is an area of study unfamiliar to
most military and civilian health care providers during peacetime. Hospitals and clinics
may be the initial site of recognition and response to bioterrorism events. In this paper
we intend to provide a short presentation of some agents and corresponding diseases
with bioterrorism potential, also a short protocol for the prompt recognition of an
bioterrorism-related outbreak at a patient first presentation to the hospital in the
emergency room setting (clinical criteria, epidemiological features), followed by
emergency department management strategies to be applied in case of possible
bioterrorism victims and concluding with a review of the latest widely accepted
opinions for infectious disease control, laboratory support and confirmation, and also
post-exposure management.

2ndJUNE2011

OP003

POLYTRAUMA MANAGEMENT IN THE MILITARY MEDICAL ACADEMY

EMERGENCY CENTER
Authors: Col. Zoran POPOVI, M.D, PhD, major dr Dragan RADOII, major dr
Jugoslav MARINKOVI
Institution: Military Medical Academy Belgrade (MMA),
SERBIA
Military medical Academy Emergency center is on duty 24 hours every day, providing
emergency health care for all serbian army forces and every wednesday for all
civilians who live in Belgrade area (approximately 2 500 000 people). MMA Emergency
center has a personnel with exceptional experience in all surgical specialties, and is
capable to provide coordinated care for war, traffic and industrial polytrauma cases.
Polytrauma with multisystem injuries is one of the major causes of morbidity and
mortality in both developed and developing countries.
The aim is to present the diagnostic and therapeutic protocols regarding polytrauma
that are operational in the Military medical Academy Emergency center , and to
present what impact the progressive implementation and review of these algorithms
has had on mortality rate and engagement of diagnostic and therapeutic resources.
Since 01.03.2010. to 31.03.2011.in MMA we registered 181 polytrauma cases. All of
them had some kind of orthopaedic trauma combined with head, neck, chest and /or
abdominal trauma. The overall survival rate was 92.2% and mortality 7.8%
respectively. Polytrauma results in a complex pathophysiological and immunological
response. Depending on the individual injury pattern, the time elapsed after injury, and
the systemic danger response, the surgical treatment has to be properly directed.
The implementation of standardized protocols of polytrauma management is
necessary for significant improvement of trauma care and decrease in morbidity and
mortality. In MMA emergency center we use the Advanced Trauma Life Support
(ATLS) protocol for the acute management of severely injured patients as well as the
Definitive Surgical Trauma Care (DSTC) algorithm and the concept of damage
control surgery for polytraumatized patients with immediate lifethreatening injuries.

OP004

ETILIC LIVER IMPAIRMENT AND ITS COEXISTENCE WITH VIRAL IMPAIRMENT

Authors: Sonja SARACI 1, L. HOXHA 2
Institution:
1- General Medical Doctor, 2nd LT
2- Gastrohepatologist, Civ.
ALBANIA
Introduction : Alcohol abuse can heavily impair human body. One of the organs that
reflect etilic impairment is liver. It may appear as hepatosteatosis, alcoholic hepatitis
and cirrhosis, associated with many complications.
Aim: To evaluate the effects of alcohol on liver, and their coexistence with liver
impairment from virus B and C. Patients evaluation with clinical, laboratory and
imaging examinations.
Material and Methods
Studies were performed in 60 patients hospitalized in the department of
gastroenterology and hepatology (Echelon 4 Hospital), during the period November
2006 till February 2007. Elissa method for viral marker evaluation was applied during
patients investigations.
Diagnostic Criteria : History (period of time and amount of alcohol consumed), viral

2NDJUNE2011

profile, lab data, Child-Pugh criteria, imaging results.

Results : In alcoholic liver disease, prevalence according to gender was: 95% of
patients were men and 5% were women. Prevalence according to the effects of
alcohol on liver was as follows: 3, 5 % were diagnosed with Hepatosteatosis, while 96,
5% were diagnosed with Alcoholic Cirrhosis. Among patients diagnosed with alcoholic
cirrhosis: 76% were diagnosed solely with alcoholic cirrhosis, while 21 % with alcoholic
cirrhosis and HBV, and 3 % alcoholic cirrhosis and HBC. Prevalence according to
Child-Pugh criteria: Child A 40%, Child B 32%, Child C 28 %. While mean age of
patients with alcoholic cirrhosis according to concomitant infection with virus B and C
was: 53yrs old for patients with no viral infection, 50yrs old for patients with
concomitant virus B infection, 42yrs old for patients with concomitant virus C infection.
We noticed no correlation between level of GGT and ALP, while AST/ALT ratio was
2.35.
Conclusions: In our country there is a prominence of alcoholic cirrhosis versus
concomitant viral and alcoholic cirrhosis. Alcoholic liver impairment is not related to
age, but to the period of time and amount of alcohol (from history) consumed.
Concomitant infection with virus C aggravates liver impairment and therefore cirrhosis
appears in an earlier age.
OP005

ANTIBIOTIC RESISTANCE, GLOBAL THREAT

Authors: SAVOV E. Prof. MD., GERGOVA I. MD, BORISOVA M., MD, JOSEVA E.
MD, TRIFONOVA A., TODOROVA I.
Institution: Laboratory of Microbiology, Military Medical Academy, Sofia,
BULGARIA
Objective: To be presented contemporary data concerning the significantcy of the
problem antibiotic resistance.
Material methods: There were used world literatute data and our experience in the
determination of the etiological structure and the resistance of frequently nosocomial
agents causing infections for the period 2006 2010.
Results: The data from the summary information present the difficulties in the
treatment of problematic for hospital pathology microorganisms and necessity in new
antibiotics research.There was registered a significant increase in the proportion of
multiresistant bacteria to the main groups of antimicrobials used in the clinical practice
third-generation of cephalosporins, carbapenems, quinolones and aminoglycosides.
Especially attention deserve so called multidrug resistant or pandrug-resistant bacteria
like Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA/,
Multi-drug resistant, ESBL producing Klebsiella species and Escherichia coli and
others. Indication for the significancy of the problem for military settings is the
determination of an increase in the number of reported multidrug-resistant
A.baumannii bloodstream and wound infections in US soldiers at military medical
facilities in Iraq, Kuwait and Afganistan.
Conclusion: The data presented demand cooperation between the United States and
Europe specialists for improving of antibiotics use.
Laboratory of Microbiology, Military medical Academy,
No 3, Georgy Sofiisky Str.,1606, Sofia, Bulgaria
Tel: (+359 2) 9522773
Fax: (+359 2) 952 65 36
Mobile: 0889201187, Email: savove@yahoo.com

2ndJUNE2011

OP006

COUNTERACTIONS AGAINST CHEMICAL AND BIOLOGICAL TERRORISM IN

TURKEY AND THE ROLE OF THE ARMY
Authors:CDR. YAREN Hakan, MD1, COL. KENAR Levent MD1, CAPT. KUNAK Zeki
lker, MD2
Institution:1Gulhane Military Medical Academy, Dept. of CBRN Ankara, TURKEY
2TAF MEDCOM, Ankara, TURKEY
TURKEY
Objective: The aim of this study is to make an evolution on counteractions against
chemical and biological terrorism in Turkey and the role of the army
Material and Method: Historical archives and literatures about the subject are included
into the study.
Results: In todays world, weapons of mass destruction become one of the most
probable threats for armed forces of a country and also for civilian people. Especially
after disintegration of U.S.S.R., terrorist groups and some terrorism-supporting states
have intented to get biological and chemical agents/weapons in order to get advantage
against their enemies. Because of its geopolitical and geostrategic position, Turkey
has been under this kind of threat. In order to provide sufficient response during a
biological and/or chemical attack, Turkey has taken necessary measures. In Turkey;
army, navy and air forces work in tight cooperation in terms of getting and sharing
intelligence, warning and reporting, protection, evacuation and also medical
countermeasures. All the activities are coordinated by Turkish General Staff. Medical
operations and counteractions are performed by Turkish Armed Forces Medical
Command under control of Turkish General Staff. Gulhane Military Medical Academy
has a key role in terms of education of all military medical stuff, getting military
hospitals ready against chem-bio attacks and providing collaboration with civilian
hospitals. On the other hand, whole counteractions against chem-bio threats in Turkey
are performed under control of premiership. Ministry of Defense, Ministry of Health,
Turkish Armed Forces, Police Department, Ministry of Interior and local authority are
the other important components of entire defense system. In the case of any chem-bio
attack, Crisis and consequence management are coordinated by Premiership Crisis
Management Centre
Conclusion: Because of its geopolitical and geostrategic position Turkey has to take
proper measures against biological and/or chemical terrorism and has a multicomponent defense system. TAF is one of the most important pieces of it.
Correspondence
Gulhane Askeri Tip Akademisi, KBRN BD. Bk.l, Etlik 06018, Ankara, TURKEY.
Tel: +90 312 3043552
Fax: +90 312 3044300
GSM: +90 535 2938889
e-mail: hyaren@gata.edu.tr

2NDJUNE2011

OP007

TREATMENT OF WEST NILE VIRUS-INFECTED PATIENTS DURING THE

SUMMER 2010 OUTBREAK IN GREECE: A MILITARY HOSPITAL EXPERIENCE
Authors: MAJ Georgios SFIKAS, MD, LTC A. PECHLIVANIDIS, LT K.
CHARALAMBOPOULOS, MAJ Ch MELLIDIS, COL M IOSIFIDIS
Institution:1ST Department of Internal Medicine, 424 General Military Hospital of
Thressaloniki,
GREECE
Introduction: The West Nile virus is spread to humans via infected mosquitoes and
causes a disease which is primarily asymptomatic but may develop to febrile illness
and even severe meningitis or/and encephalitis.
Purpose: We present our experience concerning the identification and treatment of
West Nile Virus-infected patients during the summer 2010 outbreak in Greece.
Material and methods: We conducted a retrospective study of sixty (60) cases of
patients that were admitted in our department during the trimester June-July 2010. All
of these patients presented with fever, headache and macular rash of the trunk and
extremities. Their laboratory findings were indicative of a viral infection.Out of these
patients, eight (8) (13,33%) presented also with symptoms compatible with infection of
the central nervous system (photophobia, neck stiffness, deterioration of mental
status). The diagnosis was confirmed with lumbar puncture. The serologic and
cerebrospinal fluid analysis was proven positive for West Nile virus infection (IgM and
IgG antibodies). Out of these patients, six (6) (75%) were over 70 years old. Five (5)
(62,5%) received only supportive treatment and three (3) (37,5%) presented with
severe respiratory distress and had to be admitted in ICU and placed under
mechanical ventilation.
Results: Six (6) patients (75%) fully recovered, one (1) patient (12,5%) had permanent
neurologic damage and one (1) patient (12,5%) presented with futher complications
and died.
Conclusions: The West Nile virus disease is adequately treated with supportive
measures in most patients. However, it may present as a severe infection of the
central nervous system, especially in older patients and in these cases, mechanical
ventilation may be crucial for their survival.
Correspondence:
MAJ Georgios SFIKAS, MD
+30 6945397407
+30 2310618568
+30 2310381000,
geosfik@yahoo.com

OP008

BIOTERRORISM AS AN ACTUAL PROBLEM

Authors: Sran LAZI, Sonja RADAKOVI*, Radovan EKANAC, Milena KRSTI,
Novica STAJKOVI, Slavica RAEN*, Jovan MLADENOVI, Jadranin ELJKO
Institution: Military Medical Academy, Department of Preventive Medicine, Institute of
Epidemiology, *Institute of Hygiene,
SERBIA
Biological weapons (BW) are biological agents - pathogenic microorganisms or toxins
produced by living organisms that can be used against people, animals, or plants. Of
the three weapons of mass destruction (WMD), BW are undoubtedly the most
dangerous, because they can cause mass destruction with a single use, they are easy
to produce, an ordinary laboratory is required, they can be created by any skilled

2ndJUNE2011

technician, they are not resource intensive, and most ingredients for their production
are easily available. Therefore, BW are considered as the poor man's atomic bomb.
These unique properties enhance their attractiveness to individuals or groups wanting
to inflict high morbidity and mortality on the human population. This is termed
bioterrorism, what assume the threat or use of biological agents by individuals or
groups motivated by political, religious, ecological, or other ideological objectives
without reference to its moral or political justice. The threat that biological agents will
also be used on both military forces and civilian populations is now more likely than
ever. Just threats of possible use of BW can cause considerable social disruption.
Psychological impact should not be underestimated.
The application of science and technology to living organisms for the production of
knowledge, goods and services, parallel advances in computational techniques and
the widespread use of computer networks have contributed to the exponential growth
of biotechnology and bioinformatics.This open new possibilities for biological warfare,
and therefore, these technological developments have grave implications for peace
and security. Thus, biotechnology has a dual use capability: it may be applied in
many beneficial ways or it may be employed to develop microbes capable to cause a
great harm.
Since we live in a time in which the basic knowledge needed to develop BW is more
widely available than ever before, the importance of preventing bioterrorism or
biocrime is more acute then ever. Preparedness for the deliberate use of a biological
agent requires collaboration of the intelligence community, law enforcement agencies,
military, public health professionals, and the biomedical sciences. The main steps in
preparing for biological attack include: enhance epidemiologic capacity to detect and
respond to biological attacks, supply diagnostic reagents to state and local public
health agencies, support the development of diagnostic tests, establish molecular
surveillance for microbial strains including unusual or drug resistant strains, stockpile
appropriate vaccines and drugs, enhance bioterrorism-related education and training
for health-care professionals, establish communication programs to ensure delivery of
accurate information, prepare educational materials that will inform and reassure the
public during and after a biological attack.
At the end, a sentence of eminent BW expert, prof. Barry Kellman, that brilliantly
depicts the responsibility of scientists, should be cited:
Among crimes, the most despicable is treason; among crimes against humanity, the
most despicable is species treason giving aid to the enemy in the perpetual war
between humanity and microbes.
OP009

MILITARY MEDICAL CAPABILITIES FOR TROOP PROTECTION AGAINST THE

BIOLOGICAL ATTACK
Authors: Colonel Cristian RADUT, MD, Major General (ret.) prof. Victor A. VOICU,
PhD, colonel (ret.) Viorel ORDEANU, PhD
Institution:*Medical Military Scientific Research Center, Bucharest,
ROMANIA
Keywords: biological attack, bioterrorism, CBRN medical protection
The Romanian military medical system has specific capabilities to be used in the
emergency situations. These capabilities are included into the following military
medical structures: Medical Military Scientific Research Center, Preventive Medicine
Center and specialized medical treatment facilities. In the epidemiological context and,
on request, the mobile intervention teams are fitted up with a minimum means of

10

2NDJUNE2011

diagnosis in the field and with specific materials for collection and transport of
laboratory samples to the fixed laboratories. The teams also collaborate in real-time
with civilian professionals.
The samples collected from the site are processed into the biosafety level P2+
laboratory (operational since 2001) and used for the identification of biological agents,
including the expertise of objects suspected of being infected. Since 2007 we started
building a highly biosafety secure level 4 (BSL4) laboratory needed for the in vitro
diagnostic and biologycal agents research and a complementary BSL2 bio base for the
in vivo diagnostic. These objectives are in progress, being unique at national level.
The laboratory equipments are used for detection and identification of biological
agents and for scientific research and provide necessary information for the medical
protection of troops in case of using of biological weapons or terrorist attacks.
In particular epidemiological situations (epidemics, floods, earthquakes), the
specialists from the Preventive Medicine Center perform specific immunization of
military personnel and conduct the epidemiological investigations in the case of an
outbreak of infectious diseases.
Medical facilities provide specialized treatment in poisoning, exposure to radiations
and infectious diseases (CBRN), including treatment for casualities as a result of
others emergency situations (natural disasters, industrial accidents etc).
OP010

PREVENTIVE MEDICINE PRACTICES IN PEACE SUPPORT OPERATIONS

Authors: CPT TOSUN Uur, MD
Institution: Gulhane Military Medical Academy, Dept. of Military Health Services,
Ankara,
TURKEY
Objective: In recent years, the demand for peace operations has grown significantly
and evolved from largely United Nations-led military monitoring teams on disputed
borders to enterprises that also engage the attention and resources of regional
organizations. Aim of this paper is to convey experience in preventive medicine
practices to inform the medical staff assigning to such peace support
operations.MATERIAL AND Method: Experiences of physicians deployed during the
first turn of United Nations Interim Forces in Lebanon (UNIFIL) Turkish Company are
interpreted in this paper.
Results: Personnel had medical examinations for abroad missions and Clostridium
tetani, Hepatitis A, Enteric Fewer immunization. Malaria chemoprophylaxis was a
persisted practice. At evening training, personnel were given lectures about health
issues. For psycho-social support, phone and wireless internet was established,
awarded sports activities, local site seeing tours and cookouts were conducted. Waste
transfer was contracted with a local firm. Potable water was transported from an
approved source for general use and bottled water -3lt/day/soldier- for drinking. Main
noise sources were relocated far from the accommodation facilities. Accommodation
tents were having acceptable standards. Field-expedient showers were settled. Cat
holes and field latrines and mobile, hard cover toilets were used respectively and the
sewage water disposal was contracted with a local firm. Personnel dealing with food
were examined periodically and stool samples were analyzed in Indian Level 1+
treatment facility.
Conclusion: These operations are really valuable opportunities for health care
providers to cooperate with international colleagues and learn preventive medicine
practices of other nations.

11

2ndJUNE2011

Correspondence:
Gulhane Askeri Tip Akademisi, Askeri Salk Hizmetleri AD, Etlik 06018, Ankara,
TURKEY.
+ 90 312 304 3360 (w)
+ 90 312 304 2700 (w)
+ 90 555 458 2859
e-mail: tosun2002@hotmail.com
11:00-12:30

ORAL PRESENTATIONS II
(NORWEGIAN HALL)

Chairmen: COL Assoc. Prof. Sait SIRIN, MD (Turkey)

COL Assoc. Prof. Tihomir Nikolov EFTIMOV, MD (Bulgaria)
OP011

WHO IS THE FIRST SURGEON IN THE MILITARY MEDICAL HISTORY?

Author(s):2LT Maria-Angeliki GKINI, MD, CPT Thomas LOUKAS, MD, COL Dimitrios
KASSIMOS, MD, MSc
Institution: 401 General Army Hospital, Athens,
GREECE
Purpose: Purpose of this study is to find out from the history who was the first medical
officer and surgeon.
Material and Methods: Literature review searching articles from Medline and Pubmed
databases with no publishing-time restriction, using keywords Machaon and first
medical officer.
Results: We identified 12 articles matching our search. Machaon is first mentioned in
Greek mythology as son of Asclepius, god of Medicine. Leaving mythology behind,
Homer, in the Iliad, describes Machaon practicing medicine in the battlefield of the
Trojan War 3,000 years ago. Machaon along with his brother Podalirius, were chief
medical officers of Greek forces, who set out from Thessaly to the siege of Troy. Apart
from doughty fighters, they were doctors- Machaon was surgeon while Podalirius was
a physician. Homer refers to Machaon as healer of all diseases. Unfortunately, there
is little record of Machaon's personal work. It included extracting arrows and
spearheads, checking haemorrhage, applying soothing medications to wounded
surfaces and treating abdominal wounds and wounds of extremities. Homer does not
refer to Machaon's death, which is a point of conflict among historians. Apollodorus
claimed that Machaon was killed by Panthesilia, a woman warrior. However, according
to the most prevalent theory, Machaon was killed by Eurypylus. His body was burned
by Greeks and his bones were buried in Gerinia, in Messinia.
Conclusion: Machaon appears to be the first military surgeon.
Correspondence:
2LT Maria-Angeliki GKINI, MD
0030 6939195772,
0030 2108040152,
gkinimargo@yahoo.com

12

2NDJUNE2011

OP012

PLASTIC SURGERY IN THE TREATMENT OF TISSUE DEFECTS IN DISASTER

SITUATIONS
Author(s):Col. Marijan NOVAKOVIC MD, PhD, Lt.Col. Boban DJORDJEVIC MD,
PhD, Col. Jefta KOZARSKI MD. PhD, Sasa MILICEVIC MD, Msc
Institution: Clinic for plastic surgery and burns, Military Medical Academy,Belgrade,
SERBIA
Mass civilian casualties are most often followed by extensive tissue destructions.
Tissue defects usually imply the need for plastic reconstruction. During march 24th
august 1st 1999 period 165 wounded with soft tissue defects were treated at our clinic.
Based of estimation of general condition of wounded and presence of other injuries,
blood circulation status, state of bones, muscle and nerve damage, size and
localization of defect, wounding time expired as well as extent of devitalized tissue
excision selection of reconstructive method was made. We performed primary wound
closure in 12 patients, (5,43% cases), additional wound care (36, 16,29%), secundary
suture (31, 14,03%), skin grafts (80, 36,19%) and skin flaps (58, 26,24%). We applied
almost all types of flaps: local flaps in 25 patients (43,10% cases), fasciocutaneous
flaps (10, 17,24%), reversibile flaps (4, 6,90%), myocutaneous flaps (2, 3,45%),
muscle flaps (3, 5,17%), cross leg flap (1, 1,72%), direct inguinal flap (1, 1,72%),
microvascular flaps (12, 20,69%). The correct primary excision enables appropriate
delayed covering, and the correct covering provides correct reconstruction of deep
structures. The multidisciplinary surgical work is often essential. Plastic and
reconstructive surgery is very important in surgical treatment of mass civilian
casualties with tissue defects in the stage of primary menagement as well as in the
stage of reconstructive surgery.

OP013

BASAL MENINGIOMA SURGERY NEW POSSIBILITIES

Author(s):Lt. Coll. T. EFTIMOV1, LT. I. TODOROV1, M. LILOV2, T. SHAMOV1, I.
HADZHIANGELOV1, I. STOEV1, P. KUTIN1, P. SIMEONOV1, V. PRANDJEV1, M.
MARINOV1, A. PETKOV1
Institution:
1Department of Neurosurgery
2Department of Image Diagnostics,
MILITARY MEDICAL ACADEMY Sofia,
BULGARIA
AIM: To analyze the clinical application of preoperative endovascular embolization and
intraoperative neurosonography in the basal meningioma surgery.
Material And Method: One hundred and twenty five patients with meningiomas of the
cranial base underwent surgery in our department for a 10 years period. The mean
age was 5512.21 years, and the male/female ratio approximately 1:2 (42 men and
83 women). According to the location of the tumor, the cases were distributed as
follows: anterior cranial fossa 30 /24%/; middle cranial fossa 58 /46.4%/ and
posterior cranial fossa 37 /29.6%/. Preoperative endovascular embolization was
performed on 13 patients, at least 3 days prior to surgery. We used Sonowand 1.2 and
Sonowand Invite stations to acquire ultrasonic images during surgery of 18 patients, 7
of which after embolization. All available medical data was analyzed in terms of
intraoperative blood loss, surgery duration, extent of resection and early postoperative
complications.
Results: The preoperative embolization of meningiomas considerably reduces the

13

2ndJUNE2011

blood loss during surgery and contributes to more radical tumor resection. The
intraoperative neurosonography finely depicts the tumor and the surrounding neural
and vascular structures and aids the orientation in case of altered anatomy. A
decrease in the neurological and surgical complications, by 3.1 % and by 2.7%
respectively, was present in the group with embolization/neurosonography performed,
compared to the control group. In the same time no significant change in the surgery
duration and the somatic complications was registered when these methods were
applied.
Conclusions: The precise microsurgical technique remains the key factor in the
surgery of basal meningiomas. The preoperative embolization and the intraoperative
neurosonography are useful tools in the surgeons armamentarium in order to reduce
the neurologic and surgical complications and to achieve radical resection.
Key words: basal meningioma, surgery, endovascular embolization, intraoperative
ultrasound.
OP014

ANTERIOR CERVICOTHORACIC APPROACH OF C7-T1 SPINE

Author(s):
*Maj. Adrian CIUCHE, *Col. Claudiu NISTOR, **Lt. Col. Emil POPA,
**Maj. Cristian NASTASE, *Capt. Dragos MARIN, *Lt. Daniel PANTILE,
***Col. Laurentiu ENE, **Col. Marian MITRICA
Institution:
* Department of Thoracic Surgery, Emergency University Military Central Hospital Dr.
Carol Davila, Bucharest, ROMANIA
** Department of Neurosurgery, Emergency University Military Central Hospital Dr.
Carol Davila, Bucharest, ROMANIA
*** Department of Anesthesiology, Emergency University Military Central Hospital Dr.
Carol Davila, Bucharest,
ROMANIA
Objectives: The paper presents two cases of traumatic injury with compression
fracture of C7-T1 spine. In first case, a sixty years old male patient was admitted in the
neurosurgical department with severe left forearm pain after cervico-thoracic trauma
(car accident). In second case, a 20 years old female was admitted in the same
department with paraplegia after a car accident. The authors reveal the surgical
modality of approaching of these cases through very illustrative preoperative,
intraoperative and postoperative images.
Methods: Cervicothoracic CT scan and RM reveals the existence of compression
fracture T1 spine in the first case and C7 in the second case. In both cases, the
corporeal fragments of spine caused compression of the cervicothoracic spinal cord.
The surgery procedure was removing T1 versus C7 vertebral body and discectomy
above and below the involved vertebra. Reconstruction was performing in the first
case with autogenous iliac bone graft and anteriorly fixation by using locking plate and
reconstruction with titan implant in the second one. Anterior surgical exposure of C7T1 spine was performed through combined right oblique neck and upper sternotomy
incision.
Results: Has been achieved the complete removal of the herniated corporeal
fragments and very good reconstruction of spine with decompression of the spinal
cord. Postoperative clinical results of these anterior spinal procedures were
satisfactory with substantial pain relief in the first case and ameliorated motor and
sensitive neurologic defects in the second case.

14

2NDJUNE2011

Conclusions: Anterior surgical procedures of C7-T1 spine has represented a milestone

both for the neurosurgeon (difficult resection and reconstruction beyond great
mediastinal vessels), and for thoracic surgeon (cervicothoracic dissection with
mobilization of the right thyroidian lobe without laryngeal nerve injury and protecting
innominate artery).
OP015

HYBRID TREATMENT IN MULTILEVEL ARTERIAL DISEASE IN PATIENTS WITH

CRITICAL ISCHEMIA
Author(s): Col. Dr. I. DROC, Mr. Dr. DUMITRASCU M, Col. Dr. MURGU V., Francisca
CALINESCU
Institution: Army's Center for Cardiovascular Diseases, Bucharest,
ROMANIA
Objective: There has been an explosion in endovascular technology and a revolution
in revascularization patterns for limb salvage. Hybrid reconstructions have been
increasingly used for multilevel revascularization procedures as surgeons have
embraced endovascular interventions. Our aim is to underline the usefulness and
appropriate application of different therapeutic endovascular options applied in addition
to classical open surgery methods for critical limb ischemia.
Method: Between January 2008 and May 2010, we operated on 197 patients (femuropopliteo-tibial revascularization) of which 71% (140 patients) underwent classic open
surgical intervention, 21% (41 patients) endovascular intervention and 8% (15
patients) hybrid treatment for critical limb ischemia with multilevel lesions. For belowknee reconstructions we used the great saphenous vein or prosthesis with Miller cuff
and for above-knee we used precoagulated dacron prostheses or PTFE.The follow-up
was between 1 and 24 months with an average of 12 months.
Results: Technical and haemodynamic success rates were 95% for the combined
treatment. The perioperative mortality rate was 2%. The primary patency rates were
96% in the first month, 92% at 6 months and 86% at 12 months for the combined
endovascular and open surgery treatment.
Conclusion: Endovascular treatment, when it is feasible can be regarded as firstchoice treatment for patients with multiple lesions, or for those who present high risk
for surgery. Hybrid procedures provide an effective treatment management of selected
patients with multilevel lower extremity arterial disease. The extent of the disease,
diabetes and dyslipidaemia are associated with worse outcome.

OP016

A COMPLEX RECONSTRUCTION FOR MALIGNANT STERNAL TUMORS:

THORATEX MESH , STRATOS SYSTEM AND KRYPTONITE BONE CEMENT
Author(s):*Col. Claudiu NISTOR, *Maj. Adrian CIUCHE, **Maj. Augustin TUDOSE,
*Capt. Dragos MARIN, *Lt. Daniel PANTILE
Institution: * Department of Thoracic Surgery, ROMANIA
** Department of Anesthesiology, ROMANIA
ROMANIA
Objectives: The paper presents 2 cases admitted in the thoracic surgery department
with malignant sternal tumors: a female with manubrial secondary tumor after breast
cancer and a male with a primary chondrosarcoma of the sternal body.
The authors reveal the modality of sternal resection and reconstruction in approaching
of these cases through very illustrative preoperative, intraoperative and postoperative
images.

15

2ndJUNE2011

Methods: In both cases, after radical resection of the tumors, the rigid reinforcement of
the sternum was achieved with thoratex mesh reinforced with STRATOS system and
Kryptonite bone cement. The soft reconstruction was made with widely mobilized
pectoralis major muscle flaps (humeralis insertion transected) shifted to the midline for
loose closure.
Results: The complete removal of the tumors and very good chest wall stability was
achieved in both cases. In the second case, the kryptonite bone cement mixed with
osteochondral fragments is useful both for the rigid sternal reconstruction and for
creation of a neosternum (porous structure was favorable for osseointegration and
bone regeneration).
Conclusions: Large sternal defects after resection for malignant sternal tumors are
safely reconstructed with this complex surgical system combined with pectoral major
muscular flaps.
OP017

GULHANE MILITARY MEDICAL ACADEMY EXPERIENCE IN STEREOTACTIC

RADIOSURGERY
Author(s):COL Kaan OYSUL , MD1, COL Sait SIRIN , MD2, COL Serdar SURENKOK
, MD1, CPT Ferrat DINCOGLAN , MD1, CPT Omer SAGER , MD1, Bahar DIRICAN ,
PhD1, COL Murat BEYZADEOGLU, MD1
Institution: 1Gulhane Military Medical Academy, Department of Radiation Oncology,
Ankara, TURKEY
2Gulhane Military Medical Academy, Department of Neurosurgery, Ankara,
TURKEY
Objective: Stereotactic Radiosurgery (SRS) is being increasingly used for the
treatment of both benign and malignant disorders such as tumors, vascular
abnormalities and functional disorders. The aim of this report is to describe the
experience using LINAC-based SRS technology at our center and examining the
efficacy and safety of radiosurgery.
Methods: Patients treated between 1998 and 2010 for intracranial benign and
malignant pathologies were retrospectively reviewed to determine the treatment
dosimetric parameters, response and survival of the treated patients.
Results: 423 patients were treated with SRS. Median age for all patients was 45 (979). 139 patients (33%) had malignant tumors, 191 patients (45%) had benign tumors,
88 patients (21%) had vascular malformations, and 5 patients (1%) had functional
disorders. Of the 139 patients with malignant tumors, 117 patients had brain
metastasis, 19 patients had recurrent glioblastoma, and 3 patients had other malignant
tumors. Of the 191 patients with benign tumors, 57 patients had pituitary adenomas,
53 patients had meningiomas, 52 patients had acoustic neuromas, 13 patients had
craniopharyngiomas, 16 patients had other benign tumors.
SRS resulted in functional and clinical improvement in most of the treated patients
either by improving local control, providing decompression, obliteration of pathologic
vessels, or preventing hemorrhages. Of the 88 patients with vascular malformations,
51 patients had arteriovenous malformations(AVM), and 37 patients had cavernomas.
In addition to these 418 patients aforementioned, functional disorders including
obsessive-compulsive disorder in 2 patients and trigeminal neuralgia in 3 patients were
treated using SRS.
Conclusion: SRS offers an excellent treatment approach for many intracranial
benign/malignant lesions located especially in eloquent brain sites leading to improved
survival and quality of life.

16

2NDJUNE2011

OP018

Correspondence:
COL Kaan OYSUL MD
Glhane Military Medical Academy, Department of Radiation Oncology, Ankara
TURKEY
GIST
ANATOMICAL
LOCALIZATION
HISTOMORPHOLOGY,
IMMUNOPHENOTYPING AND PROGNOSIS
Author(s): DRANDARSKA I. MD, MIHOVA A. MD,PhD, CHRISTOSKOVA R. MD,
FAKIROVA A. MD, NAKOV, E. MD KATROV E. MD, MURDJEV R. Col. KATZAROV
K. MD, PhD*, VLADOV N. MD, PhD**.
Institution:
Military Medical Academy, Department of Pathology, Sofia, BULGARIA
* Military Medical Academy, Department of Gastroenterology and Hepatology, Sofia,
BULGARIA
** Military Medical Academy, Department of Hepatopancreatic and Transplant surgery,
Sofia,
BULGARIA
Objective: The purpose of this paper is to analyze anatomical localization,
histomorphology, immunophenotyping and prognosis of Gastrointestinal stromal
tumors /GIST/.
Materails & Metods: Retrospectively are analyzed biopsies of patients with GIST
diagnosed and immunophenotyped in the Department of Pathology, Military Medical
Academy during the period 2006-2010. The patients were divided by gender, age,
anatomical localization, histomorphological appearing and risk of biological
aggressiveness.Their immunophenotyping is commented also.
Results: During the study the median age of the patients with GIST is 60 years. The
male sex excels female. The most common localization of the GIST is gastrointestinal
tract with preference affection of stomach, followed by small bowel and extragastric
localization.
The most common type is spindle cell histological type and rarely mixed. We
diagnosed one rare case of GIST with nests structure similar to paraganglioma.All
GIST express CD 117 and CD 34. Prevalent GIST were with high and intermediate
risk of aggressive biological behavior.
Conclusion: The studied series of GIST patients showed no differences in well-known
epidemiological data. All diagnosed GIST express CD 117 and CD 34. We didnt
diagnose the epitheloid cell GIST and didnt diagnose the negative CD117 GIST also.
In the study is included one case of GIST with nests structure similar to paraganglioma
primary localized in omentum.

OP019

MAY SCINTIGRAPHY EXPLAIN PROLONGED POSTOPERATIVE NECK PAIN?

Author(s):CPT Serdar KAYA, MD1, CPT Ahmet ETNKAL, MD2, COL Sait RN, MD1
Institution: 1Gulhane Military Medical Academy, Dept. of Neurosurgery, Ankara,
2Kasmpaa Military Hospital, Dept. of Neurosurgery, Istanbul, TURKEY.
TURKEY
Objective: Anterior cervical fusion procedures are of the most commonly performed
spinal operations. But prolonged neck pain stands as a common postoperative
problem. Present study questions these so-call fusions as the perdue reason of
discomfort
Material and Method: Nine cases operated for degenerative disc disease on single

17

2ndJUNE2011

level but suffering postoperative prolonged neck pain were involved in the study. All
cases underwent 99mTc-hydroxymethylene diphosphonate (HMDP) bone SPECT later
than postoperative twelfth month. Radiographic fusion, scintigraphic activity and
clinical status were evaluated.
Results: Of all nine cases one case showed type 1A fusion, three cases showed type
1B fusion and five cases showed type 2A fusion. Scintigraphic evaluation revealed
compatible activity levels with radiological fusion grading.
Conclusion: Increased and prolonged uptake of nuclear agent should cause a
suspicion on so-called fusion, proven by radiology. These cases may need advanced
stabilization of the cervical spine.
Correspondence :
Serdar KAYA, Gulhane Askeri Tp Akademisi, Beyin ve Sinir Cerrahisi AD, Etlik
06018, Ankara, TURKEY.
+ 90 312 304 5323 (w)
+ 90 312 304 5300 (w)
+ 90 555 446 5008
e-mail: drserdarkaya@gmail.com
OP020

THE MANAGEMENT OF BURNS IN MASS CIVILIAN DISASTERS

Author(s):Lt.Col. Boban DJORDJEVIC MD. PhD, Col. Marijan NOVAKOVIC MD.
PhD, Col. Jefta KOZARSKI MD. PhD, Sasa MILICEVIC MD. Msc
Institution: Clinic for plastic surgery and burns,Military Medical Academy, Belgrade,
SERBIA
Aim: Despite continued progress recently made in the treatment of massively burned
patients, mortality and morbidity rates are still quite high. Implementation of preventive
strategies has still not managed to significantly alter the dramatic epidemiological
picture of burn patients.
Material and methods: The retrospective analyses encompassed 200 patients treated
in our Clinic during five-year period. The study group included 160 male (80%) and 40
female patients (20%). In eight burned patients, it was impossible to cover electrical
burns neither with skin grafts nor with local flaps due to tissue destruction. Delayed or
secondary microvascular flap procedure was performed to cover those tissue defects.
Results: Based on the etiologic factor, the most common causes were found to be
flame in 42%, then boiling water in 26%, electricity in 10%, and chemical substances
in 7 %, The most often localization included lower extremities 20%, hands 16% and
upper extremities 15%, which were treated conservatively in 90 (45%), and surgically
in 110 (55%) cases. Defects of the whole half of the face were treated with the free
scapular flaps. Latissimus dorsi musculocutaneous flaps were the choice of treatment
for lower leg defects in three cases and free scapular flap in one case. The wound
swab was positive in 94% of cases. Hemo cultures were positive in 13% of cases,
urine cultures in 8%. Complications developed in 45 (22.5%) cases. 188 of 200
patients were cured while the other 12 died.
Conclusion: The morbidity and mortality rate, the prognosis and treatment outcome
proved to be directly associated with the burned surface area, deepness of the burned
skin, the patients age and his/her general health condition, kind of injury,
complications and other factors as well. Application of free flaps in the early phase of
covering the exposed deep structures was indicated as a possibility in the treatment of
electrical burns. Due to the growing number of burn patients, we experienced great
difficulties in providing timely diagnosis and prompt treatment for such patients.

18

2NDJUNE2011

OP021

A CERVICOMEDIASTINAL HUGE GOITER

Author(s):*Col. Claudiu NISTOR, *Maj. Adrian CIUCHE, *Capt. Dragos MARIN, *Lt.
Daniel PANTILE, **Maj. Augustin TUDOSE, *** Cristina SPIROIU, **** Cristina SANDU
Institution:
* Department of Thoracic Surgery, Emergency University Military Central Hospital
Dr. Carol Davila, Bucharest, ROMANIA
** Department of Anesthesiology, Emergency University Military Central Hospital Dr.
Carol Davila, Bucharest, ROMANIA
*** Department of Endocrinology, Emergency University Military Central Hospital Dr.
Carol Davila, Bucharest, ROMANIA
**** Department of Radiology, Emergency University Military Central Hospital Dr.
Carol Davila, Bucharest, ROMANIA
ROMANIA
Key words : cervicothoracic goiter, cervicosternotomy, thiroidectomy
Objectives: The paper presents the case of a sixty six years old obese, hypertensive
female admitted in the Thoracic Surgery Department of the Emergency University
Military Central Hospital with respiratory distress ( inspiratory dispnea, stridor )
progressively aggravated in the last month.
Methods: Cervicothoracic CT scan reveals the existence of a cervicomediastinal huge
goiter which developed mostly intrathoracic ( 2/3 of the goiter). It caused the moving to
the right side and the compression of the trachea which caliber is reduce in 1/3 of the
normal diameter. The surgery procedure was total thiroidectomy involved bipolar
approach through partial upper cervicosternotomy.
Results: Has been achieved the complete removal of the goiter and the decompresion
of the trachea. Postoperative results were very satisfactory with absence of the
respiratory distress. Histopathological examination revealed the multinodular goiter
with hyperplasia epithelium with intense hyperfunctional pattern.
Conclusions: The surgery procedure has represented a milestone both for the
anesthesiologist difficult intubation, with a thin tracheal tube in the absence of the jet
ventilation technology and for the surgeon, while the resection out of the visceral
mediastinum was difficult because of huge proportions and close relations with erector
spinae muscles, vertebral column, esophagus ( posterior ) and trachea ( anterior ).

OP022

BALLOON COMPRESSION TECHNIQUE IN THE MANAGEMENT OF PERSISTANT

INTRAOPERATIVE INTRATUMORAL HEMORRHAGE RESULTING FROM
STEREOTACTIC BIOPSY: TECHNICAL NOTE
Author(s):MAJ SIMSEK Hakan MD1, COL KUTLAY Murat MD2, COL COLAK Ahmet
MD3, COL DEMIRCAN Mehmet N MD3
Institution:
1Corlu Military Hospital, Dept. of Neurosurgery, Corlu, Tekirdag TURKEY.
2Gulhane Military Medical Academy, Dept. of Neurosurgery, Ankara TURKEY.
3Glhane Military Medical Academy, Haydarpasa Training Hospital, Dept. of
Neurosurgery, Istanbul,
TURKEY
Objective: Despite its proven safety, intraoperative intratumoral hemorrhage is an
uncommon but serious complication of stereotactic brain biopsy. We describe the
balloon compression technique that was used in the management of persistent

19

2ndJUNE2011

intraoperative bleeding that could not be arrested by conventional methods of

hemostasis.
Material and Method: Between January 2001 and March 2009, of 184 image-guided
stereotactic brain biopsy procedures, intraoperative intratumoral bleeding occurred in
12 cases (6.5%). In 3 of these 12 cases (1.6%), intraoperative hemorrhage was
persistent. In these cases, after adjustment of the optimum length, a balloon catheter
(Fogarty) was inserted through the cannula and inflated with a contrast agent. We
observed the patient for 10 minutes by checking the position of the balloon with regular
intervals, using a frozen C-arm fluoroscope to determine any significant changes in its
initial position due to possible enlargement of the hematoma. The patient was also
closely observed during this time.
Results: Hemostasis was obtained immediately after the inflation of the balloon in all 3
cases. The patients tolerated the procedure well. During and after the procedure no
complications related to the technique were observed. None of the cases required
craniotomy for evacuation of the hematoma and to secure hemostasis.
Conclusion: Our preliminary results indicate that the balloon compression technique
seems to be a safe, rapid, and effective stereotactic practice in the management of the
persistent intraoperative intratumoral bleeding that could not be arrested by standard,
conventional hemostatic methods.
Key Words: Balloon compression, Intraoperative hemorrhage, Stereotactic brain
biopsy
Correspondance
orlu Asker Hastanesi, Beyin ve Sinir Cerrahisi Servisi, orlu, Tekirda TURKEY.
Tel:
+ 90 282 651 10 51
Fax: + 90 282 652 18 46
GSM: + 90 533 388 40 87
e-mail: drhakansimsek@hotmail.com
OP023

GALLBLADDER STRANGULATION WITHIN A RECURRENT INCISIONAL

HERNIA(AFTER GUNSHOT WOUND): A UNIQUE CAUSE OF ACUTE
CHOLECYSTITIS
Author(s):A.I. POPENTIU*, C. WEBER-LAUER **, D. S. KAUVAR***, I. BARB*, D.
SABAU****
Institution:
* Department of Surgery, Emergency Military Hospital Sibiu, Romania (115th Combat
Support Hospital Baghdad, IRAQ)
** Department of Surgery ,Bayne Jones Army community Hospitall, Fort Polk, LA
(115th Combat Support Hospital Baghdad, IRAQ)
*** University of Utah School of Medicine and Uniformed Services University of the Health
Sciences Departments of Surgery (115th Combat Support Hospital Baghdad, IRAQ)
**** Department of Surgery (Prof), Victor Papilian Faculty of Medicine, Sibiu,
ROMANIA
We present a report of a unique surgical entity: acute cholecystitis resulting from
strangulation of the gallbladder within a recurrent right upper quadrant incisional
hernia. A previously healthy 39 year-old male patient presented to our emergency
department with abdominal pain, nausea, vomiting, and a tender mass in the right
upper quadrant of the abdomen, where an incisional hernia was palpable. He had a
history of a gunshot wound to the right upper quadrant and multiple operations, to
include mesh repair of an incisional hernia in that area. Abdominal computed

20

2NDJUNE2011

tomography demonstrated an acutely inflamed gallbladder within the recurrent hernia.

Open cholecystectomy and primary hernia repair were performed. Intraoperatively, the
gallbladder was noted to be strangulated within the hernia. The patient recovered
uneventfully and no cholelithiasis was noted on gross examination of the gallbladder.
Since there was no obstruction, and the intra-operative findings demonstrated the
herniated gallbladder through the abdominall wall hernia, we can conclude that the
mechanism involved in our case was the strangulation.
There were only two previous cases reported in the literature to describe a gallbladder
strangulation within primary incisional hernia . This is the first case ever reported
involving a recurrent incisional hernia.
Adrian Popentiu, MD
Department of Surgery, Emergency Military Hospital
B-dul Victoriei 44-46 Sibiu, Romania
Tel. +40.742.074.094
e-mail: adipopentiu@yahoo.com
11:00-12:30

BMMC STUDENT MEETING PART I

(THE PERFORMANCE HALL)

Chairmen: COL Lecturer Dan CORNECI, MD, PhD (ROMANIA)

COL Kaan OYSUL, MD, (TURKEY)
SM001

USEFUL TEST FOR EMERGENGY DEPARTMENT; DOES YOUR PATIENT HAVE

TETANUS IMMUNITY?
Author(s): CADET CETINER Safiye Rumeysa, Intern1, CAPT AYDIN Guclu MD2,
CAPT EROGLU Murat MD2
Institution:
1 Gulhane Military Medical Academy, Faculty of Medicine, Ankara, TURKEY
2 Gulhane Military Medical Academy, Department of Emergency Medicine, Ankara,
TURKEY
Objective: Tetanus infection is rare but a life threatening condition. Many patients with
small or severe injury apply to the emergency services in daily practise. Tetanus
prophylaxis should be considered. Some patients cannot give an appropriate
vaccination history. Also, if the physician cannot remember the proper prophylaxis
algorithm, he or she may simply administer both vaccine and immunoglobulin.
Inappropriate administration of these treatments may increase the costs and may
cause adverse effects such as Arthus reactions or Gulliain-Barr Syndrome. The aim
of this study is to determine the effectiveness of a tetanus stick test.
Material and method: A questionnaire was applied to 30 doctors. The study was
performed in a university hospital, GATA, Ankara, Turkey. SPSS v.15.0 Packet
Program was used for statistical analysis.
Result: 23 participants (76%) have difficulties to remember of tetanus prophylaxis
algorithm. 93% of doctors complain that their patients can not give the proper history of
tetanus vaccination status. Number of the doctors who have some difficulties while
determining of the injury if it is dirty or clean was 13 (44%). The tests which determines
tetanus immunity status cannot be reached by the doctors who work in the emergency
department. 26 doctors (86%) think that the test mentioned above would be useful.
Conclusion: The tetanus infection is a severe problem in the developing countries. We
think that "the quick tetanus immunity stick test" is useful for the doctors who work at
21

2ndJUNE2011

emergency departments. It may reduce the cost and prevent the complications.
Correspondence:
Gulhane Askeri Tp Akademisi, Ogrenci Alay Komutanligi 1.Tabur 3.Boluk, Etlik 06018,
Ankara, TURKEY
Tel: +90 312 304 6246
GSM: +90 555 314 7611
e-mail: s.r.c-s.r.c@hotmail.com
SM002

EVALUATION OF AUTONOMIC RESPONSE BY BASAL AND AFTER-TRAUMATIC

VISUAL STIMULUS IN VETERANS WITH POST TRAUMATIC STRESS DISORDER
Authors:MAJ CELK Cemil MD1, CADET SICIM Huseyin, Intern2, 1LT BOLU Abdullah
MD1
Institutions: 1 Gulhane Military Medical Academy, Dept. of Military Psychology and
Combat Psychiatry Trauma Psychiatry Therapy and Rehabilitation Service Psychiatry,
Ankara, TURKEY
2Gulhane Military Medical Academy, Regimental Headquarters of Student, Ankara,
TURKEY
Objective: There are several studies dealing with the functions of the autonomous
system in PTSD pathogenesis. However, the number of studies about the variability of
the heart beat rate is relatively lower.The aim of this study was to investigate the
changing of pulse and tension in veterans with PTSD by basal and after-traumatic
visual stimulus measurements.
Material and method: In this study, basal and after-traumatic visual stimulus have been
studied on 40 veterans, who applied to GMMF Center of Military Psychology and
Combat Psychiatry Trauma Psychiatry Therapy and Rehabilitation Service and
diagnosed as PTSD according to the DSM-IV diagnostic criteria and 30 healthy
control. Pulse and blood pressure were measured.
Result: In the patient group with PTSD, pulse and tension measurements which shows
the sympathetic activity were increased after the selected traumatic video. In the
control group, pulse and tension measurements were decreased after the selected
traumatic video.That shows us the parasympathetic activity were increased.
Conclusion: In this study, in the patient group with PTSD, autonomic nerve system
activity was showed after-traumatic visual stimulus. The sympathetic activity was
dominant in the patient group. That is to say, the methods which show autonomic
nerve system activation are important to determine the changing in diagnosis and
medical treatment period of PTSD.
Correspondence :
Gulhane Askeri Tp Akademisi, Ogrenci Alay Komutanligi 1.Tabur 3.Boluk, Etlik 06018,
Ankara, TURKEY
Tel: +90 312 304 6246
GSM: +90 539 243 9484
Email: hsyn.scm@hotmail.com

22

2NDJUNE2011

SM003

MILITARY LIFE: PUTS YOU IN LINE OR ON LINE?

Author(s): 5th year Military Medical Student Dimitra ZAKRI 1, 2d LT Stamatios
PETOUSIS 2 MD, MAJ Pavlos NTAFOULIS, MD1
Institutions: 1. Military Medical Academy, Thessaloniki, GREECE.
71st Airmobile Brigade, GREECE
GREECE
Purpose: The evaluation of Internet use in a sample of military population and its
correlation with parameters relating to military life.
Material and methods: An anonymous questionnaire survey was carried out, based on
Youngs questionnaire about Internet addiction, certain aspects of military life and
features of Internet use and abuse. It was completed voluntarily by 825 individuals,
including students of the Military School of Combat Support Officers (MSCSO),
soldiers, professional soldiers and military officers. The statistical analysis was
processed through SPSS Chicago 17.0. Statistically significant difference was defined
at P<.05.
Results: The percentage of MSCSO students staying online more than originally
themselves expected is 44.1%. However, only 3.8% spend on the Internet over 5
hours daily. The tendency to use the Internet beyond the scheduled time was
significantly higher in subjects aged <20 years compared with subjects > 25 years
(P<.0001) and differed significantly by year of study (P<.0001). This overuse showed a
strong tendency to the field of studies (P=.06), with the lowest rate observed among
students of the Psychology department (25%). In both MSCSO students and soldiers,
the percentage of involvement with the Internet increased significantly since the entry
into the Armed Forces. The most common activities were music, movies and facebook
(P<.0001).
Conclusion: The rate of involvement with the Internet in the early years after ranking in
the army is notably high, but over time tends to decrease. Military life seems to play an
important role in this decline, whereas it is questionable whether it is involved in the
initial overuse.
Correspondence: 5th year St. Dimitra TZAKRI
tel.: +30 6974691970
e-mail: dimitzak@hotmail.com

SM004

GLYCEMIC CONTROL IN THE CRITICALLY ILL: FIRST DO NO HARM!

Authors: 2nd LT. T. CONSTANDACHE 1 Med.Stud.,
2nd LT. A. OLARU 2, M.D. Bucharest, ROMANIA
ROMANIA
Objectives: To study the impact of strict glycemic control on the critical ill patient.
Design: A review of current evidence supporting or refuting strict glycemic control in
the ICU.
Recent findings: Hyperglycemia in the ICU was considered until recently to be no more
than a bystander to the critical illness of the patient. Recent evidence overturned this
observation and linked hyperglycemia with increased morbidity and mortality in the
ICU. This prompted a new wave of research investigating how targeting euglycemia
would improve outcomes in the ICU. Initially, the 2001 Lueven study in a surgical ICU
showed that the use of intensive insulin therapy to maintain blood glucose at a level
that did not exceed 110 mg/dL substantially reduced mortality in the ICU, in hospital
mortality and morbidity among critically ill patients. Five years later the same author

23

2ndJUNE2011

found no mortality benefit in a study of medical ICU patients. Since then more studies
(NICE-SUGAR, VISEP, Glucontrol studies) looking into the glycemic control theory
found a higher incidence of mortality and severe hypoglycemia in the strictly controlled
patients. These results uncover new dilemmas, that of the threshold for the initiation of
insulin therapy or that of the ideal intravenous insulin protocol. More studies are
needed to determine how the benefits of euglycemia in the critically ill can be obtained
with less adverse efects from the intensive insulin regimen and to determine the
specific population where intensive glycemic control would improve outcomes.
Keywords: glycemic control, critical illness, intensive insulin therapy, hyperglycemia,
ICU mortality, hypoglycemia
Author Affiliation: 1 Military Medical Institute, Faculty of Medicine, University of
Medicine and Pharmacy Carol Davila Bucharest, Romania
2 Dept. of Anaesthesiology & Intensive Care, University Emergency Military Central
Hospital Carol Davila Bucharest, Romania
Abbreviations: ICU, Intensive Care Unit;
SM005

ROMANIAN CURRICULA IN MILITARY MEDICINE AND THE ROLE OF STUDENTS

IN MILITARY MEDICINE PARTICIPATION IN MULTINATIONAL EXERCICES IN
ORDER TO IMPROVE THE TRAINING PROCESS
Authors: Col. Dragos CUZINO, MD, PhD(1,2), LTC. Bogdan SAVU, MD(1),
2nd Lt.Sergiu DODOIU, Medical Student(1,2),2nd Lt. Alexandra STOICA, Medical
Student(1,2)
Institution: (1) Military Medical Institute, Bucharest, Romania
(2) "Carol Davila" University of Medicine and Pharmacy Bucharest,Romania
ROMANIA

12:30-14:30 LUNCH (THE MILITARY CLUB AND TERRACE)

14:30-16:00

ORAL PRESENTATIONS III

(GOTHIC HALL)
Chaimen: COL Constantin GROZAVU, MD (ROMANIA)
LTC Ioannis KARELAS, MD (GREECE)

OP024

CONTROL OF THE INTRAOPERATIVE HEMORRHAGE IN LIVER SURGERY THE ROLE OF THE ANESTHESIOLOGIST
Authors: E. ODISSEEVA, D. ZIDAROVA, K. BOUTCHKOVA , N. PETROV, VLADOV N. *
Institutions:Department of Anaesthesiology, Reanimation and Critical Care Medicine
* Clinic of Liver, Pancreatic and Transplant Surgery
Military Medical Academy Sofia,
BULGARIA
Liver surgery has undergone extraordinary development over the past 60 years and
has become a daily and routine operation in many centers in the world. Advances in
surgery is due largely to the ability to control intraoperative hemorrhage, which has
made possible the modern medicine. Material and Methods: A retrospective and
prospective study of 130 patients operated at the Clinic of Liver, Pancreatic and
Transplant Surgery at the Military Medical Academy in July 2004 - December 2009.

24

2NDJUNE2011

The main criterion for inclusion in this study was large volume liver resection - more
than 3 segments.
Objective: As we define and analyze the factors responsible for intraoperative
hemorrhage, we set the goal to offer new opportunities for non surgical limitation and
reduction of intraoperative hemorrhage, using modern anesthetic methods and
knowledge.
Results: The dynamic of perioperative blood loss was directly related to anesthesia
protocol for fluid therapy and volume expansion. At the end of the period as a result
of the modified strategy, the use of plasma or blood cells was necessary only in
individual cases.
Good communication between the surgical and anesthetic team allows to implement a
multidisciplinary strategy to limit intraoperative blood loss.
OP025

MALIGNANT PLEURAL EFFUSIONS - MINIMAL INVASIVE APPROACH Authors:

*Maj. Adrian CIUCHE, *Col. Claudiu NISTOR, *Capt. D. MARIN, *Lt. Daniel PANTILE,
**Augustin TUDOSE
Institutions:Department of Thoracic Surgery, Emergency University Military Central
Hospital Dr. Carol Davila, Bucharest, ROMANIA.
** Department of Anesthesiology
ROMANIA
Key words: pleural malignant effusions, thoracoscopy, VATS
Objectives: The minimal invasive thoracic surgery (thoracoscopy and video-assisted
thoracic surgery through minithoracotomy), is a modern way for the approaching the
pleural and pericardial maladies and has many diagnostic and therapeutic advantages.
The authors share a part of their operative experience in pleural malignant effusions
that was operated through a minimal invasive approach.
Methods: 368 patients with pleural malignant effusions were operated from 1998 to
2008 through a minimal invasive approach with surgical thoracoscopic instruments
from the Karl- Storz Company.
o thoracoscopic approach: 363
o VATS approach through minithoracotomy: 5
Results: We present a comparision between preoperative imaging (Rx and CT) and
intraoperative thoracoscopic aspects and the postoperative results for the pleural
malignant effusions that was occurred in our study.
Conclusions: The minimal invasive thoracic surgery is the best approach in the pleural
effusions because of some advantages: lead to a correct diagnosis, an adequate
treatment, with a low mortality and morbidity (comparative with the classic thoracic
surgical approach).

OP026

CARDIO-SURGICAL TREATMENT IN ACUTE HEART FAILURE SECONDARY TO

THE DYSFUNCTIONS OF THE MECHANICAL CARDIAC PROTHESIS
Authors: Ass. Prof. Col. G. CRISTIAN, ; D SAVOIU; V MURGU; Andreea
TEODORESCU; D CRPACIU;
Institutions:The Army Emergency Clinical Center for Cardiovascular Diseases Dr.
Constantin Zamfir, Bucharest,
ROMANIA
The acute heart failure is one of the major cardio surgical emergencies, secondary to
the severe dysfunction of the valvular prothesis, which is associated to a high risk of

25

2ndJUNE2011

mortality, and the promptness of the diagnosis as well as of the treatment increases
potentially the recovery chances in such cases.
Our study focused on 26 patients registered at the Army Emergency Clinical Center for
Cardiovascular Diseases Dr Constantin Zamfir, during January 2009 January 2011
on suspicion of mechanical prothesis dysfunction in mitral and/or aortic position. The
diagnosis was confirmed for 16 of the patients, the others having a different etiology of
acute heart failure (major rhythm disorders-, myocarditis, acute coronary syndrome,
pericardial tamponade).
The trans-thoracic and especially the transesophageal echocardiography proved to be
the most efficient and prompt methods of imagistic diagnosis.
The protheses dysfunction was caused in 75% of the cases by the obstructive
thrombosis (clogging of prothesis) and in 25% of the cases by tardive infectious
endocarditis, because of prothesis detachment. In the case of the prothetic
thrombosis, the systemic intravenous thrombolysis represented the main therapeutic
option with 10 of the patients, the surgical treatment being of vital risk in the context of
a severe hemodynamic instability. For 2 clinical cases the option was the replacement
of the valvular prothesis. Only 20% of the patients with thrombolysis needed iterative
prothesis because of the residual prothetic stenosis after thrombolysis. In the case of
prothetic dysfunction due to infectious endocarditis it was essential to have an
interdisciplinary approach, cardiologist-doctor of infectious diseases surgeon
anesthetist, the iterative prothesis in case of emergency being the optimal solution.
Key Words: thrombosis; thrombolysis; valvular prothesis; AHF; acute heart failure;
phrotesis detachment.
OP027

CHEST WALL TUMORS RECONSTRUCTION OPTIONS AFTER THORACIC

PARIETAL TUMORECTOMY
Authors: Col. Dr. C. GROZAVU, Dr. M. ILIAS, Dr. Adrian CIUCHE, Cpt. Dr. Dragos
MARIN, Lt. Dr. Daniel PANTILE
Institutions:Emergency Military University Hospital, Department of Thoracic Surgery
Bucharest,
ROMANIA
Key words: chest wall tumors, reconstruction,spider web, reinforced mesh,
STRATOS
Objectives: Chest wall tumors are complex surgical conditions with a complex
treatment which includes surgical thoracic teams with plastic surgery training. Authors
propose surgical procedures and a classification for chest wall tumors based on
histological type and solutions. We analyze parietal reconstruction methods used in
our department.
Material and method: Patients with chest wall tumors undergoing resection during the
past 10 years were reviewed. The analysis was made on a lot with chest wall tumors
with various topographies. Diagnosis was established with: CT, MRI, bone scintigrafic
scan. The surgical intervention includes: tumoral resection within oncological limits and
chest wall reconstruction (soft tissues and bones). The target of reconstruction is chest
wall stability and lung hernia prevention.
Results and conclusions: The results were very promising using our surgical
techniques. Spider web technique and prosthetic materials (Thoratex reinforced
mesh) and STRATOS osteosynthesis system we used in chest reconstruction give
resistance and stability to the chest wall. We did not have any lung hernia in
postoperative period. Rebuilding soft tissues was made with mammary gland and

26

2NDJUNE2011

skin/muscle flaps from neighboring region. The outcome was normal.

Contact: mobile phone: 0722232508; e-mail: grozavuaxon@yahoo.com
OP028

FIELD TRIAGE VS EMERGENCY RECEIVING UNIT TRIAGE

Author: Colonel Assistant Professor TEUDEA C. B. - MD, EMDM, PhD
Institutions: Emergency Military University Hospital, Bucharest,
ROMANIA
Field triage is frequently considered an impersonal military procedure, which is hard to
be applied by the physicians, especially the young ones, but in combat situations is
the only method which can assure the balance between the need for medical care an
the medical resources. Field triage is based on the rapid evaluation of all disaster or
armed conflict victims, nature and severity injury evaluation, victims categorization,
resuscitation, stabilization and transport preparation of the victims. There are four (red
T1, yellow T2, green - T3 and black - T4) or five triage categories (urgent - red,
immediate - red, yellow, green and black) taking into account the civilian or military
setup.
Triage at Emergency Receiving Unit level is based on some specific criteria under
national law, considering patients clinical status, vital functions stability, potential
worsening of their condition, treatment initiation or the need for some laboratory tests
etc. There are five triage categories (red - resuscitation, yellow - critical, green urgent, blue no urgent and white - consultation) which are establishing the period of
time to wait for the patients, from 0 minutes the red code to maximum 120 minutes the
white code.
Triage is performed by the most competent persons (emergency medicine physician,
surgeon or a nurse with emergency medicine preparedness/competence). This
method identifies the patients/victims needs, categorize them and thus providing the
medical management of patients which include the correct treatment, increasing the
chances of survival, decreasing in the same time the morbidity and mortality.
Key words: medical triage, triage categories, triage criteria, triage tags

OP029

ROBOTIC RIGHT ADRENALECTOMY: VIDEO ANALYSIS OF INITIAL EXPERIENCE

Authors: COL YAGCI Gokhan, MD1, MAJ CAN Mehmet Fatih, MD1, BG CETINER
Sadettin, MD1.
Institutions: 1 Gulhane Military Medical Academy, Dept. of Surgery, Ankara,
TURKEY
Objective: Experience with robotic surgical interventions has significantly increased
over the last five years. Adrenalectomy has been one of the potential procedures for
robotic surgery. This video presentation aims to exhibit our first case of adrenalectomy
performed using DaVinci robotic surgical system.
Material and method: A 20-year-old male patient with a right adrenal mass of 4 cm was
referred to our institute. Adrenal-related laboratory tests revealed no functional
disorder. Since he had also acute Hepatitis B virus infection, the surgical intervention
was postponed until the acute phase subsided. The procedure was performed after
patient consent was obtained concerning robotic surgery.
Results: The patient was placed in the semi left lateral decubitus position. After the
docking procedure was completed and the instruments inserted for transperitoneal
approach, dissection was initiated just caudal to the right hepatic triangular ligament.
The right adrenal vein was identified, clipped and divided. Following the division of

27

2ndJUNE2011

adrenal arteries, the mass with surrounding adrenal gland was en-block resected and
taken out of the abdomen. No significant bleeding was seen. The procedure was
completed within 70 minutes by three robotic arms and without using assistant port.
The postoperative period was uneventful.
Conclusion: The present video analysis demonstrates the advantages of robotic
adrenal surgery in a time when the reported experience with robotic adrenalectomies
is limited to only a couple of dozens of cases worldwide.
Correspondence:
Gulhane Askeri Tip Akademisi, Genel Cerrahi AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 5120
Fax: + 90 312 304 5002
GSM: + 90 532 558 5934
e-mail: mfcan@gata.edu.tr
OP030

RETROPERITONEAL
PARAGANGLIOM

RARE
EXTRA-ADRENAL
LOCALIZATION OF PHEOCHROMOCYTOMA
Authors: E. ODISSEEVA, K. BOUTCHKOVA, N. PETROV, N. MLADENOV, S.
SERGEEV*
Institutions:
Department of Anaesthesiology, Reanimation and Critical Care Medicine Military
Medical Academy, Sofia
Clinic of Liver, Pancreatic and Transplantation Surgery Military Medical Academy,
Sofia,
BULGARIA
Tumors producing catecholamines may be located in any area in the body, where
there are clusters of chromaffincells. The extra-adrenal localization occurs in greater
frequency than reported> 10%. Tests confirming the diagnosis can not always be
implemented promptly. We offer a case report of a patient with a rare localization of
pheochromocytoma, in whom the diagnosis was discussed but not confirmed.
Preoperative preparation and patient behavior to that carried out the protocol for
hormonal active adrenal tumor, allowing surgery to be performed without
complications. Anesthesia in this patient is very risky and requires strict hemodynamic
control, availability of medicaments and anesthesiology team with extensive
experience in abdominal surgery.

OP031

SECONDARY SPONTANEOUS PNEUMOTHORAX IN A CASE OF PULMONARY

HISTIOCYTOSIS X AND DIABETES INSIPIDUS
Authors: *Maj. Adrian CIUCHE, *Col. Claudiu NISTOR, *Capt. Dragos MARIN, *Lt.
Daniel PANTILE, **Maj. Augustin TUDOSE
Institutions:
Emergency Military University Hospital, Bucharest, ROMANIA
*Department of Thoracic Surgery
**Department of Anesthesiology
ROMANIA
Objectives: The paper presents the case of a 37 years male admitted in the thoracic
surgery department with a recurrent episode of left spontaneous pneumothorax.
He was diagnosed as having pulmonary histyocitosis X and diabetes insipidus 9 years
before in the pneumology department: spontaneous pneumomediastinum with

28

2NDJUNE2011

pulmonary fibrosis associated with dryness of mouth and polyuria.

Methods: The first left sponataneous pneumothorax was resolved by left minimal
pleurotomy under local anesthesia, one month before. In the second episode of left
spontaneous pneumothorax the surgery procedure was video-assisted mechanical
and chemical pleurodesis and pulmonary biopsy with histological confirmation of
pulmonary histiocytosis X.
Results:. Immediate postoperative results were satisfactory with recovery of respiratory
function and complete pulmonary expansion.
Conclusions: The minimal invasive thoracic surgery is the best approach in the pleural
effusions because of some advantages: lead to a correct diagnosis, an adequate
treatment, with a low mortality and morbidity (comparative with the classic thoracic
surgical approach).
OP032

MINIMALLY INVASIVE REPAIR FOR PECTUS EXCAVATUM (NUSS PROCEDURE)

AESTHETIC AND/OR FUNCTIONAL?
Authors: Col. Dr. C. GROZAVU, Dr. M. ILIAS, Cpt. Dr. D. MARIN, Lt. Dr. D. PANTILE
Institutions:
Emergency Military University Hospital, Department of Thoracic Surgery Bucharest,
ROMANIA
Keywords: pectus excavatum, funnel chest, minimally invasive, Nuss technique
Background: Pectus excavatum is the most frequent anterior thoracic wall congenital
malformation. Among teenagers, when the esthetics and clinical symptoms become
more important, pectus exacvatum becomes a real psychological problem. During the
time many treatment techniques have been proposed, conservative or surgical. The
minimally invasive repair technique of pectus excavatum, Nuss technique, developed
after 1986, is now the most used technique worldwide.
Objectives: Our study aimed to analyze the degree of patients satisfaction regarding
the esthetic results after the minimally invasive repair of pectus excavatum, as well as
the improvement of respiratory functional parameters.
Method: We will present some historical data related to surgical repair of pectus
excavatum, advantages and disadvantages of open surgery; also we will present
clinical and paraclinical evaluations, including anthropometric indexes, as well as
indications and contraindications of Nuss technique and possible intraoperative and
postoperative complications (recent and late).
Our study was carried out on a group of patients with pectus excavatum, who have
been submitted to Nuss technique, during a timeframe of 4 years (2007 2011), whom
aged from 8 to 38 years. Prior to surgery the patients were submitted to a standard
protocol of investigations.
Results: We present the benefits of Nuss technique and the improvements of the
functional and aesthetical indexes. The patients who have been treated with Nuss
technique are following a strict and specific postoperative protocol recommended by
the physician.
Conclusions: Nuss technique is an efficient method, with very good aesthetical and
functional results, allowing quick social and professional patients reintegration, as well
as an improved self-image and self confidence.
Contact: mobile phone: 0722232508; e-mail: grozavuaxon@yahoo.com.

29

2ndJUNE2011

OP033

7 MYTHS ABOUT PAIN MANAGEMENT IN PRE-HOSPITAL ENVIRONMENT

Authors: LTC TEUDEA CB, MD, EMDM, PhD1; Maj. V. PRLEA, MD2; Capt. BUTOI
A 1; Capt. FANEA F 1; Maj. COSTEA F. 1;
Institutions:
1 - Central University Emergency Military Hospital Dr. CAROL DAVILA" Bucharest,
ROMANIA
2 - 45 Communications and Informatics Battalion "CPITAN GRIGORE GIOSANU"
Bucharest,
ROMANIA
Although we understand the pathophysiology of pain better than ever, it remains one
of the most under-appreciated and under-treated conditions encountered by
emergency medical systems (EMS) personnel. Pain is now recognized as the fifth
vital sign and, in many cases, pain relief is the primary expectation of our patients.
A number of studies show that pain of different type is a presenting complaint for up to
70% of all emergency departments patients, and the percentage for EMS is probably
similar. Pain management is, in many cases the only thing that we can offer the patient
other than transport to the hospital.
Nevertheless, pain management is often neglected or, at best, delayed in pre-hospital
environment, both in peace time and at war.
Why is oligoanalgesia so prevalent? There are a few common reasons, but the
most common are:
Underestimation of the patients need;
Time required for triage;
Time required for medical assessment;
Time required to dispense medication;
EMS personnel that still believe in some myths that prove to be as difficult to bust
as they are far from truth.
It is our believe that a better understanding of these myths can only result in a more
efficient pain management in pre-hospital environment and a significant better
outcome for EMS patients.
Key words: pain management, myths, emergency, pre-hospital.

OP034

ANAESTHESIA FOR PULMONARY STENT INSERTION

Authors: Nikolay PETROV, Alexandra SALTIROVA, Milena ENCHEVA *, Kosta
KOSTOV *
Institutions:
Department of Anaesthesiology, Reanimation and Critical Care Medicine
*Department of Pulmonary Diseases
Military Medical Academy, Sofia,
BULGARIA
Introduction: The stenting of stenotic blood vessels, airways and ducts has
revolutionized the management of these problems. The stenting of central airways is
an effective means of providing structural support to the trachea, carina and main
bronchi. Since these procedures are now becoming routine, every anaesthesiologist
must be familiar with the management of the patient undergoing pulmonary stent
insertion.
OBJECTIVE To review our experience in anaesthetic management for endoscopic
pulmonary stenting

30

2NDJUNE2011

Material and methods: 10 patients covering the criteria for clinically significant
tracheobronchial stenosis exertional dyspnea, cough, rhonchi, stridor, recurrent
respiratory infections, typical flow-volume curve on spirometry, were enrolled in this
study. After induction of general anaesthesia with propofol and muscle relaxant, all
patients were intubated with a rigid bronchoscope tube. JET-ventilation was used
during tracheobronchial stent insertion as an alternative to conventional ventilation.
Conclusion: Stent placement under general anaesthesia is an increasingly popular
alternative to surgery for patients with benign and malignant central airway obstruction.
Every anaesthesiologist must be familiar with the different stents currently used, and
with the anaesthetic requirements for stenting procedures.
14:30-16:00

ORAL PRESENTATIONS IV
(NORWEGIAN HALL)
Chairmen: COL Assoc. Prof. Nuri ARSLAN, MD (TURKEY)
Assoc. Prof. Krassimir Dimitrov MEKOUCHINOV, MD, PhD
(BULGARIA)

OP035

OPTIMIZATION OF FLUORIDE-ION REACTIVATION METHOD FOR ANALYSIS OF

DICHLORVOS AND PARAOXONE IN BLOOD
Authors: ATANASOV Vasil 1,2, PETROVA Iskra 1, DISHOVSKY Christofor 1 M.D., Col.
SAMNALIEV Ivan 1M. D.
Institutions:
1 Military Medical Academy, Department of Disaster Medicine and Toxicology,
Research Laboratory of Military Toxicology, Sofia, BULGARIA
2 Sofia University St. Kliment Ohridski, Faculty of Chemistry, Department of Analytical
Chemistry, Sofia,
BULGARIA
Introduction: Organophosphorous compounds (OPCs) are used as industrial
chemicals (plasticizers, antioxidants, hydraulic liquids, etc.), in medicine and
pharmacological research, and as pesticides (mainly as insecticides) . They differ in
their toxicity from practically non-toxic chemicals to highly toxic compounds (sarin,
soman, tabun, Vx, etc.) used as chemical warfare agents. OPCs are readily absorbed
across respiratory and gastrointestinal mucosa, and the lipophilic ones are readily
absorbed through the skin. The OPCs inactivate acetylcholinesterases by alkyl
phosphorylation of a serine hydroxyl group at the esteratic site of the enzyme and
blocked the neuro-muscular function. Nerve agents were also used by terrorists in
1994 and 1995 in Japan (Tokyo, Matsumoto). Therefore, the adequate diagnostic
procedure at OPCs intoxication is very actual at present. In our Laboratory, we have
earlier experience in application of fluoride reactivation method in the testing of timedependent reactivation of soman and tabun inhibited cholinesterase (rat' blood serum,
RBC, brain, liver), as well as diagnostic test in clinical cases of chlorpyrifos and
diazinon poisoned patients.
Purpose: The aim of the current study is to develope an analytical procedure for
analysis of the OPCs - dichlorvos and paraoxone. Dichlorvos is used as insecticides
and its commercial availability is a reason for intoxications as accidents, misuses or
suicide attempts. Paraoxone is used as ophthalmic collyr in treatment of some eye's
diseases. The fast biotransformation processes to common metabolites makes difficult
the identification of the parent compound, even short time after intoxication.

31

2ndJUNE2011

Results: In our study, we present an analytical procedure based on fluoride

reactivation method and instrumental GC analysis of the reactivated products.
Different experimental parameters are studied time of fluoride incubation, pH of
reactivation buffer, deproteinization, solid-phase extraction step and instrumental
parameters, in order to obtain optimal analytical result.
Conclusion: Results obtained allow to identify the studied OPCs in blood and the
procedure could be used as an additional test in clinical practice and for the purposes
of forensic toxicology in case of intoxications coused by them.
Correspondence:
Military Medical Academy
3 Georgy Sofiysky Str., 1606 Sofia,
BULGARIA
Tel.: +359-2-922-6448
Fax: +359-2-952-6536
Mobile: +359-898-645-125
E-mail: vatanasov@chem.uni-sofia.bg
OP036

A COMPROMISE OF THE HEARING EXPERTISIS BY A VOLUNTARY

MODULATION ON MIDDLE EAR REFLECTION ACTIVITY
Authors: GEORGIEV K 1., MD, BOZOV H. 1, PhD, YANEVA M 1., MD, KUTSAROV
P. 1., MD, STAVREV D . 2., PhD, VELCHEV V. 1, MD
Institutions: 1Hospital Base for Active Treatment Varna Military Medical Academy
2Medical University Varna,
BULGARIA
Objective: In the present study we make a review of the stapedius reflex, as well as
examine the opportunities to modulate it.
Material and methods: By a series of BERA, audiograms, tympanograms and
stapedograms we study the reflex modulation upon the subjective feeling of acoustic
power. A video clip presents voluntary contraction of musculus tensor tympani.
Results: Audiograms are indicative of 30 dB conductive deafness with very low level of
dispersion. BERA results indicate a decrease in amplitudes and an increase in delay of
the latent period. Differences between voluntary contractions of m. tensor tympani and
test of Walsalwa are very clear on the tympanograms. Stapedograms show the
absence of reflex on the ear without any diseases.
Conclusions: We doubt the 100% objectivity of BERA, tympanometry and
stapedometry as test methods and suggest a possible existence of non-described
untill now cortical innervations of m. tensor tympani.

OP037

SIGNIFICANCE OF BRUCELLOSIS AS A PUBLIC HEALTH THREAT IN SERBIA

Authors: Major Jovan MLADENOVI MD, Msc, Col. ass.prof. Radovan EKANAC
MD, PhD, Ass. prof. Elizabeta RISTANOVI, PhD, Col. ass.prof. Sran LAZI MD,
PhD, Col. Prof. Djoko MAKSI, MD,PhD, Prof. Novica STAJKOVI PhD, Maj. eljko
JADRANIN, MD.
Institutions: Military Medical Academy, Belgrade,
SERBIA
Introduction: Brucellosis is still a significant infectious disease. It primarily affects
domestic animals, but humans are often infected due to direct contact with animals or
ingestion of contaminated dairy products. The disease is spread all over the world with

32

2NDJUNE2011

about 500 000 new human cases occurring annually.

In the former Yugoslavia, brucellosis was first recorded in Istria and near the Slovenian
coast in 1947 but a few years later it was eliminated. In 1978, it appeared in
Macedonia, where an epidemic broke out in 1980. Since no adequate action for
elimination and eradication was taken, a rapid increase in the number of human cases
emerged in the former Yugoslavia. Since then, brucellosis has become a significant
concern in the country.
The aim of this study was to determine the frequency and distribution of human
brucellosis cases in Serbia from 1980 to 2008 and the most important factors affecting
its emergence and spread.
Methods: Public sources of data on brucellosis were used, including official reports of
infectious diseases and epidemics, as well as monthly and annual reports of the
Serbia and Vojvodina Institutes of Public Health.
Results: In 1980-2008, 1521 human brucellosis cases were recorded in Serbia. The
distribution of recorded cases of human brucellosis was 1184 (78%) in Kosovo and
Metohija, 236 (16%) in central Serbia, and 101 (6.6%) in Vojvodina. The number of
cases of human brucellosis ranged from 2 in 2000 to 324 in 1991. In 1991, the
maximum incidence was reported for whole Serbia (3.3 per 100 000), Kosovo and
Metohija (12 per 100 000), and central Serbia (1.15 per 100 000). That year, an
outbreak of brucellosis was reported for the first time.
From 1991 to 2008, 47 outbreaks of human brucellosis resulting in 304 cases were
reported in Serbia. In 14 (30%) outbreaks, the major mode of transmission was contact
with the infected animals, while 33 (70%) outbreaks were food-borne. In food-borne
outbreaks, 221 (73%) cases were recorded. In contact outbreaks, 83 (27%) cases
were recorded.
Uncontrolled trade and migration of animals is the main mode of spreading brucellosis.
Based on data from the annual reports of the Public Health Institutes of Republic
Serbia and Vojvodina, brucellosis was imported to Kosovo and Vojvodina by importing
infected animals. This suggests that controlling the animal trade is the main mode of
control and prevention of brucellosis spread. Unauthorized sale or movement of
animals from an infected area to other areas should be forbidden. Similarly,
importations into clean areas must be restricted to animals that originate from
brucellosis-free areas, that have no herd history of the disease, and that have obtained
negative results in recently performed diagnostic tests
Conclusions: Brucellosis has been a significant public health concern in Serbia. This
problem may be solved by joint efforts of all relevant factors, first of all human and
veterinary medical services.
OP038

THE NEW APPROACHES AND INTENTIONS IN FIGHTING BIOTERRORISM

Authors: Vladan RADOSAVLJEVIC, Lieutenant colonel, Associate Professor,
Institutions: Military Medical Headquarter, Ministry of Defense,
SERBIA
Background. From 15th to 17th November, in Serbian Academy of Science and Arts
(SASA),Belgrade, Serbia, was hold NATO ARW (NATO Advanced Research
Workshop), entitled:
Exploring synergies between bioterrorism preparedness and general public health
measures.
There were 45 experts from 20 countries of Europe (especially South Eastern Europe),
USA,

33

2ndJUNE2011

Israel, World Health Organization (WHO) and European Center for Disease Control
(ECDC).
Aim. This ARW was unique opportunity for building biosecurity&biodefense network
not only in the region of South-Eastern Europe, but also in the whole Europe, North
America and Middle East. Building this network is one of the key steps in fighting
bioterrorism.
Discussion/Perspectives. Today scientific community recognizes two mainstreams or
approaches in biosecurity&biodefense. The older one is American approach based on
permanent demands to government for robust investments, supported by horrible
possible scenarios. For the last fiscal year USA budget for these purposes is for over 2
billions dollars bigger than for previous year. As very different country from USA, Serbs
with help of their German colleagues developed their approaches in
biosecurity&biodefense. This approach is based on existing infrastructure, small
investments preferably in continuing professional education and in some devices.
Some part of this approach was presented during this workshop.
OP039

COMPARING
THE
ANTIDOTE
EFFICACY
ON
NEUROMUSCULAR
TRANSMISSION OF TWO NEWLY SYNTHESIZED OXIME REACTIVATORS AND
CURRENTLY
Authors: First Lt. T. Pencheva 1 MD, I. Petrova 2
Institutions:
1 Postgraduate PhD student at Military Toxicology, Military Medical Academy Sofia,
2 Laboratory of Military Toxicology, Military Medical Academy Sofia,
BULGARIA
The aim of the experimental research was to compare the effect on the neuromuscular
transmission (NMT) of two newly-synthesized oxime reactivators BT-03 and BT- 05
after block on NMT caused by soman in rats and currently available oxime HI-6.
Materials and methods : Experiments were carried out on 25 male Wistar rats, 190
30 g b.w. by using a contemporary module from a company EXPERIMETRIA LTD
(Hungary). The animals were placed under general anesthesia with urethane (1.5 mg /
kg, i.p.) and included at artificial ventilation. The characteristics of stimulation on n.
Ischiadicus were: voltage - 3V, PP-45 s, PW-1ms, TD-0, TN-0, DE-5 ms.
Poisoning was carried out with 12 LD 50 soman (i.v.) 1 min after induction of atropine
(0.86 mol / kg). All reactivators were dissolved in saline and applied in equimolar
doses (111.3 mol / kg, i.v.) 1 min after block in NMT (50% to 70% of baseline values).
The effect of BT-03 and BT-05 on NMT was compared with that of HI-6 administered
under similar conditions and doses.
Results : We have found that from both newly reactivators BT-05 provides more lasting
effect on the recovery of NMT and its therapeutic effect is comparable to that of HI-6.
Conclusion : In case of soman intoxication wich is traditionally difficult for treatment the
antidotal effectiveness of BT-03 and BT-05 to recovery block caused by soman in NMT
is promising.

34

2NDJUNE2011

OP040

DIAGNOSTIC VALUE OF SYNOVIAL FLUID CYTOLOGY

Author(s): S.R. REKKA MD1, G.E. FRAGOULIS MD2, LCDR G.E. KATSIFIS MD,PhD2
Institutions:
1) Venizeleio Medical Diagnostic Center, Athens,
2) Rheumatology Clinic, Naval Hospital of Athens,
GREECE
Purpose: The cartilage and synovium are in contact with the synovial fluid and
variations in the volume and composition of fluid reflect inflammation and degradation.
These changes lead to the presence of non-cellular particulate material and
accumulation of different cell types. Our aim was to estimate the value of synovial fluid
cytology in every day clinical practice.
Material and Methods: Synovial fluid was aspirated from the knees of 40 patients and
the specimens were stained with Papanicolaou and Hemacolor stain.
Results: Nucleated cell counts classified fluids as septic(>50,000cells/mm3) with>90%
polymorphonuclear neutrophils(n=2), inflammatory(3,000 to 50,000cells/mm3)
with>50% polymorphs(n=28), and non-inflammatory(>3,000 cells/mm3)(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 noninflammatory 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 inflammatory from non-inflammatory arthropathies, mono from
oligoarthropathy, and could be established, with collaboration between
rheumatologists and cytopathologists, as a powerful diagnostic and research tool.
Correspondence:
LCDR Gikas E. KATSIFIS MD, PhD
Phone: +30 2107261705 -068
Cell: +30 6977952910
E-mail: katsifisg@yahoo.gr

35

2ndJUNE2011

OP041

FREQUENCY OF SYMPTOMS, DISEASES, AND MEDICATIONS OF SOLDIERS IN

THE TURKISH LEVEL-1 MEDICAL FACILITY OF PEACEKEEPING UNIT IN
LEBANON
Authors: CPT BABAYIGIT Mustafa Alparslan, MD1, MAJ KARAKAS Ahmet, MD1,
MAJ SEZIGEN S, MD1, CPT GULEN Erhan, MD2,
Institutions:
1Turkish Armed Forces Health Command, Dept. of Preventive Health Services,
Ankara, TURKEY
2UN Interim Force in Lebanon, Turkish Engineering Construction Unit, Es Saatiye,
LEBANON
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 110, 2010 in the infirmary of Turkish Engineering Construction Unit,
Lebanon. In this cross-sectional study, the International Classification of Disease (ICD10) and SPSS were used to analyze the data.
Results: The mean age of the staff was 28.18.8 years; 59.2% were in the 2029 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 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). Three-quarters of
the patients were given medication, and 8.0% were referred to a level-II hospital.
Antibiotics (31.4%), analgesic/antipyretic/anti-inflammatory drugs (28.8%), and
antacids/anti-ulcer medications (7%) were the most commonly prescribed by the
physicians. Of referrals to the hospital, 79.5% were due to dental caries.
Conclusion: Health service support in peacekeeping operations should be planned
according to the most frequent diseases observed. A dental unit should be present in a
level-1 medical facility.
Correspondence
Turkish Armed Forces Health Command, Dept. of Preventive Health Services, Ankara,
TURKEY,
Tel
: +90 312 4024042
Fax
: +90 312 4177951
GSM : +905057148147
e-mail : mbabayigit@tsk.tr

OP042

FREQUENCY OF BUTYRYLCHOLINESTERASE GENE MUTATIONS

BULGARIAN MILITARY SERVICEMAN
Authors: Maj. DIMOV Dimo, MD, KANEV Kamen, MD, DSc
Institutions:
Disaster Medicine and Toxicology Department, Military Medical Academy - Sofia,
BULGARIA

IN

Obejective: A lower activity of butyrylcholinesterase, due to genetic variants, is linked

36

2NDJUNE2011

to severe damage of many organs after exposure of organophosphorus compounds

(OPs). Also human serum BChE activity has been investigated as risk factors for
developing post - succinylcholine apnea.
The aim of the present study is to assess the frequency of BChE phenotypes among
Bulgarian military personnel and to identify individuals expected to have a problem in
case of a surgical procedure (after application a short muscle relaxants) or exposure of
anticholinesterase agents.
Material and methods: We examined the frequency of BChE phenotypes in 542
military servicemen with the mean age of 35 10 years. The BChE phenotypes were
determined using BChE activity measurements and by inhibition with dibucaine and
fluoride.
Results: In our study the frequency of BChE phenotypes in Bulgarian military
personnel was as follows: normal phenotype (UU) 94.9 %, moderate sensitive to
succinylcholine including UA,US,UF phenotypes was 3.9% and hypersensitive to
succinylcholine (AA, AK, AS) was 0.58%.
Conclusion: Military personnel with low BuChE activity have lesser ability to clear or
detoxify organophosphorus compounds and short muscle relaxants. Detection of
BChE variants is essential for the identification of risk individuals among military
serviceman before mission abroad.
Disaster Medicine Scientific Research Laboratory
Disaster Medicine and Toxicology Department
Military Medical Academy
3, St. G. Sofiisky Str.
1606, Sofia
BULGARIA
Tel. +35929225929
Email: medkat@vma.bg
OP043

SPREAD HPV CARRIERS AMONG MILITARY WOMEN IN BULGARIA DURING

PERIOD 2009 2010
Authors: Major KUNCHEV M. MD, PhD, Prof ALEXANDROV E. MD., Assoc.Prof
KAMARINCHEV B. MD., Prof KALVACHEV Z. MD., ALEXANDROVA D. MD, PhD
and Assoc.Prof MEKOUCHINOV K. B.MD.
Institutions:
Military Medical Academy, Sofia,
BULGARIA
Objective: To determine HPV carriers among military women to undertake prevention
with vaccine and correct treatment.
Material methods: It was investigate gynecological materials by extraction DNA with
Sacace extraction kit. It was used PCR kit for detection and tipisation on 14 tips HPV
2 low risk and 12 hight risk. The created results have been shown by UV light.
Results:In reference to prophylaxis of HPV using vaccine among the women in army
during 2009-2010 years, it have been investigate 202 women. The results shown 47
(23) positive women for HPV: low risk 6 tip 6 (12,7) and hight risk tips - 16 tip
17 (36) ; 33 tip 7 (14,8 ); 31 tip 5 (10,6); 56 tip 5 (10,6); 59 tip 2
(4,2); 39 tip 1 (2,1); 45 tip 1 (2,1); 52 tip 1 (2,1); 58 tip 1 (2,1) and
66 tip 1 (2,1) .
Conclusion: One of most basic factors for arise womans genital cancer is HPV , the
desease caused disablement and mortality. Used molecular-genetic methods for

37

2ndJUNE2011

detection and tipisation HPV virus help to early prophylaxis and correct treatment. The
results shown that spread HPV among women in army and literature data for spread
HPV in civilian women are indiscernible.
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: ikm@techno-link.com
e-mail: mkunchev@yahoo.com
OP044

CHANGES IN CONCENTRATIONS OF SERA PROTEINS IN WAR WOUND

Authors: Sonja RADAKOVIC, Maja SURBATOVIC, Nebojsa STANKOVIC, Slavica
RADJEN, Srdjan LAZIC, Elizabeta RISTANOVIC, Mladen MILIVOJEVIC
Institutions:
Military Medical Academy, Belgrade,
SERBIA
During the general reaction to trauma, substantional changes in protein composition of
sera occure. These changes are coused by the muscle degradation and impaired
protein synthesis in liver. Additionaly during the first stage of shock, de novo synthesis
of acute-phase proteins occure. Protein disturbances may influence the complications
onset, as well as the outcome. The aim of the prospective study was to investigate net
change in total protein and albumin concentrations, as well as albumin/globulin ratio in
sera of war casualties during the first 14 posttraumatic days, and to establish the
correlation between these changes and severity of trauma. Subjects were 79 war
casualties. Controls: 33 blood donors. Methods: Injury severity was determined
according to ISS and blood samples were collected 12 hours after trauma, then on the
1st, 2nd, 5th and 14th posttraumatic day. In war casualties values of total protein and
albumin concentrations and albumin/globulin ratio were significantly decreased.
Minimal concentrations were measured on 2nd posttraumatic day (589.04 g/l for total
proteins, p<0.01; 36.66.21 g/l for albumins, p<0.001) or on 5th day (0.860.2 for
albumin/globulin ratio, p<0.001). Conclusions: During the acute-phase response to
trauma, significant changes in concentration of total proteins, albumins and
albumin/globulin ratio occure in sera of war casualties. These changes are the most
promminent during the first 5 days, with tendency for normalization after that. Intensity
of these changes depends of the severity of trauma.

OP045

MYCOTIC INFECTIONS IN ALLERGIC PATIENTS WITH ENT PATHOLOGY

Authors: Dr. Matilda RDULESCU M.D.1,2, Dr. Delia BERCEANU-VDUVA M.D.,
Ph.D.1,2
Institutions:
1. The Medical and Pharmaceutical University of Timioara,
2. The Military Clinical Emergency Hospital of Timioara,
ROMANIA
Purpose: The study is part of PNII- 41-011/2007 project and its objective is to assess
the distribution of fungi species in samples collected from alergic patients with ENT
pathology and antifungal sensitivity tests results, between 1.01.2010-29.12.2010

38

2NDJUNE2011

Material and method: Samples (pharingeal and nasal swabs, ears/surgical

site/parothida secretions) have been collected from patients from hospital environment
and ambulatory. Fungi identification was performed using both: API Candida
(BioMerieux) and Candifast systems, and susceptibility tests were performed by
classical disk-difussion method, and also on Candifast galeries.
Results: From the total number of 758 collected samples, we isolated 102 fungi
strains. The succession of species distribution was: C.albicans (71,6%), C.tropicalis
and A.niger (6,17%), C.famata (3,7%), C.parapsilosis i C.kefyr (2,46%), etc. Most C.
albicans strains were resistant to Amphotericin B and 5 Fluorocytosine.
Conclusions: C. albicans represents the most isolated fungi specie. The majority of C.
albicans strains were resistant to Amphotericin B and 5 Fluorocytosine. Both
identification systems have a similar performance, but in terms of susceptibility testing,
Candifast system performances are superior.
OP046

TRANSCRANIAL DOPPLER ULTRASOUND (TCD) CAN DETERMINE

ACCURATELY BRAIN DEATH AND CAN BE USED AS AN EARLY DETECTION
TOOL FOR INCREASED INTRACRANIAL PRESSURE
Author(s): LTC J KARELLAS, LTC G. LIAPIS, MAJ A. ARSENOGLOU, MAJ S.
SOURLAS, LTC S. ALOIZOS.
Institution: 401 Military Hospital, Athens,
GREECE
Purpose: Transcranial Doppler Ultrasound (TCD) is an innovative, flexible, accessible
and reliable examination for the evaluation of cerebral blood flow. Clinical diagnosis of
brain death (BD) in ICU patients is often precluded because of the use of barbiturates,
benzodiazepines or metabolic conditions. The purpose of this study was to compare
the efficacy of TCD in defining BD in comparison with clinical trials and its ability to
estimate raised intracranial pressure (ICP).
Materials and methods: Seven ICU patients were studied, 6 suffering from close head
injury and 1 from subarachnoid hemorrhage. A transtemporal window was used and
bilateral Middle Cerebral Arteries were examined. TCD indications of BD were a
systolic forward flow or systolic spikes and diastolic reversed flow, a brief systolic
forward flow or systolic spikes and no diastolic flow and no flow in a patient who had a
normal previous TCD examination. TCD indications of raised ICP were a high
Pulsatility Index (PI) and a low Cerebral Perfusion Pressure (CPP= MAP X EDV/ mean
velocity +14).
Results: In 3 patients TCD was able to demonstrate preliminary signs of raised ICP
compliant with CT findings of diffuse cerebral edema. In all 7 patients TCD signs of BD
were found approximately 5 days (4,71,4) before the clinical tests for BD were
eligible. In one patient adequate time was thus given for organ donation.
Conclusion: Impairment of cerebral flow can accurately be demonstrated by TCD both
as an early sign of raised ICP and as a terminate event of BD in patients with head
injury and intact skull. In all patients at risk for developing cerebral edema and not
having continuous ICP measurement, repeated TCD examinations can be a valuable
tool for early diagnosis and treatment of raised ICP.
Correspondence: LTC Ioannis KARELLAS,
Tel.:+30 2107494501,
Mob: +30 6972252679,
E-mail: ikarellas@yahoo.com

39

2ndJUNE2011

14:30-16:00

ROUND TABLE I

Multiaxial diagnosis in depressive disorders:

clinical and therapeutic dimensions
(THE PERFORMANCE HALL)
Chairmen: COL Assist. Prof. Radomir SAMARDZIC, MD, PhD (SERBIA)
COL Assoc. Prof. Daniel VASILE, MD, PhD (ROMANIA)
RT001

INTERNET ABUSE: A SYMPTOM OF DEPRESSION OR A NEW COMMORBIDITY?

Author(s): Maj. Ntafoulis PAVLOS, MD,
GREECE

RT002

DEPRESSION AND POSTTRAUMATIC STRESS DISORDER: MULTIAXIAL

APPROACH TO SHARED VULNERABILITY AND COMORBIDITY
Author(s): Col. Assist. prof. Radomir SAMARDZIC, M.D., Ph.D., Zeljko SPIRIC, M.D.,
Ph.D., Maj. Dragan KRSTIC, M.D. G. MANDIC-GAJIC, M.D.
Institution: Department of Psychiatry, Military Medical Academy, Belgrade, SERBIA
Background: Posttraumatic stress disorder (PTSD) is widely considered the signature
diagnosis of trauma. Research conducted in a variety of populations and settings has
shown that PTSD has an abundance of psychiatric comorbidities. Comorbidity is said
to be rule rather than exception for patients with PTSD. The psychiatric disorders most
often found to be comorbid with PTSD in combat veterans are alcohol use disorders,
followed by major depression, other drug abuse, and Cluster B (especially antisocial,
but also borderline personality disorders). Objective: The aim of the study was the
analysis of different types of mental disorders, depressive disorders and PTSD in
particular, as well as the relationship between them, from the aspect of comordibity
Method: A retrospective analysis of 347 war veterans medical records, who were
treated in the period between 1991-2009 in the day hospital of the psychiatry clinic of
the Military Medical Academy. Results: The most frequent diagnosis, on the first axis
of the multiaxial diagnostic system of the DSM-IV-TR, was the depressive one
(42.1%), among which the adjustment disorder (38.9%), followed by major depression
(2.6%), and dysthymia (0.6%). PTSD was diagnosed in 91 veterans (26.2%), and
alcoholism in 58 of them (16.7%). The second diagnosis was registered in 55 (37.7%)
veterans with depressive disorders. The most frequent were artherial hypertension
(25%), PTSD (14.5%) and alcoholism (12.7%). In veterans with PTSD diagnosis, the
number of registered comorbid diagnosis was 27 (29.7%), with 11 (40.7%) of them
from the group of other anxiety disorders, 8 (29.7%) with somatic and neurological
illnesses, 6 (22.2%) with psychotic disorders, and 2 (7.4%) with depressive
disorders. Conclusion: These findings suggest that war trauma produces broad
psychopathological effects, as evidenced by multiple disorders arising independently in
the wake of trauma. Multiaxial assessment of posttraumatic depression, especially
considering the first and the fourth axis of the multiaxial diagnostic system of the DSMIV-TR, is necessary for a full and precise diagnostic process that allows the selection
of appropriate treatments.

40

2NDJUNE2011

RT003

MULTIAXIAL DIAGNOSIS IN PATIENTS WITH COMBAT RELATED PHYSICAL

TRAUMA- A CASE SERIES
Author(s): Assoc. Prof. Col. VASILE Daniel MD, PhD1, Mr. VASILIU Octavian MD,
DSc1, Lt. MANGALAGIU Andrei Gabriel MD1, Lt.col. BOGDAN Vasile MD2,
STNESCU Beatrice MD1, BNIC Anioara MD1, Lt. TAIN Nicolae Florian 1
Institutions: 1Military University Emergency Central Hospital Dr. Carol Davila,
Department of Psychiatry, Bucharest, ROMANIA
2Military Hospital, Department of Psychiatry, Focsani, ROMANIA
ROMANIA
Military personnel injured in combat operations necessitate multidimensional
evaluation and therapeutic intervention, due to the high rate of physical and psychiatric
comorbidity. There are psychological consequences of physical traumas that could
develop immediately or only some time after the exposure, when the patients are
confronted with the trauma consequences in their daily life. Another situation is the
onset of organic psychotic or affective disorder after traumatic injuries. We selected a
number of three cases with severe physical traumas illustrating various aspects of the
relation between somatic and psychiatric pathology that could appear in military
personnel in combat areas. The first case is a 32 year old patient with severe traumatic
injury, who developed a manic episode due to the frontal cerebral lesions. The second
case is that of a severe injured young patient, during a combat operation, with
tetraplegia, who developed a depressive disorder secondary to the motor deficits and
permanent hospitalization. The third case is a 26 year old patient with facial mutilation,
who developed a depressive reaction, remitted after successfully skin reconstruction.
All these patients were treated by an interdisciplinary team and the results of the
multidimensional treatment were favorable.

14:30-16:00
PP001

POSTER PRESENTATION I
(BYZANTINE HALL)
FAMILIES EXPERIENCES WITH A RELATIVE IN THE INTENSIVE CARE UNIT
Author(s): CPT Maria MALLIAROU, RN, MSc1, MAJ Konstantinia KARATHANASI
RN1, MAJ Helen MOUSTAKA RN MSc2, MAJ Tatiana SERAFEIM RN3, CPT Kiriaki
SOTIRIADOU RN MSc4, Pavlos SARAFIS RN MSc PhD5
Institutions:
1. 404 General Military Hospital, Larisa, Greece.
2. Non-Commissioned Officers School, Trikala, Greece.
3. 424 General Military Hospital, Salonica, Greece.
4. 2nd Brigade/ DYG, Kozani, Greece.
5. Technological Institution of Lamia, Nursing Faculty, Greece.
GREECE
Purpose: to (a) determine needs of families during the hospitalization of a family
member in an ICU; (b) determine levels of satisfaction with how their needs were met.
Material and methods: it is a descriptive, and qualitative study. The setting that the
study took place was the surgical-trauma ICU in a General Hospital of Central Greece.
Family members in the study were N= 26. Needs were measured using the CCFNI on
which a responder rates the importance of individual needs on a scale from 1 (not
important) to 4 (very important). The 45 need statements are categorized into subsets:
assurance needs (7 items), proximity needs (9 items), information needs (8 items),
comfort needs (6 items) and support needs (15 items). SPSS 19 was used for the

41

2ndJUNE2011

analysis.
Results: Mean age of the sample was 59.38 years SD = 19.30. 22 of them were
women and 4 were men. Overall mean importance rating for family members was
found to be 158.85 SD=14.58. Mean days that family had its relative in ICU were 18.69
SD = 17.76. The need to know things were done for the patient, to receive
information once a day for patient s situation, to feel there is hope were the ones
rated as highly important. Information given was more important for the family than
fulfilling personal and emotional needs.
Conclusion: Families experience a sense of uncertainty that is eventually resolved by
seeking information and resources. Health care professionals can minimize the stress
associated with hospitalization of relatives in the ICU by anticipating and addressing
the family's needs for information and resources. Strategies to enhance information to
families, such as written information, daily contact with physician or nurse or both, and
establishing a nurse contact person for families are necessary.
Correspondence: CPT Maria MALLIAROU, RN, MSc
+30 6944796499
mmalliarou@gmail.com
PP002

VIRAL HEPATITIS AMONG WORKERS OF CLEANING DEPARTMENTS OF

MUNICIPALITIES: PILOT STUDY
Author(s): M. DRADOPOULOU, RN, MSc1, P. APOSTOLARA, RN, MSc1, A. BUNCAI
RN, MSc1, LCDR Vassiliki ROKA, RN, MSc, PhD2, D. SKAFIDAKIS, Dent.3, M.
TSIROUDA, RN, MSc1, Assoc. Prof. Athina KALOKERINOU, RN, MSc, PhD1
Institutions: 1. National and Kapodistrian University of Athens, GREECE
2. Military Nursing Academy, Athens, GREECE
3. Hellenic Open University, GREECE
GREECE
Purpose: Viral hepatitis due to hepatitis A virus (HAV), hepatitis B virus (HBV) and
hepatitis C virus (HCV) is a public health problem. The workers in the cleaning
departments of municipalities belong to the subpopulations at risk. They are
susceptible to blood-borne viral hepatitis (HBV, HCV) due to needle sticks from
equipment used by intravenous drug users, as well as to faecaloral viral hepatitis
(HAV) due to their contact with patient stools or HAV-infected water/plants. The aim of
present study is to evaluate the seroprevalence of viral hepatitis markers of these
professionals, in order to provide active immunoprophylaxis against HAV and HBV in
the seronegatives, in the context of community nursing interventions.
Material and Methods: According the pilot study, 92 mail workers of the cleaning
department of the municipality of Vyronas were examined. 22 of them refused to take
part to the study for various reasons. Routine biochemical and haematological tests
were performed using automated techniques in the Department of Microbiology,
Hippokration Hospital of Athens, Greece.
Results: None of the study population, in a mean age 42,8 years (SD=7,7 years), had
been previously vaccinated against HAV and 10 of them reported HBV vaccination in
the past. 53.6% of the examined cleaning workers were IgG anti-HAV positive, 21.7%
were anti-HBc positive and 13,0% were anti-HBs positive. Only 10.1% of the workers
were effectively HBV vaccinated.Conclusion: Community Nursing, in collaboration with
General Practitioners, should consider workers of cleaning departments of the
municipalities as target group for extended HBV vaccination programs, in order to limit
the spread of viral hepatitis.

42

2NDJUNE2011

Correspondence:

PP003

LCDR Vasiliki ROKA

+30-210-7675636,
+30-697-7787277
vassoroka2003@yahoo.gr

THE EFFECT OF BOTULINUM TOXIN IN THE CHRONIC LOW BACK PAIN

Author(s): LT Georgios KOKKORIS MD, T. AVRAMIDIS MD
Institution:
1. Neurology Dept. Athens Naval Hospital, Athens, GREECE
2. Neurology Dept. Red Cross Hospital, Athens, GREECE
GREECE
Purpose: It is known that up to 90% of adults experience low back pain at some point
in their lives and many of them are suffering from chronic low back pain. It seems that
muscular spasm contributes in a high degree in the aetiology of this pain. Botolinium
toxin is a substance known to produce dose-related neuromuscular block leading to
reversible relaxation of the muscles. The purpose of the study is to examine the effect
of botolinium toxin in the chronic low back pain in a group of patients suffering from low
back pain.
Materials and Methods: We examined 30 patients (20 men 10 women) with chronic
back pain aged from 35 to 70 years (mean age 557 years). The inclusion criteria
were low back pain (between L1 and L2), pain duration more than 6 months and not
any other systematic disease that could cause low back pain. We used botolinium
toxin 200 IU per injection and up to a total dose of 1500 IU. For pain evaluation we
used the visual analogue scale (VAS scale). We evaluated the patients at weeks 2, 4,
8, 16 and 24.
Results: All the patients had experienced improvement in the intensity of the pain. Best
results were observed at week 4 after the injection. Pre-treatment VAS value was 8.5,
while 4 and 8 weeks after the injection the VAS value was 2.5 and 4 respectively. The
improvement in pain intensity lasted for up to six months after the injection and no
serious adverse events were reported.
Conclusion: The administration of botolinium toxin significantly reduces the severity of
the symptoms in patients with chronic back pain and is an effective and safe way to
offer relief in these patients with practically no side effects.
Correspondence: LT Georgios KOKKORIS, MD, HN
tel. +30 210-7245588, +30 697-4454637
e-mail: g.kokkoris@yahoo.gr

PP004

EVALUATING THE INTERN NURSING STUDENTS DRUG DOSE CALCULATION

SKILLS
Author(s): BASAK Tulay RN, PhD, LTC YILDIZ Dilek, RN, PhD
Institutions:Gulhane Military Medical Academy, School of Nursing, Ankara,
TURKEY
Objective: The aim of this study was to evaluate the intern nursing students drug dose
calculation skills.
Material and method: The universe of this descriptive study contained 85 students of a
nursing high school in Ankara. The sample of study contained 81 students which were
participated voluntary. The data of study collected with questionnaire form by
researchers. The obtained data evaluated with SPSS for Windows, Ver. 15.0 package

43

2ndJUNE2011

program on the computer environment. Spearman correlation analysis and paired

sample t test were used during the assessment of the data.
Results: 76.3% of students declared that they executed drug dose calculation during
the internship training, 81.0% of those indicated facing difficulties in making these
calculations. In this study, mean score of students drug dose calculation skills was
70.0, and students academic achievement score was 66.6. There wasnt found a
statistically significant relationship between drug dose calculation skills and academic
achievement scores of students (p> 0.05).
Conclusion: Drug dose calculation skills of intern nursing students were found as
inadequate. It wasnt 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: tbasak2003@yahoo.com
Tel:+905323043943
GSM: +905322284622
Fax: 0 312 304 3900
PP005

TOXICOLOGICAL THREAT MILITARY MEDICAL ACADEMY READINESS FOR

MANAGEMENT
Author(s):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 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.

44

2NDJUNE2011

PP006

HEALTH MANAGEMENT PERFORMANCE: MEASURES AND INDICATORS

Author(s): COL CANKUL H.brahim, PhD1; COL TEKE Abdulkadir, PhD1; DEMR
Cesim, PhD1
Institutions:
1Gulhane 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.
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, Saglk Hizmetleri Yonetimi BD, Etlik 06018, Ankara,
TURKEY.
Tel:
+ 90 312 304 6003
Fax: + 90 312 304 2900
GSM: + 90 536 461 3597
e-mail: icankul@yahoo.com
Bu bildiri zeti diskete "cankulhealth.doc dosya adyla kaydedilecektir.

PP007

TURKISH SWORD IMAGE: A RARE CONGENITAL ANOMALY IN AN ADULT

PATIENT
Author(s):CPT CELIK Murat, MD1; LTC CELIK Turgay, MD2; CAPT IYISOY Atila,
MD2; CPT AYTEN Omer, MD3
Institutions:
1 Van Army District Hospital, Department of Cardiology,Van, TURKEY
2Gulhane Military Medical Academy, Department of Cardiology, Ankara, TURKEY
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

45

2ndJUNE2011

PP008

syndrome is usually in association with congenital heart 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 end-diastolic diameter 58 mm) with ejection
fraction of 50%. The pulmonary arterial pressures were normal Atrial and ventricular
septum were 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 (Figure 2). 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 (Figure 3).
Discussion: The Scimitar syndrome is rare and can be accidentally discovered in
adulthood when the patient is asymptomatic. The diagnosis is well-established 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
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: drcelik00@hotmail.com
DETERMINATION OF STANDARD VALUES BELONGING TO HEALTH SERVICES
INDICATORS OF MILITARY HOSPITALS UNDER TURKISH ARMED FORCES
Author(s):COL ERDOAN Endercan, PhD , ISIK Alev, MS
Institutions:
Command of Health Services, Ankara,
TURKEY
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

46

2NDJUNE2011

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.
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.
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.
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: eendercan@hotmail.com
PP009

ANESTHETIC MANAGEMENT IN A PATIENT WITH PFEIFFER SYNDROME

Author(s):CPT ERTEN Ela MD, CPT EKSERT Sami MD, COL ORHAN M. Emin MD,
COL KURT Ercan MD
Institutions:
Glhane Military Medical Academy, Dept. of Anesthesiology, ANKARA,
TURKEY
Indroducton: 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.
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.

47

2ndJUNE2011

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. After the operation the paitent was
extubated and follewed in the PACU four hours before sent to his clinic.
Dscusson: 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 Tp Akademisi, Anestezi ve Reanimasyon AD, ETLK 06018,
ANKARA, TURKEY.
Tel:
+90 312 304 5934
Fax: +90 312 304 5900
GSM: +90 533 812 0365
E-mail: drelacaliskan@hotmail.com
PP010

INVESTIGATION OF NASAL CARRIAGE RATES AND ANTIMICROBIAL

SUSCEPTIBILITY OF STAPHYLOCOCCUS AUREUS IN HOSPITAL STAFF
Author(s):CPT GULGUN Mustafa, MD1, OGUZKAYA-ARTAN Mge, Bio2, BAYKAN
Zeynep, MD2, LTC TOK Duran, MD3
Institutions:
1Gulhane Military Medical Academy, Department of Pediatrics, Ankara, TURKEY
2 Erciyes University, Halil Bayraktar Collage, Kayseri, TURKEY
3 Kayseri Military Hospital, Department of Infection Disease, Kayseri, TURKEY
TURKEY
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.
Material and method: This study is a croos-sectional study carried on Kayseri Military
100-bedded 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 discdiffusion test was 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

48

2NDJUNE2011

Tel:

PP011

+90 312 3044393Fax:

+90 312 3044381GSM:
+90 539 9645480e-mail:
mustafagulgun@yahoo.com

CONTEMPORARY TRENDS IN TOXICOLOGICAL THREAT

Author(s): KATZAROV Krum, KOSTADINOV Rostislav; KANEV Kamen,
Institutions:
Chair Disaster Medicine and Toxicology, Military Medical Academy, Sofia,
BULGARIA
CONTEMPORARY TRENDS IN TOXICOLOGICAL THREAT
Author(s): KATZAROV Krum, KOSTADINOV Rostislav; KANEV Kamen,
Institutions:Chair Disaster Medicine and Toxicology, Military Medical Academy, Sofia,
Republic of Bulgaria
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.
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 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.

49

2ndJUNE2011

PP012

ETIOLOGICAL DIAGNOSTICS ATYPICAL PNEUMONIES OF THE BULGARIAN

MILITARY MEDICAL ACADEMY CONTINGENT OF DURING 2009 -2010
Author(s):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 Medical Academy, Sofia,
BULGARIA
ETIOLOGICAL DIAGNOSTICS ATYPICAL PNEUMONIES OF THE BULGARIAN
MILITARY MEDICAL ACADEMY CONTINGENT OF DURING 2009 -2010
Author(s):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 Medical Academy, Sofia, Bulgaria
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.
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: ikm@techno-link.com

PP013

ARGON
PLASMA
COAGULATION
IN
THE
MANAGEMENT
OF
GASTROINTESTINAL BLEEDING
Author(s): JINGA Mariana, CHERANA Gabriela, POPESCU Andrada, IONI-RADU
Florentina, COJOCARU Mihai, SIMA Irina Ioana, BUCURICA Sandica, CHECHERITA
Alexandru-Ionel.
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

50

2NDJUNE2011

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.
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)
Mariana Jinga:mariana_inga@yahoo.com, 0040722232530
PP014

A RARER CASE OF DIGESTIVE HEMORRHAGE IN AN ELDERLY PATIENT;

DIAGNOSIS AND TREATMENT DIFFICULTIES.
Author(s):1 JINGA Mariana, 1 DRAGAN Cristian, 1 CIOBICA Lucian, 1 VASILESCU
Florina, 1 COSTACHE Raluca Simona, 1 JURCUT Ciprian, 1 CHERANA Gabriela, 1
POPESCU Andrada, 2 STANCU Simona Hildegard, 2 MIRCESCU Gabriel
Institutions:
1Central Universitary Emergency Military Hospital, Dr. Carol Davila, Bucharest,
ROMANIA
2Internal 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, 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

51

2ndJUNE2011

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-Schnlein
purpura in an elderly patient
Key words: digestive hemorrhage, ,nephritic proteinuria, intestinal infraction, HenochSchnlein purpura
Maria Jinga: mariana_jinga@ahoo.com, 004072232530
PP015

EVALUATION OF MEDICS FIRST AID SKILLS AND PRACTICES

Author(s):CPT OZTURK Gultekin, MD1, CPT YILDIRAN Nuri, MD, PhD2, COL OZER
Mustafa, MD, PhD1, LTC CETIN Mehmet, MD, PhD1
Institutions:
1 Gulhane Military Medical Academy, Dept. of Military Health Services, Ankara,
TURKEY.
2 Turkish Armed Forces Medical Command, Ankara, TURKEY.
TURKEY
Objective: The purpose of this research is to determine first aid skills and practices of
medics that educated in different schools and serve different military medical units.
And also we 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) was 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.
CONCLUSON A medic serving in any troop is the first step of a wounded soldiers
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: gozturk4@yahoo.com

52

2NDJUNE2011

PP016

DETERMINATION OF THE GENETIC PREDISPOSING IN DIABETES MELLITUS

TYPE 2
Author(s): S.PASHKUNOVA 1, V. IVANOV 2, . SAVOV 3
Institutions:
1Clinic of endocrinology,
2 Department of Endocrinology and pulmonary diseases,
3 Genetic laboratory for DNA analyses
BULGARIA
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 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.
Military Medical Academy
Bulgaria, Sofia 1606
3, Georgi Sofiiski Blvd.
Fax: +35929225586
Phone: +35929226333
E-mail: pashkunovasylvia@yahoo.com

PP017

TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT(TIPS) - A STATE OF

THE ART METHODE WHO SAVED THE LIFE
Author(s): Mihai COJOCARU 1, Eliyahu ATAR 2, Florentina RADU IONITA 1, Cristina
SANDU 1 , Ionela DAMIAN 3
Institutions:
1. Department of Internal medicine-Gastroenterology, 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
A fifty two years 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 taking into account because
the patient had high portal hypertension and this bleeding episode was the third within

53

2ndJUNE2011

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 observes 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 perfect positioned, followed by embolization of the large esophageal
varices.
Conclusion: sometimes a tip can do(or become) a TIPS which do save the life!.
PP018

FACIAL DIPLEGIA AND DEPRESSIVE DISORDER DIAGNOSIS INVOLVEMENTS

FOCUS ON THE DIFFERENTIAL DIAGNOSIS
Author(s):Authors: Col. E. LUNGUT, MD PhD*,Col. I. FURDU, MD**, C. CALCIU,
MD***
Institutions:
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.
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 .
*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
Col. E. Lungut, MD PhD, Phone: 0785202552
Col. I. Furdu, MD, Phone: 0785202551, email: iustinfurdu@yahoo.com

PP019

USE OF NEUTROPHILS CD64 IN DIAGNOSIS OF INFECTION AND SEPSIS

Author(s):Lt.Col. J. PEJOVIC 1 , T.ANDJELIC 1, V.SUBOTA 1. T. DJURASINOVIC 1
and M. SURBATOVIC 2
Institutions:
1Institute of Medical Biochemistry ,
2 Department of Intensive Care Medicine, Military Medical Academy, Belgrade,
SERBIA
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

54

2NDJUNE2011

sepsis. The aim of the study is to verify this statement.

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.
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 <0.05) with weak correlation in Gr.1
and Gr.2. WBC count, neutrophils, left shift and immature granulocytes demonstrate
weak correlation compared to CD64.
Conclusion: This study shows that CD64 is a useful tool to identify infection and
sepsis. The test is reliable and easy to perform, which makes it valuable in a critical
care medicine.
e-mail: jpejovic1962@gmail.com
PP020

THE PREVALENCE OF ARTERIAL HYPERTENSION AND ITS

CORRELATION
WITH SMOKING, ALCOHOL ABUSE AND EXERCISE
Author(s): LT Polykarpos PSOCHIAS MD, 5th Grade student Dimitra TZAKRI 2, 1LT
Dimitrios PAPADOPOULOS MD3, LTJG Athanasios KALOGEROPOULOS MD4
Institutions:
1) 401 Military Hospital, Athens
2) Military Medical Academy, Thessaloniki, GREECE
3) Aeromedical Centre, Athens
4) Naval Hospital of Salamis, GREECE
GREECE
Purpose: The purpose of the study is to calculate the frequency of the diagnosis of
hypertension in patients who seek help in primary health centers and to determine the
association between this pathologic condition and certain daily habits, such as
smoking, alcohol consumption and exercise
Materials and methods: The study group consisted of 170 patients (mean age 69 /
range 22-89) who visited the primary health center of Lagadas, Thessaloniki in
November 2009. They were given a questionnaire about their habits, in which the final
diagnosis after the examination was added.
Results: 50 out of the 170 patients (29,4%) had the diagnosis of arterial hypertension,
which was the most common one. 17 of those 50 (34%) were smokers and even
higher (41,7%) was the percentage of the hypertensive who smoke more than 20
cigarettes/day. The alcohol consumers (>1 glass of beer, wine or ouzo/day) were 30
out of the 50 hypertensive patients (60%). On the other hand, only 30% (15 patients)
of the hypertension subgroup used to exercise (including walking) more than 3
hours/week. In fact, 61% of those who did exercise regularly had no evidence of high
blood pressure.
Conclusion: It is a fact that hypertension is one of the most common diagnosis in
primary health centers, which is also shown in this study. Smoking seems not to be
directly related with elevated blood pressure, perhaps due to the high mean age of the

55

2ndJUNE2011

sample (there are less smokers in the third age). On the contrary, alcohol abuse
seems to favor hypertension, whereas daily exercise is related with low frequency of
this pathologic entity.
Correspondence:
LT Polykarpos PSOCHIAS, MD
+30 6976406003
psochias@yahoo.com
PP021

IMPETIGO CAUSED BY SERRATIA SP. ON AN UNDERLYING ATOPIC

DERMATITIS: A CASE REPORT
Author(s):Authors: 2LT 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 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 face and
neck. He admitted to dermatology clinic, where skin biopsy with punch was practiced
along with blood investigation. Moreover, teicoplanin i.v. and topical antibiotics were
commenced. The blood test showed elevated levels of CRP and gE. Histological
examination of the skin biopsy revealed atopic dermatitis. Finally, the patient started
on cortisone, clindamycin and penicillin i.v and itraconazole per os. Improvement was
noted within two days.
Conclusion: Atopic dermatitis is a predispoding factor for impetigo due to skin
breakdown. Therefore, it should be suspected, identified and treated in cases resistant
to conventional medication.
Correspondence: 2LT Maria-Angeliki GKINI, MD
Tel : +30 6939195772, +30 2108040152,
gkinimargo@yahoo.com

56

2NDJUNE2011

PP022

THE MOST COMMON DISEASES AND THEIR TREATMENTS IN A MILITARY

INFIRMARY
Author(s):MAJ TURKER Turker, MD1, CPT BABAYIGIT Mustafa Alparslan, MD2, COL
CEYLAN Suleyman, MD1, COL HASDE Metin, MD1
Institutions:
1 Gulhane Military Medical Academy, Dept. of Public Health, Ankara,
TURKEY.
2 Turkish Armed Forces Health Command, Dept. of Preventive Health Services,
Ankara,
TURKEY
Objective: It was aimed to identify the diseases, medications, and results of medical
examinations, and ascertain whether a demographic variable was associated with the
frequency of diseases.
Material and method: The infirmary medical records, 44.000 data, belonged to January
December 2005 of An Armour Unit School And Training Division constituted the
study population. Using a systematic and stratified sampling method, 1000 medical
records were examined between May 12-15, 2006. In this cross-sectional study,
International Classification of Disease (ICD-10), and SPSS were used to analyse the
data.
Results: Mean age of the privates was 21.72.4 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 ICD-10. 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<0.05). Furthermore, 62.0% of patients were given
medication, 29.7% were referred to the hospital. Antibiotics (32.3%),
analgesic/antipyretic/anti-inflammatory (26.1%), and antifungal (6.9%) drugs were the
most commonlly prescribed by the physicians. Of referrals to hospital, 19.4% were due
to musculoskeletal system and connective tissue disorders.
Conclusion: Health service support in a military troop should be planning according to
the most frequent diseases observed. The factors caused disease, such as sheltering
conditions, should be improved.
Correspondence
Turkish Armed Forces Health Command, Dept. of Preventive Health Services, Ankara,
TURKEY,
Tel
: +90 312 4024042
Fax
: +90 312 4177951
GSM : +905057148147
e-mail : mbabayigit@tsk.tr

57

2ndJUNE2011

PP023

THE PERSISTENT LEFT SUPERIOR VENA CAVA DRAINING INTO THE LEFT
ATRIUM VIA LEFT SUPERIOR PULMONARY VEIN
Author(s):MAJ BATTAL Bilal, MD1, CPT AKGUN Veysel, MD2, MAJ KARAMAN
Bulent, MD1, LTC BOZLAR Ugur, MD1
Institutions:
1 Gulhane Military Medical Academy, Department of Radiology, 06018, Ankara,
TURKEY
2Golcuk Military Hospital, Department of Radiology, 41650, Kocaeli,
TURKEY
Objective: Persistent left superior vena cava (PLSVC) is a rare congenital venous
anomaly. PLSVC draining into left atrium via left superior pulmonary vein is an
extremely rare entity. The aim of this case report is to present multi-detector computed
tomography angiography (MDCTA) imaging findings of the PLSVC draining into the left
atrium via left superior pulmonary vein.
Material and method: An 82-year-old female patient with acute chest pain and dyspnea
underwent multidetector computed tomography (MDCT) pulmonary angiography.
Arterial and venous structures of the thorax were evaluated with post-processed
images obtained by Multiplanar Reformation (MPR), Maximum Intensity Projection
(MIP) and Volume Rendering (VR) techniques based on the axial scan.
Results: MDCT angiography images demonstrated PLSVC draining into the left atrium
via left superior pulmonary vein. This vascular anomaly, causing right to left shunt, was
encountered incidentally and depicted by MPR, MIP, VR images. There was a patent
right superior vena cava and atherosclerotic plaques in both aorta and coronary
arteries. There was no significant sign in the lung parenchyma that can explain the
clinical symptoms.
Conclusion: There are various thoracic vascular anomalies with or without clinical
symptoms. We believe that in revealing of the thoracic vascular variations and
anomalies MDCTA is the gold standard imaging technique. MDCTA has various
applications, and enables vascular mapping that accurately demonstrates vascular
anomaly and its relationship with adjacent structures.
Correspondence
Gulhane Military Medical Academy, Department of Radiology, 06018, Ankara, Turkey
+ 90 312 3044701
+ 90 312 3260551
+ 90 533 4330667
e-mail: bilbat_23@yahoo.com

58

2NDJUNE2011

PP024

BALLOON DILATATION OF PULMONARY STENOSIS BEFORE SURGERY IS A

REASONABLE PROCEDURE IN ADULT PATIENTS WITH TETRALOGY OF
FALLOT AND RIGHT-TO-LEFT SHUNT?
Author(s):CPT BUGAN Baris, MD1, COL IYISOY Atila, MD2, LTC CELIK Turgay ,
MD2, 1LT FIRTINA Serdar, MD2, COL KURSAKLIOGLU Hurkan, MD2, COL OZKAN
Mustafa MD2
Institutions:
1 Malatya Military Hospital, Dept. of Cardiology, Malatya, TURKEY.
2 Gulhane Military Medical Academy, Dept. of Cardiology, Ankara, TURKEY.
TURKEY
Objective: Balloon dilatation in symptomatic patients with diminutive pulmonary
arteries has been reported as a palliative step for Tetralogy of Fallot (TOF). There are
conflicts regarding the efficacy and safety of this technique, especially in patients with
TOF and right-to-left shunt. We, herein, reported a 19 year old patient with TOF and
right-to-left shunt who undervent balloon dilatation of pulmonary stenosis before
corrective surgery.
Material and method: A 19 year-old-female patient with TOF was referred to our centre
for further evaluation. Her symptoms were fainting, dizziness, fatigue, and palpitation.
ECG showed sinus tachycardia with right axis deviation. Her oxygen saturation was
almost 30 % with room air. Echocardiograpy revealed right ventricular hypertrophy,
overriding aorta, VSD and pulmonary valve stenosis with a peak gradient of 100
mmHg. For further evaluation, cardiac catheterization was performed.
Results: Overriding aorta was visualized with right to left shunt. Pressure
measurements were as follow; a systolic gradient of 112 mmHg at pulmonary valve
(pulmonary artery;18,12,15 mmHg; right ventricule;130,10,50 mmHg). Pulmonary
balloon valvuloplasty was performed succesfully (Tyshsca 22mmX 4) and shunt
reversed left to right. Her oxygen saturation in blood gases raised above %90 with
room air. She was referred to cardiovasculary surgery for complete repair of TOF two
weeks later.
Conclusion: Balloon dilatation is an effective and useful palliative procedure before
corrective surgery in symptomatic adult patients with right to left shunt, however
assessment of the pulmonary tree, right ventricular function and the shunt direction are
very critical for success of the procedure.
Correspondence:
Military Hospital, Department of Cardiology, Malatya, TURKEY.
+ 90 422 336 2041
+ 90 422 336 2043
+ 90 532 347 6096
e-mail: bbugan@hotmail.com

59

2ndJUNE2011

PP025

THE ROLE OF INTRAVASCULAR ULTRASOUND GUIDANCE IN THE

TREATMENT OF INTRAMURAL HEMATOMA DID NOT RESOLVED AFTER
SPONTANEOUS CORONARY ARTERY DISSECTION AND CAUSED ACUTE
MYOCARDIAL INFARCTION
Author(s):CPT CELIK Murat, MD1; LTC CELIK Turgay, MD2; CAPT IYISOY Atila,
MD2; MAJ YUKSEL Uygar Cagdas, MD2
Institutions:
1 Van Army District Hospital, Department of Cardiology,Van, TURKEY
2 Gulhane Military Medical Academy, Department of Cardiology, Ankara,TURKEY
TURKEY
Objective:The prognosis of patients with spontaneous coronary artery dissection
(SCAD) is generally poor and the majority of them are diagnosed postmortem. Various
therapeutic options include medical therapy, PCI and surgery have been utilized, but
the optimal strategy is not yet to be defined. The current use of intravascular
ultrasound (IVUS) can facilitate the diagnosis and the treatment of SCAD.
Case report: A 30 year-old female without any cardiovascular risk factors admitted to
our hospital for resting squeezing chest pain continuing one hour. She did not have a
history of pregnancy. Resting ECG showed ST segment elevation in leads V2-V6.
Transthoracic echocardiography showed hypokinesia in the mid-apical segments of
anterolateral left ventricular wall and apical segment of left ventricular. Afterwards, the
patient underwent to CAG for the evaluation of coronary arteries. The CAG revealed a
long spiral dissection involving the proximal and mid segments of LAD with TIMI 2
flow. Because of the disappearance of ST-segment elevation during CAG, primary PCI
was not performed and treatment with aspirin, unfractionated heparin, tirofiban and a
beta-blocker was started. Her symptoms were resolved with this therapy, and control
CAG and IVUS examination were performed for investigating the presence and the
extent of the dissection on the second day of hospitalization. The control CAG
revealed that LAD was narrowed without any evidence of intimal flap and coronary
flow impairment. IVUS examination demonstrated medial dissection with an intramural
hematoma starting from the proximal segment of LAD and progressing into distal
segment of LAD, and no evidence of atherosclerosis.
In light of the foregoing analysis, we decided to implant two stents in LAD. A 3.0x20
mm stent was implanted into the proximal segment and a 2.5x20 mm stent was
implanted into the distal segment of LAD. The lumen area was optimal and the
procedural result was excellent with TIMI-3 flow distally. She discharged at a very
good condition with an optimal medical treatment. At 3-month control she did not have
any complaint and control CAG revealed no significant in-stent restenotic tissue.
Conclusions: In conclusion, the principal abnormality observed in SCAD is the
development of intramural hematoma and can cause acute coronary syndrome. PCI
can be necessary to restore distal flow in a such narrowed vessel and IVUS can guide
PCI to confirm the placement of guidewire in the true lumen, sealing the dissection,
adequate stent expansion, the adequate compression of intramural hematoma after
stent implantation.
Keywords: spontaneous coronary artery dissection, intramural hematoma,
intravascular ultrasound
Correspondence:
CPT CELIK Murat, MD

60

2NDJUNE2011

PP026

CLINICAL CASE OF PEUTZ - JEGHERS SYNDROME WITH JEJUNO-JEJUNAL

INVAGINATION
Author(s): DRANDARSKA Ivanka MD , MIHOVA Anna MD PhD , ANACHKOV K. MD,
NEDKOVA A., Col. KATZAROV K. MD, PhD*, VLADOV K. MD, PhD**.
Institutions:
Military Medical Academy, Department of Pathology, Sofia, BULGARIA
* Military Medical Academy, Department of Gastroenterology and Hepatology, Sofia,
BULGARIA
** Military Medical Academy, Department of Hepatopancreatic and Transplant
surgery, Sofia,
BULGARIA
Peutz-Jeghers syndrome is autosomal dominant disease and may be presented with
polyps in the stomach and small bowel and mucocutaneous pigmentation.
We present a clinical case of 13 year old girl, in which on the occasion of jejuno-jejunal
invagination with subsequent surgical intervention, resection of segment of small
intestine, Peutz-Jeghers polyp is found in. In the tunica muscularis propria of small
intestinal wall a pseudoinvation of polyps epithelial components is seen.The structure
of polyps is reason to be found a mucocutaneous pigmentation of the mouth both of
the child and his mother.

PP027

ADMINISTRATIVE MANAGEMENT IN MILITARY HOSPITALS

Author(s):COL ERDOAN Endercan, PhD 1, LTC NAL A.Sevim, PhD 1, CPT MER
Meltem, PhD2,
Institutions:
1 Command of Health Services, Ankara, TURKEY.
2 Beytepe Military Hospital, Ankara, TURKEY.
TURKEY
Objective: Management term is commonly used for ruling a unit, but a definition of
Management is doing the job using others is mostly agreed.
Manager is a person that executes some jobs using others while planning and
directing their works. Most important duty of the manager is said to be the organization
and coordination of the employers.
Hospital management have two sub processes that are: medical management and
general administration. Medical management consists of department of clinical
services, department of nursery services and department of medical personnel.
General administration have most commonly used departments of other organizations
besides departments such as logistics, personnel, finance, resource management and
other support facilities.
General administration in military hospitals is handled by Deputy commander for
admin. Deputy commander for administration has sub-divisions such as; logistics,
medical technics and calibration, resource management, information management,
personnel, registration and archive section and other hospital support units (security,
kitchen, ambulance services and electrical maintenance).
Results: As a result, deputy commander for admin should have excellent leadership
skills and vision to motivate and organize his sub-units to achieve strategic goals of
military hospital in peace and combat situations. In that progress one time the
responsibility that he endures can be the purchase of a medical device that is crucial
for a surgery of a trooper, other time it can be his duty to motivate the personnel that

61

2ndJUNE2011

will serve a patient.

Conclusion: Military hospitals and other hospitals in many ways similarly managed.
Correspondence:
COL ERDOAN Endercan
Command of Health Services, Ankara, TURKEY.
Tel:
+ 90 312 2431190/4005
GSM: +90 532 3432909
e-mail: meltemcos@yahoo.com
PP028

CHEMICAL TERRORISM CHALLENGES

Author(s):Assist. GALABOVA Agnes, Assoc.Prof. DRAGNEV Velichko, MD,PhD,
leut.col KONOV Valentin,MD
Institutions:Military Medical Academy, SRL Disaster Medicine, Disaster Medicine and
Toxicology Department, Sofia,
BULGARIA
Objective: Terrorism in the 21 century has become a global problem for the
international community. In recent years the number of terrorist acts has increased
along with the numerous victims and destruction. Although the used devices are
conventional, an assessment of the UN and WHO says that chemical and biological
terrorism are among the most dangerous types.
The aim of the present material is to outline a contemporary concept on hazards of
chemical weapons use for terrorist purposes.
Materials and methods: Survey of the open literature on the current status and trends
of the problem.
Results: The major means of chemical terrorism are presented, possibilities of terrorist
organizations for the acquisition, production and dissemination of chemical warfare
agents are described. In the risk assessment, experts and analysts does not reach
consensus about the hazard degree of chemical weapons use for terrorist purposes.
Conclusion: Timely and effective response in terrorist incidents is determined by
preliminary training and necessary skills. The support of these factors is based on
awareness, proper planning and personnel training in case of chemical terrorism
Disaster Medicine Scientific Research Laboratory
Disaster Medicine and Toxicology Department
Military Medical Academy
3, St. G. Sofiisky Str.
1606, Sofia
BULGARIA
Tel. +35929225929
Email: medkat@vma.bg

62

2NDJUNE2011

PP029

ASSESSMENT OF RISK FACTORS IN THE DEVELOPMENT OF MRSA INFECTION

AT GLHANE MILITARY MEDICAL FACULTY EDUCATION HOSPITAL AND THE
ROLE OF ANTIBIOTIC USE ON THE DEVELOPMENT OF MRSA INFECTION
Author(s):MAJ GUNAL Emine, MD1, COL BESIRBELLIOGLU Ahmet Bulent, MD1,
ERSOZ Fliz PhD2, COL AVCI Ismail Yasar, MD1, BG EYIGUN Can Polat, MD1.
Institutions:
1 Infectious Disease and Clinical Microbiology, Gulhane Military Medical Academy,
Ankara, TURKEY
2 Operation Researches Department, Turkish Military Academy Defense Science
Institute, Ankara,
TURKEY.
Objective: This research was carried out to determine important risk factors in the
development of methicillin resistance which were considered to be imperative in MRSA
development by comparing infections due to methicillin resistant and susceptible strains
to make suggestions to decrease MRSA ratios by pointing out the importance of preinfection antibiotic usage in the development of MRSA infection and its place among the
other risk factors.
Material and method: This research was planned as a retrospective case control study
and risk factors, which were considered important in the development of infection
among inpatients owing to S. aureus infection at GATF (Glhane Military Medical
Faculty) Education Hospital between 2003-2008 years, were compared as MRSA and
MSSA groups.
Results: Hospitalization period, previous hospitalization existence, previous
hospitalization number, lining in intensive care unit, MRSA existence in the same
milieu, polymicrobial infection, acute trauma, surgery, open lesion, any intravenous
catheter, urethral catheter, mechanical ventilation existence, invasive device number,
previous antibiotic usage, number and period of used antibiotic were found more
significant in MRSA patients (p<0,05). Respectively, flouroquinolone usage (OR, 2,56;
%95 CI: 1,0526,231; p<0,05), the time period of previous antibiotic use (OR, 2,343;
%95 CI: 1,6973,236; p<0,05), hospitalization times (OR, 1,396; %95 CI: 1,2351,578;
p<0,05), previous hospitalization period (OR, 0,992; %95 CI: 0,9860,999; p<0,05),
MRSA existence in the same milieu (OR, 0,283; %95 CI: 0,130,618; p<0,05) were
determined as independent risk factors in the development of infections due to MRSA.
Conclusion: Controlling these risk factors and either avoiding uncontrolled prescription
or decreasing the use of selected antibiotic subcategories like flouroquinolones and
cephalosporins seem to reduce infection due to MRSA.
Correspondence:
Emine GUNAL
Gulhane Military Medical Academy, Ankara, TURKEY
Tel
: + 90 312 304 4306
GSM : + 90 505 233 5296
e-mail : egunal@gata.edu.tr

63

2ndJUNE2011

PP030

EARLY AND RAPID DETECTION OF Q FEVER BY EFFECTIVE REAL-TIME PCR

SYBR GREEN SYSTEM
Author(s):Major
KUNCHEV M. MD, PhD, ALEXANDROV E. MD,Prof.,
KAMARINCHEV B. MD, Assoc.Prof., KALVACHEV Z. MD, Prof.,ALEXANDROVA D.
MD, PhD and MEKOUCHINOV K. B.MD, Assoc.Prof.
Institutions:
Military Medical Academy, Sofia,
BULGARIA
Objective: To be presented new effective and contemporary molecular biological
method for early and rapid specific detection Q fever at genetic level.
Material methods: We used one of most contemporary molecular- biological
methods for rapid and specific diagnostic Q fever at genetic level is real-time
Polymerase Chain Reaction (PCR) with conventional primers CB1/CB2 and
fluorescense SYBR green dye.
Results: We successfully tested experimental this new contemporary molecular
biological method for specificity, sensitivity and effectiveness in sequence detecting of
Coxiella burnetii genome which is strongly peculiar to that kind of microorganism.
Conclusion: Coxiella burnetii is the cause for Q- fever that is spread all over the world
and affects both, animals and humans. Coxiella burnetii is a potential biological agent
that is possible to be used as a biological weapon. Q fever is a disease of great
significance which may take a chronic or even lethal course. Prompt and specific
diagnostic tools as well as elaborating new detection methods are needed for an exact
diagnosis and a correct etiological treatment.
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: ikm@techno-link.com
e-mail: mkunchev@yahoo.com

PP031

SPREAD OF HEPATITIS B AND C VIRUSES AMONG HEALTHY MILITARY

PEOPLE IN BULGARIA DURING A PERIOD 2009 2010.
Author(s): MARINOVA E. MD, DARLEVA S.,ILIEVA L ,Major KUNCHEV M. MD, PhD,
ALEXANDROVA D. MD, PhD, Assoc.prof. MEKOUCHINOV K., MD,PhD
Institutions:
Laboratory of Virology, Military Medical Academy,
BULGARIA
Objectives: To determine HBV and HCV carriers among healthy people and to
undertake an appropriate treatment.
Material methods: All 6 313 military healthy people: 3 201 and 3 112 persons
candidates for international missions have been investigated during the years 2009
and 2010 respectively.
The detection and confirmation of specific antigens and antibodies have been
performed with ELISA and Blot tests, respectively.
Results: We found :
HBV carriers 1,6% (2009) and 1,09% (2010)

64

2NDJUNE2011

HCV carriers 0,19% (2009) and 0,13% (2010)

Conclusions: HBV and HCV carriers progressively fall in comparison with carriers of all
Bulgarian population, that correlated with improved medical screening and
immunization policy.
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: ikm@techno-link.com
PP032

DISMETABOLIC CHANGES ASSOCIATED WITH CHRONIC HEPATITIS C VIRUS.

Author(s): Mariana JINGA 1,2, Emilia RUSU 2,3, Gabriela RADULIAN 2,3, Forin RUSU
1, Georgiana ENACHE 3, Andreea DRAGOMIR 3, Victor STOICA 2,4, Dan CHETA 2,3
Institutions:
1Central Universitary Emergency Military Hospital, Bucharest, ROMANIA
2University of Medicine and Pharmacy "Carol Davila", Bucharest, ROMANIA
3Institute of Diabetes, Nutrition and Metabolic Diseases "Prof. N. Paulescu ",
Bucharest, ROMANIA
4Clinical Hospital "Dr. I. Cantacuzino", Bucharest,
ROMANIA
Introduction: The purpose of this study was to analyze the phenotype of diabetes
mellitus (DZ2) in patients with chronic hepatitis C virus (HCV).Pathogenesis of
diabetes mellitus in the context of chronic hepatitis is a subject of controversy,
involving either insulin resistance and hyperinsulinemia, insulin deficiency or
decreased insulin secretion, hepatic steatosis and proinflammatory cytokines.
Method: We selected 112 patients with HCV - group A and 60 patients with DZ2 and
HCV - group B. They were followed for anthropometric parameters (BMI, waist
circumference), glucose profile (including HOMA-IR), liver and lipid profile, adipocitare
and proinflammatory cytokines. To assess liver fibrosis we have used the AST /
platelets report (APRI), the AST / ALT report and Forns index.
Results: Obesity was present in 44.6% of patients in group A and 51.6% in group B.
The lipid profile suggesting atherogenic dyslipidemia was more common in patients
associating type 2 diabetes; 29.4% of HCV patients without diabetes had
hypertriglyceridemia, vs. 61.6% in patients with DZ2 and HCV. The AST / ALT report,
and APRI values were higher in diabetic patients with poor metabolic imbalance and in
those treated with insulin.Impaired glucose regulation (changed fasting plasma
glucose, impaired oral glucose tolerance test and diabetes mellitus) was present in
26.78% of patients with HCV.
Conclusions: This study provides data showing that HCV patients with type 2 diabetes
have clinical characteristics that are distinct from the classic type of diabetes
(abdominal obesity with hipoHDLcolesterolemia and lower triglycerides).
Key words: chronic hepatitis C virus, diabetes mellitus, steatosis, insulin resistance.
Mariana Jinga: mariana_jinga@yahoo.com, 0040722232530

65

2ndJUNE2011

PP033

NEUROENDOCRINE TUMORS OF THE PANCREAS: PREOPERATIVE

TOPOGRAPHIC DIAGNOSIS
Author(s): JINGA Mariana, SIMA Irina Ioana, CHERANA Gabriela, POPESCU
Andrada, NUTA Ionel Petrut, MACADON Bogdan, SPIROIU Cristina, RANETTI
Aurelian Emil
Institutions:
Central Universitary Emergency Military Hospital, Dr. Carol Davila, Bucharest,
ROMANIA
Introduction: Neuroendocrine tumors of the pancreas (NTP) are localized
preoperatively using conventional imaging studies as transabdominal ultrasonography,
computed tomography (CT), and/or magnetic resonance imaging (MRI). Purpose:
Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of NTP.
Methods : Between 2003 and 2010 in Central Universitary Emergency Military
Hospital, Bucharest were hospitalized 18 patients diagnosed with insulinoma, 6 male,
12 female, 26 to 75 years of age. We performed a retrospective study.
Results: Ultrasound view was positive in only 5,88% of patients (one of 17), that
presented proximal location. The sensitivity of CT was unsatisfactory, only 21,42% (3
positive results of 14), failed to detect liver metastases, but identified nodal metastatis
in one patient. MRI was performed in 13 patients and was diagnostic in 7 of them,
recording a detection sensitivity of 53,84%, including infracentimetric tumor size. High
resolution of EUS allows detection of lesions with very small diameter, is safe and
minimally invasive. EUS was performed in 16 of 18 patients, being able to identify
formations in 13, inconclusive in 3, showing a diagnosis sensitivity of 81,25%. Liver
metastases were demonstrated in 3 of 15 patients, one by US and all 3 by MRI.
Conclusions :
- CT with intravenous iodinated contrast agent has a poor sensitivity, was insensitive in
detecting liver metastases, but found nodal metastasis.
- MRI has higher sensitivity than CT including insulinomas with infracentimetric size
and is the imaging test of choice for possible liver metastases.
- EUS is preoperative imaging investigation of choice.
Keywords:neuroendocrine tumors of the pancreas, endoscopic ultrasound (EUS),
preoperative localization
Mariana Jinga: mariana_jinga@yahoo.com, 0040722232530

PP034

WHEN SHOULD A TOURNIQUET BE RELEASED?

Author(s):CPT OZTURK Gultekin, MD1, CPT YILDIRAN Nuri, MD, PhD2.
Institutions: 1 Gulhane Military Medical Academy, Dept. of Military Health Services,
Ankara,
2 Turkish Armed Forces Medical Command, Ankara, TURKEY.
TURKEY
Objective: The purpose of this study is to present the findings of researches, aspects
of literature and suggestions of training and reference books about releasing time and
duration of a tourniquet if it is a correct application.
Materials and methods: To present the historical process of tourniquet application, we
searched the words tourniquet, remove, release, time, and duration at the
published articles and we reviewed some of these items. And also some training
sheets and reference books about medical support of military operations, and
hemorrhage control are reviewed for the purpose of determining the correct procedure

66

2NDJUNE2011

about removing or releasing a tourniquet.

Results: All the medical or non-medical military personnel know the time of tourniquet
application. There is almost no question on it. But, the question of when should a
tourniquet be released? occurs, with all its uncertainty, in persons mind. Old aspects
recommend that tourniquet should be released in every 15-30 minutes intervals, but
new studies show and current training books recommend that a tourniquet should not
be released unless the evacuation time is longer than two hours or the hemorrhage
can be controlled surgically. Tourniquet can be used safely within two hours. Short
releasing intervals cant prevent limb from tourniquet related complications. Some case
reports present tourniquet related complications are temporary when tourniquet
application time is less than six hours.
Conclusion : Despite all the fear of tourniquet complications, it should not be avoided
to use when required. But soldiers should know issues about tourniquets especially
releasing time of it.
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: gozturk4@yahoo.com
PP035

ANALYSIS OF JOB STRAIN IN BLUE COLLAR WORKERS

Author(s): ALEKSI Aleksandar 1, TRKULJA Marijana 2, CIKOTA-ALEKSI Bojana 3
Institutions: 1Institute of Occupational Health, Military Medical Academy, Belgrade,
2Institute of Occupational Health Dr Dragomir Karajovi, Belgrade,
3Institute for Medical Research, Military Medical Academy, Belgrade, SERBIA
SERBIA
Introduction: Data from literature have indicated that chronic stress may contribute to
development and expression of different diseases.
AIM: The present study assessed workrelated stress in order to education and age.
Furthermore, the study analyzed relationship between stress at work and incidence of
cardiovascular diseases, endocrine/metabolic disorders and risk factors for these
diseases.
Participants and methods: A total of 457 blue collar workers (411 men and 46 women)
employed by Ministry of defense and one public organization in Serbia completed the
Job Content Questionnaire to determine the dimensions of job strain model. Data
about health condition, education, habits and presence of chronic diseases were
obtained by medical examination and interview, respectively.
Results: The frequency of job strain categories was significantly different between low
and high educated male workers (2 test, df=3, p<0.0001). The most frequently high
educated workers characterized their job as active (47%) and low educated workers as
high strain (35%). The frequency of job strain categories was also significantly different
between low and high educated women (2 test, df=3, p<0.05). The most frequently,
high educated women thought their job was low strain (52%) while in low educated
women was passive (33%). In men the frequency of job strain categories was
significantly different between different age groups (2 test, df=6, p<0.0001). The most
often, workers older than 45 years characterized their job as active (37%), workers

67

2ndJUNE2011

aged 35 to 45 years as high strain (32%) and workers younger than 35 years as high
strain (40%). In women, the frequency of job strain categories was not significantly
different between age groups. The frequencies of cardiovascular and
endocrine/metabolic disorders were not significantly different between different job
strain categories. Analyzing the most important risk factors for development of these
diseases (blood pressure, obesity, smoking, alcohol intake and serum level of
cholesterol, triglyceride and glucose), we didnt observe significant statistical difference
in frequencies of abnormal values between different job strain categories.
Conclusion: Unfavorable categories (high strain and passive jobs) were the most
frequently found in low educated workers and in younger groups of male workers.
Furthermore, unfavorable job categories were not connected with the higher incidence
of cardiovascular, endocrine/metabolic diseases and common risk factors for these
diseases.
PP036

THE PARTICIPATION OF ROMANIAN PHYSICIANS IN INTERNATIONAL MEDICOMILITARY SCIENTIFIC EVENTS IN THE 20TH CENTURY
Author(s):Autor: Mr.drd.asist.univ.dr. Alexandru KERESZTES,
Institutions: Spitalul Militar de Urgenta Regina Maria Brasov,
ROMANIA
THE PARTICIPATION OF ROMANIAN PHYSICIANS IN INTERNATIONAL MEDICOMILITARY SCIENTIFIC EVENTS IN THE 20TH CENTURY
Author(s):Mr.drd.asist.univ.dr.Alexandru Keresztes,
Institutions:Spitalul Militar de Urgenta Regina Maria Brasov, ROMANIA
Background: The first World War, through its proportions and intensity of military
conflicts, has put the health services belonging to the belligerent states in unusual
situations through their complexity. As a result, the continuous development and
improvement of the forms and strategies of organisation of military health care
services at all its levels and branches became essential. Similarly, the period was
marked by an emphasis on the organisation of scientific debates on aspects and
problems of military medicine and the enhancement of exchanges between various
countries.
Methods: The paper is based on the study of facsimile documents of the International
Congresses of Military Medicine, published in the British Medical Journal, "Am J Public
Health Nations Health", "Can Med Assoc." between 1921 and 1947, on the magazine
collection of military health care of the same period, "the voice" of the Military Medical
Corps in Romania, and on general M. Diaconescus (MD) monograph "People and
Events in the History of Romanian Military Medicine".
Results and discussion: In 1920, in New Orleans, colonel Jules Vocken (MD)
(Belgium), together with Commander William Baingidge (USA), determine the
necessity of organizing an international congress of military medicine and pharmacy,
and Belgium becomes the first country in organizing this kind of scientific meetings.
In the first half of the twentieth century, there were 11 international conferences held in
countries around Europe and North America. The themes varied not only around
purely military issues (the war organization of health services; chemical and clinical
study of toxic gas in battle; the experience in the treatment of complex wounds specific
to war), but also around issues related to civil authorities and military cooperation in
health and demographic statistics relative to such social diseases as tuberculosis,
alcoholism, vaccines, the spread of sexual diseases, the etiology and prevention of

68

2NDJUNE2011

influenza. Romanian doctors were an active presence in all these events.

Not only did the Romanian military physicians realize the need to keep abreast of the
scientific achievements and advances in the field of military medical service
organization, but they also shared and learned from the personal experience or
scientific collaborations with the great personalities of the contemporary medical world
(for example, Professor I. Cantacuzino, MD and his colleagues, on issues of etiology
and prevention of influenza).
Conclusions: The Romanian military medicine has been a constant and active
presence in all these events.
Keywords: military medicine, Congress, health services
PP037

DIAGNOSTIC AND TREATMENT DIFFICULTIES IN INSULINOMA - CASE REPORT

Author(s):Authors: B. MACADON, Florentina IONI-RADU, Mariana JINGA, M.
PATRASESCU, P. NUTA, R. COSTACHE, M. COJOCARU, S. BUCURICA
Institutions: Internal Medicine Department 2,
Central Universitary Emergency Military Hospital, Bucharest,
ROMANIA
Patient A.A. aged 27 without noticeable medical history was admitted in our hospital
complaining of several episodes of symptoms suggesting hypoglicemia (diplopia,
blured vision, confusion, loss of consciousness, diaphoresis). The common trigger was
prolonged fasting and intense physical activity. The clinical work up at admission was
unremarkable, but after an overnight fast patient developed neuroglycopenic
symptoms (plasma glucose 38mg/dl, plasma insulin 83 microU/ml, insulin/glucose=
2.18 N less than 0.3 ). Those data suggested insulinoma. The following diagnostic
work up included: abdominal US and MRI (normal pancreas and liver areas),
endoscopic US (hypoechoic and ovular sharp edged leason 31/36 mm located in the
tail of pancreas ). Pathology exam of surgically extracted body and tail of pancreas
indicated the diagnosis of neuroendocrine tumor. Hypoglycemic episodes subsided
following the surgery but reoccurred after several months. Abdominal CT scan
revealed two liver hyperdense leasons suggesting metastases. The atypical
hepatectomy of those liver segments involved indicated just segmental steatosis.
The next two years were symptom free until hypoglicemic crisis reappeared
afterwards. Endocrinologic work up (plasma glucose, plasma insulin and
insulin/glucose) further supported insulinoma diagnosis. Abdominal CT scan and MRI
indicated, this time, two liver leasons that could have been focal nodular hyperplasia.
Octreoscan yielded negative results for neuroendocrine tumors but whole body PETCT allowed us to consider liver leasons as metastasis.
Conclusion: The main features of this insulinoma case report were: this
neuroendocrine tumor may determine secondary metastatic leasons, imaging
diagnostic work up may yield confounding results even if the test is known to be very
sensitive and specific as Octreoscan is.
Key words insulinoma, hypoglycemia, octreoscan
Contact Dr. Macadon Bogdan
Email macadonbogdan@yahoo.com
Phone 0721075359

69

2ndJUNE2011

PP038

THE EFFECT OF NURSES PERSONALITY CHARACTERISTICS ON

ORGANIZATIONAL FACTORS AND HEALTH SERVICE RECOVERY
PERFORMANCE
Author(s):COL TEKE Abdulkadir, PhD1, CENGIZ Ekrem, PhD2, COL CANKUL
H.brahim, PhD1
Institutions: 1Gulhane Military Medical Academy, Dept. of Health Services
Management, Ankara,
2Gumushane University, Faculty of Economics and Administrative Sciences,
Department of Marketing, Gumushane,
TURKEY.
Objective: Understanding the constitution and antecedents of service recovery
performance is a necessary and critical starting point in improving and applying service
recovery programs. The objective of this research is to evaluate the effect of
personality characteristics and organizational factors on service recovery performance.
Material and method: A total of 300 nurses that choosen with simple convenience
sampling method from 3 private and 3 public hospitals from 3 different provinces in
Turkey. So at the last point 221 questionnaires data have been entered to data base.
Structural Equations Model was used to verify the reliability and validity of the scale
and to test the proposed model.
Results: As a result, model fit 12 of the 20 hypothesis have been accepted.
Conclusion: This study may provide useful information about perceived service
recovery contex.
Keywords: Service Recovery Performance, Personality Characteristics, Organizational
Factors.
Correspondence:
Gulhane Askeri Tip Akademisi, Saglk Hizmetleri Yonetimi BD, Etlik 06018, Ankara,
TURKEY.
Tel:
+ 90 312 304 6003
Fax: + 90 312 304 2900
GSM: + 90 533 348 2138
e-mail: ateke@gata.edu.tr

PP039

INFLAMMATION SCREENING IN VARIOUS FORMS OF ACUTE APPENDICITIS

Std. Sublocotenent A. KRAFT 1, Lecturer D. ERBAN, MD2, C. BRNESCU, MD2,
Assoc. Prof. C. AVLOVSCHI, MD, PhD2
Institutions:
1. Student, University of Medicine and Pharmacy, Carol Davila Bucharest,
ROMANIA
2. Emergency University Hospital, Surgical Clinic IV, Bucharest, ROMANIA
ROMANIA
Key words: inflammation, interdisciplinarity, pathological anatomy, bilirubinemia,
leukocytosis, acute appendicitis
Abstract: The paper is based on an interdisciplinary study performed at the IVth Upper
Digestive Surgery Clinic of the Emergency University Hospital of Bucharest, Romania.
The aim of the study was to produce an inventory of the patients diagnosed with acute
appendicitis upon admittance in the clinic, followed by the minute selection of the
laboratory data, performed in the pre-surgery stage. The relevant data for the

70

2NDJUNE2011

inflammation prognosis, i.e., bilirubinemia and leukocytosis values, were considered.

During the post-surgery stage, the paraclinical data were correlated with the anatomopathological results. Afterwards, the bilirubinemia and leukocytosis values were
analyzed in correlation with the excision pieces, the latter being classified according to
histopathological criteria.
The results of the study ascertained the fact that, during the paraclinical stage of
diagnosing acute appendicitis, inflammation markers play a major role, which can be
highlighted through complex paraclinical investigation and confirmed both by the
clinical examination and the anatomo-pathological inflammation stages.
14:30-17:30

Contact: alin_kraft@yahoo.com

BMMC STUDENT MEETING PART II (WORKSHOP)

MILITARY ROL-2 HOSPITAL

Scientific Committee: COL Lecturer Dan CORNECI, MD, PhD (Romania)

MAJ Florea COSTEA, MD (Romania)
1. Battlefield basic life support
2. Battlefield advanced life support
3. Battlefield trauma life support
16:00-16:30 COFFEE BREAK (BYZANTINE HALL)
16:30-18:00

ORAL PRESENTATIONS V
(GOTHIC HALL)
Chairmen: COL Prof. Djoko MAKSIC, MD, PhD (SERBIA)
COL Ioana STEFANESCU, MD, PhD (ROMANIA)
COL Assoc. Prof. Cristian GABRIEL, MD, PhD (ROMANIA)

OP047

WHAT IMPACT HAVE TOBACCO CONTROL POLICIES, CLEAN INDOOR AIR

LAWS, ON THE USE OF TOBACCO BY NAVY PERSONNEL?
Author(s): LTJG Athanasios KALOGEROPOULOS MD, ENS Artemis TRIKOLA MD,
4th grade student KALOGEROPOULOU Maria RN, ENS Polykarpos PSOCHIAS MD,
LTJG Vasileios KALLES MD
Institution:
Naval Hospital of Salamis, Salamis,
GREECE
Purpose: The impact of tobacco control policies related to clean indoor air on Navy
personnel smoking prevalence.
Material and Methods: A questionnaire with sociodemographic and close questions
was meted to representative sample of Navy personnel, serving on ships (aged 20 to
46 years), between December 2010 to March 2011. A total of 218 questionnaires
collected. Descriptive statistics and multivariable logistic regression were used for
analysis for potential differentiations due to specific characteristics through PASW
Statistics 18.
Results: Smoking regularly 89.3% occasional 9.5%. Among smokers 86.3% smoke at
home, 80% in the workplace and 88% in public places. The interviewees believe that
banning smoking in public places applies 5% to a large extent, 21.3% moderately and
73.7% little or no. Average daily consumption of cigarettes before the ban

71

2ndJUNE2011

was 21.08 and after the ban was reduced to 20.17 this fall despite the fact that is a
cigarette a day is statistically significant p = 0.001. However, cigarette consumption at
home before the ban is the same as the current p = 0.39, the same happens about
cigarette consumption during expeditions. The daily cigarette consumption at work fell
by an average of 0.59 (from 10.62 to 10.54) after the smoking ban, the reduction is
statistically significant p=0.002. Also, decreased the consumption in public places on
an average of 0,66 p <0.001.
Conclusions: The average daily consumption of cigarettes in general, at work, in public
places before and after the ban has reduced but not the consumption at home and
during expeditions.
Correspondence:
LTJG Athanasios KALOGEROPOULOS MD,
+30 6937029665,
kardamyla.chios@gmail.com
OP048

ALCOHOLIC KETOSIS (AK) AND KETOACIDOSIS (AKA) IN THE CLINIC OF

EMERGENCY TOXICOLOGY
Author(s): Maj. MITEV Mitko MD, Prof. KANEV Kamen MD D.Sc., NEYKOVA
Lyudmila MD
Institution:
Military Medical Academy, Clinic of Emergency Toxicology, Sofia,
BULGARIA
Objective: AKA is a poorly diagnosed medical emergency usually identified in chronic
alcohol abusers. The aim of this study was to investigate the syndrome of alcoholic
ketoacidosis and frequency of AK and AKA in patients treated in our clinic in a one
year period and their clinical and laboratory presentation.
Material & methods: Subjects of this retrospective study were all patients admitted in
the clinic with the diagnosis Toxic influence of alcohol (T 51.0) in a period of one year
(from February2007 to January2008) who were found to have some acetone in their
blood. Outpatients, patients treated in other clinics and those, having other reasons to
have acetone in their blood different from ethanol, were excluded from the study.
Patients from this selection were divided into two groups according to the blood level
of acetone under (group A) or above 100 g/mL (group B). Statistical analysis was
performed with statistical reliability p<0,05.
Results: Twenty six patients met selection criteria 88,5% male, 11,5% female. Mean
age 45,65 years. The two groups contain equal number of patients 13. More then
half of cases (53,85%) were admitted during the cold months from October till
January. At admittance only half mentioned having problem drinking duration 2,5
30 years. Group B patients had drunk larger quantity of alcohol, had more dramatic
complains and objective signs. Serum pH<7,2 was found in 8% of cases.
Conclusion: AK is a common disorder in chronic alcoholic persons. Urine negative for
ketones does not rule out AK. Blood acetone level is more reliable in diagnosis of AKA.
Determination of -(OH)-butyrate is also needed to differentiate AK and AKA.
CORRESPONDENCE:
Maj. Mitko Mitev, MD
Clinic of Emergency Toxicology, Military Medical Academy
3,Georgy Sofijski Str
1606 Sofia, BULGARIA
Phone: +35929225026

72

2NDJUNE2011

Mobile: +359887300086
e-mail: mitev_m@mail.bg
OP049

THE Febrile ATRIO-VENTRICULAR BLOCK AT A PATIENT WITH MECHANICAL

VALVULAR PROTHESIS
Authors: Associate Professor, Col. G. CRISTIAN, I. MOCANU, Andreea
TEODORESCU, D. SAVOIU,
Institution:
Army Institute of Cardio Vascular Disease - Bucharest,
ROMANIA
Overview:Infectious endocarditis of valvular prothesis is a severe complication that
may influence the premature or tardive post-surgical evolution of 4-7% of the patients
with valvular prothesis, representing 20% of all the endocarditis cases. Besides
peculiarities that depend on the patient (comorbidity) and the involved sprout, the
extremely high morbidity level generally associated with the disease, is given by a late
diagnosis and a late optimal treatment.
The high clinical suspicion and the correct integration of paraclinical data represent
solutions for a correct and prompt diagnosis that may improve the rather reserved
prognostic for these patients. The established investigations for the diagnosis of
infectious endocarditis (echocardiography and hemocultures) can be nondiagnostic in
early stages (ex. sterile hemoculture for a patient empirically treated with antibiotics,
absence of vegetations) or may emphasize modifications only at a tardive stage of the
disease, without therapeutic resources (example: the massive extension of the septic
process at the level of the adjoining cardiac structures).
Anticipation of such an evolution can modify the therapeutic approach improving
substantially the prognostic. The electrocardiogram, a routine investigation and
apparently with no value in infectious endocarditis, sometimes represents the
diagnostic key for the miocardial invasion unexpressed echographically yet. The nonspecific modifications of repolarization, the atrio-ventricular or intraventricular
conduction disturbances recently set up are some of the aspects which coroborated
with anamnestic and clinical data can acquire pathognomonic value in infectious
endocarditis.
For demonstration we present the case of a 67 years old patient, with rheumatismal
aortic valvular lesion surgically corrected 14 years ago and who was diagnosed with a
tardive endocarditis of the mechanical prothesis accompanied by a massive extension
of the septic process to the adjoining structures, clinically prefigured by an atrioventricular conduction disturbance, in a febrile context. Thus, we wanted to emphasize
a series of clinical and paraclinical elements, apparently common, that can bring
premature arguments for diagnosing this disease, generally characterized as having
an extremely reserved prognostic.
Key words: atrioventricular block, fever, aortic valvular prothesis, miocardial abscess.

73

2ndJUNE2011

OP050

UNUSUAL MASSIVE PULMONARY EMBOLISM COMPLICATED WITH

CARDIOGENIC SHOCK AND MULTIPLE ORGAN FAILURE
Authors: Diana TOMA M.D.1, Maj. A. TUDOSE M.D.2, Col. Ghe. NEAGOE M.D.3, P.
CRISAN M.D.3, Maj. A. CIUCHE M.D.2, Bianca PURCARIN M.D.2
Institution:
1-National Institute of Aerospatial Medicine Bucharest, ROMANIA
2- Central Clinical Military Hospital Bucharest, ROMANIA
3- Army Institute of Cardio Vascular Disease - Bucharest, ROMANIA
ROMANIA
Introduction: Pulmonary embolism is still a frequently challenging diagnosis, and a high
index of suspicion is required because of its potential lethal evolution. Symptoms and
signs of acute right heart failure are variable, non-specific and often vary according to
the precipitating condition.
Material and method: The presentation describe the case of a 61 years old woman,
who, developed in the first postoperative day after total tyroidectomy, an unusual
massive pulmonary embolism. The symptoms and signs of the patient chest and
epigastric pain, nausea and vomiting, marbled skin, cyanosis, hypotension 50 mmHg,
tachypnea 40 breath/min, - suggested an cardiogenic sock probably caused by an
acute coronary syndrome.
Transthoracic 2D-Doppler echocardiography showed dilatation of the RV - 36 mm, and
hypokinesia with paradoxical septal motion, low dimension of LV with an ejectin
fraction LVEF 40%, and oriented the diagnostic to acute massive pulmonary
embolism.
Thrombolytic therapy streptokinase bolus 250.000 units/30 min, followed by 100.000
units/h for 24 h was started, together with cristaloids/coloids and inotrop drugs
(Dobutamine, Epinephrine), infusion. After 24 hours of thrombolyse we continued with
anticoagulant therapy with heparin continuous infusion at a dose of 1200 units per
hour, under the control of the partial-thromboplastin time.
The evolution of the patient was initially favorable with the normalisation of the
haemodinamic parameters, but a hepatic and then renal failure appeared probably
secondary to the reduction of the cardiac output with profound mesenteric
hypoperfusion.
After 8 days of evolution, unfortunately a cardiac arrest occured without response to
CPR, and the patient died.
Conclusion: A case of massive pulmonary embolism, with an unusual presentation and
unfavorable evolution secondary to the cardiogenic sock. Despite this, thrombolysis
needs to be considered in patients in sock with proven pulmonary embolism.
Key words: massive pulmonary embolism, cardiogenic sock, thrombolytic therapy

OP051

OBESITY AMONG SERBIAN ARMY OFFICERS

Authors: Z. NIKOLI, M. MLADENOVI, V. DAI, M. MAJSTOROVI
Institution:
Military Medical Center Karaburma, Belgrade,
SERBIA
Introduction: Cardiovascular diseases (CVD) are the major cause of premature death
in Europe. The mass occurrence of CVD relates strongly to lifestyles.1,2 The
prevalence of overweight and obesity is increasing and it is associated with increased
total and CVD mortality and morbidity, mediated in part through increases in blood

74

2NDJUNE2011

pressure and blood cholesterol and an increased likelihood of diabetes.2,3,4

Purpose: How widely obesity is spread among army officers in Serbia?
Methods: Cross-sectional study covers Serbian Army officers at regular annual
medical examination in the period of November 2009 till November 2010. The group
consists of 739 army officers. BMI was computed as weight divided by height squared
(kg/m2). According to WHO recomendations1,4, healthy weight is defined as BMI 18,524,9kg/m2, overweight BMI 25-29,9kg/m2 and general obesity BMI 30kg/m2, the
border values are defined for blood-pressure <140/90 mmHg, total cholesterol < 5
mmol/l, LDL cholesterol < 3 mmol/l i blood glucose < 6 mmol/l.
Results: All 739 are male, age 33 6 years. Total of 60,9% examinees have BMI over
25, while 16,1% are obese. High values of total cholesterol were found with 65,4%
examinees and high values of LDL with 66%. Increased blood glucose level have
9,2%. High blood pressure have10,8%.
Conclusion: In the National Health Registry of the Republic of Serbia from 2006 it is
stated that there is 54,5% of population with overweight problem, among them 18,3%
suffer from obesity.2 Officers in our group are relatively young, but more than a half are
overweight. This is exactly were we see our role taking part in the national program of
prevention and control of cardiovascular diseases in the Republic of Serbia till 2020
Serbia for Healthy Heart.
OP052

LIVER TARGETED REGULATORY T CELL FREQUENCY IS SIGNIFICANTLY

CORRELATED WITH SEVERITY OF PORTAL INFLAMMATION IN CHRONIC HBV
INFECTED PATIENTS.
Authors: LTC UMUDUM Haldun MD, MAJ OZTURK lker MD, COL CERMIK Hakan MD.
Institution:
Etmesgut Military Hospital, Department of Pathology,Ankara, TURKYE
Etimesgut Military Hospital, Department of Infectious Disease, Ankara, TURKYE
TURKEY
Objective: Regulatory T cells are involved in regulating the immune tolerance against
both self and foreign antigens. These cells constitutively express both CD25+ and
CD4+. Forkhead box protein3 (FoxP3) was shown to be the most reliable biological
marker for Tregs. Current study investigates the clinicopathological characteristics of
patients with chronic HBV (CHBV) infection and Treg frequency in liver biopsy
materials.
Material and method: In this retrospective study, FoxP3 expression of liver infiltrating
inflammatory cells was evaluated with immunohistochemistry in paraffin embedded
liver biopsy materials in pathology archives. Biochemical parameters (ALT, AST level,
platelet count, INR, PT, PTT,) serological parameters (HBeAG status, HBV DNA viral
load) and histopathological parameters (portal, paranchymal and periportal
inflammation, stage of fibrosis) were obtained from files and patients were assigned in
three categories: HBV carrier, HbeAG(+)CHBV and HBeAG(-)CHBV. Treg frequency
was calculated as an index of FoxP3(+) cell count in one high power microscopic field
in which maximum expression was observed.
Results: Archival materials from 46 patients were included in the study. FoxP3
frequency was significantly correlated with degree of portal inflammation in all
diagnostic groups (p=0.04). However no significant correlation was observed with
other parameters.
Conclusion: Current study shows that Tregs frequency is increased in severe portal
inflammation. However a significant correlation with AST and ALT level or with overall

75

2ndJUNE2011

histological activity score was not observed. Based on these observations, we

proposed that Treg cell frequency may not contribute to overall liver damage in CHBV
whereas Treg cell frequency is increased with severe portal inflammation.
CORRESPONDANCE:
LTC Haldun Umudum,
Etimesgut Asker Hastanesi, 06770, Etimesgut Ankara, Turkiye
Phone: +90312249101 ext:3716
Fax: + 903122444977
E mail: humudum@yahoo.com
OP053

CONTRAST ENHANCED ULTRASOUND CLINICAL APPLICATIONS

Authors: Cpt. A. ANGHEL, Cpt. S. STANCIU, Mjr. L. CIOBICA, Mjr. D. STOICESCU,
Gen. Bg. M. MURESAN
Institution:
1st Internal Medicine Department,
Central Military Universitary Emergency Hospital , Bucharest,
ROMANIA
Ultrasound contrast agents are used to improve the limits of the conventional and
Doppler ultrasound, especially in the evaluation of the microvascularization.
With a structure made of gas-filled microbubbles stabilized by a lipophilic layer
(phospholipidics or albumin) the ultrasound contrast agents have only an intravascular
distribution offering information about the blood flow in the interest area.
Contrast enhanced ultrasound stand on the cancellation and/or the separation of the
signals generated by the tissues and the microbubblesModification of the echogenicity
using an ultrasound contrast agent has a specific dynamics described by the vascular
times: arterial phase of 20 seconds followed by the portal phase between 60 and 180
seconds and the tardive phase. By following the vascular times and the specific
dynamics of the contrast agent it will allow a more complete evaluation of the suspect
lesion enhancing the sensibility and the specificity.
Generally the ultrasound contrast agents are safety with a low incidence of the
adverse reactions, without kidney toxicity and thyroid interactions and with the
incidence of the severe allergic adverse reactions equal with the CT contrast
agents.Nowadays contrast enhanced ultrasound is getting a more and more important
place in the algorithm of investigation of the nodular lesions especially of the liver and
the future studies have the mission to evaluate this technique in characterization of
other pathologies.

76

2NDJUNE2011

OP054

THE EFFICACY OF TWO PROTOCOLS OF TREATMENT IN ANDROGENETIC

ALOPECIA.
Authors: Albana LUFI 1 , Sonja SARACI 2
Institution:
1- Dermatologist, Civilian.
2- General Medical Doctor, 2nd Lieutenant.
ALBANIA
Introduction: Androgenetic Alopecia is a hair loss that is determined genetically under
the influence of androgenic hormones. It has a characteristic view and affects men and
women in their late adolescence and early twenties.
Aim: To evaluate and to compare the efficacy of two protocols of treatment in
Androgenetic alopecia (Aa).
To evaluated the influence of gender and age in Androgenetic alopecia.
Material and Methods: Studies were performed in 32 patients with Androgenetic
alopecia, who were examined in our ambulatory service from February 2007 till
November 2007.
The treatment: 16 patients were treated with minoxidil 2% and cistidil (first protocol).
16 other patients were treated with placebo (second protocol).
Results: In Androgenetic alopecia, 38% of patients were women and 62% were men;
the prevalence according to the age was: 62% of patients were from 25-30 years old,
23% were from 31-35 years old, 9 % were from 36-40 years old, and 6 % were from
41-45 years old. From the comparison of the two treatments protocols, the first
protocol was more efficacious that the second one. (p = 0.005).
Conclusions: The gender did not influence in the appearance of AA (p=0.44). The
category of patients with age 25-30 years old influence in the appearance of the AA. (p
=0.01).
From the comparison of the two treatments protocols, the first protocol was more
efficacious that the second one. (p=0.005).
From 16 patients treated with the first protocol, 12 patients (75%) had partial result and
4 patients (25%) did not have any result.
From 16 patients treated with the second protocol, 2 patients (12%) had partial result
and 14 patients (88%) did not have any result.

OP055

WHO ARE THE MOST SATISFIED DOCTORS IN MILITARY HEALTH SERVICES?

Authors:MAJ YILDIRAN Nuri, MD, PhD1, COL OZER Mustafa, MD, PhD2, CPT
OZTURK Gultekin, MD2, LTC CETIN Mehmet, MD, PhD2
Institution:
1Turkish Armed Forces Medical Command, Ankara, TURKEY.
2Gulhane Military Medical Academy, Dept. of Military Health Services, Ankara,
TURKEY
Objective:The aim of this study is to determine the job satisfaction levels of doctors
who have different status in different services in military health system.
Material and method: Universe of the research comprises of all active duty medical
officers assigned in Armed Forces. The questionnaire is formed by using Minnesota
Job Satisfaction Inventory. Questionnaires was posted to medical officers and 1060 of
them were returned. 1028 of the questionnaires were matching the criteria of research.
The branches that have less than 20 members are excepted. So totally 859
questionnaires are analyzed.

77

2ndJUNE2011

Result: Given the mean scores of main variables of the study, overall job satisfaction
score is 3.030.78, inherent job satisfaction score is 3.140.81, external job
satisfaction score is 2.860.82 in 5 point scales. According to overall job satisfaction
scores, the most satisfied three branches of doctors are respectively dermatology
(3.620.76), emergency medicine (3.350.66) and urology (3.350.72). The least
satisfied three branches of doctors are respectively physicial medicine and
rehabilitation (2.600.76), cardiovascular surgery (2.700.61) and family medicine
(2.750.70). General practitioners overall job satisfaction score is nearly the same as
general mean score (3.060.78). When the mean scores of surgical medicine, internal
medicine, basic sciences and general practitioners compared to each other,
statistically significance is not determined (p=0,573).
Conclusion: Both surgical and internal medicine branches are taking part in the highest
and the lowest mean satisfaction scores. This state explores that there is no
statistically significance through surgical and internal medicine.
Correspondance:
Nuri YILDIRAN
TSK Saglik Komutanligi, NSA Subayi. Bakanliklar 06100, Ankara, TURKEY.
Tel:
+ 90 312 402 4078
GSM: + 90 505 798 5475
e-mail: yildirannuri@yahoo.com.tr
OP056

ACUTE CORONARY SYNDROMES CONSIST A CONSIDERABLE PROPORTION

OF THE MEDICAL EVACUATIONS IN PEACE KEEPING MISSIONS IN MILITARY
UNITS NOT DIRECTLY INVOLVED IN BATTLE
Author(s): LTC J. KARELLAS, LTC J. ZAGAS, LTC L. TSAKOS
Institution: 401 Military Hospital, Athens,
GREECE
Purpose: To analyze the medical conditions, the means used, the time needed and the
outcome of medical evacuations (MEDEVAC) performed during the first year of
operation of BELUGA camp during IFOR mission in Bosnia.
Materials and Methods: The military personnel of BELUGA camp (Belgium,
Luxemburg, Greece, Austria), consisted of approximately 800 men and women in its
first year of deployment to Visoko-Bosnia. Direct involvement in battle was not
reported but only occasional sniper attacks. The medical support of the camp was held
by a common Greek-Belgian and an Austrian facility. The medical personnel consisted
of four (4) doctors (general practitioners) and paramedical personnel. Basic laboratory
examinations, ECG and chest X-Rays were possible. There was no capability of
continuous heart rate monitoring, mechanical ventilation or oxymetry. Thrombolytic
agents, intravenous venodilators, vasopressors or inotropes were not available.
MEDEVAC sites were Serajevo and Trogir (German hospital). Means of MEDEVAC
ambulances and helicopters (Divulje-French Squadron).
Results:

78

2NDJUNE2011

5
6

Aborted Evacuations

Fatalities during
Evacuation

2
3

Acute
Coronary
Syndromes
CNS injuries
Airway
obstruction
Psychiatric
disorders
Musculoskeletal
injuries
Infections
TOTAL

Successful Medical
Evacuations

Evacuations that were

requested

Medical
condition

Duration of Evacuation

Means of
Evacuation

Ambulance

> 6 hours

Helicopter

2-3 hours

0
1(weather
condition)

Helicopter

Ambulance

> 6 hours

Ambulance

1 hour

1
14

1
13

0
2

0
1

Ambulance

1 hour

Conclusion: Acute coronary syndromes consist a significant proportion of Medical

Evacuations. The means of evacuation used, the lack of specialized personnel, the
long time elapsed until arrival to role 3 hospital and the lack of proper treatment during
evacuation make imperative the need for additional support to the ischemic
myocardium until reperfusion.
Correspondence:LTC Ioannis KARELLAS,
Tel.:+30 2107494501,
Mob:+30 6972252679,
OP057

ADMINISTRATION OF GLUCOSE-INSULIN-POTASSIUM (GIK) SOLUTION

DURING REPERFUSION LIMITS NO REFLOW PHENOMENON AND IMPROVES
CORONARY BLOOD FLOW WITHOUT AFFECTING INFARCTED MYOCARDIUM
IN A PORCINE ISCHEMIA-REPERFUSION MODEL
Author(s): LTC J. KARELLAS, CHALKIAS K, TERROVITIS J, TSAGALOU E,
TSOLAKIS E, BONIOS M, NANAS JN.
Institutions: 401 Military Hospital, 3rd Department of Cardiology, University of Athens
School of Medicine, Athens,
GREECE
Purpose: Acute coronary syndromes in general and especially during peace keeping
missions are difficultly treated mainly because timely reperfusion is unlikely. We tried
to investigate whether GIK, a solution which is cheap, easily made, safe to apply, with
no adverse reactions or interactions is beneficial to ischemic myocardium.
Materials and methods: Nineteen (19) pigs, were anesthetized, intubated and
mechanically ventilated. The heart was exposed by mid sternotomy and proximal left
anterior descending artery (LAD) was isolated and instrumented by surgical snare and
transit time ultrasound flowmeter. All animals underwent occlusion of LAD for 60min,
79

2ndJUNE2011

followed by reperfusion for 120min and were randomized into two groups. Group 1
(n=11) received normal saline solution (NaCl 0,9%) at a rate of 2 ml/kgr/hour, 10min
before reperfusion while group 2 (n=8) received GIK solution (glucose 0,3 g/ml, insulin
0,05 U/ml, potassium 0,08 mmol/ml) at the same rate. At the end of reperfusion
euthanasia was induced, the heart was extracted and the left ventricle was sliced in 68 slices. No reflow area was delineated by thioflavin S, area at risk by gentian blue and
infarcted myocardium by trifenyltetrazolium chloride. All areas were calculated by
planimetry. The coronary blood flow was monitored at the 5th, 30th, 60th, 90th and 120th
minute of reperfusion period.
Results: The coronary flow values, normalized to myocardium mass at risk were
significantly higher during reperfusion (min 30 to 120) and no reflow phenomenon as
percentage of myocardium at risk was found significantly lower (61,319 vs 41,59%,
p=0,009) in the group that received GIK in comparison with the control group.
Conclusion: GIK solution effectively reduced no reflow phenomenon and improved
coronary flow without affecting infarcted area in a porcine ischemia-reperfusion model.
These findings suggest for the use of GIK as a metabolic support to ischemic
myocardium in clinical practice.
Correspondence:
LTC Ioannis KARELLAS, E-mail:ikarellas@yahoo.com
Tel.:+30 2107494501, Mob +30 6972252679,
OP058

DIABETES MELITUS AND HEART DISEASE. A REVIEW OF THE LITERATURE.

Author(s): LT Athanassios TSARTSALIS, MD, HN(1), D.N. TSARTSALIS MD(2)
Institutions:
1) Department of Endocrinology, Naval Hospital of Athens, GREECE
2) Cardiology Clinic, Ippokrateion Hospital, Athens, GREECE
GREECE
Purpose: Diabetes mellitus contributes to the increase of cardiovascular deaths
worldwide. Despite continuous treatment evolution, patients with diabetes suffering
from an acute coronary syndrome still have a high morbidity and mortality. We aimed
to analyze the impact of diabetes mellitus in patients with acute coronary syndrome.
Materials and methods: Review of the latest literature referring to diabetes mellitus and
heart disease. We have analyzed the incidence, the predisposing factors and the life
expectancy after treatment. We have also tried to investigate if diabetes mellitus is an
equivalent of coronary artery disease and if good glycaemic control is a good
prognostic factor.
Results: Acute coronary syndrome has a great incidence among diabetic patients. All
definitions of Metabolic Syndrome were significant predictors for incident
cardiovascular disease and diabetes. Location and extension of MI and myocardial
enzymes did not differ between diabetics and non-diabetic patients. Age, duration of
diabetes and HbA1c levels, did not differ between diabetic patients with or without MI.
Conclusions: Inhibition of glycoprotein IIb/IIIa can improve the outcome of diabetic
patients undergoing percutaneous coronary interventions, possibly by improving
microvascular perfusion. Diabetes mellitus is an equivalent to acute coronary
syndrome. It is not yet clarified if coronary artery bypass grafting (CABG) or
Percutaneous coronary artery intervention (PCI) is better for revascularization in
diabetic patients. The trend is to use CABG and if it is used PCI the choice is Drug
Eluting Stent (DES). The evidence of benefit from strict glycemic control with insulin
80

2NDJUNE2011

therapy in patients with acute MI is limited. However further analysis is required to

show the advantages of the antiplatelet therapy. In addition to this, the reduction in
composite primary endpoint of major cardiovascular events (cardiovascular mortality,
nonfatal major cardiovascular event or stroke, and unstable angina requiring
hospitalisation) with atorvastatin and reduction in acute myocardial infarction relative
risk with atorvastatin were not statistically significant.
Correspondence: LT Athanasios TSARTSALIS, MD, HN
0030 6943487813
16:30-18:00

ORAL PRESENTATIONS VI
(NORWEGIAN HALL)
Chairmen: COL Murat BEYZADEOGLU, MD (TURKEY)
MAJ Dimitrios LIAPIS, MD (GREECE)

OP059

BIPOLAR TRANSURETHRAL RESECTION IN SALINE USING TURIS:

PRELIMINARY RESULTS AND COMPLICATION RATES
Authors: MAJ Dimitrios LIAPIS MD FEBU, Ioannis TSOHATZIS MD, MAJ
Anastasios MIHALAKIS MD, LTC Ioannis SIAFAKAS MD, COL Gregory RAPTIDIS, MD
Institution: Urology Dpt, 251 General Air-Force Hospital, Athens,
GREECE
Purpose: Transurethral Resection in saline (TURis) is an emerging technique showing
the same efficacy as monopolar resection. Currently, there is little available data on
the safety of bipolar devices. We assessed outcome and safety of TURis on a cohort
of patients with at least 5 months follow-up.
Materials and Methods: Between November 2008 and May 2010, 153 patients (146
male 7 female) with an average age of 70.6 +/- 12.3 years had a transurethral
resection (TUR) using TURis. On those patients, we performed 63 transurethral
resections of prostate, 65 transurethral resections of bladder neoplasm, and 25
transurethral incisions of prostate. All operations were carried out using TURis bipolar
device in physiologic saline. The resectoscope used was an Olympus 26F in
continuous flowtype Iglesias with continuous aspiration. The loops were all
disposable single-use. We recorded the incidence of unwanted stimulation of the
obturator reflex, TUR syndrome, thermal skin lesion, blood transfusion, urethral
strictures, and bladder neck contractures.
Results: The average follow- up of the entire cohort was 16 +/- 4.89 months. None of
the patients experienced neither a TUR syndrome nor a thermal skin lesion. Urethral
stricture occurred in 1 patient (0.6 %). Four patients developed a bladder neck
contracture after transurethral resection of prostate (2.5 %). Early postoperative clot
retention occurred in 2 patients (2.1%) while in 3 patients transfusion was needed
(1.1%). In 3 patients (2%) with neoplastic lesions at the lateral bladder wall, we
experienced an unwanted stimulation of the obturatorius reflex.
Conclusions: TURis seems to be as efficient as conventional monopolar technology
while showing maximal safety in terms of post-operative haemorrhage and TUR
syndrome. Its use does not correlate with an increase of the incidence of urethral
strictures.
Correspondence: MAJ Dimitrios LIAPIS
tel:+30 210 7463662

81

2ndJUNE2011

mob:+30 698 3512736

e-mail: dkliapis@gmail.com
OP060

BONE DENSITY OF MALE MILITARY PERSONNEL IS NOT AFFECTED BY

DIETARY HABITS, SMOKING AND PHYSICAL EXERCISE
Author(s): LTC Panagiotis KOKKORIS, MD, MAJ Polyzois MAKRAS, MD, COL
Georgios TOLOUMIS, MD
Institutions: Endocrinology Department, Hellenic Air Force General Hospital, Athens,
GREECE
Purpose: The purpose of the study is to investigate if bone density is affected by
factors such as dietary habits, smoking and physical exercise in a population of male
Air Force personnel.
Materials and Methods: Three hundred healthy men participated in the study. All of
them were staff of the Hellenic Air Force and they were asked to answer a
questionnaire about their dietary habits, smoking status and frequency and type of
physical activity. Specifically in the dietary habits questionnaire they were asked to
answer about the frequency of consuming red meat, chicken, fish, dairy products,
legumes, pasta, vegetables, fruits, alcoholic drinks and coffee per week. All of them
had a DEXA density scan in both the hip and the lumbar spine.
Results: The mean age of the population of the study was 33.97.4 years and the
mean body mass index (BMI) was 26.12.8 kg/m. The mean bone density value in
the hip was 1.080.14 g/cm and 1.260.15 g/cm in the lumbar spine. We found no
statistically significant correlation (either positive or negative) between dietary habits,
smoking status and physical exercise (p>0.1 for all correlations). Surprisingly there
was not statistically significant correlation even for foods which were expected to affect
positively bone density like dairy foods.
Conclusion: Dietary habits, smoking and physical activity do not seem to affect bone
density in a population of healthy young men, although it is known that all these factors
may affect bone density in other populations like women or older men.
Correspondence:

OP061

LTC Panagiotis KOKKORIS, MD

Tel. +30 210-7463714
Mob: +30 698-3517888
e-mail. pakokkoris@hotmail.com

CHAIR METHOD: A SIMPLE AND EFFECTIVE METHOD FOR REDUCTION OF

ANTERIOR SHOULDER DISLOCATION
Author(s): LT CAKMAK Selami, MD, COL MAHIROGULLARI Mahir, MD, CPT
AKYILDIZ Faruk, MD, KOKSAL Ismet, MD, LTC KURKLU Mustafa, MD, COL
KUSKUCU Mesih, MD.
Institutions: Gulhane Military Medical Academy, Haydarpasa Training Hospital,
Dept. of Orthopedics and Traumatology, Istanbul,
Kirikkale State Hospital, Dept. of Orthopedics and Traumatology, Kirikkale, TURKEY
Gulhane Military Medical Academy, Dept. of Orthopedics and Traumatology, Ankara,
TURKEY
Objective: The ideal reduction method for anterior shoulder dislocation is defined as a
practical technique applied without any assistance and minimizing patient interference.
We aimed to show the chair method is one of the ideal methods.

82

2NDJUNE2011

Material and method: Seventy four patients were treated by chair method for traumatic
anterior shoulder dislocation. Data from patients were recorded and evaluated by
using statistical methods.
Results: All dislocated shoulders were reduced by using the chair method (%100)
without any complication and difficulty. Thirty patients have first time dislocation and 44
patients had previous dislocation. The mean time between the onset of dislocation and
the time of reduction was 3 hours (1-6). The mean duration of reduction was 13.9
seconds (3-45).
Conclusion: We believe that orthopedists and emergency department physicians
should be familiar with this simple technique and the chair method could be preferred
as a method of reduction if anesthesia cannot be performed.
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Ortopedi ve
Travmatoloji Servisi, Selimiye Mah. Tibbiye Cad. 34668 Uskudar, Istanbul, TURKEY.
Tel:
+90 216 542 2020
Fax: +90 216 348 7880
GSM: +90 505 774 5830
selamicakmak@gmail.com
OP062

URINARY SYSTEM ABNORMALITIES AND PATHOLOGIES DIAGNOSED BY

ULTRASONOGRAPHY AMONG TURKISH MILITARY AIRCREW
Author(s): MAJ OKUR AKTAS Gkcan, MD1, 1LT ATA Nazim, MD2, CPT CAKMAK
Tolga, MD3, COL AKIN Ahmet, MD3.
Institutions: 1 Eskisehir Military Hospital, Radiology Clinic, Eskisehir, TURKEY.
2 Aircrews Health, Research and Training Center, Eskisehir, TURKEY.
3 Gulhane Military Medical Academy, Dept. of Aerospace Medicine, Eskisehir,
TURKEY
Objective: Urinary system abnormalities and pathologies can cause symptoms which
may be severe enough to be incapacitating. Ultrasonography can be used to detect
abnormalities and pathologies of urinary system. The purpose of the current study was
to determine the urinary system abnormalities and pathologies of military aircrew by
ultrasonographic screening.
Material and method: Ultrasonographic findings of 8355 aircrew who get in periodic
medical examination in our hospital between May 2007 and January 2011 were
analyzed.
RESULTS Ultrasonographic screening led to detection of urinary system abnormalities
and pathologies in 5.35% (447/8355) of aircrew. Of 8355, 254 (3.04%) have
nephrolithiasis (unilateral in 217 and bilateral in 37), 124 (1.48%) have simple renal
cyst, 34 (0.41%) have congenital abnormalities (horseshoe kidney in 23, malrotated
kidney in 5, solitary kidney in 5 and double collecting system in 1), 13 (0.16%) have
renal size decrease suggesting that renal hypoplasia or renal atrophy, 9 (0.11%) have
renal localization abnormalities (renal ptosis in 6, crossed fused renal ectopia in 2 and
pelvic kidney in 1), 8 (0.09%) have ureteropelvic junction abnormalities and 5 (0.06%)
have other renal diseases (renal angiomyolipoma in 3, focal cortical defect secondary
to partial nephrectomy in 1 and increased renal cortical echogenicity in 1). Verifying of
ultrosongraphic results, some additional radiologic diagnostic procedures were also
planned.
Conclusion: Ultrasonography is safe, easily available, cost effective screening tool for
diagnosing congenital and pre-symptomatic urinary system diseases in military aircrew

83

2ndJUNE2011

and consequently reduces preventable risks of in-flight incapacitation.

Correspondence:
Hv.Tbp.Bnb. Gokcan OKUR AKTAS
Eskisehir Asker Hastanesi, Radyoloji Klinigi, 26035, Eskisehir, TURKEY.
Tel:
+ 90 222 220 4530
Fax: + 90 312 230 3433
GSM: + 90 543 765 3020
e-mail: okur_g@yahoo.com
OP063

SURGICAL TREATMENT OF LEFT KIDNEY TUMOR WITH THROMBUS

MALIGNUS IN VENA CAVA AND RIGHT PULMONAL ARTERY
Author(s): N. MILOVIC 1, P.ALEKSIC 1, M. JOVANOVIC 1, R. ILIC 2, A. TOMIC 3, V.
BANCEVIC 1, B. KOSEVIC 1, Z. SLAVKOVIC 4, LJ. LAZAREVIC 4
Institutions:
1Urology Clinic, Military Medical Academy, Belgrade, SERBIA,
2Clinic for Cardiosurgery, Military Medical Academy, Belgrade, SERBIA,
3Clinic for Vascular Surgery, Military Medical Academy, Belgrade, SERBIA,
4Clinic for Anaesthesiology and Reanimathology, Military Medical Academy, Belgrade,
SERBIA
Introduction: Surgical treatment of vena caval extension with tumor thrombus first was
reported by Skinner in 1972 as potentially curable lesion provided that complete
removal could be achieved. Surgical procedures like these were beeing performed in
last 13 years at our institution. The first operated patient with tumor thrombus
extension into the right atrium is still alive.
Material and methods: We are showing a 47 year-old man with 15 cm large left kidney
tumor with malignant tumor thrombus in vena cava inferior (VCI) diagnosed through
ultrasonography and computed tomography. MSCT pulmoagiography has shown a
tumor embolus in the right pulmonal artery (RPA). On the 28th October 2009 we
performed tumor embolectomy of RPA, thrombectomy of VCI and left radical
nephrectomy. Surgical approach was achieved by sternotomy associated with chevron
bilateral subcostal laparatomy. We made taping of VCI, vena cava superior and aorta,
clamping and longitudinal incision of RPA followed by embolectomy. Then we carried
out thrombectomy of VCI after ligature of the left renal artery, double clamping of VCI
below the right atrium and on the distal ending of thrombus, clamping of the right
kidney hilum and Pringle maneuver. At the end we performed left radical nephrectomy.
Intraoperatively we also found a massive thrombosis of the left testicular vein.
Results: On the fourth day after the surgery the patient suffered no complications.
Conclusion: Exellent long-term survival can be achieved by complete surgical removal.
Surgery will remain the primary cure method in cases with renal tumors invading the
vena cava and thrombus extension.

84

2NDJUNE2011

OP064

INCIDENTAL DISCOVERIES OF BONE TUMORS - IN ORTHOPEDIC PRACTICE

AT THE UNIVERSITARY EMERGENCY CENTRAL MILITARY HOSPITAL
Author(s): Dr. Marius STANESCU, Dr. Laurentiu SAVA, Dr. Stefan MITULESCU
Institutions: Universitary Emergency Central Military Hospital, Bucharest,
ROMANIA
Background: in daily practice among the patients presentations for non-specific symptoms or
orthopaedic disorders are incidental findings of primitive bone tumors or metastases. Surgery is always
considered after clinical investigation, laboratory and mandatory oncology consult.

Methods: An analysis of incidental discoveries of primitive and secondary bone tumors

in the last 3 years, in thauthors personal practice at the Orthopedics and
Traumatology Clinic in the Universitary Emergency Central Military Hospital. Between
June 2008- May 2011 from the 3898 presentations were selected 35 cases represented 0.897% of all
cases. In our analysis we followed the protocol of diagnosis, classification (TNM, Enneking), surgical
treatment and subsequent oncology specific protocol.
Results: from 35 cases, 17 cases representing 51,42% were diagnosed as primitive tumors, 17 cases
were confirmed as metastases, representing 48,57%. In all cases surgical treatment was performed in
collaboration with the oncology specialist.
Conclusion: Frequency of incidental findings of bone tumors was 0,897% in the period mentioned by the
author in practice, in all cases surgical treatment was implied after a treatment plan agreed with the
oncology specialist.

OP065

PER CUTANEOUS DISSECTION OF OSTEOID OSTEOMAS WITH CT GUIDANCE.

A NEW, EFFECTIVE, SAFE AND EASY METHOD. FIRST ANNOUNCEMENT
Author(s): COL Dimitris TSOCANAS 1, MD, LTC Spyros DARMANIS 2, MD, SRGNT
Helen PETEVE 3, SRGNT Irene MALEFIOUDAKI 3.
Institution: 401 General Army Hospital of Athens, GREECE
1. Director of the Radiology Department
2. Consultant Orthopedic Surgeon 1st Orthopedic Dpt.
3. Radiographer
GREECE
Purpose: To show a new, safe, effective and easy method for osteoid osteomas
resection.
Materials and Methods: In a 4 years period, 12 patients with clinical signs of osteoid
osteomas were referred to the First Orthopedic Department of our Hospital. The
clinical diagnosis was confirmed with plain X-Ray film and CT perfusion and CT was
performed for differential diagnosis and for precise localization of the nidus. All above
patients were treated with per cutaneous resection of the lesion with CT guidance.
Results: All patients have been followed up for at least 12 months. Clinical signs of the
osteoid osteoma were eliminated in all cases, twelve hours after operation. The bone
reformed itself in a maximum period of 7 months. In 5 cases Hydroxyapatatite was
used to fill the remaining bone defect. In these cases reformation of the bone was
done in no more than 3 months. In one case a 48 hours pain and discomfort was
observed locally. No other complications were observed.
Conclusion: The method is proving to be efficacious, safe, easy and cost effective. A
very small piece of healthy bone is removed, comparing to the classical surgical
dissection. The whole process lasts no more than 30 minutes and the materials used
are of very low cost, comparing to the very expensive needles and the time consuming
ablation. No significant complications were observed. X-Ray radiation must be in
consideration specially in cases were sensitive organs are near by.

85

2ndJUNE2011

Correspondence: COL Dimitris TSOCANAS, MD

Tel: +30 6947122221
dtsocanas@hotmail.com
OP066

THE 2009 EXPERIENCE OF HYPERBARIC OXYGEN FOR THE TREATMENT OF

ASEPTIC OSTEONECROSIS
Author(s): LT G.G. SIDIRAS1, LTJG D. TZAVELLAS1, LCDR P. VAVASIS1, LT V.
KALENTZOS1, CDR C. BISSIAS2
Institutions:
1.Diving & Hyperbaric Medicine Unit
2. 1st Orthopaedic Dept. Athens Naval Hospital, Athens,
GREECE
Aim: To study the use of Hyperbaric Oxygen Treatment (HBOT) in patients with
aseptic osteonecrosis at the Diving & Hyperbaric Medicine Unit of the Athens Naval
Hospital during 2009.
Material & Methods: Thirteen patients, five female and eight male, aged 37.6910.62
years old, with aseptic osteonecrosis grade I-II according to ARCO were treated. Six
were active duty military personnel and four were smokers. Of the lesions, seven were
localised in the femoral head, three in the femoral condyles, and three in the talus.
Two cases were post-traumatic and four had a co-existing systemic disease; three of
the latter were under chronic prednisolone use. Non-steroids were being taken by five
patients. HBOT consisted of 2 administration via face-mask for 90 min, 5 days/week,
in a multiplace hyperbaric chamber at a pressure of 180-200 kPa. The patients
followed a mean of 25.5411.45 sessions. MRI was conducted two months after initial
diagnosis.
Results: Most patients (7) demonstrated clinical and radiological improvement. Two
discontinued treatment after three and four sessions. No improvement or relapse
presented in two femoral head cases, in one femoral condyle case with a co-existing
systemic disease, as well as in one talus case.
Conclusions: Aseptic osteonecrosis appears to respond favorably to HBOT. Cases
with a co-morbidity background require additional analyses to determine response to
HBOT. Greater patient samples will provide safer conclusions.

OP067

PARALELLISM OF BONE TRABECULAE AND ITS ROLE IN THE DIAGNOSIS OF

BONE LESIONS
Author(s): COL GNHAN mer, PhD
Institutions:Glhane Military Medical Academy, Dept. of Pathology, Ankara,
TURKEY
Objective: Osteoid is collageneous matrix of bone. The structure and amount of these
production varies widely. Sometimes reactive bone mimic neoplastic ones. Neoplastic
bone contain thin, elongated, less branching, irregulary lamellated and sometimes
parallel, spiky, mature appearing trabeculae. This appearance is an empirical
diagnostic finding for well differentiated osteosarcomas. The structures of seemingly
mature-appearing trabecular bone of well differentiated osteosarcomas need to be
uncovered in order to differentiate from reactive-nonneoplastic or benign bones. In this
study, we have focused on the paralellism of neoplastic bone trabeculae of well
differentiated osteosarcomas and compared with benign neoplastic and regenerative
or dysplastic bone trabeculae.

86

2NDJUNE2011

Material and method: Sixteen (16) well differentiated osteosarcoma and 20 cases of
non-malignant bone lesions diagnosed with clinical, radiological and histological
examinations constitute the material of this study. Selection criteria was each case
should contain at least one microscopic field having paralel bone trabeculae.
Morphometric measurement were performed on these pictures to detect the
significance.
Results: Histologically normal lamellae of bone trabeculae is the result of parallel lie of
collagen fibrils. Different direction of successive lamellation is related with orientation
and alternation of fibril layers. Neoplastic osteogenesis somehow mimic normal static
osteogenesis. Well differentiated osteosarcomas may produce more neoplastic bone
which shows a certain organisation and partly may remind nonneoplastic bone which
may cause diagnostic confusion. Parallel bone trabeculae formation of low grade
osteosarcomas is also an indicator of better differentiation. Parallellism of bone in
osteosarcomas is a reflection of independence from mecahnical stres bearing.
Conclusion: Neoplastic cells produce collagen matrix and trabeculae independent than
strength to withstand to loading, differently from normal bone. Malignant osteoid may
produce very normal looking, thin, straight and parallel trabeculae in well differentiated
osteosarcomas.
Correspondence:
Glhane Military Medical Academy, Dept. of Pathology, Ankara, TURKIYE
Tel: +90312 3045972
Fax: +90312 3045978
E mail: ogunhan@gata.edu.tr
OP068

NEPHRON SPARING SURGERY: TREATMENT OF COMPLICTIONS

Author(s): Major JOVANOVIC M.1, Col. MILOVIC N.1, CEROVIC S.2, Col. CAMPARA
Z.1, SAJINOVIC D.1, Major MILOSEVIC R.1, MARIC P.1, BANCEVIC V.1, SPASIC A.1
Institutions:
1Military Medical Academy, Clinic of urology, Belgrade, SERBIA
2Military Medical Academy, Institute of Pathology, Belgrade, SERBIA
SERBIA
Introduction and objective: Nephron-sparing surgery (NSS) is an established curative
approach for treatment of patients with renal cell carcinoma (RCC) particulary for
tumors size 4 cm or less. The short-term complication rate for selected patients with
renal tumors undergoing NSS and radical surgery are comparable. The most important
major complications emerging in up-to-date large series are perioperative mortality,
intraoperative hemorrhage, postoperative urinary fistula, acute renal failure and
postoperative hemorrhage, occurred in 3,2%-37%.
Methods: The study comprises 32 patients that have had NSS because of RCC. Data
were collected out of medical records and operative lists and we also reviewed major
complications following NSS. The average age of the operated patients from our study
was 58,7 and 56,3% of the patients were male. Imperative indications for NSS had
9(28,1%) patients, i.e. 4 patients had a tumor on a solitary kidney and 5 patients had
tumors on both kidneys. Elective indications for operation had 23(71,9%) patients. The
location of the tumors was upper, mid and lower pole, respectively at 11(34,4%),
8(25%) and 13(40,6%) patients, and the mean of tumor size was 4,4 cm(1,5 10,00).
The tumors were generally resected using a cold scissor with non-clamped, nonischemic procedure at 23(71,9%) patients, and the mean of ischemic time was 18 min
at 9(28,1%) patients. Frozen biopsy was performed at all patients. At 22(68,8%)

87

2ndJUNE2011

patients we had pT1 stage, pT2 at 4(12,5%), and pT3 stage at 6(18,7%) patients; at
6(18,8%) patients we had G1, G2 at 18(56,2%) and G3 at 8 (25%) patients.
Results: The incidence rate of complications in our study was 9,4%(3 patients).
Intraoperative bleeding at a female patient, age 62, with a 3 cm tumor at the upper
pole at pT1 stage was solved during the operation by blood compensation and a
prompt hemostasis. At a female patient age 61 with a 8 cm tumor at the upper pole of
her only kidney (the other one removed in the operation 20 years ago because of
afunction due to big staghorn calculus), in pT2 stage, a transitory acute renal failure
arose. After application of 3 hemodyalisis, the renal function was stabilized. At a
female patient age 75 and a tumor size 2,5 cm, with interpolar localisation at pT1
stage, on the 7th postoperative day a massive hematuria appeared with angiografic
verification of an artery-vein pseudoaneurism with pyelocaliceal system
communication. The complication was resolved by selective embolisation in two acts
with placing 6 metal spirals.
Conclusions: Age, tumor size, operative time and pathological stage have all been
found to be independently associated with a higher risk for early complications
following NSS. As more elective NSS is performed and as experience regarding these
techniques grows, the complication rate will undoubtedly continue to decline. However,
endoscopic and interventional radiology treatment of these complications may
occasionally be still needed.
OP069

THE TIMING OF OPERATIVE FRACTURE FIXATION IN POLYTRAUMA CASES IN

MILITARY MEDICAL ACADEMY EMERGENCY CENTER
Author(s): Major dr Dragan RADOII, colonel prof dr Zoran POPOVI, major dr
Jugoslav MARINKOVI
Institutions: Military Medical Academy Belgrade (MMA)
Orthopaedics and traumatology Clinic,
SERBIA
The question of the optimal time for surgical treatment of individual fractures in the
management of polytrauma patients still remains contraversial.
The significance of skeletal stabilization has become clear in the polytrauma
management ever since the introduction of Thomas splint. Surgical treatment for
fractures in polytrauma evolved in last two decades, from early total care of all
fractures popular in 1980s, to different approach since 1990s that recommends early
(initial) temporary stabilization followed by secondary definitive osteosynthesis of major
fractures in patients at high risk of developing systemic complications
Since 01.03.2010. to 31.03.2011.in MMA we had 181 polytrauma cases. All of them
had some kind of orthopaedic trauma combined with head, neck, chest and/or
abdominal trauma. 139 cases required urgent orthopaedic surgical intervention, 24
were operated by orthopaedic surgeons in delayed procedure, and in 18 cases
orthopaedic injuries were treted nonoperatively. Patients between 21-40 years of age
represented 65%. There were 37 patients under influence of alcohol or drugs. The
main cause of polytrama in our series were traffic accidents.
The timing of intervention is often crucial to the survival of the polytrauma patient.
Improved understanding of the pathophysiology of trauma allowed us to better identify
the patients who would benefit from damage control surgery. In Military medical
Academy we follow the concept of damage control orthopedic surgery according to the
current recommendations , we use early temporary fixation using external fixators as
soon as possible, followed by secondary definitive fixation with a wide variety of

88

2NDJUNE2011

specific orthopaedic implants in the timeline that usually extends from 2 to 4 days after
trauma (to 7-10 days for unstable pelvic fractures). In selected polytrauma cases we
find that early total care concept of managing multiple fracture patterns is still
acceptable and viable.
16:30-18:00

ROUND TABLE II
Polytrauma Patients Care:
Aspects of Emergency Medical Service and ICU Department
(THE PERFORMANCE HALL)
Chairmen: : COL Prof. Jefta KOZARSKI, MD, PhD (Serbia)
COL Lecturer Dan CORNECI, MD, PhD (Romania)
COL Assist. Prof. Bogdan TEUSDEA, MD PhD, EMDM, (Romania)

RT004

ORTHOPEDIC POLYTRAUMA PATIENT: DAMAGE CONTROL SURGERY

Lt. KONTOLATIS Ioannis, MD,
GREECE

RT005

ACUTE TRAUMA DIAGNOSIS AND TREATMENT ALGORITHM IN EMERGENCY

DEPARTMENT
Col. Dr. TEUSDEA B., Cpt. Dr. TOMA M., Mr. Dr. COSTEA F.,
ROMANIA

RT006

THE TREATMENT OF CHEMICAL BURNS

Col. Prof. Dr. Jefta KOZARSKI, MD.PhD, Boban DJORDJEVIC, MD, PhD,
NOVAKOVI Marijan MD PhD.
Clinic for plastic surgery and burns, Military Medical Academy, Belgrade,
SERBIA
A chemical burn is a special type of burn injury, caused by a chemical agent. It occurs
when of living the tissue is exposed to a corrosive chemical compound, most
commonly a base or an acid and hydrocarbons. The severity of burns associated with
chemicals depends on the concentration of a substance, the length of exposure, and
the type of chemical causing the damage. These burns don't need a source of heat
and can be extremely painful, as they evolve very quickly.
Most acids produce a coagulation necrosis by denaturing proteins, and form a
coagulum (eg, eschar) that limits the penetration of the acid. Bases typically produce
more severe injuries known as liquefaction necrosis. This involves denaturing of
proteins as well as saponification of fats, not limiting tissue penetration. Hydrofluoric
acid is somewhat different from other acids in that it produces a liquefaction necrosis.
Chemical in a gaseous form can cause direct injury to the lungs and respiratory
system. In case if the agent causes only external skin damage, it may be accompanied
by respiratory complications because they may trigger the release of histamine which
can cause swelling or bronchospasm.
Sometimes chemicals may be absorbed into the tissue thus causing secondary
injuries.
A patients history should include the following:
Offending agent, concentration, physical form, pH;
Route of exposure;
Time of exposure;

89

2ndJUNE2011

Volume of exposure;
Possibility of coexisting injury and
The timing and extent of irrigation
First aid should consist of neutralizing of the chemical agent if possible. This should be
performed with great care, because some neutralizing reactions are exotermal or
produce poisonous substances, which may cause even more damage. Irrigation of the
affected area with cool, clean water is also an option, but it should also be handled
with care because some substances react violently with water and can cause further
damage.
The treatment involves removal of the agent and, in most cases, a high-density water
shower. Surgical intervention may be required, especially if the burns are deep and
require skin grafting.
16:30-18:00
PP040

POSTER PRESENTATION II
(BYZANTINE HALL)
SUCCESSFUL TREATMENT OF FOURNIERS GANGRENE(GF)
WITH
AGGRESSIVE SURGERY AND ADJUVANT HYBERBARIC OXYGEN
THERAPY(HBO): CASE REPORT
Author(s): CPT Anastasios TZORTZINIS MD,HN, MAJ S. GOULIAMAS MD, MAJ P.
KARASTERGIOU MD, LTJG Dimitrios DELIGIANNIS MD, LTJG A. VITALIS MD
Institution: Dept. of General Surgery, Naval Hospital of Crete, Chania,
GREECE
Introduction: GF is a rare polymicrobial necrotizing fasciitis primarly involving the
perineal,perianal and genital regions.It has a fulminant presentation and is rapidly
progressing with a potentially high mortality rate up to 75%.
Materials-Methods: A 57-year old male with diabetes mellitus was admitted to our
hospital with perineal inflammation complicating a perineal abscess presented after he
had burned an external hemorrhoid using petrol,3 months ago.In two days,he was
systemically unwell(HR:120,BP:100/60,T:38,2 C,WBC:20000),the perineum was
gangrenous with extensine cellulitis and a diagnosis of GF was made.
Results: The patient was treated with immediate and complete multiple surgical
debridements,broad-spectrum antibiotic combinations and adjuvant HBO therapy.We
performed 3 extensive surgical removal of the necrotic tissue and a loop
sigmoidostomy.The patient then underwent successive successful sessions of HBO
therapy until no ongoing necrosis.He was discharged 38 days after admission having
completed 18 HBO sessions.
Conclusions: GF represent a severe condition with a high mortality and morbidity.
Therefore, an early diagnosis and initiating aggressive multidisciplinary management is
mandatory. Adjuvant HBO therapy seems to be of great importance, due to
neovasculogenesis and by increasing tissue oxygenation to a point that inhibits and
kills anaerobic bacteria and reduces the edema, thereby fascilitating the transportation
of antibiotics. As a result it accelerates the healing rate, shortens the hospitalization
time and helps full recovery.
Correspondence:
LTJG Dimitrios DELIGIANNIS,
+30 28210-82538,
+30 6955480163,
d.delijohn@yahoo.gr

90

2NDJUNE2011

PP041

GENITAL ANOMALIES DIAGNOSED DURING CIRCUMCISION CONSULTATION

Author(s): LTC AKYOL Ilker, MD, LCDR ATES Ferhat, MD, LTC SOYDAN Hasan,
MD, 1LT DURSUN Furkan, MD, CAPT SENKUL Temucin, MD, CAPT BAYKAL Kadir,
MD.
Institution: Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept.
of Urology, Istanbul,
TURKEY
Objective: We aimed to review the genital anomalies diagnosed during consultation for
traditional circumcision and at followup after circumcision elsewhere.
MATERIAL AND METHOD Those cases who do not have any known Urological
complaints or diseases were included in the study with a retrospective chart review.
Genital anomalies revealed with physical exam were recorded. Concealed and
partially concealed penises were defined as complete and 1/2 to 2/3 hiding of the
penile shaft in the lower abdominal wall respectively. Hypoplastic testis was defined as
one whose longitudinal length was smaller than 15 mm.
Results: 44 cases applied for circumcision consultation (Mean age 5 (0.5-12)).
Following anomalies were diagnosed in corresponding number of cases: Concealed
penis: 14, partially concealed penis: 2, phimosis:7, undescended testis: 7, retractile
testis: 5, penoscrotal web: 3, hypoplastic testes: 3, varicocele: 1 , ectopic testis: 1 ,
coronal hypospadias: 1. More than 1 anomaly were detected in 8 cases. 23 cases
applied for followup after circumcision elsewhere (Mean age 6.13 (1-13)). Untreated
genital anomalies in this group were hydrocele: 1, undescended testis: 3, retractile
testis: 3, penoscrotal web: 1, penile curvature: 1.
Conclusion: In a group of patients with no Urologic complaints at all, a number of
genital anomalies were detected during circuncision consult, some of which require
surgical correction, and some others require proper parental counseling and long term
followup. However, in some cases, these anomalies were overlooked even though the
patients had undergone circumcision.
Correspondence:
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
Tel:
+ 90 216 542 2020(4306)
Fax: + 90 216 348 7880
GSM: + 90 532 556 6339
e-mail: drferhatates@yahoo.com

91

2ndJUNE2011

PP042

THE EVALUATION OF HISTOPATHOLOGIC RESULTS OF 97 ORCHIECTOMY

BECAUSE OF UNILATERAL UNDESCENDED TESTIS
Author(s): LCDR ATES Ferhat, MD, LTC SOYDAN Hasan, MD, LTC AKYOL Ilker, MD, 1LT
OKCELIK Sezgin, MD, COL KARADEMIR Kenan, MD, CAPT BAYKAL Kadir, MD.
Institution:Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept. of
Urology, Istanbul,
TURKEY
Objective: Aim of this study was to evaluate histopathologic results of 97 orchiectomy
because of unilateral undescended testis.
MATERIAL AND METHOD Data were evaluated in our clinic which performed 97
orchiectomy because of unilateral undescended testis with normal contralateral testis,
between January 2004-July 2010.The location of undescended testis,testicular volume
according to pathologic examination and pathologic results were evaluated.The
correlation between location of undescended testis, pathologic results and volume
were examined.
Results: Mean age of 97 adults who performed orchiectomy was 21 .24O.75. Mean
testicular volume that calculated for pathologic specimen was 8.398.45 cc.Testicular
volume was measured <6 cc in 38, between 6-12 cc in 44 and >12 cc in 15
patients.Testicular tissue was not found in eight patients, found at inguinal channel in
74 and at superficial inguinal pouch in 5 patients. Only vas deferens was found in 8
patienls, atrophy in 33, sertoli cell only in 36 and spermatositic arrest in 20 patients,
Sixteen of them were in inguinal channel and four of them were in the superficial
inguinal region. Undescended testicle location was significantly correlated with the
pathologic result (p=0.014), location of the undescended testicle was not correlate with
testicular volume (p=0.077) but correlation between testicular volume and pathologic
results was significant (p=0.017).
Conclusion: Spermatogenesis were present about 1/5 of proximal undescended
testicle and about 1/4 of distal undescended testis.None of testicular intraepithelial
neoplasia or tumor was detected.Whether the patients with palpable undescended
testis follow up without orchiectomy, spermatogenesis can be seen contributing about
1/4 to 1/5 of patients according to location of the testis.
Correspondence:
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)
+ 90 216 348 7880
+ 90 532 556 6339
e-mail: drferhatates@yahoo.com

PP043

LAPAROSCOPIC APPENDECTOMY OUTCOMES IN RECRUIT UNDERGOING

MILITARY TRAINING
Author(s): CPT HAZER Batuhan MD
Institution:Diyarbakr Military Hospital, Department of Surgery, Diyarbakr,
TURKEY
Introducton: Acute appendicitis is a common indication for emergency abdominal
surgery with a life-time incidence between 7 and 9% , The disease may occur at any

92

2NDJUNE2011

age, but predominately presents in the second and third decades which most of
recruits are.
Materal and methods: 40 patients with appendicitis were included in the study
performed at Diyarbakr Military Hospital Turkey. Laparoscopic or open appendectomy
is performed in sequence. The patients ability to perform 3 activities: 1. vigorous
activities, such as running, lifting heavy objects, participating in strenuous sports. 2.
Climbing several flights of stairs 3. Walking more than a mile were measured one
week and one month postoperatively. All items had response categories scaled from 1
through 5, with verbal descriptors for each item. The response categories for activity
were (1) no difficulty at all; (2) a little difficulty; (3) some difficulty; (4) a lot of difficulty;
(5) not able to do it. The Activity Assessment scale is the sum of the 3 items, with
higher scores indicating poorer activity.
Results: The laparoscopic groups point was 156 (60-300) after one week
postoperatively, than 267 (60-300) for open group (P < 0.01).The laparoscopic groups
point was 62 (60-300) after one month postoperatively, than 207 (60-300) for open
group (P < 0.01).
Concluson :Laparoscopic Appendectomy is feasible and safe for acute appendicitis,
and decreases pain in recruit undergoing military training.
Key words: appendectomy, laparoscopic, military training, pain
PP044

THE EFFECTS OF ALPHA ADRENERGIC RECEPTOR BLOCKERS, USING FOR

BENIGN PROSTATE HYPERPLASIA TREATMENT, ON THE ENDOTEL
FUNCTIONS AND METABOLIC PARAMETERS
Author(s): MAJ KOCOGLU Hasan MD1, ALAN Cabir MD2, KIRILMAZ Bahadr MD3,
ALTINOLUK Blent MD3, ERTUNG Yunus MD2.
Institution:1CanakkaleMilitary Hospital Dept. of UROLOGY, Canakkale, TURKEY.
2 anakkale Onsekiz Mart University Medical Faculty Department of Urology, TURKEY.
3 anakkale Onsekiz Mart University Medical Faculty Department of Cardiology,
TURKEY.
Objective: Alpha adrenergic receptor blokers are using widely in the treatment of
benign prostate hyperplasia. We investigated the effects of the drugs on the endotel
functions and metabolic process, especially in the middle and advanced aged male
population.
Material and method: 34 Patients presenting with benign prostatic hyperplasia (BPH)
who prescribed alpha adrenergic receptor blokers were enrolled in the study. The
patients didnt have any history about coronary artery diseases. Endotel functions were
evaluated with brachial arterial doppler ultrasonography .Also the lipid profiles and
blood glucose levels were measured.
Results: Mean age of patients was 61,1 6,5. Dilatation values resulting from ow
before treatment and after treatment at 30, 60, 90, 120. second were calculated and
there were recovery after treatment, but it was not statistically significant (p>0,05).
Likewise the levels of blood glucose, LDL cholesterol, HDL cholesterol and triglyceride
were measured and there were amelioration in the results after treatment, but it was
not statistically significant too (p>0,05).
Conclusion: In the patients who are at high risk in the terms of coronary artery disease,
alpha adrenergic receptor blokers have a little positive effect in the short term on blood
glucose, LDL cholesterol, HDL cholesterol and triglyceride levels and endotel
functions, which play an important role in the atherosclerotic process.

93

2ndJUNE2011

Correspondence
Canakkale Military Hospital Dept. of UROLOGY, Canakkale, TURKEY
Tel:
+ 90 286 2172460 (1241)
Fax: + 90 286 2172407
GSM: + 90 505 6842691
e-mail: perkutanci@yahoo.com
PP045

RECONSTRUCTION WITH TRANSPLANT IN MAJOR BONE ILIAKE MARROW

DAMAGE FROM THE BULLET OF A PISTOL, WHOSE TRAJECTORY ENDS WITH
THE EMERGENCE OF LEA DEFECATE.
Author(s): Dr. Lozana BINJAKU, Dr. Alma TELITI,
ALBANIA
Introduction: Replacement of filling bone defects created by fire weapons with bone
from the peaks generated by weapons fire from the ridges iliake bone and fixing them
titanium plate in order to ensure continuity of bone uniformity and to facilitate
orthopedic replacements blocks of missing teeth. Identify a strange trajectory of bullet
without a problem digestive organs where it passes until it comes up with defecate.
Case report: A 23 year old male, presented Traumatic Military Hospital - Albania, in
conscious state, with diffuse bleeding from the bottom of the tongue. Noticed the bullet
entry holes before opertures nasal region. No other damage extra oral put. Intraoral
observed lack maxillae distance right. The bullet passed from the maxilla - tongue and is inserted into the esophagus, stomach and is stuck in the stomach, digestive
tract without a problem. Sutura bleeding mattress was stopped with tongue creating
the configuration to its fullest. The patient was trakeostomizua. The patient underwent
multiple CT examinations of head, abdomen X-ray, angio X-ray, CT torax ,
fibrogastroscopy.
Results: The case was treated. Maxillary injury was treated with transplantation of
bone iliake in place of the fault which was modeled according to the form that will
replace, and fixing her with titanium plates.Provided full coverage with soft tissue of
transplants. The case was followed until the bullet came out with defaces after 10
days.
Conclusion. Crista iliake due to the low absorption is most favorable for
transplantation. God makes miracle by referring the bullet out without other problems.

PP046

SURGICAL TREATMENT OF URINARY FISTULAS

Author(s): Major JOVANOVIC Mirko, Col. MILOVIC Novak, ALEKSIC Predrag,
BANCEVIC Vladimir, Major KOSEVIC Branko, MOCOVIC Dejan, Major NIKOLIC Ivica,
Major MILOSEVIC Radovan, SIMIC Dejan
Institution: Military Medical Academy - Urology Clinic, Belgrade,
SERBIA
Introduction: Urinary fistula can be defined as an abnormal passage communicating
with the urinary tract. The most often urinary fistulas are vesicovaginal fistulas which
appear in about 75% of cases. From the point of surgical solutions urinary fistulas can
be divided into simple and complex. Treatment methods can be conservative and
surgical.
Material and methods: In our retrospective clinical study on fistulas data of 50 patients
were processed 45 women and 5 men, that had been cured in period from 20002008 at our Clinic. The patients were classified according to their sex, kind and

94

2NDJUNE2011

localisation of the fistula, etiology, way of surgical treatment and the result of the
treatment. Average time of the follow up was 2,62 years.
Results: Average age of the patients in our study was 46,7 (min.32, max.79). 49
patients were treated surgically, and 1 woman patient was treated conservativelly
beacuse of her extremelly bad general condition. The most fistulas in our series were
vesicovaginal (60%) and vesicorectovaginal (20%) fistulas.
Average time of fistula arising after radiation was 3,15 years (from 4 months to 17
years, most frequently after 2,27 years). 87.75% of patients were successfully
surgically treated. In the group of pelvic organs fistula, 86.87% of them were
succesfully solved surgically. In the group of fistulas appeared after giving birth and
after gynaecological operations, the
percentage of successful treatment of
vesicovaginal fistulas was 100% while that percentage with vesicovaginal fistulas
appeared after radiation was 83% and percentage of successfulness of the surgical
solutions with vesicorectovaginal fistulas in our series is 86%. In case of patients with
vesicovaginal and vesicorectovaginal fistulas after radiation, bladder was succesfully
preserved in 86.36% cases. With 13.64% of cases (6 patients) and mostly in the group
with extensive communications of bladder, rectum, urethra and vagina we applied
derivations of urine by orthotopic ileal pauch or ileal conduit. The greatest number of
derivations were executed in the group of vescicorectovaginal fistulas (4 patients).
Conclusion: In our series fistulas were solved surgically in 98% of cases. The most
frequent approach that was used was transabdominal approach with interposition of
omental flap and the best results were achieved in the area of fistulas arisen after
obstetritical and gynaecological procedures without additional radiation.
PP047

MANAGEMENT OF PATIENTS WITH CONGENITAL ADRENAL HYPERPLASIA

AND BILATERAL TESTICULAR MASS
Author(s): LTC SOYDAN Hasan, MD, LCDR ATES Ferhat, 1LT DURSUN Furkan,MD,
CAPT SENKUL Temucin, MD, COL KARADEMIR Kenan, MD, CAPT BAYKAL Kadir,
MD.
Institution:Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept. of
Urology, Istanbul,
TURKEY
Objective: We aimed to put forward the management of patients with congenital
adrenal hyperplasia (CAH) and bilateral testicular mass using the data of two
differently treated patients
MATERIAL AND METHOD: Two patients were evaluated with history, physical
examination, turnor markers, spermogram, and scrotal ultrasound.Since the tumor
markers were normal, abdominal ultrasound, adrenal cortex metabolites,
abdominopelvic contrast CT and sella MRI.
Results: Both patients had history of precoccious puberty; first one nevert treated,
second one received decapeptyl between age 4 to 1 0 years. Both applied with
testicular masses. -HCG and alfa-fetoprotein values were normal; whereas ACTH,
testosteron and 17-OH ketosteroid high. First case had also right adrenal mass and
left adrenal hyprplasia, and underwent right radical orchiectomy and laparoscopic right
adrenectomy. Pathology could not differantiate between tumor and hyperplasia. There
was no biochemical improvement. Octreotide PET-CT revealed an ectopic ACTH site
in left testis. Endocrinologists recommended left orchiectomy. Second case had
bilateral adrenal hyerplasia, and corticosteroid treatment was started as suggested by
endocrinologists.

95

2ndJUNE2011

Conclusion: Testicular mass which are seen in congenital adrenal hyperplasia, can be
gonadal nodules of congenital adrenal hyperplasia, benign tumors derived from
adrenal rest tissue or Leydig cell tumors. Elimination of corticosteroid hormone
deficiency due to enzyme defect may be the first step of treatment.
Correspondence
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)
+ 90 216 348 7880
+ 90 532 556 6339
e-mail: drferhatates@yahoo.com
PP048

DOES YOUNG PATIENTS TCCA REALLY BEHAVE DIFFERENT?

Author(s): CAPT ADAYENER Cuneyt, MD1, LCDR ATES Ferhat1, MD, LTC SOYDAN
Hasan, MD1, MAJ MALKOC Ercan2, MD, COL KARADEMIR Kenan, MD1, CAPT
BAYKAL Kadir, MD1.
Institution:
1 Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept. of Urology,
Istanbul, TURKEY
2 Corlu Military Hospital Urology Clinic, Tekirdag,
TURKEY
Objective: The comparison of the epidemiological data of our young patients with
bladder transitional cell carcinoma (TCCa) with the older ones.
Material and method: The medical records of the patients aged 45 and younger with
TCCa diagnosed between 1990 and 2010 in our clinic were retrospectively
investigated. The patients' gender, smoking habits, volume and the stage of the tumor
and the recurrence percentages were compared with older cases (control group) by
chi-square test.
Results: A total of 30 patients out of the 593 who were 45 or younger included in the
study. Study group consisted of 26 men and 4 women. Control group was having 225
patients. The mean ages of the study and the control group was 33.1 and 67.2
respectively. Man/woman ratio and percentage of the smoking patients of the two
groups were 86.6% to 84.% (p=0.324) and 86.9% to 65.3% (p=0.019) respectively.
The percentage of superficial patients in study and control groups were 90 and 83.2%
(p=0.335). Patients who were having 2.5 cm and smaller tumor volume at the diagnose
were70.3% in the study group and 47.9% in the control group (p=0.024). Recurrence
rates were 37% and 35.2% in the study and control groups (p=0.481 ) respectively.
Conclusion: Younger patients with TCCa in our clinic were having higher smoking
rates but similar man/woman ratio with the older patients.Although they were having
significantly smaller tumor volume at the diagnose, the young patients' stages and the
recurrence rates were not statistically different than the older cases.
CORRESPONDENCE
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)

96

2NDJUNE2011

+ 90 216 348 7880

+ 90 532 556 6339
e-mail: drferhatates@yahoo.com
PP049

HYDRODISTENSION IMPLANTATION TECHNIQUE (HIT) IN THE TREATMENT OF

VESICOURETERIC REFLUX: INITIAL EXPERIENCE
Author(s): LTC AKYOL Ilker, MD1, LTC SOYDAN Hasan, MD1, LCDR ATES Ferhat,
MD1, MAJ MALKOC Ercan, MD2, COL KARADEMIR Kenan, MD1, CAPT BAYKAL
Kadir, MD1.
Institution:1 Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept.
of Urology, Istanbul, TURKEY
2 Corlu Military Hospital Urology Clinic Tekirdag, TURKEY
TURKEY
Objective: We evaluated our initial outcome of treatment of VUR with Hydrodistension
implantation technique (HIT).
Material and method: Patients with primary VUR who were treated with HIT, and who
have not undergone any previous surgical procedure were included. Indications for
treatment and corresponding patient numbers were as follows: Persistent VUR and
female gender: 3, breakthrough infection; 4, incompatibility to medical treatment: 1,
decreased renal reserve:l. Dextranomer hyaluronic acid copolymer (Dexell) was used
as the injection material. Injection sites were coded as follows: 'l: intravesical ureteric
wall, 2: orifice, 3: immediately distal to the orifice. Therapeutic outcome at 3 months
postoperatively was assessed with direct radionuclide cystography.
Results: Nine patients with 13 ureteric units were treated (Mean age; 7.06 years). VUR
grades and corresponding number of ureteric units were as follows: GI: 2, GII: 1 , GIII:
4, GIV: 6. Followup after 10 ureteric treatments were available, which revealed 7 cure,
and 3 downgrading. Mean injection material per ureteric treatment was 2.75 ml.
Success rates in terms of cases: 5 patients have no followup as yet, remaining 4
patients were all cured, of whom 3 at one session and 1 at 2 sessions. lnitial VUR
grades ot the cured patients were as tollows: One session cure: l grade I, 1 grade III,
one grade lV (all unilateral), 2-session cure: 1 bilateral grade IV VUR.
Conclusion: Our limited number of series suggests that HIT is a promising technique
which may increase the success rate of endoscopic VUR treatment.
CORRESPONDENCE
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)
+ 90 216 348 7880
+ 90 532 556 6339
e-mail: drferhatates@yahoo.com

97

2ndJUNE2011

PP050

THE RELATIONSHIP BETWEEN PENIL LENGTH AND FOOT SIZE, THUMB

LENGTH AND BODY MASS INDEX IN ADOLESCENT BOYS
Author(s): LCDR ATES Ferhat, MD, CPT YILMAZ Omer, MD, LTC SOYDAN Hasan,
MD, CAPT ADAYENER Cuneyt, MD, COL KARADEMIR Kenan, MD, CAPT BAYKAL
Kadir, MD.
Institution:Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept. of
Urology, Istanbul, TURKEY
TURKEY
Objective: Aim of this study was to evaluate if there was a relationship between foot
size, thumb length and body mass index (BMI) in adolescent boys in the begining of
high school period.
Material and method: The boys came from different regions in Turkey were examined
while they were standing up in normal room temperature after taking their informed
consent in July of 2010. The ages, foot sizes, lengths, weights, body mass indexes
calculated by the formula of weight/length(m)2 and stretched penil lengths of students
were measured and recorded. Stretched penil length was measured with ruler from
radix penis by putting the ruler to symphisis pubis while tooking the glans and
stretching the penis. The degree of pubic pilosity was evaluated by using Taner
classification. The relationship between these parameters was searched.
Results: The average length was 166.137.16 cm, weight was 56.309.87 kg, BMI
was 20.32.78, foot size was 41.051.63, thumb length was 6.560.46 cm, penil
length was 11.722,09 cm, Tanner classification score was 3.381.16, age was
13.860,37 years. There was significant correlation between penil length and all the
other parameters (p<0.002). It was seen that all parameters were related to penil
length(p<0.015)
Conclusion: It was seen that there was a direct proportional relation between foot size,
thumb length, pubic pilosity degree and penil length, but inversely proportional relation
with BMI in Turkish men aged between 13-15 years old.
Correspondence:
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)
+ 90 216 348 7880
+ 90 532 556 6339
e-mail: drferhatates@yahoo.com

98

2NDJUNE2011

PP051

BIOCHEMICAL CHANGES IN CAVERNOSAL TISSUE CAUSED BY SINGLE SIDED

CAVERNOZAL NERVE RESECTION AND THE EFFECTS OF ALPHA LIPOIC ACID
ON THESE CHANGES
Author(s): MAJ KOCOGLU Hasan MD1, ALAN Cabir MD2, ERSAY Ahmet Reit MD2,
EREN Ali Erhan MD2, ERTUNG Yunus MD 2 , KURT Hasan Anl MD2
Institution:
1CanakkaleMilitary Hospital Dept. of UROLOGY, Canakkale, TURKEY.
2 anakkale Onsekiz Mart University Medical Faculty Department of Urology,
TURKEY.
Objective: Alpha lipoic acid (ALA) shows its antioxidant properties by eliminating free
radicals. In this experimental study we investigated the effects of ALA on rehabilitation
of cavernosal tissue and nitric oxide synthase (NOS) containing nerve fibers on
erectile tissue.
Material and method: In this study four groups were formed by inclusion of 63 adult
fertile rats. Control group (n: 9), sham operation group (n: 18), 18 rats underwent
unilateral neurectomy of a 5-mm. segment of the cavernous nerve (group DI) and
another 18 rats group which ALA received after unilateral neurectomy (group DII).
Assessments were done 3 weeks after neurectomy.
Results: Maximal intracavernozal pressure (cm/H2O) after cavernous nerve
stimulation in sham group, in group DI and in group DII were 80.55 + 9.82, 33.8+16.9
and 58.8+12.9 respectively. We assessed number of NOS containing nerve fibers via
nicotinamide adenine
dinucleotide phosphate (NADPH) diaphorase staining. According to NADPH
diaphorase staining group DII significantly recovered comparing group DI (48.89
19.00 and 17.22 6.67 respectively) (p<0.05). The result of tissue TBARS in group DI
(79.11 8.42) is significantly higher than other groups (p<0.05). The TBARS level of
group DII (59.13 6.69) is higher than sham groups (46.37 3.09) (p<0.05). SOD
activity is reduced in both; group DI and group DII (31.42 6.06 and 40.38 4.24).
CONCLUSION: Neurectomy and surgical trauma caused oxidative stress in rat corpus
cavernosum. As a potent antioxidant ALA has positive effects on cavernosal tissue
regeneration and rehabilitation by reducing oxidative stress.
CORRESPONDENCE
Canakkale Military Hospital Dept. of UROLOGY, Canakkale, TURKEY
Tel:
+ 90 286 2172460 (1241)
Fax: + 90 286 2172407
GSM: + 90 505 6842691
e-mail: perkutanci@yahoo.com

99

2ndJUNE2011

PP052

THE PROTECTIVE EFFECT OF DECORIN ON GLOMERULOSCLEROSIS IN

RENAL ISCHEMIA/REPERFUSION DAMAGE
Author(s): MAJ KOCOGLU Hasan MD1, ALAN Cabir MD2, ERSAY Ahmet Reit MD2,
ALTINTA Ramazan MD3, ALICI Blent MD3, KURT Hasan Anl MD2
Institution:
1CanakkaleMilitary Hospital Dept. of UROLOGY, Canakkale, TURKEY.
2 anakkale Onsekiz Mart University Medical Faculty Department of Urology, TURKEY
3 stanbul University Cerrrahpasa Medical Faculty Department of Urology , TURKEY
TURKEY
Objective: TGF-1 (transforming growth factor- beta 1) is the most important growth
factor in pathogenesis of glomerulosclerosis. The agents that may antagonize and/or
reduce its effects. Between these agents, decorin has an important role. We proposed
to identify the role
of decorin in treatment of tubular and intersitial fibrosis and in inhibition of TGF-1 in
acute ischemic kidney.
Material and method: We grouped 34 female sprague dawley type rats, into 3 groups
as 9 sham, 9 ischemia-reperfusion (I/R) and 16 I/R+decorin respectively. The rats in
I/R+decorin group, decorin have been administered intraperitonally at the dose of 0,1
mg/kg for 9 days after reperfusion. After 9 days later, all the rats in 3 groups were
unilaterally nephrectomized. In nephrectomy pieces immunohistochemically TGF- 1
level measured.
Results: TGF-1 level was lower in I/R+decorin group. For evaluation apopitotic
activity level, in Caspase staining there was a statistically significant difference
between 3 groups. The number of Caspase stained cells was lower in I/R+decorin
group. The amount of collagen in interstitial tissue was relatively higher in I/R group
than I/R+decorin group. But
this difference was not statistically significant.
Conclusion: We found that the TGF-1 level -so called initiator of fibrotic activity- and
apopitotic activity was low in I/R+decorin group. Additional studies must be performed
for understanding the role of decorin in inhibition of TGF-1 and for assesment of
decorins routine usage in acute renal ischemia.
Correspondence
Canakkale Military Hospital Dept. of UROLOGY, Canakkale, TURKEY
Tel:
+ 90 286 2172460 (1241)
Fax: + 90 286 2172407
GSM: + 90 505 6842691
e-mail: perkutanci@yahoo.com

100

2NDJUNE2011

PP053

COL. DR. MIRCEA CONSTANTINESCU EXCELLENT SURGEON AND THE

CREATOR OF THE OBSTETRICS GYNECOLOGY ROMANIAN ARMY
DEPARTMENT
Author(s): 1Col. Simona BERBECAR MD, PhD, 2Col (ret.) Gheorghe BERBECAR MD,
PhD
Institution:
1National Institute of Aerospace Medicine, Clinical Laboratory, Bucharest,
2 Dimitrie Gerota Hospital, Gynecology Dept., Bucharest,
ROMANIA
Col.dr. Mircea Constantinescu is a complex personality of the military medicine;
leading surgeon of his generation, with a unique set of skills (he was ambidextrous)
and with a vast experience (he participated in both World Wars), the colonel was the
creator of the Obstetrics-Gynecology service within the army. He had a rich scientific
and educational activity. This prestigious doctor was also an exemplary husband and
father having had 4 children to whom he offered an outstanding education.
E-mail: simona_berbecar@yahoo.com
Tel: 0723.323.862

PP054

A NOVEL APPROACH IN SWL (EXTRA CORPOREAL SHOCK WAVE

LITHOTRIPSY) TREATMENT OF LOWER URETERAL STONES: TRANSGLUTEAL
SWL
Author(s): CAPT SENKUL Temucin, MD, 2LT TANIDIR Yiloren, MD, CPT UGUZ
Sami, MD, LCDR ATES Ferhat, MD, LTC SOYDAN Hasan, MD, 1LT DURSUN
Furkan, MD.
Institution: Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept.
of Urology, Istanbul,
TURKEY
Objective: Herein this study, we assess the efficacy of extracorporeal shockwave
lithotripsy for distal ureteral stones.
Material and method: A total of 26 patients with lower ureteral Stones were enrolled in
this study. Each patient's age, stone side, stone size and body mass index of patients
were recorded before the procedure. Treatment success was defined as the Stone
free status of patient at the first month of the procedure. For each procedure the total
number of shocks applied, energy level, number of sessions and the visual pain scores
were recorded; all data were expressed as mean Standard deviation.
Results: Age range of patients was 20-62 years (mean 37.1 14.2 years). Left and
right ureteral stones were present in 17 cases and 9 cases, respectively. Body mass
index of patients were between 18.3-35.6 kg/m2 (rnean 27.24 5.08 kg/m2). Treated
stone size ranged between 7 mm and 20 mm (mean 10.2 3.4 mm). The range of
applied shock wave was between 1350 and 3505 beats (mean 2954.6704.5 beats);
the total energy given was noted as 19.3-135 joules (mean 89.430.4 joules), The
overall success rate of applications was found to be 85%. Visual analogue score of
patients were between 3 and l0 (mean 4.2 2.2), Almost all of the patients' complaint
of a discomfort during the process due to the stimulation of sciatic nevre
Conclusion: Transgluteal SWL seems to have a better succes rate than standard
method in the treatment of lower ureteral stones.

101

2ndJUNE2011

Correspondence:
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Teaching Hospital, Dept. of Urology,
Uskudar 34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)
+ 90 216 348 7880
+ 90 532 556 6339
e-mail: drferhatates@yahoo.com
PP055

ULTRASOUND MONITORING OF POSTTRAUMATIC CAROTID-CAVERNOUS

FISTULA
Author(s): LEUT. I. TODOROV1, LEUT. COL. T. EFTIMOV1, M. LILOV2, S.
KARAKANEVA3, E. TITIANOVA3,A. PETKOV1
1Department of Neurosurgery,
2Department of Image Diagnostics,
3Department of Functional Diagnostics of the Nerve System, Military Medical Academy
Sofia,
BULGARIA
Aim: To perform ultrasound monitoring of posttraumatic carotid-cavernous fistula
(CCF), treated by endovascular coiling.
aterial and methods: Fifty five years old man was ultrasonically followed before and
after endovascular embolisation of a posttraumatic carotid-cavernous fistula (class A,
according to Barrows classification).
Results: The typical ultrasound picture of CCF was found on the preoperative study
turbulent blood flow up to 220 cm/s in the cavernous sinus region. Neurosonography
on the 3-rd day after endovascular coiling showed total occlusion of the fistula and the
clinical symptoms were reverting. Ultrasound control on the 26-th postoperative day
revealed no pathologic communication between the internal carotid artery and the
cavernous sinus.
Discussion: The ultrasound monitoring of blood flow velocity changes is a fast, noninvasive and high-sensitive method for diagnostics and following of carotid-cavernous
fistulas.
Key words: carotid-cavernous fistula, ultrasound monitoring, endovascular coiling,
internal carotid artery, cavernous sinus.

PP056

WHAT CHANGED IN EPIDEMIOLOGY OF OUR TCCA PATIENTS IN THE LAST 10

YEARS
Author(s): CAPT ADAYENER Cuneyt, MD, LCDR ATES Ferhat, MD, LTC SOYDAN
Hasan, MD, CAPT SENKUL Temucin, MD, COL KARADEMIR Kenan, MD, CAPT
BAYKAL Kadir, MD
Institution:Gulhane Military Medical Academy Haydarpasa Teaching Hospital, Dep. of
Urology, stanbul,
TURKEY.
Objective: The Epidemiologic data in the medical records of our patients with bladder
transitional cell carcinoma (TCCa) were evaluated and the changes by the time (1990
to 2000 versus 2000 to 2010) were recorded.
Material and method: The medical records of the patients with TCCa diagnosed from

102

2NDJUNE2011

1990 to 2010 in our clinic were retrospectively investigated. The cases divided into two
as diagnosed in between 1990 to 2000 (group 1) and between 2000 to 2010 (group 2).
The patients gender, ages at the diagnose, smoking habits, major complaint before
diagnose, tumor volumes and stages were compared in the two different groups. The
variety of the data between two groups were statistically analyzed with q-square test.
Results: A total of 574 patients were included in the study. The first group consisted
with 260 cases and the second group with 314. First and the second groups mean
ages at the diagnose was 63.2 and 66.5 (p<0.001), man/woman ratio was 5.84 and
6.58 (p<0.001), the percentage of superficial tumors was 65.3% and 80.2% (p<0.001),
the percentage of smoking cases 68.4% and 71.4% (p<0.001), the percentage of
major complaint as hematuria before diagnose was 71% and 82.6% (p<0.001), the
percentage of the patients with tumor volume smaller than 2.5 cm was 46.9% and
51.8% (p=0.321) respectively.
Conclusion: The patients diagnosed after the year 2000 when compared with the ones
diagnosed before 2000, were older, have higher percentage of smoking and
man/woman ratio, more diagnosed with hematuria and have more superficial tumors.
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Klinigi, 34668,
stanbul, TURKEY.
Tel:
+90 216 5422020(4316)
GSM: +90 532 4056043
e-mail: cuneytadayener@yahoo.com
PP057

ROUTINE LAPAROSCOPY FOR NONPALPABLE TESTES IS QUESTIONABLE

Author(s): LTC AKYOL Ilker, MD, 1LT OKCELK Sezgin, MD, LCDR ATES Ferhat,
MD, LTC SOYDAN Hasan, MD, CAPT BAYKAL Kadir, MD.
Institution:Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept. of
Urology, Istanbul,
TURKEY
Objective: Recent literature suggest that laparoscopic Fowler-Stephens orchiopexy
could harm testicular vasculature, and an open approach might be more suitable,
restricting the role of laparoscopy. We investigated the need for laparoscopy in
nonpalpable undescended testes (NPT) in our series.
Material and method: Charts of patients who underwent orchidopexy for undescended
testis were reviewed. Inguinal or high scrotal palpable, and peeping testes were
excluded. Performed procedures for the NPT and outcome of exploration were noted.
Results: 165 cases examined and operated by one experienced pediatric urologist
were identified. Mean age was 4,7 years. Six cases (3.6%) had NPT. Exploration was
started with laparoscopy in one case which identified two intraabdominal testes near
internal ring (IR), and with inguinal incisions in 5 cases. Transinguinal laparoscopy was
performed in 2 cases, and revealed one vanishing testis and a contralateral
intraabdominal testis at the inguinal ring. Two cases had inguinal nubbins and
underwent orchiectomy. Remaining abdominal testes were brought in the scrotum with
one-stage Fowler-Stephens technique. Longest incision was 4.5 cm. Laparoscopy
would have prevented an inguinal incision in only 1 of the 6 cases with NPT (16.6%) in
whom the procedure started with an inguinal incision and transinguinal laparoscopy
revealed the vanishing testis.
Conclusion: Routine use of laparoscopy for NPT is questionable. One may start the

103

2ndJUNE2011

exploration with an inguinal incision, and transinguinal laparoscopy could be used to

explore other locations of the abdomen when the inguinal incision fails to reveal the
testis.
CORRESPONDENCE
LTC AKYOL Ilker, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4303)
+ 90 216 348 7880
+ 90 532 2270960
e-mail: ilkerakyol@gmail.com
PP058

THE RELATIONSHIP BETWEEN HISTOLOGICALLY PROVEN CHRONIC

PROSTATITIS AND PSA DENSITY
Author(s): LCDR ATES Ferhat, MD1, CPT UGUZ Sami, MD1, 1LT DURSUN Furkan,
MD1, MAJ MALKOC Ercan, MD2, CAPT ADAYENER Cuneyt, MD1, COL KARADEMIR
Kenan, MD1, CAPT BAYKAL Kadir, MD1.
Institution: 1 Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept.
of Urology, Istanbul, TURKEY
2 Corlu Military Hospital Urology Clinic Tekirdag,
TURKEY
Objective: Aim of this study was to determine whether PSA density is different in
patients with chronic prostatitis and non-prostatitis patients.
Material and method: Data of patients who underwent TUR-P because of BPH and
histologically detected prostatitis between 2003 to 2009 and who underwent TUR-P
and histologically prostatitis doesn't detected between 2009 to 2010 was investigated.
Mean age, PSA, prostate volume and PSA density of patients was recorded. The
difference between two groups in terms of PSA density was evaluated. Statistics was
done with SPSS 16.0 for Windows programme and with Mann Whitney U test.
Results: Data of 80 patients whoose pathologic results was benign (group l) and 100
patients whoose pathologic results was chronic prostatitis was evaluated. Mean age,
PSA, prostate volume and PSA density was 64.369.18 (median 68 (49-81),
8.378.86 ng/ml, (median 6,3(0.3-60)), 70.363.66 cc (median 60.5(20-201) and
%13.691.73(median 9.67 (0.1-150)) in chronic prostatitis group and 68.248.53
(median 69 (46-87), 3.723.61 ng/ml (median 2.75 (0.2-21),55.071.94 cc (median 50
(19-100)) and %6.375.48 (median %5. 1 4 (0.01 -31,20)) in non-prostatitis group
respectively. The mean age was similar in both groups (p=0.628), in patients with
chronic prostatitis group, prostate volume(p=0.01 2) and PSA level was higher
(p<0.001 ) than non-prostatitis group, PSA density was also greater (p<0.001).
Conclusion: In patients with chronic prostatitis, PSA level as well as prostate volume
was higher than without prostatitis group, PSA density was also higher.
Correspondence:
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)
+ 90 216 348 7880

104

2NDJUNE2011

+ 90 532 556 6339

e-mail: drferhatates@yahoo.com
PP059

COMPARISON OF EFECTS OF ALPHA RECEPTOR BLOCKERS ON

COAGULATION PARAMETERS, ENDOTHELIAL FUNCTIONS AND ARTERIAL
BLOOD PRESSURE IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA
Author(s): MAJ KOCOGLU Hasan MD1, ALAN Cabir MD2, KIRILMAZ Bahadr MD3,
ERSAY Ahmet Reit MD2, ERTUNG Yunus MD2 , EREN Ali Erhan MD2 .
Institution: 1CanakkaleMilitary Hospital Dept. of UROLOGY, Canakkale, TURKEY.
2 anakkale Onsekiz Mart University Medical Faculty Department of Urology,
TURKEY.
3 anakkale Onsekiz Mart University Medical Faculty Department of Cardiology,
TURKEY.
Objective: To investigate the effects of alpha receptor blockers used in the treatment of
benign prostatic hypertrophy on endothelial functions, coagulation parameters and
arterial blood pressure.
MATERIAL AND METHOD: 115 patients admitted to the treatment protocol such that
doxazosin 4 mg/day (n: 25), terazosin 5 mg/day (n: 26), alfuzosin 10 mg/day (n: 26),
tamsulosin 0.4 mg/and (n: 21) and observance (n: 17) because of symptomatic BPH
were included in this prospective study. Biochemical parameters including bleeding
time, coagulation time, PT, aPTT, total PSA and free PSA values were assessed
before treatment
and in the 12th week during the treatment in these five patient groups. Systolic and
diastolic blood pressures were measured. Endothelial functions were evaluated using
ultrasonography of the brachial artery in all cases before treatment and in the 12th
week during the treatment.
Results: When coagulation tests were evaluated, there were significant increases in
bleeding and coagulation times in the groups using doxazosin and terazosin.
Doxazosin and terazosin lowered arterial blood pressure significantly compared with
other groups. Regarding effects on endothelial functions, there were significant
differences in ow-mediated dilation rates of the brachial artery at 60 and 90 seconds
before and during treatment in alfuzosin and terazosin groups.
Conclusion: Alpha receptor blockers can decrease the risk of cardiovascular
complications by both preventing thrombus formation and protecting endothelial
functions in patients with prostatic hyperplasia. The only drug having a favorable effect
in a total of four issues including BPH symptoms, blood pressure, platelet aggregation
and endothelial functions is terazosin.
Correspondence:
Canakkale Military Hospital Dept. of UROLOGY, Canakkale, TURKEY
Tel:
+ 90 286 2172460 (1241)
Fax: + 90 286 2172407
GSM: + 90 505 6842691
e-mail: perkutanci@yahoo.com

105

2ndJUNE2011

PP060

GUNSHOT INJURIES FROM WEAPONS WITH SILENCER - EXPERIMENTAL

STUDY IN VITRO
Author(s): Lt.Col. NIKOLOV Svetlin 1, MD, Col. VASILEV Borimir 2, MD DSc,
AMINLOV Bogdan 3, DSc, Maj. KESOV Georgi 2, MD
Institution: 1Experimental Surgery Ward, Military Medical Academy Sofia,
2Clinic of thoracic surgery, Military Medical Academy Sofia,
3Medical Veterinarian Institute Sofia, BULGARIA
BULGARIA
Analysis of current situation: The armies entering in armament weapons fitted with
devices to reduce the volume and flame in the shot, but often also for committing
criminal offenses are used firearms with silencers.
Till now in our country has not been conducted research and experimental study of
shooting arms trace fitted with silencer.Silencer device is an essential factor for the
occurrence of specific wound profile with modified classical parameters.In the available
literature is not described wound in simultaneous environment or biological object,
caused by a bullet with characteristics allowing its firing through silencer.
The main goal of the study (research): - Description of wound profile in simultaneous
environment or biological object, caused by a bullet with characteristics allowing its
firing trough silencer.
- X-ray, X-ray contrast of shot preparations
- Corrosive castings shot preparations
Materials and methods: Simultaneous shot of orthodox environment (block targets with
resistivity close to that of biological tissues) from multiple distances adopted by
shooting weapons systems (small arms or A-2 AK-74, etc.).
Characteristic impedance of chest and abdominal areas subsonic bullets produced in
Bulgaria.
Shooting of Pathoanatomic preparation - sternum, long tubular bones, facial bone,
placed in front of the block-target.
Results-A model of wound profile on orthodox environment by subsonic cartridges.
Conclusions: 1. Improve the knowledge of damage when using weapons with silencers
in hostilities and terrorist acts, the crime incidents.
2. Provide a behaviour algorithm in gunshot injuries, etc.
3. After conducting the second phase of experimental studies in vivo will be prepared
the legislation for standard first medical aid, medical and specialized surgical aid for
such injuries.
4. This will facilitate the implementation of tasks, missions, etc. of the Bulgarian Army,
as was performed in recent years and joint NATO exercises. Success in developing
partnership supports our military surgery with that of NATO countries and the region.
5. Will refine the principles and criteria for evaluation of this type of injury for purposes
of forensics and criminology /needs for the Ministry of Internal Affairs .
Keywords: subsonic cartridges, wound infection, burns, gunshot injuries, primary
surgical treatment of wounds, injuries, high-speed projectiles.

106

2NDJUNE2011

PP061

LARGE GIANT CELL ARTERITIS WITH EYE INVOLVEMENT- COLOR DOPPLER

IMAGING (CDI) OF RETROBULBAR VESSELS FINDINGS
Author(s): S. N. JIANU * , D.C. JIANU **
Institutions: *Military Emergency Hospital, Department of Ophthalmology,
**Victor Babes University of Medicine and Pharmacy, Clinical Emergency County
Hospital, Department of Neurology, Timisoara,
ROMANIA
Background: Giant cell arteritis is a primary vasculitis that predominantly affects
extracranial medium-sized arteries, especially branches of the ECA. Purpose: The
main objective was to assess the role of CDI of retrobulbar (orbital) vessels in the
study of three patients with giant cell arteritis with eye involvement. Methods: We used
a sonographer with 8-15 MHz linear probe for CDI of retrobulbar vessels. Results: All
patients presented malaise, temporal headache, tender temporal arteries and
laboratory signs of inflammation. The first patient had a left central retinal artery
obstruction, and the others had a left anterior ischaemic optic neuropathy. They
presented a painless, severe loss of vision of the left eye. Temporal artery histology
was positive in all cases. Ultrasound investigation was performed before corticosteroid
treatement because prior corticotheraphy may be associated with loss of the
histological features of active arteritis. CDI of retrobulbar vessels detected low blood
velocities, especially end-diastolic velocities and high resistance index in all retrobulbar
vessels in both orbits, for all patients (especially on the affected side with some
peculiar ultrasound features). Typical sonographic features in temporal arteritis were
dark halo sign (vessel wall thickening) associated with stenoses or occlusions of
branches of ECA. Interestingly, in all cases the common carotid and the internal
carotid arteries were also affected (large giant cell arteritis). Conclusions: The
ultrasound technique is a valuable diagnostic tool when investigating giant cell arteritis.
Contact: silvianajianu@yahoo.com

PP062

INPATIENT URETHRAL CATHETERISATION INDICATIONS: ONE DAY CROSS

SECTIONAL STUDY AT A TEACHING HOSPITAL
Author(s): LTC SOYDAN Hasan, MD1, LCDR ATES Ferhat, MD1, LTC AKYOL Ilker,
MD1, MAJ MALKOC Ercan, MD2, COL KARADEMIR Kenan, MD1, CAPT BAYKAL
Kadir, MD1.
Institution: 1 Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept.
of Urology, Istanbul, TURKEY
2 Corlu Military Hospital Urology Clinic Tekirdag,
TURKEY
Objective: To document the indications for urethral catheterization according to the
departments at a teaching hospital
MATERIAL AND METHOD Patients with a transurethral catheter among all patients
admitted to our hospital were identified, and the indication for the catheter was asked
to the physician on-call. during one working day in August 2010.
Results: Total of 325 patients at twenty departments, of which 9 were surgical, 11
medical clinics, were assessed. The number of catheterized patients was 26 and 19 at
surgical and medical departments respectively. Fifteen ICU patients were catheterized
admitted 1 at plastic surgery, 2 Neurosurgery, 2 Nephrology, 5 General Internal
Medicine (GIM), 5 Cardiology. One patient at Nephrology and 2 at Neurosurgery ICU

107

2ndJUNE2011

were unconscious. Ten patients at GIM and Cardiology lCUs (5 at each) were
catheterized for urinary output monitoring. Immobilization was the indication for
catheterization in 16 (all), 2, and 2 patients admitted at Orthopedics, GIM and
Oncology respectively. Five of the 16 patients admitted at Urology were catheterized, 4
of whom for recovery from urinary tract surgery, and 1 for chronic urinary retention and
obstructive uropathy.
Conclusion: Indications for urethral catheterization were found to be varied according
to the departments, most of which were not absolute indications. Healthcare
professionals must be informed about using alternative methods whenever appropriate
in order to decrease catheter related problems.
Correspondence:
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)
+ 90 216 348 7880
+ 90 532 556 6339
e-mail: drferhatates@yahoo.com
PP063

AVERAGE PENIL LENGTH AND MICROPENIS THRESHOLD VALUES IN

ADOLESCENT BOYS
Author(s): CPT YILMAZ Omer, MD, LCDR ATES Ferhat, MD, LTC SOYDAN Hasan,
MD, CAPT ADAYENER Cuneyt, MD, CAPT SENKUL Temucin, MD, CAPT BAYKAL
Kadir, MD.
Institution:Gulhane Military Medical Academy Haydarpasa Teaching Hospital, Dep. of
Urology, stanbul,
TURKEY.
Objective: The aim of this study was to invastigate mean penil size and micropenis
threshold values in adolescent boys before high school period.
MATERIAL AND METHOD: The penil length of 1607 boys came from different regions
in Turkey were measured while they were standing up in normal room temperature
after taking their informed consent in July of 2010. The penil length was measured with
ruler from radix penis by putting the ruler to symphisis pubis while taking the glans and
stretching the penis. The values under 2,5 standart deviation of average were
accepted as micropenis threshold and micropenis threshold values were determined in
age groups by that way.
Results: Penil lengths and micropenis threshold values according to age groups in this
study are here. N: 7, median length: 11,4, micropenis threshold(cm): 5,5 in age 12,5
group; N: 48 , median length(cm):11,95, micropenis threshold(cm): 5,5 in age 13
group; N: 544 , median length(cm): 11,6, micropenis threshold(cm): 5,7 in age 13,5
group; N:844, median length(cm): 12,1, micropenis threshold(cm): 7 in age 14 group;
N: 124, median length(cm): 12,05 , micropenis threshold(cm): 7,3 in age 14,5; N: 37,
median length(cm): 12,5, micropenis threshold(cm): 7,3 in age 15; N: 3, median
length(cm): 13,6, micropenis threshold(cm): 7 in age 15,5.
Conclusion: According to this study, micropenis threshold value is 5,5 cm under the
age of age of 14 and about 7 cm after 14 years. According to total result of this study,
it was found that the median value of stretched penil length was 12 cm and micropenis
threshold was 6,5 cm in adolescent boys at the beginning of high school period.

108

2NDJUNE2011

Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Klinigi, 34668,
stanbul, TURKEY.
Tel:
+90 216 5422020(4306)
GSM: +90 530 3226834
e-mail: dr_omeryilmaz@yahoo.com
PP064

SURGICAL APPROACH OF MARJOLIN ULCER

POSTCOMBUSTIONAL SCARS, ON ABDOMINAL WALL
Authors:
MAJ. Bogdan MARINESCU Assist. Prof. MD, PhD.
Ioana Nedelcu M.D., Bucharest,
ROMANIA

DEVELOPED

ON

Absract : Male patient, 60 yo, has been invalid since 5 years old, due to
postcombustional sequels of the inferior abdomen and thighs (he can't stand or walk
straight up).
One year ago he was admitted in a general surgery department with a Marjolin ulcer at
the sequels level. One month after incomplete resection of the lesions, he is
presenting in our clinic with a large local relapse of the tumor. The treatment applied
consisted in a large and complete resection of the tumor (histopathologicaly verified)
and skin graft of the defect.
Three weeks post op the patient is leaving the hospital, walking in normal straight up
position.
18:00-18:30

POSTER DISCUSSIONS
(TUDOR VLADIMIRESCU ROTONDA)

18:30-21:00 FREE TIME

21:00-23:00 DINNER (THE MILITARY CLUB) FOR THE DELEGATIONS & VIPs DINNER

109

3rdJUNE2011

08:30-10:00

ORAL PRESENTATIONS VII

(GOTHIC HALL)

Chairmen: COL Bilal BAKIR, MD (Turkey)

MAJ Pavlos NTAFOULIS, MD (GREECE)
OP070

THE ASSOCIATION BETWEEN BURNOUT, AND DEPRESSIVE SYMPTOMS IN A

TURKISH MILITARY NURSE SAMPLE
Authors : COL. BAKIR Bilal, MD1., COL OZER Mustafa, MD2., MAJ. OZCAN C.
Tangul RN3., LTC CETIN Mehmet MD2., COL FEDAI Turan 4
Institution: 1Gulhane Military Medical Academy Public Health Department Ankara
2 Gulhane Military Medical Academy Dept. of Military Health Services Ankara 3
Gulhane Military Medical Academy, School of Nursing, Ankara, TURKEY
4 Turkish Health Command Ankara, TURKEY
TURKEY
Objective: This study aims to investigate the association between the burnout
syndrome and depressive symptoms among Turkish military nurses.
MATERIAL AND METHOD: The study was conducted among Turkish military nurses
in Ankara during April 2007. From a total of 490 Nurses, 377 (76.9%) were included in
the study. The participants completed a self structured questionnaire, Maslach Burnout
Inventory (MBI), and Beck Depression Inventory (BDI). The continuous variables were
compared using the student t-test or ANOVA.
Results: The mean age of participants was 29.75.4.Cronbach alpha values were
0.87, 0.71, and 0.83 for emotional exhaustion (EE), depersonalization (DP), and
reversed reduced personal accomplishment (RPA) respectively, and was 0.93 for BDI.
BDI mean score was correlated significantly with MBI mean score and mean
scores of its all subscales. Of the all items of BDI, while the scores of 18 items were
correlated significantly with MBI mean score and mean scores of its all subscales, the
scores of remaining 3 items namely weight loss, loss of appetite, and irritability were
not. Nurses at age 30 or more and nurses with chronic disease had higher depressive
scores.
Conclusion: Based on our results a strong correlation exists between depressive
symptoms and all components of burnout syndrome. This study also demonstrated
that the burnout syndrome and depression are not identical, while depressive
symptoms include physiological involvement like weight loss and loss of appetite,
burnout syndrome does not.
Correspondence:
Bilal BAKIR,
GATA Halk Sagligi Etlik 06018 Ankara, TURKEY
Tel and Fax: 90 312 3044664
Mobile: 90 532 5899128
bakirbilal@hotmail.com; bbakir@gata.edu.tr

110

3rdJUNE2011

OP071

ASSESMENT OF NURSING STUDENTS CRITICAL THINKING LEVEL AND THE

AFFECTING FACTORS
Authors : CPT EREN FIDANCI Berna, RN, PhD, CPT CINAR Fatma Ilknur, RN, PhD,
AKAR Fatma, RN
Institution:Gulhane Military Medical Academy, School of Nursing, Ankara
TURKEY
Objective: In this study it was aimed to asses nursing high school students critical
thinking level and the affecting factors.
Material and method: The population of this descriptive research was consisted of all
students in Gulhane Military Medical Academy School of Nursing (n=378) on
NovemberDecember 2010. The data were collected with demographic data form
and California Critical Thinking Inventory. While implementing the instruments, the
researchers emphasized that participation was voluntary.
RESULTS: 314 students participated in the study, 30.9% (n=97) in the first, 32.2%
(n=101) in the second, 21.0% (n=66) in the third and 15.9% (n=50) in the fourth grade.
Students' average score was 195.3618.72 taken from the scale of critical thinking.
There was no statistically significant difference between the classes (p=0.57). Scale
subscales were compared, first-class analyticity score and fourth classes systematicty
score were significantly higher than the rates in other classes (p<0.05).
Conclusion: The high scores of first class students in analyticity can be linked with
these students were graduated from mathematic section. Forth class students had
high scores in systematicty, it can be caused by using interactive methods in the
courses, a systematic and integrated data collection method to achieve nursing
diagnoses and the features of the integrated education system. It is determined that
the students had low points form the scale generally (Low than 240 points mean as
low level). It is thought that using strategies to speed up the process of using critical
thinking strategies in education program may be improve critical thinking.
Correspondence:
Gulhane Military Medical Academy, School of Nursing, Ankara, TURKEY.
Tel
:+90 312 3043932
Fax
:+90 312 3043900
GSM :+90 505 6230614
e-mail :bernafidanci@gmail.com

OP072

PREDICTORS OF SUCCESSFUL ADAPTABILITY OF PROFESSIONAL MILITARY

PERSONNEL
BUAN V., TEPI OSTOJI V., Maj. IVI B., Col. PANI M.
Institution:Military Medical Academy, Psychiatry Clinic, Department of Mental Health
and Military Psychology, Belgrade,
SERBIA
Experience in working with the professional military personnel (PMP), especially with
those who work dislocated from their families and commute hundreds of kilometers to
their workplaces daily pointed out numerous problems with mental functioning. The
revealed disorders in emotional and cognitive spheres significantly diminished the
adaptability skill in both everyday and specific requirements of military profession. It
seemed that the closeness with the family, everyday communication and discussions
about responsibilities, duties and daily supplies gave a significant emotional support
that is missing in the said category of PMP. In order to verify factors that generally

111

3rdJUNE2011

determine better quality of life and that, as predictive factors, may affect the stability
and cohesion within the families of PMP, we applied a specially designed and
structured interview to the final year cadets of the Military Academy (MA). The final
year cadets of MA were selected due to the fact that during the regular check-ups
they showed great enthusiasm, good organisation, responsibility and high commitment
to military organization. A total of 73 cadets were interviewed out of whom 57.5%
graduated military high school, 13.7% high school, and 28.8% secondary vocational
high school. Evaluation of the primary relationship within the family revealed that
58.9% had excellent family relations, and 36.9% very good relations. The best family
closeness was revealed to be with the mother (31.5%), the brother (30.1%), the sister
(21.9%), and the father (16.4%). It was indicative that 97.2% of the cadets declared
that they would choose military profession again, in spite of the fact that 28.7% of them
failed to pass a study year. The majority of the cadets had emotional relationship,
namely 79.4% had a girlfriend, out of whom 48.7% from the place of living. As a place
they would like to take military service, 37% preferred to be close to the place of living,
and 72.6% a desired place. The reasons for that were for 28.7% of the cadets to be
close to the family, for 28.7% to have the possibility to receive advanced training, for
27.3% financial opportunities, and 15% friends and other. A pronounced motivation for
military profession, defined and went through all requirements of military education,
seemed not to be a sufficiant factor for the assessment of the successful adaptability
to professional engagement. The obligatory presence of emotional support by the
family, and the wanted place of military service make together a highly significant
factor for keeping vital and working success and adaptability.
OP073

THE CORRELATION BETWEEN DEPRESSION AND THE LOSS OF THE

PROFESSIONAL MILITARY STATUS
Authors : Col(r). PhD. Chief Lecturer, University of Medicine and Pharmacy,
Alexandru TIUGAN,Dr. Claudia TIUGAN, primary psychiatrist,
Institution:Clinical Emergency Military Hospital Craiova,
ROMANIA
Introduction :The psycho-social aspects of individual definition and evolution are
reflected in his valuation and implicitly in a good functionality.
Any change irrespective of nature (including a professional one) has impact in major
fields, including the affectivity. The senescence through the weariness of neurobiochemical precursors, membrane rigidity and apoptosis, reduces the adaptability and
increases the vulnerability for depression.
Objectives:The paper aims at highlighting the degree of interdependency between
social and provessional status and affective disorder.
Material and method: Identification of the depressive disorder ( DSM IVR criteria and
depression scales: Madrax, Hamilton-D) on retired military patients for over 6 months,
admitted in the psychiatric clinic in the last five years. The selection included patients
with pathological personal background without depressive disorder.
Results: From the spectrum of psycho-pathological boards, the clinical experience
highlights the prevalence of depressive disorder with severe episodes in the patients
retired in the last six months.
The symptomatology has improved in general over an interval of 2-3 months, and over
50% of the patients represented recurrence in the first year. After one year, there were
only intermittent hospital admissions for these patients for the same disorder.
Conclusions: Psychic stress (resistance to change) plays a determining role in onset of

112

3rdJUNE2011

depression.
This was correlated with a certain therapeutic resistance (remission of
symptomatology over a large time interval) and a reserved long term prognosis
(presence of recurrences).
Adapting to social and professional changes appeared in general over an interval
longer than one year from retirement of military staff.
Psychological counselling prior to retirement would be necessary
Key words: depression, retired military, accommodation
OP074

EMERGENCY NURSE AND ACUTE TRAUMA EVALUATON

Authors: As.Med. LEFTER M, As.Med. MOTOACA Mihai, As.Med. SCARLAT V, Col.
Dr. TEUSDEA B, Bucharest,
ROMANIA
Summary: Trauma is a public health problem which causes a lot of losses and
casualties among young people. In many situations in prehospital and in the
Emergency Department nurses must cope with trauma and multiple traumas. The
question to ask is if emergency nurses can properly assess acute trauma. They must
have knowledge of anatomy, pathophysiology, trauma severity scores and outcome.
Not to forget that in disaster situations they are first to make triage, so they also must
know how to evaluate mental status.
Key words: emergency nurse, trauma evaluation, triage

OP075

WHAT DOESN`T KILL US MAKES US STRONGER-POSTTRAUMATIC STRESS IN

MILITARY MEN
Authors :JORDANOV J., HRISTOVA K., VULOV N., ARSOV V.
Institution: Medical Intelligence Ward, Chair Disaster Medicine and Toxicology,
Military Medical Academy, Sofia,
BULGARIA
Purpose: The purpose of the present study is to accent on the actuality of the problem
with posttraumatic stress (PTS) and the development of posttraumatic stress disorder
(PTSD)
in military men taken part in military actions or missions.
The exchanged experience of the Bulgarian military doctors of medicine for
overcoming the after-effects of PTS and PTSD is shown.
Materials and metods: The summary of free access data for the number of suicided
military men during their employment in Iraq and Afghanistan and after their homecoming.
By means of the data comparison we demand an analogy of the present situation with
the Vietnam syndrome.
Results: The observations on PTS and PTSD in military men of Bulgarian military
contingent and the experience of the Bulgarian military doctors of medicine in
overcoming the consequences of them are discussed.
Conclusion: Not every military man get killed or wounded during participation in
mission but there is no case of home-coming person unchanged.
The problems of PTS and PTSD are actual and the practice of therapeutic methods for
decreasing the PTS and contemporary treatment of PTSD are of great necessity.

113

3rdJUNE2011

Correspondance:
Major JORDANOV Jordan Naidenov MD, MA
MMA, Sofia, Bulgaria
Mob.Tel.: 3592886859415
OP076

SUICIDES RISK FACTORS IN THE SERBIAN ARMED FORCES

Authors : DEDIC G., PANIC M.
Institution:Clinic of Psychiatry, Military Medical Academy, Belgrade,
SERBIA
Introduction: Analyses of the suicide risk factors enable undertaking of appropriate
preventive measures within the frame of the Suicide Prevention Program in the military
environment, which was fully applied in 2003. in the Serbian Armed Forces.
Aim of our study is to identify the most important suicide risk factors for soldiers and
professional military personnel in the Serbian Armed Forces within the period from
1998. to 2008.
Methods: Analysis of the suicide risk factors was carried out on the basis of data
obtained by psychological suicide autopsy. Descriptive statistical analysis was used.
Results: 35 soldiers aged 22-49 years (21,761,76 on average) and 30 professional
military personnel aged 22-49 years (30.536.24 on average) committed suicide within
the period 1998.-2008. The 2/3 of soldiers committed suicide within, and 1/3 out of the
military compound. More than one half of soldiers committed suicide after the transfer
to another post. Distal suicide risk factors for soldiers are primarily in immature
personality organization and its relation with family and military environment factors.
Soldiers who committed suicide most frequently come from incomplete, dysfunctional
families. In the premilitary period most of them had interpersonal problems with their
comrades and problems with law. During military service, alcohol consumption is not
frequently presented; they do not have separation problems and rarely are awarded. A
soldier who committed suicide is an emotionally and socially immature person. The
commonest proximal suicide risk factors are: decreased capacity of adaptation to
military service (40 %), actual psychic disturbance (20 %), emotional interruption (17,1
%), fear of environment judgment (11,4 %), actual family problem (5,7 %), but in more
than one fifth (22,9 %), motive remains unrecognized. The following distal suicide risk
factors for professional military personnel have been ascertained: unmarried,
psychiatric heredity, without outpatient psychiatric treatment, gambling, regular
physical practice (bodybuilding), a few transfers to different posts, low motivation for
military service, no children, parental loss in early childhood, alcohol abuse, debts in
the family; only few of them are awarded and completed military school. The
commonest proximal suicide risk factors are: actual family problems (36,6 %), actual
mental problems (13,3 %), burnout (13,3 %), negative balance of accounts (13,3 %),
professional problems (6,7 %), behavioral model (6,7 %), and for 10,0 % of the
professional military personnel suicide risk factors could not be established.
Conclusion: According to the presence of multiple suicide risk factors, Suicide
Prevention Program of the professional military personnel in the Serbian Armed
Forces is oriented to prevention of both proximal and distal suicide risk factors.

114

3rdJUNE2011

OP077

VALIDITY AND RELIABILITY OF TURKISH VERSION OF FAMILY SATISFACTION

IN THE INTENSIVE CARE UNIT (FS-ICU )
Authors :LTC TASTAN Sevinc RN, PhD1, LTC IYIGUN Emine RN, PhD1, AYHAN
Hatice RN1, MAJ KILICKAYA Oguz MD2, YILMAZ Ali Abbas MD3, COL KURT Ercan
MD2.
Institution:1 Gulhane Military Medical Academy, School of Nursing, Ankara,
2 Gulhane Military Medical Academy , Department of Anesthesiology and
Reanimation, Ankara,
TURKEY
Objective: The aim of the study was to test Turkish version of the Family Satisfaction
in the Intensive Care Unit (FS-ICU-24 ). Survey, which was developed by Heyland et
al. and re-structured and validated in 2007.
Material and method: This study was planned and applied as a methodological study.
Survey was conducted in the intensive care units of a military education and research
hospital and a medical faculty hospital, department of anesthesia and reanimation in
the capital city Ankara of Turkey. Sample of the survey was composed of 120
volunteer relatives of patients who were hospitalized in the intensive care units of
departments of anesthesia and reanimation of both of the universities. To collect data
in the survey, data collection form, that was prepared for introductory properties of
participants and patients and Family Satisfaction in the Intensive Care Unit (FS-ICU-24
) Survey were used.
Results: Family Satisfaction in the Intensive Care Unit (FS-ICU-24) Survey were
translated into Turkish, validated by professional experts, back-translated into English,
and pilot tested. Factor analysis yielded three factors. Factor analysis reveals that 13
items were loaded into Factor 1 that determines satisfaction of relatives about care.
Cronbach's alpha value for the FS-ICU-24 general internal consistency in our research
was calculated as 0.95 for total scale.
Conclusion: In this study the Turkish version of the FS-ICU-24 was found to be reliable
and valid with Turkish population.
CORRESPONDIENCE
LTC TASTAN Sevinc
Gulhane Askeri Tip Akademisi, Hemsirelik Yuksek Okulu, Etlik 06018, Ankara,
TURKEY.
Tel: +90 312 304 3948
Fax: +90 312 304 3900
GSM: +90 530 4589745
e-mail: stastan@gata.edu.tr

OP078

FACTORS INFLUENCING STRESS IN PSYCHIATRIC NURSING

Author(s): CPT Katerina STASINI, RN, Theoni-Fani TRIANTAFILLOU, Clinical
Psychologist, PhD, COL Orestis GIOTAKOS, MD, MSc, PhD
Institution: 414 Military Hospital of Special Diseases, Psychiatric Department, Athens,
GREECE
Purpose: To examine the factors which circumstantially reveal that Psychiatric Nursing
is an invariably stressfull area of nursing practice.
Material and methods: An extensive literature search was performed aiming to identify
and review research studies that investigate variables which influence stress of nurses

115

3rdJUNE2011

working in mental health settings. The research was accomplished in the databases of
MEDLINE, CINAHL and in the National Documentation Center of Greece for the
period of the last ten years, using the keywords Stress, Mental Health Nurses,

Psychiatric Nursing.
Results: Research studies show that nurses perceive various type of stressors
depending on their specialty and characteristics of the ward or work environment. The
results on psychiatric nursing come out mainly from two different type of studies: there
are those that compare mental health nurses with nurses in other nursing specialties
and those that check over stress solely in different types of psychiatric nurses. Studies
comparing mental health nurses with other groups of nurses have found that the first
are less stressed than other specialties. On the other hand the diversity of stressors
found in different psychiatric nursing specialties, as well as in student psychiatric
nurses, mean that it is difficult to generalize stressors from one setting to another.
Conclusion: First of all, psychiatric patient care and afterwards organizational issues,
lack of nursing staff, collaboration among nurses and between nurses and doctors, job
satisfaction, clinical leadership and last but not least interprofessional collaboration are
the basic factors that cause stress in psychiatric nurses. Based on the facts above, a
study concerning stress and psychiatric nurses is taking place in the Psychiatric Unit of
414 Military Hospital. Results are to be announced in a future conference.
CORRESPONDENCE: CPT Katerina STASINI, RN
Tel: +30-2106981770
Mob: +30697 7167741
E-mail: kstasini@hotmail.com
08:30-10:00

ORAL PRESENTATIONS VIII

(NORWEGIAN HALL)

Chairpersons: COL Nicolae NICULESCU, MD (Romania)

LTC Alexandra KARVOUNIARI, RN (Greece)
OP079

DIAGNOSTIC AND THERAPEUTIC MANAGEMENT OF CAESAREAN SCAR

ECTOPIC PREGNANCY
Author(s): 2d LT Stamatis PETOUSIS MD1,2, Chrysoula MARGIOULA-SIARKOU
MD2, Ioannis KALOGIANNIDIS MD2, Eleftherios TSARIDIS MD2, Prof. Nikos
PRAPAS2.
Institutions: 1. 71st Airmobile Brigade.
4th Dept. of OB/G, Aristotle University of Thessaloniki,
GREECE
Purpose: Caesarean scar pregnancy is a very rare case of ectopic pregnancy in which
the embryo is implanted in the myometrium of a previous caesarean section (CS) scar.
We report the successful surgical management of a 38-year old woman diagnosed
with a 7-week caesarean scar pregnancy.
Materials and methods: The case is presented along with review of current literature
on such a rare pathology.
Results: A 38-year old woman presented at 7th week of amenorrhea. Ultrasonography
revealed a gestational sac of 4322 mm located in the anterior wall of uterus. A fetus
with normal cardiac activity was recognized, corresponding to 7 weeks (w) & 3 days
(d) of gestation. Uterine cavity and endocervical canal were empty. The diagnosis of
116

3rdJUNE2011

ectopic pregnancy in the uterine scar of a previous caesarean was made. We initially
administered an intramuscular injection of 65mg (1mg/kgr) methotrexate (MTX) on 7w
& 4d. One week later, examination revealed reduction of -hCG to 23159 IU/mL.
However, at 9w+4d, -hCG was rasised to 328027 IU/ml. The apparent failure of
conservative approach changed our management to the surgical removal of the
gestational sac. On 9w+5d, laparotomy was performed, revealing a gestational sac
implanted in the previous CS scar. Five weeks later, -hCG levels became null. No
severe complications were mentioned from the time of surgical treatment.Current
literature reports only a few cases of caesarean scar pregnancy which demanded
surgical therapy after the failure of methotrexate treatment.
Conclusion: In conclusion, caesarean scar ectopic pregnancy is a rare obstetrical
complication. Surgical exploration seems to be the optimal treatment.
Correspondence: 2d LT Stamatios PETOUSIS
tel.: +30 6934050763, +30 2310 697409
e-mail: petustam@mail.gr
OP080

ORGANIZATION OF MEDICAL CARE IN CASES OF VIDEOTHORACOSCOPIC

SURGERY
Author(s): L. NIKOLOVA*
Institutions:* DEPARTMENT OF THORACIC SURGERY
MILITARY MEDICAL ACADEMY SOFIA,
BULGARIA
Videothoracoscopic surgical interventions are part of miniinvasive surgery the most
modern achievement of medical technologies in surgery. This completely new method
comprises maximum intensive operative treatment, minimum trauma for the organism
and a short period of hospitalization. The intensity of the treatment process required
optimization of the post-operative nurse care and improvement of the quality of this
care.
Purpose: Development of the algorithm of preoperative preparation and post-operative
nurse care.
Material and method: For the period from 1996 to 2010 in the Department of Thoracic
Surgery in Military Medical Academy 1550 patients have been treated and tested by
videothoracoscopic interventions The short hospitalization period means different
approach to the pre-operative preparation of the patients and improvement of the postoperative care so that we can ensure no complications to appear and shorten the
recovery process to up to 3 or 4 days. During a 3-year period we analyzed the
postoperative complications and the possibilities of their prevention or of their early
diagnosis. On the basis of the conclusions we have made, we have developed the
algorithm of pre-operative preparation and post-operative nurse care.
Results: The pre-operative preparation of these patients was carried out entirely in an
outpatients department, which allowed us to reduce to the minimum the preoperative
hospitalization period. The algorithm in the work of the nurse in the post-operative care
for the patients excludes the possibility of oversight and delay in the diagnosis of
possible complications. This in reality means the earliest possible treatment of the
complications and shortening of the post-operative period of hospitalization.
Conclusions: Videothoracoscopic surgery presupposes a new approach to the patient
in accordance with the high intensity of the treatment process. The algorithm optimizes
the work of the nurse and improves the quality of the pre-operative preparation and
post-operative control of the condition of the patients. This results in a shorter period of

117

3rdJUNE2011

hospitalization and reduction of the treatment cost.

For correspondence:
LILI NIKOLOVA
DEPARTMENT OF THORACIC SURGERY
MILITARY MEDICAL ACADEMY - SOFIA
OP081

THE MAXILLA FACIAL INJURIES FROM FIRE ARMS.

4-YEAR RETROSPECTIVE STUDY IN TIRANA'S MILITARY HOSPITAL.
Author(s): Dr. Lozana BINJAKU ALBANIA
Institutions:Tirana's military hospital
ALBANIA
Goal of this study is the identification and assessment of damages maxilla - facial fire
weapons order to achieve a management and treatment as fair and as close results.
Methods: The study included 58 patients presented and treated in hospital emergency
Military Traumatic Tirana in the period 2008-2011. Age ranges from 16 -80 years old.
Type of weapon causes classified into: explosives, shotguns, pistol bullet. Of these 12
patients had soft tissue injuries, 8 had isolated alveolar fractures and 38 patients had
injuries in the mandibul- maxill (only 15 patients with injuries of mandibula, only 3
patients with injuries of maxilla ,remaining 20 patients had combined injuries of the
maxilla and mandibula)
Results: Patients treated with 3 methods.
1-Only ortho;pedic surgical
2-Only (osteo- synthesis plates) + combination with surgical orthopedic treatment
(osteo- synthesis with plates)
3-The combination surgical orthopedic treatment.
80% of patients ,were made to ensure trakeoastomia breathing roads. Stopping
bleeding is provided by the removal of foreign bodies, replace the fracture,
tampanado , embolizimi ,and
any case ligim of
the main arterie.
Conclusion: The priorities in fire weapons injuries is the provision of respiratory and
stopping the bleeding and then appropriate treatment is selected as appropriate for
the relapse of function and aesthetics.

OP082

A GIANT SCAPULAR TUMOR WITH AXILARY NEURO- VASCULAR

COMPRESSION
Author(s): *Col. Claudiu NISTOR, *Maj. Adrian CIUCHE, **Col. (R) Constantin
CORHAN, *Capt. Dragos MARIN, *Lt. Daniel PANTILE, ***Maj. Augustin TUDOSE,
Institutions:
*Department of Thoracic Surgery
**Department of Orthopedics and Traumatology
***Department of Anesthesiology
Emergency University Military Central Hospital Dr. Carol Davila, Bucharest,
ROMANIA
Objectives: The paper presents the case of a sixty six years female admitted in the
thoracic surgery department with a right giant thoraco-dorsal tumor with poor motor
function of the right upper arm.
The authors reveal the difficulty in approaching of this case through very illustrative
preoperative, intraoperative and postoperative images.

118

3rdJUNE2011

Methods: Thoracic CT scan reveals the existence of a right scapular huge tumor with
extension in the right axillary region. The surgery procedure was total resection of the
right scapula with carefully protection of the axillary content. This intervention was
fulfilled in a combined thoracic and orthopedic surgical team.
Results: Has been achieved the complete removal of the scapula and the
decompression of the axillary content. Postoperative results were satisfactory with
recovery of motor function of the right upper arm. Histopathological examination
revealed the presence of scapular chondrosarcoma.
Conclusions: The surgical procedure has represented a milestone both for the
orthopedic surgeon difficult dissection and mobilization of this giant tumor, and for
the thoracic surgeon very carefully dissection and protection of the neuro-vascular
content of the axillary region.
OP083

MUSCLE TRANSPOSITION FLAP FOR COVERAGE OF SOFT TISSUE DEFECT

OF THE CALF
Author(s): Maj. Bogdan MARINESCU M.D., PhD.. Ioana NEDELCU MD
Institutions: Emergency University Military Central Hospital Dr. Carol Davila,
Bucharest, ROMANIA.
Subject: Reconstruction of posttraumatic soft tissue defects of the calf.
Material and method: We analyze a group of patients who were treated in our clinic,
suffering different types of trauma on the calf. They present soft tissue defects with
exposure of the bone or neurovascular structures in upper and middle third of the leg.
We use for reconstruction, local muscle transposition flaps covered primary with splitthickness skin grafts.
Discussions: We provided in all patients adequate coverage of the entire defects. The
period of hospitalization was 10 - 20 days. During the follow-up period, stable wound
coverage was provided by the muscle flaps. No case of muscle flap necrosis was
found. Donor site morbidity was minimal.
Conclusion: Muscle transposition flap is a reliable solution for reconstruction of
defects involving soft tissue loss over the knee as well as the upper of the leg,
especially when bone or neurovascular structures exposure are present.

OP084

PENETRATING OCULAR TRAUMA CLINICAL CASE

Authors : Col. Dr. C. STEFAN, Inga COJOCARU, Adina POP,
Institutions: Emergency University Military Central Hospital Dr. Carol Davila,
Bucharest, ROMANIA,
Departament of Ophthalmology
ROMANIA
Keywords : ocular trauma, foreign body, ocular wound
This paper presents the case of a patient, F.B., 28 years old, , military employee,
following a military exercise in the environment, that suffered a penetrating eye injury
at right eye, produced by the explosion of a pyrotechnic device, exercise grenade .
The patient was admitted in emergency at the ophthalmologycal department of the
Clinical Military Central Hospital Bucharest. Inspection of the anterior segment of the
eye founds a sclero-corneal wound about 12 mm, irregular, with stretching to the optic
nerve and involvement in the wound of membranes (iris, ciliary body, choroid) and
foreign body. Ophthalmological examination was normal in the left eye. Generally,
were found multiple escorial wounds caused by impregnation of explosive material in

119

3rdJUNE2011

right hemiface, upper lip, left ear and the left forearm. Orbital front and profile scans do
not show radiopaque foreign bodies. Ocular ultrasound shows nonsystematical,
subretinal intensity echoes, suggesting hemoftalmus aspect. After tetanus prophylaxis,
the surgical intervention revealed inspection and cleaning of the wound, foreign body
removal, cutting the membranes and suturing sclero-corneal wound. Postsurgical
patient followed a local and general antibiotic therapy. Hemifacial and forearm wounds
were treated interdisciplinary. Postoperative evolution was favorable. The patient
follows topical anti-inflammatory and antibiotic treatment for 30 days. On first month
control, inspection of the anterior segment of the right eye shows a surgical healing
process of the wound and antibiotic and anti-inflammatory topical treatment is stopped.
Anatomically speaking, eyeball is recovered, but in terms of functional the prognosis is
reserved.
Contact address: popadina@yahoo.com, 0745399306
OP085

THE POLYTRAUMA AND MAXILLOFACIAL TREATMENT

Author(s): Msc. Alma TELITI, MD (Maxillofacial surgeon)
Institutions: National Center of Trauma, Tirana,
ALBANIA
Summary. There are a large number of polytrauma centers all over the world whose
organization depends on the tradition and social-economic conditions of the countries
where these centers operate. In general, they operate either as rehabilitation or
emergency centers, but in any particular case, they are represented by medical teams
which cooperate the surgical activities of several departments specialized in the
treatment of particular kind of traumas. For example, the National Rehabilitation of
Polytrauma in USA supervises four different programs of polytrauma treatment with 82
surgical teams working all over the country. Similar organizations exist in Turkey
where Acibadem Health Care Group supervises the rehabilitation of polytrauma
through 27 regional centers; also in Greece the National Center of Trauma and in Italy
the State System of Trauma supervese a large number of surgical centers specialized
in polytrauma treatment. Political situations and ongoing wars have dictated operative
organizations of polytrauma treatments like Operation Iraq Freedom ( Iraq) and
Operation Enduring Freedom ( Afghanistan). In our country the treatment of
polytrauma is carried out from the National Center of Trauma which is part of SUQU (
Tirana ) since 1996.The treatment of trauma and polytrauma represent about 75 % of
different pathologies treated in this center during the 15 years period of its existence.
Maxillofacial trauma cases treated in this center are about 30 % of the total cases
treated in this period. Among these polytrauma the OMF treatments takes a significant
place with many cases of mandibulae and maxillae fractures. The large number of
maxillofacial trauma treated in the last few years in the National Center of Trauma and
in some other trauma centers abroad is object of a retrospective and comparative
study which aims to give the etiological results, the estimation of surgical clinical
treatment protocols, the characterizations of concrete methodologies of surgical
interventions etc.
Keywords: polytrauma, maxillofacial fractures, etiological estimations, osteosynthesis,
mandibulae fractures.

120

3rdJUNE2011

OP086

COMBINATION OF PREOPERATIVE ULTRASONOGRAPHIC MAPPING AND

RADIOGUIDED OCCULT LESION LOCALIZATION IN PATIENTS WITH LOCALLY
RECURRENT/PERSISTENT PAPILLARY THYROID CARCINOMA: A PRACTICAL
METHOD FOR CENTRAL COMPARTMENT REOPERATION
Author(s): 1st LT INCE Semra, MD1, ILGAN Seyfettin, MD1, COL ZTRK Erkan,
MD2, MAJ YILDIZ Ramazan, MD2, MAJ EMER Ozdes, MD1, AYAN Asl, MD1, COL
GORGULU Semih, MD2, CPT ALAGOZ Engin, MD1, COL DEVEC Salih, MD3 and
RDML OZGUVEN M. Ali, MD1.
Institutions:
1 Gulhane Military Medical Academy, Dept. of Nuclear Medicine, Ankara, TURKEY
2 Gulhane Military Medical Academy, Dept. of General Surgery, Ankara, TURKEY.
3 Gulhane Military Medical Academy, Dept. of Pathology, Ankara, TURKEY
TURKEY
Objective : To improve the surgical success and reduce the complication rates we
combine our routine preoperative US mapping technique with radio-guided occult
lesion localization (ROLL) in patients with papillary thyroid cancer (PTC) recurrences
in central compartment.
Material and method: In the morning of surgery, biopsy proven recurrent/persistent
tumoral lesions were plotted on a sketch and injected with Tc-99m labeled
macroaggregated albumin under US guidance. Thyroid bed exploration was carried
out based on the location of biopsy proven lesion with the guidance of intraoperative
gamma probe and neck map. The lymphoadipose tissues showing high count rates
were resected and labeled separately for histopathologic study.
Results: Despite extensive scarring in some patients probe safely guided to lesions.
Non-injected tumor foci were searched and successfully resected in the light of neck
map that showing topographic relation of injected and non-injected lesions. Among
total of 103 excised lesions from16 patients, 65 metastatic foci ranging from 2 mm to
38 mm in largest diameter were recognized at final histological examination.
Combination of preoperative mapping with ROLL was found crucial and helpful by the
operating surgeons in 12 and 4 patients, respectively. Except two patients with known
distant metastases undetectable Tg levels were reached six weeks after surgery.
Conclusion: The use of preoperative US-mapping with ROLL in patients with
nonpalpable recurrent/persistent PTC in central compartment is technically safer and
more effective comparing nonguided approach. Combination of techniques provides
best information about topographical relations of recurrent/persistent lesions during
surgery.
CORRESPONDENCE
Gulhane Askeri Tip Akademisi, Nkleer Tp AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 4807 (w)
Fax: + 90 312 304 4800 (w)
GSM: + 90 505 710 4320
e-mail: since@gata.edu.tr

121

3rdJUNE2011

OP087

FEVER AND ABDOMINAL TUMORS

Author(s): T. ARTENIE, A.C. DIMA, N. TNASE, D. FLOREA, M. PRUN
Institutions: Emergency University Military Central Hospital Dr. Carol Davila,
Bucharest, Romania.
ROMANIA
Introduction: The current approach of abdominal pathology must take into account the
rare affections having a clinical and imagistic table that mime neoplasia.
Case presentation. A 49 year-old man comes to our clinic for pain in the right
hypochondrium, diarrhea, fever. The clinical examination highlights a tumoral
formation in the right side of the abdomen, having a strong consistency, poorly defined
margins, relatively mobile in deep structures. Biological, leukocytosis with neutrofhilia,
inflammatory syndrome and hypoalbuminaemia. The first CT scan describes the
parietal thickening of the ascending colon, infiltrated with adenopathy near lesion,
lomboaortic, interaortocave and also four nodular liverish formations, natively
hypodense. Biologically, three hemocultures, three stool samples and three
coproparasitological negatives. Interdisciplinary examinations, internal medicine and
infectious diseases, sustain the diagnosis of colonic neoplasm with peritumoral
abscess and liverish affections. Colonoscopic results didnt show any relevant lesions
for neoplasia. The colonoscopic aspect and and the bio-clinical context impose
abstention from surgical intervention. Wide spectrum antibiotics and symptomatic
treatment is initiated. Ten days after internment the CT examination is repeated,
revealing the thickness reduction of the ascending colon wall but the increasing
volume of the liver formations. We continued investigations for parasite affections.
Serologically, Ac Entamoeba histolytica IgG positive.
Conclusions: The whole picture lead to the diagnosis of intestinal ameobiasis with
ascending colon affection and liverish amoebian abscesses disseminated in both
lobes. The evolution under antiparasite treatment was favorable with the remission of
colon formations and liver abscesses.
Key words: colon tumor, intestinal amoebiasis, liver abscesses.

OP088

SENTINEL LYMPH NODE BIOPSY IN BREAST NEOPLASMS

Author(s): *B. MILEV, MD, *J. KRI MD,* prof. N. STANKOVI, MD,* prof. D.
MIRKOVI, MD,** prof. M. NOVAKOVI, MD, ***Lj. JAUKOVI MD, *M.
JOVANOVI, MD
Institutions: *Clinic for Abdominal and Endocrinal Surgery,
**Management Department,
***Institute of Nuclear medicine, Military Medical Academy, Belgrade,
SERBIA
Background/Aim: Sentinel node (SN) is the first draining node from the malignant
tumor site. In the last decade, sentinel node biopsy (SNB) has been introduced as an
alternative to axillary dissection in breast cancer. In patients with negative SNB
(sentinel node uninvolved with malignancy) axillary dissection is not recommended.
The aim of this stady was defining the indications for SNB, and SNB principles, as well
as the survey of our first experiences.
Methods: In the period from 2008 to 2010, we performed SNBs in 75 patients (74
females, 1 males) with breast cancer. Indications for SNB were T1-2 and N0 lesions
according to TNM classification (Tumor, Nodus, Methastasis). In all cases,
lymphoscintigraphy was done first, and then SNB with double contrast (methylen blue
and technetium Tc-99). In 55 (73,33%) cases, one SN was confirmed, and in 20

122

3rdJUNE2011

(26,66%) 2 nodes.
Results: In 58 (74.3%) SNB, SN pathohistology was negative, and there were no
cancer metastases. In this group of patients, axillary dissection was not done in 28
(48,27%) SNB. In the remaining 30 (51,72%), lymphonodal dissection level I and II
was done after SNB, regardless of the presence or no presence of metastases within
SN. All the cases were monitored from six months to one year of the operation and
disease progression was not observed.
Conclusion: Sentinel node biopsy is an acceptable method of breast cancer diagnosis
and a good alternative to lymphonodal dissection if there are no metastases within SN.
The technique is relatively simple, but requires team work of experienced specialists:
surgeons, nuclear medicine specialists and anesthesiologists. Our first experiences
suggest a high degree of reliability of the method in selected patients and with well
trained team of doctors.
OP089

MINIMAL INVASIVE THORACIC SURGERY IN MALIGNANT PLEUROPERICARDIAL EFFUSIONS

Author(s): *Col. Claudiu NISTOR, *Maj. Adrian CIUCHE, *Lt. Daniel PANTILE,
**Augustin TUDOSE
Institutions: Emergency University Military Central Hospital Dr. Carol Davila,
Bucharest, ROMANIA.
* Department of Thoracic Surgery
** Department of Anesthesiology
ROMANIA
Objectives: The minimal invasive thoracic surgery (thoracoscopy and video-assisted
thoracic surgery through minithoracotomy), is a modern way for the approaching the
pleural and pericardial maladies and has many diagnostic and therapeutic advantages.
The authors share a part of their operative experience in pleuro-pericardial malignant
effusions that was operated through a minimal invasive approach.
Methods: 42 patients with pleuropericardial malignant effusions were operated from
1998 to 2008 through a minimal invasive approach with surgical thoracoscopic
instruments from the Karl- Storz Company.
o thoracoscopic pleuro-pericardial fenestration: 36
o VATS pleuro-pericardial fenestration through minithoracotomy: 6
Results: We present a comparision between preoperative imaging (Rx and CT) and
intraoperative thoracoscopic aspects and the postoperative results for the
pleuropericardial malignant effusions that was occurred in our study.
Conclusions: The minimal invasive thoracic surgery is the best approach in the
pleuropericardial effusions because of some advantages: lead to a correct diagnosis,
an adequate treatment, with a low mortality and morbidity (comparative with the
classic thoracic surgical approach).
Key words: pleuro-pericardial malignant effusions, thoracoscopy, VATS

123

3rdJUNE2011

OP090

TEMPORALIS MUSCLE FLAP FOR ORBITAL RECONSTRUCTION AFTER TUMOR

RESECTION
Author(s): Maj. Bogdan MARINESCU M.D., PhD.. Ioana NEDELCU MD
Institutions: Emergency University Military Central Hospital Dr. Carol Davila,
Bucharest
ROMANIA.
Subject: Reconstruction of moderate-sized periorbital
defects after orbital
exenteration, using temporalis muscle flap.
Material and method: Temporalis muscle flap is one of the most reliable flap that can
be used in reconstruction of periorbital defects. The muscle has a good vascular
blood supply and can offer a good solution in the obliteration of the dead space
following extensive resection. We use this flap in reconstruction of 4 cases of soft
tissue defects resulted from orbital exenteration . In all patients we performed radical
tumor excision with safe margins and primary one-stage reconstruction of the
postexcisional defects, using temporalis muscle transposition flap. The muscle flaps
were covered with split-thickness skin grafts.
Discussions: Following tumor resection, a large variety of techniques are available for
reconstruction of midfacial defects: direct suture, skin grafting, different types of local
and regional flaps. In certain cases microvascular flaps could be used. Temporalis
muscle flap is one of the most reliable regional flap that can be used in midfacial
reconstruction based on its constant vascular supply and availability close to the
surgical field.
Conclusions: Temporalis muscle flap can provide a good one-stage reconstructive
alternative for coverage of moderate-size postexcisional midfacial defects before
deciding on more extensive reconstructive procedure.

OP091

LMTED VERSUS EXTENDED APPROACH N SURGCAL TREATMENT OF

CRANOFACAL FRACTURES
Authors: Liliana MORARU, MD , DUMITRU Catalin, MD, GABARA Adrian, MD,
Camelia BADOIU, MD
Institutions: OMF Surgery Department, Central Military Emergency Hospital Carol
Davila, Bucharest,
ROMANIA
Objectives: Craniofacial injuries represent about 40% of medical conditions treated in
our department. The paper proposes an analysis of surgical approach pathways in
complex craniofacial fractures. Method:
They were selected complex traumas with surgical indication, treated in our
department between 2004-2010. The study, case series, examines surgical approach
pathways in terms of access, technical complexity and postoperative morbidity.
Results: For mandibular condylar fractures, the extended retroauricular approach
offered good access to reduce bone fragments and rigid internal fixation. Subparotid
dissection ensured the preservation of neuro-vascular elements with minimal aesthetic
impairment. In craniofacial complex (cominutive) fractures, bicoronal flap is the
alternative most advantageous in terms of surgical approach and aesthetic outcomes.
The intervention is technically well described, so that accidents and postoperative
complications were absent. Conclusions:
Surgical treatment of craniofacial fractures is challenging, especially when there is
high cominution. The therapeutic protocol requires: firstly a precise lesional

124

3rdJUNE2011

assessment (CT scan with 3D reconstruction), secondly a wise chosen surgical

approach technique, satisfactory in terms of good fracture exposure and aesthetic
outcome and last but not least an appropriate technical equipment.
08:30-10:00

ROUND TABLE III

New Trends in Aviation and Diving Medicine

(THE PERFORMANCE HALL)
Chairmen: COL Ahmet AKIN, MD (Turkey)
MAJ Leonard-Marin LUPU, MD (Romania)
Speakers: COL Ahmet AKIN, MD (Turkey)
MAJ Leonard-Marin LUPU, MD (Romania
MAJ Marius Ioan BUIU , MD (Romania)
MAJ Adrian MACOVEI, MD (Romania)
LT Vasileios KALENTZOS, MD (Greece)
RT007

FLYING AFTER DIVING - HOW SAFE IS IT?

Author: Adrian MACOVEI, MD, Romania
ROMANIA
Abstract: Flying after diving decompression sickness exact risk is hard to quantify.
Results may differ slightly from real world. The bottom line of this introduction is that is
hard even for the most experimented diving physician or dive master to predict the risk
of decompression sickness after diving.
Theoretical consideration will be held on:
The basics of decompression sickness
Additional risk factors
The oxygen window
Limits of oxygen or oxygen enriched air use.
Incidence reports
Current guidelines

wait for 12 hours before flying after up to two hours of no-stop diving within the
previous 48 hours

wait for 24 hours before flying after multiday, unlimited no-stop diving

wait for 24-48 hours before flying after dives that required decompression stops

do not fly with DCS symptoms unless necessary to obtain hyperbaric treatment,
and then at the lowest safe altitude.
Additionally, the role of physical exercise in DCS will be discussed.
A current practice case will be presented: brief history, treatment table and outcome.
E-mail: adrian_macovei@yahoo.com
Tel: 0744.962.97

RT008

HYPERBARIC OXYGEN THERAPY AT THE NAVAL HOSPITAL OF ATHENS:

CURRENT RESEARCH
Authors: Lt. KALENTZOS Vasileios, MD, MPH
GREECE

125

3rdJUNE2011

RT009

AEROMEDICAL EVACUATIONS IN ROMANIAN AIR FORCE

Authors: Maj.Dr. Marius Ioan BUIU; Maj.Dr. Leonard-Marin LUPU; Maj.Dr. Florin
COSTEA; Maj.Dr. Dragos TUDOSE.
Institution:
Romanian Air Force, Military Emergency University Hospital,
ROMANIA
Key words: aeromedical evacuations, MEDEVAC configuration, aircrew member,
SMMU (Military Emedgency Medical Service) .
Summary: Aeromedical evacuations is the movement of the patients to and between
medical facilities by air transportation, also called medevac. Romanian Air Force, for
aeromedical evacuations missions, helicopters and aircrafts used in MEDEVAC
configuration and equipation with medical equipment. A military medical officer is
aircrew member, is coordinating the medical team and is responsible for medical
evacuation. Missions are made day and night, if weather conditions are optimal.
Aircrews and medical teams are trained and educated through simulations and
exercices, observing the international protocols for emegency medical assistance.
In october 2010, during a military exercices with live ammunition held in shooting that
Cincu, configuration and equipment MEDEVAC helicopter in the 71 Air Flotilla,
received by SMMU (Military Emedgency Medical Service), order off a search and
rescue mission with aeromedical evacuation to Tg-Mures hospital, for two victims after
an explosion.
Contact: Maj. Dr. Marius Ioan BUIU; 0732-07.94.49; 0788-72.66.60.

RT010

FLIGHT SURGEONS IN ROMANIAN AIR FORCE.

Authors: Maj. dr. Leonard-Marin LUPU, Maj. dr. Florin COSTEA, Maj. dr. Marius Ioan
BUIU, Maj. dr. Dragos TUDOSE.
Institution:
Romanian Air Force, Military Emergency University Hospital,
ROMANIA
Summary: A flight surgeon is a military medical officer assigned to duties in the clinical
field known as aviation medicine or flight medicine. Flight surgeons are medical
doctors who are primarily responsible for the medical evaluation, certification and
treatment of aviation personnel e.g., pilots, astronauts, air traffic controllers, UAV
operators and other aircrew members. They perform routine, periodic medical
examinations ("flight physicals") of these personnel. Flight surgeons should be trained
to fill general public health and occupational and preventive medicine roles, and are
only infrequently "surgeons" in an operating theater sense. Flight surgeons are
typically on flight status, but are not required to be rated or licensed pilots. They may
be called upon to provide medical consultation as members of an investigation board
into an aviation mishap. Occasionally, they may serve to provide in-flight care to
patients being evacuated via aeromedical evacuation, either fixed or rotary wing.
The civilian equivalent of the flight surgeon is the aviation medical examiner (AME).
Though some civilian AMEs have training similar to that of military Flight Surgeons,
most are significantly less well-trained. This is not a criticism of civilian AMEs, as many
are extremely well-trained, highly experienced, and some are pilots, but it is possible
to be certified as an AME having only sat through a 4-5 day lecture course in some
countries.
Contact: Maj. dr. Leonard-Marin LUPU, 0723577452.

126

3rdJUNE2011

Key words: flight surgeon, flight physical, aviation mishap, aeromedical evacuation,
aviation medical examiner (AME).
08:30-10:00
PP065

POSTER PRESENTATION III

(BYZANTINE HALL)
THE ECHOCARDIOGRAPHIC ASSESSMENT OF RIGHT VENTRICULAR
DEFORMATION IN PATIENTS WITH COPD AND METABOLIC SYNDROME
Authors: S. STANCIU, S. DUMITRESCU, A. ANGHEL, M. MURESAN, Ioana
RADUTA, L. CIOBICA, D. STOICESCU, Daniela ANGHEL, MACADON Bogdan
Institutions: University Emergency Military Hospital Carol Davila,
ROMANIA
Objectives: To assess right ventricular deformation profile using strain and strain rate
in patient with COPD and Metabolic Syndrome
Background: The association between COPD and metabolic syndrome (MS) are
frequently seen in daily clinical practice, but the right ventricular (RV) deformation
using strain and strain rate of free wall and correlation with other markers of cardiopulmonary functional profile is poorly studied in this group of patients.
Methods&Results : Thirty-two patients with COPD was compared with thirty-one
patients with COPD and MS regarding right ventricular systolic strain and strain rate.
Longitudinal strain and strain rate analysis in the basal and mid segments of lateral
wall of RV were performed in both groups using Velocity Vector Imaging (VVI)
technique. Strain and strain rate in all segments of RV lateral wall were significantly
decreased in COPD and MS group (strain basal and mid: -23.30.2 respectively 22.40.2; strain rate basal and mid: -1.40.0 respectively -1.20.0) compared with
COPD alone (strain basal and mid: -18.60.2 respectively -16.80.2; strain rate basal
and mid: -1.20.0 respectively -1.00.0) (p <0.001). In the COPD and MS group,
decreased of 6-MWD correlated significantly with basal reduced strain rate of VD (r=0.38, p=0.03) and elevation of sPAP correlated significantly with basal and mid
reduced strain of RV (r=0.51, p=0.01 respectively r=0.41, p=0.02).
Conclusions: The assessment of strain and strain rate of free wall of RV is a good
clinical tool in evaluating of right functional cardiac profile and may be in prediction of
exercise capacity in patients with COPD and MS.

PP066

EFFECTS OF HELICOPTERS VIBRATIONS ON CREWS

Author(s): 1st Lt Eirini DEVETZI MD, 1st Lt Athanasios KALOGEROPOULOS MD,
1st Lt Georgios MARKOPOULOS MD, 1st Lt Dimitrios PAPADOPOULOS MD,
Institution: Hellenic Air Force, Aeromedical Center, Athens,
GREECE
Purpose: This report is to provide an overview of all aspects related to the effects of
helicopters vibrations to the health of crews. The vibrations have an
operational significance to aviation
because
it affects the visual acuity and
neuromuscular control, causing fatigue.
Material and Methods: Database searches for articles were conducted in PubMed,
Cochrane and archives in Aeromedical Center library.
Results: There is a detrimental impact on the musculoskeletal (backache,
intervertebral disc degeneration, increased vWFAg and reduced muscle perfusion,
muscle fatigue, spondylolisthesis, degenerative lesions of CR, herniated intervertebral
disc), cardiopulmonary( increased tidal volume/ oxygen consumption/ metabolic rate/

127

3rdJUNE2011

blood pressure/ heart rate, vasoconstriction, disorders in blood vessels walls,

hyperventilation, reduced end respiratory CO2), reduce visual acuity( vestibularocular reflex 9-10Hz, pursuit reflex 1-2Hz), cause nausea and hinder communication.
Protection: proper posture during flight, limit exposure time (small repeated flights),
maintaining fitness (fat tissue favors the transmission of vibrations in contrary muscles
function as dampers), decrease vibrations production from the source, modification of
vibration pathway.
Conclusions: The vibrations are a necessary evil, particularly during helicopters flight.
Both the health of crews and the accomplishment of missions are affected. The
correlation of the characteristics as well as degree of exposure with side-effects is
under strenuous investigation. The effort to control the vibration by engineers and
manufacturers should be continuous.
Correspondence:

PP067

1st Lt Athanasios KALOGEROPOULOS MD,

+30 6937029665,
kardamyla.chios@gmail.com

SUDDEN IN-FLIGHT INCAPACITATION.

Author(s): LTJG Athanasios KALOGEROPOULOS MD, 1st LT Dimitrios
PAPADOPOULOS MD, 1st LT Eirini DEVETZI MD, 2nd LT Polykarpos PSOCHIAS MD,
1st LT Michael DIAMANTOPOULOS DDS.
Institution: Hellenic Air Force, Aeromedical Center, Athens,
GREECE
Purpose: This report is to provide an overview of all aspects related to the issue of
sudden in-flight incapability. The epidemiology as well as etiology is reviewed and
ways of recognition and handling are referred in order to determine the aeromedical
emphasis needed to minimize accidents.
Material and Methods: Database searches for articles were conducted in PubMed,
Cochrane and archives in Aeromedical Center library.
Results: Any person who cannot carry out his duties in flight due to poor physical or
mental status is in a state of incapability. Such a situation can happen to any pilot and
threaten the safety of flight. However, aircraft accidents are much more associated to
human errors than to sudden in-flight incapacitation. The three main categories of
causes of incapacitation are the cardiovascular (mainly coronary heart disease),
nervous (any form of seizures and loss of consciousness) and gastrointestinal system
(acute pain). Psychological impotence is the most difficult in terms of recognition,
treatment and prevention. The pilot, in addition to knowledge of the causes and effects
of incapacitation, should be trained on early recognition and safely completion of a
flight through regular planning exercises in flight simulators. Doctors should take under
serious consideration the periodic medical examinations of pilots in an effort to prevent
unpleasant effects of an incapacitation.
Conclusions: The training of flight crews and medical supervision and monitoring
should be continuously improved in correlation with the development of aircraft
technology, contributing to air safety and reducing the risk of accidents attributed to
human factor.
Correspondence:
1st Lt Athanasios KALOGEROPOULOS MD,
+30 6937029665,
kardamyla.chios@gmail.com

128

3rdJUNE2011

PP068

AN OVERLOOKED ISSUE IN CHILDREN PRESENTING WITH ENURESIS:

CONSTIPATION
Authors:LTC AKYOL Ilker, MD, LCDR ATES Ferhat, MD, MAJ SOYDAN Hasan, MD,
CAPT SENKUL Temucin, MD, COL KARADEMIR Kenan, MD, CAPT BAYKAL Kadir, MD.
Institutions:Gulhane Military Medical Academy Haydarpasa Teaching Hospital Dept.
of Urology, Istanbul,
TURKEY
Objective : To investigate the prevalance of constipation among children presenting
with bedwetting.
Material and method: Charts of children applying with only bedwetting complaint were
evaluated. Those with daytime voiding symptoms and urinary tract infections were
excluded. Symptoms of voiding dysfunction were sought with detailed history. Parents
were given questionnaires designed to reveal constipation according to Rome III
criteria, and they were filled after at least one month of observation without any
treatment. Diagnosis of constipation was made when direct graph revealed an
intestinal fullness obscuring the rectal image and/or when the symptoms fulfilled the
Rome III criteria.
Results: A total of 88 patients were evaluated (female:24, male:64, mean age: 8.65
yrs). Primary and secondary enuresis nocturna (EN) was diagnosed in 79 and 9
patients respectively. Constipation was diagnosed in 62% and 67% of the patients with
primary and secondary EN respectively. Daytime irritative symptoms coexisted in
20.5% of the cases, and when these cases were excluded, constipation existed in
53.2% of the cases with primary monosymptomatic enuresis nocturna. This is a higher
rate than the similar population according to the literature.
Conclusion: A significant rate of constipation coexist in patients presenting with
bedwetting, and these cases should not be labelled as monosymptomatic nocturnal
enuretics. This subgroup of patients should be identified as cases with elimination
dysfunction and treated accordingly. Lack of daytime voiding symptoms do not exclude
defecation disorders.
Correspondence:
LCDR Ferhat ATES, MD
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Uroloji Servisi, Uskudar
34668, Istanbul, TURKEY.
+ 90 216 542 2020(4306)
+ 90 216 348 7880
+ 90 532 556 6339
e-mail: drferhatates@yahoo.com

129

3rdJUNE2011

PP069

THE RELATIONSHIP BETWEEN BASIC SYMPTOMS OF POSTTRAUMATIC

STRESS DISORDER AND STATE ANXIETY VARIABILITY AFTER VISUAL
STIMULUS
Authors:1LT BOLU Abdullah, MD1, MAJ CELK Cemil, MD2, 1LT AKARSU Suleyman,
MD1, SINICI Ebru, Psiycho.2, MAJ OZDEMIR Barbaros, MD1, CAPT OZMENLER
Kamil Nahit, MD1
Institutions: 1 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara,
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military Psychology
and War Psychiatry, Ankara, TURKEY.
TURKEY
Objective: Posttraumatic stress disorder is characterized by re-experiencing the event,
avoidance of traumatic stimuli, and symptoms of excessive arousal after a traumatic
event. It is known that the relationship between symptoms of excessive arousal and
autonomic nervous system. The aim of this study, investigate the relationship
between PTSD symptom clusters and varying levels of situational anxiety, when the
visual stimulus that is remembering the similar trauma given to the PTSD patients.
Materal and method: PTSD was diagnosed according to DSM-IV diagnostic criteria,
37 patients were included in the study. PTSD symptoms were assessed by Impact of
Event Scale (IES-R). The visual stimulus were given to the patients for ten minutes.
Situational anxiety levels were measured before and after the stimulus by STAI- I
Results: Of the 37 patients with a diagnosis of PTSD, IES-R scores ; IES-R total;
61.789.43, IES-R Intrusive: 19.434.38, IES-R avoidance: 20.083.81, IES-R
symptoms of excessive arousal; 22.274.57. State anxiety levels of patients prior to
stimulus: 41.165.20, state anxiety levels of patients after to stimulus 46.814.68 .
The difference was statistically significant. (p<0.05, r=0.42). Positive correlation was
found between change of State anxiety level and IES-R scale scores. (p<0.05, r=0.77).
Conclusion: In our study detection of further increase in the level of state anxiety after
the visual stimulus in patients who were more prominent with over-arousal of
symptoms considered as an indicator of the role of the autonomic nervous system in
PTSD pathogenesis.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
+ 90 312 3044501
+ 90 312 3044507
+ 90 505 4346744
e-mail: drcemilcelik@yahoo.com

PP070

DYSFUNCTIONS OF CORTICAL EXCITABILITY IN POSTTRAUMATIC STRESS

DISORDER
Authors:MAJ CELK Cemil, MD1, MAJ OZDEMIR Barbaros, MD1, BOLU Abdullah,
MD2, CPT AKCAY Bulent, MD2, CPT BALIKCI Adem, MD3. CAPT OZMENLER Kamil
Nahit, MD1
Institutions:1 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military
Psychology and War Psychiatry, Ankara, TURKEY.
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara, TURKEY.
3 Samsun Military Hospital, Dept. of Psychiatry, Samsun, TURKEY.
TURKEY
Objective: Transcranial magnetic stimulation (TMS) applications have an important

130

3rdJUNE2011

place among the investigative tools to study cognitive functions and neurological and
psychiatric disorders. In the present study, we applied TMS in an attempt to
investigate whether changes in cortical excitability are associated with the
development of posttraumatic stres disorder (PTSD).
Material and method: We studied 30 subjects with PTSD and 30 healthy controls
matched for age and education level. The electrophysiology of cortical inhibition and
excitability was measured with transcranial magnetic stimulation.
Results: Motor threshold, cortical latency, and central motor conduction time,which are
related with cortical excitability, have been found statistically significant lower on PTSD
group compared with healthy controls. There was no difference between two groups
on cortical silent period which reflects cortical inhibitory mechanisms.
Conclusion: The results indicate an increase in cortical motor excitability on
posttraumatic stres disorder. Increase in cortical excitability describes the symptoms of
excessive arousal of the PTSD.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 505 4346744
e-mail: drcemilcelik@yahoo.com
PP071

ELECTROCONVULSIVE THERAPY FOR COMORBID MAJOR DEPRESSIVE

DISORDER AND POSTTRAUMATIC STRESS DISORDER: AN RETROSPECTVE
STUDY
Authors:MAJ CELK Cemil, MD1, MAJ OZDEMIR Barbaros, MD1, BOLU Abdullah, MD2,
CPT AKCAY Bulent, MD2, CPT BALIKCI Adem, MD3. CAPT OZMENLER Kamil Nahit, MD1
Institutions:1 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military
Psychology and War Psychiatry, Ankara, TURKEY.
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara, TURKEY.
3 Samsun Military Hospital, Dept. of Psychiatry, Samsun, TURKEY.
TURKEY
Objective: Posttraumatic stress disorder (PTSD) and major depression occur
frequently following traumatic exposure, both as separate disorders and concurrently.
Electroconvulsive therapy (ECT) has been considered the most effective treatment for
major depressive disorder (MDD). We examined the effect of ECT in patients with cooccurring major depression and PTSD.
Material and method: Eight patients with co-occurring major depression and PTSD at
Psychiatry Department of Gulhane Military Medicine Faculty between January 2002January 2011 were evaluated retrospectively. We compared the pretreatment and the
posttreatment symptoms using the Beck Depression Inventory (BDI) and the The
Impact of Event Scale (IES).
Results: We found that patients with comorbid PTSD and MDD who received ECT
showed a significant reduction in the symptoms of depression. ECT also resulted in a
statistically significant reduction in PTSD symptoms
Conclusion: Electroconvulsive therapy may be an effective treatment for patients with
refractory depression and co-occurring PTSD.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 3044501

131

3rdJUNE2011

Fax: + 90 312 3044507

GSM: + 90 505 4346744
e-mail: drcemilcelik@yahoo.com
PP072

REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION OF THE RIGHT

DORSOLATERAL PREFRONTAL CORTEX IN COMORBID MAJOR DEPRESSIVE
DISORDER AND TREATMENT-RESISTANT POSTTRAUMATIC STRESS
DISORDER: AN OPEN TRIAL
Authors:MAJ CELK Cemil, MD1, MAJ OZDEMIR Barbaros, MD1, BOLU Abdullah,
MD1, CPT AKCAY Bulent, MD2, CPT OZSELEK Suleyman, MD2, COL BOZKURT Ali,
MD2, CAPT OZMENLER Kamil Nahit, MD1
Institutions:
1 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military Psychology
and War Psychiatry, Ankara, TURKEY.
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara, TURKEY.
TURKEY
Objective: Posttraumatic stress disorder (PTSD) and major depressive disorder
frequently co-occur. Repetitive transcranial magnetic stimulation (r TMS) is the most
effective treatment for major depressive disorder. We examined the effect of r TMS in
patients with co-occurring major depression and treatment-resistant PTSD.
Material and method: Twenty patients with treatment-resistant PTSD and major
depressive disorder were assigned to receive rTMS. Treatment was administered in
10 daily sessions over 2 weeks. We compared the pretreatment and the posttreatment
symptoms using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI)
and the The Impact of Event Scale (IES).
Results: There was no statistically significant difference the total IES scores, IES
ntrusion scores, IES avoidance scores, BDI and BAI scores before and after
treatment. However, reduction in the IES hyperarousal scores was statistically
significant
Conclusion: RTMS therapy may not be an effective treatment for patients with
treatment-resistant PTSD and major depressive disorder
Correspondence
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 505 4346744
e-mail: drcemilcelik@yahoo.com

PP073

THERAPEUTIC GROUP AS A PART OF THE COMPLEX TREATMENT OF DRUG

DEPENDENCE
Authors:DIMITROVA M., DONCHEV T., PAZDERKOVA TR.
Institutions:Clinic of psychiatry Military Medical Academy, Sofia, Bulgaria
BULGARIA
Background: The group is a mutual help endeavor, an alliance between individuals
with common needs to tackle a common problem. Participants share information on:
experiences, ideas and opinions. The confrontation between these is also part of the
mutual help.
The therapists commitment is both with the group as well as with each participant. His

132

3rdJUNE2011

mission: to facilitate the relationship between these entities.

This study presents our experiences with addicted patients in both individual and
group psychotherapy.
Methodology: Patients suffered from alcohol and heroin addiction. Their ages varied
from 24 to 59 years.
The work of the group begins according to previously stated rules that can be
discussed and updates through out the groups work. Clear boundaries are laid out
regarding each sessions time and place.
Results: One of the main focusses of the issue is that of the most negativity of the
women to confess their addiction. The women usually decrease the quantity of
alcohol, and the men increase that. Patients use alcohol as meditation against
depression, insomnia and panic. In the process of the group dynamic, the biggest
problem of work is the low motivation to stop drinking. The patients share that their
motivation is the result of family and sociality pressure.
Participants in the group have more difficulties to decide what they have to do when
they need to drink.
Conclusions: The group therapist aims to achieve insight regarding each participants
dependency and its consequences, to motivate as well as to plan for appropriate
behaviors in social and crisis situations in which drugs might be available.
Keywords: therapeutic groups, alcoholism, drug addiction.
PP074

MONITORING OF PUBLIC AND INDUSTRIAL WATHER SYSTEMS FOR

DESTRIBUTION OF BACTERIA BELONGING TO GENUS LEGIONELLA IN
BULGARIA
Authors:GEORGIEVA Elena, PhD and Major MARINOV Krustyu, PhD
Military Medical Academy- Sofia,
BULGARIA
Objective: Bacteria belonging to genus Legionella cause epidemic and sporadic cases
of severe, occasionally fatal pneumonia.
The purpose of this study was long time monitoring the distribution of Legionella in
public and industrial water systems, their species identification and evaluation of risk of
infections in common and disastrous situations.
Materials & methods: More than 400 water samples were investigated. The isolation
was performed by the common for Legionella cultural methods. BCYE, selective and
enrichment supplements were used.
Identification of the isolates was done by immune fluorescent assay. Species specific
and serotype specific antisera obtained by immunization of hares were used.
Results: In this work, we report the results from more than 10 years survey of hotels
and chemical factories.
More than 100 Legionella strains were isolated. Sg1, Sg4 and Sg6 were predominant
among L. pneumophila isolates. L. oakridgensis and L. micdadei were isolated also.
Conclusion: Significant percent of distribution of L. pneumophila including L.
pneumophila Sg1established, shows risk of infection in cases of exposure to water
aerosols, without individual protection equipment.
dr.kr.marinov@gmail.com

133

3rdJUNE2011

PP075

ACUTE POISONINGS WITH HOUSEHOLD PRODUCTS

Authors: MITEVA M., KANEV K., NEYKOVA L.
Institutions:Clinic of Emergency Toxicology MA- Sofia,
BULGARIA
Abstract: Chlorine is a chemical that prevents bacteria from growing. Chlorine
poisoning occurs when someone swallows or inhales chlorine. Chlorine reacts with
water in and out of the body to form hydrochloric acid and hypochlorous acid. Both are
extremely poisonous. Chloramines gas is released when mixing bleach with some of
the powdered cleansing products and ammonia.
Aim: The aim of this study is to present patients that were treated at The Department
of Clinical Toxicology for two year period with intoxication of household productsChlorine. They had different symptoms of poisoning and we shall represent here the
treatment in the context of the whole clinical presentation.
The following parameters were assessed the age, sex, weigh, time it was inhale or
swallow, condition dose and concentration of the swallowed or inhaled poison, the way
of penetration and elimination.
Conclusion: Chlorine gas is one of the most common single, irritant, inhalation
exposures, occupationally and environmentally. The patients condition depends on
the amount of inhaled poison and how quickly the treatment is received. We could
conclude that the complex therapeutic approach, based on the pathogenetic
mechanisms and clinical stages of intoxication is the most important part for quick
recovery.
Keywords: chlorine, poison, inhale

PP076

MEDICAL SPECIALISTS TIME MANAGEMENT

Authors : d.r.NIKOLAEV M. Evgeni, r.n. ILIEVA G. Vania, r.n.NACHEVA N. Petia
Institutions:NAVAL HOSPITAL MMM, VARNA,
BULGARIA
Summary: Effective resource management is a key issue in health management.The
analysis of data shows that the resources are often used impractically despite their
lack.The use of resources is not strictly focused towards definite goals and it does not
achieve the preliminarily set aims of health organizations.
Time is one of the key resources in health management and it is undervalued by the
helth managers.
The problem of effective using of resources is important health management.Some
scans shows,that instead of lack of resources they have been spent irracionally.
Furthermore,time is not paid attention when looking for new resources for increasing of
effectiveness and quality.Proper time management predetermines the better quality of
the provided health services
Key Words: Time, resource, health services, time management, effectiveness, quality.
e-mail: Nikolaev75@abv.bg , mobile phone: 359 888 809 883

134

3rdJUNE2011

PP077

ASSESSMENT OF DISSOCIATION IN COMBAT EXPOSED SOLDIERS WITH AND

WITHOUT POSTTRAUMATIC STRESS DISORDER
Authors:MAJ OZDEMIR Barbaros, MD1, MAJ CELK Cemil, MD1, 1LT BOLU
Abdullah, MD2, SINICI Ebru, Psiycho. 2, CAPT OZMENLER Kamil Nahit, MD1
Institutions: 1 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military
Psychology and War Psychiatry, Ankara, TURKEY.
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara, TURKEY.
TURKEY
Objective: Dissociative symptoms are known to ocur in soldiers exposed to combatreleated trauma. Likewise, the purpose of this study was to examine the level of
dissociation in combat exposed soldiers wiht and without PTSD.
Materal and method: The total sample included in combat exposed 134 male soldiers
with (84) and without (n=50) PTSD. Dissociative experiences were assessed by the
Dissociative Experiences Scale (DES).
Results: Our results have shown that the level of dissociation was significantly higher
in subjects with combat related PTSD than those without. Moreover, the number of
subjects with high DES scores (>30) were similar between the two groups.
Conclusion: Similar to previous studies, we have shown that the presence of PTSD
increase the level of dissociation in combat expose Turkish soldiers. On the other
hand, any relationship between the presence of bodily injury and high levels of
dissociation could not be shown.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 505 4346744
e-mail: bozdemir@gata.edu.tr

PP078

DIFFERENTIAL DIAGNOSIS OF ANEMIA SMALL BOWEL EVALUATION WITH

ENDOCAPSULE
Authors: Maj. Assist. Prof. Raluca COSTACHE MD; Col. Assoc. Prof. Mariana
JINGA MD PhD; Maj. D. O. COSTACHE MD, MBA; Maj. P. NUTA MD; Cpt. B.
MACADON MD; Maj. Sandica BUCURICA MD; Col. Assist. Prof. Florentina IONITA
RADU MD PhD.
Institutions:Central Universitary Emergency Military Hospital, Gastroenterology
Clinic, Bucharest,
ROMANIA
Background: The small bowel evaluation remained unclear until 1996, when the first
live pictures from pig gastrointestinal tract with wireless device was obtained.
Hundreds of thousands patients have been examined since. Nowadays it becomes the
key method for evaluation of feriprive anemia with no apparent causes.
Material and method: We present our experience with 9 rigorously selected cases,
regarding the inclusion criteria, during 2010 year. We used the Olympus
Endocapsule System. All the patient received the same preexaminations
procedures, including complete GI radiology and upper and lower endoscopy within 7
days before the procedure.
Results: The patients were examined for a medium period of time of 8 hours and 30
minutes, and all the examinations were complete. Regarding the result we find 2 cases

135

3rdJUNE2011

with small bowel tumors, 1 case celiac disease, 2 cases Crohn disease, 4 cases
angioectasias, 1 of them with active bleeding. We have no capsule retention within our
cases.
Conclusion: The capsule endoscopy represents in our days the gold standard for small
bowel evaluations in patients with hyposideremic anemia with no apparent case. A
rigorous examination can reveal the site of possible bleeding, in order to conduct
towards the most accurate possible treatment.
Contact: Assist. Prof. Raluca S. Costache Central Universitary Emergency Military
Hospital, Gastroenterology Clinic; 69M Coralilor street, Bucharest 1, Romania, +40
745 140960; fax +40 21 3162339; ralu_alf@yahoo.com
PP079

CASE REPORT: SPONTANEOUS PERITONITIS CAUSED BY CANDIDA ALBICANS

Authors: Col Dr IONITA RADU Florentina, Dr CHEAIB Bianca, Dr RASCANU Aida,
Col Dr COJOCARU Mihail, Col Dr JINGA Mariana, Mj Dr NUTA Petrut, Mj Dr
BUCURICA Sandica, Mj Dr PATRASESCU Mihai, Cpt Dr MACADON Bogdan
Institutions: Central University Emergency Military Hospital Carol Davila
2nd Department Of Internal Medicine, Bucharest,
ROMANIA
Introduction: The infection of ascitic fluid without an apparent source may be due to
bacterial or fungal microorganism. Spontaneous fungal peritonitis is common among
CAPD and immunosupressed patients (HIV infected or patients undergoing
chimiotherapy). Diagnosis is by examination of ascitic fluid.
We report a 45-year-old man, with chronic ethanol use (over 30 drink per week) and
no significant medical history is admitted for the first time in our departement with
ascites, abdominal pain and leg edema.
The following diagnosis is set - Decompensated alcoholic liver cirrhosis CHILD B,
complicated with spontaneous peritonitis caused by Candida albicans multiple drug
resistant. The patient was successfully treated with fluconazolum 200mg/day for 14
days. Due to the lack of direct risk factors, we found it necessary to fully investigat the
patient for neoplastic and other liver diseases.
A search of the literature showed that this is a rare case of spontaneous peritonitis
caused by multi durg resistent Candida albicans in a young, immunocompetent
patient.
Key words: spontaneous peritonitis, candida albicans, cirrhosis.
Contact : Col. Florentina Ionita-Radu, Sef Sectie Medicina Interna 2, Spitalul
Universitar de Urgenta Militar Central Carol Davila Bucuresti, Romania
fionita04@yahoo.com, tel + 40722232606, fax +40213193047

PP080

DEPRESSIVE DISORDER IN MILITARY PERSONNEL-OUR EXPERIENCE

Authors: Vesna TEPI OSTOJI MD, Major Bratislav IVI, MD, Vesna BUAN,
MD, Colonel Milivoj PANI, MD
Institutions:Department for Mental Health, Psychitary Clinic, Medical Military
Academy, Belgrade,
SERBIA
Major depression is a complex and heterogeneous ilness with an ethiology based
upon multiple factors wich may act on different levels (psychological, biological as well
as social) of persons well being. Early diagnosis and adequate antidepressive therapy

136

3rdJUNE2011

is consequently of a great importance in treating such patients.

802 members of military personnel were reffered to Department for Mental Health,
Medical Military Academy in Belgrade in 2010. 62 (7,73%) patients aged 27-52yrs
were fulfilling ICD-10 diagnostic criteria for depressive disorder. Due to severity of
simptoms 6 (9,67%) patients were hospitalized at presentation, and 6 (9,67%) more
during outpatient treatment. Current episode was with psychotic characteristic in 3
(4,83%) patients. Comorbid alcoholism was diagnosed in 2 (3,2%), PTSD in 3
(4,83%), adjustment disorder in 5 (8,06%) and somatophorm disorder in 2 (3,2%)
patients. Total of 53 (85,48%) patients were administrated pharmacotherapy, with 23
(44,23%) of them reffered to counselin also. 3 (4,83%) patients were reffered just for
counseling. For 2 (3,2%) there was a need for a sick leave longer than 30 days.
Our experience indicates that depressive disorder is not rare in military personnel.
Considering its clinical importance early diagnosis and antidepressive medication is of
vital importance.
PP081

THE TRANSVERSUS ABDOMINIS PLANE BLOCK PROVIDES EFFECTIVE

POSTOPERATIVE ANALGESIA AT CHILDREN UNDERGOING BILATERAL
URETERONEOCYSTOSTOMY
Authors:1MAJ PURTULOGLU Tarik, MD, 1CPT OZKAN Gokhan, MD, 2LCDR
CALISKAN Bahadir, MD, 2COL GUVEN Ahmet, MD, 2COL SURER Ilhami, MD, 1COL
KURT Ercan, MD
Institutions: 1 Gulhane Military Medical Academy, Dept. of Anesthesiology and
Reanimation, Ankara, TURKEY
2 Gulhane Military Medical Academy, Dept. of Pediatric Surgery, Ankara, TURKEY
TURKEY
Objective: Ultrasound-guided transversus abdominis plane (TAP) block has shown
promise for analgesia in surgery involving the lower abdominal wall. We evaluated the
efficacy of TAP block in children undergoing bilateral ureteral reimplantation.
Material and method: Children scheduled for elective ureteral reimplantation procedure
were prospectively randomized to US guided bilateral TAP (n=6), caudal block (n=6)
and control groups (n=6). In TAP and caudal groups 0,5ml/kg 0.25% bupivacaine was
used. Fentanyl 0.25mcg/kg was given during surgery when there was an increase in
heart rate, mean arterial pressure or respiratory rate >20% from postinduction values.
Meperidine was given 1mg/kg intravenously in the Post anesthesia care unit (PACU)
for severe pain or emergence agitation. Blinded observers assessed FLACC (face,
legs, activity, cry, consobility) score in the PACU, day stay unit and during the first 24h.
Supplemental analgesia consisted of regular ibuprofen and rescue meperidine was
noted daily.
Results: There were no complications related to the US-TAP block. It was noted that
TAP and caudal block groups had less scores when compared control group regarding
PACU agitation scale (p<0.05). When we compared all groups for supplemental
analgesia, meperidine and total ibuprophen consumption was significantly lower in the
TAP block group (p<0,05).
Conclusion: We found that the TAP block provided effective analgesia and less
agitation following ureteral reimplatation procedure in children. We assume that
ultrasound guided TAP block would be a good alternative method for children
undergoing surgery involving the lower abdominal wall when compared with caudal
epidural block accepted as gold standard for children.
Correspondence:

137

3rdJUNE2011

Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 5912
Fax: + 90 312 304 5900
GSM: + 90 533 390 9151
e-mail: tpurtuloglu@mynet.com
PP082

EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR)

APPLICATIONS IN PHANTOM LIMB PAIN
Authors:SINICI Ebru, Psiycho.1, 1LT BOLU Abdullah, MD1, 1LT AKARSU Suleyman,
MD1, MAJ CELK Cemil, MD2, CAPT OZMENLER Kamil Nahit, MD2
Institutions: 1 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara,
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military Psychology
and War Psychiatry, Ankara, TURKEY.
TURKEY
Objective: In the treatment of phantom limb pain also local anesthesia,
sympathectomy, cordotomy, pharmacological agents nrositimlasyon treatment
methods and hypnosis, biofeedback and psychological treatment methods such as
relaxation therapy can be applied. This study aimed to evaluate the effectiveness of
EMDR in the treatment of phantom limb pain.
Material and method: n this study 15 patients who were applied leg amputation
according to the various medical reasons, were treated by EMDR. EMDR treatment of
patients before and after (that day, 1 month and 3 months), Beck Anxiety Scale, Beck
Depression Inventory and the McGill Melzack Pain Questionnaire was applied.
Results: EMDR was applied to 1 season to 5 patient,2 season to 8 season and 3
season to 2 patient The difference was statistically significant When McGill Melzack
Pain Questionnaire and the Beck Depression Inventory scores were compared before
EMDR and AFTER emdr. There was no significant difference Before and after
treatment between the scores of State Anxiety Scale
Conclusion: Amputation is a traumatic event for a person. phantom painthat occurs
after amputation,is one of the factors that most affect the quality of life. EMDR can be
used as an effective method for the treatment of phantom limb pain.
CORRESPONDENCE
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 3044501
Fax: + 90 312 3044507
GSM: + 90 532 3716475
e-mail: esinici@gmail.com

PP083

THERAPEUTIC APPROACH IN ETHYLENE GLYCOL POISONINGS

Authors: TRAYKOVA V., KANEV K., MITEV, M., MMAInstitutions: Sofia, Clinic of Emergency Toxicology,
BULGARIA
Abstract: thylene glycol has major toxic effect, mainly through its metabolites on the
human body, when it is taken accidentally or intentionally. If the ethylene glycol
intoxication is left without adequate specific treatment it develops in full and can end
with serious residual injuries and even death.
The aim of this study is to summarize the cases of intoxication with ethylene glycol for
two years period, focusing on diagnostic clinical data and the proper therapeutic

138

3rdJUNE2011

attitude.
The diagnosis of intoxication with ethylene glycol has a complex characteristic and rest
on clinical manifestations, chemical analysis and biochemical constellations. It is
emphasized that the quantitative blood chemical analysis of ethylene glycol is from a
high importance to start an early, adequate and specific antidotal treatment and to
specify the need of dialysis by the toxicologist.
A conclusion has been made on the severity of intoxication in three risk groups,
defined by the ingested amount of ethylene glycol and the interval elapsed between
the time of ingestion and hospitalization. The complex treatment, based on
pathogenetic mechanisms and clinical stages of intoxication contributes to its
favorable outcome and restores normal life style prior to the incident.
Keywords: ethylene glycol, poisoning, treatment.
PP084

THE RELATIONSHIP OF MILITARY MEDICAL STUDENTS TIME MANAGEMENT

SKILLS, STUDYING METHODS AND PARTICIPATING IN SOCIAL ACTIVITIES.
Authors: CPT YAVAS Umit, MD1, CPT OZTURK Gultekin, MD1. LTC ACIKEL Cengiz
Han, MD2, COL OZER Mustafa, MD, PhD1
Institutions:
1 Gulhane Military Medical Academy, Dept. of Military Health Services, Ankara,
2 Gulhane Military Medical Academy, Dept. of Public Health, Ankara, TURKEY.
TURKEY
Objective: The purpose of this research is to determine time management skills of
military medical students that is releated with the style of studying lesson and
participating social activities.
Materials and methods: Time Management Questionnaire (Britton and Tesser,1991) is
used to determine time management skills. And some quesitons asked to establish
studying lesson style and social activities to 420 military medical students includes
each class.
Results: Analyzing the questionnaires showed that the students who plans their own
time has a studying lesson method and participating in social activities enough that
carry them to success. Remarkably males had more effective time management
behaviors than females.
Conclusion: Military physicians who works at nearly 30 different cadre duties are
graduated from military medical faculty. Improving time management skills is essential
for these key medical personnel to achieve administrative activities and to have
success on military medical practises.
Correspondence:
Umit YAVAS
Gulhane Askeri Tip Akademisi, Askeri Saglik Hizmetleri AD, Etlik 06018, Ankara,
TURKEY.
Tel: +90 312 3043359
GSM: +90 505 6462959
e-mail: umit2502@hotmail.com

139

3rdJUNE2011

PP085

THE EFFECTIVENESS OF HYPERBARIC OXYGEN AND COMBINED SYSTEMIC

STEROID TREATMENT IN PATIENTS WITH SUDDEN HEARING LOSS
Authors: CPT METIN Suleyman, MD1, LTJG KARAKUZU Engin, MD2, CAPT YILDIZ
Senol, MD2, CPT CAKMAK Tolga, MD1.
Institutions: 1Gulhane Military Medical Academy, Dept. of Aerospace Medicine, Eskisehir,
2Gulhane Military Medical Academy, Dept. of Underwater and Hyperbaric Medicine,
Ankara,
TURKEY.
Objective: We aimed to evaluate the efficacy of hyperbaric oxygen (HBO) and
combined systemic steroid treatment in patients with sudden hearing loss (SHL).
Material and method: In this study, 37 patients with SHL were evaluated
retrospectively. 29 patients had unilateral and 8 patients had bilateral SHL. Totally 45
ears; 26 left and 19 right ears were evaluated. Totally 45 ears; 26 left ears and 19 right
ears evaluated. All patients were treated with HBO and systemic steroids.
Conventional audiometric tests [frequencies lie in between 250 hertz (Hz) and 6 kHz]
were used for following the improvement of hearing function.
Results: A total of 37 patients (28 males, 9 females; mean age 44 years; range 7 to 78
years) were included. Patients were evaluated according to pre-and post-treatment
pure tone hearing levels. When hearing levels were compared, we detected a
statistically significant differences (p <0.05) at all frequencies. Patients hearing gain
were determined most at a frequency of 500 Hz (22/45, 48.9%) and at 250 Hz, 1000
Hz, 6000 Hz, 2000 Hz and 4000 Hz frequencies respectively. After the treatment,
mean hearing gain was determined 10.316.9 dB (-20 dB as minimum and 62 dB as
maximum gain) in this study.
Conclusion: HBO therapy and combined systemic steroids are to be recommended in
patients with hearing loss, especially at low frequencies.
Correspondence:
Doc.Dz.Tbp.Alb.Senol YILDIZ
Gulhane Askeri Tip Akademisi, Sualti Hekimligi ve Hiperbarik Tip AD.,Ankara,
TURKEY.
Tel:
+ 90 312 304 4791
Fax: + 90 312 304 2700
GSM: + 90 536 655 3855
E-mail:seyildiz@gata.edu.tr

PP086

NON-COMPLIANCE IN THERAPEUTICAL TREATMENT OF PATIENTS ON

DIALYSIS AND KIDNEY TRANSPLANTATION
Author(s): LTJG Athanasios KALOGEROPOULOS MD, 4th grade student
KALOGEROPOULOU Maria, RN, LTJG Theodoros LOUTAS RN
Institution: Nursing Department, University of Athens, Athens,
GREECE
Purpose: Lack of compliance to treatment is observed in almost half of patients
suffering from chronic diseases. The same is true for patients with chronic renal failure
who undergo dialysis or have undergone a successful kidney transplant. Noncompliance is associated with increased mortality and morbidity and cost of care. The
initial purpose is to highlight the factors affecting compliance in the treatment of
patients on dialysis and kidney transplantation and strategies to tackle this problem.

140

3rdJUNE2011

Material and Methods: Systematic review of the literature databases Cochrane, pub
med and Cinahl for the period 2000-2011.
Results: The factors associated with poor compliance to medication and overall
treatment are: the complexity of treatment, fatigue, young age, lack of motivation, low
socioeconomic status, lack of family and social support, the cost of drugs, reduced
patient's perception of the benefits of treatment and lack of education and information
to patients by health professionals. To improve compliance have been proposed
various strategies such as simplification of the regimen, education and close
monitoring of patients by nurses.
Conclusions: Nurses must take into account all those factors associated with
compliance to treatment in order to plan the care of patients. The improvement
compliance of patients with chronic renal failure undergoing one of the methods of
renal function, particularly in dialysis and kidney transplantation, to the treatment is
achieved largely through nursing education programs.
Correspondence:
1st Lt Athanasios KALOGEROPOULOS MD,
+30 6937029665,
kardamyla.chios@gmail.com
PP087

THE VALUE OF MUSCULOSKELETAL ULTRASONOGRAPHY IN DIAGNOSIS

AND DISEASE PROGRESS OF RHEUMATOID ARTHRITIS.
Author(s): LTJG P. ELLINAS MD1, LTJG S. PAPADAKIS MD1, LTJG N. SAKARIDIS
MD1, LCDR G. KATSIFIS MD, PhD2
Institutions: 1. Radiology Department, Naval Hospital of Athens,
2. Rheumatology Clinic, Naval Hospital of Athens,
GREECE
Purpose: Within the last decade, musculoskeletal ultrasonography (US) is playing an
important role in the evaluation and monitoring of patients with rheumatoid arthritis
(RA). US has been proven to be a sensitive and reproducible method in assessing
rheumatoid joint inflammation. Our aim was to estimate the value of musculoskeletal
US in detecting synovial changes in RA patients in every day clinical practice.
Materials and Methods: During the last 6 months, we performed musculoskeletal US in
23 RA patients. The patients were in variable disease stages (early to advanced) and
treatment protocols including corticosteroids, DMARDs and anti-TNF agents. The
examined joints were primordially the inflamed wrists and secondary the hands, knees
and ankles.
Results: High-resolution gray scale US allowed direct assessment of intra-articular and
peri-articular inflammatory activity and structural damage. Early manifestations were
joint effusion, subclinical synovial hypertrophy and tenosynovitis. In late disease,
tendon and ligament lesions, bone erosions and articular cartilage damage were
observed. Power Doppler US technique detected synovial flow, which is a sign of
increased synovial vascularization. The presence of an intra-articular Doppler signal
aids to distinguish active synovitis from inactive intra-articular thickening. Interestingly,
US proved to be more sensitive than conventional radiography in the detection of bone
erosions, especially in early disease.
Conclusion: High resolution gray scale and power Doppler US of the joints, is an
inexpensive, quick and - in experienced hands - effective and valuable tool for early
detection of inflammatory synovial changes in RA, estimation of disease activity and
response to treatment.
Correspondence: LTJG Panos ELLINAS, MD

141

3rdJUNE2011

Tel: +30 210 7261092, +30 210 7261127,

Mob: +30 6944 470770
E-mail: pae13673@hotmail.com
PP088

THE ANALYSIS OF NON-THROMBOEMBOLIC FINDINGS ENCOUNTERED IN

MULTIDETECTOR COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY
STUDIES IN PATIENTS WITH SUSPECTED PULMONARY EMBOLISM
Authors: MAJ BATTAL Bilal, MD1, MAJ KARAMAN Bulent, MD1, MAJ GUMUS
Seyfettin, MD2, CPT AKGUN Veysel, MD3, LTC BOZLAR Ugur, MD1, COL TASR
Mustafa, MD1
Institutions:
1 Gulhane Military Medical Academy, Department of Radiology, 06018, Ankara,
2 Gulhane Military Medical Academy, Department of Chest Disease, 06018, Ankara,
3 Golcuk Military Hospital, Department of Radiology, 41650, Kocaeli,
TURKEY
Objective: The aims of this study were to determine the frequency of pulmonary
embolism in patients evaluated with multidetector computed tomography (MDCT)
pulmonary angiography for suspected pulmonary embolism, and to analyze other
MDCT findings that contributed to the diagnosis and treatment in these patients.
Material and method: A total of 223 patients (128 male, 95 female, mean age: 58.6)
who underwent MDCT pulmonary angiography for suspected pulmonary embolism
between December 2009 - November 2010 were included in the study. Pulmonary CT
angiography studies were performed with 64-detector MDCT device using 70-100 ml
of non-ionic iodinated contrast material. CT images of all patients were reviewed
retrospectively. All findings that may be associated with symptomatology or detected
incidentally in patients were recorded.
Results: 11.7% of the patients (26/223) had pulmonary embolism. In 154 of the 197
(78.2%) patients who had no pulmonary embolism, imaging findings related the
symptoms and clinical findings (62.5%) or unrelated incidental findings (37.5%) were
detected in lungs mediastinal structures, chest wall or upper abdominal organs. The
most common imaging findings were lung infiltration-consolidation (15.1%), atelectasis
(13.5%) and pleural effusion (13.1%). There were no findings at MDCT pulmonary
angiography in forty-three (21.8%) patients.
Conclusion: While majority of the patients evaluated with MDCT pulmonary
angiography for suspected pulmonary embolism had no pulmonary embolism, various
data that explains symptoms and clinical findings or that is unrelated with the clinical
situation can be determined on MDCT pulmonary angiography images in these
patients. Therefore, careful examination of the structures other than pulmonary
vasculatures in the field of view and the correct interpretation of these findings in
MDCT pulmonary angiography images are also important for accurate diagnosis and
management of the patients.
CORRESPONDENCE
Gulhane Military Medical Academy, Department of Radiology, 06018, Ankara, Turkey
+ 90 312 3044701
+ 90 312 3260551
+ 90 533 4330667
e-mail: bilbat_23@yahoo.com

142

3rdJUNE2011

PP089

THE RELATIONSHIP BETWEEN SYMPTOM CLUSTERS OF POSTTRAUMATIC

STRESS DISORDER AND PROFESSIONAL EXPERIENCE
Authors: 1LT BOLU Abdullah, MD1, MAJ CELK Cemil, MD2, 1LT AKARSU
Suleyman, MD1, SINICI Ebru, Psiycho.2, MAJ OZDEMIR Barbaros, MD1, CAPT
OZMENLER Kamil Nahit, MD1
Institutions: 1 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara,
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military Psychology
and War Psychiatry, Ankara,
TURKEY.
Objective: It is known that multiple factors play a role in the occurrence of Post
Traumatic Stress Disorder and to determine the severity of the disease.In this study
we aimed to investigate the relationship between symptom clusters , and severity of
illness in PTSD patients with time spent in the profession
Material and method: According to DSM-IV diagnosis of PTSD, 38 patients enrolled in
the study whose type of trauma experienced, the nature and number of past trauma
were similar. Patients were divided into two groups,according to the professional
experience 5 years and above, and less than 5 years. IES-R between the two groups
in total and subscale scores were compared with t test.
Results: Both groups were evaluated for IES-R scores and found statistically
significant difference between IES-R, over-arousal score (t=3.07, p= 0.01) and ES-R
avoidance scores (t= 2.61, p=0.01) .Professional working in less than five years, while
higher scores of the group's over-arousal, over more than five years of professional
experience and avoidance scores were higher in the group. Also it is detected that
year career with the IES-R scores were negatively correlated with over-arousal scores.
(p<0.05, r=0.37)
Conclusion: Not all people who live a similar traumatic event are developed PTSD .At
the same time when disease occurs, the distribution of symptoms and the severity of
the disease varies from person to person. The results of this study suggest that
professional experience also plays an important role in determining this difference.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
+ 90 312 3044501
+ 90 312 3044507
+ 90 505 4346744
e-mail: drcemilcelik@yahoo.com

143

3rdJUNE2011

PP090

EFFICACY OF PAROXETINE AND AMITRIPTYLINE IN COMBAT RELATED

POSTTRAUMATC STRESS DISORDER: AN OPEN-LABEL COMPARATIVE STUDY
Authors: MAJ CELK Cemil, MD1, MAJ OZDEMIR Barbaros, MD1, CAPT OZMENLER
Kamil Nahit, MD1, CPT YELBOGA Zekeriya, MD2, CPT BALIKCI Adem, MD3, COL
DORUK Ali, MD4, COL BOZKURT Ali, MD4
Institutions:
1 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military Psychology
and War Psychiatry, Ankara, TURKEY.
2 Sivas Military Hospital, Dept. of Psychiatry, Sivas, TURKEY
3 Samsun Military Hospital, Dept. of Psychiatry, Samsun, TURKEY.
4 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara, TURKEY.
TURKEY
Objective: To evaluate the efficacy of amitriptyline and paroxetine in soldiers with
combat-related post traumatic stres disorder (PTSD).
Material and method: Fifty patients who were admitted to Glhane Military Medical
Academy Psychiatry Inpatient Clinic and who were diagnosed as chronic PTSD were
enrolled. The primary outcome measures for the study consisted of the 17-item total
severity score of the Clinician-Administered PTSD Scale (CAPS), and the investigatorrated Clinical Global Impression (CGI-S) and CGIImprovement Scale (CGI-I).
Patients were randomized to 12 weeks of treatment with either paroxetine (25
patients) or amytriptyline (25 patients). Twenty-two patients from paroxetine group and
20 patients from amytriptyline group completed the study protocol.
Results: Treatment response rates for paroxetine and amitiptyline was 31.8% and
55%, respectively. While there was a significant difference for CAPS-2 total score and
anxiety score changes between the groups, no statistically significant difference was
found for CGI severity, CGI progress and change in depression scores.
Conclusion: Both amytriptiline and paroxetine seem to be effective in the treatment of
combat related PTSD cases.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
+ 90 312 3044501
+ 90 312 3044507
+ 90 505 4346744
e-mail: drcemilcelik@yahoo.com

PP091

EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR)

APPLICATIONS FOR COMORBID MAJOR DEPRESSIVE DISORDER AND
POSTTRAUMATIC STRESS DISORDER: AN RETROSPECTVE STUDY
Authors: MAJ CELK Cemil, MD1, SINICI Ebru, Psiycho.1, MAJ OZDEMIR Barbaros,
MD1, BOLU Abdullah, MD2, CPT AKCAY Bulent, MD2, CPT BALIKCI Adem, MD3.
CAPT OZMENLER Kamil Nahit, MD1
Institutions:1 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military
Psychology and War Psychiatry, Ankara, TURKEY.
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara, TURKEY.
3 Samsun Military Hospital, Dept. of Psychiatry, Samsun, TURKEY.
TURKEY
Objective: Posttraumatic stress disorder (PTSD) and major depression occur
frequently following traumatic exposure, both as separate disorders and concurrently.

144

3rdJUNE2011

Eye movement desenstzaton and reprocessng (EMDR) has been considered the
most effective treatment for PTSD. We examined the effect of EMDR in patients with
co-occurring major depression and PTSD.
Material and method: Six patients with co-occurring major depression and PTSD at
Psychiatry Department of Gulhane Military Medicine Faculty between January 2009January 2011 were evaluated retrospectively. We compared the pretreatment and the
posttreatment symptoms using the Beck Depression Inventory (BDI), Beck Anxiety
Inventory (BEA) and the The Impact of Event Scale (IES).
Results: There was no statistically significant difference the total IES scores, IES
ntrusion scores, IES avoidance scores, IES hyperarousal scores, BDI and BAI scores
before and after treatment.
Conclusion: EMDR therapy may not be an effective treatment for patients with
refractory depression and co-occurring PTSD.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
+ 90 312 3044501
+ 90 312 3044507
+ 90 505 4346744
e-mail: drcemilcelik@yahoo.com
PP092

PSYCHIATRY AND PSYCHOLOGY ASSESSMENT FOR PATIENTS WITH LIVER

CIRRHOSIS INDICATED FOR A LIVER TRANSPLANTATION
Authors: DIMITROVA M., DONCHEV T.
Institutions: Clinic of psychiatry Military Medical Academy, Sofia,
BULGARIA
Background: Liver cirrhosis is a chronic condition which often leads to death. Different
subtypes are identified according to the etiology of the process. Patients in the present
study suffer from either biliary cirrhosis, Hep. B, or toxic hepatitis due to alcohol
abuse.
Methodology: This is a follow-up study including 30 patients from 2010 with
decompensate cirrhosis, participating in an assessment program on their eligibility for
a liver transplantation. Participants are psychologically and psychiatrically assessed
with a semi-structured interview. We also apply Zungs depression screening test as
well as a self-rating questionnaire for social adaptation (Weissmans version).
Results: According to the results - 54% of patients suffer from either Hep. B. The
patients find it difficult to accept decease, because they do not know how and when
they were taken illness.
The patients share their feelings of lifes unfairness. The bigger part of patients are not
able to talk about their decease, death, life after transplantation.
Conclusions: We focus on the problems related to the giving of bad news, as well as
emotional support and alternative therapeutic measures such as a last chance of life.
Keywords: liver cirrhosis, hepatitis B, alcohol abuse, liver transplantation

145

3rdJUNE2011

PP093

LONG TERM RESISTANCE RATES WITH LAMIVUDINE MONOTHERAPHY IN

TREATMENT NAIVE CHRONIC HEPATITIS PATIENTS IN TURKEY
Authors:BG EYIGUN Can Polat, MD1, MAJ GUNAL Emine, MD1, ARI Alpay, MD2,
COL AVCI Ismail Yasar, MD1, SIRMATEL Fatma MD3, COL GUL Hanefi Cem, MD1,
ERSOZ Fliz PhD4.
Institutions:
1 Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy,
Ankara,
2 Infectious Diseases and Clinical Microbiology, State Hospital, Izmir,
3 Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University, Bolu,
4 Operation Researches Department, Turkish Military Academy Defense Science
Institute, Ankara,
TURKEY
Objective: As is well-known, encounter rate with antiviral resistance in lamivudine
monotheraphy is very high reaching to near 76% at the end of 5th year of therapy. The
aim of this study is to display long term results of resistance to lamivudine
monotheraphy in treatment naive Turkish patients.
Material and method: Antiviral naive 175 [54 females (30,9%)] patients treated with
lamivudine monotherapy were evaluated prospectively with participation of three
therapy centers in Turkey.Serum HBV DNA and ALT levels were monitored monthly
until normalization then checked quarterly. When serum HBV DNA level re-emergence
up to measurable plasma levels or permanent increase was observed in normalised
ALT or decreased HBV DNA levels under the treatment, lamivudine resistance was
implied and investigated.
Results: The mean age of the patients was 43,3413,7 years. At the start of therapy,
56 cases were HBeAg positive(32%) while 119 patients were Anti-HBe positive(68%).
At the end of median 225 weeks (min 27, max 646) follow-up period, distribution of
lamivudine resistance by years was shown in HBeAg positive and Anti-HBe positive
patients (Table 1,2). Long term resistance rates in treatment naive chronic hepatitis B
patients in Turkey with lamivudine monotheraphy were found very high (At the end of
3th year resistance rate in Anti-HBe positive cases is 54,2% versus 87% in HBeAg
positives; at the end of 5th year 77,8% versus 92,6%; at the end of 10th year, %98,7
versus %100).
Conclusion: These results show that although its cost-effectiveness and safety for
adverse effects, long term lamivudine monotheraphy isnt available in Turkey even in
Anti-HBe positive cases especially after 3th year duo to resistance.
Correspondence:
Emine GUNAL
Gulhane Military Medical Academy, Ankara, TURKEY
Tel
: + 90 312 304 4306
GSM : + 90 505 233 5296
e-mail : egunal@gata.edu.tr
This abstract has been presented in the 21st Conference of the Asian Pacific
Association for the Study of the Liver (APASL) on 17-21 February in Bankang,
Tayland.

146

3rdJUNE2011

PP094

SANITARY-CHEMICAL EXPERTISE OF FOODSTUFF AND DRINKING WATER IN

DISASTER SITUATION AND MISSIONS OF BULGARIAN MILITARY
CONTINGENTS
Authors: HRISTOVA KR., ARSOV V., VULOV N.
Institutions:
Medical Intelligence Ward, Chair Disaster Medicine and Toxicology, Military Medical
Academy, Sofia,
BULGARIA
Purpose: The purpose of the present study is to introduce the point, elements and
organization of the sanitary-chemical (SCE) in conditions of disaster and military
mission.
Materials and metods: the sanitary control represents a complex of organizational,
preventive, sanitary and hygienic-epidemiological measures for protecting the
population against the harmful
effects of the changed due to disaster environment. The final stage of the sanitary
control is the conducting of SCE.
Results: Presenting an algorithm for action of SCE in extraordinary conditions:
medical reconnaissance; taking probes; conducting laboratory investigations; prepare
and deposit an expert conclusion. The used instrumental methods and the necessary
laboratory examinations of contaminated foodstuffs and drinking water are discussed.
Conclusion: SCE of foodstuffs and drinking water is an integral part of medical
protection of population and personnel of missions, when chemical agents and toxins
are used or the last are formed due to the disaster situation.
Key words: sanitary control, sanitary-chemical expertise, medical protection of
population in disaster situations.
Correspondance:
HRISTOVA Krassimira Gencheva
Dipl.Eng., Research Associate 1-sth degree
VMA, Sofia, Bulgaria
E-mail Address: krassimira_hristova@abv.bg
Mob.Tel.: 3592888441929

PP095

METHANOL INTOXICATIONS IN PERSONS WITH ALCOHOL ABUSE

Authors Authors: NEYKOVA L., KANEV K., TRAYKOVA V.
Institutions: Clinic of Emergency Toxicology, MMA Sofia,
BULGARIA
Introduction: The widespread use of methanol in various spheres of manufacturing and
in everyday life predisposes for risks of methanol intoxications.
Aim: In the present study several methanol intoxications, all of persons with an alcohol
abuse are presented including form of development, the clinical symptoms and the
prognosis.
Material and Method: The retrospective research is for the period January 2007
February 2011 and is carried out in the Clinic of Emergency Toxicology at Military
Medical Academy (MMA) Sofia.
Results: 5 patients are described, all male with age diapason between 20 and 61,
mean age 47.4. In 3 of them apart from methanol by toxi-chemical analysis ethylene
glycol was found, in one methanol and ethanol and in one only methanol. At
hospitalization four patients were without a loss of consciousness while one was in a

147

3rdJUNE2011

deep coma. At the same time two of the patients (1 with methanol and 1 with ethylene
glycol and methanol) were hospitalized with a delay of 18 and respectively 6 hours.
During that period no antidote or other specialized therapy was carried out. The lethal
period at methanol intoxications is from 1 to 72 hours. This allows for the full
development of the methanol toxicity and makes the treatment of those patients harder
and more expensive. It is important to emphasize that the coincidence of heavy
metabolic acidosis and coma provides a pessimistic prognostics.
Conclusion: The methanol intoxications provokes sharp metabolic acidosis that could
lead to death or to lasting disabilities while the presence of ethanol in the blood plays a
benign role reducing the harmful effects of the methanol.
The timely start of specific treatment: extra corporal depuration, antidote, specialized
renoprotective, and symptomatic therapy at the combined and the isolated methanol
intoxications, taking into account the pathogenesis mechanisms and the clinical stages
of development in the organism help for the full recovery of the organism.
Key words: methanol, persons with alcohol abuse, metabolic acidosis.
PP096

CASE REPORT: MULTIPLE HEPATIC ABCCESES IN A COMPLICATED

CHRONIC PANCREATITIS
Authors: Col. Dr. Florentina IONITA-RADU, Dr Bianca CHEAIB, Dr Aida RASCANU,
Mj. Dr. PATRASESCU M.
Institutions:
Central University Emergency Military Hospital Carol Davila
2nd Department Of Internal Medicine, Bucharest,
ROMANIA
Introduction : Chronic pancreatitis can be associated with a variety of complications.
The most common are pseudocysts formation and mechanical obstruction of the
duodenum and common bile duct, less frequent complications include pancreatic
ascites or pleural effusion, splenic vein thrombosis with portal hypertension,
pseudoaneurysm especially in the splenic artery.
Case presentation: A 43 years old male patient, known with type 2 insulinonecesitant
diabetes mellitus since 1998, is admitted in our Department in 2005, for chronic
digestive distress. He was diagnosed with pseudotumoral chronic pancreatitis,
complicated with obstructive jaundice due to common bile duct stenosis and stenosis
of the upper digestive tract, for which a duodeno-choledoc-jejunostomy anastomosys
was performed, with favorable post-operatory evolution.
In 2008 the patient developed portal vein thrombosis and stenosis of the duodenum
due to extrinsic compression, requiring surgical reintervention and carrying out a
Roux-en-Y gastric bypass anastomosis. Postoperatory, the patient developed a
subphrenic abscess that required additional therapeutic maneuvers.
In 2010 the patient has had persistent state of feverishness for which he was
investigated thoroughly, raising the suspicion of multiple liver abscesses secondary to
repeated episodes of angiocholitis, confirmed through guided ultrasonography.
Conclusion: Despite the fact that the patient is young, without risk factors and good
evolution the case stands out through the multiple complications of chronic
pseudotumoral
pancreatitis
with
relatively
fast
progression.
Contact : Col. Florentina Ionita-Radu, Chief Of 2nd Department Of Internal Medicine,
Central University Emergency Military Hospital Carol Davila Bucharest, Romania
fionita04@yahoo.com, tel + 40722232606, fax +40213193047

148

3rdJUNE2011

PP097

REVERSE VACCINOLOGY AND DNA VACCINES

Authors Sran LAZI, Sonja RADAKOVI*, Novica STAJKOVI, Radovan
EKANAC, Milena KRSTI, Slavica RAEN*, Jovan MLADENOVI, Jadranin
ELJKO
Institutions:Military Medical Academy, Department Of Preventive Medicine, Institute Of
Epidemiology, *Institute Of Hygiene,
SERBIA
Expansion of molecular biology and genetics, and the use of up to date softwares
allowed us new approaches in the development of vaccines. One of these new
concepts, termed reverse vaccinology, includes the investigation and selection of
vaccine candidate by sequencing and function analyzing of microbe,s genome by
molecular genetics techniques and bioinformatics (in silico), without the need for
cultivating the pathogen. The use of recombinant DNA technology (genetic
engineering) is the ancestor of this concept. We use this method in the production of
vaccine against hepatitis B, the vaccine with proven high eficacy and safety.
The application of reverse vaccinology for the first time was used in the development
of vaccine against group B Neisseria meningitidis, the major cause of sepsis and
meningitis in young children. DNA fragment were screened using computer analysis to
select surface proteins with predicted protective role. Further analysis revealed 29 new
protective antigens which were tested as vaccine candidates. Today this approach is
used for the investigation of vaccines against some other pathogenic agents
(Streptococcus pneumoniae, Porphyromonas gingivalis, Staphylococcus aureus,
Chlamydia pneumoniae i Bacillus anthracis).
DNA (gene-based) vaccines contain gene which, after inoculating into the host,
encodes the production of antigen and, therefore, stimulates adaptive immunity.
Advantages of these vaccines are: good humoral and/or celular immune response,
high specificty and safety, stability at room temperature, and low-cost production.
Limitations are: weak immune response in humans and uncertainties about long-term
effect of foreign genetic material. The application of new technologies, such as
nanotechnology, allows effective administration of DNA vaccines by micro and
nanoparticules in the forms of polymers, emulsions, immunostimulating complexes or
virosomes. So they could be adminstered by various routes: intramuscular,
intradermal, epidermal (gene gun), epimucosal, by attenuated viruses as vectors,
and by prime-boost scheme.
Great attention is focused on the investigation, development and fine-tuning of these
vaccines that may be used for preventive and therapeutic purposes against infectious
and non-infectious diseases such as malignant, autoimmune and alergic disorders.
Two DNA vaccines are already licenced for the prevention of animal infectious
diseases, whereas in human medicine clinical trials of these vaccines against HIV,
dengue, influenza, and various carcinomas are now carried out.
Conclusions: There is no doubt that these new strategies and methodologies in
vaccines development will augment chances for successful fighting against many
diseases that represents remarkable burden for humankind.

149

3rdJUNE2011

PP098

STEMI PROGRAM EXPERIENCES OF EMERGENCY DEPARTMENT IN

EVALUATION OF MYOCARDIAL INFARCTION
Authors: cpt. Mihai TOMA, MD; cpt. Alexandru BUTOI , MD; cpt. Florin FANEA, MD;
lt.col. Bogdan TEUSDEA, MD, EMDM, PhD ; Liliana POTERASU, MD.
Institution: Central Clinical Emergency Military Hospital Dr. Carol Davila
Emergency Department, Bucharest,
ROMANIA
Key words: STEMI.
Abstract: ST-elevation myocardial infarctions (STEMIs) remain a significant healthcare burden, with thousands of patients presenting to Emergency department each
year. The national program STEMI includes all management steps at the onset of
STEMI, including: recognition, pre-hospital and emergency department management,
in-hospital management, risk stratification, secondary prevention and long-term
management.
This presentation is about the experiences of Emergency Department of SUUMC in
evaluation of STEMI myocardial infarction.
Contact :Email: iahim_t@yahoo.com

PP099

ACUTE STRESS DISORDER FOLLOWING TRAFFIC ACCIDENT: APPLICABILITY

OF AN INTERVENTIONAL METHOD
Authors: SINICI Ebru, Psiycho.1 ,ERDEN Glsen, Psiycho. 2, MAJ KILIC Erden, MD3,
1LT BOLU Abdullah, MD1, MAJ CELK Cemil, MD1.
Institutions:
1 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara, TURKEY.
2 Ankara University, Dept. of Psychology, Ankara, TURKEY.
3 Gulhane Military Medical Academy, Dept. of Emergency, Ankara, TURKEY.
TURKEY
Objective: This study investigated the effect of the interventional method of Eye
Movements Desensitization and Reprocessing (EMDR) on symptoms of Acute Stress
Disorder following traffic accidents.
Materal and method: Research is about 30 volunteers who had treatment at GATA
Department of Orthopedics and Traumatology Clinic for acute stres disorder after
traffic accident between 2007 and 2008 years. We use Symptom Check List 90Revision, State-Trait Anxiety Inventory-I and Beck Depression scale. EMDR is made
with touch and sound vibration apparatus. We apply EMDR right after and then
applicate same process after 1 week and 1 month. We applicate vibration to right and
left hand with 9 volt applicator.
Results: We discriminate significant difference between preEMDR scores and
postEMDR score.
Conclusion: As a result we decided that EMDR technic is effective for acute stres
disorder symptoms and our resarch is proving that conclusion.
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
+ 90 312 3044501
+ 90 312 3044507
+ 90 532 3716475
e-mail: esinici@gmail.com

150

3rdJUNE2011

PP100

POSTTRAUMATC STRES DSORDER AND EYE MOVEMENT DESENSITIZATION

AND REPROCESSING (EMDR): 2 CASE REPORT
Authors: SINICI Ebru, Psiycho.1, 1LT BOLU Abdullah, MD1, MAJ CELK Cemil, MD2,
CAPT OZMENLER Kamil Nahit, MD2
Institutions: 1 Gulhane Military Medical Academy, Dept. of Psychiatry, Ankara,
2 Gulhane Military Medical Academy, Dept. of Psychiatry, Dept of Military Psychology
and War Psychiatry, Ankara, TURKEY.
TURKEY
Objective: Eye movement desensititaion and reprocessing (EMDR), is an psychologic
procedure used in treatment of affectivity disorders which caused by disturbing
experiences lived in childhood, wartime, time of disaster or abusement besides
problems such as chronic pain, panic disorder, performence anxiety. In this study we
aimed to share the results of two PTSD patients EMDR treatment.
First Case; First case was 22 years old. Seven months ago during his military service
he had an mine injury. Patients left leg was amputated below the knee, right leg above
the knee and since then he have been suffering from sleeping disorders, flashbacks
and anxiety. Treatment was 60 minutes session. After the third set he started laughing.
After the next three sets he used the phrase I can handle everything. After 8 sets
SUD decrased to zero.
Second Case; The second case was 32 years old. 8 months ago he had an left knee
desarticulation operation due to mine injury. Since then severe angerness, sleep
disorders, loss of appetite and flashbacks. Treatment was 90 minutes session. His
subjective unit of disturbance (SUD) was 10. After 18 sets he used the phrase I trust
myself and I can handle everything..
Conclusion: In our study measurements of SUD values betwwen the beginning and
end are very clear. EMDR is seemed to be very strong in the treatment of the PTSD
patients. Low number of patients may be limitation of the study. As a result our study is
compatible with other EMDR researches in the literature
Correspondence:
Gulhane Askeri Tip Akademisi, Psikiyatri AD, Etlik 06018, Ankara, TURKEY.
+ 90 312 3044501
+ 90 312 3044507
+ 90 505 4346744
e-mail:drcemilcelik@yahoo.com

PP101

DISEASE AND NONBATTLE INJURIES, EASY TO MANAGE?

Authors: CPT YAVAS Umit, MD1, LTC CETIN Mehmet, MD1.
Institutions: 1 Gulhane Military Medical Academy, Dept. of Military Health Services,
Ankara,
TURKEY
Objective: The purpose of this study is to determine the most common causes of
disease and nonbattle injuries and to present the methods for managing them.
Material and method: The PubMed and EBSCOhost databases were searched for
published articles between 1980 and January 2011, using the following keywords:
dnb, disease and non battle injuries in titles and abstracts. Seventy seven articles
were obtained and the articles were reviewed.
Results: Most of the modern armies are currently transforming in to smaller and more

151

3rdJUNE2011

mobile armed force to meet the demands of the 21st century. This reduction in size
has subsequently placed greater importance on the individual combatant. Although
combat-related injuries are often the most severe and dramatic health risks
encountered during wartime, disease and nonbattle injuries (DNBI) are more common.
DNBI casualty care statistics are dependent on many intrinsic and extrinsic factors for
example, the intensity of combat, type of unit, branch of military service, presence of
endemic diseases, climate, environment and duration of deployment. Higher DNBI
casualty rates have been reported during increased combat intensity but there have
been mixed results when comparing combat versus combat support or combat service
support units. Comparing ranks, deployment periods, unit sizes, ship types and
genders there have been mixed results also. This study documents that when the
literature is reviewed the importance of DNBI can be clearly seen.
Conclusion: This study documents that when the literature is reviewed the importance
of DNBI can be clearly seen.
Correspondence:
CAPT. Umt YAVAS
Gulhane Military Medicine Academy, Department of Military Health Services,
Etlik 06018, Ankara, TURKEY.
Tel
: +90 312 3043359
GSM : +90 505 6462956
e-mail: umit2502@hotmail.com
PP102

TRIAGE, BUT HOW?

Authors: CPT YAVAS Umit, MD1, MAJ TURK Y.Ziya, MD1
Institutions:1 Gulhane Military Medical Academy, Dept. of Military Health Services,
Ankara, TURKEY
Ojective: The purpose of this study is to determine the lessons learned about triage
activities for mass casualty incidents and to examine the approaches.
MATERIAL AND METHOD
The PubMed and EBSCOhost databases were searched for published articles
between January 2001 and January 2011, using the following keywords: disaster,
mascal, triage in titles and abstracts. Two hundred and nineteen articles were
obtained and reviewed.
Results: Disaster preparedness has become an important issue in recent years. The
medical management of a mass casualty incident or a disaster relief operation
includes many difficulties in its nature. Some of these difficulties are: flow of high
numbers of patients to treatment facilities, damaged infrastructure and healthcare
system, limited medical personnel, inadequate medical sources, etc. Triage is the
categorizing of a patients healthcare requirements by evaluating the severity of the
illness or injury. The goal is to achieve the greatest good for the greatest number of
casualties. When the literature is reviewed it can be seen that there are different
approaches about triage. Different incidents force the medical personnel to drive
different management options. Triage conducted while under hostile fire is different
from triage at the scene of an aircraft accident and different again from which is
performed by a medical team in the emergency department of a hospital.
Conclusion: This study documents that when the literature is reviewed for decreasing
the rates of deaths after MASCAL incidents, the importance of an appropriate triage
can be clearly seen.

152

3rdJUNE2011

Correspondence:
CAPT. Umt YAVAS
Gulhane Military Medicine Academy, Department of Military Health Services,
Etlik 06018, Ankara, TURKEY.
Tel
: +90 312 3043359
GSM : +90 505 6462956
e-mail: umit2502@hotmail.com
PP103

INFECTIOUS AGENTS DETECTED WITH WOUND CULTURE IN DIABETIC FOOT

ULCER.
Authors: CPT METIN Suleyman, MD1, LTJG KARAKUZU Engin, MD2, CAPT YILDIZ
Senol, MD2, CPT CAKMAK Tolga, MD1.
Institutions:
1Gulhane Military Medical Academy, Dept. of Aerospace Medicine, Eskisehir,
TURKEY.
2Gulhane Military Medical Academy, Dept. of Underwater and Hyperbaric Medicine,
Ankara, TURKEY.
Objective: Diabetic foot ulcers may harbour a large spectrum of infectious agents
which are generally resistant to antibiotherapy. We aimed to review the infectious
agents detected with wound culture in patients with diabetic foot ulcer, who was
admitted to our center for hyperbaric oxygen (HBO) treatment.
Material and method: Data from 30 patients were analyzed retrospectively. Wound
cultures were obtained before starting antibiotic therapy and HBO treatment. The
wounds were graded according to Meggitt-Wagner classification system The number
of HBO sessions, glycemic control and treatment results were evaluated for all
patients.
Results: A total of 30 patients (18 male and 12 female) were included. Mean age of the
patients were 61.3 years (range: 35-83). 14 different infectious agents were detected
in diabetic foot ulcers that we examined. Pseudomonas aeruginosa was predominantly
isolated, while the other agents like Enterococcus faecalis, Klebsiella pneumoniae,
Staphylococcus aureus and Eschercia coli.
Conclusion: Appropriate antibiotics must be started after the wound culture result and
simultaneously with the HBO treatment is very important. The results of the study will
give us an idea about the infectious agent spectrum probability in diabetic foot ulcers.
Correspondence:
Doc.Dz.Tbp.Alb.Senol YILDIZ
Gulhane Askeri Tip Akademisi, Sualti Hekimligi ve Hiperbarik Tip AD.,Ankara,
TURKEY.
Tel:
+ 90 312 304 4791
Fax: + 90 312 304 2700
GSM: + 90 536 655 3855
e-mail: seyildiz@gata.edu.tr

153

3rdJUNE2011

PP104

CORELLATION OF SPINAL MOBILITY WITH ACUTE PHASE REACTANTS IN

PACIENTS WITH ANKILOSING SPONDYLITIS
Authors: Daniela ANGHEL1, Dr. Mihai MURESAN, Dr. Lucian CIOBICA1, Cristian
ANGHEL2
Institutions:
1st Medical Departament, Universitary Military Hospital ,,Carol Davila, Bucharest,
Physical Medicine and Rehabilitation Departament, ,,Constantin Angelescu Hospital,
Bucharest,
ROMANIA
Background: Spinal mobility apreciated by BASMI (bath ankilosing spondylitis moblility
index) measures combination of structural damage and disease activity in subjects
with active ankilosing spondylitis. Elevated serological markers of disease activity such
as CRP (C reactive protein) have been corelated with C-propetide of type II colagen.
The latter biomarker has been implicated in progressiv bone formation and resultant
restrictions in mobility.
Objectives: The aim of this study was to explore the relationship between CRP and
spinal mobility at pacients with ankilosing spondylitis.
Methods: BASMI and CRP were measured at regular intervals at subjects with active
ankilosing spondylitis who were randomised to treatment with infliximab (IFN) 5 mg/kg
(week 0, 2, 6 and 8) or sulfasalazin (SSZ) 4 g daily. The corellation between change of
BASMI and CRP was analyzed at final visit (week 24). The covariated in the model
included age, disease duration, gender, baseline of BASMI and CRP levels.
Results: At baseline there were no significant differences between treatment groups in
either BASMI (INF: 3,6; SSZ: 3,4) or CRP (IFN: 20,01; SSZ: 17,4). At week 24, were
observed a significantly greater improvements in IFN group for both BASMI (INF:
280/0; SSZ 110/0) and CRP (IFN: 710/0; SSZ: 160/0 ). Gender and disease duration
were statistically insignificant in the regression models but age had a negative effect
on BASMI improvement (smaller for older subjects).
Conclusion: Our study suggest that improvement in CRP and treatment with infliximab
is significantly associeted with spinal mobility.

10:00-10:20 COFFEE BREAK (BYZANTINE HALL)

10:20-12:30

ORAL PRESENTATIONS IX
(GOTHIC HALL)
Chairpersons: COL Ozcan ALTINEL, MD (Turkey)
LTC Konstantina GAITANOU, RN (Greece)

OP092

PREHOSPITAL TRAUMA LIFE SUPPORT (PHTLS) PROGRAM IN 251 GENERAL

AIR FORCE HOSPITAL
Author: LTC Alexandra KARVOUNIARI, RN, MSc
Institution: 251 Hellenic Air Force General Hospital,
GREECE
Purpose: The statement of purpose for the PHTLS program in 251 Hellenic Air Force
General Hospital is to provide health care providers with the underlying beliefs that
constitute the foundation of the program. Since 1999, this program is available in 251
General Air Force Hospital for its medical and nursing stuff from an instructor team.
154

3rdJUNE2011

The team is consisted by doctors and nurses who have been trained by the National
Association of Emergency Medical Technicians of USA in cooperation with the
Committee of the American College of Surgeons and the National Center of PHTLS
ATLS (Advanced Trauma Life Support) of Greece in Patras.
Material Method: Data was collected from the training center for Air Force health
personnel, the head of which is in 251 General Air Force Hospital. This training center
is one among a total of eight centers operated in Greece and Cyprus.
Results: Since 1999, a total number of 26 PHTLS training programs are completed.
Health staff of 251 General Air Force Hospital who has been trained so far amounts to
594 people. Duration of each program is 3 days and includes conducting pre-test, oral
presentations, skill stations and final assessment. A percentage of 83% of the students
had a successful course completion, while failure rate in the written examinations and
skill stations was 17%. They latter had the opportunity to repeat the examinations of
which 95% completed the course successfully. Number of PHTLS teachers is 15
persons, 4 doctors and 11 nurses among the total of 102 instructors in Greece and
Cyprus.
Conclusions: PHTLS program is specifically designed for the unique situation in which
the trauma patient presents to the students. It aims to train Air Forces health personnel
so that they can move the patient quickly and efficiently out of the environment of the
emergency and transport him quickly to the appropriate hospital. Health care providers
as rescuers with the proper knowledge must not neglect to do things that could
potentially increase the patients chances for survival. It is their responsibility to
assimilate the knowledge and skills of this program in order to use them for the benefit
of the patients for whom they are responsible.
Correspondence:
LTC Alexandra KARVOUNIARI
(+30) 210 7 46 37 65,
(+30) 698 3 51 13 31
alexkarv@gmail.com
OP093

HEALTH CRISIS MANAGEMENT: PREHOSPITAL AND HOSPITAL SUPPORT IN

MULTIPLE-CASUALTY INCIDENTS
Author(s): CPT Christos OIKONOMOU, RN, Policeman Ioannis SEPENTZIS,
Psychologist
Institution: 401 General Army Hospital of Athens,
GREECE
Purpose: The management of an Emergency Medical System to support a mass
casualty situation in pre-hospital and in-hospital level.
Material and Methods: The literature review has been carried out through the database
of MEDLINE and CINAHL for a time period of the last decade using the key words,
Disaster Medicin, Integrated Incident Management System, Triage.
Results: Specific triage systems should be in place before an incident, and personnel
should be trained and exercised in their use. Simple triage methods include rapid
separation of critical patients from noncritical patients. The overarching principle for
triage is to do the most good for the most people.
Hospitals must have in place a system of coordination with other local hospitals, public
health departments, incident commands and public safety to provide care. Integrated
incident management is critical to preparing for a mass casualty situation and must be
developed prior to any catastrophic event. Training in Disaster Medicine is different

155

3rdJUNE2011

from training in other medical fields. As part of a chain, decision making must be
articulated in every single component: pre-hospital, transport, in-hospital,
communication and coordination & command; the medical stuff must be requested to
familiarize with all these different roles.
Conclusion: Disasters are difficult and stressful situations, requiring maximal effort
from all involved, and no training opportunities. Thus, training in Disaster Medicine
must be based on simulated situations. A state of emergency or disaster typically may
be declared in response to any natural or manmade event or occurrence that
threatens the publics health or safety. Thus, an official such as a Governor, State
health commissioner, army, local mayor, can declare an emergency, depending on the
laws in the jurisdiction
Correspondence:
CPT Christos OIKONOMOU, RN
+30 694 4758627
e-mail: chrisoik@vodafone.net.gr
OP094

3 YEARS STUDY CONCERNING THE RESULTS OF HUMAN FACTORS

ANALYSIS AND CLASSIFICATION SYSTEM, AS A MODEL OF MISHAP
APPROACH-INVESTIGATION IN A HAF AIR BASE.
Author(s): CPT Georgios ALEVETSOVITIS, MD,-FS, CPT Panagiotis KOUSOULIS
MD, FS, LT Vasileios MOUTEVELIS MD, FS
Institution: Aviation Medicine Office-120 Flying Training Wing,
GREECE
Purpose: Statistic analysis of the conclusions concerning Mishap investigations in a
Hellenic Air-Force base since HFACS started being the basic tool for the investigation
teams and comparison with previous mishap foundings before HFACS implementation
Material and Methods: Mishap investigation files of 120 FTW throughout the past 4
years were chosen . The Human Factors that contributed in every mishap, were
gathered classified and statistically analysed
Results: The contribution of all kinds of skill based errors was important with
procedural errors leveling up to 13% and Inadvertant Operation and Checklist Errors
sharing a percentage of 7% each. An important contribution of Supervision failure was
also observed.
Conclusion: 1.The Human Factor seizes to be a general label and takes certain
meaning-interpretation. The new data may contribute in a more efficient way in
revealing accident causation and accident prevention measures.
2.The comparison with previous types of investigation revealed that the pilot as the
final reflection of every mishap seizes to be the basic guilty factor.
Correspondence:CPT Georgios ALEVETSOVITIS MD, FS
galevetsovitis@yahoo.com

156

3rdJUNE2011

OP095

THE RATING OF THE PATIENT'S SATISFACTION FACTORS IN A CLINICAL

HYPERBARIC CENTER
Author(s): CMR Konstantina GAITANOU 1, LT Angeliki CHANDRINOU2, George
FILDISIS, MD, PhD, Prof. George BALTOPOULOS, MD, PhD, Konstantinos
EXARCHOS, MD
Institutions: 1. Medical Directorate, Hellenic Fleet Headquarters
2. Hyberbaric & Diving Medicine Department, Athens Naval Hospital
GREECE
Aim: To investigate the satisfaction of patients, from the provided services of the
Diving and Hyperbaric Medical Units (D.H.M.U) of Naval Hospital in Athens.
Material-methods: This is a descriptive study, which sample is constituted by 91
patients that arrived in the D.H.M.U for Hyperbaric Oxygen-therapy in Naval Hospital
of Athens. For the collection of data an anonymous self-completed questionnaire was
used. The first part contained questions that recorded social-demographic elements,
while second was constituted by questions that investigated the satisfaction of patients
from the DHMU with a five- level Likert scale. The description of data was via the
package of {SPSS for WINDOWS (version 17)}.
Results: In the study 38 women and 53 men participated. The 44% of whom had a
university education and 8,8% had graduated from Public school. The satisfaction of
patients from the provided of D.H.M.U. was up to 85,7% of patients considered the
telephone communication with the D.H.M.U as exceptional, while 87,6% appreciated
prompt the initiating and availability of sessions. Personnel was described by patients
that as polite (94,4%), respectful] (95,6%) and discrete (94,5%). The 92% of patients
understood the importance of abiding by the rules of safety from nurses. In addition,
the organization of therapeutic confrontation was rated from patients as absolutely
satisfactory 90,1%.
Conclusions: The patients rated care and access to the particular D.H.M.U as most
excellent, without pointing out any further ways that would improve and upgrade it.
Correspondence:CMR Konstantina GAITANOU
Mobile: +30 6945938349
Konstantina.gaitanou@gmail.com

OP096

COMPARISON OF HYPERBARIC OXYGEN AND MEDICAL OZONE THERAPIES

IN A RAT MODEL OF EXPERIMENTAL DISTAL COLITIS
Author(s): COL ALTINEL Ozcan MD 1 , LTC DEMIRBAS Seref MD 2 , CAPT CAKIR
Erdinc MD 3 , CAPT YAMAN Halil MD 3 , COL OZERHAN Ismail H. MD1, CPT
DURAN Eyup MD1 , MAJ CAYCI Tuncer MD 3 , MAJ AKGUL Emin O. MD3, LTC
ERSOZ Nail MD1 , MAJ UYSAL Bulent MD4 ,MAJ KURT Bulent MD 5, COL YASAR
Mehmet MD1 , LTC OTER Sukru MD4, BG PEKER Yusuf MD1
Institutions: 1Gulhane Military Medical Faculty, Dept.of Surgery, Ankara
2Gulhane Military Medical Faculty, Dept.of Medicine, Ankara
3Gulhane Military Medical Faculty, Dept.of Medical Biochemistry, Ankara
4Gulhane Military Medical Faculty, Dept.of Physiology, Ankara
5Gulhane Military Medical Faculty, Dept.of Pathology, Ankara
TURKEY
Objective: Previous studies have shown that hyperbaric oxygen (HBO) is effective in
reducing the severity of acute distal colitis (ADC). Ozone therapy (OT) reduces
inflammation in several pathological conditions. We aimed to compare the effects of

157

3rdJUNE2011

HBO therapy and OT in an experimental ADC rat model.

Material and method: Forty rats were randomly divided into four groups: Sham, ADC,
ADC+HBO, and ADC +OT. Rats in the sham group were given isotonic saline. In the
remaining groups, ADC was created by intracolonic administration of 4% acetic acid.
No treatment was given to the ADC group. The rats in the ADC + HBO and ADC+OT
groups were given HBO and ozone treatments, respectively. The administration of
acetic acid caused an inflammatory response in all animals. Distal colons and blood
samples were obtained.
Result: The histopathological score was significantly higher in the ADC group
compared to the other groups. The histopathological scores in the ADC+HBO and
ADC +OT groups were significantly lower compared to the ADC group (both p
0.001). The most pronounced therapeutic effect was observed in the ADC+OT
group. Malondialdehyde and neopterin levels and superoxide dismutase and
glutathione peroxidase activities in the ADC group were significantly higher compared
to the other groups (p0.001).
Conclusion: Our data showed that the therapeutic effect of OT is more pronounced
than
that of HBO therapy. It is possible effect is by means of decreasing inflammation,
edema, and oxidative stress. These findings also suggest that it is possible to improve
the outcome of ADC by using ozone therapy as an adjuvant therapy.
Correspondence:
Glhane Askeri Tp Akademisi, Genel Cerrahi AD, Etlik 06018, Ankara, TURKEY
Tel:
+90 312 304 5023
Fax: +90 312 304 5007
GSM: +90 505 556 7355
e-mail: ozcanaltinel@yahoo.com
OP097

DETERMINING THE HEALTH RISKS OF MILITARY DOCTORS AT THEIR

WORKING ENVIRONMENT
Author(s):MAJ YILDIRAN Nuri, MD, PhD1, COL OZER Mustafa, MD, PhD2, CPT
OZTURK Gultekin, MD2, MAJ TURK Yusuf Ziya, MD, PhD2
Institutions:
1Turkish Armed Forces Medical Command, Ankara,
2Gulhane Military Medical Academy, Dept. of Military Health Services, Ankara,
TURKEY.
Objective: Although the subject of quality of work life has been studied on varied
sectors since 1960s, there isnt enough number of study on health sector, especially
on military doctors. The healthy working conditions is the most effective extent of
quality of work life on human health.
Material and method: At this study close-ended questions about the risks of
threatening the health at working environment asked to 1060 military doctors from 41
different specialities. The branches that have less than 20 members are excepted. So
totally 859 questionnaires are analyzed.
RESULTS: It is established that the highest risk of incident and injury is at emergency
specialists (3.761.22), the highest risk of exposuring to violence is at psychiatrists
(3.581.23), the highest risk of exposuring to chemical and radiation is at radiologists
(4.161.18), the highest risk contaminating with infectious agent is at microbiologists
(4.710.72) and the highest risk of job releated psychological disorders is at
emergency specialists (4.101.14) in 5 point scales. Evaluating of general mean

158

3rdJUNE2011

shows that the lowest healthy working condition level is at emergency

specialists(3.800.97) .
Conclusion: Determining the health risks at occupational environment is important for
choosing the speciality branch, for the administrative arrangements to protect the
military doctors from health hazards, and for regulation additional payment.
Correspondance:
Nuri YILDIRAN
TSK Saglik Komutanligi, NSA Subayi. Bakanliklar 06100, Ankara, TURKEY.
Tel:
+ 90 312 402 4078
GSM: + 90 505 798 5475
e-mail: yildirannuri@yahoo.com.tr
OP098

THE EVALUATION OF CARBON MONOXIDE POISONING CASES TREATED WITH

HYPERBARIC OXYGEN AT GULHANE MILITARY MEDICAL ACADEMY IN 2010
Author(s): CPT METIN Suleyman, MD1, LTJG KARAKUZU Engin, MD2, CAPT YILDIZ
Senol, MD2.
Institutions:
1Gulhane Military Medical Academy, Dept. of Aerospace Medicine, Eskisehir,
2Gulhane Military Medical Academy, Dept. of Underwater and Hyperbaric Medicine,
Ankara, TURKEY.
Objective: We aimed to evaluate carbon monoxide (CO) poisoning cases treated with
hyperbaric oxygen (HBO) in 2010 in our hospital.
Material and method: In the study, the records of patients with carbon monoxide (CO)
poisoning cases treated with hyperbaric oxygen (HBO) in 2010, were reviewed
retrospectively. Cases of poisoning were classified according to the distribution by
month, age and gender characteristics, types of CO sources, COHb levels, number of
sessions of HBO, neurological symptoms, ECG changes and cardiac enzyme levels.
Results: Due to CO poisoning, a total of 155 patients were treated with HBO in our
hospital in 2010. Mean age of the patients were 30.8 20.1 years (range:1-94 years).
Gender characteristics of the patients were 73 (47.1) male and 82 (52.9%) female. In
December, the most common (31 patients, 23.2%), also in February (31, 20%),
January (30, 19.4%) and November (21, 13.5%) were encountered frequently in cases
of poisoning. The mean COHb level was 32.9 11.9 (1.1 to 68.2). The most common
findings on ECG were; tachycardia, ST depressions and ST-T changes. Syncope (47
patients, 30.3%) and loss of consciousness (37 patients, 23.8%), were the most
common neurological symptoms. 149 patients (96.1%) were applied to a single
session of HBO treatment.
Conclusion: In our country, cases of CO poisoning are common in the winter months
because of socio-economic, climatic and geographic reasons. HBO therapy which is
an effective treatment option should be considered in severe cases.
Correspondence:
Doc.Dz.Tbp.Alb.Senol YILDIZ
Gulhane Askeri Tip Akademisi, Sualti Hekimligi ve Hiperbarik Tip AD.,Ankara,
TURKEY.
Tel:
+ 90 312 304 4791
Fax: + 90 312 304 2700
GSM: + 90 536 655 3855
e-mail: seyildiz@gata.edu.tr

159

3rdJUNE2011

OP099

THE KNOWLEDGE OF HYGIENE PRACTICES AMONG NAVY PERSONEL.

Author(s): LTJG Athanasios KALOGEROPOULOS MD, ENS Artemis TRIKOLA MD,
4th grade student KALOGEROPOULOU Maria RN, LTJG Vasileios KALLES MD
Institution: Naval Hospital of Salamis, Salamis,
GREECE
Purpose: The coexistence of many people in small places is a risk factor for infectious
diseases dispersion, like in ships. The aim of this report is to provide an overview of
the knowledge on hygiene practices among Navy personnel, serving on ships, and
potential differences after courses on hygiene practices.
Material and Methods: To achieve this purpose a special questionnaire was prepared
which, in addition to demographic data, contained questions about the degree of
knowledge. The index of knowledge was estimated from a total of 34 questions (221
questionnaires) and was calculated before and after a course on hygiene practices in
the period December 2010 March 2011. Descriptive statistics and multivariable
logistic regression were used for analysis for possible differences depending on
particular characteristics.
Results: Overall hand hygiene knowledge was 20.52 degrees (SD: 3.65). The course
had a significant positive effect 25.39 degrees (SD: 5.14), significant increase p
<0,001. There was a statistically significant difference in hand hygiene after social
contact p = 0.002.There was not found differentiation neither in the way of hand
washing p = 0,77 nor in the habits of when coughing or sneezing (p = 0.12).
Conclusions: Although an increase in the index of knowledge, before and after
completion of the course, was found, some habits seem to be persistent. There is a
need to apply strenuous hygiene courses in order to improve compliance in hand
hygiene and minimize the dispersion of infectious diseases.
Correspondence:
LTJG Athanasios KALOGEROPOULOS MD,
+30 6937029665,
kardamyla.chios@gmail.com

OP100

COMPARISON BETWEEN USING ONLY RIGID CERVICAL COLLAR AND

CERVICAL COLLAR PLUS KENDRICK EXTRICATION DEVICE UPON
MEDEVACUATION FROM AN AICRAFT ACCIDENT SCENE.
Author(s): LT Vasileios MOUTEVELIS, MD, FS, CPT Panagiotis KOUSOULIS, MD,
FS, CPT Georgios ALEVETSOVITIS MD, FS
Institution: Aviation Medicine Office-120 Flying Training Wing
GREECE
Purpose: Analysis of the possibility of changing creating guidelines upon actions
taken by medical personnel ,attributing to the evacuation of an aircraft involved in an
accident, by using cervical collar and KED in order to achieve the best results for the
flying personnel.
Material and methods: A virtual-hypothetical evacuation took place in a flight simulator,
using cervical collar and KED. A Checklist of actions was generated a timing
evaluation also took place.
Results: Since the accident scene provides the appropriate conditions to practice this
kind of safe evacuation it would be safer to implement it as regular guideline in order to
avoid spinal injuries. Conclusion: Although the use of these devices, decreases the
risk for cervical injuries by all bibliographic studies, a pivotal study is needed in order

160

3rdJUNE2011

to examine the ways and methods of practicing this kind of evacuation in all types of
aircrafts.
Correspondence: CPT Georgios ALEVETSOVITIS, MD, FS,
galevetsovitis@yahoo.com
OP101

REACTIVE CHANGES THAT OCCURED IN THE FLYING PERSONNELS BLOOD

SMEAR (BS) PRELIMINARY OBSERVATIONS
Authors: Col. Simona BERBECAR MD, PhD, Simona BERAR MD, NCO Herminia
PSIL RN, NCO Daniela NEAGU RN, NCO Raluca SCHUSTER RN
Institutions:
National Institute of Aerospace Medicine (INMAS)- Clinical Laboratory
Bucharest, ROMANIA
Objective: we started a large clinico-paraclinical prospective study in January 2010 in
INMAS in order to establish the professional adaptive changes which may occur on
flying personnel (FP). This research represents the next step in a previous laboratory
research which we developed in INMAS between 1994 and 2003.
Material and method: we studied untill this moment 408 BS of FP which attended the
periodical medical expertise. We noticed that 117 (28.67%) of them presented various
types of reactive changes
Results: automatic hematology analyser showed normal or minimal abnormal results
from our subjects (moderate increase of eosinophils, neutrophils and monocytes). Still
we observed the following changes when we studied BS:
1. moderate eosinophily 5-21%) at 47 cases;
2. moderate basophily (1-3%) at 49 cases;
3. neutrophily at 10 cases;
4. limphocytosis at 20 cases;
5. moderate monocytosis at 19 cases;
6. presence of reactive limphocytes at 66 cases;
7. presence of limpho-plasmocytes at 14 cases;
8. LGL (large granular lymfocites) at 38 cases;
9. neutrophils with oversegmented nucleus at 12 cases;
10. non-segmented neutrophils at 6 cases;
11. neutrophils with apoptotic the nucleus at 5 cases.
n some cases we noticed that erytrocites and trombocites had associated
morphological changes.
Conclusion: this paper presents laboratory preliminary results focused on
hematological morphology. They justify the study of some significant clinical and
paraclinical (hematological and biochemical) changes - with possible allert significance
- at FP which perform the medical expertise at INMAS.
E-mail: simona_berbecar@yahoo.com
Tel: 0723.323.862

161

3rdJUNE2011

OP102

MEDICAL CBRN AWARENESS IN MILITARY HOSPITAL INCIDENT COMMAND

SYSTEM
Authors:MAJ SEZIGEN Sermet, MD, PhD1, MAJ DEMIR Metin, MD, PhD2, MAJ
KARAKAS Ahmet, MD1, CPT BABAYIGIT M.Alparslan, MD1, MAJ YILDIRAN Nuri,
MD, PhD1.
Institutions:
1 Turkish Armed Forces Health Command, Ankara, TURKEY.
2 Fifth Army Corps, Departmant Of Logistic, Medical and Veterinary Branch, Corlu,
Tekirdag,
TURKEY.
Objective: The aim of this study was to increase medical CBRN awareness of military
hospitals by using the key concepts of Hospital Incident Command System (HICS)
which could meet the changing requirements during disaster management.
Material and method: The generic structure of HICS was implemented to a new model
which organized military hospitals in terms of medical CBRN response. Damage
assessment, triage, decontamination, treatment of emergency patients, patient care
and transfer, agent identification, internal and external coordination, media and public
relations, surge capacity, and logistic support were included into the new model in
order to cope with CBRN mass casualty incident effectively.
Results: When key concepts of HICS were integrated into response preparedness
plans in order to build a better organization and standardization in case of CBRN mass
casualty incident, an effective system of command, coordination, and control at a
military hospital could be established as new model could control personnel, facilities,
equipment, and communication centrally. Also plans should be supported by training,
simultaneous tabletop exercises, and live drills.
Conclusion: Military hospitals could strengthen their response preparedness plans
against CBRN incidents during mitigation, preparedness, response, and recovery
phases by using Hospital Incident Command System.
CORRESPONDENCE:
Sermet SEZIGEN
TSK Saglik Komutanligi, Bakanliklar, Ankara, TURKEY
Tel
: + 90 312 402 4064
GSM : + 90 532 726 3327
e-mail : sermetsezigen@yahoo.com

OP103

THE USE OF PERFLUOROCARBONS IN DECOMPRESSION ILLNESS: A NEED

FOR RESEARCH IN MILITARY MEDICINE?
Author(s): LTJG D. TZAVELLAS, LCDR P. VAVASIS, LCDR A. ARGYROPOULOU,
LT V. KALENTZOS, LT G.SIDIRAS, LT A. CHANDRINOU
Institution:
Diving & Hyperbaric Medicine Unit, Athens Naval Hospital, Athens,
GREECE
Aim: To provide information about the utilization of Perfluorocarbons (PFCs) in
experimental Decompression Illness (DI) and gas embolism for non-iatrogenic reasons
in order to highlight areas for future research in Military Medicine.
Method: An electronic search of PUBMED and a hand search of the EUBS and the
UHMS journal were performed. The keywords used in the search criteria were

162

3rdJUNE2011

decompression sickness or decompression illness or gas embolism and

perfluorocarbons. Additional selection criteria for all searched data were year of
publication (January 1980 to December 2010), language (English) and type of
publication (all types).
Results: The administration of intravenous (IV) PFC emulsions, seems to reduce both
morbidity and mortality of DCI in animals but, the mechanism of this protected effect
has not yet been demonstrated. To date, no humans have been treated with PFCs for
DCI or gas embolism for non-iatrogenic reasons.
Conclusion: Decompression illness (DCI) and gas embolism are an occasional
occurrence in military activities such as diving, high-altitude flight, caisson bridge
construction or, in escape from a disabled submarine. The use of PFCs might be a
promising adjunctive therapy for prevention and treatment of such cases especially
during military operations where standard care with Hyperbaric Oxygen might be
unavailable.
OP104

PROLONGED ASYSTOLE DURING HYPOBARIC CHAMBER TRAINING: CASE

REPORT
Author(s): LTC OZTURK Cengiz, MD1, CPT CAKMAK Tolga, MD2, CPT METIN
Suleyman, MD2, COL AKIN Ahmet, MD2, LTC SEN Ahmet, MD2.
Institutions:
1Eskisehir Military Hospital, Dept. of Cardiology, Eskisehir, TURKEY.
2Gulhane Military Medical Academy, Dept. of Aerospace Medicine, Eskisehir,
TURKEY.
Objective: Asystole is a state of no cardiac electrical activity, hence no contractions of
the myocardium and no cardiac output. We present the case of a pilot who has
experienced prolonged asystole during hypobaric chamber training.
Material and method: A totally healthy 36-year-old, 14-year flight experienced male
helicopter pilot, undergoing hypobaric chamber training, was exposed to hypobaric
environment for about one hour with a peak value of atmospheric pressure of 35,000
feet simulated altitude for about 15 min.
Results: On the 47th minute from the training onset the pilot had nausea, vomiting, loss
of positional awareness symptoms and finally lost his consciousness on the 46th
second after the mask off. Although it was not performing routinely, an ambulatory
blood pressure monitoring and 12lead rhythm monitoring were performed for a
planned study. The monitor recorded an asystole continuing 16 seconds followed by
profound sinusal bradycardia continuing 10 second. The pilot was taken the oxygen
mask on and the normal sinus rhythm was restored. After the training the patient was
re-examined and his vital signs, electrocardiography, transthorasic echocardiography,
24-hour rhythm holter monitoring and head-up tilt tests were normal.
Conclusion: Although the asystole is an expected event in the hypobaric chamber
training, the duration of the case we reported is considered important. It is
recommended to be alert for an asystole or a profound bradycardia in pilots
undergoing hypobaric chamber training and to monitor the trainees in a careful
manner.
Correspondence:
Doc.Hv.Tbp.Alb.Ahmet AKIN
Gulhane Askeri Tip Akademisi, Hava-Uzay Hekimligi AD, 26020, Eskisehir, TURKEY.
Tel:
+ 90 222 230 0191

163

3rdJUNE2011

Fax: + 90 222 230 34 33

GSM: + 90 532 221 4051
e-mail: ahmetakin45@yahoo.com
OP105

SYDDEN HEARING LOSS AND HYPERBARIC OXYGEN THERAPY

Author(s): CMR Konstantina GAITANOU1, LT Angeliki HANDRINOU2, LCDR Paul
VAVASIS3, George FILDISIS, MD, PhD, Prof. George BALTOPOULOS, MD, PhD
Institutions:
1. Medical Directorate, Hellenic Fleet Headquarters
2. Hyberbaric & Diving Medicine Department, Athens Naval Hospital,
GREECE
Aim: The evaluation of clinical efficacy of hyperbaric oxygen in patients with
sudden hearing loss.
Material-methods: In the study entered 56 patients, suffering from sudden hearing
impaired and tinnitus. The treatment included the "classic medication" and Hyperbaric
Oxygen Therapy. The HBO protocol included 5 phases. Each phase consists of 5
sessions with HBO. The evaluation tools included evaluation of hearing loss by
measuring the tonal audiogram before and after each phase of the research protocol.
The evaluation of tinnitus was assessed and evaluated by a questionnaire for severity
of tinnitus in relation to quality of life by Folmer and Griest, and the visual analogue at
the beginning of the first and last phase of the study. The secondary assessment
points, relate to changes in the intensity and the improvement of tinnitus. The analysis
was via the package of SPSS for WINDOWS (version 17).
Results: Fifty six patients were treated in this study, mainly for hearing loss combined
with tinnitus. All of them completed phase 1 and 2 of HBO, thirty of them phase 3,
seven patients phase 4 and only six of them all 5 phases. Overall, significant
improvement was noted between the initial and the final audiogram after treatment
with HBO (p<0.001). Tinnitus evaluation score, tinnitus intensity, as well as tinnitus
related problems were also significantly reduced (p<0.001) after HBO treatment.
Conclusions: According to our study, the results were encouraging and we can say
that hyperbaric oxygen therapy, along with standard treatment has been highly
improved results for patients suffering from sudden hearing loss.
Correspondence:
CMR Konstantina GAITANOU
Mobile: +30 6945938349
Konstantina.gaitanou@gmail.com

10:20-12:30

ORAL PRESENTATIONS X
(NORWEGIAN HALL)
Chairpersons: LTC Lecturer Mariana JINGA, MD, PhD (Romania)
LTC Panagiotis Kokkoris, MD (Greece)

OP106

THE INCIDENCE OF HEALTH ISSUES DURING THE FIRST 2 MONTHS OF

RECRUITMENT IN HELLENIC SPECIAL FORCES
Author(s): CPT Stefanos BOLOMYTIS, MD, FEBU, CPT S. PSAROGIORGOU, MD,
PRIVATE A. ROUSSAKIS, MD, PRIVATE F. PSINAKIS MD, CPT G.
DASKALOGIANNAKIS MD, LT I. LINAS MD
Institution: Health Dept, Special Forces Recruit Training Center, Nea Peramos,
GREECE

164

3rdJUNE2011

Objective: Every 3 months, Special Forces Recruit Training Center accepts nearly
1000 recruits, the majority of whom on voluntary basis. The aim of this study is to
determine the health issues that arise in this specific group of soldiers, both at
presentation and during the period of basic and more advanced training.
Material and methods: From 7 to 9 February 2011, 1020 soldiers were recruited in our
training center. Another 184 volunteers from other training centers were added later.
The mean age of the recruits was 21,3 years (18-27). In order to extract our results we
studied the medical documents of each soldier upon his presentation and the book of
examined patients of our Dept during the military training.
Results: 44 soldiers (3,65%) were considered unable to start their military training
because of serious health problems , while 117 (9,7%) due to their medical history
were judged ineligible for Special forces and were deployed to other training centers.
The incidence of daltonism was 5,2%. 19 soldiers (1,5%) were found positive for drug
abuse. The BMI of the recruits was lower than the male population of the same age
(98% BMI < 25). The majority of medical cases during the training were orthopedic.
There was a peek of febrile infections in accordance to the peek of H1N1 incidents in
Greece.
Conclusion: Special Forces recruits tent to be younger and healthier than recruits of
other centers. Due to the nature of their training the majority of medical cases are
orthopedic. As the training gets more advanced and recruits become more confident
and conscious soldiers, the attendance to our department decreases.
Correspondence: CPT Stefanos BOLOMYTIS
+30 6974334921
stbolomitis@yahoo.gr
OP107

THE RELATIONSHIP OF GYNECOLOGICAL EXAMINATION AND URINE

ANALYSIS AMONG SEXUALLY ACTIVE HEALTHY WOMEN
Author(s): CPT BODUR Serkan, MD1, LTC GUN Ismet, MD2, CPT BABAYIGIT
Mustafa Alparslan, MD3, LTC BABACAN Ali, MD2, LTC MUHCU Murat2, CAPT ATAY
Mehmet Vedat2
Institution:
1Maresal Cakmak Military Hospital, Department of Obstetrics & Gynecology, Erzurum,
TURKEY
2GATA Haydarpasa Training Hospital, Department of Obstetrics & Gynecology,
Istanbul, TURKEY
3Turkish General Staff Department of Preventive Medicine, Ankara, TURKEY
TURKEY
Objective: This study was designed to assess the impact of gynecological examination
on urinalysis among women attending for routine gynecological visit.
Material and methods: One hundred women who attended only for routine
gynecological examination with no symptoms and signs of urinary tract infection were
included into the study. The urine dipstick test, direct microscopy and urine culture
results were obtained. Fifty of patients who gave midstream urine specimens on the
day of gynecological examination were considered as Group I and the other fifty of
patients who gave the urine specimens two days after the gynecological examination
were considered as Group II. Dipstick test results and direct microscopy results were
statistically compared between the two groups.

165

3rdJUNE2011

Results: The nitrite positivity was found 83,3% in Group I and 16,7% in Group II.
71,4% and 28,6% of urine specimens of Group I and Group II showed leukocyte
esterase positivity. The presence of more than five leukocytes was seen in 62.5% and
37.5% of urine specimens of Group I and II, respectively. Bacteria was found 57,7%
and 42,3% in urine specimens of Group I and II, respectively. All of the urine cultures
results were negative for both groups.
Conclusion: Gynecological examination is an important factor that negatively
influences urine test results. Time interval between gynecological examination and
urine analysis affects the urine analysis results. Results of urine analysis performed
immediately after a gynecological examination may led to make mistakes,
unnecessary medications, increased medical costs and increased bacterial antibiotic
resistance.
Correspondence
Marasal Cakmak Asker Hastanesi, Kadn Hastalklar ve Dogum Servisi, Yenisehir,
Erzurum, TURKEY.
Tel: +90 442 3172269
Fax: +90 442 3172263
GSM: +90 533 6379313
e-mail: serkan_bodur@yahoo.com
OP108

EFFECT
OFPROANTHOCYANIDIN,
ARGININE
AND
GLUTAMINE
SUPPLEMENTATION ON METHOTREXATE-INDUCED GASTROINTESTINAL
TOXICITY IN RATS
Author(s): CPT GULGUN Mustafa,MD1, CPT KARAOGLU Baki, MD1,CPT KESIK
Vural,MD1, CPT KURT Bulent,MD2, CPT ERDEM Onur,MD3, MAJ TOK Duran,MD4,
COL KISMET Erol, MD1, COL KOSEOGLU Vedat, MD1, RDMDL OZCAN Okan, MD1
Institution:
1Gulhane Military Medical Academy, Department of Pediatrics, Ankara, TURKEY
2Gulhane Military Medical Academy, Department of Pathology, Ankara, TURKEY
3Gulhane Military Medical Academy, Department of Pharmacology, Ankara, TURKEY
4Kayseri Military Hospital, Department of Infection Diseases, Kayseri, TURKEY
TURKEY
Objective: Methotrexate is a folate antagonist that is commonly used as an anti-tumor
and anti-rheumatoid drug. The aim of this study was to investigate the possible role of
exogenous glutamine (Glu), arginine (Arg) and proanthocyanidine (PA) on gut
protection from methotrexate-induced intestinal damage in rats.
Material and methods: Rats were divided into eight groups. The first group was the
control group and received a 0.9% NaCl solution. Intraperitoneal methotrexate
injection (20 mg/kg/day) was started at day 4 of the experiment and lasted for 5 days,
until day 8. The other six groups were administered PA, Glu, Arg, Glu+PA, Arg+PA or
Glu+Arg orally at the same time by gavage in addition to methotrexate application until
the rats were sacrificed at day 8 of the experiment. All animals were sacrificed 4 days
after methotrexate injection for histopathologic analysis and tissue glutathione
peroxidase, malondialdehyde and superoxide dismutase assays.
Results: Methotrexate injection resulted in intestinal damage and increased
malondialdehyde levels. Proanthocyanidin and Glu decreased the severity of intestinal
injury histologically and in terms of malondialdehyde levels. There was no difference
between study groups with regard to SOD, GSH-Px, nitrite and nitrate levels.

166

3rdJUNE2011

Histologically, PA produced better results than Glu and Arg. The administration of Arg
was not effective against methotrexate-induced intestinal injury.
Conclusion: These results suggest that PA may be superior to Glu or Arg in protecting
the small intestine from methotrexate-induced injury.
Correspondence:
Mustafa GULGUN
Gulhane Military Medical Academy, Department of Pediatrics, Ankara, TURKEY
Tel:
+90 312 3044393
Fax: +90 312 3044381
GSM: +90 539 9645480
e-mail: mustafagulgun@yahoo.com
OP109

SPECIFIC FEATURES OF MILITARY HEALTHCARE IN LIBYA

Author(s): COL M. BERECHET, M.D.
Institution:Dr. Victor Popescu Emergency Clinical Military Hospital of Timisoara
ROMANIA
Other than any social services, the libyan authorities have invested in the healthcare
service and this option led to a good general health of the population as a result of the
improvement in healthcare delivery not only in major cities but even in small human
communities located in thousands of oasis.
The libyan troops are located mainly in small cities and aviation facilities. Many
Governamental Security Officers are spread into main public buildings. The military
personnel had the same needs and rights as the civilian people.
Beside the 6,5 million of libyans, the migrant workers were almost 2 million, many of
them belonging to European countries as Romania, Bulgaria, Moldavia, Turkey, Italy
or Greece. Some of them were treated in Libyan facilities through medical assurance
contracts between foreign contractors and districtual (shabiat) healthcare secretariat (a
kind of regional ministry of health).
The remarkable feature is free medical services at any level (promotive, preventive,
curative or rehabilitative) including free treatment, due to communist-like healthcare
laws. Also, there are public (or private) pharmacies (al-saidaliya) which sell various
drugs, antiseptics, dressings. Hospitals (al-mustashfa) are throughout in towns and
even in populated oasis, some medical facilities as dispensary (al-tamiin) or
emergency clinic could be found. Medical equipment used in all healthcare facilities is
new, expensive and maintained by foreign medical suppliers. The main risk factors are
smoking and obesity. The major morbidities are: cardiovascular diseases, diabetes
and cancer.

OP110

PERIHEPATIC PACKING IN PRIMARY TREATMENT OF WAR LIVER INJURIES

Author(s): Major KRI Jovan, Col. STANKOVI Neboja, MILEV Boko, Major
MITROVI Miroslav, Major JOVANOVI Milan.
Institution: Clinical for abdominal and endocrine surgery, Military Medical Academy,
Belgrade,
SERBIA
Background: Complex liver injuries caused very high mortality rate and the
management of the injured was delicate. War circumstances and with war surgeons of
limited knowledge of the liver surgery confirmed that it was necessary to apply

167

3rdJUNE2011

damage control surgery.

Methods: Retrospective study included patiens with war liver injuries admitted in the
period July 1991 - December 1999, in total 204.
Results: A total of 82.8% of the injured were with the liver injuries combined with the
injuries of other organs. Primary management of 74.0% of the injured was performed
in war hospitals. In 140 (68.6%) of the injured there were minor lesions (grade I to II),
treated with simple repair or drainage. There were complex injuries of the liver (grade
III-V) in 64 (31.4%) wounded. After primary treatment, 72 (35.3%) of the injured were
with postoperative complications. Reoperation was done in 66 injured. Total mortality
rate in 204 injured was 18.1%. All the deceased had significant combined injuries.
Mortality rates due to the liver injury of the grade III, IV and V were 16.6%, 70.0% and
83.3%, respectively.
Conclusion: bdominal packing alone or in combination with other techniques for
hemostasis in the primary treatment of liver injuries grade III-V, resuscitation and rapid
transportation to specialized hospital had a crucial and life-saving role.
OP111

EOSINOPHILIC ESOPHAGITIS- A MODERN CHALLENGE

Authors:, Mr. Mihaita PATRASESCU MD, Col. Florentina IONITA RADU MD, Col.
Mihail COJOCARU MD, Mr. Petrut NUTA MD, Cpt. Bogdan MACADON MD
Institution: University Emergency Central Military Hospital, Bucharest,
ROMANIA
Until early 90-th there was no recognition of a disease to be called eosinophilic
esophagitis(E.Eo). Since then the scientific community experienced an increasing level
of awareness concerning this ailment which may reflect, actually, an increase in
prevalence. E.Eo. is described in young as well as in adults, the global prevalence is 1
to 4 individuals out of 10000. The main diagnostic criteria, which are not widely and
uniformly recognized involve esophageal dysfunction symptoms refractory to high
doses of proton pump inhibitors(PPI`s), food impaction (which may reflect a
complication as fibrotic strictures and represents the main reason for seeking medical
advice), specific endoscopic features (longitudinal furrows, `trahealization`, white
plaques), high grade eosinophilic infiltration of esophagus( more than 15 cell per
microscopic field). It should be noted that the degree of eosinophilic infiltration is
conversely correlated with PPI`s clinical response. The main differential diagnosis
should be made with gastroesophagial reflux disease (mainly characterized by heart
burn and regurgitation), to which may be associated. Fairly 70% of patients have an
atopic disease, a food allergic inflammation of esophagus having been recognized as
a very important part of disease pathogenesis with diagnostic work up and
therapeutical implications. Thus an allergologist advice is mandatory. The main
direction of therapy consist of dietary restrictions (conducted by food allergen skin
prick tests), topical or systemic corticosteroids, anti IL5 monoclonal antibodies. Hence
the E.Eo. should be considered in all patients refractory to PPI`s and constitutes the
necessary proof that esophagus is more than a muscular tube but an immunologicaly
active organ.
Key Words eosinophil, esophagitis, GERD, PPI
Contact mihai_patrasescu@yahoo.co.uk, mobile 0740151100

168

3rdJUNE2011

OP112

EFFECTS OF THE COMBINATION OF G-CSF AND HBO THERAPY ON COLONIC

ANASTOMOSIS IN IMMUNOSUPPRESSED RATS: AN EXPERIMENTAL STUDY
Authors:COL ZEYBEK Nazif, MD1, MAJ SINAN Huseyin, MD2, CDR OZER M Tahir,
MD1, COL SIMSEK Abdurrahman, MD1, CPT OZLER Mehmet, MD3, MAJ AKYOL
Mesut, PhD4, CPT AYDIN Fevzi, MD5, COL DEVEC Salih, MD6, MAJ SADIR Serdar,
MD3, BG PEKER Yusuf, MD1
Institution: 1Gulhane Military Medical Academy, Dept. of Surgery, Ankara, TURKEY.
2Gulhane Military Medical Academy, Dept. of Emergency, Ankara, TURKEY.
3Gulhane Military Medical Academy, Dept. of Physiology, Ankara, TURKEY.
4Gulhane Military Medical Academy, Dept. of Biostatistics, Ankara, TURKEY.
5Gulhane Military Medical Academy, Dept. of Biochemistry, Ankara, TURKEY.
6Gulhane Military Medical Academy, Dept. of Pathology, Ankara, TURKEY.
5Gulhane Military Medical Faculty, Dept.of Pathology, Ankara,TURKEY
TURKEY
Objective: The aim of this study was to investigate the effects of the combination of
granulocyte-colony stimulating factor (G-CSF) and hyperbaric oxygen therapy (HBOT)
on colonic anastomosis in rats immunosuppressed by corticosteroid treatment.
Material and method: Six groups of 10 rats each were used in our study.
Methylprednisolone 5 mg/kg was given intramuscularly for 14 days to achieve
immunosuppression. The rats received 100% O 2 with HBOT at 2.8 ATA in one 90minute session per day for 7 days. G-CSF was administered 50 g/kg/day
subcutaneously. The parameters of our study were determined as bursting pressure,
tissue hydroxyproline level and fibrosis index, inflammation level of the colonic
anastomosis, and abdominal adhesion level.
Results: Hydroxiproline levels and fibrosis index results between the experimental
groups were not statistically significant (p = 0.124 and p = 0.132, respectively).
Anastomosis inflammation levels and abdominal adhesion levels were statistically
significant (p = 0.004 and p < 0.001, respectively). Bursting pressures between the
groups were not statistically significant (p = 0.212).
Conclusion: Colonic anastomosis administered in rats with immunosuppression was
affected positively by the combination of G-CSF and HBOT. There were no significant
differences between experimental groups with respect to tissue hydroxyproline levels,
bursting pressure and fibrosis index, whereas significant differences were shown in
anastomosis inflammation levels and abdominal adhesion levels.
Correspondence:
Gulhane Askeri Tip Akademisi, Acil Tip AD, 06018, Etlik, Ankara, TURKEY
Tel
+903123043007
Fax
+903123043019
GSM +905424525301 Email: hsinan@gata.edu.tr

OP113

NEONATACIDE: NECK INJURY WITH STAB WOUND OF A NEWBORN

Authors: LCDR CALISKAN Bahadir, MD, COL GUVEN Ahmet, MD, MAJ ATABEK
Cuneyt, MD, COL DEMIRBAG Suzi, MD, COL SURER Ilhami, MD
Institution:
Gulhane Military Medical Academy, Dept. of Pediatric Surgery, Ankara,
TURKEY
Introduction: Neonatacide is described as a harmful trauma of a parent with psychotic
disorders to their child even life threatening. It is known that mothers with depression

169

3rdJUNE2011

and psychotic disorders before pregnancy have worsened problems after birth.
Case: A ten days old baby with stab wound to neck admitted to emergency room. The
physical exploration revealed a 1 cm laceration under ramus mandibula and a 2 cm
laceration inferior and anteriorly on the lateral neck region. No active bleeding was
seen but serohemorrhagic leakage and saliva came from injured lesion. Before
pregnancy 32 years old mother used medical treatment with the diagnosis of psychotic
depression learned her pregnancy at the 26th week.
Material method: Four hours after admitting primary repair was performed under
general anesthesia. Due to respiratory distress after operation she was followed up
with mechanical ventilation for two days. On the day 17 oral feeding started and she
was discharged. The controls after one week and one year were uneventful.
Conclusion: With a perfect physical examination and detailed study of
esophagography and endoscopic procedures all serious traumas can be defined. The
identification of child abuse in the primary care is a serious and hard problem. Even in
suspicion, referring to hospital and for the protection of child criminal warning is must
be done. All patients with trauma whatever its severity should be evaluated as a legal
case and the records must be written proper to legal procedure. Keeping penetrating
and cutting device away from children is a legal obligation.
Correspondence:
Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 5487
Fax: + 90 312 304 5900
GSM: + 90 505 806 4996
OP114

TULAREMIA CASES AND AN EXAMINATION IN TERMS OF BIOTERRORISM

Authors: LTC MERT Gurkan, MD1, 1LT FIDAN Gonca, MD1, LTC YAREN Hakan,
MD2, BG EYIGUN Can Polat, MD1
Institution:
1Gulhane Military Medical Academy, Dept. of Infectious Disease and Clinical
Microbiology, Ankara, TURKEY.
2Gulhane Military Medical Academy, Dept. of CBRN Ankara, TURKEY.
TURKEY
Objective: Tularemia is a zoonotic disease that is transmitted by contacting blood and
tissue of infected animals, bites of infected ticks, eating undercooked rabbit meat and
using infected water sources. Transmission from human to human is not reported.
According to CDC classification, among the potential biological agents it has a group
(A) highest priority importance. In this study eight tularemia cases in which different
personnel of TAF who are coming from different localizations were involved, were
examined and evaluated in case of being biological agents.
Material and method: The study included eight tularemia diagnosed military staff who
examined in our clinic between 2009-2010. Diagnoses were determined by suitable
clinic, positive serology and results of biopsy.
Results: Our eight male cases mean age of 31, 5; history of all included terrain
conditions and rural. Six cases from different localizations of ankr, a case from
Merzifon and a case from Ankara were determined. Cases from ankr all had story
of drinking well water. All our patients had swollen regions on their necks, chills and
shivering along with the moderately high erythrocyte sedimentation rate. Fine needle
aspirate biopsy was taken from swellings of five patients neck and a patient 1/1280(+)

170

3rdJUNE2011

had 1/320(+) tularemia agglutination (MAT) values were determined with necrotizing
granulomatous inflammation. Our other two patients diagnoses were determined to be
Oropharyngeal Tularemia by clinically, serologically and results of biopsy in 2009.
From these patients who were treated with Streptomycin, came up with symptoms with
(+) PCR results were evaluated as relapse. Our patients with present findings were
evaluated as Oropharyngeal Tularemia and treated by doxycycline 2100 mg PO and
streptomycin 11 gr IM (10 days), relapsing cases were treated by Doxycycline
2100mg PO for 21 days.
Conclusion: Tularemia do occurs in various forms in clinics and so has difficulties on
diagnosis. Generally cases come from rural sections; while evaluating patients coming
from the areas with poor infrastructures, with lymphadenopathy and fever, with clinic
and laboratory, tularemia must not be kept out of sight. The cases were not
widespread and courses of disease were not serious and incidences didnt differ from
countries of the geographical region dramatically. With the knowledge of this
information we evaluated these cases not to be a bioterrorism agent.
Correspondence :
Gulhane Askeri Tip Akademisi, Enfeksiyon Hast. Ve Kl. Mikrobiyoloji AD, Etlik 06018,
Ankara, TURKEY.
Tel: +90 312 3044308
Fax: +90 312 3044300
GSM: +90 5054870334
e-mail:gmert@gata.edu.tr
OP115

ASSESSMENT OF CARDIOLIPOTOXICITY IN PATIENTS WITH DIABETES

MELLITUS
Authors: LTC B. BUE MD*, Gral. M. MURESAN MD**, LtCol. C. RUSU MD**, Maj. P.
NUTA MD**
Institution: * Medical Center of Diagnosis and Treatment ,,Academician tefan Milcu,
Bucharest, ROMANIA
** Central Clinical Emergency Military Hospital, Bucharest, ROMANIA
ROMANIA
Purpose: The risk of heart failure in type 2 diabetes mellitus is higher than can be
accounted for by hypertension and coronary artery disease. Assessment of myocardial
lipid content could lead to an enhanced understanding of the relationship between
abnormalities in glucose handling and myocardial dysfunction, particularly in obese
individuals, and provide a new measure for evaluating responses to interventions that
improve global glucose tolerance (eg, weight loss, exercise, insulin sensitizers).
Material and method: We made clinical and paraclinical assessment in 160 patients,
ages between 45-60, divided in 4 equal groups: (1) normal weight normoglycemic, (2)
overweight and obese normoglycemic, (3) impaired glucose tolerance and (4) diabetes
mellitus
Results: cardiac dysfunction was 3-folds higher in diabetic patients, with ischemic
cardiopathy 2.5-folds higher and cardiac failure 2-folds higher in this group
comparative with normal weight normoglycemic individuals. Also in diabetic patients
with heart failure we observed high incidence of associated hepatic steatosis. Some
other studies show high incidence of cardiac steatosis in diabetic patients with heart
failure.
Conclusions: With future simplification of spectroscopic techniques, it is foreseeable

171

3rdJUNE2011

that myocardial lipid content may one day be used as a biomarker to predict the
development of cardiac dysfunction in patients with insulin-resistant states and may
serve as a measurable target for intervention before the development of diabetic
cardiomyopathy.
Contact: LtCol. Bogdan Buse MD
Tel: 0040745425116
Mail: bogdanbuse@aol.com
OP116

PARTICULARLY CASE OF HEPATIC CIRRHOSIS CASE PRESENTATION

Authors: P. NU, Florentina IONI RADU, Raluca COSTACHE, Mariana JINGA,
M. COJOCARU, Sandica BUCURICA, B. MACADON.
Institution: Internal Medicine Department 2,
Central Universitary Emergency Military Hospital, Bucharest,
ROMANIA
Background: We examined patient TF, 59 years old, diagnosed with alcoholic
cirrhosis 6 months ago, presented in our department for edematous syndrome.
Objective examination revealed a overweight patient, with pallor of teguments, and
dermatitis ocra lesion on legs, spider telangiectasia on thorax and face, jaundice of
sclera.
laboratory findings shows moderate normocrome, normocitare anemia, hepatoprive
syndrome, colestatic syndrome, and high levels of glicemia. Initial diagnosis was
alcoholic cirrhosis, complicated with hypersplenic anemia, tip 2 diabetes mellitus and
patient was treated according with it.
After 3 month of respected treatment and alcohol cessation, patient returned on clinic
with no improvement of general status or laboratory findings and clinical manifestation
of hepatic encephalopathy. The persistent anemia impose additional investigation, and
we performed iron status evaluation and medulograme that conduct us to diagnosis of
hemocromatosis.
The patient recived specific treatment with no other encephalopatic episode and
stationary evolution.
Conclusion: We present a rare case of hemocromatosis with hepatic involvement,
diabetes mellitus and anemia.
Key words. Cirrhosis, anemia, hemocromatosis
Contact person: Petrut Nuta tel 0040722308299, email petrutnuta@yahoo.com

OP117

CONNECTED.THE SURPRISING POWER OF OUR SOCIAL NETWORKS AND

HOW THEY SHAPE OUR LIVES
Author: LTJG Vasiliki KYROUDI, RN,
Institution: CCU, Naval Hospital of Athens,
GREECE
Purpose: There are very fundamental reasons we live our lives in social networks and
if we really understood the role theyre playing in our society we would take better care
of social networks and find ways to take advantage of their power to improve our
society. Military community is a social network. So, we can benefit from these
elements.
Material and Methods: The literature review has been carried out through the book

172

3rdJUNE2011

Connected of Nicholas Christakis, MD, PhD of Harvard University who has roots in
Greece and of James Fowler, PhD. Some elements were collected from the database
of MEDLINE and TED using the key words: connected, Nicholas Christakis.
Results: The social networks follow some basic rules of connection and contagion.
These comprise what they call the anatomy and the physiology of the human
superorganism. So, we can understand the spread of obesity through human
networks, the STDs, the flu or the emotions such as altruism, violence, ideas and so
on.
Conclusion: We form social networks because the benefits of a connected life
outweigh the costs. Depending on the number of connections we have, and the nature
of the connections themselves, we can influence people and be influenced by others.
By studying these connections, we can help make sure the right ideas get to the right
people.
Correspondence: LTJG Vasiliki KYROUDI, RN
+30 210 7261300
+30 694 6931910
k.vasiliki@hotmail.com
OP118

DENTAL CLINIC OF GREEK ASSIGNMENT IN KOSSOVO, INCIDENTS

ACTIVITIES
Author(s): LT Jr Michail DIAMANTOPOULOS DDS HN, LT Jr Athanasios
KALOGEROPOULOS MD
Institution: Dental Clinic of Medical Center, Rigas Fereos Greek Camp, KFOR
GREECE
Purpose: The aim of this study is to report our experience in dentistry in a mission of
Greek Army during our participation in NATO Forces in Kossovo (KFOR) in order to
help the Medical Personnel in future expeditions.
Material and Methods: We analyzed the monthly rates of dental incidents in Greek
Army in Kossovo, for a period of 6 months, between 1/6/2010-16/12/2010 which
participated in NATO KFOR. We had to take care of 838 Greek soldiers and 34 from
Armenian squad plus political staff, natives and translators. A dental medical record of
354 dental incidents were written down and treated and 1 presentation-examination
about good oral hygiene took place for local children. A database and an analysis
were carried out by the PASW Statistics 18 and Microsoft office tools.
Results: 354 patients were treated: 87,3% (n=309) were Greek soldiers and 12,7%
(n=45) were non Greek soldiers.
From 354 incidents: 11,58% concerned endodontic treatments, 31,92% inlays and
fillings, 5,93% emergency treatments, 22,88% periodontal treatments, 11,29% clinical
examinations, 2,26% prosthodontics, 6,21% extractions, 1,41% stomatological soft
tissues treatments, 6,49% temporary fillings plus 65 small dental x-rays. The majority
of prescribed drugs was Anti-inflammatory and antibiotics. The presentationexamination to native children revealed the fact that none of them knew how to brush
their teeth and preserve good oral hygiene.
Conclusion: The variety of dental incidents is high, but the percentage of the
emergency treatments is low.
The childrens presentation-examination helped local community and the army to
preserve good status and acceptance by them.
Correspondence:
LT Jr Michail DIAMANTOPOULOS, DDS, HN,
+306944564482, diamad@windowslive.com

173

3rdJUNE2011

10:20-12:30

ROUND TABLE IV

Telemedicine : Present and Future in BMMC

(THE PERFORMANCE HALL)
Chairmen: COL Omer GUNHAN, MD (Turkey)
LTC Aurelian MORARU, MD (Romania)
Speakers: COL Omer GUNHAN, MD (Turkey)
LT Milos KOSTOV, MD (Serbia)
LTC Aurelian MORARU, MD (Romania)
RT011

TELECYTOLOGY IN DEPARTMENT OF PATHOLOGY MILITARY HOSPITAL OF

NIS. ANALYSIS 102 HEMATOLOGICAL CASES
LT Milos KOSTOV, MD1, COL Ivica MILOSAVLJEVIC, MD2, Asist. prof. dr. Zeljka
TATOMIROVIC, MD3, Vesna SKULETIC, MD3.
Institutions: 1Department of Pathology, Military hospital of Nis, SERBIA
2Institute for Forensic Medicine, Military Medical Academy of Beograd, SERBIA
3Department of cytology and cytogenetics, Center for Pathology and Forensic
Medicine, Military Medical Academy of Beograd,
SERBIA
Objective: Primary aim of this study is the presentation of our experiences in
telecytological diagnostics with reference to theirs accuracy and quality assurance
through the specificity of static consultation system used.
Material and methods: We are developed the static system for remote consultation
and diagnostics. Department pathology of Military Hospital in Nis, 250 km away from
Military Medical academy in Belgrade, sending us, via POTS and e-mail, multimedial
documented requests for remote consultations and diagnostic in cytological cases. All
cases were maintenance with clinical and laboratory data and imaged using the Philips
490 1-CCD camera and Pixera digital camera, at a resolution from 768x574 to
1024x768 pixels.
Results: We analyzed 102 hematological cases in period 1998 - 2008, are
characterized with high level of accuracy and quality assurance. 81,5% of all cases are
definitive resolved in first remote consultation. 19% of cases are also definitive
resolved after: repeat sampling procedure, accessory of clinical dates or images. Only
in 8 cases definitive diagnosis was made by glass slide observation. Definitive
concordance between telecytologic and glass slide diagnosis was 88%.
Conclusion: Our study proved the efficiency and high diagnostic accuracy of static
telecytology for the diagnostic consultations in the hematological cytology.

174

3rdJUNE2011

RT012

10:20-12:30
PP105

OPTIONS FOR TELEMEDICINE PROJET IN MEDICAL MILITARY COMUNITIES

FROM ALBANIA, BULGARIA, GREECE, ROMANIA, SERBIA AND TURKEY
Lt.col. Aurelian Corneliu MORARU, MD, MA
ROMANIA

POSTER PRESENTATION IV
(BYZANTINE HALL)
FIBRIN SEALANT IN THE TREATMENT OF ACUTE RUPTURE OF THE ACHILLES
TENDON: LONG-TERM RESULTS
Author(s): LT CAKMAK Selami, MD, COL MAHIROGULLARI Mahir, MD, COL
SOLAKOGLU Can, MD, LTC TAMAM Cuneyt, MD, COL KUSKUCU Mesih, MD.
Institution: Gulhane Military Medical Academy, Haydarpasa Training Hospital, Dept.
of Orthopedics and Traumatology, Istanbul, TURKEY.
Kasimpasa Military Hospital, Dept. of Orthopedics and Traumatology, Istanbul,
TURKEY.
Objective: There are numerous methods in the treatment of acute rupture of Achilles
tendon but optimal treatment is still controversial in the literature. The purpose of this
study was to reveal the long-term results of patients treated with fibrin sealent.
Material and method: The study included 42 patients who has Achilles tendon rupture
treated with fibrin sealent between 1998 and 2007. The mean follow-up period was
51.52 (24-92) months. The patients evaluated by Thermann scoring system
postoperatively both at the early and the latest follow-up.
Results : We found that the Thermann score of the some patients slightly decreased at
the advanced age group when compared to younger patients at long-term. But overall
result remained unchanged by time. All patients but one who had a re-operation
because of a re-rupture returned to their daily work and sportive activities.
Conclusion: Because of its lower complication rates and equal results to other
treatment options, treatment of acute Achilles tendon ruptures with fibrin sealant can
be one of the first choices selected.
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Ortopedi ve
Travmatoloji Servisi, Selimiye Mah. Tibbiye Cad. 34668 Uskudar, Istanbul, TURKEY
Tel:
+90 216 542 2020
Fax: +90 216 348 7880
GSM: +90 505 774 5830
selamicakmak@gmail.com

PP106

THE COMPARATIVE RESULTS OF THE FOUR DIFFERENT REDUCTION

METHODS OF THE ANTERIOR DISLOCATION OF THE SHOULDER
Author(s): COL MAHIROGULLARI Mahir, MD, LT CAKMAK Selami, MD, CPT
AKYILDIZ Faruk, MD, PISKIN Ahmet, MD, COL KUSKUCU Mesih, MD.
Institution: Gulhane Military Medical Academy, Haydarpasa Training Hospital, Dept.
of Orthopedics and Traumatology, Istanbul, TURKEY.
19 Mayis University, School of Medicine, Dept. of Orthopedics, Samsun, TURKEY.
TURKEY
Objective: Traumatic anterior shoulder dislocation is very common problem
encountered in emergency department. Many reduction methods were described in

175

3rdJUNE2011

the literature. The aim of this study to make a comparison between different reduction
maneuvers without anesthesia to reduce the dislocated shoulder.
Material and method: The study was composed by the result of the patients treated
with different reduction maneuvers (includes different form of traction and external
rotation) in three different training hospitals ER department between 2005 and 2010.
Thirty nine patients were treated by Spaso method, 47 patients by Chair reduction
method, 40 patients by Kocher method and 27 patients by Matsens traction-counter
traction method. Patients were selected randomly. Dislocation number, reduction time,
time interval between dislocation and reduction, and associated complication pre and
post reduction period were recorded prospectively.
Results : According to reduction time, the chair method has the shortest reduction
time. All of the methods we used include traction and some external rotation. All
surgeons to be involved in this study agree with that Kocher and Matsens method
need more force to reduce. Spaso method includes flexion of the shoulder and it
blocks the muscle contraction somewhat.
Conclusion : The chair method was found to easiest method for reduction according to
all applicants because the patients could not contract their muscles while sitting on a
chair affected arm with side. We believe that the chair method is one of the easiest
method to reduce the shoulder if the patients could sit on a chair.
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Ortopedi ve
Travmatoloji Servisi, Selimiye Mah. Tibbiye Cad. 34668 Uskudar, Istanbul, TURKEY.
Tel:
+90 216 542 2020
Fax: +90 216 348 7880
GSM: +90 505 774 5830
selamicakmak@gmail.com
PP107

IMPERFORATE HYMEN AN UNUSUAL CAUSE OF ABDOMINAL PAIN IN

PUBERTAL GIRLS
Author(s): LCDR CALISKAN Bahadir, MD, MAJ ATABEK Cuneyt, MD, COL GUVEN
Ahmet, MD, COL DEMIRBAG Suzi, MD, COL SURER Ilhami, MD
Institution: Gulhane Military Medical Academy, Dept. of Pediatric Surgery, Ankara,
TURKEY
Introduction: The hymen is an embryological remnant of mesodermal tissue that
normally perforates during the later stages of embryo development. Most cases
diagnosed in the teenage years with symptoms of an expanding pelvic mass.
Case: Two girls 14 and 15 years old were presented with nausea, pelvic mass and
lower abdominal pain for 3 days. The patients had not started her menses yet. On
examination a mass palpated in the lower abdominal region and the hymen was found
to be imperforate and was bulging forwards. Ultrasonography revealed an enlarged
uterus with central portion of the uterus showing parenchymal texture and dilated
cervix and vagina suggestive of hematocolpos.
Results: In the operating room under general anesthesia a simple cruciate incision of
the hymen, was made in an attempt to preserve the traditional Turkish concept of the
importance of first-coitus bleed. The edges were everted and around 500 ml of dark,
red tarry blood was drained and then plicated. Foley catheter was inserted through
closure of plicated hymen for 2 weeks.
Discussion: Imperforate hymen occurs in approximately 0.1 % of newborn females.

176

3rdJUNE2011

Hematocolpos can be suspected in adolescent girls in the age group of 13 to 17 years

presented with primary amenorrhea, recurrent lower abdominal pain, back pain, and
urinary retention. The treatment for imperforate hymen is hymenotomy. Before the
procedure, the urethra has to be stented to avoid possible damage during the
procedure. In addition, the incidence of recurrence might further be reduced by
plicating the edge of the incised membrane.
Correspondence:
Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 5487
Fax: + 90 312 304 5900
GSM: + 90 505 806 4996
e-mail: bahadircaliskan@hotmail.com
PP108

PULSATIVE EXOPHALMOS
Author(s): Bledar KRUJA MD, Erion MUSABELLIU MD, Elvis VELIU MD
ALBANIA
16 years old girl after a shot gun in the head,with the bullet goind through the temporal
side,survived.
After a few days she present remarkable exophalmos wich was pulsating.
The comunication of the cerebral fluid with the orbit space was the reason of this rare
entity.

PP109

CONTEMPORARY VIEWS OF THE EFFECTS OF CHEMICAL DISINFECTANTS ON

MICROORGANISMS
Author(s): D. SHALAMANOV, Ph.D.1, N. BOGDANOV, MD2, Tz. TZVETANOV2, Maj
I. POPIVANOV, MD2, T. PETKOVA, MD1, Lt Col K. KANEV, MD2, E. E. GABEV, Ph.D.
3, E. PENKOV, MD2
Institution: 1 Medical University, Pleven, BULGARIA
2 Military Medical Academy, Sofia, BULGARIA
3 Bulgarian Academy of Sciences, BULGARIA
BULGARIA
The observed changes in microorganisms after treatment with solution of
chlorhexidine are described. Models of Gram-positive and Gram-negative bacteria are
used. The changes are expressed in irreversible destruction of the bacterial cell wall,
complete deformation of bacteria, breakthrough of surface structures with leakage of
cellular contents and formation of conglomerates of many agglutinated bacteria. The
occurred morphological changes and accumulation of microorganisms can be
explained by biochemical and biophysical behavior of disinfectants.
Keywords: chemical disinfection, chlorhexidine morphological changes conglomerates.

177

3rdJUNE2011

PP110

BILATERAL SYMMETRICAL TRIGGER FINGERS OF THE HAND: REPORT OF AN

UNUSUAL CASE
Author(s): MAJ YILDIRIM Cengiz, MD1, COL KUSKUCU Mesih, MD2.
Institution:
1 Tatvan Military Hospital, Dept. of Orthopaedics and Traumatology, BTLS, TURKEY
2
Gulhane Military Medical Academy, Haydarpasa Training Hospital, Dept. of
Orthopaedics and Traumatology, Istanbul, TURKEY
TURKEY
Abstract: Stenosing tenosynovitis, or trigger finger, is an entity seen commonly by
hand surgeons. This problem generally is caused by a size mismatch between the
flexor tendon and the first annular (A-1) pulley. Primary stenosing tenosynovitis is
usually idiopathic and occurs more frequently in middle-aged women than in men.
Secondary stenosing tenosynovitis of the digits can occur in patients with rheumatoid
arthritis, diabetes mellitus, gout, and other disease entities that cause connective
tissue disorders. The diagnosis of triggering digits is generally not subtle and can be
made on the basis of an adequate clinical examination. As many as 85% of triggering
fingers and thumbs can be treated successfully with conservative management.
Surgical treatment is generally indicated when nonoperative treatment fails. Surgical
treatment consists of release of the A-1 pulley. Complications are rare but include
bowstringing of the tendons, digital nerve injury, and continued triggering.
Case report: We report a patient who had symmetrical triggering of the middle and ring
fingers of bilateral hands. He was treated with conservative methods initially, but the
triggering of the middle and ring fingers of bilateral hands is not resolved. Therefore,
we performed an operative treatment. One year after the operation, the patient could
perform his work without discomfort in his both hands and showed normal range of
motion in all fingers.
Correspondence:
Cengiz YILDIRIM
Tatvan Military Hospital, Dept. of Orthopaedics and Traumatology, Tatvan, Bitlis,
TURKEY
Telephone: 00 90 434 827 20 93
Mobile Phone: 00 90 533 428 68 46
drcengizyildirim@yahoo.com

PP111

A BIODEGRADABLE ESOPHAGEAL STENT IN THE TREATMENT OF A

CORROSIVE ESOPHAGEAL STENOSIS IN A CHILD
Author(s): MAJ ATABEK Cuneyt, MD, LCDR CALISKAN Bahadir, MD, COL GUVEN
Ahmet, MD, LTC PADSHAH Waisullah, MD, COL DEMIRBAG Suzi, MD, COL SURER
Ilhami, MD
Institution: Gulhane Military Medical Academy, Dept. of Pediatric Surgery, Ankara,
TURKEY
Introduction:Household lye products have come into routine use and unfortunately
have been associated with increased frequency of accidental ingestioninduced
caustic esophagitis. Alkali agents are mainly stocked in used water bottles and have
been mistaken for water. The ingestion of lye can cause esophageal strictures in 7%
to 35% of affected persons
Case: Three child who developed strictures after ingestion of alkali solution, being

178

3rdJUNE2011

treated with repeated dilatations every month for 2 years. There was a progression for
stricture but the interval can not be prolonged. Accordind to good results of PTEH
stents used before SX-ELLA stent was planned to used.
Results: A self-expandable biodegradable SX-ELLA esophageal stent was inserted
under general anesthesia 2 years after the accidental ingestion. The stent had a body
diameter of 25 mm and a length of 80 mm; insertion was uneventful. Oral omeprazole
(20 mg/day) was continued. Biodegradable stents are made of degradable synthetic
material. The stent integrity and radial force are maintained for a period of 6 to 8
weeks following implantation. The stent disintegration occurs 11 to 12 weeks after
insertion. Dual flared ends reduce the risk for migration. Secondary damage owing to
gastroesophageal reflux may play a significant role in stricture formation. H2
antagonists and antacids should be considered in the management of these injuries.
Conclusion: The procedure is easy to perform. Given the high failure rate of the
treatment options suggested in the literature, biodegradable esophageal stents should
be evaluated as the first-choice intervention in patients developing a corrosive
esophageal stenosis
Correspondence:
Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 5487
Fax: + 90 312 304 5900
GSM: + 90 505 806 4996
e-mail: bahadircaliskan@hotmail.com
PP112

ORTHOTIC TREATMENT OF STAGE II BLOUNT DISEASE

Author(s): LT CAKMAK Selami, MD, MAJ OZNAM Kadir, MD, COL PEHLIVAN
Ozcan, MD.
Institution:
Gulhane Military Medical Academy, Haydarpasa Training Hospital, Dept. of
Orthopedics and Traumatology, Istanbul,
TURKEY.
Objective: To obtain the correction of deformity in patients who has stage II Blount
disease before its progression.
Material and method: 6 leg of 4 patients ( 1 girl, 3 girl; mean age 17 month) who has
Stage II Blount disease (increased metaphysis-diaphysis angle and proximal tibia
metaphyseal beak at anterior-posterior radiographies of lower extremity while weightbearing) treated with ring locked orthesis prepared for every patient individually.
Results: While the metapyhsis-diaphysis angle was 15 degree before application of
orthesis, it was 6,8 degree after treatnment. Metaphyseal medial beak at proximal tibia
was solved and clinical healing was occured at all cases. Mean application of orthesis
was 9 month and mean follow-up time was 18 month. There were no recurrence after
orthesis treatment. There was not any complication due to orthesis using.
Conclusion: We believe that orthesis treatment must be first treatement choice for
stage II Blount disease, because of its higher rate of healing potenatial and simplicity
of its application. It is also possible that surgical treatment options will remain
restricted when orthesis treatment was not successful.
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Ortopedi ve

179

3rdJUNE2011

Travmatoloji Servisi, Selimiye Mah. Tibbiye Cad. 34668 Uskudar, Istanbul, TURKEY.
Tel:
+90 216 542 2020
Fax: +90 216 348 7880
GSM: +90 505 774 5830
selamicakmak@gmail.com
PP113

THE EFFECTIVENESS OF THE IMMEDIATE SARMIENTO CAST APPLICATION AT

THE TREATMENT OF THE HUMERAL FRACTURES
Author(s): LT CAKMAK Selami, MD, COL MAHIROGULLARI Mahir, MD, CPT
AKYILDIZ Faruk, MD, COL KUSKUCU Mesih, MD.
Institution:
Gulhane Military Medical Academy, Haydarpasa Training Hospital, Dept. of
Orthopedics and Traumatology, Istanbul,
TURKEY.
Objective: The humerus middle and distal thirds shaft fractures are commonly seen as
fractures on the upper extremity. These fractures can be treated by mostly non
surgical way. The aim of this study to evaluate the results of humeral shaft fractures
were treated by immediate Sarmiento cast.
Material and method: The study includes 32 patients (10 mid and 22 distal thirds of the
shaft) were treated by Sarmiento cast between 2003 and 2010. The average age of
patients at the time of injury was 24 years (19-30 years). We applied Sarmiento cast
without any padding or little padding immediately. We encouraged the patients moving
their arms. The cast was ended upon the presence of a bone callus and absence of
pain at the fracture site.
Results : Average follow up time was 8 months (6-48). All fractures except 2 cases
were healed without any major problem and we didnt face any nonunion and no major
angulations axis of the humerus. Average union time was 3 months (2-4). The two
fractures underwent to surgery because there is no callus formation at 2 months of
treatment. These fractures were transverse mid shaft fractures. Three different cases
had radial nerve injury.
Conclusion : The results of non-surgical treatment of the humerus mid and distal thirds
shaft fractures are reported as a less complicated way and have a higher rate of union.
This method is practical, efficient, cheap, and safe, if good cooperation is established
with the patients and close observation is done.
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Ortopedi ve
Travmatoloji Servisi, Selimiye Mah. Tibbiye Cad. 34668 Uskudar, Istanbul, TURKEY.
Tel:
+90 216 542 2020
Fax: +90 216 348 7880
GSM: +90 505 774 5830
selamicakmak@gmail.com

180

3rdJUNE2011

PP114

THE EFFECTIVENESS OF PERCUTANEOUS DRAINAGE IN HEPATIC

MESENCHYMAL HAMARTOMA IN A CHILD; A CASE REPORT
Author(s): LCDR CALISKAN Bahadir1, MD, COL SURER Ilhami1, MD, COL GUVEN
Ahmet1, MD, MAJ ATABEK Cuneyt1, MD, LTJG ALTAN Bilal1, MD, COL USTUNSOZ
Bahri2, MD, COL DEMIRBAG Suzi1, MD
Institution: Gulhane Military Medical Academy, Dept. of Pediatric Surgery1, Dept. of
Radiology2, Ankara,
TURKEY
Introduction: Mesenchymal hamartomas are the second most common benign tumor
of the liver in the pediatric age group, and represents about 5% of all primary hepatic
tumors. They are predominantly cystic, solitary or multifocal developmental anomaly.
Approximately 85% of affected children are presenting before the age of 3 years.
Case: The patient was an asymptomatic 17-month-old male infant, in whom a large
intra-abdominal mass was incidentally detected on physical examination at the time of
vaccination
On palpation, the liver extended down to the pelvis was firm, painless hard mass on it.
Routine laboratory, liver function tests and alpha fetoprotein (AFP) levels were normal.
Prothrombin time and partial thromboplastin time were within normal limits. Abdominal
magnetic resonance scanning demonstrated a large solid and cystic mass with 10 cm
diameter was located in 2, 5 and 8 segment of the liver.
Result: After initial diagnosis he was treated with percutaneous catheterization and
500 cc yellowish liquid was aspirated. For one week 50 ml of serous non biliary liquid
discharged. Seven days later laparatomy with total mass excision was performed. The
mass was well-circumscribed from the surrounding liver tissue but not encapsulated.
On the cut surface, the central region of the mass was predominantly occupied by
yellow-whitish, translucent liquid. The cystic mass was totally excised from liver. The
pathological result was mesenchymal hamartoma.
Conclusion: Preoperative percutaneous drainage may reduce the size of the mass
and provide more exact borders so the total excision will be easier for the surgeon.
CORRESPONDENCE:
Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 5487
Fax: + 90 312 304 5900
GSM: + 90 505 806 4996
e-mail: bahadircaliskan@hotmail.com

PP115

URETEROCYSTONEOSTOMY: Y-V UNDER DETRUSOR BRIDGE AS A

MODIFICATION OF LICH-GREGOIR IN KIDNEY TRANSPLANTATION
Author(s): N.MILOVIC, JOVANOVI M., Z. CAMPARA, P. MARIC
Institution: Urology Clinic-Military Medical Academy, Belgrade,
SERBIA
Introduction: Between 30th Jan 1996 and 15th Sept 2009 in Urology Clinic - Military
Medical Academy were performed 277 kidney transplantations. Principle of
transplantation is to place kidney in the right iliac fossa and end-to-end arterial
anastomosis with external iliac artery, end-to-side venous anastomosis onto the
external iliac and ureterocystoneostomy (UCN) according to Lich-Gregoir (L-G)
technique. We describe our experience with surgical technique of modified Y-V Lich-

181

3rdJUNE2011

Gregoir ureterocystoneostomy and emphasize their extremly low complications rate in

our series.
Material and methods: In 274 recepients we performed modified Y-V L-G UCN with
two paralel incisions, 2 recepients underwent L-G technique with detrusorraphy. In 1
patient we performed Taguchi or one stitch technique of UCN. The modification of
the Lich-Gregoir technique we used consist of two paralel detrusor muscle incisions on
anterior site of bladder and creation of detrusor bridge. First incision of the bladder
wall to the mucosa is above and shorter then second. Second lower incision is longer.
Detrusor bridge is usually three times longer then thickness of the ureter. After
mucosal opening on the lower incision of detrusor we made an inverted Y on bladder
mucosa and forming a V flap which was anastomosed with spatulated ureter after his
wriggling under detrusor bridge. The detrusor muscle was closed over the ureter. All
patients were stented with 6-Fr polyurethane double-J stent .
Results: In our study we had three serious complications. In recepient who had
Taguchi one stich UCN developed long tubular ureteral stenosis up to ureteropyelic
junction (UPJ). In this case we successfully anastomsed pyelon of transplanted kidney
with native ureter. Patient who had standard L-G UCN developed stenosis
ureterovesical anastomosis what we resolved with reUCN. In third patient, the other
one with standard L-G UCN, we diagnosed large urinoma with consecutive infection
and necrosis of complete ureter up to UPJ. He was reoperated and performed
pyelovesical anastomosis with Boari flap technique.
Conclusion: Our modification of Y-V Lich-Gregoir technique is successful, simple to
perform, reproducible and without any complication.
PP116

EARLY POST OPERATIVE LAPAROSCOPIC ADHESIOLYSIS

Author(s): COL SURER Ilhami, MD, LCDR CALISKAN Bahadir, MD, MAJ ATABEK
Cuneyt, MD, COL GUVEN Ahmet, MD, COL DEMIRBAG Suzi, MD
Institution: Gulhane Military Medical Academy, Dept. of Pediatric Surgery, Ankara,
TURKEY
Introduction: Abdominal adhesions may cause infertility, bowel obstruction, difficult
reoperation, and chronic abdominal pain. Chronic abdominal pain can be caused by
postoperative abdominal adhesions, whether by the nerve fibers in the adhesions
themselves, by traction to the peritoneum or organs
CASE: Twelve years old girl presented with abdominal pain. She was treated for
enteritis for one week. Physical examination revealed rigid tenderness and rebound
positive. On blood account WBC was 16,7X109/L and hemoglobin was 11,7g/dL. With
the diagnosis of perforated appendicitis, appendectomy, partial omentectomy due to
ischemia performed. A dren is placed to right paracolic region. One week later she
reevaluated for abdominal pain and fewer and 5x7 cm abscess found and drained
percutaneously. Three weeks later she was disappointed with abdominal pain in left
lower quadrant. Plain graphies showed sentinental loops and laparoscopic intervention
was planned. One port from umbilicus and other from right lower quadrant inserted. An
atraumatic grasp is used to isolate the band adhesion between intestine and anterior
wall, which is coagulated by bipolar coagulator and then sectioned with scissors.
Conclusion:Intra-abdominal adhesions are often well-vascularized and innervated. In
laparoscopic adhesiolysis, the first trocar needs to be placed using Hasson's
technique for open laparoscopy in order to avoid accidental bowel perforations.
Electric energy should not be brought in proximity to the bowel, and the entire jaw of
each instrument should be visible at all times. Initial contraindications to laparoscopy

182

3rdJUNE2011

such as previous abdominal surgery have since disappeared with increased

experience and technical advances in surgical instrumentation.
CORRESPONDENCE
Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 5487
Fax: + 90 312 304 5900
GSM: + 90 505 806 4996
e-mail: bahadircaliskan@hotmail.com
PP117

PRE-OP SUBCONJUNCTVAL BEVACZUMAB USE N A

VASCULARZED ADVANCED PTERYGUM: CASE REPORT
Author(s): YILMAZ B, ERDENOZ S, AKARCAY R.
Institution: Military Hospital, Department of Ophthalmology, Diyarbakir,
TURKEY

HGHLY

Case report: A 57 year-old case with highly vascularized advanced pterygium was
presented. His complaints were growth extend on to colored part of his left eye and
blurred vision with same eye. His pterygium history had started 30 years ago and
complaints had gotten worse day by day. We injected 5 mg of subconjunctival
bevacizumab (0.2 mL of the aliquoted commercial solution of Avastin ) under
pterygium 5 days ahead the surgery. Sixth day; pterygium vascularity was decreased
markedly on our examination and pterygium tissue was removed with bare sclera
technique. Pre-op subconjunctival bevacizumab can be helpful for intervention on
highly vascularized pterygium.
Corresponcence:
CPT Burhan Yilmaz, MD
e-mail: drburhanyilmaz@gmail.com
PP118

MANAGEMENT OF HEAD TRAUMA DUE TO LANDMINE EXPLOSIONS: FROM

BATTLE FIELD TO OPERATION ROOM.
Author(s): MAJ ATABEY Cem, MD, CPT GOCMEN Selcuk, MD, CDR TOPUZ
Kivanc, MD, COL DEMIRCAN Mehmet Nusret, MD, 1st LT EROGLU Ahmet, MD
Institution: Gulhane Military Medical Academy, Haydarpasa Training Hospital, Dept.
of Neurosurgery, Istanbul,
TURKEY.
Objective: In recent years, there has been an increasing awareness and activism on
the landmines. Although landmines are used as a tactical barrier in the battlefield and
thus expected to be injurious on the military personnel, many studies show that injury
rate of civilians is higher. Head injuries due to landmine explosions are not well studied
and the management of such injuries is not schematized.
Material and method: The data of 119 patients who underwent surgery for the head
injuries due to landmines explosions were reviewed retrospectively. All of these
patients were military personnel and the mean age was 23 years.
Results: In terms of the injury cause, 83 (69,7%) of the cases were injured by the antipersonnel and 36 (30,3%) were injured by the vehicle landmines. Fifty percent of the
patients underwent emergency surgery for depressed skull fracture, intraparenchymal
foreign body, epidural haematoma and subdural haematoma. Six (0,05%) patients

183

3rdJUNE2011

died in the emergency room.

Conclusion: Landmine explosions can produce classic injury patterns from blunt and
penetrating mechanisms to several organ systems. They can also result in unique
injury patterns to the brain. Understanding this important difference is critical in
managing these injuries. Early surgical treatment and appropriate management could
save more lives.
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Nrosirurji Srv, Kadikoy
34668, Istanbul, TURKEY.
Tel: +90 216 542 2020 (4102)
Fax: +90 216 348 7880
GSM: +90 536 551 9106
Email: catabey@gata.edu.tr
PP119

REMODELISATION OF NEGLECTED SALTER-HARRIS TYPE-2 DISTAL PHYSEAL

FRACTURE
Author(s): LT CAKMAK Selami, MD, MAJ OZNAM Kadir, MD, COL PEHLIVAN
Ozcan, MD.
Institution:
Gulhane Military Medical Academy, Haydarpasa Training Hospital, Dept. of
Orthopedics and Traumatology, Istanbul,
TURKEY
Objective: To show the high remodelisation potential of a neglected displaced distal
radius physeal fracture without any manipulation.
Material and method: A 8 years old boy who fell down on right hand while playing was
admitted a hospital and he followed with the diagnosis of soft tissue injury. When he
admitted to our hospital after 18 days from injury, Salter Harris type II distal radius
physeal fracture (dorsal angulation was 45 degree and 50% displacement at sagittal
plane and 25% displacement at axial plane. Casting only applied for 3 weeks to
prevent further displacement and no manipulation done to prevent harming the growth
plate. After cast treatment, patient followed periodically.
Results: At 8th month after trauma, follow-up anterior-posterior and lateral
radiographies of wrist we observed that metaphyseal and physeal arrangement and
alignment of distal radius was petrfect and joint movements were full.
Conclusion: We believe that because of the high remodelisation potential of distal
radius, especially at 10 year old healing of growth plate fractures occurred without any
problem. For neglected physeal fractures, manipulation attempts to gain alignment can
lead to groth problems and lower remodelisation potential.
Correspondence:
Gulhane Askeri Tip Akademisi, Haydarpasa Egitim Hastanesi, Ortopedi ve
Travmatoloji Servisi, Selimiye Mah. Tibbiye Cad. 34668 Uskudar, Istanbul, TURKEY.
Tel:
+90 216 542 2020
Fax: +90 216 348 7880
GSM: +90 505 774 5830
selamicakmak@gmail.com

PP120

GASTRIC HETEROTOPIA AS A POLIPOID MASS IN JEJUNUM CAUSING

184

3rdJUNE2011

RECURRENT INTUSSUSCEPTION
Author(s): LCDR CALISKAN Bahadir1, MD, COL GUVEN Ahmet1, MD, MAJ ATABEK
Cuneyt1, MD, LTJG ALTAN Bilal1, MD, MAJ GUNAL Armagan2, MD, COL DEMIRBAG
Suzi1, MD, COL SURER Ilhami1, MD
Institution: Gulhane Military Medical Academy, Dept. of Pediatric Surgery1, Dept. of
Pathology2, Ankara,
TURKEY
Introduction: Heterotopic gastric mucosa (HGM) is the gastric mucosa which is located
outside the stomach in the small intestine. It is rare and found incidentally when
examining the reason of gastrointestinal bleeding, perforation, and intussusception.
Case report:A 14-year-old boy was admitted to the hospital with the history of
episodes of colicky abdominal pain, nausea, and vomiting of 9 months duration.
Physical examination revealed tenderness of both lower quadrants. Laboratory results
were within normal limits. Abdominal ultrasound showed intussusception of bowel
segments in the left lower quadrant. At laparotomy, jejunojejunal intussusception was
found 20 cm distal to the ligament of Treitz. After reduction, an intraluminal polypoid
lesion was palpated 15 cm distal to the ligament of Treitz. After performing enterotomy
a polypoid mass with 5 cm diameter was observed. 7-cm segment of jejunum was
resected together with polypoid lesion and primary jejunojejunal anastomosis was
performed. On microscopic examination, there were well demarcated zones of gastric
mucosa adjacent to jejunal mucosa.
Discussion: The common clinical picture is related to intermittent intussusception of
the lesion at about 14 years age. The treatment of HGM is surgical resection of the
involved segment. Although gastric heterotopy of the small intestine is a rare clinical
condition, if there is unexplained gastrointestinal tract bleeding, perforation, and
recurrent intussusception, the possibility of intestinal HGM should be kept in mind. In
the long-term follow-up, the major problem is recurrence of HGM adjacent to the
resection border or another segment of the small intestine.
Correspondence:
Gulhane Askeri Tip Akademisi, Cocuk Cerrahisi AD, Etlik 06018, Ankara, TURKEY.
Tel:
+ 90 312 304 5487
Fax: + 90 312 304 5900
GSM: + 90 505 806 4996
e-mail: bahadircaliskan@hotmail.com
PP121

PERIPHERAL GIANT CELL GRANULOMA IN GINGIVA: A CASE REPORT

Author(s): CPT OZCAN Erkan Dent., PhD.1, CPT BODUR Serkan, MD2, COL GALP
Erdem, MD3
Institution:
1Maresal Cakmak Military Hospital, Oral Health Center, Dept. of Periodontology,
Erzurum, TURKEY
2Maresal Cakmak Military Hospital, Dept. of Obstetrics & Gynecology, Erzurum,
TURKEY
3Maresal Cakmak Military Hospital, Dept. of Pediatrics, Erzurum, TURKEY
TURKEY
Objective: Peripheral giant-cell granuloma (PGCG) is an infrequent exophytic lesion of
the oral cavity, also known as giant-cell epulis, osteoclastoma, giant-cell reparative

185

3rdJUNE2011

granuloma, or giant-cell hyperplasia. In this case report, we aimed to present the

clinical, histopathological features and treatment of a PGCG case which is seen in
gingiva and prevents chewing functions due to its large size.
Material and methods: A 21 years-old non-pregnant female patient who complains about gingival
enlargement and pain while chewing was admitted. Patients intraoraly examination revealed a
raised, round, sessile, smooth-edged mass 2 cm in diamater located on the right
mandibular gingiva. After initial periodontal treatment, exicional biopsy was performed
under local anesthesia. Biopsy specimen embedded in 10 % formalin and sent to
department of pathology for histopathologycal investigations.
Results: A large number of stromal fibroblastic cells and multinucleated giant cells
were observed in the lesion by histopathological examination. The lesion was
diagnosed as PGCG after clinical and pathological examination. Two weeks over
surgery process, area of the lesion appeared completely normal as clinically. No
recurance of the lesion was found in six months after surgery.
Conclusion: As in our case, PGCG lesions reached in great amounts can impair the
functions of mastication. Recurrance is rarely seen when irritative factors causing such
reactive lesions are eliminated. Non-pregnant state of our patient may positively
influced recurrance rate of lesion.
Key words: Giant cell granuloma, Gingival enlargement, Oral reactive lesions
Correspondence:
Marasal Cakmak Asker Hastanesi, Kadn Hastalklar ve Dogum Servisi, Yenisehir,
Erzurum, TURKEY.
Tel: +90 442 3172269
Fax: +90 442 3172263
GSM: +90 533 6379313
e-mail: serkan_bodur@yahoo.com
PP122

CLINICAL CASE OF HEMORRHAGIC RETINAL DETACHMENT FOLLOWED BY

HEMOPHTHALM.
Author(s): VIDINOVA Christina MD PhD, Col. VOINOV Latcezar MD PhD
Institution: Clinic of Ophthalmology, Military Medical Academy -Sofia,
BULGARIA.
Hemorrhagic retinal detachment is a rare condition usually associated with trauma,
retinal detachment surgery or sickle cell retinopathy. It is extremely uncommon after
anticoagulation therapy as prophylaxis of pulmonary embolism.
Objective: The aim of our survey is to describe a rare clinical case of hemorrhagic
retinal detachment, with elevation of the IOP, complicated with hemophtalm. We would
like to discuss the diagnostical methods and possible clinical therapies.
Material and methods: We present a case of a 56 year old patient admitted for
therapy at the Eye Clinic Military Medical Academy, Sofia with sudden loss of vision in
the upper part of the visual field and pain. He underwent a complete ophthalmologic
examination, including visual acuity, tonometry, ophthalmoscopy and fluorescein
angiography. In order to exclude solid retinal detachment B- ultrasound has been
performed and MRI of the orbit with contrast was carried out.
Results: The visual acuity of the patient on admission was PPLC, with uncertainty in
nasal direction, the IOP was 40 mmHg. Ophthalmoscopically retinal detachment in the
temporal retina partly serous, but mostly hemorrhagic has been detected. Fluorescein
angiography raised the question of possible tumor lesion underneath the blood. B-

186

3rdJUNE2011

ultrasound however confirmed the diagnosis of hemorrhagic detachment and showed

partial hemophtalm into the vitreous. MRI showed with certainty that the lesion is
subretinal blood and the specific test for hemosiderin deposits was positive.
Conclusion: Hemorrhagic retinal detachments are extremely rare, especially in cases
with no traumatic injury. Differential diagnosis with tumors is very difficult and requires
lots of examinations. Usually these cases are treated with vitreous surgery to retain
the normal morphology of the eye only few of them are reported to have a
spontaneous recovery.
Contact: Clinic of Ophthalmology,Military Medical Academy, Georgy Sofiisky Str.3,
1606 Sofia,
BULGARIA.
Tel: 00359 2 922 53 21;Fax: 003592 952 65 36
Mobile: 00359 888 38 75 29.
E-mail: christinavidinova@yahoo.com
PP123

PRE-OP SUBCONJUNCTVAL BEVACIZUMAB USE IN A HIGHLY

VASCULARIZED ADVANCED PTERYGIUM: CASE REPORT
Author(s): CPT YILMAZ Burhan MD,
Institution: Diyarbakr Military Hospital, Department of Ophthalmology, Diyarbakir,
TURKEY
Abstract. A 57 year-old case with highly vascularized advanced pterygium was
presented. His complaints were growth extend on to colored part of his left eye and
blurred vision with same eye. His pterygium history had started 30 years ago and
complaints had gotten worse day by day. We injected 5 mg of subconjunctival
bevacizumab (0.2 mL of the aliquoted commercial solution of Avastin ) under
pterygium 5 days ahead the surgery. Sixth day; pterygium vascularity was decreased
markedly on our examination and pterygium tissue was removed with bare sclera
technique. Pre-op subconjunctival bevacizumab can be helpful for intervention on
highly vascularized pterygium.
Key words: Vascularized pterygium, bevacizumab, surgery.
Corresponcence to: Burhan Yilmaz, MD, e-mail: drburhanyilmaz@gmail.com

PP124

VERBAL ABUSE IN OPERATING ROOMS IN GREEK HOSPITALS

Author(s): LT Achillefs D. BOULETIS 1, AJ Konstantinia KARATHANASI, RN1 ,Eleni
G. TSIMITREA2, LT Eirini A. PAPA1
Institutions:
1. 404 General Army Hospital of Larisa
2. University Hospital of Larisa.,
GREECE
Purpose: The purpose of this study was to evaluate the occurrence of verbal abuse of
nurses working in the operating room of Greek Military and State hospitals.
Material and Methods: The survey was conducted through the use of a questionnaire
and included 50 nurses employed in four hospitals. Statistical analysis was carried out
with SPSS 19 statistical package.
Results: All of the nurses participated had experienced cases of verbal abuse more
than once and 25.6% of them had been abused an average of once a week and

187

3rdJUNE2011

consequently had a very stressful emotional impact. After the incident the emotional
reactions varied between the expressions of fear, defeat and helplessness being
predominant. The most common thoughts after the incidents were they had no right
and I do not deserve to be treated that way. The most frequent long-term negative
effect of verbal abuse is on the relationships of the victims with other hospital staff
members and an impact on their physical health. More than 70% of the nurses asked
believe that in the past years verbal abuse of nurse staff in the OR happened once a
week or more.
Conclusion: The issue of verbal abuse in the operating rooms of Greek hospitals is still
affecting the relationships, working efficiency and mental and physical health of the
personnel. Further research must be made in order to define and eventually improve
working relationships between nurses and physicians.
Correspondence:
MAJ Konstantinia Karathanasi, RN
Tel:+302410624415
Mob: +3069424708
e-mail: k.karathanasi@gmail.com
PP125

CALCIUM PHOSPHATE CERAMICS IN ORTHOPEDIC RECONSTRUCTIVE

SURGERY
Author(s):Sl. dr. R.F. TATU 1,2, R. BREDICIANU 1, Col. G. MURARIU 1, M. HURMUZ
1

Institutions:
1 Dr. Victor Popescu Emergency Clinical Military Hospital Timisoara, ROMANIA
2 Victor Babes Medicine and Pharmacy University Timisoara, ROMANIA
ROMANIA
Bone substitutes, like calcium phosphate ceramics, are being used more often in
orthopaedic and reconstructive surgery representing an alternative to autografts.
The aim of this study is to emphasize the benefits of using calcium phosphate
ceramics after posttraumatic or tumor resection defects.
Material and method: We have performed a retrospective study between 04.15.200902.15.2011 on group of 9 patients with an average age of 41 years, admitted at Dr.
Victor Popescu Emergency Clinical Military Hospital Timisoara, Orthopedics and
Trauma Department. The patients presented bone defects on the tibial diaphysis and
metaphisis with an average of 1.5 cm (1-2.2cm) . We performed bone reconstruction
with calcium phosphate ceramics (hydroxiapatite and/or tricalcic phosphate). Six
patients presented posttraumatic diaphyseal bone defects and in 3 patients the bone
defects were second to tumor resection from tibial metaphysis.
The bone consolidation has not been influenced by tumor or traumatic pathology, sex
or weight, but age, smoking and the distal localized tibial defects prolonged the bone
consolidation period. The post operative outcome of all the 9 patients was favorable,
after functional recovery, they fully regain professional and social activities. Many bone
substitutes are being used in association with classic internal and external fixation
methods. Having known these differences, it is highly important to choose a bone
substitute with the best properties to a certain clinical situation.
Conclusion. The bone defect reconstruction with calcium phosphate ceramics
represents a safe technique, easy to use, being both elegant and with no major risks.
fabitatu@gmail.com

188

3rdJUNE2011

13:30

MEETING IN THE HOTELS LOBBY

13:40-14:00 OLD TOWN BUCHAREST TOUR

14:00-16:00 TRADITIONAL LUNCH - BREWERS INN RESTAURANT
16:00-18:00 NATIONAL BANK MUSEUM TOUR
18:00-21:00 FREE TIME
21:00-23:00 GALA DINNER THE NATIONAL MILITARY CIRCLE
(THE MARBLE HALL)

189

4thJUNE2011

10:00 - 11:00

CLOSING CEREMONY

THE NATIONAL MILITARY CIRCLE (THE PERFORMANCE HALL)

13:00 - 14:30

LUNCH ( NATIONAL MILITARY CIRCLE )

15:00

DEPARTURE

190

INDEX
A
ACIKEL Cengiz Han, 139
ADAYENER Cuneyt, 96, 98, 102, 104, 108
AKAR Fatma, 111
AKARCAY R., 183
AKARSU Suleyman, 130, 138, 143
AKCAY Bulent, 130, 131, 132, 144
AKGUL Emin, 157
AKGUN Veysel, 58, 142
AKIN Ahmet, 125
AKIN Ahmet, 83, 125
AKIN Ahmet, 163
AKYILDIZ Faruk, 82, 175, 180
AKYOL Ilker, 91, 92, 97, 103, 107, 129
AKYOL Mesut, 169
ALAGOZ Engin, 121
ALAN Cabir, 93, 99, 100, 105
ALEKSI Aleksandar, 67
ALEKSIC P., 84
ALEKSIC Predrag, 94
ALEVETSOVITIS Georgios, 156, 160
ALEXANDROV E., 37, 64
ALEXANDROVA D., 37, 50, 64
ALICI Blent, 100
ALOIZOS S., 39
ALTAN Bilal, 181, 184
ALTINEL Ozcan, 154, 157
ALTINOLUK Blent, 93
ALTINTA Ramazan, 100
AMINLOV Bogdan, 106
ANACHKOV K., 61
ANDJELIC T., 54
ANGHEL A., 76, 127
ANGHEL Cristian, 154
ANGHEL Daniela, 127, 154
APOSTOLARA P., 42
ARGYROPOULOU A., 162
ARI Alpay, 146
ARSENOGLOU A., 39
ARSLAN Nuri, 31
ARSOV V., 113, 147
ARTENIE T., 122
ATA Nazim, 83
ATABEK Cuneyt, 169, 176, 178, 181, 182, 184
ATABEY Cem, 183
ATANASOV Vasil, 31
ATAR Eliyahu, 53
ATAY Mehmet Vedat, 165

ATES Ferhat, 91, 92, 95, 96, 97, 98, 101, 102,
103, 104, 107, 108, 129
AVCI Ismail Yasar, 63, 146
AVRAMIDIS T., 43
AYAN Asl, 121
AYDIN Fevzi, 169
AYDIN Guclu, 21
AYHAN Hatice, 115
AYTEN Omer, 45
B
BABACAN Ali, 165
BABAYIGIT Mustafa Alparslan, 36, 57, 162,
165
BADOIU Camelia, 124
BAKIR Bilal, 110
BALIKCI Adem, 130, 131, 144
BALTOPOULOS George, 157, 164
BANCEVIC V., 84, 87
BANCEVIC Vladimir, 94
BARB I., 20
BASAK Tulay, 43
BATTAL Bilal, 58, 142
BAYKAL Kadir, 91, 92, 95, 96, 97, 98, 102,
103, 104, 107, 108, 129
BAYKAN Zeynep, 48
BNIC Anioara, 41
BELOKONSKY Evgueni, 44
BERAR Simona, 161
BERBECAR Gheorghe, 101
BERBECAR Simona, 101, 161
BERCEANU-VDUVA Delia, 38
BERECHET M., 167
BESIRBELLIOGLU Ahmet Bulent, 63
BEYZADEOGLU Murat, 16, 81
BINJAKU Lozana, 94, 118
BISSIAS C., 86
BODUR Serkan, 165, 185
BOGDAN Vasile, 41
BOGDANOV N., 177
BOLOMYTIS Stefanos, 164
BOLU Abdullah, 22, 130, 131, 132, 135, 138,
143, 144, 150, 151
BONIOS M, 79
BORISOVA M., 7
BOULETIS D. Achillefs, 187
BOUTCHKOVA K., 24, 28
BOZKURT Ali, 132, 144
BOZLAR Ugur, 58, 142

CHRISTOSKOVA R., 17
CIKOTA-ALEKSI Bojana, 67
CINAR Fatma Ilknur, 111
CIOBICA L., 76, 127
CIOBICA Lucian, 51, 154
CIUCHE Adrian, 14, 15, 19, 25, 26, 28, 74, 118,
123
COJOCARU Inga, 119
COJOCARU M., 69, 172
COJOCARU Mihai, 50, 53
COJOCARU Mihail, 136, 168
COLAK Ahmet, 19
CONSTANDACHE T., 23
CORHAN Constantin, 118
CORNECI Dan, 21, 71, 89
COSTACHE D. O., 135
COSTACHE R., 69
COSTACHE Raluca, 135, 172
COSTACHE Raluca Simona, 51
COSTEA F., 30, 89
COSTEA Florea, 5, 71
COSTEA Florin, 126
CRISAN P., 74
CRISTIAN G., 25, 73
CUZINO Dragos, 24

BOZOV H, 32
BRNESCU C., 70
BREDICIANU R., 188
BUAN V., 111
BUAN Vesna, 136
BUCURICA S., 69
BUCURICA Sandica, 50, 135, 136, 172
BUGAN Baris, 59
BUIU Marius Ioan, 125, 126
BUNCAI A., 42
BUE B., 171
BUTOI A, 30
BUTOI Alexandru, 150
C
CAKIR Erdinc, 157
CAKMAK Selami, 82, 175, 179, 180, 184
CAKMAK Tolga, 83, 140, 153, 163
CALCIU C., 54
CALINESCU Francisca, 15
CALISKAN Bahadir, 137, 169, 176, 178, 181,
182, 184
CAMPARA Z., 87, 181
CAN Mehmet Fatih, 27
CANKUL H.brahim, 45, 70
CRPACIU D., 25
CAYCI Tuncer, 157
EKANAC Radovan, 9, 32, 149
CELK Cemil, 22, 130, 131, 132, 135, 138, 143,
144, 150, 151
CELIK Murat, 45, 60
CELIK Turgay, 45, 59, 60
CENGIZ Ekrem, 70
CERMIK Hakan, 75
CEROVIC S., 87
CETIN Mehmet, 52, 77, 110, 151
CETINER Sadettin, 27
CETINER Safiye Rumeysa, 21
CETNKAL Ahmet, 17
CEYLAN Suleyman, 57
CHALKIAS K, 79
CHANDRINOU A., 162
CHANDRINOU Angeliki, 157
CHARALAMBOPOULOS K., 9
CHATZIMICHAEL Konstantinos, 4
CHEAIB Bianca, 136, 148
CHECHERITA Alexandru-Ionel, 50
CHERANA Gabriela, 50, 51, 66
CHETA Dan, 65
CHRISTODOULOPOULOS K., 56

D
DAMIAN Ionela, 53
DARLEVA S, 50, 64
DARMANIS Spyros, 85
DAI V., 74
DASKALOGIANNAKIS G., 164
DEDIC G., 114
DELIGIANNIS Dimitrios, 90
DEMR Cesim, 45
DEMIR Metin, 162
DEMIRBAG Suzi, 169, 176, 178, 181, 182, 184
DEMIRBAS Seref, 157
DEMIRCAN Mehmet, 19
DEMIRCAN Mehmet Nusret, 183
DEVEC Salih, 121, 169
DEVETZI Eirini, 127, 128
DIAMANTOPOULOS Michael, 128
DIAMANTOPOULOS Michail, 173
DIMA A.C., 122
DIMITROVA M., 132, 145
DIMOV Dimo, 36
DINCOGLAN Ferrat, 16
DIRICAN Bahar, 16
DISHOVSKY Christofor, 31

192

FILDISIS George, 157, 164

FIRTINA Serdar, 59
FLOREA D., 122
FRAGOULIS G.E., 35
FURDU I., 54

DJORDJEVIC Boban, 13, 18, 89

DJURASINOVIC T., 54
DODOIU Sergiu, 24
DONCHEV T., 132, 145
DORUK Ali, 144
DRADOPOULOU M., 42
DRAGAN Cristian, 51
DRAGNEV Velichko, 62
DRAGOMIR Andreea, 65
DRANDARSKA I., 17
DRANDARSKA Ivanka, 61
DROC I., 15
DUMITRASCU M, 15
DUMITRESCU S., 127
DUMITRU Catalin, 124
DURAN Eyup, 157
DURSUN Furkan, 91, 95, 101, 104

G
GABARA Adrian, 124
GABEV E. E., 177
GABRIEL Cristian, 71
GAITANOU Konstantina, 154, 157, 164
GALABOVA Agnes, 62
GALP Erdem, 185
GEORGIEV K, 32
GEORGIEVA Elena, 133
GERGOVA I., 7
GIOTAKOS Orestis, 115
GKINI Maria-Angeliki, 12, 56
GOCMEN Selcuk, 183
GORGULU Semih, 121
GOULIAMAS S., 90
GROZAVU C., 26
GROZAVU C., 29
GROZAVU Constantin, 24
GUL Hanefi Cem, 146
GULEN Erhan, 36
GULGUN Mustafa, 48, 166
GUMUS Seyfettin, 142
GUN Ismet, 165
GUNAL Armagan, 184
GUNAL Emine, 63, 146
GNHAN mer, 86, 174
GUVEN Ahmet, 137, 169, 176, 178, 181, 182,
184

E
EFTIMOV T., 13, 102
EKSERT Sami, 47
ELLINAS P., 141
EMER Ozdes, 121
ENACHE Georgiana, 65
ENCHEVA Milena, 30
ENE Laurentiu, 14
ERDEM Onur, 166
ERDEN Glsen, 150
ERDENOZ S, 183
ERDOAN Endercan, 46, 61
EREMIA Adrian, 5
EREN Ali Erhan, 99, 105
EREN FIDANCI Berna, 111
EROGLU Ahmet, 183
EROGLU Murat, 21
ERSAY Ahmet Reit, 99, 100, 105
ERSOZ Fliz, 63, 146
ERSOZ Nail, 157
ERTEN Ela, 47
ERTUNG Yunus, 93, 99, 105
EXARCHOS Konstantinos, 157
EYIGUN Can Polat, 63, 146, 170

H
HADZHIANGELOV I., 13
HANDRINOU Angeliki, 164
HAZER Batuhan, 92
HOXHA L., 6
HRISTOVA K., 113
HRISTOVA KR., 147
HURMUZ M., 188

FAKIROVA A., 17
FANEA F, 30
FANEA Florin, 150
FATSEA T., 56
FEDAI Turan, 110
FIDAN Gonca, 170

ILGAN Seyfettin, 121

ILIAS M., 26, 29
ILIC R., 84
ILIEVA G. Vania, 134

193

ILIEVA L, 64
INCE Semra, 121
IONI-RADU Florentina, 50, 53, 69, 135, 136,
148, 168, 172
IOSIFIDIS M, 9
ISIK Alev, 46
IVANOV V., 53
IYIGUN Emine, 115
IYISOY Atila, 45, 59, 60

KATSIFIS G., 141

KATSIFIS G.E., 35
KATZAROV K., 17, 61
KATZAROV Krum, 49
KAUVAR D. S., 20
KAYA Serdar, 17
KENAR Levent, 8
KERESZTES Alexandru, 68
KESIK Vural, 166
KESOV Georgi, 106
KILIC Erden, 150
KILICKAYA Oguz, 115
KIRILMAZ Bahadr, 93, 105
KISMET Erol, 166
KOCOGLU Hasan, 93, 99, 100, 105
KOKKORIS Georgios, 43
KOKKORIS Panagiotis, 82
KOKSAL Ismet, 82
KONOV Valentin, 62
KONTOLATIS Ioannis, 89
KOSEOGLU Vedat, 166
KOSEVIC B., 84
KOSEVIC Branko, 94
KOSTADINOV Rostislav, 44, 49
KOSTOV Kosta, 30
KOSTOV Milos, 174
KOUSOULIS Panagiotis, 156, 160
KOZARSKI Jefta, 13, 18, 89
KRAFT A., 70
KRI J., 122
KRI Jovan, 167
KRSTIC Dragan, 40
KRSTI Milena, 9, 149
KRUJA Bledar, 177
KUNAK Zeki lker, 8
KUNCHEV M., 37, 50, 64
KURKLU Mustafa, 82
KURSAKLIOGLU Hurkan, 59
KURT Bulent, 157, 166
KURT Ercan, 47, 115, 137
KURT Hasan Anl, 99, 100
KUSKUCU Mesih, 82, 175, 178, 180
KUTIN P., 13
KUTLAY Murat, 19
KUTSAROV P., 32
KYROUDI Vasiliki, 172

J
JAUKOVI Lj., 122
JIANU D.C., 107
JIANU S. N., 107
JINGA Mariana, 50, 51, 65, 66, 69, 135, 136,
164, 172
JORDANOV J., 113
JOSEVA E., 7
JOVANOVI M., 84, 87, 122, 181
JOVANOVI Milan, 167
JOVANOVIC Mirko, 94
JURCUT Ciprian, 51
K
KALENTZOS V., 86, 162
KALENTZOS Vasileios, 125
KALLES Vasileios, 71, 160
KALOGEROPOULOS Athanasios, 55, 71, 127,
128, 140, 160, 173
KALOGEROPOULOU Maria, 71, 140, 160
KALOGIANNIDIS Ioannis, 116
KALOKERINOU Athina, 42
KALVACHEV Z., 37, 64
KAMARINCHEV B., 37, 64
KANEV K., 134, 138, 147, 177
KANEV Kamen, 36, 44, 49, 72
KARADEMIR Kenan, 92, 95, 96, 97, 98, 102,
104, 107, 129
KARAKANEVA S., 102
KARAKAS Ahmet, 36, 162
KARAKUZU Engin, 140, 153, 159
KARAMAN Bulent, 58, 142
KARAOGLU Baki, 166
KARASTERGIOU P., 90
KARATHANASI Konstantinia, 41, 187
KARELAS Ioannis, 24
KARELLAS J., 39, 78, 79
KARVOUNIARI Alexandra, 116, 154
KASSIMOS Dimitrios, 12
KATROV E., 17

L
LALOUSIS Charalampos, 4
LAZAREVIC LJ., 84

194

MILICEVIC Sasa, 13, 18

MILIVOJEVIC Mladen, 38
MILOSAVLJEVIC Ivica, 174
MILOSEVIC R., 87
MILOSEVIC Radovan, 94
MILOVIC N., 84, 87, 181
MILOVIC Novak, 94
MIRCESCU Gabriel, 51
MIRKOVI D., 122
MITEV Mitko, 72
MITEV, M., 138
MITEVA M., 134
MITRICA Marian, 14
MITROVI Miroslav, 167
MITSIOU Maria, 4
MITULESCU Stefan, 85
MLADENOV N., 28
MLADENOVI Jovan, 9, 32, 149
MLADENOVI M., 74
MOCANU I., 73
MOCOVIC Dejan, 94
MORARU Aurelian, 174
MORARU Liliana, 124
MOTOACA Mihai, 113
MOUSTAKA Helen, 41
MOUTEVELIS Vasileios, 156, 160
MUHCU Murat, 165
MURARIU G., 188
MURDJEV R., 17
MURESAN Mihai, 76, 127, 154, 171
MURGU V., 15, 25
MUSABELLIU Erion, 177

LAZI Sran, 9, 32, 149

LAZIC Srdjan, 38
LEFTER M, 113
LIAPIS Dimitrios, 81
LIAPIS G., 39
LILOV M., 102
LILOV M., 13
LOUKAS Thomas, 12
LOUTAS Theodoros, 140
LUFI Albana, 77
LUNGUT E., 54
LUPU Leonard, 5
LUPU Leonard-Marin, 125, 126
M
MACADON B., 69, 127, 135, 172
MACADON Bogdan, 66, 136, 168
MACOVEI Adrian, 125
MAHIROGULLARI Mahir, 82, 175, 180
MAJSTOROVI M., 74
MAKRAS Polyzois, 82
MAKSIC Djoko, 71
MAKSI Djoko, 32
MALEFIOUDAKI Irene, 85
MALKOC Ercan, 96, 97, 104, 107
MALLIAROU Maria, 41
MANDIC-GAJIC G., 40
MANGALAGIU Andrei Gabriel, 41
MANTOPOULOU F., 56
MARGIOULA-SIARKOU Chrysoula, 116
MARIC P., 87, 181
MARIN D., 25, 29
MARIN Dragos, 14, 15, 19, 26, 28, 118
MARINESCU Bogdan, 109, 119, 124
MARINKOVI Jugoslav, 6, 88
MARINOV Krustyu, 133
MARINOV M., 13
MARINOVA E., 64
MARKOPOULOS Georgios, 127
MEKOUCHINOV K., 37, 50, 64
MEKOUCHINOV Krassimir Dimitrov, 31
MELLIDIS Ch, 9
MER Meltem, 61
MERT Gurkan, 170
METIN Suleyman, 140, 153, 159, 163
MIHALAKIS Anastasios, 81
MIHOVA A., 17
MIHOVA Anna, 61
MILEV B., 122
MILEV Boko, 167

N
NACHEVA N. Petia, 134
NAKOV, E., 17
NANAS JN., 79
NASTASE Cristian, 14
NEAGOE Ghe., 74
NEAGU Daniela, 161
NEDELCU Ioana, 119, 124
NEDKOVA A., 61
NEYKOVA L., 134, 147
NEYKOVA Lyudmila, 72
NICULESCU Nicolae, 116
NIKOLAEV M. Evgeni, 134
NIKOLIC Ivica, 94
NIKOLI Z., 74
NIKOLOV Svetlin, 106
NIKOLOVA L., 117

195

PANTILE Daniel, 14, 15, 19, 25, 26, 28, 118,

123
PAPA Eirini A., 187
PAPACONSTANTIS M., 56
PAPADAKIS S., 141
PAPADOPOULOS Dimitrios, 55, 127, 128
PRLEA V., 30
PASHKUNOVA S., 53
PATRASESCU M., 69, 148
PATRASESCU Mihai, 136
PATRASESCU Mihaita, 168
PAZDERKOVA TR., 132
PSIL Herminia, 161
PECHLIVANIDIS A., 9
PEHLIVAN Ozcan, 179, 184
PEJOVIC J., 54
PEKER Yusuf, 157, 169
PENCHEVA T., 34
PENKOV E., 177
PETEVE Helen, 85
PETKOV A., 13, 102
PETKOVA T., 177
PETOUSIS Stamatios, 23
PETOUSIS Stamatis, 116
PETROV N., 24, 28
PETROV Nikolay, 30
PETROVA I., 34
PETROVA Iskra, 31
PISKIN Ahmet, 175
POP Adina, 119
POPA Emil, 14
POPENTIU A.I., 20
POPESCU Andrada, 50, 51, 66
POPIVANOV I., 177
POPOVI Zoran, 6, 88
POTERASU Liliana, 150
PRANDJEV V., 13
PRANTSIDIS A., 56
PRAPAS Nikos, 116
PRUN M., 122
PSAROGIORGOU S., 164
PSINAKIS F., 164
PSOCHIAS Polykarpos, 55, 71, 128
PURCARIN Bianca, 74
PURTULOGLU Tarik, 137

NISTOR Claudiu, 14, 15, 19, 25, 28, 118, 123

NOVAKOVI M., 122
NOVAKOVIC Marijan, 13, 18
NOVAKOVI Marijan, 89
NTAFOULIS Pavlos, 23, 40, 110
NTONTOGLOU Maria, 4
NUTA Ionel Petrut, 66
NUTA P., 69, 135, 171
NUTA Petrut, 136, 168
NU P., 172
O
ODISSEEVA E., 24, 28
OGUZKAYA-ARTAN Mge, 48
OIKONOMOU Christos, 155
OKCELIK Sezgin, 92
OKCELK Sezgin, 103
OKUR AKTAS Gkcan, 83
OLARU A., 23
ORDEANU Viorel, 10
ORHAN M. Emin, 47
OTER Sukru, 157
OYSUL Kaan, 16, 21
OZCAN C. Tangul, 110
OZCAN Erkan, 185
OZCAN Okan, 166
OZDEMIR Barbaros, 130, 131, 132, 135, 143,
144
OZER M Tahir, 169
OZER Mustafa, 52, 77, 110, 139, 158
OZERHAN Ismail, 157
OZGUVEN M. Ali, 121
OZKAN Gokhan, 137
OZKAN Mustafa, 59
OZLER Mehmet, 169
OZMENLER Kamil Nahit, 130, 131, 132, 135,
138, 143, 144, 151
OZNAM Kadir, 179, 184
OZSELEK Suleyman, 132
OZTURK Cengiz, 163
OZTURK Erkan, 121
OZTURK Gultekin, 52, 66, 77, 139, 158
OZTURK lker, 75
P
PADSHAH Waisullah, 178
PANIC M., 114
PANI M., 111
PANI Milivoj, 136
PANTILE D., 29

R
RADAKOVIC Sonja, 38
RADAKOVI Sonja, 9, 149
RAEN Slavica, 9, 149

196

RADJEN Slavica, 38
RADOII Dragan, 6, 88
RADOSAVLJEVIC Vladan, 33
RADULIAN Gabriela, 65
RADUT CRISTIAN, 10
RADUTA Ioana, 127
RANETTI Aurelian Emil, 66
RAPTIDIS Gregory, 81
RASCANU Aida, 136, 148
RDULESCU Matilda, 38
REKKA S.R., 35
RISTANOVIC Elizabeta, 38
RISTANOVI Elizabeta, 32
ROKA Vassiliki, 42
ROUSSAKIS A., 164
RUSU C., 171
RUSU Emilia, 65
RUSU Forin, 65

SIDIRAS G., 162

SIDIRAS G.G., 86
SIMA Irina Ioana, 50, 66
SIMEONOV P., 13
SIMIC Dejan, 94
SIMSEK Abdurrahman, 169
SIMSEK Hakan, 19
SINAN Huseyin, 169
SINICI Ebru, 130, 135, 138, 143, 144, 150, 151
SIRIN Sait, 16
SIRMATEL Fatma, 146
SKAFIDAKIS D., 42
SKULETIC Vesna, 174
SLAVKOVIC Z., 84
SOLAKOGLU Can, 175
SOTIRIADOU Kiriaki, 41
SOURLAS S., 39
SOYDAN Hasan, 91, 92, 95, 96, 97, 98, 101,
102, 103, 107, 108, 129
SPASIC A., 87
SPIRIC Zeljko, 40
SPIROIU Cristina, 19, 66
STAJKOVI Novica, 9, 32, 149
STANCIU S., 76, 127
STANCU Simona Hildegard, 51
STANESCU Marius, 85
STANKOVI N., 122
STANKOVIC Nebojsa, 38
STANKOVI Neboja, 167
STASINI Katerina, 115
STAVREV D, 32
STNESCU Beatrice, 41
STEFAN C., 119
STEFANESCU Ioana, 71
STOEV I., 13
STOICA Alexandra, 24
STOICA Victor, 65
STOICESCU D., 76, 127
SUBOTA V., 54
SURBATOVIC M., 54
SURBATOVIC Maja, 38
SURENKOK Serdar, 16
SURER Ilhami, 137, 169, 176, 178, 181, 182,
184

S
SABAU D., 20
SADIR Serdar, 169
SAGER Omer, 16
SAJINOVIC D., 87
SAKARIDIS N., 141
SALTIROVA Alexandra, 30
SAMARDZIC Radomir, 40
SAMNALIEV Ivan, 31
SANDU Cristina, 19, 53
SARACI Sonja, 6, 77
SARAFIS Pavlos, 41
SAVA Laurentiu, 85
SAVOIU D., 25, 73
SAVOV E., 7
SAVOV Encho Zapryanov, 4
SAVOV ., 53
SAVU Bogdan, 24
SCARLAT V, 113
SCHUSTER Raluca, 161
SEN Ahmet, 163
SENKUL Temucin, 91, 95, 101, 102, 108, 129
SERAFEIM Tatiana, 41
SERGEEV S., 28
SEZIGEN S, 36
SEZIGEN Sermet, 162
SFIKAS Georgios, 9
SHALAMANOV D., 177
SHAMOV T., 13
SIAFAKAS Ioannis, 81
SICIM Huseyin, 22

AVLOVSCHI C., 70
ERBAN D., 70
RN Sait, 17

197

TURKER Turker, 57
TZAKRI Dimitra, 23, 55
TZAVELLAS D., 86, 162
TZORTZINIS Anastasios, 90
TZVETANOV Tz., 177

T
TAIN Nicolae Florian, 41
TAMAM Cuneyt, 175
TANIDIR Yiloren, 101
TASR Mustafa, 142
TASTAN Sevinc, 115
TATOMIROVIC Zeljka, 174
TATU R.F., 188
TNASE N., 122
TEKE Abdulkadir, 45, 70
TELITI Alma, 94, 120
TEODORESCU Andreea, 25, 73
TEPI OSTOJI V., 111
TEPI OSTOJI Vesna, 136
TERROVITIS J, 79
TEUSDEA B, 89
TEUSDEA Bogdan, 5, 27, 30, 89, 113, 150
TITIANOVA E., 102
TIUGAN Alexandru, 112
TIUGAN Claudia, 112
TODOROV I., 13, 102
TODOROVA I., 7
TOK Duran, 48, 166
TOLOUMIS Georgios, 82
TOMA Diana, 74
TOMA M., 89
TOMA Mihai, 5, 150
TOMIC A., 84
TOPUZ Kivanc, 183
TOSUN Uur, 11
TRAYKOVA V., 138, 147
TRIANTAFILLOU Theoni-Fani, 115
TRIFONOVA A., 7
TRIKOLA Artemis, 71, 160
TRKULJA Marijana, 67
TSAGALOU E, 79
TSAKOS L., 78
TSARIDIS Eleftherios, 116
TSARTSALIS Athanassios, 80
TSARTSALIS D.N., 80
TSIMITREA Eleni G., 187
TSIROUDA M., 42
TSOCANAS Dimitris, 85
TSOHATZIS Ioannis, 81
TSOLAKIS E, 79
TUDOSE A., 74
TUDOSE Augustin, 15, 19, 25, 28, 118, 123
TUDOSE Dragos, 126
TURK Y.Ziya, 152
TURK Yusuf Ziya, 158

U
UGUZ Sami, 101, 104
UMUDUM Haldun, 75
UNAL A.Sevim, 61
USTUNSOZ Bahri, 181
UYSAL Bulent, 157
V
VASILE Daniel, 40, 41
VASILESCU Florina, 51
VASILEV Borimir, 106
VASILIU Octavian, 41
VAVASIS P., 86, 162
VAVASIS Paul, 164
VELCHEV V., 32
VELIU Elvis, 177
VIDINOVA Christina, 186
VITALIS A., 90
VLADOV K., 61
VLADOV N., 17, 24
VOICU Victor A., 10
VOINOV Latcezar, 186
VULOV N., 113, 147
W
WEBER-LAUER C., 20
Y
YAGCI Gokhan, 27
YAMAN Halil, 157
YANEVA M, 32
YAREN Hakan, 8, 170
YASAR Mehmet, 157
YAVAS Umit, 139, 151, 152
YELBOGA Zekeriya, 144
YILDIRAN Nuri, 52, 66, 77, 158, 162
YILDIRIM Cengiz, 178
YILDIZ Dilek, 43
YILDIZ Ramazan, 121
YILDIZ Senol, 140, 153, 159
YILMAZ Ali Abbas, 115
YILMAZ B, 183
YILMAZ Burhan, 187

198

YILMAZ Omer, 98, 108

YUKSEL Uygar Cagdas, 60

ZEYBEK Nazif, 169

ZIDAROVA D., 24
IVI B., 111
IVI Bratislav, 136

Z
ZAGAS J., 78
ELJKO Jadranin, 9, 32, 149

199