Cesarean scar defects and placental abnormalities – a 3 year survey study

The placenta is an essential organ for embryonic and fetal development, ensuring nutrient uptake, gas exchange (via the mother\u27s blood supply), waste elimination, thermo-regulation, immunological and hormonal factors, etc. The most common placental abnormalities are represented by placenta previa, and a morbidly adherent placenta (in the form of accreta, increta, and percreta placenta). This study was performed on a sample of 99 patients diagnosed with abnormalities of placentation who underwent cesarian delivery during a period of 3 years in Bucur Maternity Hospital. Seven patients were diagnosed with morbidly adherent placenta (5 accreta and 2 percreta subtypes), the others having placenta previa (65 with lateral disposition, 18 marginal, and 9 central insertion). All patients had been diagnosed by ultrasound (which was also used for general monitoring), being confirmed during operation and histopathologically. Complications required 4 emergency peripartum hysterectomies, with no maternal mortality but with fetal death in one case. The research literature shows that about half of women with placenta previa have several episodes of bleeding, being the leading cause of antepartum hemorrhage. For some women with placenta previa/accrete, hemorrhaging is severe and requires hysterectomy as a necessary step to control the life-threatening situation. Thus, such patients should be carefully monitored to avoid as much as possible the medical, social, and psychological implications of this critical therapeutic procedure

Patients’ perception of childbirth according to the delivery method: The experience in our clinic

Introduction: The aim of this study is to identify the way in which childbirth in general, and the delivery method in particular, influenced the maternal psychosocial status and the perception upon birth during postpartum. Material and method: We conducted a cohort type 2 prospective study. We included patients who had given birth at “Bucur” Maternity of Hospital “St. John” Bucharest from the 1st of January 2017 until the 1st of January 2018. Results: The majority of the patients (21.05%) who chose to give birth vaginally assigned the maximum degree (10) to the difficulty of birth. The patients who gave birth through cesarean section experienced the feeling of sadness in a higher percentage than those who gave birth vaginally (30.52% versus 21.05%). Among the patients who were in favor of having more children, 85.45% preferred the same delivery method. All the patients who gave birth vaginally wished to have other children using the same method, while 81.4% from the patients who gave birth through cesarean section were in favor of more children. Conclusion: The patients’ perception of childbirth was a subjective parameter. Further studies with standardized questionnaires should be applied for more reliable results

Alcohol Withdrawal – Therapeutical Management in Surgical Patients with Upper Intestinal Bleeding

Psychological dependence involves a desire to use a drug to avoid the unpleasant withdrawal syndrome that results from cessation of exposure to it. Alcohol withdrawal syndrome is one of the most feared complications of alcohol addiction and sometimes can be fatal if not treated properly. Withdrawal syndrome is characterized by neurological hyperexcitability, which can lead to severe psychological and neurological symptoms. A survey was conceived in order to monitor the efficiency of several drug associations (Clonidine, Midazolam, IV ethanol), which were administered at the beginning of intensive therapy admission of achohol addicts. By comparing the postoperative evolution parameters and complications incidences for these patients (such as the hospitalization duration in AIT department, the tracheobronchitis incidence, complications as sepsis, pneumonia and cardiac complications), we managed to determine which treatment is the most beneficial for these cases. Benzodiazepines are frequently used for pharmacological therapy of alcohol addicted patients. In our study Midazolam was very efficient, compared to other therapies. When administered for a maximum of 7 days, the inccidence of side effects remains minimal

Conservative surgery of breast cancer in women; psychological benefits

Breast surgery was one of the most dynamic fields of medicine which benefited from significant progress during the last decades. The transition from aggressive and mutilating amputations to conservative, oncoplastic and reconstructive techniques has been constant, offering improved and rewarding results, viewed from both, oncological and aesthetical perspectives. Conservative techniques, especially those which preserve the nipple areola complex, are followed by improved patient’s perception of their body image, confidence and sexuality, with the only drawback of increased anxiety linked to recurrence risk

Current Concepts on Drug Abuse and Dependence

Drug addiction is a complex disease characterized by compulsive and uncontrollable desire to seek and consume the drug. In time, drug-related terminology has undergone many changes, arising from the deepening of the mechanisms of action, but also about the need for a greater precision in the definition. Drug dependence can be assigned not only to pharmacological effects of the drugs of abuse, but also to their interaction with each particular neurological and psychological constitution. The research on the neurobiological mechanisms of addiction processes allows both a better understanding of current pharmacotherapy and the development of new treatment strategies in drug abuse and dependence. In this review we intend to present the current concepts related to drug abuse and dependence

Patients’ perception of childbirth according to the delivery method: The experience in our clinic

Introduction: The aim of this study is to identify the way in which childbirth in general, and the delivery method in particular, influenced the maternal psychosocial status and the perception upon birth during postpartum. Material and method: We conducted a cohort type 2 prospective study. We included patients who had given birth at “Bucur” Maternity of Hospital “St. John” Bucharest from the 1st of January 2017 until the 1st of January 2018. Results: The majority of the patients (21.05%) who chose to give birth vaginally assigned the maximum degree (10) to the difficulty of birth. The patients who gave birth through cesarean section experienced the feeling of sadness in a higher percentage than those who gave birth vaginally (30.52% versus 21.05%). Among the patients who were in favor of having more children, 85.45% preferred the same delivery method. All the patients who gave birth vaginally wished to have other children using the same method, while 81.4% from the patients who gave birth through cesarean section were in favor of more children. Conclusion: The patients’ perception of childbirth was a subjective parameter. Further studies with standardized questionnaires should be applied for more reliable results

Conduita terapeutica in hemoragia din postpartum

UMF „Carol Davila”, Clinica „Bucur”, Spitalul Clinic „Sf. Ioan”, Maternitatea”Bucur”, Bucureşti, România, Al VI-lea Congres Național de Obstetrică și Ginecologie cu participare internațională, 13-15 septembrie 2018, Chișinău, Republica MoldovaIntroducere: Hemoragia din postpartum reprezintă o cauza importanta de morbididate şi mortalitate materna. Cauzele cele mai frecvente sunt: atonia uterina, soluţiile de continuitate, aderenţele anormale ale placentei şi coagulopatie. Material şi metode: Am revizuit baze de date medicale internaţionale cu studii randomizate, meta-analize referitoare la tendinţele actuale despre histerectomia postpartum si tehnicile alternative in hemoragia din postpartum. Rezultate: Incidenţa hemoragiei din postpartum este de 1% in condiţiile unei atitudini terapeutice rapide. Tratamentul este direcţionat de cauză. Astfel, pentru atonie uterină iniţial se tentează mijloace farmacologice şi ulterior gesturi chirurgicale precum ligatura arterei uterine - O’Leary sau ligatura arterei hipogastrice. Sutura B-Lynch si variantele acesteia sunt concepute pentru realiza compresia uterului prin forţă mecanică. Baloanele uterine sunt proiectate pentru a realiza tamponarea zonele de sângerare placentară. Aceasta este cea mai efi cientă metoda deoarece cateterul aplică presiune directă la locul de sângerare. Dispozitivele cu balon uterin concepute special pentru tamponadă uterină după naştere vaginală sau cezariană includ: cateterul Foley, Balon Bakri, dispozitiv B-T Cath şi dispozitiv dublu-balon Ebb care este, de asemenea, proiectat şi pentru hemostaza cervicală. Radiologia intervenţională impune gestionarea avansată, minim invazivă a hemoragiei în postpartum. Conclusii: Utilizarea uterotonicelor, ligaturile vasculare pelvine şi tamponadele cu baloane sunt primii paşi în abordarea terapeutică a hemoragiei din postpartum. Conduita adecvată constă într-o atitudine promtă, deseori cu echipă multidisciplinară

Modern management of diabetic foot complications

Diabetes mellitus comprises a heterogeneous group of metabolic abnormalities, characterized by chronic hyperglycemia, resulting from a deficiency in insulin secretion, a deficiency in action, or from both situations. In its evolution, diabetes can lead to acute or chronic complications, which can be avoided or whose progression can be slowed by optimal glycemic control, provided by the effective treatment, diet, physical activity and glycemic monitoring. One of the most common complications of diabetes is diabetic neuropathy which, in combination or not with peripheral arterial disease, may result in leg changes (ulcers, gangrene, amputations), changes that are known under the heading of diabetic foot. The risk of developing leg ulcer is 25% in the life of a patient with type 1 or 2 diabetes, and amputations of varying degrees may sometimes be necessary. These can, however, be prevented by active screening characterized by the neurological examination for neuropathic signs, and the vascular examination to highlight the presence of peripheral arterial disease. Therefore, in order to prevent the appearance of leg ulcers and to reduce the morbidity associated with it, it is important to diagnose and manage risk factors

Analysis of potentially toxic contaminants in milk powder

The aim of this study was to identify potentially toxic contaminants in milk powder. Powdered milk contains a range of toxic and non-toxic substances that are present in a wide variety, also having very different origins. A number of seven milk powder samples from different producers sold on the Romanian market were analyzed, the samples that were collected from the original packaging: P1, P 2, P3, P4, P5, P6 and P7. The concentration of the following elements was analyzed using the X-ray (XRF) fluorescence method: potassium (K), chlorine (Cl), calcium (Ca), phosphorus (P) and aluminum (Al). The vast majority of the samples showed the levels of elements K, Ca, Cl, Al, P well above the maximum allowable limit (AML). In a single test, the elements potassium, calcium, chlorine, phosphorus showed levels below the maximum allowable limit, but the level of aluminum was much above. The experimental results showed that the market sells assortments of milk powder that exceed concentrations above the maximum limits established by the legislation in force for some constituent elements. Concentrations of constituent elements are not always specified on food labels, and if this information appears, they are not always the correct values

The quality of sexual life after vaginal surgical interventions

Introduction. The malfunction of the supporting pelvic system generates signs and symptoms that require various procedures. The aim of our study was to evaluate whether vaginal surgical interventions for genital prolapse or urinary incontinence have an impact on patients’ sexual quality of life. Materials and methods. We studied 40 eligible women who underwent vaginal surgical procedures in Saint John Hospital, Bucharest. Patients completed a questionnaire 6 months after the intervention. Results. Patients who underwent vaginal surgery for prolapse were 50-64 years of age. The most frequent vaginal surgical intervention was vaginal hysterectomy (32.5%), followed by anterior and posterior colporaphy (17.5%), and direct cystopexy (15.0%). Regarding their sexual life, 42.5% patients described improvement in sexual life, 22.5% described decreased libido after surgery, and 35% indicated no significant improvement. 57.5% of women indicated that they had no sexual discomfort (57.5%), whereas 27.5% had dyspareunia and 15% had dysuria. There was no negative impact on patients’ male partner quality of sexual intercourse after intervention. Conclusions. Vaginal surgical interventions for genital prolapse or urinary incontinence do not appear to lead to significant alteration of quality of sexual life in women