Investor Presentaiton

IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC Abstracts Abstracts was treated with fakotrabeculectomy and LE with laser iryidotomy. Post-operative VA RE = 0,4 stenop., VA LE = 0,5 stenop., RE IOP = 26 mmHg and LE IOP = 24 mmHg. A month later the 20-gauge vitrectomy with a re-enactment of the anterior chamber of RE was performed. VA RE = 0,6 stenop., RE IOP = 15 mmHg. LE IOP increased to 44 mmHg. LE gonioplasty was performed in 2013. In 2014 RE adhesions lysis and another re-enactment of the anterior chamber was performed. The final results were: VA RE = 0,4 c.c. 2,75 DSph, VA LE = 1,0 C.C. + 2,0 DSph, RE IOP = 15 mmHg and LE IOP = 25 mmHg. Conclusions: The final result of the treatment was a success in terms of surgical proce- dures' effectiveness, but it was a failure for the patient. The depth of the anterior chamber after procedures performed on a small eyeball with AACG is impossible to predict, so we cannot anticipate the eye's refraction. Due to an unfeasible to correct discrepancy between the eyes, the visual acuity cannot be improved and the patient's quality of life is not significantly increased. 54 Hypersensitivity Vasculitis In A Patient With Surgically Trea- ted Coronary Artery Disease Mateusz Wondołkowski, Anna Wancerz, Dominika Puchta, Wiktoria Ciechowska, Anna Słowikowska, Adam Arendarczyk, Romuald Cichoń, Radosław Wilimski Students' Scientific Group by the Department of Cardiac Sur- gery at the 1st Department of Cardiology, Medical University of Warsaw Background: Hypersensitivity vasculitis (HV) contains a heteroge- neous group of vasculitides associated with type III hypersensiti- ve response to drugs, infectious agents, and other antigens. It is characterized by immune complex deposition in capillaries followed by inflammatory response and fibrous necrosis. It may occur as a result of pharmacological therapy in many medical specialties. Case: A 48-year-old male with a history of myocardial infarctions, arterial hypertension and type II diabetes was admitted to the Department of Cardiac Surgery at the 1st Department of Cardiology, Medical Uni- versity of Warsaw for surgical treatment of coronary artery disease. The patient underwent off-pump coronary artery bypass grafting (OPCAB). The postoperative period was uneventful. The patient was discharged in the 6th post-operative day in good clinical condition with a prescription for the following: acetylsalicylic acid, atorvas- tatin, nebivolol, valsartan, metformin and torasemide. On the 13th postoperative day the patient was once again admitted to the de- partment due to the onset of bright red, well-demarcated palpable petechiae, macules and papules localized on his upper and lower extremities which put forward the suspicion of sepsis. The concen- tration of lesions was highest nearby the surgical wound after saphe- nectomy using multiple incisions with small skin bridges - tunneling on the patient's medial region of the left leg. The patient's general practitioner had prescribed Sulodexide (a mixture of heparin and dermatan sulphate) as a prevention of diabetic nephropathy. Based on extensive laboratory studies, which excluded thrombocytopenia (PLT 484 x103/uL) and significant elevation of biochemical markers of systemic inflammation (CRP 32,2mg/L, WBC 11,88K/uL) HV was suspected. The patient was referred to the Department of Dermato- logy where drug induced HV was confirmed most probably triggered by Sulodexide. Conclusions: The treatment of patients with many comorbidities frequently requires the administration of a number of different drugs. Pharmacological polytherapy creates a higher risk of suffering of sides affects. Meticulous clinical examination and doctor- patient cooperation is crucial for efficient patient medical treatment. We must not forget to treat the patient holistically and keep in mind the inseparability of all medical fields. 55 Esophageal Metastases Of Hepatocellular Carcinoma After Liver Transplantation Radosław Pietrzak, Igor Ilasz, Marta Poręcka, Emil Bik Students Scientific Group, Department of General, Transplant and Liver Surgery, Medical University of Warsaw Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer. It develops as a complication of liver cirrhosis due to viral hepatitis or alcoholic disease. When surgical resection of HCC is impossible, but the tumor meets the Milan criteria, indicated treatment is orthotopic liver transplantation (OLTX). HCC recurrence within 5 years after OLTX is reported in approximately 20% of cases. Metastases to the esophagus occur in far less than in 1% of patients and unfortunately most of them are diagnosed during autopsy. Case: : A 66-year-old male with unresectable HCC and liver cirrhosis (HBV and alcoholic liver disease) was admitted to the Department 15th November 2012 for elective OLTX. Whole procedure and hospital stay were uneventful. Patient was discharged with good function of liver transplant. In less than 2 years after OLTX, patient was admitted to the Department due to dysphagia, there were no additional symp- toms from the liver. A gastroscopy has revealed a 3 cm exophytic mass in the lower part of the esophagus occluding half of its lumen. Sample of the lesion was collected for further investigation. Histo- pathological examination confirmed HCC metastasis. Afterwards, the patient was admitted to the department for further treatment and the stenosis was nullified by esophageal prosthesis. Later on, in September 2014 gastroscopy revealed that protesis migrated to the stomach, so it was replaced with a new one. Migration occurred again and 3 months later the prosthesis was not substituted but re- moved due to hemorrhage from the tumor. It was put back in January 2015. Despite the metastasis of HCC in esophagus imaging didn't show any additional neoplastic changes. The patient still stays under surveillance of the Department. Conclusions: Any case of dysphagia after OLTX due to HCC shall arouse suspicion of metastatic process. Although, HCC metastases to esophagus after OLTX are extremely rare, an endoscopic examination should be immediately performed. 56 Reduced Level Of Pain After Labour As The Case Of Latent Diseases Magda Niedźwiedzka, Piotr Baranek Students' Scientific Group of Department of General, Trans- plant and Liver Surgery, Medical University of Warsaw Background: Surgical emergencies in the purperium are not often, that along with the abdominal symptom, which may be thought to be related to the pregnancy, and rarely convincing signs in contrast to the symptoms, may lead to delay in a diagnosis by inexperien- ced surgeon. What is more, Any of the common surgical emer- gencies could occur during puerperium, such as, acute appendicitis and symptomatic cholelithiasis. Moreover there are some of them that appear more often during puerperium, for example intestinal obstruction. Inadequate treatment of all of them could lead to the life-threatening complications. Case: 35-year old female was admit- ted to Department of General, Transplant and Liver Surgery in order to diagnose the origin of acute abdominal pain lasting two days and located in right iliac fossa with suspected appendicitis. The patient has been performed a Cesarean section three weeks before. USG examination revealed actute inflammation: turgid appendix covered with much fibrous tissue and thickened wall to 1 cm of diameter. Primary treatment showed no recovery thus patient was qualified to operation. Explorative laparoscopy has been performed along with classic appendectomy, removing gangrenous appendix. The level of pain experienced by the patient turned out to be inadequate with the symptoms. According to the literature, the threshold of pain after labour decreases due to the action of beta-endorphins. There- fore, other diseases' pain symptoms may remain reduced or latent. Conclusions: Fluctuation in the level of the pain tolerance caused by the exudation of the beta-endorphins may interrupt patient's per- ception. With the limited number of safely usable antibiotics during breastfeeding, the assessment of the condition fo the patient and the treatment could be relevantly straitened. Extensive examinations and medical imaging are necessary to establish proper diagnosis in order to conduct the most appropriate treatment. 57 Is Endoscopic Cystogastrostomy A Safe Method Of Treatment Post-Traumatic Pancreatic Pseudocysts? Emilia Kowalczyk, Wojciech Korcz Students' Scientific Group, General, Gastroenterological and Oncological Surgery, Medical University of Warsaw Background: According to the American Association for the Surgery of Trauma injuries are the third cause leading to formation pancreatic pseudocysts and represent 3-8% of them. For decades, the gold stan- dard for dealing with post-traumatic pancreatic pseudocysts is their surgical drainage. It is believed increasingly that surgery as a method of choice should be used only in rare cases, for cysts with a very large diameter or the suspicion of neoplasm. Over the last decade the importance of endoscopic treatment has increased. Endoscopic treatment of traumatic pancreatic collection is safe and effective and can be considered a first-choice alternative to surgical treatment Case: A 34-year-old patient with suspiction of post-traumatic pan- creatic pseudocyst detected in USG was admitted to our hospital. On admission she was in a good condition without any symptoms. A physical examination revealed distended abdomen with a palpable, painless mass in the epigastrium. Computer tomography showed a huge, well encysted fluid collection of distal body and tail, with segmental wall thickened to 7mm, hypodense pancreatic pseudo- cyst of about 106 × 122 × 95 mm in size. All blood investigations were normal except serum lipase (73U/L) and fibrinogen (742 mg/ dl). She was performed a gastroscopy which showed compression of the stomach. Based on all data she was qualified to endoscopic cystogastrostomy. While the endoscope was removing, it suddenly rotated and changed the initial location with the result that inte- rrupted the stomach wall. That is why it was decided to convert procedure to laparotomy. After opening the abdomen there were a large amount of air and cloudy fluid from the cyst. Sutured site of perforation and intestinal-pancreatic anastomosis was performed. After the operation, the patient was given parenteral nutrition, cour- se of empiric antibiotic and recoverd well without complications. She was discharged on the 16th postoperative day. The patient was free of symptoms and signs although a control USG showed a residual cyst durig a 6-month follow-up. Conclusions: The preferred method of treatment pancreatic pseudocysts is their endoscopic drainage (the success rate: 91-94%), but we must keep in mind that the final decision should be made individually and takes into consideration both the resort experience and patient preferences, so as to minimi- ze the risk of complications. 58 The Role of EndoVAC Therapy In Pancreatico-Gastric Anasto- mosis Insufficiency. The Novel Approach Krzysztof Szmyt, Adam Bobkiewicz Department of General, Endocrinological and Gastroente- rological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland Background: Pancreatic leakage after pancreaticoduodenectomy is associated with a high morbidity and mortality. Different techniques have been investigated to improve a safety of anastomosis after pancreatic surgery. Negative pressure wound therapy (NPWT) is a well-established treatment based on a device called vacuum-assis- ted closure (VAC) system. Endoscopic vaccum-assisted wound closu- re system (EndoVAC) therapy has been proven to be an important alternative in patients with upper and lower intestinal leakage not responding standard endoscopic and/or surgical treatment proce- dures. Case: A 72-year-old patient was admitted to the Department of General, Endocrinological and Gastroenterological Oncology Sur- gery because of diagnosed tumor in the head of the pancreas. A CT scan revealed a tumor in the head of the pancreas (14x11x10cm). Pancreatoduodenectomy (Whipple procedure) was performed. In- traoperative histopathological examination diagnosed a neuroen- docrine tumor of the pancreas. At 6 day after primary surgery a pancreatico-gastric anastomosis insufficiency was diagnosed. The patient was re-operated twice, at 7 and 15 day after the primary sur- gery. Because of deterioration of patient's general condition, patient was qualified for EndoVAC therapy at 20 day following the primary surgery. Continuous negative pressure of 100 mmHg was set up. At 6 day following initiated EndoVAC therapy, the check-up with endos- copy was performed. The size of the anastomotic fistula significantly decreased and there was no indication for further NPWT. Patient was discharged from hospital at 21 day after the NPWT was implemen- ted with any signs of pancreatico-gastric anastomotic dehiscence. Conclusions: EndoVAC provides perfect wound drainage, closure of the various kind of defect and promotes tissue granulation. This therapy may significantly improve a morbidity and mortality. Moreo- ver, EndoVAC may be usefulness in the multidisciplinary approach - from upper gastrointestinal to rectal surgery complications. Further extensive, large-cohort studies need to be performed to establish application and effectiveness of EndoVAC, before routine widespread use can be recommended. 59 Ophthalmic Dirofilariasis Radina Kirkova Medical University of Sofia Background: Dirofilariasis is a parasitic disease of domestic and wild animals, that occasionally infects humans. The genus Dirofilaria be- longs to the family Onchocercidae and subfamily Dirofilariine of the order Spirurida. Dirofilaria infects different mammals it replicates in animal's body and it could be find in the form of microfilariae (immature stage). Microfilariae are transmitted to humans through biological vectors, such as certain species of mosquitoes (Anopheles, Aedes, Culex). The human is not an appropriate host. The parasite is found in subcutaneous tissue and mucous membranes. The in- volvement of eye may be periorbital, subconjunctival and intrao- cular. Case: We describe a case of subconjunctival dirofilariasis in 64-year-old female patient, hospitalized in the Clinic of Ophthalmo- logy, University Hospital "Tsaritsa Joanna" (Sofia, Bulgaria). The pa- tient presented with redness, irritation, feeling for "movement" and intermittent local pain in the left eye. Her complaints dated from 3 months. Ophthalmic examination revealed a thin white live worm under the chaemotic and injected bulbar conjunctiva. The parasite was removed surgically under local anaesthesia. It was long 130 mm. The worm was identified as Dirofilaria repens in The Center of Pa- rasitology, Sofia, Bulgaria. Conclusions: Ocular dirofilariasis, caused by Dirofilaria repens is very rare for European countries, except the Meditarranean countries. In the literature, the biggest part of the described cases, are from Asia and Africa. The prevention is very important and consists of controlling mosquitoes and animals, that have microfilaria (treating with antihelmintics). 60 Can Glaucoma Treatment Result In Hypotony Maculopathy? - Case Study Anna Kozioł, Katarzyna Wojewoda, Karolina Kątska, Jan Os- trowski, Kinga Caban Medical University of Lublin/Department of Diagnositc and Microsurgery of Glaucoma Background: Glaucoma is a group of eye disorders characterized by progressive optic nerve damage and visual filed loss usually asso- ciated with increased intraocular pressure (IOP). Globally, it affects around 60 million people (2012 data) and remains second leading cause of blindness. Primary open-angle glaucoma is the most com- mon form of glaucoma, tends to develop slowly and usually without any symptoms until significant vision loss has occurred. Despite the fact that pathogenesis of glaucoma is not fully understood, the level of IOP is related to ganglion cell deaths. IOP is the most important and only modifiable risk for this disease, its reduction benefits in preventing the development and slowing the disease's progression. When pharmacological treatment do not achieve desired results, incisional surgery or laser are indicated. Trabeculectomy, which is a highly successful time-tested surgery, remains is the gold standard for glaucoma surgical treatment. Case: In 2004, 54 year old male patient pharmacologically treated for LE(left eye) open - angle glaucoma was admitted to Glaucoma Clinic due to high IOP. Examination showed BCVA LE 0,5 and BCVA RE (right eye) 0,25. Tonometry revealed both RE and LE ocular hypertension - 28 mmHg and 60 mmHg, respectively. After gonioskopy, the diagnosis of RE open angle glaucoma was established and patient was referred to LE trabeculectomy. In 2009 he was admitted again, due to RE ocular hypertension. RE trabeculectomy and LE filtration bleb revision were performed. Despite of adjunctive treatment (beta - blocker, alpha - mimetic and carbonic anhydrase inhibitor), LE IOP remains high and decision about another bleb revision was made. Post operative follow up revealed BCVA LE diminution to 0,1 and LE IOP 4 mmHg. Hypotony maculopathy was diagnosed and managed by adding com- $78 INTERNATIONAL JOURNAL of MEDICAL STUDENTS www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC $79