Investor Presentaiton

IJMS INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC s80 Abstracts Abstracts pression sutures. Conclusions: The goal of glaucoma treatment is to preserve irreversible loss of vision. Because of glaucoma chronic progression, therapeutic options need to be adjusted periodically. Although trabeculectomy is highly effective in advanced glaucoma treatment, its efficacy is unpredictable. Both too high and too low postoperative IOP may require interventions to restore the flow of aqueous in the filtration bleb. Hypotony maculopathy can be a vision -threatened complication of glaucoma filtration surgery. In this case direct suturing of the bleb was a preferable form of treatment and resulted in IOP normalization. 61 Temporomandibular Joint Function Before And After Unilate- ral Masticatory Muscles Excision During Oncological Salvage Surgery Piotr Janik Students' Research Group Associated with Head and Neck Cancer Department, Cancer Center, M. Sklodowska-Curie Institute, Warsaw Background: The change in stress distribution and function of tem- poromandibular joint (TMJ) leads to remodeling of articular tissues. It could result in temporomandibular disorders (TMD) but also can result in improvement of TMJ function. We present case of the pa- tient with TMJ function impairment due to the neoplastic infiltration that improved after oncological salvage surgery. Case: 60 year-old male with recurrent oral squamous cell carcinoma (SCC), metastases to the cervical lymph nodes (T4N2Mo) treated with radiotherapy one year ago developed local recurrence. Masticatory muscles infiltration caused significant trismus. The surgical procedure included partial maxillectomy, resection of the coronoid process of the mandible, buccal mucosa, masseter muscle, pterygoid muscles, upper and lower gum, and the floor of the mouth on the left side with all suprahyoid muscles. Tracheotomy was performed. Resected tissues were reconstructed with anterolateral thigh microsurgical flap. Body and ramus of the mandible was not infiltrated. TMJ function was analyzed using JMA Zebris System® before, 9 days and 3 months after surgery. Conclusions: This case shows improvement of TMJ mo- bility after unilateral excision of all masticatory muscles. Functio- nal analysis of TMJ is useful in objective assessment of masticatory function before and after treatment. Further observation is needed to assess delayed effects of surgery. 62 Improper Therapy Of The Simple Subgaleal Hematoma Can Induce A Very Serious Neurosurgical Problem Karolina Twardowska, Marcin Zarzycki Department of Neurosurgery at Second Faculty of Medicine, Medical University of Warsaw Background: A subgaleal hematoma is a collection of blood in the potential space between the skull's periosteum and the scalp's galea aponeurotica. It occurs infrequently. This could be a big problem in the elderly patients who take antiplatelet therapy. An extensive sub- galeal hematoma rarely occurs several days after minor head trau- ma, but very rare complication of this type of hematoma is subgaleal empyema formation. Case: A 46 year-old man developed a subgaleal hematoma as a result of a head injury caused by a hit of a dull object. When a mass started to develop over the scalp the patient presented to his GP, but the doctor didn't apply any treatment. After few weeks when the patient observed an aggravation of symptoms (headache and swelling of the subcutaneous tissue), he consulted a surgeon, who recommended to contact with physiotherapist. Also a sample of purulent content was taken for examination and the patient was treated with antibiotics. The therapy did not work and the patient developed a huge soft-tissue empyema measured 20cm diameter located in the parietal region, with many ulcers on the skin. After consultation with a neurosurgeon the patient was sent to the neurosurgery department of the local hospital. Computed tomogra- phy (CT) showed a significant thickening of the subcutaneous soft- tissue lesions of the head with the suspicious of the empyema in the epidural space. During surgery the empyema and damaged parts of parietal bone were removed, and the dura mater was cleaned. For the reconstruction of the damaged skin in the operative region was used a pedicle skin flap which was supplied with the occipital artery and additional free skin graft from the right tight. Conclusions: In this case we observe improper recovery of the subgaleal hematoma. This could be more often problem in the elderly patients who take antiplatelet therapy because the trauma in this group of patients has a different nature. Neglect or inappropriate treatment of the subga- leal hematoma could cause the subgaleal empyema. The lack of the decision to drain the hematoma or empyema can provoke the very serious skin and bone complications. 63 Should Mechanical Circulatory Support Be Considered As First Choice Surgical Treatment Of Terminal Heart Failure? Case Of 35 Years Old Female With Cardiomyopathy Agnieszka Jasińska, Piotr Gajewski Medical University of Warsaw Background: Ventricular assist devices (VAD) are the base of mecha- nical circulatory support. They are surgically implanted directly into heart ventricule, commonly to the left ventricule (LVAD) but also can support both ventricules (BIVAD). HeartWare VAD (HVAD) is now fre- quently used as a heart failure therapy. It provides continuous flow and due to literature can support heart for more than 5 years. Case: 35 years old female, who suffers from hypertrophic cardiomyopathy (HCM), which occurred after viral-induced lower respiratory tract in- fection and consequent myocarditis when she was 8 y/o. HCM was complicated by obstruction in the outflow area and paroxysmal atrial fibrillation. Since January 2014 patient was eligible for HTX. However, operation had to be cancelled, because of coincidence of patient's menstruation. In autumn 2014 patient's heart failure has aggravated (from NYHA III to IV), she was admitted to the Dept of Cardiosurgery and Transplantology of Institute of Cardiology. On admission patient presented deterioration of heart failure. Because of cardiogenic shock, positive inotropic agents were necessary and an intra-aortic balloon pump (IABP) was implanted. Patient's LVEF was 20% and RV contractility remained correct on cardiac echo (TTE), so a decision of long-term left ventricular assistance was made in Feb 2015. Implan- tation was executed without complications. Postoperative therapy contained haemodynamic stabilization with levosimendan, diuresis stimulation (furosemide), antibioticotherapy (piperacilin/tazobac- tam). On POD 11 patient was reffered to Cardiosurgery department. During next week, patient's cardiovascular efficency has deteriora- ted, peripheral oedema and anuria occurred. Because of cardiac tam- ponade suspicion, reoperation was necessary. Although pericardial effusion was not detected, heart failure had exacerbated and RV contractility decreased. To treat life threatening cardiac insufficiency, another mechanical support- extracorporeal membrane oxygenation (ECMO) was implanted. Since the implantation took place in the end of third week of Feb, patient stays in the postanesthesia care unit. Conclusions: Although HTX is still regarded as the "gold standard" treatment for end-stage heart failure, VAD should be considered as an alternative, but comparable method. Our case shows that VAD is suitable for patient so far considered candidat to HTX and may be a bridge to HTX, to recovery, to another bridge, but also a destination therapy. INTERNATIONAL JOURNAL of MEDICAL STUDENTS 11th WIMC www.ijms.info • 2015 Vol 3 Suppl 1 www.ijms.info . 2015 Vol 3 Suppl 1 INTERNATIONAL JOURNAL of MEDICAL STUDENTS S81