Bagdasar Arseni Emergency Hospital

Bucharest, Romania

Bagdasar Arseni Emergency Hospital

Bucharest, Romania
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Donos C.,University of Bucharest | Maliia M.D.,University of Bucharest | Mindruta I.,University of Bucharest | Mindruta I.,Carol Davila University of Medicine and Pharmacy | And 9 more authors.
NeuroImage | Year: 2016

In the context of the human brain, the term "connectivity" can refer to structural, functional or effective connectivity. Intracranial electrical stimulation is perhaps the most direct way of investigating the effective connectivity. We propose a method of mapping the effective connectivity, revealed by the electrical stimulation of brain structures, over the structural connectome (SC), obtained through diffusion spectrum imaging (DSI), to form a structural-effective connectome (SEC). A number of 24 patients with refractory epilepsy were implanted with depth electrodes for pre-surgical evaluation. Effective connectivity was assessed by analyzing the responses to single pulse electrical stimulation (SPES). Stimulation pulses having variable amplitude were applied to each pair of adjacent contacts and responses evoked by stimulation were recorded from other contacts located in other brain areas. Early responses (10-110 ms) on the stimulation-activated contacts located outside the epileptogenic zone were averaged for each patient, resulting in a patient-level physiological effective connectome (EC). The population level EC is computed by averaging the connections of the individual ECs, on a structure by structure basis. A fiber activation factor is used to weight the number of fibers connecting a pair of structures in the SC by its corresponding normalized EC value. The resulting number of effectively activated fibers describes the directional connection strength between two structures in the SEC. A physiological SEC comprising directional connections between 70 segmented brain areas in both hemispheres, was obtained by inclusion of structures outside the epileptogenic zone only. Over the entire structure set, the Spearman's correlation coefficient ρ between the number of fibers extracted from the DSI Atlas and the normalized RMS responses to SPES was ρ = 0.21 (p < 0.001), while Kendall's tau coefficients ranged -0.52-0.44 (p < 0.05). The physiological structural-effective connectomics approach we have introduced can be applied for the creation of a whole-brain connectivity atlas that can be used as a reference tool for differential analysis of altered versus normal brain connectivity in epileptic patients. © 2016 Elsevier Inc.


Bica F.,Bagdasar Arseni Emergency Hospital
Journal of medicine and life | Year: 2014

The intra articular fractures represent a challenge for the orthopaedic surgeons. Because of the three-articulary surfaces, the calcaneus represents a permanent subject of discussion about the investigation and treatment opportunities. In a retrospective audit of patients hospitalized in our clinic, I tried to identify the opportunity of the CT scan as a preoperative investigation protocol in calcaneal fractures, the results showing that the CT scan represents a mandatory standard in calcaneal fractures.


Trahan J.,Louisiana State University | Serban D.,Bagdasar Arseni Emergency Hospital | Tender G.C.,Louisiana State University
Injury | Year: 2013

Background: Gunshot wounds (GSW) to the spine represent a major health concern within today's society. Our study assessed the epidemiologic characteristics of patients with GSW to the spine treated in New Orleans. Patients and methods: A retrospective chart review was performed from January 2007 through November 2011 on all the patients who were seen in the emergency room and diagnosed with a gunshot wound to the spine. Epidemiologic factors, as well as the results of admission toxicology screening, were noted. Outcome analysis was performed on patients undergoing conservative versus operative management for their injuries. Clinical outcomes were assessed using the ASIA classification system. Complications related to initial injury, neurosurgical procedures, and hospital stay were noted. Results: A total of 147 patients were enrolled. Of those diagnosed with a GSW to the spine, 88 (59.8%) received an admission toxicology screen. Seventy-three (83%) patients out of those tested had a positive screen, with the most common substances detected being cannabis, cocaine, and alcohol. In regards to management, 127 (87%) patients were treated conservatively and only one (0.7%) patient improved clinically from ASIA D to E. Of the 20 patients who underwent surgery, one (5%) patient had clinical improvement post-operatively from ASIA C to D. Conclusions: This study evaluates the largest number of patients with GSW to the spine per year treated in a single centre, illustrating the violent nature of New Orleans. In this urban population, there was a clear correlation between drug use and suffering a GSW to the spine. Surgical intervention was seldom indicated in these patients and was predominately used for fixation of unstable fractures and decompression of compressive injuries, particularly below T11. Minimally invasive techniques were used successfully at our institution to minimize the risk of post-operative CSF leak. © 2013 Elsevier Ltd. All rights reserved.


Mischie A.N.,Bagdasar Arseni Emergency Hospital | Andrei C.L.,Bagdasar Arseni Emergency Hospital | Sinescu C.,Bagdasar Arseni Emergency Hospital
Echocardiography | Year: 2013

Aortic stenosis (AS) is the most frequent valvular heart disease encountered in our daily practice. Although there are clear guidelines for severe AS management, cardiologists often have few treatment options for patients with moderate AS; however, there is higher mortality in this patient subgroup versus an age-matched population. The authors reviewed all of the studies on moderate AS, summarized the factors that increase disease progression and discussed an ideal trial design to prospectively evaluate AS progression factors using modern cardiology tools such as strain and magnetic resonance imaging. © 2012, Wiley Periodicals, Inc.


Axente L.,Bagdasar Arseni Emergency Hospital
Journal of medicine and life | Year: 2011

Heart failure (HF) is a common, costly, disabling and deadly syndrome. Heart failure is a progressive disease characterized by high prevalence in society, significantly reducing physical and mental health, frequent hospitalization and high mortality (50% of the patients survive up to 4 years after the diagnosis, the annual mortality varying from 5% to 75%). The purpose of this study is to develop a prognostic model with easily obtainable variables for patients with heart failure. METHODS AND RESULTS. Our lot included 101 non-consecutive hospitalized patients with heart failure diagnosis. It included 49.5% women having the average age of 71.23 years (starting from 40 up to 91 years old) and the roughly estimated period for monitoring was 35.1 months (5-65 months). Survival data were available for all patients and the median survival duration was of 44.0 months. A large number of variables (demographic, etiologic, co morbidity, clinical, echocardiograph, ECG, laboratory and medication) were evaluated. We performed a complex statistical analysis, studying: survival curve, cumulative hazard, hazard function, lifetime distribution and density function, meaning residual life time, Ln S (t) vs. t and Ln(H) t vs. Ln (t). The Cox multiple regression model was used in order to determine the major factors that allow the forecasting survival and their regression coefficients: age (0.0369), systolic blood pressure (-0.0219), potassium (0.0570), sex (-0.3124) and the acute myocardial infarction (0.2662). DISCUSSION. Our model easily incorporates obtainable variables that may be available in any hospital, accurately predicting survival of the heart failure patients and enables risk stratification in a few hours after the patients' presentation. Our model is derived from a sample of patients hospitalized in an emergency department of cardiology, some with major life-altering co morbidities. The benefit of being aware of the prognosis of these patients with high risk is extremely beneficial. The use of this model may ease the estimation of the vital prognosis, to improve the compliance and increase in the use of life-saving medical or surgical therapy (pacemakers, implantable defibrillators or transplantation).


Giuglea C.,Bagdasar Arseni Emergency Hospital
Journal of medicine and life | Year: 2010

Pressure sores can be defined as lesions caused by unrelieved pressure resulting in damage of the underlying tissue. They represent a common problem in the pathology of plegic patients and, plastic surgery has a significant role in their treatment. Pressure sores occur over bony prominences and so, they are most commonly seen at the sacrum and trochanters in paralyzed patients and at ischium for the patients who sit in a wheelchair for a long time. For these patients, surgical treatment is very important because on one hand, it stops the loss of nutrients and proteins at the site of the pressure sore, and on the other hand, it permits the initiation of neuromuscular recuperation treatment much faster.


Ciurea A.V.,Bagdasar Arseni Emergency Hospital
Journal of medicine and life | Year: 2011

Craniosynostoses are recognized as a group of birth defects that impair the skull structures by early closure of one or more sutures, causing an abnormal cranial shape. Among the "simple" craniosynostoses, (a single closed suture) the most common is scaphocephaly. The 3D CT scan is the most relevant and rapid diagnostic test. The authors present the personal experience of 98 scaphocephaly cases diagnosed and surgically treated in the Neurosurgical Department of "Bagdasar-Arseni" Emergency Hospital during a period of 10 years (2000 - 2009). The procedure of choice was the Stein & Schut (1977) extensive craniotomy that removes the early closed suture. There were no post-operatory death cases and no abnormally closed sutures. The routine use of the craniotome facilitates the lateral osteotomy that allows a normal brain growth and a normal symmetrical skull shape development. The authors advocate for early surgery during the first 6 months of life.


Ciurea A.V.,Bagdasar Arseni Emergency Hospital
Journal of medicine and life | Year: 2013

Subarachnoid hemorrhage represents a serious disease with high mortality and morbidity. Two important areas are becoming the central research interest of subarachnoid hemorrhage: cerebral vasospasm and early brain injury. The authors have reviewed the major contributions in experimental subarachnoid hemorrhage documented in the medical literature in the past 5 years. Treatments interfering with nitric oxide - or endothelin-pathways continue to show antispasmotic effects in experimental models of subarachnoid hemorrhage. Inflammation and oxidative stress play a vital role in the pathophysiology of cerebral vasospasm. Apoptosis, a relevant cause of early brain injury after subarachnoid hemorrhage, also underline the etiology of cerebral vasospasm. Future research studies will continue to elucidate the pathophysiological pathways and treatment modalities targeting cerebral vasospasm and early brain injury, enabling an improvement in outcome for patients with subarachnoid hemorrhage.


Sinescu C.,Bagdasar Arseni Emergency Hospital
Journal of medicine and life | Year: 2010

Heart failure (HF) is a syndrome characterized by high prevalence in society, frequent hospitalization, reduced quality of life and high mortality (overall, 50% of patients are dead at an interval of 4 years, annual mortality varying from 5% to 75%). Outcomes in heart failure are highly variable, prognosis of individual patients differs considerably and trial data, though valuable, does not often give an adequate direction. Taking into account the high prevalence of heart failure in society and its complexity physicians need a model to predict the risk of death, to estimate the survival of heart failure patients. A key element of interest in this area is the survival function, usually noted by S and defined as S(t) = exp(-H0(t)e(a)Tx) = e(-H)0(t)e(a)Tx.


Paraschiv M.,Bagdasar Arseni Emergency Hospital
Journal of medicine and life | Year: 2014

Iatrogenic tracheobronchial ruptures most frequently occur during tracheal intubation, but they can also be produced during tracheobronchial endoscopy or thoracic surgery. The clinical presentation can be brutal, with respiratory failure, cervical emphysema, pneumothorax and hemoptysis. There are also less symptomatic presentations. The diagnosis is confirmed by bronchoscopy. The therapeutic approach can be differentiated, surgical or conservative, although the criteria are not universally accepted. This article aims to review the indications and therapeutic options.

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