Day 1 :
Keynote Forum
Willy Aasebo
Akershus University Hospital, Norway
Keynote: Why do some die from alcohol intoxication?
Time : 10:30-11:10
Biography:
Willy Aasebo is a Specialist in Internal Medicine and Nephrology and Leader of section of Nephrology (Medical Department), Akershus University Hospital, Norway. He has published a few scientific articles about alcohol intoxication, deaths in police cells and some nephrological topics including transplantation.
Abstract:
Alcohol (ethanol) is probably the most commonly used intoxication agent worldwide. During the latest decades the possible beneficial effects of moderate use of alcohol have been focused on. Alcohol abuse may cause death by a variety of causes, including accidents, violence and the many diseases that alcoholics may obtain. However, binge drinking may also cause unexpected sudden deaths, but the exact mechanism behind these deaths is not known. Many of the reports on alcohol related deaths have been casuistic, but sudden unexpected deaths have been reported more often in person drinking alcohol regularly than others. Alcoholics may have autonomic neuropathy (caused by functional changes in nervous vagus) increasing their risk of arrhythmias. In alcoholics cardiac arrhythmias, as the holiday heart syndrome, has been described in relation to binge, and atrial fibrillation may be caused by, or is at least associated with, alcoholism. Arrhythmias have also been reported when non- alcoholics drink. Thus, ventricular tachyarrhythmias degenerating into fibrillation is a possible cause of deaths by alcohol intoxication. In general, no single variable in the ECG can predict cardiac arrhythmias, though some features have been associated with later development of arrhythmia. Prolongation of the QTc interval has, during the last decade, been identified as such a risk factor. In an effort to create hypothesis on how alcohol in high blood concentrations affect the ECG, we collected ECGs from all patients that were admitted to our hospital for alcohol intoxication during a one year period and from before they were discharged. Mean alcohol blood concentration was 2.9‰. We measured durations of P-waves, PR intervals, QRS complexes and QTc intervals. We also measured voltage, thinking that if voltage differed from intoxicated to sober in the same patient; this might indicate a mechanism of action from alcohol. Finally, we measured QT dispersion (QTd), even though the significance of QTd has been disputed. We described prolongations in several ECG intervals, but also interesting differences in voltage and QTd in persons with high blood concentrations. Most important is, probably the QTc interval prolongation which has been described by other investigators also. The prolongation of QTc interval has also been found to persist during the abstinence phase in alcoholics. The studies on this topic are few and have methodological difficulties. However it is important to find out more about how alcohol (Ethanol), being as popular as it is worldwide, affects the risk of arrhythmias.
Keynote Forum
Andreas Engelbrecht
University of Pretoria, South Africa
Keynote: An audit of the management of tricyclic antidepressant overdose in the Emergency Unit of Steve Biko Academic Hospital, Pretoria, South-Africa from 2009 to 2012.
Time : 11:30-12:10
Biography:
Andreas Engelbrecht is the Head of Emergency Medicine at the University of Pretoria/Steve Biko Academic Hospital. He completed his MBChB degree from the University of Pretoria. His other qualifications include FCEM, MMed (Fam Med), Dip PEC, DA, DTM&H and MMed in Pharmacology. He is the Director of Emergency Medicine at the University of Pretoria. He has published more than 13 papers in reputed journals and chapters in emergency medicine textbooks. He developed the VAPP course (venomous animals poisonous plants) and the Pearls and Pitfalls in Emergency Medicine.
Abstract:
Background: Tricyclic antidepressants (TCA) are frequently used in South-Africa due to their availability and low costs. These drugs are highly toxic in overdose. Aim: The aim of the study was to audit the key aspects in the management of patients with TCA overdose against an international benchmark.rnMethods: A cross sectional descriptive audit of clinical records was done. The findings were measured against the Guidelines for medical therapy of the emergency network (GEM net). rnResults: Thirty-two clinical records were recruited and audited. The following findings were made: The vital signs of 30 (93.7%) patients were recorded, 21 (70%) were abnormal. One case with hypotension was not managed appropriately. Eighteen (56%) patients had their blood pH analysed and 6 were abnormal. None of these were managed appropriately. Thirty (93.7%) EKG assessments were done. Only 17 (56.6%) were recorded. Five (29%) printouts could be found within the files. Of these 4 (80%) had an abnormal tracing but had not been treated. Of those EKGs only documented, 3 (25%) were described as abnormal but were managed inappropriately. Treatment with bicarbonate was either omitted or done inappropriately and without monitoring. The level of consciousness of 31 (96%) patients was recorded. Three who required intubation were not intubated.rnrnConclusion: The management of TCA overdose did not meet the standards prescribed by GEM net in our sample. This audit had a number of limitations but was used to improve the management of this condition in our unit and may be useful to others.
Keynote Forum
Aisha Yacoub Y S Larem
Hamad Medical Corporation, Qatar
Keynote: Oropharyngeal trauma mimicking a first branchial cleft anomaly
Time : 12:10-12:50
Biography:
Aisha Larem is an ORL-HNS Consultant at Qatari nationality. She graduated from Gulf University Otology subspecialty. She is an Associate Program Director and worked as a Fellowship Program Director and is a Clinical Instructor at Weill corneal at Qatar.
Abstract:
We present a unique and challenging case of a remnant foreign body that presented to us in a child, disguised as a strongly suspected congenital branchial cleft anomaly. This case, featuring a 2 years old male child, entailed oropharyngeal trauma, with a delayed presentation as a retroauricular cyst accompanied by otorrhea that mimicked the classic presentation of an infected first branchial cleft anomaly. During surgical excision of the presumed branchial anomaly, a large wooden stick was found in the tract. The diagnostic and therapeutic obstacles in the management of such cases are highlighted. In addition to exploring the existing literature, we retrospectively analyzed a plausible explanation of the findings of this case.
- Obstetric TraumaBlunt TraumaTrauma-Emergency MedicineTrauma in Nursing & MidwiferyraumaTrauma Therapy
Chair
Willy Aasebo
Akershus University Hospital, Norway
Co-Chair
Akram Fayed
University of Alexandria, Egypt
Session Introduction
Mohamed A.Elhoseny
King Khalid University Hospital, Saudi Arabia
Title: Title: Blood transfusion - An old concept but are there any new tricks?
Time : 12:50-13:20
Biography:
Mohamed A Elhoseny have graduated in Faculty of Medicine, University of Alexandria, Egypt in 2004; where he joined the Critical Care Medicine Residency Program to finish his master of science in critical care and toxicology in 2009.He joined King Khalid University Hospital in 2010 as an intensivist. During his whole career, he always showed interest in spreading the message of how to save more lives. He is a distinguished instructor of the ATLS (advanced trauma life support) courses as well as a TCF (training center faculty) and instructor of ACLS; PALS; PEARS; ACLS EP; AHA ECG & Pharmacology courses. He is also a member of the royal colleges of physicians of the United Kingdom and a member of the royal college of physicians of Ireland.
Abstract:
The most common type of shock in trauma is hemorrhagic shock. Treatment entails two arms: source control as well as resuscitation. Blood transfusion is a corner stone in resuscitation and inspite of the fact that it is routine process since the evolution of modern medicine; but we are still trying to optimize it. Another important aspect in blood transfusion is the concept of ‘Balanced resuscitation’ which needs to be more clarified to those working on patient resuscitation. Fresh versus old PRBCs transfusion …. A debate between the theory and practice .while the theory might support the use of fresh transfusion; the studies failed to prove any difference in the outcome. Due to the shortage in blood supply all over the world; there has been an increasing international demand for the blood substitutes; which might be showing a promising future; how true can this be?
Yuko Harding　
Japanese Red Cross Toyota College Of Nursing, Japan
Title: Factors Affecting Sexual Function after Radiotherapy for Cervical Cancer
Time : 14:10-14:40
Biography:
Yuko Harding has completed Post-doctoral studies from Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of Ryukyus, Japan in 2014. She had been a Midwife/Nurse for 24 years. At present she is working as a Lecturer, Japanese Red Cross Toyota College Of Nursing, Japan.
Abstract:
Objective: To specify clinicopathological risk factors that influence sexual function after radiotherapy for cervical cancer. Methods: This observational and cross-sectional study includes a population of 60 adult women with stage I to III cervical cancer who underwent radiotherapy. Sexual function was assessed using a self-reported standardized questionnaire, the Female Sexual Function Index (FSFI). Age, clinical stage, tumor diameter, type of radiotherapy, use of hormone replacement therapy, and period of time elapsed since the completion of radiotherapy at the time of data collection were documented using participants' medical records. Multivariate logistic regression was used to identify independent risk factors for sexual morbidity. Results:　The median age of participants was 53 years (Interquartile range, IQR, 45-60 years). Using the FSFI total score compared by variable, sexual dysfunction was significantly more prevalent among women in FIGO stage III than those in stage I /II (P=0.038), and at ≥12 months after the completion of radiotherapy than at <12 months after completion (P=0.008). Multivariate analysis revealed that sexual morbidity was significantly more likely in stage III women (OR 4.60, 95% CI, 1.07-24.39, P=0.040), or where radiotherapy had occurred more than 12 months before (OR 4.78, 95% CI, 1.17- 25.20, P = 0.028). Conclusion: FIGO stage III and a period of ≥12 months after radiotherapy are associated with reduced sexual function. In medical consultations with women in these categories, adequate treatment should be provided where appropriate.
Mahmoud A. Alhussini
Alexandria University, Egypt
Title: Blunt abdominal trauma in Bilharzial hepatic fibrosis patients; How does it differ in managment?
Time : 14:40-15:10
Biography:
Mahmoud A Alhussini is a lecturer in general surgery department, Alexandria faculty of Medicine in Egypt. He succeded to finish his Ms thesis in 2010 from Alexandria University. He completed his Md in 2014 from Alexandria University also. He was trained in Alexandria Main Universty Hospital which is a tertiary refferal hospital for more than 3 governates in Egypt including the second,capital.
Abstract:
Bilharzial hepatic fibrosis is an endemic disease in Egypt. This disease affects the liver both anatomically and functionally. There is portal hypertension together with bleeding tendency. Portal hypertension causes backflow in the portal circulation. Thus, collaterals are formed in many sites including the retroperitoneum and abdominal wall. Splenomegaly is another consequence. This enlarged spleen is more vulnerable to trauma and rupture. Conservative measures usually fail. Also, splenorraphy is unreliable. Furthermore, this enlarged spleen is complicated by hypersplenism in many cases. All these present a challenge in managing these patients if exposed to blunt abdominal trauma. Both conservative measures and interventions carry major risk to the patient. Hence, those patients should have special care during their managemnt.
Seham A.Elgamal
King Saud bin Abdul-Aziz University for Health Sciences, Saudi Arabia
Title: The effect of a designed triage management protocol on complications and hospital stay among patients with blunt abdominal trauma, at a University Hospital in Egypt
Time : 15:30-16:00
Biography:
Seham A Elgamal has completed her Master’s and PhD from College of Nursing- Cairo University- Egypt. She is working as an Assisstant Professor at College of Nursing- King Saud Bin Abdulaziz University for Health Sciences. She is the Chairperson for the life support commitee and member in clinical simulation commitee. Her research intrest is emergency nursing, organ transplantation, critical care nursing, and clinical simulation.
Abstract:
Abdominal trauma is a leading cause of morbidity and mortality among all age groups. So, it is essential to understand the nature of injury (blunt/penetrating) and the affected abdominal organs to avoid complications in the recovery period. The aim of the study was to evaluate the effect of a designed triage management protocol on the complications and the length of hospital stay among patients with blunt abdominal trauma. The sample was comprised of 60 male and female patients (30 study and 30 control). Three tools were utilized for data collection in addition to structured interviews and direct nursing care for the patients were utilized. The results revealed that, in relation to traumatic complication`s signs and symptoms, the study subjects were having relatively low complications as compared to control group. The improvement was obvious in: nausea & vomiting (6.7% vs 26.7%), fever & wound infection (43.3% vs 76.7%), and abdominal distention & absent/diminished bowel sound (36.7% vs 67.7%), dyspnea (26.7% compared to 36.7%), and abdominal pain, rigidity, guarding and tenderness (73.3% vs 93.3%) respectively. In relation to length of hospital stay the mean number of hospital stay period is 4.9+2.9 & 5.8+3.7 of the study and control group subjects. Significant relationship was found between complications and hospital stay with (P<0.01, P<0.05) among study and control group subjects. Conclusion, despite the differences documented between the two groups, no statistical significant differences were found between the two groups in relation to complications and hospital stay.
Amal Roshdi Ahmed Mostafa
Beni-suef University, Egypt
Title: Effect of exercise and self- care guidelines on relieving urinary incontinence among women in Beni-Suef-University Hospital
Time : 16:00-16:30
Biography:
Amal Roshdi Ahmed has completed her PhD at the age of 33 years from Benha University on Maternal & Neonatal Health Nursing. she is the manager of Information Technology unit and quality management unit at the faculty of nursing Beni-Suef University.
Abstract:
Aim: The aim of the present study was to evaluate effect of exercise and self-care guidelines on relieving urinary incontinence among women in Beni-Suef. Methods: Design was intervention study. Sampling was purposive sample included 100 women attended at gynecological outpatient clinic of Ben-Suef University Hospital. Data collection tool consisted of an interviewing questionnaire sheet covering socio-demographic data, knowledge assessment, and exercise scale and self-care guideline regarding preventive measure urinary incontinence. Results: The results revealed that there was a lack of information regarding urinary incontinence in about 92% of study sample. The majority of women couldn't make proper self-care for relieving urinary incontinence before intervention in comparison (97%) gain knowledge and made proper self-care regarding Urinary Incontinence after intervention. Conclusion: The women’s knowledge and practices of self-care guideline regarding preventive measures of symptoms of urinary incontinence has marked positive effect on relieving it after utilization of self-care guideline carefully. Recommendation: Apply the same study on large sample in other setting to distribute awareness guideline regarding preventive measure of Urinary Incontinence.
Mohamed Ibrahim Mohamed
Beni-suef University, Egypt
Title: Effect of exercise and self- care guidelines on relieving Urinary Incontinence among women in Beni-Suef University Hospital
Time : 16:00-16:30
Biography:
Mohamed Ibrahim Mohamed as PhD in Sport Psychology from Helwan university , lecturer of Psychology at pharmacy & Nursing faculties. He is the manager of quality management unit of Faculty of Physical Education,Beni-suef University.
Abstract:
The aim of the present study was to evaluate effect of exercise and Self-care guideline on relieving Urinary Incontinence among women in beni-suef. Design was intervention study. Sampling was purposive sample included 100 women attended at gynecological outpatient clinic of Ben-Suef University Hospital. Tool: Data collection tool consisted of an interviewing questionnaire sheet covering socio demographic data, knowledge assessment, and exercise scale and self-care guideline regarding preventive measure Urinary Incontinence. The results revealed that there was a lack of information regarding Urinary Incontinence in about 92% of study sample. The majority of women couldn't make proper self-care for relieving Urinary Incontinence before intervention in comparison (97%) gain knowledge and made proper self-care regarding Urinary Incontinence after intervention. Conclusion: The women knowledge and practices of self-care guideline regarding preventive measures of symptoms of Urinary Incontinence has marked positive effect on relieving it after utilization of self-care guideline carefully. Recommendation: Apply the same study on large sample in other setting in to distribute awareness guideline regarding preventive measure of Urinary Incontinence.
Hiba Abdel Aziz
Northeast Ohio Medical University, USA
Title: DVT AND PE RATES; UNRELATED: 23 YEARS LITERATURE REVIEW
Time : 16:30-17:00
Biography:
Hiba Abdel Aziz received her Medical degree from the Royal College of Surgeons in Ireland. Her general surgery residency and fellowship in trauma/critical care were at the prestigious Institutes of Case Western Reserve University. She joined the staff at the Cleveland Clinic Foundation, University Hospitals of Cleveland and St. Elizabeth Medical Center, Ohio. She is working as an Assistant Professor at Northeast Ohio Medical University and a diplomate of the American Board of Surgery with added qualifications in Surgical Critical Care. She Chairs the Trauma guidelines committee and is program Director of the trauma critical care fellowship at Hamad General Hospital.
Abstract:
Introduction: Pulmonary embolus (PE) is thought to arise from lower extremity DVT. Lower extremity (LE) DVT surveillance is commonly used in trauma patients at risk for DVT. Methods: A comprehensive DVT surveillance literature review over the past 23 years was performed assessing: the effect of surveillance on DVT and PE rates; efficacy of chemoprophylaxis (CP) and mechanical prophylaxis (MP); and the relationship between DVT and PE. 24 publications including over 13,000 patients were found. Results: DVT rates are significantly higher with surveillance with a rate of 8.5% vs 2.6% without surveillance. PE rate without surveillance was 1.3% similar to a rate of 1.1% with surveillance (p=0.6093). There is no association between DVT rates and PE rates (P=0.7574). CP was associated with a reduction in DVT rate to 4.4%, no CP had a much higher DVT rate of 11.7%. Similarly, PE rate was lower at 0.8% on CP vs 1.5%. MP decreased DVT rate to 7.9% vs 13% without MP. PE rate was similar without MP, 1.5%, vs 1.2% with MP. With no CP and no MP, DVT rate was 13% and PE rate was 1.5% vs 7.8% and 1.2% respectively with CP and/or MP. Conclusions: DVT surveillance of the lower extremities appears to be very effective in diagnosing DVT; however the risk of PE is not decreased. Our data suggest that PE rates are not associated with (LE) DVT rates. The historical notion of their relationship may not be true. New paradigms need to be developed.
Barclay Stewart
University of Washington USA
Title: Serial assessment of trauma care capacity in Ghana: 2004 and 2014
Biography:
Barclay Stewart is an alumnus of the Medical University of South Carolina and the London School of Hygiene and Tropical Medicine. He is senior general surgery resident at the University of Washington. Currently, he lives and works in Ghana as a US NIH/Fogarty Global Health Research Fellow. In Ghana, he is working with a number of stakeholders to improve trauma care Nationwide. He has worked in Belize, Nepal, Malawi, Kenya and South Sudan, giving him considerable understanding of trauma systems in low-income countries and trauma care during humanitarian crisis.
Abstract:
This study aimed to compare the availability of trauma care services and the resources necessary to provide them in Ghana between assessments in 2004 and 2014. By doing so, the effects of a decade of change in the trauma care landscape can be assessed and recommendations for potential interventions can be made. Trauma care capacity assessments of district and regional hospitals in Ghana were performed using the World Health Organization’s Guidelines for Essential Trauma Care. Trauma care item availability ratings were compared; Wilcoxon signed ranks test was used to determine if there was a difference in item availability ratings between the two assessments and within each hospital level. There were significant improvements in mean trauma care item ratings between 2004 and 2014 assessments at district and regional level hospitals (p=0.002 and p=0.01, respectively). However, a number of critical deficiencies remain (e.g. chest tubes, mechanical ventilators, cardiac monitors, diagnostics and essential orthopaedic and neurosurgical care). Most deficiencies were related to stock outs, having never been present at a facility or a lack of training; latter two were most often reported for items that did not have improved availability in 2014 compared to 2004. Re-assessment of trauma care item availability in Ghana demonstrated significant improvement over the past decade. However, important deficiencies remain, some for low-cost items. Serial capacity assessment is a valuable tool for monitoring the effect of efforts to strengthen trauma care systems in LMICs.
Sanja Masnec
University Hospital Center Zagreb Croatia
Title: Peptadecapeptide BPC 157 andPerforating Corneal Injury in Rat
Biography:
Sanja Masnec works as an ophthalmologist at the Department of anterior segment of the eye, at the University Hospital Centre Zagreb. Her special interests are anterior segment eye surgery, cataract surgery, corneal transplantation surgery, and oculoplastic and reconstructive surgery. She has completed her PhD at the age of 34 years from Zagreb University and postdoctoral studies from Zagreb University School of Medicine. She has published 17 internationally indexed publications.
Abstract:
The effect of human gastric pentadecapeptide BPC-157 on healing of perforative corneal injury in rats was evaluated. The study included 100 Male Wistar albino rats, 280-320 g body weight, divided in 4 groups (n=25). The randomization protocol was generated by the Random Allocation Software Version 1.0, 2004 (M. Saghaei, MD, Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran). Penetrant linear incision 2mm was performed under deep anesthesia with ketamine, 20 mg/kg i.p. and diazepam, 6 mg/kg , along with topical anesthetic oxibuprocaine 0.4%, 2 drops on left cornea paralimbal on five o'clock with incision knife 20 Gauge MVR (Bausch&Lomb) under 45°, under operating microscope. Left eye was operated in aseptic conditions by the same surgeon. Lesions were stained by standard 10 % flourescein and photographed. Animals were medicated as follows: distilled water (control group) or BPC 157 2pg/ml, 2ng/ml, 2µg/ml, 2 drops per rat' s left eye started immediately after injury induction, every 8 hours up to 120 hours . Lesions were photographed before application or sacrifice (at 24, 48, 72, 96, 120 h). Healing process was analysed clinically using Fluorescein test, Seidel test, image analysis software (SFORM software (VAMSTECH, Zagreb, Croatia)., slitlamp and pathohistologically using standard tissue analysis. Throughout 120h-period a steady recovery is noted in controls. Healing was significantly accelerated in eyes on µg- or ng-topical regimen of BPC 157 (p<0.05) during all intervals. BPC 157 was shown to be effective in promoting healing of corneal layers in rats. Results were dose dependent.
Marcin Rzeszutek
University of Finance and Management Poland
Title: Trauma symptoms, temperament traits, social support and the intensity of pain in a Polish sample of patients suffering from chronic pain
Biography:
MARCIN RZESZUTEK, PhD, is an Assistant Professor at the University of Finance and Management in Warsaw. He obtained his PhD title in psychology at the Warsaw University. He also has PhD title in economics (Warsaw School of Economics). Apart from being a researcher, he works also as an accredited Gestalt psychotherapists. His research refers to the personality and social determinants of PTSD ans posttraumatic growth in a situation of chronic medical illness (see: HIV/AIDS and chronic pain syndromes). Additional scientific interests revolve around the risk factors and consequences of secondary trauma and burnout among mental health professionals.
Abstract:
The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament was measured with the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Social support was tested with the Berlin Social Support Scales (BSSS). The results of our study suggest that significant predictors of pain intensity among chronic pain sufferers were trauma symptoms. We also noticed that some temperament traits (i.e., emotional reactivity) increased the level of global trauma symptoms, which, in turn, intensified the level of pain. In addition, we showed that global trauma symptoms decreased the support participants actually received.
Tomaz Crochemore
Intensive Care Unit of Israelita Albert Einstein Hospital Brazil
Title: Thromboelastometry-guided hemostatic therapy: an efficacious approach to manage bleeding risk in acute fatty liver of pregnancy: a case report
Biography:
Tomaz Crochemore from Intensive Care Unit of Israelita Albert Einstein Hospital Brazil.
Abstract:
INTRODUCTION: Acute fatty liver of pregnancy (AFLP) is a rare but life-threatening disease. AFLP is characterized by liver failure with different degrees of coagulopathy. Outcome and survival can be dramatically improved with prompt recognition and treatment. Thromboelastometry has been considered a point of care for the management of bleeding patients. It could, therefore, be an alternative tool to treat the complex cases of AFLP involving liver failure and coagulopathy. Through this study, we present our successful experience of an AFLP case that was submitted to an emergency cesarean section in which blood transfusion was guided by thromboelastometry. CASE PRESENTATION: We report the case of a previously healthy 28-year-old woman, Afro- Brazilian, in her first pregnancy with no medical records until the 36th pregnancy week. She presented to our emergency department with an acute onset of abdominal pain, jaundice, nausea and vomiting. The laboratory examinations revealed metabolic acidosis, acute kidney injury (serum creatinine 3.4mg/dL), platelets 97 Å~ 103/mm3, serum fibrinogen 98mg/dL and increased international nationalized ratio (INR 6.9) without acute bleeding. An emergency cesarean section was indicated. Based on the results of the thromboelastometric tests EXTEM and FIBTEM, prothrombin complex concentrate and fibrinogen concentrate were administered at the beginning of the cesarean section, which succeeded with no major bleeding and without need of further transfusion. CONCLUSIONS: Thromboelastometry may be considered a useful, feasible and safe tool to monitor and manage coagulopathy in obstetric patients with acute fatty liver of pregnancy, with the potential advantage of helping avoid unnecessary transfusion in such patients. BIOGRAPHY: Dr. Tomaz Crochemore is physician, a specialist in intensive care medicine, whose area of expertise is in Hemostasis and Thrombosis, with extensive experience in the study of rotational thromboelastometry. Doctor responsible for the Support Group in coagulation and hemostasis of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo - Brazil
Cuong Tran Chi
University of Medicine and Pharmacy Vietnam
Title: Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies. Study of 172 Cases
Biography:
Dr.Cuong Tran Chi is a current Director of Stroke International Services System (S.I.S), Vietnam, Vice President of Vietnamese Interventional Radiology Society, President of Interventional Neuroradiology Society of HCM city, and Consultant of Interventional Neuroradiology of Vietnam. Professionally he is a Neurosurgeon – Neurointerventionalist. From May 2002 - April 2004: he had trained for Neurosurgeon specialist level 1 (Master Degree) in Ho Chi Minh Medical University and had worked in Neurosurgery Department in Cho Ray Hospital Ho Chi Minh. He is the member of WFITN (The World Federation of Interventional and Therapeutic Neuroradiology) and AAFITN (Asian-Australasian Federation of Interventional and Therapeutic Neuroradiology) in 2007. He studied advanced procedures for Stroke Management at USA. From 2006 - 2015: he has performed more than 1500 neurointerventional procedures including: carotid cavernous fistula, intracranial and spinal dural fistula, treatment aneurysm by coiling, treatment AVM, carotid stenting and intracranial stenting, flow-diverter stenting, percutaneous vertebroplasty.
Abstract:
Objectives: We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Methodology: Only type A CCF patients (Barrow’s classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed im-promp-tu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. Results: A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion un-der endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced sacrifice of the parent vessels and it was associated with sizes of the fistula. Total severe complication was about 2.4% which included 1 death (0.6%) due to vagal shock; 1 transient hemiparesis post-sacrifice occlusion of the carotid artery but the patient had recovered after 3 months; 1 acute thrombus embolism and the patient was completely saved with recombinant tissue plasminogen activator (rTPA); 1 balloon dislodgement then got stuck at the anterior communicating artery but the patient was asymptomatic. Conclusion: Endovascular intervention as the treatment of direct traumatic CCF had high cure rate and low complication with its ability to preserve the carotid artery. It also can supply flexible accesses to the fistulous site with various alternative embolic materials. The new classification of type A CCF based on angiographic features was helpful for planning for the embolization. Coil should be considered as the first embolic material for small size fistula meanwhile detachable balloons was suggested as the first-choice embolic agent for the medium and large size fistula.