T. Ezri¹, A. Izakson², Y. Ginosar³

¹ Head, Department of Anesthesia, Wolfson Medical Center, Holon, Associate Professor of Anesthesiology Tel Aviv University, Israel;  Outcomes Research

Consortium, Cleveland OH, USA

² Head, Department of Anesthesia, Rebecca Sief Medical Center, Zefad, Instructor of Anesthesiology, Tel Aviv University, Israel,

³ Director of the  Mother and  Child Anesthesia Center, Department of Anesthesiology and  Critical Care  Medicine, Senior Lecturer of Anesthesiology, Hadassah

Hebrew University Medical Center, Jerusalem, Israel

The  difficult airway is so much a challenge mainly for the  un-experienced anesthetist, that  it deserves a privileged position in the  train- ing program of the  residents. Enhanced awareness of the  importance of through preoperative airway assessment as routine practice, implementation of airway management algorithms and  the  introduction of new airway devices are corner stones for a good outcome. The  aim  of these steps is to  diminish the  consequences of encountering a difficult airway, that  is, to  avoid failed intubation and  thus brain failure  or other complications of hypoxia. The  review highlights recent developments in the  management of the  difficult airway, by  no  means intending to  substitute clinical teaching or comprehensive airway management courses. Difficult intubation can  lead  to failure  to  intubate and  if  associated to  difficult mask ventilation or  to  the  worst nightmare- failed mask ventilation – bare  the  risk  of ending up with unwanted outcomes.  Therefore, the  authors present the  predictors of difficult intubation, introducing the  Class zero airways, previously described by the  same team. A floppy epiglottis might hamper mask ventilation even  to this novel described class of patients. New devices and  recommended positions for  intubation are updated; ways to assess depth of intubation are exposed. The  conclusion states how far we  are from  ideally managing the  difficult airways despite novel technology. The  opening to  learning, exercising, being prepared with alternatives  and  providing  proper equipment while getting experience are  the  ways to  improve our performances and  the  patients’ final outcome.

Marcela Vasluian¹, O. Nagy², Ancuţa Zagyva²

¹ Mureş County Department of Public Health
² Orthopedic Clinic No  II, Târgu Mureş

Postmenopausal osteoporosis is a chronic disorder  of bone metabolism characterized by decreased bone mass and increased risk of fragility fracture. Currently the  gold standard for the  diagnosis of the  condition is dual  energy X-ray absorptiometry, osteoporosis been defined according to bone mineral density via the  T and  Z scores.
A series of guidelines exist  for  the  prophylaxis and  treatment of postmenopausal osteoporosis, advocating the  use  of both pharma- cological agents and  general measures like fall prevention and  physical activity. Several pharmacological options are available today, mostly antiresorptive agents such as the  bisphosphonates and  selective estrogen receptor modulators, but  recently anabolic agents have  also  been approved for the  treatment of postmenopausal osteoporosis (parathyroid hormone).
In this  article we  present the  diagnosis modalities and  main options for  prevention and  treatment of postmenopausal osteoporosis, with emphasis on the  factors that  might influence compliance to certain treatment regimes and  that  are of special importance for the general practitioner.

Phenotypic expression at the time of first presentation and also in the evolution of autosomal dominant polycystic kidney disease may differ considerably among patients who belong to the same families.
The paper presents four member of the same family with autosomal dominant polycystic kidney disease. The ages at onset of first symptoms, the type of first symptoms, the progression to end stage kidney disease were very different between family members.
Moreover, two cases were misdiagnosed until end stage renal disease was confirmed.
In the paper, a brief discussion about the clinical manifestations of autosomal dominant polycystic kidney disease and about the differential diagnosis of renal cysts is provided.

Carmen Caldararu, G. Dogaru, Mirela Gliga

Daniela-Dacia Hincu, Anda Sireteanu-Cucui, Natalia-Simona Chiujdea

Although antitoxoplasmic treatments were marketed 50 years ago and are only active on the forms that are rapidly multiplying, they remain in use all over the world. The commonly used antitoxoplasmic drugs are Sulfadiazine and Pyrimethamine, but also, Sulfamethoxazole—Trimethoprim, Atovaquone, Spiramycin, Clindamycin. No drug is really efficient on the cysts, they will usually not eradicate infection. Atovaquone was investigated briefly as a possible cysticidal agent. Treatment for ocular lesion are described. The location of the lesion in relation to the macula and optic disc, and the size and degree of vitritis induced by the lesion, are the main factors regarding the decision to start therapy. In the presence of a proeminent anterior segment inflammation, we have a low threshold for the initiation of topical steroids. The last research are in direction of strategy for vaccine development.