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Aim: The objective of this study is to evaluate divalent cations serum levels (magnesium, zinc, copper) in liver cirrhossis and one of its major complication (variceal bleeding)., Material and Methods: A prospective case-control study including 60 patients with liver cirrhosis complicated with variceal bleeding admitted to the Emergency Department, and 35 subjects without liver cirrhosis which served as group control. Serum concentrations of zinc, copper and magnesium were determined using atomic absorption spectrophotometer., Results: The concentration of magnesium was significantly lower between patients with liver cirrhosis (11.6 ± 2.77mg/l) vs group control study (17.7 = 3.86 mg/l) (p < 0.001), regarding decreased magnesium levels and the presence of complications as hepatic encephalopathy, ascites (Child C class). Serum concentrations of zinc were decreased (0.77 ± 0.35 mg/l) compared to control group (p < 0.001) in patients with liver cirrhosis and variceal bleeding. Serum levels of copper were increased (1.69 ± 0.722 mg/l) compared to control group in patients with liver cirrhosis and variceal bleeding and are also correlated with serum albumin levels (p < 0.001, Pearson coefficient r-0.631)., Conclusions: Variceal bleeding in patients with liver cirrhosis is associated to important imbalances in blood concentrations of zinc, copper and magnesium.

Emergency medicine as a medical specialty has to deal with all kind of emergency situations, from medical to post traumatic acute eyents and from new born to the elderly persons, but also with particular situations like explosions. In Romania nowadays these are accidental explosions and rare like frequency, but may be dramatic due to numbers of victims and multisystem injury that may occur. We present a case of a single victim of accidental detonated bomb, a projectile from the Second World War, which unfortunately still may be found in some areas. The management of the case from first call to 112 until the victim is discharge-involves high professional team work. We use these opportunity to make a brief review of the mechanism through the lesions may appear and also to renew the fact that the most impressive lesion may not be the most severe, and we have to examine carefully in order to find the real life threatening injury of the patient.

Aims: to assess the profile and the characteristic of oncological patients, establishing management in patients with neoplasia presented in the emergency department (ED), the analysis of short-term movements in patients with neoplasia whilst in the ED., Material and Methods: we performed a retrospective study on nonrandomized consecutive cases. The lot analysis included 1315 oncological patients admitted in the Emergency Department of the Clinical Emergency Hospital "St. Spiridon" Iaşi, in the period June 1st, 2009 - May 31st, 2010. 23.12% of the patients had high suspicion of neoplasia at the first visit to the ED., Results: 67.07% of patients were in metastatic stage disease located as follows: liver metastasis 37.59%, lung metastasis 18.36%, lymph node metastasis 13, 29%. After processing the data there were found statistically significant correlations between the age of patients and the documented/suspected diagnosis of neoplasia (p = 0.01) in the sense that a neoplasia diagnosis in emergency was more frequent in people of young age. It should be mentioned that other studies rarely mention first diagnosis of neoplasia in emergency department with presence of complications., Conclusion: 1315 oncological patients presented in ED, almost a quarter of which presented high suspicion of neoplasia (still without histopathological confirmation) when in ED (23.12%). Most of them were aged male patients (over 65 years old), with tumors of the digestive system. A significant proportion (almost 60%) of these patients ended up in emergency due to complications and the therapy intended life support and pain management. Some of these patients were directed to further exploring and emergency outpatient therapy while 75% of patients were hospitalized after stabilization. Although we expected that the frequency of complications to be higher in patients previously diagnosed with cancer, data analysis showed no statistically significant differences (p = NS) between the rate of complications in patients previously diagnosed with neoplasia and those with high-suspicion neoplasia first diagnosed in the ED.