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Author: Elena Cepoida Degree: doctor of medicine Speciality:  14.00.19 - Medical Imagistics Year: 2007 Scientific adviser: Natalia Rotaru doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova Institution: Scientific council:

Status The thesis was presented on the 26 October, 2007 Approved by NCAA on the 20 December, 2007 Abstract – 0.79 Mb / in romanian Thesis CZU 617.7-003.6-073.75 4.24 Mb / in romanian 101 pages

Keywords

Summary

The carried out study is based on the examination of 145 patients with orbital trauma complicated with foreign intraorbital body. These patients were selected from the database of 2441 cases of orbital trauma consulted in the Clinical Republican Hospital, Radiology department, in 1990 – V.2007. From etiological point of view it was the labor trauma in 397 (16,3%), homework trauma – in 1479 (60,6%) and criminal/ armed conflict trauma – 565 (23,1%) cases.

Studied group included 102 (70,3%) men (mean age 34,2±7,9 years old) and 43 (29,7%) female (mean age 38,5±9,4 years old) patients. Some clinical symptoms were statistically authentic more frequent in patients with intraorbital foreign bodies: keratitis – 67 (46,2% vs. 22,5), uveitis – 79 (54,5% vs. 39,9%), endophthalmitis – 23 (15,9% vs. 5,1%) patients. Associated rhinosinusopathias were determined in 49 (33,7% vs. 12,9%) patients, cranio-cerebral trauma signs – in 89 (61,3% vs. 30,9%) patients. Among the direct radiological signs of the orbital trauma statistically more frequent were hemophthalmus – 36 (24.8% vs. 14,1%) and orbital emphysema – 19 (13,1% vs. 2%), whether orbital fractures – 122 (84,1% vs. 84%), were not more frequent, but the multiple ones predomined. In 30 cases probe-based method was carried out along with other conventional radiological methods, but in 115 patients it has special indications: severe affection of the eye ball – 39 (33,9%), conscience disturbances, including coma, – 13 (11,3%), severe associated trauma – 20 (17,4%), eyelid lesions – 9 (7,8%), non-cooperative patients, especially children, – in 34 (29,6%) cases. Intraorbital foreign body (solitary) was localized in the corpus vitreousum – in 86 (69,4%), in transition zone and anterior chamber – 12 (9,7%), in crystalline lens – in 6 (4.8%) cases; intraorbitally extraoculary – in 20 (16,1%) patients. Probe-based method sensibility was 96,4%, its specifity – 95%. Therefore, the method of probe-based foreign body localization method is recommended for practical application in patients with roentgen-positive foreign bodies, complicated with conscience disturbances, in children and other non-cooperative patients, in case of advanced pathological modifications of the orbit as well as skull or brain, during armed conflicts.

Ultrasonography was performed in 115 patients, having the sensibility of 82,2% and specifity of 86,5% with maximum utility in patients with intraocular, anterior segment localized, especially radio-negative foreign bodies, or during the postoperative follow up. Classic computed tomography was carried aut in 19 patients, helicoidal one – in 10 patients. Its sensibility was 93,5%, but specificity – 95,4%. This method is recommended in patients with complex cranio-cerebral trauma, suspection on brain lesions or advanced modifications of the orbit. In the framework of studied data a sequential diagnostic algorithm was proposed, that is able to minimize expenditures and in the same time is capable to determine the correct and well-timed diagnosis.

Oficial Reviewers

• Valeriu Cuşnir
  doctor habilitat, professor,
• Mihai Eftodii
  doctor, associate professor (docent)

 Theses