Gastroduodenal ulcer with bleeding – a reconsideration of therapy

Spitalul Clinic de Urgență Sfântul Pantelimon, București, România, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere: Complicația hemoragică a ulcerului gastroduodenal cunoaște o incidența în creștere în ultimii ani. Studiul își propune reevaluarea atitudinii terapeutice în cazul ulcerului gastroduodenal hemoragic, cu stabilirea unor criterii de gravitate în care intervenția chirurgicală se impune. Material si metode: Studiul analizează retrospectiv un număr de 337 de pacienți cu diagnosticul de ulcer gastroduodenal hemoragic, internați și tratați în Clinica Chirurgie a Spitalului Clinic de Urgență „Sf. Pantelimon”, în decurs de 3 ani, în perioada ian. 2008 – dec. 2010. S-au analizat datele din foile de observație, protocoale operatorii, rezultate histopatologice. Rezultate: Majoritatea hemoragiilor digestive superioare de cauză ulceroasă au fost rezolvate cu tratament medicamentos (278 bolnavi). La restul de 59 de pacienți a fost necesar un tratament chirurgical, dintre care la 43 pacienți intervenția a fost impusă de pierderea de sânge ce amenință viața, iar la 16 pacienți intervenția a fost impusă de criteriile de gravitate/criteriile prognostice: repetarea sângerarii la scurt timp, criterii endoscopice de gravitate, grupa de sânge rară, etc. La 32 de bolnavi s- au practicat rezecții gastrice subtotale cu diferite tipuri de anastomoză iar în 27 de cazuri s-a practicat ulceroexcizie și hemostaza in situ. Concluzii: Evoluția ascendentă a terapiei farmacologice și endoscopice a scăzut semnificativ necesitatea intervențiilor chirurgicale. Intervenția chirurgicală rămâne mijloc terapeutic util în cazurile cu sângerare masivă și în cazurile neglijate terapeutic.As a complication of gastroduodenal ulcer, bleeding is more and more frequent. The study aims to reevaluate the therapeutic approach together with the development of criteria recommending surgery. Material and methods: The study evaluates 337 patients diagnosed with gastroduodenal ulcer, complicated with bleeding, between January 2008 and December 2010. Data was collected from patient charts, operative recordings, histopathological results. Results: The majority of upper GI bleeding, following the development of an ulcer was managed with medical therapy (278 patients). The remaining 59 patients required surgery, imposed in 43 cases by life threatening blood loss, and in 16 by gravity/prognostic criteria: frequent recurrence of bleeding, endoscopic gravity criteria, rare blood group, etc. Subtotal gastrectomy with various types of anastomosis was performed in 32 cases while in the remaining 27 cases we performed the excision of the lesion and in situ hemostasis. Conclusions: The evolution of pharmacological and endoscopic management significantly reduced the necessity for surgery. Surgery remains a useful therapeutic tool in cases with massive bleeding and in neglected cases

Leveraging HPC Profiling & Tracing Tools to Understand the Performance of Particle-in-Cell Monte Carlo Simulations

Large-scale plasma simulations are critical for designing and developing next-generation fusion energy devices and modeling industrial plasmas. BIT1 is a massively parallel Particle-in-Cell code designed for specifically studying plasma material interaction in fusion devices. Its most salient characteristic is the inclusion of collision Monte Carlo models for different plasma species. In this work, we characterize single node, multiple nodes, and I/O performances of the BIT1 code in two realistic cases by using several HPC profilers, such as perf, IPM, Extrae/Paraver, and Darshan tools. We find that the BIT1 sorting function on-node performance is the main performance bottleneck. Strong scaling tests show a parallel performance of 77% and 96% on 2,560 MPI ranks for the two test cases. We demonstrate that communication, load imbalance and self-synchronization are important factors impacting the performance of the BIT1 on large-scale runs.Comment: Accepted by the Euro-Par 2023 workshops (TDLPP 2023), prepared in the standardized Springer LNCS format and consists of 12 pages, which includes the main text, references, and figure

Hydrocephalus of King Charles II of Spain, the Bewitched King.

King of the Spanish Habsburg dynasty and sovereign of the overseas Spanish Empire, Charles II of Spain, was physically disabled, disfigured, mentally retarded, and he proved impotent. He is known in history as El Hechizado (the Bewitched) because both him and the people believed that his mental and physical incapacity were due to a "witchcraft act." Although several authors speculated about different diseases, most of them genetic such as pituitary hormone deficiency, distal renal tubular acidosis, Klinefelter syndrome, fragile X syndrome, or male XX hermaphroditism, the hypothesis of hydrocephalus was not taken into account. We don't have clear elements to hypothesize a certain etiology of Charles II' hydrocephalus; however, we think the herpetic infection he suffered of after his birth should not be ignored

Tritiation of amorphous and crystalline silicon using T <inf>2</inf> gas

Incorporation of tritium in hydrogenated amorphous silicon (a-Si:H) and crystalline silicon (c-Si) at 250 °C using tritium (T 2) gas at pressures of up to 120 atm is reported. The tritium is stored in a surface layer which is approximately 150 and 10 nm for a-Si:H and c-Si, respectively. The concentration of tritium occluded in planar and textured c-Si is linearly dependent on the total surface area. The tritium is stable and the dominant tritium evolution occurs at temperatures above 300 °C. The concentration of tritium locked in a-Si:H and c-Si was 20 and 4 at. %, respectively. Self-catalysis appears to be important in the tritiation process. © 2006 American Institute of Physics

Extradural autologous temporal muscle graft mimicking a meningioma: Case report

Meningiomas are the most common dural tumour, but there are also many other dural masses which mimic their appearances, such as neoplastic and non-neoplastic lesions. In this paper we report another mass which may mimic a dural lesion, namely a muscle graft harvested from the temporal site and left in situ, used to achieve haemostasis in a posttraumatic temporal extradural hematoma in a young male patient. Solid knowledge of differentiating neuroimaging characteristics of dural masses, as well as its corroboration with the patient’s medical history are extremely helpful in establishing an accurate diagnostic

Current management of abdominal stab wounds

Spitalul Clinic de Urgență ”Sfântul Pantelimon”, București, România, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Cunoscând faptul că atitudinea de management selectiv non-operativ a devenit un standard pentru plăgile înjunghiate, studiul nostru și-a propus validarea atitudinii diferențiate față de plăgile înjunghiate ale abdomenului anterior. Materiale și metodă: Studiul este descriptiv, retrospectiv, analiza fiind centrată pe o experiență de 11 ani (2000-2010) cuprinzând 64 cazuri de plăgi abdominale anterioare. Media de vârstă a lotului studiat a fost de 32 ani (17-65), lot alcătuit din 41 bărbați, 23 femei. Etiologia a fost la toate cazurile reprezentată de agresiune fizică cu armă albă. Rezultate: 48 cazuri (75%) au fost supuse laparotomiei exploratorii immediate datorită semnelor de iritație peritoneală, instabilității hemodinamice sau semnelor paraclinice (hemogramă, biochimie, ecografie abdominală, CT) ce sugerau leziuni de organ. 16 cazuri (25%) au fost monitorizate clinic și imagistic, laparotomia exploratorie fiind necesară în 3 cazuri. Mortalitatea a fost nulă, morbiditatea de aproximativ 18% a inclus supurații parietale, 1 relaparotomie pentru hemostază suplimentară într-o plagă hepatică. Durata spitalizării fost similară la pacienții operați și la cei tratați non- operativ. Concluzii: Studiul relevă că nu s-a înregistrat morbiditate majoră prin acest abord selectiv, pacienții supuși laparotomiei tardive fiind fără risc vital. Aceste observații confirmă concluziile din literatură, și anume faptul că o perioadă de observație de 24 ore este adecvată pentru această patologie.Selective, non-operative management is now a standard for the management of abdominal stab wounds. Our study wishes to validate the differentiated approach to stab wounds of the anterior abdomen. Materials and method: Our study is descriptive and retrospective, centering on an eleven year experience (2000-2010), comprising of 64 abdominal stab wounds. The studied population was made up of 41 male and 23 female, with a median age of 32. All wounds were produced by stabbing. Results: 48 cases (75%) were subjected to immediate surgery because of the presence of peritonitic signs, hemodynamic instability or explorations that suggested organ injury (CBC, biochemistry, abdominal ultrasound, computed tomography). 16 cases (25%) were monitored clinically and by imaging studies, exploratory laparotomy being needed in only 3 of these cases. We recorded no fatalities, and overall morbidity was around 18% (surgical site infections, and one reintervention for supplementary hemostasis in a liver laceration). Duration of hospital stay was constant. Conclusions: Our study shows that the selective approach did not lead to major morbidity, the patients subjected to late laparotomy presenting no major or life threatening complications. Our observations confirm the recent consensus, stating that a 24 hour surveillance period is adequate for this pathology

INGA 3D - creative transfer of competence in 3D footwear CAD to VET professionals

INGA 3D project - Creative Transfer of Competence in 3D Footwear CAD to VET Professionals aims to transfer and extend innovative software solutions and 3D technologies for Footwear Computer Aided Design. The project brings together universities, research and training centres, adult education providers and IT companies from Romania, Spain, Portugal, and UK. The project products introduce innovative solutions for e-learning in order to test and to validate new teaching methodologies and approaches suitable for vocational training. The INGA 3D training content, its supportive guide as well as the online learning platform was designed, developed, tested and evaluated in line with the best practices identified by partners in their institutions, countries and elsewhere in Europe. INGA 3D project contributes to developing skills and competencies of VET teachers, trainers, tutors, in order to face the future challenges raised by the necessity of adding to the current curricula in VET institutions ICT skill sets that will enable their graduates to work with highly specialized footwear CAD technologies

To be or not to be a neurovascular conflict: importance of the preoperative identification of the neurovascular conflict in the trigeminal neuralgia

The trigeminal neuralgia caused by neurovascular compression is a neurosurgical pathology requiring the preoperative identification as exact as possible of the neurovascular conflict. In this case, neuroimaging is very useful, as it allows not only the determination of the neurovascular conflict of the trigeminal nerve, but also the correct indication of an adequate surgical approach

The tumour volume influence on tumour recurrence and progression-free survival in the case of atypical meningiomas: Our experience on a series of 81 cases

Objective: The objective of our study was to evaluate a possible relation between the volume of atypical meningiomas (AMs) and the risk of tumour recurrence, as well as progression-free survival (PFS). Material and methods: We evaluated 81 patients diagnosed with AMs (WHO grade II meningioma) who have undergone surgery at the "Prof. Dr. N. Oblu" Emergency Clinical Hospital Iasi between January 1, 2010, and December 31, 2019. The recorded data were demographic and imagistic (MRI, contrast-enhanced T1WI). We calculated the tumour volume prior to the surgery and evaluated the tumour recurrence using MRI at 12, 24, 36, 48 and 60 months after the surgery. Results: 50.6% of patients had meningioma volume &lt; 26.4 cm3. Women had larger tumour volumes than men (52.6%). Patients of age ? 60 years old, had tumour volumes ? 26.4 cm3 in 58.5% of cases and meningiomas with volumes ? 26.4 cm3 recurred earlier (p=0.010). Also, patients who had tumour volumes ? 26.4 cm3, had a shorter PFS (40.976 months), compared to patients with tumour volumes &lt; 26.4 cm3, who had better PFS (53.4 months). Conclusions: the tumour volume of AMs ? 26.4 cm3 represents a negative prognostic factor for both early tumour recurrence and reduced PFS

The employee as 'Dish of the Day’:human resource management and the ethics of consumption

This article examines the ethical implications of the growing integration of consumption into the heart of the employment relationship. Human resource management (HRM) practices increasingly draw upon the values and practices of consumption, constructing employees as the ‘consumers’ of ‘cafeteria-style’ benefits and development opportunities. However, at the same time employees are expected to market themselves as items to be consumed on a corporate menu. In relation to this simultaneous position of consumer/consumed, the employee is expected to actively engage in the commodification of themselves, performing an appropriate organizational identity as a necessary part of being a successful employee. This article argues that the relationship between HRM and the simultaneously consuming/consumed employee affects the conditions of possibility for ethical relations within organizational life. It is argued that the underlying ‘ethos’ for the integration of consumption values into HRM practices encourages a self-reflecting, self-absorbed subject, drawing upon a narrow view of individualised autonomy and choice. Referring to Levinas’ perspective that the primary ethical relation is that of responsibility and openness to the Other, it is concluded that these HRM practices affect the possibility for ethical being