Quantitative methods to analyze the severe obesity in Romania and its impact over public administration health expenditures

© 2018, Universitatea Babes-Bolyai. All rights reserved. In this article we present the situation of the Romanian population suffering from severe obesity (measured using BMI), focusing on specific situations with regard to age, gender, residence, development region or educational level. The main dataset used for the current paper is extracted from the Romanian Report for 2008 European Health Interview Survey (EHIS). The sample (a representative one) consists of more than 10,000 randomly selected households. Also, the article shows the consequences of this economic and social state especially for people who have been forced to seek surgical treatment. All financial estimates regarding the obesity burden are produced at country level

Management of a Case of Colovesical Fistula with Fecaluria as First Sign

Introduction. Fecaluria and pneumaturia are the patognomonic signs of an abnormal communication between the bladder and the intestinal tract. Therefore, when a history of digestive signs, symptoms or digestive diseases is missing, this borderline pathology leads the patients in the care of urologists. From diagnosis to treatment the management of these cases can be difficult and challenging. Materials and Methods. A 48 year old patient, without any significant medical history, presented to the emergency room for fecaluria, pneumaturia and an episode of haematuria. He had no prior digestive symptoms. The contrast enhanced abdominal and pelvic CT scan revealed a pelvic mass involving the sigmoid colon and the dome and the posterior wall of the bladder. The cystoscopy objectifies a tumor mass involving the right postero-lateral bladder wall, with extravasation of faeces. A biopsy was taken and the frozen section found mainly uncertain inflammatory type tissue. A colonoscopy couldn’t be done because of an impassable obstacle at 15 cm from the anus. Together with general surgeons we decided for en bloc resection of the tumor with partial cystectomy, right ureterocystoneostomy and rectosigmoid resection with mechanic end to end anastomosis. Results. The postoperative period was uneventful. The histopathological examination revealed an abscessed sigmoid diverticulum with vesico-sigmoid fistula and perilesional inflammatory tissue. Two years after the surgery the patient is asymptomatic with a normal function of the right kidney and restored bladder capacity. Conclusions. Being a borderline pathology, patients with fecaluria and pneumaturia and lack of digestive symptoms are referred and managed by the urologists. Despite extensive investigations, even when preoperative biopsies reveal inflammatory tissue the patients should be treated as oncologic cases. A close cooperation with general surgeons for en bloc multiorgan resection within oncologic safety margins is mandatory

Right RCC with cavo-cardiac tumor thrombus

Introduction: One of the unique features of RCC is the frequent pattern of growth intraluminally into the renal venous circulation in extreme cases this growth may extend into the inferior vena cava with cephaled migration in the heart. Material and method: It has been pur experience that an anterior surgical approach through c subcostal and pararectal incision provides excellent exposure for performing radical nephrectomy. A second cardio-vascular team, through a median sternotomy, canulated the ascending aorta ana the right atrium and cardiopulmonary bypass is initiated. The tumor thrombus is gently removed from the IVC. Results: In our department we performed more than 1305 radical nephrectomies for RCC. We have had 117 lateral or total IVC resection and in 8 cases we removed the thrombus from the right atrium. Conclusions: This approach allows such thrombus to be removed completely in a controlled operative setting that provides excellent exposure and reduces the potential for massive blood loss a major vascular injury

Hot new directions for quasi-Monte Carlo research in step with applications

This article provides an overview of some interfaces between the theory of quasi-Monte Carlo (QMC) methods and applications. We summarize three QMC theoretical settings: first order QMC methods in the unit cube $[0,1]^s$ and in $\mathbb{R}^s$, and higher order QMC methods in the unit cube. One important feature is that their error bounds can be independent of the dimension $s$ under appropriate conditions on the function spaces. Another important feature is that good parameters for these QMC methods can be obtained by fast efficient algorithms even when $s$ is large. We outline three different applications and explain how they can tap into the different QMC theory. We also discuss three cost saving strategies that can be combined with QMC in these applications. Many of these recent QMC theory and methods are developed not in isolation, but in close connection with applications