Hind Right Approach Pancreaticoduodenectomy: From Skill to Indications

Background. Pancreaticoduodenectomy is the potentially curative treatment for malignant and several benign conditions of the pancreatic head and periampullary region. While performing pancreaticoduodenectomy, early neck division may be impossible or inadequate in case of hepatic artery anatomic variants, suspected involvement of the superior mesenteric vessels, intraductal papillary mucinous neoplasm, and pancreatic head bleeding pseudoaneurysm. Our work aims to highlight a particular hind right approach pancreaticoduodenectomy in selected indications and assess the preliminary results. Methods. We describe our early hind right approach to the retropancreatic vasculature during pancreaticoduodenectomy by mesopancreas dissection before any pancreatic or digestive transection. Results. We used this approach in 52 patients. Thirty-two had hepatic artery anatomic variant and 2 had bleeding pancreatic head pseudoaneurysm. The hepatic artery variant was preserved in all cases out of 2 in which arterial reconstruction was performed. In nine patients with intraductal papillary mucinous neoplasms the pancreaticoduodenectomy was extended to the body in 6 and totalized in 3 patients. Seven patients with adenocarcinoma involving the portomesenteric axis required venous resection and reconstruction. Conclusions. Early hind right approach is advocated in selected cases of pancreaticoduodenectomy to improve locoregional vascular control and determine, safely and early, whether there is mesopancreas involvement

Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers

Introduction Hydrocephalus represents impairment in cerebrospinal fluid (CSF) dynamics. If the treatment of hydrocephalus is considered difficult, the repeated revisions of ventriculo-peritoneal (VP) shunts are even more challenging. Objective The aim of this article is to evaluate the efficiency of ventriculo-epiplooic (VEp) shunt as a feasible alternative in hydrocephalic patients. Material and methods A technical modification regarding the insertion of peritoneal catheter was imagined: midline laparotomy 8–10cm long was performed in order to open the peritoneal cavity; the great omentum was dissected between its two layers; we placed the distal end of the catheter between the two epiplooic layers; a fenestration of 4cm in diameter into the visceral layer was also performed. A retrospective study of medical records of 15 consecutive patients with hydrocephalus treated with VEp shunt is also presented. Results Between 2008 and 2014 we performed VEp shunt in 15 patients: 5 with congenital hydrocephalus, 8 with secondary hydrocephalus and 2 with normal pressure hydrocephalus. There were 7 men and 8 women. VEp shunt was performed in 13 patients with multiple distal shunt failures and in 2 patients, with history of abdominal surgery, as de novo extracranial drainage procedure. The outcome was favorable in all cases, with no significant postoperative complications. Conclusions VEp shunt is a new, safe and efficient surgical technique for the treatment of hydrocephalus. VEp shunt is indicated in patients with history of recurrent distal shunt failures, and in patients with history of open abdominal surgery and high risk for developing abdominal complications

Removal of an Intraperitoneal Foreign Body Using a Single Port Laparoscopic Procedure

A single-port laparoscopic approach may be feasible and safe for the removal of a foreign body in the peritoneal cavity

Bridges connecting Encryption Schemes

The present work investigates a type of morphisms between encryption schemes, called bridges. By associating an encryption scheme to every such bridge, we define and examine their security. Inspired by the bootstrapping procedure used by Gentry to produce fully homomorphic encryption schemes, we exhibit a general recipe for the construction of bridges and we give various examples. We shall also present an example of a bridge that does not fall in this category

Ultra Deep Wave Equation Imaging and Illumination

In this project we developed and tested a novel technology, designed to enhance seismic resolution and imaging of ultra-deep complex geologic structures by using state-of-the-art wave-equation depth migration and wave-equation velocity model building technology for deeper data penetration and recovery, steeper dip and ultra-deep structure imaging, accurate velocity estimation for imaging and pore pressure prediction and accurate illumination and amplitude processing for extending the AVO prediction window. Ultra-deep wave-equation imaging provides greater resolution and accuracy under complex geologic structures where energy multipathing occurs, than what can be accomplished today with standard imaging technology. The objective of the research effort was to examine the feasibility of imaging ultra-deep structures onshore and offshore, by using (1) wave-equation migration, (2) angle-gathers velocity model building, and (3) wave-equation illumination and amplitude compensation. The effort consisted of answering critical technical questions that determine the feasibility of the proposed methodology, testing the theory on synthetic data, and finally applying the technology for imaging ultra-deep real data. Some of the questions answered by this research addressed: (1) the handling of true amplitudes in the downward continuation and imaging algorithm and the preservation of the amplitude with offset or amplitude with angle information required for AVO studies, (2) the effect of several imaging conditions on amplitudes, (3) non-elastic attenuation and approaches for recovering the amplitude and frequency, (4) the effect of aperture and illumination on imaging steep dips and on discriminating the velocities in the ultra-deep structures. All these effects were incorporated in the final imaging step of a real data set acquired specifically to address ultra-deep imaging issues, with large offsets (12,500 m) and long recording time (20 s)

DLT Based Authentication Framework for Industrial IoT Devices

The latest technological progress in the industrial sector has led to a paradigm shift in manufacturing efficiency and operational cost reduction. More often than not, this cost reduction comes at the price of dismissing information security, especially when multiple stakeholders are involved and the complexity increases. As a further matter, most of the legacy systems and smart factoring processes lack a security by design approach, making them highly vulnerable to cyber-attacks. Taking into consideration the aforementioned issues, we propose an architectural framework for Industrial Internet of Things (IIoT) that provides authentication and guaranteed integrity. Our proposal properly addresses the security by design principle while combining some of the emerging technologies like Secure Multi-Party Computation (SMPC) for grounded policy rules and Distributed Ledger Technology (DLT) for an immutable and transparent registry

Design and implementation of a secure platform for IoT device management

IoT devices are being used ever more often in industries and businesses, from production pipelines to security and facility access control. It is, therefore, essential for the businesses to secure the devices and to be able to manage them with ease and efficiency. This thesis aimed to design and implement a management platform where IoT devices can be securely enrolled, listed, and updated by authorized personnel. The focus of the thesis was on the architectural software design of the platform. The architectural decisions resulted in the creation of a management platform built following the zero trust and event driven architectural patterns, in which simple microcomputers could be registered into the platform and updated over-the-air from a web interface, accessed by registered and authorized users, and secured using biometric authentication. In the future, the management platform could be deployed to several customers, and for each customer, multiple interconnected instances could be created

Acceleration measurements inside vehicles: Passengers’ comfort mapping on railways

Monitoring the status of infrastructural networks along their service life is fundamental to ensure a safe and good service quality. Due to the length and extension of infrastructures, it is fundamental to develop effective and low cost approaches that can allow a continuous monitoring. In this paper, an assessment method based on the ride comfort evaluation inside vehicles according to ISO 2631 (i.e. frequency weighted acceleration) was developed and tested on an Italian railway. In particular, the frequency weighted acceleration was calculated along the whole trip between two consecutive stops. In order to identify and localize the most critical areas along the traveling path, the vertical frequency weighted acceleration was also calculated for sub-sections of fixed lengths (i.e. 10 m) and then mapped on geographic information systems (GIS). In this way, it is also possible to determine, for example considering a railway infrastructure, whether the eventual discomfort may be due to localized irregularities or due to the passage on worn switches. Once proper threshold limit values are defined, early interventions can be planned in order to restore adequate comfort and safety levels. To test the proposed procedure, it was applied to a surface metropolitan railway characterized by an automatic guide, which granted the chance of evaluating the repeatability of the present approach. During the in-situ measurements, an inertial measurement unit (IMU) integrated together with a GPS receiver was used

Systemic Venous Inflow to the Liver Allograft to Overcome Diffuse Splanchnic Venous Thrombosis

Diffuse splanchnic venous thrombosis (DSVT), formerly defined as contraindication for liver transplantation (LT), is a serious challenge to the liver transplant surgeon. Portal vein arterialisation, cavoportal hemitransposition and renoportal anastomosis, and finally combined liver and small bowel transplantation are all possible alternatives to deal with this condition. Five patients with preoperatively confirmed extensive splanchnic venous thrombosis were transplanted using cavoportal hemitransposition (4x) and renoportal anastomosis (1x). Median follow-up was 58 months (range: 0,5 to 130 months). Two patients with previous radiation-induced peritoneal injury died, respectively, 18 days and 2 months after transplantation. The three other patients had excellent long-term survival, despite the fact that two of them needed a surgical reintervention for severe gastrointestinal bleeding. Extensive splanchnic venous thrombosis is no longer an absolute contraindication to liver transplantation. Although cavoportal hemitransposition and renoportal anastomosis undoubtedly are life-saving procedures allowing for ensuring adequate allograft portal flow, careful follow-up of these patients remains necessary as both methods are unable to completely eliminate the complications of (segmental) portal hypertension

Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease

Abdominopelvic actinomycosis is a rare chronic or subacute bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium that normally colonizes the digestive and genital tracts, clinically presented as an inflammatory mass or abscess formation. Methods: We reviewed the medical records of the patients from our clinic with abdominopelvic actinomycosis who underwent surgery between 2002 and 2022. In this period, 28 cases (9 men and 19 women) were treated. The mean age was 43.36 years and they were hospitalized for abdominopelvic tumors or inflammatory tumors in 15 cases and inflammatory disease in 13 cases. Results: Causes of actinomycosis in the studied group were an intra-uterine contraceptive device in 17 cases, foreign bodies in 2 cases, diabetes in 4 cases, stenting of the bile duct in 1 case, and immunodepression. For 6 patients, we performed surgery by open approach and for 21 patients by a laparoscopic approach. For nine patients, abdominopelvic actinomycosis had been mimicking a colon malignancy (cecum and ascending colon, four cases; transverse colon, two cases; and on the greater omentum, three cases) and for six patients, a pelvic tumor (advanced ovarian cancer). After surgery the patients underwent specific treatment with antibiotics, with good results. In two cases we discovered and treated hepatic actinomycosis, one case by a laparoscopic approach and one case by a percutaneous approach. In our lot we noticed three recurrences that required reintervention in patients who had had short-term antibiotics due to non-compliance with treatment out of four such cases. Conclusions: For abdominopelvic malignancies, actinomycosis should be included in the differential diagnosis, as well as for inflammatory bowel diseases and bowel obstructions. We have a wide range of patients considering the rarity of this condition. Long-term antibiotics are necessary to prevent recurrence