The porcelain gallbladder – laparoscopic approach

Clinica I Chirurgie, Clinica Universitară „Sf.Spiridon”, Universitatea de Medicină şi Farmacie „Gr.T.Popa”, Iaşi, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Un timp îndelungat colecistul de porţelan a fost considerat o contraindicaţie relativă către colecistectomia laparoscopică datorită incidenţei înalte a cancerului veziculei biliare. Material şi metode: Dintre 12000 pacienţi supuşi colecistectomiei în Clinica I Chirurgie, Iaşi, 5 (0,04%) pacienţi au avut colecist de porţelan. Toţi bolnavii au fost supuşi examenului ultrasonografic. Pacienţii cu colecist de porţelan au fost clasificaţi ca Tip I şi II în conformitate cu rezultatele analizei ultrasonografice preoperatorii: trei cazuri cu colecist de porţelan de tip I şi două cazuri cu colecist de porţelan de tip II (într-un caz a fost identificat carcinom asociat de veziculă biliară). Rezultate: Noi descriem trei cazuri de colecist de porţelan de tip I (calcificarea completă a peretelui vezicii biliare) tratate prin metoda laparoscopică. Colecistectomia laparoscopică a fost dificilă din cauza adeziunii şi problemelor de tracţiune a veziculei biliare cu pereţii îngroşaţi, însă parcursul postoperator a fost fără particularităţi. Rezultatul histopatologic a pieselor a permis stabilirea diagnosticului de colecist de porţelan de tip I şi lipsa cancerului în peretele calcificat al veziculei biliare. Concluzii: În baza cazurilor prezentate şi revistei literaturii, concluzionăm că în pofida unei rate înalte de conversie, pacienţilor cu colecist de porţelan de tip I ar urma să le fie indicată colecistectomia laparoscopică, utilizînd selecţia preoperatorie în baza rezultatelor ultrasonografiei.Introduction: A long time porcelain gallbladder was considered a relative contraindication to laparoscopic cholecystectomy, because of a high incidence of gallbladder cancer. Material and methods: From 12000 patients underwent cholecystectomy in First Surgical Clinic of Iasi, 5 (0.04%) patients had porcelain gallbladder. All patients underwent ultrasound examen. Patients with porcelain gallbladder were classified as Type I to II according to preoperative ultrasound findings: three cases with porcelain gallbladder type I and two cases with porcelain gallbladder type II (in one case we found associated gallbladder carcinoma). Results: We describe a three cases with porcelain gallbladder type I (complete calcification of gallbladder wall) treated by laparoscopic approach. Laparoscopic cholecystectomy was difficult because of adhesions and problems with grasping the thick gallbladder wall, but the postoperative course was uneventful. The histopathologic result of the specimen established the diagnosis of porcelain gallbladder type I and no cancer in the calcified wall of the gallbladder. Conclusions: We conclude based on cases presented and the literature review, although there is a high conversion rate, that patients with a type I porcelain gallbladder should be considered for laparoscopic cholecystectomy using a preoperative selection based on the ultrasound findings

Retrosternal goiters

Clinica 1 Chirurgie, Clinica de Endocrinologie, Spitalul „Sf.Spiridon”, UMF ”Gr.T.Popa”, Iaşi, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Noțiunea de guşă retrosternală sau substernală reprezintă coborîrea a mai mult de 50% de glanda tiroidă în cavitatea toracică. Material şi metode: A fost efectuat un studiu retrospectiv a cazurilor de guşă retrosternală sau substernală din totalul de 2482 pacienți ce au suportat tiroidectomie în Clinica 1 Chirurgie din Iaşi în perioada 2000-2010. Guşa retrosternală a fost depistată la 54 (2,17%) pacienți. Toți bolnavii au fost îndreptați la operație din Clinica de Endocrinologie. Rezultate: Vîrsta medie a pacienților la momentul instalării diagnosticului a constituit 55,3±3,58 ani, majoritatea fiind femei – 83,3%. În manifestările clinice ale guşei retrosternale au dominat fenomenele de compresie. Dereglările funcției glandei tiroide au fost determinate prin teste hormonale efectuate în Clinica de Endocrinologie în 15 (27,7%) cazuri. Diagnoza de guşă retrosternală a fost suspectată în baza examenului clinic şi confirmată imagistic: radiografie toracică, ultrasonografie, computer tomografie. Abordul cervical a fost utilizat cu siguranță, sternotomia fiind necesară doar în 8 (14,8%) cazuri. Morbiditatea postoperatorie a constituit 5,5% (3 cazuri) cu mortalitate nulă. Durata medie de spitalizare a fost 4,3 zile. Noi am comparat datele noastre recente cu raportul privind tratamentul guşei retrosternale şi toracice în Clinica 1 Chirurgie din Iaşi în perioada anilor 1950-1979, publicat în revista „Chirurgia” în 1981. Concluzii: Guşa retrosternală reprezintă o formă specifică de patologie a glandei tiroide cu o incidență scăzută. Diagnosticul şi tratamentul guşei retrosternale implică o abordare multidisciplinară. Medicul endocrinolog are un rol important în diagnosticul şi supravegherea postoperatorie. Deşi intervenția chirurgicală este o metoda curativă de elecție pentru guşa substernală, persistă controverse privind abordul chirurgical şi rata complicațiilor. Abordul cervical poate fi utilizat cu siguranță aproape în toate cazurile, sternotomia fiind efectuată fără ezitare în caz de necesitate.Introduction: The term of retrosternal or substernal goiter means that more than 50% of thyroid gland descends in the thorax. Material and methods: There is a retrospective study on retrosternal and substernal goiter and its pathological features among 2482 patients who underwent thyroidectomy between 2000 and 2010 in the First Surgery Clinic of Iasi. Retrosternal goiter was diagnosed in 54 (2.17%) patients. All patients were referred to surgery from the Clinic of Endocrinology. Results: Mean age at diagnosis was 55.3±3.58 years, and most cases were found in women – 83.3%). The clinical picture of retrosternal goiter was dominated by compressive disorders. Thyroid function abnormalities were identified by hormonal assays performed on Endocrinology Clinic Iasi in 15 (27.7%) cases. The diagnosis of retrosternal goiter was suggested by clinical examination and confirmed by imaging: chest X-ray, ultrasound, CT scan. The cervical approach was safely performed. Only in 8 cases (14.8%), sternotomy was necessary. There was no mortality, and morbidity was 5.5% (3 cases). The length of stay in the hospital was 4.3 days. We compared our recent data with a previous report on retrosternal and thoracic goiter treated in First Surgery Clinic of Iasi during 1950 to 1979 and published in the journal “Chirurgia” in 1981. Conclusions: Retrosternal goiter is a particular form of thyroid surgical pathology presented with reduced incidence. Diagnosis and treatment of retrosternal goiter involve a multidisciplinary team. The endocrinologist has an important role in diagnosis and postoperative follow-up. Surgery is the treatment of choice for substernal goiters, but there are still some controversies on surgical approach, and complication rate. The cervical approach can be safely performed in almost all cases but when required, sternotomy should be performed without hesitation

Are N=1 and N=2 supersymmetric quantum mechanics equivalent?

After recalling different formulations of the definition of supersymmetric quantum mechanics given in the literature, we discuss the relationships between them in order to provide an answer to the question raised in the title.Comment: 15 page

Color-accurate underwater imaging using perceptual adaptive illumination

Capturing color in water is challenging due to the heavy non-uniform attenuation of light in water across the visible spectrum, which results in dramatic hue shifts toward blue. Yet observing color in water is important for monitoring and surveillance as well as marine biology studies related to species identification, individual and group behavior, and ecosystem health and activity monitoring. Underwater robots are equipped with motor control for large scale transects but they lack sensors that enable capturing color-accurate underwater images. We present a method for color-accurate imaging in water called perceptual adaptive illumination. This method dynamically mixes the illumination of an object in a distance-dependent way using a controllable multi-color light source. The color mix compensates correctly for color loss and results in an image whose color composition is equivalent to rendering the object in air. Experiments were conducted with a color palette in the pool and at three different coral reefs sites, and with an underwater robot collecting image data with the new sensor.United States. Office of Naval Research (Project N000140911051

The Arabidopsis thaliana-Alternaria brassicicola pathosystem: A model interaction for investigating seed transmission of necrotrophic fungi

Seed transmission constitutes a major component of the parasitic cycle for several fungal pathogens. However, very little is known concerning fungal or plant genetic factors that impact seed transmission and mechanisms underlying this key biological trait have yet to be clarified. Such lack of available data could be probably explained by the absence of suitable model pathosystem to study plant-fungus interactions during the plant reproductive phase

Забезпечення сейсмічного захисту наземних об'єктів на кар'єрах, що видобувають вапняк та гіпс

The paper highlights the research undertaken at three limestone and gypsum quarries belonging to a large cement producer in Romania, in order to evaluate the seismic protection of civil and industrial objectives located near the exploitation perimeters. In this regard, the results obtained from the tests on the determination of seismic parameters are presented, in order to assess the seismic effect generated by the blasting works on civil and industrial objectives located in the vicinity of exploitation areas.У статті висвітлено дослідження, проведене на трьох кар’єрах вапняку та гіпсу, що належать великому виробнику цементу в Румунії, з метою оцінки сейсмічного захисту цивільних та промислових об’єктів, розташованих поблизу периметрів експлуатації. У зв'язку з цим представлені результати, отримані в результаті випробувань з визначення сейсмічних параметрів, з метою оцінки сейсмічного ефекту, що виникає підривними роботами на цивільні та промислові об'єкти, розташовані в районі експлуатаційних зон

Pathology of Idiopathic Pulmonary Fibrosis Assessed by a Combination of Microcomputed Tomography, Histology, and Immunohistochemistry

Idiopathic pulmonary fibrosis (IPF) is a fibrotic disease showing the histology of usual interstitial pneumonia (UIP). While the pathologist's visual inspection is central in histological assessments, three-dimensional microCT assessment may complement pathologist's scoring. This study examined associations between the histopathological features of UIP/IPF in explanted lungs and quantitative microCT measurements including alveolar surface density, total lung volume taken up by tissue (tissue%), and terminal bronchiolar number. Sixty frozen samples from 10 air-inflated explanted lungs with severe IPF and 36 samples from 6 donor control lungs were scanned with microCT and processed for histology. An experienced pathologist scored 3 major UIP criteria (patchy fibrosis, honeycomb, and fibroblastic foci), 5 additional pathological changes such as emphysema, and immunohistochemical staining for CD68, CD4, CD8, and CD79a positive cells, graded on a 0-3+ scale. The alveolar surface density and terminal bronchiolar number decreased and the tissue% increased in IPF compared to controls. In lungs with IPF, lower alveolar surface density and higher tissue% were correlated with greater scores of patchy fibrosis, fibroblastic foci, honeycomb, CD79a-positive cells, and lymphoid follicles. A decreased number of terminal bronchioles was correlated with honeycomb score, but not with the other scores. The three-dimensional microCT measurements reflect the pathological UIP/IPF criteria and further suggest that the reduction in the terminal bronchioles may be associated with honeycomb cyst formation