Prosthetic Reconstruction of the Upper Digestive Tract

In cases of locally advanced cancers involving the junction between the hypopharynx and cervical oesophagus, the curative surgical treatment is total circular laryngo-pharyngectomy with resection of the upper cervical oesophagus, coupled with modified radical neck dissection. Techniques used to re-establish the continuity of the digestive tract have been pectoral transposition flap, gastric pull-up, jejunum or colon transposition and free pedicled fascial-cutaneous flap reconstruction. Prosthetic reconstruction was thought of and used only as a temporary solution. In our clinic, we adapted the Montgomery oesophageal prosthesis as more than just a temporary solution and used it in 63 patients operated from 2004 to 2014 with advanced (stages III and IV) cancer involving most of the hypopharynx or extending towards the upper cervical oesophagus. Following total circular laryngo-pharyngectomy with bilateral modified radical neck dissection, prosthetic reconstruction was performed using the Montgomery oesophageal tube. Patients were followed up on, and their status was monitored. Favourable results encouraged the authors to further develop a new active prosthesis, with advanced design and materials that better mimic the anatomy and physiology of the replaced segment. Prosthetic reconstruction of the upper digestive tract following radical oncologic surgery is a viable option, with advantages compared to other laborious plastic techniques. The new active model is under development, hopefully offering soon a safe and more cost-effective alternative to the other techniques

Development of a framework and decision tool for the evaluation of health technologies based on surrogate endpoint evidence

In the drive toward faster patient access to treatments, health technology assessment (HTA) agencies and payers are increasingly faced with reliance on evidence based on surrogate endpoints, increasing decision uncertainty. Despite the development of a small number of evaluation frameworks, there remains no consensus on the detailed methodology for handling surrogate endpoints in HTA practice. This research overviews the methods and findings of four empirical studies undertaken as part of COMED (Pushing the Boundaries of Cost and Outcome Analysis of Medical Technologies) program work package 2 with the aim of analyzing international HTA practice of the handling and considerations around the use of surrogate endpoint evidence. We have synthesized the findings of these empirical studies, in context of wider contemporary body of methodological and policy-related literature on surrogate endpoints, to develop a web-based decision tool to support HTA agencies and payers when faced with surrogate endpoint evidence. Our decision tool is intended for use by HTA agencies and their decision-making committees together with the wider community of HTA stakeholders (including clinicians, patient groups, and healthcare manufacturers). Having developed this tool, we will monitor its use and we welcome feedback on its utility

Current Applications of Recycled Aggregates from Construction and Demolition: A Review

A literature review comprising 163 publications published over a period of 26 years from 1992 to 2018 is presented in this paper. This review discusses the generation and recycling of construction and demolition waste (CDW) as well as its main uses as raw materials for the construction engineering sector. This review pays attention to the use of CDW aggregates for sand, pavements/roads, bricks, ceramics, cementitious materials, and concrete productions, as well its uses as eco-friendly materials for water decontamination. The physical-chemical and mechanical characteristics of recycled aggregates play an important role in their correctly chosen applications. The results found in this literature survey allow us to conclude that recycled aggregates from CDW can be successfully used to produce construction materials with quality comparable to those produced with natural aggregates. We concluded that the use of CDWs as raw materials for manufacturing new construction materials is technically feasible, economical, and constitutes an environmentally friendly approach for a future construction and demolition waste management strategy

Aspects of diagnosis and treatment of liver tumors

Laboratorul Chirurgia reconstructivă a tractului digestiv, USMF ”Nicolae Testemiţanu” Catedra chirurgie, USMF „Nicolae Testemiţanu” Spitalul Clinic RepublicanSurgical treatment of hepatic tumors was considerably progressed last years caused by number of reasons. The level of mortality after liver resections decreased due to correct establishing of volume of operation, improvement of surgical techniques and developing of pre- and postoperative management. Materials and Methods: 286 patients with liver tumors were treated in surgical clinic during the period 2000-2013. Surgical treatment included 212 (74.1%) patients. Major hepatic resections were performed in 76 (26.6+-2.6, p<0.001) cases, 8 of them after ligation of right portal vein, when weight of leaving hepatic tissue didn’t exceed 30%. In 12 cases (2.1%+-0.83, p<0.05) was made posterior right sectionectomy. In 112 cases (39.2+-2.88, p<0.001) were performed non anatomical liver resections and in 12 cases (2.1%+-0.83, p<0.05) was made angiographic chemoembolisation. Diagnostical laparotomy with biopsy used in 42 cases. Conclusions:1. Diagnostical algorithm in patients with hepatic tumors included patient’s clinical examination, functional hepatic test, tests of hepatic biosynthesis, dynamic tests of liver, determining of viral markers (HBV, HCV), tumor markers, imaging methods (US, CT, MRI, liver scintigraphy, irigoscopy, liver biopsy. US is a screening method for determining of liver tumors. Standard CT of liver and CT angio were used for establishing of tumor localization, dimensions, liver volumetry in case of massive tumors. 2. The techniques of hepatectomies were improved by developing of different methods of vascular control and modern devices for livertransection, based on perfect knowledge of vessels anatomy, the fact very important for improving of postoperative results. Introducere:Tratamentului chirurgical a tumorilor hepatice s-a dezvoltat remarcabil în ultimii ani din mai multe motive. Rata de mortalitate la pacienţi, care au suportat rezecţii de ficat a scăzut datorită aprecierii adecvate a volumului operaţiei, perfecţionării tehnicii chirurgicale şi dezvoltarea managementului pre- şi postoperator. Materiale şi metode: Pe parcursul anilor 2000 – 2013 în clinica de chirurgie 2 au fost internaţi 286 de pacienţi cu tumori a ficatului. Tratament chirurgical a inclus 212 (74,1%) de bolnavi. Rezecţii hepatice majore s-au efectuat la 76 ( 26,6%±2,6, p<0.001) pacienţi, dintre care 8 peste 4-6 săptămâni după ligaturarea ramului portal drept, când masa ţesutului hepatic restant nu depăşea 30%. În 12 ( 2,1%±0,83, p<0.05) cazuri s-a recurs la secţionectomie posterioară dreapta. La 112 (39,2%±2,88, p<0.001) de bolnavi s-a efectuat rezecţii hepatice non anatomice şi în 12 (2,1%±0,83, p<0.05) cazuri efectuat chimioembolizare angiografică. Laparotomie diagnostică cu biopsie în 42 de cazuri. Concluzii:1. Algoritmul de diagnostic la pacienţi cu tumori hepatice include examenarea clinică, teste funcţionale hepatice, teste de biosinteză hepatică, teste dinamice a ficatului, aprecierea marcherilor virali (HBV, HCV), tumorali, investigaţii imagistice (USG, CT, RMN, scintigrafie hepatică, irigoscopie), biopsia hepatică. CT a ficatului în regim standard şi angiografic cu evaluarea localizării, dimensiunelor; volumometria ficatului în cazul tumorilor masive. 2. Tehnicile hepatectomiei perfecţionate prin diferite metode de control vascular şi apariţia dipozitivelor moderne pentru secţionarea ficatului, bazate pe înţelegerea perfectă a anatomiei vasculare joacă un rol foarte important în imbunătăţirea rezultatelor postoperatorii

Hypopharyngeal Cancer

Hypopharyngeal cancer is one of the most challenging pathologies regarding location, evolution, prognosis and functional implications. Since the hypopharynx is a crossroad in the digestive and respiratory pathways malignant pathology located at this site can cause dysphagia, odynophagia, respiratory distress and dysphonia. Complex anatomy and physiology of the hypopharynx make for pathology with a poor prognosis in late stages. Diagnosis and therapy are mandatory for ensuring high survival rates and as little functional impairment as possible. Therapy of hypopharyngeal cancer is a difficult test for both physician and patient. It requires a good collaboration between the ENT surgeon, pathologist, radiotherapist, chemotherapist, nutrition therapist and psychologist. Our approach to the subject is due to that data concerning this pathology is limited and the results of the overall oncology therapy are discouraging. Nonetheless, the technical steps of surgery make it difficult for ENT cancer surgeons to approach it, therefore the surgeons’ experience plays a very important role in decision making and establishing a good doctor-patient relationship, both during initial therapy and follow-up. We will also present an original technique developed in our clinic for restoring the continuity of the pharynx after total circular resection using the synthetic prosthesis

EXPLICIT: a feasibility study of remote expert elicitation in health technology assessment

This is the final version of the article. Available from BioMed Central via the DOI in this recordBACKGROUND: Expert opinion is often sought to complement available information needed to inform model-based economic evaluations in health technology assessments. In this context, we define expert elicitation as the process of encoding expert opinion on a quantity of interest, together with associated uncertainty, as a probability distribution. When availability for face-to-face expert elicitation with a facilitator is limited, elicitation can be conducted remotely, overcoming challenges of finding an appropriate time to meet the expert and allowing access to experts situated too far away for practical face-to-face sessions. However, distance elicitation is associated with reduced response rates and limited assistance for the expert during the elicitation session. The aim of this study was to inform the development of a remote elicitation tool by exploring the influence of mode of elicitation on elicited beliefs. METHODS: An Excel-based tool (EXPLICIT) was developed to assist the elicitation session, including the preparation of the expert and recording of their responses. General practitioners (GPs) were invited to provide expert opinion about population alcohol consumption behaviours. They were randomised to complete the elicitation by either a face-to-face meeting or email. EXPLICIT was used in the elicitation sessions for both arms. RESULTS: Fifteen GPs completed the elicitation session. Those conducted by email were longer than the face-to-face sessions (13 min 30 s vs 10 min 26 s, p = 0.1) and the email-elicited estimates contained less uncertainty. However, the resulting aggregated distributions were comparable. CONCLUSIONS: EXPLICIT was useful in both facilitating the elicitation task and in obtaining expert opinion from experts via email. The findings support the opinion that remote, self-administered elicitation is a viable approach within the constraints of HTA to inform policy making, although poor response rates may be observed and additional time for individual sessions may be required.This paper presents independent research funded by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula

Orbital complications of acute rhinosinusitis

Introduction. Rhinosinusitis is the infection and inflammation of at least one of the 4 paranasal sinuses (frontal, maxillary, ethmoid and sphenoid). Their correct diagnosis is generally determined by examining the patient clinically and by rhinosinusal endoscopic examination. There are also cases that show complications or continued evolution despite the correct treatment, and then we will use some imaging investigations to find out more about affection(radiography of anterior sinuses of the face, sinus computerized tomography, sinus magnetic resonance imaging). In particular, acute rhinosinusitis should be carefully managed to avoid complications such as the local ones: orbital cellulitis, orbital abscess, osteomyelitis, cavernous sinus thrombosis; and intracranial complications: meningitis, epidural abscess, subdural abscess, cerebral abscess.Materials and methods. There will be presented all orbital complications according to the cases treated in the ENT Clinic of the Coltea Clinical Hospital.Conclusions. Diagnosis of rhinosinusitis is largely clinical and endoscopic.When complications of the condition arise, these should be investigated imagistically to determine their exact extent and to institute the correct treatment as soon as possible. The complications of rhinosinusitis are medical and surgical life-threatening emergencies, which is why in order to diagnose and correct and quickly institute therapy requires a multidisciplinary approach

OBTAINING AND TESTING OF FERTILIZERS WITH ORGANIC SUBSTANCES

Due to legislation for environmental protection and the need to obtain products "cleaner" worldwide there is a major trend of development both the research and the production of fertilizers with organic substances with growth stimulating effect for use for intensive and organic agriculture (especially for protection of crops, and prevent and combat nutritional deficiencies).Approaching the concept of fertilizers containing substances of category biostimulators is a difficult task by the fact that describing the concept of biostimulants is far from being completely understood and legislation, research and experimentation are, regarding this category of products used in agriculture, at an early stage of development.This paper presents a range of NPK fertilizers with organic substances represented by protein hydrolysates and extracts from algae, with primary and secondary nutrients and physical and chemical characteristics of fertilizers obtained experimentally. These fertilizers were tested in the national network of testing of fertilizers in order of authorization for use in agriculture. It was observed that the combination of fertilizer is well assimilated by plants, with a synergistic effect of growth and protection against diseases and pests.If the application of these fertilizers were obtained yield increases between 25-30% for the tomato crop and 27 - 32.5% for the apple, as well as changes in photosynthesis process marked by increases of 30-37% of assimilating pigments

Pharyngocutaneous Fistulas Following Total Laryngectomy

Total laryngectomy is still the final therapeutic solution in cases of locally advanced laryngeal cancer, as well as in cases of therapeutic failure of organ-sparing surgery or radiation therapy. Following excision of the larynx, the remaining pharynx is reconstructed to obtain continuity of the upper digestive tract. One of the most common complications in these patients, despite constant refinement of the procedure, is the development of a pharyngo-cutaneous fistula. These fistulas prolong hospital stay and often require a second surgical procedure, increasing morbidity and cost for the patient, while diminishing his quality of life. Some risk-factors have been identified, but only some may be corrected before surgery to lower this risk. Managing the fistula once present depends on multiple factors, essential being the size of the fistula as well as the position and concomitant factors, with options ranging from conservative measures to aggressive reconstructive surgery with local miocutaneous flaps. Modern vocal rehabilitation with T.E.P. (tracheo-esophageal puncture) and vocal prosthesis placement presents a new challenge – because of the risk of developing a tracheo-esophageal fistula, with an even higher risk for the patient because of tracheal aspiration. Understanding healing mechanisms of these structures is key to proper management of this complication