Right hepatic artery aneurysm with secondary aneurysm-coledocian fistula

Institutul Clinic Fundeni, București România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Vascularizarea arterială a ficatului reprezintă pentru anatomist și nu numai un subiect de mare interes. Variantele de origine și distribuție sunt multiple și recunoașterea lor este importantă. Anevrismul arterei hepatice este o patologie rară, incidența fiind de aproximativ 20% din anevrismele viscerale. Material și metode: Scopul acestui articol este de a prezenta un caz de anevrism de artera hepatica dreapta, parițal trombozat cu compresie inițială asupra CBP, ulterior cu fistulă anevrismo-coledociană secundară, și cu artera heaptică stângă accesorie emergentă din artera gastrică stânga, situație în care autorii nu au găsit în literatura de specialitate consultată. Rezultate: Examenul histopatologic a confirmat diagnosticul de anevrism al arterei hepatice. Concluzii: Importanța cunoașterii exactă a modelului vascularizării este de interes pentru chirurg, internist și imagist, precum și existența acestui tip de patologie anevrismală suprapusă poate întări procesul de diagnostic și terapeutic.Introduction: Liver vascularization is an anatomist and not only a subject of great interest. Variants of origin and distribution are multiple and their recognition is important. Liver artery aneurysm is a rare pathology, with an incidence of approximately 20% of visceral aneurysms. Material and methods: The aim of this article is to present a case of right hepatic artery aneurysm, partial thrombosis with initial compression on CBP, later with the secondary aneurysm-coledocyan fistula, and with left hepatic accessory artery from left gastric artery, where the authors do not have found in the literature. Results: The histopathological examination confirmed the diagnosis of hepatic artery aneurysm. Conclusions: The importance of accurate knowledge of the vascularization model is of interest to the surgeon, internist and imagist, and the existence of this type of overlapping aneurysmal pathology can strengthen the diagnostic and therapeutic process

Liver retransplantation as a therapeutic method in graft dysfunctions in the immediate postoperative period

Departament Chirurgie Generală, I.C. Fundeni, București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaCu toate că în ultimii ani au apărut progrese importante în domeniul hepatic, problema prevenirii apariției disfuncției și eșecului post-transplant nu a prezentat progrese semnificative. Intrucât disfuncția hepatică primară influențează dramatic evoluția grefei și a pacientului transplantat hepatic, prevenirea acestui fenomen devine obligatoriu. Creșterea penuriei de organe și a numărului persoanelor aflate pe lista de așteptare a dus la folosirea unor grefe ce depășesc criteriile normale de selecție pentru recoltare precum și transplantarea unor donatori considerați marginali. Aceste circumstanțe au adus în prim plan importanța diagnosticării și tratamentului disfuncției hepatice primare. Conceptul de disfuncție hepatică primară nu este clar definit. Există un spectru de evenimente ce definesc disfuncția hepatică postoperatorie precoce: non funcția primară (PNF), nonfuncția întârziată, funcția slabă/săracă inițială (initial poor function – IPF), non funcția inițială, insuficiența hepatică primară și disfuncția primară. Distincția între aceste entități ia în considerare gradul disfuncției hepatice, necesitatea retransplantării urgente, precum și apariția și durata acestor evenimente după transplantul hepatic.Although important progress has been made over the last few years, the problem of preventing dysfunction and post-transplant liver failure has not shown significant progress. Since primary liver dysfunction dramatically influences the progress of the graft and the liver transplant patient, prevention of this phenomenon becomes obligatory. The increase in organ shortage and the number of people on the waiting list led to the use of grafts that exceeded the normal selection criteria for harvesting as well as the transplantation of marginal donors. These circumstances have highlighted the importance of diagnosis and treatment of primary hepatic dysfunction. The concept of primary liver dysfunction is not clearly defined. There is a spectrum of events that defines early postoperative liver dysfunction: primary non-function (PNF), delayed dysfunction, initial poor function (IPF), primary hepatic failure, and primary dysfunction. The distinction between these entities takes into account the degree of hepatic dysfunction, the need for urgent retransplantation, and the occurrence and duration of these events after liver transplantation

Acute Cardiovascular Manifestations in 286 Children With Multisystem Inflammatory Syndrome Associated With COVID-19 Infection in Europe

Background: The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. Methods: This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. Results: A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8-12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (P<0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died. Conclusions: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.info:eu-repo/semantics/publishedVersio

Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations

Cecilia Lazea,1,* Oana Man,2,* Lucia Maria Sur,1 Radu Serban,1 Calin Lazar1 1University of Medicine and Pharmacy, Emergency Clinic Hospital for Children, Department Pediatrics I, Cluj-Napoca, Romania; 2Emergency Clinic Hospital for Children, Department Pediatrics I, Cluj-Napoca, Romania*These authors contributed equally to this workCorrespondence: Cecilia LazeaUniversity of Medicine and Pharmacy, Iuliu Hatieganu Cluj-Napoca, Department Pediatrics I, 68, Motilor Street, Cluj-Napoca 400370, RomaniaTel +40744353764Fax +40264402539Email [email protected]: Diagnosis of Kawasaki disease (KD) is based on well-established clinical criteria. In incomplete or atypical KD, the diagnosis is challenging, because of the paucity of clinical signs or because of the presence of clinical manifestations that generally are not seen in KD. We describe the case of a 3-year-old female patient with persistent high fever, vomiting, watery diarrhea, metabolic acidosis and severe hypopotassemia. On the fourth day of fever, bilateral conjunctivitis, mucous and extremity changes were registered. Urine changes as glycosuria and proteinuria were also noticed. Echocardiography revealed ectasia of the left anterior descending coronary artery, and diagnosis of KD was established. The treatment consisted of intravenous immunoglobulin (IVIG) and oral aspirin. Recurrence of disease was recorded on the 23rd day of the disease, with favorable evolution after the second dose of IVIG was infused.Keywords: atypical, incomplete, Kawasaki disease, gastrointestinal, rena

Classification of Electromyographic Signals during Finger Isometric Flexion: Using Electrodes Arrays

The classification of electromiographic signals provides a method to identify one’s intent or movement. This paper presents a study on choosing the best model for a classifier used to group electromiographic signals into classes corresponding to the isometric flexion effort of different fingers. The signals were collected from the Flexor Digitorum Superficialis and Profundus of seven healthy subjects. Different features (root mean square - RMS, average rectified value - ARV, mean and median frequency) and different classifier structures (discriminant analysis, nearest neighbor analysis, naive Bayes algorithm, neural network, fuzzy logic based algorithm) were implemented with classification success rates ranging from 50 to 99 %. The success rate of the classifiers corresponds to the ability of a numerical system to decode the physiological manifestations associated with the finger movements

Open web-based learning environments and knowledge forums to support people with special needs

Internet technology and, in particular Web‐based services, have the potential to revolutionise approaches to learning. These new forms of learning could provide additional educational opportunities for people with special needs to support their social integration and integration into the knowledge‐based economy. This paper starts with a short presentation on open Web‐based learning environments and knowledge forums followed by a discussion of some recent results on e‐learning and special needs users. Two examples of learning portals for supporting e‐learning forums developed within the European projects, EURO H 2000 and a DAAD German‐Romanian cooperation, are given. Ways of including users with special needs in projects on the design of learning materials and environments are also discussed

Recent outcome of liver transplantation for Budd Chiari syndrome - analysis of the european liver transplant registry (ELTR) and affiliated centres

..