Prospects for the use of the laparoscopic transabdominal pre-peritoneal approach (TAPP) in groin hernia repair

Curs Chirurgie al Facultăţii Stomatologie, USMF “Nicolae Testemiţanu”, Spitalul Clinic Militar Central, Chisinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Abordul laparoscopic în cura herniilor inghinale devine o metodă de elecţie pe plan mondial. Rămîne actuală problema standardizării tehnicii chirurgicale şi optimizării rezultatelor acestui procedeu. Material şi metode: În perioada anilor 2008-2014 în Clinică a fost efectuată cura laparoscopică a herniei inghinale la 271 pacienţi (16 – bilateral). Repartiţia herniilor conform clasificării Nyhus: tip II (n=188), tip IIIa (n=64), tip IIIb (n=18), tip IIIc (n=9), tip IV (n=12). A fost utilizată tehnica transabdominală preperitoneală (TAPP). Rezultate: Durata intervenţiei a constituit în medie 47,8±25,07 min, fiind mai lungă pentru herniile recidivante – 95±48,99 min (60-180) şi bilaterale – 92,78±23,47 min (65-140). Mediana spitalizării – 3 zile, reîntoarcerea în cîmpul muncii – sub 10 zile. Incidentele intraoperatorii au fost corectate laparoscopic. Conversia a fost efectuată la un pacient. Nu au fost constatate cazuri de infecţie a plăgii postoperatorii. Aprecierea rezultatelor tratamentului chirurgical la distanţă a fost realizată la 223 pacienţi. Pentru evaluarea durerii la pacienţii cu diagnosticul hernie inghinală a fost utilizată scala de evaluare numerică NRS – 11. În perioada postoperatorie au prevalat pacienţi cu sindrom algic redus (NRS: 1-3). Algoparestezia postoperatorie persistentă a fost diagnosticată la 4 pacienţi. Recidiva herniei a fost înregistrată la 2 pacienţi, în ambele cazuri recidiva a fost corectată laparoscopic. Concluzii: Experienţa noastră confirmă posibilitatea utilizării procedeului TAPP la diferite tipuri de hernie inghinală. Acumularea experienţei permite de a lărgi indicaţiile pentru abordul laparoscopic la pacienţii cu hernii bilaterale, glisante şi recurente. Avantajele hernioplastiei laparoscopice sunt: micşorarea sindromului algic postoperator, reintegrarea socioprofesională rapidă şi numărul redus de complicaţii parietale.Introduction: The transabdominal pre-peritoneal procedure (TAPP) represents one of the most popular techniques used for inguinal hernia repair. The analysis of the reported cases helps to standardize the relatively new laparoscopic technique and to improve the overall results. Material and methods: The group of 271 patients underwent laparoscopic hernia repair (16 bilateral) for the period 2008-2014. According to Nyhus classification, the groin hernias were classified as type II (n=188), type IIIa (n=64), type IIIb (n=18), type IIIc (n=9), type IV (n=12). The TAPP procedure was utilized. Results: The mean operating time was 47.8±25.07 minutes, being statistically longer for recurrent hernias 95±48.99 min (range, 60-180) and bilateral hernias – 92.78±23.47 min (range, 65-140). The average length of hospital stay was 3 days. Patients returned to work in an average of 10 days. The postoperative morbidity rate was 2.2%. The majority of intraoperative incidents (intraoperative hemorrhage, n=4) were solved laparoscopically without sequelae. One case was converted to Lichtenstein repair. Patients were evaluated at a median follow up of 24 month (range, 12-36 month). A total of 223 patients were assesssed for long-term outcomes. Pain was assessed with Numerical Rating Scale (NRS – 11). The vast majority of post-operative patients had minor pain manifestation of pain (NRS: 1-3). We observed 4 cases of persistent inguinal pain. The hernia recurrence was developed in 2 patients and has been corrected via laparoscopic approach. Conclusions: While laparoscopic hernia repair requires a lengthy learning curve, it represents safe and valid alternative to open hernia repairs and could be effectively used for bilateral, recurrent and sliding hernias. The advantages of laparoscopic repair include less postoperative pain, faster return to normal activities and low wound infection rate

Present status and preliminary results of the VLF/LF radio recording European network installed in 2009.

In January 2009 a European network of receivers able to measure the electric field intensity from various VLF/LF broadcasting stations located throughout Europe, was installed. Five new receivers constructed by an Italian enterprise have been delivered to Greece, Romania, Turkey and to the Italian team. The motivation of this effort is to study the possible connections between the preparatory phase of earthquakes and perturbations in the transmitted radio signals. The receivers can be reached via ftp and gsm mobile connection, thus allowing a real time data collection. We present here the status of the network and the various testing steps performed in order to achieve a correct set up. We show how antennas variations, receivers locations and changes of selected frequencies affect the performances of the whole network. After this necessary testing period, several LF/VLF radio signals are now simultaneously and continuously being sampled by the five receivers. As a preliminary result we inspect also specific cases in which an anomaly in the radio signals is clearly related to the transmitter or to the receiver (e.g. meteorological conditions around the sampling site). At a basic level, the analysis adopted consists in a simple statistical evaluation of the signals by comparing the instantaneous values to the trend of the signal

Medical data processing and analysis for remote health and activities monitoring

Recent developments in sensor technology, wearable computing, Internet of Things (IoT), and wireless communication have given rise to research in ubiquitous healthcare and remote monitoring of human\u2019s health and activities. Health monitoring systems involve processing and analysis of data retrieved from smartphones, smart watches, smart bracelets, as well as various sensors and wearable devices. Such systems enable continuous monitoring of patients psychological and health conditions by sensing and transmitting measurements such as heart rate, electrocardiogram, body temperature, respiratory rate, chest sounds, or blood pressure. Pervasive healthcare, as a relevant application domain in this context, aims at revolutionizing the delivery of medical services through a medical assistive environment and facilitates the independent living of patients. In this chapter, we discuss (1) data collection, fusion, ownership and privacy issues; (2) models, technologies and solutions for medical data processing and analysis; (3) big medical data analytics for remote health monitoring; (4) research challenges and opportunities in medical data analytics; (5) examples of case studies and practical solutions

Laparoscopic transabdominal pre-peritoneal approach (TAPP) in groin hernia repair: 10 year experience

Catedra de chirurgie nr. 5, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, Spitalul Clinic Militar Central, Chişinău, Republica Moldova, 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: Abordul laparoscopic în cura herniilor inghinale devine intervenție de elecție pe plan mondial. Rămâne actuală problema standardizării tehnicii chirurgicale şi optimizarii rezultatelor acestui procedeu. Material şi metode: În perioada anilor 2008-2018 în Clinică a fost efectuată cura laparoscopică a herniei inghinale la 415 pacienţi (37 bilateral). Repartiţia herniilor conform clasificării L. M. Nyhus: tip II (n=245), tip IIIa (n=109), tip IIIb (n=30), tip IIIc (n=13), typ IV (n=18). A fost utilizată tehnică transabdominală preperitoneală (TAPP). Rezultate: Durata intervenţiei a constituit in medie 40.8±20.07 minute, fiind mai lungă pentru hernii recidivante 80±40.9 min (60-180) şi bilaterale 75.7±20.5 min (65-140). Mediana spitalizării 3 zile, reîntoarcerea în cîmpul muncii – sub 10 zile. Incidentele intraoperatorii au fost corectate laparoscopic. Conversia efectuată la doi pacienti. Nu au fost constatate cazuri de infecţie în plaga postoperatorie. Aprecierea rezultatelor tratamentului chirurgical la distanţă a fost realizată la 337 pacienţi. Pentru evaluarea durerii la pacienţii cu diagnosticul hernie inghinală a fost utilizată scala de evaluare numerică NRS-10. În perioada postoperatorie au prevalat pacienţi cu sindrom algic redus (NRS 1-3). Algoparestezia postoperatorie persistentă a fost diagnosticată la 6 pacienţi. Recidiva herniei a fost înregistrată la 3 pacienţi, în ambele cazuri recidiva a fost corectată laparoscopic. Concluzii: Experienţa noastră confirmă posibilitatea utilizării procedeului TAPP la diferite tipuri de hernie inghinală. Acumularea experienţei permite de a lărgi indicaţiile pentru abordul laparoscopic la pacienţii cu hernii bilaterale, glisante şi recurente. Avantajele hernioplastiei laparoscopice sunt: micşorarea sindromului algic postoperator, reintegrarea socioprofesională rapidă şi numărul redus de complicaţii parietale.Background: the transabdominal pre-peritoneal procedure (TAPP) represents one of the most popular techniques used for inguinal hernia repair. The analysis of the reported cases helps to standardize the relatively new laparoscopic technique and to improve the overall results. Methods and materials: The group of 415 patients underwent laparoscopic hernia repair (37 bilateral) for the period 2008-2018. According to L. M. Nyhus classification, the groin hernias were classified as type II (n=245), type IIIa (n=109), type IIIb (n=30), type IIIc (n=13), type IV (n=18). The TAPP procedure was utilized. Results: The mean operating time was 40.8±20.07 minutes, being statistically longer for recurrent hernias 80±40,9 min (range 60- 180) and bilateral hernias 75,7±20,5 min (range 65-140). The average length of hospital stay was 3 days. Patients returned to work in an average of 10 days. The postoperative morbidity rate was 2.2%. The majority of intraoperative incidents (intraoperative hemorrhage n=5) were solved laparoscopically without sequelae. Two cases were converted to Lichtenstein repair. Patients were evaluated at a median follow up of 24 month (range 12-36 month). A total of 337 patients were assesssed for long-term outcomes. Pain was assessed with Numerical Rating Scale (NRS-10). The vast majority of post-operative patients had minor pain manifestation of pain (NRS 1-3). We observed 6 cases of persistent inguinal pain. The hernia recurrence was developed in 3 patients and has been corrected via laparoscopic approach. Conclusions: While laparoscopic hernia repair requires a lengthy learning curve, it represents safe and valid alternative to open hernia repairs and can be effectively used for bilateral, recurrent and sliding hernias. The advantages of laparoscopic repair include less postoperative pain, faster return to normal activities and low wound infection rate

Direct determination of Pb isotope ratios in archaeological materials by coupling liquid chromatography to multicollector ICP-MS

A procedure for the determination of Pb isotope ratios by coupling liquid chromatography to a multicollector ICP-MS has been developed. The procedure allows the direct injection of samples after dissolution without resorting to time-consuming off-line separation procedures. The separation of Pb from concomitant elements is carried out by anionic exchange as ethylenediamine tetraacetic acid (EDTA) chelates using EDTA and ammonium nitrate as a mobile phase. A flow injection system allows the injection of NIST 981 Pb isotopic standard, before and after the Pb peak from the sample, and the on-line addition of Tl for mass bias correction and bracketing. The procedure was validated by injecting NIST 981 into the chromatographic system and by comparing the results for real samples with the classical off-line separation procedure using Pb spec resins. The optimised procedure was applied to archaeological samples containing different concentrations of Pb. It was observed that the only limitation to the accuracy of the procedure was the concentration of Pb in the samples as no preconcentration is performed. Solid archaeological samples containing at least 500 μg g−1 of Pb can be studied using the proposed procedure

Hybrid-Trefftz stress element for bounded and unbounded poroelastic media

SUMMARY The equations that govern the dynamic response of saturated porous media are first discretized in time to define the boundary value problem that supports the formulation of the hybrid-Trefftz stress element. The (total) stress and pore pressure fields are directly approximated under the condition of locally satisfying the domain conditions of the problem. The solid displacement and the outward normal component of the seepage displacement are approximated independently on the boundary of the element. Unbounded domains are modelled using either unbounded elements that locally satisfy the Sommerfeld condition or absorbing boundary elements that enforce that condition in weak form. As the finite element equations are derived from first-principles, the associated energy statements are recovered and the sufficient conditions for the existence and uniqueness of the solutions are stated. The performance of the element is illustrated with the time domain response of a biphasic unbounded domain to show the quality of the modelling that can be attained for the stress, pressure, displacement and seepage fields using a high-order, wavelet-based time integration procedure

The preliminary results of laparoscopic hiatal hernia repair – a particular consideration

Spitalul Clinic Militar Central, Curs Chirurgie al Facultăţii Stomatologie, USMF “Nicolae Testemiţanu”, Chisinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Herniile hiatale (HH) simptomatice reprezintă o patologie frecventă care este supusă tratamentului structurat în etape. HH paraesofagiene şi HH asociate bolii de reflux gastro-esofagean (BRGE) severe necesită tratament chirurgical. Material şi metode: În Clinică au fost supuşi tratamentului chirurgical prin abord laparoscopic 111 pacienţi cu HH simptomatice (aa. 2011-2015). Repartiţia HH conform SAGES (2013): tip I (n=94); tip II (n=3); tip III (n=13); tip IV, “upside-down” (n=1). Pacienţii cu HH asociate cu BRGE au fost selectaţi pentru cura chirurgicală în baza criteriilor ghidului SAGES (2010): tratamentul medicamentos ineficient (n=58); alternativa tratamentului medicamentos (n=15); manifestări extra-esofagiene (n=18); BRGE agravată (n=3). Intervenţia a inclus reducerea herniei, identificarea pilierilor și joncțiunii eso-gastrice, recalibrarea hiatusului esofagian prin crurorafia posterioară şi realizarea valvei anti-reflux. În 84 cazuri a fost realizată fundoplicatura Nissen- Rossetti, la 19 pacienţi – procedeul Toupet şi la 7 pacienţi – procedeul Dor. Rezultate: Incidentele intraoperatorii rezolvate laparoscopic au inclus: leziuni hepatice (n=4), hemoragie din vasele scurte (n=3), capnotorax (n=3). Leziunea esofagiana (n=1) a servit indicaţii către conversie. Mediana spitalizării a constituit 4 zile. Peste 3 luni după intervenţie rezultat excelent (scorul modificat Visick) a fost înregistrat la 11% pacienţi; bun – 76%; satisfăcător – 7%, nesatisfăcător – 3%. Cinci pacienţi nu au fost evaluaţi. Disfagia persistentă postoperator la 8 pacienţi a necesitat dilatare endoscopică. Recurenţă semnelor de HH confirmată radiologic a fost constatată în 3 cazuri (3%). Concluzii: Avantajele tehnicii chirurgicale laparoscopice sunt evidente în perioada postoperatorie: reducerea sindromului algic, spitalizarea redusă, recuperarea rapidă şi rezultatele funcţionale satisfăcătoare. Abordul laparoscopic al HH voluminoase reprezintă o intervenţie laborioasă şi necesită experienţă în posedarea tehnicilor laparoscopice avansate.Introduction: Hiatal hernia (HH) is the common benign medical condition of the stomach and esophagus which needs step-bystep treatment approach. For patients that experience life-limiting symptoms of gastroesophageal reflux disease (GERD) despite medical therapy and those diagnosed with paraesophageal hernia, surgical approach should be considered. Material and methods: The group of 111 patients underwent laparoscopic hiatal hernia repair for the period 2011-2015. Patients who have a HH associated with GERD were selected for interventional procedures based on SAGES guidelines (2010) criteria: medical management failure (n=58); desire for surgery due to quality of life considerations (n=15); presence of extraesophageal manifestations (n=18) and complicated GERD (n=3). The procedure included reduction of the hernia sac, identification of both crura and the eso-gastric junction, obtaining at least 4 cm of intra-abdominal esophageal length, hiatal closure and laparoscopic antireflux procedure (LARP). LARP was performed as follows: 84 cases according to Nissen-Rosetti, 19 according to Toupet, and 7 according to Dor. Results: The majority of intraoperative incidents – bleeding from live (n=4) and short gastric vessels (n=3), capnotorax (n=3), were solved laparoscopically without sequelae. The esophageal lesion (n=1) served as an indication to open antireflux procedure. The average length of hospital stay was 3 days. Follow up data were analyzed based on modified Visick scale 3 month after surgery: excellent result was obtained for 11% of the patients, good – 76%, satisfactory – 7%, and unsatisfactory – 3 %. Five individuals have not been evaluated. We observed the persistent dysphagia post-fundoplication in 8 patient, these cases underwent the endoscopic dilation of the eso-gastric junction. The HH recurrence developed in 3 patients (3%). Conclusions: The advantages of laparoscopic HH repair include less postoperative pain, short length of hospital stay, fast return to normal activities and satisfactory functional results. Although technically challenging, laparoscopic repair of giant HH is a viable alternative to "open" surgical approaches