Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

  Introduction: The need for parathyroidectomy remains high in the group of patients on long-term dialysis with medically refractory secondary hyperparathyroidism (sHPT). We aim to compare the results after subtotal parathyroidectomies (sPtx) and total parathyroidectomies with autotransplant (tPtx + AT) performed for sHPT at a single referral centre. Material and methods: This prospective study comparatively analysed sPtx and tPtx + AT performed in our department between February 2010 and December 2014. We followed-up both surgical techniques, with respect to the main clinical symptoms, laboratory data, mortality, and recurrent disease. Results: Forty-three patients on whom we performed 26 sPtx and 19 tPtx + AT were entered in the study. There were no statistically significant differences between groups as far as demographic and preoperative clinical data are concerned. We did not encounter postoperative mortality in either of the groups. The follow-up period was significantly longer for the sPtx group (p = 0.04). The immediate postoperative serum calcium levels were significantly lower in the tPtx + AT group (p = 0.009). Definitive hypoparathyroidism was encountered in two patients in the sPtx group (8.3%) and in one from the tPtx + AT group (5.26%). Four patients from the sPtx group (16.6%) and three from the tPtx + AT group (15.78%) died during the follow-up due to causes unrelated to parathyroidectomy. Overall we had two recurrences in the sPtx group and none in the tPtx + AT group (p = 0.57). Conclusions: In our opinion both techniques have comparable results concerning the clinical and laboratory outcomes and rates of postoperative hypoparathyroidism, at least in short- and medium-term follow-up. (Endokrynol Pol 2016; 67 (2): 202–209)    Wstęp: Potrzeba wykonywania zabiegu usunięcia przytarczyc pozostaje na wysokim poziomie wśród grupy pacjentów poddawanych długoterminowej dializie cierpiących na wtórną nadczynność przytarczyc (sHPT) oporną na leczenie. W niniejszym badaniu, autorzy porównują wyniki po częściowym usunięciu przytarczyc (sPtx) oraz całkowitym ich usunięciu z autoprzeszczepem (tPtx + AT) wykonanym dla sHPT w jednym ośrodku referencyjnym. Materiał i metody: Niniejsze prospektywne badanie dokonuje analizy porównawczej sPtx oraz tPtx + AT, wykonanych w miejscu pracy autorów w okresie od lutego 2010 do grudnia 2014 roku. Autorzy porównali obie techniki operacyjne w związku z głównymi objawami klinicznymi, badaniami laboratoryjnymi, śmiertelnością oraz nawrotowością choroby. Wyniki: W badaniu wzięło udział 43 pacjentów: 26 poddano sPtx, a 19 tPtx + AT. Pomiędzy grupami nie było znaczących różnic statystycznych, jeśli chodzi o dane demograficzne i przedoperacyjne dane kliniczne. Nie stwierdzono śmiertelności pooperacyjnej w żadnej z grup. Okres obserwacji trwał zdecydowanie dłużej w grupie sPtx (p = 0,04). Stężenie wapnia w osoczu mierzone zaraz po operacji było znacznie niższe w grupie tPtx + AT (p = 0,009). Całkowita niedoczynność przytarczyc zidentyfikowano u dwóch pacjentów w grupie sPtx (8,3%) oraz jednego z drugiej grupy (5,26%). Czterech pacjentów z grupy sPtx (16,6%) i trzech z grupy tPtx + AT (15,78%) zmarło podczas okresu obserwacji z powodów niezwiązanych z usunięciem przytarczyc. Ogółem zidentyfikowano dwa nawroty choroby w grupie sPtx i żadnego z drugiej grupie (p = 0,57). Wnioski: W opinii autorów, obie techniki dają porównywalne wyniki, biorąc pod uwagę wyniki laboratoryjne oraz kliniczne, a także wskaźniki pooperacyjnej niedoczynności przytarczyc, przynajmniej w krótko- i średnioterminowym okresie obserwacji. (Endokrynol Pol 2016; 67 (2): 202–209)

Seguimiento remoto de la recaída de hernia después de procesos abiertos de plastia de la pared abdominal– estudio prospectivo que incluye 142 pacientes

ResumenAntecedentesLa hernia incisional sigue siendo una complicación común de las laparotomías. El propósito del estudio es analizar la recidiva de hernia en un año, después de varios métodos abiertos de plastia de la pared abdominal.Material y métodosEstudio longitudinal prospectivo, en el que se incluyó a 142 pacientes. Se analizaron: los datos individuales, el grado de obesidad, las variaciones intraoperatorias de la presión abdominal, la intensidad del dolor postoperatorio, las complicaciones postoperatorias y los tipos de plastias de la pared abdominal: simple y con malla de polipropileno.ResultadosEl análisis del grupo estudiado estableció una tasa general de reincidencia de 16.9% y, en los 4 procesos, del 40.74% en caso de plastias simples, del 16.07% después de plastias onlay, del 6.97% después de plastias retromusculares y del 6.25% después de la sustitución completa de la avería parietal. Mediante el análisis de los datos obtenidos, la recidiva de la hernia fue significativamente correlacionada con: el grado de obesidad, las variaciones de la presión intraabdominal, el dolor postoperatorio y el tipo de procedimiento realizado.ConclusionesLa recurrencia de la hernia fue más frecuente en las plastias simples. Entre los procesos con malla, a la plastia onlay se le asignó una mayor tasa de recaídas y complicaciones postoperatorias. La recurrencia de la hernia fue más frecuente en las variaciones de la presión intraabdominal y con el dolor postoperatorio aumentado. La realización de la ecografía puede aumentar la precisión de la presencia de la hernia.AbstractBackgroundThe incisional hernia continues to be a frequent complication of laparotomies. The purpose of study is the analysis of hernia disease relapse after one year after different open plasties methods of the abdominal wall.Material and methodsA prospective longitudinal study was performed that included 142 patients. An analysis was performed on the individual data, the level of obesity, intra-surgical variations in intra-abdominal pressure, the intensity of post-surgical pain, the post-surgical complications, and the types of plasties of abdominal wall, simple and with polypropylene mesh.ResultsThe analysis of studied group showed a general rate of relapse of 16.9%, and within the 4 procedures, 40.74% in the case of simple plasties, of 16.07% after the only plasties, 6.97% after the retro-muscular plasties, and 6.25% after the full substitution of parietal defect. On analysing the collected, hernia relapse was statistically significantly related to the level of obesity, variations in intra-abdominal pressure, post-surgical pain, and the type of procedure performed.ConclusionsHernia is a frequent complication of laparotomies. Hernia relapse was more frequent in the case of simple plasties. Among the mesh procedures, the onlay plasty showed a higher rate of relapse and post-surgical complications. Hernia relapse was more frequent in the case of variations of intra-abdominal pressure, and with increased post-surgical pain. The use of an echography examination may increase the accuracy of the presence of hernia disease

On the Accuracy of a Stewart Platform: Modelling and Experimental Validation

Non

Rare cause of digestive hemorrhage – synchronous gastrointestinal stromal tumor of jejunum – case report

Clinica Chirurgicală II Tg-Mureş, Departamentul de Anatomie PatologicăTumora gastrointestinală stromală este o neoplazie malignă rară, reprezentând 0,1-3% din neoplaziile gastrointestinale. Tumora interesează cel mai frecvent stomacul (50-70%), intestinul subţire (20-30%) şi colonul – mai puţin de 10%. Descriem cazul unui pacient de sex masculin în vârstă de 61 ani internat cu anemie severă, datorate unei hemoragii digestive grave prin tumoare stromală gastrointestinală sincronă jejunală cu ulceraţie dublă a mucoasei intestinale. Gastroscopia, colonoscopia şi irigografia nu poate preciza sursa hemoragiei. Computer tomografia evidenţiază îngroşarea marcată a peretelui jejunal (21 mm). Se intervine chirurgical constatându-se intraoperator două tumori jejunale, prima la 30 cm de unghiul Treitz aderent de o ansă ileală şi epiplon, iar a doua la 30 de cm distal de prima tumoră. S-a practicat rezecţie segmentară de jejun şi ileon ”en bloc” cu anastomoză jejuno-jejunală şi ileo-ileală. Evoluţia postoperatorie a fost favorabilă, cu externarea pacientului în ziua a 6-a postoperatorie. Rezultatul examinării histopatologice: tumori stromale gastrointestinale maligne, pleomorfe sincrone, CD117 pozitiv. Concluzii: tumorile stromale gastrointestinale pot fi evidenţiate prin explorări imagistice; rezecţia chirurgicală completă ”en bloc” constituie terapia în cazul tumorilor rezecabile.Gastrointestinal stromal tumor is a rare malignant neoplasia, representing 0,1-3% of gastrointestinal cancers. This tumor appeares most frequently in the stomach (50-70%), small bowel (20-30%) and colon – less than 10%. We describe here the case of a 61 years male patient who was admitted in our surgical department for severe digestive hemorrhage by jejunal gastrointestinal stromal tumours with synchronous double ulceration of intestinal mucosa. Gastroscopy, colonoscopy and irigography did not specify the source of bleeding. Computer tomography shows marked wall thickening of jejunum (21 mm). Intraoperatively we found two jejunal tumors, first at 30 cm from the angle of Treitz joint to the ileon and epiplon and the second at 30 cm from the first tumor. We performed “en bloc” segmental jejunal and ileal resection with jejuno-jejunal and ileo-ileal anastomosis. The postoperative outcome was favorable; the patient was discharged on day 6 after surgery. The histopathological examination showes: pleomorfe synchronous malignant gastrointestinal stromal tumors, CD117 positive. Conclusions: gastrointestinal stromal tumors can be revealed by echo and CT ; “en bloc” surgical resection is the therapy of choice for resectable tumors

Comparative study on metal versus zirconium dioxide infrastructure manufacturing in prosthetic rehabilitation in the maxillary frontal zone

Prosthetic rehabilitation of the maxillary front teeth is an extremely laborious problem for the dental team, consisting of the dentist and the dental technician. If for the physiognomic component the most recommended materials are the ceramic masses, for the resistance substrate there are several variants. Conventional technologies using dental alloys and modern ones involving the use of zirconium dioxide can be used successfully in performing fixed prosthetic restorations in the maxillary frontal area, both options having both advantages and disadvantages, as we will describe in this material

Conceptual Synthesis of Speed Increasers for Wind Turbine Conversion Systems

Most wind turbines (WT) are of the single-rotor type, which means they are simple, reliable and durable, but unlikely to convert more than 40% of the available wind energy. Different solutions are proposed to minimize WT energy loss and improve performance, such as the use of speed increasers, counter-rotating wind rotors or counter-rotating electric generators. Downsizing the design, saving weight and reducing the cost of WT conversion systems, while increasing their efficiency, have posed constant challenges to WT designers. Nevertheless, very little research in the field is concerned with, and partially recommends, the design of conversion systems. Therefore, the aim of this paper is to propose a specific algorithm for the conceptual synthesis of speed increasers integrated in WT conversion systems, starting with an inventory of all combinations of the main components of a conversion system that prove compatible for efficient functioning. The algorithm is structured in two sections: the first one includes a four-step approach to WT system design, while the second one follows a three-step procedure for identifying the speed increaser concept. Twenty-two variants of speed increasers are further generated and analyzed, four of which are innovative solutions proposed by the authors. The paper also provides guidelines for identifying the WT conversion system concept according to the circumstances of its application

A generalized approach to the efficiency analysis of torque-adding transmissions used in renewable energy systems

The paper presents a general approach to the steady-state efficiency analysis of one degree of freedom (1-DOF) speed increasers with one or two inputs, and one or two outputs, applicable to wind, hydro and marine-current power generating systems. The mechanical power flow, and the efficiency of this type of complex speed increasers, are important issues in the design and development of new power-generating systems. It is revealed that speed increases, with in-parallel transmission of the mechanical power from the wind or water rotors to the electric generator, have better efficiency than serial transmissions, but their efficiency calculus is still a challenging problem, solved in the paper by applying the decomposition method of complex speed increasers into simpler component planetary gear sets. Therefore, kinematic, steady-state torque and efficiency equations are derived for a generic 1-DOF speed increasers with two inputs and two outputs, obtained by connecting in parallel two gear mechanisms. These equations allow any speed increaser to be analysed with two inputs and one output, with one input and two outputs, and with one input and one output. We discuss a novel design of a patent-pending planetary-gear speed increaser, equipped with a two-way clutch, which can operate (in combination with the pitch adjustment of the rotors blades) in four distinct configurations. It was found that the mechanical efficiency of this speed increaser in the steady-state regime is influenced by the interior kinematic ratios, the input-torque ratio and by the meshing efficiency of its individual gear pairs. The efficiency of counter-rotating dual-rotor systems was found to be the highest, followed by systems with counter-rotating electric generator, and both have higher efficiency than conventional systems with one rotor and one electric generator with fixed-stator.The paper presents a general approach to the steady-state efficiency analysis of one degree of freedom (1-DOF) speed increasers with one or two inputs, and one or two outputs, applicable to wind, hydro and marine-current power generating systems. The mechanical power flow, and the efficiency of this type of complex speed increasers, are important issues in the design and development of new power-generating systems. It is revealed that speed increases, with in-parallel transmission of the mechanical power from the wind or water rotors to the electric generator, have better efficiency than serial transmissions, but their efficiency calculus is still a challenging problem, solved in the paper by applying the decomposition method of complex speed increasers into simpler component planetary gear sets. Therefore, kinematic, steady-state torque and efficiency equations are derived for a generic 1-DOF speed increasers with two inputs and two outputs, obtained by connecting in parallel two gear mechanisms. These equations allow any speed increaser to be analysed with two inputs and one output, with one input and two outputs, and with one input and one output. We discuss a novel design of a patent-pending planetary-gear speed increaser, equipped with a two-way clutch, which can operate (in combination with the pitch adjustment of the rotors blades) in four distinct configurations. It was found that the mechanical efficiency of this speed increaser in the steady-state regime is influenced by the interior kinematic ratios, the input-torque ratio and by the meshing efficiency of its individual gear pairs. The efficiency of counter-rotating dual-rotor systems was found to be the highest, followed by systems with counter-rotating electric generator, and both have higher efficiency than conventional systems with one rotor and one electric generator with fixed-stator

A Generalized Approach to the Steady-State Efficiency Analysis of Torque-Adding Transmissions Used in Renewable Energy Systems

The paper presents a general approach to the steady-state efficiency analysis of one degree of freedom (1-DOF) speed increasers with one or two inputs, and one or two outputs, applicable to wind, hydro and marine-current power generating systems. The mechanical power flow, and the efficiency of this type of complex speed increasers, are important issues in the design and development of new power-generating systems. It is revealed that speed increases, with in-parallel transmission of the mechanical power from the wind or water rotors to the electric generator, have better efficiency than serial transmissions, but their efficiency calculus is still a challenging problem, solved in the paper by applying the decomposition method of complex speed increasers into simpler component planetary gear sets. Therefore, kinematic, steady-state torque and efficiency equations are derived for a generic 1-DOF speed increasers with two inputs and two outputs, obtained by connecting in parallel two gear mechanisms. These equations allow any speed increaser to be analysed with two inputs and one output, with one input and two outputs, and with one input and one output. We discuss a novel design of a patent-pending planetary-gear speed increaser, equipped with a two-way clutch, which can operate (in combination with the pitch adjustment of the rotors blades) in four distinct configurations. It was found that the mechanical efficiency of this speed increaser in the steady-state regime is influenced by the interior kinematic ratios, the input-torque ratio and by the meshing efficiency of its individual gear pairs. The efficiency of counter-rotating dual-rotor systems was found to be the highest, followed by systems with counter-rotating electric generator, and both have higher efficiency than conventional systems with one rotor and one electric generator with fixed-stator