Аnalysis and anthropometric study of port placement in robotic rectal cancer surgery

Robotic surgery is an innovative, minimally invasive technique, which has already proved its advantages in the operative-technical field by providing ergonomics, three dimensional (3D) visualization of the operative field, more precise dissection in narrow spaces, etc. The additional time needed for docking of the console and collision (internal and external) between the robotic hands is a part of the specific difficulties related to this type of surgery. The aim of this study was to analyze the position of ports and their efficiency in robotic rectal surgery based on our initial experience with this type of surgery in the University Hospital of Pleven- Bulgaria as well as to seek for additional anatomical landmarks to improve the work process. The initial experience with robotic rectal resections for rectal cancer revealed that the recommended distance of 8 cm between the ports doesn`t provide sufficient efficacy. Additional topography anatomical landmarks are required for personalized preoperative planning of port positions and enhanced effectiveness of the robotic system in rectal cancer treatment. Further studies in this field are necessary

Open lateral sphincterotomy - A method of choice in the treatment of chronic anal fissure. Indications and results

Aim: The key to the treatment of chronic anal fissures is the reduction of the abnormal values of anal resting pressure. The aim of the surgical treatment is to reduce the activity of the internal anal sphincter and to provide proper conditions for the fissure to cure, which can be achieved by internal sphincterotomy. In the modern surgical practice the internal sphincterotomy is performed away from the fissure, lateral of the last, using open or closed technique.Methods: In our study we performed open lateral internal sphincterotomy (OLST) of 82 patients with chronic anal fissure, compared to a control group of 231 patients, treated with different methods. Results: We didn`t register any recurrences in the sixth post-operative moth after OLST. 11% of patients with OLST were with registered incontinence after the sixth post-operative month compared with 4.4% in non-OLST patients. The data was statistically significant (p=0.032)Conclusion: Choosing an OLST as a method for treatment of chronic anal fissure requires careful selection of patients. It is not recommended for patients with a risk of incontinence like those with a previous birth trauma, age beyond 60 years, previous ano-rectal operations, neurological diseases and low values in anal resting pressure.Aim: The key to the treatment of chronic anal fissures is the reduction of the abnormal values of anal resting pressure. The aim of the surgical treatment is to reduce the activity of the internal anal sphincter and to provide proper conditions for the fissure to cure, which can be achieved by internal sphincterotomy. In the modern surgical practice the internal sphincterotomy is performed away from the fissure, lateral of the last, using open or closed technique.Methods: In our study we performed open lateral internal sphincterotomy (OLST) of 82 patients with chronic anal fissure, compared to a control group of 231 patients, treated with different methods. Results: We didn`t register any recurrences in the sixth post-operative moth after OLST. 11% of patients with OLST were with registered incontinence after the sixth post-operative month compared with 4.4% in non-OLST patients. The data was statistically significant (p=0.032)Conclusion: Choosing an OLST as a method for treatment of chronic anal fissure requires careful selection of patients. It is not recommended for patients with a risk of incontinence like those with a previous birth trauma, age beyond 60 years, previous ano-rectal operations, neurological diseases and low values in anal resting pressure

Deroofing - a method of choice in the treatment of suppurative perineal hidradenitis

Purpose: Suppurative hidradenitis is a chronic relapsing inflammatory disease that affects the apocrine sweat glands. Therefore, it is most often located in the axilla, groin and perianal area. Usually, people of working age affected. Perineal and perianal locations cover about 37% of the total morbidity rate and are more common in males. The objective of this study was to share our experience with the application of deroofing for the treatment of purulent perineal hidradenitis.Material and methods: This prospective interventional study covered 13 patients with suppurative fistulasing hidradenitis of perineum treated in Division of Coloproctology and Septic Surgery, Georgi Stranski University Hospital of Pleven for the period from 2008 till 2013.Results: The interval between the occurrence of disease and its surgical treatment was very long - from two to 36 years (average of 9,2 years). It resulted from the progression of the disease with enlarged soft tissue involvement. Sometimes, the disease was complicated by chroniosepsis. The average hospital stay was 13,5-day long. Operative wounds healed secondarily at an average of about 30 days. The patients were followedup for six months, one year and two years. Two patients with relapses on the sixth postoperative month were hospitalized again. The surgical intervention warranted good results.Conclusion: Treatment of suppurative hidradenitis of the perineum is complex, both in terms of local status and systematic violations resulting in chronic infection. There are numerous surgical techniques for treating this pathology. The advantages of deroofing are the following: minimal trauma to the patient, application by using local anesthesia at the early stage in order to minimize hospital stay, no need of special equipment, a lower recurrence rate than the other methods and formation of aesthetically acceptable scar

Laser-induced surface modification of biopolymers - Micro/nanostructuring and functionalization

The medical-grade polydimethylsiloxane (PDMS) elastomer is a widely used biomaterial in medicine for preparation of high-tech devices because of its remarkable properties. In this paper, we present experimental results on surface modification of PDMS elastomer by using ultraviolet, visible, and near-infrared ns-laser system and investigation of the chemical composition and the morphological structure inside the treated area in dependence on the processing parameters - wavelength, laser fluence and number of pulses. Remarkable chemical transformations and changes of the morphological structure were observed, resulting in the formation of a highly catalytically active surface, which was successfully functionalized via electroless Ni and Pt deposition by a sensitizing-activation free process. The results obtained are very promising in view of applying the methods of laser-induced micro- and nano-structuring and activation of biopolymers' surface and further electroless metal plating to the preparation of, e.g., multielectrode arrays (MEAs) devices in neural and muscular surface interfacing implantable systems

Neutrino tomography - Learning about the Earth's interior using the propagation of neutrinos

Because the propagation of neutrinos is affected by the presence of Earth matter, it opens new possibilities to probe the Earth's interior. Different approaches range from techniques based upon the interaction of high energy (above TeV) neutrinos with Earth matter, to methods using the MSW effect on the neutrino oscillations of low energy (MeV to GeV) neutrinos. In principle, neutrinos from many different sources (sun, atmosphere, supernovae, beams etc.) can be used. In this talk, we summarize and compare different approaches with an emphasis on more recent developments. In addition, we point out other geophysical aspects relevant for neutrino oscillations.Comment: 22 pages, 9 figures. Proceedings of ``Neutrino sciences 2005: Neutrino geophysics'', December 14-16, 2005, Honolulu, USA. Minor changes, some references added. Final version to appear in Earth, Moon, and Planet

Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017

Antimicrobial agents used to treat infections are life-saving. Overuse may result in more frequent adverse effects and emergence of multidrug-resistant microorganisms. In 2016-17, we performed the second point-prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals. We included 1,209 hospitals and 310,755 patients in 28 of 31 European Union/European Economic Area (EU/EEA) countries. The weighted prevalence of antimicrobial use in the EU/EEA was 30.5% (95% CI: 29.2-31.9%). The most common indication for prescribing antimicrobials was treatment of a community-acquired infection, followed by treatment of HAI and surgical prophylaxis. Over half (54.2%) of antimicrobials for surgical prophylaxis were prescribed for more than 1 day. The most common infections treated by antimicrobials were respiratory tract infections and the most commonly prescribed antimicrobial agents were penicillins with beta-lactamase inhibitors. There was wide variation of patients on antimicrobials, in the selection of antimicrobial agents and in antimicrobial stewardship resources and activities across the participating countries. The results of the PPS provide detailed information on antimicrobial use in European acute care hospitals, enable comparisons between countries and hospitals, and highlight key areas for national and European action that will support efforts towards prudent use of antimicrobials