The Surgical Approach in Adrenal Gland Pathology

The pathology of the adrenal gland and the clinical management of the adrenal clinical entities are particularly complex. The surgical approach to adrenal disorders, both in the classic way and especially in the minimally invasive way, is reserved for highly addressable centers and experienced surgeons. The surgical treatment is dedicated to both functional and nonfunctional adrenal tumors, closely following specific criteria. Regarding adrenal pathology, the surgical treatment is indicated for adrenal tumors that secret mineralocorticoid hormones (Conn syndrome), adrenal tumors secreting glucocorticoids (Cushing syndrome), pheochromocytomas, paragangliomas, neuroblastomas, adrenal carcinomas, and metastases. At the same time, non-secreting tumors should be removed as soon as imaging details are recorded an increasing dimensions of these tumors during a short time interval (up to one year). Although laparoscopic adrenal removal became a gold standard procedure in the late 90s, the classic open surgical adrenalectomy is reserved for bulky adrenal tumors and adrenal cancers, but it is overshadowed by possible multiple complications such as lung damage, wound infections, thrombosis, bleeding, etc. The minimally invasive approach, either laparoscopically or robotically, is dedicated to small tumors, with the advantage of rapid patient recovery, rapid socio-professional reintegration, and reduction of complications. Laparoscopic adrenalectomy is indicated in a wide range of pathologies, ranging from Conn adenoma, Cushing syndrome, and pheochromocytoma, to hormonal inactive tumors or other pathologies. The surgical sparing of the adrenal cortex is advised in cases of hereditary disorders affecting the adrenal gland (such as the MEN2 syndrome) in order to avoid primary adrenal insufficiency after the surgical excision. The postoperative evolution must be closely monitored by the anesthetic-surgical team, and the subsequent follow-up must not be neglected. We will discuss the primary surgical indications and contraindications of adrenal gland pathology in this chapter, as well as the perioperative management of specific tumors, surgical approach types, pluses and minuses of various adrenal surgery procedures, surgical technique and tactics, potential complications, and postoperative management

Surgical Approach in Pheochromocytoma

Pheochromocytomas are tumors composed of chromaffin cells that can produce, secrete and metabolise catecholamines. The surgical excision procedure of these tumors may present the risk of significant variations in blood pressure, as well as the chance of cardiovascular complications in the perioperative period. During surgery, patients may be at risk for cardiovascular events such as major variations in blood pressure, pulmonary edema, stroke, myocardial infraction and a long period of intubation. The surgical approach to pheochromocytomas must always be preceded by accurate imaging evaluation, endocrine screening and identification of associated genetic mutations. In addition, the surgical technique of choice consists in using minimally invasive surgical methods, with a transabdominal or retroperitoneal approach

Comparison of quality control for trauma management between Western and Eastern European trauma center

<p>Abstract</p> <p>Background</p> <p>Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care.</p> <p>Methods</p> <p>We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT).</p> <p>Results</p> <p>Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation.</p> <p>Conclusion</p> <p>The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.</p

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

Background: The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.Methods: We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).Results:In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for "HIV/AIDS and sexually transmitted diseases" and "transport injuries" (each -19%). "Diabetes and kidney diseases" showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, "mental disorders" showed an increasing age-standardised YLL rate (14.5%).Conclusions: There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

Gestion de la mobilité dans les réseaux ambiants

This thesis was motivated by the new ubiquitous context of ambient wireless networks. The Internet protocols were designed 30 years ago without taking into consideration the nomadic use of networks and do not respond to the new constraints of mobility. We aimed to conceive mechanisms to make the mobility transparent to the applications and users. A part of our work was focused on the improvement of handoff delay of physical layer 802.11 to about 20 ms. Host mobility and network changes often require the reconfiguration of several parameters at IP layer. For the local mobility we chosen to allow the hosts to keep theirs IP address unchanged and to propagate host routes in the local domain. On the contrary, for global mobility, the optimal routing in Internet force us to conceive a solution where the mobile hosts change their IP addresses according to the subnet there are connected to. Our solution is based on "end-to-end" paradigm where the two hosts implied in a connection are the only ones to ensure the connection transfer to the new attachment points. It use interception of calls to the socket library and of DNS requests as well as local address translation to virtualise IP addresses into stable host identifiers that are presented to upper layers.Cette thèse a été motivée par le nouveau contexte ubiquitaire des réseaux ambiants sans-fil. Les protocoles Internet ont été conçus il y a 30 ans sans prendre en considération l'usage nomade des réseaux et ne répondent pas aux nouvelles contraintes de la mobilité. Notre but a été de concevoir des mécanismes pour rendre la mobilité transparente aux applications et utilisateurs. Une partie de notre travail a été axé sur l'amélioration du délai du handoff au niveau physique 802.11 à quelques dizaines de millisecondes. Le déplacement des hôtes et le changement de réseau demandent souvent une reconfiguration des plusieurs paramètres au niveau IP. Dans le cas d'une mobilité locale, l'approche que nous avons choisi est de permettre aux hôtes de garder inchangées leurs adresses et de mettre en place des routes d'hôte dans le domaine local. Au contraire, pour la mobilité globale, le routage optimal à travers l'Internet nous oblige de concevoir une solution dans laquelle les hôtes mobiles changent leurs adresses IP, en conformité avec le réseau ou ils s'y trouvent. Notre solution est basée sur le principe général « de bout en bout » dans laquelle les deux hôtes impliquées dans une connexion sont les seuls à assurer le transfert de cette connexion aux nouveaux points d'attachement. Elle utilise l'interception des appels de la bibliothèque socket et des requêtes DNS ainsi que la translation locale d'adresses pour virtualiser les adresses IP réelles dans des identificateurs d'hôte stables présentés aux niveaux supérieurs

Innovation Management and SMEs Development in Romania

The lack of innovation affects the capacity of companies to survive and grow in the current process of liberalization and openness toward international markets. The ability of an enterprise to create innovation will be improved by the introduction of information technology in the support of fair competitiveness, by the training of qualified personnel and the adoption of an innovation culture within. Although in the specialty literature there are many works that address the management of SMEs from the perspective of their impact on the economy and employment, there are very few that address SMEs in terms of innovation, and those that do this are oriented more on SMEs with activity field in the high-tech area. The main objective of our research was represented by the identification of the way in which the patterns of innovation could lead to further changes in the performance of SMEs

Primary aortoduodenal fistula: first you should suspect it

ABSTRACT A 59 year-old patient was admitted with upper gastrointestinal bleeding. The clinical exam showed mild hypotension and blood samples revealed acute anemia (hemoglobin = 7.5 g/dl). Emergency computed tomography showed an infrarenal abdominal aortic aneurysm and extravasation of the arterial contrast material toward the digestive tract. The patient was transported to the operating room for emergency laparotomy, which showed an aortoduodenal fistula. After proximal and distal aortic vascular control, the two anatomical structures were dissected with duodenorrhaphy, patch repair of the aortic tear and omentum interposition. The postoperative recovery was uneventful, with discharge after 12 days

THEORETICAL APPROACH ON THE ROLE OF INNOVATION IN DEVELOPMENT AND INCREASING COMPETITIVENESS OF ENTERPRISES

The intensity of the process of globalization and the new technological advances have resulted in changes in vision and behavior, so that the competitiveness and survival of European companies is linked increasingly more to IT processes efficiency and knowledge. In general, we consider innovation as a boosting factor of progress even in the period of economic and political crisis in which we find ourselves. The need for this research is the interest of companies from Romania towards innovation. In many industrial enterprises, or in the intermediate category of advice, and even among those in public services it has become necessary because of the innovation manager.. In this paper we dealt with the theoretical notion of innovation and impact on the development of enterprises