Right-sided diaphragmatic rupture after blunt trauma. An unusual entity

Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery, especially when it comes to blunt trauma and injuries of the right diaphragm. We report the case of a patient with blunt trauma with right diaphragmatic rupture that required urgent surgical treatment for hepatothorax and iatrogenic severe liver injury. Blunt trauma can cause substantial diaphragmatic rupture. It must have a high index of suspicion for diaphragmatic injury in patients, victims of vehicle collisions, mainly if they have suffered frontal impacts and/or side precipitates in patients with severe thoracoabdominal trauma. The diagnosis can be performed clinically and confirmation should be radiological. The general measures for the management of multiple trauma patients must be applied. Surgery at the time of diagnosis should restore continuity

Endoscopic Management of Drain Inclusion in the Gastric Pouch after Gastrojejunal Leakage after Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity (LRYGBP)

Background. Drain inclusion inside the gastric pouch is rare and can represent an important source of morbidity and mortality associated with laparocopic Roux-en-Y gastric bypass (LRYGBP). These leaks can become chronic and challenging. Surgical options are often unsuccessful. We present the endoscopic management of four patients with drain inclusion. Patients. All four obese morbidly patients underwent LRYGBP and presented a gastro-jejunal fistula after acute anastomotic leakage. During follow-up endoscopy the drain was found inside the gastric pouch. It was moved into the abdominal cavity. Fistula debit reduced significantly and closed. Results. Gastric leak closure in less than 24 hours was achieved in all, with complete resolution of symptoms. These patients benefited exclusively from endoscopic treatment. Conclusions. Endoscopy is useful and technically feasible in chronic fistulas. This procedure is a less invasive alternative to traditional surgical revision. Other therapeutic strategies can be used such as clips and fibrin glue. Drains should not be placed in contact with the anastomosis or stapled lines. Drain inclusion must be suspected when fistula debit suddenly arises. If so, endoscopy is indicated for diagnostic accuracy. Under endoscopy vision, the drain is gently removed from the gastric reservoir leading to sudden and complete resolution of the fistula

Embedding Kalman techniques in the one-shot task model when non-uniform samples are corrupted by noise

The performance of several closed-loop systems whose controllers concurrently execute in a multitasking realtime system may be deteriorated due to timing uncertainties in tasks´executions, problem known as scheduling jitters. Recently, the one-shot task model, that combines irregular sampling, a predictor observer, and strictly periodic actuation, was presented in order to remove the negative effects of jitters. However, its successful application required noise-free samples. In this paper we extend the one-shot task model to the case of noisy measurements. In particular, we embed a Kalman filter into the model taking into account that the available measurements are not periodic. This poses the problem of adapting the standard discrete-time Kalman filter to the case under study, and decide when to apply the prediction and the correction phase. Two different strategies are presented, and their control performance and computation demand are analyzed through real experiments.Peer ReviewedPostprint (published version

Past and present in abdominal surgery management for Cushing's syndrome

Data on specific abdominal surgery and Cushing's syndrome are infrequent and are usually included in the adrenalectomy reports. Current literature suggests the feasibility and reproducibility of the surgical adrenalectomies for patients diagnosed with non-functioning tumours and functioning adrenal tumours including pheochromocytoma, Conn's syndrome and Cushing's syndrome. Medical treatment for Cushing's syndrome is feasible but follow-up or clinical situations force the patient to undergo a surgical procedure. Laparoscopic surgery has become a gold standard nowadays in a broad spectrum of pathologies. Laparoscopic adrenalectomies are also standard procedures nowadays. However, despite the different characteristics and clinical disorders related to the laparoscopically removed adrenal tumours, the intraoperative and postoperative outcomes do not significantly differ in most cases between the different groups of patients, techniques and types of tumours. Tumour size, hormonal type and surgeon's experience could be different factors that predict intraoperative and postoperative complications. Transabdominal and retroperitoneal approaches can be considered. Outcomes for Cushing's syndrome do not differ depending on the surgical approach. Novel technologies and approaches such as single-port surgery or robotic surgery have proven to be safe and feasible. Laparoscopic adrenalectomy is a safe and feasible approach to adrenal pathology, providing the patients with all the benefits of minimally invasive surgery. Single-port access and robotic surgery can be performed but more data are required to identify their correct role between the different surgical approaches. Factors such as surgeon's experience, tumour size and optimal technique can affect the outcomes of this surgery

A Risk-Based Screening Approach to Patients Needing Surgery During the De-Escalation Phase of COVID-19 Pandemic

Since the outbreak of COVID-19 pandemic, many national and international surgical societies have produced guidelines regarding the management of surgical patients. During the mitigation phase of the pandemic, most documents suggested to consider postponing elective procedures, unless this might have impacted the life expectancy of patients. As awareness and knowledge about COVID-19 are gradually increasing, and as we enter a phase when surgical services are resuming their activities, surgical strategies have to adapt to this rapidly evolving scenario. This is particularly relevant when considering screening policies and the associated findings. We herein describe a risk-based approach to the management of patients with surgical diseases, which might be useful in order to limit the risks for healthcare workers and patients, while allowing for resuming elective surgical practice safely

Potencial biotecnològic del cultiu de cèl·lules vegetals per a l'obtenció de productes farmacèutics

Plants produce a peculiar group of natural products, particular to the plant kingdom, the secondary metabolites, which are very numerous and structurally diverse. Provided that plant cells can grow 'in vitro', their culture offers the possibility of producing some of these compounds of pharmaceutical interest in large quantities. Alkaloids, steroids, cardiotonic glycosides, quinones and terpens, for example. are produced by either cell suspension cultures or immobilized cells; sometimes at a higher rate than in the whole plant. These systems are also used to yield several substances by means of a given biotransformation reaction which cannot be achieved in any other way. The use of cell cultures in pharmaceutical industry is just one of the many sides of plant biotechnology, which is proving to become an indispensable technique soon in the future

Design of a hands-on course in networked control systems

This report presents a hands-on course in networked control systems (NCS) to be integrated in the education of embedded control systems engineers. The course activities have a strong practical component and most of them are ap- plied exercises to be implemented in a NCS setup. The report containts four parts: a) a report that describes the experimental setup, proposing several activities that can be shaped into a course program according to the needs and diverse background of the targeted audience, b) a tentative program ex- ample for master students, c) a user manual to help setting up the hardware and software from a Live CD, and d) a quick guide to start working with the programming environment.Preprin