[Transanal endoscopic microsurgery--our initial experience]. / Chirurgia transanala endoscopica--experienta noastra initiala.

UNLABELLED: The aim of this study was to describe a single institution's experience with transanal endoscopic microsurgery (TEMS) in patients with benign and malignant rectal tumors. MATERIAL AND METHOD: This was a prospective descriptive survey. Between January 2006 and January 2010, 14 patients underwent transanal endoscopic microsurgery excision of benign (8) or malignant (6) rectal tumors, located 4 to 15 cm from the dentate line. Median age was 59.7 years and the mean follow up was 29 months. RESULTS: The average tumor size was 3.4 cm, median operating time was 40 min. Median length of hospital stay was 4.35 days. During the follow-up period, benign tumor recurrence was observed in one patient (7.14%), managed by repeated TEMS. Histologic staging of malignant tumors was T1 (2) and T2 (4). In two patients with inadequate resection margins open radical surgery was performed. One had recurrent disease, which was managed by radical surgery. No cancer-related deaths were observed during the follow-up period. There was no operative mortality. No major postoperative complications were recorded. Anal incontinence persisted for 3 weeks in one patient. CONCLUSION: Transanal endoscopic microsurgery excision is a safe and precise technique and should become a procedure of choice for benign rectal tumors and selected early malignant neoplasms.

Gastrojejunocolic fistula: report of six cases and review of the literature.

UNLABELLED: Six gastrojejunocolic fistulae were recorded at our service between 1995-2005. All the fistulae occurred in men who had gastric resection performed for duodenal ulcer. METHOD: Diarrhea, weight loss, postprandial pain and fecal breath were the clinical findings present in descending frequency. Preoperative diagnosis was possible in 5 patients by endoscopy and barium contrast studies. In five patients the option was a one-stage procedure with revision gastrectomy and segmental resection of the transverse colon. In one case simple dismantling of the fistula was performed. RESULTS: Although in two patients anastomotic leakage developed no mortality was recorded.

[Non-ulcerous duodenal perforations: a clinical analysis of 23 cases]. / Perforatiile neulceroase ale duodenului: analiza a 23 de cazuri.

Non-ulcerous duodenal perforations are a rare and seldom studied pathology. The present retrospective study analyses a group of 23 patients, over a 10 year period (Jan 1st 2000 - Dec 31st 2009) with this pathology. The most frequent etiology was iatrogenic (52.17 % after ERCP and 17.39% after upper gastrointestinal endoscopy). Other rare etiologies included were tumoral perforations, penetrating wounds, and ingestion of foreign bodies. The lesions vary from millimetric perforations to total necrosis of the wall of a duodenal segment and are often associated with other complex lesions. The overall mortality was 52.17%, a little lower for the post ERCP injuries (40%). Usually the iatrogenic lesions are diagnosed earlier (ex. 54.54% of the post ERCP lesions undergo surgery during the first 24 h), probably increasing the chance of surviving. 43.47% of cases undergo surgery in the condition of severe sepsis, with multiple organ failure, thus aggravating the prognosis. Sometimes the patient required multiple interventions (with a maximum of 8 in our group). In 26% of the cases the primary intervention was just paraduodenal and/or retroperitoneal drainage, suture of the duodenum (6 cases - 26%), usually under the protection of a gastro-enteroanastomosis (4 cases - 17.39%), suture of the duodenum around a decompression tube (26%), sometimes suture of the duodenum with a jejunal serous patch or duodeno-jejunal anastomosis. The bile drainage and the jejunostomy were associated sometimes. The procedures in this pathology have a significant morbidity, with a high rate of reinterventions (30.4%).

[Improvement in the quality of life for patients with adjustable gastric banding: initial results]. / Ameliorarea calitatii vietii la pacientii cu inel gastric reglabil: rezultate initiale.

UNLABELLED: The aim of the study was to evaluate the improvement in quality of life for patients that have undergone the laparoscopic gastric banding, using the BAROS and Moorehead-Ardelt II questionnaires. METHODS: We selected a 20 patient group (65% women) that underwent this surgical procedure in our clinic. The initial average weight was 123.45kg, and the body-mass index of 42.36. The average age was 29.25 years. The pars flaccida technique was used in 18, and the perigastric approach in 2 cases. RESULTS: No complications or intraoperative accidents occurred. The mean operation time was 115.5 minutes. Elective conversion was needed in one case with a BMI of 55. The average hospital stay was of 3.2 days. The follow-up was conducted at least through phone in 95% of cases, and its average duration was of 10 months. The only postoperative complications were infections of the subcutaneous port (5 cases - 25%) which needed removal of the port, but not of the banding. The average loss of excess weight was 48.23%. Using the BAROS score to determine the overall improvement of quality of life, 30% of the patients scored as "Very Good", 50% as "Good", 20% as "Fair". Using the Moorehead-Ardelt QLQ II score, 65% scored as "Very Good", 30% as "Good" and 5% as "Fair". CONCLUSION: The laparoscopic adjustable gastric banding significantly improves the quality of life for most patients with this procedure.

[Ascending colon perforation by ingested fruit stones]. / Perforatia colonului ascendent prin sâmburi ingerati.

BACKGROUND: Ingested foreign bodies present problems due to the related complications, perforation being the most frequent. MATERIAL AND METHOD: This is a descriptive study of two cases of ascending colon perforation by numerous ingested fruit stones. The main symptoms were abdominal pain with tenderness in the lower right quadrant. RESULTS: In both cases the diagnosis was made at operation, with right hemicolectomy and termino-lateral ileo-colic anastomosis. Post-operative outcome was uneventful with the exception of a wound infection. The possible mechanism of the delayed perforation is discussed. Diagnosis and treatment modality alternatives in foreign body ingestion and the literature data are reviewed. CONCLUSIONS: Delayed perforations by ingested fruit stones can be difficult to diagnose preoperatively but if operated in due time are curable by resection of the affected bowel.

Protein surface functional description.

The paper presents an image-oriented description of artificial and biological nanostructured surfaces, with applicability to the functional characterization of atom neighborhoods at the surface of proteins. The property which is considered is the hydrophobicity around each surface atom. The actual hydrophobicity distribution on the atoms that form an atom's vicinity is replaced by an equivalent hydrophobicity density distribution, computed in a standardized hexagonal or octagonal pattern around the atom. The purpose of this work is to create a database of molecular surfaces that will be used in several nanotechnology research fields.

[Correlation between C677T and A1298C mutations of the MTHFR gene and therapeutic prognostic elements in colorectal cancer]. / Relatia mutatiilor C677T si A1298C ale genei MTHFR cu elemente de prognostic terapeutic in cancerul colorectal.

The MTHFR gene polymorphism may influence the risk of developing sporadic CRC. The aim of this study is to assess the relationship between the mutations of this gene and certain aspects of the surgical practice: the tumoral resectability, the tumoral recurrence and the disease-free interval. 69 patients with sporadic colorectal cancer that underwent surgery at the 3rd Surgery Department of Cluj-Napoca between October 2003-May 2005 were randomly selected. The correlations between the C677T, A1298C mutations and the prognostic factors mentioned above were analyzed. The results show that the C677T mutation increases the risk of non-resectability (OR = 3.5, p = 0.099), while the A1298C mutation does not (OR = 1.1). For the A1298C mutation there is a major risk of recurrence (OR = 3,063), but in the group with C677T mutation there is only a small increase of the risk, non-significant statistically (OR = 1,196). Both the groups with the C677T mutation and the "wild" genotype 1298AA have more precocious recurrences then the other groups, so a shorter disease-free interval (HR = 0.9458 respectively 3.1070). The patients with the A1298C mutations have more often non-resectable recurrences. In conclusion, the mutations of the MTHFR gene are a prognostic factor for the treatment and evolution of patients with CRC.

Conversion of nucleotides sequences into genomic signals.

An original tetrahedral representation of the Genetic Code (GC) that better describes its structure, degeneration and evolution trends is defined. The possibility to reduce the dimension of the representation by projecting the GC tetrahedron on an adequately oriented plane is also analyzed, leading to some equivalent complex representations of the GC. On these bases, optimal symbolic-to-digital mappings of the linear, nucleic acid strands into real or complex genomic signals are derived at nucleotide, codon and amino acid levels. By converting the sequences of nucleotides and polypeptides into digital genomic signals, this approach offers the possibility to use a large variety of signal processing methods for their handling and analysis. It is also shown that some essential features of the nucleotide sequences can be better extracted using this representation. Specifically, the paper reports for the first time the existence of a global helicoidal wrapping of the complex representations of the bases along DNA sequences, a large scale trend of genomic signals. New tools for genomic signal analysis, including the use of phase, aggregated phase, unwrapped phase, sequence path, stem representation of components' relative frequencies, as well as analysis of the transitions are introduced at the nucleotide, codon and amino acid levels, and in a multiresolution approach.

Wavelet-based lossless compression of coronary angiographic images.

The final diagnosis in coronary angiography has to be performed on a large set of original images. Therefore, lossless compression schemes play a key role in medical database management and telediagnosis applications. This paper proposes a wavelet-based compression scheme that is able to operate in the lossless mode. The quantization module implements a new way of coding of the wavelet coefficients that is more effective than the classical zerotree coding. The experimental results obtained on a set of 20 angiograms show that the algorithm outperforms the embedded zerotree coder, combined with the integer wavelet transform, by 0.38 bpp, the set partitioning coder by 0.21 bpp, and the lossless JPEG coder by 0.71 bpp. The scheme is a good candidate for radiological applications such as teleradiology and picture archiving and communications systems (PACS's).

Wavelet image compression--the quadtree coding approach.

Perfect reconstruction, quality scalability, and region-of-interest coding are basic features needed for the image compression schemes used in telemedicine applications. This paper proposes a new wavelet-based embedded compression technique that efficiently exploits the intraband dependencies and uses a quadtree-based approach to encode the significance maps. The algorithm produces a losslessly compressed embedded data stream, supports quality scalability, and permits region-of-interest coding. Moreover, experimental results obtained on various images show that the proposed algorithm provides competitive lossless/lossy compression results. The proposed technique is well suited for telemedicine applications that require fast interactive handling of large image sets, over networks with limited and/or variable bandwidth.

Beat-to-beat wavelet variance of the QRS complex as a marker of arrhythmogenic substrate in ventricular tachycardia patients.

This study proposes a wavelet transform based technique to assess the beat-to-beat variation of the QRS signal in post-myocardial infarction patients with sustained monomorphic ventricular tachycardia. Recent electrophysiological investigations suggested that the diminished synchrony between the normal myocardium and the scarred arrhythmogenic tissue bordering a myocardial infarction area gives rise to beat-variable ECG signal components. Using a mathematical model of small variations in a largely repetitive waveform, we show that the inherent alignment errors (trigger jitter) of the high-resolution ECG (HRECG) can artificially increase the value of the time-domain beat-to-beat variance, making it less valuable as a marker of beat-variable signal components. To overcome this drawback, we propose the wavelet based approach which discriminates between the different factors responsible for the beat variability (the alignment error and the beat-variable signal components). The Morlet wavelet transform is performed on HRECG signals from normal individuals (control group) and postmyocardial infarction patients with documented ventricular tachycardia. Electrical variability is quantitatively assessed via the beat-to-beat wavelet variance measurements. A marker of arrhythmogenic induced variance which achieves a good performance in discrimination of ventricular tachycardia patients from normal subjects was found between 200 Hz and 300 Hz. This finding is in agreement with the proposed mathematical model which states that the useful part of the time-frequency map is shifted upward in a precise mathematical way, as the variance induced by the beat-variable arrhythmogenic signals depend on the frequency characteristics of the first derivative of these signals. We conclude that the dynamics of the arrhythmogenic substrate as revealed by the beat-to-beat wavelet variance can be a new estimator of ventricular tachycardia risk.

Cardiac electrical instability of the arrhythmogenic tissue substrate assessed by means of wavelet transform.

The unstable activation wavefront from the tissue responsible for the production of ventricular tachycardia (VT) gives rise to beat-variable signals components that are eluded during the averaging step of high resolution ECG (HRECG). We used a mathematical model of small variations in a largely repetitive waveform to evaluate the beat-to-beat variance of the HRECG signal. The ability of the Morlet Wavelet Transform to discriminate the different factors responsible for the beat-variability (the alignment error and the beat-variable signal component) has been assessed on simulated signals. The performance evaluation on real ECG signals from normal subjects and patients with a documented history of ventricular tachycardia showed that the dynamics of the arrhythmogenic substrate as revealed by wavelet transform offers a significant improvement in ventricular tachycardia risk assessment.