GERD is a frequent, evolving, life quality-impairing disease. In addition to medication and lapar... more GERD is a frequent, evolving, life quality-impairing disease. In addition to medication and laparoscopic fundoplication we have recently added endoluminal fundoplication (ELF). The EsophyX2 is currently the most efficient device for endoluminal fundoplication. This device produces a partial, anterior valve, redesigning the antireflux barrier and the Hiss angle geometry, thus improving the activity of the lower esophageal sphincter (LES). This paper presents the operative technique, the patient selection criteria and published results. It has been shown that this technique is both secure, reproductible and effective in patients followed for 12-24 months: life-quality improvement, decreased acid exposure, suppression of antiacids, reduced hospitalization and recovery. Compared to antiacid therapy, ELF is far more effective and less invasive than laparoscopic fundoplication. For the moment we have no long-term results. ELF with EsophyX2 is a minimally invasive and efficient therapy for GERD that requires further evaluation.
Introduction: By definition, conversion means giving up laparoscopic surgery and continuing the o... more Introduction: By definition, conversion means giving up laparoscopic surgery and continuing the operation with open, conventional surgery no matter the reason, nor the moment of the operation. Purpose: To evaluate the causes and the moment of conversion, the technique used to perform the cholecystectomy after conversion, analysing the experience of the surgical team in deciding the moment of conversion. Method: A retrospective study performed on patients which underwent a laparoscopic operation for acute cholecystitis between January 1st 2004 - December 31st 2007. Clinical examination, biological parameters, surgical proceedings, histopathological examination of the pieces removed and the patient's postoperative evolution were analysed. Findings: There were performed 1522 laparoscopic cholecystectomies for acute cholecystitis, out of which 108 (7.1% of all) were converted to open surgery. Analysing the experience of the surgical team, we can say that the converted laparoscopic cholecystectomies are found mainly in teams formed by senior surgeons assisted by junior surgeons--43% (46/108), in comparison with teams formed by residents assisted by senior surgeons--22% (25/108). The nondissecable fibrotic shirt front, woody inflammation of the pedicle, adhesions after past surgery and suspicion of a fistula are the most frequent causes of conversion--45.35% (49/108). The distribution according to the gender was analysed in patients which underwent conversion, showing a significant difference: 5.39% (60/1112) in women and 11.7% (48/410) in men. The percentage of conversion was significantly higher for operations performed at more than 96 hours away from the beginning of the symptoms--15.1% (29/192). The highest number of conversions occurred for gangrenous acute cholecystitis--72% (77/108). 82.40% of all the acute cholecystitis which were converted were complicated with shirt front (89/108). Conclusions: Conversion performed for laparoscopic cholecystectomies is a proof of ripening and professional responsibility, a fit solution for cases in which the advantages of laparoscopic surgery are overwhelmed by the risks found during surgery; gangrenous acute cholecystitis is one of the most important causes of conversion--72%; the shirt front around the gallbladder was converted in 82.4% of cases; conversion is more frequent in men--11.7%; acute cholecystitis with symptoms found for more than 96 hours are converted in 15.1% of cases.
Background: Suture repair became the standard treatment for perforated duodenal ulcer (PDU) due t... more Background: Suture repair became the standard treatment for perforated duodenal ulcer (PDU) due to the efficacy of modern anti-ulcer therapy. This study compared short-term outcomes of open versus laparoscopic suture repair of PDU in patients without risk factors. Method: Patients with perforated duodenal ulcer were selected for open or laparoscopic suture repair. Patients with either one or more of the following risk factors were excluded: age > 50 years, interval between perforation and operation > or = 12 hours, presence of major comorbidities (American Society of Anesthesiologists [ASA] III-IV), and previous abdominal surgery. Results: 174 patients underwent open surgery (OSG) and 85 underwent laparoscopic surgery (LSG). The two groups were similar in regard to age, sex, ulcer disease history, time between onset of surgery, ASA score, and presence of free air on X-ray. There were statistical differences between OSG and LSG in the duration of operating time (55 vs 85 min), analgesic doses (16 vs 9) and hospital stay (7.8 vs 6.1 days). During the night (10:00 PM - 06:00 AM), 129 patients were operated: 107/174 in OSG and 22/85 in LSG. In LSG we performed suture repair in 37 patients and suture repair with omental patch in 41 patients. In OSG, 7 patients had a wrong preoperative diagnosis of acute appendicitis. Five patients (5.8%) in LSG group and 15 patients (8.6%) in OSG had postoperative complications and 2 respectively 1 patient needed reoperation. The two reoperated patients in LSG presented suture repair leak and a right subphrenic abscess. Both had only suture repair. There were no mortalities. Conclusion: We believe that suture repair with omental patch associated with anti-ulcer medical therapy is the standard therapeutic solution in PDU for young patients without risk factors.
Fundoplicatura endoscopică cu dispozitivul EsophyX (FEE) la pacienţii cu BRGE riguros selectaţi, ... more Fundoplicatura endoscopică cu dispozitivul EsophyX (FEE) la pacienţii cu BRGE riguros selectaţi, este eficace, sigură şi durabilă. Prezentăm cazul unui pacient de 63 de ani (unul dintre autori) cu simptomatologie de BRGE cu debut în urmă cu 15 ani cu simptome tipice şi atipice. In 2009, EDS evidenţiază o hernie hiatală (HH) de 3 cm şi o esofagită erozivă Los Angeles B. S-a efectuat o FEE cu dispozitivul EsophyX 2® (EndoGastric Solutions, Inc., Redmond, WA, USA). Postoperator simptomele au dispărut, la EDS esofagita era vindecată. La 6 ani postoperator, simptome atipice de BRGE au reapărut (răguşeală), la EDS s-a evidenţiat o HH de 2 cm, esofagită erozivă Los Angeles A, pH-metria cu impedaţă confirmă refluxul, scor DeMeester 44,5. In 2016 (7 ani de la FEE) se efectuează o nouă FEE, de asta cu noul dispozitiv perfecţionat, EsophyX Z®. Acest dispozitiv se acţionează ca un "stapler", este mai uşor de manevrat şi mai sigur. Durata FEE cu noul dispozitiv a fost la jumătate comparativ cu vechiul dispozitiv. Simptomele atipice au dispărut, EDS efectuată la 90 de zile postoperator de aspect normal, pH-metria cu impedanţă efectuată la 13 luni postoperator scorul DeMeester era de 8, în limite normale. Este prima reoperaţie mondiala cu noul dispozitiv EsophyX Z ® după FEE cu rezultate postoperatorii bune şi cu reducerea considerabilă a duratei intervenţiei.
In a large number of cases, post-traumatic diaphragmatic hernias (PTDH) are a consequence of occu... more In a large number of cases, post-traumatic diaphragmatic hernias (PTDH) are a consequence of occult diaphragmatic injuries associated with penetrating abdominal trauma. We present a case of a 26-year-old male patient who, 2 months prior to the current admission, sustained a non-penetrating stab wound to the left anterior chest below the nipple. Upon presentation the patient complained of epigastric pain radiated to the left shoulder, and nausea and vomiting. The chest X-ray, and abdominal and thoracic CT scan were inconclusive. The patient was sutured and discharged. The laparoscopic approach was selected as a diagnostic and minimally invasive therapeutic method. The suspected diagnosis of PTDH was confirmed. The herniated organs (transverse colon, small bowel loops, and greater omentum) were reduced, and the diaphragmatic defect was sutured by placing 3 non-resorbable 2.0 knots. The suture was reinforced with a composite mesh affixed with resorbable clips. Postoperative period was uneventful, and the patient was discharged 4 days later.
Laparoscopia este acceptată în plăgile abdominale (PA), dar în contuziile abdominale (CA) utiliza... more Laparoscopia este acceptată în plăgile abdominale (PA), dar în contuziile abdominale (CA) utilizarea ei este controversată. Lucrarea noastra evalueaza utilizarea laparoscopiei diagnostice (LD) si al laparoscopiei terapeutice (LT) in traumatismele abdominale în perioada Decembrie 2006-Ianuarie 2016. S-au analizat indicaţiile, leziunile, LT, conversiile, complicaţiile, durata spitalizarii. LD s-a efectuat la 49 de pacienţi stabili hemodinamic, 42 de barbaţi şi 7 femei cu varsta medie 36,6 ±13,3 ani. Au fost 20 PA SI 29 CA. Principalele indicaţii au fost: diagnosticul penetraţiei în PA, suspiciunea de leziune de organ cavitar sau diafragm, hemoragia activă în leziunile viscerale din CA. Preoperator, 11/48 ecografii abdominale şi 4/28 examene CT au fost fals negative. Dintre cele 20 LD pentru PA, 3 au fost negative si 4 nonterapetice. Au fost 4 LT şi 7 conversii. La cele 29 de CA, principalele leziuni au fost: perforaţie de organ cavitar 9, dilacerări mezenterice 6, leziuni splenice 2, leziuni de diafragm 2. Au fost 10 LT şi 9 conversii si 14 LT: enterorafii şi enterectomii 6 (5 asistate), frenorafii 4, colecistectomie 1, hemostaze 4. Durata intervenţiilor şi spitalizarea postoperatorie au fost mai mari în conversii. Au fost 6 complicaţii şi 3 decese. Nu au fost leziuni omise. O laparotomie nenecesară s-a evitat în 18/49 cazuri (36,73%). În cazuri selectate de PA şi CA cu diagnostic clinic şi imagistic echivoc, laparoscopia este o modalitate diagnostica utilă, cu potenţial terapeutic, care reduce laparotomiile nenecesare, perioada de spitalizare şi complicaţiile.
Societatea Română de Endoscopie Digestivă (SRED) şi Asociaţia Română de Chirurgie Endoscopică (AR... more Societatea Română de Endoscopie Digestivă (SRED) şi Asociaţia Română de Chirurgie Endoscopică (ARCE) au decis să înfiinţeze un grup de lucru comun pentru a elabora recomandările necesare pentru organizarea procedurilor minim-invazive diagnostice şi intervenţionale, în contextul pandemiei COVID-19. Recomandările www.revistachirurgia.ro Chirurgia, 115 (3), 2020 se bazează pe ghidurile societăţilor internaţionale de endoscopie şi gastroenterologie (ESGE / BSG / ASGE / ACG / AGA), respectiv chirurgie endoscopică (EAES & SAGES) (4-8), pe experienţa ţărilor afectate grav de pandemie (Italia, Franţa, Spania, SUA, Germania, etc.) şi vor fi aplicată în limitele măsurilor impuse la nivel local şi guvernamental de către autorităţile competente. Pe de altă parte, aceste recomandări trebuie să aibă o evoluţie dinamică, în funcţie de tendinţa ascendentă sau descendentă a pandemiei COVID-19 la nivel regional şi local, dar şi în funcţie de concluziile societăţilor profesionale şi academice, necesitând analize periodice bazate pe publicarea de recomandări suplimentare sau studii clinice internaţionale. Obiectivele recomandărilor SRED şi ARCE vizează organizarea de activităţi de endoscopie şi chirurgie laparoscopică, fiind aplicate nediscriminatoriu în scop diagnostic sau terapeutic, urmărind beneficiile demonstrate ale acestor proceduri, în condiţii sigure pentru pacienţi şi personalul medical.
BRGE a devenit cea mai frecventã afecţiune a polului digestiv superior, afecţiune spectralã şi ev... more BRGE a devenit cea mai frecventã afecţiune a polului digestiv superior, afecţiune spectralã şi evolutivã cu posibile complicaţii severe. Terapia principalã şi efectivã în majoritatea cazurilor este tratamentul medical (TM) axat pe IPP. Cazurile severe cu alterarea funcţiei sfincterului esofagian inferior (SEI) şi modificãri anatomice importante vor fi abordate chirurgical, fundoplicatura laparoscopicã (FL), intervenţia de elecţie, cu rezultate bune la distanţã, dar cu posibile efecte negative postoperatorii. 30-40 % dintre pacienţi sunt refractãri la TM, dar mulţi nu doresc intervenţia chirurgicalã. Apare un "gol terapeutic", pacienţi cu BRGE care nu beneficiazã de tratament. Pentru pacienţii cu BRGE, selectaţi, fãrã forme severe şi complicaţii şi fãrã modificãri anatomice importante (hernii hiatale mici), în mod special pentru cei refractari la TM, au apãrut noi terapii miniminvazive: mai eficiente ca şi TM, dar mai puţin agresive şi cu efecte secundare minime comparativ cu FL. Sunt terapii endoscopice care amelioreazã funcţia SEI prin terapie termicã, procedeul Stretta® şi rezecţia mucoasei antireflux, respectiv realizarea unei fundoplicaturi parţiale cu ajutorul unor dipozitive de agrafare: EsophyX®, Muse™, Gerd-X™. Tehnicile laparoscopice pot rezolva HH mai mari (peste 2 cm) când se impune, iar în locul fundoplicaturii se poate monta un şirag de mãrgele magnetice la nivelul joncţiunii gastroesofagiene, procedeul LINX®, respectiv electrozi pentru stimulare electricã a SEI, EndoStim®. Aceste procedee s-au dovedit
The use of laparoscopy in traumatic and non-traumatic abdominal surgical emergencies is unanimous... more The use of laparoscopy in traumatic and non-traumatic abdominal surgical emergencies is unanimously accepted due to the well-known advantages of minimally invasive surgery. In the period 1961-1966 in the Clinical Emergency Hospital of Bucharest (CEHB) the first diagnostic laparoscopes were performed in the acute surgical abdomen, respectively in the obstructive jaundice by dr. Gh.Popovici, respectively dr.C.Petrescu.In the modern era, the first laparoscopic cholecystectomy was performed in 4 dec. 1993 by A.E.N.In 1994 the first laparoscopic appendectomies, gynecological emergencies, exploration in traumatic abdominal contusion, followed by perforated ulcer (1995), intestinal occlusion (1997), were performed. In the specialized literature, out of the 42 emergency laparoscopy articles published in the journal “Chirurgia” (1994-2019), 16 (38,08%) belonged to the CEHB team, 11 of AEN. In 2004 the original monograph "Laparoscopic Emergency Surgery" appeared. Specialized chapter...
While multicore/multiprocessor systems achieve significant speedup for many applications by explo... more While multicore/multiprocessor systems achieve significant speedup for many applications by exploiting loop level parallelism, they also suffer from increased reliability problems as a result of ever scaling device size. This paper addresses the reliability of loop dominated applications, aiming to execute parallel loops efficiently in the presence of various types of hardware faults. In this paper, we present a fault tolerant work-stealing scheme which makes parallel loop execution resilient to hardware faults. A lightweight buffer-commit mechanism is applied in the proposed scheme to ensure the correctness of the re-execution of loop iterations. In addition, we split large failing chunks of loop iterations at runtime to improve load balancing, and a worker thread is discarded when faults occur frequently on it. We evaluated our techniques on a multi-socket multicore system, using a set of loop dominated benchmarks. The proposed scheme achieves the minimum overhead of supporting fa...
Sepsis arises when a patient’s immune system has an extreme reaction to an infection. This is fol... more Sepsis arises when a patient’s immune system has an extreme reaction to an infection. This is followed by septic shock if damage to organ tissue is so extensive that it causes a total systemic failure. Early detection of septic shock among septic patients could save critical time for preparation and prevention treatment. Due to the high variance in symptoms and patient state before shock, it is challenging to create a protocol that would be effective across patients. However, since septic shock is an acute change in patient state, modeling patient stability could be more effective in detecting a condition that departs from it. In this paper we present a one-class classification approach to septic shock using hyperdimensional computing. We built various models that consider different contexts and can be adapted according to a target priority. Among septic patients, the models can detect septic shock accurately with 90% sensitivity and overall accuracy of 60% of the cases up to three ...
Pneumonia is a common complication associated with COVID-19 infections. Unlike common versions of... more Pneumonia is a common complication associated with COVID-19 infections. Unlike common versions of pneumonia spread quickly through large lung regions, COVID-19 related pneumonia starts in small localized pockets before spreading over the course of several days. This makes the infection more resilient and with a high probability of developing acute respiratory distress syndrome. Because of the peculiar spread pattern, the use of pulmonary computerized tomography (CT) scans was key in identifying COVID-19 infections. Identifying uncommon pulmonary diseases could be a strong line of defense in early detection of new respiratory infection-causing viruses. In this paper we describe a classification algorithm based on hyperdimensional computing for the detection of COVID-19 pneumonia in CT scans. We test our algorithm using three different datasets. The highest reported accuracy is 95.2% with an F1 score of 0.90, and all three models had a precision of 1 (0 false positives).
Abordul laparoscopic al defectelor parietale ventrale devine tot mai actual, având în vedere avan... more Abordul laparoscopic al defectelor parietale ventrale devine tot mai actual, având în vedere avantajele binecunoscute ale chirurgiei miniminvazive la care se adaugă incidenţa mai redusă a infecţiilor parietale postoperatorii şi a recidivelor comparativ cu abordul deschis cu sau fără plasă. Prezentăm tehnica curei laparoscopice a herniilor ventrale mici (defect < 2 cm) utilizând plasa Ventralex, bifaţetată, polipropilen şi PTFE, circulară, de 8 cm în diametru, fixată cu 4 fire de sutură transparietale, după închiderea defectului parietal. Plasa respectivă este concepută pentru chirurgia deschisă, dar se poziţionează intraperitoneal. Am folosit tehnica la 28 de pacienţi pacienţi,16 femei şi 12 bărbaţi, cu vârsta medie de 53,3 ani (29-72 ani): 22 hernii ombilicale (HO), 2 hernii epigastrice (HE), o hernie Spiegel stg., o hernie incizională după cura deschisă a unei HO cu plasă Ventralex şi 2 eventaţii de trocar (ET) după colecistectomie laparoscopică. Durata operaţiei a fost în medie de 52 de min (42-70 min), spitalizare postoperatorie 1,8 zile (1-5zile). Avantaje: plasă preformată circular, diametru 8 cm, fixare prin sutură transfascială, laparoscopic se verifică corecta poziţionare şi depliere, costuri reduse. Tehnica este uşor de reprodus. Cuvinte cheie: hernie ventrală mică, laparoscopie, plasă
3rd Workshop on Embedded Systems for Real-Time Multimedia, 2005., 2005
Digital watermarking is a process that embeds an imperceptible signature or watermark in a digita... more Digital watermarking is a process that embeds an imperceptible signature or watermark in a digital file containing audio, image, text or video data. The watermark is later used to authenticate the data file and for tamper detection. It is particularly valuable in the use and exchange of digital media such as audio and video on emerging handheld devices. However, watermarking is computationally expensive and adds to the drain of the available energy in handheld devices. We present an approach in which we partition the watermarking embedding and extraction algorithms and migrate some tasks to a proxy server. This leads to a lower energy consumption on the handheld without compromising the security of the watermarking process. Our results show that executing watermarking partitioned between the proxy and the handheld reduces the total energy consumed by 80% over running it only on the handheld and improves performance by over two orders of magnitude.
Laparoscopic fundoplication (LF) is the treatment of choice for gastroesophageal reflux disease (... more Laparoscopic fundoplication (LF) is the treatment of choice for gastroesophageal reflux disease (GERD).Our paper evaluates post LF quality of life (QL). Patients treated between January 2008 and May 2011 by the same surgeon were asked to fill in the Velanovich questionnaires for Gastro - Oesophageal Reflux Disease - Health Related Quality of Life (GERD-HRQL). The 10 questions were designed to assess GERD specific symptoms prior to (part A) and after surgery (part B). The Velanovich score is 0 if the patient is asymptomatic and 50 if the symptoms are at maximum intensity. Only 32 out of the 54 patients operated during the study filled in the questionnaire:28 patients (87.5%) had hiatus hernia (HH), 16 cases were associated with reflux erosive esophagitis (EE), 4 patients had non-erosive reflux disease (NERD) and one had Barrett's esophagus (BE). We used Toupet partial posterior fund oplication for 12 patients and Nissen total fundoplication for 20 patients. The short gastric vess...
Proceedings of the The 51st Annual Design Automation Conference on Design Automation Conference - DAC '14, 2014
With memories continuing to dominate the area, power, cost and performance of a design, there is ... more With memories continuing to dominate the area, power, cost and performance of a design, there is a critical need to provision reliable, high-performance memory bandwidth for emerging applications. Memories are susceptible to degradation and failures from a wide range of manufacturing, operational and environmental effects, requiring a multi-layer hardware/software approach that can tolerate, adapt and even opportunistically exploit such effects. The overall memory hierarchy is also highly vulnerable to the adverse effects of variability and operational stress. After reviewing the major memory degradation and failure modes, this paper describes the challenges for dependability across the memory hierarchy, and outlines research efforts to achieve multi-layer memory resilience using a hardware/software approach. Two specific exemplars are used to illustrate multilayer memory resilience: first we describe static and dynamic policies to achieve energy savings in caches using aggressive voltage scaling combined with disabling faulty blocks; and second we show how software characteristics can be exposed to the architecture in order to mitigate the aging of large register files in GPGPUs. These approaches can further benefit from semantic retention of application intent to enhance memory dependability across multiple abstraction levels, including applications, compilers, run-time systems, and hardware platforms.
GERD is a frequent, evolving, life quality-impairing disease. In addition to medication and lapar... more GERD is a frequent, evolving, life quality-impairing disease. In addition to medication and laparoscopic fundoplication we have recently added endoluminal fundoplication (ELF). The EsophyX2 is currently the most efficient device for endoluminal fundoplication. This device produces a partial, anterior valve, redesigning the antireflux barrier and the Hiss angle geometry, thus improving the activity of the lower esophageal sphincter (LES). This paper presents the operative technique, the patient selection criteria and published results. It has been shown that this technique is both secure, reproductible and effective in patients followed for 12-24 months: life-quality improvement, decreased acid exposure, suppression of antiacids, reduced hospitalization and recovery. Compared to antiacid therapy, ELF is far more effective and less invasive than laparoscopic fundoplication. For the moment we have no long-term results. ELF with EsophyX2 is a minimally invasive and efficient therapy for GERD that requires further evaluation.
Introduction: By definition, conversion means giving up laparoscopic surgery and continuing the o... more Introduction: By definition, conversion means giving up laparoscopic surgery and continuing the operation with open, conventional surgery no matter the reason, nor the moment of the operation. Purpose: To evaluate the causes and the moment of conversion, the technique used to perform the cholecystectomy after conversion, analysing the experience of the surgical team in deciding the moment of conversion. Method: A retrospective study performed on patients which underwent a laparoscopic operation for acute cholecystitis between January 1st 2004 - December 31st 2007. Clinical examination, biological parameters, surgical proceedings, histopathological examination of the pieces removed and the patient's postoperative evolution were analysed. Findings: There were performed 1522 laparoscopic cholecystectomies for acute cholecystitis, out of which 108 (7.1% of all) were converted to open surgery. Analysing the experience of the surgical team, we can say that the converted laparoscopic cholecystectomies are found mainly in teams formed by senior surgeons assisted by junior surgeons--43% (46/108), in comparison with teams formed by residents assisted by senior surgeons--22% (25/108). The nondissecable fibrotic shirt front, woody inflammation of the pedicle, adhesions after past surgery and suspicion of a fistula are the most frequent causes of conversion--45.35% (49/108). The distribution according to the gender was analysed in patients which underwent conversion, showing a significant difference: 5.39% (60/1112) in women and 11.7% (48/410) in men. The percentage of conversion was significantly higher for operations performed at more than 96 hours away from the beginning of the symptoms--15.1% (29/192). The highest number of conversions occurred for gangrenous acute cholecystitis--72% (77/108). 82.40% of all the acute cholecystitis which were converted were complicated with shirt front (89/108). Conclusions: Conversion performed for laparoscopic cholecystectomies is a proof of ripening and professional responsibility, a fit solution for cases in which the advantages of laparoscopic surgery are overwhelmed by the risks found during surgery; gangrenous acute cholecystitis is one of the most important causes of conversion--72%; the shirt front around the gallbladder was converted in 82.4% of cases; conversion is more frequent in men--11.7%; acute cholecystitis with symptoms found for more than 96 hours are converted in 15.1% of cases.
Background: Suture repair became the standard treatment for perforated duodenal ulcer (PDU) due t... more Background: Suture repair became the standard treatment for perforated duodenal ulcer (PDU) due to the efficacy of modern anti-ulcer therapy. This study compared short-term outcomes of open versus laparoscopic suture repair of PDU in patients without risk factors. Method: Patients with perforated duodenal ulcer were selected for open or laparoscopic suture repair. Patients with either one or more of the following risk factors were excluded: age > 50 years, interval between perforation and operation > or = 12 hours, presence of major comorbidities (American Society of Anesthesiologists [ASA] III-IV), and previous abdominal surgery. Results: 174 patients underwent open surgery (OSG) and 85 underwent laparoscopic surgery (LSG). The two groups were similar in regard to age, sex, ulcer disease history, time between onset of surgery, ASA score, and presence of free air on X-ray. There were statistical differences between OSG and LSG in the duration of operating time (55 vs 85 min), analgesic doses (16 vs 9) and hospital stay (7.8 vs 6.1 days). During the night (10:00 PM - 06:00 AM), 129 patients were operated: 107/174 in OSG and 22/85 in LSG. In LSG we performed suture repair in 37 patients and suture repair with omental patch in 41 patients. In OSG, 7 patients had a wrong preoperative diagnosis of acute appendicitis. Five patients (5.8%) in LSG group and 15 patients (8.6%) in OSG had postoperative complications and 2 respectively 1 patient needed reoperation. The two reoperated patients in LSG presented suture repair leak and a right subphrenic abscess. Both had only suture repair. There were no mortalities. Conclusion: We believe that suture repair with omental patch associated with anti-ulcer medical therapy is the standard therapeutic solution in PDU for young patients without risk factors.
Fundoplicatura endoscopică cu dispozitivul EsophyX (FEE) la pacienţii cu BRGE riguros selectaţi, ... more Fundoplicatura endoscopică cu dispozitivul EsophyX (FEE) la pacienţii cu BRGE riguros selectaţi, este eficace, sigură şi durabilă. Prezentăm cazul unui pacient de 63 de ani (unul dintre autori) cu simptomatologie de BRGE cu debut în urmă cu 15 ani cu simptome tipice şi atipice. In 2009, EDS evidenţiază o hernie hiatală (HH) de 3 cm şi o esofagită erozivă Los Angeles B. S-a efectuat o FEE cu dispozitivul EsophyX 2® (EndoGastric Solutions, Inc., Redmond, WA, USA). Postoperator simptomele au dispărut, la EDS esofagita era vindecată. La 6 ani postoperator, simptome atipice de BRGE au reapărut (răguşeală), la EDS s-a evidenţiat o HH de 2 cm, esofagită erozivă Los Angeles A, pH-metria cu impedaţă confirmă refluxul, scor DeMeester 44,5. In 2016 (7 ani de la FEE) se efectuează o nouă FEE, de asta cu noul dispozitiv perfecţionat, EsophyX Z®. Acest dispozitiv se acţionează ca un "stapler", este mai uşor de manevrat şi mai sigur. Durata FEE cu noul dispozitiv a fost la jumătate comparativ cu vechiul dispozitiv. Simptomele atipice au dispărut, EDS efectuată la 90 de zile postoperator de aspect normal, pH-metria cu impedanţă efectuată la 13 luni postoperator scorul DeMeester era de 8, în limite normale. Este prima reoperaţie mondiala cu noul dispozitiv EsophyX Z ® după FEE cu rezultate postoperatorii bune şi cu reducerea considerabilă a duratei intervenţiei.
In a large number of cases, post-traumatic diaphragmatic hernias (PTDH) are a consequence of occu... more In a large number of cases, post-traumatic diaphragmatic hernias (PTDH) are a consequence of occult diaphragmatic injuries associated with penetrating abdominal trauma. We present a case of a 26-year-old male patient who, 2 months prior to the current admission, sustained a non-penetrating stab wound to the left anterior chest below the nipple. Upon presentation the patient complained of epigastric pain radiated to the left shoulder, and nausea and vomiting. The chest X-ray, and abdominal and thoracic CT scan were inconclusive. The patient was sutured and discharged. The laparoscopic approach was selected as a diagnostic and minimally invasive therapeutic method. The suspected diagnosis of PTDH was confirmed. The herniated organs (transverse colon, small bowel loops, and greater omentum) were reduced, and the diaphragmatic defect was sutured by placing 3 non-resorbable 2.0 knots. The suture was reinforced with a composite mesh affixed with resorbable clips. Postoperative period was uneventful, and the patient was discharged 4 days later.
Laparoscopia este acceptată în plăgile abdominale (PA), dar în contuziile abdominale (CA) utiliza... more Laparoscopia este acceptată în plăgile abdominale (PA), dar în contuziile abdominale (CA) utilizarea ei este controversată. Lucrarea noastra evalueaza utilizarea laparoscopiei diagnostice (LD) si al laparoscopiei terapeutice (LT) in traumatismele abdominale în perioada Decembrie 2006-Ianuarie 2016. S-au analizat indicaţiile, leziunile, LT, conversiile, complicaţiile, durata spitalizarii. LD s-a efectuat la 49 de pacienţi stabili hemodinamic, 42 de barbaţi şi 7 femei cu varsta medie 36,6 ±13,3 ani. Au fost 20 PA SI 29 CA. Principalele indicaţii au fost: diagnosticul penetraţiei în PA, suspiciunea de leziune de organ cavitar sau diafragm, hemoragia activă în leziunile viscerale din CA. Preoperator, 11/48 ecografii abdominale şi 4/28 examene CT au fost fals negative. Dintre cele 20 LD pentru PA, 3 au fost negative si 4 nonterapetice. Au fost 4 LT şi 7 conversii. La cele 29 de CA, principalele leziuni au fost: perforaţie de organ cavitar 9, dilacerări mezenterice 6, leziuni splenice 2, leziuni de diafragm 2. Au fost 10 LT şi 9 conversii si 14 LT: enterorafii şi enterectomii 6 (5 asistate), frenorafii 4, colecistectomie 1, hemostaze 4. Durata intervenţiilor şi spitalizarea postoperatorie au fost mai mari în conversii. Au fost 6 complicaţii şi 3 decese. Nu au fost leziuni omise. O laparotomie nenecesară s-a evitat în 18/49 cazuri (36,73%). În cazuri selectate de PA şi CA cu diagnostic clinic şi imagistic echivoc, laparoscopia este o modalitate diagnostica utilă, cu potenţial terapeutic, care reduce laparotomiile nenecesare, perioada de spitalizare şi complicaţiile.
Societatea Română de Endoscopie Digestivă (SRED) şi Asociaţia Română de Chirurgie Endoscopică (AR... more Societatea Română de Endoscopie Digestivă (SRED) şi Asociaţia Română de Chirurgie Endoscopică (ARCE) au decis să înfiinţeze un grup de lucru comun pentru a elabora recomandările necesare pentru organizarea procedurilor minim-invazive diagnostice şi intervenţionale, în contextul pandemiei COVID-19. Recomandările www.revistachirurgia.ro Chirurgia, 115 (3), 2020 se bazează pe ghidurile societăţilor internaţionale de endoscopie şi gastroenterologie (ESGE / BSG / ASGE / ACG / AGA), respectiv chirurgie endoscopică (EAES & SAGES) (4-8), pe experienţa ţărilor afectate grav de pandemie (Italia, Franţa, Spania, SUA, Germania, etc.) şi vor fi aplicată în limitele măsurilor impuse la nivel local şi guvernamental de către autorităţile competente. Pe de altă parte, aceste recomandări trebuie să aibă o evoluţie dinamică, în funcţie de tendinţa ascendentă sau descendentă a pandemiei COVID-19 la nivel regional şi local, dar şi în funcţie de concluziile societăţilor profesionale şi academice, necesitând analize periodice bazate pe publicarea de recomandări suplimentare sau studii clinice internaţionale. Obiectivele recomandărilor SRED şi ARCE vizează organizarea de activităţi de endoscopie şi chirurgie laparoscopică, fiind aplicate nediscriminatoriu în scop diagnostic sau terapeutic, urmărind beneficiile demonstrate ale acestor proceduri, în condiţii sigure pentru pacienţi şi personalul medical.
BRGE a devenit cea mai frecventã afecţiune a polului digestiv superior, afecţiune spectralã şi ev... more BRGE a devenit cea mai frecventã afecţiune a polului digestiv superior, afecţiune spectralã şi evolutivã cu posibile complicaţii severe. Terapia principalã şi efectivã în majoritatea cazurilor este tratamentul medical (TM) axat pe IPP. Cazurile severe cu alterarea funcţiei sfincterului esofagian inferior (SEI) şi modificãri anatomice importante vor fi abordate chirurgical, fundoplicatura laparoscopicã (FL), intervenţia de elecţie, cu rezultate bune la distanţã, dar cu posibile efecte negative postoperatorii. 30-40 % dintre pacienţi sunt refractãri la TM, dar mulţi nu doresc intervenţia chirurgicalã. Apare un "gol terapeutic", pacienţi cu BRGE care nu beneficiazã de tratament. Pentru pacienţii cu BRGE, selectaţi, fãrã forme severe şi complicaţii şi fãrã modificãri anatomice importante (hernii hiatale mici), în mod special pentru cei refractari la TM, au apãrut noi terapii miniminvazive: mai eficiente ca şi TM, dar mai puţin agresive şi cu efecte secundare minime comparativ cu FL. Sunt terapii endoscopice care amelioreazã funcţia SEI prin terapie termicã, procedeul Stretta® şi rezecţia mucoasei antireflux, respectiv realizarea unei fundoplicaturi parţiale cu ajutorul unor dipozitive de agrafare: EsophyX®, Muse™, Gerd-X™. Tehnicile laparoscopice pot rezolva HH mai mari (peste 2 cm) când se impune, iar în locul fundoplicaturii se poate monta un şirag de mãrgele magnetice la nivelul joncţiunii gastroesofagiene, procedeul LINX®, respectiv electrozi pentru stimulare electricã a SEI, EndoStim®. Aceste procedee s-au dovedit
The use of laparoscopy in traumatic and non-traumatic abdominal surgical emergencies is unanimous... more The use of laparoscopy in traumatic and non-traumatic abdominal surgical emergencies is unanimously accepted due to the well-known advantages of minimally invasive surgery. In the period 1961-1966 in the Clinical Emergency Hospital of Bucharest (CEHB) the first diagnostic laparoscopes were performed in the acute surgical abdomen, respectively in the obstructive jaundice by dr. Gh.Popovici, respectively dr.C.Petrescu.In the modern era, the first laparoscopic cholecystectomy was performed in 4 dec. 1993 by A.E.N.In 1994 the first laparoscopic appendectomies, gynecological emergencies, exploration in traumatic abdominal contusion, followed by perforated ulcer (1995), intestinal occlusion (1997), were performed. In the specialized literature, out of the 42 emergency laparoscopy articles published in the journal “Chirurgia” (1994-2019), 16 (38,08%) belonged to the CEHB team, 11 of AEN. In 2004 the original monograph "Laparoscopic Emergency Surgery" appeared. Specialized chapter...
While multicore/multiprocessor systems achieve significant speedup for many applications by explo... more While multicore/multiprocessor systems achieve significant speedup for many applications by exploiting loop level parallelism, they also suffer from increased reliability problems as a result of ever scaling device size. This paper addresses the reliability of loop dominated applications, aiming to execute parallel loops efficiently in the presence of various types of hardware faults. In this paper, we present a fault tolerant work-stealing scheme which makes parallel loop execution resilient to hardware faults. A lightweight buffer-commit mechanism is applied in the proposed scheme to ensure the correctness of the re-execution of loop iterations. In addition, we split large failing chunks of loop iterations at runtime to improve load balancing, and a worker thread is discarded when faults occur frequently on it. We evaluated our techniques on a multi-socket multicore system, using a set of loop dominated benchmarks. The proposed scheme achieves the minimum overhead of supporting fa...
Sepsis arises when a patient’s immune system has an extreme reaction to an infection. This is fol... more Sepsis arises when a patient’s immune system has an extreme reaction to an infection. This is followed by septic shock if damage to organ tissue is so extensive that it causes a total systemic failure. Early detection of septic shock among septic patients could save critical time for preparation and prevention treatment. Due to the high variance in symptoms and patient state before shock, it is challenging to create a protocol that would be effective across patients. However, since septic shock is an acute change in patient state, modeling patient stability could be more effective in detecting a condition that departs from it. In this paper we present a one-class classification approach to septic shock using hyperdimensional computing. We built various models that consider different contexts and can be adapted according to a target priority. Among septic patients, the models can detect septic shock accurately with 90% sensitivity and overall accuracy of 60% of the cases up to three ...
Pneumonia is a common complication associated with COVID-19 infections. Unlike common versions of... more Pneumonia is a common complication associated with COVID-19 infections. Unlike common versions of pneumonia spread quickly through large lung regions, COVID-19 related pneumonia starts in small localized pockets before spreading over the course of several days. This makes the infection more resilient and with a high probability of developing acute respiratory distress syndrome. Because of the peculiar spread pattern, the use of pulmonary computerized tomography (CT) scans was key in identifying COVID-19 infections. Identifying uncommon pulmonary diseases could be a strong line of defense in early detection of new respiratory infection-causing viruses. In this paper we describe a classification algorithm based on hyperdimensional computing for the detection of COVID-19 pneumonia in CT scans. We test our algorithm using three different datasets. The highest reported accuracy is 95.2% with an F1 score of 0.90, and all three models had a precision of 1 (0 false positives).
Abordul laparoscopic al defectelor parietale ventrale devine tot mai actual, având în vedere avan... more Abordul laparoscopic al defectelor parietale ventrale devine tot mai actual, având în vedere avantajele binecunoscute ale chirurgiei miniminvazive la care se adaugă incidenţa mai redusă a infecţiilor parietale postoperatorii şi a recidivelor comparativ cu abordul deschis cu sau fără plasă. Prezentăm tehnica curei laparoscopice a herniilor ventrale mici (defect < 2 cm) utilizând plasa Ventralex, bifaţetată, polipropilen şi PTFE, circulară, de 8 cm în diametru, fixată cu 4 fire de sutură transparietale, după închiderea defectului parietal. Plasa respectivă este concepută pentru chirurgia deschisă, dar se poziţionează intraperitoneal. Am folosit tehnica la 28 de pacienţi pacienţi,16 femei şi 12 bărbaţi, cu vârsta medie de 53,3 ani (29-72 ani): 22 hernii ombilicale (HO), 2 hernii epigastrice (HE), o hernie Spiegel stg., o hernie incizională după cura deschisă a unei HO cu plasă Ventralex şi 2 eventaţii de trocar (ET) după colecistectomie laparoscopică. Durata operaţiei a fost în medie de 52 de min (42-70 min), spitalizare postoperatorie 1,8 zile (1-5zile). Avantaje: plasă preformată circular, diametru 8 cm, fixare prin sutură transfascială, laparoscopic se verifică corecta poziţionare şi depliere, costuri reduse. Tehnica este uşor de reprodus. Cuvinte cheie: hernie ventrală mică, laparoscopie, plasă
3rd Workshop on Embedded Systems for Real-Time Multimedia, 2005., 2005
Digital watermarking is a process that embeds an imperceptible signature or watermark in a digita... more Digital watermarking is a process that embeds an imperceptible signature or watermark in a digital file containing audio, image, text or video data. The watermark is later used to authenticate the data file and for tamper detection. It is particularly valuable in the use and exchange of digital media such as audio and video on emerging handheld devices. However, watermarking is computationally expensive and adds to the drain of the available energy in handheld devices. We present an approach in which we partition the watermarking embedding and extraction algorithms and migrate some tasks to a proxy server. This leads to a lower energy consumption on the handheld without compromising the security of the watermarking process. Our results show that executing watermarking partitioned between the proxy and the handheld reduces the total energy consumed by 80% over running it only on the handheld and improves performance by over two orders of magnitude.
Laparoscopic fundoplication (LF) is the treatment of choice for gastroesophageal reflux disease (... more Laparoscopic fundoplication (LF) is the treatment of choice for gastroesophageal reflux disease (GERD).Our paper evaluates post LF quality of life (QL). Patients treated between January 2008 and May 2011 by the same surgeon were asked to fill in the Velanovich questionnaires for Gastro - Oesophageal Reflux Disease - Health Related Quality of Life (GERD-HRQL). The 10 questions were designed to assess GERD specific symptoms prior to (part A) and after surgery (part B). The Velanovich score is 0 if the patient is asymptomatic and 50 if the symptoms are at maximum intensity. Only 32 out of the 54 patients operated during the study filled in the questionnaire:28 patients (87.5%) had hiatus hernia (HH), 16 cases were associated with reflux erosive esophagitis (EE), 4 patients had non-erosive reflux disease (NERD) and one had Barrett's esophagus (BE). We used Toupet partial posterior fund oplication for 12 patients and Nissen total fundoplication for 20 patients. The short gastric vess...
Proceedings of the The 51st Annual Design Automation Conference on Design Automation Conference - DAC '14, 2014
With memories continuing to dominate the area, power, cost and performance of a design, there is ... more With memories continuing to dominate the area, power, cost and performance of a design, there is a critical need to provision reliable, high-performance memory bandwidth for emerging applications. Memories are susceptible to degradation and failures from a wide range of manufacturing, operational and environmental effects, requiring a multi-layer hardware/software approach that can tolerate, adapt and even opportunistically exploit such effects. The overall memory hierarchy is also highly vulnerable to the adverse effects of variability and operational stress. After reviewing the major memory degradation and failure modes, this paper describes the challenges for dependability across the memory hierarchy, and outlines research efforts to achieve multi-layer memory resilience using a hardware/software approach. Two specific exemplars are used to illustrate multilayer memory resilience: first we describe static and dynamic policies to achieve energy savings in caches using aggressive voltage scaling combined with disabling faulty blocks; and second we show how software characteristics can be exposed to the architecture in order to mitigate the aging of large register files in GPGPUs. These approaches can further benefit from semantic retention of application intent to enhance memory dependability across multiple abstraction levels, including applications, compilers, run-time systems, and hardware platforms.
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Papers by Eugen Nicolau