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Over time, academic and research institutions worldwide have commenced the transformation of their digital libraries into a more structured concept, the Learning Object Repository (LOR) that enables the educators to share, manage and use educational resources much more effectively. The key point of LORs interoperability and scalability is without doubt the various standards and protocols such as LOM, SCORM etc. On the other hand, Learning Management Systems have boosted the expansion of the e-learning notion by providing the chance to follow remotely courses of the most well-known universities. However, there is no a uniform way to integrate these two achievements of e-learning and assure an effective collaboration between them. In this paper, we propose a solution on how we can ingest learning objects metadata into the Open eClass platform.

Background: We conducted a randomised, prospective trial to evaluate the safety and effectiveness of suprapubic percutaneous cystostomy (SPC) in comparison with pemrethral catheteri

Critically ill patients need appropriate nutritional support strictly correlated to their REE to avoid complications either from hypo or hyper alimentation. Resting Energy Expenditure (REE) in the I.C.U setting can be measured or calculated by several methods. The aim of our study was to compare two methods of indirect calorimetry. The REE calculated by the Fick equation (REET) and the traditional method of Douglas bag (REEi). Twelve ICU patients on mechanical ventilation were studied and the following results were obtained REET = 2295±552 Kcal/day and REEi = 2339±512 Kcal/day (mean±sd). A good correlation between the two methods showed by regression analysis. We conclude that the evaluation of REE using the thermodilution method of Fick is reliable in estimating the energy expenditure of critical ill patients.

Background: Situs inversus viscerum is a rare condition with a genetic predisposition. We report 2 patients with situs inversus totalis and symptomatic cholelithiasis successfully treated via laparoscopic cholecystectomy. Patients and Methods: The first patient was a 61-year-old female presenting with pain in the left upper quadrant associated with fever, chills, nausea and vomiting. The abdomen was tender with guarding and rebounding pain in the same region. Abdominal ultrasound and CT scan confirmed the diagnosis of gallstones as well as situs inversus with the liver and gallblader on the left side and the spleen on the right. The second patient was a 37-year-old male with known situs inversus who presented with biliary colic due to cholelithiasis. In both patients cholecystectomy was performed laparoscopically in a reverse fashion. Results: Laparoscopic cholecystectomy was carried out successfully despite the reversed anatomic relationships and both patients made a smooth recovery. Conclusion: Cholelithiasis occurring with situs inversus totalis is rare and may present a diagnostic problem. Laparoscopic cholecystectomy can be safely and effectively applied in the setting of situs inversus, although attention must be paid to the details of left-right reversal.

Background: Experimental studies have shown that elevation of intraabdominal pressure by means of gas insufflation produces hemodynamic disturbances in the peritoneal viscera, leading to splanchnic ischemia. The purpose of this clinical investigation is to reproduce the experimental data in humans undergoing laparoscopic cholecystectomy. Methods: Sixteen females participated in this study. Eight of them (the control group) were subjected to open laparotomy for biliary surgery, while on the remaining eight laparoscopic cholecystectomy was performed. In all patients hepatic microcirculation was registered during the time of operation using the laser-Doppler technique. A single-fiber laser-Doppler microprobe was introduced transcutaneously within the hepatic parenchyma, through a Chiba needle, under direct or laparoscopic vision. Additionally, gastric intramucosal/intramural pH, a low level of which indicates tissue ischemia, was assessed by means of a tonometric nasogastric catheter. Hepatic microcirculation and gastric intramucosal/intramural pH were assessed between controls and pneumoperitoneum-subjected patients, and within the laparoscopic surgery group, i.e., during pneumoperitoneum and after abdominal deflation. Results: Hepatic microcirculation was found to be significantly decreased in laparoscopic surgery patients in relation to controls (22.21±5.48 vs 57.52±18.06 perfusion units of flow, P=0.0001) as was gastric intramural pH (7.15±0.16 vs 7.37±0.02, P=0.003). Similarly, immediately after abdominal deflation, hepatic microcirculation exhibited a sudden elevation (22.21±5.48 vs 67.49±7.93 perfusion units of flow, P=0.0001), while gastric intramural pH return to its normal values (7.15±0.16 vs 7.43±0.07, P=0.0001). Conclusions: It is concluded that during laparoscopic cholecystectomy abdominal organs are hypoperfused, leading to a splanchnic ischemia environment. The clinical significance of these events remains to be clarified.

This experimental study compares the effects of early postoperative administration of three enteral diets of different compositions on the healing of colonic anastomoses. Sixty Wistar rats were subjected to colonic anastomoses. Following surgery, the rats were randomly allocated to four groups of 15 each. The rats in control group A received an electrolyte and glucose solution, the rats in group B received a complete balanced nutrition, in group C a complete balanced nutrition supplemented with fiber and in group D an isocaloric specialized elemental nutrition enriched with glutamine. The rats were sacrificed on day 7 following operation. Rupture of the anastomosis was higher in rats of the control group compared to the other three groups. Adhesion formation was more extensive in group A in comparison to the other three groups. The anastomotic bursting pressures were statistically significantly higher in groups C and D compared to the other two groups (p0.05). There was no statistically significant difference between group C and D (p0.05) while a statistically significant difference was noted between group B and group A (p0.05). Histological examination showed more profound inflammatory reaction in group A compared to the other three groups. There was also a statistically significant difference between group B and groups C and D while inflammatory reaction was of no statistically significant difference between group C and group D. Healing of the anastomoses was statistically significantly impaired in group A compared to the other three groups. There was no statistically significant difference between group C and group D while a statistically significant difference was found between group B and groups C and D. In conclusion, early postoperative enteral feeding improves healing of experimental colonic anastomoses in rats. This effect was more evident when fiber-supplemented diets or diets enriched with glutamine were administered.

The aim of this study was to evaluate the possible repair of large rectal wall defects using an open pedicle ileal graft as a mucosal patch. This experiment was carried out in 14 adult mongrel dogs. By excision of a portion of the antimesenteric wall comprising 50-70% of the circumference and measuring 5-6 cm in length, a suitable full thickness defect was created in the lower part of the rectum. A segment of the distal ileum was then isolated on a mesenteric pedicle and opened from its antimesenteric border. This was sutured over the defect in two layers. The animals were observed for a period of 15 days to 12 months. All the animals survived the operation apart from 1 dog that died of fecal peritonitis. Function of the rectum generally remained normal. Barium X-ray did not show any obstruction, shrinkage of the patch, lumen dilatation or extravasation. At the time of autopsy pedicles of ileal grafts appeared intact and pulsating. On gross examination there was no evidence of focal hemorrhage, ulceration or any cicatricial thickening of the grafts. Healing was good and the ileal mucosa retained its villi and general characteristics without any major inflammatory reactions. There was an increase in the number of goblet cells which returned to normal in 6 months.