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Sample records for acute calculus cholecystitis

  1. Acute emphysematous cholecystitis.

    PubMed

    Abengowe, C U; McManamon, P J

    1974-11-16

    Acute emphysematous cholecystitis is an uncommon condition caused by gas-forming organisms and characterized by the presence of gas in the wall and lumen of the gallbladder. Its incidence is higher among male diabetics. AEC in an elderly North American diabetic man with Indian ancestry is reported with a brief review of the world literature. The diagnosis was made preoperatively with the aid of plain radiographic films of the abdomen. A gangrenous distended gallbladder was removed at operation. Clostridium perfringens was cultured from the gallbladder contents and wall. If AEC is suspected, intensive antimicrobial therapy and fluid and electrolyte replacement should be given prior to early surgical intervention.

  2. [Laparoscopic cholecystectomy in acute cholecystitis].

    PubMed

    Neufeld, D; Sivak, G; Jessel, J; Freund, U

    1996-04-01

    We performed 417 laparoscopic cholecystectomies, including 58 for acute cholecystitis, between September 1991 and April 1995,. All operations were successful, with no mortality or complications. In about 10%, the laparoscopic approach failed and we converted to open cholecystectomy. Average post-operative hospitalization was 24 hours. We also performed primary open cholecystectomies in 55 patients with acute cholecystitis, because of limitations of operating room and staff availability for unscheduled laparoscopic surgery. In these patients, hospital stay was longer and rate of complications higher. In our opinion laparoscopic cholecystectomy is safe and the preferred approach in acute cholecystitis.

  3. Cholescintigraphy in acute and chronic cholecystitis

    SciTech Connect

    Freitas, J.E.

    1982-01-01

    Since the introduction of /sup 99m/Tc-labeled cholescintigraphic agents in the mid-1970s, there has been extensive investigation of their role in the evaluation of biliary tract disorders. These agents accurately assess the patency of the cystic and common bile ducts, and to date, their greatest impact has been on the diagnostic evaluation of suspected acute cholecystitis. This article reviews the use of /sup 99m/Tc-iminodiacetic acid (IDA) derivatives in acute and chronic cholecystitis. Since acute cholecystitis is characterized by cystic duct obstruction, failure of the gallbladder to visualize following /sup 99m/Tc-IDA administration is indicative of cystic duct obstruction and acute cholecystitis. Using this approach, cholescintigraphy has been shown to be highly sensitive, specific, and efficacious in the diagnosis of acute cholecystitis. Cholescintigraphy is now the procedure of choice for the detection of acute cholecystitis. Unlike its successful applications in acute cholecystitis, cholescintigraphy appears of limited value in chronic cholecystitis. Certain circumstances where cholescintigraphy is of value in chronic cholecystitis are discussed. Whether or not cholescintigraphy may play a greater role in the future in elucidating the pathogenesis of chronic cholecystitis by assessment of biliary kinetics remains unanswered.

  4. 2016 WSES guidelines on acute calculous cholecystitis.

    PubMed

    Ansaloni, L; Pisano, M; Coccolini, F; Peitzmann, A B; Fingerhut, A; Catena, F; Agresta, F; Allegri, A; Bailey, I; Balogh, Z J; Bendinelli, C; Biffl, W; Bonavina, L; Borzellino, G; Brunetti, F; Burlew, C C; Camapanelli, G; Campanile, F C; Ceresoli, M; Chiara, O; Civil, I; Coimbra, R; De Moya, M; Di Saverio, S; Fraga, G P; Gupta, S; Kashuk, J; Kelly, M D; Koka, V; Jeekel, H; Latifi, R; Leppaniemi, A; Maier, R V; Marzi, I; Moore, F; Piazzalunga, D; Sakakushev, B; Sartelli, M; Scalea, T; Stahel, P F; Taviloglu, K; Tugnoli, G; Uraneus, S; Velmahos, G C; Wani, I; Weber, D G; Viale, P; Sugrue, M; Ivatury, R; Kluger, Y; Gurusamy, K S; Moore, E E

    2016-01-01

    Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.

  5. Cholecystitis.

    PubMed

    Knab, Lawrence M; Boller, Anne-Marie; Mahvi, David M

    2014-04-01

    Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of acute cholecystitis is laparoscopic cholecystectomy. Operating early in the disease course decreases overall hospital stay and avoids increased complications, conversion to open procedures, and mortality. Cholecystitis during pregnancy is a challenging problem for surgeons. Operative intervention is generally safe for both mother and fetus, given the improved morbidity of the laparoscopic approach compared with open, although increased caution should be exercised in women with gallstone pancreatitis.

  6. Indium-111-leukocyte imaging in acute cholecystitis

    SciTech Connect

    Fink-Bennett, D.; Clarke, K.; Tsai, D.; Nuechterlein, P.; Gora, G. )

    1991-05-01

    Eleven patients with suspected acute cholecystitis underwent sequential {sup 99}mTc-iminodiacetic derivative (IDA) and {sup 111}In-white blood cell (WBC) imaging to determine if {sup 111}In-WBCs accumulate within an acutely inflamed hemorrhagic gallbladder wall and, thus, could be employed as a reasonable alternative to {sup 99}mTc-IDA scintigraphy in detecting acute cholecystitis. Seven patients had surgically confirmed acute cholecystitis. Of these cases, five had a true-positive {sup 99}mTc-IDA and {sup 111}In-WBC, one an indeterminate {sup 111}In-WBC and true-positive {sup 99}mTc-IDA, and one a true-positive {sup 111}In-WBC and false-negative {sup 99}mTc-IDA scan. The remaining four patients did not have acute cholecystitis. All visualized their gallbladder within 1 hr after {sup 99}mTc-IDA administration and none had {sup 111}In-WBC gallbladder wall uptake. Both {sup 111}In-WBC and {sup 99}mTc-IDA scintigraphy accurately detected acute cholecystitis: hepatobiliary scintigraphy demonstrated a cystic duct obstruction and {sup 111}In-WBC imaging detected the inflammatory infiltrate within the gallbladder wall. The sensitivity and specificity of each was 86% and 100%, respectively.

  7. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis.

    PubMed

    del-Moral-Martínez, María; Barrientos-Delgado, Andrés; Crespo-Lora, Vicente; Cervilla-Sáez-de-Tejada, María Eloísa; Salmerón-Escobar, Javier

    2015-01-01

    Eosinophilic cholecystitis (EC) is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. When imaging tests revealed acalculous cholecystitis, an urgent cholecystectomy was performed. Histological examination of the surgical specimen revealed eosinophilic cholecystitis. No cause of the symptoms was found.

  8. Percutaneous gallbladder aspiration for acute cholecystitis

    PubMed Central

    Rassameehiran, Supannee; Nugent, Kenneth

    2016-01-01

    Early cholecystectomy for patients with acute cholecystitis may not be possible in some clinical settings. Percutaneous gallbladder aspiration (PGBA) offers an alternative approach, but the benefits and risks of this procedure are unclear. We synthesized data on the outcomes of PGBA in acute cholecystitis patients using data sources from online databases, including MEDLINE and EMBASE, and bibliographies of included studies from January 2000 through December 2015. Two reviewers independently reviewed and critiqued the quality of each study. Seven eligible studies met our criteria. The success rates in single PGBA and repetitive PGBA (2–4 times) were 50% to 93% and 76% to 96%, respectively. Complication rates were 0% to 8% and were unrelated to the size of needle gauge used for aspiration and the number of aspirations. Salvage percutaneous cholecystostomy (PC) and urgent surgery were required in 0% to 43% of patients and 0% to 4% of patients, respectively. Two studies with antibiotic instillation had clinical success rates of 95% and 96%. In conclusion, repetitive PGBA combined with antibiotic instillation and salvage PC are useful alternatives to early cholecystectomy in patients with acute cholecystitis. PMID:27695167

  9. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting

    PubMed Central

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-01-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgical planning. Imaging features of acute cholecystitis have been described in the literature and are variable, depending on the stage of inflammation. This article discusses the spectrum of cholecystitis-associated complications and their imaging manifestations. We also suggest a checklist for the prompt and accurate identification of complications in acute cholecystitis. PMID:26311909

  10. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.

    PubMed

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-08-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgical planning. Imaging features of acute cholecystitis have been described in the literature and are variable, depending on the stage of inflammation. This article discusses the spectrum of cholecystitis-associated complications and their imaging manifestations. We also suggest a checklist for the prompt and accurate identification of complications in acute cholecystitis.

  11. Acute calculous cholecystitis with patent cystic duct

    SciTech Connect

    Massie, J.D.; Moinuddin, M.; Phillips, J.C.

    1983-07-01

    In the diagnosis of acute cholecystitis, the interpretation of cholescintigraphy is usually not difficult. It is conceivable, however, that wth unusual location of obstructing calculi atypical images could result. Three cases were studied with cholescintigraphy and one with cholecystography in which more distal locations of obstructing calculi resulted in partial visualization of the gallbladder and erroneous interpretations were possible. Nuclear medicine radiologists should, therefore, be aware that atypical gallbladder images may be the result of unexpected location of obstructing calculi. Clues for assisting in interpretation are offered.

  12. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis.

    PubMed Central

    Rattner, D W; Ferguson, C; Warshaw, A L

    1993-01-01

    OBJECTIVE: This article determined which preoperative data correlated with successful completion of a laparoscopic cholecystectomy in patients with acute cholecystitis. SUMMARY BACKGROUND DATA: Although laparoscopic cholecystectomy is the procedure of choice in chronic cholecystitis, its use in acute cholecystitis may be associated with higher costs and complication rates. It is not known which patients with acute cholecystitis are likely to require conversion to open cholecystectomy based on preoperative data or if a cooling-off period with medical therapy can diminish inflammation and increase the chance of successful laparoscopic cholecystectomy. METHODS: All laparoscopic cholecystectomies done by the authors between 10/90 and 2/92 were reviewed. Data on cases of acute cholecystitis were prospectively collected on standardized data forms. RESULTS: Twenty of 281 laparoscopic cholecystectomies were done for acute cholecystitis; 7/20 patients with acute cholecystitis required conversion to open cholecystectomy compared with 6/281 patients undergoing elective operation for chronic cholecystitis. In patients with acute cholecystitis the interval from admission to cholecystectomy in the successful cases was 0.6 days vs. 5 days in the cases requiring conversion to open cholecystectomy (p = .01). Cases requiring conversion to open cholecystectomy also had higher WBC (14.0 vs. 9.0, p < .05), alkaline phosphatase (206 vs. 81, p < .02, and APACHE II scores (10.6 vs. 5.1, p < .05). Ultrasonographic findings such as gallbladder distention, wall thickness, and pericholecystic fluid did not correlate with the success of laparoscopic cholecystectomy. Patients converted from laparoscopic to open cholecystectomy required more operating room time (120 min vs. 87 min, p < .01) and more postop hospital days (6 vs. 2, p < .001). CONCLUSIONS: Laparoscopic cholecystectomy for acute cholecystitis should be done immediately after the diagnosis is established because delaying surgery

  13. A case of scrub typhus complicated by acute calculous cholecystitis.

    PubMed

    Lee, Su Jin; Cho, Young Hye; Lee, Sang Yeoup; Jeong, Dong Wook; Choi, Eun Jung; Kim, Yun Jin; Lee, Jeong Gyu; Lee, Yu Hyun

    2012-07-01

    We report a case of acute calculous cholecystitis through scrub typhus. A 69-year-old woman presented with a history of general myalgia, fever, and right abdominal pain. She referred to our hospital for surgical treatment of clinically suspected acute cholecystitis. Physicians concluded the cause of cholecystitis as gall bladder (GB) stone and proper antibiotics treatment of scrub typhus was started later. The patient developed acute respiratory distress syndrome and multi organ failure through scrub typhus. Five days after admission, the patient was treated with proper antibiotics and discharged on the 13th day after starting doxycycline treatment without any sequelae. In areas endemic for tsutsugamushi disease, even though a patient with GB stone presents with symptoms of acute cholecystitis, careful history and physical examination are required to reveal the existence of eschars or skin eruptions.

  14. Acute Calculous Cholecystitis: What is new in diagnosis and therapy?

    PubMed Central

    Gouma, Dirk J.; Obertop, Huug

    1992-01-01

    The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce. PMID:1292590

  15. Laparoscopic Cholecystectomy for Acute Cholecystitis in Elderly Patients

    PubMed Central

    Filho, Euler de Medeiros Ázaro; Galvão, Thales Delmondes; Ettinger, João Eduardo Marques de Menezes; Silva Reis, Jadson Murilo; Lima, Marcos; Fahel, Edvaldo

    2006-01-01

    Background: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. Method: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. Results: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (≤65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P=1). Conclusion: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age. PMID:17575761

  16. Chronic cholecystitis

    MedlinePlus

    Cholecystitis - chronic ... Most of the time, chronic cholecystitis is caused by repeated attacks of acute (sudden) cholecystitis. Most of these attacks are caused by gallstones in the gallbladder. These ...

  17. Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis.

    PubMed

    Sagrini, Elisabetta; Pecorelli, Anna; Pettinari, Irene; Cucchetti, Alessandro; Stefanini, Federico; Bolondi, Luigi; Piscaglia, Fabio

    2016-02-01

    Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis.

  18. [Acute acalculous cholecystitis. Results of surgical treatment].

    PubMed

    de la Garza Villaseñor, L

    1993-01-01

    During an 11 year period, 47 patients with acute acalculous cholecystitis were operated on. Two to one male/female ratio was observed with a mean age of 55 age of 55 years. No one had a past history of biliary tract pathology but 70 per cent of the patients had risk factors, mainly diabetes mellitus, cardiovascular and collagenous diseases, some different of those reported in the world literature (sepsis, trauma, non biliary tract surgery, etc.). The ultrasound was the best diagnostic tool. Open cholecystectomy was performed in all patients and some sort of local complication was found in 85 per cent of patients (empyema, gangrene or perforation) in spite of the surgical procedure was done on emergency or early elective basis, a 31 per cent operative mortality rate was found and a 10.6% Operative mortality rates was observed. The bacterial cultures showed gram negative and anaerobic flora. This report shows that an early diagnosis and surgical treatment keeps a low morbidity and mortality rates but the gallbladder late complications have a high rates.

  19. Clinical acute cholecystitis and the Curtis-Fitz-Hugh syndrome.

    PubMed Central

    Shanahan, D.; Lord, P. H.; Grogono, J.; Wastell, C.

    1988-01-01

    When patients are admitted with clinically diagnosed acute cholecystitis, no cause will be found for their pain in 9-13% (4.5). Our retrospective study shows that women between 15-35 years are most likely to be in this group. Our prospective study of all patients in the 15-35 year age group admitted with clinical 'acute cholecystitis', showed that in 6 out of 7 patients with 'undiagnosed' pain, the Curtis-Fitz-Hugh syndrome was the cause. We suggest that screening for the Curtis-Fitz-Hugh syndrome is performed in all patients with right upper quadrant pain who have a normal ultrasound scan. PMID:3408139

  20. Acute cholecystitis developed immediately after thoracic kyphoplasty -A case report-

    PubMed Central

    An, Sang-Bum; Yim, Jiyeon; Kim, Eunjung; Shin, Jae-Hyuck; Lee, Sang Chul

    2012-01-01

    Postoperative acute cholecystitis is a rare complication of orthopaedic surgery and is unrelated to the biliary tract. In particular, in the case of immediate postoperative state after surgery such as kyphoplasty at the thoracic vertebra, symptoms related to inflammation mimic those of abdominal origin, so the diagnosis and the treatment of acute cholecystitis can be delayed leading to a fatal outcome. It is important that physicians should be aware of the postoperative patient's condition in order to make an early diagnosis and determine treatment. PMID:23060986

  1. Cholescintigraphy in acute cholecystitis: use of intravenous morphine

    SciTech Connect

    Choy, D.; Shi, E.C.; McLean, R.G.; Hoschl, R.; Murray, I.P.C.; Ham, J.M.

    1984-04-01

    Conventional cholescintigraphy (60 patients) and a modified protocol (59 patients) were compared in 74 females and 45 males with acute cholecystitis. In the modified protocol, intravenous morphine was administered whenever the gallbladder was not seen 40 minutes after injection of Tc-99m-pyroxylidene-glutamate. Accuracy was 98% with morphine, compared with 88% for the conventional protocol; specificity improved from 83% to 100% with no loss of sensitivity. Low doses of morphine are well tolerated and can result in a highly accurate diagnosis of acute cholecystitis without the need for delayed imaging.

  2. Effects of melatonin on gallbladder neuromuscular function in acute cholecystitis.

    PubMed

    Gomez-Pinilla, Pedro J; Camello, Pedro J; Pozo, María J

    2007-10-01

    Gallbladder stasis is associated to experimental acute cholecystitis. Impaired contractility could be, at least in part, the result of inflammation-induced alterations in the neuromuscular function. This study was designed to determine the changes in gallbladder neurotransmission evoked by acute inflammation and to evaluate the protective and therapeutic effects of melatonin. Experimental acute cholecystitis was induced in guinea pigs by common bile duct ligation for 2 days, and then the neuromuscular function was evaluated using electrical field stimulation (EFS; 5-40 Hz). In a group of animals with the bile duct ligated for 2 days, a deligation of the duct was performed, and after 2 days, the neuromuscular function was studied. The EFS-evoked isometric gallbladder contraction was significantly lower in cholecystitic tissue. In addition, inflammation changed the pharmacological profile of these contractions that were insensitive to tetrodotoxin but sensitive to atropine and omega-conotoxin, indicating that acute cholecystitis affects action potential propagation in the intrinsic nerves. Nitric oxide (NO)-mediated neurotransmission was reduced by inflammation, which also increased the reactivity of sensitive fibers. Melatonin treatment prevented qualitative changes in gallbladder neurotransmission, but it did not improve EFS-induced contractility. The hormone recovered gallbladder neuromuscular function once the biliary obstruction was resolved, even when the treatment was started after the onset of gallbladder inflammation. These findings show for the first time the therapeutic potential of melatonin in the recovery of gallbladder neuromuscular function during acute cholecystitis.

  3. Training vs practice: A tale of opposition in acute cholecystitis.

    PubMed

    Patel, Purvi P; Daly, Shaun C; Velasco, Jose M

    2015-10-18

    Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons. Despite its high incidence there remains a range of treatment of approaches. Current practices in biliary surgery vary as to timing, intraoperative utilization of biliary imaging, and management of bile duct stones despite growing evidence in the literature defining best practice. Management of patients with acute cholecystitis with early laparoscopic cholecystectomy (LC) results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy. Regardless of this data, many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis. The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy, minimizing the risk for inadvertent injury to surrounding structures, and lowering conversion rates, however it is rarely utilized. Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal. Yet, there is evidence that intraoperative laparoscopic stone extraction is safe, feasible and may have added advantages. This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations.

  4. Endoscopic Gallbladder Drainage for Acute Cholecystitis

    PubMed Central

    Widmer, Jessica; Alvarez, Paloma; Sharaiha, Reem Z.; Gossain, Sonia; Kedia, Prashant; Sarkaria, Savreet; Sethi, Amrita; Turner, Brian G.; Millman, Jennifer; Lieberman, Michael; Nandakumar, Govind; Umrania, Hiren; Gaidhane, Monica

    2015-01-01

    Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities. PMID:26473125

  5. Comparison of ultrasonography, computerized tomography, and radionuclide imaging in the diagnosis of acute and chronic cholecystitis

    SciTech Connect

    Matolo, N.M.; Stadalnik, R.C.; McGahan, J.P.

    1982-12-01

    Seventy-five patients with abdominal pain in the right upper quadrant who were subsequently confirmed operatively and histologically to have acute or chronic cholecystitis underwent radionuclide imaging of the biliary tree, ultrasonography, and/or computerized tomography before operation. fifty-eight of the patients had acute cholecystitis and 17 had chronic cholecystitis and cholelithiasis. Analysis of our data indicates that ultrasonography is an accurate and better screening test than cholescintigraphy in the diagnosis of chronic cholecystitis and cholelithiasis, but it is less accurate in the detection of acute cholecystitis. On the other hand, radionuclide imaging is highly sensitive and specific in the early diagnosis of acute cholecystitis, but it is poor in the diagnosis of chronic cholecystitis and cholelithiasis unless the cystic duct is obstructed. CT scanning is more expensive than ultrasonography but may be extremely helpful in problematic cases such as the diagnosis of the cause in biliary obstruction or in imaging of the pancreas.

  6. Role of cholescintigraphy in management of acute acalculous cholecystitis

    PubMed Central

    Gokhale, Shefali M; Lokare, SD; Nemade, Pankaj

    2012-01-01

    Aim: This study is aimed to evaluate the role of cholescintigraphy in management of acute acalculous cholecystitis. Materials and Methods: A total of thirty two patients who had presented to the surgical out-patient department or referred from in-patient department or intensive care unit between February 2008 and February 2010 were studied. All patients with Ultrasonography abdomen findings of acalculous cholecystitis were included in the study and they underwent cholescintigraphy. Gall bladder ejection fraction (GBEF) was calculated 30 min after fatty meal. Patients who either had non-visualization of gall bladder or GBEF less than 40% were considered to have acalculous cholecystitis on cholescintigraphy. The patients were followed-up for a period of 3 months after the commencement of treatment. Results: Eleven patients had either non-visualization of gall bladder or GBEF < 40%. Of these, six patients underwent cholecystectomy and the rest were medically managed, as patients deferred surgery. 83.33% of post-cholecystectomy patients as against 40% of medically treated patients were symptom free. Twenty one patients had GBEF > 40%, 90.74% of these patients were symptom free at the end of 3 months, with medical management. Conclusion: Cholescintigraphy is an important adjunct in management of patients with acalculous cholecystitis by guiding the course of therapy-surgical management versus medical management. PMID:24019652

  7. Laparoscopic management of a cystic artery pseudoaneurysm in a patient with calculus cholecystitis

    PubMed Central

    Loizides, Sofronis; Ali, Asad; Newton, Richard; Singh, Krishna Kumar

    2015-01-01

    INTRODUCTION Pseudoaneurysm of the cystic artery is very rare. In the majority of cases it has been reported as a post-operative complication of laparoscopic cholecystectomy, however it has also been associated with the presence of acute cholecystitis or pancreatitis. When these pseudoaneurysms rupture they can lead to intraperitoneal bleeding, haemobilia and upper gastrointestinal haemorrhage. Radiological as well as open surgical approaches have been described for control of this rare pathology. PRESENTATION OF CASE We report the laparoscopic surgical management of an incidental, unruptured cystic artery pseudoaneurysm in a patient presenting with acute cholecystitis. DISCUSSION Cystic artery pseudoaneurysm is a rare entity and as such there is no consensus on the clinical management of this condition. A variety of treatment strategies have been reported in the literature including radiological selective embolisation and coiling, open cholecystectomy with ligation of the aneurysm, or a two-step approach involving radiological management of the pseudoaneurysm followed by an elective cholecystectomy. CONCLUSION In this report we have demonstrated that laparoscopic management of a cystic artery pseudoaneurysm with simultaneous laparoscopic cholecystectomy is feasible and safe. This avoids multiple invasive procedures and decreases morbidity associated with open surgery. PMID:26291047

  8. Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review.

    PubMed

    Albarrak, Abdullah A; Khairy, Sami; Ahmed, Alzahrani Mohammed

    2015-01-01

    Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts.

  9. Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation.

    PubMed

    Manuel, Valdano; Pedro, Gertrudes Maria; Cordeiro, Lemuel Bornelli; de Miranda, Sandra Maria da Rocha Neto

    2016-01-01

    Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis.

  10. Protocol for extended antibiotic therapy after laparoscopic cholecystectomy for acute calculous cholecystitis (Cholecystectomy Antibiotic Randomised Trial, CHART)

    PubMed Central

    Pellegrini, Pablo; Campana, Juan Pablo; Dietrich, Agustín; Goransky, Jeremías; Glinka, Juan; Giunta, Diego; Barcan, Laura; Alvarez, Fernando; Mazza, Oscar; Sánchez Claria, Rodrigo; Palavecino, Martin; Arbues, Guillermo; Ardiles, Victoria; de Santibañes, Eduardo; Pekolj, Juan; de Santibañes, Martin

    2015-01-01

    Introduction Acute calculous cholecystitis represents one of the most common complications of cholelithiasis. While laparoscopic cholecystectomy is the standard treatment in mild and moderate forms, the need for antibiotic therapy after surgery remains undefined. The aim of the randomised controlled Cholecystectomy Antibiotic Randomised Trial (CHART) is therefore to assess if there are benefits in the use of postoperative antibiotics in patients with mild or moderate acute cholecystitis in whom a laparoscopic cholecystectomy is performed. Methods and analysis A single-centre, double-blind, randomised trial. After screening for eligibility and informed consent, 300 patients admitted for acute calculus cholecystitis will be randomised into two groups of treatment, either receiving amoxicillin/clavulanic acid or placebo for 5 consecutive days. Postoperative evaluation will take place during the first 30 days. Postoperative infectious complications are the primary end point. Secondary end points are length of hospital stay, readmissions, need of reintervention (percutaneous or surgical reinterventions) and overall mortality. The results of this trial will provide strong evidence to either support or abandon the use of antibiotics after surgery, impacting directly in the incidence of adverse events associated with the use of antibiotics, the emergence of bacterial resistance and treatment costs. Ethics and dissemination This study and informed consent sheets have been approved by the Research Projects Evaluating Committee (CEPI) of Hospital Italiano de Buenos Aires (protocol N° 2111). Results The results of the trial will be reported in a peer-reviewed publication. Trial registration number NCT02057679. PMID:26582405

  11. [Toxocarosis and acalculous acute cholecystitis: Consequence or coincidence?].

    PubMed

    Strickler, Alexis; Vásquez, Natalia; Maggi, Leonardo; Hernández, Juvenal; Hidalgo, Ximena

    2016-06-01

    Human toxocarosis is a chronic larval parasitosis listed as one of the five most important neglected diseases by the CDC. The larvae can spread systemically and migrate to different tissues including liver and gallbladder. Acalculous acute cholecystitis (AAC) is a rare disease in children. The diagnosis is based on clinical parameters and imaging criteria. It has been reported in relation to sepsis, shock, trauma, burns, severe systemic diseases, congenital anomalies, infections and also in healthy children. We report a pediatric case of toxocarosis, with clinical symptoms and imaging criteria compatible with AAC treated medically, and discuss the relationship between toxocarosis and AAC based on published evidence.

  12. Partial cholecystectomy resulting in recurrent acute cholecystitis and choledocholithiasis

    PubMed Central

    Sosulski, AB; Fei, JZ; DeMuro, JP

    2012-01-01

    Partial cholecystectomy has been documented in the literature as a safe alternative in the management of patients with acute cholecystitis when the degree of inflammation prevents a safe dissection to identify the biliary structures for complete removal of the gallbladder. Partial cholecystectomy however is not without risk of recurrence, and the need for further surgical or endoscopic intervention in management of complications. We review a case in which partial cholecystectomy was performed without any relief of symptoms, to review the possible postoperative complications, and caution that these patients will need to be considered for a completion cholecystectomy. PMID:24960803

  13. Use of stapling devices for safe cholecystectomy in acute cholecystitis.

    PubMed

    Odabasi, Mehmet; Muftuoglu, M A Tolga; Ozkan, Erkan; Eris, Cengiz; Yildiz, Mehmet Kamil; Gunay, Emre; Abuoglu, Haci Hasan; Tekesin, Kemal; Akbulut, Sami

    2014-01-01

    Many techniques are described for the ligation of a difficult cystic duct (CD). The aim of this study is to assess the effectiveness and safety of stapling of a difficult CD in acute cholecystitis using Endo-GIA. From January 2008 to June 2012, 1441 patients with cholelithiasis underwent laparoscopic cholecystectomy (LC) at the Department of General Surgery, Haydarpasa Numune Education and Research Hospital. Of these, 19 (0.62%) were identified as having a difficult CD and were ligated using an Endo-GIA stapler. All patients were successfully treated with a laparoscopic approach. The length of hospital stay was 3.4 days. There were umbilical wound infections in 4 patients (21%). The length of follow-up ranged from 1.0 to 50.4 months. In conclusion, Endo-GIA is a safe and easy treatment method for patients with a dilated and difficult CD. The cystic artery should be isolated and ligated if possible before firing the Endo-GIA stapler. If isolation and stapling are not possible, fibrin sealant can be applied to avoid bleeding. The vascular Endo-GIA can be applied in a large CD, but for acute cholecystitis with an edematous CD, the Endo-GIA roticulator 4.8 or 3.5 stapler is preferred.

  14. Amebic abscess of the liver presenting as acute cholecystitis.

    PubMed

    Miller; Kenney; Cotlar

    2000-09-01

    A case report is presented of a 37-year-old active duty Navy petty officer with amebic abscess of the liver presenting as acute cholecystitis. He was admitted with severe right upper quadrant pain and a positive Murphy's sign, but sonogram and computed tomography (CT) scan demonstrated an abscess in the right lobe of the liver. "Anchovy paste" material was obtained on percutaneous drainage, and he was placed on metronidazole administration with a tentative diagnosis of amebic abscess. This was confirmed on enzyme-linked immunosorbent assay. Symptoms resolved within a few days, and the abscess progressively decreased in size. Amebic abscess of the liver is discussed, with emphasis on pathogenesis, diagnosis, and treatment. Although uncommon, the condition is still seen in various population groups including the United States military. Difficulty in diagnosis is not unusual, and as in the herein-reported case, amebic abscesses of the liver may be confused with acute cholecystitis and other intra-abdominal infections. Abdominal sonogram and CT examination will identify a process in the liver, but the presence of amebiasis must be confirmed by laboratory studies on serum or contents of the abscess. Amebicidal agents are effective in many cases, but there remain roles for aspiration of the abscess, percutaneous drainage, and even open surgical drainage. Failure to establish an early diagnosis may result in rupture of the abscess, with catastrophic results.

  15. Diagnosis of acute cholecystitis using hepatobiliary scan with technetium-99m PIPIDA

    SciTech Connect

    Bennett, M.T.; Sheldon, M.I.; dos Remedios, L.V.; Weber, P.M.

    1981-09-01

    Sixty patients were evaluated for acute abdominal pain using technetium-99m PIPIDA hepatobiliary imaging. The sensitivity of the test was 90.6 percent in all patients and the accuracy was 93.3 percent. In the evaluation of acutely ill patients with right upper quadrant pain, fever, nausea and vomiting, hepatobiliary imaging with PIPIDA is the preferred test for diagnosing acute cholecystitis. If the test is positive, disease of the gallbladder and probably acute cholecystitis are present. Early operation can proceed if desirable. If the test is negative and the bilirubin level is less than 5.0 mg/dl, acute cholecystitis is not present. In such cases conservative treatment is appropriate, and follow-up tests should be performed to evaluate the possibility of chronic cholecystitis. When the bilirubin level exceeds 5.0 mg/dl, the test is often indeterminate.

  16. Laparoscopic cholecystectomy for acute cholecystitis: early or delayed?

    PubMed Central

    Song, Guo-Min; Bian, Wei; Zeng, Xian-Tao; Zhou, Jian-Guo; Luo, Yong-Qiang; Tian, Xu

    2016-01-01

    Abstract The laparoscopic cholecystectomy (LC) is an important approach of treating acute cholecystitis and the timing of performing this given treatment is associated with clinical outcomes. Although several meta-analyses have been done to investigate the optimal timing of implementing this treatment, the conflicting findings from these meta-analyses still confuse decision-making. And thus, we performed this systematic review to assess discordant meta-analyses and generate conclusive findings to facilitate informed decision-making in clinical context eventually. We electronically searched the PubMed, Cochrane Library, and EMBASE to include meta-analysis comparing early (within 7 days of the onset of symptoms) with delayed LC (at least 1 week after initial conservative treatment) for acute cholecystitis through August 2015. Two independent investigators completed all tasks including scanning and appraising eligibility, abstracting essential information using prespecified extraction form, assessing methodological quality using Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) tool, and assessing the reporting quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), as well as implementing Jadad algorithm in each step for the whole process. A heterogeneity degree of ≤50% is accepted. Seven eligible meta-analyses were included eventually. Only one was Level I of evidence and remaining studies were Level II of evidence. The AMSTAR scores varied from 8 to 11 with a median of 9. The PRISMA scores varied from 19 to 26. The most heterogeneity level fell into the desired criteria. After implementing Jadad algorithm, 2 meta-analyses with more eligible RCTs were selected based on search strategies and implication of selection. The best available evidence indicated a nonsignificant difference in mortality, bile duct injury, bile leakage, overall complications, and conversion to open surgery, but a significant

  17. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis.

    PubMed

    Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

    2015-03-04

    An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7 days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices.

  18. Gastric perforation due to foreign body ingestion mimicking acute cholecystitis

    PubMed Central

    Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

    2015-01-01

    An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7 days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices. PMID:25739796

  19. HIDA scanning and ultrasonography in the expeditious diagnosis of acute cholecystitis

    SciTech Connect

    Massie, J.D.; Austin, H.M.; Kuvula, M.; Tarcan, Y.

    1982-02-01

    Radionuclide hepatobiliary imaging (HIDA scanning), a pathophysiologic modality, has become the diagnostic method of choice for suspected acute cholecystitis. The diagnosis is made quickly with this technic, which is simple, safe, and accurate. It is in widespread use and will soon be available for small community hospitals as well as large metropolitan and university centers. Ultrasound, though an excellent anatomic modality for diagnosing cholelithiasis, does not demonstrate the status of the cystic duct, information essential to the diagnosis of acute cholecystitis.

  20. Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement

    SciTech Connect

    Miyayama, Shiro Yamashiro, Masashi; Takeda, Taro; Aburano, Hiroyuki; Komatsu, Tetsuya; Sanada, Taku; Kosaka, Shotaro; Toya, Daisyu; Matsui, Osamu

    2008-07-15

    We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

  1. Update on bedside ultrasound (US) diagnosis of acute cholecystitis (AC).

    PubMed

    Zenobii, Maria Francesca; Accogli, Esterita; Domanico, Andrea; Arienti, Vincenzo

    2016-03-01

    Acute cholecystitis (AC) represents a principal cause of morbidity worldwide and is one of the most frequent reasons for hospitalization due to gastroenteric tract diseases. AC should be suspected in presence of clinical signs and of gallstones on an imaging study. Upper abdominal US represents the first diagnostic imaging step in the case of suspected AC. Computed tomography (CT) with intravenous contrast (IV) or magnetic resonance imaging (MRI) with gadolinium contrast and technetium hepatobiliary iminodiacetic acid (Tc-HIDA) can be employed to exclude complications. US examination should be performed with right subcostal oblique, with longitudinal and intercostal scans. Normal gallbladder US findings and AC major and minor US signs are described. Polyps, sludge and gallbladder wall thickening represent the more frequent pitfalls and they must be differentiated from stones, duodenal artifacts and many other non-inflammatory conditions that cause wall thickening, respectively. By means of bedside ultrasound, the finding of gallstones in combination with acute pain, when the clinician presses the gallbladder with the US probe (the sonographic Murphy's sign), has a 92.2 % positive predictive value for AC. In our preliminary experience, bedside US-performed by echoscopy (ES) and/or point-of-care US (POCUS) demonstrated good reliability in detecting signs of AC, and was always integrated with physical examination and performed by a skilled operator.

  2. Acute acalculous cholecystitis and cardiovascular disease: a land of confusion.

    PubMed

    Tana, Marco; Tana, Claudio; Cocco, Giulio; Iannetti, Giovanni; Romano, Marcello; Schiavone, Cosima

    2015-12-01

    Acute acalculous cholecystitis (AAC) can be defined as acute inflammatory disease of the gallbladder without evidence of gallstones. The first case was reported in 1844 by Duncan et al.; however, some cases may have been missed previously in view of the complexity of the diagnosis. Several risk factors have been identified, and cardiovascular disease (CVD), in view of its multiple mechanisms of action, seems to play a key role. Atypical clinical onset, paucity of symptoms, overlap with comorbidities, and lack of robust, controlled trials result often in under or misdiagnosed cases. Moreover, laboratory results may be negative or not specific in the late stage of the disease, when a surgical treatment cannot be longer helpful if complications arise. A rapid diagnosis is therefore essential to achieve a prompt treatment and to avoid further clinical deterioration. In this short review, we would present the current evidence regarding epidemiology, pathophysiology, and clinical presentation of the complex relation between AAC and CVD. Then, we fully emphasize the role of ultrasound to achieve an early diagnosis and an appropriate treatment in suspected cases, reducing mortality and complications rates.

  3. Morphine-augmented cholescintigraphy in the diagnosis of acute cholecystitis

    SciTech Connect

    Kim, E.E.; Pjura, G.; Lowry, P.; Nguyen, M.; Pollack, M.

    1986-12-01

    Cholescintigraphy is a sensitive procedure for diagnosing or excluding acute cholecystitis. However, when rapid diagnosis is critical, the requirement for delayed images (4 hr or more after injection) to minimize the false-positive rate diminishes its utility. We prospectively evaluated 40 cholescintigraphic examinations that did not visualize the gallbladder 1 hr after injection of 99mTc diisopropyliminodiacetic acid. These examinations were then augmented by administration of IV morphine, followed by an additional 30 min of imaging. After the morphine, 18 of these examinations demonstrated visualization of the gallbladder; none subsequently required surgical exploration. Of the remaining 22, who demonstrated persistent nonvisualization of the gallbladder post-morphine, 11 were explored surgically and found to be abnormal. The 11 others were treated medically. Low-dose morphine administered when the gallbladder fails to visualize after 1 hr is a useful adjunct to conventional cholescintigraphy because it reduces the time required to obtain a diagnostic result and decreases the number of false-positive results.

  4. Capnocytophaga canimorsus bacteremia presenting with acute cholecystitis after a dog bite.

    PubMed

    Nishioka, Hiroaki; Kozuki, Tomohiro; Kamei, Hiroki

    2015-03-01

    Capnocytophaga canimorsus is part of normal gingival flora of dogs and cats. The organism can cause septicemia, meningitis, and endocarditis in humans after contact with dogs or cats. In spite of the frequency of gastrointestinal symptoms in C. canimorsus infection patients, specific gastrointestinal disease or clinical images have not been reported. We report a case of C. canimorsus bacteremia presenting with acute cholecystitis in elderly woman. She suffered from general fatigue and right upper abdominal pain. She had leukocytosis and abnormal liver function tests. She showed abnormal findings of the gallbladder by abdominal computed tomography and ultrasonography. She was diagnosed with acute cholecystitis without gallstones and was administered with antibiotics. C. canimorsus was isolated from blood cultures. A history of an insignificant wound secondary to a dog bite was elicited. She recovered completely with antibiotic treatment. This case revealed that C. canimorsus bacteremia can be presented with acute cholecystitis, suggesting that C. canimorsus could cause cholecystitis. And this cholecystitis can be treated with antibiotics without operation. Physicians seeing patients with acute cholecysitis should ask questions regarding animal contact.

  5. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.

    PubMed

    Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals.

  6. Laparoscopic Management of a Very Rare Case: Cystic Artery Pseudoaneurysm Secondary to Acute Cholecystitis

    PubMed Central

    Ferahman, Sina; Demiryas, Süleyman; Samanci, Cesur

    2016-01-01

    Pseudoaneurysm of a cystic artery is a rare entity that commonly occurs secondary to biliary procedures. Most of the cases in literature are consisted of ruptured aneurysms and to our knowledge, except our case, there were only 3 cases with unruptured aneurysms, which incidentally were detected by radiological methods. When cystic artery pseudoaneurysm is present with acute cholecystitis, most of the reports in literature suggested open cholecystectomy with the ligation of the cystic artery as a main treatment option. In this paper we present a case of acute cholecystitis with unruptured cystic artery pseudoaneurysm that incidentally was detected by computed tomography (CT). Cystic artery pseudoaneurysm was handled laparoscopically with simultaneous cholecystectomy. Due to high risk of rupture, surgeons have evaded laparoscopic approach to acute cholecystitis, which accompanied cystic artery pseudoaneurysm. However herein, we proved that laparoscopic management of cystic artery pseudoaneurysm with simultaneous cholecystectomy is feasible and reliable method. PMID:27635274

  7. Acute cholecystitis associated with infection of Enterobacteriaceae from gut microbiota.

    PubMed

    Liu, J; Yan, Q; Luo, F; Shang, D; Wu, D; Zhang, H; Shang, X; Kang, X; Abdo, M; Liu, B; Ma, Y; Xin, Y

    2015-09-01

    Acute cholecystitis (AC) is one of the most common surgical diseases. Bacterial infection accounts for 50% to 85% of the disease's onset. Since there is a close relationship between the biliary system and the gut, the aims of this study were to characterize and determine the influence of gut microbiota on AC, to detect the pathogenic microorganism in the biliary system, and to explore the relationship between the gut and bile microbiota of patients with AC. A total of 185 713 high-quality sequence reads were generated from the faecal samples of 15 patients and 13 healthy controls by 16S rRNA gene pyrosequencing. Patients' samples were significantly enriched in Akkermansia, Enterobacter and Escherichia/Shigella group. The healthy controls, however, showed significant enrichment of Clostridiales, Coprococcus, Coprobacillaceae, Paraprevotella, Turicibacter and TM7-3 in their faecal samples. Escherichia coli was the main biliary pathogenic microorganism, among others such as Klebsiella spp., Clostridium perfringens, Citrobacter freundii and Enterobacter cloacae in the bile of the patients. Additionally, the amount of bile endotoxin significantly correlated with the number of Enterobacteriaceae, especially E. coli. Our data indicate that Enterobacteriaceae might play essential role in the pathogenesis and/or progress of AC. This was verified in an in vivo model using a pathogenic E. coli isolated from one of the patients in guinea pigs and observed marked gallbladder inflammation and morphologic changes. This study thus provides insight which could be useful for the prevention, diagnosis and treatment of AC and related diseases by controlling the growth of Enterobacteriaceae to alleviate the infection.

  8. [Acute lithiasic cholecystitis, situs viscerum inversus, vena porta preduodenale (considerations on a clinical case)].

    PubMed

    Amadio, M; Galimberti, G B; Perovani Vicari, P

    1982-10-01

    Authors report a case of preduodenal portal vein in a woman 68 years old with acute cholecystitis in situs viscerum inversus adbominis and levocardia. Surgery was difficult. They shortly analyze also etiology and clinical manifestations of situs inversus and PPV, with related malformations. They conclude that it is important to recognize the presence of situs inversus preoperatively and everytime suspect other anatomical anomalies.

  9. First Report of Acute Cholecystitis with Sepsis Caused by Cellulomonas denverensis▿

    PubMed Central

    Ohtaki, Hirofumi; Ohkusu, Kiyofumi; Sawamura, Haruki; Ohta, Hirotoshi; Inoue, Rina; Iwasa, Junpei; Ito, Hiroyasu; Murakami, Nobuo; Ezaki, Takayuki; Moriwaki, Hisataka; Seishima, Mitsuru

    2009-01-01

    Cellulomonas denverensis is a small and thin gram-positive rod-shaped bacterium that was proposed as a new species in 2005. Here we report a female case of acute cholecystitis and sepsis in which C. denverensis was determined to be causative. PMID:19656981

  10. Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis.

    PubMed

    Mayumi, Toshihiko; Someya, Kazuki; Ootubo, Hiroki; Takama, Tatsuo; Kido, Takashi; Kamezaki, Fumihiko; Yoshida, Masahiro; Takada, Tadahiro

    2013-12-01

    The Japanese Guidelines for management of acute cholangitis and cholecystitis were published in 2005 as the first practical guidelines presenting diagnostic and severity assessment criteria for these diseases. After the Japanese version, the Tokyo Guidelines (TG07) were reported in 2007 as the first international practical guidelines. There were some differences between the two guidelines, and some weak points in TG07 were pointed out, such as low sensitivity for diagnosis and the presence of divergence between severity assessment and clinical judgment for acute cholangitis. Therefore, revisions were started to not only make them up to date but also concurrent with the same diagnostic and severity assessment criteria. The Revision Committee for the revision of TG07 (TGRC) performed validation studies of TG07 and new diagnostic and severity assessment criteria of acute cholangitis and cholecystitis. These were retrospective multi-institutional studies that collected cases of acute cholangitis, cholecystitis, and non-inflammatory biliary disease. TGRC held 35 meetings as well as international email exchanges with co-authors abroad and held three International Meetings. Through these efforts, TG13 improved the diagnostic sensitivity for acute cholangitis and cholecystitis, and presented criteria with extremely low false positive rates. Furthermore, severity assessment criteria adapted for clinical use, flowcharts, and many new diagnostic and therapeutic modalities were presented. The world's first management bundles of acute cholangitis and cholecystitis were also presented. The revised Japanese version was published with the same content as TG13. An electronic application of TG13 that can help to diagnose and assess the severity of these diseases using the criteria of TG13 was made for free download.

  11. Retroperitoneal abscess and acute acalculous cholecystitis after iatrogenic colon injury: report of a case

    PubMed Central

    Dong, Chengwei; Wang, Yuxu; Hu, Sanyuan; Du, Futian; Ding, Wei

    2015-01-01

    Acute acalculous cholecystitis has a high mortality rate due to the difficulties in early diagnosis and high rate of complications like empyema, gangrene and perforation. We report a case of 20-year-old male with acute severe pancreatitis, acute renal failure and acute peripancreatic fluid collection who was transferred to our department after blood filtration treatment in ICU. After percutaneous catheter drainage for 20 hours, the patient got a high fever. Computed tomography revealed retroperitoneal colon injury. In this case, percutaneous catheter drainage was performed again and the pus cavity was flushed regularly, after which the patient’s state gradually improved. Unpredictably, septic shock appeared on the 51st day. Repeated computed tomography revealed acute acalculous cholecystitis and abscess formation. After percutaneous transhepatic gallbladder catheterization and drainage, the patient got better gradually. Three months later the retroperitoneal catheter was removed. Four months later, ultrasound examination showed normal gallbladder and the catheter was removed. PMID:26131252

  12. Acute acalculous cholecystitis: sensitivity in detection using technetium-99m iminodiacetic acid cholescintigraphy

    SciTech Connect

    Swayne, L.C.

    1986-07-01

    Forty-one proved cases of acute acalculous cholecystitis imaged with technetium-99m iminodiacetic acid (IDA) cholescintigraphy were retrospectively analyzed. After the exclusion of one indeterminate scan (showing poor initial hepatic uptake and excretion), the study yielded a 92.5% (37 of 40) sensitivity for the detection of cystic or common bile duct obstruction. Each of the three patients with false-negative scintigrams had other abnormal scintigraphic findings suggestive of biliary tract disease. Of the 20 patients (48.8%) with focal or diffuse gangrenous cholecystitis or perforation, seven (35%) exhibited either free peritoneal spill or increased pericholecystic activity to indicate the presence of advanced disease.

  13. Impact of scheduled laparoscopic cholecystectomy in patients with acute cholecystitis, following percutaneous transhepatic gallbladder drainage

    PubMed Central

    Jung, Bo-Hyun

    2017-01-01

    Backgrounds/Aims Frequently encountered in practice, the first-line treatment for acute cholecystitis is early or urgent cholecystectomy, with laparoscopic cholecystectomy (LC) being the preferred method. Percutaneous transhepatic gallbladder drainage (PTGBD) is considered as a safe alternative therapeutic option for resolving acute cholecystitis in surgically high-risk patients. We evaluated the surgical outcomes of acute cholecystitis, focusing on the differences between emergent LC without PTGBD, and scheduled LC following PTGBD. Methods Between March 2010 and December 2014, 294 patients with acute cholecystitis who had undergone LC, were retrospectively studied. Group I included 166 patients who underwent emergency LC without PTGBD. Group II included 128 patients who underwent scheduled LC after PTGBD. Clinical outcomes were analyzed according to each group. Results On admission, Group II had a higher mean level of c-reactive protein than Group I. According to the classification of the American Society of Anesthesiologists (ASA), group II had a greater number of high-risk patients than group I. There was no significant difference on perioperative outcomes between the two groups, including open conversion rate and complications. Analysis as per the ASA classes revealed no statistically remarkable finding between the groups. Conclusions There are no significant differences in the surgical outcomes of emergency LC group without PTGBD, and scheduled LC group following PTGBD. Comparison between two groups according to ASA classification reflecting the comorbidity and severity of condition of the patients also revealed no significant differences. However, scheduled LC following PTGBD is important for patients having acute cholecystitis with concurrent comorbidity. PMID:28317042

  14. A rare case of listeriosis, acute cholecystitis and multiple myeloma.

    PubMed

    Polanco, Thais O; Alothman, Sara; Depaz, Hector; Ramcharan, Alexius

    2016-05-11

    Listeria monocytogenes (LM) is an aerobic, motile, intracellular gram-positive bacterium. Most invasive systemic infections caused by LM are commonly seen in patients at both extremes of age, during pregnancy or in immunocompromised hosts. Common clinical manifestations of LM infection in immunocompromised adults are bacteremia, infections of central nervous system, such as meningitis, and self-limiting febrile gastroenteritis. Focal infections of listeria are rare, especially cholecystitis, with only few cases reported in the last 33 years. A 62-year-old man presented with multiple myeloma, cholecystitis and LM bacteremia. Due to prompt surgical treatment and antibiotics (amoxicillin plus clavulanic acid and gentamycin), this high-risk patient recovered without any complications.

  15. A rare case of listeriosis, acute cholecystitis and multiple myeloma

    PubMed Central

    Polanco, Thais O.; Alothman, Sara; Depaz, Hector; Ramcharan, Alexius

    2016-01-01

    Listeria monocytogenes (LM) is an aerobic, motile, intracellular gram-positive bacterium. Most invasive systemic infections caused by LM are commonly seen in patients at both extremes of age, during pregnancy or in immunocompromised hosts. Common clinical manifestations of LM infection in immunocompromised adults are bacteremia, infections of central nervous system, such as meningitis, and self-limiting febrile gastroenteritis. Focal infections of listeria are rare, especially cholecystitis, with only few cases reported in the last 33 years. A 62-year-old man presented with multiple myeloma, cholecystitis and LM bacteremia. Due to prompt surgical treatment and antibiotics (amoxicillin plus clavulanic acid and gentamycin), this high-risk patient recovered without any complications. PMID:27170703

  16. Torsion of Hydrosalpinx with Concurrent Acute Cholecystitis: Case Report and Review of Literature

    PubMed Central

    Pasley, Amelia M.

    2016-01-01

    Introduction. Isolated torsion of the Fallopian tube is an uncommon cause of acute lower abdominal pain and can occur in women of all age groups. Cholecystitis is a frequent cause of upper abdominal pain. We present an unusual case with the presence of these two distinct pathological entities occurring concurrently in the same patient, causing simultaneously occurring symptoms. To our knowledge, this is the first reported presentation of such a case. Methods. We describe a 34-year-old premenopausal woman who presented with right sided upper and lower abdominal pain and nausea. Abdominal ultrasound (US) revealed acute cholecystitis. Vaginal US was suggestive of right hydrosalpinx. Intravenous antibiotics were administered and consent was obtained for operative intervention. During laparoscopy, the right Fallopian tube with hydrosalpinx was noted to be twisted three times. The right ovary appeared normal. The gall bladder wall was thickened and inflamed. Laparoscopic right salpingectomy and cholecystectomy were performed. Results. Surgical pathology revealed hydrosalpinx with torsion and acute calculous cholecystitis. The patient had an uneventful postoperative course and was discharged home on the first postoperative day. Her symptoms resolved after the procedure. Conclusions. In women with abdominal pain, both gynecologic and nongynecologic etiologies should be considered in the differential diagnoses. Concurrent presence of symptomatic gynecologic and nongynecologic intra-abdominal pathology is rare. Isolated Fallopian tube torsion is rare and is associated most often with hydrosalpinx. Some torqued Fallopian tubes can be salvaged. Laparoscopy is useful in management of both Fallopian tube torsion and cholecystitis. PMID:28070439

  17. The role of technetium-99m iminodiacetic acid (IDA) cholescintigraphy in acute acalculous cholecystitis

    SciTech Connect

    Weissmann, H.S.; Berkowitz, D.; Fox, M.S.; Gliedman, M.L.; Rosenblatt, R.; Sugarman, L.A.; Freeman, L.M.

    1983-01-01

    Technetium-99m iminodiacetic acid (IDA) cholescintigraphy was performed in 15 patients with acute acalculous cholecystitis. Fourteen of the 15 patients with acute disease had positive findings, indicating the presence of cystic duct or common duct obstruction. One case in which the gallbladder was visualized failed to respond to sincalide stimulation; this was classified as a suggestive finding of disease. The diagnostic accuracy of /sup 99m/Tc-IDA cholescintigraphy was far superior to the other imaging studies used (8 sonograms, 1 intravenous cholangiogram, 3 oral cholecystograms, 1 percutaneous transhepatic cholangiogram). The /sup 99m/Tc-IDA study is recommended as the imaging procedure of choice for examining patients with suspected acute acalculous cholecystitis.

  18. The role of technetium-99m iminodiacetic acid (IDA) cholescintigraphy in acute acalculous cholecystitis

    SciTech Connect

    Weissmann, H.S.; Berkowitz, D.; Fox, M.S.; Gliedman, M.L.; Rosenblatt, R.; Sugarman, L.A.; Freeman, F.M.

    1983-01-01

    Technetium-99m iminodiacetic acid (IDA) cholescintigraphy was performed in 15 patients with acute acalculous cholecystitis. Fourteen of the 15 patients with acute disease had positive findings, indicating the presence of cystic duct or common duct obstruction. One case in which the gallbladder was visualized failed to respond to sincalide stimulation; this was classified as a suggestive finding of disease. The diagnostic accuracy of /sup 99//sup m/Tc-IDA cholescintigraphy was far superior to the other imaging studies used (8 sonograms, 1 intravenous cholangiogram, 3 oral cholecystograms, 1 percutaneous transhepatic cholangiogram). The /sup 99//sup m/Tc-IDA study is recommended as the imaging procedure of choice for examining patients with suspected acute acalculous cholecystitis.

  19. [Risk and prophylaxis acute pancreatitis while enteral tube feeding in patients operated for destructive cholecystitis].

    PubMed

    Zhurikhina, A V; Kitiashvili, I Z; Kutukov, V V; Kondrashova, Iu V

    2011-01-01

    Determined by risk and method of prophylaxis of acute pancreatitis in the postoperative enteral tube feeding in patients with destructive cholecystitis, analyzed levels of a-amylase in blood serum and clinical manifestations of acute pancreatitis in 135 operated patients. It was established that the use of nasoduodenal access is more likely to cause the elevated level of serum amylase (p<0,05) and more incidence of sings of acute pancreatitis in contrast to nasoduodenal tube placement. For the prevention of acute pancreatitis with enteral tube feeding is preferred mode designed using nasoduodenal access.

  20. Comparison of Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: Experience from A Single Center

    PubMed Central

    Gul, Rouf; Dar, Rayees Ahmad; Sheikh, Riyaz Ahmad; Salroo, Nazir Ahmad; Matoo, Adnan Rashid; Wani, Sabiya Hamid

    2013-01-01

    Background: Cholecystectomy for symptomatic gallstones is mainly performed after the acute cholecystitis episode settles because of the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis. Aims: To evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy. Materials and Methods: This was a prospective and randomized study. For patients assigned to early group, laparoscopic cholecystectomy was performed as soon as possible within 72 hours of admission. Patients in the delayed group were treated conservatively and discharged as soon as the acute attack subsided. They were subsequently readmitted for elective laparoscopic cholecystectomy 6-12 weeks later. Results: There was no significant difference in the conversion rates, postoperative analgesia requirements, or postoperative complications. However, the early group had significantly more blood loss, more operating time, and shorter hospital stay. Conclusion: Early laparoscopic cholecystectomy within 72 hours of onset of symptoms has both medical as well as socioeconomic benefits and should be the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy. PMID:24020050

  1. Acute cholecystitis is a common complication after allogeneic stem cell transplantation and is associated with the use of total parenteral nutrition.

    PubMed

    Bagley, Stephen J; Sehgal, Alison R; Gill, Saar; Frey, Noelle V; Hexner, Elizabeth O; Loren, Alison W; Mangan, James K; Porter, David L; Stadtmauer, Edward A; Reshef, Ran; Luger, Selina M

    2015-04-01

    The incidence and risk factors for acute cholecystitis after allogeneic hematopoietic stem cell transplantation (HSCT) are not well defined. Of 644 consecutive adult transplants performed at our institution between 2001 and 2011, acute cholecystitis occurred in the first year of transplant in 32 patients (5.0%). We conducted 2 retrospective case-control studies of this population to determine risk factors for cholecystitis after HSCT and to evaluate the performance of different methods of imaging to diagnosis cholecystitis in patients undergoing HSCT compared with non-HSCT patients. In the HSCT population, development of cholecystitis was associated with an increased 1-year overall mortality rate (62.5% versus 19.8%, P < .001). The risk of developing cholecystitis was higher in patients who received total parenteral nutrition (TPN) (adjusted odds ratio, 3.41; P = .009). There was a trend toward more equivocal abdominal ultrasound findings in HSCT recipients with acute cholecystitis compared with nontransplant patients (50.0% versus 30.6%, P = .06). However, hepatobiliary iminodiacetic acid (HIDA) scans were definitively positive for acute cholecystitis in most patients in both populations (80.0% of HSCT recipients versus 77.4% of control subjects, P = .82). In conclusion, acute cholecystitis is a common early complication of HSCT, the risk is increased in patients who receive TPN, and it is associated with high 1-year mortality. In HSCT recipients with findings suggestive of acute cholecystitis, especially those receiving TPN, early use of HIDA scan may be considered over ultrasound.

  2. Acute Cholecystitis Following Total Knee Replacement: A Case Report and Literature Review

    PubMed Central

    Ghalimah, Bayan; Hamdi, Amre

    2016-01-01

    Introduction: Infection poses a substantial challenge after joint replacement. Case Presentation: We report a 53-year-old female with multiple co-morbidities, who underwent unilateral total knee arthroplasty. Her postoperative course was complicated by acute cholecystitis necessitating cholecystectomy. Conclusion: In patients who require joint replacement surgery, careful and detailed preoperative assessment is important to identify those at risk for this complication in order to provide timely treatment. PMID:27703950

  3. Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis

    PubMed Central

    Hokkam, Emad N.

    2014-01-01

    Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies. Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A) and delayed (B) cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient's satisfaction. Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient's satisfaction was 92.66 ± 6.8 in group A compared with 75.34 ± 12.85 in group B. Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques. PMID:25197568

  4. Emphysematous cholecystitis: Imaging findings in nine patients

    PubMed Central

    Sunnapwar, Abhijit; Raut, Abhijit A; Nagar, Arpit M; Katre, Rashmi

    2011-01-01

    Objective: Emphysematous cholecystitis is a severe form of acute cholecystitis and can be rapidly fatal. We present the imaging features of nine patients with proven emphysematous cholecystitis. PMID:21799598

  5. Spectrum of 99m-Tc-IDA cholescintigraphic patterns in acute cholecystitis

    SciTech Connect

    Weissmann, H.S.; Badia, J.; Sugarman, L.A.; Kluger, L.; Rosenblatt, R.; Freeman, L.M.

    1981-01-01

    Cholescintigraphy with 99m-Tc labeled iminodiacetic acid (IDA) derivatives has proved to be extremely reliable in the evaluation of suspected acute cholecystitis. The major diagnostic feature of the study is the presence (cystic dust patency) or absence (cystic duct obstruction) of gallbladder visualization. Secondary findings include degree and rate of liver uptake, visualization and caliber of the intrahepatic and common bile ducts, and the presence of intestinal activity as well as rapidity of biliary tract-to-bowel transit of the radiotracer. Various combinations of these secondary parameters result in a spectrum of cholescintigraphic patterns which can assist in determining the cause of the patient's acute clinical problem.

  6. A case of acute acalculous cholecystitis complicated by primary Epstein-Barr virus infection.

    PubMed

    Suga, Kenichi; Shono, Miki; Goji, Aya; Matsuura, Sato; Inoue, Miki; Kawahito, Masami; Mori, Kazuhiro

    2014-01-01

    Acute acalculous cholecystitis (AAC) is a rare complication of infectious mononucleosis (IM). An immunocompetent 6-year-old Japanese girl complained of epigastralgia during the course of IM. Ultrasonography (US) revealed a markedly thickened and sonolucent gallbladder wall. No gallstones were apparent. Antibodies against Epstein-Barr virus (EBV) confirmed primary EBV infection. Cytomegalovirus immunoglobulin M showed a false-positive result in the acute phase, probably due to cross-reaction to EBV nuclear antigen. We diagnosed her as AAC related with primary EBV infection. She recovered completely by conservative treatment. US should be performed in consideration of the possibility of AAC when a patient with IM complains of epigastralgia.

  7. Changes in guinea pig gallbladder smooth muscle Ca2+ homeostasis by acute acalculous cholecystitis.

    PubMed

    Gomez-Pinilla, Pedro J; Morales, Sara; Camello-Almaraz, Cristina; Moreno, Rosario; Pozo, María J; Camello, Pedro J

    2006-01-01

    Impaired smooth muscle contractility is a hallmark of acute acalculous cholecystitis. Although free cytosolic Ca2+ ([Ca2+]i) is a critical step in smooth muscle contraction, possible alterations in Ca2+ homeostasis by cholecystitis have not been elucidated. Our aim was to elucidate changes in the Ca2+ signaling pathways induced by this gallbladder dysfunction. [Ca2+]i was determined by epifluorescence microscopy in fura 2-loaded isolated gallbladder smooth muscle cells, and isometric tension was recorded from gallbladder muscle strips. F-actin content was quantified by confocal microscopy. Ca2+ responses to the inositol trisphosphate (InsP3) mobilizing agonist CCK and to caffeine, an activator of the ryanodine receptors, were impaired in cholecystitic cells. This impairment was not the result of a decrease in the size of the releasable pool. Inflammation also inhibited Ca2+ influx through L-type Ca2+ channels and capacitative Ca2+ entry induced by depletion of intracellular Ca2+ pools. In addition, the pharmacological phenotype of these channels was altered in cholecystitic cells. Inflammation impaired contractility further than Ca2+ signal attenuation, which could be related to the decrease in F-actin that was detected in cholecystitic smooth muscle cells. These findings indicate that cholecystitis decreases both Ca2+ release and Ca2+ influx in gallbladder smooth muscle, but a loss in the sensitivity of the contractile machinery to Ca2+ may also be responsible for the impairment in gallbladder contractility.

  8. Two cases of cystic artery pseudoaneurysm rupture due to acute cholecystitis with gallstone impaction in the neck.

    PubMed

    Kaida, Shogo; Arahata, Kyouko; Itou, Asako; Takarabe, Sakiko; Kimura, Kayoko; Kishikawa, Hiroshi; Nishida, Jiro; Fujiyama, Yoshiki; Takigawa, Yutaka; Matsui, Junichi

    2016-09-01

    A cystic artery aneurysm is a rare cause of hemobilia. Herein, we report two cases of acute cholecystitis with a ruptured cystic artery pseudoaneurysm. Two patients (a 69-year-old man and an 83-year-old man) were admitted to our hospital because of acute cholecystitis with gallstone impaction in the neck. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed for both patients. After a few days of PTGBD, gallbladder hemorrhage was observed. Abdominal angiography showed cystic artery aneurysm. A transcatheter arterial embolization was therefore performed, followed by an open cholecystectomy.

  9. Gallbladder Volvulus: A Rare Emergent Cause of Acute Cholecystitis, if Untreated, Progresses to Necrosis and Perforation

    SciTech Connect

    Justin L, Regner Angela, Lomas

    2016-03-25

    An 86 year-old woman with a past medical history significant for abdominal hernia and Alzheimer dementia presented to the Emergency Department with a 24 hour history of acute right upper quadrant pain associated with nausea and non-bilious emesis. Physical exam revealed right sided abdominal tenderness with associated mass. All laboratory values were within normal ranges. Both abdominal ultrasound and computed tomography of the abdomen/pelvis revealed a large distended gallbladder with wall thickening and gallstones. Based on presentation and radiologic findings, the emergency general surgery service was consulted for suspected acute cholecystitis. The patient was then admitted for intravenous antibiotics and scheduled for laparoscopic cholecystectomy the following day. Intra-operative findings revealed volvulus with acute necrosis of the entire gallbladder. The gallbladder had a long pedunculated cystic duct and artery that was detorsed before proceeding with resection. Postoperatively, the patient did well and was discharged a few days later tolerating a regular diet.

  10. Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis

    PubMed Central

    Rodríguez-Sanjuán, Juan C.; Martín-Acebes, Fernando; Llorca-Díaz, Francisco J.; Gómez-Fleitas, Manuel; Zambrano Muñoz, Rocío; Sánchez-Manuel, F. Javier

    2016-01-01

    Objective. To evaluate if early cholecystectomy (EC) is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC). Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1) postoperative hospital morbidity, (2) hospital mortality, (3) days of hospital stay, (4) readmissions, (5) admission to the Intensive Care Unit (ICU), (6) type of surgery, (7) operating time, and (8) reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9%) was significantly lower than the DC group (38.7%). EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days), readmission percentage (6.8% versus 21.9%), and percentage of ICU admission (2.3% versus 7.8%), which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment. PMID:27803512

  11. Choledochal cyst complicated by acute cholecystitis and bypass obstruction: diagnostic role of Tc-99m-HIDA cholescintigraphy

    SciTech Connect

    Weissmann, H.S.; Gold, M.; Goldstein, R.D.; Sugarman, L.A.; Freeman, L.M.

    1981-09-01

    An unusual case of malignant degeneration of a choledochal cyst is presented. The presence of acute cholecystitis with the cystic duct originating from the cyst as well as the subsequent obstruction of the cyst-jejunal surgical anastomosis was readily detected with Tc-99m-dimethyl-iminodiacetic (Tc-99m-HIDA) cholescintigraphy.

  12. Is the male gender an independent risk factor for complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis?

    PubMed

    Ambe, Peter C; Köhler, Lothar

    2015-05-01

    This paper was designed to investigate the gender dependent risk of complication in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. Laparoscopic cholecystectomy is the standard procedure for benign gallbladder disorders. The role of gender as an independent risk factor for complicated laparoscopic cholecystectomy remains unclear. A retrospective single-center analysis of laparoscopic cholecystectomies performed for acute cholecystitis over a 5-year period in a community hospital was performed. Within the period of examination, 1884 laparoscopic cholecystectomies were performed. The diagnosis was acute cholecystitis in 779 cases (462 female, 317 male). The male group was significantly older (P = 0.001). Surgery lasted significantly longer in the male group (P = 0.008). Conversion was done in 35 cases (4.5%). There was no significant difference in the rate of conversion between both groups. However the rate of conversion was significantly higher in male patients > 65 years (P = 0.006). The length of postoperative hospital stay was significantly longer in the male group (P = 0.007), in the group > 65 years (P = 0.001) and following conversion to open surgery (P = 0.001). The male gender was identified as an independent risk factor for prolonged laparoscopic cholecystectomy on multivariate analysis. The male gender could be an independent risk factor for complicated or challenging surgery in patients undergoing laparoscopic cholecystectomy for acute cholecystitis.

  13. Laparoscopic cholecystectomy for acalculous cholecystitis in a neutropenic patient after chemotherapy for acute lymphoblastic leukemia

    PubMed Central

    Ejduk, Anna; Wróblewski, Tadeusz; Szczepanik, Andrzej B.

    2014-01-01

    Acute acalculous cholecystitis (ACC) is most frequently reported in critically ill patients following sepsis, extensive injury or surgery. It is rather uncommon as a chemotherapy-induced complication, which is usually life-threatening in neutropenic patients subjected to myelosuppressive therapy. A 23-year-old patient with acute lymphoblastic leukemia was subjected to myelosuppressive chemotherapy (cyclophosphamide, cytarabine, pegaspargase). After the first chemotherapy cycle the patient was neutropenic and feverish; she presented with vomiting and pain in the right epigastrium. Ultrasound demonstrated an acalculous gallbladder with wall thickening up to 14 mm. The ACC was diagnosed. Medical therapy included a broad spectrum antibiotic regimen and granulocyte-colony stimulating factors. On the second day after ACC diagnosis the patient's general condition worsened. Laparoscopic cholecystectomy was performed. The resected gallbladder showed no signs of bacterial or leukemic infiltrates. The postoperative course was uneventful. In the management of neutropenic patients with ACC surgical treatment is as important as pharmacological therapy. PMID:25337176

  14. Ultrasound-guided percutaneous cholecystostomy in acute cholecystitis: case vignette and review of the technique.

    PubMed

    Blanco, Pablo A; Do Pico, Juan J

    2015-12-01

    Acute cholecystitis is a frequent condition. Although cholecystectomy is the indicated treatment of this entity, it cannot be performed in some high-risk surgery patients, such as critically ill or those with multiple comorbidities. In these non-uncommon scenarios, percutaneous cholecystostomy is the recommended alternative treatment, which allows immediate decompression and drainage of the acutely inflamed gallbladder and thus reducing the patient's symptoms and the systemic inflammatory response. Ultrasound is the imaging method of choice to guide the percutaneous cholecystostomy procedure due to its real-time guidance, lack of ionizing radiation and portability, avoiding the need to transfer unhealthy patients to the radiology department. We will review the ultrasound-guided percutaneous cholecystostomy procedure, of special interest for radiologists, surgeons, and also intensive care and emergency physicians.

  15. Acute cholecystitis

    MedlinePlus

    ... liver (may occur after gallbladder surgery) Pancreatitis Perforation Peritonitis (inflammation of the lining of the abdomen) When ... Abdominal pain Bile Empyema Gallbladder removal - laparoscopic Gallstones Peritonitis Patient Instructions Gallbladder removal - laparoscopic - discharge Gallbladder removal - ...

  16. A Complicated Course of Acute Viral Induced Pharyngitis, Icteric Hepatitis, Acalculous Cholecystitis, and Skin Rash

    PubMed Central

    Erfani, Seddigheh Sadat

    2016-01-01

    This case reveals the complexities and challenges in the diagnosis of acute Epstein-Barr virus (EBV) infection, indicating the potential relationship between EBV infection and severe icteric hepatitis, acalculous cholecystitis, and lymphocytic vasculitis. We suggest including EBV infectious mononucleosis in the list of differential diagnoses when any of these clinical syndromes (or a combination thereof) occurs without apparent cause, especially in the presence of lymphocytosis. To our knowledge, this is the first report to suggest the possible role of EBV in the pathogenesis of cutaneous lymphocytic vasculitis. Also it is possible that EBV infection triggered the flare-up of the underlying rheumatologic disease. Therefore, it could be assumed that a part of the clinical syndrome (e.g., dermatologic manifestations) might be related to the flare-up of the underlying rheumatologic disease. PMID:27847520

  17. Cellular turnover and expression of hypoxic-inducible factor in acute acalculous and calculous cholecystitis

    PubMed Central

    Vakkala, Merja; Laurila, Jouko J; Saarnio, Juha; Koivukangas, Vesa; Syrjälä, Hannu; Karttunen, Tuomo; Soini, Ylermi; Ala-Kokko, Tero I

    2007-01-01

    Introduction Epithelial corrective and destructive mechanisms have not been studied in inflammatory gallbladder disease. Methods Epithelial apoptosis, cell proliferation and expression of hypoxia-inducible factor (HIF)-1α were compared in gallbladders from patients with acute acalculous cholecystitis (AAC; n = 30) and acute calculous cholecystitis (ACC; n = 21), and from patients undergoing surgery for other reasons (normal gallbladders; n = 9), which were removed during open cholecystectomy. The immunohistochemical stains included antibodies to Ki-67 (proliferation), M30 (apoptosis) and HIF-1α. Proliferation and apoptosis were expressed as percentages of positive cells. HIF-1α expression was expressed as absent, weak, or strong. Results Apoptosis (median [25th to 75th percentile]) was significantly increased in AAC (1.31% [0.75% to 1.8%], P < 0.001) and ACC (1.10% [0.63% to 1.64%], P = 0.001), compared with control samples (0.20% [0.07% to 0.45%]. The proliferation rate was significantly increased in AAC (8.0% [4.0% to 17.0%], P < 0.001) and ACC (14% [7.5% to 26.5%], P = 0.001) compared with control samples (1.0% [1.0% to 3.0%]). Strong HIF-1α staining was observed in 57% of AAC, in 100% of ACC and in 44% of control specimens (P < 0.001). Intense HIF-1α expression was associated with increased cell proliferation (P = 0.002). Conclusion Cell proliferation and apoptosis were increased in AAC and ACC, as compared with normal gallbladders. Expression of HIF-1α was lower in AAC than in ACC. PMID:17974017

  18. A huge bladder calculus causing acute renal failure.

    PubMed

    Komeya, Mitsuru; Sahoda, Tamami; Sugiura, Shinpei; Sawada, Takuto; Kitami, Kazuo

    2013-02-01

    A 81-year-old male was referred to our emergency outpatient unit due to acute renal failure. The level of serum creatinine was 276 μmol/l. A CT scan showed bilateral hydronephroureter, large bladder stone (7 cm × 6 cm × 6 cm) and bladder wall thickness. He was diagnosed as post renal failure due to bilateral hydronephroureter. Large bladder stone is thought to be the cause of bilateral hydronephroureter and renal failure. To improve renal failure, we performed open cystolithotomy and urethral catheterization. Three days after the surgery, the level of serum creatinine decreased to 224 μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure. We summarize the characteristics of bladder calculus causing renal failure. We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind.

  19. Protective effect of melatonin on Ca2+ homeostasis and contractility in acute cholecystitis.

    PubMed

    Gomez-Pinilla, Pedro J; Camello, Pedro J; Pozo, María J

    2008-04-01

    Impaired Ca2+ homeostasis and smooth muscle contractility co-exist in acute cholecystitis (AC) leading to gallbladder dysfunction. There is no pharmacological treatment for this pathological condition. Our aim was to evaluate the effects of melatonin treatment on Ca2+ signaling pathways and contractility altered by cholecystitis. [Ca2+]i was determined by epifluorescence microscopy in fura-2 loaded isolated gallbladder smooth muscle cells, and isometric tension was recorded from gallbladder muscle strips. Malondialdehyde (MDA) and reduced glutathione (GSH) contents were determined by spectrophotometry and cycloxygenase-2 (COX-2) expression was quantified by western blot. Melatonin was tested in two experimental groups, one of which underwent common bile duct ligation for 2 days and another that was later de-ligated for 2 days. Inflammation-induced impairment of Ca2+ responses to cholecystokinin and caffeine were recovered by melatonin treatment (30 mg/kg). This treatment also ameliorated the detrimental effects of AC on Ca2+ influx through both L-type and capacitative Ca2+ channels, and it was effective in preserving the pharmacological phenotype of these channels. Despite its effects on Ca2+ homeostasis, melatonin did not improve contractility. After de-ligation, Ca2+ influx and contractility were still impaired, but both were recovered by melatonin. These effects of melatonin were associated to a reduction of MDA levels, an increase in GSH content and a decrease in COX-2 expression. These findings indicate that melatonin restores Ca2+ homeostasis during AC and resolves inflammation. In addition, this indoleamine helps in the subsequent recovery of functionality.

  20. Percutaneous cholecystostomy for acute cholecystitis in high-risk elderly patients.

    PubMed

    Lin, Wei-Chen; Chang, Chen-Wang; Chu, Cheng-Hsin

    2016-10-01

    Emergency cholecystectomy for acute cholecystitis (AC) is associated with high morbidity and mortality rates in elderly patients with significant comorbidities. The aim of this study was to evaluate percutaneous cholecystostomy for AC in elderly patients with various coexisting diseases. We retrospectively reviewed the records of 4311 patients with AC treated in Mackay Memorial Hospital between the years 2000 and 2015. The clinical course of AC was compared between nonelderly (age ≤70 years) and elderly patients (age>70 years). In total, 67 elderly patients and 32 nonelderly patients received percutaneous cholecystostomy. The rate of percutaneous cholecystostomy increased between the years 2011 and 2015 (from 2.5% to 12.2%) and this procedure was more common in the elderly group (p=0.009). In addition, the comorbidities of ischemic heart disease and chronic kidney disease were higher in elderly than in nonelderly patients (p=0.014 and p=0.015, respectively). The American Society of Anesthesiologists' classification was higher in the elderly patients (p=0.001). The overall survival-free rate of recurrent cholecystitis in patients who did not receive cholecystectomy was not significantly different in the two groups. When compared with emergent cholecystectomy in high-risk elderly patients, percutaneous cholecystostomy resulted in reduced hospital stay and morbidity (p=0.002 and p=0.013, respectively). Our results demonstrate that percutaneous cholecystostomy has become a common and early treatment for AC in high-risk elderly patients with ischemic heart disease or chronic kidney disease. Identifying such patients will possibly improve clinical outcomes, reduce hospital stay and morbidity, and facilitate delayed laparoscopic cholecystectomy.

  1. Bacterobilia in acute cholecystitis: Bile cultures' isolates, antibiotic sensitivities and antibiotic usage. A study on a Pakistani population.

    PubMed

    Hadi, Yousaf Bashir; Waqas, Muhammad; Umer, Hafiz Muhammad; Alam, Ammar; Alvi, Abdul Rehman; Khan, Muhammad Rizwan

    2016-10-01

    Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystitis. The current retrospective observational study was conducted at a tertiary care hospital in Karachi, and comprised medical records of patients admitted between 2008 and 2014with acute cholecystitis and in whom bile cultures were obtained. Of the 509 patients with a mean age of 51.15 ± 13.4years, early laparoscopic cholecystectomy (within 72hours) was performed on 473(92.9%) cases, while the rest underwent percutaneous cholecystostomy. Bile cultureswere positive in 171(33.6%) patients. Predominantly gram-negative organisms were isolated among a total of 137(27%), with E.coli 63(46%) being the most commonly isolated organism. Of the gram-positive organism, enterococcus 11(8%) was the most common. Antibiotic sensitivities were determined.Based on our findings gram-negative coverage alone should be sufficient in our segment of the population.

  2. [Emphysematous cholecystitis (author's transl)].

    PubMed

    Tögel, H; Sommer, P

    1981-04-24

    Emphysematous cholecystitis is a dangerous form of acute cholecystitis. Preoperative early diagnosis can only be made radiologically and is based on the presence of gas in the gallbladder, the gallbladder wall, or in the pericholecystic space. Cholelithiasis occurs in only 50% of cases, more often in men, significantly more frequently in diabetics. Bacteriologically, organisms of the clostridia group are predominant, but bacteriology is altogether negative in ca. 50% of cases.

  3. Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case

    PubMed Central

    Lobo, Ana Luísa; Branca, Fernando

    2016-01-01

    A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy's sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy's sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160) for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection. PMID:27200203

  4. Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

    PubMed Central

    Bokhari, S; Walsh, U; Qurashi, K; Liasis, L; Watfah, J; Sen, M; Gould, S

    2016-01-01

    Introduction Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. Methods The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. Results The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to ‘surgeon preference/skill’, was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. Conclusions A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital. PMID:26673047

  5. Management of a patient with situs inversus totalis with acute cholecystitis and common bile duct stones: A case report

    PubMed Central

    Reddy, Ashwanth; Paramasivam, Surendran; Alexander, Naveen; Abhilash; Ravisankar, Vigneshwar; Thillai, Manoj

    2014-01-01

    INTRODUCTION The incidence of situs inversus thought to be in the range of 1:10,000–1:20,000 according to Mayo et al. PRESENTATION OF CASE A forty-five year-old lady presented with pain in the left hypochondrium and was diagnosed to have acute cholecystitis with choledocholithiasis in situs inversus totalis. Patient underwent endoscopic sphincterotomy and common bile duct stone extraction in view of choledocholithiasis and after common bile duct cannulation patient taken up for elective laparoscopic cholecystectomy (LC) within 24 h. DISCUSSION The most challenging factor for performing surgery in a patient with situs inversus is dealing with the mirror image anatomy. The first laparoscopic cholecystectomy in situs inversus was reported by Campos et al. in 1991. Since then, 50 other cases have been reported in literature making a point that laparoscopic procedure is not contraindicated. CONCLUSION Acute cholecystitis with choledocholithiasis is extremely rare and requires expert intervention from both the endoscopist and the laparoscopic surgeons because of the reverse anatomy and the fact that both are attuned to the constant practice of the procedures in normal anatomy. PMID:25462042

  6. Laparoscopic cholecystectomy for acute cholecystitis: early or delayed?: Evidence from a systematic review of discordant meta-analyses.

    PubMed

    Song, Guo-Min; Bian, Wei; Zeng, Xian-Tao; Zhou, Jian-Guo; Luo, Yong-Qiang; Tian, Xu

    2016-06-01

    The laparoscopic cholecystectomy (LC) is an important approach of treating acute cholecystitis and the timing of performing this given treatment is associated with clinical outcomes. Although several meta-analyses have been done to investigate the optimal timing of implementing this treatment, the conflicting findings from these meta-analyses still confuse decision-making. And thus, we performed this systematic review to assess discordant meta-analyses and generate conclusive findings to facilitate informed decision-making in clinical context eventually. We electronically searched the PubMed, Cochrane Library, and EMBASE to include meta-analysis comparing early (within 7 days of the onset of symptoms) with delayed LC (at least 1 week after initial conservative treatment) for acute cholecystitis through August 2015. Two independent investigators completed all tasks including scanning and appraising eligibility, abstracting essential information using prespecified extraction form, assessing methodological quality using Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) tool, and assessing the reporting quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), as well as implementing Jadad algorithm in each step for the whole process. A heterogeneity degree of ≤50% is accepted. Seven eligible meta-analyses were included eventually. Only one was Level I of evidence and remaining studies were Level II of evidence. The AMSTAR scores varied from 8 to 11 with a median of 9. The PRISMA scores varied from 19 to 26. The most heterogeneity level fell into the desired criteria. After implementing Jadad algorithm, 2 meta-analyses with more eligible RCTs were selected based on search strategies and implication of selection. The best available evidence indicated a nonsignificant difference in mortality, bile duct injury, bile leakage, overall complications, and conversion to open surgery, but a significant reduction

  7. Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

    PubMed Central

    Kamata, Ken; Takenaka, Mamoru; Kitano, Masayuki; Omoto, Shunsuke; Miyata, Takeshi; Minaga, Kosuke; Yamao, Kentaro; Imai, Hajime; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Kudo, Masatoshi

    2017-01-01

    AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed. METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured. RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492). CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction. PMID:28216973

  8. A huge pelvic calculus causing acute renal failure.

    PubMed

    Lai, Allen Yu-Hung; Kuo, Yuh-Chen

    2008-02-01

    We present a 69-year-old man with repeated urinary tract infection and lower abdominal pain. Kidney-ureter-bladder (KUB) scout film showed a huge, 320-g triangular pelvic calculus that was surgically removed with excellent results. Bladder stone is a common disease, but it is rare for such a calculus to be so large as to cause bilateral hydronephrosis. Surgical intervention by cystolithotomy or endoscopic cystolithotripsy can achieve satisfactory results. Bladder outlet obstruction should be treated simultaneously. Close follow-up, however, is mandatory because the recurrence of urolithiasis is high in those patients with voiding problems and recurrent urinary infection. To the best of our knowledge, this is the largest bladder stone in a human male. This case report also illustrates the importance of radiologic evaluation of patients with repeated urinary infections.

  9. [The pneumoperitoneum course forecasting and surgery tactic in the group of patients with acute and chronic cholecystitis and concomitant pathology of cardiovascular system].

    PubMed

    Korotkyĭ, V M; Soliaryk, S O; Tsyganok, A M; Sysak, O M

    2012-01-01

    The share of elderly and senile patients with acute cholecystitis concomitant cardiovascular pathology whom the laparoscopic cholecystectomy has been provided is increased. The heightened intraabdominal pressure has negative influence at the cardiovascular system, so the alternative ways for treatment of this group of patients are used in clinic. We propose the pneumoperitoneum model using the pneumatic belt which is fixed at the abdomen in preoperative period in patients with an acute and chronic cholecystitis. This model is useful to forecast cardiovascular disorders during future laparoscopic cholecystectomy. The arterial pressure level, pulse score and ECG are monitored during the test (90 min). Myocardial ischemia appearance seems that the risk of laparoscopic cholecystectomy with pneumoperitoneum is high. The alternative method of surgery in such group of patients (no pneumoperitoneum is applied) is laparoscopic assisted cholecystectomya from miniaccess. This method allows to reducing frequency of intra- and postoperative complications connected with pneumoperitoneum negative influence at the patients with concomitant pathology of cardiovascular system.

  10. Complicated cholecystitis: the complementary roles of sonography and computed tomography.

    PubMed

    Charalel, Resmi A; Jeffrey, R Brooke; Shin, Lewis K

    2011-09-01

    Acute cholecystitis is a common cause of abdominal pain in the Western world. Unless treated promptly, patients with acute cholecystitis may develop complications such as gangrenous, perforated, or emphysematous cholecystitis. Because of the increased morbidity and mortality of complicated cholecystitis, early diagnosis and treatment are essential for optimal patient care. Nevertheless, complicated cholecystitis may pose significant challenges with cross-sectional imaging, including sonography and computed tomography (CT). Interpreting radiologists should be familiar with the spectrum of sonographic findings seen with complicated cholecystitis and as well as understand the complementary role of CT. Worrisome imaging findings for complicated cholecystitis include intraluminal findings (sloughed mucosa, hemorrhage, abnormal gas), gallbladder wall abnormalities (striations, asymmetric wall thickening, abnormal gas, loss of sonoreflectivity and contrast enhancement), and pericholecystic changes (echogenic fat, pericholecystic fluid, abscess formation). Finally, diagnosis of complicated cholecystitis by sonography and CT can guide alternative treatments including minimally invasive percutaneous and endoscopic options.

  11. Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality. Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based advice. Methods/Design The CHOCOLATE trial is a randomised controlled, parallel-group, superiority multicenter trial. High risk patients, defined as APACHE-II score 7-14, with acute calculous cholecystitis will be randomised to laparoscopic cholecystectomy or percutaneous cholecystostomy. During a two year period 284 patients will be enrolled from 30 high volume teaching hospitals. The primary endpoint is a composite endpoint of major complications within three months following randomization and need for re-intervention and mortality during the follow-up period of one year. Secondary endpoints include all other complications, duration of hospital admission, difficulty of procedures and total costs. Discussion The CHOCOLATE trial is designed to provide the surgical community with an evidence based guideline in the treatment of acute calculous cholecystitis in high risk patients. Trial Registration Netherlands Trial Register (NTR): NTR2666 PMID:22236534

  12. Cholecystitis during pregnancy. A case report and brief review of the literature.

    PubMed

    Chloptsios, C; Karanasiou, V; Ilias, G; Kavouras, N; Stamatiou, K; Lebren, F

    2007-01-01

    Cholecystitis is an inflammation of the gallbladder caused by obstruction of the cystic duct. A gallstone usually causes the obstruction (calculus cholecystitis). However, in some cases the obstruction may be acalculous or caused by sludge. The clinical course of biliary sludge varies, from complete resolution to gallbladder obstruction. This obstruction can result in gallbladder distension and acute cholecystitis. When inflammation occurs it could either be aseptic or bacterial. Biliary disease during pregnancy is relatively rare and occurs mainly during the last trimester. Whether women who are pregnant or have multiple pregnancies are more likely to develop stones or whether they are simply more symptomatic with stones is unknown. We present a 33-year-old obese pregnant woman with fever, moderately elevated bile acids, and leukocytosis in the 28th week of pregnancy. Since need for surgery in these cases is controversial, the patient has been treated conservatively. In our case cholecystitis responded very well to treatment with amoxicillin, with no detrimental effects for mother and child. A healthy child was born at term. In the differential diagnosis of liver function abnormalities during pregnancy, cholelithiasis should be included.

  13. Pneumomediastinum as a complication of emphysematous cholecystitis: Case report

    PubMed Central

    2010-01-01

    Background Emphysematous cholecystitis is a variant of acute cholecystitis which is generally caused by gas-forming organisms. Emphysematous cholecystitis may cause gas spreading within the subcutaneous tissue, peritoneal cavity and retroperitoneum. Case presentation We present a case of emphysematous cholecystitis in a middle-aged diabetic patient who, postoperatively, presented edema in both flanks and left chest crepitation on palpation, associated with hemodynamic worsening. Computed tomography scan of the chest and abdomen revealed a large pneumomediastinum, pneumoretroperitoneum, gas in subcutaneous tissue and flank abscesses. In both blood and surgical wound exudate cultures, Escherichia coli was found. Conclusion Emphysematous cholecystitis should be considered as a possible cause of pneumomediastinum. PMID:20813063

  14. Juxtarenal Mycotic Aneurysm as a Complication of Acute Exacerbation of Chronic Cholecystitis Treated by Resection and Replacement by a Fresh Allograft.

    PubMed

    Grus, Tomáš; Lambert, Lukáš; Rohn, Vilém; Klika, Tomáš; Grusová, Gabriela; Michálek, Pavel

    2016-01-01

    We present a case of a female patient with infectious (mycotic) juxtarenal abdominal aneurysm with atypical symptoms beginning as acute exacerbation of chronic cholecystitis. Apart from common antibiotic treatment, the patient successfully underwent resection of the diseased segment and replacement by a fresh allograft in order to reduce the risk of infection of the graft, but with the need of subsequent life-long immunosuppressive therapy. Perioperative monitoring of the spinal cord by near infrared spectroscopy was used to identify possible spinal ischemia. The choice of the fresh allograft was based on our experience supported by review of the literature.

  15. Acute Acalculous Cholecystitis: A Rare Presentation of Primary Epstein-Barr Virus Infection in Adults—Case Report and Review of the Literature

    PubMed Central

    Karadeniz, Asli; Kaya, Fatih Oner

    2017-01-01

    Primary Epstein-Barr virus (EBV) infection is almost always a self-limited disease characterized by sore throat, fever, and lymphadenopathy. Hepatic involvement is usually characterized by mild elevations of aminotransferases and resolves spontaneously. Although isolated gallbladder wall thickness has been reported in these patients, acute acalculous cholecystitis is an atypical presentation of primary EBV infection. We presented a young women admitted with a 10-day history of fever, nausea, malaise who had jaundice and right upper quadrant tenderness on the physical examination. Based on diagnostic laboratory tests and abdominal ultrasonographic findings, cholestasis and acute acalculous cholecystitis were diagnosed. Serology performed for EBV revealed the acute EBV infection. Symptoms and clinical course gradually improved with the conservative therapy, and at the 1-month follow-up laboratory findings were normal. We reviewed 16 adult cases with EBV-associated AAC in the literature. Classic symptoms of EBV infection were not predominant and all cases experienced gastrointestinal symptoms. Only one patient underwent surgery and all other patients recovered with conservative therapy. The development of AAC should be kept in mind in patients with cholestatic hepatitis due to EBV infection to avoid unnecessary surgical therapy and overuse of antibiotics. PMID:28194287

  16. Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis

    PubMed Central

    Hearne, Christopher B.; Taboada, Jorge

    2017-01-01

    Epiploic appendagitis (EA) is a rare cause of acute abdominal pain caused by inflammation of an epiploic appendage. It has a nonspecific clinical presentation that may mimic other acute abdominal pathologies on physical exam, such as appendicitis, diverticulitis, or cholecystitis. However, EA is usually benign and self-limiting and can be treated conservatively. We present the case of a patient with two episodes of EA, the first mimicking acute appendicitis and the second mimicking acute cholecystitis. Although recurrence of EA is rare, it should be part of the differential diagnosis of acute, localized abdominal pain. A correct diagnosis of EA will prevent unnecessary hospitalization, antibiotic use, and surgical procedures. PMID:28127129

  17. Emphysematous cholecystitis successfully treated by laparoscopic surgery

    PubMed Central

    Katagiri, Hideki; Yoshinaga, Yasuo; Kanda, Yukihiro; Mizokami, Ken

    2014-01-01

    Emphysematous cholecystitis (EC) is an uncommon variant of acute cholecystitis, which is caused by secondary infection of the gallbladder wall with gas-forming organisms. The mortality rate of EC is still as high as 25%. Emergency surgical intervention is indicated. Open cholecystectomy has been traditionally accepted as a standard treatment for EC. We present a case of EC successfully treated by laparoscopic surgery. Laparoscopic cholecystectomy for EC is considered to be safe and effective when indicated. PMID:24876461

  18. Patients' experiences with cholecystitis and a cholecystectomy.

    PubMed

    Lindseth, Glenda N; Denny, Dawn L

    2014-01-01

    Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care.

  19. [ROLE OF MICROFLORA OF THE ABDOMINAL CAVITY EXUDATE IN THE ENDOGENIC INTOXICATION OCCURRENCE IN PATIENTS, SUFFERING COMPLICATED ACUTE CHOLECYSTITIS WITH CONCURRENT CARDIAC INSUFFICIENCY OF ISCHEMIC GENESIS].

    PubMed

    Ivantsok, V M

    2015-05-01

    While complicated acute cholecystitis (ACH) course the focus of infection constitutes one of the main causes of the endogenic intoxication (EI) occurrence, what leads to ischemic and hypoxic myocardial damage. There were presented the treatment results analysis in 213 patients, ageing 60 years old and older, managed for an ACH, complicated by peritonitis, paravesical abscess, with concurrent cardiac insufficiency of ischemic genesis, to whom laparoscopic cholecytectomy (LCHE) was conducted. Microflora of the abdominal cavity exudates in the patients, suffering an ACH of various severity, was studied. More rapid regression of inflammatory process, the EI severity and the ischemic-hypoxic myocardial affection reduction, positive impact on hemodynamics, reduction of myocardial ischemia severity were noted while local affection, when bacteriophages for treatment were applied.

  20. Use of morphine in cholescintigraphy for obstructive cholecystitis

    SciTech Connect

    Kim, E.E.; Nguyen, M.; Pjura, G.; Pollack, M.; Gobuty, A.

    1985-05-01

    Non-visualization of the gallbladder (GB) during the first hour of cholescintigraphy is observed in cystic duct obstruction (e.g. in acute cholecystitis) but may also occur in chronic cholecystitis, hepatocellular disease, alcoholism and prolonged total parenteral nutrition. Low dose morphine is shown to improve the specificity of the diagnosis of acute cholecystitis (from 85% to 100%) with no loss in sensitivity (98%) at a small cost in terms of additional study time. The authors reviewed 27 selected cholescintigraphic examinations augmented by intravenous (IV) morphine (0.04 mg/Kg). Of the 16 cases with persistent nonvisualization of the GB, ultrasound revealed gallstones in 5 cases, sludge in 4, acalculous cholecystitis in 3, one distended GB, one contracted GB and 2 normal GB's. Of the 4 patients taken to surgery, one with gallstones and one with acalculous cholecystitis were confirmed to have acute cholecystitis while another with gallstones had chronic cholecystitis and the final patient, who was sonographically normal, presented a single common duct stone. The authors conclude that the use of IV morphine is an effective adjunct to cholescintigraphy in the evaluation of gallbladder disease, especially when visualization post morphine rules out acute cholecystitis.

  1. Surgical, pathological and clinical correlation of Tc-99m DISIDA hepatobiliary imaging in 138 adult males, in the diagnosis of functional cystic duct obstruction VS acute or chronic cholecystitis

    SciTech Connect

    Yoo, J.H.K.; Beal, W.H.; Ware, R.W.; Straw, J.D.; Chaudhuri, T.K.

    1985-05-01

    Despite the wide acceptance of the hepatobiliary scintigraphy as a popular diagnostic imaging modality for gallbladder and hepatobiliary disease, correlation between radionuclide diagnoses and the final clinical and/or pathologic findings have not been thoroughly evaluated. The lack of correlative studies frequently generates difficulties in making appropriate diagnostic interpretation of the objective findings. A retrospective clinical pathological and surgical correlative study was undertaken by the authors in 138 male veteran patients, who underwent computer assisted minute by minute Tc-99m DISIDA cholescintigraphy. A very high percentage (75%) revealed abnormalities; non-visualization of gallbladder (GB) with normal choledochus system (46%), choledochal obstruction with no GB visualization (13%), choledochal obstruction with normal GB visualization (6%), severe hepatocellular disease with non-diagnostic GB (4%), and delayed GB visualization (longer than 60 minutes) (3%). Non-visualization of GB but normal choledochus demonstrated diverse pathologic etiologies, acute and chronic cholecystitis (64%), S/P cholecystectomy (8%), functional obstruction secondary to sepsis or pancreatitis (6%), and various other pathologies including porcelain GB and cholangitis (22%). The most important cause of choledochal obstruction was mass lesions or local infiltration with metastases (33%) rather than acute cholecystitis (27%). Although the sensitivity (98%) and specificity (92%) for cystic duct obstruction were very high, the specificity decreases significantly for cholecystitis.

  2. Eosinophilic cholecystitis with common bile duct stricture: a rare disease.

    PubMed

    Mehanna, Daniel; Naseem, Zainab; Mustaev, Muslim

    2016-05-24

    Although the most common cause of cholecystitis is gallstones, other conditions may present as acute cholecystitis. We describe a case of eosinophilic cholecystitis with common bile duct stricture. A 36-year-old woman initially had generalised abdominal pain and peripheral eosinophilia. Diagnostic laparoscopy showed eosinophilic ascites and necrotic nodules on the posterior abdominal wall. She was treated with anthelminthics on presumption of toxacara infection based on borderline positivity of serological tests. She later presented with acute cholecystitis and had a cholecystectomy and choledocotomy. Day 9 T-tube cholangiogram showed irregular narrowing of the distal common bile duct. The patient's symptoms were improved with steroids and the T-tube was subsequently removed.

  3. A rare finding during a common procedure: xanthogranulomatous cholecystitis.

    PubMed

    Taskesen, Fatih; Arikanoglu, Zulfu; Uslukaya, Omer; Oguz, Abdullah; Aliosmanoglu, Ibrahim; Dusak, Abdurrahim; Turkcu, Gul; Kuzu, Hekim

    2014-01-01

    Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in regions of destructive inflammation. Xanthogranulomatous cholecystitis clinically and radiologically mimics early-stage gallbladder cancer, with wall thickening on computed tomography. The study included 14 xanthogranulomatous cholecystitis patients that were identified following retrospective analysis of the records of 1248 patients that underwent cholecystectomy between 2005 and 2011. Mean age of the 5 male and 9 female patients was 56.7 years. All 14 patients had gallbladder stones; 10 had a history of acute cholecystitis, 1 had cholangitis, and 2 presented with obstructive jaundice. A right-upper quadrant mass was palpable in 2 patients. All patients underwent cholecystectomy. Open surgery was planned and performed in 6 of the 14 patients, and laparoscopic cholecystectomy was planned in 8 patients, but was converted to open surgery in 1 case. In total, 1 patient developed wound infection, 1 patient had postoperative pneumonia, and 1 patient developed intraabdominal hematoma. None of the patients in the series died. Xanthogranulomatous cholecystitis is difficult to diagnose, both preoperatively and intraoperatively, and definitive diagnosis depends exclusively on pathological examination. Xanthogranulomatous cholecystitis should be a consideration in all difficult cholecystectomy cases.

  4. Gangrenous cholecystitis in an asymptomatic patient found during an elective laparoscopic cholecystectomy: a case report

    PubMed Central

    2011-01-01

    Introduction Gangrenous cholecystitis is a severe complication of acute cholecystitis. We present an unusual case of gangrenous cholecystitis which was totally asymptomatic, with normal pre-operative parameters, and was discovered incidentally during a laparoscopic cholecystectomy. We have not found any similar cases in the published literature. Case presentation A 79-year-old British Caucasian man presented initially with acute cholecystitis which responded to conservative management. After six weeks he was asymptomatic and had normal blood parameters. An elective laparoscopic cholecystectomy was performed and our patient was found to have a totally gangrenous gall bladder. Conclusion It is important to keep a high index of suspicion for the diagnosis of gangrenous cholecystitis in order to avoid potentially serious complications. PMID:21600009

  5. Xanthogranulomatous cholecystitis mimicking gallbladder cancer.

    PubMed

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma

    2014-05-08

    Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer.

  6. A Giant Urethral Calculus.

    PubMed

    Sigdel, G; Agarwal, A; Keshaw, B W

    2014-01-01

    Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

  7. Simultaneous xanthogranulomatous cholecystitis and gallbladder cancer in a patient with a large abdominal aortic aneurysm.

    PubMed

    Al-Abed, Yahya; Elsherif, Mohammed; Firth, John; Borgstein, Rudi; Myint, Fiona

    2012-09-01

    There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.

  8. Obstructive uropathy and acute renal failure due to ureteral calculus in renal graft: a case report

    PubMed Central

    Lusenti, T.; Fiorini, F.; Barozzi, L.

    2009-01-01

    Introduction Obstructive uropathy caused by kidney stones is quite rare in transplant kidneys. Clinical case The authors report the case of a patient, previously gastrectomized for gastric carcinoma. He underwent renal transplantation using uretero-ureterostomy, and presented an episode of acute renal failure 7 years after surgery. Ultrasound (US) examination showed no sign of rejection but allowed detection of moderate hydronephrosis in the transplant kidney. Subsequent computed tomography (CT) revealed a kidney stone in the middle ureter at the crossing of the iliac vessels. The patient therefore urgently underwent percutaneous nephrostomy of the graft and recovered diuresis and renal function. The patient was transferred to the Transplant Center where he underwent ureterotomy with removal of the stone and subsequent ureteropyelostomy. Also transureteral resection of the prostate (TURP) was performed due to urinary retention of prostatic origin. Histological examination showed prostate carcinoma, Gleason stage 3, which was treated conservatively using radiotherapy without suspension of the administered low dose of immunotherapy. Discussion Calculosis is one of the least common causes of obstructive uropathy in transplant kidneys. In the described case, US examination performed after onset of renal insufficiency led to subsequent radiological investigation and resulting interventional procedures (nephrostomy and surgical removal of the stone) with complete recovery of pre-existing renal function. PMID:23397045

  9. Soft tissue gas gangrene: a severe complication of emphysematous cholecystitis.

    PubMed

    Safioleas, Michael; Stamatakos, Michael; Kanakis, Meletios; Sargedi, Constantina; Safioleas, Constantinos; Smirnis, Anastasios; Vaiopoulos, George

    2007-12-01

    Soft tissue gas gangrene with myonecrosis is a severe complication of traumatic and non-traumatic conditions with a potentially lethal outcome. Emphysematous cholecystitis is a complication of acute cholecystitis, which is characterized by air accumulation in the gallbladder wall and is reported in the literature as a rare causative factor of soft tissue gas gangrene. Here we report 4 patients who developed soft tissue gas gangrene as a complication of emphysematous cholecystitis. Two patients were female octogenarians (one with a history of diabetes mellitus), and underwent percutaneous trans-gallbladder drainage and fascia incisions of the affected soft tissue with prompt administration of antibiotics. Finally, both of them died. The other two patients were male (32 years old diabetic and 47 years old with a history of chronic alcoholism). They underwent open cholecystectomy. Fascia incisions of the gangrenous areas and antibiotic therapy administration were also performed. Both of them were discharged from the hospital and are currently in excellent clinical status. We also present the ultrasonographic and/or radiologic images of these four patients. Soft tissue gas gangrene may complicate emphysematous cholecystitis, and clinicians should be aware of the coexistence of these two clinical conditions, since immediate management is needed in order to prevent fatal outcome.

  10. PIPIDA scintigraphy for cholecystitis: false positives in alcoholism and total parenteral nutrition

    SciTech Connect

    Shuman, W.P.; Gibbs, P.; Rudd, T.G.; Mack, L.A.

    1982-01-01

    A review of gallbladder scintigraphy in patients with potentially compromised hepatobiliary function revealed two groups in whom cholecystitis might be mistakenly diagnosed. In 200 consecutive hospitalized patients studied with technetium-99m-PIPIDA for acute cholecystitis or cholestasis, there were 41 alcoholics and 17 patients on total parenteral nutrition. In 60% of the alcoholics and 92% of those on parenteral nutrition, absent or delayed visualization of the gallbladder occurred without physical or clinical evidence of cholecystitis. A cholecystagogue, sincalide, did not prevent the false-positive features which presumably are due to altered bile flow kinetics related to alcoholism and parenteral nutrition. Four patients on parenteral nutrition undergoing cholecystectomy for suspected cholecystitis had normal gallbladders filled with jellylike viscous thick bile. A positive (nonvisualized or delayed visualized) gallbladder PIPIDA scintigram in these two populations should not be interpreted as indicating a need for cholecystectomy.

  11. Flipping Calculus

    ERIC Educational Resources Information Center

    McGivney-Burelle, Jean; Xue, Fei

    2013-01-01

    In this paper we discuss flipping pedagogy and how it can transform the teaching and learning of calculus by applying pedagogical practices that are steeped in our understanding of how students learn most effectively. In particular, we describe the results of an exploratory study we conducted to examine the benefits and challenges of flipping a…

  12. Humanizing Calculus

    ERIC Educational Resources Information Center

    Cirillo, Michelle

    2007-01-01

    In this article, the author explores the history and the mathematics used by Newton and Leibniz in their invention of calculus. The exploration of this topic is intended to show students that mathematics is a human invention. Suggestions are made to help teachers incorporate the mathematics and the history into their own lessons. (Contains 3…

  13. How to image the gallbladder in suspected cholecystitis

    SciTech Connect

    Marton, K.I.; Doubilet, P.

    1988-11-01

    As a result of important advances in medical imaging, the oral cholecystogram is no longer the primary test of gallbladder function and anatomy. Real-time ultrasonography and cholescintigraphy, both highly sensitive and specific tests, are the two major methods for assessing gallbladder pathology. Oral cholecystography, endoscopic retrograde pancreatography, and percutaneous gallbladder puncture serve as supplementary tests. Decisions about which test to use depend on the kind of gallbladder disease that is suspected as well as the estimated likelihood of the disease before the information is obtained from the procedure. Thus, ultrasonography is the test of choice for chronic cholecystitis, with oral cholecystography reserved for situations in which the diagnosis is uncertain after ultrasonography. When acute cholecystitis is suspected, ultrasonography is also the test of choice in most patients, and cholescintigraphy is used to resolve uncertainty. 103 references.

  14. TG13 miscellaneous etiology of cholangitis and cholecystitis.

    PubMed

    Higuchi, Ryota; Takada, Tadahiro; Strasberg, Steven M; Pitt, Henry A; Gouma, Dirk J; Garden, O James; Büchler, Markus W; Windsor, John A; Mayumi, Toshihiko; Yoshida, Masahiro; Miura, Fumihiko; Kimura, Yasutoshi; Okamoto, Kohji; Gabata, Toshifumi; Hata, Jiro; Gomi, Harumi; Supe, Avinash N; Jagannath, Palepu; Singh, Harijt; Kim, Myung-Hwan; Hilvano, Serafin C; Ker, Chen-Guo; Kim, Sun-Whe

    2013-01-01

    This paper describes typical diseases and morbidities classified in the category of miscellaneous etiology of cholangitis and cholecystitis. The paper also comments on the evidence presented in the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG 07) published in 2007 and the evidence reported subsequently, as well as miscellaneous etiology that has not so far been touched on. (1) Oriental cholangitis is the type of cholangitis that occurs following intrahepatic stones and is frequently referred to as an endemic disease in Southeast Asian regions. The characteristics and diagnosis of oriental cholangitis are also commented on. (2) TG 07 recommended percutaneous transhepatic biliary drainage in patients with cholestasis (many of the patients have obstructive jaundice or acute cholangitis and present clinical signs due to hilar biliary stenosis or obstruction). However, the usefulness of endoscopic naso-biliary drainage has increased along with the spread of endoscopic biliary drainage procedures. (3) As for biliary tract infections in patients who underwent biliary tract surgery, the incidence rate of cholangitis after reconstruction of the biliary tract and liver transplantation is presented. (4) As for primary sclerosing cholangitis, the frequency, age of predilection and the rate of combination of inflammatory enteropathy and biliary tract cancer are presented. (5) In the case of acalculous cholecystitis, the frequency of occurrence, causative factors and complications as well as the frequency of gangrenous cholecystitis, gallbladder perforation and diagnostic accuracy are included in the updated Tokyo Guidelines 2013 (TG13). Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.

  15. Eosinophilic cholecystitis caused by Ascaris lumbricoides

    PubMed Central

    Montiel-Jarquín, Alvaro

    2008-01-01

    Eosinophilic cholecystitis is caused by the accumulation of eosinophils in the gallbladder wall and diagnosis is usually made based on histopathologic studies. The purpose of this paper is to comment on a case report published in World J Gastroenterol 2007 July; 13 (27): 3760-3762, about eosinophilic cholecystitis along with pericarditis without histopathological studies, which are considered necessary for its diagnosis. PMID:18461667

  16. Percutaneous Placement of Permanent Metallic Stents in the Cystic Duct to Treat Obstructive Cholecystitis.

    PubMed

    Brown, Nicholas I; Jhamb, Ashu; Brooks, Duncan M; Little, Andrew F

    2015-12-01

    This report presents a series of five patients unsuitable for surgery who had nonretrievable self-expanding metallic stents deployed along the cystic duct as treatment for benign and malignant causes of gallbladder obstruction. Techniques are described for draining cholecystitis, removing gallstones, bypassing gallbladder obstructions, and inserting metallic stents across the cystic duct to restore permanent antegrade gallbladder drainage in acute and chronic cholecystitis. Symptoms resolved in all cases, and stents remained patent for as long as 22 months. This procedure may be an effective alternative to cholecystectomy or long-term gallbladder drainage for patients in inoperable condition.

  17. [DISSEMINATION BY H. PYLORI IN PATIENTS, SUFFERING VARIOUS FORMS OF CHOLECYSTITIS].

    PubMed

    Kyazimov, I L; Takhmazova, Ch T

    2015-05-01

    Comparative analysis of dissemination by H. pylori of the bile portions in patients of a control group, suffering an acute calculous cholecystitis (ACCH), was performed. Dissemination of H. pylori in a control group was significantly less, than in a bile portions of patients, suffering ACCH. While analyzing the rate and degree of dissemination by H. pylori of the gastic and gallbladder mucosa biopsies of patients, suffering chronic non-calculous cholecystitis, associated with duodenogastric reflux and gastroduodenitis, bacteria were revealed trustworthy more often and in more number, than in a gallbladder mucosa in patients, suffering ACCH.

  18. Cystoisosporiasis-related human acalculous cholecystitis: the need for increased awareness.

    PubMed

    Agholi, Mahmoud; Aliabadi, Elham; Hatam, Gholam Reza

    2016-01-01

    Cholecystitis is one of the common surgical indications affecting human beings in many countries. A variety of infectious agents can be associated with acute or chronic acalculous cholecystitis, especially in HIV/AIDS patients. In this investigation, the authors aim to describe two cases of histologically and molecularly documented cystoisosporiasis (syn. isosporiasis) as the cause of chronic acalculous cholecystitis in two immunodeficient patients. During microscopic examinations of more than 2500 diarrheic patients' samples, 11 cases of cystoisosporiasis-related recurrent persistent/chronic diarrhea were detected. A review of the medical records of Cystoisospora belli (syn. Isospora belli)-positive patients showed that two of them, i.e. a patient with prolonged corticosteroid therapy and an AIDS patient, several months prior to fecal examinations had undergone cholecystectomy due to acalculous cholecystitis. The study was continued by a review of the histopathological investigation of the recuts prepared from the excised gallbladder tissue sections and stained with hematoxylin and eosin in order to detect a possible specific clinical correlation with cystoisosporiasis. Light microscopic examination revealed the presence of various developmental stages of a coccidial parasite, namely Cystoisospora belli, in both patients' gallbladder tissue sections. To the best of our knowledge, C. bellii-associated cholecystitis has not been previously reported in a patient with prolonged corticosteroid therapy.

  19. Expression of phenotypic markers of mast cells, macrophages and dendritic cells in gallbladder mucosa with calculous cholecystitis.

    PubMed

    Kasprzak, A A; Szmyt, M; Malkowski, W; Surdyk-Zasada, J; Przybyszewska, W; Szmeja, J; Helak-Łapaj, C; Seraszek-Jaros, A; Kaczmarek, E

    2013-12-01

    The study aimed at quantitative analysis of expression involving markers of mast cells (tryptase), monocytes/macrophages (CD68 molecule) and dendritic cells (S100 protein) in gallbladder mucosa with acute and chronic calculous cholecystitis. Routinely prepared tissue material from the patients with acute (ACC) (n = 16) and chronic calculous cholecystitis (CCC) (n = 55) was evaluated. Three cellular markers were localized by immunocytochemistry. Their expression was quantified using spatial visualization technique. The expression of tryptase was similar in acute and chronic cholecystitis. CD68 expression in ACC was significantly higher than in the CCC group. Expression of S100 protein was significantly higher in CCC as compared to the ACC group. No significant correlations were disclosed between expression of studied markers and grading in the gallbladder wall. A weak negative correlation was noted between expression of CD68 and number of gallstones in the CCC group. The spatial visualization technique allowed for a credible quantitative evaluation of expression involving markers of mast cells (MCs), monocytes/macrophages (Mo/Ma) and dendritic cells (DCs) in gallbladder mucosa with ACC and CCC. For the first time mucosal expression of S100 protein-positive DCs was evaluated in calculous cholecystitis. The results point to distinct functions of studied cell types in the non-specific immune response in calculous cholecystitis.

  20. Diagnosis and treatment of xanthogranulomatous cholecystitis: a report of 39 cases.

    PubMed

    Han, Sheng-Hua; Chen, Yan-Ling

    2012-11-01

    This study focuses on providing diagnosis and treatment for xanthogranulomatous cholecystitis (XGC). Clinical data from 39 patients diagnosed with XGC by pathological examination between 2002 and 2010 were analyzed retrospectively. As a result, in this group of patients, the male to female ratio was 30:9 and the average age of XGC onset was 62.2 years. Clinical manifestation of the disease was similar to general cholecystitis and preoperative CT examination showed that there were only 4 XGC cases, while the others were possibly misdiagnosed. Intraoperative observations showed that all the patients had gallbladder wall thickening. This was associated with gallbladder stones in 37 patients (94.9 %), choledocholith in 11 patients (28.2 %), and Mirizzi syndrome in 5 patients (12.8 %). In this study, intraoperative frozen section pathology was conducted in 14 patients and no gallbladder cancer was found. Laparoscopic cholecystectomy was performed on 7 patients, of which two were transferred to laparotomy. Of the remaining 32 cases, 25 were subjected to open cholecystectomy, 3 to partial cholecystectomy, and 4 to the cholecystectomy and partial liver wedge resection. It was concluded that XGC is a unique type of cholecystitis with atypical clinical manifestations and is often difficult to diagnose preoperatively. Pathological examination is a key to diagnose XGC and cholecystectomy is the primary surgical treatment. In patients with choledochectasia or jaundice, for whom we cannot exclude calculus of common bile duct, common bile duct exploration should be considered. The prognosis of XGC appears to be good with the above approaches.

  1. Cholecystitis

    MedlinePlus

    ... bile through your body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the production and flow of bile ... to your small intestine and shows blockage. A HIDA scan involves injecting a radioactive dye into your ...

  2. Xanthogranulomatous cholecystitis--a diagnostic challenge.

    PubMed

    Jetley, Sujata; Rana, Safia; Khan, Rehan Nabi; Jairajpuri, Zeeba Shamim

    2012-11-01

    Xanthogranulomatous cholecystitis is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammation of the gall bladder. The present study was undertaken to analyse the clinical presentation, pre-operative imaging, intra-operative findings and histological features of xanthogranulomatous cholecystitis and the results compared with those in the literature. Thirteen histologically confirmed cases of xanthogranulomatous cholecystitis were identified from the retrospective analysis of the patient records of 217 cholecystectomies performed during the period January 2011 to March 2012 at the Hakeem Abdul Hameed Centenary Hospital, New Delhi. The clinical, radiological and operative details of these patients have been analysed. The incidence of xanthogranulomatous cholecystitis was 6% and age range was between 25 and 62 years with a mean age of 40.3 years. A female: male ratio was 1.6:1. Chronic right upper quadrant pain was the most common clinical presentation. In 2 patients, a gall bladder carcinoma was suspected radiologically as well as clinically, but was later disproved on histology. Abdominal ultrasound scan showed marked thickening of the gall bladder wall in 11 cases (84.6%). Laproscopic procedure required conversion to an open procedure in 8 patients (61.5% conversion rate). Histologically focal or diffuse inflammation with foamy histiocytes, inflammatory cells, giant cells and fibroblasts in varying proportion were seen. Xanthogranulomatous cholecystitis is an unusual destructive inflammatory process, characterised by severe fibrosis and gall bladder wall thickening presenting as a gall bladder mass that mimics gall bladder carcinoma. The pre- and intra-operative differential diagnosis of the disease still remains a challenge to the practising surgeon and histological assessment of all gall bladders excised for xanthogranulomatous cholecystitis is critical, considering the occasional coexistence with gall bladder

  3. Calculus ABCs: A Gateway for Freshman Calculus

    ERIC Educational Resources Information Center

    Fulton, Scott R.

    2003-01-01

    This paper describes a gateway testing program designed to ensure that students acquire basic skills in freshman calculus. Students must demonstrate they have mastered standards for "Absolutely Basic Competency"--the Calculus ABCs--in order to pass the course with a grade of C or better. We describe the background, standards, and testing program.…

  4. Diffuse lymphoplasmacytic acalculous cholecystitis: a distinctive form of chronic cholecystitis associated with primary sclerosing cholangitis.

    PubMed

    Jessurun, J; Bolio-Solis, A; Manivel, J C

    1998-05-01

    Inflammation of the gallbladder is known to occur in patients with primary sclerosing cholangitis (PSC). However, the histological features of this form of cholecystitis have not been adequately defined. The aim of this study was to compare the inflammatory lesions of PSC-associated cholecystitis with those present in other cholecystopathies. The cases consisted of 11 gallbladders from patients with PSC who underwent liver transplantation. As controls, gallbladders from liver transplant patients with primary biliary cirrhosis (n = 4) and other chronic nonbiliary hepatopathies (n = 8), and 13 cholecystectomies from patients with chronic cholecystitis with (n = 10) and without (n = 3) lithiasis, were studied. The following histological features were tabulated on coded slides: presence, depth of involvement, and distribution of the inflammatory infiltrate, predominant cell type, presence of lymphoid aggregates, epithelial damage, metaplastic changes (pyloric or intestinal), fibrosis, smooth muscle hypertrophy, and presence of Rokitansky-Aschoff sinuses. At variance with the wide range of histological abnormalities present in other forms of chronic cholecystitis, most PSC-related cholecystitis showed a diffuse infiltrate (6 of 11) rich in plasma cells (6 of 11) predominantly confined to the lamina propria (9 of 11). The combination of these three features was present exclusively in PSC (5 of 11 PSC cholecystitis compared with 0 of 25 controls; P = .001). In conclusion, this study suggests that a characteristic form of cholecystitis may develop in patients with PSC.

  5. A complication of xanthogranulomatous cholecystitis with Mirizzi syndrome.

    PubMed

    Zhang, H-Y; Cao, X-D; Chen, J-J; Luo, Y-Q; Wang, X-C

    2015-05-01

    A patient had right upper quadrant pain with sclera was transferred from emergency room to the hospital, she was proposed to have acute cholecystitis, gallstones, obstructive jaundice, and a four-year history of gallbladder stones. The NMR results showed that the gallbladder was significantly enlarged and the gallbladder wall was thickening irregularly. The liver morphology was not abnormal except with extensive intrahepatic bile duct dilatation. The MRCP results demonstrated that the intrahepatic bile ducts were significant expanded. The ERCP results showed that duodenal stenosis and extra-hepatic bile duct stenosis. We placed a plastic stent of 8.5Fr and 12 cm in length in the hepatic duct, and after biliary plastic stent placement, jaundice was rapidly reduced and liver function was improved significantly. A surgery was performed and the final pathologic diagnosis is a complication of Xanthogranulomatous cholecystitis with Mirizzi syndrome. After the surgery of cholecystectomy and a bile duct repair were performed, the patient was recovered well. Conclusively, if a patient was diagnosed as biliary stricture, a biliary metal stent should not be placed until pathological diagnosis of malignancy.

  6. Ultrasonic evaluation of patients with acute right upper quadrant pain.

    PubMed

    Laing, F C; Federle, M P; Jeffrey, R B; Brown, T W

    1981-08-01

    To define the role of ultrasound in evaluating acute right upper quadrant pain, a prospective study was performed on 52 patients having clinically suspected acute cholecystitis. Ultrasonographic determination of acute or chronic cholecystitis, or diagnosis of a normal gallbladder, was based on analysis of location of tenderness, calculi, sludge, and wall thickness. The diagnosis of acute cholecystitis (34.6% of patients) was based on the highly significant observations of focal gallbladder tenderness and calculi. Sludge and wall thickening were also statistically significant, but to a lesser degree. Cholelithiasis allowed differentiation of patients with chronic cholecystitis (32.7%) from patients with normal gallbladders (32.7%). Neither of these two groups had significant focal gallbladder tenderness, sludge, or thickened walls. Because acute cholecystitis is found in the minority of patients with acute right upper quadrant pain, and because ultrasound is rapid, accurate, and noninvasive, it should be the initial modality used to evaluate these patients.

  7. Emphysematous cholecystitis in a Siberian husky.

    PubMed Central

    Armstrong, J A; Taylor, S M; Tryon, K A; Porter, C D

    2000-01-01

    A 6-year-old, intact male Siberian husky was evaluated for a 24-hour history of vomiting and lethargy. Diagnosis of emphysematous cholecystitis was achieved based on survey abdominal radiographs, a barium contrast gastrointestinal series, and abdominal ultrasound. Diagnosis and medical and surgical management of the condition are discussed. Images Figure 1. PMID:10642874

  8. Coexistence of xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: a fortuitous association?

    PubMed

    Limaiem, F; Chelly, B; Hassan, F; Haddad, I; Ben Slama, S; Lahmar, A; Bouraoui, S; Mzabi-Regaya, S

    2013-08-01

    Xanthogranulomatous cholecystitis is a relatively uncommon variant of chronic cholecystitis, characterized by marked thickening of the gallbladder wall and dense local adhesions. Not only does xanthogranulomatous cholecystitis mimic malignancy, it can also be infrequently associated with gallbladder carcinoma in 0.2% to 35.4% of cases. Herein, the authors report a new case of xanthogranulomatous cholecystitis concomitant with gallbladder adenocarcinoma in a 65-year-old female patient. Because of its overlapping clinical, radiological and macroscopic findings with gallbladder cancer, definitive diagnosis of xanthogranulomatous cholecystitis relies on extensive sampling and thorough microscopic examination of the surgical specimen to exclude the possibility of coexisting tumour. It is still a matter of debate whether xanthogranulomatous cholecystitis is truly a precursor of gallbladder carcinoma or if it is just an incidental finding. This aspect needs to be explored in the future with further studies.

  9. Calculus Demonstrations Using MATLAB

    ERIC Educational Resources Information Center

    Dunn, Peter K.; Harman, Chris

    2002-01-01

    The note discusses ways in which technology can be used in the calculus learning process. In particular, five MATLAB programs are detailed for use by instructors or students that demonstrate important concepts in introductory calculus: Newton's method, differentiation and integration. Two of the programs are animated. The programs and the…

  10. Initialized Fractional Calculus

    NASA Technical Reports Server (NTRS)

    Lorenzo, Carl F.; Hartley, Tom T.

    2000-01-01

    This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

  11. Teaching the Calculus

    ERIC Educational Resources Information Center

    Sauerheber, Richard D.

    2012-01-01

    Methods of teaching the Calculus are presented in honour of Sir Isaac Newton, by discussing an extension of his original proofs and discoveries. The methods, requested by Newton to be used that reflect the historical sequence of the discovered Fundamental Theorems, allow first-time students to grasp quickly the basics of the Calculus from its…

  12. Impact of Calculus Reform in a Liberal Arts Calculus Course.

    ERIC Educational Resources Information Center

    Brosnan, Patricia A.; Ralley, Thomas G.

    This report describes the changes in a freshman-level calculus course that occurred as a consequence of adopting the Harvard Consortium Calculus text. The perspective is that of the lecturer. The course is intended as an introduction to calculus for liberal arts students, that is, students who will not be expected to use calculus as a mathematical…

  13. Gangrenous cholecystitis: mortality and risk factors.

    PubMed

    Önder, Akın; Kapan, Murat; Ülger, Burak Veli; Oğuz, Abdullah; Türkoğlu, Ahmet; Uslukaya, Ömer

    2015-02-01

    As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 ± 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P < 0.001, P = 0.001, P = 0.044, P = 0.005, P = 0.049, P = 0.009, P = 0.022, P = 0.011, and P = 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

  14. Hermeneutic operative calculus

    NASA Astrophysics Data System (ADS)

    Ramakrishnan, Sivakumar; Isawasan, Pradeep; Mohanan, Vasuky

    2014-07-01

    The predicate calculus used currently by mathematical logic in computer science, philosophy and linguistic was found to be too restrictive and inadequate for describing the grammar of natural and artificial language. Therefore many higher order logics have been developed to overcome the limitation of predicate calculus. In this paper a new representation of logic using mathematical principles has been developed for the natural language called Hermeneutic Operative Calculus. This Hermeneutic Operative Calculus is a new language interpretive calculus developed to account for the syntactic, semantic and pragmatic features of natural language and allows removing the restrictions of any particular natural language in the semantic field its map out. The logic of Hermeneutic Operative Calculus capable of represent the syntactic and semantic of factual information of a natural language precisely in any language. The logic of this Hermeneutic Operative Calculus has two different forms of operations called object and meta-operations. The object operation allow for listing the various objects, picturing the various propositions and so forth. The meta-operation would specify what cannot be specified by the object operation like semantical stances of a proposition. The basic operative processes of linguistics and cognitive logic will be mathematically conceptualized and elaborated in this paper.

  15. A Logical Process Calculus

    NASA Technical Reports Server (NTRS)

    Cleaveland, Rance; Luettgen, Gerald; Bushnell, Dennis M. (Technical Monitor)

    2002-01-01

    This paper presents the Logical Process Calculus (LPC), a formalism that supports heterogeneous system specifications containing both operational and declarative subspecifications. Syntactically, LPC extends Milner's Calculus of Communicating Systems with operators from the alternation-free linear-time mu-calculus (LT(mu)). Semantically, LPC is equipped with a behavioral preorder that generalizes Hennessy's and DeNicola's must-testing preorder as well as LT(mu's) satisfaction relation, while being compositional for all LPC operators. From a technical point of view, the new calculus is distinguished by the inclusion of: (1) both minimal and maximal fixed-point operators and (2) an unimple-mentability predicate on process terms, which tags inconsistent specifications. The utility of LPC is demonstrated by means of an example highlighting the benefits of heterogeneous system specification.

  16. Xanthogranulomatous cholecystitis: a rare cause of digestive hemorrhage.

    PubMed

    Scheiwe, C; Muller, A; Rocas, D; Cotte, E

    2014-02-01

    Xanthogranulomatous cholecystitis is a rare affection with non-specific symptoms. It is essential to differentiate it from gall bladder adenocarcinoma. Presentation signs include hemorrhage or fistula. This report concerns a patient with pseudotumoral xanthogranulomatous cholecystitis who presented with gastrointestinal hemorrhage.

  17. Putting Differentials Back into Calculus

    ERIC Educational Resources Information Center

    Dray, Tevian; Manogue, Corrine A.

    2010-01-01

    We argue that the use of differentials in introductory calculus courses is useful and provides a unifying theme, leading to a coherent view of the calculus. Along the way, we meet several interpretations of differentials, some better than others.

  18. The History of the Calculus

    ERIC Educational Resources Information Center

    Harding, Simon; Scott, Paul

    2004-01-01

    Calculus is a mathematical concept that is fundamental to how we understand the world around us. Whether it is in the world of technology, finance, astronomy, sociology, medicine, calculus in one form or another can be found. This brief article describes the origins of calculus in Greece, further developments by Newton and Leibniz, and the…

  19. [A case of perforated xanthogranulomatous cholecystitis presenting as biloma].

    PubMed

    Ahn, Yeon Jeong; Kim, Tae Hyo; Moon, Sung Won; Choi, Su Nyoung; Kim, Hyun Jin; Jung, Woon Tae; Lee, Ok Jae; Ko, Gyung Hyuck

    2011-09-25

    Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.

  20. From Calculating to Calculus

    ERIC Educational Resources Information Center

    Steckroth, Jeffrey J.

    2010-01-01

    For nearly three decades, during which the author taught everything from basic algebra to advanced placement calculus, the author thought of himself as a secondary school mathematics teacher. The notion of teaching elementary school math never appealed to him because of its simplicity. The author stresses that anyone could teach children to count,…

  1. Tangent Lines without Calculus

    ERIC Educational Resources Information Center

    Rabin, Jeffrey M.

    2008-01-01

    This article presents a problem that can help high school students develop the concept of instantaneous velocity and connect it with the slope of a tangent line to the graph of position versus time. It also gives a method for determining the tangent line to the graph of a polynomial function at any point without using calculus. (Contains 1 figure.)

  2. Localized IgG4-related Cholecystitis Mimicking Gallbladder Cancer.

    PubMed

    Inoue, Tadahisa; Okumura, Fumihiro; Mizushima, Takashi; Nishie, Hirotada; Iwasaki, Hiroyasu; Anbe, Kaiki; Ozeki, Takanori; Kachi, Kenta; Fukusada, Shigeki; Suzuki, Yuta; Watanabe, Kazuko; Sano, Hitoshi

    2015-01-01

    We encountered a case of localized IgG4-cholecystitis mimicking gallbladder cancer with focal/segmental type1 autoimmune pancreatitis (AIP). In this case, we were unable to exclude a diagnosis of gallbladder cancer and thus performed radical cholecystectomy. Type1 AIP is often associated with gallbladder lesions, accompanied by generally diffuse, circumferential thickening of the gallbladder wall. Although localized IgG4-related cholecystitis is extremely rare, differentiating this condition from gallbladder cancer is often very difficult.

  3. Fractional calculus in bioengineering.

    PubMed

    Magin, Richard L

    2004-01-01

    Fractional calculus (integral and differential operations of noninteger order) is not often used to model biological systems. Although the basic mathematical ideas were developed long ago by the mathematicians Leibniz (1695), Liouville (1834), Riemann (1892), and others and brought to the attention of the engineering world by Oliver Heaviside in the 1890s, it was not until 1974 that the first book on the topic was published by Oldham and Spanier. Recent monographs and symposia proceedings have highlighted the application of fractional calculus in physics, continuum mechanics, signal processing, and electromagnetics, but with few examples of applications in bioengineering. This is surprising because the methods of fractional calculus, when defined as a Laplace or Fourier convolution product, are suitable for solving many problems in biomedical research. For example, early studies by Cole (1933) and Hodgkin (1946) of the electrical properties of nerve cell membranes and the propagation of electrical signals are well characterized by differential equations of fractional order. The solution involves a generalization of the exponential function to the Mittag-Leffler function, which provides a better fit to the observed cell membrane data. A parallel application of fractional derivatives to viscoelastic materials establishes, in a natural way, hereditary integrals and the power law (Nutting/Scott Blair) stress-strain relationship for modeling biomaterials. In this review, I will introduce the idea of fractional operations by following the original approach of Heaviside, demonstrate the basic operations of fractional calculus on well-behaved functions (step, ramp, pulse, sinusoid) of engineering interest, and give specific examples from electrochemistry, physics, bioengineering, and biophysics. The fractional derivative accurately describes natural phenomena that occur in such common engineering problems as heat transfer, electrode/electrolyte behavior, and sub

  4. Fatty meal ultrasonography in chronic acalculous cholecystitis

    PubMed Central

    Donen, Anna; Kantor, Robin

    2014-01-01

    Chronic acalculous cholecystits typically presents with biliary symptoms, normal blood tests and unremarkable ultrasound, computerized tomography and magnetic resonance cholangiopancreatography. However, cholescintigraphy may show reduced gallbladder ejection fraction (GBEF). There are no reports on using ultrasound to measure GBEF in adults. Twenty-eight patients with the above presentation underwent ultrasound before and after ingestion of a standardized fatty meal. Consequently, GBEF was calculated. Seven patients had reduced GBEFs (<38%). Two of these patients underwent cholecystectomy and both were found to have chronic gallbladder inflammation. Three patients with normal GBEFs underwent cholecystectomy and were also found to have chronic gallbladder inflammation. There may be a role for fatty meal ultrasonography in the diagnosis of chronic acalculous cholecystitis, but it should be used more widely in this patient cohort for its role to be established. It ideally needs to performed alongside cholescintigraphy for the comparison of accuracy. PMID:25409675

  5. Cholecystitis caused by infiltration of immature myeloid cells: a case report.

    PubMed

    Shimizu, Tetsuya; Tajiri, Takashi; Akimaru, Koho; Arima, Yasuo; Yokomuro, Shigeki; Yoshida, Hiroshi; Mamada, Yasuhiro; Taniai, Nobuhiko; Mizuguchi, Yoshiaki; Kawahigashi, Yutaka; Naito, Zenya

    2006-04-01

    A 59-year-old man with myelodysplastic syndrome who was hospitalized for evaluation of fever and generalized fatigue had elevated levels of C-reactive protein and pancytopenia. A search for a site of infection and empiric treatment with antibiotics were unsuccessful. Over 5 to 6 weeks right upper quadrant pain and rebound tenderness developed. Sonographic Murphys sign was present. Computed tomography showed thickening of the gallbladder wall, and repeated ultrasonography demonstrated changes consistent with cholecystitis. Open cholecystectomy was performed as an emergency procedure. Macroscopically the resected gallbladder showed an edematous and thickened wall. Histopathologic examination revealed transmural infiltration by atypical mononuclear cells with distinct nuclei. The cells showed immunohistochemical staining for CD15, indicating myeloid lineage. By 10 days after surgery, counts of leukocytes and leukoblasts had markedly increased, reaching 36,700/microL and 76.0%, respectively. The blast crisis was thought to indicate progression from myelodysplastic syndrome to leukemia. The patient died of progressive disease 12 days after surgery. We have described a rare case of acute cholecystitis caused by infiltration of immature myeloid cells to the gallbladder. An acute abdomen complicating hematologic disorders is life-threatening and requires prompt and appropriate treatment.

  6. Boolean integral calculus

    NASA Technical Reports Server (NTRS)

    Tucker, Jerry H.; Tapia, Moiez A.; Bennett, A. Wayne

    1988-01-01

    The concept of Boolean integration is developed, and different Boolean integral operators are introduced. Given the changes in a desired function in terms of the changes in its arguments, the ways of 'integrating' (i.e. realizing) such a function, if it exists, are presented. The necessary and sufficient conditions for integrating, in different senses, the expression specifying the changes are obtained. Boolean calculus has applications in the design of logic circuits and in fault analysis.

  7. Multiplicative calculus and its applications

    NASA Astrophysics Data System (ADS)

    Bashirov, Agamirza E.; Kurpinar, Emine Misirli; Özyapici, Ali

    2008-01-01

    Two operations, differentiation and integration, are basic in calculus and analysis. In fact, they are the infinitesimal versions of the subtraction and addition operations on numbers, respectively. In the period from 1967 till 1970 Michael Grossman and Robert Katz gave definitions of a new kind of derivative and integral, moving the roles of subtraction and addition to division and multiplication, and thus established a new calculus, called multiplicative calculus. In the present paper our aim is to bring up this calculus to the attention of researchers and demonstrate its usefulness.

  8. Early Vector Calculus: A Path through Multivariable Calculus

    ERIC Educational Resources Information Center

    Robertson, Robert L.

    2013-01-01

    The divergence theorem, Stokes' theorem, and Green's theorem appear near the end of calculus texts. These are important results, but many instructors struggle to reach them. We describe a pathway through a standard calculus text that allows instructors to emphasize these theorems. (Contains 2 figures.)

  9. Polynomial Calculus: Rethinking the Role of Calculus in High Schools

    ERIC Educational Resources Information Center

    Grant, Melva R.; Crombie, William; Enderson, Mary; Cobb, Nell

    2016-01-01

    Access to advanced study in mathematics, in general, and to calculus, in particular, depends in part on the conceptual architecture of these knowledge domains. In this paper, we outline an alternative conceptual architecture for elementary calculus. Our general strategy is to separate basic concepts from the particular advanced techniques used in…

  10. Polynomial calculus: rethinking the role of calculus in high schools

    NASA Astrophysics Data System (ADS)

    Grant, Melva R.; Crombie, William; Enderson, Mary; Cobb, Nell

    2016-08-01

    Access to advanced study in mathematics, in general, and to calculus, in particular, depends in part on the conceptual architecture of these knowledge domains. In this paper, we outline an alternative conceptual architecture for elementary calculus. Our general strategy is to separate basic concepts from the particular advanced techniques used in their definition and exposition. We develop the beginning concepts of differential and integral calculus using only concepts and skills found in secondary algebra and geometry. It is our underlining objective to strengthen students' knowledge of these topics in an effort to prepare them for advanced mathematics study. The purpose of this reconstruction is not to alter the teaching of limit-based calculus but rather to affect students' learning and understanding of mathematics in general by introducing key concepts during secondary mathematics courses. This approach holds the promise of strengthening more students' understanding of limit-based calculus and enhancing their potential for success in post-secondary mathematics.

  11. [A rare case of obstructive jaundice and cholecystitis in hepatic fascioliasis in Italy].

    PubMed

    Caprino, Paola; Ferranti, Fabrizio; Passa, Giuseppe; Quintiliani, Alberto

    2007-01-01

    The human infestation caused by Fasciola hepatica is a rare zoonosis, with an incidence of about 10 cases/year in Italy. We report a case of cholecystitis and obstructive jaundice in a patient affected by fascioliasis in which the diagnosis was secondary to the extraction of viable flukes from the bile duct during ERCP. The endoscopic examination permits, in addition to a rapid, correct diagnosis, direct clearance of the bile ducts. Oral drug therapy, when carried out following the endoscopic treatment, is aimed at killing any flukes potentially evading mechanical clearance. The healing achieved is confirmed by normalisation of antibody levels 6-12 months after therapy. Cholecystectomy is indicated and appropriate for the frequent occurrence of biliary colic related to acute and chronic cholecystitis and cholelithiasis, induced by the presence of the flukes. Infestation by Fasciola hepatica has to be considered among the differential diagnoses of obstructive jaundice. ERCP plays a major diagnostic and therapeutic role, and cholecystectomy, considering the pathogenetic effects of flukes on the organ, is mandatory.

  12. Haemorrhagic cholecystitis: an unusual cause of upper gastrointestinal bleeding.

    PubMed

    Hicks, Natalie

    2014-01-17

    Haemorrhagic cholecystitis is a rare cause of upper gastrointestinal bleeding and is a difficult diagnosis to make. This case report describes an orthopaedic patient, who developed deranged liver function tests and anaemia after a hemiarthroplasty of the hip. The patient had upper abdominal pain and black stools which clinically appeared to be melaena. An ultrasound scan of the abdomen was inconclusive, and therefore a CT was performed and the potential diagnosis of haemorrhagic cholecystitis was raised. An endoscopic evaluation of the upper gastrointestinal tract showed no evidence of other causes of upper gastrointestinal bleeding. Following an emergency laparotomy and cholecystectomy, she recovered well. This report aims to increase awareness about the uncommon condition of haemorrhagic cholecystitis, and to educate regarding clinical and radiological signs which lead to this diagnosis.

  13. Chronic cholecystitis with Cystoisospora belli in an immunocompetent patient.

    PubMed

    Takahashi, Hideo; Falk, Gavin A; Cruise, Michael; Morris-Stiff, Gareth

    2015-06-11

    A 47-year-old woman presented with a history of vague abdominal pain for several years, which worsened over the past 2 months, with pain more prominent in the right upper quadrant. She also had a history of peptic ulcer disease. The ultrasound scan of right upper quadrant revealed normal gallbladder and oesophagogastroduodenoscopy was unremarkable. A (99m)technetium labelled hepato iminodiacetic acid (HIDA) scan with cholecystokinin provocation demonstrated a decreased gallbladder ejection fraction (EF) of 32%. On this basis, the patient was diagnosed with biliary dyskinesia and underwent an elective laparoscopic cholecystectomy. Histopathological analysis revealed chronic cholecystitis with Cystoisospora belli identified in the gallbladder wall. Cystoisospora has been identified to cause an opportunistic acalculous cholecystitis among immunocompromised hosts, especially those with AIDS. This is the first case report of chronic cholecystitis due to C. belli in an immunocompetent patient.

  14. Calculus in the Middle School?

    ERIC Educational Resources Information Center

    Barger, Rita H.; McCoy, Ann C.

    2010-01-01

    This article presents an example of how middle school teachers can lay a foundation for calculus. Although many middle school activities connect directly to calculus concepts, the authors have decided to look in depth at only one: the concept of change. They will show how teachers can lead their students to see and appreciate the calculus…

  15. The Basic Principle of Calculus?

    ERIC Educational Resources Information Center

    Hardy, Michael

    2011-01-01

    A simple partial version of the Fundamental Theorem of Calculus can be presented on the first day of the first-year calculus course, and then relied upon repeatedly in assigned problems throughout the course. With that experience behind them, students can use the partial version to understand the full-fledged Fundamental Theorem, with further…

  16. The Calculus of a Vase

    ERIC Educational Resources Information Center

    Scherger, Nicole

    2012-01-01

    Of the most universal applications in integral calculus are those involved with finding volumes of solids of revolution. These profound problems are typically taught with traditional approaches of the disk and shell methods, after which most calculus curriculums will additionally cover arc length and surfaces of revolution. Even in these visibly…

  17. Evaluation of acute right upper quadrant pain: sonography and 99mTc-PIPIDA cholescintigraphy.

    PubMed

    Shuman, W P; Mack, L A; Rudd, T G; Rogers, J V; Gibbs, P

    1982-07-01

    A group of 75 patients with acute right upper quadrant pain was evaluated with both sonography and cholescintigraphy. Accuracy in screening for gallbladder disease was significantly greater with sonography (96%) than with cholescintigraphy (74%). For selecting patients with acute cholecystitis from this population that included acute and chronic cholecystitis as well as nonbiliary pathology, PIPIDA was less accurate (77%) than might be expected based on previous reports primarily due to false positive nonvisualization caused by chronic cholecystitis. Of patients with nonbiliary pathology, sonography was able to detect the cause of the right upper quadrant pain in 21%. Patients with acute right upper quadrant pain should first be screened with sonography. If cholescintigraphy is subsequently used for suspected acute cholecystitis, positive results should be interpreted with caution before surgery is planned.

  18. Evaluation of acute right upper quadrant pain: sonography and /sup 99m/Tc-PIPIDA cholescintigraphy

    SciTech Connect

    Shuman, W.P.; Mack, L.A.; Rudd, T.G.; Rogers, J.V.; Gibbs, P.

    1982-07-01

    A group of 75 patients with acute right upper quadrant pain was evaluated with both sonography and cholescintigraphy. Accuracy in screening for gallbladder disease was significantly greater with sonography (96%) than with cholescintigraphy (74%). For selecting patients with acute cholecystitis from this population that included acute and chronic cholecystitis as well as nonbiliary pathology, PIPIDA was less accurate (77%) than might be expected based on previous reports primarily due to false positive nonvisualization caused by chronic cholecystitis. Of patients with nonbiliary pathology, sonography was able to detect the cause of the right upper quadrant pain in 21%. Patients with acute right upper quadrant pain should first be screened with sonography. If cholescintigraphy is subsequently used for suspected acute cholecystitis, positive results should be interpreted with caution before surgery is planned.

  19. Experience with partial cholecystectomy in severe cholecystitis

    PubMed Central

    2013-01-01

    Backgrounds/Aims Partial cholecystectomy (PC) is often an inevitable operative procedure when Calot triangle is severely inflamed and fibrosed with conglomerated structures. We reviewed our clinical outcomes of PC to compare its feasibility with conventional total cholecystectomy (TC), especially for its possible application to laparoscopic procedure. Methods From Aug. 2000 to July 2008, 20 cases of PC by laparotomy were performed, including converted cases during laparoscopic cholecystectomy. Sixty-eight cases of TC by open method during the same period were compared in a mean follow-up period of 108 months. Results Bile fistula was observed in 3 cases of PC; one case needed endoscopic biliary stent for management and a second case showed fistula that closed by supportive care in 2 months. The last patient died from peritonitis. No bile fistula was observed in PC. Morbidities were found in 9 cases of PC (45%) and in 11 cases of TC (16.2%). Bile fistula (n=3) and wound infection (n=3) were prominent in the PC group, and wound infection (n=7) in the TC group. Reoperations were necessary for 5 (25.0%) and 4 (5.9%) patients from PC and TC, respectively. Mortality occurred in 2 (2/10 10%) and 4 cases (4/68 5.9%) of PC and TC, respectively. Two mortalities in each group resulted from direct extension of cholecystitis. Conclusions Considering the higher risks of complications and mortality, PC should be avoided as long as possible, and patients should always be informed of its clinical outcomes postoperatively. Further elaboration of a safer operative plan should be sought. PMID:26155235

  20. Leveraging Prior Calculus Study with Embedded Review

    ERIC Educational Resources Information Center

    Nikolov, Margaret C.; Withers, Wm. Douglas

    2016-01-01

    We propose a new course structure to address the needs of college students with previous calculus study but no course validations as an alternative to repeating the first year of calculus. Students are introduced directly to topics from Calculus III unpreceded by a formal review of topics from Calculus I or II, but with additional syllabus time…

  1. Open Calculus: A Free Online Learning Environment

    ERIC Educational Resources Information Center

    Korey, Jane; Rheinlander, Kim; Wallace, Dorothy

    2007-01-01

    Dartmouth College mathematicians have developed a free online calculus course called "Open Calculus." Open Calculus is an exportable distance-learning/self-study environment for learning calculus including written text, nearly 4000 online homework problems and instructional videos. The paper recounts the evaluation of course elements since 2000 in…

  2. A Simple Acronym for Doing Calculus: CAL

    ERIC Educational Resources Information Center

    Hathaway, Richard J.

    2008-01-01

    An acronym is presented that provides students a potentially useful, unifying view of the major topics covered in an elementary calculus sequence. The acronym (CAL) is based on viewing the calculus procedure for solving a calculus problem P* in three steps: (1) recognizing that the problem cannot be solved using simple (non-calculus) techniques;…

  3. A generalized nonlocal vector calculus

    NASA Astrophysics Data System (ADS)

    Alali, Bacim; Liu, Kuo; Gunzburger, Max

    2015-10-01

    A nonlocal vector calculus was introduced in Du et al. (Math Model Meth Appl Sci 23:493-540, 2013) that has proved useful for the analysis of the peridynamics model of nonlocal mechanics and nonlocal diffusion models. A formulation is developed that provides a more general setting for the nonlocal vector calculus that is independent of particular nonlocal models. It is shown that general nonlocal calculus operators are integral operators with specific integral kernels. General nonlocal calculus properties are developed, including nonlocal integration by parts formula and Green's identities. The nonlocal vector calculus introduced in Du et al. (Math Model Meth Appl Sci 23:493-540, 2013) is shown to be recoverable from the general formulation as a special example. This special nonlocal vector calculus is used to reformulate the peridynamics equation of motion in terms of the nonlocal gradient operator and its adjoint. A new example of nonlocal vector calculus operators is introduced, which shows the potential use of the general formulation for general nonlocal models.

  4. Cartooning in Algebra and Calculus

    ERIC Educational Resources Information Center

    Moseley, L. Jeneva

    2014-01-01

    This article discusses how teachers can create cartoons for undergraduate math classes, such as college algebra and basic calculus. The practice of cartooning for teaching can be helpful for communication with students and for students' conceptual understanding.

  5. ``Riemann equations'' in bidifferential calculus

    NASA Astrophysics Data System (ADS)

    Chvartatskyi, O.; Müller-Hoissen, F.; Stoilov, N.

    2015-10-01

    We consider equations that formally resemble a matrix Riemann (or Hopf) equation in the framework of bidifferential calculus. With different choices of a first-order bidifferential calculus, we obtain a variety of equations, including a semi-discrete and a fully discrete version of the matrix Riemann equation. A corresponding universal solution-generating method then either yields a (continuous or discrete) Cole-Hopf transformation, or leaves us with the problem of solving Riemann equations (hence an application of the hodograph method). If the bidifferential calculus extends to second order, solutions of a system of "Riemann equations" are also solutions of an equation that arises, on the universal level of bidifferential calculus, as an integrability condition. Depending on the choice of bidifferential calculus, the latter can represent a number of prominent integrable equations, like self-dual Yang-Mills, as well as matrix versions of the two-dimensional Toda lattice, Hirota's bilinear difference equation, (2+1)-dimensional Nonlinear Schrödinger (NLS), Kadomtsev-Petviashvili (KP) equation, and Davey-Stewartson equations. For all of them, a recent (non-isospectral) binary Darboux transformation result in bidifferential calculus applies, which can be specialized to generate solutions of the associated "Riemann equations." For the latter, we clarify the relation between these specialized binary Darboux transformations and the aforementioned solution-generating method. From (arbitrary size) matrix versions of the "Riemann equations" associated with an integrable equation, possessing a bidifferential calculus formulation, multi-soliton-type solutions of the latter can be generated. This includes "breaking" multi-soliton-type solutions of the self-dual Yang-Mills and the (2+1)-dimensional NLS equation, which are parametrized by solutions of Riemann equations.

  6. The Power of Investigative Calculus Projects

    ERIC Educational Resources Information Center

    Perrin, John Robert; Quinn, Robert J.

    2008-01-01

    This article describes investigative calculus projects in which students explore a question or problem of their own construction. Three exemplary pieces of student work are showcased. Investigative calculus projects are an excellent way to foster student understanding and interest in calculus. (Contains 4 figures.)

  7. An AP Calculus Classroom Amusement Park

    ERIC Educational Resources Information Center

    Ferguson, Sarah

    2016-01-01

    Throughout the school year, AP Calculus teachers strive to teach course content comprehensively and swiftly in an effort to finish all required material before the AP Calculus exam. As early May approaches and the AP Calculus test looms, students and teachers nervously complete lessons, assignments, and assessments to ensure student preparation.…

  8. Calculus Student Understanding of Continuity

    ERIC Educational Resources Information Center

    Wangle, Jayleen Lillian

    2013-01-01

    Continuity is a central concept in calculus. Yet very few students seem to understand the nature of continuity. The research described was conducted in two stages. Students were asked questions in multiple choice and true/false format regarding function, limit and continuity. These results were used to identify participants as strong, weak or…

  9. Portfolio Analysis for Vector Calculus

    ERIC Educational Resources Information Center

    Kaplan, Samuel R.

    2015-01-01

    Classic stock portfolio analysis provides an applied context for Lagrange multipliers that undergraduate students appreciate. Although modern methods of portfolio analysis are beyond the scope of vector calculus, classic methods reinforce the utility of this material. This paper discusses how to introduce classic stock portfolio analysis in a…

  10. Constructivized Calculus in College Mathematics

    ERIC Educational Resources Information Center

    Lawrence, Barbara Ann

    2012-01-01

    The purpose of this study is to present some of the classical concepts, definitions, and theorems of calculus from the constructivists' point of view in the spirit of the philosophies of L.E.J. Brouwer and Errett Bishop. This presentation will compare the classical statements to the constructivized statements. The method focuses on giving…

  11. Calculus Students' Understanding of Volume

    ERIC Educational Resources Information Center

    Dorko, Allison; Speer, Natasha M.

    2013-01-01

    Researchers have documented difficulties that elementary school students have in understanding volume. Despite its importance in higher mathematics, we know little about college students' understanding of volume. This study investigated calculus students' understanding of volume. Clinical interview transcripts and written responses to volume…

  12. Mathematical Features of the Calculus

    ERIC Educational Resources Information Center

    Sauerheber, Richard D.

    2010-01-01

    The fundamental theorems of the calculus describe the relationships between derivatives and integrals of functions. The value of any function at a particular location is the definite derivative of its integral and the definite integral of its derivative. Thus, any value is the magnitude of the slope of the tangent of its integral at that position,…

  13. Reading the World with Calculus

    ERIC Educational Resources Information Center

    Verzosa, Debbie

    2015-01-01

    It is now increasingly recognized that mathematics is not a neutral value-free subject. Rather, mathematics can challenge students' taken-for-granted realities and promote action. This article describes two issues, namely deforestation and income inequality. These were specifically chosen because they can be related to a range of calculus concepts…

  14. The Pendulum and the Calculus.

    ERIC Educational Resources Information Center

    Sworder, Steven C.

    A pair of experiments, appropriate for the lower division fourth semester calculus or differential equations course, are presented. The second order differential equation representing the equation of motion of a simple pendulum is derived. The period of oscillation for a particular pendulum can be predicted from the solution to this equation. As a…

  15. Children, Additive Change, and Calculus.

    ERIC Educational Resources Information Center

    Nemirovsky, Ricardo; And Others

    Students can learn to solve problems of qualitative integration and differentiation independently of their study of formal calculus or algebra. This exploratory study investigated the basic intuitions that elementary school children construct in their daily experience with physical and symbolic change. Elementary school children (n=18) were…

  16. Conceptual Knowledge in Introductory Calculus.

    ERIC Educational Resources Information Center

    White, Paul; Mitchelmore, Michael

    1996-01-01

    Responses to rate-of-change problems were collected during and after 24 hours of conceptual calculus instruction given to first-year university students. Analysis revealed three categories of error in which variables were treated as symbols to be manipulated rather than quantities to be related. Contains test questions. (Author/MKR)

  17. Factors Associated with Success in College Calculus II

    ERIC Educational Resources Information Center

    Rosasco, Margaret E.

    2013-01-01

    Students are entering college having earned credit for college Calculus 1 based on their scores on the College Board's Advanced Placement (AP) Calculus AB exam. Despite being granted credit for college Calculus 1, it is unclear whether these students are adequately prepared for college Calculus 2. College calculus classes are often taught from a…

  18. Complexity and the Fractional Calculus

    DTIC Science & Technology

    2013-01-01

    Paolo Grigolini,, Mauro Bologna,, Bruce West 611102 c. THIS PAGE The public reporting burden for this collection of information is estimated to...dx.doi.org/10.1155/2013/498789 Research Article Complexity and the Fractional Calculus Pensri Pramukkul,1 Adam Svenkeson,1 Paolo Grigolini,1 Mauro ...8. PERFORMING ORGANIZATION REPORT NUMBER 19a. NAME OF RESPONSIBLE PERSON 19b. TELEPHONE NUMBER Paolo Grigolini Pensri Pramukkul, Adam Svenkeson

  19. Obstructive cholelithiasis and cholecystitis in a kinkajou (Potos flavus).

    PubMed

    Potier, Romain; Reineau, Olivier

    2015-03-01

    A 14.5-yr-old female kinkajou (Potos flavus) was diagnosed with cholelithiasis after an episode of vomiting; diagnostics included biochemical analysis and abdominal ultrasound exam. Despite antimicrobial treatment, cholelithiasis led to cholecystitis. A cholecystotomy was performed to remove choleliths and inspissated bile. Morphological and spectroscopic properties of the choleliths were similar to those of gallstones from the brown pigment family and Streptococcus sp. and Escherichia coli were isolated from the bile. Biliary tract infection is directly related to pathogenesis of brown pigment gallstones. Serial ultrasound exams revealed that cholecystitis developed secondary to the presence of gallstones in the biliary tree. Despite full recovery postsurgery, the patient died 15 mo later from gallbladder necrosis. Based on the progression of this case, a cholecystectomy would be preferred over a cholecystotomy in similar cases, and the efficacy of long-acting antibiotics may not be adequate in nontarget species. Gallstones and biliary tract infection are rarely described in small domestic carnivores, and this is the first reported case in a kinkajou.

  20. Heterogenous wall thickening of gall blabber: xanthogranulomatous cholecystitis or carcinoma, with type 3 choledochal cyst.

    PubMed

    Darji, Parth; Thakkar, Gurudatt; Prajapati, Sanjay

    2012-06-21

    Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterised by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. The authors present a case of xanthogranulomatous cholecystitis with type 3 choledochal cyst in a 20-year-old man who was referred to our hospital with a 1-week history of abdominal pain and fever. He underwent endoscopic sphincterotomy and then open cholecystectomy. A histological diagnosis of xanthogranulomatous cholecystitis was made.

  1. Generalized vector calculus on convex domain

    NASA Astrophysics Data System (ADS)

    Agrawal, Om P.; Xu, Yufeng

    2015-06-01

    In this paper, we apply recently proposed generalized integral and differential operators to develop generalized vector calculus and generalized variational calculus for problems defined over a convex domain. In particular, we present some generalization of Green's and Gauss divergence theorems involving some new operators, and apply these theorems to generalized variational calculus. For fractional power kernels, the formulation leads to fractional vector calculus and fractional variational calculus for problems defined over a convex domain. In special cases, when certain parameters take integer values, we obtain formulations for integer order problems. Two examples are presented to demonstrate applications of the generalized variational calculus which utilize the generalized vector calculus developed in the paper. The first example leads to a generalized partial differential equation and the second example leads to a generalized eigenvalue problem, both in two dimensional convex domains. We solve the generalized partial differential equation by using polynomial approximation. A special case of the second example is a generalized isoperimetric problem. We find an approximate solution to this problem. Many physical problems containing integer order integrals and derivatives are defined over arbitrary domains. We speculate that future problems containing fractional and generalized integrals and derivatives in fractional mechanics will be defined over arbitrary domains, and therefore, a general variational calculus incorporating a general vector calculus will be needed for these problems. This research is our first attempt in that direction.

  2. Dental Calculus Arrest of Dental Caries

    PubMed Central

    Keyes, Paul H.; Rams, Thomas E.

    2016-01-01

    Background An inverse relationship between dental calculus mineralization and dental caries demineralization on teeth has been noted in some studies. Dental calculus may even form superficial layers over existing dental caries and arrest their progression, but this phenomenon has been only rarely documented and infrequently considered in the field of Cariology. To further assess the occurrence of dental calculus arrest of dental caries, this study evaluated a large number of extracted human teeth for the presence and location of dental caries, dental calculus, and dental plaque biofilms. Materials and methods A total of 1,200 teeth were preserved in 10% buffered formal saline, and viewed while moist by a single experienced examiner using a research stereomicroscope at 15-25× magnification. Representative teeth were sectioned and photographed, and their dental plaque biofilms subjected to gram-stain examination with light microscopy at 100× magnification. Results Dental calculus was observed on 1,140 (95%) of the extracted human teeth, and no dental carious lesions were found underlying dental calculus-covered surfaces on 1,139 of these teeth. However, dental calculus arrest of dental caries was found on one (0.54%) of 187 evaluated teeth that presented with unrestored proximal enamel caries. On the distal surface of a maxillary premolar tooth, dental calculus mineralization filled the outer surface cavitation of an incipient dental caries lesion. The dental calculus-covered carious lesion extended only slightly into enamel, and exhibited a brown pigmentation characteristic of inactive or arrested dental caries. In contrast, the tooth's mesial surface, without a superficial layer of dental calculus, had a large carious lesion going through enamel and deep into dentin. Conclusions These observations further document the potential protective effects of dental calculus mineralization against dental caries. PMID:27446993

  3. First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS.

    PubMed

    Agholi, Mahmoud; Heidarian, Hamid Reza; Moghadami, Mohsen; Hatam, Gholam Reza

    2014-06-01

    Acalculous cholecystitis and cholangitis are increasingly being recognized as complications of AIDS. The opportunistic parasites that have been most commonly associated with these disorders are Cryptosporidium species, Isospora belli, Cyclospora cayetanensis and Enterocytozoon bieneusi. The authors performed a parasitological survey on the gallbladder tissue sections of patients underwent cholecystectomy due to chronic acalculous cholecystitis at the Shiraz University of Medical Sciences, Iran. Light microscopic investigation in more than three hundred archived histopathological slides revealed the presence of sexual stages (i.e., mature sporocysts) of a coccidial protozoan in a patient with AIDS who developed acalculous cholecystitis as confirmed by histological, parasitological and molecular tests in which Sarcocystis species was the only identifiable pathogen in gallbladder sections. In the best of our knowledge it's the first documented case of chronic non-calculous cholecystitis due to Sarcocystis parasite in an Iranian AIDS patient from worldwide.

  4. Catheterization of the gallbladder: A novel mouse model of severe acute cholangitis

    PubMed Central

    Yu, Jian-Hua; Tang, Hai-Jun; Zhang, Wei-Guang; Zhu, Zhi-Yang; Ruan, Xin-Xian; Lu, Bao-Chun

    2017-01-01

    AIM To establish a severe acute cholangitis (SAC) model in mice. METHODS Cholecystic catheterization was performed under the condition of bile duct ligation (BDL). Trans-cholecystic injection of lipopolysaccharide (LPS) was defined as the SAC animal model. Sham operation group, intraperitoneal injection of LPS without BDL group, intraperitoneal injection of LPS with BDL group and trans-cholecystic injection of normal saline with BDL group were defined as control groups. The survival rates and tissue injuries in liver, lungs and kidney were evaluated. RESULTS Mice in the SAC group showed a time-dependent mortality and much more severe tissue injuries in liver, lungs and kidney, compared with other groups. However, relieving biliary obstruction could effectively reduce mortality and attenuate liver injury in the SAC mouse model. CONCLUSION Trans-cholecystic injection of LPS under the condition of biliary obstruction could establish a repeatable and reversible mouse model of SAC. PMID:28348482

  5. Study on bioactive compounds of in vitro cultured Calculus Suis and natural Calculus Bovis.

    PubMed

    Wan, Tien-Chun; Cheng, Fu-Yuan; Liu, Yu-Tse; Lin, Liang-Chuan; Sakata, Ryoichi

    2009-12-01

    The purpose of the study was to investigate bioactive compounds of in vitro cultured Calculus Suis and natural Calculus Bovis obtained as valuable by-products from animals used for meat production. The results showed that the components of natural Calculus Bovis were rich in bilirubin and biliverdin and had higher content of essential amino acids. The major amino acids of in vitro cultured Calculus Suis were identified as glycine, alanine, glutamic acid and aspartic acid, and those for natural Calculus Bovis were found to be glutamic acid, aspartic acid, proline, and arginine. The methionine and cysteine contents of precursors for glutathione in natural Calculus Bovis were significantly higher than those of in vitro cultured Calculus Suis. The mineral contents of zinc, iron and manganese of natural Calculus Bovis were significantly higher than those of in vitro cultured Calculus Suis. The major bile acids in both products were cholic acid and dehydrocholic acid, respectively. The chenodeoxycholic and ursodeoxycholic acid content of in vitro cultured Calculus Suis was significantly higher than that of natural Calculus Bovis.

  6. Calculus and Success in a Business School

    ERIC Educational Resources Information Center

    Kim, Dong-gook; Garcia, Fernando; Dey, Ishita

    2012-01-01

    Many business schools or colleges require calculus as a prerequisite for certain classes or for continuing to upper division courses. While there are many studies investigating the relationship between performance in calculus and performance in a single course, such as economics, statistics, and finance, there are very few studies investigating…

  7. A Cross-National Study of Calculus

    ERIC Educational Resources Information Center

    Chai, Jun; Friedler, Louis M.; Wolff, Edward F.; Li, Jun; Rhea, Karen

    2015-01-01

    The results from a cross-national study comparing calculus performance of students at East China Normal University (ECNU) in Shanghai and students at the University of Michigan before and after their first university calculus course are presented. Overall, ECNU significantly outperformed Michigan on both the pre- and post-tests, but the Michigan…

  8. Educating about Sustainability while Enhancing Calculus

    ERIC Educational Resources Information Center

    Pfaff, Thomas J.

    2011-01-01

    We give an overview of why it is important to include sustainability in mathematics classes and provide specific examples of how to do this for a calculus class. We illustrate that when students use "Excel" to fit curves to real data, fundamentally important questions about sustainability become calculus questions about those curves. (Contains 5…

  9. Calculus: An Active Approach with Projects.

    ERIC Educational Resources Information Center

    Hilbert, Stephen; And Others

    1993-01-01

    Discusses a pedagogical approach to calculus based on the question: What kinds of problems should students be able to solve? Includes a discussion of types of problems and curriculum threads for such a course. Describes a projects-based calculus with examples of projects and classroom activities. (Author/MDH)

  10. Attendance and Attainment in a Calculus Course

    ERIC Educational Resources Information Center

    Meulenbroek, Bernard; van den Bogaard, Maartje

    2013-01-01

    In this paper the relationship between attendance and attainment in a standard calculus course is investigated. Calculus could in principle be studied without attending lectures due to the wealth of material available (in hardcopy and online). However, in this study we will show that the pass rate of students attending classes regularly (>75%…

  11. Imagine Yourself in This Calculus Classroom

    ERIC Educational Resources Information Center

    Bryan, Luajean

    2007-01-01

    The efforts to attract students to precalculus, trigonometry, and calculus classes became more successful at the author's school when projects-based classes were offered. Data collection from an untethered hot air balloon flight for calculus students was planned to maximize enrollment. The data were analyzed numerically, graphically, and…

  12. Calculus: An Active Approach with Projects.

    ERIC Educational Resources Information Center

    Hilbert, Steve; And Others

    Ithaca College, in New York, has developed and tested a projects-based first-year calculus course over the last 3 years which uses the graphs of functions and physical phenomena to illustrate and motivate the major concepts of calculus and to introduce students to mathematical modeling. The course curriculum is designed to: (1) emphasize on the…

  13. Hyalinizing cholecystitis with features of immunoglobulin G4-related disease-coincidence or an unrecognized association? A case report.

    PubMed

    Gupta, Rajib K; Patton, Kurt T

    2015-04-01

    Hyalinizing cholecystitis (HC) is a recently described rare subtype of chronic cholecystitis characterized by dense, paucicellular collagenous transmural fibrosis, which usually replaces the mucosa and muscularis propria. Immunoglobulin (Ig)G4-associated cholecystitis is also a newly described cholecystitis variant characterized by transmural or extramural lymphoplasmacytic inflammation, lymphoid follicles, storiform fibrosis, phlebitis, and increased tissue IgG4-positive plasma cells. We describe a case of cholecystitis in an elderly white man who harbored features of both HC and IgG4-associated cholecystitis. In retrospect, the patient also had a significantly elevated serum IgG4 level. To the best of our knowledge, an association between HC and IgG4-related disease has not been previously described in the literature. Although not entirely conclusive, our observations raise the possibility that some cases of HC represent the end stage of IgG4-related disease.

  14. [Some aspects of the complex treatment of acute suppurative perionitis].

    PubMed

    Kovalev, M M; Roĭ, V P; Zaritskiĭ, I; Konovalenko, V V; Mellin, V M

    1976-10-01

    The authors present an analysis of the results of complex treatment in 4318 patients operated upon for acute peritonitis, caused by acute appendicitis, perforating gastric and duodenal ulcers, acute cholecystitis, ruptures and perforations of the intestine and other surgical and gynecological diseases. Patients with diffuse purulent peritonitis showed marked disorders in protein-aminoacid, nitrogen, and water electrolyte metabolism, acid-base balance, a reduced nonspecific immune responsiveness of the organism. Therpeutic tactics was delineated taking into account the revealed changes.

  15. Using Dynamic Software to Address Common College Calculus Stumbling Blocks

    ERIC Educational Resources Information Center

    Seneres, Alice W.; Kerrigan, John A.

    2014-01-01

    There are specific topics in college calculus that can be major stumbling blocks for students. Having taught college calculus for four years to over a thousand students, we observed that even the students who have already taken pre-calculus or calculus during their high school careers had common misunderstandings. Students may remember a technique…

  16. Calculus: The Dynamics of Change. MAA Notes Number 39.

    ERIC Educational Resources Information Center

    Roberts, A. Wayne, Ed.

    This book discusses the calculus reform effort. The first essay captures the basic themes that should characterize a calculus course that is modern in its vision as well as its pedagogy and content. The next section contains essays on the vision of calculus reform: "Visions of Calculus" (Sharon Cutler Ross); "Nonalgebraic Approaches…

  17. The Impact of Taking a College Pre-Calculus Course on Students' College Calculus Performance

    ERIC Educational Resources Information Center

    Sonnert, Gerhard; Sadler, Philip M.

    2014-01-01

    Poor performance on placement exams keeps many US students who pursue a STEM (science, technology, engineering, mathematics) career from enrolling directly in college calculus. Instead, they must take a pre-calculus course that aims to better prepare them for later calculus coursework. In the USA, enrollment in pre-calculus courses in two- and…

  18. Motivation and Study Habits of College Calculus Students: Does Studying Calculus in High School Make a Difference?

    ERIC Educational Resources Information Center

    Gibson, Megan

    2013-01-01

    Due in part to the growing popularity of the Advanced Placement program, an increasingly large percentage of entering college students are enrolling in calculus courses having already taken calculus in high school. Many students do not score high enough on the AP calculus examination to place out of Calculus I, and many do not take the…

  19. Recursive sequences in first-year calculus

    NASA Astrophysics Data System (ADS)

    Krainer, Thomas

    2016-02-01

    This article provides ready-to-use supplementary material on recursive sequences for a second-semester calculus class. It equips first-year calculus students with a basic methodical procedure based on which they can conduct a rigorous convergence or divergence analysis of many simple recursive sequences on their own without the need to invoke inductive arguments as is typically required in calculus textbooks. The sequences that are accessible to this kind of analysis are predominantly (eventually) monotonic, but also certain recursive sequences that alternate around their limit point as they converge can be considered.

  20. Abdominal ultrasound in patients with acute right upper quadrant pain.

    PubMed

    Philbrick, T H; Kaude, J V; McInnis, A N; Wright, P G

    1981-01-01

    Ultrasonography was performed as the first imaging procedure in 100 patients who presented with acute right upper quadrant pain suggestive of cholecystitis or cholelithiasis. In the final analysis 46 patients were found to have gallbladder disease (40 patients with cholelithiasis, 5 with acalculous cholecystitis, and 1 with a cholesterol polyp in the gallbladder). In 22 of 54 patients with a normal gallbladder, other abdominal disease was found. The error rate for ultrasound was 5%, and in 4 patients ultrasound was not the suitable procedure for the diagnosis. In 91 patients the ultrasonographic diagnosis was correct.

  1. Generalized Laplace Transforms and Extended Heaviside Calculus

    ERIC Educational Resources Information Center

    Deakin, Michael A. B.

    2008-01-01

    An extended Heaviside calculus proposed by Peraire in a recent paper is similar to a generalization of the Laplace transform proposed by the present author. This similarity will be illustrated by analysis of an example supplied by Peraire.

  2. Applications of Monte Carlo Methods in Calculus.

    ERIC Educational Resources Information Center

    Gordon, Sheldon P.; Gordon, Florence S.

    1990-01-01

    Discusses the application of probabilistic ideas, especially Monte Carlo simulation, to calculus. Describes some applications using the Monte Carlo method: Riemann sums; maximizing and minimizing a function; mean value theorems; and testing conjectures. (YP)

  3. Extending stochastic network calculus to loss analysis.

    PubMed

    Luo, Chao; Yu, Li; Zheng, Jun

    2013-01-01

    Loss is an important parameter of Quality of Service (QoS). Though stochastic network calculus is a very useful tool for performance evaluation of computer networks, existing studies on stochastic service guarantees mainly focused on the delay and backlog. Some efforts have been made to analyse loss by deterministic network calculus, but there are few results to extend stochastic network calculus for loss analysis. In this paper, we introduce a new parameter named loss factor into stochastic network calculus and then derive the loss bound through the existing arrival curve and service curve via this parameter. We then prove that our result is suitable for the networks with multiple input flows. Simulations show the impact of buffer size, arrival traffic, and service on the loss factor.

  4. One Answer to "What Is Calculus?"

    ERIC Educational Resources Information Center

    Shilgalis, Thomas W.

    1979-01-01

    A number of questions are posed that can be answered with the aid of calculus. These include best value problems, best shape problems, problems involving integration, and growth and decay problems. (MP)

  5. Generalized Cartan Calculus in general dimension

    DOE PAGES

    Wang, Yi -Nan

    2015-07-22

    We develop the generalized Cartan Calculus for the groups G = SL(2,R) × R+, SL(5,R) and SO(5,5). They are the underlying algebraic structures of d=9,7,6 exceptional field theory, respectively. These algebraic identities are needed for the "tensor hierarchy" structure in exceptional field theory. The validity of Poincar\\'e lemmas in this new differential geometry is also discussed. Lastly, we explore some possible extension of the generalized Cartan calculus beyond the exceptional series.

  6. IgG4-related cholecystitis presenting as biliary malignancy: report of three cases.

    PubMed

    Feely, Michael M; Gonzalo, David H; Corbera, Montserrat; Hughes, Steven J; Trevino, Jose G

    2014-09-01

    An increased awareness of IgG4-related diseases has led to an escalation in the number of sites known to be involved by this fibroinflammatory disease. We report three cases of IgG4-related cholecystitis which were thought to represent biliary malignancies both clinically and radiographically. All three cases underwent surgery tailored towards presumed malignant neoplasms. Only following pathologic examination was the true nature of the disease identified. Recognition of the clinical, radiographic, and pathologic presentation of IgG4-related cholecystitis is essential for the consideration of this disease process prior to surgical management for suspected gallbladder malignancies. However, the pre-operative diagnosis remains challenging and extensive surgical intervention is often necessary given the distressing presentation of IgG4-related cholecystitis.

  7. Gangrenous Cholecystitis Related to Transcatheter Arterial Chemoembolization (TACE) Treatment for Hepatocellular Carcinoma.

    PubMed

    Karavias, Dimitrios; Kourea, Helen; Sotiriadi, Athanasia; Karnabatidis, Dimitrios; Karavias, Dionissios

    2015-11-01

    A 69-year-old male with a history of hepatitis B-induced cirrhosis underwent segmental liver resection for hepatocellular carcinoma. At his 12-month follow-up, local recurrence in segment VII was diagnosed, measuring 7.8 by 6.2 cm, with irregular margins and the presence of a tumor thrombus in the portal vein. After evaluation by the multidisciplinary liver team, the patient underwent transcatheter arterial chemoembolization with drug-eluting beads. Forty-eight hours after his discharge, the patient presented with gangrenous cholecystitis and he underwent an uneventful cholecystectomy. Cholecystitis is a well-documented complication of transcatheter arterial chemoembolization due to inadvertent reflux of the embolic material into the cystic artery. However, super selective embolization significantly reduces the risk of cholecystitis. In most cases, management is conservative and only severe cases require further intervention.

  8. [A case of hemorrhagic cholecystitis associated with Churg-Strauss syndrome].

    PubMed

    Koizumi, Satomi; Kamisawa, Terumi; Kuruma, Sawako; Chiba, Kazuro; Tabata, Taku; Koizumi, Koichi; Kurata, Masanao; Horiguchi, Shinichiro; Hishima, Tsunekazu

    2016-01-01

    A woman in her 70s with Churg-Strauss syndrome presented with epigastric pain. She was being treated with steroids at the time of admission. Computed tomography showed swelling of the gallbladder, and percutaneous transhepatic cholangiography revealed bloody secretion. On duodenoscopy, bleeding was observed from the orifice of the major duodenal papilla. Emergency cholecystectomy was performed under a diagnosis of hemorrhagic cholecystitis;intraoperatively, extensive hematoma was detected in the thickened wall of the gallbladder. Subsequent histopathological examination revealed mucosal ulceration with infiltration of inflammatory cells, torn small vessels, and extensive transmural bleeding and abscess formation in the thickened wall of the gallbladder. We considered that the hemorrhagic cholecystitis was induced by either vasculitis or corticosteroid therapy. To the best of our knowledge, this is the first report of hemorrhagic cholecystitis associated with Churg-Strauss syndrome.

  9. Characterization, treatment, and outcome of bacterial cholecystitis and bactibilia in dogs.

    PubMed

    Lawrence, Yuri A; Ruaux, Craig G; Nemanic, Sarah; Milovancev, Milan

    2015-05-01

    Objective-To characterize historical, clinicopathologic, ultrasonographic, microbiological, surgical, and histopathologic features of bacterial cholecystitis and bactibilia in dogs and evaluate response to treatment and outcomes in these patients. Design-Retrospective case-control study. Animals-40 client-owned dogs (10 with bacterial cholecystitis on histologic analysis or bactibilia on cytologic examination [case dogs] and 30 without bactibilia [controls]) evaluated at a veterinary teaching hospital between 2010 and 2014. Procedures-Signalment, history, clinicopathologic findings, ultrasonographic features, microbiological results, surgical findings, histopathologic changes, treatments, and outcomes of case dogs were derived from medical records and summarized. Demographic and clinicopathologic data and ultrasonographic findings were compared between case and control dogs. Relationships among prior antimicrobial treatment, sediment formation in the gallbladder, presence of immobile biliary sludge, and presence of bactibilia or bacterial cholecystitis were assessed. Results-No finding was pathognomonic for bactibilia or bacterial cholecystitis in dogs. Case dogs were significantly more likely to have immobile biliary sludge and had a greater degree of biliary sediment formation than did control dogs. All case dogs for which gallbladders were examined histologically (6/6) had bacterial cholecystitis. Five of 10 case dogs were Dachshunds. Medical or surgical treatment resulted in good outcomes. Conclusions and Clinical Relevance-Bactibilia and bacterial cholecystitis were important differential diagnoses in dogs with signs referable to biliary tract disease. Dachshunds were overrepresented, which may suggest a breed predisposition. Cytologic evaluation of bile should be considered in the routine assessment of dogs with hepatobiliary disease if immobile biliary sludge is present. (J Am Vet Med Assoc 2015;246:982-989).

  10. Functional calculus using wavelet transforms

    NASA Astrophysics Data System (ADS)

    Holschneider, Matthias

    1994-07-01

    It is shown how the wavelet transform may be used to compute for a function s the symbol s(A) for any (not necessarily) self-adjoint operator A whose spectrum is contained in the upper half plane. For self-adjoint operators it is shown that this functional calculus coincides with the usual one. In particular it is shown how the exponential eitA can be written in terms of the resolvent Rz=(A-z)-1 of A as follows: eitA=(1/c) ∫0∞da an-2∫-∞+∞ dbĝ¯ (at)eitbRb-ian(A), with c=-2iπ×∫0∞(dω/ω) (-iω)n-1ĝ¯(ω)e-ω, and n∈N, and the integral is understood as the Cesaro limit. This shows explicitly how the behavior for large t is determined by the behavior of Rz at Iz ≂1/t.

  11. Teaching Special Relativity Without Calculus

    NASA Astrophysics Data System (ADS)

    Ruby, Lawrence

    2009-04-01

    I 2007 many AAPT members received a booklet that is the first chapter of a physics textbook available on a CD. This book espouses the new educational philosophy of teaching special relativity as the first item in the topic of mechanics. Traditionally, special relativity is part of one or more modern physics chapters at the end of the text,2 and very often this material is never utilized due to time constraints. From a logical standpoint, special relativity is important in satellite communications and in cosmology, as well as in modern physics applications such as atomic theory and high-energy physics. The purpose of this paper is to show that the new philosophy can be carried out in a noncalculus physics course, by demonstrating that all of the principal results of special relativity theory can be obtained by simple algebra. To accomplish this, we shall propose alternate derivations for two results that are usually obtained with calculus. Textbooks2 typically obtain the equations for time dilation and for length contraction from simple considerations based on Einstein's second postulate.3 We shall start from this point.

  12. Acute abdominal pain.

    PubMed

    Stone, R

    1998-01-01

    Abdominal pain is among the most frequent ailments reported in the office setting and can account for up to 40% of ailments in the ambulatory practice. Also, it is in the top three symptoms of patients presenting to emergency departments (ED) and accounts for 5-10% of all ED primary presenting ailments. There are several common sources for acute abdominal pain and many for subacute and chronic abdominal pain. This article explores the history-taking, initial evaluation, and examination of the patient presenting with acute abdominal pain. The goal of this article is to help differentiate one source of pain from another. Discussion of acute cholecystitis, pancreatitis, appendicitis, ectopic pregnancy, diverticulitis, gastritis, and gastroenteritis are undertaken. Additionally, there is discussion of common laboratory studies, diagnostic studies, and treatment of the patient with the above entities.

  13. Ancient DNA analysis of dental calculus.

    PubMed

    Weyrich, Laura S; Dobney, Keith; Cooper, Alan

    2015-02-01

    Dental calculus (calcified tartar or plaque) is today widespread on modern human teeth around the world. A combination of soft starchy foods, changing acidity of the oral environment, genetic pre-disposition, and the absence of dental hygiene all lead to the build-up of microorganisms and food debris on the tooth crown, which eventually calcifies through a complex process of mineralisation. Millions of oral microbes are trapped and preserved within this mineralised matrix, including pathogens associated with the oral cavity and airways, masticated food debris, and other types of extraneous particles that enter the mouth. As a result, archaeologists and anthropologists are increasingly using ancient human dental calculus to explore broad aspects of past human diet and health. Most recently, high-throughput DNA sequencing of ancient dental calculus has provided valuable insights into the evolution of the oral microbiome and shed new light on the impacts of some of the major biocultural transitions on human health throughout history and prehistory. Here, we provide a brief historical overview of archaeological dental calculus research, and discuss the current approaches to ancient DNA sampling and sequencing. Novel applications of ancient DNA from dental calculus are discussed, highlighting the considerable scope of this new research field for evolutionary biology and modern medicine.

  14. Anti-calculus and whitening toothpastes.

    PubMed

    van Loveren, Cor; Duckworth, Ralph M

    2013-01-01

    In terms of novel formulations, there seems to have been a shift in emphasis from anti-caries/anti-gingivitis to anti-calculus/whitening toothpastes in recent years. The anti-calculus and whitening effects of toothpastes are to some extent based on the same active ingredients: compounds of high affinity for tooth mineral. Due to this affinity, crystal growth may be hindered (anti-calculus) and chromophores be displaced (whitening). Besides these common ingredients, both types of toothpaste may contain agents specifically aimed at each condition. Clinical studies have shown that these active ingredients can be successfully formulated in fluoride toothpastes to give significant reductions in supragingival calculus and stain formation and facilitate their removal. Some of the ingredients are formulated in toothpastes that additionally contain anti-plaque and anti-gingivitis ingredients, making these toothpastes (together with the fluoride) truly multi-functional. The development of these products is not straightforward because of interaction between formulation components and because the active ingredients must maintain their beneficial characteristics during the shelf life of the paste. Neither a therapeutic benefit (in terms of less gingivitis or less caries) nor a societal benefit (in terms of less treatment demand) has been demonstrated as a result of the anti-calculus and whitening effects of toothpastes.

  15. On realizations of exterior calculus with dN = 0

    NASA Astrophysics Data System (ADS)

    Abramov, V.

    1998-11-01

    We study realizations of the q-exterior calculus with exterior differential d satisfying d N = 0, N > 2 on the free associative algebra with one generator and on the generalized Clifford algebras. Analogs of the notions of connection and curvature are discussed in the case of the q-exterior calculus on the generalized Clifford algebra. We show that the q-exterior calculus on the free associative algebra with one generator is related to q-calculus on the braided line.

  16. Measuring Transducer Modelled by Means of Fractional Calculus

    NASA Astrophysics Data System (ADS)

    Luft, Mirosław; Szychta, Elżbieta; Cioć, Radosław; Pietruszczak, Daniel

    The article is inspired by developments of the fractional calculus in different areas of science such as the control theory and electrical measurements. The current interest in mathematical analysis employing the fractional differential and integral calculus reflects the usefulness of this calculus in the development of more precise - closer to the actual observation - mathematical models of various phenomena. A model of a measuring transducer is presented, developed by means of fractional calculus. Tests are executed in the programming environment MATLAB-SIMULINK.

  17. On Development of an Adaptive Tutoring System for Calculus Learning

    NASA Astrophysics Data System (ADS)

    Yokota, Hisashi

    2010-06-01

    One-on-one tutoring is known to be an effective model for learning calculus. Therefore, implementing one-on-one tutoring system into calculus learning software is a natural thing to do. The purpose of this article is to describe how to diagnose a students' knowledge structure about calculus without asking many questions and to show how an adaptive tutoring system is implemented into our calculus learning software JCALC.

  18. Fractional vector calculus and fractional Maxwell's equations

    SciTech Connect

    Tarasov, Vasily E.

    2008-11-15

    The theory of derivatives and integrals of non-integer order goes back to Leibniz, Liouville, Grunwald, Letnikov and Riemann. The history of fractional vector calculus (FVC) has only 10 years. The main approaches to formulate a FVC, which are used in the physics during the past few years, will be briefly described in this paper. We solve some problems of consistent formulations of FVC by using a fractional generalization of the Fundamental Theorem of Calculus. We define the differential and integral vector operations. The fractional Green's, Stokes' and Gauss's theorems are formulated. The proofs of these theorems are realized for simplest regions. A fractional generalization of exterior differential calculus of differential forms is discussed. Fractional nonlocal Maxwell's equations and the corresponding fractional wave equations are considered.

  19. Isolated IgG4-related cholecystitis mimicking gallbladder cancer: a case report.

    PubMed

    Shin, Sang-Wook; Kim, Yongsoo; Jeong, Woo Kyoung; Kim, Jinoo; Kim, Min Yeong; Oh, Young Ha; Pyo, Ju Yeon

    2013-01-01

    A 58-year-old man with right upper quadrant pain was referred to the radiology department. The patient underwent computed tomography and magnetic resonance imaging, which suggested the diagnosis of gallbladder cancer invading the liver. After surgical removal of the gallbladder, and the adjacent liver parenchyma was performed, the histologic diagnosis of IgG4-related cholecystitis was made.

  20. Improving Calculus II and III through the Redistribution of Topics

    ERIC Educational Resources Information Center

    George, C. Yousuf; Koetz, Matt; Lewis, Heather A.

    2016-01-01

    Three years ago our mathematics department rearranged the topics in second and third semester calculus, moving multivariable calculus to the second semester and series to the third semester. This paper describes the new arrangement of topics, and how it could be adapted to calculus curricula at different schools. It also explains the benefits we…

  1. A Transition Course from Advanced Placement to College Calculus

    ERIC Educational Resources Information Center

    Lucas, Timothy A.; Spivey, Joseph

    2011-01-01

    In the Spring of 2007, a group of highly motivated mathematics graduate students conducted a review of Duke's Calculus curriculum. They focused on two main problems. The first problem is the result of a very positive trend: a growing number of students are earning AP credit for Calculus I in high school. However, this results in Calculus II…

  2. Science 101: How Do We Use Calculus in Science?

    ERIC Educational Resources Information Center

    Robertson, Bill

    2014-01-01

    How is calculus used in science? That might seem like an odd question to answer in a magazine intended primarily for elementary school teachers. After all, how much calculus gets used in elementary science? Here the author guesses that quite a few readers of this column do not know a whole lot about calculus and have not taken a course in…

  3. A Historical Perspective on Teaching and Learning Calculus

    ERIC Educational Resources Information Center

    Doorman, Michiel; van Maanen, Jan

    2008-01-01

    Calculus is one of those topics in mathematics where the algorithmic manipulation of symbols is easier than understanding the underlying concepts. Around 1680 Leibniz invented a symbol system for calculus that codifies and simplifies the essential elements of reasoning. The calculus of Leibniz brings within the reach of an ordinary student…

  4. Computer Managed Instruction Homework Modules for Calculus I.

    ERIC Educational Resources Information Center

    Goodman-Petrushka, Sharon; Roitberg, Yael

    This booklet contains 11 modules (290 multiple-choice items) designed for use in the first course of a three-course calculus sequence using the textbook "Calculus with Analytic Geometry" (Dennis G. Zill). In each module, relevant sections of the textbook are identified for users. It can, however, be used in conjunction with any calculus textbook.…

  5. Generalized Cartan Calculus in general dimension

    SciTech Connect

    Wang, Yi -Nan

    2015-07-22

    We develop the generalized Cartan Calculus for the groups G = SL(2,R) × R+, SL(5,R) and SO(5,5). They are the underlying algebraic structures of d=9,7,6 exceptional field theory, respectively. These algebraic identities are needed for the "tensor hierarchy" structure in exceptional field theory. The validity of Poincar\\'e lemmas in this new differential geometry is also discussed. Lastly, we explore some possible extension of the generalized Cartan calculus beyond the exceptional series.

  6. An Executable Calculus for Service Choreography

    NASA Astrophysics Data System (ADS)

    Besana, Paolo; Barker, Adam

    The Lightweight Coordination Calculus (LCC) is a compact choreography language based on process calculus. LCC is a directly executable specification and can therefore be dynamically distributed to a group of peers for enactment at run-time; this offers flexibility and allows peers to coordinate in open systems without prior knowledge of an interaction. This paper contributes to the body of choreography research by proposing two extensions to LCC covering parallel composition and choreography abstraction. These language extensions are evaluated against a subset of the Service Interaction Patterns, a benchmark in the process modelling community.

  7. Variational calculus with constraints on general algebroids

    NASA Astrophysics Data System (ADS)

    Grabowska, Katarzyna; Grabowski, Janusz

    2008-05-01

    Variational calculus on a vector bundle E equipped with a structure of a general algebroid is developed, together with the corresponding analogs of Euler-Lagrange equations. Constrained systems are introduced in the variational and geometrical settings. The constrained Euler-Lagrange equations are derived for analogs of holonomic, vakonomic and nonholonomic constraints. This general model covers the majority of first-order Lagrangian systems which are present in the literature and reduces to the standard variational calculus and the Euler-Lagrange equations in classical mechanics for E = TM.

  8. Is Calculus Really That Different from Algebra? A More Logical Way To Understand and Teach Calculus.

    ERIC Educational Resources Information Center

    Elk, Seymour B.

    1998-01-01

    Discards the blinders that have hampered the traditional teaching of calculus and reexamines some of the intuitive ideas that underlie this subject matter. Analyzes the various indeterminate forms that arise through the blind application of algebraic operations. (Author/ASK)

  9. Using Matlab in a Multivariable Calculus Course.

    ERIC Educational Resources Information Center

    Schlatter, Mark D.

    The benefits of high-level mathematics packages such as Matlab include both a computer algebra system and the ability to provide students with concrete visual examples. This paper discusses how both capabilities of Matlab were used in a multivariate calculus class. Graphical user interfaces which display three-dimensional surfaces, contour plots,…

  10. On Online Assignments in a Calculus Class

    ERIC Educational Resources Information Center

    Jungic, Veselin; Kent, Deborah; Menz, Petra

    2012-01-01

    In this paper, we describe our experience with the creation and utilization of online assignments for several calculus classes at Simon Fraser University (SFU). We present our findings regarding available software by considering the needs and perspectives of the instructors, students, and administrators. We provide a list of questions that guide…

  11. Are Homeschoolers Prepared for College Calculus?

    ERIC Educational Resources Information Center

    Wilkens, Christian P.; Wade, Carol H.; Sonnert, Gerhard; Sadler, Philip M.

    2015-01-01

    Homeschooling in the United States has grown considerably over the past several decades. This article presents findings from the Factors Influencing College Success in Mathematics (FICSMath) survey, a national study of 10,492 students enrolled in tertiary calculus, including 190 students who reported homeschooling for a majority of their high…

  12. Boolean integral calculus for digital systems

    NASA Technical Reports Server (NTRS)

    Tucker, J. H.; Tapia, M. A.; Bennett, A. W.

    1985-01-01

    The concept of Boolean integration is introduced and developed. When the changes in a desired function are specified in terms of changes in its arguments, then ways of 'integrating' (i.e., realizing) the function, if it exists, are presented. Boolean integral calculus has applications in design of logic circuits.

  13. Some Factors Effected Student's Calculus Learning Outcome

    ERIC Educational Resources Information Center

    Rajagukguk, Wamington

    2016-01-01

    The purpose of this study is to determine the factors effected calculus learning outcome of the student. This study was conducted with 176 respondents, which were selected randomly. The data were obtained by questionnaire, and then analyzed by using multiple regressions, and correlation, at level of a = 0.05. The findings showed there is the…

  14. I Teach Economics, Not Algebra and Calculus

    ERIC Educational Resources Information Center

    Hey, John D.

    2005-01-01

    Most people learn to drive without knowing how the engine works. In a similar vein, the author believes that students can learn economics without knowing the algebra and calculus underlying the results. If instructors follow the philosophy of other economics courses in using graphs to illustrate the results, and draw the graphs accurately, then…

  15. Students' Difficulties with Vector Calculus in Electrodynamics

    ERIC Educational Resources Information Center

    Bollen, Laurens; van Kampen, Paul; De Cock, Mieke

    2015-01-01

    Understanding Maxwell's equations in differential form is of great importance when studying the electrodynamic phenomena discussed in advanced electromagnetism courses. It is therefore necessary that students master the use of vector calculus in physical situations. In this light we investigated the difficulties second year students at KU Leuven…

  16. Beliefs about Proof in Collegiate Calculus.

    ERIC Educational Resources Information Center

    Raman, Manya

    The broad aim of this research is to characterize the views of proof held by college calculus students and their two types of teachers mathematics graduate students and professors. The analysis is based on an examination of the ways in which people in all three groups produce and evaluate different types of solutions to a proof-based problem from…

  17. A symbol calculus for Toeplitz operators.

    PubMed

    Berger, C A; Coburn, L A

    1986-05-01

    We give a complete characterization of those functions on 2n-dimensional Euclidean space for which the Berezin-Toeplitz quantizations admit a symbol calculus modulo the compact operators. The functions in question are characterized by a condition of "small oscillation at infinity."

  18. Sharks, Minnows, and Wheelbarrows: Calculus Modeling Projects

    ERIC Educational Resources Information Center

    Smith, Michael D.

    2011-01-01

    The purpose of this article is to present two very active applied modeling projects that were successfully implemented in a first semester calculus course at Hollins University. The first project uses a logistic equation to model the spread of a new disease such as swine flu. The second project is a human take on the popular article "Do Dogs Know…

  19. Maple Graphing Tools for Calculus III

    ERIC Educational Resources Information Center

    Cook, Darwyn

    2006-01-01

    For those instructors lacking artistic skills, teaching 3-dimensional calculus can be a challenge. Although some instructors spend a great deal of time working on their illustrations, trying to get them just right, students nevertheless often have a difficult time understanding some of them. To address this problem, the author has written a series…

  20. Cartan calculus on quantum Lie algebras

    SciTech Connect

    Schupp, P.; Watts, P.; Zumino, B.

    1993-12-09

    A generalization of the differential geometry of forms and vector fields to the case of quantum Lie algebras is given. In an abstract formulation that incorporates many existing examples of differential geometry on quantum spaces we combine an exterior derivative, inner derivations, Lie derivatives, forms and functions au into one big algebra, the ``Cartan Calculus.``

  1. Using the Microcomputer to Enhance Calculus Teaching.

    ERIC Educational Resources Information Center

    Clayton, Debbie; And Others

    1990-01-01

    Discusses differences between computer-enhanced learning (CEL) and computer-aided learning (CAL), and describes a microcomputer-based graph-plotting program called Capgraph that was developed for use in a college calculus course. Results of a course evaluation are presented; student attitudes are described; and future considerations are discussed.…

  2. Dogs Don't Need Calculus

    ERIC Educational Resources Information Center

    Bolt, Mike

    2010-01-01

    Many optimization problems can be solved without resorting to calculus. This article develops a new variational method for optimization that relies on inequalities. The method is illustrated by four examples, the last of which provides a completely algebraic solution to the problem of minimizing the time it takes a dog to retrieve a thrown ball,…

  3. Students' Understanding of Functions in Calculus Courses.

    ERIC Educational Resources Information Center

    Monk, G. S.

    1994-01-01

    Reports on a study of students' responses to two types of questions on final examinations in calculus. Concludes that the two kinds of understanding--pointwise and across time--are clearly distinguishable. Discusses the differences between these two types of understanding. (ASK)

  4. Developing Flexible Procedural Knowledge in Undergraduate Calculus

    ERIC Educational Resources Information Center

    Maciejewski, Wes; Star, Jon R.

    2016-01-01

    Mathematics experts often choose appropriate procedures to produce an efficient or elegant solution to a mathematical task. This "flexible procedural knowledge" distinguishes novice and expert procedural performances. This article reports on an intervention intended to aid the development of undergraduate calculus students' flexible use…

  5. Enabling quaternion derivatives: the generalized HR calculus

    PubMed Central

    Xu, Dongpo; Jahanchahi, Cyrus; Took, Clive C.; Mandic, Danilo P.

    2015-01-01

    Quaternion derivatives exist only for a very restricted class of analytic (regular) functions; however, in many applications, functions of interest are real-valued and hence not analytic, a typical case being the standard real mean square error objective function. The recent HR calculus is a step forward and provides a way to calculate derivatives and gradients of both analytic and non-analytic functions of quaternion variables; however, the HR calculus can become cumbersome in complex optimization problems due to the lack of rigorous product and chain rules, a consequence of the non-commutativity of quaternion algebra. To address this issue, we introduce the generalized HR (GHR) derivatives which employ quaternion rotations in a general orthogonal system and provide the left- and right-hand versions of the quaternion derivative of general functions. The GHR calculus also solves the long-standing problems of product and chain rules, mean-value theorem and Taylor's theorem in the quaternion field. At the core of the proposed GHR calculus is quaternion rotation, which makes it possible to extend the principle to other functional calculi in non-commutative settings. Examples in statistical learning theory and adaptive signal processing support the analysis. PMID:26361555

  6. [Report of a case of tonsillar calculus].

    PubMed

    García Rodríguez, M R; Cabanas López, A; García Calleja, J M; García Rodríguez, J F

    1990-01-01

    We describe the case of a patient with odynophagia without treatment response. The pharynx exploration shows a stony tumor in vertex of left palatine amygdala which was extirpated. The laboratory analysis signs calcium and oxalic calculus. The anatomopathological study of the amygdala bed biopsy informs like absent of malignancy images.

  7. Bladder calculus presenting as excessive masturbation.

    PubMed

    De Alwis, A C D; Senaratne, A M R D; De Silva, S M P D; Rodrigo, V S D

    2006-09-01

    Masturbation in childhood is a normal behaviour which most commonly begins at 2 months of age, and peaks at 4 years and in adolescence. However excessive masturbation causes anxiety in parents. We describe a boy with a bladder calculus presenting as excessive masturbation.

  8. A symbol calculus for Toeplitz operators

    PubMed Central

    Berger, C. A.; Coburn, L. A.

    1986-01-01

    We give a complete characterization of those functions on 2n-dimensional Euclidean space for which the Berezin-Toeplitz quantizations admit a symbol calculus modulo the compact operators. The functions in question are characterized by a condition of “small oscillation at infinity.” PMID:16593695

  9. Exposing Calculus Students to Advanced Mathematics

    ERIC Educational Resources Information Center

    Griffiths, Barry J.; Haciomeroglu, Erhan Selcuk

    2014-01-01

    To ensure the competitiveness of the USA in the global economy, and its role as a leader in science and engineering, it is important to cultivate the next generation of home grown mathematicians. However, while universities across the USA offer calculus classes to thousands of undergraduate students each year, very few of them go on to major in…

  10. Online Calculus: The Course and Survey Results.

    ERIC Educational Resources Information Center

    Allen, G. Donald

    2001-01-01

    Describes the development and implementation of a Web-based calculus course at Texas A & M University. Discusses the course design, layout of content and the contrast with textbook structure, results of course surveys that included student reactions, and how students learn form Web-based materials. (Author/LRW)

  11. Enabling quaternion derivatives: the generalized HR calculus.

    PubMed

    Xu, Dongpo; Jahanchahi, Cyrus; Took, Clive C; Mandic, Danilo P

    2015-08-01

    Quaternion derivatives exist only for a very restricted class of analytic (regular) functions; however, in many applications, functions of interest are real-valued and hence not analytic, a typical case being the standard real mean square error objective function. The recent HR calculus is a step forward and provides a way to calculate derivatives and gradients of both analytic and non-analytic functions of quaternion variables; however, the HR calculus can become cumbersome in complex optimization problems due to the lack of rigorous product and chain rules, a consequence of the non-commutativity of quaternion algebra. To address this issue, we introduce the generalized HR (GHR) derivatives which employ quaternion rotations in a general orthogonal system and provide the left- and right-hand versions of the quaternion derivative of general functions. The GHR calculus also solves the long-standing problems of product and chain rules, mean-value theorem and Taylor's theorem in the quaternion field. At the core of the proposed GHR calculus is quaternion rotation, which makes it possible to extend the principle to other functional calculi in non-commutative settings. Examples in statistical learning theory and adaptive signal processing support the analysis.

  12. A Note on Discrete Mathematics and Calculus.

    ERIC Educational Resources Information Center

    O'Reilly, Thomas J.

    1987-01-01

    Much of the current literature on the topic of discrete mathematics and calculus during the first two years of an undergraduate mathematics curriculum is cited. A relationship between the recursive integration formulas and recursively defined polynomials is described. A Pascal program is included. (Author/RH)

  13. Teaching Calculus Students How to Study.

    ERIC Educational Resources Information Center

    Boelkins, Matthew R.; Pfaff, Thomas J.

    1998-01-01

    Addresses the problem of poor study habits in calculus students and presents techniques to teach students how to study consistently and effectively. Concludes that many students greatly appreciate the added structure, work harder than in previous courses, and witness newfound success as a consequence. (Author/ASK)

  14. Exploring Flipped Classroom Instruction in Calculus III

    ERIC Educational Resources Information Center

    Wasserman, Nicholas H.; Quint, Christa; Norris, Scott A.; Carr, Thomas

    2017-01-01

    In an undergraduate Calculus III class, we explore the effect of "flipping" the instructional delivery of content on both student performance and student perceptions. Two instructors collaborated to determine daily lecture notes, assigned the same homework problems, and gave identical exams; however, compared to a more traditional…

  15. Supercalculators and University Entrance Calculus Examinations.

    ERIC Educational Resources Information Center

    Hong, Ye Yoon; Thomas, Mike; Kiernan, Christine

    2000-01-01

    Investigates whether the use of computer algebra systems could provide a significant advantage to students taking standard university entrance calculus examinations. Indicates that supercalculators would probably provide a significant advantage, particularly for lower-achieving students. Demonstrates that it is possible to write questions in which…

  16. Using Discovery in the Calculus Class

    ERIC Educational Resources Information Center

    Shilgalis, Thomas W.

    1975-01-01

    This article shows how two discoverable theorems from elementary calculus can be presented to students in a manner that assists them in making the generalizations themselves. The theorems are the mean value theorems for derivatives and for integrals. A conjecture is suggested by pictures and then refined. (Author/KM)

  17. Flipping a Calculus Class: One Instructor's Experience

    ERIC Educational Resources Information Center

    Palmer, Katrina

    2015-01-01

    This paper describes one instructor's experiences during a year of flipping four calculus classes. The first exploration attempts to understand student expectations of a math class and their preference towards a flipped classroom. The second examines success of students from a flipped classroom, and the last investigates relationships with student…

  18. A TENTATIVE GUIDE, DIFFERENTIAL AND INTEGRAL CALCULUS.

    ERIC Educational Resources Information Center

    BRANT, VINCENT; GERARDI, WILLIAM

    THE COURSE IS INTENDED TO GO BEYOND THE REQUIREMENTS OF THE ADVANCED PLACEMENT PROGRAM IN MATHEMATICS AS DESIGNED BY THE COLLEGE ENTRANCE EXAMINATION BOARD. THE ADVANCED PLACEMENT PROGRAM CONSISTS OF A 1-YEAR COURSE COMBINING ANALYTIC GEOMETRY AND CALCULUS. PRESUPPOSED HERE ARE--A SEMESTER COURSE IN ANALYTIC GEOMETRY AND A THOROUGH KNOWLEDGE OF…

  19. A Calculus Project that Really Makes Cents

    ERIC Educational Resources Information Center

    Green, Daniel L.

    2006-01-01

    This article describes a calculus project that exposes students to the concept of retirement annuities in both the saving and withdrawal phases, via revenue streams represented by integrals. Students use modeling skills to solve several related problems as the assumptions of the original problem are changed, and the project requires them to use a…

  20. A prospective study of radionuclide biliary scanning in acute pancreatitis.

    PubMed Central

    Neoptolemos, J. P.; Fossard, D. P.; Berry, J. M.

    1983-01-01

    Early surgery for biliary pancreatitis has resulted in a need for an accurate method of gallstone detection in acute pancreatitis. Fifty patients with acute pancreatitis were studied prospectively to assess the diagnostic value of Radionuclide Biliary Scanning (RBS) performed within 72 hours of an attack. To assess the general accuracy of RBS a further 154 patients with suspected acute cholecystitis or biliary colic were similarly studied. There were 34 patients with biliary pancreatitis and 18 (53%) had a positive scan (no gallbladder seen). There were 16 patients with non-biliary pancreatitis and 5 (31%) had a positive scan. All 51 patients with acute cholecystitis had a positive scan, as did 82% of the 51 patients with biliary colic. There were 52 patients with no biliary or pancreatic disease and none of these had a positive scan. RBS is highly accurate in confirming a diagnosis of acute cholecystitis or biliary colic. However, it cannot be relied on to differentiate between biliary and non-biliary pancreatitis and should certainly not be used as the basis for biliary surgery in these patients. PMID:6859781

  1. Fractional calculus in bioengineering, part 3.

    PubMed

    Magin, Richard L

    2004-01-01

    Fractional calculus (integral and differential operations of noninteger order) is not often used to model biological systems. Although the basic mathematical ideas were developed long ago by the mathematicians Leibniz (1695), Liouville (1834), Riemann (1892), and others and brought to the attention of the engineering world by Oliver Heaviside in the 1890s, it was not until 1974 that the first book on the topic was published by Oldham and Spanier. Recent monographs and symposia proceedings have highlighted the application of fractional calculus in physics, continuum mechanics, signal processing, and electromagnetics, but with few examples of applications in bioengineering. This is surprising because the methods of fractional calculus, when defined as a Laplace or Fourier convolution product, are suitable for solving many problems in biomedical research. For example, early studies by Cole (1933) and Hodgkin (1946) of the electrical properties of nerve cell membranes and the propagation of electrical signals are well characterized by differential equations of fractional order. The solution involves a generalization of the exponential function to the Mittag-Leffler function, which provides a better fit to the observed cell membrane data. A parallel application of fractional derivatives to viscoelastic materials establishes, in a natural way, hereditary integrals and the power law (Nutting/Scott Blair) stress-strain relationship for modeling biomaterials. In this review, I will introduce the idea of fractional operations by following the original approach of Heaviside, demonstrate the basic operations of fractional calculus on well-behaved functions (step, ramp, pulse, sinusoid) of engineering interest, and give specific examples from electrochemistry, physics, bioengineering, and biophysics. The fractional derivative accurately describes natural phenomena that occur in such common engineering problems as heat transfer, electrode/electrolyte behavior, and sub

  2. Characteristics of subgingival calculus detection by multiphoton fluorescence microscopy

    NASA Astrophysics Data System (ADS)

    Tung, Oi-Hong; Lee, Shyh-Yuan; Lai, Yu-Lin; Chen, How-Foo

    2011-06-01

    Subgingival calculus has been recognized as a major cause of periodontitis, which is one of the main chronic infectious diseases of oral cavities and a principal cause of tooth loss in humans. Bacteria deposited in subgingival calculus or plaque cause gingival inflammation, function deterioration, and then periodontitis. However, subgingival calculus within the periodontal pocket is a complicated and potentially delicate structure to be detected with current dental armamentaria, namely dental x-rays and dental probes. Consequently, complete removal of subgingival calculus remains a challenge to periodontal therapies. In this study, the detection of subgingival calculus employing a multiphoton autofluorescence imaging method was characterized in comparison with a one-photon confocal fluorescence imaging technique. Feasibility of such a system was studied based on fluorescence response of gingiva, healthy teeth, and calculus with and without gingiva covered. The multiphoton fluorescence technology perceived the tissue-covered subgingival calculus that cannot be observed by the one-photon confocal fluorescence method.

  3. Characteristics of subgingival calculus detection by multiphoton fluorescence microscopy.

    PubMed

    Tung, Oi-Hong; Lee, Shyh-Yuan; Lai, Yu-Lin; Chen, How-Foo

    2011-06-01

    Subgingival calculus has been recognized as a major cause of periodontitis, which is one of the main chronic infectious diseases of oral cavities and a principal cause of tooth loss in humans. Bacteria deposited in subgingival calculus or plaque cause gingival inflammation, function deterioration, and then periodontitis. However, subgingival calculus within the periodontal pocket is a complicated and potentially delicate structure to be detected with current dental armamentaria, namely dental x-rays and dental probes. Consequently, complete removal of subgingival calculus remains a challenge to periodontal therapies. In this study, the detection of subgingival calculus employing a multiphoton autofluorescence imaging method was characterized in comparison with a one-photon confocal fluorescence imaging technique. Feasibility of such a system was studied based on fluorescence response of gingiva, healthy teeth, and calculus with and without gingiva covered. The multiphoton fluorescence technology perceived the tissue-covered subgingival calculus that cannot be observed by the one-photon confocal fluorescence method.

  4. Gallbladder removal - laparoscopic - discharge

    MedlinePlus

    Cholecystectomy laparoscopic - discharge; Cholelithiasis - laparoscopic discharge; Biliary calculus - laparoscopic discharge; Gallstones - laparoscopic discharge; Cholecystitis - laparoscopic discharge

  5. Fractional calculus in bioengineering, part 2.

    PubMed

    Magin, Richard L

    2004-01-01

    Fractional calculus (integral and differential operations of noninteger order) is not often used to model biological systems. Although the basic mathematical ideas were developed long ago by the mathematicians Leibniz (1695), Liouville (1834), Riemann (1892), and others and brought to the attention of the engineering world by Oliver Heaviside in the 1890s, it was not until 1974 that the first book on the topic was published by Oldham and Spanier. Recent monographs and symposia proceedings have highlighted the application of fractional calculus in physics, continuum mechanics, signal processing, and electromagnetics, but with few examples of applications in bioengineering. This is surprising because the methods of fractional calculus, when defined as a Laplace or Fourier convolution product, are suitable for solving many problems in biomedical research. For example, early studies by Cole (1933) and Hodgkin (1946) of the electrical properties of nerve cell membranes and the propagation of electrical signals are well characterized by differential equations of fractional order. The solution involves a generalization of the exponential function to the Mittag-Leffler function, which provides a better fit to the observed cell membrane data. A parallel application of fractional derivatives to viscoelastic materials establishes, in a natural way, hereditary integrals and the power law (Nutting/Scott Blair) stress-strain relationship for modeling biomaterials. In this review, I will introduce the idea of fractional operations by following the original approach of Heaviside, demonstrate the basic operations of fractional calculus on well-behaved functions (step, ramp, pulse, sinusoid) of engineering interest, and give specific examples from electrochemistry, physics, bioengineering, and biophysics. The fractional derivative accurately describes natural phenomena that occur in such common engineering problems as heat transfer, electrode/electrolyte behavior, and sub

  6. Students' difficulties with vector calculus in electrodynamics

    NASA Astrophysics Data System (ADS)

    Bollen, Laurens; van Kampen, Paul; De Cock, Mieke

    2015-12-01

    Understanding Maxwell's equations in differential form is of great importance when studying the electrodynamic phenomena discussed in advanced electromagnetism courses. It is therefore necessary that students master the use of vector calculus in physical situations. In this light we investigated the difficulties second year students at KU Leuven encounter with the divergence and curl of a vector field in mathematical and physical contexts. We have found that they are quite skilled at doing calculations, but struggle with interpreting graphical representations of vector fields and applying vector calculus to physical situations. We have found strong indications that traditional instruction is not sufficient for our students to fully understand the meaning and power of Maxwell's equations in electrodynamics.

  7. A Case of Amyloidosis Presenting as Chronic Cholecystitis, Misdiagnosed as Polymyalgia Rheumatica.

    PubMed

    Um, Yoo Jin; Kim, Hyoun Ah; Jung, Jin Hee; Cho, Hundo; Kang, Joon Koo

    2016-07-25

    Amyloidosis is a rare disease defined by extracellular deposits of amorphous fibrillar proteins, derived from aggregations of misfolded proteins. Localization of amyloidosis in the gallbladder is uncommon; only eight cases have been reported. We describe a case of amyloidosis diagnosed by cholecystectomy, which possibly also affected the liver and kidney. The patient was misdiagnosed with polymyalgia rheumatica, but after a cholecystectomy to treat chronic cholecystitis, we ultimately diagnosed him with amyloidosis. We review amyloidosis with gallbladder involvement in the literature.

  8. Double dumb-bell calculus in childhood.

    PubMed

    Joshi, Prashant; Sarda, Dinesh; Ahmad, Ashraf; Kothari, Paras

    2009-01-01

    An eight-year old male was admitted with complaints of right scrotal swelling, dysuria and intermittent retention of urine for 10 days. On per-rectal examination, a hard mass was palpable in the posterior urethra. An X-ray (KUB) of the abdomen revealed a double dumb-bell calculus at the base of bladder, extending into the posterior urethra. A cystolithotomy via the suprapubic approach was successfully curative.

  9. Eosinophilic granulomatosis with polyangiitis complicated by cholecystitis: a case report and review of the literature.

    PubMed

    Ye, Lu; Lu, Xiaoyong; Xue, Jing

    2016-01-01

    The objectives are to report an atypical case of eosinophilic granulomatosis with polyangiitis (EGPA) associated with cholecystitis and to review the main clinical features, therapy, and prognosis of it. We present a 49-year-old male with non-classic clinical manifestations of EGPA and EGPA-related cholecystitis. EGPA was diagnosed by histology of the gallbladder after cholecystectomy. In addition, 11 cases of EGPA-associated cholecystitis have been reported and were described in details in this article. Gallbladder involvement is very uncommon in EGPA. All cases reviewed showed multiple organs involved as well as obviously elevated eosinophilic granulocyte proportion with inflammatory index, although antineutrophil cytoplasmic antibody may be negative. All patients in this cohort that showed gallbladder involvement were eventually confirmed with EGPA by histology examination after cholecystectomy. The pathological change could be infiltration of inflammatory mononuclear cells of small- and medium-sized vessels. Of the cases, 91.7% responded well to steroid and immunosuppressant therapy. Gallbladder involvement is a very rare comorbid condition in EGPA. However, it is an important symptom or secondary condition to alert physicians the diagnosis of EGPA. Moreover, timely diagnosis and correct administration in the early stage of this disease could obviously improve the prognosis.

  10. Hepatobiliary scan with delayed gallbladder visualization in a case of acute appendicitis

    SciTech Connect

    Smathers, R.L.; Harman, P.K.; Wanebo, H.J.; Read, M.E.

    1982-05-01

    A 40-year-old woman presented with acute epigastric pain with vomiting. Within 24 hours, the pain spread to the right periumbilical region. /sup 99m/Tc disofenin hepatobiliary scan failed to demonstrate the gallbladder on a 60-minute view. The presumative diagnosis of acute cholecystitis was thought to be confirmed on this basis by the patient's physicians. However, a 75-minute view demonstrated filling of the gallbladder. In hepatobiliary scanning for acute abdominal pain, delayed views (2 to 24 hours) are recommended when the gallbladder is not visualized on the 60-minute view. If the gallbladder is visualized, cystic duct obstruction can be excluded and diagnoses such as pancreatitis, acalculous cholecystitis, and acute appendicitis should be investigated.

  11. Hyalinizing cholecystitis and associated carcinomas: clinicopathologic analysis of a distinctive variant of cholecystitis with porcelain-like features and accompanying diagnostically challenging carcinomas.

    PubMed

    Patel, Samip; Roa, Juan Carlos; Tapia, Oscar; Dursun, Nevra; Bagci, Pelin; Basturk, Olca; Cakir, Asli; Losada, Hector; Sarmiento, Juan; Adsay, Volkan

    2011-08-01

    We describe a clinicopathologically distinct subtype of cholecystitis, the extensively calcific version of which has been presented in the clinical literature as "porcelain gallbladder (PG)." This cholecystitis, which we propose to refer to as hyalinizing cholecystitis (HC), is characterized by dense, paucicellular hyaline fibrosis transforming the gallbladder (GB) wall into a relatively thin and uniform band. The process diffusely effaces most of the normal structures of GB, and some cases show calcifications. To determine the clinicopathologic associations of HC, we systematically analyzed 4231 cholecystectomies (606 of which had carcinoma) histopathologically, in addition to a targeted search in our databases. Ninety-six cases of HC were identified (1.6% of cholecystectomies). Patients with HC were a decade older than ordinary cholecystitis patients (56 vs. 47; P<0.001), suggesting that HC may be a long-term complication of chronic injury in some patients. Calcifications of variable amounts and degrees were identified in two thirds of the cases. In addition, 10 cases showed diffuse marked calcifications and were considered separately as "complete porcelain" GB. Thirty-eight HC cases had carcinoma with a calculated frequency of 15% and an odds ratio of cancer risk of 4.6. Only 42% of the invasive cases were associated with calcifications; none of the 10 diffusely calcific cases had carcinoma. HC-related carcinomas were challenging diagnostically. They did not form distinct masses or any significant thickening (mean thickness, 2.6 vs. 4.0 mm in ordinary adenocarcinomas; P<0.002). Microscopically, they had widely scattered and bland-appearing glands embedded in the thin band of hyaline stroma of HC, commonly showing a disappearing lining, leaving behind the granular, necrotic intraluminal debris (regression) with or without calcifications, which could be the only sign of cancer in some sections. The morphologic features that allowed the recognition of these glands

  12. A new proof of the generalized Hamiltonian–Real calculus

    PubMed Central

    Gao, Hua; Mandic, Danilo P.

    2016-01-01

    The recently introduced generalized Hamiltonian–Real (GHR) calculus comprises, for the first time, the product and chain rules that makes it a powerful tool for quaternion-based optimization and adaptive signal processing. In this paper, we introduce novel dual relationships between the GHR calculus and multivariate real calculus, in order to provide a new, simpler proof of the GHR derivative rules. This further reinforces the theoretical foundation of the GHR calculus and provides a convenient methodology for generic extensions of real- and complex-valued learning algorithms to the quaternion domain.

  13. [Acute gastrointestinal involvement in dengue disease by serotype 4: a case report and literature review].

    PubMed

    Marín, Johan; Vilcarromero, Stalin; Forshey, Brett M; Celis-Salinas, Juan C; Ramal-Asayag, Cesar; Morrison, Amy C; Laguna-Torres, Alberto; Casapía, Martín; Halsey, Eric S

    2013-10-01

    Dengue fever is the world's most important arboviral disease, presenting a wide clinical spectrum. We report for the first time in Peru, a case caused by dengue virus serotype 4 with significant gastrointestinal involvement (acute acalculous cholecystitis and acute hepatitis). In addition we carried out a review of the literature atypical presentation illustrating the importance of the characteristics of abdominal pain (right upper quadrant); presence of Murphy's sign, ultrasound, and liver enzymes levels, for appropriate diagnosis and clinical management.

  14. Fluorodeoxyglucose positron emission tomography-computed tomography: a novel approach for the diagnosis of cholecystitis for equivocal diagnoses after ultrasound imaging.

    PubMed

    Nasseri, Yosef; Ourian, Ariel J; Waxman, Alan; D'Angolo, Alessandro; Thomson, Louise E; Margulies, Daniel R

    2012-10-01

    Although hepatobiliary iminodiacetic acid (HIDA) scan is often used when the diagnosis of cholecystitis remains questionable after ultrasound, it carries a high false-positive rate and has other limitations. Fluorodeoxyglucose positron emission tomography-computed tomography (18FDG PET-CT) has recently gained enthusiasm for its ability to detect infection and inflammation. In this study, we evaluate the accuracy of 18FDG PET-CT in diagnosing cholecystitis. Nineteen patients with suspected cholecystitis (Group S) underwent PET-CT and 10 had positive PET-CT findings. Of these 10, nine underwent cholecystectomies, and pathology confirmed cholecystitis in all nine. One patient was managed nonoperatively as a result of multiple comorbidities. Of the nine patients with negative PET-CT, six were managed nonoperatively, safely discharged, and had no readmissions at 3-month follow-up. The other three patients with negative PET-CT underwent cholecystectomies, and two showed no cholecystitis on pathology. The third had mild to moderate cholecystitis with focal mucosal erosion/ulceration without gallbladder wall thickening on pathology. 18FDG PET-CT detected gallbladder inflammation in all but one patient with pathology-proven cholecystitis with a sensitivity and specificity of 0.90 and 1.00, respectively. 18FDG-PET-CT appears to be a promising, rapid, direct, and accurate test in diagnosing cholecystitis and could replace HIDA scan in cases that remain equivocal after ultrasound.

  15. [Laparoscopic cholecystectomy and open cholecystectomy in acute cholecystitis: critical analysis of 520 cases].

    PubMed

    Teixeira, João Araújo; Ribeiro, Carlos; Moreira, Luís M; de Sousa, Fabiana; Pinho, André; Graça, Luís; Maia, José Costa

    2014-01-01

    IntroduçÉo: Apesar do cepticismo com que inicialmente foi encarada, a colecistectomia laparoscópica é hoje a técnica de eleiçÉo na colecistite aguda. Torna-se, porém, importante avaliar os seus resultados, em comparaçÉo com a colecistectomia clássica, uma vez que esta última ainda é seguida por alguns cirurgiões em determinadas situações.Material e Métodos: No nosso estudo foram incluídos 520 doentes com colecistites agudas operados no Serviço de Cirurgia Geral do Hospital de S. JoÉo, entre 2007 e 2013, dos quais 412 (79,2%) por laparoscopia e 108 (20,8%) por via aberta, com uma incidência de conversÉo de 10,7%. Procedeu-se ao estudo relativo às doenças coexistentes, leucocitose, tempo decorrido entre o diagnóstico na urgência e a cirurgia, classificaçÉo ASA, complicações intra e pós-operatórias, mortalidade, reintervenções, lesÉo biliar e estadia hospitalar. Os doentes convertidos foram incluídos no grupo das colecistectomias laparoscópicas. A análise estatística baseou-se em processos descritivos e a avaliaçÉo das diferenças entre grupos foi realizada com base no teste exato de Fisher, sendo considerados valores significativos para p < 0,05.Resultados: Colecistectomia laparoscópica versus Colecistectomia aberta: Mortalidade: 0,7% vs 3,7% (p = 0,0369); Complicações per-operatórias: 3,6% vs 12,9% (p = 0,0006); Complicações pós-operatórias cirúrgicas: 7,7% vs 17,5% (p = 0,0055); Pós-operatórias médicas: 4,3% vs 5,5% (p = 0,6077); LesÉo da via biliar principal: 0,9% vs 1,8% (p = 0,6091); Reintervenções: 2,9% vs 5,5% (p = 0,2315); Internamento hospitalar inferior ou igual a quatro dias: 64,8% vs 18,5% (p < 0,0001). Na colecistectomia laparoscópica houve 10,7% de conversões: nas precoces (intervenções realizadas antes das 96 h após o diagnóstico na urgência) esta taxa foi de 8,8% e nas tardias (após aquele período de tempo mas no mesmo internamento) de 13,7% (p = 0,1425); Complicações nos doentes convertidos vs nÉo convertidos: nas cirúrgicas 20,4% vs 6,2% (p = 0,0034) e nas médicas 6,8% vs 4,1% (p = 0,4484). As causas de conversÉoforam condicionadas por complicações cirúrgicas (lesões biliares, lacerações entéricas, perfurações vesiculares com a disseminaçÉo de cálculos), intoler'ncia ao pneumoperitoneo, indefiniçÉo do pedículo biliar e escoliose.DiscussÉo: Há poucas investigações relativas à comparaçÉo da colecistectomia laparoscópica vs colecistectomia aberta nos doentes com colecistectomia aberta, correspondendo a maior parte delas a estudos multicêntricos. Por esta razÉo, julgamos de interesse proceder a uma análise inerente a 520 operados com aquela doença no Serviço de Cirurgia Geral do Hospital de S. JoÉo dos quais 412 por colecistectomia laparoscópica e 108 por colecistectomia aberta. Verificamos na colecistectomia laparoscópica melhores resultados do que na colecistectomia aberta no que se refere à mortalidade, complicações per e pós-operatórias cirúrgicas e estadia hospitalar. A incidência da via biliar principal, complicações médicas e reintervenções, embora menos evidentes na colecistectomia laparoscópica, nÉo se revelaram com significado estatístico. Merece referência o maior número de complicações no grupo das colecistectomias laparoscópicasconvertidas do que naquelas em que tal nÉo foi necessário confirmando-se, assim, o já referido em estudos multicêntricos citados na literatura. Este facto levanta a necessidade de, mediante complicações ocorridas durante a colecistectomia laparoscópica, nÉo se proceder à conversÉo tardiamente. A análise do presente estudo valoriza, assim, devidamente a colecistectomia laparoscópica na cirurgia dos doentes com colecistite aguda.ConclusÉo: Os resultados obtidos justificam a frequência com que a colecistectomia laparoscópica é realizada na colecistite aguda, em comparaçÉo com a via aberta, ocupando cada vez mais, um lugar primordial, no tratamento desta doença.

  16. Improving Student Success in Calculus I Using a Co-Requisite Calculus I Lab

    ERIC Educational Resources Information Center

    Vestal, Sharon Schaffer; Brandenburger, Thomas; Furth, Alfred

    2015-01-01

    This paper describes how one university mathematics department was able to improve student success in Calculus I by requiring a co-requisite lab for certain groups of students. The groups of students required to take the co-requisite lab were identified by analyzing student data, including Math ACT scores, ACT Compass Trigonometry scores, and…

  17. Success in Introductory Calculus: The Role of High School and Pre-Calculus Preparation

    ERIC Educational Resources Information Center

    Ayebo, Abraham; Ukkelberg, Sarah; Assuah, Charles

    2017-01-01

    Calculus at the college level has significant potential to serve as a pump for increasing the number of students majoring in STEM fields. It is a foundation course for all STEM majors and, if mastered well, should provide students with a positive and successful first-year experience and gateway into more advanced courses. Studies have shown that a…

  18. An Evaluative Calculus Project: Applying Bloom's Taxonomy to the Calculus Classroom

    ERIC Educational Resources Information Center

    Karaali, Gizem

    2011-01-01

    In education theory, Bloom's taxonomy is a well-known paradigm to describe domains of learning and levels of competency. In this article I propose a calculus capstone project that is meant to utilize the sixth and arguably the highest level in the cognitive domain, according to Bloom et al.: evaluation. Although one may assume that mathematics is…

  19. Operator calculus for information field theory

    NASA Astrophysics Data System (ADS)

    Leike, Reimar H.; Enßlin, Torsten A.

    2016-11-01

    Signal inference problems with non-Gaussian posteriors can be hard to tackle. Through using the concept of Gibbs free energy these posteriors are rephrased as Gaussian posteriors for the price of computing various expectation values with respect to a Gaussian distribution. We present a way of translating these expectation values to a language of operators which is similar to that in quantum mechanics. This simplifies many calculations, for instance such as those involving log-normal priors. The operator calculus is illustrated by deriving a self-calibrating algorithm which is tested with mock data.

  20. On the origins of generalized fractional calculus

    NASA Astrophysics Data System (ADS)

    Kiryakova, Virginia

    2015-11-01

    In Fractional Calculus (FC), as in the (classical) Calculus, the notions of derivatives and integrals (of first, second, etc. or arbitrary, incl. non-integer order) are basic and co-related. One of the most frequent approach in FC is to define first the Riemann-Liouville (R-L) integral of fractional order, and then by means of suitable integer-order differentiation operation applied over it (or under its sign) a fractional derivative is defined - in the R-L sense (or in Caputo sense). The first mentioned (R-L type) is closer to the theoretical studies in analysis, but has some shortages - from the point of view of interpretation of the initial conditions for Cauchy problems for fractional differential equations (stated also by means of fractional order derivatives/ integrals), and also for the analysts' confusion that such a derivative of a constant is not zero in general. The Caputo (C-) derivative, arising first in geophysical studies, helps to overcome these problems and to describe models of applied problems with physically consistent initial conditions. The operators of the Generalized Fractional Calculus - GFC (integrals and derivatives) are based on commuting m-tuple (m = 1, 2, 3, …) compositions of operators of the classical FC with power weights (the so-called Erdélyi-Kober operators), but represented in compact and explicit form by means of integral, integro-differential (R-L type) or differential-integral (C-type) operators, where the kernels are special functions of most general hypergeometric kind. The foundations of this theory are given in Kiryakova 18. In this survey we present the genesis of the definitions of the GFC - the generalized fractional integrals and derivatives (of fractional multi-order) of R-L type and Caputo type, analyze their properties and applications. Their special cases are all the known operators of classical FC, their generalizations introduced by other authors, the hyper-Bessel differential operators of higher integer

  1. The Calculus of Responsibility and Commitment

    NASA Astrophysics Data System (ADS)

    Pollard, Carl

    Ever since Montague (1974 [1970]) laid the foundations for formally precise analysis of natural language (hereafter NL) semantics in the late 1960's, the typed lambda calculus (hereafter TLC) and certain of its extensions have been the linguists' tool of choice for representing the meanings of NL expressions. But starting around the turn of the millenium, motivated by a range of linguistic phenomena collectively known as covert movement phenomena, logical grammarians of various persuasions have proposed the use of other semantic term calculi that embody, directly or indirectly, some notion or other of continuation.

  2. Applications of fractional calculus to epidemiological models

    NASA Astrophysics Data System (ADS)

    Skwara, Urszula; Martins, José; Ghaffari, Peyman; Aguiar, Maíra; Boto, João; Stollenwerk, Nico

    2012-09-01

    Epidemiological spreading does not only happen from person to neighbouring person but often over wide distances, when infected but asymptomatic persons travel and carry infection to others over wide distances. Superdiffusion has been suggested to model such spreading in spatially restriced contact networks, i.e. there is still a notion of geographical distance, but spreading happens with high probability proportional to large distances. From fractional calculus several ways of describing superdiffusion are know. Here we investigate the representation in Fourier space and which is easily generalizable to higher dimensional space in order to compare with stochastic models of epidemiological spreading.

  3. Operator calculus for information field theory.

    PubMed

    Leike, Reimar H; Enßlin, Torsten A

    2016-11-01

    Signal inference problems with non-Gaussian posteriors can be hard to tackle. Through using the concept of Gibbs free energy these posteriors are rephrased as Gaussian posteriors for the price of computing various expectation values with respect to a Gaussian distribution. We present a way of translating these expectation values to a language of operators which is similar to that in quantum mechanics. This simplifies many calculations, for instance such as those involving log-normal priors. The operator calculus is illustrated by deriving a self-calibrating algorithm which is tested with mock data.

  4. Denoising Medical Images using Calculus of Variations.

    PubMed

    Kohan, Mahdi Nakhaie; Behnam, Hamid

    2011-07-01

    We propose a method for medical image denoising using calculus of variations and local variance estimation by shaped windows. This method reduces any additive noise and preserves small patterns and edges of images. A pyramid structure-texture decomposition of images is used to separate noise and texture components based on local variance measures. The experimental results show that the proposed method has visual improvement as well as a better SNR, RMSE and PSNR than common medical image denoising methods. Experimental results in denoising a sample Magnetic Resonance image show that SNR, PSNR and RMSE have been improved by 19, 9 and 21 percents respectively.

  5. Regge calculus and observations. II. Further applications.

    NASA Astrophysics Data System (ADS)

    Williams, Ruth M.; Ellis, G. F. R.

    1984-11-01

    The method, developed in an earlier paper, for tracing geodesies of particles and light rays through Regge calculus space-times, is applied to a number of problems in the Schwarzschild geometry. It is possible to obtain accurate predictions of light bending by taking sufficiently small Regge blocks. Calculations of perihelion precession, Thomas precession, and the distortion of a ball of fluid moving on a geodesic can also show good agreement with the analytic solution. However difficulties arise in obtaining accurate predictions for general orbits in these space-times. Applications to other problems in general relativity are discussed briefly.

  6. Student Created Calculus Movies Using Computers and the TI-92.

    ERIC Educational Resources Information Center

    Sher, Lawrence; Wilkinson, Patricia

    The Mathematics Department at Borough of Manhattan Community College (BMCC) (New York) has been actively involved since 1988 in a serious and successful program to improve instruction, understanding, and retention for women and minority students in calculus courses. One result of this work has been students creating calculus animations using…

  7. Effects of Clicker Use on Calculus Students' Mathematics Anxiety

    ERIC Educational Resources Information Center

    Batchelor, John

    2015-01-01

    This paper reports the results of a survey study of clicker use and mathematics anxiety among students enrolled in an undergraduate calculus course during the Fall 2013 semester. Students in two large lecture sections of calculus completed surveys at the beginning and end of the course. One class used clickers, whereas the other class was taught…

  8. Improving Student Success in Calculus at Seattle University

    ERIC Educational Resources Information Center

    Carter, J. D.; Helliwell, D.; Henrich, Allison; Principe, M.; Sloughter, J. M.

    2016-01-01

    Finding ways to improve student success in calculus is a critically important step on the path to supporting students who are pursuing degrees in STEM fields. Far too many students fail calculus 1 and are pushed to drop their majors in technical fields. One way of addressing this issue is by following a program that was pioneered at University of…

  9. Descartes' Calculus of Subnormals: What Might Have Been

    ERIC Educational Resources Information Center

    Boudreaux, Gregory Mark; Walls, Jess E.

    2013-01-01

    Rene Descartes' method for finding tangents (equivalently, subnormals) depends on geometric and algebraic properties of a family of circles intersecting a given curve. It can be generalized to establish a calculus of subnormals, an alternative to the calculus of Newton and Leibniz. Here we prove subnormal counterparts of the well-known…

  10. Modelling the Landing of a Plane in a Calculus Lab

    ERIC Educational Resources Information Center

    Morante, Antonio; Vallejo, Jose A.

    2012-01-01

    We exhibit a simple model of a plane landing that involves only basic concepts of differential calculus, so it is suitable for a first-year calculus lab. We use the computer algebra system Maxima and the interactive geometry software GeoGebra to do the computations and graphics. (Contains 5 figures and 1 note.)

  11. Reflections on Our First Calculus Undergraduate Teaching Assistant

    ERIC Educational Resources Information Center

    Deshler, Jessica M.

    2016-01-01

    This article describes some reflections from the first Calculus I undergraduate teaching assistant in our department as she explored the various ways in which she was able to support both novice and experienced Calculus teachers and the effect of her experience on her academic and career plans.

  12. On Flipping the Classroom in Large First Year Calculus Courses

    ERIC Educational Resources Information Center

    Jungic, Veselin; Kaur, Harpreet; Mulholland, Jamie; Xin, Cindy

    2015-01-01

    Over the course of two years, 2012-2014, we have implemented a "flipping" the classroom approach in three of our large enrolment first year calculus courses: differential and integral calculus for scientists and engineers. In this article we describe the details of our particular approach and share with the reader some experiences of…

  13. Coordinating Multiple Representations in a Reform Calculus Textbook

    ERIC Educational Resources Information Center

    Chang, Briana L.; Cromley, Jennifer G.; Tran, Nhi

    2015-01-01

    Coordination of multiple representations (CMR) is widely recognized as a critical skill in mathematics and is frequently demanded in reform calculus textbooks. However, little is known about the prevalence of coordination tasks in such textbooks. We coded 707 instances of CMR in a widely used reform calculus textbook and analyzed the distributions…

  14. Visual Thinking and Gender Differences in High School Calculus

    ERIC Educational Resources Information Center

    Haciomeroglu, Erhan Selcuk; Chicken, Eric

    2012-01-01

    This study sought to examine calculus students' mathematical performances and preferences for visual or analytic thinking regarding derivative and antiderivative tasks presented graphically. It extends previous studies by investigating factors mediating calculus students' mathematical performances and their preferred modes of thinking. Data were…

  15. Coordinating Multiple Representations in a Reform Calculus Textbook

    ERIC Educational Resources Information Center

    Chang, Briana L.; Cromley, Jennifer G.; Tran, Nhi

    2016-01-01

    Coordination of multiple representations (CMR) is widely recognized as a critical skill in mathematics and is frequently demanded in reform calculus textbooks. However, little is known about the prevalence of coordination tasks in such textbooks. We coded 707 instances of CMR in a widely used reform calculus textbook and analyzed the distributions…

  16. Transitioning from Introductory Calculus to Formal Limit Conceptions

    ERIC Educational Resources Information Center

    Nagle, Courtney

    2013-01-01

    The limit concept is a fundamental mathematical notion both for its practical applications and its importance as a prerequisite for later calculus topics. Past research suggests that limit conceptualizations promoted in introductory calculus are far removed from the formal epsilon-delta definition of limit. In this article, I provide an overview…

  17. The Use of Technology and Visualization in Calculus Instruction

    ERIC Educational Resources Information Center

    Samuels, Jason

    2010-01-01

    This study was inspired by a history of student difficulties in calculus, and innovation in response to those difficulties. The goals of the study were fourfold. First, to design a mathlet for students to explore local linearity. Second, to redesign the curriculum of first semester calculus around the use of technology, an emphasis on…

  18. Calculus Students' Early Concept Images of Tangent Lines

    ERIC Educational Resources Information Center

    Vincent, Brittany; LaRue, Renee; Sealey, Vicki; Engelke, Nicole

    2015-01-01

    This study explored first-semester calculus students' understanding of tangent lines as well as how students used tangent lines within the context of Newton's method. Task-based interviews were conducted with twelve first-semester calculus students who were asked to verbally describe a tangent line, sketch tangent lines for multiple curves, and…

  19. Our Experiences with Using Visualization Tools in Teaching Calculus.

    ERIC Educational Resources Information Center

    Kowalczyk, Robert E.; Hausknecht, Adam O.

    This paper describes two uses of the software package TEMATH (Tools for Exploring Mathematics) with calculus students: (1) as a demonstration tool in the classroom to visually explore with students the many mathematical models introduced in a first year calculus course; and (2) as a part of a lab where students use a set of laboratory explorations…

  20. Restricted diversity of dental calculus methanogens over five centuries, France

    PubMed Central

    Huynh, Hong T. T.; Nkamga, Vanessa D.; Signoli, Michel; Tzortzis, Stéfan; Pinguet, Romuald; Audoly, Gilles; Aboudharam, Gérard; Drancourt, Michel

    2016-01-01

    Methanogens are acknowledged archaeal members of modern dental calculus microbiota and dental pathogen complexes. Their repertoire in ancient dental calculus is poorly known. We therefore investigated archaea in one hundred dental calculus specimens collected from individuals recovered from six archaeological sites in France dated from the 14th to 19th centuries AD. Dental calculus was demonstrated by macroscopic and cone-beam observations. In 56 calculus specimens free of PCR inhibition, PCR sequencing identified Candidatus Methanobrevibacter sp. N13 in 44.6%, Methanobrevibacter oralis in 19.6%, a new Methanomassiliicoccus luminyensis-like methanogen in 12.5%, a Candidatus Nitrososphaera evergladensis-like in one and Methanoculleus bourgensis in one specimen, respectively. One Candidatus Methanobrevibacter sp. N13 dental calculus was further documented by fluorescent in situ hybridization. The prevalence of dental calculus M. oralis was significantly lower in past populations than in modern populations (P = 0.03, Chi-square test). This investigation revealed a previously unknown repertoire of archaea found in the oral cavity of past French populations as reflected in preserved dental calculus. PMID:27166431

  1. Calculus: A Computer Oriented Presentation, Part 1 [and] Part 2.

    ERIC Educational Resources Information Center

    Stenberg, Warren; Walker, Robert J.

    Parts one and two of a one-year computer-oriented calculus course (without analytic geometry) are presented. The ideas of calculus are introduced and motivated through computer (i.e., algorithmic) concepts. An introduction to computing via algorithms and a simple flow chart language allows the book to be self-contained, except that material on…

  2. Interrater Agreement on Subgingival Calculus Detection Following Scaling.

    ERIC Educational Resources Information Center

    Pippin, David J.; Feil, Philip

    1992-01-01

    Two studies investigated interrater agreement among 10 clinical dental examiners who scored residual subgingival calculus after student scaling on 4,160 real and 92 manikin tooth surfaces. Interrater reliability was low. Results suggest a need in periodontics for effective examiner calibration methods and objective subgingival calculus detection…

  3. Utilizing Microsoft Mathematics in Teaching and Learning Calculus

    ERIC Educational Resources Information Center

    Oktaviyanthi, Rina; Supriani, Yani

    2015-01-01

    The experimental design was conducted to investigate the use of Microsoft Mathematics, free software made by Microsoft Corporation, in teaching and learning Calculus. This paper reports results from experimental study details on implementation of Microsoft Mathematics in Calculus, students' achievement and the effects of the use of Microsoft…

  4. Experimental Design: Utilizing Microsoft Mathematics in Teaching and Learning Calculus

    ERIC Educational Resources Information Center

    Oktaviyanthi, Rina; Supriani, Yani

    2015-01-01

    The experimental design was conducted to investigate the use of Microsoft Mathematics, free software made by Microsoft Corporation, in teaching and learning Calculus. This paper reports results from experimental study details on implementation of Microsoft Mathematics in Calculus, students' achievement and the effects of the use of Microsoft…

  5. Evaluating the Use of Learning Objects for Improving Calculus Readiness

    ERIC Educational Resources Information Center

    Kay, Robin; Kletskin, Ilona

    2010-01-01

    Pre-calculus concepts such as working with functions and solving equations are essential for students to explore limits, rates of change, and integrals. Yet many students have a weak understanding of these key concepts which impedes performance in their first year university Calculus course. A series of online learning objects was developed to…

  6. How Students Use Physics to Reason about Calculus Tasks

    ERIC Educational Resources Information Center

    Marrongelle, Karen A.

    2004-01-01

    The present research study investigates how undergraduate students in an integrated calculus and physics class use physics to help them solve calculus problems. Using Zandieh's (2000) framework for analyzing student understanding of derivative as a starting point, this study adds detail to her "paradigmatic physical" context and begins to address…

  7. Modelling the landing of a plane in a calculus lab

    NASA Astrophysics Data System (ADS)

    Morante, Antonio; Vallejo, José A.

    2012-10-01

    We exhibit a simple model of a plane landing that involves only basic concepts of differential calculus, so it is suitable for a first-year calculus lab. We use the computer algebra system Maxima and the interactive geometry software GeoGebra to do the computations and graphics.

  8. Calculus Instructors' and Students' Discourses on the Derivative

    ERIC Educational Resources Information Center

    Park, Jungeun

    2011-01-01

    Recently, there has been an increasing interest in collegiate mathematics education, especially teaching and learning calculus (e.g., Oehrtman, Carlson, & Thompson, 2008; Speer, Smith, & Horvath, 2010). Of many calculus concepts, the derivative is known as a difficult concept for students to understand because it involves various concepts…

  9. Partial Fractions in Calculus, Number Theory, and Algebra

    ERIC Educational Resources Information Center

    Yackel, C. A.; Denny, J. K.

    2007-01-01

    This paper explores the development of the method of partial fraction decomposition from elementary number theory through calculus to its abstraction in modern algebra. This unusual perspective makes the topic accessible and relevant to readers from high school through seasoned calculus instructors.

  10. DIFFERENTIAL AND INTEGRAL CALCULUS. A TENTATIVE CURRICULUM GUIDE.

    ERIC Educational Resources Information Center

    BRANT, VINCENT; GERARDI, WILLIAM

    A GUIDE FOR A 1-YEAR COURSE IN DIFFERENTIAL AND INTEGRAL CALCULUS PREREQUISITED KNOWLEDGE IN ALGEBRA, ANALYTIC TRIGONOMETRY, AND ELEMENTARY ANALYSIS. EACH ASSIGNMENT CONTAINED BOTH NEW AND REVIEW WORK TO REINFORCE THE NEW WORK. THERE WERE ELEVEN UNITS OF STUDY USING THE FOLLOWING FOUR BOOKS--"CALCULUS AND ANALYTIC GEOMETRY, THIRD…

  11. An Exploration of Definition and Procedural Fluency in Integral Calculus

    ERIC Educational Resources Information Center

    Grundmeier, Todd A.; Hansen, Jennifer; Sousa, Emily

    2006-01-01

    A survey was administered to calculus students who had previously been exposed to a course on integral calculus. The purpose of the survey was to explore students' understanding of the definition of a definite integral, their abilities to evaluate definite integrals, and their graphical interpretations of definite integrals. The analysis of…

  12. Calculus detection technologies: where do we stand now?

    PubMed

    Archana, V

    2014-01-01

    Epidemiological studies have implicated dental calculus as an ideal substrate for subgingival microbial colonization. Therefore, the main objective of periodontal therapy is to eliminate the microbial biofilm along with the calculus deposits from the root surface by root surface debridement. Over the past years, a large number of clinical and laboratory studies have been conducted to evaluate the efficacy of calculus removal by various methods. None of these conventional methods or devices was effective in completely eliminating all the calculus from the diseased root surfaces. In this context, a number of newer technologies have been developed to identify and selectively remove the dental calculus. Regarding this fact, the present article highlights a critical review of these devices based on published clinical and experimental data.

  13. Intitialization, Conceptualization, and Application in the Generalized Fractional Calculus

    NASA Technical Reports Server (NTRS)

    Lorenzo, Carl F.; Hartley, Tom T.

    1998-01-01

    This paper provides a formalized basis for initialization in the fractional calculus. The intent is to make the fractional calculus readily accessible to engineering and the sciences. A modified set of definitions for the fractional calculus is provided which formally include the effects of initialization. Conceptualizations of fractional derivatives and integrals are shown. Physical examples of the basic elements from electronics are presented along with examples from dynamics, material science, viscoelasticity, filtering, instrumentation, and electrochemistry to indicate the broad application of the theory and to demonstrate the use of the mathematics. The fundamental criteria for a generalized calculus established by Ross (1974) are shown to hold for the generalized fractional calculus under appropriate conditions. A new generalized form for the Laplace transform of the generalized differintegral is derived. The concept of a variable structure (order) differintegral is presented along with initial efforts toward meaningful definitions.

  14. Calculus detection technologies: where do we stand now?

    PubMed Central

    Archana, V

    2014-01-01

    Epidemiological studies have implicated dental calculus as an ideal substrate for subgingival microbial colonization. Therefore, the main objective of periodontal therapy is to eliminate the microbial biofilm along with the calculus deposits from the root surface by root surface debridement. Over the past years, a large number of clinical and laboratory studies have been conducted to evaluate the efficacy of calculus removal by various methods. None of these conventional methods or devices was effective in completely eliminating all the calculus from the diseased root surfaces. In this context, a number of newer technologies have been developed to identify and selectively remove the dental calculus. Regarding this fact, the present article highlights a critical review of these devices based on published clinical and experimental data. PMID:25870667

  15. Acute gastrointestinal complications after cardiac surgery.

    PubMed

    Halm, M A

    1996-03-01

    Gastrointestinal problems, with an incidence of about 1%, may complicate the postoperative period after cardiovascular surgery, increasing morbidity, length of stay, and mortality. Several risk factors for the development of these complications, including preexisting conditions; advancing age; surgical procedure, especially valve, combined bypass/valve, emergency, reoperative, and aortic dissection repair; iatrogenic conditions; stress; ischemia; and postpump complications, have been identified in multiple research studies. Ischemia is the most significant of these risk factors after cardiovascular surgery. Mechanisms that have been implicated include longer cardiopulmonary bypass and aortic cross-clamp times and hypoperfusion states, especially if inotropic or intra-aortic balloon pump support is required. These risk factors have been linked to upper and lower gastrointestinal bleeding, paralytic ileus, intestinal ischemia, acute diverticulitis, acute cholecystitis, hepatic dysfunction, hyperamylasemia, and acute pancreatitis. Gastrointestinal bleeding accounts for almost half of all complications, followed by hepatic dysfunction, intestinal ischemia, and acute cholecystitis. Identification of these gastrointestinal complications may be difficult because manifestations may be masked by postoperative analgesia or not reported by patients because they are sedated or require prolonged mechanical ventilation. Furthermore, clinical manifestations may be nonspecific and not follow the "classic" clinical picture. Therefore, astute assessment skills are needed to recognize these problems in high-risk patients early in their clinical course. Such early recognition will prompt aggressive medical and/or surgical management and therefore improve patient outcomes for the cardiovascular surgical population.

  16. DETECTION OF HELICOBACTER ANTIGEN IN STOOL SAMPLES AND ITS RELATION TO H. PYLORI POSITIVE CHOLECYSTITIS IN EGYPTIAN PATIENTS WITH CHRONIC CALCULAR CHOLECYSTITIS.

    PubMed

    Hassan, Ehsan H; Gerges, Shawkat S; Ahmed, Rehab; Mostafa, Zeinab M; Al-Hamid, Hager Abd; Abd El-Galil, Heba; Thabet, Suzan

    2015-12-01

    Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its noninvasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay (EIA) based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. Fifty patients were included presented with symptomatic qholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients (90%) by laparoscopic Cholecystectomy and 5 patients (10%) by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that (82%) were females with mean age (42.6 +/- 1 years). The mean BMI was (29 + 7.2) H. pylori-specific antigen in stool samples was detected in 40% of patients and 38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases.

  17. Understanding Calculus beyond Computations: A Descriptive Study of the Parallel Meanings and Expectations of Teachers and Users of Calculus

    ERIC Educational Resources Information Center

    Ferguson, Leann J.

    2012-01-01

    Calculus is an important tool for building mathematical models of the world around us and is thus used in a variety of disciplines, such as physics and engineering. These disciplines rely on calculus courses to provide the mathematical foundation needed for success in their courses. Unfortunately, due to the basal conceptions of what it means to…

  18. The Problem of University Courses on Infinitesimal Calculus and Their Demarcation from Infinitesimal Calculus in High Schools - ERRATUM.

    PubMed

    Toeplitz, Otto

    2016-12-01

    In the above mentioned article [1] unfortunately the names of the translators of Toeplitz's lecture were omitted. The correct title is: The Problem of University Courses on Infinitesimal Calculus and Their Demarcation from Infinitesimal Calculus in High Schools Otto Toeplitz Translated into English by Michael N. Fried and Hans Niels Jahnke.

  19. HOSPITALIZATIONS FOR CHOLECYSTITIS AND CHOLELITHIASIS IN THE STATE OF RIO GRANDE DO SUL, BRAZIL

    PubMed Central

    NUNES, Emeline Caldana; ROSA, Roger dos Santos; BORDIN, Ronaldo

    2016-01-01

    ABSTRACT Background: The cholelithiasis is disease of surgical resolution with about 60,000 hospitalizations per year in the Sistema Único de Saúde (SUS - Brazilian National Health System) of the Rio Grande do Sul state. Aim: To describe the profile of hospitalizations for cholecystitis and cholelithiasis performed by the SUS of Rio Grande do Sul state, 2011-2013. Methods: Hospital Information System data from the National Health System through morbidity list for cholelithiasis and cholecystitis (ICD-10 K80-K81). Variables studied were sex, age, number of hospitalizations and approved Hospitalization Authorizations (AIH), total amount and value of hospital services generated, days and average length of stay, mortality, mortality and case fatality ratio, from health regions of the Rio Grande do Sul. Results: During 2011-2013 there were 60,517 hospitalizations for cholecystitis and cholelithiasis, representing 18.86 hospitalizations per 10,000 inhabitants/year, most often in the age group from 60 to 69 years (41.34 admissions per 10,000 inhabitants/year) and female (27.72 hospitalizations per 10,000 inhabitants/year). The fatality rate presented an inverse characteristic: 13.52 deaths per 1,000 admissions/year for males, compared with 7.12 deaths per 1,000 admissions/year in females. The state had an average total amount spent and value of hospital services of R$ 16,244,050.60 and R$ 10,890,461.31, respectively. The health region "Capital/Gravataí Valley" exhibit the highest total expenditure and hospital services, and the largest number of deaths, and average length of stay. Conclusion: The hospitalization and lethality coefficients, the deaths, the length of stay and spending related to admissions increased from 50 years old. Females had a higher frequency and higher values ​​spent on hospitalization, while the male higher coefficient of mortality and mean hospital stay. PMID:27438030

  20. Affine connection form of Regge calculus

    NASA Astrophysics Data System (ADS)

    Khatsymovsky, V. M.

    2016-12-01

    Regge action is represented analogously to how the Palatini action for general relativity (GR) as some functional of the metric and a general connection as independent variables represents the Einstein-Hilbert action. The piecewise flat (or simplicial) spacetime of Regge calculus is equipped with some world coordinates and some piecewise affine metric which is completely defined by the set of edge lengths and the world coordinates of the vertices. The conjugate variables are the general nondegenerate matrices on the three-simplices which play the role of a general discrete connection. Our previous result on some representation of the Regge calculus action in terms of the local Euclidean (Minkowsky) frame vectors and orthogonal connection matrices as independent variables is somewhat modified for the considered case of the general linear group GL(4, R) of the connection matrices. As a result, we have some action invariant w.r.t. arbitrary change of coordinates of the vertices (and related GL(4, R) transformations in the four-simplices). Excluding GL(4, R) connection from this action via the equations of motion we have exactly the Regge action for the considered spacetime.

  1. Graphical calculus for Gaussian pure states

    SciTech Connect

    Menicucci, Nicolas C.; Flammia, Steven T.; Loock, Peter van

    2011-04-15

    We provide a unified graphical calculus for all Gaussian pure states, including graph transformation rules for all local and semilocal Gaussian unitary operations, as well as local quadrature measurements. We then use this graphical calculus to analyze continuous-variable (CV) cluster states, the essential resource for one-way quantum computing with CV systems. Current graphical approaches to CV cluster states are only valid in the unphysical limit of infinite squeezing, and the associated graph transformation rules only apply when the initial and final states are of this form. Our formalism applies to all Gaussian pure states and subsumes these rules in a natural way. In addition, the term 'CV graph state' currently has several inequivalent definitions in use. Using this formalism we provide a single unifying definition that encompasses all of them. We provide many examples of how the formalism may be used in the context of CV cluster states: defining the 'closest' CV cluster state to a given Gaussian pure state and quantifying the error in the approximation due to finite squeezing; analyzing the optimality of certain methods of generating CV cluster states; drawing connections between this graphical formalism and bosonic Hamiltonians with Gaussian ground states, including those useful for CV one-way quantum computing; and deriving a graphical measure of bipartite entanglement for certain classes of CV cluster states. We mention other possible applications of this formalism and conclude with a brief note on fault tolerance in CV one-way quantum computing.

  2. [Gas in the abdominal cavity--due to cholecystitis caused by gas-producing bacteria].

    PubMed

    Miettinen, Simo; Hakkarainen, Timo; Reinikainen, Matti; Hakala, Tapio

    2010-01-01

    In most cases, gas in the abdominal cavity indicates perforation of the gastrointestinal wall. We describe a patient, in whom the cause of abdominal gas detected in computed tomography turned out to be emphysematous cholecystitis caused by gas-producing bacteria. It is a rare disease characterized by accumulation of gas into the gall bladder or its wall. The gas can be easily observed in computed tomography. The disease easily becomes complicated and is associated with high mortality. Prompt cholecystectomy and antibiotic therapy are the cornerstones of the treatment.

  3. Radiation-induced cholecystitis after hepatic radioembolization: do we need to take precautionary measures?

    PubMed

    Prince, Jip F; van den Hoven, Andor F; van den Bosch, Maurice A A J; Elschot, Mattijs; de Jong, Hugo W A M; Lam, Marnix G E H

    2014-11-01

    Controversy exists over the need to take precautionary measures during hepatic radioembolization to minimize the risk of radiation-induced cholecystitis. Strategies for a variety of clinical scenarios are discussed on the basis of a literature review. Precautionary measures are unnecessary in the majority of patients and should be taken only when single photon-emission computed tomography (CT; SPECT)/CT shows a significant concentration of technetium-99m macroaggregated albumin in the gallbladder wall. In this case report with quantitative SPECT analysis, it is illustrated how an adjustment of the catheter position can effectively reduce the absorbed dose of radiation delivered to the gallbladder wall by more than 90%.

  4. Miniature endoscopic optical coherence tomography for calculus detection.

    PubMed

    Kao, Meng-Chun; Lin, Chun-Li; Kung, Che-Yen; Huang, Yi-Fung; Kuo, Wen-Chuan

    2015-08-20

    The effective treatment of periodontitis involves the detection and removal of subgingival dental calculus. However, subgingival calculus is more difficult to detect than supragingival calculus because it is firmly attached to root surfaces within periodontal pockets. To achieve a smooth root surface, clinicians often remove excessive amounts of root structure because of decreased visibility. In addition, enamel pearl, a rare type of ectopic enamel formation on the root surface, can easily be confused with dental calculus in the subgingival environment. In this study, we developed a fiber-probe swept-source optical coherence tomography (SSOCT) technique and combined it with the quantitative measurement of an optical parameter [standard deviation (SD) of the optical coherence tomography (OCT) intensity] to differentiate subgingival calculus from sound enamel, including enamel pearl. Two-dimensional circumferential images were constructed by rotating the miniprobe (0.9 mm diameter) while acquiring image lines, and the adjacent lines in each rotation were stacked to generate a three-dimensional volume. In OCT images, compared to sound enamel and enamel pearls, dental calculus showed significant differences (P<0.001) in SD values. Finally, the receiver operating characteristic curve had a high capacity (area under the curve=0.934) for discriminating between healthy regions (including enamel pearl) and dental calculus.

  5. Pulsed laser ablation of dental calculus in the near ultraviolet.

    PubMed

    Schoenly, Joshua E; Seka, Wolf; Rechmann, Peter

    2014-02-01

    Pulsed lasers emitting wavelengths near 400 nm can selectively ablate dental calculus without damaging underlying and surrounding sound dental hard tissue. Our results indicate that calculus ablation at this wavelength relies on the absorption of porphyrins endogenous to oral bacteria commonly found in calculus. Sub- and supragingival calculus on extracted human teeth, irradiated with 400-nm, 60-ns laser pulses at ≤8  J/cm2, exhibits a photobleached surface layer. Blue-light microscopy indicates this layer highly scatters 400-nm photons, whereas fluorescence spectroscopy indicates that bacterial porphyrins are permanently photobleached. A modified blow-off model for ablation is proposed that is based upon these observations and also reproduces our calculus ablation rates measured from laser profilometry. Tissue scattering and a stratified layering of absorbers within the calculus medium explain the gradual decrease in ablation rate from successive pulses. Depending on the calculus thickness, ablation stalling may occur at <5  J/cm2 but has not been observed above this fluence.

  6. Trygve Haavelmo and the Emergence of Causal Calculus

    DTIC Science & Technology

    2014-06-01

    Econometric Theory, 2014, Page 1 of 28. doi:10.1017/S0266466614000231 TRYGVE HAAVELMO AND THE EMERGENCE OF CAUSAL CALCULUS JUDEA PEARL University of...Emergence of Causal Calculus 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK...definition of a (Pearl, 1994): a = ∂ ∂x E(Y |do(x)) (3) HAAVELMO AND CAUSAL CALCULUS 3 which refers to a controlled experiment in which an agent (e.g

  7. Discrete Quantum Gravity in the Regge Calculus Formalism

    SciTech Connect

    Khatsymovsky, V.M.

    2005-09-01

    We discuss an approach to the discrete quantum gravity in the Regge calculus formalism that was developed in a number of our papers. The Regge calculus is general relativity for a subclass of general Riemannian manifolds called piecewise flat manifolds. The Regge calculus deals with a discrete set of variables, triangulation lengths, and contains continuous general relativity as a special limiting case where the lengths tend to zero. In our approach, the quantum length expectations are nonzero and of the order of the Plank scale, 10{sup -33} cm, implying a discrete spacetime structure on these scales.

  8. Area Regge calculus and continuum limit [rapid communication

    NASA Astrophysics Data System (ADS)

    Khatsymovsky, V. M.

    2002-11-01

    Encountered in the literature generalisations of general relativity to independent area variables are considered, the discrete (generalised Regge calculus) and continuum ones. The generalised Regge calculus can be either with purely area variables or, as we suggest, with area tensor-connection variables. Just for the latter, in particular, we prove that in analogy with corresponding statement in ordinary Regge calculus (by Feinberg, Friedberg, Lee and Ren), passing to the (appropriately defined) continuum limit yields the generalised continuum area tensor-connection general relativity.

  9. Intra-cholecystic approach for laparoscopic management of Mirizzi's syndrome: A case series

    PubMed Central

    Nag, Hirdaya H.; Gangadhara, Vageesh Bettageri; Dangi, Amit

    2016-01-01

    INTRODUCTION: Laparoscopic management of patients with Mirizzi's syndrome (MS) is not routinely recommended due to the high risk of iatrogenic complications. PATIENTS AND METHODS: Intra-cholecystic (IC) or inside-gall bladder (GB) approach was used for laparoscopic management of 16 patients with MS at a tertiary care referral centre in North India from May 2010 to August 2014; a retrospective analysis of prospectively collected data was performed. RESULTS: Mean age was 40.1 ± 14.7 years, the male-to-female ratio was 1:3, and 9 (56.25%) patients had type 1 MS (MS1) and 7 (43.75%) had type 2 MS (MS2) (McSherry's classification). The laparoscopic intra-cholecystic approach (LICA) was successful in 11 (68.75%) patients, whereas 5 patients (31.25%) required conversion to open method. Median blood loss was 100 mL (range: 50-400 mL), and median duration of surgery was 3.25 h (range: 2-7.5 h). No major complications were encountered except 1 patient (6.5%) who required re-operation for retained bile duct stones. The final histopathology report was benign in all the patients. No remote complications were noted during a mean follow-up of 20.18 months. CONCLUSION: LICA is a feasible and safe approach for selected patients with Mirizzi's syndrome; however, a low threshold for conversion is necessary to avoid iatrogenic complications. PMID:27251843

  10. Bubaline Cholecyst Derived Extracellular Matrix for Reconstruction of Full Thickness Skin Wounds in Rats

    PubMed Central

    Shakya, Poonam; Sharma, A. K.; Kumar, Naveen; Vellachi, Remya; Mathew, Dayamon D.; Dubey, Prasoon; Singh, Kiranjeet; Shrivastava, Sonal; Shrivastava, Sameer; Maiti, S. K.; Hasan, Anwarul; Singh, K. P.

    2016-01-01

    An acellular cholecyst derived extracellular matrix (b-CEM) of bubaline origin was prepared using anionic biological detergent. Healing potential of b-CEM was compared with commercially available collagen sheet (b-CS) and open wound (C) in full thickness skin wounds in rats. Thirty-six clinically healthy adult Sprague Dawley rats of either sex were randomly divided into three equal groups. Under general anesthesia, a full thickness skin wound (20 × 20 mm2) was created on the dorsum of each rat. The defect in group I was kept as open wound and was taken as control. In group II, the defect was repaired with commercially available collagen sheet (b-CS). In group III, the defect was repaired with cholecyst derived extracellular matrix of bovine origin (b-CEM). Planimetry, wound contracture, and immunological and histological observations were carried out to evaluate healing process. Significantly (P < 0.05) increased wound contraction was observed in b-CEM (III) as compared to control (I) and b-CS (II) on day 21. Histologically, improved epithelization, neovascularization, fibroplasia, and best arranged collagen fibers were observed in b-CEM (III) as early as on postimplantation day 21. These findings indicate that b-CEM have potential for biomedical applications for full thickness skin wound repair in rats. PMID:27127678

  11. Eosinophilic Granulomatosis with Polyangiitis Presenting with Skin Rashes, Eosinophilic Cholecystitis, and Retinal Vasculitis

    PubMed Central

    Zeng, Mingbing; Liu, Xialin; Liu, Yizhi

    2016-01-01

    Patient: Female, 20 Final Diagnosis: Eosinophilic granulomatosis with polyangiitis Symptoms: Fever • skin rashes • eosinophilic cholecystitis • retinal vasculitis Medication: — Clinical Procedure: — Specialty: Ophthalmology Objective: Rare co-existance of disease or pathology Background: Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome (CSS), is a rare vasculitis of unknown etiology. Most of the patients have a long history of asthma and then develop autoimmune inflammation of small and medium-sized blood vessels, with consequent reduction of blood flow to various organs and tissues. EGPA can cause disorders in multiple systems; the most seriously affected organs are the retina, kidney, brain, cardiovascular system, and skin. Case Report: The patient was hospitalized for high fever and skin rashes and then developed right upper abdominal pain, decreased visual acuity, coma, and convulsions. Laboratory investigations showed marked eosinophilia (9412/mm3). Following cholecystectomy, histopathological examination revealed a marked inflammatory cell infiltrate composed mainly of eosinophils. Retinal vasculitis and medium and peripheral vascular closure were confirmed by fundus fluorescence angiography (FFA). The coma and convulsions were controlled successfully by high-dose methylprednisolone. After gradual tapering of the methylprednisolone, the patient’s blood count recovered to a normal level, and the other systematic disorders disappeared; however, she was left with irreversible blindness. Conclusions: EGPA can cause eosinophilic cholecystitis, retinal vasculitis, and neuropathy in the short term and calls for effective treatments in order to avoid binocular blindness. PMID:27857032

  12. Aberrant activation of Sonic hedgehog signaling in chronic cholecystitis and gallbladder carcinoma.

    PubMed

    Xie, Fang; Xu, Xiaoping; Xu, Angao; Liu, Cuiping; Liang, Fenfen; Xue, Minmin; Bai, Lan

    2014-03-01

    Sonic hedgehog (Shh) signaling has been extensively studied and is implicated in various inflammatory diseases and malignant tumors. We summarized the clinicopathological features and performed immunohistochemistry assays to examine expression of Shh signaling proteins in 10 normal mucosa, 32 gallbladder carcinoma (GBC), and 95 chronic cholecystitis (CC) specimens. The CC specimens were classified into three groups according to degree of inflammation. Compared with normal mucosa, CC, and GBC specimens exhibited increased expression of Shh. The immunoreactive score of Shh in the GBC group was higher than that in the mild to moderate CC groups but lower than that in the severe CC group (P < .05). Expression of Patched (Ptch) and Gli1 gradually increased from non-malignant cholecystitis to malignant tumors. Compared with CC specimens, GBC specimens showed higher cytoplasmic and membranous expression for Ptch (P < .05). Gli1 staining showed cytoplasmic expression of Gli1 in both CC (60% for mild, 77% for moderate, and 84% for severe) and GBC specimens (97%). Nuclear expression of Gli1 was detected in 16% of severe CC specimens with moderate to poor atypical hyperplasia, and in 62.5% of GBC specimens. Shh expression strongly correlated with expression of Ptch and Gli1. Furthermore, patients with strongly positive Gli1 staining had significantly lower survival rates than those with weakly positive staining. Our data indicate that the Shh signaling pathway is aberrantly activated in CC and GBC, and altered Shh signaling may be involved in the course of development from CC to gallbladder carcinogenesis.

  13. Emphysematous pyelonephritis with calculus: Management strategies

    PubMed Central

    Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

    2007-01-01

    Objective: Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Materials and Methods: Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. Results: EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. Conclusion: In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures. PMID:19718324

  14. VEST: Abstract vector calculus simplification in Mathematica

    NASA Astrophysics Data System (ADS)

    Squire, J.; Burby, J.; Qin, H.

    2014-01-01

    We present a new package, VEST (Vector Einstein Summation Tools), that performs abstract vector calculus computations in Mathematica. Through the use of index notation, VEST is able to reduce three-dimensional scalar and vector expressions of a very general type to a well defined standard form. In addition, utilizing properties of the Levi-Civita symbol, the program can derive types of multi-term vector identities that are not recognized by reduction, subsequently applying these to simplify large expressions. In a companion paper Burby et al. (2013) [12], we employ VEST in the automation of the calculation of high-order Lagrangians for the single particle guiding center system in plasma physics, a computation which illustrates its ability to handle very large expressions. VEST has been designed to be simple and intuitive to use, both for basic checking of work and more involved computations.

  15. Regge calculus models of closed lattice universes

    NASA Astrophysics Data System (ADS)

    Liu, Rex G.; Williams, Ruth M.

    2016-01-01

    This paper examines the behavior of closed "lattice universes" wherein masses are distributed in a regular lattice on the Cauchy surfaces of closed vacuum universes. Such universes are approximated using a form of Regge calculus originally developed by Collins and Williams to model closed Friedmann-Lemaître-Robertson-Walker universes. We consider two types of lattice universes, one where all masses are identical to each other and another where one mass gets perturbed in magnitude. In the unperturbed universe, we consider the possible arrangements of the masses in the Regge Cauchy surfaces and demonstrate that the model will only be stable if each mass lies within some spherical region of convergence. We also briefly discuss the existence of Regge models that are dual to the ones we have considered. We then model a perturbed lattice universe and demonstrate that the model's evolution is well behaved, with the expansion increasing in magnitude as the perturbation is increased.

  16. VEST: Abstract Vector Calculus Simplification in Mathematica

    SciTech Connect

    J. Squire, J. Burby and H. Qin

    2013-03-12

    We present a new package, VEST (Vector Einstein Summation Tools), that performs abstract vector calculus computations in Mathematica. Through the use of index notation, VEST is able to reduce scalar and vector expressions of a very general type using a systematic canonicalization procedure. In addition, utilizing properties of the Levi-Civita symbol, the program can derive types of multi-term vector identities that are not recognized by canonicalization, subsequently applying these to simplify large expressions. In a companion paper [1], we employ VEST in the automation of the calculation of Lagrangians for the single particle guiding center system in plasma physics, a computation which illustrates its ability to handle very large expressions. VEST has been designed to be simple and intuitive to use, both for basic checking of work and more involved computations. __________________________________________________

  17. Staghorn calculus endotoxin expression in sepsis.

    PubMed

    McAleer, Irene M; Kaplan, George W; Bradley, John S; Carroll, Stephen F

    2002-04-01

    Staghorn calculi are infrequent and generally are infected stones. Struvite or apatite calculi are embedded with gram-negative bacteria, which can produce endotoxin. Sepsis syndrome may occur after surgical therapy or endoscopic manipulation of infected or staghorn calculi. Sepsis, which can occur despite perioperative antibiotic use, may be due to bacteremia or endotoxemia. We present a child with an infected staghorn calculus who developed overwhelming sepsis and died after percutaneous stone manipulation. Endotoxin assay of stone fragments demonstrated an extremely high level of endotoxin despite low colony bacterial culture growth. This is the first reported case in which endotoxin was demonstrated in stone fragments from a child who died of severe sepsis syndrome after percutaneous staghorn stone manipulation.

  18. Improving Student Success in Calculus: A Comparison of Four College Calculus Classes

    NASA Astrophysics Data System (ADS)

    Bagley, Spencer Franklin

    The quality of education in science, technology, engineering, and mathematics (STEM) fields is an issue of particular educational and economic importance, and Calculus I is a linchpin course in STEM major tracks. A national study is currently being conducted examining the characteristics of successful programs in college calculus (CSPCC, 2012). In work related to the CSPCC program, this study examines the effects on student outcomes of four different teaching strategies used at a single institution. The four classes were a traditional lecture, a lecture with discussion, a lecture incorporating both discussion and technology, and an inverted model. This dissertation was guided by three questions: (1) What impact do these four instructional approaches have on students' persistence, beliefs about mathematics, and conceptual and procedural achievement in calculus? (2) How do students at the local institution compare to students in the national database? And (3) How do the similarities and differences in opportunities for learning presented in the four classes contribute to the similarities and differences in student outcomes? Quantitative analysis of surveys and exams revealed few statistically significant differences in outcomes, and students in the inverted classroom often had poorer outcomes than those in other classes. Students in the technology-enhanced class scored higher on conceptual items on the final exam than those in other classes. Comparing to the national database, local students had similar switching rates but less expert-like attitudes and beliefs about mathematics than the national average. Qualitative analysis of focus group interviews, classroom observations, and student course evaluations showed that several implementation issues, some the result of pragmatic constraints, others the result of design choice, weakened affordances provided by innovative features and shrunk the differences between classes. There were substantial differences between the

  19. A transition calculus for Boolean functions. [logic circuit analysis

    NASA Technical Reports Server (NTRS)

    Tucker, J. H.; Bennett, A. W.

    1974-01-01

    A transition calculus is presented for analyzing the effect of input changes on the output of logic circuits. The method is closely related to the Boolean difference, but it is more powerful. Both differentiation and integration are considered.

  20. Teacher-Controlled Programs for Demonstrating Concepts in Calculus.

    ERIC Educational Resources Information Center

    Hativa, Nira; Barall, Michael

    1984-01-01

    Describes the principles underlying computer programs designed to improve undergraduate calculus instruction. The programs were produced for teacher use on a single microcomputer for when there are not enough microcomputers available to allow students to have access to them. (JN)

  1. Forest Carbon Uptake and the Fundamental Theorem of Calculus

    ERIC Educational Resources Information Center

    Zobitz, John

    2013-01-01

    Using the fundamental theorem of calculus and numerical integration, we investigate carbon absorption of ecosystems with measurements from a global database. The results illustrate the dynamic nature of ecosystems and their ability to absorb atmospheric carbon.

  2. Spontaneous bladder rupture caused by a giant vesical calculus.

    PubMed

    Kaur, Navneet; Attam, Amit; Gupta, Ashish; Amratash

    2006-01-01

    Spontaneous rupture of the urinary bladder is an uncommon occurrence. A 36-year-old man had complaints of pain and progressive distension of abdomen and anuria for 2 days. His abdomen was tense, tender and distended with free fluid. Blood urea was 340 mg% and ascitic fluid urea was 337 mg%. An USG showed massive ascitis, a large vesical calculus and a left renal calculus. The urinary bladder could not be catheterized. Patient underwent hemodialysis and placement of abdominal drains. About 2 l of yellow turbid fluid was drained. Cystolithotomy showed a 6 cm size impacted calculus with a rent in the dome of the bladder, which was repaired. Subsequently patient underwent percutaneous nephrolithotrypsy for left staghorn renal calculus and nephrectomy for right non-functioning kidney.

  3. Ants, Tunnels, and Calculus: An Exercise in Mathematical Modeling.

    ERIC Educational Resources Information Center

    Winkel, Brian J.

    1994-01-01

    Discusses an activity which models the building of a tunnel by ants using the definitions of derivative and indefinite integral from calculus. Includes a discussion of reasonableness and interpretation of the problem. (MKR)

  4. Geometric constrained variational calculus. II: The second variation (Part I)

    NASA Astrophysics Data System (ADS)

    Massa, Enrico; Bruno, Danilo; Luria, Gianvittorio; Pagani, Enrico

    2016-10-01

    Within the geometrical framework developed in [Geometric constrained variational calculus. I: Piecewise smooth extremals, Int. J. Geom. Methods Mod. Phys. 12 (2015) 1550061], the problem of minimality for constrained calculus of variations is analyzed among the class of differentiable curves. A fully covariant representation of the second variation of the action functional, based on a suitable gauge transformation of the Lagrangian, is explicitly worked out. Both necessary and sufficient conditions for minimality are proved, and reinterpreted in terms of Jacobi fields.

  5. Using `min' and `max' functions in calculus teaching

    NASA Astrophysics Data System (ADS)

    Satianov, Pavel; Dagan, Miriam; Amram, Meirav

    2015-08-01

    In this paper, we discuss the use of the min and max functions in teaching calculus to engineering students. Our experience illustrates that such functions have great possibilities in the development of a student's analytical thinking. The types of problems we present here are not common in most instructional texts, which lead us to suggest that the paper will be interesting and useful to calculus lecturers.

  6. Dental Calculus and the Evolution of the Human Oral Microbiome.

    PubMed

    Warinner, Christina

    2016-07-01

    Characterizing the evolution of the oral microbiome is a challenging, but increasingly feasible, task. Recently, dental calculus has been shown to preserve ancient biomolecules from the oral microbiota, host tissues and diet for tens of thousands of years. As such, it provides a unique window into the ancestral oral microbiome. This article reviews recent advancements in ancient dental calculus research and emerging insights into the evolution and ecology of the human oral microbiome.

  7. Fisher information, Borges operators, and q-calculus

    NASA Astrophysics Data System (ADS)

    Pennini, F.; Plastino, A.; Ferri, G. L.

    2008-10-01

    We discuss applying the increasingly popular q-calculus, or deformed calculus, so as to suitably generalize Fisher’s information measure and the Cramer-Rao inequality. A q-deformation can be attained in multiple ways, and we show that most of them do not constitute legitimate procedures. Within such a context, the only completely acceptable q-deformation is that ensuing from using the so-called Borges derivative [E.P. Borges, Physica A 340 (2004) 95].

  8. College Readiness: The Evaluation of Students Participating in the Historically Black College and University Program in Pre-Calculus and the Calculus Sequence

    ERIC Educational Resources Information Center

    Hall, Angela Renee

    2011-01-01

    This investigative research focuses on the level of readiness of Science, Technology, Engineering, and Mathematics (STEM) students entering Historically Black Colleges and Universities (HBCU) in the college Calculus sequence. Calculus is a fundamental course for STEM courses. The level of readiness of the students for Calculus can very well play a…

  9. Study on relationship of nitric oxide, oxidation, peroxidation, lipoperoxidation with chronic chole-cystitis

    PubMed Central

    Zhou, Jun-Fu; Cai, Dong; Zhu, You-Gen; Yang, Jin-Lu; Peng, Cheng-Hong; Yu, Yang-Hai

    2000-01-01

    AIM: To study relationship of injury induced by nitric oxide, oxidation, peroxidation, lipoperoxidation with chronic cholecystitis. METHODS: The values of plasma nitric oxide (P-NO), plasma vitamin C (P-VC), plasma vitamin E (P-VE), plasma β-carotene (P-β-CAR), plasma lipoperoxides (P-LPO), erythrocyte superoxide dismutase (E-SOD), erythrocyte catalase (E-CAT), erythrocyte glutathione peroxidase (E-GSH-Px) activities and erythrocyte lipoperoxides (E-LPO) level in 77 patients with chro nic cholecystitis and 80 healthy control subjects were determined, differences of the above average values between t he patient group and the control group and differences of the average values bet ween preoperative and postoperative patients were analyzed and compared, linear regression and correlation of the disease course with the above determination values as well as the stepwise regression and correlation of the course with th e values were analyzed. RESULTS: Compared with the control group, the average values of P-NO, P-LPO, E-LPO were significantly increased (P < 0.01), and of P-VC, P-VE, P-β-CAR, E-SOD, E-CAT and E-GSH-Px decreased (P < 0.01) in the patient group. The analysis of the lin ear regression and correlation s howed that with prolonging of the course, the values of P-NO, P-LPO and E-LPO in the patients were gradually ascended and the values of P-VC, P-VE, P-β-CAR, E-SOD, E-CAT and E-GSH-Px descended (P < 0.01). The analysis of the stepwise regression and correlation indicated that the correlation of the course with P-NO, P-VE and P-β-CAR values was the closest. Compared with the preoperative patients, the average values of P-NO, P-LPO and E-LPO were significantly decre ased (P < 0.01) and the average values of P-VC, E-SOD, E-CAT and E-GSH-Px in postoperative pa tients increased (P < 0.01) in postoperative patients. But there was no signif icant difference in the average values of P-VE, P-β-CAR preope rative and postoperative patients. CONCLUSION: Chronic

  10. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    PubMed

    Schmitt, Todd L; Sur, Roger L

    2012-03-01

    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over

  11. Water content contribution in calculus phantom ablation during Q-switched Tm:YAG laser lithotripsy.

    PubMed

    Zhang, Jian J; Rajabhandharaks, Danop; Xuan, Jason Rongwei; Wang, Hui; Chia, Ray W J; Hasenberg, Tom; Kang, Hyun Wook

    2015-01-01

    Q-switched (QS) Tm:YAG laser ablation mechanisms on urinary calculi are still unclear to researchers. Here, dependence of water content in calculus phantom on calculus ablation performance was investigated. White gypsum cement was used as a calculus phantom model. The calculus phantoms were ablated by a total 3-J laser pulse exposure (20 mJ, 100 Hz, 1.5 s) and contact mode with N=15 sample size. Ablation volume was obtained on average 0.079, 0.122, and 0.391  mm3 in dry calculus in air, wet calculus in air, and wet calculus in-water groups, respectively. There were three proposed ablation mechanisms that could explain the effect of water content in calculus phantom on calculus ablation performance, including shock wave due to laser pulse injection and bubble collapse, spallation, and microexplosion. Increased absorption coefficient of wet calculus can cause stronger spallation process compared with that caused by dry calculus; as a result, higher calculus ablation was observed in both wet calculus in air and wet calculus in water. The test result also indicates that the shock waves generated by short laser pulse under the in-water condition have great impact on the ablation volume by Tm:YAG QS laser.

  12. Dumbbell Gallbladder Cholecystitis on Tc-99m Diisopropyliminodiacetic acid Hepatobiliary Imaging

    PubMed Central

    Fakhri, Asif Ali; Rodrigue, Paul David; Hussain, Aun; Taiyebi, Abbas

    2017-01-01

    We present a case of a 79-year-old immunocompromised female admitted for abdominal pain and sepsis, who had an abdominal computed tomography (CT) showing distal gallbladder fundus wall thickening, pericholecystic edema, and a right posteroinferior hepatic abscess. Subsequent hepatobiliary scintigraphy with Tc-99m diisopropyliminodiacetic acid showed gallbladder filling of the proximal gallbladder fundus, yet no radiotracer filling of the distal gallbladder fundus. Further correlation with the initial CT showed a partial gallbladder stricture and a resultant altered morphology resembling a dumbbell-shaped gallbladder. Percutaneous cholangiogram also confirmed this dumbbell morphology. Nonfilling of radiotracer into the distal end of the dumbbell gallbladder correlating with CT findings of focal gallbladder inflammation indicated that there was a focal inflammation suggesting a distal dumbbell gallbladder cholecystitis. This case demonstrates a unique finding of focal inflammatory pathology involving an anatomic variant - the dumbbell-shaped gallbladder, and the challenges this anatomic variant presents in hepatobiliary scintigraphy image interpretation. PMID:28242983

  13. Noninvasive control of dental calculus removal: qualification of two fluorescence methods

    NASA Astrophysics Data System (ADS)

    Gonchukov, S.; Sukhinina, A.; Bakhmutov, D.; Biryukova, T.

    2013-02-01

    The main condition of periodontitis prevention is the full calculus removal from the teeth surface. This procedure should be fulfilled without harming adjacent unaffected tooth tissues. Nevertheless the problem of sensitive and precise estimating of tooth-calculus interface exists and potential risk of hard tissue damage remains. In this work it was shown that fluorescence diagnostics during calculus removal can be successfully used for precise noninvasive detection of calculus-tooth interface. In so doing the simple implementation of this method free from the necessity of spectrometer using can be employed. Such a simple implementation of calculus detection set-up can be aggregated with the devices of calculus removing.

  14. Generalized Functions for the Fractional Calculus

    NASA Technical Reports Server (NTRS)

    Lorenzo, Carl F.; Hartley, Tom T.

    1999-01-01

    Previous papers have used two important functions for the solution of fractional order differential equations, the Mittag-Leffler functionE(sub q)[at(exp q)](1903a, 1903b, 1905), and the F-function F(sub q)[a,t] of Hartley & Lorenzo (1998). These functions provided direct solution and important understanding for the fundamental linear fractional order differential equation and for the related initial value problem (Hartley and Lorenzo, 1999). This paper examines related functions and their Laplace transforms. Presented for consideration are two generalized functions, the R-function and the G-function, useful in analysis and as a basis for computation in the fractional calculus. The R-function is unique in that it contains all of the derivatives and integrals of the F-function. The R-function also returns itself on qth order differ-integration. An example application of the R-function is provided. A further generalization of the R-function, called the G-function brings in the effects of repeated and partially repeated fractional poles.

  15. The Calculus of Relativistic Temporal Geometry

    NASA Astrophysics Data System (ADS)

    Mayer, Alexander

    2009-05-01

    Richard Feynman's unpublished 1965 gedanken experiment, discussed on pages 60-62 of A. F. Mayer, On the Geometry of Time in Physics and Cosmology (April 2009), demonstrates that the principles of relativity destroy both Newton's concept of absolute time and the concept of a Newtonian gravitational equipotential surface. According to logic arising from experience, it has long been falsely assumed that no energy cost is incurred for translation over an ideally frictionless level surface in the presence of a vertical acceleration. However, that the speed of light is a limiting velocity implies that while two distinct points on such a surface can be considered to be at the same potential relative to a third point that is not on that surface, a particle translated between two such points must incur energy transfer to the accelerating field. Typically, this manifests as a redshift of electromagnetic radiation as demonstrated by ``Feynman's rocket.'' Accurate calculation of this relativistic transverse gravitational redshift (TGR) for observable phenomena in a real-world astrophysical gravitational field requires the calculus of relativistic temporal geometry. Calculations using this technique accurately predict the following empirically observed but heretofore unexplained natural phenomena: the center-to-limb variation of solar wavelength (˜1 km/ s), the K-effect for massive main sequence stars (˜2-3 km/s), and the excess redshift of white dwarf stars (˜10-15 km/s).

  16. Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus.

    PubMed

    Verit, Ayhan; Savas, Murat; Ciftci, Halil; Unal, Dogan; Yeni, Ercan; Kaya, Mete

    2006-02-01

    Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months' follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.

  17. Application of skin electrical conductance of acupuncture meridians for ureteral calculus: a case report.

    PubMed

    Lin, Wu-Chou; Chen, Yung-Hsiang; Xu, Jian-Ming; Chen, Der-Cherng; Chen, Wen-Chi; Lee, Chao-Te

    2011-01-01

    Renal colic is a common condition seen in the emergency department (ED). Our recent study showed that measures of electrical conductance may be used as supplementary diagnostic methods for patients with acute renal colic. Here, we describe the case of a 30-year-old male subject with a left ureteral calculus who presented with frequency and normal-looking urine. He had already visited the outpatient department, but in vain. Normal urinalysis and nonobstructive urogram were reported at that time. Two days later, he was admitted to the ED because of abdominal pain in the left lower quadrant. The urinalysis did not detect red blood cells. Ultrasonography did not indicate hydronephrosis. The meridian electrical conductance and index of sympathovagal balance were found to be abnormal. High level of electrical conductance on the left bladder meridian was found. An unenhanced helical computed tomography was scheduled to reveal a left ureterovesical stone. Ureteroscopic intervention was later uneventfully performed, and the patient's pain was relieved. The follow-up measurements showed that the meridian parameters had returned to normal one month after treatment. This case suggests that bladder meridian electrical conductance might be used as a supplemental method for ureteral calculus diagnosis.

  18. Colloquium: Fractional calculus view of complexity: A tutorial

    NASA Astrophysics Data System (ADS)

    West, Bruce J.

    2014-10-01

    The fractional calculus has been part of the mathematics and science literature for 310 years. However, it is only in the past decade or so that it has drawn the attention of mainstream science as a way to describe the dynamics of complex phenomena with long-term memory, spatial heterogeneity, along with nonstationary and nonergodic statistics. The most recent application encompasses complex networks, which require new ways of thinking about the world. Part of the new cognition is provided by the fractional calculus description of temporal and topological complexity. Consequently, this Colloquium is not so much a tutorial on the mathematics of the fractional calculus as it is an exploration of how complex phenomena in the physical, social, and life sciences that have eluded traditional mathematical modeling become less mysterious when certain historical assumptions such as differentiability are discarded and the ordinary calculus is replaced with the fractional calculus. Exemplars considered include the fractional differential equations describing the dynamics of viscoelastic materials, turbulence, foraging, and phase transitions in complex social networks.

  19. On flipping first-semester calculus: a case study

    NASA Astrophysics Data System (ADS)

    Petrillo, Joseph

    2016-05-01

    High failure rates in calculus have plagued students, teachers, and administrators for decades, while science, technology, engineering, and mathematics programmes continue to suffer from low enrollments and high attrition. In an effort to affect this reality, some educators are 'flipping' (or inverting) their classrooms. By flipping, we mean administering course content outside of the classroom and replacing the traditional in-class lectures with discussion, practice, group work, and other elements of active learning. This paper presents the major results from a three-year study of a flipped, first-semester calculus course at a small, comprehensive, American university with a well-known engineering programme. The data we have collected help quantify the positive and substantial effects of our flipped calculus course on failure rates, scores on the common final exam, student opinion of calculus, teacher impact on measurable outcomes, and success in second-semester calculus. While flipping may not be suitable for every teacher, every student, and in every situation, this report provides some evidence that it may be a viable option for those seeking an alternative to the traditional lecture model.

  20. Two-parameter asymptotics in magnetic Weyl calculus

    SciTech Connect

    Lein, Max

    2010-12-15

    This paper is concerned with small parameter asymptotics of magnetic quantum systems. In addition to a semiclassical parameter {epsilon}, the case of small coupling {lambda} to the magnetic vector potential naturally occurs in this context. Magnetic Weyl calculus is adapted to incorporate both parameters, at least one of which needs to be small. Of particular interest is the expansion of the Weyl product which can be used to expand the product of operators in a small parameter, a technique which is prominent to obtain perturbation expansions. Three asymptotic expansions for the magnetic Weyl product of two Hoermander class symbols are proven as (i) {epsilon}<< 1 and {lambda}<< 1, (ii) {epsilon}<< 1 and {lambda}= 1, as well as (iii) {epsilon}= 1 and {lambda}<< 1. Expansions (i) and (iii) are impossible to obtain with ordinary Weyl calculus. Furthermore, I relate the results derived by ordinary Weyl calculus with those obtained with magnetic Weyl calculus by one- and two-parameter expansions. To show the power and versatility of magnetic Weyl calculus, I derive the semirelativistic Pauli equation as a scaling limit from the Dirac equation up to errors of fourth order in 1/c.

  1. Today's Calculus Courses Are Too Watered Down and Outdated to Capture the Interest of Students.

    ERIC Educational Resources Information Center

    Douglas, Ronald G.

    1988-01-01

    Calculus provides the language for expressing the differential equations that govern change and also the methods for solving them. In order to insure that more Americans qualify for science-related careers, the way calculus is taught must change. (MLW)

  2. Left main coronary artery obstruction by dislodged native-valve calculus after transcatheter aortic valve replacement.

    PubMed

    Durmaz, Tahir; Ayhan, Huseyin; Keles, Telat; Aslan, Abdullah Nabi; Erdogan, Kemal Esref; Sari, Cenk; Bilen, Emine; Akcay, Murat; Bozkurt, Engin

    2014-08-01

    Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement.

  3. Dental wax decreases calculus accumulation in small dogs.

    PubMed

    Smith, Mark M; Smithson, Christopher W

    2014-01-01

    A dental wax was evaluated after unilateral application in 20 client-owned, mixed and purebred small dogs using a clean, split-mouth study model. All dogs had clinical signs of periodontal disease including plaque, calculus, and/or gingivitis. The wax was randomly applied to the teeth of one side of the mouth daily for 30-days while the contralateral side received no treatment. Owner parameters evaluated included compliance and a subjective assessment of ease of wax application. Gingivitis, plaque and calculus accumulation were scored at the end of the study period. Owners considered the wax easy to apply in all dogs. Compliance with no missed application days was achieved in 8 dogs. The number of missed application days had no effect on wax efficacy. There was no significant difference in gingivitis or plaque accumulation scores when comparing treated and untreated sides. Calculus accumulation scores were significantly less (22.1 %) for teeth receiving the dental wax.

  4. A Tutorial Review on Fractal Spacetime and Fractional Calculus

    NASA Astrophysics Data System (ADS)

    He, Ji-Huan

    2014-11-01

    This tutorial review of fractal-Cantorian spacetime and fractional calculus begins with Leibniz's notation for derivative without limits which can be generalized to discontinuous media like fractal derivative and q-derivative of quantum calculus. Fractal spacetime is used to elucidate some basic properties of fractal which is the foundation of fractional calculus, and El Naschie's mass-energy equation for the dark energy. The variational iteration method is used to introduce the definition of fractional derivatives. Fractal derivative is explained geometrically and q-derivative is motivated by quantum mechanics. Some effective analytical approaches to fractional differential equations, e.g., the variational iteration method, the homotopy perturbation method, the exp-function method, the fractional complex transform, and Yang-Laplace transform, are outlined and the main solution processes are given.

  5. Quantum Stratonovich calculus and the quantum Wong-Zakai theorem

    SciTech Connect

    Gough, John

    2006-11-15

    We extend the Ito(bar sign)-to-Stratonovich analysis or quantum stochastic differential equations, introduced by Gardiner and Collett for emission (creation), absorption (annihilation) processes, to include scattering (conservation) processes. Working within the framework of quantum stochastic calculus, we define Stratonovich calculus as an algebraic modification of the Ito(bar sign) one and give conditions for the existence of Stratonovich time-ordered exponentials. We show that conversion formula for the coefficients has a striking resemblance to Green's function formulas from standard perturbation theory. We show that the calculus conveniently describes the Markov limit of regular open quantum dynamical systems in much the same way as in the Wong-Zakai approximation theorems of classical stochastic analysis. We extend previous limit results to multiple-dimensions with a proof that makes use of diagrammatic conventions.

  6. Analysis-based arguments for abstract data type calculus.

    SciTech Connect

    Rouson, Damian W. I.

    2008-10-01

    Increasing demands on the complexity of scientific models coupled with increasing demands for their scalability are placing programming models on equal footing with the numerical methods they implement in terms of significance. A recurring theme across several major scientific software development projects involves defining abstract data types (ADTs) that closely mimic mathematical abstractions such as scalar, vector, and tensor fields. In languages that support user-defined operators and/or overloading of intrinsic operators, coupling ADTs with a set of algebraic and/or integro-differential operators results in an ADT calculus. This talk will analyze ADT calculus using three tool sets: object-oriented design metrics, computational complexity theory, and information theory. It will be demonstrated that ADT calculus leads to highly cohesive, loosely coupled abstractions with code-size-invariant data dependencies and minimal information entropy. The talk will also discuss how these results relate to software flexibility and robustness.

  7. Integral calculus problem solving: an fMRI investigation.

    PubMed

    Krueger, Frank; Spampinato, Maria Vittoria; Pardini, Matteo; Pajevic, Sinisa; Wood, Jacqueline N; Weiss, George H; Landgraf, Steffen; Grafman, Jordan

    2008-07-16

    Only a subset of adults acquires specific advanced mathematical skills, such as integral calculus. The representation of more sophisticated mathematical concepts probably evolved from basic number systems; however its neuroanatomical basis is still unknown. Using fMRI, we investigated the neural basis of integral calculus while healthy participants were engaged in an integration verification task. Solving integrals activated a left-lateralized cortical network including the horizontal intraparietal sulcus, posterior superior parietal lobe, posterior cingulate gyrus, and dorsolateral prefrontal cortex. Our results indicate that solving of more abstract and sophisticated mathematical facts, such as calculus integrals, elicits a pattern of brain activation similar to the cortical network engaged in basic numeric comparison, quantity manipulation, and arithmetic problem solving.

  8. Golden quantum oscillator and Binet-Fibonacci calculus

    NASA Astrophysics Data System (ADS)

    Pashaev, Oktay K.; Nalci, Sengul

    2012-01-01

    The Binet formula for Fibonacci numbers is treated as a q-number and a q-operator with Golden ratio bases q = φ and Q = -1/φ, and the corresponding Fibonacci or Golden calculus is developed. A quantum harmonic oscillator for this Golden calculus is derived so that its spectrum is given only by Fibonacci numbers. The ratio of successive energy levels is found to be the Golden sequence, and for asymptotic states in the limit n → ∞ it appears as the Golden ratio. We call this oscillator the Golden oscillator. Using double Golden bosons, the Golden angular momentum and its representation in terms of Fibonacci numbers and the Golden ratio are derived. Relations of Fibonacci calculus with a q-deformed fermion oscillator and entangled N-qubit states are indicated.

  9. Numerical Method for Darcy Flow Derived Using Discrete Exterior Calculus

    NASA Astrophysics Data System (ADS)

    Hirani, A. N.; Nakshatrala, K. B.; Chaudhry, J. H.

    2015-05-01

    We derive a numerical method for Darcy flow, and also for Poisson's equation in mixed (first order) form, based on discrete exterior calculus (DEC). Exterior calculus is a generalization of vector calculus to smooth manifolds and DEC is one of its discretizations on simplicial complexes such as triangle and tetrahedral meshes. DEC is a coordinate invariant discretization, in that it does not depend on the embedding of the simplices or the whole mesh. We start by rewriting the governing equations of Darcy flow using the language of exterior calculus. This yields a formulation in terms of flux differential form and pressure. The numerical method is then derived by using the framework provided by DEC for discretizing differential forms and operators that act on forms. We also develop a discretization for a spatially dependent Hodge star that varies with the permeability of the medium. This also allows us to address discontinuous permeability. The matrix representation for our discrete non-homogeneous Hodge star is diagonal, with positive diagonal entries. The resulting linear system of equations for flux and pressure are saddle type, with a diagonal matrix as the top left block. The performance of the proposed numerical method is illustrated on many standard test problems. These include patch tests in two and three dimensions, comparison with analytically known solutions in two dimensions, layered medium with alternating permeability values, and a test with a change in permeability along the flow direction. We also show numerical evidence of convergence of the flux and the pressure. A convergence experiment is included for Darcy flow on a surface. A short introduction to the relevant parts of smooth and discrete exterior calculus is included in this article. We also include a discussion of the boundary condition in terms of exterior calculus.

  10. Recalling Prerequisite Material in a Calculus II Course to Improve Student Success

    ERIC Educational Resources Information Center

    Mokry, Jeanette

    2016-01-01

    This article discusses preparation assignments used in a Calculus II course that cover material from prerequisite courses. Prior to learning new material, students work on problems outside of class involving concepts from algebra, trigonometry, and Calculus I. These problems are directly built upon in order to answer Calculus II questions,…

  11. The Development and Nature of Problem-Solving among First-Semester Calculus Students

    ERIC Educational Resources Information Center

    Dawkins, Paul Christian; Epperson, James A. Mendoza

    2014-01-01

    This study investigates interactions between calculus learning and problem-solving in the context of two first-semester undergraduate calculus courses in the USA. We assessed students' problem-solving abilities in a common US calculus course design that included traditional lecture and assessment with problem-solving-oriented labs. We investigate…

  12. An Analysis of College Mathematics Departments' Credit Granting Policies for Students with High School Calculus Experience

    ERIC Educational Resources Information Center

    Laurent, Theresa A.

    2009-01-01

    The purpose of this study was to investigate higher education mathematics departments' credit granting policies for students with high school calculus experience. The number of students taking calculus in high school has more than doubled since 1982 (NCES, 2007) and it is estimated that approximately 530,000 students took a calculus course in high…

  13. An operator calculus for surface and volume modeling

    NASA Technical Reports Server (NTRS)

    Gordon, W. J.

    1984-01-01

    The mathematical techniques which form the foundation for most of the surface and volume modeling techniques used in practice are briefly described. An outline of what may be termed an operator calculus for the approximation and interpolation of functions of more than one independent variable is presented. By considering the linear operators associated with bivariate and multivariate interpolation/approximation schemes, it is shown how they can be compounded by operator multiplication and Boolean addition to obtain a distributive lattice of approximation operators. It is then demonstrated via specific examples how this operator calculus leads to practical techniques for sculptured surface and volume modeling.

  14. Stochastic Calculus and Differential Equations for Physics and Finance

    NASA Astrophysics Data System (ADS)

    McCauley, Joseph L.

    2013-02-01

    1. Random variables and probability distributions; 2. Martingales, Markov, and nonstationarity; 3. Stochastic calculus; 4. Ito processes and Fokker-Planck equations; 5. Selfsimilar Ito processes; 6. Fractional Brownian motion; 7. Kolmogorov's PDEs and Chapman-Kolmogorov; 8. Non Markov Ito processes; 9. Black-Scholes, martingales, and Feynman-Katz; 10. Stochastic calculus with martingales; 11. Statistical physics and finance, a brief history of both; 12. Introduction to new financial economics; 13. Statistical ensembles and time series analysis; 14. Econometrics; 15. Semimartingales; References; Index.

  15. The relationships between malocclusion, gingival inflammation, plaque and calculus.

    PubMed

    Buckley, L A

    1981-01-01

    Certain features of malocclusion considered important in relation to periodontal health were analyzed in a study of 300 subjects. It was found that plaque and gingival inflammation were not related to vertical incisor overbite, horizontal incisor overjet or posterior cuspal interdigitation. Individual tooth irregularity measured as tilting, rotation, displacement and crowding had a low but statistically significant correlation with plaque, calculus and gingival inflammation. However, the study showed that these features of malocclusion are far less important than the extent of plaque and calculus deposits in the development of gingival inflammation.

  16. The calculus of differences: Effects of a psychosocial, cultural, and pedagogical intervention in an all women's university calculus class

    NASA Astrophysics Data System (ADS)

    Steele, Diana F.; Levin, Amy K.; Blecksmith, Richard; Shahverdian, Jill

    2005-10-01

    The purpose of this study was to investigate the ways in which a multi-layered women's calculus course influenced the participants' learning of mathematics. This study, conducted in a state university in the Midwestern region of the United States, revealed not only that women in this particular section of calculus were likely to select careers that involved mathematics, but that the focus on peer support, psychosocial issues such as self-confidence, and pedagogy helped the young women overcome gender barriers, as well as barriers of class, poverty, and race. In this article we provide some of the relevant quantitative statistics and relate the stories of two particular women through excerpts from interviews, student artefacts, and participant observation data. We selected these young women because they faced multiple barriers to success in Calculus I and might not have completed the course or taken additional mathematics courses without the support structures that were fundamental to the course.

  17. Questions Revisited: A Close Examination of Calculus of Inference and Inquiry

    NASA Technical Reports Server (NTRS)

    Knuth, Kevin H.; Koga, Dennis (Technical Monitor)

    2003-01-01

    In this paper I examine more closely the way in which probability theory, the calculus of inference, is derived from the Boolean lattice structure of logical assertions ordered by implication. I demonstrate how the duality between the logical conjunction and disjunction in Boolean algebra is lost when deriving the probability calculus. In addition, I look more closely at the other lattice identities to verify that they are satisfied by the probability calculus. Last, I look towards developing the calculus of inquiry demonstrating that there is a sum and product rule for the relevance measure as well as a Bayes theorem. Current difficulties in deriving the complete inquiry calculus will also be discussed.

  18. Concepts and Skills in High School Calculus: An Examination of a Special Case in Japan and the United States

    ERIC Educational Resources Information Center

    Judson, Thomas W.; Nishimori, Toshiyuki

    2005-01-01

    In this study we investigated above-average high school calculus students from Japan and the United States in order to determine any differences in their conceptual understanding of calculus and their ability to use algebra to solve traditional calculus problems. We examined and interviewed 18 Calculus BC students in the United States and 26…

  19. Calculus of One and More Variables with Maple

    ERIC Educational Resources Information Center

    Samkova, Libuse

    2012-01-01

    This is a guide to using Maple in teaching fundamental calculus of one, two and three variables (limits, derivatives, integrals, etc.), also suitable for Maple beginners. It outlines one of the ways to effective use of computers in the teaching process. It scans advantages and disadvantages of using Maple in relation to students and teacher. The…

  20. Flipping the Calculus Classroom: A Cost-Effective Approach

    ERIC Educational Resources Information Center

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  1. On λ-Bell polynomials associated with umbral calculus

    NASA Astrophysics Data System (ADS)

    Kim, T.; Kim, D. S.

    2017-01-01

    In this paper, we introduce some new λ-Bell polynomials and Bell polynomials of the second kind and investigate properties of these polynomials. Using our investigation, we derive some new identities for the two kinds of λ-Bell polynomials arising from umbral calculus.

  2. Non-Mathematics Students' Reasoning in Calculus Tasks

    ERIC Educational Resources Information Center

    Jukic Matic, Ljerka

    2015-01-01

    This paper investigates the reasoning of first year non-mathematics students in non-routine calculus tasks. The students in this study were accustomed to imitative reasoning from their primary and secondary education. In order to move from imitative reasoning toward more creative reasoning, non-routine tasks were implemented as an explicit part of…

  3. On Flipping First-Semester Calculus: A Case Study

    ERIC Educational Resources Information Center

    Petrillo, Joseph

    2016-01-01

    High failure rates in calculus have plagued students, teachers, and administrators for decades, while science, technology, engineering, and mathematics programmes continue to suffer from low enrollments and high attrition. In an effort to affect this reality, some educators are "flipping" (or inverting) their classrooms. By flipping, we…

  4. Renal artery aneurysm mimicking renal calculus with hydronephrosis.

    PubMed

    Chen, Shanwen; Meng, Hongzhou; Cao, Min; Shen, Baihua

    2013-06-01

    A 51-year-old woman was found to have a left renal calculus with hydronephrosis. She underwent unsuccessful extracorporeal shock wave lithotripsy, leading to the recommendation that percutaneous lithotomy was necessary to remove the renal calculus. In view of the unusual shape of the calculus and absence of abnormalities in urine sediment, preoperative computed tomography and renal angiography were performed, which instead showed a calcified left renal artery aneurysm. Subsequent efforts to perform an aneurysmectomy also failed, eventually necessitating left nephrectomy. This case illustrates the pitfalls in the diagnosis of a renal artery aneurysm, which is a relatively common condition that may have unusual presentations. Hence, it is suggested that the possibility of a renal artery aneurysm be considered in the differential diagnosis when one detects a renal calculus with an unusual appearance. In addition, we propose that 3-dimensional reconstruction computed tomography be performed before considering surgical options for such renal calculi to rule out the possibility of a renal artery aneurysm.

  5. Formalization of the Integral Calculus in the PVS Theorem Prover

    NASA Technical Reports Server (NTRS)

    Butler, Ricky W.

    2004-01-01

    The PVS Theorem prover is a widely used formal verification tool used for the analysis of safety-critical systems. The PVS prover, though fully equipped to support deduction in a very general logic framework, namely higher-order logic, it must nevertheless, be augmented with the definitions and associated theorems for every branch of mathematics and Computer Science that is used in a verification. This is a formidable task, ultimately requiring the contributions of researchers and developers all over the world. This paper reports on the formalization of the integral calculus in the PVS theorem prover. All of the basic definitions and theorems covered in a first course on integral calculus have been completed.The theory and proofs were based on Rosenlicht's classic text on real analysis and follow the traditional epsilon-delta method. The goal of this work was to provide a practical set of PVS theories that could be used for verification of hybrid systems that arise in air traffic management systems and other aerospace applications. All of the basic linearity, integrability, boundedness, and continuity properties of the integral calculus were proved. The work culminated in the proof of the Fundamental Theorem Of Calculus. There is a brief discussion about why mechanically checked proofs are so much longer than standard mathematics textbook proofs.

  6. Assessing Online Homework in First-Semester Calculus

    ERIC Educational Resources Information Center

    Callahan, Jason T.

    2016-01-01

    This paper describes and assesses the implementation of online homework in a first-semester calculus course. Comparing sections of the course before implementation to those after, we find statistically significant improvements in retention rates, measures of student engagement, and participation on homework. We do not, however, find statistically…

  7. An Experiment in "Flipped" Teaching in Freshman Calculus

    ERIC Educational Resources Information Center

    Anderson, Laura; Brennan, Joseph Phillip

    2015-01-01

    At Binghamton, Calculus 1 is taught to over 1000 students each fall in sections of about 30-40 students, with graduate student instructors teaching most sections. Despite having small classrooms instead of lecture halls, the satisfaction and performance of students has historically been poor. We had hoped to improve student success by changing how…

  8. Using Origami Boxes to Explore Concepts of Geometry and Calculus

    ERIC Educational Resources Information Center

    Wares, Arsalan

    2011-01-01

    The purpose of this classroom note is to provide an example of how a simple origami box can be used to explore important concepts of geometry and calculus. This article describes how an origami box can be folded, then it goes on to describe how its volume and surface area can be calculated. Finally, it describes how the box could be folded to…

  9. Readiness and Attitudes as Indicators for Success in College Calculus

    ERIC Educational Resources Information Center

    Pyzdrowski, Laura J.; Sun, Ye; Curtis, Reagan; Miller, David; Winn, Gary; Hensel, Robin A. M.

    2013-01-01

    This study examined student indicators for success in entry-level college calculus. An attitude toward mathematics inventory, course performance, readiness assessment, and student interviews were used to determine characteristics and behaviors of students who succeeded in the course. In addition to student indicators, difficult topics and…

  10. Relation of Spatial Skills to Calculus Proficiency: A Brief Report

    ERIC Educational Resources Information Center

    Cromley, Jennifer G.; Booth, Julie L.; Wills, Theodore W.; Chang, Briana L.; Tran, Nhi; Madeja, Michael; Shipley, Thomas F.; Zahner, William

    2017-01-01

    Spatial skills have been shown in various longitudinal studies to be related to multiple science, technology, engineering, and math (STEM) achievement and retention. The specific nature of this relation has been probed in only a few domains, and has rarely been investigated for calculus, a critical topic in preparing students for and in STEM…

  11. Integrating Precalculus Review with the First Course in Calculus.

    ERIC Educational Resources Information Center

    Sevilla, Alicia; Somers, Kay

    1993-01-01

    Describes a course designed by Moravian College, Pennsylvania, to integrate precalculus topics as needed into a first calculus course. The textbook developed for the course covers the concepts of functions, Cartesian coordinates, limits, continuity, infinity, and the derivative. Examples are discussed. (MDH)

  12. Will Discrete Mathematics Surpass Calculus in Importance? and Responses .

    ERIC Educational Resources Information Center

    Ralston, Anthony; And Others

    1984-01-01

    Ralston proposes that the decrease in the importance of calculus in the world of mathematics is accelerating and the world of applied mathematics is changing rapidly. He briefly presents arguments for discrete mathematics. Then follow reactions from McLane, Wagner, Hilton, Woodriff, Kleitman, and Lax, and a response by Ralston. (MNS)

  13. Evaluating the Performance of Calculus Classes Using Operational Research Tools.

    ERIC Educational Resources Information Center

    Soares de Mello, Joao Carlos C. B.; Lins, Marcos P. E.; Soares de Mello, Maria Helena C.; Gomes, Eliane G.

    2002-01-01

    Compares the efficiency of calculus classes and evaluates two kinds of classes: traditional and others that use computational methods in teaching. Applies quantitative evaluation methods using two operational research tools, multicriteria decision aid methods (mainly using the MACBETH approach) and data development analysis. (Author/YDS)

  14. Students' Exploratory Thinking about a Nonroutine Calculus Task

    ERIC Educational Resources Information Center

    Nabb, Keith

    2013-01-01

    In this article on introductory calculus, intriguing questions are generated that can ignite an appreciation for the subject of mathematics. These questions open doors to advanced mathematical thinking and harness many elements of research-oriented mathematics. Such questions also offer greater incentives for students to think and reflect.…

  15. Designing a Telescope Mirror for Second-Semester Calculus Students

    ERIC Educational Resources Information Center

    Marchand, Richard J.; Rogers, Robert R.; Parker, Andrew T.

    2006-01-01

    The purpose of this article is to present an interdisciplinary project, developed as a collaborative effort by the authors, involving the design of a telescope mirror as it was given to second semester calculus students. The goals of the project are to provide an applied setting for the topics typically covered in this type of course including the…

  16. Hamiltonian dynamics and constrained variational calculus: continuous and discrete settings

    NASA Astrophysics Data System (ADS)

    de León, Manuel; Jiménez, Fernando; Martín de Diego, David

    2012-05-01

    The aim of this paper is to study the relationship between Hamiltonian dynamics and constrained variational calculus. We describe both using the notion of Lagrangian submanifolds of convenient symplectic manifolds and using the so-called Tulczyjew triples. The results are also extended to the case of discrete dynamics and nonholonomic mechanics. Interesting applications to the geometrical integration of Hamiltonian systems are obtained.

  17. A White Noise Theory of Infinite Dimensional Calculus

    DTIC Science & Technology

    1989-10-01

    a general theory; however it is his hope that this attempt would be the very first step towards the study of Gaussian random fields using variational ... calculus . Contents: White noise; Generalized functionals; Rotation group and harmonic analysis; Applications to Physics; Gaussian random fields. Keywords: Statistic processes.

  18. A Measurement Activity to Encourage Exploration of Calculus Concepts

    ERIC Educational Resources Information Center

    McGuffey, William

    2015-01-01

    This article describes an activity that incorporates measurement in order to lead students to discover and explore fundamental concepts of calculus. Students are provided with an experientially real starting point involving measurement and are encouraged to engage in mathematical discussions in a low-stakes environment. I describe the activity as…

  19. The Vector Calculus Gap: Mathematics (Does Not Equal) Physics.

    ERIC Educational Resources Information Center

    Dray, Tevian; Manogue, Corinne A.

    1999-01-01

    Discusses some of the differences between the ways mathematicians and physicists view vector calculus and the gap between the way this material is traditionally taught by mathematicians and the way physicists use it. Suggests some ways to narrow the gap. (Author/ASK)

  20. Development of Boolean calculus and its applications. [digital systems design

    NASA Technical Reports Server (NTRS)

    Tapia, M. A.

    1980-01-01

    The development of Boolean calculus for its application to developing digital system design methodologies that would reduce system complexity, size, cost, speed, power requirements, etc., is discussed. Synthesis procedures for logic circuits are examined particularly asynchronous circuits using clock triggered flip flops.

  1. An Application of Calculus: Optimum Parabolic Path Problem

    ERIC Educational Resources Information Center

    Atasever, Merve; Pakdemirli, Mehmet; Yurtsever, Hasan Ali

    2009-01-01

    A practical and technological application of calculus problem is posed to motivate freshman students or junior high school students. A variable coefficient of friction is used in modelling air friction. The case in which the coefficient of friction is a decreasing function of altitude is considered. The optimum parabolic path for a flying object…

  2. Contrasting Cases of Calculus Students' Understanding of Derivative Graphs

    ERIC Educational Resources Information Center

    Haciomeroglu, Erhan Selcuk; Aspinwall, Leslie; Presmeg, Norma C.

    2010-01-01

    This study adds momentum to the ongoing discussion clarifying the merits of visualization and analysis in mathematical thinking. Our goal was to gain understanding of three calculus students' mental processes and images used to create meaning for derivative graphs. We contrast the thinking processes of these three students as they attempted to…

  3. Making Implicit Multivariable Calculus Representations Explicit: A Clinical Study

    ERIC Educational Resources Information Center

    McGee, Daniel; Moore-Russo, Deborah; Martinez-Planell, Rafael

    2015-01-01

    Reviewing numerous textbooks, we found that in both differential and integral calculus textbooks the authors commonly assume that: (i) students can generalize associations between representations in two dimensions to associations between representations of the same mathematical concept in three dimensions on their own; and (ii) explicit…

  4. Airfoil Design in Multivariable Calculus: Tying It All Together

    ERIC Educational Resources Information Center

    Laverty, Rich; Povich, Timothy; Williams, Tasha

    2005-01-01

    Near the conclusion of their final term in the calculus sequence at The United States Military Academy, cadets are given a week long group project. At the end of the week, the project is briefed to their instructors, classmates, and superior officers. From a teaching perspective, the goal is to encapsulate as much of the course as possible in one…

  5. Factors Affecting Achievement in the First Course in Calculus.

    ERIC Educational Resources Information Center

    Edge, Orlyn P.; Friedberg, Stephen H.

    1984-01-01

    American College Testing Program (ACT) scores, high school rank, high school GPA, high school algebra grades, algebra pretest score, sex, birth order, family size, and high school size were used to predict course grades in the first semester of college calculus. The best predictors were the algebra pretest and high school rank. (Author/BW)

  6. Geometric Demonstration of the Fundamental Theorems of the Calculus

    ERIC Educational Resources Information Center

    Sauerheber, Richard D.

    2010-01-01

    After the monumental discovery of the fundamental theorems of the calculus nearly 350 years ago, it became possible to answer extremely complex questions regarding the natural world. Here, a straightforward yet profound demonstration, employing geometrically symmetric functions, describes the validity of the general power rules for integration and…

  7. Inertial Navigation: A Bridge between Kinematics and Calculus

    ERIC Educational Resources Information Center

    Sadler, Philip M.; Garfield, Eliza N.; Tremblay, Alex; Sadler, Daniel J.

    2012-01-01

    Those who come to Cambridge soon learn that the fastest route between Harvard and MIT is by the subway. For many students, this short ride is a quick and easy way to link physics and calculus. A simple, homemade accelerometer provides all the instrumentation necessary to produce accurate graphs of acceleration, velocity, and displacement position…

  8. Calculus Students' Understanding of Area and Volume Units

    ERIC Educational Resources Information Center

    Dorko, Allison; Speer, Natasha

    2015-01-01

    Units of measure are critical in many scientific fields. While instructors often note that students struggle with units, little research has been conducted about the nature and extent of these difficulties or why they exist. We investigated calculus students' unit use in area and volume computations. Seventy-three percent of students gave…

  9. Developing Reasoning through Proof in High School Calculus

    ERIC Educational Resources Information Center

    Perrin, John Robert

    2008-01-01

    Developing students' ability to reason has long been a fundamental goal of mathematics education. A primary way in which mathematics students develop reasoning skills is by constructing mathematical proofs. This article presents a number of nontypical results, along with their proofs, that can be explored with students in any calculus classroom.…

  10. An Investigation of Calculus Learning Using Factorial Modeling.

    ERIC Educational Resources Information Center

    Dick, Thomas P.; Balomenos, Richard H.

    Structural covariance models that would explain the correlations observed among mathematics achievement and participation measures and related cognitive and affective variables were developed. A sample of college calculus students (N=268; 124 females and 144 males) was administered a battery of cognitive tests (including measures of spatial-visual…

  11. Multivariate Limits and Continuity: A Survey of Calculus Textbooks.

    ERIC Educational Resources Information Center

    Thompson, Thomas M.; Wiggins, Kenneth L.

    There has been much recent discussion concerning the content of the standard calculus course for students majoring in mathematics and the sciences. Some of this discussion has focused on the available textbooks. One weakness noted in some of these books involves the definitions of limit and continuity for functions of several variables. A…

  12. Using the Pottery Wheel to Explore Topics in Calculus

    ERIC Educational Resources Information Center

    Farnell, Elin; Snipes, Marie A.

    2015-01-01

    Students sometimes struggle with visualizing the three-dimensional solids encountered in certain integral problems in a calculus class. We present a project in which students create solids of revolution with clay on a pottery wheel and estimate the volumes of these objects using Riemann sums. In addition to giving students an opportunity for…

  13. Assessing college students' retention and transfer from calculus to physics

    NASA Astrophysics Data System (ADS)

    Cui, Lili

    Many introductory calculus-based physics students have difficulties when solving physics problems involving calculus. This study investigates students' retention and transfer from calculus to physics. While retention is the ability to recall your knowledge at a later point in time, transfer of learning is defined as the ability to apply what one has learned in one situation to a different situation. In this dissertation we propose a theoretical framework to assess students' transfer of learning in the context of problem solving. We define two kinds of transfer---horizontal transfer and vertical transfer. Horizontal transfer involves applying previously learned ideas in a problem. Vertical transfer involves constructing new ideas to solve the problem. Students need to employ both horizontal and vertical transfer when they solve any problem. This framework evolves through this research and provides a lens that enables us to examine horizontal and vertical transfer. Additionally, this proposed framework offers researchers a vocabulary to describe and assess transfer of learning in any problem solving context. We use a combination of qualitative and quantitative methods to examine transfer in the context of problem solving. The participants in this study were students enrolled in a second-semester physics course taken by future engineers and physicists, calculus instructors and physics instructors. A total of 416 students' exam sheets were collected and reviewed. Statistical methods were used to analyze the quantitative data. A total of 28 students and nine instructors were interviewed. The video and audio recordings were transcribed and analyzed in light of the aforementioned theoretical framework. A major finding from this study is that a majority of students possess the requisite calculus skills, yet have several difficulties in applying them in the context of physics. These difficulties included: deciding the appropriate variable and limits of integration; not

  14. Multimodality approach for imaging of non-traumatic acute abdominal emergencies.

    PubMed

    Gangadhar, Kiran; Kielar, Ania; Dighe, Manjiri K; O'Malley, Ryan; Wang, Carolyn; Gross, Joel A; Itani, Malak; Lalwani, Neeraj

    2016-01-01

    "Acute abdomen" includes spectrum of medical and surgical conditions ranging from a less severe to life-threatening conditions in a patient presenting with severe abdominal pain that develops over a period of hours. Accurate and rapid diagnosis of these conditions helps in reducing related complications. Clinical assessment is often difficult due to availability of over-the-counter analgesics, leading to less specific physical findings. The key clinical decision is to determine whether surgical intervention is required. Laboratory and conventional radiographic findings are often non-specific. Thus, cross-sectional imaging plays a pivotal role for helping direct management of acute abdomen. Computed tomography is the primary imaging modality used for these cases due to fast image acquisition, although US is more specific for conditions such as acute cholecystitis. Magnetic resonance imaging or ultrasound is very helpful in patients who are particularly sensitive to radiation exposure, such as pregnant women and pediatric patients. In addition, MRI is an excellent problem-solving modality in certain conditions such as assessment for choledocholithiasis in patients with right upper quadrant pain. In this review, we discuss a multimodality approach for the usual causes of non-traumatic acute abdomen including acute appendicitis, diverticulitis, cholecystitis, and small bowel obstruction. A brief review of other relatively less frequent but important causes of acute abdomen, such as perforated viscus and bowel ischemia, is also included.

  15. Developing and Connecting Calculus Students' Notions of Rate-of Change and Accumulation: The Fundamental Theorem of Calculus

    ERIC Educational Resources Information Center

    Carlson, Marilyn P.; Smith, Nanci; Persson, Joni

    2003-01-01

    An overview of the conceptual underpinnings, reasoning abilities and notational issues related to learning the Fundamental Theorem of Calculus (FTC) is provided. Using this theoretical framework, curricular materials were developed to promote these understandings and reasoning abilities in students. Results from a study that investigated the…

  16. Generalising Calculus Ideas from Two Dimensions to Three: How Multivariable Calculus Students Think about Domain and Range

    ERIC Educational Resources Information Center

    Dorko, Allison; Weber, Eric

    2014-01-01

    We analysed multivariable calculus students' meanings for domain and range and their generalisation of that meaning as they reasoned about the domain and range of multivariable functions. We found that students' thinking about domain and range fell into three broad categories: input/output, independence/dependence, and/or as attached to specific…

  17. Patient with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas.

    PubMed

    Kanehiro, Tetsuya; Tsumura, Hiroaki; Ichikawa, Toru; Hino, Yuji; Murakami, Yoshiaki; Sueda, Taijiro

    2008-01-01

    We report an 84-year-old man with perforation caused by emphysematous cholecystitis who showed flare on the skin of the right dorsal lumbar region and intraperitoneal free gas. The patient was admitted for abdominal pain, abdominal swelling, and consciousness disorder 18 days after the onset. Abdominal computed tomography (CT) revealed emphysema in the gallbladder and a small amount of intraperitoneal free gas. Intraoperative findings suggested gangrenous cholecystitis. The gallbladder wall was perforated, and an abscess involving the right subphrenic region, the periphery of the liver and gallbladder, and the right paracolonic groove, was detected. The flare on the body surface may have reflected abscess formation in the right abdominal cavity. Emphysematous cholecystitis induces necrosis and perforation in many patients, and immediate strategies such as emergency surgery are important.

  18. Enterococcus hirae Bacteremia Associated with Acute Pancreatitis and Septic Shock

    PubMed Central

    Dicpinigaitis, Peter V.; De Aguirre, Manuel; Divito, Joseph

    2015-01-01

    Infection with Enterococcus hirae has rarely been reported in humans but is not uncommon in mammals and birds. We describe a case of Enterococcus hirae bacteremia associated with acute pancreatitis, acute cholecystitis, and septic shock responsive to antibiotic therapy and supportive critical care management. Unique aspects of this case of Enterococcus hirae bacteremia are its association with acute pancreatitis and its geographical origin. To our knowledge, this is the first report of Enterococcus hirae bacteremia occurring in a patient in the United States. Although human infection with this organism appears to be rare, all cases reported to date describe bacteremia associated with severe and life-threatening illness. Thus, physicians need to be cognizant of the clinical significance of this heretofore little recognized pathogen. PMID:26417465

  19. Study Modules for Calculus-Based General Physics. [Includes Modules 1 and 2: Dimensions and Vector Addition; Rectilinear Motion; plus a Trigonometry and Calculus Review].

    ERIC Educational Resources Information Center

    Fuller, Robert G., Ed.; And Others

    This is part of a series of 42 Calculus Based Physics (CBP) modules totaling about 1,000 pages. The modules include study guides, practice tests, and mastery tests for a full-year individualized course in calculus-based physics based on the Personalized System of Instruction (PSI). The units are not intended to be used without outside materials;…

  20. R-Function Relationships for Application in the Fractional Calculus

    NASA Technical Reports Server (NTRS)

    Lorenzo, Carl F.; Hartley, Tom T.

    2000-01-01

    The F-function, and its generalization the R-function, are of fundamental importance in the fractional calculus. It has been shown that the solution of the fundamental linear fractional differential equation may be expressed in terms of these functions. These functions serve as generalizations of the exponential function in the solution of fractional differential equations. Because of this central role in the fractional calculus, this paper explores various intrarelationships of the R-function, which will be useful in further analysis. Relationships of the R-function to the common exponential function, e(t), and its fractional derivatives are shown. From the relationships developed, some important approximations are observed. Further, the inverse relationships of the exponential function, el, in terms of the R-function are developed. Also, some approximations for the R-function are developed.

  1. Numerical approaches to fractional calculus and fractional ordinary differential equation

    NASA Astrophysics Data System (ADS)

    Li, Changpin; Chen, An; Ye, Junjie

    2011-05-01

    Nowadays, fractional calculus are used to model various different phenomena in nature, but due to the non-local property of the fractional derivative, it still remains a lot of improvements in the present numerical approaches. In this paper, some new numerical approaches based on piecewise interpolation for fractional calculus, and some new improved approaches based on the Simpson method for the fractional differential equations are proposed. We use higher order piecewise interpolation polynomial to approximate the fractional integral and fractional derivatives, and use the Simpson method to design a higher order algorithm for the fractional differential equations. Error analyses and stability analyses are also given, and the numerical results show that these constructed numerical approaches are efficient.

  2. Calculus students' early concept images of tangent lines

    NASA Astrophysics Data System (ADS)

    Vincent, Brittany; LaRue, Renee; Sealey, Vicki; Engelke, Nicole

    2015-07-01

    This study explored first-semester calculus students' understanding of tangent lines as well as how students used tangent lines within the context of Newton's method. Task-based interviews were conducted with twelve first-semester calculus students who were asked to verbally describe a tangent line, sketch tangent lines for multiple curves, and use tangent lines within the context of Newton's method. We examined students' graphical illustrations and the language they used to describe tangent lines and identified six prominent categories that described students' concept images of tangent lines. Our data show that individual students often possessed multiple concept images of tangent lines, and often these multiple concept images were conflicting. Furthermore, students were usually willing to modify their concept images of tangent lines depending on the task presented to the students.

  3. Quantum stochastic calculus associated with quadratic quantum noises

    NASA Astrophysics Data System (ADS)

    Ji, Un Cig; Sinha, Kalyan B.

    2016-02-01

    We first study a class of fundamental quantum stochastic processes induced by the generators of a six dimensional non-solvable Lie †-algebra consisting of all linear combinations of the generalized Gross Laplacian and its adjoint, annihilation operator, creation operator, conservation, and time, and then we study the quantum stochastic integrals associated with the class of fundamental quantum stochastic processes, and the quantum Itô formula is revisited. The existence and uniqueness of solution of a quantum stochastic differential equation is proved. The unitarity conditions of solutions of quantum stochastic differential equations associated with the fundamental processes are examined. The quantum stochastic calculus extends the Hudson-Parthasarathy quantum stochastic calculus.

  4. R-function relationships for application in the fractional calculus.

    PubMed

    Lorenzo, Carl F; Hartley, Tom T

    2008-01-01

    The F-function, and its generalization the R-function, are of fundamental importance in the fractional calculus. It has been shown that the solution of the fundamental linear fractional differential equation may be expressed in terms of these functions. These functions serve as generalizations of the exponential function in the solution of fractional differential equations. Because of this central role in the fractional calculus, this paper explores various intrarelationships of the R-function, which will be useful in further analysis. Relationships of the R-function to the common exponential function, et, and its fractional derivatives are shown. From the relationships developed, some important approximations are observed. Further, the inverse relationships of the exponential function, et, in terms of the R-function are developed. Also, some approximations for the R-function are developed.

  5. Fractional calculus in hydrologic modeling: A numerical perspective.

    PubMed

    Benson, David A; Meerschaert, Mark M; Revielle, Jordan

    2013-01-01

    Fractional derivatives can be viewed either as handy extensions of classical calculus or, more deeply, as mathematical operators defined by natural phenomena. This follows the view that the diffusion equation is defined as the governing equation of a Brownian motion. In this paper, we emphasize that fractional derivatives come from the governing equations of stable Lévy motion, and that fractional integration is the corresponding inverse operator. Fractional integration, and its multi-dimensional extensions derived in this way, are intimately tied to fractional Brownian (and Lévy) motions and noises. By following these general principles, we discuss the Eulerian and Lagrangian numerical solutions to fractional partial differential equations, and Eulerian methods for stochastic integrals. These numerical approximations illuminate the essential nature of the fractional calculus.

  6. Fractional Calculus in Hydrologic Modeling: A Numerical Perspective

    SciTech Connect

    David A. Benson; Mark M. Meerschaert; Jordan Revielle

    2012-01-01

    Fractional derivatives can be viewed either as a handy extension of classical calculus or, more deeply, as mathematical operators defined by natural phenomena. This follows the view that the diffusion equation is defined as the governing equation of a Brownian motion. In this paper, we emphasize that fractional derivatives come from the governing equations of stable Levy motion, and that fractional integration is the corresponding inverse operator. Fractional integration, and its multi-dimensional extensions derived in this way, are intimately tied to fractional Brownian (and Levy) motions and noises. By following these general principles, we discuss the Eulerian and Lagrangian numerical solutions to fractional partial differential equations, and Eulerian methods for stochastic integrals. These numerical approximations illuminate the essential nature of the fractional calculus.

  7. Separation of noncommutative differential calculus on quantum Minkowski space

    SciTech Connect

    Bachmaier, Fabian; Blohmann, Christian

    2006-02-15

    Noncommutative differential calculus on quantum Minkowski space is not separated with respect to the standard generators, in the sense that partial derivatives of functions of a single generator can depend on all other generators. It is shown that this problem can be overcome by a separation of variables. We study the action of the universal L-matrix, appearing in the coproduct of partial derivatives, on generators. Powers of the resulting quantum Minkowski algebra valued matrices are calculated. This leads to a nonlinear coordinate transformation which essentially separates the calculus. A compact formula for general derivatives is obtained in form of a chain rule with partial Jackson derivatives. It is applied to the massive quantum Klein-Gordon equation by reducing it to an ordinary q-difference equation. The rest state solution can be expressed in terms of a product of q-exponential functions in the separated variables.

  8. Quantum stochastic calculus associated with quadratic quantum noises

    SciTech Connect

    Ji, Un Cig; Sinha, Kalyan B.

    2016-02-15

    We first study a class of fundamental quantum stochastic processes induced by the generators of a six dimensional non-solvable Lie †-algebra consisting of all linear combinations of the generalized Gross Laplacian and its adjoint, annihilation operator, creation operator, conservation, and time, and then we study the quantum stochastic integrals associated with the class of fundamental quantum stochastic processes, and the quantum Itô formula is revisited. The existence and uniqueness of solution of a quantum stochastic differential equation is proved. The unitarity conditions of solutions of quantum stochastic differential equations associated with the fundamental processes are examined. The quantum stochastic calculus extends the Hudson-Parthasarathy quantum stochastic calculus.

  9. Example Solar Electric Propulsion System asteroid tours using variational calculus

    NASA Technical Reports Server (NTRS)

    Burrows, R. R.

    1985-01-01

    Exploration of the asteroid belt with a vehicle utilizing a Solar Electric Propulsion System has been proposed in past studies. Some of those studies illustrated multiple asteroid rendezvous with trajectories obtained using approximate methods. Most of the inadequacies of those approximations are overcome in this paper, which uses the calculus of variations to calculate the trajectories and associated payloads of four asteroid tours. The modeling, equations, and solution techniques are discussed, followed by a presentation of the results.

  10. q-CALCULUS and the Discrete Inverse Scattering

    NASA Astrophysics Data System (ADS)

    Karlo, T.; Jacob, H.; Tripathy, K. C.

    The discrete inverse scattering in one dimension has been re-identified with lattice calculus. By transforming the deformation parameter, the coordinate and the partial derivatives from lattice space to q-space, the Schrödinger equation with a potential is systematically analyzed. The potential having explicit q-dependence is derived from the knowledge of the spectral measure. The role of q to generate simulation is also highlighted.

  11. A formalism for the calculus of variations with spinors

    SciTech Connect

    Bäckdahl, Thomas; Valiente Kroon, Juan A.

    2016-02-15

    We develop a frame and dyad gauge-independent formalism for the calculus of variations of functionals involving spinorial objects. As a part of this formalism, we define a modified variation operator which absorbs frame and spin dyad gauge terms. This formalism is applicable to both the standard spacetime (i.e., SL(2, ℂ)) 2-spinors as well as to space (i.e., SU(2, ℂ)) 2-spinors. We compute expressions for the variations of the connection and the curvature spinors.

  12. Bunny hops: using multiplicities of zeroes in calculus for graphing

    NASA Astrophysics Data System (ADS)

    Miller, David; Deshler, Jessica M.; Hansen, Ryan

    2016-07-01

    Students learn a lot of material in each mathematics course they take. However, they are not always able to make meaningful connections between content in successive mathematics courses. This paper reports on a technique to address a common topic in calculus I courses (intervals of increase/decrease and concave up/down) while also making use of students' pre-existing knowledge about the behaviour of functions around zeroes based on multiplicities.

  13. Multiple multiresolution representation of functions and calculus for fast computation

    SciTech Connect

    Fann, George I; Harrison, Robert J; Hill, Judith C; Jia, Jun; Galindo, Diego A

    2010-01-01

    We describe the mathematical representations, data structure and the implementation of the numerical calculus of functions in the software environment multiresolution analysis environment for scientific simulations, MADNESS. In MADNESS, each smooth function is represented using an adaptive pseudo-spectral expansion using the multiwavelet basis to a arbitrary but finite precision. This is an extension of the capabilities of most of the existing net, mesh and spectral based methods where the discretization is based on a single adaptive mesh, or expansions.

  14. Some basic results on the sets of sequences with geometric calculus

    NASA Astrophysics Data System (ADS)

    Türkmen, Cengiz; Başar, Feyzi

    2012-08-01

    As an alternative to the classical calculus, Grossman and Katz [Non-Newtonian Calculus, Lee Press, Pigeon Cove, Massachusetts, 1972] introduced the non-Newtonian calculus consisting of the branches of geometric, anageometric and bigeometric calculus. Following Grossman and Katz, we construct the field C(G) of geometric complex numbers and the concept of geometric metric. Also we give the triangle and Minkowski's inequalities in the sense of geometric calculus. Later we respectively define the sets w(G), ℓ∞(G), c(G), c0(G) and ℓp(G) of all, bounded, convergent, null and p-absolutely summable sequences, in the sense of geometric calculus and show that each of the set forms a complete vector space on the field C(G).

  15. Fractional variational calculus in terms of Riesz fractional derivatives

    NASA Astrophysics Data System (ADS)

    Agrawal, O. P.

    2007-06-01

    This paper presents extensions of traditional calculus of variations for systems containing Riesz fractional derivatives (RFDs). Specifically, we present generalized Euler-Lagrange equations and the transversality conditions for fractional variational problems (FVPs) defined in terms of RFDs. We consider two problems, a simple FVP and an FVP of Lagrange. Results of the first problem are extended to problems containing multiple fractional derivatives, functions and parameters, and to unspecified boundary conditions. For the second problem, we present Lagrange-type multiplier rules. For both problems, we develop the Euler-Lagrange-type necessary conditions which must be satisfied for the given functional to be extremum. Problems are considered to demonstrate applications of the formulations. Explicitly, we introduce fractional momenta, fractional Hamiltonian, fractional Hamilton equations of motion, fractional field theory and fractional optimal control. The formulations presented and the resulting equations are similar to the formulations for FVPs given in Agrawal (2002 J. Math. Anal. Appl. 272 368, 2006 J. Phys. A: Math. Gen. 39 10375) and to those that appear in the field of classical calculus of variations. These formulations are simple and can be extended to other problems in the field of fractional calculus of variations.

  16. On certain realizations of the q-deformed exterior differential calculus

    NASA Astrophysics Data System (ADS)

    Kerner, Richard; Abramov, Viktor

    1999-04-01

    We investigate two particular realizations of a q-deformed differential calculus at q being a primitive root of unity, qN = 1. Particular attention is paid to the Z3-graded case N = 3. First we construct an analogue of the exterior differential calculus on a manifold, then we introduce a discrete realization of such a calculus on generalized Clifford algebras. Finally, combining both constructions, we discuss a ZN-graded generalization of gauge theory.

  17. A case of microscopic polyangiitis in an elderly patient presenting predominantly with cholecystitis successfully treated with mizoribine.

    PubMed

    Ichinose, Kunihiro; Iwanaga, Nozomi; Okada, Akitomo; Tamai, Mami; Yamasaki, Satoshi; Nakamura, Hideki; Origuchi, Tomoki; Kawakami, Atsushi

    2014-11-01

    An 82-year-old woman was previously diagnosed with cholecystitis and treated with antibiotics at another hospital. Because her fever and inflammation persisted, therapeutic cholecystectomy was performed. Histopathology of the gallbladder revealed periarterial vasculitis. After transfer to our hospital, an elevated titer of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was observed (47 U/mL). The patient's renal dysfunction had previously been thought to be sequelae of her cholecystectomy. We diagnosed microscopic polyangiitis (MPA) and began treatment with 40 mg orally of prednisolone daily. The titer of MPO-ANCA decreased with the treatment, but fever recurred with prednisolone taper. We, therefore, added 50 mg orally of mizoribine (MZR) daily as an immunosuppressant and increased the MZR to 100 mg daily while monitoring its blood peak concentration. The peak level of MZR was 1.58 μg/mL at 6 h after administration. After adding MZR, we successfully tapered the orally dosed prednisolone without recurrent fever or complications. We describe this case of MPA in an elderly patient manifesting predominantly with cholecystitis and successfully treated with orally dosed prednisolone and MZR.

  18. Tiny cystine stones in the gallbladder of a patient with cholecystolithiasis complicating acute cholecystitis: a case report.

    PubMed

    Qiao, Tie; Ma, Rui-Hong; Luo, Xiao-Bing; Feng, Yu-Yang; Wang, Xing-Qiang; Zheng, Pei-Ming; Luo, Zhen-Liang

    2012-03-29

    Cystine stones, the main component of which is cystine, are very common urinary calculi, but are rare in the gall bladder. In animals, there has been only one report of cystine gallstones in tree shrews, and to our knowledge, this is the first report of cystine gallstones in humans.

  19. [Optimization of an acute destructive cholecystitis treatment using application of mini-laparotomy access, laser irradiation and regional lymphotropic therapy].

    PubMed

    Mamedov, R A; Mamedov, K M; Iusubov, M O; Gasymov, É M; Dadashev, A I; Agaeva, N I

    2012-12-01

    Comparative analysis of the treatment results in 120 patients, suffering destructive form of biliary calculous disease (DFBCD) was performed. Depending on operative access and postoperative conservative therapy applied the patients were divided into two groups. In the main group in 58 patients, suffering DFBCD, a minilaparotomy access was applied, using "mini-assistant" apparatus named after M. I. Prudkov and postoperatively--low-intensive laser irradiation and regional lymphotropic therapy. In a comparison group in 62 patients various laparotomic accesses were used, and a standard postoperative therapy was performed. Normalization of clinical, laboratory and immune indices in the main group were observed in twice earlier than in a control one, and economical together with moral-psychological effect was measured in reduction of the medicines quantity used as well as the patients stationary stay.

  20. Dental calculus: recent insights into occurrence, formation, prevention, removal and oral health effects of supragingival and subgingival deposits.

    PubMed

    White, D J

    1997-10-01

    Dental calculus, both supra- and subgingival occurs in the majority of adults worldwide. Dental calculus is calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms. A viable dental plaque covers mineralized calculus deposits. Levels of calculus and location of formation are population specific and are affected by oral hygiene habits, access to professional care, diet, age, ethnic origin, time since last dental cleaning, systemic disease and the use of prescription medications. In populations that practice regular oral hygiene and with access to regular professional care, supragingival dental calculus formation is restricted to tooth surfaces adjacent to the salivary ducts. Levels of supragingival calculus in these populations is minor and the calculus has little if any impact on oral-health. Subgingival calculus formation in these populations occurs coincident with periodontal disease (although the calculus itself appears to have little impact on attachment loss), the latter being correlated with dental plaque. In populations that do not practice regular hygiene and that do not have access to professional care, supragingival calculus occurs throughout the dentition and the extent of calculus formation can be extreme. In these populations, supragingival calculus is associated with the promotion of gingival recession. Subgingival calculus, in "low hygiene" populations, is extensive and is directly correlated with enhanced periodontal attachment loss. Despite extensive research, a complete understanding of the etiologic significance of subgingival calculus to periodontal disease remains elusive, due to inability to clearly differentiate effects of calculus versus "plaque on calculus". As a result, we are not entirely sure whether subgingival calculus is the cause or result of periodontal inflammation. Research suggests that subgingival calculus, at a minimum, may expand the

  1. The development and nature of problem-solving among first-semester calculus students

    NASA Astrophysics Data System (ADS)

    Dawkins, Paul Christian; Mendoza Epperson, James A.

    2014-08-01

    This study investigates interactions between calculus learning and problem-solving in the context of two first-semester undergraduate calculus courses in the USA. We assessed students' problem-solving abilities in a common US calculus course design that included traditional lecture and assessment with problem-solving-oriented labs. We investigate this blended instruction as a local representative of the US calculus reform movements that helped foster it. These reform movements tended to emphasize problem-solving as well as multiple mathematical registers and quantitative modelling. Our statistical analysis reveals the influence of the blended traditional/reform calculus instruction on students' ability to solve calculus-related, non-routine problems through repeated measures over the semester. The calculus instruction in this study significantly improved students' performance on non-routine problems, though performance improved more regarding strategies and accuracy than it did for drawing conclusions and providing justifications. We identified problem-solving behaviours that characterized top performance or attrition in the course. Top-performing students displayed greater algebraic proficiency, calculus skills, and more general heuristics than their peers, but overused algebraic techniques even when they proved cumbersome or inappropriate. Students who subsequently withdrew from calculus often lacked algebraic fluency and understanding of the graphical register. The majority of participants, when given a choice, relied upon less sophisticated trial-and-error approaches in the numerical register and rarely used the graphical register, contrary to the goals of US calculus reform. We provide explanations for these patterns in students' problem-solving performance in view of both their preparation for university calculus and the courses' assessment structure, which preferentially rewarded algebraic reasoning. While instruction improved students' problem

  2. Caring for the woman with acute fatty liver of pregnancy.

    PubMed

    Holub, Karen; Camune, Barbara

    2015-01-01

    Acute fatty liver of pregnancy, although rare, is usually a third trimester of pregnancy occurrence that may be life threatening for both the pregnant woman and the fetus. Often, the onset resembles gastroenteritis or cholecystitis and correct diagnosis is delayed. Because it can also present with preeclampsia and eclampsia, it may be mistakenly diagnosed as hemolysis, elevated liver enzymes, low platelet syndrome. This article presents diagnostic differences between liver conditions that can complicate pregnancy and management strategies for treating and maintaining the well-being of pregnant women, fetuses, and infants who are affected by acute fatty liver of pregnancy. Early recognition and rapid intervention from antepartum diagnosis through delivery and the postpartum period are required by the nursing team and medical providers to reduce maternal and neonatal morbidity and mortality.

  3. Alien calculus and non perturbative effects in Quantum Field Theory

    NASA Astrophysics Data System (ADS)

    Bellon, Marc P.

    2016-12-01

    In many domains of physics, methods for dealing with non-perturbative aspects are required. Here, I want to argue that a good approach for this is to work on the Borel transforms of the quantities of interest, the singularities of which give non-perturbative contributions. These singularities in many cases can be largely determined by using the alien calculus developed by Jean Écalle. My main example will be the two point function of a massless theory given as a solution of a renormalization group equation.

  4. Using Case Studies in Calculus-based Physics

    NASA Astrophysics Data System (ADS)

    Katz, Debora M.

    2006-12-01

    Do your students believe that the physics only works in your classroom or laboratory? Or do they see that physics underlies their everyday experience? Case studies in physics help students connect physics principles to their everyday experience. For decades, case studies have been used to teach law, medicine and biology, but they are rarely used in physics. I am working on a calculus-based physics textbook for scientists and engineers. Case studies are woven into each chapter. Stop by and get a case study to test out in your classroom. I would love to get your feedback.

  5. Loop calculus in statistical physics and information science.

    PubMed

    Chertkov, Michael; Chernyak, Vladimir Y

    2006-06-01

    Considering a discrete and finite statistical model of a general position we introduce an exact expression for the partition function in terms of a finite series. The leading term in the series is the Bethe-Peierls (belief propagation) (BP) contribution; the rest are expressed as loop contributions on the factor graph and calculated directly using the BP solution. The series unveils a small parameter that often makes the BP approximation so successful. Applications of the loop calculus in statistical physics and information science are discussed.

  6. Real-Time Exponential Curve Fits Using Discrete Calculus

    NASA Technical Reports Server (NTRS)

    Rowe, Geoffrey

    2010-01-01

    An improved solution for curve fitting data to an exponential equation (y = Ae(exp Bt) + C) has been developed. This improvement is in four areas -- speed, stability, determinant processing time, and the removal of limits. The solution presented avoids iterative techniques and their stability errors by using three mathematical ideas: discrete calculus, a special relationship (be tween exponential curves and the Mean Value Theorem for Derivatives), and a simple linear curve fit algorithm. This method can also be applied to fitting data to the general power law equation y = Ax(exp B) + C and the general geometric growth equation y = Ak(exp Bt) + C.

  7. Spontaneous uretero-sigmoid fistula secondary to calculus

    PubMed Central

    Marzouk, Ines; Moussa, Makram; Saadallah, Lotfi; Bouchoucha, Sami; Hendaoui, Lotfi

    2016-01-01

    A 25-year-old man was referred to the urology department after a subacute history of left back pain, burning micturition associated with pneumaturia and fecaluria. Ultrasonography was performed showing hydronephrosis, and plain film radiography demonstrated a long vertical left pelvic calculi. Uro-computed tomography (CT) combined with a water enema CT showed a 10 cm long calculus with the cranial extremity fistulating the sigmoidal wall. Surgical treatment included left nephroureterectomy and sigmoidectomy with a colorectal anastomosis. Postoperative course was uneventful. PMID:28096928

  8. Simplifying the modal mu-calculus alternation hierarchy

    NASA Astrophysics Data System (ADS)

    Bradfield, J. C.

    In [Bra96], the strictness of the modal mu-calculus alternation hierarchy was shown by transferring a hierarchy from arithmetic; the latter was a corollary of a deep and highly technical analysis of [Lub93]. In this paper, we show that the alternation hierarchy in arithmetic can be established by entirely elementary means; further, simple examples of strict alternation depth n formulae can be constructed, which in turn give very simple examples to separate the modal hierarchy. In addition, the winning strategy formulae of parity games are shown to be such examples.

  9. Advanced Jones calculus for the classification of periodic metamaterials

    SciTech Connect

    Menzel, Christoph; Rockstuhl, Carsten; Lederer, Falk

    2010-11-15

    By relying on an advanced Jones calculus, we analyze the polarization properties of light upon propagation through metamaterial slabs in a comprehensive manner. Based on symmetry considerations, we show that all periodic metamaterials may be divided into five different classes only. It is shown that each class differently affects the polarization of the transmitted light and sustains different eigenmodes. We show how to deduce these five classes from symmetry considerations and provide a simple algorithm that can be applied to decide to which class a given metamaterial belongs by measuring only the transmitted intensities.

  10. Symbol calculus and zeta-function regularized determinants

    SciTech Connect

    Kaynak, Burak Tevfik; Turgut, O. Teoman

    2007-11-15

    In this work, we use semigroup integral to evaluate zeta-function regularized determinants. This is especially powerful for nonpositive operators such as the Dirac operator. In order to understand fully the quantum effective action, one should know not only the potential term but also the leading kinetic term. In this purpose, we use the Weyl type of symbol calculus to evaluate the determinant as a derivative expansion. The technique is applied both to a spin-0 bosonic operator and to the Dirac operator coupled to a scalar field.

  11. Calculus students' ability to solve geometric related-rates problems

    NASA Astrophysics Data System (ADS)

    Martin, Tami

    2000-09-01

    This study assessed the ability of university students enrolled in an introductory calculus course to solve related-rates problems set in geometric contexts. Students completed a problem-solving test and a test of performance on the individual steps involved in solving such problems. Each step was characterised as primarily relying on procedural knowledge or conceptual understanding. Results indicated that overall performance on the geometric related-rates problems was poor. The poorest performance was on steps linked to conceptual understanding, specifically steps involving the translation of prose to geometric and symbolic representations. Overall performance was most strongly related to performance on the procedural steps.

  12. Teaching calculus using module based on cooperative learning strategy

    NASA Astrophysics Data System (ADS)

    Arbin, Norazman; Ghani, Sazelli Abdul; Hamzah, Firdaus Mohamad

    2014-06-01

    The purpose of the research is to evaluate the effectiveness of a module which utilizes the cooperative learning for teaching Calculus for limit, derivative and integral. The sample consists of 50 semester 1 students from the Science Programme (AT 16) Sultan Idris Education University. A set of questions of related topics (pre and post) has been used as an instrument to collect data. The data is analyzed using inferential statistics involving the paired sample t-test and the independent t-test. The result shows that students have positive inclination towards the modulein terms of understanding.

  13. Computational approach to Thornley's problem by bivariate operational calculus

    NASA Astrophysics Data System (ADS)

    Bazhlekova, E.; Dimovski, I.

    2012-10-01

    Thornley's problem is an initial-boundary value problem with a nonlocal boundary condition for linear onedimensional reaction-diffusion equation, used as a mathematical model of spiral phyllotaxis in botany. Applying a bivariate operational calculus we find explicit representation of the solution, containing two convolution products of special solutions and the arbitrary initial and boundary functions. We use a non-classical convolution with respect to the space variable, extending in this way the classical Duhamel principle. The special solutions involved are represented in the form of fast convergent series. Numerical examples are considered to show the application of the present technique and to analyze the character of the solution.

  14. A miniture spectrometer using color CCD and frame calculus technique

    NASA Astrophysics Data System (ADS)

    Wan, Wei; Zhang, Guoping; Chen, Minghong; Liu, Minmin

    2005-01-01

    A design of spectrometer is presented, which uses a holographic grating and a two-dimensional color CCD camera connected with PC via video format port. And in the image post-procession, a real-time frame calculus technique and a non-linear filter were applied to provider higher image quality and better resistant to background noise. With improved designed zoom mechanics, the device has a wide resolution dynamic range and high frequency, since it can gather more spectrum information than linear black-white CCD. The spectrum analysis experiments for water quality detection indicate that the device can meet variant requirements of analysis at low cost.

  15. [Professor WU Xu's clinical experiences on acupuncture for acute upper abdominal pain].

    PubMed

    Wu, Xiao-Liang; Lu, Bin; Sun, Jian-Hua; Ai, Bing-Wei; Bao, Chao; Wu, Wen-Zhong; Li, Jian-Bing; Liu, Lan-Ying; Wu, Wen-Yun; Pei, Li-Xia; Zhou, Jun-Ling; Li, Yan-Cai; Qin, Shan

    2014-03-01

    The clinical experiences and proven cases of distinguished doctor of TCM, professor WU Xu, on acupuncture for acute upper abdominal pain is introduced. Professor WU's manipulation characteristics of acupuncture for acute upper abdominal pain, including acute cholecystitis, kidney stone, acute stomach pain, are one-hand shape but both hands in nature, moving like Tai Chi, force on the tip of needle, movement of qi mainly. The main technique posture is one-hand holding needle with middle finger for pressing, the needle is hold by thumb and index finger, and is assisted by middle finger. The special acupuncture experience of emergency is treatment according to syndrome differentiation, combination of acupuncture and moxibustion, selecting acupoint based on experience, blood-letting acupuncture therapy and so on.

  16. Incorporating Inquiry-Based Learning in the Calculus Sequence: A Most Challenging Endeavour

    ERIC Educational Resources Information Center

    McLoughlin, M. Padraig M. M.

    2009-01-01

    A course in the Calculus sequence is arguably the most difficult course in which inquiry-based learning (IBL) can be achieved with any degree of success within the curriculum in part due to: (1) the plethora of majors taking Calculus to which the sequence relates to their majors in what is considered an "applied" manner; and (2) the…

  17. Assessment of Peer-Led Team Learning in Calculus I: A Five-Year Study

    ERIC Educational Resources Information Center

    Merkel, John Conrad; Brania, Abdelkrim

    2015-01-01

    This five-year study of the peer-led team learning (PLTL) paradigm examined its implementation in a Calculus I course at an all-male HBCU institution. For this study we set up a strong control group and measured the effect of PLTL in the teaching and learning of Calculus I through two points of measure: retention and success rates and learning…

  18. Analysis of Errors and Misconceptions in the Learning of Calculus by Undergraduate Students

    ERIC Educational Resources Information Center

    Muzangwa, Jonatan; Chifamba, Peter

    2012-01-01

    This paper is going to analyse errors and misconceptions in an undergraduate course in Calculus. The study will be based on a group of 10 BEd. Mathematics students at Great Zimbabwe University. Data is gathered through use of two exercises on Calculus 1&2.The analysis of the results from the tests showed that a majority of the errors were due…

  19. The Role of Cognitive Ability and Preferred Mode of Processing in Students' Calculus Performance

    ERIC Educational Resources Information Center

    Haciomeroglu, Erhan Selcuk

    2015-01-01

    The present study sought to design calculus tasks to determine students' preference for visual or analytic processing as well as examine the role of preferred mode of processing in calculus performance and its relationship to spatial ability and verbal-logical reasoning ability. Data were collected from 150 high school students who were enrolled…

  20. Using Dynamic Tools to Develop an Understanding of the Fundamental Ideas of Calculus

    ERIC Educational Resources Information Center

    Verzosa, Debbie; Guzon, Angela Fatima; De Las Peñas, Ma. Louise Antonette N.

    2014-01-01

    Although dynamic geometry software has been extensively used for teaching calculus concepts, few studies have documented how these dynamic tools may be used for teaching the rigorous foundations of the calculus. In this paper, we describe lesson sequences utilizing dynamic tools for teaching the epsilon-delta definition of the limit and the…

  1. Improving Student Learning of Calculus Topics via Modified Just-in-Time Teaching Methods

    ERIC Educational Resources Information Center

    Natarajan, Rekha; Bennett, Andrew

    2014-01-01

    Although the use of traditional just-in-time teaching techniques has long been viewed positively by students and instructors in undergraduate calculus courses, past studies in this area have not addressed gains in student achievement with respect to specific calculus topics. This paper investigates the latter by administering modified just-in-time…

  2. Factors Associated with Success in a Calculus Course: An Examination of Personal Variables

    ERIC Educational Resources Information Center

    Ubuz, Behiye

    2011-01-01

    This study examined relationships between students' personal variables (gender, prior achievements, age and academic major) and their success in the first year undergraduate calculus course. The study sample consisted of 59 first year undergraduate students taking Math 154 Calculus II course. A written test about integral, sequence and series…

  3. The Association of Precollege Use of Calculators with Student Performance in College Calculus

    ERIC Educational Resources Information Center

    Mao, Yi; White, Tyreke; Sadler, Philip M.; Sonnert, Gerhard

    2017-01-01

    This study investigates how the use of calculators during high school mathematics courses is associated with student performance in introductory college calculus courses in the USA. Data were drawn from a nationally representative sample of 7087 students enrolled in college calculus at 134 colleges and universities. They included information about…

  4. A Decade of Teaching "Reform Calculus" Has Been a Disaster, Critics Charge.

    ERIC Educational Resources Information Center

    Wilson, Robin

    1997-01-01

    A decade after mathematicians began a crusade to make calculus more relevant to undergraduate students ("Reform Calculus"), a backlash threatens to derail the effort and divide the profession. Critics charge the movement has watered down mathematics courses, teaching only superficial use of skills. The debate is fierce and the stakes…

  5. A Preliminary Evaluation of Student Preparation for the Study of Calculus.

    ERIC Educational Resources Information Center

    Henderson, Ronald W.; Landesman, Edward M.

    This report explores the student background characteristics that might be associated with success or failure in calculus and evaluates the effectiveness of remedial mathematics education. The sample consisted of two groups at the University of California, Santa Cruz: (1) all students (105) who took first quarter calculus in spring, 1985; and (2)…

  6. Calculus structure on the Lie conformal algebra complex and the variational complex

    SciTech Connect

    De Sole, Alberto; Hekmati, Pedram; Kac, Victor G.

    2011-05-15

    We construct a calculus structure on the Lie conformal algebra cochain complex. By restricting to degree one chains, we recover the structure of a g-complex introduced in [A. De Sole and V. G. Kac, Commun. Math. Phys. 292, 667 (2009)]. A special case of this construction is the variational calculus, for which we provide explicit formulas.

  7. Students' Conceptual Knowledge of Limits in Calculus: A Two-Part Constructivist Case Study

    ERIC Educational Resources Information Center

    Adams, Margaret Smolinka

    2013-01-01

    This case study investigated students' conceptual knowledge of limits in calculus by implementing semi-structured interviews. The constructivist learning principles of Piaget and Inhelder as well as theories of understanding by Skemp guided the study. In Phase I, a pilot study was conducted with 15 students from a Calculus III class. By using…

  8. Building Mathematical Maturity in Calculus: Teaching Implicit Differentiation through a Review of Functions

    ERIC Educational Resources Information Center

    Hare, Angela; Phillippy, Doug

    2004-01-01

    A program on calculus is conducted, which helps students learn about inherent differentiation through a study of mathematical functions, while simultaneously reinforcing their understanding of functional concepts. This process develops their mathematical experience in the field of calculus and in other advanced quantitative programs.

  9. Student Achievement in College Calculus, Louisiana State University 1967-1968.

    ERIC Educational Resources Information Center

    Scannicchio, Thomas Henry

    An investigation of freshmen achievement in an introductory calculus course was performed on the basis of high school mathematics background to find predictors of college calculus grades. Overall high school academic achievement, overall high school mathematics achievement, number of high school mathematics units, pattern of college preparatory…

  10. Tablet PC: A Preliminary Report on a Tool for Teaching Calculus

    ERIC Educational Resources Information Center

    Gorgievski, Nicholas; Stroud, Robert; Truxaw, Mary; DeFranco, Thomas

    2005-01-01

    This study examined students' perceptions of the Tablet PC as an instructional tool for teaching Calculus. A thirteen item survey was developed by the researchers and administered to 103 students in an introductory Calculus course at a large university in the Northeast of the United States. The purpose of this survey was to collect data regarding…

  11. Analyzing Conceptual Gains in Introductory Calculus with Interactively-Engaged Teaching Styles

    ERIC Educational Resources Information Center

    Thomas, Matthew

    2013-01-01

    This dissertation examines the relationship between an instructional style called Interactive-Engagement (IE) and gains on a measure of conceptual knowledge called the Calculus Concept Inventory (CCI). The data comes from two semesters of introductory calculus courses (Fall 2010 and Spring 2011), consisting of a total of 482 students from the…

  12. Towards the Development of an Automated Learning Assistant for Vector Calculus: Integration over Planar Regions

    ERIC Educational Resources Information Center

    Yaacob, Yuzita; Wester, Michael; Steinberg, Stanly

    2010-01-01

    This paper presents a prototype of a computer learning assistant ILMEV (Interactive Learning-Mathematica Enhanced Vector calculus) package with the purpose of helping students to understand the theory and applications of integration in vector calculus. The main problem for students using Mathematica is to convert a textbook description of a…

  13. The Introduction of Calculus in 12th Grade: The Role of Artefacts

    ERIC Educational Resources Information Center

    Maschietto, Michela

    2004-01-01

    The paper concerns the analysis of the role of artefacts and instruments in approaching calculus by graphic-symbolic calculator at high school level. We focus on an element of the introduction of calculus: the global/local game. We discus the hypothesis that the zoom-controls of calculator support the production of gestures and metaphors that…

  14. Preparatory Year Program Courses as Predictors of First Calculus Course Grade

    ERIC Educational Resources Information Center

    Yushau, B; Omar, M. H

    2007-01-01

    This study investigates the effect of the preparatory year program courses on the first calculus course (Calculus I) at King Fahd University of Petroleum and Minerals (KFUPM). The data consists of more than 2,000 bilingual Arab university students studying in the English language, tracked over seven semesters. These students represent over 70% of…

  15. An Excel-Aided Method for Teaching Calculus-Based Business Mathematics

    ERIC Educational Resources Information Center

    Liang, Jiajuan; Martin, Linda

    2008-01-01

    Calculus-based business mathematics is a required quantitative course for undergraduate business students in most AACSB accredited schools or colleges of business. Many business students, however, have relatively weak mathematical background or even display math-phobia when presented with calculus problems. Because of the popularity of Excel, its…

  16. What Does It Mean for a Student to Understand the First-Year Calculus? Perspectives of 24 Experts

    ERIC Educational Resources Information Center

    Sofronas, Kimberly S.; DeFranco, Thomas C.; Vinsonhaler, Charles; Gorgievski, Nicholas; Schroeder, Larissa; Hamelin, Chris

    2011-01-01

    This article presents the views of 24 nationally recognized authorities in the field of mathematics, and in particular the calculus, on student understanding of the first-year calculus. A framework emerged that includes four overarching end goals for understanding of the first-year calculus: (a) mastery of the fundamental concepts and-or skills of…

  17. A giant dumbbell shaped vesico-prostatic urethral calculus: a case report and review of literature.

    PubMed

    Prabhuswamy, Vinod Kumar; Tiwari, Rahul; Krishnamoorthy, Ramakrishnan

    2013-01-01

    Calculi in the urethra are an uncommon entity. Giant calculi in prostatic urethra are extremely rare. The decision about treatment strategy of calculi depends upon the size, shape, and position of the calculus and the status of the urethra. If the stone is large and immovable, it may be extracted via the perineal or the suprapubic approach. In most of the previous reported cases, giant calculi were extracted via the transvesical approach and external urethrotomy. A 38-year-old male patient presented with complaints of lower urinary tract symptoms. Further investigations showed a giant urethral calculus secondary to stricture of bulbo-membranous part of the urethra. Surgical removal of calculus was done via transvesical approach. Two calculi were found and extracted. One was a huge dumbbell calculus and the other was a smaller round calculus. This case was reported because of the rare size and the dumbbell nature of the stone. Giant urethral calculi are better managed by open surgery.

  18. Daclatasvir and Asunaprevir Combination Therapy-induced Hepatitis and Cholecystitis with Coagulation Disorder due to Hypersensitivity Reactions

    PubMed Central

    Miyashima, Yuichi; Honma, Yuichi; Miyagawa, Koichiro; Oe, Shinji; Senju, Michio; Shibata, Michihiko; Hiura, Masaaki; Abe, Shintaro; Harada, Masaru

    2016-01-01

    A 70-year-old woman with chronic hepatitis C was admitted to our hospital due to liver injury, cholecystitis, and disseminated intravascular coagulation with a fever and skin rash. She had been on a combination regimen of daclatasvir and asunaprevir for 2 weeks of a 24-week regimen. Because of the symptoms, laboratory findings, results of a drug-induced lymphocyte stimulation test, and pathological findings of liver biopsy, we diagnosed her with drug-induced liver injury. Although daclatasvir and asunaprevir combination therapy is generally well-tolerated, some serious adverse effects have been reported. Our findings indicate that immunoallergic mechanisms were associated with daclatasvir and asunaprevir-induced liver injury. PMID:27980259

  19. Direct evidence of milk consumption from ancient human dental calculus

    PubMed Central

    Warinner, C.; Hendy, J.; Speller, C.; Cappellini, E.; Fischer, R.; Trachsel, C.; Arneborg, J.; Lynnerup, N.; Craig, O. E.; Swallow, D. M.; Fotakis, A.; Christensen, R. J.; Olsen, J. V.; Liebert, A.; Montalva, N.; Fiddyment, S.; Charlton, S.; Mackie, M.; Canci, A.; Bouwman, A.; Rühli, F.; Gilbert, M. T. P.; Collins, M. J.

    2014-01-01

    Milk is a major food of global economic importance, and its consumption is regarded as a classic example of gene-culture evolution. Humans have exploited animal milk as a food resource for at least 8500 years, but the origins, spread, and scale of dairying remain poorly understood. Indirect lines of evidence, such as lipid isotopic ratios of pottery residues, faunal mortality profiles, and lactase persistence allele frequencies, provide a partial picture of this process; however, in order to understand how, where, and when humans consumed milk products, it is necessary to link evidence of consumption directly to individuals and their dairy livestock. Here we report the first direct evidence of milk consumption, the whey protein β-lactoglobulin (BLG), preserved in human dental calculus from the Bronze Age (ca. 3000 BCE) to the present day. Using protein tandem mass spectrometry, we demonstrate that BLG is a species-specific biomarker of dairy consumption, and we identify individuals consuming cattle, sheep, and goat milk products in the archaeological record. We then apply this method to human dental calculus from Greenland's medieval Norse colonies, and report a decline of this biomarker leading up to the abandonment of the Norse Greenland colonies in the 15th century CE. PMID:25429530

  20. Direct evidence of milk consumption from ancient human dental calculus.

    PubMed

    Warinner, C; Hendy, J; Speller, C; Cappellini, E; Fischer, R; Trachsel, C; Arneborg, J; Lynnerup, N; Craig, O E; Swallow, D M; Fotakis, A; Christensen, R J; Olsen, J V; Liebert, A; Montalva, N; Fiddyment, S; Charlton, S; Mackie, M; Canci, A; Bouwman, A; Rühli, F; Gilbert, M T P; Collins, M J

    2014-11-27

    Milk is a major food of global economic importance, and its consumption is regarded as a classic example of gene-culture evolution. Humans have exploited animal milk as a food resource for at least 8500 years, but the origins, spread, and scale of dairying remain poorly understood. Indirect lines of evidence, such as lipid isotopic ratios of pottery residues, faunal mortality profiles, and lactase persistence allele frequencies, provide a partial picture of this process; however, in order to understand how, where, and when humans consumed milk products, it is necessary to link evidence of consumption directly to individuals and their dairy livestock. Here we report the first direct evidence of milk consumption, the whey protein β-lactoglobulin (BLG), preserved in human dental calculus from the Bronze Age (ca. 3000 BCE) to the present day. Using protein tandem mass spectrometry, we demonstrate that BLG is a species-specific biomarker of dairy consumption, and we identify individuals consuming cattle, sheep, and goat milk products in the archaeological record. We then apply this method to human dental calculus from Greenland's medieval Norse colonies, and report a decline of this biomarker leading up to the abandonment of the Norse Greenland colonies in the 15(th) century CE.

  1. On the construction of unitary quantum group differential calculus

    NASA Astrophysics Data System (ADS)

    Pyatov, Pavel

    2016-10-01

    We develop a construction of the unitary type anti-involution for the quantized differential calculus over {{GL}}q(n) in the case | q| =1. To this end, we consider a joint associative algebra of quantized functions, differential forms and Lie derivatives over {{GL}}q(n)/{{SL}}q(n), which is bicovariant with respect to {{GL}}q(n)/{{SL}}q(n) coactions. We define a specific non-central spectral extension of this algebra by the spectral variables of three matrices of the algebra generators. In the spectrally expended algebra, we construct a three-parametric family of its inner automorphisms. These automorphisms are used for the construction of the unitary anti-involution for the (spectrally extended) calculus over {{GL}}q(n). This work has been funded by the Russian Academic Excellence Project ‘5-100’. The results of section 5 (propositions 5.2, 5.3 and theorem 5.5) have been obtained under support of the RSF grant No.16-11-10160.

  2. Unusual case of calculus in floor of mouth: a case report.

    PubMed

    Bahadure, Rakesh N; Thosar, Nilima; Jain, Eesha S

    2012-09-01

    Calculus consists of mineralized bacterial plaque that forms on the surfaces of natural teeth. It is supragingival or subgingival depending upon its relation with gingival margin. The two most common locations for supragingival calculus are the buccal surfaces of maxillary molars and lingual surfaces of mandibular anterior teeth. It is very important to rule out the predisposing factor for calculus formation. In the present case of an 11-year- old female child, 1.2 × 1.5 cm large indurated mass suggestive of calculus in the left side of floor of mouth was observed. After surgical removal, along with indurated mass, an embedded root fragment was seen. Biochemical analysis of the specimen detected the calcium and phosphate ions approximately equals to the level in calculus. Thus, we diagnosed it as a calculus. Oral hygiene instructions and regular follow-up was advised. How to cite this article: Bahadure RN, Thosar N, Jain ES. Unusual Case of Calculus in Floor of Mouth: A Case Report. Int J Clin Pediatr Dent 2012;5(3):223-225.

  3. Fractal Physiology and the Fractional Calculus: A Perspective

    PubMed Central

    West, Bruce J.

    2010-01-01

    This paper presents a restricted overview of Fractal Physiology focusing on the complexity of the human body and the characterization of that complexity through fractal measures and their dynamics, with fractal dynamics being described by the fractional calculus. Not only are anatomical structures (Grizzi and Chiriva-Internati, 2005), such as the convoluted surface of the brain, the lining of the bowel, neural networks and placenta, fractal, but the output of dynamical physiologic networks are fractal as well (Bassingthwaighte et al., 1994). The time series for the inter-beat intervals of the heart, inter-breath intervals and inter-stride intervals have all been shown to be fractal and/or multifractal statistical phenomena. Consequently, the fractal dimension turns out to be a significantly better indicator of organismic functions in health and disease than the traditional average measures, such as heart rate, breathing rate, and stride rate. The observation that human physiology is primarily fractal was first made in the 1980s, based on the analysis of a limited number of datasets. We review some of these phenomena herein by applying an allometric aggregation approach to the processing of physiologic time series. This straight forward method establishes the scaling behavior of complex physiologic networks and some dynamic models capable of generating such scaling are reviewed. These models include simple and fractional random walks, which describe how the scaling of correlation functions and probability densities are related to time series data. Subsequently, it is suggested that a proper methodology for describing the dynamics of fractal time series may well be the fractional calculus, either through the fractional Langevin equation or the fractional diffusion equation. A fractional operator (derivative or integral) acting on a fractal function, yields another fractal function, allowing us to construct a fractional Langevin equation to describe the evolution of a

  4. Developing the Fundamental Theorem of Calculus. Applications of Calculus to Work, Area, and Distance Problems. [and] Atmospheric Pressure in Relation to Height and Temperature. Applications of Calculus to Atmospheric Pressure. [and] The Gradient and Some of Its Applications. Applications of Multivariate Calculus to Physics. [and] Kepler's Laws and the Inverse Square Law. Applications of Calculus to Physics. UMAP Units 323, 426, 431, 473.

    ERIC Educational Resources Information Center

    Lindstrom, Peter A.; And Others

    This document consists of four units. The first of these views calculus applications to work, area, and distance problems. It is designed to help students gain experience in: 1) computing limits of Riemann sums; 2) computing definite integrals; and 3) solving elementary area, distance, and work problems by integration. The second module views…

  5. Successful enrichment and recovery of whole mitochondrial genomes from ancient human dental calculus

    PubMed Central

    Ozga, Andrew T.; Nieves‐Colón, Maria A.; Honap, Tanvi P.; Sankaranarayanan, Krithivasan; Hofman, Courtney A.; Milner, George R.; Lewis, Cecil M.; Stone, Anne C.

    2016-01-01

    ABSTRACT Objectives Archaeological dental calculus is a rich source of host‐associated biomolecules. Importantly, however, dental calculus is more accurately described as a calcified microbial biofilm than a host tissue. As such, concerns regarding destructive analysis of human remains may not apply as strongly to dental calculus, opening the possibility of obtaining human health and ancestry information from dental calculus in cases where destructive analysis of conventional skeletal remains is not permitted. Here we investigate the preservation of human mitochondrial DNA (mtDNA) in archaeological dental calculus and its potential for full mitochondrial genome (mitogenome) reconstruction in maternal lineage ancestry analysis. Materials and Methods Extracted DNA from six individuals at the 700‐year‐old Norris Farms #36 cemetery in Illinois was enriched for mtDNA using in‐solution capture techniques, followed by Illumina high‐throughput sequencing. Results Full mitogenomes (7–34×) were successfully reconstructed from dental calculus for all six individuals, including three individuals who had previously tested negative for DNA preservation in bone using conventional PCR techniques. Mitochondrial haplogroup assignments were consistent with previously published findings, and additional comparative analysis of paired dental calculus and dentine from two individuals yielded equivalent haplotype results. All dental calculus samples exhibited damage patterns consistent with ancient DNA, and mitochondrial sequences were estimated to be 92–100% endogenous. DNA polymerase choice was found to impact error rates in downstream sequence analysis, but these effects can be mitigated by greater sequencing depth. Discussion Dental calculus is a viable alternative source of human DNA that can be used to reconstruct full mitogenomes from archaeological remains. Am J Phys Anthropol 160:220–228, 2016. © 2016 The Authors American Journal of Physical Anthropology

  6. Primary vaginal calculus in a middle-aged woman with mental and physical disabilities.

    PubMed

    Ikeda, Yuji; Oda, Katsutoshi; Matsuzawa, Naoki; Shimizu, Ken

    2013-07-01

    Vaginal calculi are rarely encountered and are often misdiagnosed as bladder calculi because of the difficulty in achieving an appropriate diagnosis. Most vaginal calculi result from the presence of a urethrovaginal fistula; those occurring in the absence of such fistulas are extremely rare. We present a case of a 42-year-old bedridden woman with mental and physical disabilities who had been misdiagnosed for a decade as having a bladder calculus. We removed the calculus nonsurgically and the analyzed the components. Results demonstrated the presence of a primary vaginal calculus. Vaginal calculi may occasionally occur in disabled women, but further investigation of the etiology of such calculi is required.

  7. Factors associated with success in a calculus course: an examination of personal variables

    NASA Astrophysics Data System (ADS)

    Ubuz, Behiye

    2011-01-01

    This study examined relationships between students' personal variables (gender, prior achievements, age and academic major) and their success in the first year undergraduate calculus course. The study sample consisted of 59 first year undergraduate students taking Math 154 Calculus II course. A written test about integral, sequence and series including demographic survey items was used to gather data. The test was administered prior to and upon the completion of the calculus course. Multiple regression analysis result indicated that there is relationship between students' personal variables (gender and prior achievements) and their success. Gender differences favouring males typically occurred on Riemann sum and Riemann integral.

  8. Effect of Imperfections on the Collapse of Rectangular Plates Using Variational Calculus.

    DTIC Science & Technology

    1979-12-01

    UCLASSIFIEO AFI/AE/AA/79D014 ru oIN280 11 AFIT/GAE/AA/7 9D-l 4 EFFECT OF IMPERFECTIONS ON THE COLLAPSE OF RECTANGULAR KLATES USING VARIATIONAL CALCULUS , THESIS...Imperfections on the Collapse of Rectangular Plates Using Variational Calculus THESIS Presented to the Faculty of the School of Engineering of the Air...PLATES USING VARIATIONAL CALCULUS I. Introduction Background The first problems in elastic instabi. ty were solved over 200 years ago by Euler (1

  9. The chain collocation method: A spectrally accurate calculus of forms

    NASA Astrophysics Data System (ADS)

    Rufat, Dzhelil; Mason, Gemma; Mullen, Patrick; Desbrun, Mathieu

    2014-01-01

    Preserving in the discrete realm the underlying geometric, topological, and algebraic structures at stake in partial differential equations has proven to be a fruitful guiding principle for numerical methods in a variety of fields such as elasticity, electromagnetism, or fluid mechanics. However, structure-preserving methods have traditionally used spaces of piecewise polynomial basis functions for differential forms. Yet, in many problems where solutions are smoothly varying in space, a spectral numerical treatment is called for. In an effort to provide structure-preserving numerical tools with spectral accuracy on logically rectangular grids over periodic or bounded domains, we present a spectral extension of the discrete exterior calculus (DEC), with resulting computational tools extending well-known collocation-based spectral methods. Its efficient implementation using fast Fourier transforms is provided as well.

  10. A fractional calculus model of anomalous dispersion of acoustic waves.

    PubMed

    Wharmby, Andrew W

    2016-09-01

    An empirical formula based on viscoelastic analysis techniques that employs concepts from the fractional calculus that was used to model the dielectric behavior of materials exposed to oscillating electromagnetic fields in the radiofrequency, terahertz, and infrared bands. This work adapts and applies the formula to model viscoelastic behavior of materials that show an apparent increase of phase velocity of vibration with an increase in frequency, otherwise known as anomalous dispersion. A fractional order wave equation is derived through the application of the classic elastic-viscoelastic correspondence principle whose analytical solution is used to describe absorption and dispersion of acoustic waves in the viscoelastic material displaying anomalous dispersion in a specific frequency range. A brief discussion and comparison of an alternative fractional order wave equation recently formulated is also included.

  11. Geometric constrained variational calculus. III: The second variation (Part II)

    NASA Astrophysics Data System (ADS)

    Massa, Enrico; Luria, Gianvittorio; Pagani, Enrico

    2016-03-01

    The problem of minimality for constrained variational calculus is analyzed within the class of piecewise differentiable extremaloids. A fully covariant representation of the second variation of the action functional based on a family of local gauge transformations of the original Lagrangian is proposed. The necessity of pursuing a local adaptation process, rather than the global one described in [1] is seen to depend on the value of certain scalar attributes of the extremaloid, here called the corners’ strengths. On this basis, both the necessary and the sufficient conditions for minimality are worked out. In the discussion, a crucial role is played by an analysis of the prolongability of the Jacobi fields across the corners. Eventually, in the appendix, an alternative approach to the concept of strength of a corner, more closely related to Pontryagin’s maximum principle, is presented.

  12. Promoting Metacognition in Introductory Calculus-based Physics Labs

    NASA Astrophysics Data System (ADS)

    Grennell, Drew; Boudreaux, Andrew

    2010-10-01

    In the Western Washington University physics department, a project is underway to develop research-based laboratory curriculum for the introductory calculus-based course. Instructional goals not only include supporting students' conceptual understanding and reasoning ability, but also providing students with opportunities to engage in metacognition. For the latter, our approach has been to scaffold reflective thinking with guided questions. Specific instructional strategies include analysis of alternate reasoning presented in fictitious dialogues and comparison of students' initial ideas with their lab group's final, consensus understanding. Assessment of student metacognition includes pre- and post- course data from selected questions on the CLASS survey, analysis of written lab worksheets, and student opinion surveys. CLASS results are similar to a traditional physics course and analysis of lab sheets show that students struggle to engage in a metacognitive process. Future directions include video studies, as well as use of additional written assessments adapted from educational psychology.

  13. Relativistic differential-difference momentum operators and noncommutative differential calculus

    SciTech Connect

    Mir-Kasimov, R. M.

    2013-09-15

    The relativistic kinetic momentum operators are introduced in the framework of the Quantum Mechanics (QM) in the Relativistic Configuration Space (RCS). These operators correspond to the half of the non-Euclidean distance in the Lobachevsky momentum space. In terms of kinetic momentum operators the relativistic kinetic energy is separated as the independent term of the total Hamiltonian. This relativistic kinetic energy term is not distinguishing in form from its nonrelativistic counterpart. The role of the plane wave (wave function of the motion with definite value of momentum and energy) plays the generating function for the matrix elements of the unitary irreps of Lorentz group (generalized Jacobi polynomials). The kinetic momentum operators are the interior derivatives in the framework of the noncommutative differential calculus over the commutative algebra generated by the coordinate functions over the RCS.

  14. Path integral in area tensor Regge calculus and complex connections

    NASA Astrophysics Data System (ADS)

    Khatsymovsky, V. M.

    2006-06-01

    Euclidean quantum measure in Regge calculus with independent area tensors is considered using example of the Regge manifold of a simple structure. We go over to integrations along certain contours in the hyperplane of complex connection variables. Discrete connection and curvature on classical solutions of the equations of motion are not, strictly speaking, genuine connection and curvature, but more general quantities and, therefore, these do not appear as arguments of a function to be averaged, but are the integration (dummy) variables. We argue that upon integrating out the latter the resulting measure can be well-defined on physical hypersurface (for the area tensors corresponding to certain edge vectors, i.e. to certain metric) as positive and having exponential cutoff at large areas on condition that we confine ourselves to configurations which do not pass through degenerate metrics.

  15. Stokes integral of economic growth. Calculus and the Solow model

    NASA Astrophysics Data System (ADS)

    Mimkes, Jürgen

    2010-04-01

    Economic growth depends on capital and labor and two-dimensional calculus has been applied to economic theory. This leads to Riemann and Stokes integrals and to the first and second laws of production and growth. The mathematical structure is the same as in thermodynamics, economic properties may be related to physical terms: capital to energy, production to physical work, GDP per capita to temperature, production function to entropy. This is called econophysics. Production, trade and banking may be compared to motors, heat pumps or refrigerators. The Carnot process of the first law creates two levels in each system: cold and hot in physics; buyer and seller, investor and saver, rich and poor in economics. The efficiency rises with the income difference of rich and poor. The results of econophysics are compared to neoclassical theory.

  16. A new class of problems in the calculus of variations

    NASA Astrophysics Data System (ADS)

    Ekeland, Ivar; Long, Yiming; Zhou, Qinglong

    2013-11-01

    This paper investigates an infinite-horizon problem in the one-dimensional calculus of variations, arising from the Ramsey model of endogeneous economic growth. Following Chichilnisky, we introduce an additional term, which models concern for the well-being of future generations. We show that there are no optimal solutions, but that there are equilibrium strateges, i.e. Nash equilibria of the leader-follower game between successive generations. To solve the problem, we approximate the Chichilnisky criterion by a biexponential criterion, we characterize its equilibria by a pair of coupled differential equations of HJB type, and we go to the limit. We find all the equilibrium strategies for the Chichilnisky criterion. The mathematical analysis is difficult because one has to solve an implicit differential equation in the sense of Thom. Our analysis extends earlier work by Ekeland and Lazrak.

  17. Prevention of retrograde calculus migration with the Stone Cone.

    PubMed

    Pardalidis, N P; Papatsoris, A G; Kosmaoglou, E V

    2005-02-01

    Retrograde calculus migration during ureteroscopic lithotripsy remains a problem in 5-40% of cases. We assessed the safety and efficacy of the Stone Cone device, in comparison with the standard flat wire basket. A total of 56 consecutive patients with ureteral calculi, suitable for ureteroscopic extraction and/or lithotripsy, where included in this prospective study. Patients were randomly allocated into two groups. In group A (30 patients), we used the Stone Cone, while in group B (26 patients) we used the standard flat wire basket. The Stone Cone was placed through a cystoscope under fluoroscopic guidance, or when necessary under direct ureteroscopic control. Whenever necessary, intracorporeal electrohydraulic lithotripsy took place in both groups. Statistical significance was assessed by the paired t-test. The mean operative time was 48.5 min in group A, and 42.4 min in group B. Intact calculus extraction was possible in 16.6% in group A, and in 7.6% in group B (P < 0.01). Retrograde stone migration was revealed in 23% in group B only (P < 0.001). Also, residual fragments > 3 mm were recorded in 30.7% in group B only (P < 0.001). None of the patients in group A required auxiliary procedures, in contrary to 23% in group B (P < 0.001). No major complications were recorded in group A, while in group B a case of major ureteral mucosal abrasion was recorded. The Stone Cone is safe and efficient in preventing retrograde stone migration and in minimizing residual fragments during ureteroscopic lithotripsy in comparison with the flat wire basket.

  18. Rare calcium oxalate monohydrate calculus attached to the wall of the renal pelvis.

    PubMed

    Grases, Felix; Costa-Bauza, Antonia; Prieto, Rafael M; Saus, Carlos; Servera, Antonio; García-Miralles, Reyes; Benejam, Joan

    2011-04-01

    Most renal calculi can be classified using well-established criteria in a manner that reflects both composition and fine structure under specific pathophysiological conditions. However, when a large patient population is considered, rare renal calculi invariably appear, some of which have never been classified; careful study is required to establish stone etiology in such cases. The patient in the present case report formed two types of calculi. One was attached on the wall of the renal pelvis near the ureter and part of the calculus was embedded inside pelvic renal tissue. The calculus developed on an ossified calcification located in the pelvis tissue. Current knowledge on the development of calcification in soft tissues suggests a pre-existing injury as an inducer of its development. A mechanism of calculus formation is proposed. The second stone was a typical jack-stone calculus.

  19. History of the Infinitely Small and the Infinitely Large in Calculus.

    ERIC Educational Resources Information Center

    Kleiner, Israel

    2001-01-01

    Considers examples of aspects of the infinitely small and large as they unfolded in the history of calculus from the 17th through the 20th centuries. Presents didactic observations at relevant places in the historical account. (Author/MM)

  20. Calculus Technique of Integration by Parts, Correlated with a Geometric Picture

    ERIC Educational Resources Information Center

    Fromhold, Albert T., Jr.

    2005-01-01

    The method of integration by parts is one of the most useful in integral calculus. Among the most important applications is the integration of differentials involving products, differentials in involving logarithms, and differentials involving inverse circular functions.