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Sample records for gastric outlet obstruction

  1. Update on endoscopic management of gastric outlet obstruction in children

    PubMed Central

    Chao, Hsun-Chin

    2016-01-01

    Endoscopic balloon dilatation (EBD) and surgical intervention are two most common and effective treatments for gastric outlet obstruction. Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has developed with EBD, advanced treatments like local steroid injection, electrocauterization, and stent have been added recently. The most common causes of pediatric gastric outlet obstruction are idiopathic hypertrophic pyloric stenosis, peptic ulcer disease followed by the ingestion of caustic substances, stenosis secondary to surgical anastomosis; antral web, duplication cyst, ectopic pancreas, and other rare conditions. A complete clinical, radiological and endoscopic evaluation of the patient is required to make the diagnosis, with complimentary histopathologic studies. EBD are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD. The future of endoscopic treatment seems to be aimed at the use of endoscopic electrocauterization and balloon dilatations. PMID:27803770

  2. Gastric outlet obstruction caused by total band erosion.

    PubMed

    Pinsk, Ilya; Dukhno, Oleg; Levy, Itzchak; Ovnat, Amnon

    2004-10-01

    Laparoscopic adjustable gastric banding for the treatment of morbid obesity has gained widespread popularity because of its simplicity both for the surgeon and more so for the patient. On the other hand, with this procedure there are complications such as band slippage, erosion, balloon problems and tubing problems, which have required reoperations for remedy. Herein we describe a case of band erosion into the stomach causing gastric outlet obstruction. Of particular interest are the clinical appearance and the operative management of this complication.

  3. Wandering spleen causing gastric outlet obstruction and pancreatitis.

    PubMed

    Sanchez, Ramon; Lobert, Philip; Herman, Richard; O'Malley, Ryan; Mychaliska, George

    2010-12-01

    Excessive splenic mobility (i.e. wandering spleen) is a rare condition caused by laxity or deficiency of all the spleen's normal ligamentous attachments in the left hypochondrium. In the pediatric population, a wandering spleen may present as an incidental finding, an abdominal mass or torsion of the vascular pedicle causing venous congestion and acute abdominal pain, and eventually infarction. We present an unusual case of wandering spleen causing pancreatitis and gastric outlet obstruction via direct external compression.

  4. A rare presentation of breast cancer: near obstructing rectal mass and gastric outlet obstruction

    PubMed Central

    Martin, Rachel; Mathews, Winn; Scarcliff, Steven

    2016-01-01

    Breast cancer metastasizes to the gastrointestinal (GI) tract are exceedingly rare. The low incidence and vague presentation of GI metastasizes often cause delay in diagnosis and treatment. Here, we present a case of metastatic breast cancer causing gastric outlet obstruction and rectal obstruction. PMID:27672104

  5. Primary gastric tuberculosis presenting as pyloric outlet obstruction.

    PubMed

    Tromba, J L; Inglese, R; Rieders, B; Todaro, R

    1991-12-01

    A 38-yr-old Haitian male with a longstanding history of peptic ulcer disease presented with persistent vomiting and weight loss. Barium studies and upper endoscopy revealed gastric outlet obstruction with prepyloric ulcerations. Endoscopic biopsies were consistent with chronic gastritis. The patient did not respond to intensive medical management, including total parenteral nutrition, intravenous cimetidine, and nasogastric suctioning. At the time of surgery, large celiac lymph nodes were noted surrounding the pylorus and the first portion of the duodenum. Biopsies of the wall of the stomach and lymph nodes demonstrated necrotizing granulomas. Cultures for acid-fast bacilli subsequently grew Mycobacterium tuberculosis. A search for foci outside the gastrointestinal tract was negative. Primary gastric tuberculosis remains an extremely uncommon clinical entity; the definitive diagnosis is made by biopsy and positive culture for the organism.

  6. Endoscopic management of combined malignant biliary and gastric outlet obstruction.

    PubMed

    Nakai, Yousuke; Hamada, Tsuyoshi; Isayama, Hiroyuki; Itoi, Takao; Koike, Kazuhiko

    2017-01-01

    Patients with periampullary cancer or gastric cancer often develop malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), and combined MBO and GOO is not rare in these patients. Combined MBO and GOO is classified by its location and sequence, and treatment strategy can be affected by this classification. Historically, palliative surgery, hepaticojejunostomy and gastrojejunostomy were carried out, but the current standard treatment is combined transpapillary stent and duodenal stent placement. Although a high technical success rate is reported, the procedure can be technically difficult and duodenobiliary reflux with subsequent cholangitis is common after double stenting. Recent development of endoscopic ultrasound (EUS)-guided procedures enables the management of MBO as well as GOO under EUS guidance. EUS-guided biliary drainage is now increasingly reported as an alternative to percutaneous transhepatic biliary drainage in failed endoscopic retrograde cholangiopancreatography (ERCP), and GOO is one of the major reasons for failed ERCP. In addition to EUS-guided biliary drainage, the feasibility of EUS-guided double-balloon-occluded gastrojejunostomy bypass for MBO was recently reported, and EUS-guided double stenting can potentially become the treatment of choice in the future. However, as each procedure has its advantages and disadvantages, treatment strategy should be selected based on the type of obstruction and the prognosis and performance status of the patient.

  7. Rare causes of gastric outlet obstruction in children.

    PubMed

    Feng, Jiexiong; Gu, Weizhong; Li, Minju; Yuan, Jiyan; Weng, Yizhen; Wei, Minfa; Zhou, Xuefeng

    2005-08-01

    Gastric outlet obstruction (GOO) presenting beyond the newborn period is a relatively rare condition, when infantile hypertrophic pyloric stenosis (IHPS) is excluded. This report describes the clinical features, evaluation and management of 18 patients with GOO which was not caused by IHPS. The sex, age, and main presenting features were recorded on admission. Hemoglobin estimation, serum chemistry and blood gas analysis were also assessed in these patients. The diagnosis was confirmed with gastrointestinal barium, B ultrasound, gastroscopy, or at surgery. Some of them underwent gastroscopy with biopsy sampling for rapid urease test or histologic examination with Giemsa stains for Helicobacter pylori. Thirteen patients had peptic ulcer disease, of which six were successfully treated with medications. While the other seven needed operative management which included Heineke-Mikulicz pyloroplasty, gastroduodenostomy or gastrojejunostomy, respectively. All the patients who had Heineke-Mikulicz pyloroplasty or gastrojejunostomy developed bile reflux gastritis that could be alleviated with omeprazol. None of the patients developed dumping syndrome, failing to thrive, or anemia. Three children with antral diaphragm recovered without any complications by diaphragm excision with Heineke-Mikulicz pyloroplasty. The pylorus was compressed by fibrotic band in one 30-month boy, and he recovered uneventfully with Heineke-Mikulicz pyloroplasty during 10-year follow-up. Gastric outlet obstruction secondary to ingestion of sulfuric acid was noted in one patient, and he was successfully treated with gastroduodenostomy. Our data suggests that the satisfactory results could be expected in children with GOO with different therapeutic modalities based on the specific cause and degree of obstruction.

  8. Surgical palliation of gastric outlet obstruction in advanced malignancy

    PubMed Central

    Potz, Brittany A; Miner, Thomas J

    2016-01-01

    Gastric outlet obstruction (GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract. Palliative treatment of patients’ symptoms who present with GOO is an important aspect of their care. Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life. Palliative treatment for GOO includes operative (open and laparoscopic gastrojejunostomy) and non-operative (endoscopic stenting) options. The performance status and medical condition of the patient, the extent of the cancer, the patients prognosis, the availability of a curative procedure, the natural history of symptoms of the disease (primary and secondary), the durability of the procedure, and the quality of life and life expectancy of the patient should always be considered when choosing treatment for any patient with advanced malignancy. Gastrojejunostomy appears to be associated with better long term symptom relief while stenting appears to be associated with lower immediate procedure related morbidity. PMID:27648158

  9. Gastric Leiomyosarcoma as a rare cause of gastric outlet obstruction and perforation: a case report

    PubMed Central

    2014-01-01

    Background Gastrointestinal stromal tumours are the most common mesenchymal malignancies of the gastrointestinal (GI) tract and gastric leiomyosarcoma represent 1-3% of gastric malignancies. Case presentation We report a case of a 69-year- old black African man who presented with a rare cause of gastric outlet obstruction and duodenal perforation. A Billroth- II gastrectomy was performed and histology confirmed a gastric leiomyosarcoma. Conclusions It is important to identify the gastric leiomyosarcoma which is a variant of the more common malignant gastrointestinal stromal tumours as the pathogenesis and management are currently well established. As the facilities for differentiating these are not easily available in resource-limited areas gastrointestinal stromal tumours may remain underdiagnosed and undertreated. PMID:25069607

  10. A newly designed big cup nitinol stent for gastric outlet obstruction

    PubMed Central

    Shi, Ding; Liao, Sheng-Hui; Geng, Jian-Ping

    2010-01-01

    AIM: To find out whether a newly designed big cup nitinol stent is suitable for treatment of patients with gastric outlet obstruction resulting from gastric cancer. METHODS: The new stent is composed of a proximal big cup segment (20 mm in length and 48-55 mm in diameter), a middle part (60 mm in length and 20 mm in diameter) covered by a polyethylene membrane and a distal sphericity (20 mm in length and 28 mm in diameter). Half of the proximal big cup segment is also covered by a polyethlene membrane, which is adjacent to the middle part of the stent. The stent is preloaded in a 6.0-mm-diameter introducer system. Thirteen patients with gastric outlet obstruction resulting from gastric cancer received the new stents under endoscopic and fluoroscopic guidance. RESULTS: Technical success was achieved in 12 of 13 (92.3%) patients. Among the 12 patients in whom endoscopic stent was placed successfully, the clinical success rate was 91.7% during a follow-up of average 6.5 mo. During the first month follow-up, the migration rate was 0%, recurrent obstruction 0% and gastric bleeding 8.3%. During the follow-up between 2-12 mo, no migration, recurrent obstruction and gastric bleeding occurred. CONCLUSION: The proximal big cup segment seems to be effective and promising for technical efficacy, clinical outcome, and preventing migration and tumor ingrowth and increasing the emptying rate of sinus ventriculi. PMID:20806440

  11. The location of obstruction predicts stent occlusion in malignant gastric outlet obstruction

    PubMed Central

    Grunwald, Douglas; Cohen, Jonah; Bartley, Anthony; Sheridan, Jennifer; Chuttani, Ram; Sawhney, Mandeep S.; Pleskow, Douglas K.; Berzin, Tyler M.; Mizrahi, Meir

    2016-01-01

    Background: Gastric outlet obstruction (GOO) can occur with locally invasive or metastatic cancer involving the upper gastrointestinal tract at the pylorus or the duodenum. Endoscopic management with self-expanding metal stents (SEMSs) is often the preferred palliative approach. Stent occlusion is a common reason for failure and reintervention. We set out to determine whether the location of the malignant obstruction is associated with the angulation of the stent and can predict stent occlusion. Methods: We performed a retrospective review of consecutive patients who underwent successful duodenal stenting with SEMS for malignant GOO between 2006 and 2015 at a large advanced endoscopy referral center. We determined the location of obstruction, the stent angle, and the rate of technical and clinical success of stent placement. We then identified cases of subsequent stent occlusion confirmed by endoscopic evaluation. Results: A total of 100 consecutive patients were included in the study; 91 of these patients had enough data to evaluate SEMS occlusion. A total of 21 patients (23%) developed stent occlusion with a median time of 39 days. The risk of occlusion sequentially increased as the obstruction occurred more distally from the antrum to the third or fourth portion of the duodenum (p = 0.006). This relationship was maintained after controlling for stent angle (p = 0.05). Conclusions: A distal location of malignant GOO was strongly predictive of stent occlusion, independent of stent angle. This may be due to longer and more complex distal obstructions, along with foreshortening of the stent during placement and tumor infiltration. If replicated, these results will have implications for endoscopic practice and future device development. PMID:27803736

  12. [Gastric outlet obstruction caused by gastrostomy tube balloon in 3 cases].

    PubMed

    Akashi, Tetsuro; Takahashi, Shunsuke; Yodoe, Kentaro; Yamada, Mariko; Yoshimura, Daisuke; Ochiai, Toshiaki; Tsuchida, Osamu; Kabemura, Teppei

    2012-04-01

    We report 3 cases with unusual complications of gastric outlet obstruction caused by a gastrostomy tube balloon. All cases developed vomiting, and 2 cases were accompanied by hematemesis. Gastric ulcer was observed in 1 case, aspiration pneumonia was observed in 2 cases, and pancreatitis was observed in 1 case. This condition improved rapidly by correction of the position of the balloon in all cases. In patient vomiting during management for gastrostomy we need to consider migration of the gastrostomy tube balloon. Careful management of the gastrostomy tube balloon is important.

  13. Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review

    PubMed Central

    Minata, Mauricio Kazuyoshi; Bernardo, Wanderley Marques; Rocha, Rodrigo Silva de Paula; Morita, Flavio Hiroshi Ananias; Aquino, Julio Cesar Martins; Cheng, Spencer; Zilberstein, Bruno; Sakai, Paulo; de Moura, Eduardo Guimarães Hourneaux

    2016-01-01

    Background and study aims: Palliative treatment of gastric outlet obstruction can be done with surgical or endoscopic techniques. This systematic review aims to compare surgery and covered and uncovered stent treatments for gastric outlet obstruction (GOO). Patients and methods: Randomized clinical trials were identified in MEDLINE, Embase, Cochrane, LILACs, BVS, SCOPUS and CINAHL databases. Comparison of covered and uncovered stents included: technical success, clinical success, complications, obstruction, migration, bleeding, perforation, stent fracture and reintervention. The outcomes used to compare surgery and stents were technical success, complications, and reintervention. Patency rate could not be included because of lack of uniformity of the extracted data. Results: Eight studies were selected, 3 comparing surgery and stents and 5 comparing covered and uncovered stents.The meta-analysis of surgical and endoscopic stent treatment showed no difference in the technical success and overall number of complications. Stents had higher reintervention rates than surgery (RD: 0.26, 95 % CI [0.05, 0.47], NNH: 4). There is no significant difference in technical success, clinical success, complications, stent fractures, perforation, bleeding and the need for reintervention in the analyses of covered and uncovered stents. There is a higher migration rate in the covered stent therapy compared to uncovered self-expanding metallic stents (SEMS) in the palliation of malignant GOO (RD: 0.09, 95 % CI [0.04, 0.14], NNH: 11). Nevertheless, covered stents had lower obstruction rates (RD: – 0.21, 95 % CI [-0.27, – 0.15], NNT: 5). Conclusions: In the palliation of malignant GOO, covered SEMS had higher migration and lower obstruction rates when compared with uncovered stents. Surgery is associated with lower reintervention rates than stents. PMID:27857965

  14. Novel Use of a Uniquely Designed, Lumen-Apposing, Metal Stent in Benign Gastric Outlet Obstruction in Two Patients

    PubMed Central

    Pathirana, Induruwa; Magulick, John; Domanski, Jeremy; Okoh, Emuejevoke; Womeldorph, Craig

    2017-01-01

    Current guidelines recommend management of benign gastric outlet obstruction (GOO) with serial dilations. Self-expanding metal stents are effective, but their use is complicated by high rates of migration. We present two cases from our institution where a uniquely designed, lumen-apposing metal stent (LAMS) was successfully used to alleviate benign GOO without stent migration. PMID:28184377

  15. Successful Resolution of Gastric Outlet Obstruction Caused by Pancreatic Pseudocyst or Walled-Off Necrosis After Acute Pancreatitis

    PubMed Central

    Zhang, Yun; Zhang, Shao-Yang; Gao, Shun-Liang; Liang, Zhong-Yan; Yu, Wen-Qiao; Liang, Ting-Bo

    2015-01-01

    Objective Delayed gastric emptying (DGE) in patients with acute pancreatitis (AP) can be caused by gastroparesis or gastric outlet obstruction, which may occur when pancreatic pseudocyst (PP) or walled-off necrosis (WON) compresses the stomach. The aim of the study was to explore a proper surgical treatment. Methods From June 2010 to June 2013, 25 of 148 patients with AP suffered DGE. Among them, 12 were caused by gastroparesis, 1 was a result of obstruction from a Candida albicans plug, and 12 were gastric outlet obstruction (GOO) compressed by PP (n = 8) or WON (n = 4), which were treated by percutaneous catheter drainage (PCD). Results All 12 cases of compressing GOO achieved resolution by PCD after 6 [1.86] and 37.25 [12.02] days for PP and WON, respectively. Five cases developed intracystic infection, 3 cases had pancreatic fistulae whereas 2 achieved resolution and 1 underwent a pseudocyst jejunostomy. Conclusions Gastric outlet obstruction caused by a PP or WON is a major cause of DGE in patients with AP. Percutaneous catheter drainage with multiple sites, large-bore tubing, and lavage may be a good therapy due to high safety and minimal invasiveness. PMID:26465954

  16. An Assessment of Radiologically Inserted Transoral and Transgastric Gastroduodenal Stents to Treat Malignant Gastric Outlet Obstruction

    SciTech Connect

    Miller, Bethany H. T.; Griffiths, Ewen A.; Pursnani, Kishore G. Ward, Jeremy B.; Stockwell, Robert C.

    2013-12-15

    IntroductionSelf-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist. Methods: Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients' case notes. Univariate survival analysis was performed. Results: Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39-89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1-624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001). Conclusions: The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival.

  17. Intussuscepting Ampullary Adenoma: An Unusual Cause of Gastric Outlet Obstruction Leading to Cavitating Lung Lesions

    PubMed Central

    McCluney, Simon J.; Balarajah, Vickna; Giakoustidis, Alex; Chin-Aleong, Joanne; Lovett, Bryony; Kocher, Hemant M.

    2016-01-01

    Ampullary adenomas are a rare clinical entity, occurring at a rate of 0.04–0.12% in the general population. They are premalignant lesions which have the capability to progress to malignancy, and they should be excised if they are causing immediate symptoms and/or are likely to degenerate to carcinoma. Intestinal intussusception in adults is rare and, unlike in children, is often due to a structural pathology. Intussuscepting duodenal/ampullary adenomas have been reported in the literature on 13 previous occasions, however never before with this presentation. We report the case of a woman who presented with a 1-year history of recurrent chest infections. She was treated with numerous antibiotics, whilst intermittent symptoms of recurrent vomiting and weight loss were initially attributed to her lung infections. A chest CT demonstrated multiple cavitating lung lesions, whilst an obstructing polypoid mass was noted at D2 on dedicated abdominal imaging. Due to ongoing nutritional problems, she had a semi-urgent pancreaticoduodenectomy. Intraoperative findings demonstrated a large mass at D2 with a duodeno-duodenal intussusception. Histological analysis reported a duodenal, ampullary, low-grade tubular adenoma, 75 × 28 × 30 mm in size, with intussusception and complete resection margins. The patient recovered well and was discharged on postoperative day 10, with no complications to date. Ampullary adenomas may present with obstruction of the main gastrointestinal tract and/or biliary/pancreatic ducts. Common presentations include gastric outlet obstruction, gastrointestinal bleeding or acute pancreatitis. This unique presentation should remind clinicians of the need to investigate recurrent chest infections for a possible gastrointestinal cause. PMID:27920640

  18. Self-expanding metal stents for the palliation of malignant gastric outlet obstruction in patients with peritoneal carcinomatosis

    PubMed Central

    Rademacher, Christoph; Bechtler, Matthias; Schneider, Steffen; Hartmann, Bettina; Striegel, Johannes; Jakobs, Ralf

    2016-01-01

    AIM To evaluate the efficacy of self-expanding metal stents (SEMS) for the palliation of malignant gastric outlet obstruction in patients with and without peritoneal carcinomatosis (PC). METHODS We performed a retrospective analysis of 62 patients who underwent SEMS placement for treatment of malignant gastroduodenal obstruction at our hospital over a six-year period. Stents were deployed through the scope under combined fluoroscopic and endoscopic guidance. Technical success was defined as successful stent placement and expansion. Clinical success was defined as an improvement in the obstructive symptoms and discharge from hospital without additional parenteral nutrition. According to carcinomatosis status, patients were assigned into groups with or without evidence of peritoneal disease. RESULTS In most cases, obstruction was caused by pancreatic (47%) or gastric cancer (23%). Technical success was achieved in 96.8% (60/62), clinical success in 79% (49/62) of all patients. Signs of carcinomatosis were identified in 27 patients (43.5%). The diagnosis was confirmed by pathology or previous operation in 7 patients (11.2%) and suspected by CT, MRI or ultrasound in 20 patients (32.2%). Presence of carcinomatosis was associated with a significantly lower clinical success rate compared to patients with no evidence of peritoneal disease (66.7% vs 88.6%, P = 0.036). There was no significant difference in overall survival between patients with or without PC (median 48 d vs 70 d, P = 0.21), but patients showed significantly longer survival after clinical success of SEMS placement compared to those experiencing clinical failure (median 14.5 d vs 75 d, P = 0.0003). CONCLUSION Given the limited therapeutic options and a clinical success rate of at least 66.7%, we believe that SEMS are a reasonable treatment option in patients with malignant gastric outlet obstruction with peritoneal carcinomatosis. PMID:27920476

  19. Successful treatment with a combination of endoscopic injection and irrigation with coca cola for gastric bezoar-induced gastric outlet obstruction.

    PubMed

    Lin, Chen-Sheng; Tung, Chun-Fang; Peng, Yen-Chun; Chow, Wei-Keung; Chang, Chi-Sen; Hu, Wei-Hsiung

    2008-01-01

    We report a case of gastric bezoar-induced gastric outlet obstruction that was successfully treated with a combination of endoscopic injection and irrigation with Coca Cola. A 73-year-old diabetic woman had a history of perforated peptic ulcer and had received pyloroplasty more than 20 years previously. She had been ingesting Pho Pu Zi (Cordia dichotoma Forst. f.) as an appetizer for 1 month. She presented with epigastric pain, nausea, and vomiting. Upper gastrointestinal endoscopy, performed at a local hospital, showed 2 gastric bezoars in the stomach, and 1 of them impacted at the pylorus. She was referred to our emergency department for removal of the gastric bezoars that were suspected to be causing gastric outlet obstruction. All attempts at endoscopic removal using a polypectomy snare, biopsy forceps and Dormia basket failed. We then injected Coca Cola directly into the bezoar mass, followed by irrigation with Coca Cola. Follow-up endoscopy was performed the next day, which revealed that the gastric bezoars had dissolved spontaneously.

  20. The Effects of Pre-Operative Enteral Nutrition from Nasal Feeding Tubes on Gastric Outlet Obstruction.

    PubMed

    Chen, Zhi-Hua; Lin, Su-Yong; Dai, Qi-Bao; Hua, Jin; Chen, Shao-Qin

    2017-04-10

    We examined gastric outlet obstruction (GOO) patients who received two weeks of strengthening pre-operative enteral nutrition therapy (pre-EN) through a nasal-jejenal feeding tube placed under a gastroscope to evaluate the feasibility and potential benefit of pre-EN compared to parenteral nutrition (PN). In this study, 68 patients confirmed to have GOO with upper-gastrointestinal contrast and who accepted the operation were randomized into an EN group and a PN group. The differences in nutritional status, immune function, post-operative complications, weight of patients, first bowel sound and first flatus time, pull tube time, length of hospital stay (LOH), and cost of hospitalization between pre-operation and post-operation were all recorded. Statistical analyses were performed using the chi square test and t-test; statistical significance was defined as p < 0.05. The success rate of the placement was 91.18% (three out of 31 cases). After pre-EN, the levels of weight, albumin (ALB), prealbumin (PA), and transferrin (TNF) in the EN group were significantly increased by pre-operation day compared to admission day, but were not significantly increased in the PN group; the weights in the EN group were significantly increased compared to the PN group by pre-operation day and day of discharge; total protein (TP), ALB, PA, and TNF of the EN group were significantly increased compared to the PN group on pre-operation and post-operative days one and three. The levels of CD3+, CD4+/CD8+, IgA, and IgM in the EN group were higher than those of the PN group at pre-operation and post-operation; the EN group had a significantly lower incidence of poor wound healing, peritoneal cavity infection, pneumonia, and a shorter first bowel sound time, first flatus time, and post-operation hospital stay than the PN group. Pre-EN through a nasal-jejunum feeding tube and placed under a gastroscope in GOO patients was safe, feasible, and beneficial to the nutrition status, immune function

  1. Gastric Outlet Obstruction--An Unexpected Complication during Coca-Cola Therapy for a Gastric Bezoar: A Case Report and Literature Review.

    PubMed

    Lu, Lei; Zhang, Xiao-Feng

    2016-01-01

    Gastric bezoars are concretions of undigested material, and Coca-Cola therapy is an easy, efficacious and safe approach for bezoar treatment. Gastric outlet obstruction due to a migratory gastric bezoar during Coca-Cola therapy is an uncommon presentation and, to the best of our knowledge, no cases have been previously reported. We herein describe one such case with no known predisposing factors that recovered via the endoscopic technique. A thorough literature search was performed, which yielded eight relevant patients from seven publications, all of who developed gastrointestinal obstruction during dissolution treatment and recovered uneventfully after surgical intervention. In conclusion, this potential complication should be kept in mind in the event that alternative treatment is necessary.

  2. Cystic Lymhangioma of the Lesser Sac in Adult Presenting with Features of Gastric Outlet Obstruction - A Case Report

    PubMed Central

    Kumar, Sathasivam Suresh; Das, Sri Aurobindo Prasad

    2015-01-01

    Cystic lymphangioma is a paediatric benign tumour, occurs commonly in head and neck region. Adult intraabdominal lymphangiomas are uncommon and only few cases of lesser sac cystic lymphangioma are reported in the literature. We present a case of lesser sac cystic lymphangioma in a 26-year-old lady who presented with features of gastric outlet obstruction. Clinical examination revealed a 10x10 cm firm, non tender, mobile intraabdominal lump in the epigastrium. An upper gastrointestinal endoscopy showed possible external compression at the body of the stomach. Ultrasound demonstrated a multicystic lesion, with internal echoes in one locule. CECT showed a large multiloculated cystic lesion with hyper-dense content in the lesser sac extending up to the left lobe of the liver and indenting the stomach, lesser sac, and upper border of pancreas. On surgical exploration, a 10X8 cm multi cystic lesion with clear fluid was found in the lesser sac very close to the lesser curvature of stomach. Histopathological examination of the excised lesion showed features of cystic lymphangioma. Though very rare, intraabdominal cystic lymphangiomas should be considered in all atypical cases of gastric outlet obstruction. A reasonable knowledge about these benign lesions will aid in establishing the diagnosis and surgical management. PMID:26672967

  3. Entirely Laparoscopic Gastrectomy and Colectomy for Remnant Gastric Cancer with Gastric Outlet Obstruction and Transverse Colon Invasion

    PubMed Central

    Kim, Hyun Il

    2015-01-01

    It is well known that gastrectomy with curative intent is the best way to improve outcomes of patients with remnant gastric cancer. Recently,several investigators reported their experiences with laparoscopic gastrectomy of remnant gastric cancer. We report the case of an 83-year-old female patient who was diagnosed with remnant gastric cancer with obstruction. She underwent an entirely laparoscopic distal gastrectomy with colectomy because of direct invasion of the transverse colon. The operation time was 200 minutes. There were no postoperative complications. The pathologic stage was T4b (transverse colon) N0M0. Our experience suggests that laparoscopic surgerycould be an effective method to improve the surgical outcomes of remnant gastric cancer patients. PMID:26819808

  4. Long-Term Palliative Effect of Stenting in Gastric Outlet Obstruction Due to Transarterial Chemoembolization with Yttrium-90 in a Patient with Metastatic Neuroendocrine Tumor

    PubMed Central

    Caglar, Erkan; Doğusoy, Gulen; Kabasakal, Levent; Dobrucali, Ahmet

    2016-01-01

    Internal radioembolization with yttrium-90 is a promising treatment method, predominantly for liver tumors. However, the shifting of yttrium-90-loaded spherules into the arteries and veins that supply the duodenum and stomach, leading to ulceration, hemorrhage, perforation, and outlet obstruction of these organs, is one of the major undesirable consequences of this technique. We report a case of gastric outlet obstruction (GOO) due to antropyloric stenosis with ulceration, edema, and inflammation following transarterial yttrium-90 treatment for a metastatic neuroendocrine tumor in a 58-year-old man. Stenting was used for palliation in this case. GOO improved after stenting and recovery of oral intake was permanent after stent removal. PMID:27353368

  5. Bladder Outlet Obstruction: Causes in Men?

    MedlinePlus

    ... is the most common cause of bladder outlet obstruction in men Scarring of the urinary channel (urethra) or bladder neck, as a result of injury or surgery Use of certain medications, including antihistamines, decongestants ... of bladder outlet obstruction is important to prevent serious problems caused by ...

  6. International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction

    PubMed Central

    Khashab, Mouen A.; Bukhari, Majidah; Baron, Todd H.; Nieto, Jose; El Zein, Mohamad; Chen, Yen-I; Chavez, Yamile Haito; Ngamruengphong, Saowanee; Alawad, Ahmad S.; Kumbhari, Vivek; Itoi, Takao

    2017-01-01

    Background and study aims EUS-guided gastroenterostomy (EUS-GE) is a novel procedure that potentially offers long-lasting luminal patency without the risk of tumor ingrowth/overgrowth. This study compared the clinical success, technical success, adverse events (AEs), length of hospital stay (LOHS) and symptom recurrence in EUS-GE versus SGJ. Methods This was a multicenter international retrospective comparative study of EUS-GE and SGJ in patients with malignant gastric outlet obstruction (GOO) who underwent either EUS-GE or SGJ. EUS-GE was performed using lumen apposing metal stents. Results A total of 93 patients with malignant GOO treated with either EUS-GE (n = 30) or SGJ (n = 63) were identified. Peritoneal carcinomatosis was present in 13 (43 %) patients in the EUS-GE group and 7 (11 %) patients in the SGJ group (P < 0.001). Although the technical success rate was significantly higher in the SGJ group as compared to the EUS-GE group (100 % vs. 87 %, P = 0.009), the clinical success rate was not different (90 % vs. 87 %, P = 0.18, OR 0.8, 95 %CI 0.44 – 7.07). The rate of AEs was lower in the EUS-GE group, but the difference was not statistically significant (16 % vs 25 %, P = 0.3). The mean LOHS was similar in the EUS-GE group compared to SGJ (P = 0.35). The rate of recurrent GOO was not different between the two groups (3 % vs. 14 %, P = 0.08). Similarly, the mean time to reintervention was similar (88 days vs. 121 days, P = 0.83). Conclusions EUS-GE is associated with equivalent efficacy and safety as compared to surgical GJ. This is the first comparative trial between both techniques and suggests EUS-GE as a non-inferior but less invasive alter to surgery. PMID:28382326

  7. Third ventriculostomy and fourth ventricle outlets obstruction.

    PubMed

    Ferrer, Enrique; de Notaris, Matteo

    2013-02-01

    A dilated fourth ventricle due to outlet obstruction is a clinical-radiologic entity with symptoms similar to those of a posterior fossa space-occupying lesion. Indeed, blockage of the foramina of Luschka and Magendie and of the aqueduct results in a "trapped" fourth ventricle. Continued cerebrospinal fluid (CSF) production within the fourth ventricle leads to cystic dilatation of the fourth ventricle. We could not, until now, understand the phenomenon, mainly on exploring endoscopically the permeability of the whole aqueduct. In adults, we call this condition the functional trapped fourth ventricle because in none of our cases have we found physical obstruction of CSF flow. Third ventricle-fourth ventriculostomy is by far the most frequently used technique for cannulation of the aqueduct in a trapped fourth ventricle. In our reported cases, we have introduced a silicone tube stent from below after accessing the fourth ventricle through a small suboccipital craniectomy, ascending it on the aqueduct in order to reach the third ventricle. Management of this infrequently isolated fourth ventricle, but communicated with the rest of ventricular system, remains a challenge for neurosurgeons. Lack of knowledge of the pathophysiology makes it difficult to treat a problem that we do not understand.

  8. Gastric bezoar with small bowel obstruction

    PubMed Central

    Urgancı, Ayvaz Ulaş; Akıncılar, Ebru

    2016-01-01

    In the operation performed on a patient with a history of abdominal surgery, a gastric bezoar and a small bowel bezoar were detected. Adhesive bowel obstruction was suspected; however, the patient was diagnosed with mechanical intestinal obstruction. Small bowel bezoar has resulted in intestinal obstruction. This case was discussed in accordance with the literature. PMID:28149129

  9. Bladder outlet obstruction treated with transurethral ultrasonic aspiration

    NASA Astrophysics Data System (ADS)

    Malloy, Terrence R.

    1991-07-01

    Fifty-nine males with bladder outlet obstruction were treated with transurethral ultrasonic aspiration of the prostate. Utilizing a 26.5 French urethral sheath, surgery was accomplished with a 10 French, 0-700 micron vibration level ultrasonic tip with an excursion rate of 39 kHz. Complete removal of the adenoma was accomplished, followed by transurethral electrocautery biopsies of both lateral lobes to compare pathologic specimens. One-year follow-up revealed satisfactory voiding patterns in 57 of 59 men (96%). Two men developed bladder neck contractures. Pathologic comparisons showed 100% correlation between aspirated and TUR specimens (56 BPH, 3 adeno-carcinoma). Forty-sevel men were active sexually preoperatively (6 with inflatable penile prostheses). Post ultrasonic aspiration, 46 men had erectile function similar to preoperative levels with one patient suffering erectile dysfunction. Forty men (85%) had antegrade ejaculation while 7 (15%) experienced retrograde or retarded ejaculation. No patients were incontinent.

  10. Benefits of Recurrent Colonic Stent Insertion in a Patient with Advanced Gastric Cancer with Carcinomatosis Causing Colonic Obstruction

    PubMed Central

    Park, Semi; Shin, Sang Joon; Ahn, Joong Bae; Jeung, Hei-Cheul; Rha, Sun Young; Lee, Sang Kil

    2009-01-01

    Malignant obstruction develops frequently in advanced gastric cancer. Although it is primarily the gastric outlet that is obstructed, there are occasional reports of colonic obstruction. Treating intestinal obstruction usually requires emergency surgery or stent insertion. There are several kinds of complications with stent insertion, such as bowel perforation, stent migration, bleeding, abdominal pain and reobstruction. Nevertheless, endoscopic stent insertion could be a better treatment than emergency surgery in cases of malignant bowel obstruction in cancer patients with poor performance status. We report a case of advanced gastric cancer with carcinomatosis in which a recurrent colonic stent was inserted at the same site because of cancer growth into the stent. The patient maintained a good condition for chemotherapy, thus improving their chances for survival. PMID:19430568

  11. Percutaneous gastric drainage as a treatment for small bowel obstruction after gastric bypass.

    PubMed

    Hamoui, Nahid; Crookes, Peter F; Kaufman, Howard S

    2007-10-01

    The authors report the case of a patient who developed small bowel obstruction after laparoscopic gastric bypass. Imaging revealed an obstruction at the enteroenterostomy resulting in dilation of the bypassed stomach and proximal small bowel. The bypassed stomach was percutaneously drained using CT guidance, leading to resolution of the small bowel obstruction. Biliopancreatic limb obstructions can be successfully treated non-operatively after gastric bypass.

  12. Deletion of neuropilin 2 enhances detrusor contractility following bladder outlet obstruction

    PubMed Central

    Vasquez, Evalynn; Cristofaro, Vivian; Lukianov, Stefan; Burkhard, Fiona C.; Monastyrskaya, Katia; Bielenberg, Diane R.; Sullivan, Maryrose P.; Adam, Rosalyn M.

    2017-01-01

    Chronic urethral obstruction and the ensuing bladder wall remodeling can lead to diminished bladder smooth muscle (BSM) contractility and debilitating lower urinary tract symptoms. No effective pharmacotherapy exists to restore BSM contractile function. Neuropilin 2 (Nrp2) is a transmembrane protein that is highly expressed in BSM. Nrp2 deletion in mice leads to increased BSM contraction. We determined whether genetic ablation of Nrp2 could restore BSM contractility following obstruction. Partial bladder outlet obstruction (pBOO) was created by urethral occlusion in mice with either constitutive and ubiquitous, or inducible smooth muscle–specific deletion of Nrp2, and Nrp2-intact littermates. Mice without obstruction served as additional controls. Contractility was measured by isometric tension testing. Nrp2 deletion prior to pBOO increased force generation in BSM 4 weeks following surgery. Deletion of Nrp2 in mice already subjected to pBOO for 4 weeks showed increased contractility of tissues tested 6 weeks after surgery compared with nondeleted controls. Assessment of tissues from patients with urodynamically defined bladder outlet obstruction revealed reduced NRP2 levels in obstructed bladders with compensated compared with decompensated function, relative to asymptomatic controls. We conclude that downregulation of Nrp2 promotes BSM force generation. Neuropilin 2 may represent a novel target to restore contractility following obstruction. PMID:28194441

  13. Deletion of neuropilin 2 enhances detrusor contractility following bladder outlet obstruction.

    PubMed

    Vasquez, Evalynn; Cristofaro, Vivian; Lukianov, Stefan; Burkhard, Fiona C; Gheinani, Ali Hashemi; Monastyrskaya, Katia; Bielenberg, Diane R; Sullivan, Maryrose P; Adam, Rosalyn M

    2017-02-09

    Chronic urethral obstruction and the ensuing bladder wall remodeling can lead to diminished bladder smooth muscle (BSM) contractility and debilitating lower urinary tract symptoms. No effective pharmacotherapy exists to restore BSM contractile function. Neuropilin 2 (Nrp2) is a transmembrane protein that is highly expressed in BSM. Nrp2 deletion in mice leads to increased BSM contraction. We determined whether genetic ablation of Nrp2 could restore BSM contractility following obstruction. Partial bladder outlet obstruction (pBOO) was created by urethral occlusion in mice with either constitutive and ubiquitous, or inducible smooth muscle-specific deletion of Nrp2, and Nrp2-intact littermates. Mice without obstruction served as additional controls. Contractility was measured by isometric tension testing. Nrp2 deletion prior to pBOO increased force generation in BSM 4 weeks following surgery. Deletion of Nrp2 in mice already subjected to pBOO for 4 weeks showed increased contractility of tissues tested 6 weeks after surgery compared with nondeleted controls. Assessment of tissues from patients with urodynamically defined bladder outlet obstruction revealed reduced NRP2 levels in obstructed bladders with compensated compared with decompensated function, relative to asymptomatic controls. We conclude that downregulation of Nrp2 promotes BSM force generation. Neuropilin 2 may represent a novel target to restore contractility following obstruction.

  14. Urethrolysis with Martius labial fat pad graft for iatrogenic bladder outlet obstruction.

    PubMed

    Carey, Jeffrey M; Chon, Joanna K; Leach, Gary E

    2003-04-01

    This article evaluates treatment outcomes of urethrolysis with the Martius labial fat pad graft for patients with outlet obstruction after incontinence surgery. A total of 23 women were diagnosed with iatrogenic bladder outlet obstruction by urinary retention, urodynamic criteria, physical examination findings, and/or temporal relation of voiding dysfunction to anti-incontinence surgery. The urodynamic definition of female outlet obstruction was a maximum flow rate <12 mL/sec and a detrusor pressure at maximum flow >20 cm of water. Surgical treatment consisted of urethrolysis with complete circumferential urethral mobilization. A Martius labial fat pad graft was used to circumferentially wrap the urethra. No concurrent resuspension procedures were performed. Procedure efficacy was determined by retrospective review and phone interview. Mean patient age was 55 years (range, 37 to 85 years). Mean postoperative follow-up time was 15 months (maximum, 44 months). All patients related voiding dysfunction symptoms to their anti-incontinence surgery. In all, 17 of 23 (74%) patients had preoperative urinary retention requiring catheterization, and 63% of patients met urodynamic criteria for obstruction. After urethrolysis with a Martius labial fat pad graft, 20 of 23 (87%) patients had complete resolution of their obstruction; 3 patients required persistent catheterization. Postoperative stress incontinence was reported by 6 of 23 (13%) patients. Urodynamically documented detrusor instability occurred in 6 of 23 (26%) patients with de novo detrusor instability occurring in 3 of 15 (20%) patients.

  15. Urethral duplication with unusual cause of bladder outlet obstruction

    PubMed Central

    Venkatramani, Vivek; George, Arun Jacob Philip; Chandrasingh, J.; Panda, Arabind; Devasia, Antony

    2016-01-01

    A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age of 3 years. The evaluation revealed urethral duplication with a hypoplastic dorsal urethra and patent ventral urethra. He also had duplication of the bladder neck, and on voiding cystourethrogram the ventral bladder neck appeared hypoplastic and compressed by the dorsal bladder neck during voiding. The possibility of functional obstruction of the ventral urethra by the occluded dorsal urethra was suspected, and he underwent a successful urethro-urethrostomy. PMID:27127361

  16. Urethral duplication with unusual cause of bladder outlet obstruction.

    PubMed

    Venkatramani, Vivek; George, Arun Jacob Philip; Chandrasingh, J; Panda, Arabind; Devasia, Antony

    2016-01-01

    A 12-year-old boy presented with poor flow and recurrent urinary tract infections following hypospadias repair at the age of 3 years. The evaluation revealed urethral duplication with a hypoplastic dorsal urethra and patent ventral urethra. He also had duplication of the bladder neck, and on voiding cystourethrogram the ventral bladder neck appeared hypoplastic and compressed by the dorsal bladder neck during voiding. The possibility of functional obstruction of the ventral urethra by the occluded dorsal urethra was suspected, and he underwent a successful urethro-urethrostomy.

  17. Rapid deterioration of primary fourth ventricular outlet obstruction resulting in syndrome of inappropriate antidiuretic hormone secretion.

    PubMed

    Hashimoto, Hiroyuki; Maeda, Akiko; Kumano, Koichi; Kimoto, Tatsuya; Fujisawa, Yuko; Akai, Takuya

    2014-08-01

    Fourth ventricular outlet obstruction (FVOO) is a rare cause of obstructive hydrocephalus. Although FVOO accompanied by malformative syndrome and secondary causes of obstruction are common, there are few reports of primary FVOO (PFVOO). The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare presenting feature of hydrocephalus. A 1-year, 8-month-old boy with a normal head circumference developed SIADH accompanied by rapid deterioration of symptoms of intracranial hypertension. PFVOO was diagnosed because magnetic resonance imaging revealed an enlarged ventricular system with a barely visible membranous obstacle at the foramen of Magendie. All symptoms were resolved by endoscopic third ventriculostomy. PFVOO should be considered as a rare form of congenital obstructive hydrocephalus, especially in patients with tetraventricular hydrocephalus. To the best of our knowledge, this is the first case of an infant with SIADH, resulting from acute deterioration of non-tumoral raised pressure hydrocephalus.

  18. Transvaginal Mesh and Transanal Resection to Treat Outlet Obstruction Constipation Caused by Rectocele

    PubMed Central

    Shi, Yang; Yu, Yongjun; Zhang, Xipeng; Li, Yuwei

    2017-01-01

    Background The aim of this study was to evaluate the curative effect of transvaginal mesh repair (TVMR) and stapled transanal rectal resection (STARR) in treating outlet obstruction constipation caused by rectocele. Material/Methods Patients who had outlet obstruction constipation caused by rectocele were retrospectively analyzed and 39 patients were enrolled the study. Patients were assigned to either the TVMR or STARR group. Postoperative factors such as complications, pain, recurrence rate, and operative time were compared between the 2 groups. Results Total effective rate was 100% in both groups. No long-term chronic pain occurred and discomfort rate of tenesmus was higher in the STARR group than in the TVMR group. Postoperative defecography showed that the rectocele depth was significantly reduced, and the prolapse of the rectal mucosa and the lower rectal capacity was also decreased. Four cases had mesh exposure in the TVMR group and 2 cases in the STARR group had anastomotic bleeding after the surgery. Conclusions For outlet obstruction constipation caused by rectocele, TVMR and STARR both obtained satisfactory results. Although TVMR is complex with longer operative time and hospitalization period, its long-term effect is better than that of STARR. PMID:28146137

  19. Case of duplication of the urethra in an adult male, presenting with symptoms of bladder outlet obstruction.

    PubMed

    Slavov, Chavdar; Donkov, Ivo; Popov, Elenko

    2007-10-01

    Duplication of the urethra is a rare congenital anomaly, usually found in children and adolescents. The authors present a rare case of urethral duplication, presenting in a 58-yr-old man, with symptoms of bladder outlet obstruction.

  20. Rhabdomyosarcoma of prostate presenting as bladder outlet obstruction in a young adult

    PubMed Central

    Prabhakaran, Pranab; Sanjayan, Rajitha; Somanathan, Thara; Narayanan, Geetha

    2013-01-01

    A 19-year-old boy presented with bladder outlet obstruction and on evaluation was found to have prostatomegaly, which on biopsy was diagnostic of embryonal rhabdomyosarcoma (RMS). He had pulmonary metastasis and received chemotherapy with cyclophosphamide, doxorubicin, vincristine, actinomycin D, and radical radiotherapy. At one year, his prostatic tumour has resolved completely. Embryonal RMS of prostate occurs more commonly in infancy and childhood, so occurrence in young adults is rare, and a high index of suspicion is essential for early diagnosis and treatment. PMID:24143154

  1. Rhabdomyosarcoma of prostate presenting as bladder outlet obstruction in a young adult.

    PubMed

    Prabhakaran, Pranab; Sanjayan, Rajitha; Somanathan, Thara; Narayanan, Geetha

    2013-01-01

    A 19-year-old boy presented with bladder outlet obstruction and on evaluation was found to have prostatomegaly, which on biopsy was diagnostic of embryonal rhabdomyosarcoma (RMS). He had pulmonary metastasis and received chemotherapy with cyclophosphamide, doxorubicin, vincristine, actinomycin D, and radical radiotherapy. At one year, his prostatic tumour has resolved completely. Embryonal RMS of prostate occurs more commonly in infancy and childhood, so occurrence in young adults is rare, and a high index of suspicion is essential for early diagnosis and treatment.

  2. Compensatory Paracrine Mechanisms That Define The Urothelial Response to Injury in Partial Bladder Outlet Obstruction

    SciTech Connect

    Bassuk, James; Lendvay, Thomas S.; Sweet, Robert; Han, Chang-Hee; Soygur, Tarkan; Cheng, Jan-Fang; Plaire, J. Chadwick; Charleston, Jay S.; Charleston, Lynne B.; Bagai, Shelly; Cochrane, Kimberly; Rubio, Eric; Bassuk, James A.; Fuchs, Elaine

    2007-06-21

    Diseases and conditions affecting the lower urinary tract are a leading cause of dysfunctional sexual health, incontinence, infection, and kidney failure. The growth, differentiation, and repair of the bladder's epithelial lining are regulated, in part, by fibroblast growth factor (FGF)-7 and -10 via a paracrine cascade originating in the mesenchyme (lamina propria) and targeting the receptor for FGF-7 and -10 within the transitional epithelium (urothelium). The FGF-7 gene is located at the 15q15-q21.1 locus on chromosome 15 and four exons generate a 3.852-kb mRNA. Five duplicated FGF-7 gene sequences that localized to chromosome 9 were predicted not to generate functional protein products, thus validating the use of FGF-7-null mice as an experimental model. Recombinant FGF-7 and -10 induced proliferation of human urothelial cells in vitro and transitional epithelium of wild-type and FGF-7-null mice in vivo.To determine the extent that induction of urothelial cell proliferation during the bladder response to injury is dependent on FGF-7, an animal model of partial bladder outlet obstruction was developed. Unbiased stereology was used to measure the percentage of proliferating urothelial cells between obstructed groups of wild-type and FGF-7-null mice. The stereological analysis indicated that a statistical significant difference did not exist between the two groups, suggesting that FGF-7 is not essential for urothelial cell proliferation in response to partial outlet obstruction. In contrast, a significant increase in FGF-10 expression was observed in the obstructed FGF-7-null group, indicating that the compensatory pathway that functions in this model results in urothelial repair.

  3. Comparison between prostate volume and intravesical prostatic protrusion in detecting bladder outlet obstruction due to benign prostatic hyperplasia.

    PubMed

    Hossain, A K M S; Alam, A K M K; Habib, A K M K; Rashid, M M; Rahman, H; Islam, A K M A; Jahan, M U

    2012-04-01

    The objectives of this study were to determine and compare the correlation of intravesical prostatic protrusion (IPP) and prostate volume (PV) with bladder outlet obstruction (BOO). This study was conducted in the department of urology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between July 2009 to September 2010. Fifty benign prostatic hyperplasia (BPH) patients were included in the study. Their evaluation consisted of history along with International Prostate Symptoms Score (IPSS), digital rectal examination (DRE), transabdominal ultrasonography to measure prostate volume, intravesical prostatic protrusion & post voidal residual (PVR) urine and pressure-flow studies to detect bladder outflow obstruction (BOO). Statistical analysis included Unpaired 't' test, Chi-square test and Spearman's Rank correlation test. Receiver Operator Characteristic (ROC) curves were used to compare the correlation of PV and IPP with BOO. Mean prostate volume was significantly larger in bladder outlet obstructed patients (P<0.05). Mean IPP was significantly greater in obstructed patients (P<0.001). Area under ROC curve was 0.700 for PV and 0.821 for IPP. Prostate volume & intravesical prostatic protrusion measured through transabdominal ultrasonography are noninvasive and accessible method that significantly correlates with bladder outlet obstruction in patients with benign prostatic hyperplasia and the correlation of IPP is much more stronger than that of prostate volume.

  4. Percutaneous Transhepatic Duodenal Drainage as an Alternative Approach in Afferent Loop Obstruction with Secondary Obstructive Jaundice in Recurrent Gastric Cancer

    SciTech Connect

    Yao, N.-S.; Wu, C.-W.; Tiu, Chui-Mei; Liu, Jacqueline M.; Whang-Peng, Jacqueline; Chen, L.-T.

    1998-07-15

    Two cases are reported of chronic, partial afferent loop obstruction with resultant obstructive jaundice in recurrent gastric cancer. The diagnosis was made by characteristic clinical presentations, abdominal computed tomography, and cholescintigraphy. Percutaneous transhepatic duodenal drainage (PTDD) provided effective palliation for both afferent loop obstruction and biliary stasis. We conclude that cholescintigraphy is of value in making the diagnosis of partial afferent loop obstruction and in differentiating the cause of obstructive jaundice in such patients, and PTDD provides palliation for those patients in whom surgical intervention is not feasible.

  5. Does uroflowmetry parameter facilitate discrimination between detrusor underactivity and bladder outlet obstruction?

    PubMed Central

    Lee, Kwon Soo; Song, Phil Hyun

    2016-01-01

    Purpose Though urodynamic study (UDS) is the current established standard to distinguish between detrusor underactivity (DU) and bladder outlet obstruction (BOO), concerns of patient discomfort and potential complications of catheterization deters its use. We inspected clinical variables to discriminate between DU and BOO in uroflowmetry, which can be more easily performed in clinical practice. Materials and Methods Total 240 men who both underwent UDS and uroflowmetry were reviewed. The patients were divided into 2 groups by a single experienced urologist based on UDS outcome; DU (n=111) and BOO (n=129). From uroflowmetry, 5 variables including maximal flow rate (Qmax), average flow rate (Qave), voiding volume (VV), postvoid residual urine (PVR), and value of Qmax minus Qave (DeltaQ) was obtained. Multivariable analysis including receiver operating characteristic (ROC) curve analysis was performed to identify the important diagnostic predictors. Results The mean age (±standard deviation) was 65.3±9.2 years. Except Qave, all uroflowmetry components were significantly different between DU and BOO groups. DeltaQ was smaller in DU group (8.71 mL/s vs. 5.26 mL/s, p<0.001). By logistic regression analysis, DeltaQ (Exp(B)=0.648, p<0.001) and PVR (Exp(B)=1.009, p<0.001) significantly discriminate DU and BOO diagnosis. In diagnosing DU using a single variable, the area under the curve of ROC from DeltaQ (0.806) was significantly higher than that from Qmax (0.763, p=0.0126) and Qave (0.574, p<0.0001). Conclusions Our findings suggest that DeltaQ is a novel predictor capable of discriminating DU from BOO in men with obstructive lower urinary tract symptom. PMID:27847918

  6. Molecular Mechanisms of Bladder Outlet Obstruction in Transgenic Male Mice Overexpressing Aromatase (Cyp19a1)

    PubMed Central

    Lin, Wei; Rahman, Nafis A.; Lin, Jian; Zhang, Hua; Gou, Kemian; Yu, Wanpeng; Zhu, Dahai; Li, Ning; Huhtaniemi, Ilpo; Li, Xiangdong

    2011-01-01

    We investigated the etiology and molecular mechanisms of bladder outlet obstruction (BOO). Transgenic (Tg) male mice overexpressing aromatase (Cyp19a1) under the ubiquitin C promoter in the estrogen-susceptible C57Bl/6J genetic background (AROM+/6J) developed inguinal hernia by 2 months and severe BOO by 9 to 10 months, with 100% penetrance. These mice gradually developed uremia, renal failure, renal retention, and finally died. The BOO bladders were threefold larger than in age-matched wild-type (WT) males and were filled with urine on necropsy. Hypotrophic smooth muscle cells formed the thin detrusor urinae muscle, and collagen III accumulation contributed to the reduced compliance of the bladder. p-AKT and ERα expression were up-regulated and Pten expression was down-regulated in the BOO bladder urothelium. Expression of only ERα in the intradetrusor fibroblasts suggests a specific role of this estrogen receptor form in urothelial proliferation. Inactivation of Pten, which in turn activated the p-AKT pathway, was strictly related to the activation of the ERα pathway in the BOO bladders. Human relevance for these findings was provided by increased expression of p-AKT, PCNA, and ERα and decreased expression of PTEN in severe human BOO samples, compared with subnormal to mild samples. These findings clarify the involvement of estrogen excess and/or imbalance of the androgen/estrogen ratio in the molecular pathogenetic mechanisms of BOO and provide a novel lead into potential treatment strategies for BOO. PMID:21356374

  7. Primary gastric tuberculosis – report of 5 cases

    PubMed Central

    Amarapurkar, Deepak N; Patel, Nikhil D; Amarapurkar, Anjali D

    2003-01-01

    Background Gastric tuberculosis is rare, and usually associated with pulmonary tuberculosis or an immunodeficient state. Here, we report five cases of gastric tuberculosis in immunocompetent patients without evidence of pulmonary involvement. Case presentation Three patients presented with gastric outlet obstruction that required surgery to relieve the obstruction as well as to confirm the diagnosis. The remaining two had involvement of gastroesophageal junction. All of them responded well to standard antitubercular treatment. Conclusion Though gastric tuberculosis is rare, it should be considered a possibility when patients present with gastric outlet obstruction or with endoscopic evidence of diffuse chronic inflammatory activity, particularly in areas endemic for tuberculosis. PMID:12703983

  8. Giant primary vaginal calculus secondary to vesicovaginal fistula with partial vaginal outlet obstruction in a 12-year-old girl.

    PubMed

    Chen, Shushang; Ge, Rong; Zhu, Lingfeng; Yang, Shunliang; Wu, Weizhen; Yang, Yin; Tan, Jianming

    2011-10-01

    A vesicovaginal fistula with vagina obstruction associated with vaginal calculi is an extremely rare medical condition. We report a giant primary vaginal calculus resulting from vesicovaginal fistula with partial vaginal outlet obstruction secondary to perineum trauma and surgery in a 12-year-old girl. Episiotomy was performed and the adhesive labia minora was split. After the removal of a giant calculus in the vagina, approximately 8 cm in diameter, the fistula tract was completely excised, followed by the repair of the vesicovagina fistula and the vagina. The patient was symptom-free at 6-month follow-up examination.

  9. Resting anal pressure, not outlet obstruction or transit, predicts healthcare utilization in chronic constipation: a retrospective cohort analysis

    PubMed Central

    Staller, Kyle; Barshop, Kenneth; Kuo, Braden; Ananthakrishnan, Ashwin N

    2015-01-01

    Background Chronic constipation is common and exerts a considerable burden on health-related quality of life and healthcare resource utilization. Anorectal manometry (ARM) and colonic transit testing have allowed classification of subtypes of constipation, raising promise of targeted treatments. There has been limited study of the correlation between physiological parameters and healthcare utilization. Methods All patients undergoing ARM and colonic transit testing for chronic constipation at two tertiary care centers from 2000 to 2014 were included in this retrospective study. Our primary outcomes included number of constipation-related and gastroenterology visits per year. Multivariate linear regression adjusting for confounders defined independent effect of measures of colonic and anorectal function on healthcare utilization. Key Results Our study included 612 patients with chronic constipation. More than 50% (n=333) of patients had outlet obstruction by means of balloon expulsion testing and 43.5% (n=266) had slow colonic transit. On unadjusted analysis, outlet obstruction (1.98 vs. 1.68), slow transit (2.40 vs 2.07) and high resting anal pressure (2.16 vs. 1.76) were all associated with greater constipation-related visits/year compared to patients without each of those parameters (P<0.05 for all). Outlet obstruction and high resting anal pressure were also associated with greater number of gastroenterology visits/year. After multivariate adjustment, high resting anal pressure was the only independent predictor of increased constipation-related visits/year (P=0.02) and gastroenterology visits/year (P=0.04). Conclusions and Inferences Among patients with chronic constipation, high resting anal pressure, rather than outlet obstruction or slow transit, predicts healthcare resource utilization. PMID:26172284

  10. Detection of Subpubic Tumor Causing Bladder Outlet Obstruction by 3D Perineal Ultrasound.

    PubMed

    Albrich, S; Steetskamp, J; Rommens, K; Porta, S; Battista, M; Hoffmann, G; Skala, C

    2015-07-01

    This case report shows that 3D perineal ultrasound can be superior to clinical examination and routine 2D perineal ultrasound in the detection of an unusual subpubic tumor. A 73-year-old female patient was referred to our urogynecological outpatient unit complaining of over-active bladder symptoms and voiding dysfunction for 3 years. Gynecological examination found no signs of pelvic organ prolapse or abnormality in the vaginal cavity. Routine 2D perineal ultrasound showed substantial residual urine (ca. 300 ml on catheter) and limited bladder neck mobility, but no signs of pelvic organ prolapse. Use of standardized 3D perineal ultrasound revealed a 24 × 26 × 32 mm spherical, hypoechoic tumor below the pubic symphysis between the distal urethra and the pubic bones. This structure was mistaken for the pubic symphysis in the midline on 2D ultrasound performed earlier. At surgery, the tumor was completely excised through a vaginal incision between the urethra and the pubic symphysis. After an uneventful postoperative recovery the patient developed de-novo stress urinary incontinence, which was corrected successfully by the insertion of a retropubic tension-free suburethral sling after an interval of 8 weeks. After a further follow-up of 8 weeks the patient reported well-being, urinary continence and no voiding dysfunction; no abnormalities were found on examination. In conclusion, 3D perineal ultrasound is a useful additional tool for the diagnostic workup of bladder outlet obstruction.

  11. Increased susceptibility of estrogen-induced bladder outlet obstruction in a novel mouse model.

    PubMed

    Tam, Neville Ngai-Chung; Zhang, Xiang; Xiao, Hong; Song, Dan; Levin, Linda; Meller, Jarek; Ho, Shuk-Mei

    2015-05-01

    Disorders of the prostate and lower urinary tract are common in elderly men. We investigated the role of metallothionein-1 (MT1) in prostate carcinogenesis by generating a prostate-specific, MT1-expressing mouse. Unexpectedly, genomic analyses revealed that a 12.1-kb genomic region harboring several conserved noncoding elements was unintentionally deleted, upstream of the transgene integration site in the mouse, which we named it 12.1ΔMT1. Male 12.1ΔMT1 mice chronically treated with testosterone (T) plus 17β-estradiol (E2) to induce prostate cancer exhibited no evidence of precancerous or cancerous lesions. Instead, most of them exhibited a bladder outlet obstruction (BOO) phenotype not observed in treated wild-type (WT) mice. Thus, we hypothesized that 12.1ΔMT1 is a novel model for studying the hormonal requirement for BOO induction. Adult male 12.1ΔMT1 and WT mice were treated with T, E2, bisphenol A (BPA), T+E2, or T+BPA for up to 6 months. Histologic and immunohistochemical analysis of the prostate, bladder, and urethra were performed. No significant prostate pathologies were observed in WT or 12.1ΔMT1 mice treated with any of the hormone regimens. As expected, prostatic regression occurred in all E2-treated animals (WT and 12.1ΔMT1). Of great interest, despite a small prostate, 100% of E2-treated 12.1ΔMT1 mice, but only 40% of E2-treated WT mice, developed severe BOO (P<0.01). In contrast, T+E2 treatment was less effective than E2 treatment in inducing severe BOO in 12.1ΔMT1 mice (68%, P<0.05) and was completely ineffective in WT animals. Similarly, T, BPA, and T+BPA treatments did not induce BOO in either WT or 12.1ΔMT1 mice. The BOO pathology includes a thinner detrusor wall, narrowing of bladder neck and urethral lumen, and basal cell hyperplasia in the bladder body and urethra. These findings indicate that 12.1ΔMT1 mice exhibit enhanced susceptibility to E2-induced BOO that is independent of prostate enlargement but that is attenuated by the

  12. Efferent limb of gastrojejunostomy obstruction by a whole okra phytobezoar: Case report and brief review

    PubMed Central

    Zin, Thant; Maw, Myat; Pai, Dinker Ramananda; Paijan, Rosaini Binti; Kyi, Myo

    2012-01-01

    A phytobezoar is one of the intraluminal causes of gastric outlet obstruction, especially in patients with previous gastric surgery and/or gastric motility disorders. Before the proton pump inhibitor era, vagotomy, pyloroplasty, gastrectomy and gastrojejunostomy were commonly performed procedures in peptic ulcer patients. One of the sequelae of gastrojejunostomy is phytobezoar formation. However, a bezoar causing gastric outlet obstruction is rare even with giant gastric bezoars. We report a rare case of gastric outlet obstruction due to a phytobezoar obstructing the efferent limb of the gastrojejunostomy site. This phytobezoar which consisted of a whole piece of okra (lady finger vegetable) was successfully removed by endoscopic snare. To the best of our knowledge, this is the first case of okra bezoar-related gastrojejunostomy efferent limb obstruction reported in the literature. PMID:22624073

  13. A Novel Intraurethral Device Diagnostic Index to Classify Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms

    PubMed Central

    Reis, Leonardo O.; Barreiro, Guilherme C.; Prudente, Alessandro; Silva, Cleide M.; Bassani, José W. M.; D'Ancona, Carlos A. L.

    2009-01-01

    Objectives. Using a urethral device at the fossa navicularis, bladder pressure during voiding can be estimated by a minimal invasive technique. This study purposes a new diagnostic index for patients with lower urinary tract symptoms (LUTSs). Methods. Fifty one patients presenting with LUTSs were submitted to a conventional urodynamic and a minimal invasive study. The results obtained through the urethral device and invasive classic urodynamics were compared. The existing bladder outlet obstruction index (BOOI) equation that classifies men with LUTSs was modified to allow minimal invasive measurement of isovolumetric bladder pressure in place of detrusor pressure at maximum urine flow. Accuracy of the new equation for classifying obstruction was then tested in this group of men. Results. The modified equation identified men with obstruction with a positive predictive value of 68% and a negative predictive value of 70%, with an overall accuracy of 70%. Conclusions. The proposed equation can accurately classify over 70% of men without resorting to invasive pressure flow studies. We must now evaluate the usefulness of this classification for the surgical treatment of men with LUTSs. PMID:19125194

  14. Review of invasive urodynamics and progress towards non-invasive measurements in the assessment of bladder outlet obstruction

    PubMed Central

    Griffiths, C. J.; Pickard, R. S.

    2009-01-01

    Objective: This article defines the need for objective measurements to help diagnose the cause of lower urinary tract symptoms (LUTS). It describes the conventional techniques available, mainly invasive, and then summarizes the emerging range of non-invasive measurement techniques. Methods: This is a narrative review derived form the clinical and scientific knowledge of the authors together with consideration of selected literature. Results: Consideration of measured bladder pressure urinary flow rate during voiding in an invasive pressure flow study is considered the gold standard for categorization of bladder outlet obstruction (BOO). The diagnosis is currently made by plotting the detrusor pressure at maximum flow (pdetQmax) and maximum flow rate (Qmax) on the nomogram approved by the International Continence Society. This plot will categorize the void as obstructed, equivocal or unobstructed. The invasive and relatively complex nature of this investigation has led to a number of inventive techniques to categorize BOO either by measuring bladder pressure non-invasively or by providing a proxy measure such as bladder weight. Conclusion: Non-invasive methods of diagnosing BOO show great promise and a few have reached the stage of being commercially available. Further studies are however needed to validate the measurement technique and assess their worth in the assessment of men with LUTS. PMID:19468436

  15. Bladder outlet obstruction triggers neural plasticity in sensory pathways and contributes to impaired sensitivity in erectile dysfunction.

    PubMed

    Malykhina, Anna P; Lei, Qi; Chang, Shaohua; Pan, Xiao-Qing; Villamor, Antonio N; Smith, Ariana L; Seftel, Allen D

    2013-05-15

    Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are common problems in aging males worldwide. The objective of this work was to evaluate the effects of bladder neck nerve damage induced by partial bladder outlet obstruction (PBOO) on sensory innervation of the corpus cavernosum (CC) and CC smooth muscle (CCSM) using a rat model of PBOO induced by a partial ligation of the bladder neck. Retrograde labeling technique was used to label dorsal root ganglion (DRG) neurons that innervate the urinary bladder and CC. Contractility and relaxation of the CCSM was studied in vitro, and expression of nitric oxide synthase (NOS) was evaluated by Western blotting. Concentration of the sensory neuropeptides substance P (SP) and calcitonin gene-related peptide was measured by ELISA. Partial obstruction of the bladder neck caused a significant hypertrophy of the urinary bladders (2.5-fold increase at 2 wk). Analysis of L6-S2 DRG sections determined that sensory ganglia received input from both the urinary bladder and CC with 5-7% of all neurons double labeled from both organs. The contractile responses of CC muscle strips to KCl and phenylephrine were decreased after PBOO, followed by a reduced relaxation response to nitroprusside. A significant decrease in neuronal NOS expression, but not in endothelial NOS or protein kinase G (PKG-1), was detected in the CCSM of the obstructed animals. Additionally, PBOO caused some impairment to sensory nerves as evidenced by a fivefold downregulation of SP in the CC (P ≤ 0.001). Our results provide evidence that PBOO leads to the impairment of bladder neck afferent innervation followed by a decrease in CCSM relaxation, downregulation of nNOS expression, and reduced content of sensory neuropeptides in the CC smooth muscle. These results suggest that nerve damage in PBOO may contribute to LUTS-ED comorbidity and trigger secondary changes in the contraction/relaxation mechanisms of CCSM.

  16. Octreotide acetate enables the administration of chemoradiotherapy, including the oral anticancer drug S-1, in gastric cancer patients with malignant gastrointestinal obstruction.

    PubMed

    Takahashi, Tsunehiro; Saikawa, Yoshiro; Igarashi, Takahiro; Tsuwano, Shinichi; Kumagai, Koshi; Nakamura, Rieko; Ooyama, Takashi; Wada, Norihito; Takeuchi, Hiroya; Takaishi, Hiromasa; Kitagawa, Yuko

    2010-07-01

    Advanced gastric cancer frequently results in the inability to ingest food or drink orally, a condition called malignant gastrointestinal obstruction (MGO). MGO is clinically defined as a gastrointestinal outlet obstruction caused by a large tumor, or malignant bowel obstruction with peritoneal dissemination. MGO impacts the quality of life by interfering with oral intake and by causing gastrointestinal symptoms, such as nausea, vomiting and abdominal pain. Octreotide acetate (OA) is an analogue of somatostatin which has been increasingly used to relieve gastrointestinal symptoms since it decreases the secretion of digestive juices and increases the absorption of water and electrolytes. In Japan, the oral anticancer drug S-1 was recently adopted as a key chemotherapeutic agent in advanced gastric cancer; however, its oral formulation precludes its utility in the MGO setting. This is a pilot study of chemoradiotherapy plus OA in gastric cancer with MGO. Patients were initially treated with OA to control gastrointestinal symptoms. Following resolution of their symptoms, the patients received chemotherapy with S-1 plus low-dose cisplatin and radiation. Irradiation was targeted at the primary tumor and surrounding lesions, including the lymph nodes. Grade 4 toxicity was observed in only 1 patient, and no treatment-related deaths were noted. After treatment, 3 patients achieved a partial response and 4 achieved stable disease. Of the 9 patients, 8 were able to tolerate solid food orally and were discharged. The outcomes of these cases suggest that OA is a useful adjunctive therapy that enables advanced gastric cancer patients with MGO to receive S-1-containing chemotherapy.

  17. Assessing the contribution of thrombospondin-4 induction and ATF6α activation to endoplasmic reticulum expansion and phenotypic modulation in bladder outlet obstruction

    PubMed Central

    Krawczyk, Katarzyna K.; Ekman, Mari; Rippe, Catarina; Grossi, Mario; Nilsson, Bengt-Olof; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2016-01-01

    Phenotypic modulation of smooth muscle cells is a hallmark of disease. The associated expansion of endoplasmic reticulum (ER) volume remains unexplained. Thrombospondin-4 was recently found to promote ATF6α activation leading to ER expansion. Using bladder outlet obstruction as a paradigm for phenotypic modulation, we tested if thrombospondin-4 is induced in association with ATF6α activation and ER expansion. Thrombospondin-4 was induced and ATF6α was activated after outlet obstruction in rodents. Increased abundance of spliced of Xbp1, another ER-stress sensor, and induction of Atf4 and Creb3l2 was also seen. Downstream of ATF6α, Calr, Manf, Sdf2l1 and Pdi increased as did ER size, whereas contractile markers were reduced. Overexpression of ATF6α, but not of thrombospondin-4, increased Calr, Manf, Sdf2l1 and Pdi and caused ER expansion, but the contractile markers were inert. Knockout of thrombospondin-4 neither affected bladder growth nor expression of ATF6α target genes, and repression of contractile markers was the same, even if ATF6α activation was curtailed. Increases of Xbp1s, Atf4 and Creb3l2 were similar. Our findings demonstrate reciprocal regulation of the unfolded protein response, including ATF6α activation and ER expansion, and reduced contractile differentiation in bladder outlet obstruction occurring independently of thrombospondin-4, which however is a sensitive indicator of obstruction. PMID:27581066

  18. Dissimilar Effects of Tolterodine on Detrusor Overactivity in Awake Rats with Chemical Cystitis and Partial Bladder Outlet Obstruction

    PubMed Central

    Jin, Long-Hu; Park, Chang-Shin; Shin, Hwa-Yeon; Yoon, Sang-Min

    2011-01-01

    Purpose We investigated bladder function, with a special focus on nonvoiding contractions (NVCs), in awake rats with chronic chemical cystitis and bladder outlet obstruction (BOO) by use of simultaneous registrations of intravesical and intraabdominal pressures. In addition, we tested the effects of tolterodine on the NVCs in these models. Methods A total of 20 female Sprague-Dawley rats were used in this study. In eight rats, chemical cystitis was induced by intravesical instillation of HCl. Twelve rats were subjected to sham instillations or partial BOO. Four weeks after intravesical instillation or 2 weeks after partial BOO, cystometrograms were obtained by use of simultaneous recording of intravesical and intraabdominal pressure in all unanesthetized, unrestrained rats in metabolic cages. Results A total of 17 rats survived. In the rats with acute injury by HCl, 50% showed detrusor overactivity (DO), which was not seen in the sham group. The cystitis group had lower DO pressure without a difference in DO frequency compared with the BOO group. After the administration of tolterodine, the cystitis group showed no difference in DO frequency or pressure, whereas the BOO group showed decreased values for both parameters. Conclusions Our study showed that toleterodine produced no effect on DO during the filling phase in rats with chronic chemical cystitisbut decreased the frequency and pressure of DO in rats with BOO. Clinically, studies are needed to improve the treatment effect of anticholinergic drugs ininterstitial cystitis patients with overactive bladder. PMID:22087420

  19. Combined usage of Ho:YAG laser with monopolar resectoscope in the treatment of bladder stone and bladder outlet obstruction

    PubMed Central

    Wu, Jian Hui; Yang, Kuo; Liu, Qian; Yang, Shi Qiang; Xu, Yong

    2014-01-01

    Objective: Bladder stones in elderly men are commonly associated with bladder outlet obstruction, and many different treatment modalities have been presented for both these conditions. To evaluate the effectiveness and safety of a novel method concerning spontaneous usage of both monopoplar transurethral resection of the prostate and Holmium Laser cystolithotripsy, we compared the transurethral use of resectoscope and cystoscope lithotripsy approaches retrospectively. Methods: Patients data of one hundred and nine male patients with benign prostatic hyperplasia (BPH) and bladder stone(s) were analyzed retrospectively. Two groups of patients were compared: Group I was treated with combination of transurethral holmium laser cystolithotripsy (HLC) and transurethral resection of the prostate (TURP) using the 24F resectoscope, and group II used 22F cystoscope and 24F resectoscope for treating both these conditions. Result: We reviewed the records of 109 patients undergoing transurethral cystolithotripsy with holmium laser and simultaneous TURP. The mean bladder stone size were 3.6±1.5 cm in Group-I and 3.7±1.1 cm (mean 3.8) in Group-II (p>0.05). The mean operation time of Group-I and Group-II was 49.0±22.5 minutes and 79.0±28.5 minutes, respectively (p<0.05). Stone fragments were removed completely and TURP procedures were done successfully in all of the patients. Mild hematuria was found more frequently in Group-II (22.2%), and four (7.4%) patients had urethral stricture in the same group during the late follow-up. Conclusion: Combination of transurethral laser cystolithotripsy and TURP using the same 24F resectooscope is an effective, safe and economical treatment for bladder stones in BPH patients. It is minimally invasive and involves and has lower complication rates and shorter hospital stay. However, this combined approach should be taken in the treatment of calculus within 4 or 5 centimeters. PMID:25097543

  20. Non-Invasive Clinical Parameters for the Prediction of Urodynamic Bladder Outlet Obstruction: Analysis Using Causal Bayesian Networks

    PubMed Central

    Kim, Myong; Cheeti, Abhilash; Yoo, Changwon; Choo, Minsoo; Paick, Jae-Seung; Oh, Seung-June

    2014-01-01

    Purpose To identify non-invasive clinical parameters to predict urodynamic bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia (BPH) using causal Bayesian networks (CBN). Subjects and Methods From October 2004 to August 2013, 1,381 eligible BPH patients with complete data were selected for analysis. The following clinical variables were considered: age, total prostate volume (TPV), transition zone volume (TZV), prostate specific antigen (PSA), maximum flow rate (Qmax), and post-void residual volume (PVR) on uroflowmetry, and International Prostate Symptom Score (IPSS). Among these variables, the independent predictors of BOO were selected using the CBN model. The predictive performance of the CBN model using the selected variables was verified through a logistic regression (LR) model with the same dataset. Results Mean age, TPV, and IPSS were 6.2 (±7.3, SD) years, 48.5 (±25.9) ml, and 17.9 (±7.9), respectively. The mean BOO index was 35.1 (±25.2) and 477 patients (34.5%) had urodynamic BOO (BOO index ≥40). By using the CBN model, we identified TPV, Qmax, and PVR as independent predictors of BOO. With these three variables, the BOO prediction accuracy was 73.5%. The LR model showed a similar accuracy (77.0%). However, the area under the receiver operating characteristic curve of the CBN model was statistically smaller than that of the LR model (0.772 vs. 0.798, p = 0.020). Conclusions Our study demonstrated that TPV, Qmax, and PVR are independent predictors of urodynamic BOO. PMID:25397903

  1. Testosterone and 17β-estradiol induce glandular prostatic growth, bladder outlet obstruction, and voiding dysfunction in male mice.

    PubMed

    Nicholson, Tristan M; Ricke, Emily A; Marker, Paul C; Miano, Joseph M; Mayer, Robert D; Timms, Barry G; vom Saal, Frederick S; Wood, Ronald W; Ricke, William A

    2012-11-01

    Benign prostatic hyperplasia (BPH) and bladder outlet obstruction (BOO) are common in older men and can contribute to lower urinary tract symptoms that significantly impact quality of life. Few existing models of BOO and BPH use physiological levels of hormones associated with disease progression in humans in a genetically manipulable organism. We present a model of BPH and BOO induced in mice with testosterone (T) and 17β-estradiol (E(2)). Male mice were surgically implanted with slow-releasing sc pellets containing 25 mg T and 2.5 mg E(2) (T+E(2)). After 2 and 4 months of hormone treatment, we evaluated voiding patterns and examined the gross morphology and histology of the bladder, urethra, and prostate. Mice treated with T+E(2) developed significantly larger bladders than untreated mice, consistent with BOO. Some mice treated with T+E(2) had complications in the form of bladder hypertrophy, diverticula, calculi, and eventual decompensation with hydronephrosis. Hormone treatment caused a significant decrease in the size of the urethral lumen, increased prostate mass, and increased number of prostatic ducts associated with the prostatic urethra, compared with untreated mice. Voiding dysfunction was observed in mice treated with T+E(2), who exhibited droplet voiding pattern with significantly decreased void mass, shorter void duration, and fewer sustained voids. The constellation of lower urinary tract abnormalities, including BOO, enlarged prostates, and voiding dysfunction seen in male mice treated with T+E(2) is consistent with BPH in men. This model is suitable for better understanding molecular mechanisms and for developing novel strategies to address BPH and BOO.

  2. Bladder outlet obstruction

    MedlinePlus

    ... narrowing of the urethra Tests to determine how fast urine flows out of the body ( uroflowmetry ) Tests to see how much the urine flow is blocked and how well the bladder contracts (urodynamic testing) Ultrasound to locate the blockage of urine and find ...

  3. Sulforaphane Ameliorates Bladder Dysfunction through Activation of the Nrf2-ARE Pathway in a Rat Model of Partial Bladder Outlet Obstruction

    PubMed Central

    Liu, Chong; Xu, Huan; Fu, Shi; Chen, Yanbo; Chen, Qi; Cai, Zhikang; Zhou, Juan; Wang, Zhong

    2016-01-01

    Purpose. We evaluated the effect of sulforaphane (SFN) treatment on the function and changes of expression of Nrf2-ARE pathway in the bladder of rats with bladder outlet obstruction (BOO). Materials and Methods. A total of 18 male Sprague-Dawley rats at age of 8 weeks were divided into 3 groups (6 of each): the sham operated group, the BOO group, and the BOO+SFN group. We examined histological alterations and the changes of oxidative stress markers and the protein expression of the Nrf2-ARE pathway. Results. We found that SFN treatment could prolong micturition interval and increase bladder capacity and bladder compliance. However, the peak voiding pressure was lower than BOO group. SFN treatment can ameliorate the increase of collagen fibers induced by obstruction. SFN treatment also increased the activity of SOD, GSH-Px, and CAT compared to the other groups. The level of bladder cell apoptosis was decreased in BOO rats with SFN treatment. Moreover, SFN could reduce the ratio of Bax/Bcl-2 expression. Furthermore, SFN could activate the Nrf2 expression with elevation of its target antioxidant proteins. Conclusions. The sulforaphane-mediated decrease of oxidative stress and activation of the Nrf2-ARE pathway may ameliorate bladder dysfunction caused by bladder outlet obstruction. PMID:27433291

  4. AB298. SPR-25 NLRP3/IL-1β mediates denervation during bladder outlet obstruction in rats

    PubMed Central

    Lutolf, Robin; Hughes, Francis M.; Purves, J. Todd

    2016-01-01

    Objective Bladder outlet obstruction (BOO) is a common condition resulting from benign prostatic hyperplasia, neurologic pathology, organ prolapse, etc. Long-term, obstruction is well-established to evoke denervation in the bladder which causes the detrusor to become hypocontractile, resulting in inefficient bladder emptying and consequent infections, continence issues or even renal failure. Recently, considerable attention has been paid to a role for inflammation in bladder deterioration during BOO and we have shown a central role for the NLRP3 inflammasome in triggering this inflammation. In the present study we explore a possible connection between this NLRP3-induced inflammation and bladder denervation. Methods Rats were divided into five groups: (I) control; (II) sham operated; (III) BOO + vehicle (1 mL, 40% ethanol in PBS, p.o.); (IV) BOO + glyburide (Gly, NLRP3 inhibitor; 10 mg/kg, p.o.); (V) BOO + anakinra (Ana, IL-1 receptor antagonist; 25 mg/kg, i.p.). BOO is constructed in female rats by inserting a 1 mm outer diameter transurethral catheter, tying a silk ligature around the urethra and removing the catheter. Medications were administered prior to surgery and once daily. At 12 days animals were sacrificed and the bladders processed for histological analysis. Transverse sections (5 µm) were stained for PGP9.5 expression (a pan-neuronal marker) using standard immunohistochemistry techniques. Entire sections were scanned, using a 10× objective, into TIFF files using Zen software (Zeiss Inc.). Images were imported into Elements software (Nikon Inc.) and the area of individual neurons designated as well as total bladder area (exclusive of the urothelium and lumen). The number of neurons and respective areas were used to calculate nerve density. Results Denervation in the bladder wall during BOO was significant, as measured by nerve density. This effect was attenuated by either preventing NLRP3 activation with Gly or blocking IL-1β’s action at its

  5. Pancreatic and Gastric Plasmacytoma Presenting with Obstructive Jaundice, Diagnosed with Endoscopic Ultrasound-Guided Fine Needle Aspiration.

    PubMed

    Padda, Manmeet S; Milless, Tiffani; Adeniran, Adebowale J; Mahooti, Sepi; Aslanian, Harry R

    2010-09-28

    Pancreatic plasmacytoma is a rare disorder which may present with obstructive jaundice. Only eighteen cases have been reported in the English language literature. We present the first case of pancreatic plasmacytoma and gastric plasmacytoma diagnosed with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). A 75-year-old male with a known history of multiple myeloma presented with obstructive jaundice and a pancreatic mass. A concomitant gastric mass due to gastric plasmacytoma was seen. The diagnosis was established via EUS-FNA of the pancreatic mass. Pancreatic plasmacytoma should be suspected in patients with a history of myeloma. EUS-FNA is a safe and effective modality in the diagnosis of pancreatic plasmacytoma. Radiation therapy should be the first-line of therapy in treating pancreatic plasmacytomas.

  6. Pancreatic and Gastric Plasmacytoma Presenting with Obstructive Jaundice, Diagnosed with Endoscopic Ultrasound-Guided Fine Needle Aspiration

    PubMed Central

    Padda, Manmeet S.; Milless, Tiffani; Adeniran, Adebowale J.; Mahooti, Sepi; Aslanian, Harry R.

    2010-01-01

    Pancreatic plasmacytoma is a rare disorder which may present with obstructive jaundice. Only eighteen cases have been reported in the English language literature. We present the first case of pancreatic plasmacytoma and gastric plasmacytoma diagnosed with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). A 75-year-old male with a known history of multiple myeloma presented with obstructive jaundice and a pancreatic mass. A concomitant gastric mass due to gastric plasmacytoma was seen. The diagnosis was established via EUS-FNA of the pancreatic mass. Pancreatic plasmacytoma should be suspected in patients with a history of myeloma. EUS-FNA is a safe and effective modality in the diagnosis of pancreatic plasmacytoma. Radiation therapy should be the first-line of therapy in treating pancreatic plasmacytomas. PMID:21060710

  7. Diagnostic value of urodynamic bladder outlet obstruction to select patients for transurethral surgery of the prostate: Systematic review and meta-analysis

    PubMed Central

    Kim, Myong; Jeong, Chang Wook; Oh, Seung-June

    2017-01-01

    Purpose To investigate the diagnostic value of urodynamic bladder outlet obstruction (BOO) in the selection of patients for transurethral surgery of the prostate. Materials and methods We systematically searched online PubMed, Embase, and Cochrane Library databases from January 1989 to June 2014. Results A total of 19 articles met the eligibility criteria for this systematic review. The eligible studies included a total of 2321 patients with a median number of 92 patients per study (range: 12–437). Of the 19 studies, 15 conducted conventional transurethral prostatectomy (TURP), and 7 used other or multiple modalities. In urodynamic bladder outlet obstruction (BOO) positive patients, the pooled mean difference (MD) was significant for better improvement of the International Prostate Symptom Score (IPSS) (pooled MD, 3.48; 95% confidence interval [CI], 1.72–5.24; p < 0.01; studies, 16; participants, 1726), quality of life score (QoL) (pooled MD, 0.56; 95% CI, 0.14–1.02; p = 0.010; studies, 9; participants, 1052), maximal flow rate (Qmax) (pooled MD, 3.86; 95% CI, 2.17–5.54; p < 0.01; studies, 17; participants, 1852), and post-void residual volume (PVR) (pooled MD, 32.46; 95% CI, 23.34–41.58; p < 0.01; studies, 10; participants, 1219) compared with that in non-BOO patients. Some comparisons showed between-study heterogeneity despite the strict selection criteria of the included studies. However, there was no clear evidence of publication bias in this meta-analysis. Conclusions Our meta-analysis results showed a significant association between urodynamic BOO and better improvements in all treatment outcome parameters. Preoperative UDS may add insight into postoperative outcomes after surgical treatment of benign prostatic hyperplasia. PMID:28241023

  8. Evaluation of the effects of omega-3 & interferon alpha-2b administration on partial bladder outlet obstruction in a rat model

    PubMed Central

    Firat, Fatih; Uluocak, Nihat; Erdemir, Fikret; Atilgan, Dogan; Markoc, Fatma; Parlaktas, Bekir Suha; Yasar, Adem

    2016-01-01

    Background & objectives: In bladder outlet obstruction-induced rat models, the transforming growth factor-beta (TGF-β) and collagen ratios have been shown to be increased. Increased TGF-β leads to fibrosis. In this study, the effect of omega-3 and interferon alpha-2b (IFN α-2b) was investigated on oxidative stress, inflammation and fibrosis in bladder structure in a partial bladder outlet obstruction (PBOO) rat model. Methods: A total of 35 male Wistar albino rats, weighing 300-350 g, were used in the study. The rats were randomly divided into five groups. At the end of the experimental period, bladders were harvested from all the rats, and pathological analysis of the rat bladder tissues was performed. In addition, investigations were carried out with enzymatic and non-enzymatic antioxidant systems to study the antioxidant properties of omega-3 fatty acid and IFN alpha-2b. Results: Increased bladder weight in the PBOO group, in comparison to the control group, was decreased by the administration of omega-3 and IFN α-2b (P=0.002). Significantly higher superoxide dismutase (SOD) levels were detected in group 2 in comparison to the control group. It was also detected that serum SOD, glutathione peroxidase and nitric oxide (NO) levels were significantly higher in group 2 when compared to the control group (P<0.05). In the pathologic evaluation, group 2 showed significantly increased inflammation and fibrosis compared to the control group. Omega-3 treatment significantly decreased inflammation. It was shown that IFN α-2b application partially decreased inflammation. Interpretation & conclusions: The results of the present study showed that in addition to the standard primary approaches to prevent the damage to the upper urinary tract secondary to PBOO, omega-3 fatty acid and IFN α-2b could be beneficial as adjunct treatment in clinical practice. However, this needs to be further investigated with prospective, randomized clinical trials with larger sample sizes

  9. Detrusor induction of miR-132/212 following bladder outlet obstruction: association with MeCP2 repression and cell viability.

    PubMed

    Sadegh, Mardjaneh Karbalaei; Ekman, Mari; Krawczyk, Katarzyna; Svensson, Daniel; Göransson, Olga; Dahan, Diana; Nilsson, Bengt-Olof; Albinsson, Sebastian; Uvelius, Bengt; Swärd, Karl

    2015-01-01

    The microRNAs (miRNAs) miR-132 and miR-212 have been found to regulate synaptic plasticity and cholinergic signaling and recent work has demonstrated roles outside of the CNS, including in smooth muscle. Here, we examined if miR-132 and miR-212 are induced in the urinary bladder following outlet obstruction and whether this correlates with effects on gene expression and cell growth. Three to seven-fold induction of miR-132/212 was found at 10 days of obstruction and this was selective for the detrusor layer. We cross-referenced putative binding sites in the miR-132/212 promoter with transcription factors that were predicted to be active in the obstruction model. This suggested involvement of Creb and Ahr in miR-132/212 induction. Creb phosphorylation (S-133) was not increased, but the number of Ahr positive nuclei increased. Moreover, we found that serum stimulation and protein kinase C activation induced miR-132/212 in human detrusor cells. To identify miR-132/212 targets, we correlated the mRNA levels of validated targets with the miRNA levels. Significant correlations between miR-132/212 and MeCP2, Ep300, Pnkd and Jarid1a were observed, and the protein levels of MeCP2, Pnkd and Ache were reduced after obstruction. Reduction of Ache however closely matched a 90% reduction of synapse density arguing that its repression was unrelated to miR-132/212 induction. Importantly, transfection of antimirs and mimics in cultured detrusor cells increased and decreased, respectively, the number of cells and led to changes in MeCP2 expression. In all, these findings show that obstruction of the urethra increases miR-132 and miR-212 in the detrusor and suggests that this influences gene expression and limits cell growth.

  10. Phytobezoar-induced small bowel obstruction associated with a concomitant gastric phytobezoar and ulcer in an elderly woman.

    PubMed

    De Cesare, Alessandro; Fiori, Enrico; Bononi, Marco; Ferraro, Daniele

    2015-01-01

    Bezoars are aggregates of indigested foreign material that accumulate in the gastroenteric tract, expecially in the stomach and in the narrowest points of the small bowel. They often occur in subjects who follow a diet rich in fruit and vegetables and in those one who previously underwent gastric resective surgery for peptic ulcer. Bezoar formation has even been observed in case of reduced gastric motility and secretion due to diabetes, hypothyroidism, pernicious anemia, myotonic syndromes, and Guillain-Barré syndrome. As they are an uncommon cause of small bowel obstruction, phytobezoars are often not considered in the differential diagnosis of occlusive intestinal syndromes and so frequently come as an intraoperative finding. A consequence of this missed diagnosis in the preoperative period is an unnecessary diagnostic delay that can significantly increase morbidity and mortality. This case report illustrates the need to include phytobezoars in the preoperative diagnostic workout of intestinal obstruction in order to rule out the presence of multiple bezoars and prevent recurrent obstruction. Now that phytobezoars are becoming a less infrequent cause of small bowel obstruction than previously thought, such a diagnostic possibility should always be considered.

  11. A Novel Endoscopic Technique to Diagnose Gastric Cancer in Excluded Stomach after Roux-en-Y Gastric Bypass

    PubMed Central

    Pitea, Teodor C.

    2017-01-01

    Access to the bypassed portion of the stomach after Roux-en-Y gastric bypass remains a challenge. We present a case of 64-year-old woman who presented with gastric outlet obstruction. We used a novel endoscopic technique to access the bypassed stomach by creating a jejunogastrostomy using a specialized stent, which allowed the insertion of a pediatric gastroscope to examine the bypassed portion of the stomach. Stomach biopsies revealed poorly differentiated adenocarcinoma with signet cell features. PMID:28331875

  12. Effect of silodosin, a selective α(1A)-adrenoceptor antagonist, on voiding behavior and bladder blood flow in a rat model of bladder outlet obstruction.

    PubMed

    Goi, Yoshiaki; Tomiyama, Yoshitaka; Yokoyama, Ayaka; Tatemichi, Satoshi; Maruyama, Kazuyasu; Kobayashi, Mamoru; Yamaguchi, Osamu

    2015-10-05

    This study was performed to investigate the effects of silodosin (selective α1A-adrenoceptor antagonist) on bladder blood flow (BBF) and bladder function in a rat model of bladder outlet obstruction (BOO) and to determine the expression of α1-adrenoceptor subtype mRNA in human and rat bladder microvessels. BOO was produced by partial ligature of the proximal urethra, which was maintained for 2 weeks. The BOO rats received either silodosin at a rate of 0.3mg/kg/day or vehicle subcutaneously via an osmotic pump for 2 weeks after BOO surgery. A metabolic cage study was performed in conscious animals. BBF was measured using a Laser Speckle Blood Flow Imager. Urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and nerve growth factor (NGF) were measured. Immunohistological examinations of nerve distribution and NGF expression in the rat bladder were conducted. The expression of each α1-adrenoceptor subtype mRNA in human and rat bladder microvessels was determined by in situ hybridization. Silodosin ameliorated the increase in voiding frequency and decrease in mean voided volume in BOO rats in the metabolic cage study. Silodosin also abrogated the decrease in BBF in BOO rats. The levels of 8-OHdG and NGF in BOO rats were significantly decreased by administration of silodosin. Silodosin prevented the decrease in nerve distribution and increase in NGF expression. Human and rat bladder microvessels showed expression of all α1-adrenoceptor subtype mRNAs. The results presented here suggest that silodosin improves voiding behavior in rat models with BOO by inducing recovery of BBF.

  13. Effects of Spinal and Peripheral Injection of α1A or α1D Adrenoceptor Antagonists on Bladder Activity in Rat Models with or without Bladder Outlet Obstruction

    PubMed Central

    Kim, Jae Heon; Shim, Ji Sung; Kang, Seung Chul; Shim, Kang Soo; Park, Jae Young; Moon, Du Geon; Lee, Jeong Gu

    2011-01-01

    Purpose Antagonists of α1-adrenergic receptors (α1ARs) relax prostate smooth muscle and relieve voiding and storage symptoms. Recently, increased expression of α1ARs with change of its subtype expression has been proved in bladder outlet obstruction (BOO). To search for the evidence of changes in α1ARs subtype expression and activity in the peripheral and spinal routes, the effects of spinal and peripheral administration of tamsulosin (an α1A/D-selective AR), naftopidil (an α1A/D-selective AR), and doxazosin (non-selective AR) on bladder activity were investigated in a rat model with or without BOO. Methods A total of 65 female Sprague-Dawley rats were divided into the BOO surgery group (n=47) and the sham surgery group (n=18). After 6 weeks, cystometry was assessed before and after intrathecal and intra-arterial administrations of tamsulosin, naftopidil, and doxazosin. Results After intra-arterial administrations of all three drugs, bladder capacity (BC) was increased and maximal intravesical pressure (Pmax) was decreased in both BOO and the sham rat models (P<0.05). After intrathecal administration of all three drugs, BC was increased and Pmax was decreased in only the BOO group. The episodes of involuntary contraction in the BOO rat models were decreased by intra-arterial administration (P=0.031). The increase of BC after intrathercal and intra-arterial administrations of α1ARs was significantly greater in the BOO group than in the sham group (P=0.023, P=0.041). In the BOO group, the increase of BC and decrease in Pmax were greater by intra-arterial administration than by intrathecal administration (P=0.035). There were no significant differences of the degrees of changes in the cystometric parameters among the three different α1ARs. Conclusions Up-regulations of the α1ARs in BOO were observed by the greater increases of BC after α1AR antagonist administrations in the BOO group than in the sham group. However, there were no subtype differences of the

  14. Gastric lipoma and pyloric obstruction in a 51-year-old woman.

    PubMed

    Furtado, W S; Mello, D A C P G; Santos, V M; Bringel, T L; Oliveira Junior, W P; Moura, H J L

    2013-01-01

    Gastric lipoma is considered a rare condition that may constitute a challenging diagnosis. A 51-year-old woman presented dysphagia and abdominal pain, and an upper digestive endoscopic study disclosed a gastric tumor located in the submucosa of the pyloric antrum. Conclusive diagnosis was established after repeated endoscopic biopsies, and the patient was subjected to an atypical gastrectomy, which evolved into a pyloric stenosis. This complication was appropriately corrected and the patient remains symptomless, under outpatient surveillance.

  15. Acute small bowel obstruction due to a large intraluminal blood clot after laparoscopic Roux-en-Y gastric bypass

    PubMed Central

    Green, Jessica; Ikuine, Tomoko; Hacker, Shoshana; Urrego, Hernan; Tuggle, Karleena

    2016-01-01

    Small bowel obstructions (SBOs) are a known perioperative complication of laparoscopic Roux-en-Y gastric bypass and common etiologies include internal hernia, port site hernia, jejunojejunostomy stricture, ileus and adhesions. Less commonly, SBO can be caused by superior mesenteric artery syndrome, intussusception and intraluminal blood clot. We present a case of SBO caused by intraluminal blood clot from jejunojejunostomy staple line bleeding in a patient with a normal coagulation profile. Computed tomography was used to elucidate the cause of perioperative SBO, and diagnostic laparoscopy was used to both diagnose and treat the complication. In this case, the intraluminal clot was evacuated laparoscopically by enterotomy, thrombectomy and primary closure without anastomotic revision since there was no evidence of continued bleeding. Administration of enoxaparin and Toradol post-operatively may have exacerbated mild intraluminal bleeding occurring at the stapled jejunojejunal anastomosis. Prompt recognition and treatment of perioperative SBO can prevent catastrophic consequences related to bowel perforation. PMID:27554828

  16. Laparoscopic Repair and Percutaneous Endoscopic Gastrostomy to Treat Giant Esophageal Hiatal Hernia with Gastric Obstruction: A Case Report.

    PubMed

    Hamai, Yoichi; Hihara, Jun; Tanabe, Kazuaki; Furukawa, Takaoki; Yamakita, Ichiko; Ibuki, Yuta; Okada, Morihito

    2015-06-01

    We describe a 74-year-old man with repeated aspiration pneumonia who developed gastric obstruction due to giant esophageal hiatal hernia (EHH). We repaired the giant EHH by laparoscopic surgery and subsequently anchored the stomach to the abdominal wall by percutaneous endoscopic gastrostomy (PEG) using gastrofiberscopy. Thereafter, the patient resumed oral intake and was discharged on postoperative day 21. At two years after these procedures, the patient has adequate oral intake and lives at home. Because this condition occurs more frequently in the elderly with comorbidities, laparoscopic surgery contributes to minimally invasive treatment. Furthermore, the procedure combined with concurrent gastropexy via PEG is useful for treating patients who have difficulty swallowing and for preventing recurrent hernia.

  17. AB279. SPR-06 Fibrosis in the bladder in response to outlet obstruction is triggered through the NLRP3 inflammasome and the production of IL-1β

    PubMed Central

    Hughes, Francis M.; Govada, Vihasa; Sexton, Stephanie; Purves, J. Todd

    2016-01-01

    Objective Bladder outlet obstruction (BOO), most commonly created by benign prostatic hyperplasia, promotes an inflammatory state that produces voiding dysfunction. Recently, we have shown that the NLRP3 inflammasome triggers this inflammation. Over time, inflammation promotes fibrosis. In this study we explore the role of NLRP3 (and IL-1β produced by activated NLRP3) in BOO-induced fibrosis. Methods Rats were divided into 5 groups: (I) control, (II) sham, (III) BOO + Vehicle (Veh; 1 mL, 40% EtOH, p.o.), (IV) BOO + glyburide (Gly; NLRP3 inhibitor; 10 mg/kg, p.o.) or (V) BOO + Anakinra (Ana; IL-1 receptor antagonist; 25 mg/kg, i.p.). BOO is constructed by inserting a 1-mm transurethral catheter, tying a suture around the urethra and removing the catheter. Medications were given prior to surgery and once daily for 12 days. Hypertrophy was assessed by bladder weight, fibrosis by collagen staining (Masson’s Trichrome Stain), IL-1 receptor 1 (IL-1R1), prolyl 4-hydroylase (P4H) and lysyl oxidase (LOX) localization by immunofluorescence and collagen secretion by Sirius Red. Results BOO increased production of collagen in the bladder which was blocked by either preventing NLRP3 activation with glyburide or blocking IL-1β’s action at its receptor, clearly implicating the NLRP3/IL-1β pathway in fibrosis during BOO. IL-1β directly triggers collagen synthesis in other tissues and we found that recombinant IL-1β stimulated pro-collagen production in control urothelial cells placed in culture. Consistent with urothelia as a source of pro-collagen production, isolated urothelial cells from BOO rats secreted significantly more IL-1β than control cells. In control rats, the IL-1β receptor, IL-1R1, was highly expressed in the basal layer of the urothelia with less staining in the umbrella cells and detrusor and no staining in the interstitium. P4H (a marker of pro-collagen synthesis) exhibited similar staining, although enhanced expression in the basal urothelia was not

  18. Gastric suction

    MedlinePlus

    Gastric lavage; Stomach pumping; Nasogastric tube suction; Bowel obstruction - suction ... A tube is inserted through your nose or mouth, down the food pipe (esophagus), and into the stomach. Your ...

  19. AB283. SPR-10 Down-regulation of ryanodine receptor gene expression in murine urinary bladder smooth muscle following partial bladder outlet obstruction

    PubMed Central

    Boopathi, Ettickan; Javed, Elham; Addya, Shankar; Fortina, Paolo; Zderic, Stephen; Wein, Alan; Chacko, Samuel

    2016-01-01

    Objective Urinary bladder smooth muscle (UBSM) displays spontaneous action potentials and this potential is related to the phasic nature of spontaneous contractions in this tissue. The amplitude of a phasic contraction depends on the increase in Ca2+ entry caused by membrane depolarization. Ryanodine receptors (RyRs) in UBSM decreases the force production by decreasing the frequency of phasic contractions through interactions with large-conductance Ca2+-activated K+ (BK) and small-conductance Ca2+-activated K+ (SK) channels. Microarray and network analysis were employed to determine the changes in mRNA in 14-day obstructed murine bladders. We found that obstruction significantly down-regulated the RyRs in bladder smooth muscle (BSM). Methods Male C57Bl/6 mice were surgically obstructed and kept for 14 days. Sham-operated mice served as a control. Bladders were excised; urothelium scraped off with a scalpel, and the serosa was removed. BSM obtained from PBOO and sham control animals were used for microarray and western blotting Results Pathway-based analysis of these gene signatures showed significant number of under-expressed genes in obstructed bladder and they were mapped to proteins involved in calcium signaling. We focused our work on RyR protein expression in BSM. There was a four-fold reduction of RyR3 in BSM in 14-day obstructed groups as shown by microarray and immunoblotting compared to that of sham-operated animals. Conclusions These results confirm that the RyR gene expression is down-regulated in obstructed murine bladder smooth muscle. Funding Source(s) None

  20. Factors That Affect Stent-Related Complications in Patients with Malignant Obstruction of the Esophagus or Gastric Cardia

    PubMed Central

    Iwasaki, Hiroyasu; Mizushima, Takashi; Suzuki, Yuta; Fukusada, Shigeki; Kachi, Kenta; Ozeki, Takanori; Anbe, Kaiki; Tsukamoto, Hironobu; Okumura, Fumihiro; Joh, Takashi; Sano, Hitoshi

    2017-01-01

    Background/Aims Self-expandable metallic stent (SEMS) placement is effective for dysphagia that results from malignant obstruction of the esophagus or gastric cardia; however, stent-related complications may be life-threatening. Thus, the goal of this study was to identify risk factors associated with complications following esophageal stenting. Methods Of the 71 patients who underwent SEMS placement for dysphagia as a result of malignant stricture of the esophagus or gastric cardia, 53 patients with squamous cell carcinoma or adenocarcinoma, without previous SEMS placement, without a fistula, and without recurrent tumor after surgery were retrospectively identified. The occurrence of stent-related complications was used as an endpoint. Results Stent-related complications were identified in 26 patients (49.1%), and major complications occurred in 14 patients (26.4%). The use of an Ultraflex stent (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.54 to 30.00; p=0.011) and prior chemotherapy (OR, 6.13; 95% CI, 1.46 to 25.70; p=0.013) were significantly associated with stent-related complications. Moreover, the use of an Ultraflex stent (OR, 19.60; 95% CI, 2.26 to 170.00; p=0.007) and prior radiation (OR, 25.70; 95% CI, 2.37 to 280.00; p=0.008) significantly increased the risk of major complications. Conclusions The use of an Ultraflex stent and prior radiation and/or chemotherapy may represent risk factors for complications following esophageal SEMS placement. PMID:27728966

  1. Spontaneous Acute Mesenteroaxial Gastric Volvulus Diagnosed by Computed Tomography Scan in a Young Man

    PubMed Central

    Jabbour, Gaby; Afifi, Ibrahim; Ellabib, Mohamed; El-Menyar, Ayman; Al-Thani, Hassan

    2016-01-01

    Patient: Male, 23 Final Diagnosis: Acute spontaneous gastric volvulus Symptoms: — Medication: — Clinical Procedure: Laparotomy Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Acute gastric volvulus is a surgical emergency that requires early recognition and treatment. Acute idiopathic mesenteroaxial gastric volvulus is a rare sub-type and there are few cases reported in children and there are even fewer reports in adults. Case Report: We report a rare case of a 23-year-old man who presented with a 1-day history of vomiting, epigastric pain, distention, and constipation. The diagnosis for mesenteroaxial type gastric volvulus was confirmed by abdominal radiography and computed tomography. The patient was successfully treated by laparotomy with resection of the ischemic stomach wall and anastomosis. Acute spontaneous mesenteroaxial gastric volvulus is rare in adults and early diagnosis is challenging due to non-specific symptoms. A missed or delayed diagnosis may result in serious complications due to gastric obstruction. Conclusions: A patient presenting with severe epigastric pain and clinical evidence of gastric outlet obstruction should be considered as a surgical emergency to rule out gastric volvulus. High index of suspicion, early diagnosis and prompt surgical management are important for favorable outcome in patients with acute spontaneous gastric volvulus. PMID:27112797

  2. Gastric-type extremely well-differentiated adenocarcinoma arising in the blind pouch of a bypassed stomach, presenting as colonic pseudo-obstruction.

    PubMed

    McFarland, Sarah; Manivel, Carlos J; Ramaswamy, Archana; Mesa, Hector

    2015-01-01

    Gastric carcinoma after gastric bypass is rare. Extremely well-differentiated adenocarcinoma (EWDA) of the stomach is a rare variant that has been mostly reported in Japan. We present a case of a 68-year-old man with EWDA arising in the bypassed stomach that presented as a colonic pseudo-obstruction (CPO). Several imaging, endoscopic and pathologic studies performed in the course of 2 months were non-diagnostic. An iatrogenic duodenal perforation during a diagnostic procedure led to an emergent exploratory laparotomy in which the dilated colonic segment was resected. Pathologic examination showed metastatic EWDA in the colonic wall. Post-operative complications led to the patient's demise. At autopsy the primary tumor was identified in the blind pouch of the bypassed stomach. A literature review on gastric EWDA and carcinomas arising in bypassed stomachs is discussed. EWDA of the stomach is rare, difficult to diagnose, and shows an aggressive clinical course discordant with its near-benign histology. Gastric cancer arising in a bypassed stomach is uncommon; when it occurs it is usually diagnosed at advanced stage. Surveillance of the blind pouch is not currently recommended. Malignant infiltration of the colonic wall should be included in the differential diagnosis of CPO of unclear etiology.

  3. CT of gastro-duodenal obstruction.

    PubMed

    Millet, I; Doyon, F Curros; Pages, E; Faget, C; Zins, M; Taourel, P

    2015-10-01

    Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.

  4. Assessment of gastric motility using meal labeled with technetium-99m sulfur colloid

    SciTech Connect

    Matolo, N.M.; Stadalnik, R.C.

    1983-12-01

    During a 2 year period, 83 patients with gastric motility problems were evaluated using radionuclide imaging. The patients presented with epigastric distress, postprandial fullness, pain, nausea, vomiting, and diarrhea; signs and symptoms suggestive of either gastroparesis or gastric outlet obstruction. Upper gastrointestinal series or endoscopy, or both, demonstrated no mechanical obstruction. After oral administration of a 300 g meal labeled with 600 muCi of technetium-99m sulfur colloid, a gastric emptying study consisting of serial images and data acquisition was performed. Of the patients studied, 52 had had peptic ulcer surgery, 17 were suspected of having gastroesophageal reflux, 8 were diabetic and suspected of having visceral enteropathy, and 6 had a history of irritable bowel syndrome. The normal mean gastric half emptying time was 77 +/- 16 minutes. Of the patients who had had gastric surgery, 90.4 percent had abnormal emptying: 69.2 percent had delayed gastric emptying and 21.2 percent had rapid gastric emptying time; 9.6 percent had normal emptying time. Of the gastroesophageal reflux group, all but two had normal gastric emptying time; 65 percent demonstrated gastroesophageal reflux within 15 minutes. Two of the patients with irritable bowel syndrome had prolonged emptying; the rest had normal emptying. All diabetic patients with gastroparesis had prolonged gastric emptying time, and all responded favorably to metoclopramide. Of the patients who previously had peptic ulcer surgery and had prolonged emptying time, 72 percent also responded favorably to metoclopramide. We conclude that radionuclide gastric imaging is a useful diagnostic test for the measurement of gastric emptying in patients with a variety of gastrointestinal motility disorders and may be helpful in assessing medical therapy and selecting those who may be candidates for surgery.

  5. MiR-133 modulates TGF-β1-induced bladder smooth muscle cell hypertrophic and fibrotic response: implication for a role of microRNA in bladder wall remodeling caused by bladder outlet obstruction.

    PubMed

    Duan, Liu Jian; Qi, Jun; Kong, Xiang Jie; Huang, Tao; Qian, Xiao Qiang; Xu, Ding; Liang, Jun Hao; Kang, Jian

    2015-02-01

    Bladder outlet obstruction (BOO) evokes urinary bladder wall remodeling significantly, including the phenotype shift of bladder smooth muscle cells (BSMCs) where transforming growth factor-beta1 (TGF-β1) plays a pivotal role given the emerging function of modulating cellular phenotype. miR-133 plays a role in cardiac and muscle remodeling, however, little is known about its roles in TGF-β1-induced BSMC hypertrophic and fibrotic response. Here, we verified BOO induced bladder wall remodeling and TGF-β1 expression mainly located in bladder endothelium. Furthermore, we uncovered miR-133a/b expression profile in BOO rats, and then explored its regulated effects on BSMCs' phenotypic shift. Our study found that miR-133 became down-regulated during rat bladder remodeling. Next, we sought to examine whether the expression of miR-133 was down-regulated in primary BSMCs in response to TGF-β1 stimulation and whether forced overexpression of miR-133 could regulate profibrotic TGF-β signaling. We found that stimulation of BSMCs with exogenous TGF-β1 of increasing concentrations resulted in a dose-dependent decrease of miR-133a/b levels and transfection with miR-133 mimics attenuated TGF-β1-induced α-smooth muscle actin, extracellular matrix subtypes and fibrotic growth factor expression, whereas it upregulated high molecular weight caldesmon expression compared with the negative control. Also, downregulation of p-Smad3, not p-Smad2 by miR-133 was detected. Additionally, miR-133 overexpression suppressed TGF-β1-induced BSMC hypertrophy and proliferation through influencing cell cycle distribution. Bioinformatics analyses predicted that connective tissue growth factor (CTGF) was the potential target of miR-133, and then binding to the 3'-untranslated region of CTGF was validated by luciferase reporter assay. These results reveal a novel regulator for miR-133 to modulate TGF-β1-induced BSMC phenotypic changes by targeting CTGF through the TGF-β-Smad3 signaling pathway

  6. Modified Devine Exclusion for Unresectable Distal Gastric Cancer in Symptomatic Patients

    PubMed Central

    Fernández-Moreno, María Carmen; Martí-Obiol, Roberto; López, Fernando; Ortega, Joaquín

    2017-01-01

    Background In patients with outlet obstruction syndrome and/or severe anemia secondary to unresectable gastric cancer (GC), partial stomach-partitioning gastrojejunostomy, or modified Devine exclusion, is a surgical alternative. Methods A retrospective study was conducted on patients with unresectable distal GC treated with modified Devine exclusion as palliative surgery between February 2005 and December 2015. It consisted of a series of 10 patients with outlet obstruction syndrome and/or severe anemia. The outcomes of this technique were based on oral tolerance, blood transfusions, postoperative complications, and survival. Results Early oral tolerance and a low rate of blood transfusions were observed postoperatively. There was no postoperative mortality and a very low complication rate without anastomotic leakage. Median survival was 9 months. Conclusions Partial stomach-partitioning gastrojejunostomy is a safe procedure for unresectable GC which can improve the quality of life of these patients. PMID:28203132

  7. [Gastric and intestinal bezoars].

    PubMed

    Larbi, Noureddine; Kaâbi, Samarra; Ben Salah, Khiareddine

    2003-12-01

    The authors report a retrospective study of 10 cases of gastric and small bowel bezoars. There was one gastric trichobezoar diagnosed by an abdominal mass and 9 small bowel obstruction due to phytobezoars. All patients underwent surgery: the gastric trichobezoar was removed through a gastrotomy; small bowel bezoars were treated either by enterotomy (n = 3), fragmentation (n = 5) or bowel resection (n = 1). Non operative treatment is efficient in gastric phytobezoars. Surgery is advisable for trichobezoars and small bowel bezoars. Prevention is main and patients who have gastric surgery must be alarmed from consumption of cactus in our country Tunisia.

  8. Gastric necrosis: A late complication of nissen fundoplication

    PubMed Central

    Salinas, Javier; Georgiev, Tihomir; González-Sánchez, Juan Antonio; López-Ruiz, Elena; Rodríguez-Montes, José Antonio

    2014-01-01

    Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. “Gas-bloat” syndrome is a well known Nissen fundoplication postoperative complication. It may cause severe gastric dilatation, but very rarely an ischemic compromise of the organ. Other factors, such as gastric outlet obstruction, may concur to cause an intraluminal pressure enough to blockade venous return and ultimately arterial blood supply and oxygen deliver, leading to ischaemia. We report a case of a 63-year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and a pyloric phytobezoar which was the trigger event. No preexisting gastric motility disorders were present by the time of surgery, as demonstrated in the preoperative barium swallow, thus a poor mastication (patient needed no dentures) of a high fiber meal (cabbage) may have been predisposing factors for the development of a bezoar in an otherwise healthy women at the onset of old age. A total gastrectomy with esophagojejunostomy was performed and patient was discharged home after a 7-d hospital stay with no immediate complications. We also discuss some technical aspects of the procedure that might be important to reduce the incidence of this complication. PMID:25276288

  9. Double Outlet Right Ventricle

    MedlinePlus

    ... Kawasaki Disease Long Q-T Syndrome Marfan Syndrome Metabolic Syndrome Mitral Valve Prolapse Myocardial Bridge Myocarditis Obstructive Sleep Apnea Pericarditis Peripheral Vascular Disease Rheumatic Fever Sick Sinus Syndrome Silent Ischemia Stroke Sudden ...

  10. [Gastric perforation caused by a lactobezoar in an infant: a case report].

    PubMed

    Gambart, M; Breinig, S; Breton, A; Vial, J; Herbault-Barres, B; Bouali, O

    2012-09-01

    Lactobezoar is a compact mass of undigested milk concretions and mucous secretions in the gastrointestinal tract. It is usually located in the stomach, resulting in various degrees of gastric outlet obstruction. Lactobezoar is the most common type of bezoar in infancy. We report the case of rare and complicated gastric outlet obstruction secondary to lactobezoar. A female infant, 35weeks and 4days' gestation, one of dichorionic, diamniotic twins (birth weight, 1.890kg), was referred to our center at 5days of life for shock and food intolerance. She was on discontinuous oral feedings with a maltodextrin-enriched infant formula. On examination on day 4, there was a tender mass palpable in the left hypochondrium and on day 5, there was abdominal distension with signs of hemodynamic instability and sepsis. Plain abdominal X-ray showed a pneumoperitoneum associated with a heterogeneous mass in a distended stomach, consistent with a bezoar. An emergency laparotomy revealed a gastric perforation secondary to a large lactobezoar, with necrosis of the greater curvature and anterior wall of the stomach. Surgical treatment consisted of extraction of the lactobezoar, partial gastrectomy (resection of necrotic areas), and gastrostomy. Pathological examination confirmed the necrosis of the gastric mucosa. The postoperative course was complicated by prolonged sepsis. The child was kept NPO for 21days. On day 21 postsurgery, an upper gastrointestinal contrast study showed a well-dimensioned stomach, with a good pyloric passage. Gastrostomy and oral feedings were then initiated with good outcome at 6months. Etiopathogenic factors of lactobezoar are prematurity, low birth weight, altered gastric secretions and disturbed gastric emptying, hypercaloric and predominantly casein-based formulas, and inadequate milk composition. Lactobezoar should be considered in infants with symptoms of gastrointestinal obstruction with evocative images. Conservative management with nil per os

  11. AGU hydrology publication outlets

    NASA Astrophysics Data System (ADS)

    Freeze, R. Allan

    In recent months I have been approached on several occasions by members of the hydrology community who asked me which of the various AGU journals and publishing outlets would be most suitable for a particular paper or article that they have prepared.Water Resources Research (WRR) is the primary AGU outlet for research papers in hydrology. It is an interdisciplinary journal that integrates research in the social and natural sciences of water. The editors of WRR invite original contributions in the physical, chemical and biological sciences and also in the social and policy sciences, including economics, systems analysis, sociology, and law. The editor for the physical sciences side of the journal is Donald R. Nielson, LAWR Veihmeyer Hall, University of California Davis, Davis, CA 95616. The editor for the policy sciences side of the journal is Ronald G. Cummings, Department of Economics, University of New Mexico, Albuquerque, NM 87131

  12. Severe gastric impaction secondary to a gastric polyp in a horse

    PubMed Central

    Furness, Mary Catherine; Snyman, Heindrich Nicolaas; Abrahams, Miranda; Moore, Alison; Vince, Andrew; Anderson, Maureen E.C.

    2013-01-01

    A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse. PMID:24155420

  13. Severe gastric impaction secondary to a gastric polyp in a horse.

    PubMed

    Furness, Mary Catherine; Snyman, Heindrich Nicolaas; Abrahams, Miranda; Moore, Alison; Vince, Andrew; Anderson, Maureen E C

    2013-10-01

    A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse.

  14. Core Outlet Temperature Study

    SciTech Connect

    Moisseytsev, A.; Hoffman, E.; Majumdar, S.

    2008-07-28

    It is a known fact that the power conversion plant efficiency increases with elevation of the heat addition temperature. The higher efficiency means better utilization of the available resources such that higher output in terms of electricity production can be achieved for the same size and power of the reactor core or, alternatively, a lower power core could be used to produce the same electrical output. Since any nuclear power plant, such as the Advanced Burner Reactor, is ultimately built to produce electricity, a higher electrical output is always desirable. However, the benefits of the higher efficiency and electricity production usually come at a price. Both the benefits and the disadvantages of higher reactor outlet temperatures are analyzed in this work.

  15. 16. VIEW OF HIGHLINE CANAL PIPELINE OUTLET, SHOWING THE OUTLET, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    16. VIEW OF HIGHLINE CANAL PIPELINE OUTLET, SHOWING THE OUTLET, A GROUNDWATER PUMP (LEFT), AND THE SOUTH BRANCH OF THE CANAL (FOREGROUND), August 1989 - Highline Canal & Pumping Station, South side of Salt River between Tempe, Phoenix & Mesa, Tempe, Maricopa County, AZ

  16. 6. VIEW OF OUTLET GATE WHEEL AND STEM, WITH OUTLET ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW OF OUTLET GATE WHEEL AND STEM, WITH OUTLET CHANNEL IN BACKGROUND, LOOKING SOUTHEAST - High Mountain Dams in Upalco Unit, Island Lake Dam, Ashley National Forest, 4.8 miles North of Miners Gulch Campground, Mountain Home, Duchesne County, UT

  17. Intestinal Obstruction

    MedlinePlus

    An intestinal obstruction occurs when food or stool cannot move through the intestines. The obstruction can be complete or partial. ... abdomen Inability to pass gas Constipation A complete intestinal obstruction is a medical emergency. It often requires surgery. ...

  18. Mushroom Bezoar Causing Small Bowel Obstruction.

    PubMed

    Hamzah, Azhar Amir; Keow, Chin Kim; Syazri, Azreen; Mallhi, Tauqeer Hussain; Khan, Amer Hayat; Khan, Yusra Habib; Adnan

    2017-03-01

    A bezoar is a concretion of foreign or indigestible matter in the alimentary canal and is usual cause of gastric obstruction. Bezoars can become fragmented and migrate downward leading to intestinal obstruction. Diagnosis of phytobezoar has become challenging in clinical practice due to lack of patient history and inability of patient to correlate preceding events with the episode of bowel obstruction. Bezoar associated small bowel obstruction rarely occurs and is usually found in patients with history of gastrointestinal surgery. Very few cases are reported of small bowel obstruction due to bezoar in healthy population without prior illness or surgery. We present a case of small bowel obstruction due to mushroom bezoar in a 62-year patient with no past history of medical illness or gastric surgery. Enterotomy was performed and a whole piece of undigested mushroom measuring 5 x 3 cm was successfully removed.

  19. Bowel Obstruction.

    PubMed

    Gore, Richard M; Silvers, Robert I; Thakrar, Kiran H; Wenzke, Daniel R; Mehta, Uday K; Newmark, Geraldine M; Berlin, Jonathan W

    2015-11-01

    Small bowel obstruction and large bowel obstruction account for approximately 20% of cases of acute abdominal surgical conditions. The role of the radiologist is to answer several key questions: Is obstruction present? What is the level of the obstruction? What is the cause of the obstruction? What is the severity of the obstruction? Is the obstruction simple or closed loop? Is strangulation, ischemia, or perforation present? In this presentation, the radiologic approach to and imaging findings of patients with known or suspected bowel obstruction are presented.

  20. Gastric hyperplastic polyps causing upper gastrointestinal hemorrhage in a young adult.

    PubMed

    Secemsky, Brian J; Robinson, Kenika R; Krishnan, Kumar; Matkowskyj, Kristina A; Jung, Barbara H

    2013-04-16

    Here, we report a case of a young man who presented with a significant upper gastrointestinal bleed treated by endoscopic removal of multiple hyperplastic polyps. Gastric hyperplastic polyps are a relatively uncommon cause of overt gastrointestinal bleeding. While most hyperplastic gastric polyps are asymptomatic, they may present with abdominal pain, iron deficiency anemia or gastric outlet obstruction. These polyps are associated with conditions such as Helicobacter pylori gastritis and atrophic autoimmune gastritis, which predispose the epithelium to chronic inflammation and epithelial repair. The patient presented to Northwestern Memorial Hospital in July 2011. The polyps were resected by clip-assisted snare polypectomy. Histopathologic assessment of the resected polyps demonstrated multiple, non-ulcerative hyperplastic polyps measuring 1.3-1.8 cm in size, without evidence of dysplasia or malignancy. This case describes a young adult patient with multiple, large gastric polyps causing overt gastrointestinal bleeding. This is a rare presentation in a young individual, as these polyps are typically identified in patients older than 60 years of age and less commonly, pediatric populations.

  1. Phytobezoar: a rare cause of small bowel obstruction.

    PubMed

    Pujar K, Anupama; Pai A, Sreekar; Hiremath V, Bharati

    2013-10-01

    Phytobezoar is an unusual cause of small bowel obstruction. It accounts for about 0.4%-4% of all mechanical bowel obstruction. However, the symptoms are not very different from those caused by usual aetiologies of small bowel obstruction. The commonest site of obstruction is terminal ileum. Treatment of small bowel obstruction due to Phytobezoar is surgery. Prevention includes avoidance of high fibre diet, prokinetics particularly in patients who have undergone gastric surgery. A 57-year-old male presented with symptoms and signs of small bowel obstruction. On exploratory laparotomy Phytobezoar in the ileum was found to be the cause of obstruction. Diagnosis was confirmed by histopathology.

  2. Modelling Greenland Outlet Glaciers

    NASA Technical Reports Server (NTRS)

    vanderVeen, Cornelis; Abdalati, Waleed (Technical Monitor)

    2001-01-01

    The objective of this project was to develop simple yet realistic models of Greenland outlet glaciers to better understand ongoing changes and to identify possible causes for these changes. Several approaches can be taken to evaluate the interaction between climate forcing and ice dynamics, and the consequent ice-sheet response, which may involve changes in flow style. To evaluate the icesheet response to mass-balance forcing, Van der Veen (Journal of Geophysical Research, in press) makes the assumption that this response can be considered a perturbation on the reference state and may be evaluated separately from how this reference state evolves over time. Mass-balance forcing has an immediate effect on the ice sheet. Initially, the rate of thickness change as compared to the reference state equals the perturbation in snowfall or ablation. If the forcing persists, the ice sheet responds dynamically, adjusting the rate at which ice is evacuated from the interior to the margins, to achieve a new equilibrium. For large ice sheets, this dynamic adjustment may last for thousands of years, with the magnitude of change decreasing steadily over time as a new equilibrium is approached. This response can be described using kinematic wave theory. This theory, modified to pertain to Greenland drainage basins, was used to evaluate possible ice-sheet responses to perturbations in surface mass balance. The reference state is defined based on measurements along the central flowline of Petermann Glacier in north-west Greenland, and perturbations on this state considered. The advantage of this approach is that the particulars of the dynamical flow regime need not be explicitly known but are incorporated through the parameterization of the reference ice flux or longitudinal velocity profile. The results of the kinematic wave model indicate that significant rates of thickness change can occur immediately after the prescribed change in surface mass balance but adjustments in flow

  3. Endoscopic Placement of Metal Stents in Treating Patients With Cancer- Related Duodenal Obstruction

    ClinicalTrials.gov

    2012-05-31

    Colorectal Cancer; Constipation, Impaction, and Bowel Obstruction; Extrahepatic Bile Duct Cancer; Gastric Cancer; Gastrointestinal Carcinoid Tumor; Gastrointestinal Stromal Tumor; Pancreatic Cancer; Quality of Life; Small Intestine Cancer

  4. Gastrin and gastric surgery.

    PubMed

    Fabri, P J; McGuigan, J E

    1976-01-01

    data are present. These differential tests are of value in identifying the Zollinger-Ellison patient who has borderline serum gastrin levels and in differentiation from the syndrome of the retained antrum. 6. In a patient with a recurrent ulcer following surgery in whom a drug-induced ulcer can be excluded and gastric outlet obstruction cannot be demonstrated, a serum gastrin level may be indicated. A serum gastrin value greater than 300 pg. per ml. (normal less than 200 pg. per ml.) in a fasting morning serum sample is significantly elevated, even after vagotomy, and warrants further investigation. Provocative testing of the gastrin response to calcium and secretin should elucidate the etiology of the recurrent ulceration in this type of patient.

  5. UPJ obstruction

    MedlinePlus

    ... of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; ... of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology . 10th ed. Philadelphia, PA: Elsevier Saunders; ...

  6. Intestinal obstruction

    MedlinePlus

    Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal; Colonic ileus ... objects that are swallowed and block the intestines) Gallstones (rare) Hernias Impacted stool Intussusception (telescoping of 1 ...

  7. Intestinal Obstruction

    MedlinePlus

    ... Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of the Digestive ... Wall Hernias Inguinal Hernia Acute Mesenteric Ischemia Appendicitis Ileus Intestinal Obstruction Ischemic Colitis Perforation of the Digestive ...

  8. 49 CFR 178.346-4 - Outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS REGULATIONS SPECIFICATIONS FOR PACKAGINGS Specifications for Containers for Motor Vehicle Transportation § 178.346-4 Outlets. (a) All outlets on each...

  9. 49 CFR 178.346-4 - Outlets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Outlets. 178.346-4 Section 178.346-4 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... Containers for Motor Vehicle Transportation § 178.346-4 Outlets. (a) All outlets on each tank must conform...

  10. 49 CFR 178.346-4 - Outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Outlets. 178.346-4 Section 178.346-4 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... Containers for Motor Vehicle Transportation § 178.346-4 Outlets. (a) All outlets on each tank must conform...

  11. 49 CFR 178.346-4 - Outlets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Outlets. 178.346-4 Section 178.346-4 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... Containers for Motor Vehicle Transportation § 178.346-4 Outlets. (a) All outlets on each tank must conform...

  12. 49 CFR 178.346-4 - Outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Outlets. 178.346-4 Section 178.346-4 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... Containers for Motor Vehicle Transportation § 178.346-4 Outlets. (a) All outlets on each tank must conform...

  13. Gastric giardiasis.

    PubMed Central

    Doglioni, C.; De Boni, M.; Cielo, R.; Laurino, L.; Pelosio, P.; Braidotti, P.; Viale, G.

    1992-01-01

    AIMS: To assess the prevalence of gastric giardiasis in patients undergoing upper gastrointestinal endoscopy, and to define the clinicopathological correlates of gastric Giardia lamblia infection. METHODS: Consecutive gastric biopsy specimens (n = 15,023) from 11,085 patients, taken at Feltre City Hospital (north eastern Italy) from January 1986 to December 1991, were histologically and immunocytochemically examined for the occurrence of G lamblia trophozoites. Three gastric biopsy specimens from patients harbouring G lamblia infection, who repeated endoscopy before treatment, were also examined electron microscopically. RESULTS: Forty one patients (0.37% of the population study) harboured gastric giardiasis. All patients underwent upper gastrointestinal endoscopy because of dyspepsia, epigastric pain, or abdominal distension. Only two patients had diarrhoea at the time of investigation. Giardiasis was clinically unsuspected in all cases, although the nine patients who also had duodenal biopsies performed had concomitant intestinal giardiasis. Gastric giardiasis was invariably associated with chronic atrophic gastritis. Intestinal metaplasia of the gastric mucosa and Helicobacter pylori infection were found in 32 and 37 of the 41 patients with gastric giardiasis, respectively. CONCLUSIONS: The invariable association of gastric giardiasis with chronic atrophic gastritis, most often showing intestinal metaplasia and H pylori infection, indicates that a decreased gastric acidity is a prerequisite for localisation of G lamblia to the gastric mucosa. Though its possible role as a gastric pathogen remains to be elucidated, these findings suggest that trophozoites should be carefully searched for when examining gastric biopsy specimens showing chronic atrophic gastritis. Images PMID:1452790

  14. Gastric cancer

    SciTech Connect

    Douglass, H.O. )

    1988-01-01

    This book contains 10 selections. Some of the titles are: Radiation therapy for gastric cancer; Experimental stomach cancer: Drug selection based on in vitro testing; Western surgical adjuvant trials in gastric cancers: Lessons from current trials to be applied in the future; and Chemotherapy of gastric cancer.

  15. Gastric Microbiome and Gastric Cancer

    PubMed Central

    Brawner, Kyle M.; Morrow, Casey D.; Smith, Phillip D.

    2014-01-01

    Cancer of the stomach is the fourth most common cancer worldwide. The single strongest risk factor for gastric cancer is Helicobacter pylori-associated chronic gastric inflammation. Among persons with H. pylori infection, strain-specific components, host immune responses, and environmental factors influence the risk for gastric disease, including adenocarcinoma of the stomach, although only a small proportion of infected persons develop the malignancy. Recent advances in DNA sequencing technology have uncovered a complex community of non-cultivatable inhabitants of the human stomach. The interaction between these inhabitants, collectively referred to as the gastric microbiota, and H. pylori likely impacts gastric immunobiology and possibly the sequelae of H. pylori infection. Thus, characterization of the gastric microbiota in subjects with and without H. pylori infection could provide new insight into gastric homeostasis and the pathogenesis of H. pylori-associated disease, including gastric cancer. PMID:24855010

  16. Symptomatic subserosal gastric lipoma successfully treated with enucleation.

    PubMed

    Krasniqi, Avdyl-Selmon; Hoxha, Faton-Tatil; Bicaj, Besnik-Xhafer; Hashani, Shemsedin-Isuf; Hasimja, Shpresa-Mehmet; Kelmendi, Sadik-Mal; Gashi-Luci, Lumturije-Hasan

    2008-10-14

    Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.

  17. Natural outlet of flue gases

    NASA Astrophysics Data System (ADS)

    Adámek, Karel; Kolář, Jan; Peukert, Pavel

    2016-06-01

    Many incidents of poisoning all the time became due to bad natural exhaust of burnt product from heating devices. The aim of this article is to simulate some reasons of it, therefore the content is focused on some influences, only - the vertical and horizontal shape of the outlet channel, the design of the chimney cap, situation of the surrounding walls, combined with the wind influence etc. It does not solve the possible bad maintaining of both chimney and device, bad supply of the combustion air etc. As main results of simulation there is presented an optimum cap shape of the chimney and an unsuitable influence of the unsteady starting of the flow just after the burner ignition.

  18. Intelligent electrical outlet for collective load control

    DOEpatents

    Lentine, Anthony L.; Ford, Justin R.; Spires, Shannon V.; Goldsmith, Steven Y.

    2015-10-27

    Various technologies described herein pertain to an electrical outlet that autonomously manages loads in a microgrid. The electrical outlet can provide autonomous load control in response to variations in electrical power generation supply in the microgrid. The electrical outlet includes a receptacle, a sensor operably coupled to the receptacle, and an actuator configured to selectively actuate the receptacle. The sensor measures electrical parameters at the receptacle. Further, a processor autonomously controls the actuator based at least in part on the electrical parameters measured at the receptacle, electrical parameters from one or more disparate electrical outlets in the microgrid, and a supply of generated electric power in the microgrid at a given time.

  19. Laparoscopic gastric banding

    MedlinePlus

    ... adjustable gastric banding; Bariatric surgery - laparoscopic gastric banding; Obesity - gastric banding; Weight loss - gastric banding ... gastric banding is not a "quick fix" for obesity. It will greatly change your lifestyle. You must ...

  20. Gastric rupture after the Heimlich maneuver.

    PubMed

    Bintz, M; Cogbill, T H

    1996-01-01

    Since 1975, the Heimlich maneuver has been widely applied to relieve upper airway obstruction caused by aspirated material. Life-threatening complications have been documented following this simple procedure. We report two cases of gastric rupture after use of the Heimlich maneuver. Both patients experienced pulmonary and abdominal symptoms. The diagnosis was confirmed in each case by the demonstration of free intraperitoneal air on an upright chest roentgenogram. Full-thickness gastric rupture along the lesser curvature of the stomach was repaired in both patients; one patient died. Abdominal pain or persistent abdominal distention despite nasogastric suction after the Heimlich maneuver should prompt evaluation for possible gastric rupture.

  1. Unilateral ureteral obstruction: beyond obstruction.

    PubMed

    Ucero, Alvaro C; Benito-Martin, Alberto; Izquierdo, Maria C; Sanchez-Niño, Maria D; Sanz, Ana B; Ramos, Adrian M; Berzal, Sergio; Ruiz-Ortega, Marta; Egido, Jesus; Ortiz, Alberto

    2014-04-01

    Unilateral ureteral obstruction is a popular experimental model of renal injury. However, the study of the kidney response to urinary tract obstruction is only one of several advantages of this model. Unilateral ureteral obstruction causes subacute renal injury characterized by tubular cell injury, interstitial inflammation and fibrosis. For this reason, it serves as a model both of irreversible acute kidney injury and of events taking place during human chronic kidney disease. Being a unilateral disease, it is not useful to study changes in global kidney function, but has the advantage of a low mortality and the availability of an internal control (the non-obstructed kidney). Experimental unilateral ureteral obstruction has illustrated the molecular mechanisms of apoptosis, inflammation and fibrosis, all three key processes in kidney injury of any cause, thus providing information beyond obstruction. Recently this model has supported key concepts on the role in kidney fibrosis of epithelial-mesenchymal transition, tubular epithelial cell G2/M arrest, the anti-aging hormone Klotho and renal innervation. We now review the experimental model and its contribution to identifying novel therapeutic targets in kidney injury and fibrosis, independently of the noxa.

  2. Perioperative Epirubicin, Oxaliplatin, and Capecitabine Chemotherapy in Locally Advanced Gastric Cancer: Safety and Feasibility in an Interim Survival Analysis

    PubMed Central

    Sahu, Arvind; Ramaswamy, Anant; Sirohi, Bhawna; Bose, Subhadeep; Talreja, Vikas; Goel, Mahesh; Patkar, Shraddha; Desouza, Ashwin; Shrikhande, Shailesh V.

    2017-01-01

    Purpose Perioperative chemotherapy improves survival outcomes in locally advanced (LA) gastric cancer. Materials and Methods We retrospectively analyzed patients with LA gastric cancer who were offered perioperative chemotherapy consisting of epirubicin, oxaliplatin, and capecitabine (EOX) from May 2013 to December 2015 at Tata Memorial Hospital in Mumbai. Results Among the 268 consecutive patients in our study, 260 patients (97.0%) completed neoadjuvant chemotherapy, 200 patients (74.6%) underwent D2 lymphadenectomy, and 178 patients (66.4%) completed adjuvant chemotherapy. The median follow-up period was 17 months. For the entire cohort, the median overall survival (OS), 3-year OS rate, median progression-free survival (PFS), and 3-year PFS rate were 37 months, 64.4%, 31 months, and 40%, respectively. PFS and OS were significantly inferior in patients who presented with features of obstruction than in those who did not (P=0.0001). There was no difference in survival with respect to tumor histology (well to moderately differentiated vs. poorly differentiated, signet ring vs. non-signet ring histology) or location (proximal vs. distal). Survival was prolonged in patients with an early pathological T stage and a pathological node-negative status. In a multivariate analysis, postoperative pathological nodal status and gastric outlet obstruction on presentation significantly correlated with survival. Conclusions EOX chemotherapy with curative resection and D2 lymphadenectomy is a suggested alternative to the existing perioperative regimens. The acceptable postoperative complication rate and relatively high resection, chemotherapy completion, and survival rates obtained in this study require further evaluation and validation in a clinical trial. PMID:28337360

  3. Thoracic outlet syndrome in whiplash injury.

    PubMed Central

    Capistrant, T D

    1977-01-01

    Thirty-five cases of thoracic outlet syndrome complicating whiplash or cervical strain injury were studied. Thirty cases had confirmation by the demonstration of slowed ulnar nerve conduction velocity (UNCV) through the thoracic outlet. Two distinct groups of patients were found. An acute group, seen an average of 3 1/2 months post injury, had severe neck pain with often mild or incidental thoracic outlet syndrome. A chronic group, with symptoms persisting more than 2 years after cervical injury, often had thoracic outlet symptoms as the predominant complaint. This study suggests that the arm aches and parethesias seen in association with both acute and chronic cervical strain injury are most often secondary to thoracic outlet syndrome. PMID:836089

  4. Complex Greenland outlet glacier flow captured

    PubMed Central

    Aschwanden, Andy; Fahnestock, Mark A.; Truffer, Martin

    2016-01-01

    The Greenland Ice Sheet is losing mass at an accelerating rate due to increased surface melt and flow acceleration in outlet glaciers. Quantifying future dynamic contributions to sea level requires accurate portrayal of outlet glaciers in ice sheet simulations, but to date poor knowledge of subglacial topography and limited model resolution have prevented reproduction of complex spatial patterns of outlet flow. Here we combine a high-resolution ice-sheet model coupled to uniformly applied models of subglacial hydrology and basal sliding, and a new subglacial topography data set to simulate the flow of the Greenland Ice Sheet. Flow patterns of many outlet glaciers are well captured, illustrating fundamental commonalities in outlet glacier flow and highlighting the importance of efforts to map subglacial topography. Success in reproducing present day flow patterns shows the potential for prognostic modelling of ice sheets without the need for spatially varying parameters with uncertain time evolution. PMID:26830316

  5. Double outlet from chambers of left ventricular morphology.

    PubMed Central

    Coto, E O; Jimenez, M Q; Castaneda, A R; Rufilanchas, J J; Deverall, P B

    1979-01-01

    This series of 5 cases with double outlet of morphologically left ventricular chamber includes 4 found during a review of 1700 heart specimens (incidence 0.23%) and 1 found at operation and successfully corrected. Abnormal atrioventricular connection precluding total correction was present in the 4 anatomical cases. Clinical diagnosis may be difficult and it is suggested that axial cineangiography may make anatomical diagnosis easier. Absence of the infundibular septum and aortic laevoposition are frequent. As some cases can be surgically corrected, accurate information is required on the size of the right ventricle, the morphology and function of the atrioventricular valves, the presence, size, and position of the ventricular septal defect, and the degree and type of outflow tract obstruction. Images PMID:475930

  6. Complete vaginal outlet stenosis in a patient with Sheehan's syndrome.

    PubMed

    Choo, Minji; Park, Hana; Yi, Kyong Wook

    2016-11-01

    We present a case of complete vaginal stenosis in a woman diagnosed with Sheehan's syndrome. The patient delivered at full-term 5 months prior, and experienced massive postpartum bleeding at that time. During evaluation of persistent amenorrhea, we found that her vaginal orifice was completely adhesive and obstructed. Prior to corrective surgery, we managed the patient with an oral contraceptive to induce uterine bleeding into the vaginal outflow tract. After three cycles of an oral contraceptive, we could confirm that there was no stenotic lesion in the vaginal cavity as a hematocolpos was created. Adhesiolysis with scar revision for the vaginal stenosis was successfully performed; it was found that the lesion was limited to only the distal part of the vaginal outlet. Complete vaginal stenosis in reproductive age women with hypopituitarism has not been reported. The artificial induction of hematometrocolpos before surgery was useful in determining the extent of the stenotic lesion, and assured safety.

  7. Race, Ethnicity, and Exposure to Alcohol Outlets

    PubMed Central

    Morrison, Christopher; Gruenewald, Paul J.; Ponicki, William R.

    2016-01-01

    Objective: Prior studies suggest that Black and Hispanic minority populations are exposed to greater concentrations of alcohol outlets, potentially contributing to health disparities between these populations and the White majority. We tested the alternative hypothesis that urban economic systems cause outlets to concentrate in low-income areas and, controlling for these effects, lower demand among minority populations leads to fewer outlets. Method: Market potential for alcohol sales, a surrogate for demand, was estimated from survey and census data across census block groups for 50 California cities. Hierarchical Bayesian conditional autoregressive Poisson models then estimated relationships between observed geographic distributions of outlets and the market potential for alcohol, income, population size, and racial and ethnic composition. Results: Market potentials were significantly smaller among lower income Black, Hispanic, and Asian populations. Block groups with greater market potential and lower income had greater concentrations of outlets. When we controlled for these effects, the racial and ethnic group composition of block groups was mostly unrelated to outlet concentrations. Conclusions: Health disparities related to exposure to alcohol outlets are primarily driven by distributions of income and population density across neighborhoods. PMID:26751356

  8. Combined Arterial Infusion and Stent Implantation Compared with Metal Stent Alone in Treatment of Malignant Gastroduodenal Obstruction

    SciTech Connect

    Wang Zhongmin; Chen Kemin; Gong Ju; Zheng Yunfeng; Wang Tianxiang

    2009-09-15

    Many patients with malignant gastroduodenal obstruction have an unresectable primary lesion and distant metastases, which may prompt palliative management to allow the patient to eat and to improve the quality of life. Intraluminal metallic stent implantation (MSI) under fluoroscopic guidance has been reported to be an effective option for symptomatic relief in these patients, with a good safety record. An alternative, dual interventional therapy (DIT), has been used during the last decade, in which prosthesis insertion is followed by intra-arterial chemotherapy via the tumor-feeding arteries. The aim of this study was to compare success rates, complication rates, and survival time between MSI and DIT in patients who presented with gastroduodenal obstruction from advanced upper gastrointestinal tract cancer. All consecutive patients with malignant gastroduodenal obstruction seen at our center between October 2002 and August 2007 were retrospectively studied. Patients were treated palliatively by either MSI or DIT by the patient's or the next of kin's decision. Outcomes included technical and clinical success, complication rates, and survival. Of the 164 patients with malignant gastric and duodenal outlet obstructions, 80 (49%) underwent stent insertion as the primary therapy, while the remaining 84 (51%) received DIT. Clinical characteristics were similar between the two groups. In the MSI cohort initial stent implantation was successful in 73 patients (91%), two stents were used in 5 patients, and delayed additional stent insertion for stent obstruction related to tumor overgrowth was required in 3 patients during follow-up. In the DIT cohort the technical success rate was 94%, 3 patients required two stents, and stent obstruction occurred in 2 patients after initial stent placement. Early postprocedural clinical success, indicated by average dysphagia score, improved significantly in both groups: MSI group, from 4.56 to 1.51 (P < 0.01); and DIT group, from 4

  9. Octreotide as Palliative Therapy for Cancer-Related Bowel Obstruction That Cannot Be Removed by Surgery

    ClinicalTrials.gov

    2012-05-31

    Colorectal Cancer; Constipation, Impaction, and Bowel Obstruction; Extrahepatic Bile Duct Cancer; Gastric Cancer; Gastrointestinal Stromal Tumor; Nausea and Vomiting; Ovarian Cancer; Pancreatic Cancer; Peritoneal Cavity Cancer; Small Intestine Cancer

  10. Plug into a Great Outlet for Creativity

    ERIC Educational Resources Information Center

    Skophammer, Karen

    2009-01-01

    Is there beauty in the wall socket that people plug their appliances into daily? Can one find beauty in the grate covering the heat vent in his classroom? The author posed these very questions to her third-grade students. She had the students take a good look at the outlet cover (or plate) on the wall. After thinking and discussing the outlets,…

  11. Alcohol outlets, social disorganization, and robberies: accounting for neighborhood characteristics and alcohol outlet types.

    PubMed

    Snowden, Aleksandra J; Freiburger, Tina L

    2015-05-01

    We estimated spatially lagged regression and spatial regime models to determine if the variation in total, on-premise, and off-premise alcohol outlet(1) density is related to robbery density, while controlling for direct and moderating effects of social disorganization.(2) Results suggest that the relationship between alcohol outlet density and robbery density is sensitive to the measurement of social disorganization levels. Total alcohol outlet density and off-premise alcohol outlet density were significantly associated with robbery density when social disorganization variables were included separately in the models. However, when social disorganization levels were captured as a four item index, only the association between off-premise alcohol outlets and robbery density remained significant. More work is warranted in identifying the role of off-premise alcohol outlets and their characteristics in robbery incidents.

  12. Obstructed uterus

    SciTech Connect

    Scott, W.W.; Rosenshein, N.B.; Siegelman, S.S.; Sanders, R.C.

    1981-12-01

    Eleven patients with an obstructed, fluid-filled uterus, due to carcinoma of the uterus or to its treatment by radiation therapy, were examined with computed tomography (CT) and/or ultrasound. It is important to recognize this abnormality to differentiate it from other causes of pelvic mass and to ensure prompt treatment of pyometra, should it develop. Both CT and ultrasound reliably identified this condition and differentiated it from other pelvic masses.

  13. Gastric sarcoidosis.

    PubMed Central

    Akinyemi, Emmanuel; Rohewal, Upinder; Tangorra, Matthew; Abdullah, Muhammad

    2006-01-01

    A 58-year-old Jamaican male presented with acute-onset, right-sided facial droop and slurred speech. He had an episode of upper gastrointestinal (GI) bleed on the second day of admission and endoscopy with biopsy of antral ulcer revealed gastric sarcoidosis. This case demonstrates the rare entity of gastric sarcoidosis presenting acutely with an upper GI bleed. Images Figure 1 Figure 2 PMID:16775918

  14. Bowel Obstruction: Sonographic Evaluation.

    PubMed

    Hollerweger, A; Wüstner, M; Dirks, K

    2015-06-01

    Learning objectives: Sonographic examination concept in the case of suspicion of bowel obstruction. Recognition of the sonographic criteria of a bowel obstruction. Ability to detect the level of a bowel obstruction. Sonographic detection of typical causes of bowel obstruction. Detection of sonographic signs of complicated bowel obstruction. Ability to sonographically define important differential diagnoses. Further diagnostic procedures in unclear situations.

  15. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    PubMed Central

    Ochieng, Vincent; Hendrickx, Leo; Valk, Jody

    2016-01-01

    Background The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. Summary The unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. Conclusion This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP. PMID:27107305

  16. [Gastric lymphoma].

    PubMed

    Ruskoné-Fourmestraux, A

    1997-04-15

    The stomach is the most common site involved in primary gastrointestinal lymphoma. Gastric lymphoma originates from the mucosa-associated lymphoid tissue so called MALT. It comprises a group of distinctive clinicopathological entities which are important to take in account for clinical behavior. In recent years, new diagnostic tools and modern modes of treatment have improved their overall prognosis. One of the most exciting recent discoveries is the hypothesis that an infection by a bacterium. Helicobacter pylori has a decisive role in gastric lymphoma.

  17. [Gastric volvulus].

    PubMed

    Solórzano, J; Acosta, D; Morales, H; Vásquez, F; Mora, G; Chávez, M; Andrade, D; Joutteaux, R; Sánchez, I; García, D; Valenzuela, E

    2006-10-01

    Gastric volvulus is a rare condition in pediatric population in which there is an abnormal rotation of one part of the stomach around itself. It's a surgical emergency. We report a six year old female admitted in the emergency due to upper abdominal distention, nausea without vomiting, physical exam revealed upper abdominal distention and abdominal tenderness, no bowel sounds. Laparotomy was performed and a gastric volvulus with occlusive vascular involvement was found. In the post operative period she required a second laparotomy due to adhesions in small bowel.

  18. [Gastric cancer].

    PubMed

    Belén Fraile, M; Serra Bartual, M; Segarra Sánchez, J; Richart Rufino, M J

    1991-11-01

    Gastric cancer represents a disorder which incidence has come down last years. Its etiology is unknown, but diet is the principal determinant risk of suffering it. Clinic history is not much useful, because in the early stage symptoms can fail and in the late stage are inespecific. Election diagnosis is endoscopy. Surgery is the only curative treatment. By these features, it would be useful to left under vigilance to: a) patients 40 years older with dispepsia; b) patients following gastric operations; c) patients with disorders presenting aclorhidria. The authors report a clinic case that can be of frequent presentation in primary assistance.

  19. [Gastric cleansing].

    PubMed

    Zimmermann Serret, Alina; Alcaraz Bravo, Judit; Carballo Alvarez, Montse; Fernández Vargas, Carmen

    2006-10-01

    Numerous cases in emergency wards are due to the ingestion of potentially toxic substances. One of the most utilized procedures under these circumstances is gastric cleansing. This procedure is a technique habitually practiced by nursing personnel but is not without its risks. Therefore, the motive of this article is to make known the indications, contraindications, related complications of gastric cleansing and its integral patient care process in order to offer quality care methods which enable their being performed in an effective and efficient manner, under the maximum security conditions with the minimum inconveniences for the patient while at the same time describing the system most commonly used by our service.

  20. Obstruction of the bypassed stomach treated with percutaneous drainage: an alternative treatment for selected cases.

    PubMed

    López-Tomassetti Fernández, E M; Arteaga González, I; Diaz-Luis, H; Carrillo Pallares, A

    2008-02-01

    Biliopancreatic limb obstruction in Roux-en-Y gastric bypass is an infrequent complication that should be recognized early to avoid the risk of peritonitis and death. In this manuscript, we report a case of acute gastric remnant dilatation secondary to intraabdominal hematoma provoked by trocar injury that was compressing the second portion of duodenum lumen. To treat this problem, we decided on a less invasive treatment consisting of percutaneous decompression of the stomach. The procedure was performed using sonographic guidance with local anesthesia, thus, avoiding a new surgical procedure. In this selected case, percutaneous radiological catheter placement provided an effective decompression of the excluded gastric remnant until spontaneous resolution of the obstruction.

  1. Vascular thoracic outlet syndrome developed after minimally invasive repair of pectus excavatum.

    PubMed

    Kılıç, Burcu; Demirkaya, Ahmet; Turna, Akif; Kaynak, Kamil

    2013-09-01

    The Nuss procedure is a minimally invasive surgical repair technique for pectus excavatum with fewer delayed complications compared to open procedures. We report the case of a 22-year-old man with deep pectus excavatum who developed vascular thoracic outlet syndrome after the Nuss procedure. Further evaluation demonstrated that the first rib was causing severe obstruction of the right subclavian artery. The patient showed clinical features of subclavian artery compression. A first rib resection, division of the anterior scalene muscle and fibrous bands provided complete relief of the complaints. The forced structural and spatial changes produced by the elevation of the depressed upper chest might have caused this complication. Vascular thoracic outlet syndrome should be kept in mind as a possible complication in patients who have undergone minimally invasive repair of pectus excavatum, and this complication can be treated by first rib resection.

  2. Neonatal Sleeve Gastrectomy for Multiple Gastric Perforations: A Case Report

    PubMed Central

    Reyna-Sepulveda, Francisco

    2017-01-01

    Neonatal gastric perforation (NGP) may be spontaneous, secondary to necrotizing enterocolitis (NEC), or due to distal obstruction. A 27-week old premature male newborn presented with pneumoperitoneum. A single perforation of stomach was found at surgery. Primary repair and gastrostomy were performed. On fifth postoperative day, pneumoperitoneum was again detected. At reoperation, multiple gastric perforations of the greater curvature were found. Sleeve gastrectomy was performed. The patient responded well to the treatment. PMID:28083496

  3. 46 CFR 108.453 - Discharge outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Discharge outlets. 108.453 Section 108.453 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Fire Extinguishing Systems Fixed Carbon Dioxide Fire Extinguishing Systems § 108.453...

  4. 46 CFR 108.453 - Discharge outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Discharge outlets. 108.453 Section 108.453 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Fire Extinguishing Systems Fixed Carbon Dioxide Fire Extinguishing Systems § 108.453...

  5. 24 CFR 3280.806 - Receptacle outlets.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... compartments accessible from the outdoors, in bathrooms, and within 6 feet of a kitchen sink to serve counter... receptacle outlet shall be installed: (1) Over or adjacent to counter tops in the kitchen (at least one on... occupied by built-in kitchen or wardrobe cabinets, (ii) Wall space behind doors which may be opened...

  6. 49 CFR 192.157 - Extruded outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Extruded outlets. 192.157 Section 192.157 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... equal to the design strength of the pipe and other fittings in the pipeline to which it is attached....

  7. Thoracic outlet syndromes and magnetic resonance imaging.

    PubMed

    Panegyres, P K; Moore, N; Gibson, R; Rushworth, G; Donaghy, M

    1993-08-01

    The thoracic outlet syndromes encompass the diverse clinical entities affecting the branchial plexus or subclavian artery including cervical ribs or bands. Thoracic outlet syndrome are often difficult to diagnose on existing clinical and electrophysiological criteria and new diagnostic methods are necessary. This study reports our experience with magnetic resonance imaging (MRI) of the brachial plexus in 20 patients with suspected thoracic outlet syndrome. The distribution of pain and sensory disturbance varied widely, weakness and wasting usually affected C8/T1 innervated muscles, and electrophysiology showed combinations of reduced sensory nerve action potentials from the fourth and fifth digits, and prolonged F-responses or tendon reflex latencies. The MRI study was interpreted blind. Deviation of the brachial plexus was recorded in 19 out of the 24 symptomatic sides (sensitivity 79%). Absence of distortion was correctly identified in 14 out of 16 asymptomatic sides (specificity 87.5%). The false positive rate was 9.5%. Magnetic resonance imaging demonstrated all seven cervical ribs visible on plain cervical spine radiographs. Magnetic resonance imaging also showed a band-like structure extending from the C7 transverse process in 25 out of 33 sides; similar structures were detected in three out of 18 sides in control subjects. These MRI bands often underlay the brachial plexus distortion observed in our patients. We also observed instances of plexus distortion by post-traumatic callus of the first rib, and by a hypertrophied serratus anterior muscle. If they did not demonstrate a cervical rib, plain cervical spine radiographs had no value in predicting brachial plexus distortion. We believe MRI to be of potential value in the diagnosis of thoracic outlet syndrome by: (i) demonstrating deviation or distortion of nerves or blood vessels; (ii) suggesting the presence of radiographically invisible bands; (iii) disclosing other causes of thoracic outlet syndrome

  8. Gastric bypass surgery - discharge

    MedlinePlus

    Bariatric surgery - gastric bypass - discharge; Roux-en-Y gastric bypass - discharge; Gastric bypass - Roux-en-Y - discharge; Obesity ... Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic ...

  9. 49. OUTLET WORKS: THREE TON CRANE, ELECTRICAL SYSTEM NO 4. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    49. OUTLET WORKS: THREE TON CRANE, ELECTRICAL SYSTEM NO 4. Sheet H-4, December 12, 1939. File no. SA 342/60. - Prado Dam, Outlet Works, Santa Ana River near junction of State Highways 71 & 91, Corona, Riverside County, CA

  10. 14 CFR 23.977 - Fuel tank outlet.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... tank outlet. (a) There must be a fuel strainer for the fuel tank outlet or for the booster pump. This... turbine engine powered airplanes, prevent the passage of any object that could restrict fuel flow...

  11. 14 CFR 23.977 - Fuel tank outlet.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... tank outlet. (a) There must be a fuel strainer for the fuel tank outlet or for the booster pump. This... turbine engine powered airplanes, prevent the passage of any object that could restrict fuel flow...

  12. 14 CFR 23.977 - Fuel tank outlet.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... tank outlet. (a) There must be a fuel strainer for the fuel tank outlet or for the booster pump. This... turbine engine powered airplanes, prevent the passage of any object that could restrict fuel flow...

  13. 14 CFR 23.977 - Fuel tank outlet.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... tank outlet. (a) There must be a fuel strainer for the fuel tank outlet or for the booster pump. This... turbine engine powered airplanes, prevent the passage of any object that could restrict fuel flow...

  14. Completion of Embankment, Spillway and Outlet Works

    DTIC Science & Technology

    1990-08-01

    principal features of the project include (1) a rolled earthfill embankment approximately 14,980 feet long; (2) a limited service spillway consisting...approach channel, intake structure and service bridge, a 708-foot long by 13-foot diameter cut and cover conduit, stilling basin and excavated discharge...FOUNDATION. a. General. The limited service spillway is founded in weathered clay shale of the Pawpaw Formation of Lower Cretaceous age. The outlet works

  15. 46 CFR 76.15-25 - Discharge outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 3 2010-10-01 2010-10-01 false Discharge outlets. 76.15-25 Section 76.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 76.15-25 Discharge outlets. (a) Discharge outlets...

  16. 46 CFR 76.15-25 - Discharge outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 3 2011-10-01 2011-10-01 false Discharge outlets. 76.15-25 Section 76.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 76.15-25 Discharge outlets. (a) Discharge outlets...

  17. 46 CFR 76.15-25 - Discharge outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 3 2013-10-01 2013-10-01 false Discharge outlets. 76.15-25 Section 76.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 76.15-25 Discharge outlets. (a) Discharge outlets...

  18. 46 CFR 76.15-25 - Discharge outlets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 3 2012-10-01 2012-10-01 false Discharge outlets. 76.15-25 Section 76.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 76.15-25 Discharge outlets. (a) Discharge outlets...

  19. 46 CFR 76.15-25 - Discharge outlets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 3 2014-10-01 2014-10-01 false Discharge outlets. 76.15-25 Section 76.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 76.15-25 Discharge outlets. (a) Discharge outlets...

  20. 49 CFR 178.337-8 - Openings, inlets, and outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... used to transport chlorine. The requirements for inlets and outlets on chlorine cargo tanks are in... equalization of pressure. (b) Inlets and discharge outlets on chlorine tanks. The inlet and discharge outlets on a cargo tank used to transport chlorine must meet the requirements of § 178.337-1(c)(2) and...

  1. 49 CFR 178.337-8 - Openings, inlets, and outlets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... used to transport chlorine. The requirements for inlets and outlets on chlorine cargo tanks are in... equalization of pressure. (b) Inlets and discharge outlets on chlorine tanks. The inlet and discharge outlets on a cargo tank used to transport chlorine must meet the requirements of § 178.337-1(c)(2) and...

  2. 49 CFR 178.337-8 - Openings, inlets, and outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... used to transport chlorine. The requirements for inlets and outlets on chlorine cargo tanks are in... equalization of pressure. (b) Inlets and discharge outlets on chlorine tanks. The inlet and discharge outlets on a cargo tank used to transport chlorine must meet the requirements of § 178.337-1(c)(2) and...

  3. 49 CFR 178.337-8 - Openings, inlets, and outlets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... used to transport chlorine. The requirements for inlets and outlets on chlorine cargo tanks are in... equalization of pressure. (b) Inlets and discharge outlets on chlorine tanks. The inlet and discharge outlets on a cargo tank used to transport chlorine must meet the requirements of § 178.337-1(c)(2) and...

  4. 49 CFR 178.337-8 - Openings, inlets, and outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... used to transport chlorine. The requirements for inlets and outlets on chlorine cargo tanks are in... equalization of pressure. (b) Inlets and discharge outlets on chlorine tanks. The inlet and discharge outlets on a cargo tank used to transport chlorine must meet the requirements of § 178.337-1(c)(2) and...

  5. 14 CFR 23.977 - Fuel tank outlet.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Fuel tank outlet. 23.977 Section 23.977... STANDARDS: NORMAL, UTILITY, ACROBATIC, AND COMMUTER CATEGORY AIRPLANES Powerplant Fuel System § 23.977 Fuel tank outlet. (a) There must be a fuel strainer for the fuel tank outlet or for the booster pump....

  6. 14 CFR 25.977 - Fuel tank outlet.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Fuel tank outlet. 25.977 Section 25.977... STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.977 Fuel tank outlet. (a) There must be a fuel strainer for the fuel tank outlet or for the booster pump. This strainer must— (1)...

  7. 14 CFR 27.977 - Fuel tank outlet.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Fuel tank outlet. 27.977 Section 27.977... STANDARDS: NORMAL CATEGORY ROTORCRAFT Powerplant Fuel System § 27.977 Fuel tank outlet. (a) There must be a fuel stainer for the fuel tank outlet or for the booster pump. This strainer must— (1)...

  8. 46 CFR 95.17-20 - Discharge outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Discharge outlets. 95.17-20 Section 95.17-20 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS FIRE PROTECTION EQUIPMENT Foam Extinguishing Systems, Details § 95.17-20 Discharge outlets. (a) Discharge outlets shall...

  9. 46 CFR 76.17-20 - Discharge outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 3 2010-10-01 2010-10-01 false Discharge outlets. 76.17-20 Section 76.17-20 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) PASSENGER VESSELS FIRE PROTECTION EQUIPMENT Foam Extinguishing Systems, Details § 76.17-20 Discharge outlets. (a) Discharge outlets shall be of...

  10. Lower Esophageal Thickening Due to a Laparoscopic Adjustable Gastric Band.

    PubMed

    Makker, Jitin; Conklin, Jeffrey; Muthusamy, V Raman

    2015-10-01

    Laparoscopic adjustable gastric band (LAGB) is a surgical device to treat obesity that is widely used and generally considered to be safe. We report an adverse event related to the physiological and mechanical changes that occur after LAGB placement, namely chronic obstruction resulting in marked lower esophageal thickening.

  11. Lower Esophageal Thickening Due to a Laparoscopic Adjustable Gastric Band

    PubMed Central

    Makker, Jitin; Conklin, Jeffrey

    2015-01-01

    Laparoscopic adjustable gastric band (LAGB) is a surgical device to treat obesity that is widely used and generally considered to be safe. We report an adverse event related to the physiological and mechanical changes that occur after LAGB placement, namely chronic obstruction resulting in marked lower esophageal thickening. PMID:26504870

  12. Youth activity spaces and daily exposure to tobacco outlets.

    PubMed

    Lipperman-Kreda, Sharon; Morrison, Christopher; Grube, Joel W; Gaidus, Andrew

    2015-07-01

    We explored whether exposure to tobacco outlets in youths' broader activity spaces differs from that obtained using traditional geographic measures of exposure to tobacco outlet within buffers around homes and schools. Youths completed an initial survey, daily text-prompted surveys, and carried GPS-enabled phones for one week. GPS locations were geocoded and activity spaces were constructed by joining sequential points. We calculated the number of tobacco outlets around these polylines and around homes and schools. Results suggest that activity spaces provide a more accurate measure of tobacco outlet exposures than traditional measures. Assessing tobacco outlet exposure within activity spaces may yield significant information to advance the field.

  13. Obstructive sleep apnea - adults

    MedlinePlus

    Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...

  14. The Transhepatic Route for the Placement of a Duodenojejunal Stent: Application in a Postoperative Closed Loop Obstruction of the Duodenum

    SciTech Connect

    Ozden, Ilgin; Poyanli, Arzu; Kaygusuz, Arslan; Rozanes, Izzet; Alper, Aydin

    2001-01-15

    A patient who had undergone gastric resection for carcinoma, had closed loop obstruction of the duodenum due to neoplasia at the duodenojejunal junction. The obstruction was relieved successfully by transhepatic placement of a duodenojejunal stent. We were compelled to use the transhepatic route because a Roux-Y reconstruction had been performed. Transhepatic placement may be the only chance of palliation in a small subset of patients with malignant intestinal obstruction.

  15. Gastric antral webs in adults: A case series characterizing their clinical presentation and management in the modern endoscopic era

    PubMed Central

    Morales, Shannon J; Nigam, Neha; Chalhoub, Walid M; Abdelaziz, Dalia I; Lewis, James H; Benjamin, Stanley B

    2017-01-01

    AIM To investigate the current management of gastric antral webs (GAWs) among adults and identify optimal endoscopic and/or surgical management for these patients. METHODS We reviewed our endoscopy database seeking to identify patients in whom a GAW was visualized among 24640 esophagogastroduodenoscopies (EGD) over a seven-year period (2006-2013) at a single tertiary care center. The diagnosis of GAW was suspected during EGD if aperture size of the antrum did not vary with peristalsis or if a “double bulb” sign was present on upper gastrointestinal series. Confirmation of the diagnosis was made by demonstrating a normal pylorus distal to the GAW. RESULTS We identified 34 patients who met our inclusion criteria (incidence 0.14%). Of these, five patients presented with gastric outlet obstruction (GOO), four of whom underwent repeated sequential balloon dilations and/or needle-knife incisions with steroid injection for alleviation of GOO. The other 29 patients were incidentally found to have a non-obstructing GAW. Age at diagnosis ranged from 30-87 years. Non-obstructing GAWs are mostly incidental findings. The most frequently observed symptom prompting endoscopic work-up was refractory gastroesophageal reflux (n = 24, 70.6%) followed by abdominal pain (n = 11, 33.4%), nausea and vomiting (n = 9, 26.5%), dysphagia (n = 6, 17.6%), unexplained weight loss, (n = 4, 11.8%), early satiety (n = 4, 11.8%), and melena of unclear etiology (n = 3, 8.82%). Four of five GOO patients were treated with balloon dilation (n = 4), four-quadrant needle-knife incision (n = 3), and triamcinolone injection (n = 2). Three of these patients required repeat intervention. One patient had a significant complication of perforation after needle-knife incision. CONCLUSION Endoscopic intervention for GAW using balloon dilation or needle-knife incision is generally safe and effective in relieving symptoms, however repeat treatment may be needed and a risk of perforation exists with thermal

  16. Gastric malpositioning and chronic, intermittent vomiting following prophylactic gastropexy in a 20-month-old great Dane dog.

    PubMed

    Sutton, Jessie S; Steffey, Michele A; Bonadio, Cecily M; Marks, Stanley L

    2015-10-01

    A 20-month-old castrated male great Dane dog was presented for evaluation of chronic intermittent vomiting of 2 months' duration. A prophylactic incisional gastropexy performed at 6 mo of age resulted in gastric malpositioning and subsequent partial gastric outflow tract obstruction.

  17. Gastric malpositioning and chronic, intermittent vomiting following prophylactic gastropexy in a 20-month-old great Dane dog

    PubMed Central

    Sutton, Jessie S.; Steffey, Michele A.; Bonadio, Cecily M.; Marks, Stanley L.

    2015-01-01

    A 20-month-old castrated male great Dane dog was presented for evaluation of chronic intermittent vomiting of 2 months’ duration. A prophylactic incisional gastropexy performed at 6 mo of age resulted in gastric malpositioning and subsequent partial gastric outflow tract obstruction. PMID:26483580

  18. Fast-flowing outlet glaciers on Svalbard ice caps

    SciTech Connect

    Dowdeswell, J.A. ); Collin, R.L. )

    1990-08-01

    Four well-defined outlet glaciers are present on the 2510 km{sup 2} cap of Vestfonna in Nordaustlandet, Svalbard. Airborne radio echo sounding and aerial-photograph and satellite-image analysis methods are used to analyze the morphology and dynamics of the ice cap and its component outlet glaciers. The heavily crevassed outlets form linear depressions in the ice-cap surface and flow an order of magnitude faster than the ridges of uncrevassed ice between them. Ice flow on the ridges is accounted for by internal deformation alone, whereas rates of outlet glacier flow require basal motion. One outlet has recently switched into and out of a faster mode of flow. Rapid terminal advance, a change from longitudinal compression to tension, and thinning in the upper basin indicate surge behavior. Observed outlet glacier discharge is significantly greater than current inputs of mass of the ice cap, indicating that present rates of flow cannot be sustained under the contemporary climate.

  19. 11. Photographic copy of copy of Twin Lakes Outlet Works ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. Photographic copy of copy of Twin Lakes Outlet Works construction drawing dated January 15, 1951. Drawn by W.A. Doe for the Twin Lakes Reservoir and Canal Co. (copy in possession of Bureau of Reclamation, location of original unknown) 'AS CONSTRUCTED' PLANS OF 1949-1950, REHABILITATION OF TWIN LAKES RESERVOIR OUTLET WORKS, DETAILS OF UPSTREAM WING WALLS. - Twin Lakes Dam & Outlet Works, Beneath Twin Lakes Reservoir, T11S, R80W, S22, Twin Lakes, Lake County, CO

  20. 12. Photographic copy of copy of Twin Lakes Outlet Works ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. Photographic copy of copy of Twin Lakes Outlet Works construction drawing dated January 15, 1951. Drawn by W.A. Doe for the Twin Lakes Reservoir and Canal Co. (copy in possession of Bureau of Reclamation, location of original unknown) 'AS CONSTRUCTED' PLANS OF 1949-50, REHABILITATION OF TWIN LAKES RESERVOIR OUTLET WORKS, DETAILS OF DISCHARGE BASIN. - Twin Lakes Dam & Outlet Works, Beneath Twin Lakes Reservoir, T11S, R80W, S22, Twin Lakes, Lake County, CO

  1. Antivortex Device for Multi-Outlet Liquid Reservoir

    NASA Technical Reports Server (NTRS)

    Grayson, Gary David (Inventor); Addison, Stephen Michael (Inventor)

    2016-01-01

    A liquid reservoir with a sump includes at least two outlet ports in fluid communication with a fluid conduit. An anti-vortex device includes a first plate extending across the at least two outlet ports and a second plate coupled to the first plate and extending substantially perpendicular to the first plate. The anti-vortex device is configured to disrupt formation of a vortex formed by liquid passing from the reservoir through said outlet ports.

  2. Chronic Gastric Ischemia Leading to Gastric Perforation

    PubMed Central

    Lundsmith, Emma; Zheng, Matthew; McCue, Peter

    2016-01-01

    A 69-year-old man with diabetes, peripheral vascular disease, and hypertension presented with 3 months of diffuse abdominal pain that worsened with meals, weight loss, and dysphagia. Esophagogastroduodenoscopy and computed tomography revealed findings consistent with chronic gastric ischemia secondary to atherosclerosis. Gastric ischemia eventually led to perforation. We discuss causes, symptoms, diagnosis, and management of gastric ischemia, an underdiagnosed and potentially fatal condition that requires urgent diagnosis and treatment. PMID:28119945

  3. Gastric stromal tumor.

    PubMed

    Ovali, Gülgün Yilmaz; Tarhan, Serdar; Serter, Selim; Pabuşçu, Yüksel

    2005-06-01

    Gastric stromal tumors are rare neoplasms of the stomach. In this report we present a gastric stromal tumor with an exophytic growth pattern, and describe magnetic resonance imaging and endoscopic ultrasonography findings.

  4. Chronic Gastric Volvulus with Laparoscopic Gastropexy after Endoscopic Reduction: A Case Report

    PubMed Central

    Lee, Hye Yeon; Park, Jung Hyun

    2015-01-01

    Gastric volvulus is an uncommon clinical entity. There are three types of gastric volvulus; organoaxial, mesenteroaxial and combined type. This condition can lead to a closed-loop obstruction or strangulation. Traditional surgical therapy for gastric volvulus is based on an open approach. Here we report a successful case of a patient with chronic gastric volvulus with a laparoscopic treatment. A 79-year-old woman came to the emergency department with epigastric pain accompanied by nausea for 2 weeks. Abdominal computed tomography revealed markedly distended stomach with transposition of gastroesophageal Junction and gastric antrum. Barium meal study revealed presence of the antrum was folded over 180 degrees that was located above gastroesophageal junction. We attempted an endoscopic reduction, but it was unsuccessful. The patient got laparoscopic anterior gastropexy. Based on our result, laparoscopic gastropexy can be considered as a good choice of the treatment for gastric volvulus. PMID:26161290

  5. Incisional Hernia as a Cause of Blader Outlet Obstruction: A Case Report

    PubMed Central

    Ali, Shadan; Desai, Gunjan; Sharma, Kartikeya; Thomas, Shaji

    2016-01-01

    Incisional hernia usually contains intra peritoneal organs as its content. Extra peritoneal structures like bladder as a content of incisional hernia are relatively uncommon. We managed a young male with an incisional hernia containing a large bladder diverticulum as its content. The bladder diverticulum was going up to the base of scrotum along the posterolateral surface of penile corpora. The patient was diagnosed pre operatively with radiological investigations and underwent exploration with release of diverticulum from corpora and pubic arch followed by diverticulectomy and herniorraphy. To the best of our knowledge and available literature search, there isn’t any similar reported case. PMID:27790521

  6. 6. VIEW OF DAM 83, SHOWING OUTLET CHANNEL FLOWING INTO ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW OF DAM 83, SHOWING OUTLET CHANNEL FLOWING INTO POND A WITH DIVERSION GATES LONG EAST (LEFT) SIDE OF OUTLET CHANNEL, LOOKING SOUTH FROM DOWNSTREAM FACE OF THE DAM - Upper Souris National Wildlife Refuge, Dam 83, Souris River Basin, Foxholm, Surrey (England), ND

  7. 7 CFR 929.61 - Outlets for excess cranberries.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Outlets for excess cranberries. 929.61 Section 929.61... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE CRANBERRIES GROWN IN STATES OF... excess cranberries. (a) Noncommercial outlets. Excess cranberries may be disposed of in...

  8. 7 CFR 929.57 - Outlets for restricted cranberries.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 8 2013-01-01 2013-01-01 false Outlets for restricted cranberries. 929.57 Section 929... SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE CRANBERRIES....57 Outlets for restricted cranberries. (a) Except as provided in this section and in §...

  9. 7 CFR 929.61 - Outlets for excess cranberries.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 8 2013-01-01 2013-01-01 false Outlets for excess cranberries. 929.61 Section 929.61... AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE CRANBERRIES GROWN IN STATES OF... excess cranberries. (a) Noncommercial outlets. Excess cranberries may be disposed of in...

  10. 7 CFR 929.57 - Outlets for restricted cranberries.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 8 2012-01-01 2012-01-01 false Outlets for restricted cranberries. 929.57 Section 929... SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE CRANBERRIES....57 Outlets for restricted cranberries. (a) Except as provided in this section and in §...

  11. 7 CFR 929.57 - Outlets for restricted cranberries.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Outlets for restricted cranberries. 929.57 Section 929... SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE CRANBERRIES....57 Outlets for restricted cranberries. (a) Except as provided in this section and in §...

  12. 7 CFR 929.61 - Outlets for excess cranberries.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 8 2012-01-01 2012-01-01 false Outlets for excess cranberries. 929.61 Section 929.61... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE CRANBERRIES GROWN IN STATES OF... excess cranberries. (a) Noncommercial outlets. Excess cranberries may be disposed of in...

  13. 7 CFR 929.57 - Outlets for restricted cranberries.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 8 2014-01-01 2014-01-01 false Outlets for restricted cranberries. 929.57 Section 929... SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE CRANBERRIES....57 Outlets for restricted cranberries. (a) Except as provided in this section and in §...

  14. 7 CFR 929.57 - Outlets for restricted cranberries.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 8 2011-01-01 2011-01-01 false Outlets for restricted cranberries. 929.57 Section 929... SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE CRANBERRIES....57 Outlets for restricted cranberries. (a) Except as provided in this section and in §...

  15. 7 CFR 929.61 - Outlets for excess cranberries.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 8 2014-01-01 2014-01-01 false Outlets for excess cranberries. 929.61 Section 929.61... AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE CRANBERRIES GROWN IN STATES OF... excess cranberries. (a) Noncommercial outlets. Excess cranberries may be disposed of in...

  16. 7 CFR 929.61 - Outlets for excess cranberries.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 8 2011-01-01 2011-01-01 false Outlets for excess cranberries. 929.61 Section 929.61... Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE CRANBERRIES GROWN IN STATES OF... excess cranberries. (a) Noncommercial outlets. Excess cranberries may be disposed of in...

  17. 46 CFR 193.15-25 - Discharge outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 7 2010-10-01 2010-10-01 false Discharge outlets. 193.15-25 Section 193.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 193.15-25 Discharge outlets. (a) Discharge...

  18. 46 CFR 95.15-25 - Discharge outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Discharge outlets. 95.15-25 Section 95.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 95.15-25 Discharge outlets. (a) Discharge...

  19. 25. UPSTREAM VIEW OF LOWER END OF OUTLET STRUCTURE SHOWING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    25. UPSTREAM VIEW OF LOWER END OF OUTLET STRUCTURE SHOWING FORMS IN PLACE FOR GRAVITY WALL SECTIONS.... Volume XVI, No. 16, August 16, 1939. - Prado Dam, Outlet Works, Santa Ana River near junction of State Highways 71 & 91, Corona, Riverside County, CA

  20. 49 CFR 178.345-11 - Tank outlets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... Containers for Motor Vehicle Transportation § 178.345-11 Tank outlets. (a) General. As used in this section... outlet where vehicle length allows, or on the end of the cargo tank farthest away from the...

  1. 49 CFR 178.345-11 - Tank outlets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... Containers for Motor Vehicle Transportation § 178.345-11 Tank outlets. (a) General. As used in this section... outlet where vehicle length allows, or on the end of the cargo tank farthest away from the...

  2. 49 CFR 178.345-11 - Tank outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... Containers for Motor Vehicle Transportation § 178.345-11 Tank outlets. (a) General. As used in this section... outlet where vehicle length allows, or on the end of the cargo tank farthest away from the...

  3. 49 CFR 178.345-11 - Tank outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY... Containers for Motor Vehicle Transportation § 178.345-11 Tank outlets. (a) General. As used in this section... outlet where vehicle length allows, or on the end of the cargo tank farthest away from the...

  4. 49 CFR 179.103-5 - Bottom outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS REGULATIONS SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.103-5 Bottom outlets..., bottom outlet valves must meet the following requirements: (1) On cars with center sills, a ball...

  5. 8. CLOSEUP OF THE GATES ON THE TOBY CREEK OUTLET ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. CLOSEUP OF THE GATES ON THE TOBY CREEK OUTLET AND THE OUTLET OF THE PUMP DISCHARGE CHANNEL, LOOKING NORTHEAST. - Wyoming Valley Flood Control System, Woodward Pumping Station, East of Toby Creek crossing by Erie-Lackawanna Railroad, Edwardsville, Luzerne County, PA

  6. 46 CFR 193.15-25 - Discharge outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 7 2011-10-01 2011-10-01 false Discharge outlets. 193.15-25 Section 193.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 193.15-25 Discharge outlets. (a) Discharge...

  7. 46 CFR 95.15-25 - Discharge outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Discharge outlets. 95.15-25 Section 95.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 95.15-25 Discharge outlets. (a) Discharge...

  8. 46 CFR 193.15-25 - Discharge outlets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 7 2014-10-01 2014-10-01 false Discharge outlets. 193.15-25 Section 193.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide and Clean Agent Extinguishing Systems, Details § 193.15-25 Discharge outlets....

  9. 46 CFR 193.15-25 - Discharge outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 7 2013-10-01 2013-10-01 false Discharge outlets. 193.15-25 Section 193.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) OCEANOGRAPHIC RESEARCH VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide and Clean Agent Extinguishing Systems, Details § 193.15-25 Discharge outlets....

  10. 46 CFR 95.15-25 - Discharge outlets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Discharge outlets. 95.15-25 Section 95.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CARGO AND MISCELLANEOUS VESSELS FIRE PROTECTION EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 95.15-25 Discharge outlets. (a) Discharge...

  11. 7 CFR 993.108 - Non-human consumption outlet.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 8 2014-01-01 2014-01-01 false Non-human consumption outlet. 993.108 Section 993.108... CALIFORNIA Administrative Rules and Regulations Definitions § 993.108 Non-human consumption outlet. Non-human... feed, or other product for non-human use, who has established, to the satisfaction of the...

  12. 7 CFR 993.108 - Non-human consumption outlet.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 8 2012-01-01 2012-01-01 false Non-human consumption outlet. 993.108 Section 993.108... CALIFORNIA Administrative Rules and Regulations Definitions § 993.108 Non-human consumption outlet. Non-human... feed, or other product for non-human use, who has established, to the satisfaction of the...

  13. 7 CFR 993.108 - Non-human consumption outlet.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 8 2013-01-01 2013-01-01 false Non-human consumption outlet. 993.108 Section 993.108... CALIFORNIA Administrative Rules and Regulations Definitions § 993.108 Non-human consumption outlet. Non-human... feed, or other product for non-human use, who has established, to the satisfaction of the...

  14. 46 CFR 108.459 - Number and location of outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND EQUIPMENT Fire Extinguishing Systems Foam Extinguishing Systems § 108.459 Number and location of outlets. (a) A foam extinguishing system in a space must have enough outlets to spread a layer of foam of uniform thickness over the deck or bilge areas of the space. (b) A foam extinguishing system in a...

  15. 14 CFR 25.977 - Fuel tank outlet.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Fuel tank outlet. 25.977 Section 25.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.977 Fuel tank outlet. (a) There must...

  16. 14 CFR 29.977 - Fuel tank outlet.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Fuel tank outlet. 29.977 Section 29.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Powerplant Fuel System § 29.977 Fuel tank outlet. (a) There must...

  17. 14 CFR 25.977 - Fuel tank outlet.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Fuel tank outlet. 25.977 Section 25.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.977 Fuel tank outlet. (a) There must...

  18. 14 CFR 29.977 - Fuel tank outlet.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Fuel tank outlet. 29.977 Section 29.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Powerplant Fuel System § 29.977 Fuel tank outlet. (a) There must...

  19. 14 CFR 25.977 - Fuel tank outlet.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Fuel tank outlet. 25.977 Section 25.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.977 Fuel tank outlet. (a) There must...

  20. 14 CFR 25.977 - Fuel tank outlet.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Fuel tank outlet. 25.977 Section 25.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Powerplant Fuel System § 25.977 Fuel tank outlet. (a) There must...

  1. 14 CFR 29.977 - Fuel tank outlet.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Fuel tank outlet. 29.977 Section 29.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Powerplant Fuel System § 29.977 Fuel tank outlet. (a) There must...

  2. 14 CFR 29.977 - Fuel tank outlet.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Fuel tank outlet. 29.977 Section 29.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Powerplant Fuel System § 29.977 Fuel tank outlet. (a) There must...

  3. 14 CFR 29.977 - Fuel tank outlet.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Fuel tank outlet. 29.977 Section 29.977 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY ROTORCRAFT Powerplant Fuel System § 29.977 Fuel tank outlet. (a) There must...

  4. 46 CFR 111.79-1 - Receptacle outlets; general.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Receptacle outlets; general. 111.79-1 Section 111.79-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Receptacles § 111.79-1 Receptacle outlets; general. (a) There must be a...

  5. 46 CFR 111.79-1 - Receptacle outlets; general.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 4 2011-10-01 2011-10-01 false Receptacle outlets; general. 111.79-1 Section 111.79-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Receptacles § 111.79-1 Receptacle outlets; general. (a) There must be a...

  6. 46 CFR 111.79-1 - Receptacle outlets; general.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 4 2013-10-01 2013-10-01 false Receptacle outlets; general. 111.79-1 Section 111.79-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Receptacles § 111.79-1 Receptacle outlets; general. (a) There must be a...

  7. 46 CFR 111.79-1 - Receptacle outlets; general.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 4 2012-10-01 2012-10-01 false Receptacle outlets; general. 111.79-1 Section 111.79-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Receptacles § 111.79-1 Receptacle outlets; general. (a) There must be a...

  8. 46 CFR 111.79-1 - Receptacle outlets; general.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 4 2014-10-01 2014-10-01 false Receptacle outlets; general. 111.79-1 Section 111.79-1 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) ELECTRICAL ENGINEERING ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Receptacles § 111.79-1 Receptacle outlets; general. (a) There must be a...

  9. 7 CFR 993.108 - Non-human consumption outlet.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 8 2011-01-01 2011-01-01 false Non-human consumption outlet. 993.108 Section 993.108... CALIFORNIA Administrative Rules and Regulations Definitions § 993.108 Non-human consumption outlet. Non-human... feed, or other product for non-human use, who has established, to the satisfaction of the...

  10. 7 CFR 993.108 - Non-human consumption outlet.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Non-human consumption outlet. 993.108 Section 993.108... CALIFORNIA Administrative Rules and Regulations Definitions § 993.108 Non-human consumption outlet. Non-human... feed, or other product for non-human use, who has established, to the satisfaction of the...

  11. 49 CFR 178.345-11 - Tank outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 2 2010-10-01 2010-10-01 false Tank outlets. 178.345-11 Section 178.345-11... Specifications for Containers for Motor Vehicle Transportation § 178.345-11 Tank outlets. (a) General. As used in this section, “loading/unloading outlet” means any opening in the cargo tank wall used for loading...

  12. 49 CFR 179.200-17 - Bottom outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the valve shall be closed by a plug, cap, or approved quick coupling device. The bottom outlet...) or including an auxiliary valve with a threaded closure. (iii) A quick-coupling device using a... the outlet nozzle above the closure (see Fig. E17.7). (iv) A two-piece quick-coupling device using...

  13. DESCHUTES. WICKIUP DAM OUTLET WORKS. LOOKING DOWNSTREAM; AFTER COMPLETION OF ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    DESCHUTES. WICKIUP DAM OUTLET WORKS. LOOKING DOWNSTREAM; AFTER COMPLETION OF MONTAG & SONS CONTRACT. Photocopy of historic photograph (original photograph on file at National Archives, Rocky Mountain Region, Denver, CO). Unknown USBR photographer, November 24, 1940 - Wickiup Dam, Outlet Works, Deschutes River, La Pine, Deschutes County, OR

  14. The geography of Fast Food outlets: a review.

    PubMed

    Fraser, Lorna K; Edwards, Kimberly L; Cade, Janet; Clarke, Graham P

    2010-05-01

    The availability of food high in fat, salt and sugar through Fast Food (FF) or takeaway outlets, is implicated in the causal pathway for the obesity epidemic. This review aims to summarise this body of research and highlight areas for future work. Thirty three studies were found that had assessed the geography of these outlets. Fourteen studies showed a positive association between availability of FF outlets and increasing deprivation. Another 13 studies also included overweight or obesity data and showed conflicting results between obesity/overweight and FF outlet availability. There is some evidence that FF availability is associated with lower fruit and vegetable intake. There is potential for land use policies to have an influence on the location of new FF outlets. Further research should incorporate good quality data on FF consumption, weight and physical activity.

  15. Complete vaginal outlet stenosis in a patient with Sheehan’s syndrome

    PubMed Central

    Choo, Minji; Park, Hana

    2016-01-01

    We present a case of complete vaginal stenosis in a woman diagnosed with Sheehan’s syndrome. The patient delivered at full-term 5 months prior, and experienced massive postpartum bleeding at that time. During evaluation of persistent amenorrhea, we found that her vaginal orifice was completely adhesive and obstructed. Prior to corrective surgery, we managed the patient with an oral contraceptive to induce uterine bleeding into the vaginal outflow tract. After three cycles of an oral contraceptive, we could confirm that there was no stenotic lesion in the vaginal cavity as a hematocolpos was created. Adhesiolysis with scar revision for the vaginal stenosis was successfully performed; it was found that the lesion was limited to only the distal part of the vaginal outlet. Complete vaginal stenosis in reproductive age women with hypopituitarism has not been reported. The artificial induction of hematometrocolpos before surgery was useful in determining the extent of the stenotic lesion, and assured safety. PMID:27896263

  16. Intestinal obstruction repair - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100116.htm Intestinal obstruction repair - series—Normal anatomy To use the sharing ... M. Editorial team. Related MedlinePlus Health Topics Adhesions Intestinal Obstruction A.D.A.M., Inc. is accredited by ...

  17. Intestinal obstruction (pediatric) - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100165.htm Intestinal obstruction (pediatric) - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Intestinal Obstruction A.D.A.M., Inc. is accredited by ...

  18. Development of a CFD urethral model to study flow-generated vortices under different conditions of prostatic obstruction.

    PubMed

    Pel, Johan J M; van Mastrigt, Ron

    2007-01-01

    A novel, non-invasive method to diagnose bladder outlet obstruction involves the recording of noise with a contact microphone pressed against the perineum (between anus and scrotum). This noise results from flow-generated vortices caused by prostatic obstruction. We developed a computational fluid dynamic (CFD) urethral model including urethral geometry to study the relation between generated noise and the degree of obstruction. This model comprised a bladder, bladder neck, prostate and urethra. Calculations were carried out at four bladder pressures, five degrees of obstruction and three obstruction shapes. For each of the sixty simulations, the velocity and pressure distributions along the urethra were calculated including wall shear stresses to localize flow transition from disturbed to normal. Negative pressures at the obstruction outlet induced recirculation of flow. The location of transition was independent of the applied bladder pressure, but it depended primarily on the degree and secondarily on the shape of the obstruction. Based on the presented results, we hypothesize that the location of the maximum amplitude of perineal noise mainly depends on the degree and shape of the prostatic obstruction. Our future aim is to test our hypothesis in male patients and to extend the presented model to 3D with a viscoelastic urethral wall to calculate the fluid-wall interaction.

  19. Authorship outlets of academic health sciences librarians.

    PubMed Central

    Bradigan, P S; Mularski, C A

    1992-01-01

    Journal articles are the most common publication format for U.S. academic health sciences librarians. This is consistent with the findings of other researchers. Of the total publications in this study, 68% were in journals. Watson found that 69% of the academic librarians' publications were published in some type of journal [8]. Similarly, Yerkey and Glogowski found that 67% of the publications in their study were journal articles, although their population consisted of all types of authors of library/information science materials [9]. Both the present study and Watson found that monographs were the second most common publication outlet. Watson found that 16% of the total publications were monographs; the current study identified 14.8% of the total publications as monographs [10]. Although Watson's findings are similar to the newer results, it is important to note that Watson's study was conducted in a different manner and included book reviews, which were not counted in the present study. The health sciences librarians in the present study published more than two thirds of their articles in library/information science journals and 27% in health sciences journals. Similarly, in Yerkey and Glogowski's study, the second-largest number of library/information science articles appeared in medical and health sciences journals [11]. Fang also found that 22.57% of the journal articles on health sciences librarianship or by health sciences librarians were in medical journals [12. This seems to demonstrate the desire of health sciences librarians to communicate with the health professionals. Yerkey and Glogowski that library and information science is an interdisciplinary field, "borrowing and supplying information to and from other disciplines"[13]. PMID:1600429

  20. 1. View east at west facade of culvert outlet headwall, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. View east at west facade of culvert outlet headwall, above which part of the canal bank has been removed. Foreground to background: streambed and coffer dam (mound in center) that was used in dewatering the culvert; intake pipes (extreme left and right) for dewatering pumps; deteriorated culvert outlet headwall with upper portion of wall fallen away; horizontal masonry cutoff wall extending above the culvert outlet partially up the canal bank (cutoff wall was exposed by removal of part of canal bank); towpath at top of canal bank. - Delaware & Raritan Canal, Six Mile Run Culvert, .2 mile South of Blackwells Mills Road, East Millstone, Somerset County, NJ

  1. Venous Thoracic Outlet Syndrome as a Cause of Intractable Migraines.

    PubMed

    Chahwala, Veer; Tashiro, Jun; Li, Xiaoyi; Baqai, Atif; Rey, Jorge; Robinson, Handel R

    2017-02-01

    Thoracic outlet syndrome (TOS) refers to the compression of the neurovascular bundle within the thoracic outlet. Cases are classified by primary etiology-arterial, neurogenic, or venous. In addition to the typical symptoms of arm swelling and paresthesias, headaches have been reported as a potential symptom of TOS. In this report, we describe a patient with debilitating migraines, which were consistently preceded by unilateral arm swelling. Resolution of symptoms occurred only after thoracic outlet decompression. Patients with migraines and concomitant swelling and/or paresthesias, especially related to provocative arm maneuvers, should be considered a possible atypical presentation of TOS and evaluated in more detail.

  2. [Laparoscopic treatment of duodenal obstruction in a patient with pancreatic cancer].

    PubMed

    Machado, M A; da Rocha, J R; Bove, C; Machado, M C

    1997-01-01

    We present a case report of laparoscopic gastrojejunostomy in a patient with duodenal obstruction from unresectable cancer. We performed an side-to-side intracorporeal gastrojejunostomy using endoscopic stapling devices. The patient had no morbidity and he was discharge on fourth postoperative day. Laparoscopic gastric bypass is an alternative to open procedure in well selected cases.

  3. Measuring Nasal Obstruction.

    PubMed

    Keeler, Jarrod; Most, Sam P

    2016-08-01

    The nose and the nasal airway is highly complex with intricate 3-dimensional anatomy, with multiple functions in respiration and filtration of the respired air. Nasal airway obstruction (NAO) is a complex problem with no clearly defined "gold-standard" in measurement. There are 3 tools for the measurement of NAO: patient-derived measurements, physician-observed measurements, and objective measurements. We continue to work towards finding a link between subjective and objective nasal obstruction. The field of evaluation and surgical treatment for NAO has grown tremendously in the past 4-5 decades and will continue to grow as we learn more about the pathophysiology and treatment of nasal obstruction.

  4. Field Validation of Secondary Data Sources for Enumerating Retail Tobacco Outlets in a State without Tobacco Outlet Licensing

    PubMed Central

    D’Angelo, Heather; Fleischhacker, Sheila; Rose, Shyanika W.; Ribisl, Kurt M.

    2014-01-01

    Identifying tobacco retail outlets for U.S. FDA compliance checks or calculating tobacco outlet is difficult in the 13 states without tobacco retail licensing or where licensing lists are unavailable for research. This study uses primary data collection to identify tobacco outlets in three counties in a non-licensing state and validate two commercial secondary data sources. We calculated sensitivity and positive predictive values (PPV) to validate the secondary data sources, and conducted a geospatial analysis to determine correct allocation to census tract. ReferenceUSA had almost perfect sensitivity (0.82) while Dun & Bradstreet (D&B) had substantial sensitivity (0.69) for identifying tobacco outlets; combined, sensitivity improved to 0.89. D&B identified fewer “false positives” with a PPV of 0.82 compared to 0.71 for ReferenceUSA. ReferenceUSA geocoded over 90% of outlets to the correct census tract. Combining two commercial data sources resulted in enumeration of nearly 90% of tobacco outlets in a three county area. Commercial databases appear to provide a reasonably accurate way to identify tobacco outlets for enforcement operations and density estimation. PMID:24742811

  5. Field validation of secondary data sources for enumerating retail tobacco outlets in a state without tobacco outlet licensing.

    PubMed

    D'Angelo, Heather; Fleischhacker, Sheila; Rose, Shyanika W; Ribisl, Kurt M

    2014-07-01

    Identifying tobacco retail outlets for U.S. FDA compliance checks or calculating tobacco outlet density is difficult in the 13 States without tobacco retail licensing or where licensing lists are unavailable for research. This study uses primary data collection to identify tobacco outlets in three counties in a non-licensing state and validate two commercial secondary data sources. We calculated sensitivity and positive predictive values (PPV) to examine the evidence of validity for two secondary data sources, and conducted a geospatial analysis to determine correct allocation to census tract. ReferenceUSA had almost perfect sensitivity (0.82) while Dun & Bradstreet (D&B) had substantial sensitivity (0.69) for identifying tobacco outlets; combined, sensitivity improved to 0.89. D&B identified fewer "false positives" with a PPV of 0.82 compared to 0.71 for ReferenceUSA. More than 90% of the outlets identified by ReferenceUSA were geocoded to the correct census tract. Combining two commercial data sources resulted in enumeration of nearly 90% of tobacco outlets in a three county area. Commercial databases appear to provide a reasonably accurate way to identify tobacco outlets for enforcement operations and density estimation.

  6. Gastric rupture after Heimlich maneuver and cardiopulmonary resuscitation.

    PubMed

    Tung, P H; Law, S; Chu, K M; Law, W L; Wong, J

    2001-01-01

    Choking is a common emergency problem. The Heimlich maneuver is unquestionably effective in relieving airway obstruction. Serious and life-threatening complications may arise, however, if the maneuver is applied incorrectly. Two cases of gastric rupture after Heimlich maneuver are reported. Lay public, paramedics and the medical professionals should be educated with the correct technique of Heimlich maneuver and its potential complications. All patients receiving Heimlich maneuver should be examined by an experienced physician.

  7. Mechanical Intestinal Obstruction in a Porcine Model: Effects of Intra-Abdominal Hypertension. A Preliminary Study

    PubMed Central

    Sánchez-Margallo, F. M.; Latorre, R.; López-Albors, O.; Wise, R.; Malbrain, M. L. N. G.; Castellanos, G.

    2016-01-01

    Introduction Mechanical intestinal obstruction is a disorder associated with intra-abdominal hypertension and abdominal compartment syndrome. As the large intestine intraluminal and intra-abdominal pressures are increased, so the patient’s risk for intestinal ischaemia. Previous studies have focused on hypoperfusion and bacterial translocation without considering the concomitant effect of intra-abdominal hypertension. The objective of this study was to design and evaluate a mechanical intestinal obstruction model in pigs similar to the human pathophysiology. Materials and Methods Fifteen pigs were divided into three groups: a control group (n = 5) and two groups of 5 pigs with intra-abdominal hypertension induced by mechanical intestinal obstruction. The intra-abdominal pressures of 20 mmHg were maintained for 2 and 5 hours respectively. Hemodynamic, respiratory and gastric intramucosal pH values, as well as blood tests were recorded every 30 min. Results Significant differences between the control and mechanical intestinal obstruction groups were noted. The mean arterial pressure, cardiac index, dynamic pulmonary compliance and abdominal perfusion pressure decreased. The systemic vascular resistance index, central venous pressure, pulse pressure variation, airway resistance and lactate increased within 2 hours from starting intra-abdominal hypertension (p<0.05). In addition, we observed increased values for the peak and plateau airway pressures, and low values of gastric intramucosal pH in the mechanical intestinal obstruction groups that were significant after 3 hours. Conclusion The mechanical intestinal obstruction model appears to adequately simulate the pathophysiology of intestinal obstruction that occurs in humans. Monitoring abdominal perfusion pressure, dynamic pulmonary compliance, gastric intramucosal pH and lactate values may provide insight in predicting the effects on endorgan function in patients with mechanical intestinal obstruction. PMID

  8. 49 CFR 179.103-5 - Bottom outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... include an in-line auxiliary valve, either integral with the quick-coupling device or located between the... integral auxiliary test valve, a minimum 1-inch NPT pipe plug shall be installed in the outlet nozzle...

  9. 3. VIEW OF UPSTREAM FACE OF DAM, SHOWING OUTLET GATE, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. VIEW OF UPSTREAM FACE OF DAM, SHOWING OUTLET GATE, LOOKING NORTHEAST - High Mountain Dams in Upalco Unit, Island Lake Dam, Ashley National Forest, 4.8 miles North of Miners Gulch Campground, Mountain Home, Duchesne County, UT

  10. 3. VIEW SHOWING CRIBBED LOG HOUSING FOR OUTLET GATE WHEEL, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. VIEW SHOWING CRIBBED LOG HOUSING FOR OUTLET GATE WHEEL, LOOKING SOUTHEAST - High Mountain Dams in Upaco Unit, Superior Lake Dam, Ashley National Forest, 12.4 miles Northwest of Swift Creek Campground, Mountain Home, Duchesne County, UT

  11. 3. AERIAL VIEW OF THREE BEARS LAKE, SHOWING OUTLET STREAM, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. AERIAL VIEW OF THREE BEARS LAKE, SHOWING OUTLET STREAM, BURLINGTON NORTHERN TRACKS, AND U.S. HIGHWAY 2, LOOKING NORTHEAST - Three Bears Lake & Dams, North of Marias Pass, East Glacier Park, Glacier County, MT

  12. 8. DETAIL VIEW OF INCLINED OUTLET GATE WHEEL, LOOKING EAST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. DETAIL VIEW OF INCLINED OUTLET GATE WHEEL, LOOKING EAST - High Mountain Dams in Upalco Unit, Kidney Lake Dam, Ashley National Forest, 4.7 miles North of Miners Gulch Campground, Mountain Home, Duchesne County, UT

  13. 7. VIEW OF INCLINED OUTLET GATE WHEEL AND STEM, LOOKING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. VIEW OF INCLINED OUTLET GATE WHEEL AND STEM, LOOKING NORTH - High Mountain Dams in Upalco Unit, Kidney Lake Dam, Ashley National Forest, 4.7 miles North of Miners Gulch Campground, Mountain Home, Duchesne County, UT

  14. 64. Penstock housing with outlet needle valve at lower left. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    64. Penstock housing with outlet needle valve at lower left. Roadway support work is visible at top. Photographer Mark Durben. Source: Salt River Project. - Waddell Dam, On Agua Fria River, 35 miles northwest of Phoenix, Phoenix, Maricopa County, AZ

  15. Materials for outlet ducts in wet FGD systems

    SciTech Connect

    Rosenberg, H.S.; Koch, G.H.; Kistler, C.W.; Beavers, J.A.; Meadows, M.L.; Stewart, D.A.; Dene, C.E.

    1985-01-01

    It was found that the major materials problems are occurring with outlet ducts and stack linings. Outlet ducts and stacks are critical components in that failures may require complete boiler shutdown and loss of generating capacity for lengthy periods due to the lack of standby components or bypass capability. Accordingly, EPRI funded a study by Battelle on the performance of candidate materials in the outlet ducts of FGD systems at two utility plants. Because of the impact of materials failures on FGD system reliability, EPRI is currently funding a study by Battelle on the causes of these failures. This study involves site visits for field evaluations of the failures, laboratory analyses of samples collected in the field, and analysis of the data to establish the causes of the failures. Information on outlet ducts is presented in this paper.

  16. 3. GENERAL VIEW LOOKING EAST. DISCHARGE OUTLET IS VISIBLE AT ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. GENERAL VIEW LOOKING EAST. DISCHARGE OUTLET IS VISIBLE AT CENTER. WASTE WEIR BUILDING IS AT RIGHT. - Old Croton Aqueduct, Mill River Waste Weir, U.S. Route 9 at Sleepy Hollow Cemetery, Tarrytown, Westchester County, NY

  17. 5. VIEW OF TUNNEL OUTLET AND CHANNEL, LOOKING SOUTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW OF TUNNEL OUTLET AND CHANNEL, LOOKING SOUTH - High Mountain Dams in Upalco Unit, Farmers Lake Tunnel, Ashley National Forest, 5.7 miles North of Swift Creek Campground, Mountain Home, Duchesne County, UT

  18. 28. Main water inlet and outlet pipes under central corridor ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    28. Main water inlet and outlet pipes under central corridor of filtration bed building. - Lake Whitney Water Filtration Plant, Filtration Plant, South side of Armory Street between Edgehill Road & Whitney Avenue, Hamden, New Haven County, CT

  19. 20. OUTLET (FOREGROUND) AND WEIR (BACKGROUND) OF DEER FLAT CALDWELL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. OUTLET (FOREGROUND) AND WEIR (BACKGROUND) OF DEER FLAT CALDWELL CANAL ON DOWNSTREAM FACE OF UPPER EMBANKMENT. VIEW TO NORTH. - Boise Project, Deer Flat Embankments, Lake Lowell, Nampa, Canyon County, ID

  20. 16. DETAIL OF OUTLET OF DEER FLAT NAMPA CANAL ON ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    16. DETAIL OF OUTLET OF DEER FLAT NAMPA CANAL ON DOWNSTREAM FACE OF UPPER EMBANKMENT (NOTE TWO FILLED-IN PORTALS). VIEW TO EAST. - Boise Project, Deer Flat Embankments, Lake Lowell, Nampa, Canyon County, ID

  1. 4. View of dam front and sluiceway outlets Mississippi ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. View of dam front and sluiceway outlets - Mississippi River 9-Foot Channel, Lock & Dam No. 1, In Mississippi River at Mississippi Boulevard, below Ford Parkway Bridge, Saint Paul, Ramsey County, MN

  2. 7. VIEW OF UPRIGHT OUTLET GATE, WHEEL STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. VIEW OF UPRIGHT OUTLET GATE, WHEEL STEM AND STEM GUIDE (14' DIAMETER CIRCULAR CALCO CAST IRON SLIDE GATE), LOOKING SOUTHEAST - High Mountain Dams in Bonneville Unit, Fire Lake Dam, Wasatch National Forest, Kamas, Summit County, UT

  3. 5. VIEW OF INCLINED OUTLET GATE WHEEL, STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW OF INCLINED OUTLET GATE WHEEL, STEM AND STEM GUIDE, (12' DIAMETER HARDESTY MODEL 112 CIRCULAR GATE), LOOKING NORTHEAST - High Mountain Dams in Bonneville Unit, Island Lake Dam, Wasatch National Forest, Kamas, Summit County, UT

  4. 4. VIEW OF INCLINED OUTLET GATE WHEEL AND STEM, LOOKING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. VIEW OF INCLINED OUTLET GATE WHEEL AND STEM, LOOKING NORTHWEST - High Mountain Dams in Upalco Unit, Brown Duck Lake Dam, Ashley National Forest, 4.4 miles North of Miners Gulch Campground, Mountain Home, Duchesne County, UT

  5. 5. VIEW SHOWING INCLINED OUTLET GATE WHEEL, STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW SHOWING INCLINED OUTLET GATE WHEEL, STEM AND STEM GUIDE (28' WIDE HARDESTY CAST IRON SLIDE HEADGATE), LOOKING NORTHEAST - High Mountain Dams in Bonneville Unit, Duck Lake Dam, Wasatch National Forest, Kamas, Summit County, UT

  6. 5. VIEW OF UPRIGHT OUTLET GATE WHEEL, STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW OF UPRIGHT OUTLET GATE WHEEL, STEM AND STEM GUIDE, LOOKING NORTHWEST - High Mountain Dams in Upalco Unit, Drift Lake Dam, Ashley National Forest, 11.4 miles Northwest of Swift Creek Campground, Mountain Home, Duchesne County, UT

  7. 4. VIEW SHOWING OUTLET GATE WHEEL AND STEM, LOOKING NORTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. VIEW SHOWING OUTLET GATE WHEEL AND STEM, LOOKING NORTH - High Mountain Dams in Upalco Unit, Clements Lake Dam, Ashley National Forest, 6.5 miles North of Miners Gulch Campground, Mountain Home, Duchesne County, UT

  8. 6. VIEW SHOWING INCLINED OUTLET GATE WHEEL, STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW SHOWING INCLINED OUTLET GATE WHEEL, STEM AND STEM GUIDE (18' HARDESTY GATE), LOOKING SOUTHEAST - High Mountain Dams in Bonneville Unit, Long Lake Dam, Wasatch National Forest, Kamas, Summit County, UT

  9. 5. VIEW OF UPRIGHT OUTLET GATE, STEM, STEM GUIDE AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW OF UPRIGHT OUTLET GATE, STEM, STEM GUIDE AND WHEEL (10' HARDESTY CAST IRON VERTICAL LIFT GATE), LOOKING WEST - High Mountain Dams in Bonneville Unit, Weir Lake Dam, Wasatch National Forest, Kamas, Summit County, UT

  10. 6. VIEW OF OUTLET GATE WHEEL AND STEM, LOOKING NORTHWEST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW OF OUTLET GATE WHEEL AND STEM, LOOKING NORTHWEST - High Mountain Dams in Upalco Unit, Twin Pots Dam, Ashley National Forest, 10.1 miles North of Mountain Home, Mountain Home, Duchesne County, UT

  11. 5. VIEW OF OUTLET GATE WHEEL AND STEM, LOOKING NORTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW OF OUTLET GATE WHEEL AND STEM, LOOKING NORTH - High Mountain Dams in Upalco Unit, Island Lake Dam, Ashley National Forest, 4.8 miles North of Miners Gulch Campground, Mountain Home, Duchesne County, UT

  12. 7. VIEW OF INCLINED OUTLET GATE WHEEL, STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. VIEW OF INCLINED OUTLET GATE WHEEL, STEM AND STEM GUIDE (15' HARDESTY MODEL 115 GATE), LOOKING NORTHWEST - High Mountain Dams in Bonneville Unit, Marjorie Lake Dam, Wasatch National Forest, Kamas, Summit County, UT

  13. 4. VIEW OF INCLINED OUTLET GATE, STEM, STEM GUIDE AND ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. VIEW OF INCLINED OUTLET GATE, STEM, STEM GUIDE AND WHEEL (10' HARDESTY VERTICAL LIFT GATE), LOOKING NORTHWEST - High Mountain Dams in Bonneville Unit, Pot Lake Dam, Wasatch National Forest, Kamas, Summit County, UT

  14. 5. VIEW OF UPRIGHT OUTLET GATE WHEEL, STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW OF UPRIGHT OUTLET GATE WHEEL, STEM AND STEM GUIDE (HARDESTY CAST IRON RECTANGULAR SLIDE GATE), LOOKING SOUTHWEST - High Mountain Dams in Bonneville Unit, Lost Lake Dam, Kamas, Summit County, UT

  15. Gastric syphilis - Case report*

    PubMed Central

    Guimarães, Tais Ferreira; Novis, Camila Freitas Lobo; Bottino, Caroline Bertolini; D'Acri, Antonio Macedo; Lima, Ricardo Barbosa; Martins, Carlos José

    2016-01-01

    Gastric syphilis is an uncommon extracutaneous manifestation of syphilis, occurring in less than 1% of patients, presenting nonspecific clinical manifestations. In general, it occurs on secondary stage. The critical point is the recognition of the syphilitic gastric involvement, without which there may be incorrect diagnosis of malignancy of the digestive tract. In this report, a case of secondary syphilis with gastric involvement that had complete remission with benzathine penicillin will be described. PMID:27828649

  16. Thoracic outlet syndrome: Fact or fancy? A review of 409 consecutive patients who underwent operation

    PubMed Central

    Jamieson, William G.; Chinnick, Barbara

    1996-01-01

    Objectives From an analysis of patients operated on by a single surgeon between 1973 and 1994 for thoracic outlet syndrome (TOS), to determine what findings are helpful in substantiating this diagnosis and what are the results of decompressive thoracic outlet surgery in the management of TOS. Design A chart review with emphasis on signs, symptoms and results. A preoperative questionnaire was presented to all patients operated on since 1989. Postoperative follow-up was by interview or telephone. Setting A 560-bed university-affiliated tertiary-care teaching hospital. Patients There were 409 adults; 83% were women and the average age was 36 years. In 95% of patients physiotherapy had been unsuccessful. Patients presented with neurologic type (368 [(90%]), arterial impingement (29 [7%]) and venous obstructive symptoms (12 [3%]). The series included 44 patients with bilateral symptoms and 26 patients with cervical ribs. Some form of litigation or compensation was associated with 177 patients. Interventions Transaxillary first rib resection in 380 (93%) patients and supraclavicular thoracic outlet decompression in 29 (7%). In 244 patients there was a follow-up of at least 2 years. These patients constituted the follow-up group. Results Preoperatively, in the 368 patients who had neurologic TOS, 99% displayed supraclavicular brachial plexus tenderness and 98% exacerbation of symptoms with arms in the abduction external rotated position. There were eight complications of surgical intervention (1.9%). In the follow-up group, there were no deaths, no subclavian/axillary artery or vein damage and no brachial plexus injury. Seventy-eight percent of the patients with neurologic TOS in this group improved postoperatively; 21% had complete relief, 32% had good relief and 25% had fair relief. Twenty-two percent showed no improvement. Conclusions Signs and symptoms helpful in making the diagnosis of neurologic TOS are supraclavicular tenderness on palpation and exacerbation of

  17. [Non obstructive retrocaval ureter].

    PubMed

    Cao Avellaneda, E; Server Pastor, G; López López, A I; Maluff Torres, A; López Cubillana, P; Rigabert Montiel, M; Pérez Albacete, M

    2005-01-01

    We report a case on circumcavum ureter without obstruction or type two, according the Batenson and Atkinson's classification, in a forty-nine year old man. It was diagnosticated for a gross haematuria and renoureteral pain, because of a simultaneous urinary tract infection. We emphasize its absence of the typical morphology and obstruction signs. After twelve months the patient is still asymptomatic, without any medical or surgical treatment.

  18. Gastrin and Gastric Cancer

    PubMed Central

    Waldum, Helge L.; Sagatun, Liv; Mjønes, Patricia

    2017-01-01

    Gastric cancer although occurring in reduced frequency is still an important disease, partly because of the bad prognosis when occurring in western countries. This decline in occurrence may mainly be due to the reduced prevalence of Helicobacter pylori (Hp) infection, which is the most important cause of gastric cancer. There exist many different pathological classifications of gastric carcinomas, but the most useful seems to be the one by Lauren into intestinal and diffuse types since these types seldom transform into the other and also have different epidemiology. During the nearly 30 years that have passed since the groundbreaking description of Hp as the cause of gastritis and gastric cancer, a continuous search for the mechanism by which Hp infection causes gastric cancer has been done. Interestingly, it is mainly atrophic gastritis of the oxyntic mucosa that predisposes to gastric cancer possibly by inducing hypoacidity and hypergastrinemia. There are many arguments in favor of an important role of gastrin and its target cell, the enterochromaffin-like cell, in gastric carcinogenesis. The role of gastrin in gastric carcinogenesis implies caution in the long-term treatment with inhibitors of gastric acid secretion inducing secondary hypergastrinemia, in a common disease like gastroesophageal reflux disease. PMID:28144230

  19. [Obstructive uropathy in childhood].

    PubMed

    Balster, S; Schiborr, M; Brinkmann, O A; Hertle, L

    2005-08-01

    "Obstructive uropathy" is a generic term which combines different diseases in infants and childhood. Both the upper and lower urinary tract may be affected. Diseases of the urinary tract can cause an intrinsic obstruction. Sometimes tumours may cause a compression and as secondary effect an obstruction (extrinsic). Ultrasound is the key diagnostic tool and shows dilatation of the obstructed urinary tract. But for the functional exploration of babies and toddlers, renal scanning and X-ray examinations are necessary. These examinations lead to an exposure to radiation which necessitates careful indication. Some of the congenital diseases (for example ureteropelvic junction obstruction, megaureter) show a maturation without any intervention. So one has to decide whether to wait and see or to operate. A percutaneous nephrostomy or a DJ-catheter is not often used in the treatment of obstruction in general. These forms of drainage are more often used in the treatment of stones or of extrinsic obstruction. A pyelocutaneostomy or ureterocutaneostomy is a special surgical procedure in pediatric urology for transient drainage of the upper urinary tract (megaureter). The operation of a seriously ill new-born should be done in a centre for pediatric urology and pediatric nephrology. When the upper urinary tract is dilated, patients may need an antibiotic prophylaxis, because the dilatation of the upper urinary tract increases the risk of urinary tract infections (UTI). The indication for antibiotic prophylaxis should by guided by the criteria of the APN-Consensus Paper. Long-term follow-up is necessary and should comprise ultrasound, physical examination, controlling the blood pressure, urine analysis and blood tests. The aims of diagnostics, treatment and long-term follow-up are the preservation of renal function and to protect the children from UTI. This goal must be reached under conditions that are appropriate for children and their parents.

  20. Improving data accuracy of commercial food outlet databases.

    PubMed

    Ohri-Vachaspati, Punam; Martinez, Diane; Yedidia, Michael J; Petlick, Nirvana

    2011-01-01

    PURPOSE. Assessing food environments often requires using commercially available data. Disparate methods used for classifying food outlets in these databases call for creating a classification approach using common definitions. A systematic strategy for reclassifying food stores and restaurants, as they appear in commercial databases, into categories that differentiate the availability of healthy options is described here. DESIGN AND SETTING. Commercially available data on food outlets including names, addresses, North American Industry Classification System codes, and associated characteristics was obtained for five New Jersey communities. ANALYSIS. A reclassification methodology was developed using criteria and definitions from the literature to categorize food outlets based on availability of healthy options. Information in the database was supplemented by systematic Internet and key word searches, and from phone calls to food outlets. RESULTS. The methodology resulted in 622 supermarket/grocery stores, 183 convenience stores, and 148 specialty stores in the original data to be reclassified into 58 supermarkets, 30 grocery stores, 692 convenience stores, and 115 specialty stores. Outlets from the original list of 1485 full-service restaurants and 506 limited-service restaurants were reclassified as 563 full-service restaurants and 1247 limited-service restaurants. Reclassification resulted in less than one-seventh the number of supermarkets and grocery stores, more than three times the number of convenience stores, and twice as many limited-service restaurants-a much less healthy profile than the one generated by using exclusively the commercial databases. CONCLUSION. An explicit and replicable strategy is proposed for reclassifying food outlets in commercial databases into categories that differentiate on the basis of healthy food availability. The intent is to contribute towards building a consensus among researchers on definitions used in public health

  1. Pediatric primary gastric lymphoma.

    PubMed

    Harris, G J; Laszewski, M J

    1992-04-01

    Primary gastric lymphoma in the pediatric population is rare. We have described a case of non-Hodgkin's lymphoma (Burkitt's type) manifested as a gastric mass. Despite its rarity in children, this tumor should be treated aggressively, since long-term survival has been reported.

  2. Treatment of gastric cancer

    PubMed Central

    Orditura, Michele; Galizia, Gennaro; Sforza, Vincenzo; Gambardella, Valentina; Fabozzi, Alessio; Laterza, Maria Maddalena; Andreozzi, Francesca; Ventriglia, Jole; Savastano, Beatrice; Mabilia, Andrea; Lieto, Eva; Ciardiello, Fortunato; De Vita, Ferdinando

    2014-01-01

    The authors focused on the current surgical treatment of resectable gastric cancer, and significance of peri- and post-operative chemo or chemoradiation. Gastric cancer is the 4th most commonly diagnosed cancer and the second leading cause of cancer death worldwide. Surgery remains the only curative therapy, while perioperative and adjuvant chemotherapy, as well as chemoradiation, can improve outcome of resectable gastric cancer with extended lymph node dissection. More than half of radically resected gastric cancer patients relapse locally or with distant metastases, or receive the diagnosis of gastric cancer when tumor is disseminated; therefore, median survival rarely exceeds 12 mo, and 5-years survival is less than 10%. Cisplatin and fluoropyrimidine-based chemotherapy, with addition of trastuzumab in human epidermal growth factor receptor 2 positive patients, is the widely used treatment in stage IV patients fit for chemotherapy. Recent evidence supports the use of second-line chemotherapy after progression in patients with good performance status PMID:24587643

  3. 46 CFR 111.81-1 - Outlet boxes and junction boxes; general.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Outlet boxes and junction boxes; general. 111.81-1... ELECTRIC SYSTEMS-GENERAL REQUIREMENTS Outlet Boxes and Junction Boxes § 111.81-1 Outlet boxes and junction boxes; general. (a) The requirements of this subpart apply to each outlet box used with a...

  4. Intestinal or bowel obstruction - discharge

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000150.htm Intestinal or bowel obstruction - discharge To use the sharing features on this ... your bowel (intestine). This condition is called an intestinal obstruction . The blockage may be partial or total (complete). ...

  5. Hydrological Modeling of the Jezero Crater Outlet-Forming Flood

    NASA Technical Reports Server (NTRS)

    Fassett, Caleb I.; Goudge, Timothy A.

    2017-01-01

    Jezero crater is a site of prime scientific interest because it was a lake early in Mars history. Preserved clay- and carbonate-bearing sedimentary fans on Jezero's western and northwestern margin (Fig. 2) are accessible to future exploration. Geologic context [1] and stratigraphic analysis of the western fan strongly support the interpretation that these fans were deposited as deltas into the lake. This has helped establish Jezero as one of the final candidate landing sites for Mars 2020. The high level of certainty that Jezero was a lake results from the existence of its outlet valley, which required filling of the crater to form [e.g., 1,4]. Here, we specifically focus on how this outlet valley was carved by the dam breach flood that eroded the eastern crater rim. We have completed preliminary modeling in both 1D and 2D of the outlet's formation.

  6. Melting beneath Greenland outlet glaciers and ice streams

    NASA Astrophysics Data System (ADS)

    Alexander, David; Perrette, Mahé; Beckmann, Johanna

    2015-04-01

    Basal melting of fast-flowing Greenland outlet glaciers and ice streams due to frictional heating at the ice-bed interface contributes significantly to total glacier mass balance and subglacial meltwater flux, yet modelling this basal melt process in Greenland has received minimal research attention. A one-dimensional dynamic ice-flow model is calibrated to the present day longitudinal profiles of 10 major Greenland outlet glaciers and ice streams (including the Jakobshavn Isbrae, Petermann Glacier and Helheim Glacier) and is validated against published ice flow and surface elevation measurements. Along each longitudinal profile, basal melt is calculated as a function of ice flow velocity and basal shear stress. The basal shear stress is dependent on the effective pressure (difference between ice overburden pressure and water pressure), basal roughness and a sliding parametrization. Model output indicates that where outlet glaciers and ice streams terminate into the ocean with either a small floating ice tongue or no floating tongue whatsoever, the proportion of basal melt to total melt (surface, basal and submarine melt) is 5-10% (e.g. Jakobshavn Isbrae; Daugaard-Jensen Glacier). This proportion is, however, negligible where larger ice tongues lose mass mostly by submarine melt (~1%; e.g. Nioghalvfjerdsfjorden Glacier). Modelled basal melt is highest immediately upvalley of the grounding line, with contributions typically up to 20-40% of the total melt for slippery beds and up to 30-70% for resistant beds. Additionally, modelled grounding line and calving front migration inland for all outlet glaciers and ice streams of hundreds of metres to several kilometres occurs. Including basal melt due to frictional heating in outlet glacier and ice stream models is important for more accurately modelling mass balance and subglacial meltwater flux, and therefore, more accurately modelling outlet glacier and ice stream dynamics and responses to future climate change.

  7. Nasal obstruction and human communication.

    PubMed

    Malinoff, R; Moreno, C

    1989-04-01

    Nasal obstruction may cause a variety of communication disorders, particularly in children. The effects of nasal obstruction on hearing, speech, language, and voice are examined. Methods for assessing the effects of nasal obstruction are delineated, and recommendations for therapeutic interventions are described.

  8. Contractile properties of human prostate adenomas and the development of infravesical obstruction.

    PubMed

    Gup, D I; Shapiro, E; Baumann, M; Lepor, H

    1989-01-01

    The contractile response of human prostate adenomas to KCl, phenylephrine (alpha 1 adrenergic agonist), UK 14304 (alpha 2 adrenergic agonist), and carbachol (muscarinic cholinergic agonist) was evaluated in tissue specimens obtained from men with symptomatic and asymptomatic BPH. Prostate specimens were obtained from 5 men with asymptomatic BPH undergoing cystoprostatectomy, 11 men with symptomatic BPH undergoing open prostatectomy, and 11 men with symptomatic BPH undergoing transurethral resection of the prostate (TURP). Quantitative symptom score analysis and urinary flow rate determination documented the absence of bladder outlet obstruction in men undergoing cystoprostatectomy and confirmed the presence of bladder outlet obstruction in men undergoing prostatectomy. The magnitude of the contractile response (Emax) and the potency of phenylephrine-induced contractions (EC50) in prostatic preparations obtained from men with symptomatic and asymptomatic BPH were similar. The IC50 for the inhibition of phenylephrine-induced contractions by prazosin was 3.2 nM, confirming that phenylephrine-induced contraction in the human prostate is mediated by the alpha 1 adrenoceptor. The contractile responses of prostate adenomas to muscarinic cholinergic and alpha 2 agonists were negligible. This study demonstrates that the development of bladder outlet obstruction in men with BPH is not related to alterations in the functional response of the smooth muscle component of the prostate adenoma.

  9. Long thoracic nerve paralysis associated with thoracic outlet syndrome.

    PubMed

    Nakatsuchi, Y; Saitoh, S; Hosaka, M; Uchiyama, S

    1994-01-01

    Two cases of long thoracic nerve palsy associated with thoracic outlet syndrome are reported. Both patients had abnormal posture, with low-set shoulders and winged scapulae. Clinically there was weakness of the serratus anterior muscle with partial denervotion on electromyography. The diagnosis of thoracic outlet syndrome was based on positive vascular tests and brachial plexus nerve compression symptoms induced by the vascular testing positions. An orthosis that held the shoulder in an elevated position was used in both cases. Complete recovery of shoulder function and relief of the symptoms was achieved in both cases at 8 and 13 months, respectively, after application of the orthosis.

  10. Osteoid osteoma of the rib presenting as thoracic outlet syndrome.

    PubMed

    Kargar, Saeed; Arefanian, Saeed; Ghasemi, Afsaneh; Binesh, Fariba; Heiranizadeh, Naeimeh

    2013-12-01

    Osteoid osteoma of the rib is a rare condition mostly mentioned in case report studies as lesions involving posterior region of the rib causing scoliosis. This report presents a 22-year-old man who complained of neurologic thoracic outlet syndrome symptoms. The pathologic study of the resected mass of the first rib confirmed the diagnosis of osteoid osteoma. This unique presentation of the osteoid osteoma as thoracic outlet syndrome suggests that this pathologic involvement of the ribs is not confined to the symptoms of pain and scoliosis.

  11. Genetics of Gastric Cancer.

    PubMed

    Strand, Matthew S; Lockhart, Albert Craig; Fields, Ryan C

    2017-04-01

    Gastric cancer represents a major cause of cancer mortality worldwide despite a declining incidence. New molecular classification schemes developed from genomic and molecular analyses of gastric cancer have provided a framework for understanding this heterogenous disease, and early findings suggest these classifications will be relevant for designing and implementing new targeted therapies. The success of targeted therapy and immunotherapy in breast cancer and melanoma, respectively, has not been duplicated in gastric cancer, but trastuzumab and ramucirumab have demonstrated efficacy in select populations. New markers that predict therapeutic response are needed to improve patient selection for both targeted and immunotherapies.

  12. An Unusual Cause of Duodenal Obstruction: Persimmon Phytobezoar.

    PubMed

    Fan, Shengxian; Wang, Jing; Li, Yousheng

    2016-12-01

    Duodenal phytobezoar, an unusual cause of acute duodenal obstruction, is rarely seen. The most common cause of this type of bezoar is persimmon. It frequently arises from underlying gastrointestinal tract pathologies (gastric surgery, etc.). Here, we report the case of a 66-year-old man who had undergone distal gastrectomy with Billroth I reconstruction for gastric cancer and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. The abdominal computed tomography scan showed a large-sized mass in the horizontal portion of the duodenum. On following endoscopic examination, a large phytobezoar was revealed in the duodenum. He was treated with endoscopic fragmentation combined with nasogastric Coca-Cola. The patient tolerated the procedure well and resumed a normal oral diet 3 days later.

  13. Experimental validation of tonal noise control from subsonic axial fans using flow control obstructions

    NASA Astrophysics Data System (ADS)

    Gérard, Anthony; Berry, Alain; Masson, Patrice; Gervais, Yves

    2009-03-01

    This paper presents the acoustic performance of a novel approach for the passive adaptive control of tonal noise radiated from subsonic fans. Tonal noise originates from non-uniform flow that causes circumferentially varying blade forces and gives rise to a considerably larger radiated dipolar sound at the blade passage frequency (BPF) and its harmonics compared to the tonal noise generated by a uniform flow. The approach presented in this paper uses obstructions in the flow to destructively interfere with the primary tonal noise arising from various flow conditions. The acoustic radiation of the obstructions is first demonstrated experimentally. Indirect on-axis acoustic measurements are used to validate the analytical prediction of the circumferential spectrum of the blade unsteady lift and related indicators generated by the trapezoidal and sinusoidal obstructions presented in Ref. [A. Gérard, A. Berry, P. Masson, Y. Gervais, Modelling of tonal noise control from subsonic axial fans using flow control obstructions, Journal of Sound and Vibration (2008), this issue, doi: 10.1016/j.jsv.2008.09.027.] and also by cylindrical obstructions used in the literature. The directivity and sound power attenuation are then given in free field for the control of the BPF tone generated by rotor/outlet guide vane (OGV) interaction and the control of an amplified BPF tone generated by the rotor/OGV interaction with an added triangular obstruction between two outlet guide vanes to enhance the primary non-uniform flow. Global control was demonstrated in free field, attenuation up to 8.4 dB of the acoustic power at BPF has been measured. Finally, the aerodynamic performances of the automotive fan used in this study are almost not affected by the presence of the control obstruction.

  14. OBSTRUCTION LIGHT SYSTEM.

    DTIC Science & Technology

    The report describes the design, development and fabrication of a prototype high intensity obstruction lighting system. A detailed light source ... study was made which indicated a newly developed lamp consisting of a quartz-iodide lamp sealed in a parabolic envelope, was the most advantageous type

  15. Biliary obstruction - slideshow

    MedlinePlus

    ... anatomy URL of this page: //medlineplus.gov/ency/presentations/100199.htm Biliary obstruction - series—Normal anatomy To use the sharing features on this page, please enable JavaScript. Go to slide 1 out of 4 Go to slide 2 ...

  16. Occupation and gastric cancer

    PubMed Central

    Raj, A; Mayberry, J; Podas, T

    2003-01-01

    Gastric cancer is a cause of significant morbidity and mortality. There are several risk factors, with occupation emerging as one of these. There is considerable evidence that occupations in coal and tin mining, metal processing, particularly steel and iron, and rubber manufacturing industries lead to an increased risk of gastric cancer. Other "dusty" occupations—for example, wood processing, or work in high temperature environments have also been implicated but the evidence is not strong. The mechanism of pathogenesis of gastric cancer is unclear and the identification of causative agents can be difficult. Dust is thought to be a contributor to the pathological process, but well known carcinogens such as N-nitroso compounds have been detected in some environments. Further research on responsible agents is necessary and screening for detection of precursor gastric cancer lesions at the workplace merits consideration. PMID:12782770

  17. Gastric Sleeve Surgery

    MedlinePlus

    ... or "sleeve" out of the rest. The new, banana-shaped stomach is much smaller than the original ... of your stomach, leaving you with a smaller banana-shaped stomach called the gastric sleeve. Because it's ...

  18. Gastric bypass surgery

    MedlinePlus

    ... your legs to help prevent blood clots from forming. You will receive shots of medicine to prevent ... diversion with duodenal switch Dumping syndrome References Buchwald H. Laparoscopic Roux-en-Y gastric bypass. In: Buchwald ...

  19. 7 CFR 929.104 - Outlets for excess cranberries.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 8 2014-01-01 2014-01-01 false Outlets for excess cranberries. 929.104 Section 929... SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE CRANBERRIES... excess cranberries. (a) In accordance with § 929.61, excess cranberries may be disposed of only in...

  20. 7 CFR 929.104 - Outlets for excess cranberries.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 8 2013-01-01 2013-01-01 false Outlets for excess cranberries. 929.104 Section 929... SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE CRANBERRIES... excess cranberries. (a) In accordance with § 929.61, excess cranberries may be disposed of only in...

  1. 7 CFR 929.104 - Outlets for excess cranberries.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 8 2012-01-01 2012-01-01 false Outlets for excess cranberries. 929.104 Section 929... SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE CRANBERRIES... excess cranberries. (a) In accordance with § 929.61, excess cranberries may be disposed of only in...

  2. Triple outlet right ventricle: a previously unknown cardiac malformation.

    PubMed

    Tingo, Jennifer E; Carroll, Sheila J; Crystal, Matthew A

    2015-03-01

    We present the case of an infant with three distinct outflow tracts from the right ventricle. Three outlets from the heart have been previously named the "Tritruncal Heart". We review the two previously reported cases of tritruncal hearts and describe the anatomy, diagnosis, surgical management, and outcome of our case. Embryologic implications are also discussed.

  3. 6. DAM AFTERBAY, WITH OWYEE RIVER IN FOREGROUND, SHOWING OUTLET ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. DAM AFTERBAY, WITH OWYEE RIVER IN FOREGROUND, SHOWING OUTLET TUNNEL PORTAL (LEFT) AND POWERHOUSE AND ENTRANCE PORTAL TO DAM INTERIOR (RIGHT). NOTE RELEASE OF WATER FROM NEEDLE VALVE NUMBER 2 IN VALVEHOUSE ON DAM. VIEW TO SOUTHEAST. - Owyhee Dam, Across Owyhee River, Nyssa, Malheur County, OR

  4. 7 CFR 929.104 - Outlets for excess cranberries.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... GROWN IN STATES OF MASSACHUSETTS, RHODE ISLAND, CONNECTICUT, NEW JERSEY, WISCONSIN, MICHIGAN, MINNESOTA, OREGON, WASHINGTON, AND LONG ISLAND IN THE STATE OF NEW YORK Rules and Regulations § 929.104 Outlets for... nonhuman food use. (4) Research and development projects approved by the committee dealing with...

  5. 7 CFR 929.104 - Outlets for excess cranberries.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... GROWN IN STATES OF MASSACHUSETTS, RHODE ISLAND, CONNECTICUT, NEW JERSEY, WISCONSIN, MICHIGAN, MINNESOTA, OREGON, WASHINGTON, AND LONG ISLAND IN THE STATE OF NEW YORK Rules and Regulations § 929.104 Outlets for... nonhuman food use. (4) Research and development projects approved by the committee dealing with...

  6. Remote determinations on fumarole outlet temperatures in an eruptive volcano

    NASA Astrophysics Data System (ADS)

    Tsunogai, Urumu; Cheng, Lin; Ito, Masanori; Komatsu, Daisuke D.; Nakagawa, Fumiko; Shinohara, Hiroshi

    2016-11-01

    Direct measurement of the fumarole outlet temperature in active volcanoes is impractical. Therefore, we used an aircraft to sample H2 in the volcanic plume ejected from Sakurajima volcano to remotely estimate the highest fumarolic temperatures of the volcano based on hydrogen isotopic fractionation between H2 and magmatic H2O. We successfully estimated that the δD of the fumarolic H2 in September and December 2014 was -135 ± 13‰ and -113 ± 11‰, respectively, and that the corresponding highest outlet temperatures were 1050 ± 120°C and 1199 ± 139°C. Although the temperatures were higher than those determined by using infrared remote sensing, we concluded that they are more reliable estimates of the highest fumarole outlet temperatures. Combined with plume sampling by using aircraft, remote temperature sensing based on the δD of H2 in volcanic plumes can be widely applied to active volcanoes to determine the highest fumarole outlet temperatures.

  7. Early prenatal detection of double outlet right ventricle by echocardiography.

    PubMed Central

    Stewart, P A; Wladimiroff, J W; Becker, A E

    1985-01-01

    A double outlet right ventricle with subpulmonary ventricular septal defect and right sided hypoplastic aorta was diagnosed in a 22 week fetus of a mother with diabetes mellitus. Elective termination of pregnancy was carried out and the echocardiographic findings were confirmed. Early prenatal detection of congenital heart disease may allow elective termination of pregnancy when the fetus has severe defects. Images PMID:4041305

  8. Thoracic outlet syndrome in musicians - an approach to treatment.

    PubMed

    Campbell, R M

    1996-01-01

    Thoracic outlet syndrome (TOS) can affect the skill of instrumental musicians. This paper details the way in which symptomatic TOS affects the musician and describes two cases of symptomatic TOS in a drummer and a violinist. Evaluation tools and treatment techniques are described.

  9. 49 CFR 179.200-17 - Bottom outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... least 3/8-inch chain, or its equivalent, except that the bottom outlet closure plugs may be attached by... attachment. In no case shall the breakage groove or equivalent extend below the bottom flange of the center... exterior valves may be steam jacketed, in which case the breakage groove or its equivalent must be...

  10. Outlet side of gate, showing the afterbay and knifeedged, cipoletti ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Outlet side of gate, showing the afterbay and knife-edged, cipoletti weir, and drop to canal. View to the southwest - Wellton-Mohawk Irrigation System, Radial Gate Check with Drop, Wellton Canal 9.9, West of Avenue 34 East & north of County Ninth Street, Wellton, Yuma County, AZ

  11. Food prices, access to food outlets and child weight.

    PubMed

    Powell, Lisa M; Bao, Yanjun

    2009-03-01

    This study examines the importance of food prices and restaurant and food store outlet availability for child body mass index (BMI). We use the 1998, 2000 and 2002 waves of the child-mother merged files from the 1979 cohort of the National Longitudinal Survey of Youth combined with fruit and vegetable and fast food price data obtained from the American Chamber of Commerce Researchers Association and outlet density data on fast food and full-service restaurants and supermarkets, grocery stores and convenience stores obtained from Dun & Bradstreet. Using a random effects estimation model, we found that a 10% increase in the price of fruits and vegetables was associated with a 0.7% increase in child BMI. Fast food prices were not found to be statistically significant in the full sample but were weakly negatively associated with BMI among adolescents with an estimated price elasticity of -0.12. The price estimates were robust to whether we controlled for outlet availability based on a per capita or per land area basis; however, the association between food outlets and child BMI differed depending on the definition. The associations of fruit and vegetable and fast food prices with BMI were significantly stronger both economically and statistically among low- versus high-socioeconomic status children. The estimated fruit and vegetable and fast food price elasticities were 0.14 and -0.26, respectively, among low-income children and 0.09 and -0.13, respectively, among children with less educated mothers.

  12. School Characteristics, Student Mobility Rates and Outlets in Hong Kong.

    ERIC Educational Resources Information Center

    Lam, Yee Lay Jack

    This survey compares mobility and outlets of secondary students in Hong Kong by the type of schools within the educational system. Student mobility is defined as transfer to other local schools, transfer to overseas schools, and dropping out. The six types of schools within the system include three Anglo-Chinese instructed schools -- government,…

  13. Working with Media Outlets To Communicate with the Public.

    ERIC Educational Resources Information Center

    Wallace, Mark L.

    2000-01-01

    Offers suggestions from a veteran public relations practitioner on how colleges can effectively use media resources to advertise academic programs, workforce training, and continuing education opportunities. Focuses on maximizing the benefits of using these five media outlets: newspapers, radio and TV, direct mail, the Internet, and cable…

  14. 7 CFR 989.24a - Non-normal outlets.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 8 2011-01-01 2011-01-01 false Non-normal outlets. 989.24a Section 989.24a Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE RAISINS PRODUCED FROM...

  15. 7 CFR 989.24a - Non-normal outlets.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 8 2012-01-01 2012-01-01 false Non-normal outlets. 989.24a Section 989.24a Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE RAISINS PRODUCED FROM...

  16. 49 CFR 179.100-14 - Bottom outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS REGULATIONS SPECIFICATIONS FOR TANK CARS Specifications for Pressure Tank Car Tanks (Classes DOT-105, 109, 112, 114 and 120) § 179.100-14 Bottom outlets... Tank Cars (IBR, see § 171.7 of this subchapter). (2) Bottom washout shall be of cast, forged...

  17. 49 CFR 179.220-18 - Bottom outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HAZARDOUS MATERIALS REGULATIONS SPECIFICATIONS FOR TANK CARS Specifications for Non-Pressure Tank Car Tanks (Classes DOT-111AW and 115AW) § 179.220-18 Bottom outlets. (a) The... of the AAR Specifications for Tank Cars (IBR, see § 171.7 of this subchapter). All bottom...

  18. 10. INTERIOR OF OUTLET TOWER LOOKING DOWN TO TIER #1 ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. INTERIOR OF OUTLET TOWER LOOKING DOWN TO TIER #1 OF SLIDE GATES. STRUCTURE HAS LEVELS ENABLING OPERATORS TO CHOOSE LEVEL WITH BEST QUALITY WATER. OVERHANGING DEVICE THAT LOOKS LIKE A LIGHT STANDARD IS ACTUALLY A METER FOR MEASURING WATER LEVELS. - Lake Mathews, East of Route 15, Riverside, Riverside County, CA

  19. 29. DETAIL OF OUTLET DUCTS FOR MST AIRCONDITIONING SYSTEM IN ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    29. DETAIL OF OUTLET DUCTS FOR MST AIR-CONDITIONING SYSTEM IN NORTHWEST CORNER OF SLC-3W MST STATION 70.5 (LOWEST PAYLOAD SERVICE STATION). NOTE RING ATTACHMENT FOR PERSONNEL SAFETY HARNESS IN LEFT FOREGROUND. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Pad 3 West, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

  20. 7 CFR 989.24a - Non-normal outlets.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false Non-normal outlets. 989.24a Section 989.24a Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE RAISINS PRODUCED FROM...

  1. 7 CFR 989.24a - Non-normal outlets.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 8 2014-01-01 2014-01-01 false Non-normal outlets. 989.24a Section 989.24a Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; FRUITS, VEGETABLES, NUTS), DEPARTMENT OF AGRICULTURE RAISINS PRODUCED FROM...

  2. 49 CFR 179.220-18 - Bottom outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... may be equipped with a bottom outlet of approved design and an opening provided in the outer shell of... at or below the “V” groove, or its equivalent. (8) The valve must have no wings or stem projection... repairs, including grinding. (b) Inner container may be equipped with bottom washout of approved...

  3. 49 CFR 179.100-14 - Bottom outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Bottom outlets. 179.100-14 Section 179.100-14 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for...

  4. 49 CFR 179.100-14 - Bottom outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Bottom outlets. 179.100-14 Section 179.100-14 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for...

  5. 49 CFR 179.220-18 - Bottom outlets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Bottom outlets. 179.220-18 Section 179.220-18 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for...

  6. 49 CFR 179.200-17 - Bottom outlets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Bottom outlets. 179.200-17 Section 179.200-17 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for...

  7. 49 CFR 179.100-14 - Bottom outlets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Bottom outlets. 179.100-14 Section 179.100-14 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for...

  8. 49 CFR 179.100-14 - Bottom outlets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Bottom outlets. 179.100-14 Section 179.100-14 Transportation Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) SPECIFICATIONS FOR TANK CARS Specifications for...

  9. 36. MACHINERY CHAMBER FOR SLUICE GATE OUTLET WORKS ON GALLERY ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    36. MACHINERY CHAMBER FOR SLUICE GATE OUTLET WORKS ON GALLERY 1 (LOCATED AT A ON SITE PLAN), SHOWING HYDRAULIC GATE HOIST (SIX, TOTAL, MANUFACTURED BY JOSHUA HENDRY IRON WORKS, SAN FRANCISCO) ON LEFT AND INSPECTION GALLERY ON RIGHT. VIEW TO NORTHEAST. - Owyhee Dam, Across Owyhee River, Nyssa, Malheur County, OR

  10. 3. OVERALL VIEW OF DEER LAKE AND UPRIGHT OUTLET GATE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. OVERALL VIEW OF DEER LAKE AND UPRIGHT OUTLET GATE WHEEL, STEM AND STEM GUIDE, LOOKING NORTH - High Mountain Dams in Upalco Unit, Deer Lake Dam, Ashley National Forest, 5.8 miles North of Swift Creek Campground, Mountain Home, Duchesne County, UT

  11. 6. VIEW SHOWING UPRIGHT OUTLET GATE WHEEL, STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW SHOWING UPRIGHT OUTLET GATE WHEEL, STEM AND STEM GUIDE, WITH LOG ACCESS STRUCTURE, LOOKING WEST - High Mountain Dams in Upalco Unit, Bluebell Lake Dam, Ashley National Forest, 11.2 miles Northwest of Swift Creek Campground, Mountain Home, Duchesne County, UT

  12. 6. VIEW SHOWING CREST OF DAM AND OUTLET GATE WHEEL, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW SHOWING CREST OF DAM AND OUTLET GATE WHEEL, STEM AND STEM GUIDE, LOOKING SOUTHEAST - High Mountain Dams in Upalco Unit, Milk Lake Dam, Ashley National Forest, 9.4 miles Northwest of Swift Creek Campground, Mountain Home, Duchesne County, UT

  13. 5. VIEW SHOWING UPRIGHT OUTLET GATE WHEEL, STEM AND STEM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    5. VIEW SHOWING UPRIGHT OUTLET GATE WHEEL, STEM AND STEM GUIDE, WITH LOG ACCESS STRUCTURE, LOOKING SOUTHEAST - High Mountain Dams in Upalco Unit, Bluebell Lake Dam, Ashley National Forest, 11.2 miles Northwest of Swift Creek Campground, Mountain Home, Duchesne County, UT

  14. Familial Gastric Cancers

    PubMed Central

    Setia, Namrata; Clark, Jeffrey W.; Duda, Dan G.; Hong, Theodore S.; Kwak, Eunice L.; Mullen, John T.

    2015-01-01

    Although the majority of gastric carcinomas are sporadic, approximately 10% show familial aggregation, and a hereditary cause is determined in 1%–3% cases. Of these, hereditary diffuse gastric cancer is the most recognized predisposition syndrome. Although rare, the less commonly known syndromes also confer a markedly increased risk for development of gastric cancer. Identification and characterization of these syndromes require a multidisciplinary effort involving oncologists, surgeons, genetic counselors, biologists, and pathologists. This article reviews the molecular genetics, clinical and pathologic features, surveillance guidelines, and preventive measures of common and less common hereditary gastric cancer predisposition syndromes. Implications for Practice: Although the majority of gastric adenocarcinomas are sporadic with many of those related to chronic Helicobacter pylori infection, approximately 10% of the cases show familial aggregation, and a specific hereditary cause is determined in 1%–3% cases. This review describes the molecular genetics, clinical and pathologic features, surveillance guidelines, and preventive measures of common and less common hereditary gastric cancer predisposition syndromes. Ultimately, a better understanding of the biology of these conditions should allow early identification and intervention as part of a multidisciplinary approach involving oncologists, surgeons, genetic counselors, and pathologists. PMID:26424758

  15. IL-32: A Novel Pluripotent Inflammatory Interleukin, towards Gastric Inflammation, Gastric Cancer, and Chronic Rhino Sinusitis

    PubMed Central

    2016-01-01

    A vast variety of nonstructural proteins have been studied for their key roles and involvement in a number of biological phenomenona. Interleukin-32 is a novel cytokine whose presence has been confirmed in most of the mammals except rodents. The IL-32 gene was identified on human chromosome 16 p13.3. The gene has eight exons and nine splice variants, namely, IL-32α, IL-32β, IL-32γ, IL-32δ, IL-32ε, IL-32ζ, IL-32η, IL-32θ, and IL-32s. It was found to induce the expression of various inflammatory cytokines including TNF-α, IL-6, and IL-1β as well as macrophage inflammatory protein-2 (MIP-2) and has been reported previously to be involved in the pathogenesis and progression of a number of inflammatory disorders, namely, inflammatory bowel disease (IBD), gastric inflammation and cancer, rheumatoid arthritis, and chronic obstructive pulmonary disease (COPD). In the current review, we have highlighted the involvement of IL-32 in gastric cancer, gastric inflammation, and chronic rhinosinusitis. We have also tried to explore various mechanisms suspected to induce the expression of this extraordinary cytokine as well as various mechanisms of action employed by IL-32 during the mediation and progression of the above said problems. PMID:27143819

  16. [Usefulness of gastric emptying scintigraphy for the evaluation and management of scleroderma related gastroparesis].

    PubMed

    Piskorz, María M; Rank, Gerardo; Velázquez Espeche, María; García Cainzo, Analisa; Pisarevsky, Andrea; Sorda, Juan A; Olmos, Jorge

    2015-03-01

    Scleroderma is a chronic autoimmune disease of unknown cause characterized by fibrotic skin and multiple organs involvement, including the gastrointestinal tract. It occurs mainly in women between 35 and 65 years of age. It is classified as limited or diffuse based on the extent of skin involvement. Gastrointestinal dysmotility is observed in up to 90% of patients with a diffuse and limited scleroderma. It may involve any segment of the gastrointestinal tract from the esophagus to the anus and is related to collagen deposition at the level of enteric and vascular smooth muscle. Gastroparesis is a condition characterized by abnormal gastric motility, delay gastric emptying, in the absence of a mechanical obstruction to outflow. Gastric scintigraphy with radiolabeled solid food is the gold standard for the diagnosis of gastroparesis. Two cases of patients with systemic scleroderma and severe gastroparesis are presented in order to discuss the diagnostic and therapeutic approach, emphasizing the utility of gastric emptying scintigraphy.

  17. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

    PubMed

    Lokich, J J; Kane, R A; Harrison, D A; McDermott, W V

    1987-06-01

    Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC.

  18. Successful Treatment of Gastric Relapse in Multiple Myeloma with Bortezomib after Autologous Hematopoietic Stem Cell Transplantation (autoHSCT)

    PubMed Central

    Sivgin, Serdar; Baldane, Suleyman; Kaynar, Leylagul; Kurnaz, Fatih; Baskol, Mevlut; Kula, Mustafa; Eroglu, Celalettin; Deniz, Kemal; Eser, Bulent; Unal, Ali; Cetin, Mustafa

    2013-01-01

    We report a case of 59-year-old Turkish man with history of mitral valve replacement (MVR) and chronic obstructive pulmonary disease (COPD) who was diagnosed with stage IIIA IgG lambda multiple myeloma (MM) in 1997. He underwent autologous hematopoietic stem cell transplantation after a conditioning regimen with melphalan 200mg per body area (m2) in February 2006. On February 2011, he was admitted to the emergency service of university hospital with complaints of hematemesis and melena. Pathological evaluation of gastric biopsy, obtained from a lesion of small gastric curvature, showed the gastric mucosa infiltrated by neoplastic plasma cells, monoclonal lambda light chain positive. The patient was considered as having local gastric relapsed disease and was treated with 2 cycles of bortezomib. He achieved an excellent local response after 2 cycles of bortezomib, cyclophosphamide and prednisone (BEP) regimen, with healing of gastric ulcer and no recurrence of the hematemesis or melena. PMID:23350019

  19. Gastric cancer and trastuzumab: first biologic therapy in gastric cancer

    PubMed Central

    Gunturu, Krishna S.; Woo, Yanghee; Beaubier, Nike; Remotti, Helen E.

    2013-01-01

    Gastric cancer remains difficult to cure and has a poor overall prognosis. Chemotherapy and multimodality therapy has shown some benefit in the treatment of gastric cancer. Current therapies for gastric cancer have their limitations; thus, we are in need of newer treatment options including targeted therapies. Here, we review the biologic therapy with trastuzumab in human epidermal growth factor receptor 2 (HER2)+ gastric cancer. PMID:23450234

  20. Adult obstructive sleep apnoea

    PubMed Central

    Jordan, Amy S.; McSharry, David G.; Malhotra, Atul

    2013-01-01

    Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, which leads to oxygen desaturation and disrupted sleep. Symptoms include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, adenotonsillar hypertrophy, and smoking. Obstructive sleep apnoea causes sleepiness, road traffic accidents, and probably systemic hypertension. It has also been linked to myocardial infarction, congestive heart failure, stroke, and diabetes mellitus though not definitively. Continuous positive airway pressure is the treatment of choice, with adherence of 60–70%. Bi-level positive airway pressure or adaptive servo-ventilation can be used for patients who are intolerant to continuous positive airway pressure. Other treatments include dental devices, surgery, and weight loss. PMID:23910433

  1. [Chronic obstructive pulmonary disease].

    PubMed

    Lange, Peter

    2013-04-15

    The new version of the GOLD document on chronic obstructive pulmonary disease (COPD), introduces a profound change in the stratification of the patients. In addition to the level of forced expiratory volume in the first second (FEV1), the new stratification also includes the level of daily symptoms, in particular dyspnoea, and the history of exacerbations. This review describes this stratification and the treatment of stable COPD according to the GOLD document. It focuses on early diagnosis, smoking cessation, rehabilitation and medical treatment.

  2. [Obstructive sleep apnea syndromes].

    PubMed

    Poirrier, R

    1993-01-01

    Snoring and excessive sleepiness are the hallmarks of obstructive sleep apnea syndrome but other clinical manifestations are present and a precise assessment of the disease involves clear definitions of the various kinds of apnea. Several pathogenetic factors (functional, anatomical, neurological, genetical) are still being discussed. However new insights of the pathophysiology of apneas allow more reliable treatments. Central nervous and cardiovascular complications as well as the traumatic morbidity, associated with excessive daytime sleepiness, make it a major public health problem.

  3. Obstructive Biliary Tract Disease

    PubMed Central

    White, Thomas Taylor

    1982-01-01

    The techniques that have come into general use for diagnosing problems of obstructive jaundice, particularly in the past ten years, have been ultrasonography, computerized tomography, radionuclide imaging, transhepatic percutaneous cholangiography using a long thin needle, transhepatic percutaneous drainage for obstructive jaundice due to malignancy, endoscopic retrograde cannulation of the papilla (ERCP), endoscopic sphincterotomy and choledochoscopy. It is helpful to review obstructive jaundice due to gallstones from a clinical point of view and the use of the directable stone basket for the retrieval of retained stones, choledochoscopy for the same purpose using the rigid versus flexible choledochoscopes and dissolution of stones using various fluids through a T tube. The use of dilation of the sphincter for the treatment of stenosis or stricture of the bile duct is now frowned on; rather, treatment choices are between the use of sphincteroplasty versus choledochoduodenostomy and choledochojejunostomy. Any patient with obstructive jaundice or anyone undergoing manipulation of the bile ducts should have prophylactic antibiotic therapy. The current literature regarding treatment of cancer of the bile ducts is principally devoted to the new ideas relative to treatment of tumors of the upper third, especially the bifurcation tumors that are now being resected rather than bypassed. Tumors of the distal bile duct are still being resected by focal operations. Finally, it is now felt that early operation for congenital biliary atresia and choledochal cysts gives the best prognosis, with preoperative diagnosis now possible with the use of ultrasonography and ERCP. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 8.Figure 9. PMID:7051569

  4. Airflow obstruction and exercise.

    PubMed

    Cooper, Christopher B

    2009-03-01

    The primary abnormality in chronic obstructive pulmonary disease (COPD) is chronic airway inflammation which results in airflow limitation. Disease progression is usually depicted as an accelerated decline in FEV(1) over time. However, COPD patients also manifest progressive static hyperinflation due to the combined effects of reduced lung elastic recoil and increased airway resistance. Superimposed on static hyperinflation are further increases in operational lung volumes (dynamic hyperinflation) brought on during exercise, exacerbations or tachypnea. An important consequence of exertional dyspnea is activity limitation. COPD patients have been shown to spend only a third of the day walking or standing compared with age-matched healthy individuals who spend more than half of their time in these activities. Furthermore, the degree of activity limitation measured by an accelerometer worsens with disease progression. COPD patients have been shown to have an accelerated loss of aerobic capacity (VO(2)max) and this correlates with mortality just as is seen with hypertension, diabetes and obesity. Thus physical inactivity is an important therapeutic target in COPD. Summarizing; airflow obstruction leads to progressive hyperinflation, activity limitation, physical deconditioning and other comorbidities that characterize the COPD phenotype. Targeting the airflow obstruction with long-acting bronchodilator therapy in conjunction with a supervised exercise prescription is currently the most effective therapeutic intervention in earlier COPD. Other important manifestations of skeletal muscle dysfunction include muscle atrophy and weakness. These specific problems are best addressed with resistance training with consideration of anabolic supplementation.

  5. [Jejunostomy catheter feeding during postoperative chemotherapy for Stage IV gastric cancer].

    PubMed

    Matsuyama, Jin; Fukushima, Yukio; Toshiyama, Reishi; Takeda, Mitsunobu; Tokuoka, Masayoshi; Ide, Yoshihito; Hashimoto, Kazuhiko; Yokoyama, Shigekazu; Morimoto, Takashi; Nomura, Takashi; Kodama, Ken; Sasaki, Yo

    2013-11-01

    Chemotherapy followed by surgery for Stage IV gastric cancer with passage obstruction poses a problem in terms of poor postoperative nutritional status. By maintaining an adequate postoperative nutrition status with jejunostomy catheter feeding, chemotherapy may possibly be continued. We treated 40 cases of Stage IV gastric cancer with passage obstruction from January 2008 to December 2011. In every case, jejunostomy catheter feeding tubes were placed during gastric cancer surgery. We performed 13 total gastrectomies, 20 distal gastrectomies, and 7 gastrojejunal bypass surgeries. Tube obstruction in 4 cases( 10%) and tube deviation in 1 case( 2.5%) occurred during the tube feeding period. Chemotherapy could be resumed in 37 cases( 92.5%), and the duration of chemotherapy was 330 days( range, 41-721). In cases of Stage IV gastric cancer, patients are obliged to start postoperative chemotherapy at an unstable period. By starting jejunal catheter feeding at an early stage after surgery, improved results could be expected in terms of shortening of the hospital stay or continuation of chemotherapy.

  6. A review on gastric diverticulum

    PubMed Central

    2012-01-01

    The gastric fundal diverticulae are rare. They can present with variable symptoms. We are enclosing a literature review on gastric fundal diverticulum. Lessons have emerged which may help in the management of this rare condition in future. PMID:22257431

  7. Gastric cancer: basic aspects.

    PubMed

    Resende, Carlos; Thiel, Alexandra; Machado, José C; Ristimäki, Ari

    2011-09-01

    Gastric cancer (GC) is a world health burden, ranging as the second cause of cancer death worldwide. Etiologically, GC arises not only from the combined effects of environmental factors and susceptible genetic variants but also from the accumulation of genetic and epigenetic alterations. In the last years, molecular oncobiology studies brought to light a number of genes that are implicated in gastric carcinogenesis. This review is intended to focus on the recently described basic aspects that play key roles in the process of gastric carcinogenesis. Genetic variants of the genes IL-10, IL-17, MUC1, MUC6, DNMT3B, SMAD4, and SERPINE1 have been reported to modify the risk of developing GC. Several genes have been newly associated with gastric carcinogenesis, both through oncogenic activation (GSK3β, CD133, DSC2, P-Cadherin, CDH17, CD168, CD44, metalloproteinases MMP7 and MMP11, and a subset of miRNAs) and through tumor suppressor gene inactivation mechanisms (TFF1, PDX1, BCL2L10, XRCC, psiTPTE-HERV, HAI-2, GRIK2, and RUNX3). It also addressed the role of the inflammatory mediator cyclooxygenase-2 (COX-2) in the process of gastric carcinogenesis and its importance as a potential molecular target for therapy.

  8. Primary gastric lymphoma

    PubMed Central

    Al-Akwaa, Ahmad M; Siddiqui, Neelam; Al-Mofleh, Ibrahim A

    2004-01-01

    AIM: The purpose of this review is to describe the various aspects of primary gastric lymphoma and the treatment options currently available. METHODS: After a systematic search of Pubmed, Medscape and MDconsult, we reviewed and retrieved literature regarding gastric lymphoma. RESULTS: Primary gastric lymphoma is rare however, the incidence of this malignancy is increasing. Chronic gastritis secondary to Helicobacter pylori (H pylori) infection has been considered a major predisposing factor for MALT lymphoma. Immune histochemical marker studies and molecular biology utilizing polymerase chain reaction have facilitated appropriate diagnosis and abolished the need for diagnostic surgical resection. Advances in imaging techniques including Magnetic Resonance Imaging (MRI) and Endoscopic Ultrasonography (EUS) have helped evaluation of tumor extension and invasion. The clinical course and prognosis of this disease is dependent on histopathological sub-type and stage at the time of diagnosis. Controversy remains regarding the best treatment for early stages of this disease. Chemotherapy, surgery and combination have been studied and shared almost comparable results with survival rate of 70%-90%. However, chemotherapy possesses the advantage of preserving gastric anatomy. Radiotherapy alone has been tried and showed good results. Stage IIIE, IVE disease treatment is solely by chemotherapy and surgical resection has been a remote consideration. CONCLUSION: We conclude that methods of diagnosis and staging of the primary gastric lymphoma have dramatically improved. The modalities of treatment are many and probably chemotherapy is superior because of high success rate, preservation of stomach and tolerable complications. PMID:14695759

  9. Gastric Banding: Advantages and Complications. A 5- and 10-Year Follow-up.

    PubMed

    Fried; Peskova

    1995-11-01

    BACKGROUND: Gastric banding is one of the simplest surgical procedures for the treatment of morbid obesity. We performed more than 150 'laparotomy' (open) gastric bandings and more than 50 'laparoscopic' bandings in the last 1 0 years. METHODS: In most procedures we used non-adjustable bands, but since the beginning of 1995 we have used adjustable silicone banding. RESULTS: The 5- and 10-year follow-up weight loss results are encouraging. The average long-term weight loss was 35.5 kg. Since 1993, we performed all the procedures laparoscopically, and the postoperative complications decreased from 18.5% in the 'laparotomy' group to 9.5% in the 'laparoscopic' group, with the majority being esophagus and outlet area irritation. CONCLUSION: Gastric banding itself and especially the minimally invasive laparoscopic approach is an easy technical procedure. The long-term weight loss results and the reoperation rate are acceptable for bariatric surgery criteria.

  10. Intramural hemorrhage simulating gastric neoplasm.

    PubMed

    Sheward, S E; Davis, M; Amparo, E G; Gogel, H K

    1988-01-01

    We report a case of benign gastric ulcer with secondary extensive intramural hemorrhage causing a radiographic appearance consistent with a large ulcerated gastric neoplasm. This is the second such case reported and the first studied with sonography and computed tomographic scan. A brief review of the literature on intramural gastric hematoma is presented.

  11. 40. OUTLET WORKS: VIBRATION ABSORBER FOR STANDBY UNIT, Sheet H7, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    40. OUTLET WORKS: VIBRATION ABSORBER FOR STANDBY UNIT, Sheet H-7, September, 1940. File no. SA 342/79. - Prado Dam, Outlet Works, Santa Ana River near junction of State Highways 71 & 91, Corona, Riverside County, CA

  12. 46. OUTLET WORKS: ELECTRICAL SYSTEM NO. 1. Sheet H1, date ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    46. OUTLET WORKS: ELECTRICAL SYSTEM NO. 1. Sheet H-1, date stamped May, 1939. File no. SA 342/9. - Prado Dam, Outlet Works, Santa Ana River near junction of State Highways 71 & 91, Corona, Riverside County, CA

  13. 48. OUTLET WORKS: ELECTRICAL SYSTEM NO. 3. Sheet H3, October, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    48. OUTLET WORKS: ELECTRICAL SYSTEM NO. 3. Sheet H-3, October, 1939. File no. SA 342/59. - Prado Dam, Outlet Works, Santa Ana River near junction of State Highways 71 & 91, Corona, Riverside County, CA

  14. 47. OUTLET WORKS: ELECTRICAL SYSTEM NO. 2. Sheet H2, date ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    47. OUTLET WORKS: ELECTRICAL SYSTEM NO. 2. Sheet H-2, date stamped May, 1939. File no. SA 342/10. - Prado Dam, Outlet Works, Santa Ana River near junction of State Highways 71 & 91, Corona, Riverside County, CA

  15. Hydrological Modeling of the Jezero Crater Outlet-Forming Flood

    NASA Technical Reports Server (NTRS)

    Fassett, C. I.; Goudge, T. A.

    2017-01-01

    Abundant evidence exists for lakes on Mars both from orbital observations [e.g., 1-3] and in situ exploration [e.g., 4-5]. These lakes can be divided into two classes: those that were hydrologically closed, so their source valley(s) terminated at the basin [3], and those that were hydrologically open, where there was sufficient flow from inlet valley(s) to cause the lake to breach and form an outlet valley [2]. It is easier to be confident from orbital data alone that a standing body of water must have existed in open basins, because there is no other way for their perched outlet valleys to form. The majority of basins fed by valley networks, rather than by isolated inlet valleys, are open [6], with some important exceptions (e.g., Gale Crater). Jezero crater (Fig. 1) is one of the most well-studied open basin paleolakes on Mars, with a breach that re-mains well above the lowest part of the crater floor, and two sedimentary fans at its northwestern margin that are likely deltaic in origin [7-9]. CRISM observations of these sediments indicate they host a variety of alteration minerals [9-11], including smectite and carbonate, and both the mineralogy of the sediments and their settings suggest they have a strong potential for preserving organic materials [10]. As a result, Jezero is a strong candidate landing site for the Mars 2020 rover. Approximate formative discharges have been estimated for its well-preserved western fan (Q approximately 500m3/s) [7], but to our knowledge, no estimates for the dis-charges associated with formation and incision of its outlet valley have been presented. Indeed, only a few studies [e.g., 12-14] have attempted to reconstruct the formation of outlet breaches broadly similar to Jezero anywhere on Mars, despite the apparent commonality of basins with large outlets [e.g., 2]. The outlet valley formed as a dam breach when the lake overflowed. In such an event, the growth and incision of the breach is directly coupled to flood discharge

  16. Turbofan gas turbine engine with variable fan outlet guide vanes

    NASA Technical Reports Server (NTRS)

    Wood, Peter John (Inventor); Zenon, Ruby Lasandra (Inventor); LaChapelle, Donald George (Inventor); Mielke, Mark Joseph (Inventor); Grant, Carl (Inventor)

    2010-01-01

    A turbofan gas turbine engine includes a forward fan section with a row of fan rotor blades, a core engine, and a fan bypass duct downstream of the forward fan section and radially outwardly of the core engine. The forward fan section has only a single stage of variable fan guide vanes which are variable fan outlet guide vanes downstream of the forward fan rotor blades. An exemplary embodiment of the engine includes an afterburner downstream of the fan bypass duct between the core engine and an exhaust nozzle. The variable fan outlet guide vanes are operable to pivot from a nominal OGV position at take-off to an open OGV position at a high flight Mach Number which may be in a range of between about 2.5-4+. Struts extend radially across a radially inwardly curved portion of a flowpath of the engine between the forward fan section and the core engine.

  17. Airshuffler implementation at freezer air outlets for heat transfer enhancement

    NASA Astrophysics Data System (ADS)

    Ćerezci, Gökhan; Darka, Murat; Şenman, Ozan

    2016-06-01

    A study which is composed of computational simulation and experimental validation has been conducted for implementation of small, vane type geometries at freezer air outlets, similar to microvortex generators used in aircraft wings, in order to improve the heat transfer efficiency inside the freezer compartment by decreasing airside thermal resistance and improving the air distribution. Both simulation and experimental validation were performed in a loaded condition which was prepared according to `Household refrigerating appliances - characteristics and test methods - IEC 62552 [1]. Solutions for the incompressible K-epsilon (k-ɛ) turbulence model obtained for Bosch KDN 49 refrigerator freezer both with and without airshufflers at air outlets, which are similar to vane type microvortex generators with different geometric dimensions. The airshuffler dimensions were chosen with design of experiment (DOE) principles for finding the optimum geometry. The best combinations were tested according to cooling rate inside freezer compartment. Results were evaluated for feasibility of implementing of vortex generating surfaces (airshufflers) for cooling appliances.

  18. Spinal accessory neuropathy, droopy shoulder, and thoracic outlet syndrome.

    PubMed

    Al-Shekhlee, Amer; Katirji, Bashar

    2003-09-01

    Droopy shoulder has been proposed as a cause of thoracic outlet syndrome. Two patients developed manifestations of neurovascular compression upon arm abduction, associated with unilateral droopy shoulder and trapezius muscle weakness caused by iatrogenic spinal accessory neuropathies following cervical lymph node biopsies. The first patient developed a cold, numb hand with complete axillary artery occlusion when his arm was abducted to 90 degrees. The second patient complained of paresthesias in digits 4 and 5 of the right hand, worsened by elevation of the arm, with nerve conduction findings of right lower trunk plexopathy (low ulnar and medial antebrachial cutaneous sensory nerve action potentials). Spinal accessory nerve grafting (in the first patient) coupled with shoulder strengthening physical exercises in both patients resulted in gradual improvement of symptoms in 2 years. These two cases demonstrate that unilateral droopy shoulder secondary to trapezius muscle weakness may cause compression of the thoracic outlet structures.

  19. 23. OUTLET PIPE EMBEDDED IN CONCRETE FOR THE HEAD GATE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    23. OUTLET PIPE EMBEDDED IN CONCRETE FOR THE HEAD GATE SHOWN IN CO-43-A-22. - Highline Canal, Sand Creek Lateral, Beginning at intersection of Peoria Street & Highline Canal in Arapahoe County (City of Aurora), Sand Creek lateral Extends 15 miles Northerly through Araphoe County, City & County of Denver, & Adams County to its end point, approximately 1/4 mile Southest of intersectioin of D Street & Ninth Avenue in Adams County (Rocky Mountain Arsenal, Commerce City Vicinity), Commerce City, Adams County, CO

  20. 21. OUTLET PIPE AND CONCRETE CHANNEL FOR THE HEAD GATE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. OUTLET PIPE AND CONCRETE CHANNEL FOR THE HEAD GATE PICTURED IN CO-43-A-20. - Highline Canal, Sand Creek Lateral, Beginning at intersection of Peoria Street & Highline Canal in Arapahoe County (City of Aurora), Sand Creek lateral Extends 15 miles Northerly through Araphoe County, City & County of Denver, & Adams County to its end point, approximately 1/4 mile Southest of intersectioin of D Street & Ninth Avenue in Adams County (Rocky Mountain Arsenal, Commerce City Vicinity), Commerce City, Adams County, CO

  1. [Neuroblastoma presenting as obstructive jaundice].

    PubMed

    García de Andoin Barandiaran, N; Lassaletta Atienza, A; Scaglione Ríos, C; Contra Martín, T; Madero López, L

    2006-01-01

    Obstructive jaundice as a presentation of abdominal tumors in childhood is extremely rare. To date, only 4 cases of neuroblastoma causing obstructive jaundice at diagnosis have been reported in children. We report a 4-year-old boy who presented to the emergency department with abdominal pain, jaundice, choluria and acholia. A diagnosis of unresectable, nonmetastatic neuroblastoma was made. Chemotherapy reduced the size of the tumor and relieved the symptoms of obstructive jaundice without the need for decompressive surgery. Abdominal tumors should be included in the differential diagnoses of obstructive jaundice in childhood.

  2. Acute intestinal obstruction caused by a persimmon phytobezoar after dissolution therapy with Coca-Cola.

    PubMed

    Ha, Seung Soo; Lee, Hyun Suk; Jung, Min Kyu; Jeon, Seong Woo; Cho, Chang Min; Kim, Sung Kook; Choi, Yong Hwan

    2007-12-01

    Bezoars are concretions or hard masses of foreign matter that are found in the gastrointestinal tract. Recent reports have demonstrated the efficacy of Coca-Cola administration for the dissolution of phytobezors. Here we report on a 73-year-old man with a very large gastric persimmon diospyrobezoar, and this caused small intestinal obstruction after partial dissolution with oral and injected Coca-Cola.

  3. Emerging technology monitors ice-sea interface at outlet glaciers

    NASA Astrophysics Data System (ADS)

    Dixon, Timothy H.; Voytenko, Denis; Lembke, Chad; de la Peña, Santiago; Howat, Ian; Gourmelen, Noel; Werner, Charles; Oddsson, Björn

    2012-11-01

    Recent melting in Greenland and Antarctica has led to concerns about the long-term stability of these ice sheets and their potential contributions to future sea level rise. Marine-terminating outlet glaciers play a key role in the dynamics of these ice sheets; recent mass losses are likely related to increased influx of warmer water to the base of outlet glaciers, as evidenced by the fact that changes in ocean currents, calving front retreats, glacial thinning, mass redistribution based on satellite gravity data, and accelerating coastal uplift are roughly concurrent [e.g., Holland et al., 2008; Wouters et al., 2008; Jiang et al., 2010; Straneo et al., 2012; Bevis et al., 2012]. However, collecting quantitative measurements within the dynamic environment of marine outlet glaciers is challenging. Oceanographic measurements are limited in iceberg-laden fjords. Measuring ice flow speeds near the calving front is similarly challenging; satellite methods lack temporal resolution (satellite revisit times are several days or longer), while GPS gives limited spatial resolution, a problem for assessing changes near the highly variable calving front.

  4. Alcohol Outlets and Substance Use among High Schoolers

    PubMed Central

    Milam, Adam J.; Johnson, Sarah Lindstrom; Furr-Holden, C. Debra M.; Bradshaw, Catherine P.

    2016-01-01

    Few studies have considered the potential role of the built environment in increasing adolescent substance use. The current study explored the relationship between alcohol outlets, a potential malleable component of the neighborhood environment, and adolescent behavioral outcomes. Specifically, we investigated the relationship between alcohol outlet density, perceived alcohol, tobacco, and marijuana availability (ATOD), perception of substance use as a problem at the school, and self-reported ATOD use. Data come from Maryland Safe and Supportive Schools (MDS3) Initiative, a statewide project focused on measuring and improving school climate. The sample includes 25,308 adolescents from 58 high schools (9th–12th grade) across 12 counties. Multi-level path models indicated a positive relationship between the count of alcohol outlets and perceived availability of ATOD among girls but not boys. Perceived availability was associated with increased ATOD use at both the individual- and school-level, as well as other students’ ATOD use. Findings provide support for the potential role of the built environment in adolescent risk for substance use, particularly among girls. PMID:27574339

  5. Metal halogen battery system with multiple outlet nozzle for hydrate

    DOEpatents

    Bjorkman, Jr., Harry K.

    1983-06-21

    A metal halogen battery system, including at least one cell having a positive electrode and a negative electrode contacted by aqueous electrolyte containing the material of said metal and halogen, store means whereby halogen hydrate is formed and stored as part of an aqueous material, means for circulating electrolyte through the cell and to the store means, and conduit means for transmitting halogen gas formed in the cell to a hydrate former whereby the hydrate is formed in association with the store means, said store means being constructed in the form of a container which includes a filter means, said filter means being inoperative to separate the hydrate formed from the electrolyte, said system having, a hydrate former pump means associated with the store means and being operative to intermix halogen gas with aqueous electrolyte to form halogen hydrate, said hydrate former means including, multiple outlet nozzle means connected with the outlet side of said pump means and being operative to minimize plugging, said nozzle means being comprised of at least one divider means which is generally perpendicular to the rotational axes of gears within the pump means, said divider means acting to divide the flow from the pump means into multiple outlet flow paths.

  6. Immunotherapy in gastric cancer.

    PubMed

    Matsueda, Satoko; Graham, David Y

    2014-02-21

    Gastric cancer is the second most common of cancer-related deaths worldwide. In the majority of cases gastric cancer is advanced at diagnosis and although medical and surgical treatments have improved, survival rates remain poor. Cancer immunotherapy has emerged as a powerful and promising clinical approach for treatment of cancer and has shown major success in breast cancer, prostate cancer and melanoma. Here, we provide an overview of concepts of modern cancer immunotherapy including the theory, current approaches, remaining hurdles to be overcome, and the future prospect of cancer immunotherapy in the treatment of gastric cancer. Adaptive cell therapies, cancer vaccines, gene therapies, monoclonal antibody therapies have all been used with some initial successes in gastric cancer. However, to date the results in gastric cancer have been disappointing as current approaches often do not stimulate immunity efficiently allowing tumors continue to grow despite the presence of a measurable immune response. Here, we discuss the identification of targets for immunotherapy and the role of biomarkers in prospectively identifying appropriate subjects or immunotherapy. We also discuss the molecular mechanisms by which tumor cells escape host immunosurveillance and produce an immunosuppressive tumor microenvironment. We show how advances have provided tools for overcoming the mechanisms of immunosuppression including the use of monoclonal antibodies to block negative regulators normally expressed on the surface of T cells which limit activation and proliferation of cytotoxic T cells. Immunotherapy has greatly improved and is becoming an important factor in such fields as medical care and welfare for human being. Progress has been rapid ensuring that the future of immunotherapy for gastric cancer is bright.

  7. 12 CFR 7.1014 - Sale of money orders at nonbanking outlets.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Sale of money orders at nonbanking outlets. 7... ACTIVITIES AND OPERATIONS Bank Powers § 7.1014 Sale of money orders at nonbanking outlets. A national bank may designate bonded agents to sell the bank's money orders at nonbanking outlets. The...

  8. 12 CFR 7.1014 - Sale of money orders at nonbanking outlets.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Sale of money orders at nonbanking outlets. 7... ACTIVITIES AND OPERATIONS Bank Powers § 7.1014 Sale of money orders at nonbanking outlets. A national bank may designate bonded agents to sell the bank's money orders at nonbanking outlets. The...

  9. 12 CFR 7.1014 - Sale of money orders at nonbanking outlets.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Sale of money orders at nonbanking outlets. 7... ACTIVITIES AND OPERATIONS Bank Powers § 7.1014 Sale of money orders at nonbanking outlets. A national bank may designate bonded agents to sell the bank's money orders at nonbanking outlets. The...

  10. 12 CFR 7.1014 - Sale of money orders at nonbanking outlets.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Sale of money orders at nonbanking outlets. 7... ACTIVITIES AND OPERATIONS Bank Powers § 7.1014 Sale of money orders at nonbanking outlets. A national bank may designate bonded agents to sell the bank's money orders at nonbanking outlets. The...

  11. 12 CFR 7.1014 - Sale of money orders at nonbanking outlets.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Sale of money orders at nonbanking outlets. 7... ACTIVITIES AND OPERATIONS Bank Powers § 7.1014 Sale of money orders at nonbanking outlets. A national bank may designate bonded agents to sell the bank's money orders at nonbanking outlets. The...

  12. A Geospatial Statistical Analysis of the Density of Lottery Outlets within Ethnically Concentrated Neighborhoods

    ERIC Educational Resources Information Center

    Wiggins, Lyna; Nower, Lia; Mayers, Raymond Sanchez; Peterson, N. Andrew

    2010-01-01

    This study examines the density of lottery outlets within ethnically concentrated neighborhoods in Middlesex County, New Jersey, using geospatial statistical analyses. No prior studies have empirically examined the relationship between lottery outlet density and population demographics. Results indicate that lottery outlets were not randomly…

  13. 16 CFR Appendix E to Part 436 - Sample Item 20(4) Table-Status of Company-Owned Outlets

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... RULES DISCLOSURE REQUIREMENTS AND PROHIBITIONS CONCERNING FRANCHISING Pt. 436, App. E Appendix E to Part... 5Outlets Reacquired From Franchisees Column 6Outlets Closed Column 7Outlets Sold to Franchisees...

  14. Airflow obstruction and mining

    SciTech Connect

    Stenton, S.C.; Hendrick, D.J. )

    1993-01-01

    Bronchitis and emphysema have long been described as diseases of miners, but the precise contribution of occupational exposures to coal and other mine dusts in causing these disorders, as opposed to cofactors such as social class, environmental pollution, and cigarette smoking, has not been fully defined. Epidemiologic studies have attempted, with varying degrees of success, to determine the incidence and severity of chronic obstructive pulmonary diseases in miners as compared to the general population. The results from these studies, and those in other nonmining industries with dust exposures, are examined. 98 refs.

  15. Mouse Models of Gastric Carcinogenesis

    PubMed Central

    Yu, Sungsook; Yang, Mijeong

    2014-01-01

    Gastric cancer is one of the most common cancers in the world. Animal models have been used to elucidate the details of the molecular mechanisms of various cancers. However, most inbred strains of mice have resistance to gastric carcinogenesis. Helicobacter infection and carcinogen treatment have been used to establish mouse models that exhibit phenotypes similar to those of human gastric cancer. A large number of transgenic and knockout mouse models of gastric cancer have been developed using genetic engineering. A combination of carcinogens and gene manipulation has been applied to facilitate development of advanced gastric cancer; however, it is rare for mouse models of gastric cancer to show aggressive, metastatic phenotypes required for preclinical studies. Here, we review current mouse models of gastric carcinogenesis and provide our perspectives on future developments in this field. PMID:25061535

  16. [Obstructive sleep apnea syndrome].

    PubMed

    Alvarez-Sala Walther, José Luis

    2002-01-01

    The obstructive sleep apnea syndrome (OSAS) is caused by an intermittent and repetitive obstruction of the upper respiratory tract during sleep, which leads to a complete (apnea) or partial (hypopnea) block of air flow. It is quite prevalent, being seen in 4-6% of males and 2% of females. Structural abnormalities present in the upper respiratory tract and obesity are the fundamental etiological factors. Clinical manifestations are due to sleep fragmentation and oxygen desaturation which cause the apnea. Day hypersomnia, snoring and episodes of apnea described by the spouse are the three basic symptoms. The diagnosis is based on polysomnography, which can be substituted for a night cardiorespiratory polygraphy. It has an important morbimortality rate, mainly due to traffic and labor accidents, ischemic heart disease and chronic respiratory failure. The treatment is multifactorial. First, eliminating alcohol and hypnotic drugs. Obesity, which is almost always present, must also be corrected. Structural abnormalities of the upper respiratory tract may require a surgical solution. The treatment preferred nowadays is the application of a nasal continuous positive airway pressure (CPAP) while the patient is asleep. It should be considered for those symptomatic patients with an apnea-hypopnea index over 30, or if the index is below 30, than when a respiratory insufficiency or cardiovascular risk factors are present. In some cases surgical procedures may be considered, such as uvulopalatopharyngoplasty.

  17. The prevention of alcoholism: an empirical report on the effects of outlet availability.

    PubMed

    Parker, D A; Wolz, M W; Harford, T C

    1978-10-01

    Recent studies suggest that alcohol availability as measured by outlet rates is unrelated to per capita consumption or rates of alcoholism in the United States. Drawing from the same data bases, this article assesses the effects of outlet rates while controlling for the effects of per capita income, urbanism, and limitations by population on the number of sales outlets. The analysis discloses strong effects of outlet availability on per capita consumption and alcoholism rates in states that do not have restrictions on the number of outlets per unit of population.

  18. Models of gastric emptying.

    PubMed Central

    Stubbs, D F

    1977-01-01

    Some empirical and theoretical models of the emptying behaviour of the stomach are presented. The laws of Laplace, Hooke, and Poisseuille are used to derive a new model of gastric emptying. Published data on humans are used to test the model and evaluate empirical constants. It is shown that for meals with an initial volume of larger than or equal to 300 ml, the reciprocal of the cube root of the volume of meal remaining is proportional to the time the meal is in the stomach.For meals of initial volume of less than 300 ml the equation has to be corrected for the fact that the 'resting volume' of gastric contents is about 28 ml. The more exact formula is given in the text. As this model invokes no neural or hormonal factors, it is suggested that the gastric emptying response to the volume of a meal does not depend on these factors. The gastric emptying response to the composition of the meal does depend on such factors and a recent model of this process is used to evaluate an empirical constant. PMID:856678

  19. Melanoma with gastric metastases

    PubMed Central

    Wong, Katherine; Serafi, Sam W.; Bhatia, Abhijit S.; Ibarra, Irene; Allen, Elizabeth A.

    2016-01-01

    An 81-year-old woman with a history of malignant melanoma who presented with dyspnea and fatigue was found to have metastases to the stomach detected on endoscopy. Primary cutaneous malignant melanoma with gastric metastases is a rare occurrence, and it is often not detected until autopsy because of its non-specific manifestations. PMID:27609722

  20. Chronic intestinal pseudo-obstruction.

    PubMed

    Antonucci, Alexandra; Fronzoni, Lucia; Cogliandro, Laura; Cogliandro, Rosanna-F; Caputo, Carla; De Giorgio, Roberto; Pallotti, Francesca; Barbara, Giovanni; Corinaldesi, Roberto; Stanghellini, Vincenzo

    2008-05-21

    Chronic intestinal pseudo-obstruction (CIPO) is a severe digestive syndrome characterized by derangement of gut propulsive motility which resembles mechanical obstruction, in the absence of any obstructive process. Although uncommon in clinical practice, this syndrome represents one of the main causes of intestinal failure and is characterized by high morbidity and mortality. It may be idiopathic or secondary to a variety of diseases. Most cases are sporadic, even though familial forms with either dominant or recessive autosomal inheritance have been described. Based on histological features intestinal pseudo-obstruction can be classified into three main categories: neuropathies, mesenchymopathies, and myopathies, according on the predominant involvement of enteric neurones, interstitial cells of Cajal or smooth muscle cells, respectively. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological and surgical therapies, but it is often unsatisfactory and the long-term outcome is generally poor in the majority of cases.

  1. Chronic intestinal pseudo-obstruction

    PubMed Central

    Antonucci, Alexandra; Fronzoni, Lucia; Cogliandro, Laura; Cogliandro, Rosanna F; Caputo, Carla; Giorgio, Roberto De; Pallotti, Francesca; Barbara, Giovanni; Corinaldesi, Roberto; Stanghellini, Vincenzo

    2008-01-01

    Chronic intestinal pseudo-obstruction (CIPO) is a severe digestive syndrome characterized by derangement of gut propulsive motility which resembles mechanical obstruction, in the absence of any obstructive process. Although uncommon in clinical practice, this syndrome represents one of the main causes of intestinal failure and is characterized by high morbidity and mortality. It may be idiopathic or secondary to a variety of diseases. Most cases are sporadic, even though familial forms with either dominant or recessive autosomal inheritance have been described. Based on histological features intestinal pseudo-obstruction can be classified into three main categories: neuropathies, mesenchymopathies, and myopathies, according on the predominant involvement of enteric neurones, interstitial cells of Cajal or smooth muscle cells, respectively. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological and surgical therapies, but it is often unsatisfactory and the long-term outcome is generally poor in the majority of cases. PMID:18494042

  2. Gastric cancer and family history

    PubMed Central

    Choi, Yoon Jin; Kim, Nayoung

    2016-01-01

    Gastric cancer is associated with high morbidity and mortality rates worldwide. Identifying individuals at high risk is important for surveillance and prevention of gastric cancer. Having first-degree relatives diagnosed with gastric cancer is a strong and consistent risk factor for gastric cancer, but the pathogenic mechanisms behind this familial aggregation are unclear. Against this background, we reviewed the risk factors for gastric cancer in those with a first-degree relative with gastric cancer, and the possible causes for familial clustering of gastric cancer including bacterial factors, inherited genetic susceptibility, environmental factors or a combination thereof. Among individuals with a family history, current or past Helicobacter pylori infection, having two or more first-degree affected relatives or female gender was associated with an increased risk of developing gastric cancer. To date, no specific single nucleotide polymorphism has been shown to be associated with familial clustering of gastric cancer. H. pylori eradication is the most important strategy for preventing gastric cancer in first-degree relatives of gastric cancer patients, particularly those in their 20s and 30s. Early H. pylori eradication could prevent the progression to intestinal metaplasia and reduce the synergistic effect on gastric carcinogenesis in individuals with both H. pylori infection and a family history. Endoscopic surveillance is also expected to benefit individuals with a family history. Further large-scale, prospective studies are warranted to evaluate the cost-effectiveness and optimal time point for endoscopy in this population. Moreover, genome-wide association studies that incorporate environmental and dietary factors on a ‘big data’ basis will increase our understanding of the pathogenesis of gastric cancer. PMID:27809451

  3. 19. OUTLET OF PIPE WITH A CONCRETE CHANNEL SERVING THE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    19. OUTLET OF PIPE WITH A CONCRETE CHANNEL SERVING THE HEAD GATE SHOWN IN CO-43-A-18. - Highline Canal, Sand Creek Lateral, Beginning at intersection of Peoria Street & Highline Canal in Arapahoe County (City of Aurora), Sand Creek lateral Extends 15 miles Northerly through Araphoe County, City & County of Denver, & Adams County to its end point, approximately 1/4 mile Southest of intersectioin of D Street & Ninth Avenue in Adams County (Rocky Mountain Arsenal, Commerce City Vicinity), Commerce City, Adams County, CO

  4. Shoaling Problems on the Mississippi River - Gulf Outlet

    DTIC Science & Technology

    1966-02-01

    project, "Mississippi River, Baton Rouge to the Gulf of Mexico ," was authorized by the River and Harbor Act of 29 March 1956 (Public Law 455, 84th...dedicated 25 July 1963, at which time the first ship traveled from New Orleans to the Gulf of Mexico via the Mississippi River-Gulf Outlet. The narrow...19.9 BEP predicted minimum shoaling rate, Cu. Yds/Yr/Mi 300,000 220,000 Avg. minimum shoaling rate, Cu.Yds/Yr/Mi 260,000 Avg. maximum shoaling rate

  5. Congenital pseudarthrosis of the clavicle causing thoracic outlet syndrome

    PubMed Central

    Watson, Hannah Isabella; Hopper, Graeme Philip; Kovacs, Peter

    2013-01-01

    A 7-year-old girl presented with an asymptomatic right supraclavicular swelling. Radiographs were interpreted as showing a non-union of her clavicle. No treatment was given at this time. However, she represented 12 years later with right upper limb pain and altered sensation. Examination revealed a positive Allen's test on the right. Repeat radiographs demonstrated a pseudarthrosis of the clavicle, associated with a secondary complication of thoracic outlet syndrome with vascular and neurological complications present. Non-operative management failed to relieve her symptoms. Operative intervention successfully treated her symptoms. PMID:23975919

  6. Severe adhesive small bowel obstruction.

    PubMed

    Di Saverio, Salomone; Catena, Fausto; Kelly, Michael D; Tugnoli, Gregorio; Ansaloni, Luca

    2012-12-01

    Adhesive small bowel obstruction is a frequent cause of hospital admission. Water soluble contrast studies may have diagnostic and therapeutic value and avoid challenging demanding surgical operations, but if bowel ischemia is suspected, prompt surgical intervention is mandatory. A 58-year-old patient was operated for extensive adhesive small bowel obstruction after having had two previous laparotomies for colorectal surgery, and had a complex clinical course with multiple operations and several complications. Different strategies of management have been adopted, including non-operative management with the use of hyperosmolar water soluble contrast medium, multiple surgical procedures, total parenteral nutrition (TPN) support, and finally use of antiadherences icodextrin solution. After 2 years follow-up the patient was doing well without presenting recurrent episodes of adhesive small bowel obstruction. For patients admitted several times for adhesive small bowel obstruction, the relative risk of recurring obstruction increases in relation to the number of prior episodes. Several strategies for non-operative conservative management of adhesive small bowel obstruction have already addressed diagnostic and therapeutic value of hyperosmolar water soluble contrast. According to the most recent evidence-based guidelines, open surgery is the preferred method for surgical treatment of strangulating adhesive small bowel obstruction as well as after failed conservative management. Research interest and clinical evidence are increasing in adhesions prevention. Hyaluronic acid-carboxycellulose membrane and icodextrin may reduce incidence of adhesions.

  7. Chronic obstructive pulmonary disease.

    PubMed

    Vijayan, V K

    2013-02-01

    The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD) in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are observed in central airways, small airways and alveolar space. The proposed pathogenesis of COPD includes proteinase-antiproteinase hypothesis, immunological mechanisms, oxidant-antioxidant balance, systemic inflammation, apoptosis and ineffective repair. Airflow limitation in COPD is defined as a postbronchodilator FEV1 (forced expiratory volume in 1 sec) to FVC (forced vital capacity) ratio <0.70. COPD is characterized by an accelerated decline in FEV1. Co morbidities associated with COPD are cardiovascular disorders (coronary artery disease and chronic heart failure), hypertension, metabolic diseases (diabetes mellitus, metabolic syndrome and obesity), bone disease (osteoporosis and osteopenia), stroke, lung cancer, cachexia, skeletal muscle weakness, anaemia, depression and cognitive decline. The assessment of COPD is required to determine the severity of the disease, its impact on the health status and the risk of future events (e.g., exacerbations, hospital admissions or death) and this is essential to guide therapy. COPD is treated with inhaled bronchodilators, inhaled corticosteroids, oral theophylline and oral phosphodiesterase-4 inhibitor. Non pharmacological treatment of COPD includes smoking cessation, pulmonary rehabilitation and nutritional support. Lung volume reduction surgery and lung transplantation are advised in selected severe patients. Global strategy for the diagnosis, management and prevention of Chronic Obstructive Pulmonary Disease guidelines

  8. Molecular biology of gastric cancer.

    PubMed

    Cervantes, A; Rodríguez Braun, E; Pérez Fidalgo, A; Chirivella González, I

    2007-04-01

    Despite its decreasing incidence overall, gastric cancer is still a challenging disease. Therapy is based mainly upon surgical resection when the tumour remains localised in the stomach. Conventional chemotherapy may play a role in treating micrometastatic disease and is effective as palliative therapy for recurrent or advanced disease. However, the knowledge of molecular pathways implicated in gastric cancer pathogenesis is still in its infancy and the contribution of molecular biology to the development of new targeted therapies in gastric cancer is far behind other more common cancers such as breast, colon or lung. This review will focus first on the difference of two well defined types of gastric cancer: intestinal and diffuse. A discussion of the cell of origin of gastric cancer with some intriguing data implicating bone marrow derived cells will follow, and a comprehensive review of different genetic alterations detected in gastric cancer, underlining those that may have clinical, therapeutic or prognostic implications.

  9. Clinical epidemiology of gastric cancer

    PubMed Central

    Ang, Tiing Leong; Fock, Kwong Ming

    2014-01-01

    Gastric cancer is the second leading cause of cancer-related mortality and the fourth most common cancer globally. There are, however, distinct differences in incidence rates in different geographic regions. While the incidence rate of gastric cancer has been falling, that of gastric cardia cancers is reportedly on the rise in some regions. Helicobacter pylori (H. pylori) infection is a major risk factor of non-cardia gastric cancer, and data has emerged concerning the role of H. pylori eradication for primary prevention of gastric cancer. Dietary, lifestyle and metabolic factors have also been implicated. Although addressing these other factors may contribute to health, the actual impact in terms of cancer prevention is unclear. Once irreversible histological changes have occurred, endoscopic surveillance would be necessary. A molecular classification system offers hope for molecularly tailored, personalised therapies for gastric cancer, which may improve the prognosis for patients. PMID:25630323

  10. Technologies for Upgrading Light Water Reactor Outlet Temperature

    SciTech Connect

    Daniel S. Wendt; Piyush Sabharwall; Vivek Utgikar

    2013-07-01

    Nuclear energy could potentially be utilized in hybrid energy systems to produce synthetic fuels and feedstocks from indigenous carbon sources such as coal and biomass. First generation nuclear hybrid energy system (NHES) technology will most likely be based on conventional light water reactors (LWRs). However, these LWRs provide thermal energy at temperatures of approximately 300°C, while the desired temperatures for many chemical processes are much higher. In order to realize the benefits of nuclear hybrid energy systems with the current LWR reactor fleets, selection and development of a complimentary temperature upgrading technology is necessary. This paper provides an initial assessment of technologies that may be well suited toward LWR outlet temperature upgrading for powering elevated temperature industrial and chemical processes during periods of off-peak power demand. Chemical heat transformers (CHTs) are a technology with the potential to meet LWR temperature upgrading requirements for NHESs. CHTs utilize chemical heat of reaction to change the temperature at which selected heat sources supply or consume thermal energy. CHTs could directly utilize LWR heat output without intermediate mechanical or electrical power conversion operations and the associated thermodynamic losses. CHT thermal characteristics are determined by selection of the chemical working pair and operating conditions. This paper discusses the chemical working pairs applicable to LWR outlet temperature upgrading and the CHT operating conditions required for providing process heat in NHES applications.

  11. Mount assembly for porous transition panel at annular combustor outlet

    NASA Technical Reports Server (NTRS)

    Sweeney, Ralph B. (Inventor); Verdouw, Albert J. (Inventor)

    1980-01-01

    A gas turbine engine combustor assembly of annular configuration has outer and inner walls made up of a plurality of axially extending multi-layered porous metal panels joined together at butt joints therebetween and each outer and inner wall including a transition panel of porous metal defining a combustor assembly outlet supported by a combustor mount assembly including a stiffener ring having a side undercut thereon fit over a transition panel end face; and wherein an annular weld joins the ring to the end face to transmit exhaust heat from the end face to the stiffener ring for dissipation from the combustor; a combustor pilot member is located in axially spaced, surrounding relationship to the end face and connector means support the stiffener ring in free floating relationship with the pilot member to compensate for both radial and axial thermal expansion of the transition panel; and said connector means includes a radial gap for maintaining a controlled flow of coolant from outside of the transition panel into cooling relationship with the stiffener ring and said weld to further cool the end face against excessive heat build-up therein during flow of hot gas exhaust through said outlet.

  12. A Longitudinal Analysis of Cigarette Prices in Military Retail Outlets

    PubMed Central

    Haddock, Christopher Keith; Hyder, Melissa L.; Poston, Walker S. C.; Jahnke, Sara A.; Williams, Larry N.; Lando, Harry

    2014-01-01

    Objectives. We conducted a longitudinal assessment of tobacco pricing in military retail outlets, including trends within each service branch. Methods. We determined the price of a single pack of Marlboro Red cigarettes at military retail stores located in the continental United States, Alaska, and Hawaii and at their nearest Walmarts in spring 2011 and 2013 (n = 128 for pairs available at both assessments). Results. The average difference between cigarettes sold in military retail outlets and Walmarts decreased from 24.5% in 2011 to 12.5% in 2013. The decrease was partially attributable to significant price decreases at Walmarts. The largest increases in cigarette prices occurred on naval installations. Potential savings at stores on several installations remained substantial in 2013; the largest approached $6 per pack. Stores on 17 military installations decreased cigarette prices during the study period. Conclusions. Tobacco can be purchased in military retail stores at substantial savings over civilian stores. If tobacco pricing is to cease to be an incentive for use among personnel, a revised military tobacco pricing policy is needed. PMID:24524503

  13. A gastric acid secretion model.

    PubMed Central

    de Beus, A M; Fabry, T L; Lacker, H M

    1993-01-01

    A theory of gastric acid production and self-protection is formulated mathematically and examined for clinical and experimental correlations, implications, and predictions using analytic and numerical techniques. In our model, gastric acid secretion in the stomach, as represented by an archetypal gastron, consists of two chambers, circulatory and luminal, connected by two different regions of ion exchange. The capillary circulation of the gastric mucosa is arranged in arterial-venous arcades which pass from the gastric glands up to the surface epithelial lining of the lumen; therefore the upstream region of the capillary chamber communicates with oxyntic cells, while the downstream region communicates with epithelial cells. Both cell types abut the gastric lumen. Ion currents across the upstream region are calculated from a steady-state oxyntic cell model with active ion transport, while the downstream ion fluxes are (facilitated) diffusion driven or secondarily active. Water transport is considered iso-osmotic. The steady-state model is solved in closed form for low gastric lumen pH. A wide variety of previously performed static and dynamic experiments on ion and CO2 transport in the gastric lumen and gastric blood supply are for the first time correlated with each other for an (at least) semiquantitative test of current concepts of gastric acid secretion and for the purpose of model verification. Agreement with the data is reported with a few outstanding and instructive exceptions. Model predictions and implications are also discussed. Images FIGURE 1 PMID:8396457

  14. Rett syndrome and gastric perforation.

    PubMed

    Shah, Malay B; Bittner, James G; Edwards, Michael A

    2008-04-01

    Rett Syndrome is associated with decreased peristaltic esophageal waves and gastric dysmotility, resulting in swallowing difficulties and gastric dilation. Rarely, gastric necrosis and perforation occur. Our case represents the third reported case of gastric necrosis and perforation associated with Rett Syndrome. A 31-year-old female after 11 hours of intermittent emesis and constant, sharp abdominal pain presented with evidence of multiorgan system failure including hypovolemic shock, metabolic acidosis, coagulopathy, and hepatorenal failure. A chest radiograph revealed intra-abdominal free air necessitating emergent laparotomy. During exploration, a severely dilated, thin-walled stomach with an area of necrosis and gross perforation was noted. Wedge resection of the necrotic tissue and primary closure were performed. Despite aggressive perioperative resuscitation and ventilation support, the patient died 3 hours postoperatively secondary to refractory shock and hypoxemia. Severe gastric dilation can occur with Rett Syndrome and may cause gastric necrosis and perforation. Prolonged elevated gastric pressures can decrease perfusion and may contribute to perforation. Timely decompression via percutaneous endoscopic or surgical gastrostomy could decrease the risk of perforation particularly when significant gastric distention is present. Consideration of gastric necrosis and perforation in patients with Rett Syndrome may lead to earlier intervention and decreased mortality.

  15. pH-responsive supramolecular polymer gel as an enteric elastomer for use in gastric devices

    PubMed Central

    Zhang, Shiyi; Bellinger, Andrew M.; Glettig, Dean L.; Barman, Ross; Lee, Young-Ah Lucy; Zhu, Jiahua; Cleveland, Cody; Montgomery, Veronica A; Gu, Li; Nash, Landon D.; Maitland, Duncan J.; Langer, Robert; Traverso, Giovanni

    2015-01-01

    Devices resident in the stomach -- which are used for a variety of clinical applications including nutritional modulation for bariatrics, ingestible electronics for diagnosis and monitoring, and gastric retentive dosage forms for prolonged drug delivery -- typically incorporate elastic polymers to compress the devices during delivery through the esophagus and other narrow orifices in the digestive system. However, in the event of accidental device fracture or migration, the non-degradable nature of these materials risks intestinal obstruction. Here, we show that an elastic, pH-responsive supramolecular gel remains stable and elastic in the acidic environment of the stomach but can be dissolved in the neutral-pH environment of the small and large intestines. In a large animal model, prototype devices with these materials as the key component demonstrated prolonged gastric retention and safe passage. These enteric elastomers should increase the safety profile for a wide range of gastric retentive devices. PMID:26213897

  16. A Rare Case of an Early Postoperative Obstructive Ileus in a Young Female Patient due to a Residual Trichobezoar Mass

    PubMed Central

    Christopoulos, P.; Ross-Thriepland, S.; McCarthy, H.; Day, C. S.; Sasi, W.

    2016-01-01

    Trichobezoar is a rare cause of small bowel obstruction, whereby a mass forms most commonly in the stomach and duodenum of young females, from ingestion of hair, a condition known as trichophagia. We present a case of recurrent small bowel obstruction due to a residual hair mass that was removed surgically in a young female patient who had a laparotomy and gastrotomy for removal of a large gastric trichobezoar just two weeks prior to the current admission. This case illustrates the importance of a thorough inspection of the whole bowel to ensure that no residual bezoars remain after surgery. PMID:27148464

  17. Large rhinolith causing nasal obstruction

    PubMed Central

    Dincer Kose, Onur; Kose, Taha Emre; Erdem, Mehmet Ali; Cankaya, Abdulkadir Burak

    2015-01-01

    Rhinoliths are calcified masses located in the nasal cavity and may cause symptoms such as nasal obstruction, fetid odour and facial pain. They are usually diagnosed incidentally on radiographic examinations or depending on the symptoms. In this paper we report a 27-year-old Caucasian woman with a calcified mass in the right nasal cavity causing nasal obstruction, anosmia and facial pain. The calcified mass was removed by endonasal approach. PMID:25759270

  18. Obstructive sleep apnoea and anaesthesia

    PubMed Central

    Rudra, A.; Chatterjee, S.; Das, T.; Sengupta, S.; Maitra, G.; Kumar, P.

    2008-01-01

    Obstructive sleep apnoea (OSA) correlates positively with obesity and age, both of which are becoming increasingly prevalent. Obstructive sleep apnoea occurs much more frequently in clinical practice than formerly diagnosed, and that this condition represents complex challenges for difficulty in mask ventilation, laryngoscopic intubation, accelerated arterial desaturation, postoperative monitoring and discharge status. In this review article pathophysiology, diagnosis, and perioperative management of this group of patients have been discussed in detail. PMID:19742249

  19. Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities?

    PubMed Central

    Richardson, E.A.; Hill, S.E.; Mitchell, R.; Pearce, J.; Shortt, N.K.

    2015-01-01

    Alcohol consumption may be influenced by the local alcohol retailing environment. This study is the first to examine neighbourhood alcohol outlet availability (on- and off-sales outlets) and alcohol-related health outcomes in Scotland. Alcohol-related hospitalisations and deaths were significantly higher in neighbourhoods with higher outlet densities, and off-sales outlets were more important than on-sales outlets. The relationships held for most age groups, including those under the legal minimum drinking age, although were not significant for the youngest legal drinkers (18–25 years). Alcohol-related deaths and hospitalisations were higher in more income-deprived neighbourhoods, and the gradient in deaths (but not hospitalisations) was marginally larger in neighbourhoods with higher off-sales outlet densities. Efforts to reduce alcohol-related harm should consider the potentially important role of the alcohol retail environment. PMID:25840352

  20. Chronic intestinal pseudo-obstruction.

    PubMed

    Gabbard, Scott L; Lacy, Brian E

    2013-06-01

    Chronic intestinal pseudo-obstruction (CIP) is a rare and serious disorder of the gastrointestinal (GI) tract characterized as a motility disorder with the primary defect of impaired peristalsis; symptoms are consistent with a bowel obstruction, although mechanical obstruction cannot be identified. CIP is classified as a neuropathy, myopathy, or mesenchymopathy; it is a neuropathic process in the majority of patients. The natural history of CIP is generally that of a progressive disorder, although occasional patients with secondary CIP note significant symptomatic improvement when the underlying disorder is identified and treated. Symptoms vary from patient to patient depending on the location of the luminal GI tract involved and the degree of involvement; however, the small intestine is nearly always involved. Common symptoms include dysphagia, gastroesophageal reflux, abdominal pain, nausea, vomiting, bloating, abdominal distension, constipation or diarrhea, and involuntary weight loss. Unfortunately, these symptoms are nonspecific, which can contribute to misdiagnosis or a delay in diagnosis and treatment. Since many of the symptoms and signs suggest a mechanical bowel obstruction, diagnostic tests typically focus on uncovering a mechanical obstruction, although routine tests do not identify an obstructive process. Nutrition supplementation is required for many patients with CIP due to symptoms of dysphagia, nausea, vomiting, and weight loss. This review discusses the epidemiology, etiology, pathogenesis, diagnosis, and treatment of patients with CIP, with an emphasis on nutrition assessment and treatment options for patients with nutrition compromise.

  1. EARLY POSTOPERATIVE COMPLICATIONS IN ROUX-EN-Y GASTRIC BYPASS

    PubMed Central

    STOLL, Aluisio; ROSIN, Leandro; DIAS, Mariana Fernandes; MARQUIOTTI, Bruna; GUGELMIN, Giovana; STOLL, Gabriela Fanezzi

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim: To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method: Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results: The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion: In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death. PMID:27683781

  2. Obstructive sleep apnea

    PubMed Central

    Ho, Matthew L.; Brass, Steven D.

    2011-01-01

    Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual's risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances. PMID:22368774

  3. Obstructive sleep apnea.

    PubMed

    Ho, Matthew L; Brass, Steven D

    2011-11-29

    Obstructive sleep apnea (OSA) affects millions of Americans and is estimated to be as prevalent as asthma and diabetes. Given the fact that obesity is a major risk factor for OSA, and given the current global rise in obesity, the prevalence of OSA will increase in the future. Individuals with sleep apnea are often unaware of their sleep disorder. It is usually first recognized as a problem by family members who witness the apneic episodes or is suspected by their primary care doctor because of the individual's risk factors and symptoms. The vast majority remain undiagnosed and untreated, despite the fact that this serious disorder can have significant consequences. Individuals with untreated OSA can stop breathing hundreds of times a night during their sleep. These apneic events can lead to fragmented sleep that is of poor quality, as the brain arouses briefly in order for the body to resume breathing. Untreated, sleep apnea can have dire health consequences and can increase the risk of hypertension, diabetes, heart disease, and heart failure. OSA management has also become important in a number of comorbid neurological conditions, including epilepsy, stroke, multiple sclerosis, and headache. Diagnosis typically involves use of screening questionnaires, physical exam, and an overnight polysomnography or a portable home study. Treatment options include changes in lifestyle, positive airway pressure, surgery, and dental appliances.

  4. Integrating Tobacco Control and Obesity Prevention Initiatives at Retail Outlets

    PubMed Central

    D’Angelo, Heather; Evenson, Kelly R.; Fleischhacker, Sheila; Myers, Allison E.; Rose, Shyanika W.

    2016-01-01

    Tobacco products are sold in approximately 375,000 US retail outlets, including convenience stores and pharmacies, which often sell energy-dense, low-nutrient foods and beverages. The Food and Drug Administration’s (FDA’s) increased authority over tobacco product sales and marketing, combined with declining smoking rates, provides an opportunity to transition tobacco retailers toward healthier retail environments. Unfortunately, research into improving consumer retail environments is often conducted in isolation by researchers working in tobacco control, nutrition, and physical activity. Interdisciplinary efforts are needed to transform tobacco retailers from stores that are dependent on a declining product category, to the sale and promotion of healthful foods and creating environments conducive to active living. The objective of this article is to describe the potential for interdisciplinary efforts to transition retailers away from selling and promoting tobacco products and toward creating retail environments that promote healthful eating and active living. PMID:26963859

  5. North Atlantic warming and the retreat of Greenland's outlet glaciers.

    PubMed

    Straneo, Fiammetta; Heimbach, Patrick

    2013-12-05

    Mass loss from the Greenland ice sheet quadrupled over the past two decades, contributing a quarter of the observed global sea-level rise. Increased submarine melting is thought to have triggered the retreat of Greenland's outlet glaciers, which is partly responsible for the ice loss. However, the chain of events and physical processes remain elusive. Recent evidence suggests that an anomalous inflow of subtropical waters driven by atmospheric changes, multidecadal natural ocean variability and a long-term increase in the North Atlantic's upper ocean heat content since the 1950s all contributed to a warming of the subpolar North Atlantic. This led, in conjunction with increased runoff, to enhanced submarine glacier melting. Future climate projections raise the potential for continued increases in warming and ice-mass loss, with implications for sea level and climate.

  6. Investigating Long-term Behavior of Outlet Glaciers in Greenland

    NASA Technical Reports Server (NTRS)

    Csatho, Beata; vanderVeen, Kees; Schenk, Toni

    2005-01-01

    Repeat surveys by airborne laser altimetry in the 1990s have revealed significant thinning of outlet glaciers draining the interior of the Greenland Ice Sheet, with thinning rates up to several meters per year. To fully appreciate the significance of these recent glacier changes, the magnitude of retreat and surface lowering must be placed within the broader context of the retreat since the Last Glacial Maximum and, more significantly, of the retreat following the temporary glacier advance during the Little Ice Age (LIA). The LIA maximum stand is marked by trimlines, sharp boundaries between recently deglacifated unvegetated rocks, and vegetated surfaces at higher elevations. The objective of this project was to demonstrate the use of remote sensing data to map these trimlines and other glacial geomorphologic features.

  7. Double outlet right ventricle. Study of 27 cases.

    PubMed Central

    Cameron, A H; Acerete, F; Quero, M; Castro, M C

    1976-01-01

    Out of 1610 children's hearts with congenital malformations there were 27 specimens showing double outlet right ventricle. Cases with dextrocardia, situs inversus, or l-venticular loop were excluded. Anatomical examination was performed with particular reference to the infundibular region, the great vessels, and the ventricular septum. The commonest associated malformations were ventricular septal defect and pulmonary stenosis. Aortic stenosis was the predominant finding in those cases dying in the neonatal period. An aortic conus was associated with pulmonary stenosis, ventricular septal defect, and d-transposition, a pulmonary conus with ventricular septal defect and a double conus with stenosis of either great vessel. The anterior vessel always had a muscular conus and the posterior vessel was commonly stenotic. Images PMID:1008954

  8. Radially leaned outlet guide vanes for fan source noise reduction

    NASA Technical Reports Server (NTRS)

    Kazin, S. B.

    1973-01-01

    Two quiet engine program half scale fans one with a subsonic and the other with a supersonic fan tip speed at takeoff were run with 30 degree leaned and radial outlet guide vanes. Acoustic data at takeoff fan speed on the subsonic tip speed fan showed decreases in 200-foot sideline noise of from 1 to 2 PNdb. The supersonic tip speed fan a takeoff fan speed, however, showed noise increases of up 3 PNdb and a decrease in fan efficiency. At approach fan speed, the subsonic tip speed fan showed a noise decrease of 2.3 PNdb at the 200-foot sideline maximum angle and an increase in efficiency. The supersonic tip speed fan showed noise increase of 3.5 PNdb and no change in efficiency. The decrease in fan efficiency and the nature of the noise increase largely high frequency broadband noise lead to the speculation that an aerodynamic problem occurred.

  9. Integrating Tobacco Control and Obesity Prevention Initiatives at Retail Outlets.

    PubMed

    Ribisl, Kurt M; D'Angelo, Heather; Evenson, Kelly R; Fleischhacker, Sheila; Myers, Allison E; Rose, Shyanika W

    2016-03-10

    Tobacco products are sold in approximately 375,000 US retail outlets, including convenience stores and pharmacies, which often sell energy-dense, low-nutrient foods and beverages. The Food and Drug Administration's (FDA's) increased authority over tobacco product sales and marketing, combined with declining smoking rates, provides an opportunity to transition tobacco retailers toward healthier retail environments. Unfortunately, research into improving consumer retail environments is often conducted in isolation by researchers working in tobacco control, nutrition, and physical activity. Interdisciplinary efforts are needed to transform tobacco retailers from stores that are dependent on a declining product category, to the sale and promotion of healthful foods and creating environments conducive to active living. The objective of this article is to describe the potential for interdisciplinary efforts to transition retailers away from selling and promoting tobacco products and toward creating retail environments that promote healthful eating and active living.

  10. Effects of Outlets on Cracking Risk and Integral Stability of Super-High Arch Dams

    PubMed Central

    Hu, Hang

    2014-01-01

    In this paper, case study on outlet cracking is first conducted for the Goupitan and Xiaowan arch dams. A nonlinear FEM method is then implemented to study effects of the outlets on integral stability of the Xiluodu arch dam under two loading conditions, i.e., normal loading and overloading conditions. On the basis of the case study and the numerical modelling, the outlet cracking mechanism, risk, and corresponding reinforcement measures are discussed. Furthermore, the numerical simulation reveals that (1) under the normal loading conditions, the optimal distribution of the outlets will contribute to the tensile stress release in the local zone of the dam stream surface and decrease the outlet cracking risk during the operation period. (2) Under the overloading conditions, the cracks initiate around the outlets, then propagate along the horizontal direction, and finally coalesce with those in adjacent outlets, where the yield zone of the dam has a shape of butterfly. Throughout this study, a dam outlet cracking risk control and reinforcement principle is proposed to optimize the outlet design, select the appropriate concrete material, strengthen the temperature control during construction period, design reasonable impounding scheme, and repair the cracks according to their classification. PMID:25152907

  11. Community organization moderates the effect of alcohol outlet density on violence.

    PubMed

    Pridemore, William Alex; Grubesic, Tony H

    2012-12-01

    There is growing evidence from multiple disciplines that alcohol outlet density is associated with community levels of assault. Based on the theoretical and empirical literatures on social organization and crime, we tested the hypothesis that the association between alcohol outlet density and neighbourhood violence rates is moderated by social organization. Using geocoded police data on assaults, geocoded data on the location of alcohol outlets, and controlling for several structural factors thought to be associated with violence rates, we tested this hypothesis employing negative binomial regression with our sample of 298 block groups in Cincinnati. Our results revealed direct effects of alcohol outlet density and social organization on assault density, and these effects held for different outlet types (i.e., off-premise, bars, restaurants) and levels of harm (i.e., simple and aggravated assaults). More importantly, we found that the strength of the outlet-assault association was significantly weaker in more socially organized communities. Subsequent analyses by level of organization revealed no effects of alcohol outlet density on aggravated assaults in organized block groups, but significant effects in disorganized block groups. We found no association between social (dis)organization and outlet density. These results clarify the community-level relationship between alcohol outlets and violence and have important implications for municipal-level alcohol policies.

  12. Examining tobacco outlet concentration in New Jersey: does income and ethnicity matter?

    PubMed

    Reid, Robert J; Morton, Cory M; Garcia-Reid, Pauline; Peterson, N Andrew; Yu, Danlin

    2013-01-01

    This study examined the geographic association between tobacco outlet density and the demographic indicators of median household income and percentage of Hispanic residents in New Jersey. Tobacco outlet density was assessed by examining all tobacco retailers licensed in 2004 in New Jersey, and demographic variables were based on the 2000 United States Census. Results indicated that the percentage of Hispanic residents and median household income were both salient predictors of tobacco outlet density. We also observed that income level moderated the relationship between the percentage of Hispanics residents and tobacco outlet density. Implications for environmentally based tobacco prevention and control initiatives are discussed.

  13. Fan noise reduction of an aircraft engine by inclining the outlet guide vanes

    NASA Astrophysics Data System (ADS)

    Khaletskiy, Yu. D.; Pochkin, Ya. S.

    2015-01-01

    The paper presents the results of an experimental study of the acoustic characteristics of an aircraft engine fan in the design of which the outlet guide vanes are leaned in the circumferential direction. It was found that the configuration of the outlet guide with the vanes leaned along the rotation of the rotor leads to fan noise reduction with respect to the configuration with outlet guide vanes, and a configuration of the outlet guide with an lean of the vane counterrotation of the rotor wheel leads to its increase.

  14. Phytobezoar in a jejunal diverticulum as a cause of small bowel obstruction: a case report

    PubMed Central

    2011-01-01

    Introduction Phytobezoars are concretions of poorly digested fruit and vegetable fibers found in the alimentary tract. Previous gastric resection, gastrojejunostomy, or pyloroplasty predispose people to bezoar formation. Small-bowel bezoars normally come from the stomach, and primary small-bowel bezoars are very rare. They are seen only in patients with underlying small-bowel diseases such as diverticula, strictures, or tumors. Primary small-bowel bezoars almost always present as intestinal obstructions, although it is a very rare cause, being responsible for less than 3% of all small-bowel obstructions in one series. Jejunal diverticula are rare, with an incidence of less than 0.5%. They are usually asymptomatic pseudodiverticula of pulsion type, and complications are reported in 10% to 30% of patients. A phytobezoar in a jejunal diverticulum is an extremely rare presentation. Case presentation A 78-year-old Pakistani man presented to our clinic with small-bowel obstruction. Upon exploration, we found a primary small-bowel bezoar originating in a jejunal diverticulum and causing jejunal obstruction. Resection and anastomosis of the jejunal segment harboring the diverticulum was performed, and our patient had an uneventful recovery. Conclusion Primary small-bowel bezoars are very rare but must be kept in mind as a possible cause of small-bowel obstruction. PMID:21951579

  15. A rare cause of small bowel obstruction due to bezoar in a virgin abdomen

    PubMed Central

    Nasri, Baongoc; Calin, Marius; Shah, Ajay; Gilchrist, Brian

    2015-01-01

    Introduction Bezoar is an unusual cause of small bowel obstruction accounting for 0.4–4% of all mechanical bowel obstruction. The common site of obstruction is terminal ileum. Case report A 28-year-old male with no past surgical history, known to have severe mental retardation presented with anorexia. CT scan demonstrated dilated small bowel loops and intraluminal ileal mass with mottled appearance. At exploratory laparotomy, a bezoar was found impacted in the terminal ileum 5–6 inches away from the ileocecal valve and was removed through an enterotomy. Discussion Bezoars are concretions of fibers or foreign bodies in the alimentary tract. Small bowel obstruction is one of common clinical symptoms. The typical finding of well-defined intraluminal mass with mottled gas pattern in CT scan is suggestive of an intestinal bezoar. The treatment option of bezoar is surgery including manual fragmentation of bezoar and pushing it toward cecum, enterotomy or segmental bowel resection. Thorough exploration of abdominal cavity should be done to exclude the presence of concomitant bezoars. Recurrence is common unless underlying predisposing condition is corrected. Conclusions Bezoar-induced small bowel obstruction remains an uncommon diagnosis. It should be suspected in patients with an increased risk of bezoar formation, such as in the presence of previous gastric surgery, a history suggestive of increased fiber intake, or patient with psychiatric disorders. CT scan is helpful for preoperative diagnosis. PMID:26764889

  16. Gut microbiota and gastric disease.

    PubMed

    Sgambato, Dolores; Miranda, Agnese; Romano, Lorenzo; Romano, Marco

    2017-02-15

    The gut microbiota may be considered a crucial "organ" of human body because of its role in the maintenance of the balance between health as well as disease. It is mainly located in the small bowel and colon, while, the stomach was long thought to be sterile in particular for its high acid production. In particular, stomach was considered "an hostile place" for bacterial growth until the identification of Helicobacter pylori (HP). Now, the stomach and its microbiota can be considered as two different "organs" that share the same place and they have an impact on each other. In fact microscopic structures of gastric mucosa (mucus layer and luminal contents) influence local microflora and vice versa. In this article our attention is directed specifically to explain the effects of this "cross-talk" on gastric homeostais. The gastric microbiota grossly consists of two macrogroups: HP and non-HP bacteria. Here, we review the relationship between these two populations and their role in the development of the different gastric disorders: functional dyspepsia, gastric premalignant lesions (chronic atrophic gastritis, intestinal metaplasia and dysplasia of the gastric mucosa) and gastric cancer. Moreover we focus on the effects on the gastric microbiota of exogenous interference as diet and use of proton pump inhibitors (PPIs).

  17. Epigenetic mechanisms in gastric cancer.

    PubMed

    Gigek, Carolina Oliveira; Chen, Elizabeth Suchi; Calcagno, Danielle Queiroz; Wisnieski, Fernanda; Burbano, Rommel Rodriguez; Smith, Marilia Arruda Cardoso

    2012-06-01

    Cancer is considered one of the major health issues worldwide, and gastric cancer accounted for 8% of total cases and 10% of total deaths in 2008. Gastric cancer is considered an age-related disease, and the total number of newly diagnosed cases has been increasing as a result of the higher life expectancy. Therefore, the basic mechanisms underlying gastric tumorigenesis is worth investigation. This review provides an overview of the epigenetic mechanisms, such as DNA methylation, histone modifications, chromatin remodeling complex and miRNA, involved in gastric cancer. As the studies in gastric cancer continue, the mapping of an epigenome code is not far for this disease. In conclusion, an epigenetic therapy might appear in the not too distant future.

  18. Pediatric Gastric Teratoma

    PubMed Central

    Valenzuela-Ramos, Marco Cesar; Mendizábal-Méndez, Ana Luisa; Ríos-Contreras, Carlos Alberto; Rodríguez-Montes, Claudia Esther

    2010-01-01

    Neoplasms from germ cell origin are a heterogeneous group of tumors rarely seen in the pediatric population, teratoma is the most frequent among them. They can occur in either gonadal or extragonadal locations. Extragonadal teratoma arising from abdominal viscera is very unusual. There are less than a hundred reported cases of gastric teratoma in the worldwide literature. Since the occurrence of this pathology in the pediatric age group is quite rare, we describe a case of a teratoma located in the lesser curvature of the stomach in an infant with an emphasis in radiologic-pathologic correlation. PMID:22470691

  19. [Secretory eosinophilia and obstructive rhinitis].

    PubMed

    Rouvier, P; Mondain, M; Elkhoury, J

    1992-01-01

    Detecting eosinophilia in the nasal secretions of patients complaining of nasal obstruction makes it possible to identify a group of high risk patients. Hosty use of surgery in these patients carries a high risk of iatrogenic complications and little potential for improvement. The 2 most frequently used methods of obtaining cytologic specimens (swabbing versus washing) were compared in 37 patients with obstructive rhinitis (early stage polyposis and nonallergic rhinitis with eosinophilia syndrome, NARES). Swabbing gave reliable results. Eosinophilia was negligible in a group of 25 control subjects. The mean eosinophil count was 2.5% and only 1 patient had a positive cystogram. The 220 patients which nasal obstruction were classed in 5 groups according to the severity of clinical signs and symptoms. The mean eosinophil count and the percentage of patients with positive cystogram increased with increased severity of the clinical syndrome. 28 patients had uncomplicated obstructive rhinitis, 10 had NARES, 43 had allergic rhinitis, 52 had chronic obstructive rhinitis, and 87 had nasosinal polyposis. The respective mean eosinophil counts were 6.42%, 10.3%, 13.8% 16.8% and 31.4%. The percentage of patients with positive cytograms was respectively, 10.8%, 20%, 23.3%, 28.8% and 54%.

  20. 46 CFR 34.15-25 - Discharge outlets-T/ALL.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Discharge outlets-T/ALL. 34.15-25 Section 34.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS FIREFIGHTING EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 34.15-25 Discharge outlets—T/ALL. (a) Discharge outlets shall be of an...

  1. 46 CFR 34.15-25 - Discharge outlets-T/ALL.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Discharge outlets-T/ALL. 34.15-25 Section 34.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS FIREFIGHTING EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 34.15-25 Discharge outlets—T/ALL. (a) Discharge outlets shall be of an...

  2. 46 CFR 34.15-25 - Discharge outlets-T/ALL.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Discharge outlets-T/ALL. 34.15-25 Section 34.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS FIREFIGHTING EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 34.15-25 Discharge outlets—T/ALL. (a) Discharge outlets shall be of an...

  3. 46 CFR 34.15-25 - Discharge outlets-T/ALL.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Discharge outlets-T/ALL. 34.15-25 Section 34.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS FIREFIGHTING EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 34.15-25 Discharge outlets—T/ALL. (a) Discharge outlets shall be of an...

  4. 46 CFR 34.15-25 - Discharge outlets-T/ALL.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Discharge outlets-T/ALL. 34.15-25 Section 34.15-25 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS FIREFIGHTING EQUIPMENT Carbon Dioxide Extinguishing Systems, Details § 34.15-25 Discharge outlets—T/ALL. (a) Discharge outlets shall be of an...

  5. 46 CFR 153.352 - B/3 and 4 m venting system outlets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false B/3 and 4 m venting system outlets. 153.352 Section 153.352 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES... Cargo Venting Systems § 153.352 B/3 and 4 m venting system outlets. A B/3 or 4 m venting system...

  6. 46 CFR 153.352 - B/3 and 4 m venting system outlets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false B/3 and 4 m venting system outlets. 153.352 Section 153.352 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES... Cargo Venting Systems § 153.352 B/3 and 4 m venting system outlets. A B/3 or 4 m venting system...

  7. Survey of Publication Outlets in Early Childhood Education: Descriptive Data, Review Processes, and Advice to Authors

    ERIC Educational Resources Information Center

    Amodei, Michelle L.; Jalongo, Mary Renck; Myers, Jacqueline; Onchwari, Jacqueline; Gargiulo, Richard M.

    2013-01-01

    Publishing outlets in the field of early childhood vary widely in terms of emphasis on theory, practice, and research as they relate to the care and education of the very young; these outlets also have different readerships (i.e., primarily for teachers, the teachers of their teachers, or the fellow scholars/researchers). Included in the mixture…

  8. Alcohol outlet density and alcohol consumption in Los Angeles county and southern Louisiana.

    PubMed

    Schonlau, Matthias; Scribner, Richard; Farley, Thomas A; Theall, Katherine; Bluthenthal, Ricky N; Scott, Molly; Cohen, Deborah A

    2008-11-01

    The objective of this study was to assess the relationship between alcohol availability, as measured by the density of off-premise alcohol outlets, and alcohol consumption in Los Angeles county and southern Louisiana, USA. Consumption information was collected through a telephone survey of 2,881 households in Los Angeles county and pre-Katrina southern Louisiana, nested within 220 census tracts. Respondents' addresses were geo-coded and both neighbourhood (census tracts and buffers of varying sizes) and individual (network distance to the closest alcohol outlet) estimates of off-sale alcohol outlet density were computed. Alcohol outlet density was not associated with the percentage of people who were drinkers in either site. Alcohol outlet density was associated with the quantity of consumption among drinkers in Louisiana but not in Los Angeles. Outlet density within a one-mile buffer of the respondent's home was more strongly associated with alcohol consumption than outlet density in the respondent's census tract. The conclusion is that the relationship between neighbourhood alcohol outlet density and alcohol consumption is complex and may vary due to differences in neighbourhood design and travel patterns.

  9. Secondhand Effects of Student Alcohol Use Reported by Neighbors of Colleges: The Role of Alcohol Outlets.

    ERIC Educational Resources Information Center

    Wechsler, Henry; Lee, Jae Eun; Hall, John; Wagenaar, Alexander C.; Lee, Hang

    2002-01-01

    Examined the relationship of a college's level of binge drinking and the number of alcohol outlets to lowered quality of neighborhood life through secondhand effects. Analysis indicated that the number of nearby alcohol outlets was an important factor mediating the relationship between colleges, especially those with high rates of binge drinking,…

  10. Review of recent developments and applications in low-pressure (vacuum outlet) gas chromatography

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The concept of low pressure (LP) vacuum outlet gas chromatography (GC) was introduced more than 50 years ago, but it was not until the 2000s that its theoretical applicability to fast analysis of GC-amenable chemicals was realized. In practice, LPGC is implemented by placing the outlet of a short, ...

  11. Co-Construction, Infrastructure, and Purpose: Influences on Implementation of Hub-Outlet School Reform

    ERIC Educational Resources Information Center

    Lenhoff, Sarah Winchell

    2013-01-01

    This dissertation is a collection of three interrelated chapters that explore unique dimensions of hub-outlet school reform. This type of school reform, in which a central hub organization designs a model for instructional improvement meant to be implemented with fidelity across unique outlet school sites, has gained credibility in the crowded…

  12. 46 CFR 34.20-20 - Discharge outlets-T/ALL.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Discharge outlets-T/ALL. 34.20-20 Section 34.20-20 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS FIREFIGHTING EQUIPMENT Deck Foam System, Details § 34.20-20 Discharge outlets—T/ALL. (a) Discharge outlets shall be of an approved type. (b)...

  13. 46 CFR 34.17-20 - Discharge outlets-T/ALL.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Discharge outlets-T/ALL. 34.17-20 Section 34.17-20 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY TANK VESSELS FIREFIGHTING EQUIPMENT Fixed Foam Extinguishing Systems, Details § 34.17-20 Discharge outlets—T/ALL. (a) Discharge outlets shall be of an...

  14. Fetal lower urinary tract obstruction.

    PubMed

    Lissauer, David; Morris, Rachel K; Kilby, Mark D

    2007-12-01

    Fetal lower urinary tract obstruction affects 2.2 per 10,000 births. It is a consequence of a range of pathological processes, most commonly posterior urethral valves (64%) or urethral atresia (39%). It is a condition of high mortality and morbidity associated with progressive renal dysfunction and oligohydramnios, and hence fetal pulmonary hypoplasia. Accurate detection is possible via ultrasound, but the underlying pathology is often unknown. In future, magnetic resonance imaging (MRI) may be increasingly used alongside ultrasound in the diagnosis and assessment of fetuses with lower urinary tract obstruction. Fetal urine analysis may provide improvements in prenatal determination of renal prognosis, but the optimum criteria to be used remain unclear. It is now possible to decompress the obstruction in utero via percutaneous vesico-amniotic shunting or cystoscopic techniques. In appropriately selected fetuses intervention may improve perinatal survival, but long-term renal morbidity amongst survivors remains problematic.

  15. Recurrent airway obstruction: a review.

    PubMed

    Pirie, R S

    2014-05-01

    Recurrent airway obstruction is a widely recognised airway disorder, characterised by hypersensitivity-mediated neutrophilic airway inflammation and lower airway obstruction in a subpopulation of horses when exposed to suboptimal environments high in airborne organic dust. Over the past decade, numerous studies have further advanced our understanding of different aspects of the disease. These include clarification of the important inhaled airborne agents responsible for disease induction, improving our understanding of the underlying genetic basis of disease susceptibility and unveiling the fundamental immunological mechanisms leading to establishment of the classic disease phenotype. This review, as well as giving a clinical overview of recurrent airway obstruction, summarises much of the work in these areas that have culminated in a more thorough understanding of this debilitating disease.

  16. Small bowel obstruction- a surprise.

    PubMed

    Mathew, Jeffrey Daniel; Cp, Ganesh Babu; M, Balachandar; M, Ramanathan

    2015-01-01

    Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction.

  17. Abdominal muscle and quadriceps strength in chronic obstructive pulmonary disease

    PubMed Central

    Man, W; Hopkinson, N; Harraf, F; Nikoletou, D; Polkey, M; Moxham, J

    2005-01-01

    Background: Quadriceps muscle weakness is common in chronic obstructive pulmonary disease (COPD) but is not observed in a small hand muscle (adductor pollicis). Although this could be explained by reduced activity in the quadriceps, the observation could also be explained by anatomical location of the muscle or fibre type composition. However, the abdominal muscles are of a similar anatomical and fibre type distribution to the quadriceps, although they remain active in COPD. Cough gastric pressure is a recently described technique that assesses abdominal muscle (and hence expiratory muscle) strength more accurately than traditional techniques. A study was undertaken to test the hypothesis that more severe weakness exists in the quadriceps than in the abdominal muscles of patients with COPD compared with healthy elderly controls. Methods: Maximum cough gastric pressure and quadriceps isometric strength were measured in 43 patients with stable COPD and 25 healthy elderly volunteers matched for anthropometric variables. Results: Despite a significant reduction in mean quadriceps strength (29.9 kg v 41.2 kg; 95% CI –17.9 to –4.6; p = 0.001), cough gastric pressure was preserved in patients with COPD (227.3 cm H2O v 204.8 cm H2O; 95% CI –5.4 to 50.6; p = 0.11). Conclusions: Abdominal muscle strength is preserved in stable COPD outpatients in the presence of quadriceps weakness. This suggests that anatomical location and fibre type cannot explain quadriceps weakness in COPD. By inference, we conclude that disuse and consequent deconditioning are important factors in the development of quadriceps muscle weakness in COPD patients, or that activity protects the abdominal muscles from possible systemic myopathic processes. PMID:15923239

  18. Relating Off-Premises Alcohol Outlet Density to Intentional and Unintentional Injuries

    PubMed Central

    Morrison, Christopher; Smith, Karen; Gruenewald, Paul J.; Ponicki, William R.; Lee, Juliet P.; Cameron, Peter

    2015-01-01

    Aims This study investigated the hypotheses that (i) intentional and unintentional injuries occur more frequently in areas with greater density of off-premises alcohol outlets; and (ii) larger and chain outlets selling cheaper alcohol contribute more substantially to injury risk than smaller and independent outlets. Design Ecological cross-sectional. Setting From the 256 Statistical Area level 2 (SA2) Census units in Melbourne, Australia, we selected a random sample of 62 units. There were 2,119 Statistical Area level 1 (SA1) units nested within the selected SA2 units. Participants The selected units contained 295 off-premises outlets. Measurements Two independent observers conducted premises assessments in all off-premises outlets, assessing the volume of alcohol available for sale (paces of shelf space), price (least wine price), and other operating characteristics (chain vs. independent, drive-through). Outlet counts, assessed outlet characteristics, and other area characteristics (population density, median age, median income, retail zoning) were aggregated within SA1 units. Dependent variables were counts of ambulance attended intentional injuries (assaults, stabbings, shootings) and unintentional injuries (falls, crush injuries, and object strikes). Findings In univariable analyses, chain outlets were larger (r = 0.383; p < 0.001) and sold cheaper alcohol (r = −0.484; p < 0.001) compared with independent outlets. In Bayesian spatial Poisson models, off-premises outlet density was positively related to both intentional (Incidence Rate Ratio = 1.38; 95% Credible Interval: 1.19, 1.60) and unintentional injuries (IRR = 1.18; 95% CI: 1.06, 1.30). After disaggregation by outlet characteristics, chain outlet density was also related to both intentional (IRR = 1.35; 95% CI: 1.11, 1.64) and unintentional injuries (IRR = 1.20; 95% CI: 1.08, 1.38). Conclusions Greater off-premises outlet density is related to greater incidence of traumatic injury, and chain outlets

  19. EFFECTS OF DIFFERENT PERIODS OF GASTRIC ISCHAEMIA IN THE VIABILITY OF THE TISSUE OF BODY, FUNDUS AND ANTRUM REGION OF RABBIT STOMACH

    PubMed Central

    MAGALHÃES, Maria Angélica B.; BARBOSA, Alfredo J. A.; FIGUEIREDO, Juliano A.; ALBERTI, Luiz R.; PETROIANU, Andy

    2015-01-01

    BACKGROUND: Despite the rich vascular arcade of the stomach, gastric ischemia represents an important medical challenge and can be the consequence of obstructive or non-obstructive vascular processes of pathological or iatrogenic origin. AIM: To assess the effects of acute gastric ischaemia on the different regions of the stomach. METHOD: Fifteen New Zeland rabbits were divided into three groups: group 1, animals were observed during 3 h; group 2, during 6 h; group 3, during 12 h. Rabbit stomachs were subjected to devascularization of the greater and lesser curvatures. After predetermined time, the stomachs were removed for macro and microscopic studies. RESULTS: Haemorrhagic necrosis was more marked in the gastric fundus and body. In contrast, the antropylorus remained preserved in 80% of the animals. Necrosis of the gastric body and fundus mucosa were observed in all animals after 6 h and 12 h of ischaemia. CONCLUSION: Acute gastric ischaemia in rabbits produces haemorrhagic necrosis of the gastric fundus and body even in a short period of time. Beside this, the antropyloric region was significantly more resistant to ischaemia. PMID:26247325

  20. Obstructive Sleep Apnea and Atherosclerosis.

    PubMed

    Amin, Zulkifli; Amin, Hilman Z; Amin, Lukman Z

    2016-01-01

    Obstructive sleep apnea (OSA) is a sleep respiratory disorder characterized by recurrent episodes of complete or partial airway obstruction, resulting in apneas or hypopneas. OSA could contribute to atherosclerosis through direct and indirect mechanisms. Endothelial dysfunction, sympathetic stimulation, and proinflammatory cytokine modulation caused by OSA play significant role to an atherosclesrotic event. Other risk factors of atherosclerosis like hypertension and diabetes mellitus also associated with OSA. Animal and clinical studies recently showed promising data to prove association between OSA, atherosclerosis, and its risk factors. However, provided data has not showed consistent result. In the future, demand of further research both basic and clinical sciences need to be fulfilled.

  1. Alcohol beverage control, privatization and the geographic distribution of alcohol outlets

    PubMed Central

    2012-01-01

    Background With Pennsylvania currently considering a move away from an Alcohol Beverage Control state to a privatized alcohol distribution system, this study uses a spatial analytical approach to examine potential impacts of privatization on the number and spatial distribution of alcohol outlets in the city of Philadelphia over a long time horizon. Methods A suite of geospatial data were acquired for Philadelphia, including 1,964 alcohol outlet locations, 569,928 land parcels, and school, church, hospital, park and playground locations. These data were used as inputs for exploratory spatial analysis to estimate the expected number of outlets that would eventually operate in Philadelphia. Constraints included proximity restrictions (based on current ordinances regulating outlet distribution) of at least 200 feet between alcohol outlets and at least 300 feet between outlets and schools, churches, hospitals, parks and playgrounds. Results Findings suggest that current state policies on alcohol outlet distributions in Philadelphia are loosely enforced, with many areas exhibiting extremely high spatial densities of outlets that violate existing proximity restrictions. The spatial model indicates that an additional 1,115 outlets could open in Philadelphia if privatization was to occur and current proximity ordinances were maintained. Conclusions The study reveals that spatial analytical approaches can function as an excellent tool for contingency-based “what-if” analysis, providing an objective snapshot of potential policy outcomes prior to implementation. In this case, the likely outcome is a tremendous increase in alcohol outlets in Philadelphia, with concomitant negative health, crime and quality of life outcomes that accompany such an increase. PMID:23170899

  2. Intrarenal Doppler Indices in Acute Ureteric Obstruction

    PubMed Central

    2014-01-01

    Context: Urolithiasis remains a major health problem despite advances in therapy. Obstruction results in an increase in pressure within the urinary tract, causing structural and physiologic changes. This study aimed to calculate the intra renal Resistivity Index (RI) of acutely obstructed kidney, to determine the significance of Resistivity Index Ratio (RIR) and difference in Resistivity Index of obstructed and contralateral non obstructed kidney. Materials and Methods: Prospective study with renal Doppler for patients presenting with acute unilateral ureteric obstruction. Seventy two patients between the age group 20-45 y presenting to the Department of Radiodiagnosis, between January – December 2006 with acute unilateral ureteric obstruction were included in the study. Gray scale and Doppler evaluation of the kidneys done; with assessment of the ureteric calculus. Renal Doppler indices calculated and follow up of the same done after relief of obstruction. Statistical Analysis: Statistical analysis was done using SPSS Software V13 and p-value <0.05 was considered as statistically significant. Results: Forty two patients (58.33%) had mild, 28 (38.89%) moderate and 2 (2.78%) severe hydronephrosis. The mean RI of the obstructed kidney was 0.66±0.88 and that of contralateral non obstructed kidney was 0.569±0.05. Delta RI between the obstructed and contralateral non obstructed kidney was 0.08±0.03. The mean RIR between the obstructed and non obstructed kidney was 1.12±0.04 and the same after relief of obstruction was 1.03±0.06. Conclusion: The intrarenal Resistivity indices are less sensitive indicators in predicting the diagnosis of acute ureteric obstruction, although Resistivity Index Ratio appears to be a better parameter. The indices within the normal range do not rule out the absence of obstruction. Hence these parameters should not be interpreted in isolation. PMID:25654006

  3. [Diagnosis and treatment of an intestinal obstruction].

    PubMed

    Hor, Thévy; Paye, François

    2016-01-01

    Intestinal obstruction, revealed by obstruction syndrome, is defined by the cessation of the bowel function whatever the cause. Bowel obstructions are one of the most frequent reasons for hospitalisation in digestive system surgery. They represent a surgical emergency. Diagnosis must enable the obstruction to be confirmed and its mechanisms and location to be specified. The treatment must always include restoring water-electrolyte balance, particularly in elderly people.

  4. [Neurological Signs and Symptoms of True Neurogenic Thoracic Outlet Syndrome].

    PubMed

    Higashihara, Mana; Konoeda, Fumie; Sonoo, Masahiro

    2016-05-01

    Thoracic outlet syndrome (TOS) is a well-known disorder, but many aspects of its pathology, including its definition, has been disputed. True neurogenic TOS (TN-TOS) is a rare but well-defined clinical condition. TN-TOS results from the compression of the C8/T1 roots (dominant for the T1 root) or the proximal lower trunk of the brachial plexus by a fibrous band. The band extends from the first rib to either the tip of an elongated C7 transverse process or a rudimentary cervical rib. The most common presenting symptoms of TN-TOS are insidious-onset atrophy and weakness of the intrinsic hand muscles, predominantly in the thenar eminence and radial digit flexors. Nerve conduction studies demonstrate pathognomonic findings: severely attenuated compound muscle action potential of the abductor pollicis brevis muscle, and usually, loss of the sensory nerve action potential of the medial antebrachial cutaneous nerve. Numbness and sensory loss are typically observed, mainly in the medial forearm, although they are usually mild, and may be absent in some patients. Severe pain or paresthesia proximal to the elbow is not observed. The classical concept of TOS underlie nonspecific neurogenic TOS. It has been primarily diagnosed using provocative maneuvers. However, there is controversy regarding its pathological conceptualization and existence, as objective evidence of the disease is still lacking.

  5. Focal hand dystonia in a patient with thoracic outlet syndrome

    PubMed Central

    Quartarone, A; Girlanda, P; Risitano, G; Picciolo, G; Sinicropi, S; Nicolosi, C; Macaione, V; Messina, C

    1998-01-01

    A patient affected by thoracic outlet syndrome, with an involvement of the left lower primary trunk due to a rudimentary cervical rib, developed a severe hand dystonia on the same side. The dystonic posture was characterised by a flexion of the wrist with the fingers curled into the palm. Polygraphic recordings performed on the left flexor digitorum superficialis (FDS4) and extensor digitorum superficialis (EDC4) muscles, during a repetitive tapping task of the fourth digit, showed a loss of well formed bursts without a clear silent period along with long duration bursts of cocontraction in antagonistic muscles. The study of reciprocal inhibition between forearm flexor and extensor muscles showed a reduced amount of inhibition in both the disynaptic and the later presynaptic phase of inhibition. The patient underwent an operation with resection of the cervical rib. Twelve hours after the operation the patient experienced a significant improvement of the hand dystonia; the distonia had disappeared completely by two months with a progressive normalisation of reciprocal inhibition.

 PMID:9703190

  6. Focal hand dystonia in a patient with thoracic outlet syndrome.

    PubMed

    Quartarone, A; Girlanda, P; Risitano, G; Picciolo, G; Sinicropi, S; Nicolosi, C; Macaione, V; Messina, C

    1998-08-01

    A patient affected by thoracic outlet syndrome, with an involvement of the left lower primary trunk due to a rudimentary cervical rib, developed a severe hand dystonia on the same side. The dystonic posture was characterised by a flexion of the wrist with the fingers curled into the palm. Polygraphic recordings performed on the left flexor digitorum superficialis (FDS4) and extensor digitorum superficialis (EDC4) muscles, during a repetitive tapping task of the fourth digit, showed a loss of well formed bursts without a clear silent period along with long duration bursts of cocontraction in antagonistic muscles. The study of reciprocal inhibition between forearm flexor and extensor muscles showed a reduced amount of inhibition in both the disynaptic and the later presynaptic phase of inhibition. The patient underwent an operation with resection of the cervical rib. Twelve hours after the operation the patient experienced a significant improvement of the hand dystonia; the distonia had disappeared completely by two months with a progressive normalisation of reciprocal inhibition.

  7. Combustor cap having non-round outlets for mixing tubes

    SciTech Connect

    Hughes, Michael John; Boardman, Gregory Allen; McConnaughhay, Johnie Franklin; Arguinzoni, Carlo Antonio

    2016-12-27

    A system includes a a combustor cap configured to be coupled to a plurality of mixing tubes of a multi-tube fuel nozzle, wherein each mixing tube of the plurality of mixing tubes is configured to mix air and fuel to form an air-fuel mixture. The combustor cap includes multiple nozzles integrated within the combustor cap. Each nozzle of the multiple nozzles is coupled to a respective mixing tube of the multiple mixing tubes. In addition, each nozzle of the multiple nozzles includes a first end and a second end. The first end is coupled to the respective mixing tube of the multiple mixing tubes. The second end defines a non-round outlet for the air-fuel mixture. Each nozzle of the multiple nozzles includes an inner surface having first and second portions, the first portion radially diverges along an axial direction from the first end to the second end, and the second portion radially converges along the axial direction from the first end to the second end.

  8. Measuring of Gastric Emptying in Egyptian Pediatric Patients with Portal Hypertension by Using Real-time Ultrasound

    PubMed Central

    Fahmy, Mona E.; Osman, Mahmoud A.; Mahmoud, Rehab A.; Mohamed, Lamiaa K.; Seif-elnasr, Khaled I.; Eskander, Ayman E.

    2012-01-01

    Background/Aim: Among the various methods for evaluating gastric emptying, the real-time ultrasound is safe, does not require intubation, or rely on either radiologic or radionuclide technique. The aim of our work was to measure the gastric emptying in pediatric patients with portal hypertension by using the real-time ultrasound. Patients and Methods: Forty patients with portal hypertension with mean age 7 ± 2.8 years and 20 healthy children as a control group underwent gastric emptying study by using real-time ultrasound. The cross-sectional area of the gastric antrum was measured in the fasting state and then each subject was allowed to drink tap water then calculated by using formula area (π longitudinal × anteroposterior diameter/4). The intragastric volume was assumed to be directly proportional to the cross-sectional area of the antrum. Results: The mean gastric emptying half-time volume was significantly delayed in portal hypertension patients (40 ± 6.8 min) compared with the control subjects (27.1 ± 3.6) min (P<0.05). Patients with extrahepatic portal vein obstruction had significant delayed gastric emptying in comparison to patients with portal hypertension due to other etiologies (36.14 ± 4.9 vs 44.41 ± 6.04 min; P<0.01). Conclusion: Ultrasound is a noninvasive and a reliable method for measuring gastric emptying in pediatric patients. Gastric emptying was significantly delayed in patients with portal hypertension. Etiology of portal hypertension may influence gastric emptying time in patients with chronic liver disease. PMID:22249091

  9. What gastric cancer proteomic studies show about gastric carcinogenesis?

    PubMed

    Leal, Mariana Ferreira; Wisnieski, Fernanda; de Oliveira Gigek, Carolina; do Santos, Leonardo Caires; Calcagno, Danielle Queiroz; Burbano, Rommel Rodriguez; Smith, Marilia Cardoso

    2016-08-01

    Gastric cancer is a complex, heterogeneous, and multistep disease. Over the past decades, several studies have aimed to determine the molecular factors that lead to gastric cancer development and progression. After completing the human genome sequencing, proteomic technologies have presented rapid progress. Differently from the relative static state of genome, the cell proteome is dynamic and changes in pathologic conditions. Proteomic approaches have been used to determine proteome profiles and identify differentially expressed proteins between groups of samples, such as neoplastic and nonneoplastic samples or between samples of different cancer subtypes or stages. Therefore, proteomic technologies are a useful tool toward improving the knowledge of gastric cancer molecular pathogenesis and the understanding of tumor heterogeneity. This review aimed to summarize the proteins or protein families that are frequently identified by using high-throughput screening methods and which thus may have a key role in gastric carcinogenesis. The increased knowledge of gastric carcinogenesis will clearly help in the development of new anticancer treatments. Although the studies are still in their infancy, the reviewed proteins may be useful for gastric cancer diagnosis, prognosis, and patient management.

  10. Intestinal obstruction and pseudo-obstruction in patients with systemic sclerosis.

    PubMed

    Zapatier, Jorge A; Ukleja, Andrew

    2013-09-01

    Chronic intestinal pseudo-obstruction is a known complication of patients with systemic sclerosis, manifested as nausea, vomiting, constipation, abdominal distension and pain. We report a series of cases with systemic sclerosis that presented with signs of intestinal obstruction. In all cases, the differentiation between a pseudo-obstruction and true mechanical obstruction remained a formidable challenge. Our goal was to present different scenarios of patients with systemic sclerosis and features of intestinal obstruction, with a review on its clinical approach.

  11. Inflammation, atrophy, and gastric cancer

    PubMed Central

    Fox, James G.; Wang, Timothy C.

    2006-01-01

    The association between chronic inflammation and cancer is now well established. This association has recently received renewed interest with the recognition that microbial pathogens can be responsible for the chronic inflammation observed in many cancers, particularly those originating in the gastrointestinal system. A prime example is Helicobacter pylori, which infects 50% of the world’s population and is now known to be responsible for inducing chronic gastric inflammation that progresses to atrophy, metaplasia, dysplasia, and gastric cancer. This Review provides an overview of recent progress in elucidating the bacterial properties responsible for colonization of the stomach, persistence in the stomach, and triggering of inflammation, as well as the host factors that have a role in determining whether gastritis progresses to gastric cancer. We also discuss how the increased understanding of the relationship between inflammation and gastric cancer still leaves many questions unanswered regarding recommendations for prevention and treatment. PMID:17200707

  12. Gastric tissue biopsy and culture

    MedlinePlus

    ... Mean Abnormal results may be due to: Stomach (gastric) cancer Gastritis , when the lining of the stomach becomes ... team. Related MedlinePlus Health Topics Biopsy Peptic Ulcer Stomach Cancer Stomach Disorders Browse the Encyclopedia A.D.A. ...

  13. Oxidative stress in obstructive nephropathy.

    PubMed

    Dendooven, Amélie; Ishola, David A; Nguyen, Tri Q; Van der Giezen, Dionne M; Kok, Robbert Jan; Goldschmeding, Roel; Joles, Jaap A

    2011-06-01

    Unilateral ureteric obstruction (UUO) is one of the most commonly applied rodent models to study the pathophysiology of renal fibrosis. This model reflects important aspects of inflammation and fibrosis that are prominent in human kidney diseases. In this review, we present an overview of the factors contributing to the pathophysiology of UUO, highlighting the role of oxidative stress.

  14. Oxidative stress in obstructive nephropathy

    PubMed Central

    Dendooven, Amélie; Ishola, David A; Nguyen, Tri Q; Van der Giezen, Dionne M; Kok, Robbert Jan; Goldschmeding, Roel; Joles, Jaap A

    2011-01-01

    Unilateral ureteric obstruction (UUO) is one of the most commonly applied rodent models to study the pathophysiology of renal fibrosis. This model reflects important aspects of inflammation and fibrosis that are prominent in human kidney diseases. In this review, we present an overview of the factors contributing to the pathophysiology of UUO, highlighting the role of oxidative stress. PMID:20804541

  15. Electrochemical Machining Removes Deep Obstructions

    NASA Technical Reports Server (NTRS)

    Catania, Mark J.

    1987-01-01

    Electrochemical machining (ECM) is effective way of removing obstructing material between two deep holes supposed to intersect but do not because of misalignment of drilling tools. ECM makes it possible to rework costly castings otherwise scrapped. Method fast even for tough or hard alloys and complicated three-dimensional shapes.

  16. [Chronic intestinal pseudo-obstruction].

    PubMed

    Joly, Francisca; Amiot, Aurélien; Coffin, Benoît; Lavergne-Slove, Anne; Messing, Bernard; Bouhnik, Yoram

    2006-01-01

    Chronic intestinal pseudo-obstruction (CIPO) is a disease characterized by episodes resembling mechanical obstruction in the absence of organic, systemic, or metabolic disorders. Pseudo-obstruction is an uncommon condition and can result from primary (40%) or secondary (60%) causes. The most common symptoms are nausea, vomiting, abdominal distension, abdominal pain and constipation or diarrhea. These symptoms are usually present many years before CIPO diagnosis. They can lead to severe electrolyte disorders and malnutrition. Principles for management of patients with CIPO are: to establish a correct clinical diagnosis in excluding mechanical obstruction; to perform a symptomatic and physiologic assessment of the gastrointestinal tract involved; to look for extra-intestinal manifestations, especially for myopathy and neuropathy; to discuss in some cases a surgery for full-thickness intestinal biopsies, and/or a neuromuscular biopsy in case of mitochondrial cytopathy suspicion. The management is primarily focused on symptom control and nutritional support to prevent weight loss and malnutrition. Treatment of CIPO includes prokinetic agents which may help to reduce gastrointestinal symptoms Courses of antibiotics may be needed in patients with symptoms suggestive of bacterial overgrowth. When necessary, enteral nutrition is preferred. In carefully selected patients, feeding jejunostomy with or without decompression gastrostomy may be tried. Long term parenteral nutrition should be reserved for patients who can not tolerate enteral nutrition. Intestinal transplantation can be discussed in selected patients.

  17. Gene methylation in gastric cancer.

    PubMed

    Qu, Yiping; Dang, Siwen; Hou, Peng

    2013-09-23

    Gastric cancer is one of the most common malignancies and remains the second leading cause of cancer-related death worldwide. Over 70% of new cases and deaths occur in developing countries. In the early years of the molecular biology revolution, cancer research mainly focuses on genetic alterations, including gastric cancer. Epigenetic mechanisms are essential for normal development and maintenance of tissue-specific gene expression patterns in mammals. Disruption of epigenetic processes can lead to altered gene function and malignant cellular transformation. Recent advancements in the rapidly evolving field of cancer epigenetics have shown extensive reprogramming of every component of the epigenetic machinery in cancer, including DNA methylation, histone modifications, nucleosome positioning, noncoding RNAs, and microRNAs. Aberrant DNA methylation in the promoter regions of gene, which leads to inactivation of tumor suppressor and other cancer-related genes in cancer cells, is the most well-defined epigenetic hallmark in gastric cancer. The advantages of gene methylation as a target for detection and diagnosis of cancer in biopsy specimens and non-invasive body fluids such as serum and gastric washes have led to many studies of application in gastric cancer. This review focuses on the most common and important phenomenon of epigenetics, DNA methylation, in gastric cancer and illustrates the impact epigenetics has had on this field.

  18. Endovascular management of gastric varices.

    PubMed

    Saad, Wael E

    2014-11-01

    Bleeding from gastric varices is a major complication of portal hypertension. Although less common than bleeding associated with esophageal varices, gastric variceal bleeding has a higher mortality. From an endovascular perspective,transjugular intrahepatic portosystemic shunts (TIPS) to decompress the portal circulation and/or balloon-occluded retrograde transvenous obliteration (BRTO) are utilized to address bleeding gastric varices. Until recently, there was a clear medical cultural divide between the strategy of decompressing the portal circulation (TIPS creation, for example) and transvenous obliteration for the management of gastric varices. However, the practice of BRTO is gaining acceptance in the United States and its practice is spreading rapidly. Recently, the American College of Radiology has identified BRTO to be a viable alternative to TIPS in particular anatomical and clinical scenarios. However, the anatomical and clinical applications of BRTO were not defined beyond the conservative approach of resorting to BRTO in non-TIPS candidates. The article discusses the outcomes of BRTO and TIPS for the management of gastric varices individually or in combination. Definitions, endovascular technical concepts and contemporary vascular classifications of gastric variceal systems are described in order to help grasp the complexity of the hemodynamic pathology and hopefully help define the pathology better for future reporting and lay the ground for more defined stratification of patients not only based on comorbidity and hepatic reserve but on anatomy and hemodynamic classifications.

  19. DBGC: A Database of Human Gastric Cancer

    PubMed Central

    Wang, Chao; Zhang, Jun; Cai, Mingdeng; Zhu, Zhenggang; Gu, Wenjie; Yu, Yingyan; Zhang, Xiaoyan

    2015-01-01

    The Database of Human Gastric Cancer (DBGC) is a comprehensive database that integrates various human gastric cancer-related data resources. Human gastric cancer-related transcriptomics projects, proteomics projects, mutations, biomarkers and drug-sensitive genes from different sources were collected and unified in this database. Moreover, epidemiological statistics of gastric cancer patients in China and clinicopathological information annotated with gastric cancer cases were also integrated into the DBGC. We believe that this database will greatly facilitate research regarding human gastric cancer in many fields. DBGC is freely available at http://bminfor.tongji.edu.cn/dbgc/index.do PMID:26566288

  20. DBGC: A Database of Human Gastric Cancer.

    PubMed

    Wang, Chao; Zhang, Jun; Cai, Mingdeng; Zhu, Zhenggang; Gu, Wenjie; Yu, Yingyan; Zhang, Xiaoyan

    2015-01-01

    The Database of Human Gastric Cancer (DBGC) is a comprehensive database that integrates various human gastric cancer-related data resources. Human gastric cancer-related transcriptomics projects, proteomics projects, mutations, biomarkers and drug-sensitive genes from different sources were collected and unified in this database. Moreover, epidemiological statistics of gastric cancer patients in China and clinicopathological information annotated with gastric cancer cases were also integrated into the DBGC. We believe that this database will greatly facilitate research regarding human gastric cancer in many fields. DBGC is freely available at http://bminfor.tongji.edu.cn/dbgc/index.do.

  1. Assessing the relationship between alcohol outlets and domestic violence: routine activities and the neighborhood environment.

    PubMed

    Roman, Caterina G; Reid, Shannon E

    2012-01-01

    Studies have consistently found a positive relationship between alcohol outlet density and assault, but only a handful of studies have examined whether outlet density has an influence on domestic violence. Using a framework based in crime opportunity theories, this study estimates spatial econometric regression models to test whether the density of alcohol outlets across neighborhoods is positively associated with police calls for service for domestic violence. Models also were developed to test whether the relationships found were consistent across time periods associated with the use of alcohol outlets (weeknights and weekends). The findings indicate that off-premise outlets were associated with a significant increase in domestic violence, but on-premise outlets (specifically restaurants and nightclubs) were associated with a decrease in domestic violence. The risk for domestic violence in areas of high densities of off-premise outlets was found to be high during the weekend but not during the weeknight, suggesting different routine activities for domestic violence offenders during the week.

  2. Neighborhood Characteristics Associated with the Availability of Alcohol Outlets in Quebec, Canada

    PubMed Central

    Ngamini Ngui, André; Apparicio, Philippe; Philibert, Mathieu; Fleury, Marie-Josée

    2015-01-01

    Objectives. The objectives of this study were to examine the spatial accessibility to alcohol outlets in Quebec and to assess the association between neighborhood level characteristics and availability of alcohol outlets. Methods. The Tobit Model was used to assess the association between neighborhood level characteristics and the availability of alcohol outlets within 500, 1000, 2000, and 3000 metres, respectively. Results. Alcohol outlets were found to be most available in the two largest metropolitan areas of the province of Quebec (Montréal and Québec City). Within 1000 metres, alcohol outlets are more available in neighbourhoods with the following characteristics: highest concentration of men, least materially deprived highest concentration of persons aged 20 years or more, and location either in a metropolitan area or in a small town. Finally, the number of bars with video lottery terminals increases with the level of social and material deprivation. Conclusion. In Québec, there is no rule governing the location of alcohol outlets. Thus, there is an abundant literature indicating that the regulation of alcohol outlet density could be an effective means of controlling risk attributable to alcohol consumption. PMID:25810946

  3. Tobacco advertising and sales practices in licensed retail outlets after the Food and Drug Administration regulations.

    PubMed

    Frick, Ryan G; Klein, Elizabeth G; Ferketich, Amy K; Wewers, Mary Ellen

    2012-10-01

    To assess retailer compliance with Food and Drug Administration (FDA) regulations on tobacco sales and advertising practices, including point-of-sale advertisements, in two distinct Columbus, Ohio neighborhood groups by income. Data were gathered from a random sample of 129 licensed tobacco retailers, which included data on both exterior and interior advertisements as well as sales practices. Descriptive analyses compared retail outlets by high and low income neighborhood locations. Compliance with FDA regulations was high in the random sample of urban tobacco retail outlets. None of the retail outlets sold loose cigarettes or offered free items with purchase. Less than 10% of the outlets surveyed offered self-service access to cigarettes or smokeless tobacco products. From all surveyed retail outlets 95% had cigarette, 57% had smokeless, and 57% had cigar advertisements at the point-of-sale. There were no significant differences in compliance by income, but the mean number of advertisements on the building and self-service access to cigars was significantly different by neighborhood income. There was a high degree of compliance with the new FDA regulation on tobacco marketing and sales practices in urban retail tobacco outlets in Columbus, Ohio. Tobacco advertising and marketing remain highly prevalent in retail outlets, with some significant differences between high and low income neighborhoods.

  4. Evaluation of Complications after Surgical Treatment of Thoracic Outlet Syndrome

    PubMed Central

    Hosseinian, Mohammad Ali; Loron, Ali Gharibi; Soleimanifard, Yalda

    2017-01-01

    Background Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery. Methods In this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months. Results The prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05). Conclusion The supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations. PMID:28180101

  5. The parallel flow assumption in Greenland outlet glaciers

    NASA Astrophysics Data System (ADS)

    Gourmelen, N.; Shepherd, A.; Park, J. W.

    2012-04-01

    Climate warming over the 20th century has forced dramatic changes in the Greenland Ice Sheet (GrIS). These changes have led to a reduction in the mass of the GrIS and a consequent rise in global sea level. Satellite observations have revealed an increased flow of the glaciers to the sea [Rignot et al., 2008], increased surface melting [Steffen et al., 2004], lowering of the Ice Sheet surface [Zwally and Giovinetto, 2001], retreat of the glaciers' fronts [Box et al., 2006], and gravity anomaly related to ice mass loss [Velicogna and Wahr, 2006]. When measuring the flow of ice from spaceborne sensors, it is often assumed that the direction and dip of flow follow the direction and dip of the ice surface [Rignot et al., 2011]; this is known as the surface parallel flow assumption [Joughin et al., 1996]. This assumption is often the only way to constrain glaciers' flow, as observation by spaceborne sensors in Polar Regions is limited. Departure from the parallel flow assumption means that the magnitude of ice flow and its changes will be misestimated. Departure from the ice parallel flow assumption also provides clues on the mechanisms leading to the flow pattern and to the change in flow magnitude. Here we exploit 20 years of Synthetic Aperture Radar spaceborn missions to constrain the three-dimensional flow of marine terminating glaciers in the GrIS. We use datasets from past and present ERS1, ERS2, ENVISAT, ALOS and TerraSAR-X missions to construct 3-dimensional flow maps of selected outlet glaciers of the GrIS. This dataset is used to explore the relationship between flow patterns, its temporal evolution, and processes at play at the margins of the GrIS.

  6. Availability of healthier options in traditional and nontraditional rural fast-food outlets

    PubMed Central

    Creel, Jennifer S; Sharkey, Joseph R; McIntosh, Alex; Anding, Jenna; Huber, J Charles

    2008-01-01

    Background Food prepared away from home has become increasingly popular to U.S. families, and may contribute to obesity. Sales have been dominated by fast food outlets, where meals are purchased for dining away from home or in the home. Although national chain affiliated fast-food outlets are considered the main source for fast food, fast foods are increasingly available in convenience stores and supermarkets/grocery stores. In rural areas, these nontraditional fast-food outlets may provide most of the opportunities for procurement of fast foods. Methods Using all traditional and nontraditio nal fast-food outlets identified in six counties in rural Texas, the type and number of regular and healthiermenu options were surveyed using on-site observation in all food venues that were primarily fast food, supermarket/grocery store, and convenience store and compared with 2005 Dietary Guidelines. Results Traditional fast-food outlets represented 84 (41%) of the 205 opportunities for procurement of fast food; 109 (53.2%) were convenience stores and 12 (5.8%) supermarkets/grocery stores. Although a s imilar variety of regular breakfast and lunch/dinner entrées were available in traditional fast-food outlets and convenience stores, the variety of healthier breakfast and lunch/dinner entrées was significantly greater in fast food outlets. Compared with convenience stores, supermarkets/grocery stores provided a greater variety of regular and healthier entrées and lunch/dinner side dishes. Conclusion Convenience stores and supermarkets/grocery stores more than double the potential access to fast foods in this rural area than traditional fast-food outlets alone; however, traditional fast food outlets offer greater opportunity for healthier fast food options than convenience stores. A complete picture of fast food environment and the availability of healthier fast food options are essential to understand environmental influences on diet and health outcomes, and identify

  7. Pembrolizumab, Combination Chemotherapy, and Radiation Therapy Before Surgery in Treating Adult Patients With Locally Advanced Gastroesophageal Junction or Gastric Cardia Cancer That Can Be Removed by Surgery

    ClinicalTrials.gov

    2016-12-30

    Adenocarcinoma of the Gastroesophageal Junction; Gastric Cardia Adenocarcinoma; Stage IB Gastric Cancer; Stage IIA Gastric Cancer; Stage IIB Gastric Cancer; Stage IIIA Gastric Cancer; Stage IIIB Gastric Cancer

  8. Experimental study of flow distribution and pressure loss with circumferential inlet and outlet manifolds

    NASA Technical Reports Server (NTRS)

    Dittrich, R. T.

    1972-01-01

    Water flow tests with circumferential inlet and outlet manifolds were conducted to determine factors affecting fluid distribution and pressure losses. Various orifice sizes and manifold geometries were tested over a range of flow velocities. With inlet manifolds, flow distribution was related directly to orifice discharge coefficients. A correlation indicated that nonuniform distribution resulted when the velocity head ratio at the orifice was not in the range of constant discharge coefficient. With outlet manifolds, nonuniform flow was related to static pressure variations along the manifold. Outlet manifolds had appreciably greater pressure losses than comparable inlet manifolds.

  9. Influence of outlet geometry on strongly swirling turbulent flow through a circular tube

    NASA Astrophysics Data System (ADS)

    Escudier, M. P.; Nickson, A. K.; Poole, R. J.

    2006-12-01

    The results are reported for an extensive series of measurements (using laser Doppler anemometry) of the mean and fluctuating flow fields for swirling turbulent flow downstream of an orifice in a tube. The influence of a concentric outlet contraction is found to be negligible for low "supercritical" swirl. For high "subcritical" swirl, the outlet geometry is found to have a significant influence throughout the flow field and, in the case of an eccentric (i.e., offset) outlet, to lead to an asymmetric flow with a distorted core. In no case was the core found to precess or the flow to be periodic.

  10. A newborn with duodenal atresia and a gastric perforation.

    PubMed

    Akcora, Bulent; Eris, Ozge

    2010-01-01

    Congenital duodenal atresia complicated by gastric perforation (GP) is a very rare and a very mortal condition. Only three newborns could be cured in the reported 13 cases. We report a successfully treated newborn with this complicated disease. A 2-day-old male was hospitalized with prediagnosis of duodenal obstruction. Twelve hours later, significant abdominal distention occurred promptly. At laparotomy, GP and preampullary duodenal atresia were detected. Gastrorrhaphy and duodenoduodenostomy were performed in the same operation. The patient was discharged on the 15th postoperative day. This complicated disease can be treated by early diagnosis and surgical intervention. We choose one-stage operation because of the clean peritoneal cavity. However, generalized peritonitis may require two-stage operation in delayed cases.

  11. Theoretical analysis and simulation of obstructed breakup of micro-droplet in T-junction under an asymmetric pressure difference

    NASA Astrophysics Data System (ADS)

    Fu, Yuhang; Bai, Lin; Jin, Yong; Cheng, Yi

    2017-03-01

    Asymmetric droplet breakup under a pressure difference at two outlets of a T-junction is investigated theoretically and numerically in this study. An accurate analysis of the evolution of droplet dynamics during the obstructed breakup process has been conducted. Meanwhile, the lattice Boltzmann method based on color gradient model is employed to simulate the system with the verification of the theoretical results. It is demonstrated that the Zou-He boundary setting at each outlet is advantageous for modifying the pressure drop of the two branches of T-junction. The results reveal that asymmetric breakup of the unequally sized droplets follows two steps, namely, the filling stage and the breakup stage. Then a universal parameter is proposed to describe the asymmetric condition of droplet breakup in T-junction, which plays a key role to characterize the temporal evolution of volume ratio and the droplet length of formed smaller droplets.

  12. The Moderating Role of Gender in the Relationship Between Tobacco Outlet Exposure and Tobacco Use Among African American Young Adults.

    PubMed

    Brown, Qiana; Milam, Adam J; Bowie, Janice V; Ialongo, Nicholas S; Gaskin, Darrell J; Furr-Holden, Debra

    2016-04-01

    Tobacco outlet exposure is a correlate of tobacco use with potential differences by gender that warrant attention. The aim of this study is to explore the moderating role of gender in the relationship between tobacco outlet exposure and past month tobacco use among African American young adults 21 to 24 years old. This cross-sectional study (n = 283) used geospatial methods to determine the number of tobacco outlets within walking distance (i.e., a quarter mile) of participants' homes and distance to the nearest outlet. Logistic regression models were used to test interactions between gender and tobacco outlet exposure (i.e., density and proximity). Tobacco outlets were classified based on whether or not they were licensed to sell tobacco only (TO outlets) or tobacco and alcohol (TA outlets). Neither density nor proximity was associated with past month tobacco use in the pooled models. However, gender modified the relationship between TO outlet density and tobacco use, and this relationship was significant only among women (OR = 1.02; p < 0.01; adjusted OR = 1.01; p < 0.05). This study underscores the importance of reducing tobacco outlet density in residential neighborhoods, especially TO outlets, as well as highlights potential gender differences in the relationship between tobacco outlet density and tobacco use.

  13. 16 CFR Appendix D to Part 436 - Sample Item 20(3) Table-Status of Franchise Outlets

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Sample Item 20(3) Table-Status of Franchise Outlets D Appendix D to Part 436 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES... Item 20(3) Table—Status of Franchise Outlets Status of Franchise Outlets For years 2004 to 2006...

  14. A pH-responsive supramolecular polymer gel as an enteric elastomer for use in gastric devices.

    PubMed

    Zhang, Shiyi; Bellinger, Andrew M; Glettig, Dean L; Barman, Ross; Lee, Young-Ah Lucy; Zhu, Jiahua; Cleveland, Cody; Montgomery, Veronica A; Gu, Li; Nash, Landon D; Maitland, Duncan J; Langer, Robert; Traverso, Giovanni

    2015-10-01

    Devices resident in the stomach-used for a variety of clinical applications including nutritional modulation for bariatrics, ingestible electronics for diagnosis and monitoring, and gastric-retentive dosage forms for prolonged drug delivery-typically incorporate elastic polymers to compress the devices during delivery through the oesophagus and other narrow orifices in the digestive system. However, in the event of accidental device fracture or migration, the non-degradable nature of these materials risks intestinal obstruction. Here, we show that an elastic, pH-responsive supramolecular gel remains stable and elastic in the acidic environment of the stomach but can be dissolved in the neutral-pH environment of the small and large intestines. In a large animal model, prototype devices with these materials as the key component demonstrated prolonged gastric retention and safe passage. These enteric elastomers should increase the safety profile for a wide range of gastric-retentive devices.

  15. A pH-responsive supramolecular polymer gel as an enteric elastomer for use in gastric devices

    NASA Astrophysics Data System (ADS)

    Zhang, Shiyi; Bellinger, Andrew M.; Glettig, Dean L.; Barman, Ross; Lee, Young-Ah Lucy; Zhu, Jiahua; Cleveland, Cody; Montgomery, Veronica A.; Gu, Li; Nash, Landon D.; Maitland, Duncan J.; Langer, Robert; Traverso, Giovanni

    2015-10-01

    Devices resident in the stomach--used for a variety of clinical applications including nutritional modulation for bariatrics, ingestible electronics for diagnosis and monitoring, and gastric-retentive dosage forms for prolonged drug delivery--typically incorporate elastic polymers to compress the devices during delivery through the oesophagus and other narrow orifices in the digestive system. However, in the event of accidental device fracture or migration, the non-degradable nature of these materials risks intestinal obstruction. Here, we show that an elastic, pH-responsive supramolecular gel remains stable and elastic in the acidic environment of the stomach but can be dissolved in the neutral-pH environment of the small and large intestines. In a large animal model, prototype devices with these materials as the key component demonstrated prolonged gastric retention and safe passage. These enteric elastomers should increase the safety profile for a wide range of gastric-retentive devices.

  16. A Case of Advanced Gastric Cancer with Para-Aortic Lymph Node Metastasis from Co-Occurring Prostate Cancer

    PubMed Central

    Park, Miyeong; Lee, Young-Joon; Park, Ji-Ho; Choi, Sang-Kyung; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-tae; Jeong, Chi-Young; Lee, Jeong-Hee; Ha, Woo-Song

    2017-01-01

    An 84-year-old man was diagnosed with two synchronous adenocarcinomas, a Borrmann type IV advanced gastric adenocarcinoma in his antrum and a well-differentiated Borrmann type I carcinoma on the anterior wall of the higher body of his stomach. Pre-operatively, computed tomography of the abdomen revealed the presence of advanced gastric cancer with peri-gastric and para-aortic lymph node (LN) metastasis. He planned for palliative total gastrectomy owing to the risk of obstruction by the antral lesion. We performed a frozen biopsy of a para-aortic LN during surgery and found that the origin of the para-aortic LN metastasis was from undiagnosed prostate cancer. Thus, we performed radical total gastrectomy and D2 LN dissection. Post-operatively, his total prostate-specific antigen levels were high (227 ng/mL) and he was discharged 8 days after surgery without any complications. PMID:28337367

  17. 64Cu DOTA-Trastuzumab PET/CT in Studying Patients With Gastric Cancer

    ClinicalTrials.gov

    2017-03-24

    Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Gastric Cancer; Stage IA Gastric Cancer; Stage IB Gastric Cancer; Stage IIA Gastric Cancer; Stage IIB Gastric Cancer; Stage IIIA Gastric Cancer; Stage IIIB Gastric Cancer; Stage IIIC Gastric Cancer; Stage IV Gastric Cancer

  18. Enhanced separation performance using a new column technology: parallel segmented outlet flow.

    PubMed

    Camenzuli, Michelle; Ritchie, Harald J; Ladine, James R; Shalliker, R Andrew

    2012-04-06

    A new column technology - termed parallel segmented outlet flow was employed here to illustrate gains in separation performance that are achievable by the active management of flow as it exits from the outlet of the chromatography column. Parallel segmented outlet flow requires a column be fitted with an outlet fitting that separates flow from the central region of the column from that of wall region. Each region of flow is able to be processed independently, such that post column detection emulates end column localised detection. As a result of this flow segmentation and the subsequent more efficient means of detection, column efficiency was observed to increase by more than 20%, with gains in sensitivity by as much as 22%, and a decrease in peak volume by up to 85%.

  19. Coolant mixing in LMFBR rod bundles and outlet plenum mixing transients. Progress report

    SciTech Connect

    Todreas, N.E.; Golay, M.W.; Wold, L.

    1981-02-01

    Four tasks are reported on: bundle geometry (wrapped and bare rods), subchannel geometry (bare rods), LMFBR outlet plenum flow mixing, and theoretical determination of local temperature fields in LMFBR fuel rod bundles. (DLC)

  20. Double-outlet right ventricle with intact ventricular septum in a foetus with trisomy-18.

    PubMed

    Patel, C R; Muise, K L; Redline, R W

    1999-07-01

    A rare case of double-outlet right ventricle with intact ventricular septum diagnosed by foetal echocardiography at 21 weeks of gestation is described. Amniocentesis revealed trisomy-18. The cardiac diagnosis was confirmed at autopsy.

  1. The electrophoresis of human gastric juice

    PubMed Central

    Piper, D. W.; Stiel, Mirjam C.; Builder, Janet E.

    1962-01-01

    The electrophoretic pattern of normal human gastric juice is described. The effect of autodigestion of gastric juice and of the peptic digestion of albumin is described. The fallacies involved in the study of gastric juice proteins where peptic digestion of the protein constituent has not been prevented are emphasized. In this study the gastric juice was neutralized within the stomach to prevent changes due to autodigestion. PMID:13943717

  2. Obstructive sleep apnea and asthma*

    PubMed Central

    Salles, Cristina; Terse-Ramos, Regina; Souza-Machado, Adelmir; Cruz, Álvaro A

    2013-01-01

    Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worsening of asthma symptoms, OSAS being one of the most important factors. In patients with asthma, OSAS should be investigated whenever there is inadequate control of symptoms of nocturnal asthma despite the treatment recommended by guidelines having been administered. There is evidence in the literature that the use of continuous positive airway pressure contributes to asthma control in asthma patients with obstructive sleep apnea and uncontrolled asthma. PMID:24310634

  3. Gastric juice miR-129 as a potential biomarker for screening gastric cancer.

    PubMed

    Yu, Xing; Luo, Lin; Wu, Yibo; Yu, Xiuchong; Liu, Yang; Yu, Xuelin; Zhao, Xiaoyan; Zhang, Xinjun; Cui, Long; Ye, Guoliang; Le, Yanping; Guo, Junming

    2013-03-01

    MicroRNAs (miRNAs) play crucial roles during the occurrence and development of gastric cancer. Conventional serological tests for screening gastric cancer have limits on sensitivity and specificity. Several miRNAs in peripheral blood have been used as biomarkers of gastric cancer. However, most of these miRNAs are shared by several types of cancer. Thanks to the tissue specificity of gastric juice, here we examined the feasibility of using gastric juice miR-129-1/2, which are aberrantly expressed in gastric cancer, to screen gastric cancer. Total of 141 gastric juices samples from gastric cancer, gastric ulcer, atrophic gastritis, and minimal gastritis patients or subjects with normal mucosa were collected by gastroscopy. The gastric juice miR-129-1/2 levels were detected by quantitative reverse transcription-polymerase chain reaction. A receiver operating characteristic (ROC) curve was constructed for differentiating patients with gastric cancer from patients with benign gastric diseases. We showed that, compared with patients with benign gastric diseases, patients with gastric cancer had significantly lower levels of gastric juice miR-129-1-3p and miR-129-2-3p. The areas under ROC curve (AUC) were 0.639 and 0.651 for miR-129-1-3p and miR-129-2-3p, respectively. Using the parallel combination test, the AUC was up to 0.656. In summary, our results suggest that gastric juice miR-129-1-3p and miR-129-2-3p are potential biomarkers for the screening gastric cancer, and the detection of gastric juice miRNAs is a convenient non-invasion method for the diagnosis of gastric cancer.

  4. Acetaldehyde and gastric cancer.

    PubMed

    Salaspuro, Mikko

    2011-04-01

    Aldehyde dehydrogenase (ALDH2) and alcohol dehydrogenase (ADH) gene polymorphisms associating with enhanced acetaldehyde exposure and markedly increased cancer risk in alcohol drinkers provide undisputable evidence for acetaldehyde being a local carcinogen not only in esophageal but also in gastric cancer. Accordingly, acetaldehyde associated with alcoholic beverages has recently been classified as a Group 1 carcinogen to humans. Microbes are responsible for the bulk of acetaldehyde production from ethanol both in saliva and Helicobacter pylori-infected and achlorhydric stomach. Acetaldehyde is the most abundant carcinogen in tobacco smoke and it readily dissolves into saliva during smoking. Many foodstuffs and 'non-alcoholic' beverages are important but unrecognized sources of local acetaldehyde exposure. The cumulative cancer risk associated with increasing acetaldehyde exposure suggests the need for worldwide screening of the acetaldehyde levels of alcoholic beverages and as well of the ethanol and acetaldehyde of food produced by fermentation. The generally regarded as safe status of acetaldehyde should be re-evaluated. The as low as reasonably achievable principle should be applied to the acetaldehyde of alcoholic and non-alcoholic beverages and food. Risk groups with ADH-and ALDH2 gene polymorphisms, H. pylori infection or achlorhydric atrophic gastritis, or both, should be screened and educated in this health issue. L-cysteine formulations binding carcinogenic acetaldehyde locally in the stomach provide new means for intervention studies.

  5. Spatial panel analyses of alcohol outlets and motor vehicle crashes in California: 1999–2008

    PubMed Central

    Ponicki, William R.; Gruenewald, Paul J.; Remer, Lillian G.

    2014-01-01

    Although past research has linked alcohol outlet density to higher rates of drinking and many related social problems, there is conflicting evidence of density’s association with traffic crashes. An abundance of local alcohol outlets simultaneously encourages drinking and reduces driving distances required to obtain alcohol, leading to an indeterminate expected impact on alcohol-involved crash risk. This study separately investigates the effects of outlet density on (1) the risk of injury crashes relative to population and (2) the likelihood that any given crash is alcohol-involved, as indicated by police reports and single-vehicle nighttime status of crashes. Alcohol outlet density effects are estimated using Bayesian misalignment Poisson analyses of all California ZIP codes over the years 1999–2008. These misalignment models allow panel analysis of ZIP-code data despite frequent redefinition of postal-code boundaries, while also controlling for overdispersion and the effects of spatial autocorrelation. Because models control for overall retail density, estimated alcohol-outlet associations represent the extra effect of retail establishments selling alcohol. The results indicate a number of statistically well-supported associations between retail density and crash behavior, but the implied effects on crash risks are relatively small. Alcohol-serving restaurants have a greater impact on overall crash risks than on the likelihood that those crashes involve alcohol, whereas bars primarily affect the odds that crashes are alcohol-involved. Off-premise outlet density is negatively associated with risks of both crashes and alcohol involvement, while the presence of a tribal casino in a ZIP code is linked to higher odds of police-reported drinking involvement. Alcohol outlets in a given area are found to influence crash risks both locally and in adjacent ZIP codes, and significant spatial autocorrelation also suggests important relationships across geographical units

  6. Alcohol outlets, neighborhood characteristics, and intimate partner violence: ecological analysis of a California city.

    PubMed

    Cunradi, Carol B; Mair, Christina; Ponicki, William; Remer, Lillian

    2011-04-01

    Neighborhood indicators of social disadvantage, such as poverty and unemployment, are associated with intimate partner violence (IPV). Despite the well-established link between heavy drinking and IPV, few studies have analyzed the contribution of alcohol outlet density to the occurrence of IPV. Greater numbers of alcohol outlets in a community may be a sign of loosened normative constraints against violence, promote problem drinking among at-risk couples, and provide environments where groups of persons at risk for IPV may form and mutually reinforce IPV-related attitudes, norms, and problem behaviors. This study used ecological data to determine if alcohol outlet density (number of bars, restaurants serving alcohol, and off-premise outlets per unit area) is related to rates of IPV-related police calls and IPV-related crime reports in Sacramento, California. Separate analyses for IPV calls and crime reports were conducted using Bayesian space-time models adjusted for area characteristics (poverty rate, unemployment rate, racial/ethnic composition). The results showed that each additional off-premise alcohol outlet is associated with an approximate 4% increase in IPV-related police calls and an approximate 3% increase in IPV-related crime reports. Bars and restaurants were not associated with either outcome. The findings suggest that alcohol outlet density, especially off-premise outlets, appear to be related to IPV events. Further research is needed to understand the mechanisms by which neighborhood factors, such as alcohol outlet density, affect IPV behaviors. Understanding these mechanisms is of public health importance for developing environmental IPV prevention strategies, such as changes in zoning, community action, education, and enforcement activities.

  7. Spatial panel analyses of alcohol outlets and motor vehicle crashes in California: 1999-2008.

    PubMed

    Ponicki, William R; Gruenewald, Paul J; Remer, Lillian G

    2013-06-01

    Although past research has linked alcohol outlet density to higher rates of drinking and many related social problems, there is conflicting evidence of density's association with traffic crashes. An abundance of local alcohol outlets simultaneously encourages drinking and reduces driving distances required to obtain alcohol, leading to an indeterminate expected impact on alcohol-involved crash risk. This study separately investigates the effects of outlet density on (1) the risk of injury crashes relative to population and (2) the likelihood that any given crash is alcohol-involved, as indicated by police reports and single-vehicle nighttime status of crashes. Alcohol outlet density effects are estimated using Bayesian misalignment Poisson analyses of all California ZIP codes over the years 1999-2008. These misalignment models allow panel analysis of ZIP-code data despite frequent redefinition of postal-code boundaries, while also controlling for overdispersion and the effects of spatial autocorrelation. Because models control for overall retail density, estimated alcohol-outlet associations represent the extra effect of retail establishments selling alcohol. The results indicate a number of statistically well-supported associations between retail density and crash behavior, but the implied effects on crash risks are relatively small. Alcohol-serving restaurants have a greater impact on overall crash risks than on the likelihood that those crashes involve alcohol, whereas bars primarily affect the odds that crashes are alcohol-involved. Off-premise outlet density is negatively associated with risks of both crashes and alcohol involvement, while the presence of a tribal casino in a ZIP code is linked to higher odds of police-reported drinking involvement. Alcohol outlets in a given area are found to influence crash risks both locally and in adjacent ZIP codes, and significant spatial autocorrelation also suggests important relationships across geographical units

  8. Gastric Duplication: A Rare Cause of Recurrent Vomiting

    PubMed Central

    Koduri, Brahmananda; Yost, Christina; Goodman, Michael H.; Hoelzer, Dennis

    2017-01-01

    Vomiting is a physical finding that can occur at any age but presents the greatest challenge when it is recurrent in a child. The etiology is varied (Sieunarine and Manmohansingh, 1989; Suzuki, 1982), and recurrent vomiting can be a symptom of life threatening medical or surgical emergencies. Early recognition is mandatory for preventing delay in management and potential complications. Gastric duplication is rare and mostly diagnosed in infancy with only a few cases documented in the medical literature presenting in childhood. We present a three-year-old Vietnamese female with recurrent vomiting. Obstruction and sepsis were ruled out as a cause of the recurrent vomiting by history and appropriate tests. Persistent vomiting and paucity of air on the plain abdominal films provided a clue to the diagnosis. A CT scan of the abdomen with contrast revealed a uniformly thin walled fluid attenuation mass in the epigastric region which did not opacify with contrast. An abdominal ultrasound confirmed gastric duplication cyst and the patient was taken to the operating room for excision of the cyst. PMID:28337353

  9. Gastric and Duodenal Stents: Follow-Up and Complications

    SciTech Connect

    Pinto Pabon, Isabel Teresa; Paul Diaz, Laura; Ruiz de Adana, Juan Carlos; Lopez Herrero, Julio

    2001-05-15

    Purpose: To assess the efficacy of self-expanding metallic stents in treating inoperable gastric and duodenal stenoses during follow-up and to evaluate the complications encountered.Methods: A total of 31 patients suffering from gastroduodenal obstruction (29 malignant, 2 benign) were treated with a self-expanding metallic stent (Wallstent). In 24 cases insertion was by the peroral route, in seven cases via gastrostomy.Results: All the strictures were successfully negotiated under fluoroscopic guidance without having to resort to endoscopy. A total of 27 patients (87%) were able to resume a regular diet, a soft diet, or a liquid diet orally. Complications included one case of stent malpositioning, one case of leakage of ascitic fluid through the gastrostomy orifice, one case of perforation and fistula to the biliary tree, and two cases of hematemesis. In two patients (6%) additional stents were implanted to improve patency. In all patients follow-up was maintained until death. Recurrence of symptoms immediately before death occurred in seven cases (23%). Mean survival time of patients was 13.3 weeks (SE {+-} 4.6).Conclusions: The deployment of gastroduodenal stents resulted in good palliation of inoperable gastric and duodenal stenoses. Certain technical aspects, e.g., adaptation of stents to bowel morphology, is critical to proper stent function and avoidance of complications.

  10. Visualization of gastric bands on radionuclide gastric emptying studies

    SciTech Connect

    Alazraki, N.; McIntyre, B.; Elgin, D.; Christian, P.; Moore, J.

    1984-01-01

    In the course of performing many gastric emptying studies with radionuclide labeled solid and liquid meals, the authors have noted the appearance of gastric ''bands'' on images. These bands do not appear to be peristaltic contractions because they persist in individual subjects for hours of imaging. Peristaltic contraction waves move and change appearance within a few seconds. Bands have been described in humans at autopsy and in dogs, pigs, and monkeys, typically in transverse and mid-gastric locations. However, because the bands have not been seen on radiographic studies with barium meals, the finding has been ignored in gastro-intestinal and radiologic textbooks. An anatomic basis or physiologic role in regulating gastric emptying is unknown. SPECT imaging of 5 normal subjects after ingestion of Tc-99m sulfur colloid labeled chicken liver meals on two separate study days was performed. Linear photon deficient regions (''bands'') were identified on gastric images in all subjects. Multiple bands were sometimes seen, including a transverse band across the mid lower body of the stomach and a vertical longitudinal band which appeared to bisect the fundus in three subjects. In one subject, multiple body positions including upright, upside-down, and supine, did not alter the appearance or location of the transverse gastric band. Conventional imaging did not always demonstrate presence of the band, since the optimal projection for imaging the band may not have been part of the planar imaging routine. Sixty-four acquisitions over 360/sup 0/ of SPECT imaging showed that bands were seen in some projections and not in others.

  11. [Chronic intestinal pseudo-obstruction].

    PubMed

    Muñoz, M T; Solís Herruzo, J A

    2007-02-01

    Chronic intestinal pseudo-obstruction (CIPO) is a syndrome characterized by the presence of recurrent episodes of clinical intestinal obstruction in the absence of obstructive lesions. Although this syndrome is rare, it causes a high morbidity. It is caused by a disturbance of the intestinal motility, that results in a failure of the progression of the intestinal content. Basically, the failure of the intestinal motility is a consequence of muscular disorder, neurological disorder or both. Usually, CIPO is secondary to other systemic disease; however, in the last years, many cases of primary CIPO have been described. The use of new manometric tecniques and specific histological procedures have allowed to clarify the pathogenesis of some of these entities including mitochondrial diseases and paraneoplasic syndromes. Clinical manifestations of CIPO are diverse, depending on the location and extension of the motility disorder. As the diagnosis of this disease is usually not an easy task, patients frecuently undergo unnecesary surgical interventions, are diagnosed of psyquiatric disorders, or the correct diagnosis is delayed several years after the first symptoms arise. The aims of the treatment are to maintain the nutritional condition and to improve symptoms using nutritional measures, drugs or, eventually, endoscopical or surgical procedures.

  12. Gastric ulceration in an equine neonate

    PubMed Central

    Lewis, Susan

    2003-01-01

    A 24-hour-old colt presented with clinical signs consistent with gastric ulceration. Treatment was initiated with a histamine type-2 receptor antagonist and clinical signs resolved. Gastroscopy at 16 d confirmed the presence of a gastric ulcer. Although gastric ulceration is common in foals, it is rarely reported in foals this young. PMID:12757136

  13. Esophageal motility disorders after gastric banding.

    PubMed

    O'Rourke, R W; Deveney, C W; McConnell, D B; Wolfe, B M; Jobe, B A

    2007-01-01

    The long-term effects of gastric banding on esophageal function are not well described. This report describes a 28-year-old woman who developed signs and symptoms of abnormal esophageal motility and lower esophageal sphincter hypotension after gastric banding for morbid obesity. The current literature addressing the effects of gastric banding on esophageal function in light of this case report is discussed.

  14. The ecology of domestic violence: the role of alcohol outlet density.

    PubMed

    Livingston, Michael

    2010-11-01

    Studies have consistently found positive associations between the density of alcohol outlets and levels of violence in areas. Few studies have examined whether this relationship holds for domestic violence. This study assesses whether alcohol outlet density is related to domestic violence and whether this relationship is due to alcohol availability or to co-occurring economic disadvantage and social disorganisation. Cross-sectional data on family incidents, liquor outlets and socio-demographic characteristics were obtained for 217 postcodes in Melbourne, Australia. These data were used to construct models assessing the association between alcohol outlet density and domestic violence, both with and without controlling for socio-demographic factors. Models were tested for spatial autocorrelation, and spatial- error models were developed to control for its influence. Outlet density was significantly associated with rates of domestic violence, even controlling for socio-demographic factors. The density of hotels (pubs) was positively associated with domestic violence rates and the density of restaurants and bars was negatively associated with domestic violence. Socio-economic disadvantage was also associated with domestic violence rates. The density of packaged liquor outlets was not associated with rates of domestic violence. The results present a mixed picture, and further study is required to develop a clearer understanding of the links between alcohol availability and domestic violence.

  15. Development of a solenoid actuated planar valveless micropump with single and multiple inlet-outlet arrangements

    NASA Astrophysics Data System (ADS)

    Kumar, N.; George, D.; Sajeesh, P.; Manivannan, P. V.; Sen, A. K.

    2016-07-01

    We report a planar solenoid actuated valveless micropump with multiple inlet-outlet configurations. The self-priming characteristics of the multiple inlet-multiple outlet micropump are studied. The filling dynamics of the micropump chamber during start-up and the effects of fluid viscosity, voltage and frequency on the dynamics are investigated. Numerical simulations for multiple inlet-multiple outlet micropumps are carried out using fluid structure algorithm. With DI water and at 5.0 Vp-p, 20 Hz frequency, the two inlet-two outlet micropump provides a maximum flow rate of 336 μl min-1 and maximum back pressure of 441 Pa. Performance characteristics of the two inlet-two outlet micropump are studied for aqueous fluids of different viscosity. Transport of biological cell lines and diluted blood samples are demonstrated; the flow rate-frequency characteristics are studied. Viability of cells during pumping with multiple inlet multiple outlet configuration is also studied in this work, which shows 100% of cells are viable. Application of the proposed micropump for simultaneous pumping, mixing and distribution of fluids is demonstrated. The proposed integrated, standalone and portable micropump is suitable for drug delivery, lab-on-chip and micro-total-analysis applications.

  16. Using public health and community partnerships to reduce density of alcohol outlets.

    PubMed

    Jernigan, David H; Sparks, Michael; Yang, Evelyn; Schwartz, Randy

    2013-04-11

    Excessive alcohol use causes approximately 80,000 deaths in the United States each year. The Guide to Community Preventive Services recommends reducing the density of alcohol outlets - the number of physical locations in which alcoholic beverages are available for purchase either per area or per population - through the use of regulatory authority as an effective strategy for reducing excessive alcohol consumption and related harms. We briefly review the research on density of alcohol outlets and public health and describe the powers localities have to influence alcohol outlet density. We summarize Regulating Alcohol Outlet Density: An Action Guide, which describes steps that local communities can take to reduce outlet density and the key competencies and resources of state and local health departments. These include expertise in public health surveillance and evaluation methods, identification and tracking of outcome measures, geographic information systems (GIS) mapping, community planning and development of multisector efforts, and education of community leaders and policy makers. We illustrate the potential for partnerships between public health agencies and local communities by presenting a contemporary case study from Omaha, Nebraska. Public health agencies have a vital and necessary role to play in efforts to reduce alcohol outlet density. They are often unaware of the potential of this strategy and have strong potential partners in the thousands of community coalitions nationwide that are focused on reducing alcohol-related problems.

  17. Fetoscopic laser surgery to decompress distal urethral obstruction caused by prolapsed ureterocele.

    PubMed

    Torres Montebruno, X; Martinez, J M; Eixarch, E; Gómez, O; García Aparicio, L; Castañón, M; Gratacos, E

    2015-11-01

    We report on the successful use of fetoscopic surgery to treat a case of prolapsed ureterocele in a female fetus. At 21 weeks' gestation, a double renal system with an intravesical ureterocele obstructing the bladder outlet was diagnosed, causing severe megacystis, bilateral hydronephrosis and progressive oligohydramnios. Ultrasound evaluation following referral to our center confirmed severe bilateral hydronephrosis with pelvic and calyceal dilatation, but amniotic fluid volume was normal and the ureterocele was not visualized in the bladder. Instead, a cystic mass within the external genitalia was observed, suggestive of a prolapsed ureterocele, causing intermittently severe obstruction of the urethra. The parents were counseled about the uncertain prognosis and fetal surgery to decompress the urinary system was proposed. The procedure involved firing a contact diode laser until perforation of the ureterocele was achieved. Following laser surgery, resolution of megacystis, reduction of hydronephrosis and normalization of amniotic fluid volume were observed. Our report demonstrates that fetoscopic decompression of a distal urethral obstruction is feasible in the rare event of congenital prolapsed ureterocele.

  18. Gastric dilatation and volvulus in a brachycephalic dog with hiatal hernia.

    PubMed

    Aslanian, M E; Sharp, C R; Garneau, M S

    2014-10-01

    A brachycephalic dog was presented with an acute onset of retching and abdominal discomfort. The dog had a chronic history of stertor and exercise intolerance suggestive of brachycephalic airway obstructive syndrome. Radiographs were consistent with a Type II hiatal hernia. The dog was referred and within hours of admission became acutely painful and developed tympanic abdominal distension. A right lateral abdominal radiograph confirmed gastric dilatation and volvulus with herniation of the pylorus through the hiatus. An emergency exploratory coeliotomy was performed, during which the stomach was derotated, and an incisional gastropexy, herniorrhaphy and splenectomy were performed. A staphylectomy was performed immediately following the exploratory coeliotomy. The dog recovered uneventfully. Gastric dilatation and volvulus is a potentially life-threatening complication that can occur in dogs with Type II hiatal hernia and should be considered a surgical emergency.

  19. Etiology and Prevention of Gastric Cancer

    PubMed Central

    Cheng, Xiao Jiao; Lin, Jia Cheng; Tu, Shui Ping

    2016-01-01

    Background Gastric cancer is a heterogeneous malignant disease associated with environmental and genetic predisposing factors. While gastric cancer incidence and mortality fell greatly globally over the past decades, it remains the fourth cause of cancer-related death worldwide. Thus, prevention of gastric cancer is still a major strategy for improvement of gastric cancer prognosis. Summary Helicobacter pylori infection has been demonstrated to be a major risk factor for the development of gastric cancer. Unhealthy diet and lifestyle, including high-salt food, smoking and drinking, are able to induce genotypic and phenotypic transformation of gastric epithelial cells. Gene mutations (such as E-cadherin) in stomach epithelial cells are major genetic causes for gastric cancer. The eradication of H. pylori has been demonstrated to be an effective approach for primary prevention of gastric cancer. Increased intake of a diet rich in vegetables and fresh fruits as well as smoking cessation have been shown to reduce the incidence of gastric cancer. The secondary prevention strategy is to screen premalignant gastric lesions by endoscopy. Biomarker tests are also reliable methods to identify gastric precancerous lesions. Endoscopy screening is still the gold standard for diagnosis of gastric cancer. Key Message H. pylori infection, a diet rich in salted and/or smoked food and red meat, as well as gene mutations are major risk factors for the development of gastric cancer. Practical Implications The eradication of H. pylori is a major primary preventive strategy of gastric cancer. A healthy lifestyle, including increased intake of a diet rich in fruit and vegetables, reduced intake of salted and smoked food and red meat, a reduction of alcohol intake as well as smoking cessation will be effective approaches for the prevention of gastric cancer. PMID:27722154

  20. Asthma and chronic obstructive pulmonary disease overlap: asthmatic chronic obstructive pulmonary disease or chronic obstructive asthma?

    PubMed

    Slats, Annelies; Taube, Christian

    2016-02-01

    Asthma and chronic obstructive pulmonary disease (COPD) are different disease entities. They are both clinical diagnoses, with diagnostic tools to discriminate between one another. However, especially in older patients (>55 years) it seems more difficult to differentiate between asthma and COPD. This has led to the definition of a new phenotype called asthma COPD overlap syndrome (ACOS). However, our understanding of ACOS is at a very preliminary stage, as most research has involved subjects with existing diagnoses of asthma or COPD from studies with different definitions for ACOS. This has led to different and sometimes opposing results between studies on several features of ACOS, also depending on the comparison with COPD alone, asthma alone or both, which are summarized in this review.We suggest not using the term ACOS for a patient with features of both asthma and COPD, but to describe a patient with chronic obstructive airway disease as completely as possible, with regard to characteristics that determine treatment response (e.g. eosinophilic inflammation) and prognosis (such as smoking status, exacerbation rate, fixed airflow limitation, hyperresponsiveness, comorbidities). This will provide a far more clinically relevant diagnosis, and would aid in research on treatment in more homogenous groups of patients with chronic airways obstruction. More research is certainly needed to develop more evidence-based definitions for this patient group and to evaluate biomarkers, which will help to further classify these patients, treat them more adequately and unravel the underlying pathophysiological mechanism.